[Intimate partner violence: suffering for the child, a challenge for parenthood]. / Violence dans le couple : une souffrance pour l'enfant, un défi pour la parentalité.

Intrafamily violence has a significant impact on the child's neurobiological, psychological and social development. While psychosomatic and psychotraumatic suffering is frequent, parenthood is also impacted, caught up in this context of violence. The support provided to the children and the couple must respond to specific practices.

Prenatal immune activation in mice blocks the effects of environmental enrichment on exploratory behavior and microglia density.

Adverse environmental factors including prenatal maternal infection are capable of inducing long-lasting behavioral and neural alterations which can enhance the risk to develop schizophrenia. It is so far not clear whether supportive postnatal environments are able to modify such prenatally-induced alterations. In rodent models, environmental enrichment influences behavior and cognition, for instance by affecting endocrinologic, immunologic, and neuroplastic parameters. The current study was designed to elucidate the influence of postnatal environmental enrichment on schizophrenia-like behavioral alterations induced by prenatal polyI:C immune stimulation at gestational day 9 in mice. Adult offspring were tested for amphetamine-induced locomotion, social interaction, and problem-solving behavior as well as expression of dopamine D1 and D2 receptors and associated molecules, microglia density and adult neurogenesis. Prenatal polyI:C treatment resulted in increased dopamine sensitivity and dopamine D2 receptor expression in adult offspring which was not reversed by environmental enrichment. Prenatal immune activation prevented the effects of environmental enrichment which increased exploratory behavior and microglia density in NaCl treated mice. Problem-solving behavior as well as the number of immature neurons was affected by neither prenatal immune stimulation nor postnatal environmental enrichment. The behavioral and neural alterations that persist into adulthood could not generally be modified by environmental enrichment. This might be due to early neurodevelopmental disturbances which could not be rescued or compensated for at a later developmental stage.

Central nervous system deficits in fetal alcohol spectrum disorder.

"Fetal alcohol spectrum disorders" is a nondiagnostic umbrella term encompassing the wide variations in clinical presentation among individuals that are prenatally exposed to alcohol. This article discusses brain development and central nervous system abnormalities and reviews prevention and interventions for these neurologic manifestations.

Can low-level ethanol exposure during pregnancy influence maternal care? An investigation using two strains of rat across two generations.

Gestational alcohol use is well documented as detrimental to both maternal and fetal health, producing an increase in offspring's tendency for alcoholism, as well as in behavioral and neuropsychological disorders. In both rodents and in humans, parental care can influence the development of offspring physiology and behavior. Animal studies that have investigated gestational alcohol use on parental care and/or their interaction mostly employ heavy alcohol use and single strains. This study aimed at investigating the effects of low gestational ethanol dose on parental behavior and its transgenerational transmission, with comparison between two rat strains. Pregnant Sprague Dawley (SD) and Long Evans (LE) progenitor dams (F0) received 1g/kg ethanol or water through gestational days 17-20 via gavage, or remained untreated in their home cages. At maturity, F1 female offspring were mated with males of the same strain and treatment and were left undisturbed through gestation. Maternal behavior was scored in both generations during the first six postnatal days. Arch-back nursing (ABN) was categorized as: 1, when the dam demonstrated minimal kyphosis; 2, when the dam demonstrated moderate kyphosis; and 3, when the dam displayed maximal kyphosis. Overall, SD showed greater amounts of ABN than LE dams and spent more time in contact with their pups. In the F0 generation, water and ethanol gavage increased ABN1 and contact with pups in SD, behaviors which decreased in treated LE. For ABN2, ethanol-treated SD dams showed more ABN2 than water-treated dams, with no effect of treatment on LE animals. In the F1 generation, prenatal exposure affected retrieval. Transgenerational transmission of LG was observed only in the untreated LE group. Strain-specific differences in maternal behavior were also observed. This study provides evidence that gestational gavage can influence maternal behavior in a strain-specific manner. Our results also suggest that the experimental procedure during gestation and genetic variations between strains may play an important role in the behavioral effects of prenatal manipulations.

Neonatal eosinophilic gastroenteritis: possible in utero sensitization to cow's milk protein.

