Medical Correlates of Infant Development

Littman, Bruce H.; Parmelee, Arthur H.

doi:10.1542/peds.61.3.470

Cited by 293 publications

(94 citation statements)

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“…Obstetric and postnatal complications were recorded based on the Littman and Parmelee [1978] scales of the same name. After delivery, obstetric complications and perinatal factors were quantified using the OCS and PNF scales.…”

Section: Methodsmentioning

confidence: 99%

Pregnancy anxiety and comorbid depression and anger: Effects on the fetus and neonate

et al. 2003

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One hundred sixty-six women were classified as experiencing high or low anxiety during the second trimester of pregnancy. The high anxiety women also had high scores on depression and anger scales. In a follow-up across pregnancy, the fetuses of the high anxiety women were noted to be more active and to experience growth delays. The high anxiety mothers' high prenatal norepinephrine and low dopamine levels were followed by their neonates having low dopamine and serotonin levels. The high anxiety mothers' newborns also had greater relative right frontal EEG activation and lower vagal tone. Finally, the newborns of high anxiety mothers spent more time in deep sleep and less time in quiet and active alert states and showed more state changes and less optimal performance on the Brazelton Neonatal Behavior Assessment Scale (motor maturity, autonomic stability and withdrawal). These data highlight the need for prenatal intervention for elevated anxiety symptoms during pregnancy.

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Section: Methodsmentioning

confidence: 99%

Pregnancy anxiety and comorbid depression and anger: Effects on the fetus and neonate

et al. 2003

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“…Risk status was assessed by the following measures: birth weight; 1-and 5-min Apgar; a combined measure of respiratory support, which ranks subjects on a 6-point scale based on the length of time requiring oxygen, and/or ventilator support'; the Hobel Neonatal Risk Scale (26); and PCS (30). Fifty-eight % of the subjects were female and 77% were nonwhite.…”

Section: Methodsmentioning

confidence: 99%

Vagal Responsiveness to Gavage Feeding as an Index of Preterm Status

DiPietro

Porges

1991

Pediatr Res

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ABSTRACT. Vagal responsivity to orogastric stimulation is necessary for gastrointestinal function and may reflect autonomic regulation. Our study evaluated vagal responsivity during gavage feeding as an index of preterm clinical status. Vagal and behavioral responsivity of 26 preterm infants during gavage feeding was measured. Vagal tone was quantified with a noninvasive measure (vagal tone index) developed by Porges (Porges SW: U.S. patent 4 510 944,1985), which extracts a valid measure of cardiac vagal tone from the ECG. The study investigated whether vagal tone changed during gavage feeding and whether individual differences in the vagal tone response pattern were related to clinical outcome. Infants who demonstrated an increase in vagal tone during feeding and a decrease after feeding had significantly shorter hospitalizations. This effect was independent of weight gain trajectories. Baseline levels of vagal tone were positively associated with subsequent weight gain. Traditional risk measures did not predict length of hospitalization independently of gestational age. This study represents the first documentation that small changes in cardiac vagal tone during gavage feeding, previously imperceptible to clinicians and researchers, may be quantitatively extracted from the ECG and provide an important index of clinical status. The concept of perinatal risk as a continuous dimension has developed over the last three decades (1-3). A number of perinatal events including preterm birthllow birth weight (4, 5), respiratory distress (6), and persistent mechanical ventilation (7) have been associated with neonatal morbidity and altered development. However, identification of risk characteristics that significantly predict morbidity in preterm infants is often confounded by large variation in outcome within risk groups (8-1 1).Traditional risk scales attempt to gauge physiologic compromise, but must do so indirectly through observable events (e.g. prematurity, ventilatory assistance, etc.). These risk indicators do not directly assess the compromise of physiologic function. Rather these risk scales focus on detailing the occurrence of specific events and assume that the functional impact of each event is relatively invariant across individuals. The current study proposes that risk status can be more directly assessed by measReceived July 16, 1990; accepted October 19, 1990. Reprint requests: Janet DiPietro, Johns Hopkins University, Department of Maternal &Child Health, 624 N. Broadway, Baltimore. MD 21205.Supported by Grant no. HD22628 from NICHHD (S.W.P.).urement of physiologic function in response to a standard clinical intervention, gavage feeding. In the healthy, mature individual, gastric filling stimulates vagal afferents in the stomach that reflexively stimulate the vagal efferents necessary for enhanced gastrointestinal motility (12) and polypeptide release (13). Thus, in the preterm neonate, gastric filling via gavage feeding should have direct consequences on the vagus. Individual differences in the vagal r...

