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Background Maternal smoking during pregnancy (MSDP) is associated with early and long-term neurobehavioral deficits; however mechanisms remain unknown. We tested the hypothesis that MSDP programs the hypothalamic pituitary adrenocortical (HPA) axis of the offspring leading to adverse outcomes. In an intensive, prospective study, we investigated associations between MSDP and infant cortisol stress response and explored whether alterations in cortisol response were mediated by epigenetic modulation of the placental glucocorticoid receptor gene (NR3C1). Methods Participants were 100 healthy mother-infant pairs (53% MSDP-exposed; 42% female) from a low income, racially/ethnically diverse sample (55% minorities). MSDP was assessed by timeline followback interview verified by saliva and meconium cotinine. Infant cortisol responses to a neurobehavioral exam were assessed seven times over the first postnatal month. Methylation of placental NR3C1 promoter exon 1F was assessed using bisulfite pyrosequencing in a subsample (n = 45). Results MSDP-exposed infants showed significantly and persistently attenuated basal and reactive cortisol levels over the first postnatal month vs. unexposed infants. Exploratory analyses revealed that MSDP was associated with altered methylation of the placental NR3C1 promoter; degree of methylation of the placentalNR3C1 was associated with infant basal and reactive cortisol over the first postnatal month and mediated effects of MSDP on infant basal cortisol. Conclusions Results provide initial support for our hypothesis that MSDP programs offspring HPA (dys)regulation. Epigenetic regulation of placental GR may serve as a novel underlying mechanism. Results may have implications for delineating pathways to adverse outcomes from MSDP. [ABSTRACT FROM AUTHOR]

Preterm birth is associated with long-term deficits in executive functioning and cognitive performance. As advances in neonatal care enable more preterm infants to survive, development of strategies to address high rates of neurodevelopmental disabilities and poor academic achievement in preterm infants are crucial. Evidence suggests that infants' brains are plastic in nature and, therefore, can be shaped by the environment. Kangaroo care has become popularized as a means of modifying the stress of the NICU environment. However, few studies have examined whether kangaroo care affects neurodevelopmental outcomes in preterm infants. This review examined available literature that investigated the effect of kangaroo care on cognition in preterm infants. Current evidence suggests that short-term benefits of kangaroo care are associated with improved neurodevelopment. However, few studies have examined the long-term impact of kangaroo care on cognitive outcomes in preterm infants. To address neurological disparities in children born preterm, research using kangaroo care as a strategy to improve neurodevelopment in preterm infants is warranted. [ABSTRACT FROM AUTHOR]

Background Skin-to-skin care (SSC) is widely used in neonatal intensive care units due to its positive effects on infant physiology and parent-infant interaction. Aims We investigated the safety and the effect of SSC on the diaphragm electrical activity (EAdi) in premature infants recovering from respiratory distress syndrome treated on noninvasive neurally adjusted respiratory assist. Study design An observational cross-over study design was used. The infants were evaluated during SSC and in both prone and supine positions before and after SSC during a 9-hour study period. The EAdi was measured via miniaturized sensors incorporated into a feeding tube. Subjects Seventeen premature infants with a mean age of 20 d (range, 2-43 d) were studied. Their mean birth weight was 900 g (490-1845 g) and mean gestational age at birth 28 wk (25-32 wk). Outcome measures Under each condition, EAdi peak (representing tidal, neural inspiratory effort) and EAdi minimum (representing neural expiratory activity) were numerically quantified. Oxygen saturation, heart rate, and apnea were recorded. Results The mean EAdi minimum values were lower during SSC and prone position. In addition, a tendency towards lower EAdi peak values was found during SSC. There were no differences in the occurrence of apnea between the study phases. Conclusions SSC is safe and it is not associated with increased neural activity of the diaphragm. On the contrary, low EAdi minimum values were registered reflecting more complete diaphragmatic de-activation between respiratory cycles. [ABSTRACT FROM AUTHOR]

Highlights: [•] We measured auditory localization acuity on blind and sighted children. [•] Both groups discriminate precedence effect stimuli positional changes. [•] Lag discrimination was difficult for blind and sighted children. [•] Blind children had significantly lower thresholds for the lag condition. [•] Specific auditory orienting behaviors were observed in the blind group. [Copyright &y& Elsevier]

Can infants appreciate that others have false beliefs? Do they have a theory of mind? In this article I provide a detailed review of more than 20 experiments that have addressed these questions, and offered an affirmative answer, using nonverbal 'violation of expectation' and 'anticipatory looking' procedures. Although many of these experiments are both elegant and ingenious, I argue that their results can be explained by the operation of domain-general processes and in terms of 'low-level novelty'. This hypothesis suggests that the infants' looking behaviour is a function of the degree to which the observed (perceptual novelty) and remembered or expected (imaginal novelty) low-level properties of the test stimuli - their colours, shapes and movements - are novel with respect to events encoded by the infants earlier in the experiment. If the low-level novelty hypothesis is correct, research on false belief in infancy currently falls short of demonstrating that infants have even an implicit theory of mind. However, I suggest that the use of two experimental strategies - inanimate control procedures, and self-informed belief induction - could be used in combination with existing methods to bring us much closer to understanding the evolutionary and developmental origins of theory of mind. [ABSTRACT FROM AUTHOR]

Background: There is risk of developing bilirubin encephalopathy (kernicterus) in cases in which early diagnosis and treatment of high bilirubin levels are not available. The follow-up and treatment of neonatal indirect hyperbilirubinemia are, therefore, important. Aim: This study was conducted to evaluate the relationship between serum bilirubin levels and the frequency of urination and stooling in infants admitted to an outpatient neonatology department to determine the exact/cut off frequency of urination and stooling that will enable the prediction of high/critical serum bilirubin levels. Methods: The study was carried out with the parents of 70 infants who were admitted to the outpatient Neonatology Department. Determination of the urination and stooling frequency of the infants included in this study was based on the number of changed urine wet diapers and the number of stooling in the last 24 hours before admission. The capillary bilirubin level measured at first routine control was recorded as the serum total bilirubin level. Results: A statistically significant negative linear correlation was found between capillary serum bilirubin levels and the number of stoolings and number of changed urine wet diapers in the last 24 hours. A stooling number of ≤7 predicted being in the ≥50% risk group in terms of neonatal jaundice with 91.5% sensitivity, while ≤7 changed urine wet diapers in the last 24 hours also had 91.5% sensitivity. Conclusions: This study will enable parents and health care providers to be aware of the exact frequency of urination and stooling that predicts high bilirubin levels. This simple observation will also make it possible to guide parents and health care providers about the critical serum bilirubin level for a risk of significant jaundice and related complications before high bilirubin levels develop dangerously. [ABSTRACT FROM AUTHOR]

