Variation in Car Seat Tolerance Screen Performance in Newborn Nurseries.

BACKGROUND: Currently, car seat tolerance screens (CSTSs) are recommended for all infants born prematurely in the United States. Although many late-preterm infants are cared for exclusively in newborn nurseries (NBNs), data on implementation of CSTS in nurseries are limited. Our objective for this study was to determine management strategies and potential variation in practice of CSTS in NBNs across the nation. METHODS: We surveyed NBNs across 35 states using the Better Outcomes through Research for Newborns (BORN) network to determine what percentage perform CSTSs, inclusion and failure criteria, performance characteristics, follow-up of failed CSTSs including use of car beds, and provider attitudes toward CSTS. RESULTS: Of the 84 NBNs surveyed, 90.5% performed predischarge CSTSs. The most common failure criteria were saturation <90%, bradycardia <80 beats per minute, and apnea >20 seconds. More than 55% noted hypotonia as an additional inclusion criterion for testing, and >34% tested any infant who had ever required supplemental oxygen. After an initial failed CSTS, >93% of NBNs retested in a car seat at a future time point, whereas only ∼1% automatically discharged infants in a car bed. When asked which infants should undergo predischarge CSTS, the most common recommendations by survey respondents included infants with hypotonia (83%), airway malformations (78%), hemodynamically significant congenital heart disease (63%), and prematurity (61%). CONCLUSIONS: There is a large degree of variability in implementation of CSTS in NBNs across the United States. Further guidance on screening practices and failure criteria is needed to inform future practice and policy.

Evaluation by ultrasound of the hips of babies carried in baby carriers. / Exploración ecográfica de las caderas del bebé en mochilas de porteo.

BACKGROUND AND OBJECTIVE: Hip dysplasia has been associated with risk factors such as breech presentation, female gender or family history. However, external factors, such as the use of baby carriers, seem to influence the development of the hip in the first months of life. The aim of this study is to evaluate the position of the hips of babies placed in different types of baby carriers by ultrasound image. METHOD: An ultrasound study of the hips of healthy babies between 1.5 and 3.5 months of age was carried out, when the children were carried in three different baby backpacks, which provide different degrees of support for the babies' thighs. All hips were typeI according to the Graf classification. Graf's alpha angle, acetabular coverage and distance to the pubis were assessed at baseline (examination table) and when the children were carried in the three different backpacks. RESULTS: In all cases, the babies showed normal values in the three studied parameters, without statistically significant differences between any of the situations. There were also no differences in the ultrasound parameters related to the sex, age or weight of the baby. CONCLUSIONS: The right hip of the babies shows normal ultrasound parameters when placed in any of the baby carriers studied.

Evaluation of a Crib Distribution and Safe Sleep Educational Program to Reduce Risk of Sleep-Related Infant Death.

To increase access to safe infant sleep surfaces and reduce risk of sleep-related infant deaths, the Georgia Department of Public Health implemented a portable crib distribution and safe sleep educational program. The aim of this evaluation was to compare parental knowledge and practices related to infant sleep before and after receipt of the safe sleep educational program and crib. A prospective, matched pre- and post-test cohort design with a follow-up survey was utilized to evaluate changes in knowledge and practices. Female participants were recruited through the county health department and met the following criteria: (1) between 32 and 40 weeks pregnant or within 3 months postpartum, and (2) demonstrated financial need. Participants completed a survey prior to the start of a group educational program and upon program completion. For those who agreed, a follow-up phone survey was conducted approximately 10 weeks after program completion or after the infant's birth. McNemar's Chi square tests were conducted to detect significant differences between specific items on pre-test, post-test, and follow-up surveys, and paired sample t tests were conducted to compare differences in knowledge and practice scores. A total of 132 participants completed matched pre- and post-test surveys and 76 completed follow-up surveys. Knowledge of recommendations regarding position, surface, environment, smoking, breastfeeding, and pacifier use increased significantly between pre- and post-test, with most participants maintaining knowledge at follow-up. The proportion of recommended practices also increased significantly. A group-based safe sleep educational program can be effective in reducing risky infant sleep practices.

