Through the lens of infant observation: some reflections on teaching infant observation and its applications to professionals working with infants

This paper discusses the teaching of infant observation to social workers. A brief literature review of publications about the relevance and application of infant observations to social work tasks is given. The relevance and application of infant observation to two specific social work tasks is considered: supervision of contact between Looked After infants and their birth parents; and assessment of parenting capacity where infants have been removed at birth and a decision has to be made about whether to return the infant to the birth parents or seek permanence (usually in the form of adoption). The innovation of running two short life infant observation groups for social workers undertaking each of these two professional tasks respectively is described. Anonymised infant observation extracts from a local authority social work Parenting Capacity Assessment Team are used to illustrate the learning process of the team in the course of undertaking infant observation training. The use and relevance of infant observation is explored with respect to four inter-related core professional tasks: observation; recording; analysis and comment; reporting. Finally, the specificity and uniqueness of psychoanalytic infant observation is discussed in relation to the added value it brings to professional practice.     

Understanding babies from the standpoint of experience

Abstract

This paper raises questions about the use of psychoanalysis as a frame of meaning in infant observation. It is part of an ongoing dialogue with Michael Rustin and others about the meanings and justifications of infant observational research. The author begins with his experience as a teacher of infant observation together with some introductory comments on his approach to understanding. He elaborates on the experience of understanding by comparing the use of infant observation in teaching and research.     

Fetal valproate syndrome with reduction deformity of limb

A case is reported of a female infant having multiple anomalies, including epicanthic folds, hypertelorism, bifid nasal bridge, shallow philtrum, low-set ears, brain atrophy, cleft palate, hemangioma on the chest, and reduction deformity of the left upper limb. This is the first case where an infant who was exposed to sodium valproate intra-uterine has a reduction deformity of the upper limb.     

Balloon Dilation of the Pulmonary Valve in Premature Infants with Tetralogy of Fallot

Infants with tetralogy of Fallot (ToF) presenting with desaturation may require augmentation of the pulmonary blood flow, usually in the form of a Blalock-Taussig shunt. Shunts may result in a preferential increase in blood flow to one lung. They also may be associated with significant morbidity and possibly mortality of premature infants. Balloon dilation of the pulmonary valve is reported to improve saturation in early infancy. This report describes two premature infants (weighing, respectively, 1.8 and 1.6 kg) with ToF and desaturation for whom balloon dilation of the pulmonary valve showed good results. Neither infant required palliative surgery. At this writing, one infant has already undergone complete repair.     

Persistent hyperinsulinemic hypoglycemia of infancy--successful therapy with nifedipine

Recent studies have demonstrated a role for calcium channel blocking agents in the treatment of persistent hyperinsulinemic hypoglycemia of infancy. We report a 30 day old infant with PHHI whom we successfully treated with oral nifedipine alone.     

Ascites due to spontaneous rupture of the renal pelvis in an 11-month-old infant with uretero-pelvic junction obstruction

The authors describe an infant with ureteropelvic junction obstruction who developed ascites. The case is unusual because the ascites was due to spontaneous rupture of the renal pelvis as described before in adults and because the infant was older than previously reported (11 months).     

Hypertrophic cardiomyopathy and transposition of great arteries associated with maternal diabetes and presumed gestational diabetes

Maternal diabetes mellitus affects the foetal heart both structurally and functionally. In early gestation, it has a teratogenic effect causing defects of primary cardiogenesis. In late gestation, it causes a unique form of hypertrophic cardiomyopathy. We report an infant of a diabetic mother and an infant where there was presumed gestational diabetes during the pregnancy who presented with combined severe hypertrophic cardiomyopathy and complex transposition of the great arteries. This rare combination of structural and functional cardiac abnormalities reflects the different mechanisms and timings of injury that may occur to the foetal heart in association with maternal diabetes and has not been previously reported. The combination has significant implications regarding medical and surgical management, and necessitates prolonged supportive therapy whilst awaiting regression of the hypertrophic cardiomyopathy followed by delayed arterial switch operation. CONCLUSION: We describe two infants with the unusual combination of both hypertrophic cardiomyopathy and transposition of the great arteries. One was an infant of a diabetic mother, and the second was associated with presumed gestational diabetes.     

