THE INFLUENCE OF AMPHETAMINE ADDICTION ON PREGNANCY AND THE NEWBORN INFANT1

ABSTRACT. influence of amphetamine addiction on pregnancy and the newborn infant has been studied retrospectively in 23 cases. Six of the mothers claimed to have discontinued their abuse in early pregnancy, while the remaining 17 mothers continued throughout. In comparison with the average number of visits by pregnant Swedish women to maternal health centres, the 17 women who continued their abuse made significantly fewer visits, although there was a wide variation. Complications related to pregnancy and delivery were few, however. One child with a myelomeningocele was stillborn. Six children were preterm and three were small for gestational age. Two full-term children were extremely drowsy and in need of tube feeding, symptoms that might be due to the maternal abuse. Eight of the ten mothers, who had previous children placed in foster homes by the Social Welfare Department, left the hospital with their newborn infant in their care as well as all the eleven primiparae.     

LISTERIOSIS DURING PREGNANCY AND NEONATAL PERIOD IN SWEDEN 1958–1974

Abstract. In 1958–1974 altogether 46 cases of bacteriologically verified infection of Listeria monocytogenes were diagnosed during pregnancy and the neonatal period. Eight pregnancies resulted in abortion and three in stillbirth. Thirty-seven children were born alive, 17 of whom died, all but one within a few days. These children were divided into three groups according to their age at the onset of illness: 22 cases with "Early disease" (≤2 days), four cases with "Intermediate disease" (3–5 days) and eight cases with "Late disease" (≤6 days). Three children were apparently healthy. Septicemia or "Granulomatosis infantiseptica" dominated in "Early disease" and claimed as many as 13 deaths. In "Late disease" all the children had meningo-encephalitis, and only one of them died. The symptoms were typical of purulent meningitis. The group of "Intermediate disease" consisted of overlapping cases of the other two groups. Ampicillin alone or combined with gentamicin seemed to be the drug of choice in the therapy of neonatal listeriosis. Of the surviving children, two were seriously damaged and two had moderate injuries. Fifteen children are apparently healthy. In cases where pregnancy terminated in abortions, stillborns or children with "Early disease", the mothers often showed signs of infection. The mothers of the children with "Late disease" were apparently healthy. These children were infected from other sources, some of them nosocomially. If listeriosis is diagnosed during pregnancy, the women should be treated with ampicillin.     

Pre-school Children of Amphetamine-addicted Mothers: II. Environment and Supportive Social Welfare

ABSTRACT. Sixty-five children, whose 63 mothers took amphetamine during pregnancy, were followed prospectively with regard to their environmental conditions, during their first four years of life. Nine of the 16 mothers, who gave up drug-taking in early pregnancy, were able to remain drug-free until their children reached four years of age. All but three of the remaining 47 mothers have continued to be addicts. Twenty-two of 52 children (42 %), who had initially been left in the care of their mothers, were placed in foster-homes at four years of age. The decision to take the child into custody was often based on several negative factors, as determined by the social worker, such as a continuing addiction, unsatisfactory social conditions (12/22), and neglect (6/22). In many cases the decision was made following the failure of different noncompulsory supportive measures     

LEFT-SIDE PREFERENCE IN HOLDING AND CARRYING NEWBORN INFANTS

ABSTRACT. Eighty to ninety per cent of primiparous and multiparous women held their newborn infants to the left of the body midline. Left side preference was independent of handedness and was typical also of non-pregnant female—but not male—students and may therefore be a genetically determined human, female behaviour. Right-holding, occurring in 10 to 20% of non-separated women, was observed in 30 to 40% when mother and infant had been separated for about 24 hours. This observation may be of general interest, suggesting that perinatal maternal anxiety and uncertainty can alter a pre-existing behaviour. The right-holding, non-separated mothers differed from left-holding ones in a number of ways: they held their babies with less body contact, they perceived a delay in accepting the foetus or newborn as their own, and—when checked 3 years after delivery—they had had a more frequent contact with the Child Health Center during this time. Right-holding may in some mothers be an early sign of a disturbed mother-infant relationship. It may indicate either an insensitivity of the mother to the signals of the infant or that the infants signals are inappropriate. Carrying differed somewhat from holding. In addition to right and left preference a third modality—"in hands"—was observed. Immediate post partum naked skin-to-skin and suckling contact between mother and infant eliminated the "carrying-in-hands" behaviour. This observation adds to others showing that experiences during the immediate postnatal period may mould the maternal behaviour pattern.     