Background:Direct measurement of adipose tissue (AT) using magnetic resonance imaging is increasingly used to characterise infant body composition. Optimal techniques for adjusting direct measures of infant AT remain to be determined.Objectives:To explore the relationships between body size and direct measures of total and regional AT, the relationship between AT depots representing the metabolic load of adiposity and to determine optimal methods of adjusting adiposity in early life.Design:Analysis of regional AT volume (ATV) measured using magnetic resonance imaging in longitudinal and cross-sectional studies.Subjects:Healthy term infants; 244 in the first month (1-31 days), 72 in early infancy (42-91 days).Methods:The statistical validity of commonly used indices adjusting adiposity for body size was examined. Valid indices, defined as mathematical independence of the index from its denominator, to adjust ATV for body size and metabolic load of adiposity were determined using log-log regression analysis.Results:Indices commonly used to adjust ATV are significantly correlated with body size. Most regional AT depots are optimally adjusted using the index ATV/(height)3 in the first month and ATV/(height)2 in early infancy. Using these indices, height accounts for<2% of the variation in the index for almost all AT depots. Internal abdominal (IA) ATV was optimally adjusted for subcutaneous abdominal (SCA) ATV by calculating IA/SCA0.6.Conclusions:Statistically optimal indices for adjusting directly measured ATV for body size are ATV/height3 in the neonatal period and ATV/height2 in early infancy. The ratio IA/SCA ATV remains significantly correlated with SCA in both the neonatal period and early infancy; the index IA/SCA0.6 is statistically optimal at both of these ages. [ABSTRACT FROM AUTHOR]

Background In this multi-country cluster-randomized behavioural intervention trial promoting exclusive breastfeeding (EBF) in Africa, we compared growth of infants up to 6 months of age living in communities where peer counsellors promoted EBF with growth in those infants living in control communities. Methods A total of 82 clusters in Burkina Faso, Uganda and South Africa were randomised to either the intervention or the control arm. Feeding data and anthropometric measurements were collected at visits scheduled 3, 6, 12 and 24 weeks post-partum. We calculated weight-forlength (WLZ), length-for-age (LAZ) and weight-for-age (WAZ) z-scores. Country specific adjusted Least Squares Means with 95% confidence intervals (CI) based on a longitudinal analysis are reported. Prevalence ratios (PR) for the association between peer counselling for EBF and wasting (WLZ < -2), stunting (LAZ < -2) and underweight (WAZ < -2) were calculated at each data collection point. Results The study included a total of 2,579 children. Adjusting for socio-economic status, the mean WLZ at 24 weeks were in Burkina Faso -0.20 (95%CI -0.39 to -0.01) and in Uganda -0.23 (95%CI -0.43 to -0.03) lower in the intervention than in the control arm. In South Africa the mean WLZ at 24 weeks was 0.23 (95%CI 0.03 to 0.43) greater in the intervention than in the control arm. Differences in LAZ between the study arms were small and not statistically significant. In Uganda, infants in the intervention arm were more likely to be wasted compared to those in the control arm at 24 weeks (PR 2.36; 95%CI 1.11 to 5.00). Differences in wasting in South Africa and Burkina Faso and stunting and underweight in all three countries were small and not significantly different. Conclusions There were small differences in mean anthropometric indicators between the intervention and control arms in the study, but in Uganda and Burkina Faso, a tendency to slightly lower ponderal growth (weight-for-length z-scores) was found in the intervention arms. [ABSTRACT FROM AUTHOR]

The 2014 objection to birth in water voiced by both the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists (ACOG) in ACOG Bulletin #594 on immersion in water during labor and birth is nothing new. The Committee on Fetus and Newborn published the very same opinion in 2005, based on a case report that was published in 2002 in the journal Pediatrics. What has changed since 2002 is a growing body of evidence that reports on the safety and efficacy of labor and birth in water. This article reviews the retrospective literature on water birth and explains newborn physiology and the protective mechanisms that prevent babies from breathing during a birth in water. [ABSTRACT FROM AUTHOR]

Abstract: We investigated the effects of linguistic experience and language familiarity on the perception of audio-visual (A-V) synchrony in fluent speech. In Experiment 1, we tested a group of monolingual Spanish- and Catalan-learning 8-month-old infants to a video clip of a person speaking Spanish. Following habituation to the audiovisually synchronous video, infants saw and heard desynchronized clips of the same video where the audio stream now preceded the video stream by 366, 500, or 666ms. In Experiment 2, monolingual Catalan and Spanish infants were tested with a video clip of a person speaking English. Results indicated that in both experiments, infants detected a 666 and a 500ms asynchrony. That is, their responsiveness to A-V synchrony was the same regardless of their specific linguistic experience or familiarity with the tested language. Compared to previous results from infant studies with isolated audiovisual syllables, these results show that infants are more sensitive to A-V temporal relations inherent in fluent speech. Furthermore, the absence of a language familiarity effect on the detection of A-V speech asynchrony at eight months of age is consistent with the broad perceptual tuning usually observed in infant response to linguistic input at this age. [Copyright &y& Elsevier]