Screening of endocrine activity of compounds migrating from plastic baby bottles using a multi-receptor panel of in vitro bioassays.

Endocrine activity of 65 compounds migrating from polycarbonate replacement plastic baby bottles was assessed using in vitro cell based assays (reporter gene assays) involving 7 nuclear receptors, i.e. human steroid hormones receptors (oestrogen, androgen, progesterone and glucocorticoid receptors), human thyroid beta and peroxisome proliferator-activated gamma receptors, and the mouse aryl hydrocarbon receptor. The chemicals were tested at 4 concentrations ranging from 0.001mM to 1mM. Only twelve chemicals did not show any activity towards any of the nuclear receptors, while fifty three compounds showed a possible endocrine activity. Most of the agonistic activities were observed towards the oestrogen receptor while the PPARγ was the target for most of the recorded antagonistic activities. Agonistic activities were recorded for several phthalates, benzophenones, aromatic hydrocarbons and phenols, while compounds such as benzaldehydes, ketones and esters of fatty acid showed antagonistic activities. Thirty five chemicals were able of agonistic activities on 1 to 4 receptors and antagonistic activities were recorded for 35 compounds as well, towards 1 to 7 receptors. Sixteen compounds were able of both agonistic and antagonistic activities, but not on the same receptors, except in 2 cases for the oestrogen receptor and 4 cases for the PPARγ.

Análise eletromiográfica de músculos da coluna vertebral durante a marcha em diferentes formas de carregar o bebê / Electromyographic analysis of the spinal muscles during the gait in different ways to carry a baby

Introdução: A forma de carregar o bebê pode causar desequilíbrios em músculos relacionados à coluna vertebral. Objetivos: Investigar a atividade elétrica dos músculos trapézio fibras descendentes e eretores lombares durante a marcha na simulação de carregar um bebê. Métodos: 20 voluntárias, destras e saudáveis participaram das coletas durante a marcha em esteira na simulação do ato de carregar o bebê em diferentes formas: 1) posição horizontal; 2) posição vertical; 3) suporte tipo "canguru" e 4) suporte tipo "sling". Os resultados eletromiográficos foram analisados pela análise da intensidade do sinal eletromiográfico dos músculos trapézio fibras descendentes e eretores espinhais lombares bilateralmente. Resultados: A ANOVA de dois fatores indicou que a forma de carregar (F(4,59)=17,1 p<0,001) e lado (F(1, 59)=89,6 p<0,001) afetaram a intensidade da atividade do músculo eretor espinhal e também a forma de carregar (F(4, 59)=6,4 p<0,001) e lado (F(1, 59)=59,9 p<0,001) do músculo trapézio fibras descendentes. Conclusões: O suporte canguru gerou menor ativação em músculos espinhais durante a quando comparado a outras situações.

Introduction: The way to carry the baby may cause imbalances in muscles related to the spine. Objectives: To investigate the electrical activity of the muscles trapezius descending fibers and lumbar erector during the simulation of carrying a baby. Methods: 20 volunteers right-handed and healthy participate of the study during walking on a treadmill to simulate the act of carrying the baby in different ways: 1) horizontal position; 2) vertical position; 3) Support Type "kangaroo" and 4) Support Type "sling". The EMG results were analyzed by analysis of the intensity of the electromyographic signal of the muscles trapezius fibers descendants and spinal lumbar erector bilaterally. Results: A two-way ANOVA indicated that the way of loading (F(4, 59)=17.1 p <0,001) and next (F(1, 59)=89.6 p <0.001) affected the intensity of the activity spinal erector muscles and also the way of loading (F(4, 59)=6.4 p <0.001) and next (F(1, 59)=59.9 p <0.001) of the trapezius muscle fibers descendants. Conclusions: Kangaroo support generated less activation in spinal muscles during when compared to other situations.