新生儿及婴儿胆汁淤积症诊断方法及流程进展

<正>胆汁淤积症(cholestasis)是以高结合胆红素血症为主要临床表现的综合征~([1]),病因复杂;除胆道闭锁(biliary atresia,BA)、早产儿静脉营养相关、感染等病因外,多种导致胆汁淤积症的遗传学病因,逐渐被认识。尽早确定病因,是改善患儿预后的关键,但目前国内关于新生儿及婴儿胆汁淤积症的临床诊断流程尚未达成共识。本文就胆汁淤积症不同诊断方法进展及国内外诊断管理方案最新     

EXCRETION OF BILE ACIDS IN EXTRAHEPATIC BILIARY ATRESIA AND INTRAHEPATIC CHOLESTASIS OF INFANCY

This series included 24 infants, 16 boys and 8 girls, who were admitted to hospital with the diagnosis of obstructive jaundice. Five of the infants were subsequently found to have extra-hepatic biliary atresia (BA) and the other 19 infants intrahepatic cholestasis of infancy (IHC). The infants were investigated given special attention to: the quantitative urinary excretion of cholic and chenodeoxycholic acids, the isotope excretion after intramuscular injection of cholic acid-24–¹⁴C, the nature of labelled urinary bile acids, the half-life and the pool size of cholic acid. At the first examination of the infants after admission the urinary excretion of cholic and chenodeoxycholic acids varied greatly between the patients. However, on comparing the values obtained in the two groups, it was found that there was virtually no difference between the mean daily values of cholic and chenodeoxycholic acids in urine, and the ratio cholic to chenodeoxycholic acid between the BA group and the IHC group. After the injection of isotopic cholic acid most of the isotope was recovered in the urine in all cases. In the infants with BA the faecal excretion of the isotope was low, being less than 3 per cent of the injected isotope. Out of the 19 infants with IHC the recovery of the injected isotope in faeces was also less than 3% in 11 infants. In 8 infants with IHC the faecal isotope excretion was significantly high to exclude extrahepatic biliary atresia. The first 24 hour urine specimen contained small amounts of unconjugated labelled cholic acid in all cases whereas in no case did the patients excrete unconjugated labelled cholic acid 48 hours after the injection of the isotope. No transformation of cholic acid was observed. There was no difference between the BA group and IHC group with regard to the percentage labelled glycine conjugates of total excreted urinary conjugates. Neither was there any difference between the two groups with regard to half-life and pool size of cholic acid. There was no difference with respect to the bile acid metabolism between infants with congenital CMV infection, decreased serum concentrations of alfal-antitrypsin and the other patients.     

Neonatal polycythemia in appropriately grown infants of hypertensive mothers

Neonatal polycythemia is a frequent finding after pregnancies complicated by diabetes and by maternal hypertension with intrauterine growth retardation (IUGR). It is still unclear if the association of polycythemia with hypertension is the result of IUGR or of hypertension per se. To establish the incidence of neonatal polycythemia in populations at risk, we analyzed the results of hematocrit values obtained from 1592 neonates born consecutively at the Hospital de Clinicas, Buenos Aires. Capillary hematocrit values were obtained by heel stick before 6 h of age. When the values were 65% or greater, new samples were obtained from an antecubital vein. The risk of polycythemia in appropriately grown infants of hypertensive mothers was 12.6-fold greater than the risk in the general population. These data show that maternal hypertension poses a significant risk for polycythemia, regardless of fetal growth. We suggest that, to prevent possible sequela, hematocrit is measured routinely in all infants of hypertensive mothers for prompt diagnosis and treatment.     

Pre-school Children of Amphetamine-addicted Mothers: I. Somatic and Psychomotor Development

ABSTRACT. Sixty-five children whose mothers took amphetamine during pregnancy have been followed prospectively since birth. At 4 years of age their somatic growth and general health did not differ from that of another unselected Swedish population of the same age examined at the Child Health Centre. Developmental screening by the Terman Merrill method showed that the group as a whole had a significantly lower IQ (103) than a sampled Swedish group (110). The psychological assessment of the child's adaptation and emotional wellbeing showed that there were more disturbed children or "problem children" in the group that had lived partly or all the time with a mother who was still addicted to drugs     

Permanent neonatal diabetes caused by a homozygous nonsense mutation in the glucokinase gene

