Book Review

Abstract

This article describes the author's experience working as a consultant to a home-based Early Head Start Program. The model that developed was a complex multilayered intervention, involving work of a supervisory nature with a home visitor, direct work with the mother-infant pair, and work with the agency. Both the dyad and the home visitor showed evidence of growth over the course of the intervention. Recommendations are offered regarding the potential benefits of introducing this model in similar programmes.     

Impact of a new aggressive nutrition policy incorporating early introduction of parenteral nutrition and mother’s own milk on growth of preterm infants

Background

Most of the evidence on early feeding of preterm infants was derived from high income settings, it is equally important to evaluate whether it can be successfully implemented into less resourced settings. This study aimed to compare growth and feeding of preterm infants before and after the introduction of a new aggressive feeding policy in Penang Hospital, a tertiary referral hospital in a middle income country.

Methods

The new aggressive feeding policy was developed mainly from Cochrane review evidence, using early parenteral and enteral nutrition with standardized breastfeeding counselling aimed at empowering mothers to provide early expressed milk. A total of 80 preterm babies (34 weeks and below) discharged from NICU were included (40 pre- and 40 post-intervention). Pre and post-intervention data were compared. The primary outcome was growth at day 7, 14, 21 and at discharge and secondary outcomes were time to full oral feeding, breastfeeding rates, and adverse events.

Results

Complete data were available for all babies to discharge. One baby was discharged prior to day 14 and 10 babies before day 21, so growth data for these babies were unavailable. Baseline data were similar in the two groups. There was no significant weight difference at 7, 14, 21 days and at discharge. More post-intervention babies were breastfed at discharge than pre-intervention babies (21 vs. 8, P=0.005). Nosocomial infection (11 vs. 4, P=0.045), and blood transfusion were significantly lower in the postintervention babies than in the pre-intervention babies (31 vs. 13, P=0.01). The post-intervention babies were more likely to achieve shorter median days (interquartile range) to full oral feeding [11 (6) days vs. 13 (11) days, P=0.058] and with lower number affecting necrotising enterocolitis (0 vs. 5, P=0.055).

Conclusion

Early aggressive parenteral nutrition and early provision of mother’s milk did not result in improved growth as evidenced by weight gain at discharge. However we found more breastfeeding babies, lower nosocomial infection and transfusion rates. Our findings suggest that implementing a more aggressive feeding policy supported by high level scientific evidence is able to improve important outcomes

     

Factors Associated With Early Intervention Referral and Evaluation: A Mixed Methods Analysis

ObjectiveTo identify parent, child, community, and health care provider characteristics associated with early intervention (EI) referral and multidisciplinary evaluation (MDE) by EI.MethodsWe conducted a mixed methods secondary analysis of data from a randomized controlled trial of a developmental screening program in 4 urban primary care practices. Children <30 months of age not currently enrolled in EI and their parents were included. Using logistic regression, we tested whether parent, child, community, and health care provider characteristics were associated with EI referral and MDE completion. We also conducted qualitative interviews with 9 pediatricians. Interviews were recorded, transcribed, and coded. We identified themes using modified grounded theory.ResultsOf 2083 participating children, 434 (21%) were identified with a developmental concern. A total of 253 children (58%) with a developmental concern were referred to EI. A total of 129 children (30%) received an MDE. Failure in 2 or more domains on developmental assessments was associated with EI referral (adjusted odds ratio [AOR] 3.15, 95% confidence interval [CI] 1.89–5.24) and completed MDE (AOR 2.16, 95% CI 1.19–3.93). Faxed referral to EI, as opposed to just giving families a phone number to call was associated with MDE completion (AOR 2.94, 95% CI 1.48–5.84). Pediatricians reported that office processes, family preference, and whether they thought parents understood the developmental screening tool influenced the EI referral process.ConclusionsIn an urban setting, one third of children with a developmental concern were not referred to EI, and two thirds of children with a developmental concern were not evaluated by EI. Our results suggest that practice-based strategies that more closely connect the medical home with EI such as electronic transmission of referrals (eg, faxing referrals) may improve completion rates of EI evaluation.     

Un nouveau regard sur la dyslexie dysorthographie. Plaidoyer pour une reconnaissance précoce de ce handicap

Dyslexia is a primary development disorder characterized by reading and writing disability. Although frequent, it remains underdetected at school and badly known by practitioners. As a consequence, many children remain severely handicapped in their school life, and later on in their adult social life, although being fairly intelligent. Pediatricians must be involved in its early detection and management ERTL4 test is a useful test of detection to be applied in 5-7-year-old children.     

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??A large number of studies have demonstrated that the infants in development have great “use-dependent plasticity”. It is driven by targeted activities to develop the best control strategy accompanied with the adaptive changes from brain to muscle in the structure and function. Therefore??the design of targeted activities according to the individual situation is considered to be the most effective strategy to optimize early development in the high risk infants with brain damage.     

Early intervention for infants and toddlers: Applications for pediatric oncology

Young children (<3 years) with cancer are at risk for delays in development due to their disease and its required treatments and restrictions. In the United States, Part C of the Individuals with Disabilities Education Act describes a system of early intervention (EI) services for young children with delays or the potential for delays in development. Children with cancer may be eligible for EI but are rarely referred. Our objectives are to describe the critical impact of early childhood development on long‐term outcomes, review current considerations for EI, and advocate for the referral to EI for young children with cancer.     