Rectal bleeding in neonates is an alarming sign that suggests a possible serious underlying condition, such as infection or bleeding disorder that would necessitate hospitalization and prompt intervention. We report a case of eosinophilic gastroenteritis caused by cow's milk protein allergy in a one-day- old infant, who presented with frankly bloody stools associated with massive gastrointestinal and peripheral blood eosinophilia prior to initiation of enteral feedings. The patient's outcome was favorable, with complete spontaneous recovery in one week, after a period of bowel rest, parenteral nutrition, and use of amino acid formula. The eosinophilia was also transient and gradually resolving by two months of age. Rectal bleeding secondary to allergic colitis caused by cow's milk sensitization may occur in neonates, and failure to appreciate this possibility may lead to inappropriate diagnostic or therapeutic intervention.

Antidepressant medication and pregnancy: time for randomized controlled trials.

Despite the high prevalence of depression and the fairly common use of anti-depressant drugs during pregnancy, no randomized controlled treatment trials (RCTs) prospectively assess the efficacy and safety of antidepressant drugs in depressed pregnant women and then the subsequent effect of drug exposure (versus placebo exposure) on the neonate and later on the child's development. Observational studies are used to determine whether a drug exposure during pregnancy is associated with an adverse outcome, but they include various confounding factors and other sources of bias. Systematic reviews and meta-analyses, as well as published guidelines from various organizations, all analyze, interpret, and emphasize the same data somewhat differently, and they do not provide consistent or unequivocal guidance for patients or prescribers. Whether antidepressant drugs are efficacious in pregnant women; whether any or certain antidepressant drugs are harmful to the fetus, neonate, or developing child; and whether untreated depression itself is harmful are uncertainties that should now be addressed in rigorous, well-designed, prospective RCTs.

Refining Neurobehavioral Assessment of the High-Risk Infant Using the NICU Network Neurobehavioral Scale.

Nurses caring for high-risk infants use advanced assessment skills to identify the nature of infant instability and to assure timely intervention. The NICU Network Neurobehavioral Scale (NNNS) is a comprehensive assessment of neurological integrity and behavioral function of infants at risk. Research evidence supports its validity and reliability for clinical and research use. The NNNS offers nurses a neurobehavioral assessment especially suited to high-risk and premature infants.

Developmental considerations in working with newborn infants of mothers with diabetes.

Infants of diabetic mothers (IDMs) are at risk for an altered developmental course beginning with physiologic alterations in utero. This article describes physiologic and behavioral factors that impact the fetus and newborn infant and may have long-term developmental consequences. A clinical reasoning process to support development optimizes the outcomes of IDMs while in the NICU. Specific interventions are suggested.

Childhood adversities and adult health.

Child abuse and neglect have lifelong ramifications for adult mental health and health in general. In this brief overview, a range of childhood adversities (including prenatal substance exposure and prenatal malnutrition) is reviewed, and the evidence for their later negative implications is considered. The role of a chronically stressed hypothalamic-pituitary-adrenal axis likely has significant influence in this process. Strategies for nurses include developing awareness of the presence of early adversity in the lives of many Americans, as well as helping parents improve their functional status by treating mental illness and addictive disorders.

Follow-up of infants prenatally exposed to cocaine.

Maternal cocaine use during pregnancy continues to be of great concern for health care professionals. Research in this area has increased as investigators examine the effects of prenatal cocaine exposure in the infant/young child. This paper will critically review the literature, identify the primary care needs of infants and young children with a known history of prenatal cocaine exposure, and present guidelines for the primary care practitioner to monitor the infant's physiologic and developmental sequelae during the first 3 years of life. Findings in the literature demonstrate inconsistencies in regard to the physiologic and developmental outcomes of infants/young children prenatally exposed to cocaine. Further research is warranted, as it is evident from studies that not all investigators are controlling for confounding variables such as poly-drug use, which is necessary in isolating cocaine's effects. Subtle effects, however, have been reported from well-controlled studies and, thus, particular attention needs to be paid to early identification and interventions by primary care practitioners to prevent negative health outcomes. The guidelines proposed assist the practitioner with a thorough and focused approach to assessing the physiologic and developmental effects that are currently known to occur in the infant/young child prenatally exposed to cocaine.