Copyright of Acta Paulista de Enfermagem is the property of Universidade Federal de Sao Paulo, Escola Paulista de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Previous research has shown that young infants perceive others' actions as structured by goals. One open question is whether the recruitment of this understanding when predicting others' actions imposes a cognitive challenge for young infants. The current study explored infants' ability to utilize their knowledge of others' goals to rapidly predict future behavior in complex social environments and distinguish goal-directed actions from other kinds of movements. Fifteen-month-olds (N = 40) viewed videos of an actor engaged in either a goal-directed (grasping) or an ambiguous (brushing the back of her hand) action on a Tobii eye-tracker. At test, critical elements of the scene were changed and infants' predictive fixations were examined to determine whether they relied on goal information to anticipate the actor's future behavior. Results revealed that infants reliably generated goal-based visual predictions for the grasping action, but not for the back-of-hand behavior. Moreover, response latencies were longer for goal-based predictions than for location-based predictions, suggesting that goal-based predictions are cognitively taxing. Analyses of areas of interest indicated that heightened attention to the overall scene, as opposed to specific patterns of attention, was the critical indicator of successful judgments regarding an actor's future goal-directed behavior. These findings shed light on the processes that support “smart” social behavior in infants, as it may be a challenge for young infants to use information about others' intentions to inform rapid predictions. [ABSTRACT FROM AUTHOR]

Adults tend to attribute agency and intention to the causes of negative outcomes, even if those causes are obviously mechanical. Is this over-attribution of negative agency the result of years of practice with attributing agency to actual conspecifics, or is it a foundational aspect of our agency-detection system, present in the first year of life? Here we present two experiments with 6-month-old infants, in which they attribute agency to a mechanical claw that causes a bad outcome, but not to a claw that causes a good outcome. Control experiments suggest that the attribution stems directly from the negativity of the outcome, rather than from physical cues present in the stimuli. Together, these results provide evidence for striking developmental continuity in the attribution of agency to the causes of negative outcomes. [ABSTRACT FROM AUTHOR]

Cortical mapping of cognitive function during infancy is poorly understood in low-income countries due to the lack of transportable neuroimaging methods. We have successfully piloted functional near infrared spectroscopy (fNIRS) as a neuroimaging tool in rural Gambia. Four-to-eight month old infants watched videos of Gambian adults perform social movements, while haemodynamic responses were recorded using fNIRS. We found distinct regions of the posterior superior temporal and inferior frontal cortex that evidenced either visual-social activation or vocally selective activation (vocal > non-vocal). The patterns of selective cortical activation in Gambian infants replicated those observed within similar aged infants in the UK. These are the first reported data on the measurement of localized functional brain activity in young infants in Africa and demonstrate the potential that fNIRS offers for field-based neuroimaging research of cognitive function in resource-poor rural communities. [ABSTRACT FROM AUTHOR]

Highlights: [•] We designed a new eyetracking task to study word learning at 19- and 15-months. [•] Can infants use known verbs to identify referents of novel nouns? [•] 19-month-olds successfully used familiar verbs as cues when learning novel nouns. [•] 15-month-olds failed to use familiar verbs as cues when learning novel nouns. [•] Infants’ eye movements show that this task requires significant cognitive effort. [Copyright &y& Elsevier]

In-utero the placenta is the primary organ responsible for neonatal homeostasis of fluid and electrolyte balance. With birth, this responsibility now transitions to the neonatal kidney. For successful transition to extrauterine renal physiology to occur maturation of neonatal glomerular filtration must occur, which is dependent on the development of renal blood flow. While these functions are decreased at birth, the term infant's kidneys are still able to manage homeostasis and are sufficient for growth and development. However, stressors can limit the adaptive properties of the neonatal kidney. This is especially important for those infants born before 34 weeks' gestation, when nephrogenesis is not yet complete. Knowledge of the changes in renal physiology is essential in caring for the neonate during transition. This article describes those changes. [ABSTRACT FROM AUTHOR]

Successful transition from intrauterine to extrauterine life involves significant physiologic changes. The majority of these changes occur relatively quickly during those first moments following delivery; however, transition for the extremely preterm infant occurs over a longer period of time. Careful assessment and perceptive interventions on the part of neonatal care providers is essential as the extremely preterm infant adjusts to life outside the womb. This article will focus on respiratory, cardiovascular, gastrointestinal, and neurologic transitional events experienced by the extremely premature infant. [ABSTRACT FROM AUTHOR]

Copyright of Ciencia, Cuidado e Saude is the property of Universidade Estadual de Maringa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Troponin T (cTnT) and Creatinine Kinase Isoenzyme (CK-MB) are both markers of myocardial injuries. However, CK-MB is also elevated in acute kidney injury. Objective: The diagnostic value of both cTnT and cardiac CK-MB in combined myocardial and acute kidney injuries (AKI) in asphyxiated neonates was evaluated. Method: 40 asphyxiated infants and 40 non-asphyxiated controls were consecutively recruited. Serum levels of cTnT, CK-MB and creatinine were measured. Myocardial injury and AKI were defined as cTnT >95th percentile of the control and serum creatinine >1.0 mg/dl respectively. Results: Of the 40 subjects, 9 (22.50%), 8 (20.00%) and 4 (10.00%) had myocardial injury, AKI and combined AKI and myocardial injuries respectively. The mean cTnT and CK-MB values were highest in infants with combined AKI and myocardial injuries. The Mean cTnT in infants with AKI, myocardial injury and combined AKI and myocardial injuries were 0.010±0.0007 ng/ml, 0.067±0.040 ng/ml and 0.084±0.067 ng/ml respectively, p = 0.006. The mean CK-MB in infants with AKI, myocardial injury and combined AKI and myocardial injuries were 2.78±0.22 ng/ml, 1.28±0.11 ng/ml and 4.58±0.52 ng/ml respectively, p = <0.0001. Conclusion: In severe perinatal asphyxia, renal and myocardial injuries could co-exist. Elevated cTnT signifies the presence of myocardial injury. Elevated CK-MB indicates either myocardial injury, AKI or both. Therefore renal injury should be excluded in asphyxiated infants with elevated CK-MB. [ABSTRACT FROM AUTHOR]