The effect of early contact on maternal perception of infant behavior

The effect of extra maternal-infant contact during the first postpartum hour on maternal perception of infant behavior one month after delivery was measured by the Broussard Neonatal Perception Inventories and the attachment questions of Klaus and colleagues. All mothers were indigent primiparas who vaginally delivered normal, term infants. 60 mother-infant dyads were randomly assigned to either an extra contact or routine contact group. 49 mothers were available 1 month later for home visits. Scores on the Neonatal Perception Inventories were not significantly affected by either degree of contact or the sex of the child. There was also no difference between contact groups in the maternal response to the attachment questions. Infant behaviors recorded by 24 mothers during the 4 days following home visits were similar in the 2 contact groups. Mothers reported significantly more negative behaviors for female than for male infants. Any effects of extra contact during the first hour after birth on maternal-infant interaction are unlikely to result from changes in maternal perception of infant behavior.     

Early detection of infant hearing loss: current experiences of health professionals in a developing country

AIM AND METHODS: To investigate the experiences of doctors and nurses in infant hearing loss through an open-ended questionnaire in Lagos, Nigeria. RESULTS: Few respondents detected children with hearing loss within the first 6 mo of life. Parental concern was the most significant lead for doctors. Children suspected of hearing loss were often referred to ENT surgeons before objective hearing evaluation was conducted. CONCLUSION: Doctors and nurses should routinely seek objective infant hearing assessment for timely detection of permanent hearing loss.     

小儿病毒性脑膜炎病原诊断与临床分析

应用酶联免疫吸附（ELISA）方法，对88例临床诊断病毒性脑膜炎患儿急性期及恢复期脑脊液进行了单纯疱疹病毒（HSV－I、HSV－Ⅱ）、柯萨奇B组病毒（CoxBV）、埃可病毒（ECHO）、EB病毒（EBV）、腺病毒（AdV)及流感病毒（IFV）特异性IgM抗体检测。结果表明：HSV、CoxBV、ECHO、EBV、AdV、IFV病毒感染率分别为9．09％、18．18％、22．72％、3．41％、4．54％、5．68％；HSV及EBV感染致残率及病死率分别为87．5％（7／8）和100％（3／3）。提示脑脊液中病毒特异性IgM抗体检测可作为早期病原诊断的指标之一；CoxBV及ECH病毒是本地区小儿中枢神经系统病毒感染的主要病毒；HSV及EBV感染致残率及病死率较其它病毒高，预后不良；早期阿昔洛韦治疗，可大大降低病死率。     

婴儿早期教育的效果

目的 从新生儿期开始即进行早期教育，以达到优生优育的效果。方法 对每一位自协和医院出生的婴儿会员进行定期生长发育监测；婴儿喂养及营养的指导；心理行为测评和指导；疾病的早期发现和早期干预；高危儿的随诊。结果 俱乐部的工作保障了会员的体格发育正常，他们的身高、体重及头围的均值均高于1995年全国九城市儿童的生长发育标准的均值；精神发育，采用CDCC（婴幼儿智能发育测定）量表，精神发育指标（MEI）和运动发育指标（PDI）均在正常范围；在早产儿、窒息儿及高危儿的随诊中，起到了早期发现、早期干预的作用；创造了新型和谐的医患关系。结论 俱乐部的工作，保障了会员的精神发育、体格发育的健康生长，进一步验证了婴儿早期教育的效果。     

Very early onset inflammatory bowel disease

Very early onset inflammatory bowel disease (VEO-IBD) represents a unique and growing subset of patients with inflammatory bowel disease (IBD). Some VEO-IBD patients present with immunodeficiency and possess loss of function genetic mutations involving immune pathways that cause their IBD. A search for Mendelian causes of IBD is likely most beneficial when the presentation involves extra-intestinal autoimmunity or involves intestinal histopathology that is atypical for IBD. While a subset of these young patients will have highly aggressive courses (and likely present with immunodeficiency), the majority of patients with VEO-IBD appear to have disease courses similar to that of their older counterparts. Most notably, many of these young children will require long courses of immunosuppression simply as a result of the profoundly early presentation—thus increasing their long-term risks of cancer and opportunistic infections.     

Blutungen in der Frühschwangerschaft: Ein Hinweis auf kindliche Mißbildungen?

Zusammenfassung Die Frage, ob es nach Blutungen in der Frühschwangerschaft gehäuft zu kindlichen Mißbildungen kommt, wird in der Literatur unterschiedlich beantwortet. In der vorliegenden Arbeit werden die vielfältigen methodischen Schwierigkeiten aufgezeigt, die zu einer falschen Beurteilung führen können. Diese Fehlermöglichkeiten können mit der Technik des Paarvergleichs weitgehend ausgeschaltet werden. An Hand eines prospektiv gesammelten Materials von insgesamt 5257 Fällen kann gezeigt werden, daß sich bei 68 schweren Mißbildungsfällen und 136 paarweise zugeordneten gesunden Kindern statistisch keine Unterschiede der Blutungshäufigkeit in der Frühschwangerschaft sichern ließen. Ein unterschiedliches zeitliches Blutungsmuster läßt sich gleichfalls nicht nachweisen.Arbeit im Rahmen des Schwerpunktprogramms Schwangerschaftsverlauf und Kindesentwicklung der Deutschen Forschungsgemeinschaft (auszugsweise als Vortrag gebracht auf 4th International Conference on Birth Defects, September 1973 in Wien).     

Early death in children with acute lymphoblastic leukemia: does malnutrition play a role?

The study aim was to correlate malnutrition and early death in children with acute lymphoblastic leukemia (ALL). A study was conducted in 100 consecutive children with ALL. An analysis included clinical and laboratory parameters as well as co-morbidity factors. Forty patients were standard risk and 60 high risk. Multivariate analysis showed variables of statistical importance, including female gender (p 010), ALL high-risk (p 04), and infection (p 036). Malnutrition (p 1.0) and poverty (p 0.5) did not influence. Early mortality was documented in 15/100 (15%) patients. The study shows that high-risk ALL and infection represent the leading causes of early mortality.