Life-Threatening Intracranial Bleeding in a Newborn with Congenital Cytomegalovirus Infection: Late-Onset Neonatal Hemorrhagic Disease

The authors present a case of a 36-day-old infant with intracranial and intramuscular hemorrhage due to vitamin K deficiency bleeding, who received intramuscular vitamin K prophylaxis at birth. In this case, laboratory tests showed anemia, liver dysfunction with cholestasis, and coagulopathy, consistent with vitamin K deficiency abnormality. Serological analyses showed that cytomegalovirus immunoglobulin (Ig)M and IgG avidity were both positive. The infant was treated successfully with intravenous ganciclovir and blood products. This case suggests that it is imperative to meticulously investigate the etiology in neonates with late-onset hemorrhagic disease of the newborn. Cholestatic liver disease caused by congenital cytomegalovirus infection should be in mind in term infants who presented with late-onset hemorrhagic disease.     

Ventricular septal defect with mobile tricuspid valve pouch mimicking tetralogy of Fallot

Summary A newborn with partial deletion of the long arm of chromosome six presented with cyanosis at birth. Initial studies suggested the diagnosis of tetralogy of Fallot and the infant underwent a Waterston shunt procedure with subsequent clinical improvement. The infant subsequently died of unrelated causes. Autopsy revealed a ventricular septal defect and a dysplastic pouchlike structure related to an anomalous tricuspid valve leaflet which obstructed right ventricular outflow. Classical anatomic findings of tetralogy of Fallot were absent. Clinical and echocardiographic findings that would be expected to aid early diagnosis of future cases are presented.     

Injuries associated with infant walkers

In 1999, an estimated 8800 children younger than 15 months were treated in hospital emergency departments in the United States for injuries associated with infant walkers. Thirty-four infant walker-related deaths were reported from 1973 through 1998. The vast majority of injuries occur from falls down stairs, and head injuries are common. Walkers do not help a child learn to walk; indeed, they can delay normal motor and mental development. The use of warning labels, public education, adult supervision during walker use, and stair gates have all been demonstrated to be insufficient strategies to prevent injuries associated with infant walkers. To comply with the revised voluntary standard (ASTM F977-96), walkers manufactured after June 30, 1997, must be wider than a 36-in doorway or must have a braking mechanism designed to stop the walker if 1 or more wheels drop off the riding surface, such as at the top of a stairway. Because data indicate a considerable risk of major and minor injury and even death from the use of infant walkers, and because there is no clear benefit from their use, the American Academy of Pediatrics recommends a ban on the manufacture and sale of mobile infant walkers. If a parent insists on using a mobile infant walker, it is vital that they choose a walker that meets the performance standards of ASTM F977-96 to prevent falls down stairs. Stationary activity centers should be promoted as a safer alternative to mobile infant walkers.     

Incomplete unilateral renal duplication with hydronephrosis and cystic dilatation at confluence of ureters

An extremely rare incomplete duplex system with cystic dilatation of the upper part of the conjoint ureter presenting as hydronephrosis in a 2-year-old infant is reported.     

AP-ROP in an infant with minimal oxygen exposure

Abstract   Retinopathy of prematurity (ROP) is a multifactorial disease affecting the developing retinal vasculature and remains an important cause of blindness in very preterm infants. Rush disease, or aggressive posterior ROP (AP-ROP), progresses rapidly to stage 5 disease without exhibiting the classical course that includes stages 1–3. We describe an infant with minimal exposure to oxygen who developed AP-ROP that led to bilateral retinal detachments and a poor visual outcome, despite following current recommended screening guidelines.     

Omphalocele minor associated with complete absence of the large bowel

Colonic atresia, unlike small intestine atresia, is a rare congenital malformation. Congenital absence of the entire colon is exceptionally rare. Moreover, an association of omphalocele and complete absence of the colon has not yet been reported in the literature. We present an infant born with such combination of congenital anomalies.     