Aim Dopamine is used as an inotropic medication in preterm infants. The preterm human blood brain barrier ( BBB) is permeable to intravascular dopamine, and the impact of exogenous dopamine on the preterm brain remains unknown. The preterm lamb model may be suitable for studying the cerebral impact of dopamine therapy whether its BBB permeability is similar to preterm human infants. We aimed to examine BBB permeability to exogenous dopamine in the preterm lamb, by measuring dopamine levels in the cerebrospinal fluid ( CSF). Methods Nine preterm foetal lambs (125-130 days, term = 147 days) were given either dopamine at 10 μg/kg/min (dopamine, n = 4) or saline (control, n = 5). CSF, and plasma samples were taken for dopamine assay. Results The median (range) baseline CSF dopamine level for the combined control and dopamine groups (n = 9) was 0.10(0.03-0.16) ng/mL, and baseline plasma dopamine was 0.30(0.13-0.84) ng/mL. The dopamine lambs showed increase in CSF dopamine to 3.91(1.87-11.35) ng/mL with plasma dopamine increased to 14.2 (9.1-57.9) ng/mL. No change was found in the control lambs. Conclusion In the preterm lamb, the BBB permeability and pharmacokinetics to dopamine infusion are similar to findings in the preterm human infant, supporting applicability of the preterm lamb model for studying effects of dopamine infusion in the preterm human brain. [ABSTRACT FROM AUTHOR]

This article reviews the literature relating to the potential impact of exposure to screen media on the emotional development of infants. The available literature suggests that screen media, in particular television, has a substantially disruptive effect on the quantity and quality of parent-child interactions, which are essential for developing secure attachments. Parental attitudes towards screen media, that is if they are happy to use it as a 'babysitter' or do not see any negative consequences to excessive exposure, are also noted to be major factors in how much screen time children have daily. There is a critical need for evidence-based guidelines for parents and professionals concerning the use of screen media. [ABSTRACT FROM AUTHOR]

Abstract: Background: Nursing children are exposed to dietary aluminum (in breast milk and/or infant formulas) and through aluminum-adjuvanted vaccines (AAVs). We studied total hair-Al concentrations of nursing children that had been immunized with hepatitis B, DTP, and meningococcal vaccines. Methods: We studied the hair of 37 young children (aged 26 to 824days) who were exposed to cumulative doses of Al ranging from 0.63 to 6.88mg from AAVs. Graphite furnace atomic absorption spectrometry was used to reliably measure total Al concentrations in hair samples. Results: The analytical method proved sensitive enough to quantify Al in the hair of nursing children. At current levels of exposure it is possible to determine total Al in hair sample of 1.65mg. Cumulative doses of AAV in children ranged from 0.63 to 6.88mg Al. Median hair-Al was 47.7μgg−1 (ranging from 12.2 to 221.9μgg−1). There was no statistically significant correlation between hair-Al concentration and age of child (r =−0.049; p =0.774), total exposure from vaccine (r =−0.078; p =0.643), or the time elapsed after the last AAVs (r =0.015; p =0.931). Conclusion: Aluminum in children's hair can be reliably measured but we are still uncertain how representative it can be of the Al body burden. [Copyright &y& Elsevier]

Abstract: Low birth weight (LBW, <2500 g) infants have a reduced number of glomeruli and nephrons and, therefore, smaller kidneys. The purpose of this pilot study was to determine whether renal parenchymal thickness might be a better indicator of renal growth. We carried out a pilot study over 12 mo to determine whether renal parenchymal thickness could be used to detect differences in renal growth between LBW and normal birth weight (NBW, 2500–4500 g) infants. Thirty-eight term infants (12 LBW and 26 NBW) underwent renal ultrasound. Parenchymal thickness, length, transverse diameter and antero-posterior diameter were measured. Mean renal parenchymal thickness was significantly lower in LBW infants than in NBW infants. Renal parenchymal thickness was closely correlated with an increase in renal volume (r = 0.76, p < 0.0001). Renal parenchymal thickness is a single measurement that could potentially be a more useful and accurate approach to monitoring renal growth in growth-restricted infants than renal volume. [Copyright &y& Elsevier]

Objective: The aim of this study was to examine whether asymmetric dimethylarginine (ADMA) concentrations are associated with ventricular function in the infants of mothers with gestational diabetes. Method: Twenty-five term newborns of mothers with gestational diabetes and term newborns as the control group ( n = 25) with normal general health status were evaluated at two time points, on the 3rd postnatal day, at the 3th months. Echocardiographic evaluations of all participants were performed and ADMA level was measured. Results: In the first analysis, 10 patients (40%) had a septal thickness of 6 mm or more, indicating septal hypertrophy. In the first and second analysis, interventricular septum end-diastolic thickness (IVSTd) and the left ventricular posterior wall end-diastolic thickness (LVPWTd) in the patient group were higher than the control group. ADMA level measurement was not significantly different between the groups the first and second analysis. There was no difference in ADMA levels of the group with septal thickness ≥6 mm and the group with <6 mm. Conclusion: Newborn cardiac wall thickness was increased in pregnancies complicated by Gestational diabetes mellitus (GDM), and the increase was independent of glycemic control. Diastolic newborn cardiac function was impaired in GDM, and this effect was independent of septal thickness. We found no association between ADMA levels and cardiac systolic, diastolic functions or septum thickness in the GDM newborn. [ABSTRACT FROM AUTHOR]

Background While fungal exposures are assumed to provoke wheeze through irritant or allergenic mechanisms, little is known about the differential effects of indoor and outdoor fungi on early-life wheeze. Methods In a Boston prospective birth cohort of 499 at-risk infants, culturable fungi in bedroom air and dust and outdoor air were measured at the age of 2-3 months. Wheeze was determined using bimonthly telephone questionnaires. Odds ratios were estimated for an interquartile increase in fungal natural log-transformed concentrations, adjusting for predictors of wheeze and potential confounders. Results Increased odds of 'any wheeze' (≥1 vs 0 episodes) by age one were positively associated with indoor dust Alternaria [odds ratio ( OR) = 1.83; 95% confidence interval ( CI), 1.07-3.14] , Penicillium [ OR = 1.18; (0.98-1.43)], and Cladosporium [ OR = 1.47; (1.16-1.85)]; indoor air Penicillium [ OR = 1.26; (0.92-1.74)]; and outdoor air Cladosporium [ OR = 1.68; (1.04-2.72)]. In contrast, indoor dust yeasts were protective [ OR = 0.78; (0.66-0.93)]. 'Frequent wheeze' (≥2 vs <2 episodes) by age one was borderline associated with dust yeasts [ OR = 0.86; (0.70-1.04)] and indoor air yeasts [ OR = 1.53; (0.93-2.53)]. Alternaria concentration was associated with any wheeze for children with maternal mold sensitization [ OR = 9.16; (1.37-61.22)], but not for those without maternal mold sensitization [ OR = 1.32; (0.79-2.20)]. Conclusions While wheeze rates were higher with exposures to fungal taxa considered to be irritant or allergenic in sensitive subjects, yeasts in the home had a strong protective association with wheeze in infancy. Molecular microbiologic studies may elucidate specific components of innate microbiologic stimulants that lead to contrasting effects on wheeze development. [ABSTRACT FROM AUTHOR]

