Interactions Between Mothers and Their Infants with Developmental Disabilities:

This paper has two goals: to review the research related to interaction of mothers and their infants with developmental disabilities during play and to demonstrate the necessity of addressing this area in intervention programs. The scope of this review, therefore, is the analysis and integration of theoretical and empirical literature that relates to mother and their infants with developmental disabilities during play to provide new and more comprehensive avenues for programming and research in this area.     

Neonatal Jaundice in Infants of Diabetic Mothers

Jährig, D., Jährig, K., Stiete, S., Beyersdorff, E., Poser, H. and Hopp, H. (Department of Paediatrics, the Data Centre of the Ernst Moritz Arndt University of Greifswald, Greifswald, and the'Gerhard Katsch'Central Research Institute for Diabetes, Karlsburg, G.D.R.). Neonatal jaundice in infants of diabetic mothers. Acta Paediatr Scand Suppl 360: 101, 1989.
357 IDMs and 20 healthy newborns of non-diabetic mothers were examined at term for body measurements, red blood cell count, serum bilirubin, cord blood insulin and blood glucose during the first postnatal week. The stage of maternal diabetes did not influence the course of neonatal bilirubin levels, but the IDMs had prolonged and higher bilirubinaemia compared with the controls. Hyperbilirubinaemia was found to be most prominent in newborns with an increased birthweightllength ratio and was not simply related to macrosomia (LGA). These infants had significantly lower blood glucose concentrations immediately after birth, whereas cord blood insulin was found to be identical between the IDM sub-groups. Bilirubinaemia in heavy for length infants was slightly correlated to haematocrit. For the pathogenesis of hyperbilirubinaemia in IDMs induction of heme oxygenase (due to a lack of energy provision following a phosphory lation disorder) is discussed. Nutritional support (early feeding, glucose infusions) does not affect the course of bilirubinaemia.     

Serum Vitamin A Levels in Mothers and Their Breast-Fed Term Infants with or without Supplemental Vitamin A

ABSTRACT. Serum concentrations of vitamin A were measured in term infants ( n =72) and their mothers at delivery and after 20 weeks of breast-feeding ( n =48). During the 20 weeks the infants received either no supplemental vitamin A (but the mothers were given 3000 IU vitamin A daily) ( n =16) or a daily vitamin A supplementation of 600 ( n =17) or 1500 IU ( n =15). After 20 weeks of breast-feeding the vitamin A levels in the unsupplemented infants were similar to those at birth. The infants supplemented either with 600 or 1500 IU had higher vitamin A serum levels than at birth ( p <0.01), however, there was no difference between the two supplemented groups. During lactation, the serum vitamin A concentrations of the mothers increased significantly in all groups with or without vitamin A supplementation.     

Oxygenation, Heart Rate and Temperature in Very Low Birthweight Infants during Skin-to-Skin Contact with Their Mothers

ABSTRACT. Fourteen very low birthweight infants were studied positioned either prone horizontal or skin-to-skin at 60 degree tilt between the mother's breasts. Heart rate, skin temperature and oxygenation by transcutaneous Po₂ and pulse oximetry were measured. Nine of the infants had normal lungs when studied. These infants showed no change in tcPo₂, or oxygen saturation but heart rate increased significantly by a mean of 6.5 beats per min during skin-to-skin contact. Five infants with chronic lung disease, including two on nasal catheter oxygen, showed a significant 1.0 kPa rise in tcPo₂ during skin-to-skin contact. Back skin temperature was well maintained during skin-to-skin contact with the room temperature at 26 to 29°C. None of the infants had a significant apnoea or bradycardia during the study. Stable very low birthweight infants can enjoy such close contact with their mothers and the tilted position may improve pulmonary function in some cases.     

Perinatal Morbidity of Infants of Diabetic Mothers

Along with the recent progress in controlling the diabetic state during pregnancy, the number of diabetic pregnancies in our country has been increasing. It is not appropriate to apply White's classification to Japanese pregnant women, because more than two-thirds are NIDDM and it is not easy to clarify their duration of illness. Neonatal complications were analyzed in 160 infants of diabetic mothers (IDMs) who were admitted to Tokyo Women's Medical College over the past five years. All were inborn except four. Neonatal outcomes of IDDM and NIDDM were not statistically different. The overall incidence of neonatal complications in IDMs was 66%, and there were no neonatal deaths. Offspring whose mothers had been suffering from retinopathy were likely to be premature and light-for-date infants. A planned pregnancy in diabetic women is likely to decrease neonatal complications. The cooperative total care of diabetic mothers and their offspring by respective specialists, namely endocrinologists, obstetricians and neonatologists is essential for the better prognosis of infants of diabetic mothers.     

The Effect of Intervention on the Free-Play Experience for Mothers and Their Infants with Developmental Delay and Cerebral Palsy

An intervention study designed to investigate the effects of one hour of maternal and infant behavior was conducted using experimental and control groups of mothers and their infants with cerebral palsy. Ten mother-infant pairs were in each group; infants ranged in age from 8-32 months. Infants of mothers in the control group received one hour of NDT-based occcupational therapy. Two-factor repeated measures analysis of variance with repeated measures of the second factor indicated that the nonverbal instruction methods were significantly more successful in modifying maternal and infant behavior than were the verbal instruction methods. Implications of the results for intervention programs and future research were discussed.     

Support for Mothers of Infants Born at Risk

No abstract available for this article.     