Rede de descanso e ninho: comparação entre efeitos fisiológicos e comportamentais em prematuros / Hamaca y nido: comparación entre los efectos fisiológicos y de comportamiento en prematuros / Hammock position and nesting: comparison of physiological and behavioral effects in preterm infants

RESUMO Objetivo comparar os efeitos da aplicação de redes de descanso em prematuros, após a troca de fraldas, em comparação com o ninho. Métodos pesquisa quase experimental, crossover, com 30 prematuros internados em uma unidade de cuidados intermediários de um hospital público de Brasília, DF, no período de novembro de 2011 a março de 2012. Foram avaliados os efeitos das duas intervenções (ninho e rede) após a troca de fraldas. Para análise dos dados utilizou-se o teste t de Student com nível de confiança de 95% (p < 0,05). Resultados os prematuros, quando em rede, se mostraram menos estressados (p=0,002), tiveram menos características definidoras para o diagnóstico de enfermagem “Comportamento Desorganizado do Bebê” (p=0,05) e permaneceram em postura terapêutica em relação ao ninho (p=0,04). Conclusão quando comparado ao ninho, os prematuros posicionados em redes estiveram menos estressados, mais organizados e em melhor postura terapêutica.

RESUMEN Objetivo Para comparar los efectos de la aplicación de las hamacas en los bebés prematuros después de cambiarles pañales, en comparación con el nido. Métodos investigación casi experimental, cruzada con 30 recién nacidos prematuros en una unidad de cuidados intermedios en un hospital público en Brasilia-DF, a partir de noviembre de 2011 a marzo de 2012. Los efectos de las dos intervenciones (nido y la hamaca) después de cambiar pañales. Para el análisis de datos se utilizó la prueba t de Student con un nivel de confianza del 95% (p <0,05). Resultados prematuros cuando posicionados en hamaca, estaban menos estresados (p = 0,002), tenían menos características definitorias para el diagnóstico de enfermería “Comportamiento Desorganizado del Bebé” (p = 0,05) y se mantuvo en la postura terapéutica en relación con el nido (p = 0,04). Conclusión en comparación con el nido, los prematuros posicionados en hamaca estaban menos estresados, más organizados y con mejor posicionamiento terapéutico.

ABSTRACT Objective To compare the effects of the use of hammocks versus nesting in preterm infants, after diaper changing. Methods quasi-experimental study, a cross-over trial with 30 preterm newborns in an intermediate care nursery (ICN) in a public hospital in Brasilia-DF, conducted from November 2011 to March 2012. The effects of the two interventions (nesting and hammock) after diaper changing were assessed. Student’s t test with a confidence level of 95% (p <0.05) was used in data analysis. Results In hammock position the preterm infants were found to be less stressed (p = 0.002), had fewer defining characteristics indicating nursing diagnosis “Disorganized Infant Behavior” (p = 0.05) and remained in a more suitable position for receiving intensive care compared to nesting (p = 0.04). Conclusion Preterm infants in hammock position, compared to nesting, were less stressed, with a more organized behavior and in a better position for receiving intensive care.

Brief report: sound output of infant humidifiers.

The sound pressure levels (SPLs) of common infant humidifiers were determined to identify the likely sound exposure to infants and young children. This primary investigative research study was completed at a tertiary-level academic medical center otolaryngology and audiology laboratory. Five commercially available humidifiers were obtained from brick-and-mortar infant supply stores. Sound levels were measured at 20-, 100-, and 150-cm distances at all available humidifier settings. Two of 5 (40%) humidifiers tested had SPL readings greater than the recommended hospital infant nursery levels (50 dB) at distances up to 100 cm. In this preliminary study, it was demonstrated that humidifiers marketed for infant nurseries may produce appreciably high decibel levels. Further characterization of the effect of humidifier design on SPLs and further elucidation of ambient sound levels associated with hearing risk are necessary before definitive conclusions and recommendations can be made.