Eye tracking was used to show that 18-month-old infants are sensitive to social context as a sign that others' actions are bound together as a collaborative sequence based on a joint goal. Infants observed five identical demonstrations in which Actor 1 moved a block to one location and Actor 2 moved the same block to a new location, creating a sequence of actions that could be considered either individual actions or collaboration. In the test phase, Actor 1 was alone and sitting so that she could reach both locations. The question was whether she would place a new block in the location she had previously (individual goal) or in the location that could be considered the goal of collaboration (joint goal). Importantly, in the Social condition, the actors were socially engaged with each other before and during the demonstration, while in the Non-Social condition, they were not. Results revealed that infants in the Social condition spontaneously anticipated Actor 1 placing her block in the joint goal location more often than those in the Non-Social condition. Thus, the social context seems to allow infants to bind actions into a collaborative sequence and anticipate joint rather than individual goals, giving insight into how actions are perceived using top-down processing early in life. [ABSTRACT FROM AUTHOR]

An apparatus was designed to mimic lactation from a human breast. It was used to determine the influence of milk fat content and flow rate, and suction pulse rate of a breastfeeding infant upon the release of a model compound from a nipple shield delivery system ( NSDS). The NSDS would be worn by a mother to deliver drugs and nutrients to her infant during breastfeeding. Sulforhodamine B dye ( SB) was used as model compound and formulated as a dispersible tablet to be placed within the NSDS. Increasing suction pulse rate from 30 to 120 pulses/min clearly correlated with increased cumulative release of SB for the same volume of milk passed through the NSDS. No distinct correlation was found between flow rates (1, 5, and 8 mL/min) and SB release, possibly because of competing factors controlling release rate at different flow rates. A highly similar SB release rate into two fat content fluids (2.9 and 4.2 wt %) was observed for identical flow conditions. This proof of concept study outlines a novel method to mimic lactation from a breast, and future studies will lead to effective methods to identify key physiological factors that influence drug release from a NSDS. © 2013 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 102:3773-3783, 2013 [ABSTRACT FROM AUTHOR]

Abstract: Background: There have been very few studies concerning the Babkin reflex—opening of the mouth and flexion of the arms in response to stimulation of the palms. We attempted to clarify the clinical significance and neural mechanism of the reflex through systematic review. Methods: Searches were conducted on Medline, Embase, and Google Scholar from their inception through August 2012. Results: In normal term infants, the Babkin reflex can be elicited from the time of birth, becomes increasingly suppressed with age, and disappears in the great majority by the end of the fifth month of age. A marked response in the fourth or fifth month of age and persistence of the reflex beyond the fifth month of age are generally regarded as abnormal. On the other hand, because there are some normal infants showing no response during the neonatal period or early infancy, the absence of the response during these periods is not necessarily an abnormal finding. Conclusions: Infants with these abnormal findings should be carefully observed for the appearance of neurological abnormalities including cerebral palsy and mental retardation. It is most likely that the Babkin reflex is mediated by the reticular formation of the brainstem, which receives inputs from the nonprimary motor cortices. On the basis of the hand–mouth reflex, more adaptive movement develops as control of the nonprimary motor cortices over the reflex mechanism in the reticular formation increases. Soon it evolves into the voluntary eye-hand-mouth coordination necessary for food intake as the control of the prefrontal cortex over the nonprimary motor cortices becomes predominant. [Copyright &y& Elsevier]

Objectives: Rates of pregnancy and HIV infection are high among South African adolescents, yet little is known about rates of mother-to-child transmission of HIV (MTCT) in this group. We report a comparison of the characteristics of adolescent mothers and adult mothers, including HIV prevalence and MTCT rates. Methods: We examined patterns of health service utilization during the antenatal and early postnatal period, HIV prevalence and MTCT amongst adolescent (<20-years-old) and adult (20 to 39-years-old) mothers with infants aged ≤16 weeks attending immunization clinics in six districts of KwaZulu-Natal between May 2008 and April 2009. Findings: Interviews were conducted with 19,093 mothers aged between 12 and 39 years whose infants were aged ≤16 weeks. Most mothers had attended antenatal care four or more times during their last pregnancy (80.3%), and reported having an HIV test (98.2%). A greater proportion of HIV-infected adult mothers, compared to adolescent mothers, reported themselves as HIV-positive (41.2% vs. 15.9%, p<0.0001), reported having a CD4 count taken during their pregnancy (81.0% vs. 66.5%, p<0.0001), and having received the CD4 count result (84.4% vs. 75.7%, p<0.0001). Significantly fewer adolescent mothers received the recommended PMTCT regimen. HIV antibody was detected in 40.4% of 7,800 infants aged 4–8 weeks tested for HIV, indicating HIV exposure. This was higher among infants of adult mothers (47.4%) compared to adolescent mothers (17.9%, p<0.0001). The MTCT rate at 4–8 weeks of age was significantly higher amongst infants of adolescent mothers compared to adult mothers (35/325 [10.8%] vs. 185/2,800 [6.1%], OR 1.7, 95% CI 1.2–2.4). Conclusion: Despite high levels of antenatal clinic attendance among pregnant adolescents in KwaZulu-Natal, the MTCT risk is higher among infants of HIV-infected adolescent mothers compared to adult mothers. Access to adolescent-friendly family planning and PMTCT services should be prioritised for this vulnerable group. [ABSTRACT FROM AUTHOR]