Beta-Cell Hyperplasia in Macrosomic Infants and Fetuses of Nondiabetic Mothers

The objective of this study was to test the hypothesis that macrosomic infants of nondiabetic mothers have beta-cell hyperplasia in their pancreases. Pancreatic tissues were examined from 10 macrosomic fetuses and liveborn infants and from 10 comparison cases matched for gestational age and gender. None of the mothers had a history of diabetes and all had normal glucose screening during pregnancy. Tissues were stained with hematoxylin and eosin and a monoclonal antibody against beta cells and were analyzed using an image analysis program to evaluate the size and surface area of beta-cell clusters. Brain/liver weight ratios were calculated and compared. The total surface area and cluster size of beta cells in the pancreases of macrosomic subjects were significantly larger than in the comparison pancreases. The study subjects lacked macroscopic and histopathologic findings expected in infants of diabetic mothers. We conclude that some macrosomic fetuses and infants of nondiabetic mothers manifest beta-cell hyperplasia. This corresponds to the higher insulin levels in macrosomic infants of nondiabetic mothers described in previous clinical studies. In macrosomic fetuses the stimulus for beta-cell hyperplasia may not involve aberrant maternal glucose levels.     

Impaired Vascular Reactivity in Newborn Infants of Smoking Mothers

ABSTRACT. A transcutaneous PO₂ technique was used to study the influence of cigarette smoking during pregnancy on postocclusive reactive hyperaemia of the skin of newborn infants and their mothers. Forty-seven mothers and their infants were studied on two occasions (24–48 and 96–144 h) after birth. Twenty of the mothers were habitual smokers, 27 were non-smokers. All mothers were healthy and their pregnancies and deliveries were normal. The infants were all healthy throughout their first week of life. The mothers had more marked reactive hyperaemia than their newborn infants ( p <0.001). Infants of smoking mothers had a significantly weaker postischaemic hyperaemic response 24–48 h after birth than infants of nonsmoking mothers ( p <0.01). This difference had disappeared 96–144 h after birth. Smoking mothers also showed a significantly weaker hyperaemic response to ischaemia than the control mothers at the first investigation ( p <0.05). This difference was smaller and not statistically significant at the second recording. A decreased capacity for postocclusive reactive hyperaemia might be particularly harmful in asphyctic infants, but it may also be detrimental for a normal postnatal circulatory adaptation.     

Prolonged QT Dispersion in the Infants of Diabetic Mothers

Myocardial hypertrophy and cardiac dysfunction frequently occur in newborns of diabetic mothers. The authors hypothesized that wall hypertrophy or disproportionate left ventricular wall thickness in newborns of diabetic mothers may affect both QT and QTc dispersion. This study aimed to assess whether left ventricular hypertrophy affects the QT variables of infants born to diabetic mothers. This prospective cross-sectional study was conducted with 47 consecutively selected neonates of gestational diabetic mothers and 30 healthy neonates born to healthy mothers. All the subjects were evaluated during the neonatal period. Electrocardiography with echocardiography was performed for the patients and the control subjects. The newborns of the diabetic mothers were classified according to septal thickness as group 1 (16 newborns with septal hypertrophy) or group 2 (31 newborns without septal hypertrophy). The study group consisted of three cohorts: groups 1, 2, and 3 (control group). Both QT and QTc dispersion were computed from a randomly selected beat as well as from an average beat derived from 12 beats included in a 10-s electrocardiography. A total of 16 infants (34 %) had a septal thickness of 6 mm or greater. The left ventricular end-systolic diameter in group 1 was smaller (p = 0.0029) than in groups 2 and 3 (p = 0.003). The interventricular septal thickness at end diastole (IVSTd) and the left ventricular posterior wall thickness at end diastole in group 1 were higher than in of groups 2 and 3. The QT and QTc dispersion intervals were longer in group 1 than in groups 2 and 3 (p < 0.001), and a highly significant positive correlation was detected between IVSTd and QT dispersion (r = 0.514, p = 0.042). Elevated QT and QTc dispersions may be risk factors for the development of arrhythmias in newborns of diabetic mothers. These patients may critically need systematic cardiac screening.     

Birth weights of Infants of Teenage Mothers in Nairobi

ABSTRACT. Teenage pregnancies lower average birthweight. In the NBS, teenage mothers had significantly lower average birthweight of 2920±553 g compared with 3133±533 g among women in the general population. A high rate of LBW on the infants of the teenage mothers was the significant factor in lowering the average birthweight. In both NBS and the PMHS the incidence of LBW 18% and 15% respectively as well as the rate of preterm delivery of 24% and 23% respectively were high. In PMHS although the numbers were small, the incidence of LBW was high (13%) in the 14-year-olds and in the 15-year-olds it was 4.8% which was much lower than that for 17- and 18-year-olds. In a large series in Nigeria the incidence of LBW was 27% in mothers aged less than 15 years, 26% in mothers aged 15-19, 20% in those aged 20-24 and least (18%) in the 25-29 year age group. Many unfavourable socioeconomic circumstances and lack of adequate antenatal supervision contribute to these high rates. Some of the teenage mothers—particularly the very young, below 16 years—are physically immature and are still growing children themselves. Their nutrient intake is shared between their own growth needs and those of their foetuses. In the Nigerian study, administration of folic acid and iron together with antimalarials to pregnant mothers resulted in increased maternal height as well as foetal growth, thus stressing the importance of nutritional care for the teenage mothers.