Abstract:  Glucokinase deficiency is an unfrequent cause of permanent neonatal diabetes (PND), as only seven patients have been reported, either homozygous for a missense or frameshift mutation or compound heterozygous for both of them. We report here the first known case caused by a homozygous nonsense mutation (Y61X) in the glucokinase gene ( GCK ) that introduces a premature stop codon, generating a truncated protein that is predicted to be completely inactive as it lacks both the glucose- and the adenosine triphosphate-binding sites. The proband, born to consanguineous parents, was a full-term, intra-uterine growth-retarded male newborn who presented with a glycaemia of 129 mg/dL (7.16 mmol/L) on his second day of life, increasing thereafter up to 288 mg/dL (15.98 mmol/L) and 530 mg/dL (29.41 mmol/L) over the next 24 h, in the face of low serum insulin (<3 μIU/mL; <20.83 pmol/L). He was put on insulin on the third day of life. Insulin has never been discontinued since then. The patient was tested negative for anti-insulin and islet cell antibodies at age 5 months. His father had non-progressive, impaired fasting glucose for several years. The mother was found to be mildly hyperglycaemic only when her glucose was checked after the child was diagnosed. In conclusion, biallelic GCK loss should be considered as a potential cause of PND in children born to consanguineous parents, even if they are not known to be diabetic at the time of PND presentation.     

TERATOGENIC AND PHARMACOKINETIC STUDIES OF PRIMIDONE DURING PREGNANCY AND IN THE OFFSPRING OF EPILEPTIC WOMEN

ABSTRACT. Fourteen epileptic women treated with primidone, either alone or in combination with other antiepileptic drugs, were studied prospectively during their pregnancy. Plasma levels of primidone and its metabolites were monitored and correlated to findings in the offspring. Maternal serum concentrations of primidone and metabolites were generally low during pregnancy. The levels of its main metabolites–phenobarbital and PEMA–were found to drop within the first month of pregnancy in two cases. The plasma concentrations remained low until birth and rose sharply thereafter. The phenobarbital/primidone ratio (mean 0.84) and PEMA/primidone ratio (mean 0.56) in pregnant patients were found to be lower than in non-pregnant patients, except when primidone was given in combination with phenytoin in which case the expected phenobarbital/primidone (mean 2.5) and PEMA/primidone (mean 1.5) ratios were found. A ventricular septal defect was found in one of the offspring of the fourteen mothers and five children had microcephaly. There was a high incidence of poor somatic development with dystrophy ( n =3) and short stature ( n =2). Head circumferences ( n =8), lengths ( n =4) and/or weights ( n =8) were below the 10th percentile in a number of children. Four children showed marked facial dysmorphy. Our preliminary data suggest that primidone intake during pregnancy may be important in the pathogenesis of minor anomalies and in the induction of poor somatic development.     

URINARY EXCRETION OF ERYTHROPOIETIN AND ERYTHROPOIESIS INHIBITORS IN THE NEONATAL PERIOD

ABSTRACT. Lindemann, R. (Pediatric Research Institute, Department of Pediatrics, University Hospital, Rikshospitalet, Oslo, Norway). Urinary excretion of erythropoietin and erythropoiesis inhibitors in the neonatal period. Acta Paediatr Scand, 63:764, 1974. —The regulation and suppression of erythropoiesis in the neonatal period has been studied. Urines from normal newborn babies were collected from time of delivery and during the first week of life. Both erythropoietin (ESF) and an erythropoiesis inhibiting factor (EIF) were separated by Sephadex gel filtration. The factors were tested according to days after birth and related to the creatinine coefficient. The exhypoxic polycythemic mouse bioassay was used and the results were expressed as the per cent incorporation of ⁵⁹Fe into newly formed red blood cells. A demonstrable amount of ESF was found only in the urine voided the first day of life, indicating that the ESF production is shut off immediately after birth. From the third day of Life, a marked inhibitory effect of the EIF fractions was found. This may indicate a dual mechanism behind the decrease in neonatal erythropoiesis: a shut off of the ESF production and the appearence of erythropoiesis inhibitors.     

Mother's attachment concerns regarding spouse and infant's temperament as modulators of maternal separation anxiety

The modulators of maternal separation anxiety were examined in a longitudinal study with 97 mothers of infants from 3 to 9 months of age. The objective of the study was to examine the joint contribution of the mother's attachment concerns as related to her husband together with the perception of the infant's temperament to her concerns over separation from her child. Maternal worries about separation from 3-month-old infants predicted maternal separation anxiety when infants were 9 months old. Mother's attachment to her husband and her perception of her child's temperament further predicted maternal separation anxiety at 9 months over and above the worries at 3 months. Mothers who feared dependent relationships with their husbands experienced high levels of maternal separation anxiety. This tendency was particularly marked when the infant was perceived as adaptable at 3 months. In addition, secure mothers, namely, mothers low in fear of abandonment and in fear of being dependent, increased their maternal separation anxiety as a function of their infant's perceived unadaptability.     