The bones of infants and children are soft and so they tend to buckle and bend rather than frankly break. In addition, to accommodate growth, epiphyseal plates exist. These areas represent weak zones in the long bones and shearing/twisting forces cause fractures. All of this results in fractures different than what one sees in adults and this communication deals with how to identify these fractures, how to appreciate the more subtle of these fractures, and how to utilize comparative views for the subtle cases. [ABSTRACT FROM AUTHOR]

Objective: Bowel dysfunction remains a major problem in neonates. Traditional auscultation of bowel sounds as a diagnostic aid in neonatal gastrointestinal complications is limited by skill and inability to document and reassess. Consequently, we built a unique prototype to investigate the feasibility of an electronic monitoring system for continuous assessment of bowel sounds. Method: We attained approval by the Institutional Review Boards for the investigational study to test our system. The system incorporated a prototype stethoscope head with a built-in microphone connected to a digital recorder. Recordings made over extended periods were evaluated for quality. We also considered the acoustic environment of the hospital, where the stethoscope was used. The stethoscope head was attached to the abdomen with a hydrogel patch designed especially for this purpose. We used the system to obtain recordings from eight healthy, full-term babies. A scoring system was used to determine loudness, clarity, and ease of recognition comparing it to the traditional stethoscope. The recording duration was initially two hours and was increased to a maximum of eight hours. Results: Median duration of attachment was three hours (3.75, 2.68). Based on the scoring, the bowel sound recording was perceived to be as loud and clear in sound reproduction as a traditional stethoscope. We determined that room noise and other noises were significant forms of interference in the recordings, which at times prevented analysis. However, no sound quality drift was noted in the recordings and no patient discomfort was noted. Minimal erythema was observed over the fixation site which subsided within one hour. Conclusion: We demonstrated the long-term recording of infant bowel sounds. Our contributions included a prototype stethoscope head, which was affixed using a specially designed hydrogel adhesive patch. Such a recording can be reviewed and reassessed, which is new technology and an improvement over current practice. The use of this system should also, theoretically, reduce risk of infection. Based on our research we concluded that while automatic assessment of bowel sounds is feasible over an extended period, there will be times when analysis is not possible. One limitation is noise interference. Our larger goals include producing a meaningful vital sign to characterize bowel sounds that can be produced in real-time, as well as providing automatic control for patient feeding pumps. [ABSTRACT FROM AUTHOR]

Abstract: Mercury (Hg) is a ubiquitous heavy metal that can negatively affect human health; however, few studies have examined the impact of prenatal low-level Hg exposure on fetal growth. We investigated prenatal exposure levels of Hg and the relationship between Hg levels and neonatal anthropometrics, including birth weight, length, and head circumference. A total of 258 mother–infant pairs were recruited from a rural community located on the southern coastal area of Laizhou Bay of the Bohai Sea in northern China between September 2010 and December 2011. We measured maternal and cord whole blood Hg levels and examined their association with neonatal anthropometrics. The geometric means (GMs) of Hg in maternal and cord whole blood were 0.84μgL−1 and 1.46μgL−1, respectively. The Hg exposure levels in our study population were much lower than those reported in previous domestic studies. No significant associations were found between maternal or cord blood Hg levels and birth weight, length, and head circumference. However, our results should be interpreted with caution given the high toxicity of Hg and its persistence in the body. Studies focusing on long-term adverse outcomes are needed to further examine the cumulative effects of low-level Hg exposure. [Copyright &y& Elsevier]

Infants' sensitivity to ostensive signals, such as direct eye contact and infant-directed speech, is well documented in the literature. We investigated how infants interpret such signals by assessing common processing mechanisms devoted to them and by measuring neural responses to their compounds. In Experiment 1, we found that ostensive signals from different modalities display overlapping electrophysiological activity in 5-month-old infants, suggesting that these signals share neural processing mechanisms independently of their modality. In Experiment 2, we found that the activation to ostensive signals from different modalities is not additive to each other, but rather reflects the presence of ostension in either stimulus stream. These data support the thesis that ostensive signals obligatorily indicate to young infants that communication is directed to them. [ABSTRACT FROM AUTHOR]

Background: Advancements in knowledge of obesity aetiology and mobile phone technology have created the opportunity to develop an electronic tool to predict an infant’s risk of childhood obesity. The study aims were to develop and validate equations for the prediction of childhood obesity and integrate them into a mobile phone application (App). Methods and Findings: Anthropometry and childhood obesity risk data were obtained for 1868 UK-born White or South Asian infants in the Born in Bradford cohort. Logistic regression was used to develop prediction equations (at 6±1.5, 9±1.5 and 12±1.5 months) for risk of childhood obesity (BMI at 2 years >91st centile and weight gain from 0–2 years >1 centile band) incorporating sex, birth weight, and weight gain as predictors. The discrimination accuracy of the equations was assessed by the area under the curve (AUC); internal validity by comparing area under the curve to those obtained in bootstrapped samples; and external validity by applying the equations to an external sample. An App was built to incorporate six final equations (two at each age, one of which included maternal BMI). The equations had good discrimination (AUCs 86–91%), with the addition of maternal BMI marginally improving prediction. The AUCs in the bootstrapped and external validation samples were similar to those obtained in the development sample. The App is user-friendly, requires a minimum amount of information, and provides a risk assessment of low, medium, or high accompanied by advice and website links to government recommendations. Conclusions: Prediction equations for risk of childhood obesity have been developed and incorporated into a novel App, thereby providing proof of concept that childhood obesity prediction research can be integrated with advancements in technology. [ABSTRACT FROM AUTHOR]