Periventricular calcifications in a newborn associated with aneurysm of the great vein of Galen

Summary A newborn infant who presented with heart failure was diagnosed to have an aneurysm of the vein of Galen. Skull radiographs and CT scan demonstrated multiple periventricular calcifications. This case illustrates a new diagnostic possibility for the radiologic finding of periventricular calcifications in the newborn. It also establishes the importance of performing good skull roentgenographic series in all neonates with unexplained heart failure.     

Severe primary hyperparathyroidism in a neonate with two hypercalcemic parents: management with parathyroidectomy and heterotopic autotransplantation

A neonate with severe primary hyperparathyroidism was successfully managed by parathyroidectomy and heterotopic autotransplantation (one third of one gland of the infant was implanted in the forearm). In vitro studies of parathyroid tissue from the infant revealed a severe defect in parathyroid suppressibility. Postoperatively, the infant had modest hypercalcemia, normal serum immunoreactive parathyroid hormone levels, hypermagnesemia, and relative hypocalciuria. The parents were related and both had asymptomatic hypercalcemia with mean serum immunoreactive parathyroid hormone levels that were within the normal range. Similar to the findings in the infant postoperatively, relative hypocalciuria in the presence of hypercalcemia was found in the mother; in contrast, the father had hypercalciuria. The presumed dominantly transmitted hypercalcemia in this kindred is consistent with familial hypocalciuric hypercalcemia with a confounding factor of ethanol possibly accounting for the hypercalciuria in the father.     

母乳脂联素浓度变化与婴儿生长发育的相关性研究

目的 分析母乳脂联素(adiponectin,APN)浓度变化,探讨其与婴儿血APN的相关性,及其与0～1岁婴儿生长发育的关系.方法 选择2008年3-12月在上海国际和平妇婴保健院出生的健康足月儿及其母亲73对入组.收集母亲产后2、4、l3、26周母乳,用ELISA法测定母乳APN浓度.分析母乳APN浓度变化趋势及其与婴儿体格生长指标的关系,并运用多元回归方法分析与婴儿生长指标相关的影响因素.且于出生26周时收集婴儿血标本,探讨母乳APN与婴儿血APN的相关性.结果 产后2、4、13、26周母乳APN浓度分别为:14.62(5.93～140.40)、7.32(2.04～29.35)、6.84(2.72～15.65)、4.88(1.12～13.38)μg/L.其中产后2周母乳APN与婴儿13、26、52周年龄别体重Z分值(WAZ)均呈负相关(P＜0.05);4周母乳APN与婴儿4、13、26、52周WAZ、身长别体重Z分值(WLZ)、体重指数Z分值(zBMI)均呈负相关(P＜0.05);13周母乳APN与婴儿13、26、52周WAZ、WLZ、zBMI均呈显著负相关(P＜0.01);26周母乳APN与婴儿52周WAZ、WLZ、zBMI呈负相关关系(P＜0.05).多元线性回归分析发现母乳APN均为13、26及52周WAZ、WLZ、zBMI最重要的影响因素.婴儿26周血APN与13、26周母乳APN呈正相关(P＜0.05).结论 随泌乳期的延续,母乳APN浓度呈下降趋势.母乳中APN浓度越高,婴儿体重则明显偏低.婴儿血APN与母乳APN显著相关.

