Do infants of depressed mothers cry more than other infants?

Objectives: This study compared the crying behaviour of infants of depressed and non-depressed mothers at 3 and 6 months of age.
Methodology Twenty-nine depressed and 44 non-depressed mothers, their infants and partners participated in this study. Mothers were asked to complete 24-hour diaries of the amount their infants cried for 1 week.
Results The diurnal variations in crying patterns of infants of depressed and non-depressed mothers were not significantly different. However, infants of depressed mothers were found to cry significantly more in total per day than infants of non-depressed mothers at 3 months of age, but not at 6 months. The results could not be explained by differences in infant temperament.
Conclusion Maternal depression may be a contributory factor to infant crying at 3 months of age.     

Vitamin K status of lactating mothers and their infants

Vitamin K deficiency remains a world-wide problem in the newborn. Vitamin K traverses the placenta from mother to infant very poorly and is present only in very low concentrations in human milk. Thus, it is not surprising that the newborn infant has undetectable vitamin K serum levels with abnormal amounts of the coagulation proteins and undercarboxylated prothrombin. Hemorrhagic disease of the newborn, secondary to vitamin K deficiency, remains largely a disease of breastfed infants. Lactating mothers easily achieve the recommended dietary allowance for vitamin K (1 μg kg⁻¹ d⁻¹) and the breast milk concentration is readily increased by increasing maternal vitamin K intake. Breastfed infants do not receive the recommended vitamin K intake via human milk. To prevent vitamin K deficiency in the newborn, intramuscular or oral vitamin K prophylaxis is necessary.     

Decreased total antioxidant capacity and increased oxidative stress in passive smoker infants and their mothers

BACKGROUND: Smoking has many adverse health effects in infants and adults. The purpose of the study was to study the effect of passive cigarette smoking on oxidative and antioxidative status of plasma in passive smoker infants and their mothers and to compare with those of non-smokers. METHODS: Subjects were randomly chosen from infants aged 8-26 weeks and their mothers aged 20-34 years. Passive smoker infants (n = 29) and their mothers (n = 29) were defined as having other family members who smoked six or more cigarettes per day continually for at least 8 weeks. Non-smokers were defined as infants (n = 30) and their mothers (n = 24) who had never been exposed to passive smoking. The antioxidative status of plasma were perused by measuring the total antioxidant capacity. Oxidative status was evaluated by predicating total peroxide level, oxidative stress index, protein oxidation and lipid peroxidation. RESULTS: Plasma concentrations of total antioxidant capacity were significantly lower in passive smoker infants and their mothers than non-passive smoker infants and their mothers. However, lipid peroxidation and oxidative stress index were remarkably higher in passive smoker infants and their mothers than those of non-passive smoker infants and their mothers. There were significant correlations between the oxidative and antioxidative parameters of the passive smoker infants and their mothers. CONCLUSIONS: Oxidants are increased and antioxidants are decreased in passive smoker infants and their mothers than those of non-smokers. Passive smoker infants and their mothers are exposed to potent oxidative stress.     

Sleep and arousal, synchrony and independence, among mothers and infants sleeping apart and together (same bed): an experiment in evolutionary medicine

Although solitary sleeping in infancy is a very recent custom, limited to Western industrialized societies, and most contemporary people practice parent-infant co-sleeping, virtually all laboratory research on sleep in human infants assumes that solitary infant sleep is the normal and desirable environment. We have used evolutionary and developmental data to challenge this view. We suggest that co-sleeping provides a sensory-rich environment which is the more appropriate environment in which to study infant sleep. In addition, two preliminary, in-laboratory, polygraphic investigations of mother-infant co-sleeping are reported in normal infants, within the peak age range for sudden infant death syndrome (SIDS). Five mother-infant pairs co-slept one night in the first study; in the second, three additional pairs slept separately for two nights and co-slept the third consecutive night. The results suggest that co-sleeping is associated with enhanced infant arousals and striking temporal overlap (synchronicity) in infant and maternal arousals, and that, possibly as a result, co-sleeping mothers and infants spend more time in the same sleep stage or awake condition. The implications of the hypothesis and preliminary results for research on the normal development of infant sleep and on SIDS are discussed.     