Actitud de los pediatras sobre el uso de andadores para los bebés / Pediatricians' attitude about the use of infant walkers

Los andadores se utilizan frecuentemente a pesar de que su uso puede ocasionar lesiones. Se realizó una encuesta para obtener información sobre las actitudes y el abordaje de los pediatras respecto del uso de andadores. Se invitó a 247 pediatras que asistieron al 44° Congreso Turco de Pediatría y Europediatría (2008) a responder un cuestionario preparado por los autores. Se incluyeron en el análisis 226 cuestionarios respondidos en forma completa. La mediana de edad de los participantes (119 mujeres) fue de 39 años (29 a 58). De ellos, 4% recomendaban el uso de andadores, 32,3% dejaban la decisión a criterio de los padres y 63,7% no lo recomendaban. Ciento cinco habían tratado con anterioridad a un bebé que sufrió una lesión relacionada con el uso del andador; de ellos, 73,3% no recomendaron su uso y 57,1% opinaron que la producción y el uso de andadores deberían prohibirse. Conclusiones. El 4% de los pediatras encuestados recomiendan el uso de andadores para bebés y más del 30% dejan la decisión a los padres. Los pediatras que atendieron a un bebé que sufrió una lesión por el uso del andador fueron menos proclives a recomendarlo.

Infant walkers are still very popular even though their use might cause injuries. A survey was carried out to obtain information about attitudes and pediatricians' approach regarding the use of infant walkers. Two hundred and forty seven pediatricians who attended the 44th Turkish Congress of Pediatrics and Europediatrics (2008) were invited to reply to a questionnaire prepared by the authors. Two hundred and twenty six questionnaires replied in full were included. The median age of participants (119 women) was 39 years old (range: 29-58 years old). Out of the total, 4% recommended the use of a walker; 32.2% left the decision to parents' judgment, and 63.7% did not recommend its use. A hundred and five had previously treated an infant who had an injury associated to the use of the walker; out of them, 73.3% did not recommend its use and 57.1% stated that there should be a ban on the sale and manufacture of walkers. Conclusions. Out of the total number of surveyed pediatricians, 4% recommend the use of infant walkers and over 30% leave this decision to parents. Those pediatricians who took care of babies who had an injury associated to the use of a walker were less prone to recommending it.

Inappropriate use of infant seating devices increases risks of injury.

PURPOSE: The purpose of our study was to investigate the epidemiology and resulting injuries following falls sustained by infants seated in a variety of seating devices. METHODS: A retrospective chart review of a cohort of infants less than 12 months old who presented to our institution from 1991 to 2010 after a fall from various seating devices was performed. RESULTS: Two hundred five infants were identified, including 146 patients who were admitted to our institution (1991-2010) and 59 patients who were seen and discharged from the ED (2008-2010). Mean age of admitted infants was younger (3.5 vs. 5.3 months). Two patients (1%) required surgery for a depressed skull fracture. Overall, 18% had an intra-cranial hemorrhage. More patients requiring an admission secondary to their injuries fell from a table or counter (42% vs. 27%). CONCLUSION: Falls sustained by children seated in a variety of devices are frequent. Failure to restrain children in seating devices or improperly placing them on a table/counter is associated with more significant injuries. In order to minimize such injuries, it is important to educate caregivers of the risk in utilizing such seating devices.

An evaluation of portable sleeping spaces for babies following the Christchurch earthquake of February 2011.

AIM: To describe how recipients of portable sleeping spaces (PSSs) for babies received and used these devices, offered as emergency baby beds in earthquake-ravaged Christchurch, New Zealand, 2011. METHOD: The PSS package responded to increased risk to babies from disrupted living and sleeping conditions in families. 'Door-to-door' distribution offered easy access to those in need. A subgroup of recipients gave feedback via a survey. RESULTS: From 642 families who received PSSs between March and August, 139 were invited to complete a survey on usage and 100 (72%) responded. Risks identified were 'earthquake related' (82%), bed-sharing (41%), smoking in pregnancy (26%) and prematurity or low birthweight (11%). PSSs were used for same-bed co-sleeping by 87%. They were used even though most families (96%) also had a cot or bassinet. Features most appreciated were 'having baby close' (90%), 'peace of mind' (88%) and portability (74%). CONCLUSION: PSSs were acceptable to parents and used as instructed. Enabling physical protection of babies when same-bed co-sleeping, they gave peace of mind to parents. PSSs could be considered in ordinary times for protecting babies from sudden infant death.