Abstract: Prenatal anxiety has been linked with altered immune function in offspring in animal studies, but the relevance for human health is unknown. We examined prenatal maternal anxiety as a predictor of adaptive immunity in infants at 2 and 6months of age as part of a prospective longitudinal study. The humoral immune response to hepatitis B vaccine was assessed at 2months (n =80) and 6months (n =76) of age. Prenatal anxiety predicted lower hepatitis B antibody titers at 6months of age independent of obstetric and socio-demographic covariates; the effects were limited to those infants who had not completed the 3-dose vaccine series (for transformed titer values, r =−.36, p <.05). Cell-mediated immune responses at 2 (n =56) and 6 (n =54) months of age were examined by ELISpot assays for interferon(IFN)-γ, interleukin(IL)-2, and IL-4 responder cell frequencies to three antigens: hepatitis B surface antigen, tetanus toxoid, and phytohaemagglutinin (PHA). Prenatal maternal anxiety was associated with reduced IFN-γ and increased IL-4 responder cell frequencies at 6months of age, independent of obstetric and socio-demographic covariates. No effect of prenatal anxiety was found on adaptive immunity at 2months of age. The findings provide the first demonstration in humans that prenatal anxiety alters adaptive immunity in the infant. [Copyright &y& Elsevier]

Abstract: In infants, the fontanels and sutures as well as conductivity of the skull influence the volume currents accompanying primary currents generated by active neurons and thus the associated electroencephalography (EEG) and magnetoencephalography (MEG) signals. We used a finite element method (FEM) to construct a realistic model of the head of an infant based on MRI images. Using this model, we investigated the effects of the fontanels, sutures and skull conductivity on forward and inverse EEG and MEG source analysis. Simulation results show that MEG is better suited than EEG to study early brain development because it is much less sensitive than EEG to distortions of the volume current caused by the fontanels and sutures and to inaccurate estimates of skull conductivity. Best results will be achieved when MEG and EEG are used in combination. [Copyright &y& Elsevier]

Abstract: Background: Movement by an infant during the first year of life might influence its activity level and thereby influence growth in early childhood. Aim: To examine whether the time that an infant is able to move unrestrictedly and time spent in baby seats are related to weight and waist circumference at age 9months and growth from 9 to 24months. Methods: In the GECKO Drenthe birth cohort, weight and height were measured in Well Baby Clinics at the ages of 9 and 24months. Time spent moving unrestrictedly and time spent in baby seats were reported on a questionnaire at age 9months. Children born <37weeks or with a low birthweight (<2500g) were excluded. Outcomes were defined as the Z-scores for weight-for-height, weight-for-age, and waist circumference-for-age at the ages of 9 and 24months, and changes in Z-scores as between 9 and 24months of age. Results: The time an infant is able to move unrestrictedly at age 9months was inversely related to Z-score waist circumference at 9months, and the change in Z-scores weight-for-height and weight-for-age between the ages 9 and 24months. For time spent in baby seats, ‘never users’ showed a decline in Z-score weight-for-height as compared to those who used baby seats. On the contrary, Z-score waist circumference-for-age declined in children sitting for 1h or more in baby seats. Conclusion: More time spent moving unrestrictedly in infancy may contribute to a healthy growth pattern. [Copyright &y& Elsevier]

Infant faces elicit early, specific activity in the orbitofrontal cortex (OFC), a key cortical region for reward and affective processing. A test of the causal relationship between infant facial configuration and OFC activity is provided by naturally occurring disruptions to the face structure. One such disruption is cleft lip, a small change to one facial feature, shown to disrupt parenting. Using magnetoencephalography, we investigated neural responses to infant faces with cleft lip compared with typical infant and adult faces. We found activity in the right OFC at 140 ms in response to typical infant faces but diminished activity to infant faces with cleft lip or adult faces. Activity in the right fusiform face area was of similar magnitude for typical adult and infant faces but was significantly lower for infant faces with cleft lip. This is the first evidence that a minor change to the infant face can disrupt neural activity potentially implicated in caregiving. [ABSTRACT FROM PUBLISHER]

Therapeutic trials in Duchenne Muscular Dystrophy (DMD) exclude young boys because traditional outcome measures rely on cooperation. The Bayley III Scales of Infant and Toddler Development (Bayley III) have been validated in developing children and those with developmental disorders but have not been studied in DMD. Expanded Hammersmith Functional Motor Scale (HFMSE) and North Star Ambulatory Assessment (NSAA) may also be useful in this young DMD population. Clinical evaluators from the MDA-DMD Clinical Research Network were trained in these assessment tools. Infants and boys with DMD (n =24; 1.9±0.7years) were assessed. The mean Bayley III motor composite score was low (82.8±8; p ⩽.0001) (normal=100±15). Mean gross motor and fine motor function scaled scores were low (both p ⩽.0001). The mean cognitive comprehensive (p =.0002), receptive language (p ⩽.0001), and expressive language (p =.0001) were also low compared to normal children. Age was negatively associated with Bayley III gross motor (r =−0.44; p =.02) but not with fine motor, cognitive, or language scores. HFMSE (n =23) showed a mean score of 31±13. NSAA (n =18 boys; 2.2±0.4years) showed a mean score of 12±5. Outcome assessments of young boys with DMD are feasible and in this multicenter study were best demonstrated using the Bayley III. [ABSTRACT FROM AUTHOR]

Highlights: [•] Infants born VLBW showed dysynchrony in affective and cortisol stress responses. [•] VLBW infants evidenced uncorrelated affective and cortisol responses to SF stressors. [•] Full-term infants showed significant associations between positive affect and cortisol responses across both SF stressors. [•] Affective and cortisol associations were different for VLBW versus full-term infants. [Copyright &y& Elsevier]

Background Although cow's milk allergy (CMA) is one of the most common food allergies, mislabelling nonallergic infants as being allergic to cow's milk is more common. Despite this, characteristics of families and infants with mislabelled CMA are lacking. Methods Using a prospective population-based study, we identified infants with any possible adverse reaction to cow's milk (n=381) from a cohort of 13 019 infants followed from birth. They had a detailed history taken, skin prick tests and an oral food challenge when indicated. Infants with symptoms for which the causative relationship to cow's milk protein was excluded were compared with infants with IgE-mediated CMA and with a control group, and followed for 2-5 years. Results Overall, 243 infants (1.87%) with mislabelled CMA were identified. Compared with 66 infants with IgE-mediated CMA, those with mislabelled CMA presented earlier and with symptoms usually involving a single organ system. Doctor-diagnosed atopic dermatitis (AD) was associated with mislabelled CMA (p<0.001), manifested primarily as skin rashes, compared with control infants. Higher maternal and paternal education were also associated with mislabelled CMA (p=0.007 and p=0.035, respectively) and manifested primarily as non-specific symptoms. Conclusions Mislabelled CMA typically presents within the first 3 months of life involving a single organ. Infant AD and higher parental academic education are associated with mislabelled reactions. Better parental and physician awareness of the importance of objectively diagnosing milk allergy is required to avoid mislabelling of infants as being allergic to cow's milk and to prevent potential nutritional deficiencies. [ABSTRACT FROM AUTHOR]