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“…Inclusion criteria included: 1) age greater than 20 hours; 2) uncomplicated vaginal or caesarean birth; 3) weight between 3000 and 4000 grams at birth; 4) a 5-minute Apgar score of greater than or equal to 8; 5) a full-term infant defined as a greater than or equal to 37-weeks-postconception age by the Ballard assessment; 27 6) a normal range score on the Littman-Parmelee Obstetric Complication Scale 28 ; and 7) a normal physical exam by a pediatrician. Informed consent was obtained from the parents of all infants and the study was approved by the Institutional Review Boards of GHI, Fairview Riverside Medical Center, and the University of Minnesota.…”

Section: Methodsmentioning

confidence: 99%

Beyond Dorsal Penile Nerve Block: A More Humane Circumcision

et al. 1997

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ABSTRACT. Objective. To explore techniques that can be utilized in addition to the dorsal penile nerve block (DPNB) to further reduce the neonate's stress and pain from routine circumcision, and thus make the procedure more humane.Setting. Level 1 nursery at a community hospital. Subjects. Eighty healthy, term, newborn male infants scheduled for routine neonatal circumcision.Study Design. Prospective and randomized; double blind and placebo controlled for the study solutions.Methods. Four statistically similar groups of 20 were studied. The control group included infants circumcised using: a) a rigid plastic restraint board; b) standard DPNB; and c) a pacifier dipped in water to comfort the infant. Each study group differed from the controls in one variable including: 1) using a specially designed, physiologic circumcision restraint chair; 2) pH buffering of lidocaine hydrochloride used for DPNB; and 3) offering a pacifier dipped in a 24% sucrose solution during the DPNB and circumcision. Behavioral observations were recorded and compared for each group starting before the injection of lidocaine hydrochloride and continuing through the completion of the circumcision. Plasma for cortisol levels were collected 30 minutes after the circumcision.Results. Neonates circumcised on the new restraint chair showed a significant decrease in distress scores (>50%) compared with the control group on the rigid molded-plastic restraint. The pacifier dipped in sucrose had a distress-reducing effect during both the post-DPNB injection and circumcision periods. The infants who were injected with the buffered lidocaine showed no differences in distress from the controls. The plasma cortisol levels were not significantly affected by any additional technique and were comparable to the levels previously reported.Conclusions. When neonatal circumcisions are performed routinely, they should be done as humanely as possible. This study demonstrates that, when used in conjunction with DPNB, a pacifier dipped in 24% sucrose and a more comfortable, padded, and physiologic restraint can be useful in decreasing distress and pain. Pediatrics 1997;100(2). URL: http://www.pediatrics.org/ cgi/content/full/100/2/e3; dorsal penile nerve block, circumcision, neonatal pain.ABBREVIATIONS. DPNB, dorsal penile nerve block; EMLA, eutectic mixture of local anesthetics; GHI, Group Health, Inc.; ANOVA, analysis of variance. R outine neonatal circumcision, when performed without anesthesia, is a painful and stressful operation.

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Medical Correlates of Infant Development

Cited by 293 publications

References 0 publications

Pregnancy anxiety and comorbid depression and anger: Effects on the fetus and neonate

Pregnancy anxiety and comorbid depression and anger: Effects on the fetus and neonate

Vagal Responsiveness to Gavage Feeding as an Index of Preterm Status

Beyond Dorsal Penile Nerve Block: A More Humane Circumcision

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