Nidos de contención para recién nacidos y riesgo de muerte súbita del lactante / Newborn sleep positioners and sudden infant death syndrome risk

La incidencia de muerte súbita del lactante disminuyó con las primeras campañas de prevención, desde 1992. En la actualidad, aumentaron las muertes infantiles por sofocación, asfixia o atrapamiento, algunas relacionadas con el uso de nidos, posicionadores o almohadillas laterales para la cuna. Los medios de comunicación y los fabricantes debieran respetar las recomendaciones sobre sueño seguro, pero la fabricación, publicidad y venta de objetos que pueden afectar la seguridad de los niños carece de fiscalización. Se enfatiza la importancia de los profesionales de la salud en la difusión de las recomendaciones actuales para prevenir la muerte infantil durante el sueño.

The rate of sudden infant death decreased after the publication of the first guidelines regarding infant sleep position and safe environment in 1992. From 2005 onwards, infant deaths by suffocation, choking or entrapment have increased. Some of them were associated with wedges, positioning devices, and bumper pads. Media and manufacturers should follow safe sleep guidelines in their messaging and advertising, but there is a lack of control over this. We emphasize the important role of health professionals in disseminating the recommendation for a safe infant sleep environment.

Baby bottle steam sterilizers disinfect home nebulizers inoculated with bacterial respiratory pathogens.

BACKGROUND: Contaminated nebulizers are a potential source of bacterial infection but no single method is universally accepted for disinfection. We hypothesized that baby-bottle steam sterilizers effectively disinfect home nebulizers. METHODS: Home nebulizers were inoculated with the common CF respiratory pathogens methicillin resistant Staphylococcus aureus, Burkholderia cepacia, Haemophilus influenzae, mucoid and non mucoid Pseudomonas aeruginosa, and Stenotrophomonas maltophilia. The nebulizers were swabbed for bacterial growth, treated with either the AVENT (Philips), the NUK Quick & Ready (Gerber) or DRY-POD (Camera Baby) baby bottle steam sterilizer and reswabbed for bacterial growth. RESULTS: All steam sterilizers were effective at disinfecting all home nebulizers. Viable bacteria were not recovered from any inoculated site after steam treatment, under any conditions tested. CONCLUSIONS: Steam treatment is an effective disinfection method. Additional studies are needed to confirm whether these results are applicable to the clinical setting.

Use of baby carriers to increase breastfeeding duration among term infants: the effects of an educational intervention in Italy.

AIM: To investigate whether the use of baby carriers by term infants during the first month of life is associated with increased rates of breastfeeding. METHODS: Prospective cohort study. Two hundred mothers with healthy term infants were assigned to receive either a baby carrier and some accurate information and training about the use thereof or only information about breastfeeding. Study groups were followed by phone interviews. RESULTS: Of the 100 mothers to whom baby carriers were provided, 69 utilized it for at least 1 h per day during the first month of life, while 31 did not use it at all. While breastfeeding rates were similar in both intervention and control groups at discharge from the maternity ward, mothers in the intervention group scored significantly higher with their infants at two (72% vs 51%) and at 5 months of age (48% vs 24%), respectively. The intervention group infants were breastfed significantly more frequently than those of the control group. CONCLUSIONS: Our finding seems to suggest that the use of baby carriers in healthy term infants during their first month is associated with increased breastfeeding duration.