The composition of polyunsaturated fatty acids in erythrocytes of lactating mothers and their infants

Long-chain polyunsaturated fatty acids (LCPUFA) in breastmilk, specifically docosahexaenoic acid (DHA), are important for infant brain development. Accretion of DHA in the infant brain is dependent on DHA-status, intake and metabolism. The aim of this study was to describe changes in maternal and infant erythrocyte (RBC) DHA-status during the first four months of lactation. We examined 17 mothers and their term infants at 1, 2 and 4 months of age. Milk samples and RBC from the mothers and infants were obtained and analysed for fatty acid composition. Comparative analysis of the results showed that the content of DHA in maternal RBC-phosphatidylcholine (PE) decreased over the four month period and this was not accompanied by a decrease in DHA in infant RBC-PE (P = 0.005). The ratio of n-6 PUFA to n-3 PUFA increased over time in maternal RBC-PE, but not in infant RBC-PE (P < 0.001). The level of 22:5n-6 and the ratio of LCPUFA to precursor PUFAs in infant RBC was higher than in maternal RBC phospholipids. (P = and P < 0.001 respectively). We found a decrease in the level of LCPUFA in milk, specifically AA. However, we did not observe a significant decrease in milk DHA, which may have been due to two outliers. These results indicate better DHA-status and a higher n-3/n-6 PUFA in RBC of infants than in mothers. Whether these differences reflect preferential n-3 PUFA transfer via breastmilk or differences in PUFA-metabolism and utilization remains to be shown.     

Bed sharing patterns in a cohort of Australian infants during the first six months after birth

OBJECTIVE: To measure bed sharing (BS) activity in healthy term infants. METHODOLOGY: The sleep-wake behaviour and place of infant sleep were recorded for infants aged between 2 and 24 weeks. Infants were then identified as BS or non bed sharing (NBS) according to each of four different definitions of bed sharing. RESULTS: The mean proportion of infants who spent any time BS during a 24-h period was significantly greater (P < 0.05) between 2 and 12 weeks (40.9 +/- 1. 4%) than between 13 and 24 weeks (36.5 +/- 1.5%). A significantly greater proportion (P < 0.005) of infants bed shared for more than 2 h (25 +/- 1%) than for either 1-2 h (10.5 +/- 1.1%) or for less than 1 h/24 h (3.2 +/- 0.5%) during the whole study period. Each of the definitions of BS used in the study separated infants on the basis of the amount and frequency of BS activity. CONCLUSION:: Bed sharing activity was common and varied in this cohort. It was possible, using quantitative definitions, to identify those infants who routinely bed share.     

Relationship between the nutritional status of breastfeeding Mayan mothers and their infants in Guatemala

A case–control study was conducted to determine the association between maternal height and infant length‐for‐age, and to evaluate how this association is modified by either maternal or infant nutritional status. We hypothesised that maternal excess caloric intake [measured as body mass index (BMI)] would increase the association, while infant nutrition (measured in main meals consumed in addition to breastfeeding) will diminish the effect. Mother and infant pairs in Chimaltenango, Guatemala, were measured for anthropometric values and nutritional status, and mothers were interviewed to elicit nutritional and socio‐economic information. Infant length was converted into z‐scores based on the World Health Organization's (WHO) standards. Odds ratios (ORs), associated 95% confidence intervals (CIs) and the relative excess risk due to interaction (RERI) were calculated. Cases were infants below 2 z‐scores of the WHO's length‐for‐age, while controls were infants within the ?2 to 2 z‐score range. Cases (n = 84) had an increased odds (OR: 3.00, 95% CI: 1.57–5.74) of being born to a stunted mother (below 145 cm) when compared with controls (n = 85). When adjusted for potential confounders, the OR decreased to 2.55 (95% CI: 1.30–5.02). Negative RERI values were produced for the joint exposure of maternal BMI ≥ 25 and maternal stuntedness (RERI: ?0.96), as well as for the joint exposure of maternal stuntedness and infant nutrition (RERI: ?2.27). Our results confirm that maternal stuntedness is a significant contributor to infant stuntedness; however, this association is modified negligibly by maternal nutritional status and significantly by infant nutritional status, each in a protective manner.     

Short-term outcome in infants with a birthweight less than 501 grams

AIM: To report survival and morbidity until discharge in preterm infants <501 g with life support started immediately after birth. Methods/study design: Cohort study of all preterm infants with birthweights < 501 g born in three tertiary perinatal centres between 1 January 1998 and 31 December 2001 (gestational age (GA) 25.2 [21.0-30.7] wk; birthweight 435 [290-500] g; median [range]). RESULTS: A total of 107 infants with birthweights <501 g were born. Twenty-nine were stillborn. A prenatal decision to initiate life support immediately after birth was reached in 9/37 (24%) infants <24.0 wk GA and in 39/42 (93%) infants > or =24.0 wk GA. Survival was 3/37 (8%) and 26/41 (63%) in infants <24 wk GA and > or =24.0 wk GA, respectively. Twenty-nine of the 48 infants with immediate life support (60%) survived (95% CI: 46-75%). Forty-two of these 48 (88%) infants were small for gestational age. No infant without immediate life support survived (0/30). Twenty-three (79%) survivors developed chronic lung disease (CLD) and eight (28%) received photocoagulation for retinopathy of prematurity (ROP). CONCLUSION: In this population of extremely low birthweight infants, survival was higher than in previous studies when life support was provided immediately after birth. Short-term morbidity was similar to other studies. The presented data on survival support our concept to offer immediate life support after birth in preterm infants with birthweights <501 g. The long-term outcome of these infants needs to be assessed urgently.     