Maternal consumption of dairy products during pregnancy and lactation, and the development of cow's milk antibodies in the offspring

OBJECTIVE: To assess whether the maternal consumption of milk and milk products affects development of cow's milk (CM) antibodies in infants. DESIGN: A randomized pilot trial using food frequency questionnaires (mothers) and food records (infants). SETTING: Families with a newborn infant with increased HLA-DQB1-conferred risk of type 1 diabetes and at least one first-degree relative affected by type 1 diabetes from 16 hospitals in Finland between April 1995 and November 1997. Subjects and intervention: Infants randomized to receive a hydrolysed formula when breast milk was not available during their first 6-8 mo (n=112). Of these, 13 dropped out by the age of 3 mo and two were excluded due to incomplete CM antibody data. RESULTS: Maternal milk protein intake from cheese during pregnancy was inversely related to IgA-class antibody titres to beta-lactoglobulin (BLG) and casein (CAS) at 3 mo, and to IgA antibody titres to BLG at 6 mo. Maternal consumption of raw milk products during lactation was positively related to the development of IgA antibody titres to CAS at 6 mo, and inversely correlated to IgG antibody titres to bovine serum albumin (BSA) and IgA antibody titres to CAS at 2 y. Maternal cheese consumption was inversely related to the IgG antibody titres to CM formula and CAS and to the IgA antibody titres to CAS in early infancy. CONCLUSIONS: Few associations were established between maternal CM protein intake and CM protein antibody levels in the infants. The milk and milk products taken by the mother differed in their impact on the emerging CM antibody response in the offspring.     

Hepatoblastoma in early infancy

A case of hepatoblastoma which presented in early infancy is being reported.     

Depressive symptoms among rural Bangladeshi mothers: implications for infant development

OBJECTIVE: To examine how maternal depressive symptoms are related to infant development among low-income infants in rural Bangladesh and to examine how the relationship is affected by maternal perceptions of infant irritability and observations of caregiving practices. METHODS: Development was measured among 221 infants at 6 and 12 months with the Bayley Scales II. Mothers reported on their depressive symptoms and on perceptions of their infant's temperament, and a home visit was made to complete the HOME Inventory. RESULTS: Half (52%) the mothers reported depressive symptoms. In bivariate analyses, maternal depressive symptoms were related to low scores on the Bayley Scales. Infants whose mothers reported depressive symptoms and perceived their infants to be irritable acquired fewer cognitive, motor, and Orientation/Engagement skills between 6-12 months than infants whose mothers reported neither or only one condition. The relationship linking maternal depressive symptoms and perceived infant irritability with infant cognitive skills was partially mediated by parental responsiveness and opportunities for play in the home. CONCLUSIONS: The intergenerational risks of maternal depressive symptoms on infant development extend to rural Bangladesh and are accentuated when mothers perceive their infants as irritable. Mothers who report depressive symptoms and infant irritability may lack the capacity to provide responsive, developmentally-oriented caregiving environments.     

Children younger than 4 years and their substance-dependent mothers in the child welfare clinic

AIM: To explore the prevalence of substance dependency among mothers of small children and to evaluate the value of a routine-style maternal report on social support, child's somatic health history and child caregiving experiences to differentiate the substance-dependent group from the non-dependent group. METHODS: Mothers (n = 413) of children less than 4 y in the child welfare clinics filled in the Substance Abuse Subtle Screening Inventory (SASSI, Miller 1985) and questionnaires concerning social support, somatic history of the child, difficulties in social environment and in caring for the child. RESULTS: The prevalence of substance dependency was 5.8%. The maternal perceptions of the child's somatic history could not differentiate the dependent from the non-dependent group, while the child caregiving difficulties were more often present in the group of substance-dependent mothers. The combined group of substance dependency and substance use was significantly associated with low social support and difficulties in social environment. CONCLUSIONS: The prevalence of substance dependency among mothers of small children is considerable and significantly associated with child caregiving difficulties and low social support, while the perceptions on the somatic health of the child did not differentiate the dependent from the non-dependent group. This suggests the value of considering the maternal experiences in caring for the child and well-being of the mother during check-ups in the child welfare clinic in order to identify the mother-child pairs at risk.     

MALTREATED INFANTS: VULNERABILITY AND RESILIENCE

This study of maltreated infants offers evidence supporting a model of bidirectional effects in which the mother initiates the maltreatment but both mother and infant behave so as to maintain the situation. Maltreated infants were found not to differ from control infants in congenital characteristics. They did, however, display deviance in learned behavior patterns. After intervention with the mother the infants showed behavioral improvement. These results suggested that maltreated infants were not inherently different from other children and that they were resilient in response to environmental improvement. Their earlier behavior may, however, have functioned to maintain their mothers' maltreating responses.