Children with poor nutrition are at increased risk of pneumonia. In many tropical settings seasonal pneumonia epidemics occur during the rainy season, which is often a period of poor nutrition. We have investigated whether seasonal hunger may be a driver of seasonal pneumonia epidemics in children in the tropical setting of the Philippines. In individual level cohort analysis, infant size and growth were both associated with increased pneumonia admissions, consistent with findings from previous studies. A low weight for age z-score in early infancy was associated with an increased risk of pneumonia admission over the following 12 months (RR for infants in the lowest quartile of weight for age z-scores 1.28 [95% CI 1.08 to 1.51]). Poor growth in smaller than average infants was also associated with an increased risk of pneumonia (RR for those in the lowest quartile of growth in early infancy 1.31 [95%CI 1.02 to 1.68]). At a population level, we found that seasonal undernutrition preceded the seasonal increase in pneumonia and respiratory syncytial virus admissions by approximately 10 weeks (pairwise correlation at this lag was −0.41 [95%CI −0.53 to −0.27] for pneumonia admissions, and −0.63 [95%CI −0.72 to −0.51] for respiratory syncytial virus admissions). This lag appears biologically plausible. These results suggest that in addition to being an individual level risk factor for pneumonia, poor nutrition may act as a population level driver of seasonal pneumonia epidemics in the tropics. Further investigation of the seasonal level association, in particular the estimation of the expected lag between seasonal undernutrition and increased pneumonia incidence, is recommended. [ABSTRACT FROM AUTHOR]

Background: The FTO gene, located on chromosome 16q12.2, and the MAF gene, located on chromosome 16q22-23, were identified as genes harboring common variants with an impact on obesity predisposition. We studied the association of common variants with birth weight, gain of body weight, body mass index (BMI), Ponderal index and relevant neonatal outcomes in a large German cohort of infants with a birth weight below 1500 grams. Methods: The single nucleotide polymorphisms rs9939609 (FTO gene) and rs1424233 (MAF gene) were genotyped using allelic discrimination assays in a prospective multicenter cohort study conducted in 15 neonatal intensive care units in Germany from September 2003 until January 2008. DNA samples were extracted from buccal swabs according to standard protocols. Results: 1946 infants were successfully genotyped at FTO and 2149 infants at MAF. Allele frequencies were not significantly different from other European cohorts. The polymorphisms were in Hardy-Weinberg equilibrium. The polymorphisms did not show associations with birth weight, BMI and Ponderal Index at discharge, and weight gain, neither testing for a dominant, additive nor for a recessive model. Discussion: Since an association of the polymorphisms with weight gain has been demonstrated in multiple populations, the lack of association in a population of preterm infants with regular tube feeding after birth and highly controlled feeding volumes provides evidence for the hypothesis that these polymorphisms affect food intake behavior and hunger rather than metabolism and energy consumption. [ABSTRACT FROM AUTHOR]

Abstract: As humans, we are attuned to the moods and emotions of others. This understanding of emotions enables us to interpret other people’s actions on the basis of their emotional displays. However, the development of this capacity is not well understood. Here we show a developmental pattern in 10- and 14-month-old infants’ sensitivity to others’ emotions and actions. Infants were shown video clips in which happy or angry actors performed a positive action (patting a toy tiger) or a negative action (thumping the toy tiger). Only 14-month-olds, but not 10-month-olds, showed selectively greater sympathetic activity (i.e., pupil dilation) both when an angry actor performed the positive action and when a happy actor performed the negative action, in contrast to the actors performing the actions congruent with their displayed emotions. These results suggest that at the beginning of the second year of life, infants become sensitive to the congruence of other people’s emotions and actions, indicating an emerging abstract concept of emotions during infancy. The results are discussed in light of previous research on emotion understanding during infancy. [Copyright &y& Elsevier]

Abstract: Infant responses to adult-defined unattractive male body shapes versus attractive male body shapes were assessed using visual preference and habituation procedures. Looking behavior indicated that 9-month-olds have a preference for unattractive male body shapes over attractive ones; however, this preference is demonstrated only when head information is obscured. In contrast, 6- and 3.5-month-olds did not show a preference for unattractive or attractive bodies. The 6-month-olds discriminated between the two categories, whereas the 3.5-month-olds did not. Because unattractive body shapes are more common than attractive/athletic body shapes in our everyday environment, a preference for unattractive body shapes at 9months of age suggests that preferences for particular human body shapes reflect level of exposure and familiarity rather than culturally defined stereotypes of body attractiveness. [Copyright &y& Elsevier]

This essay illustrates how members of the Association of Collegiate Alumnae ( ACA), and most prominently among them Milicent Shinn, a University of California, Berkeley graduate, created an unprecedented network of at-home scientific observation of infants that spanned the North American continent. Shinn and her female peers were inspired by contemporary scholarly enthusiasm for the physiological and mental development of infants and toddlers. During the last decades of the 19th century men of science discovered in their own and others' offspring, to borrow Charles Darwin's phrase, 'objects of natural history.' This analysis of unpublished archival materials reveals how the ACA's collective at-home observation of babies transformed the nursery into a laboratory and mothers into scientific observers. The practices developed by Shinn and her network of college-educated mothers blurred distinctions between university and home, expert and amateur. The most visible outcome of the network's enterprise was Shinn's 1907 authoritative study, The Development of the Senses in the First Three Years of Childhood. [ABSTRACT FROM AUTHOR]