Severe sleep problems among infants in a normal population in Sweden: prevalence, severity and correlates

The aim of this study was to explore the prevalence of parentally experienced infant sleep problems, with special interest in severe problems, in a total community sample of 2518 infants aged 6-18 mo. Correlates to severe sleep problems were sought. The families were approached using a questionnaire and 83% responded. Data from the collection procedure point to a non-selective dropout. Sixteen percent of the parents reported their children as having moderate or severe difficulties in falling asleep at night (sleep refusal, bedtime struggles) and 30% reported frequent night waking. Almost all (93%) of the parents had sought help at the Child Health Centre (CHC), but only 48% were satisfied with the support and advice they got. Severe sleep problems as defined by the ICSD (International Classification of Sleep Disorders, 1990) were found in 129 of the children (6.2%), who were studied in detail, with the rest of the population as controls. Severe sleep problems were found to be correlated with parental worries and anxiety concerning infant health (although the children were reported as being as healthy as the controls), infant feeding problems and intensive parental interventional behaviour (especially feeding) during the evening and night. A common factor of insecurity in the parental role is suggested.     

Utility of a new transcutaneous jaundice device with two optical paths in premature infants

BACKGROUND: Hyperbilirubinemia may cause dysfunction of the central nervous system of newborn infants. Recently, a new transcutaneous bilirubin device has been developed, which is not limited by maturity or melanin concentration of the skin. However, there have been few reports limiting the subjects to preterm and very low-birthweight (VLBW) infants. METHODS: Transcutaneous bilirubin (TcB) and total serum bilirubin (TSB) were measured within 1 h of time lag in 50 premature infants. TcB was measured with the new jaundice device on the forehead. TSB samples were measured by direct colorimetry. The correlation coefficient and regression line were calculated. RESULTS: The results showed a good correlation between TcB and TSB. However, the correlation tended to be worse with infants whose birthweights were lower than 1000 g, or whose gestational ages at birth were shorter than 28 weeks. CONCLUSION: TcB and TSB have a close correlation, and TcB tends to be higher than TSB. The Minolta transcutaneous jaundice device could be used as a screening instrument, leading to the avoidance of invasive blood samplings for preterm and VLBW infants. However, in patients whose birthweights are lower than 1000 g or whose gestational ages are shorter than 28 weeks, care must be taken when using the transcutaneous jaundice device because of low reliability in these patients.     

Outcomes for infants weighing less than 1000 grams cared for with a nasal continuous positive airway pressure-based strategy

OBJECTIVE: To compare outcomes for infants weighing less than 1000 g treated with a predominantly nasal continuous positive airways pressure (CPAP) approach (modelled on that of Columbia University, New York) with outcomes audited by the Australian and New Zealand Neonatal Network (ANZNN). METHODS: Data on all infants weighing less than 1000 g admitted for intensive care were collected prospectively for the 29 neonatal units contributing to the ANZNN database. Outcomes for infants treated at Middlemore Hospital over a 3-year period (1998-2001) were compared with the ANZNN data for 1999. RESULTS: Sixty-four infants were admitted to Middlemore Hospital and 954 to the other 28 neonatal units. The two groups were similar with respect to birthweight, Apgar scores, sex and delivery method. Gestational age was lower in the Middlemore infants and outcome variables were adjusted for this difference. Fewer babies at Middlemore were born to mothers who had completed antenatal corticosteroids. The Middlemore Hospital group spent longer on CPAP (P < 0.001) but had less time in oxygen (median 4 days compared to 54 days; P < 0.001). Fewer of the Middlemore cohort were in oxygen at both 28 days (odds ratio 0.17 with 95% CI 0.09-0.30) and 36 weeks corrected gestation (odds ratio 0.15 95% CI 0.07-0.32) and fewer infants were discharged home on oxygen (odds ratio risk 0.38 95% CI 0.16-0.90). Other outcomes were a reduction in the number of infants with culture proven sepsis at Middlemore Hospital but a higher rate of necrotizing enterocolitis. Length of hospital stay and survival rates were not significantly different. CONCLUSIONS: Improved respiratory outcomes for infants weighing less than 1000 g were evident at Middlemore Hospital. This was attributed to the use of a nasal CPAP-based respiratory support system.     