Abstract：

Objective To investigate the variation of human breast milk adiponectin (APN)concentration during lactation, analyze the relationship of APN concentrations in human breast milk with APN in infant serum, determine the association between maternal milk APN and infant body proportionality in the first year of life, and the period of greatest human milk exposure.Method Subjects included 73mother-infant pairs from Shanghai International Peace Maternity & Child Health Hospital.Maternal milk was collected at 2, 4, 13, 26 weeks and infant serum was collected at 26 weeks.The concentration of APN in maternal milk and infant serum were measured with commercially available ELISAs (R&D Systems).Weight-for-age Z-scores (WAZ) , length-for-age Z-scores ( LAZ ) , weight-for-length Z-scores ( WLZ ) and body mass index Z-scores ( zBMI ) of infants up to 1 year of age were calculated using World Health Organization (WHO) standards.Then the variation of maternal milk APN was investigated, the correlation between maternal milk APN and infant serum APN was analyzed; multivariate regression analysis was used to analyze covariates correlated with infant body proportionality, meanwhile determined the association between maternal milk APN and infant anthropometrics.Result The concentration of APN in maternal milk at 2, 4,13, 26 weeks was respectively (14.62 μg/L, 5.93-140.40 μg/L), (7.32 μg/L, 2.04-29.35 μg/L),(6.84 μg/L, 2.72-15.65 μg/L) and (4.88 μg/L, 1.12-13.38 μg/L).Higher milk APN in postpartum 2weeks was associated with lower infant WAZ at 13, 26 and 52 weeks ( P ＜ 0.05 ).Milk APN in postpartum 4 weeks was inversely related to infant WAZ, WLZ, zBMI at 13, 26 and 52 weeks ( all P ＜ 0.05 ).Meanwhile, milk APN in postpartum 13 weeks had significantly negative correlation with infant WAZ, WLZ,zBMI at 13, 26 and 52 weeks (P＜0.01).Milk APN in postpartum 26 weeks also was inversely associated with infant WAZ, WLZ and zBMI at 52 weeks (P ＜0.05).After adjusting covariates like birth weight using multivariate regression analysis, milk APN level is the most important influence factor to infant WAZ, WLZ,zBM1 at 13, 26 and 52 weeks.There was a positive correlation between maternal milk APN and infant serum APN at 13, 26 weeks.Conclusion Milk APN concentration declines throughout lactation.Maternal milk APN may play a vital role in the growth and development of breastfed infants, particularly closely associated with infant weight.Infant serum APN clearly correlated with maternal milk APN.     

Spontaneous bilateral pneumothorax in an infant with bronchiolitis

Spontaneous pneumothorax is an uncommon complication of bronchiolitis due to respiratory syncytial virus. Bilateral spontaneous pneumothorax in an infant with respiratory syncytial virus bronchiolitis has not been previously reported. We report the case of a four-month-old infant who presented in respiratory distress owing to respiratory syncytial virus bronchiolitis with bilateral pneumothoraces. The infant improved with evacuation of air from the chest.     

Plasma carnitine levels during intravenous feeding of the neonate.

The premature infant has a limited capacity for fatty acid oxidation. This study shows that solutions commonly used for intravenous feedings in the newborn infant contain no carnitine. Infants maintained on this solution have significantly lower total, free, and acylcarnitine levels as compared to when they are fed orally with expressed human milk or a proprietary formula, which is known to contain carnitine. The exogenous supply of carnitine to the premature infant may have a significant influence on the ability to stimulate optimal fatty acid oxidation.     

Unusual Hemodynamic Changes in an Infant with a Restrictive Ventricular Septal Defect

A 7-month-old asymptomatic infant was known to have a restrictive membranous ventricular septal defect partially closed by an aneurysm of the membranous septum. At 13 months of age, he developed unexpected pulmonary hypertension, with no clinical sign of cardiac failure. Cardiac catheterization assessed the pulmonary artery pressure at a systemic level with significant left-to-right shunt. After surgical closure, the pulmonary arterial pressure decreased by 50%. We suspect an enlargement of the ventricular septal defect caused by the rupture of the aneurysm of the membranous septum—a rare complication.     

An infant with trisomy 21 and tachypnea

A 4-month-old infant with trisomy 21 is brought to the emergency department for breathing difficulty. Subsequently, he is diagnosed with a Morgagni diaphragmatic hernia. Tachypnea in an infant with trisomy 21 may be the result of diagnosis such as congenital heart disease, infectious processes, structural anomalies, or aspiration secondary to gastroesophageal reflux or swallowing dysfunction. Knowledge of these abnormalities is important when generating a differential diagnosis in these patients. Although uncommon, a Morgagni hernia may present beyond the newborn period and should be considered when evaluating an infant with trisomy 21 and respiratory difficulty.