Outcome and hospital cost for infants weighing less than 500 grams: a tertiary centre experience in Taiwan

AIM: To determine the outcome and hospital cost for infants weighing < or =500 g at a tertiary centre in Taiwan. METHODS: We retrospectively reviewed the medical records of infants who were born alive with birthweight < or =500 g at the National Taiwan University Hospital from 1997 to 2004. Their outcome and hospital cost were analysed. RESULTS: A total of 168 infants were included for analysis that 146 of them died after compassionate care in the delivery room and 22 received postnatal resuscitation. The infants who received resuscitation were more likely to have higher birthweights, older gestational ages and multiple births compared with those who received compassionate care. After resuscitation, five of the infants died and 17 were admitted to neonatal intensive care unit (NICU) for further management. Subsequently, 12 infants died and five infants survived to discharge. Two infants were discharged against advice and died within days. After exclusion of those receiving compassionate care, the NICU survival rate was 22.7% and the long-term survival rate was 13.6%. The most common early morbidities were respiratory distress syndrome, intraventricular haemorrhage and patent ductus arteriosus, whereas the late morbidities included cholestatic jaundice, retinopathy of prematurity and chronic lung disease. The average total hospital costs for the NICU survivors with birthweight < or =500 g was US $42,411 and the average hospital cost per day was US $350. CONCLUSION: Exclusive compassionate care was given to the majority of the infants weighing < or =500 g in Taiwan. The survival rate remained low in these marginally viable infants.     

一种新的早产儿脑电发育成熟度评价方法的初步研究

目的 基于早产儿脑电活动特征建立一种新的早产儿脑电成熟度评价方法。方法 前瞻性收集经后龄（postmenstrual age,PMA）25~36周符合纳入标准的早产儿生后7 d内视频脑电图和同步振幅整合脑电图（amplitude-integrated electroencephalography,aEEG）的监测资料。将aEEG与常规脑电图（conventional electroencephalography,cEEG）背景活动指标（aEEG+cEEG）按发育成熟规律赋分作为新的评价体系,并与单一aEEG评价方法比较,分析二者与胎龄（gestational age,GA）、PMA、头围的相关性。计算不同PMA早产儿aEEG+cEEG总分和aEEG总分的分值区间,比较组间差异。在不同评价者之间对新评分体系进行一致性分析。结果 共纳入52例早产儿。aEEG+cEEG总分、aEEG总分分别与GA、PMA、头围呈显著正相关（均P<0.05）,与PMA和GA的相关系数均>0.9。aEEG+cEEG评价方法和单一aEEG评价方法在不同PMA早产儿中正常分值区间分别为：<28周组为13.0（11.0,14.0）、6.0（4.0,7.0）分,28~29⁺⁶周组为16.0（14.5,17.0）、8.0（6.0,8.0）分,30~31⁺⁶周组为18.0（17.0,21.0）、9.0（8.0,10.0）分,32~33⁺⁶周组为22.0（20.0,24.5）、10.0（10.0,10.8）分,34~36周组为26.0（24.5,27.5）、11.0（10.0,12.0）分。不同PMA早产儿组间aEEG+cEEG总分和aEEG总分差异有统计学意义（P<0.05）。不同评价者之间应用该评分体系进行早产儿成熟度评价时一致性高（κ=0.86）。结论 该研究所建立的脑电评分体系可以定量反映早产儿脑电发育的成熟度,不同PMA组间有很好的区分度,在不同评价者之间应用一致性高。     

The pitch of maternal voice: a comparison of mothers suffering from depressed mood and non-depressed mothers reading books to their infants

BACKGROUND: Research suggests that storybook reading promotes language development and that there is a relationship between maternal affective responses in relation to infant affect and language development. The purpose of this study is to relate maternal paralinguistic and verbal behaviour during storybook reading to maternal mood state. METHOD: Mothers (n = 32) reporting depressed mood (as measured by the Edinburgh Postnatal Depression Scale) were matched on age of baby (mean age = 6 months, mean age = 10 months), sex of baby, educational status of mother and parity with 32 non-depressed mothers. They were video- and audio-taped in their homes while reading a picture-book to their infants. Maternal textual and extra-textual utterances were transcribed and analysed in terms of mean length utterance (MLU), fundamental frequency and pitch modulation. RESULTS: There was an interaction between psychological well being and age group with regard to MLU for text read. Non-depressed mothers had a smaller MLU for younger babies in comparison with older babies, while depressed mothers showed no difference in their MLU. There was a main effect of psychological well being with depressed mothers speaking with a higher mean pitch and more modulations in their pitch, in comparison with non-depressed mothers. Furthermore, there was a significant interaction of the psychological well being of the mother and the mean fundamental frequency used when reading the text and when speaking to their child during the picture-book session. CONCLUSIONS: These differences in maternal speech indicate that mothers who are depressed are less attuned to their infants which might force the infant into self-regulatory patterns that eventually compromise the child's development.