Beliefs about the use of baby walkers / Crenças sobre o uso do andador infantil

OBJECTIVES: To understand the opinion of the parents about the baby walker and compare the age of gait acquisition between infants that used a walker and those that did not. METHODS: In this quali-quantitative study, an interview involving a semi-structured questionnaire was carried out with 26 parents, 14 of whose infants used the equipment (BWG) and 12 of whose infants did not (NBWG) prior to gait acquisition. After extensive content analysis, categories for interpreting the results emerged. For data triangulation, the age of gait acquisition was documented by weekly telephone contact. Student's t-test was used for comparison between groups with a significance level of α=0.05. RESULTS: The following categories were identified in the parents' reports: a) information about the baby walker; b) doubt/decision to use it vs. certainty about not using it; c) beliefs about the use of a baby-walker; and d) benefits and harm from use. The age of independent gait acquisition did not differ between groups (p=0.837): BWG initiated gait at 376.17 (SD=32.62) days and NBWG did so at 378.75 (SD=27.99) days. CONCLUSIONS: The beliefs and feelings that permeate the decision to use a baby walker illustrate the different rationales adopted by parents about the role of this equipment in the child's development of gait and autonomy. The use of a baby walker did not influence the age of gait acquisition. The results broaden the understanding of choices that influence child-rearing practices prior to gait acquisition.

OBJETIVOS: Conhecer a opinião dos pais sobre o uso do andador infantil e comparar a idade de aquisição da marcha independente entre os lactentes que usaram e os que não usaram o andador. MÉTODOS: Neste estudo qualiquantitativo, realizou-se entrevista com questionário semiestruturado com 26 pais, 14 de lactentes que usaram (GUAI) e 12 dos que não usaram o equipamento (GNUAI) antes da aquisição da marcha. Empregou-se análise de conteúdo, a partir da qual, após extensa leitura, emergiram-se as categorias para interpretação dos resultados. Para triangulação dos dados, a idade de aquisição de marcha foi documentada por contato telefônico semanal e, para comparação entre grupos, usou-se o teste t de Student, nível de significância α=0,05. RESULTADOS: Foram identificadas, nos relatos dos pais, as categorias: a) informações sobre o andador infantil; b) dúvida/decisão em usar versus certeza de não usar; c) crenças sobre o uso do andador infantil e d) benefícios e malefícios do uso. A idade de aquisição da marcha independente não foi diferente entre os grupos (p=0,837): GUAI iniciou a marcha com 376,17 (DP=32,62) dias e GNUAI, com 378,75 (DP= 27,99) dias. CONCLUSÕES: As crenças e sentimentos que permeiam a decisão de usar o andador ilustram racionalidades distintas entre os pais sobre o significado desse equipamento para o desenvolvimento da marcha e ganho de autonomia da criança. O uso do andador infantil não influenciou a idade de aquisição da marcha. Os resultados ampliam o entendimento das escolhas que podem influenciar as práticas maternas no período pré-aquisição da marcha.

Estimulação ambiental e uso do andador infantil por lactentes com desenvolvimento normal / Environmental stimulation and use of a children's baby walkers by infants with normal development

OBJETIVOS: avaliar a quantidade e qualidade de estímulos ambientais disponíveis para lactentes com desenvolvimento normal que fizeram uso do andador infantil anteriormente à aquisição da marcha independente. MÉTODOS: estudo transversal, com 24 lactentes distribuídos em dois grupos, sendo 12 do grupo exposto ao andador infantil (AI) e 12 do grupo não-exposto (C), mantendo-se equivalência entre grupos em idade, sexo e nível sócio econômico da família. O teste Observation for Measurement of the Environment (HOME) documentou os estímulos oferecidos pelo ambiente. Teste-t de Student para amostras independentes comparou os escores médios do teste HOME de ambos os grupos, considerando o nível de significância α=0,05. RESULTADOS: diferenças no teste HOME foram observadas, tendo o grupo AI obtido escores superiores ao grupo C (p=0,014), com efeito de magnitude fraca (d=0,24). CONCLUSÕES: o uso do voador infantil no período pré-aquisição da marcha por lactentes com desenvolvimento normal, pode estar associado a ambientes domiciliares mais estimuladores.

OBJECTIVES: to evaluate the quantity and quality of environmental stimuli available to infants with normal development who use a baby walkers prior to learning to walk by themselves. METHODS: a cross-sectional study was carried out with 24 infants distributed into two groups of twelve: one group of children who had used a baby walkers (BW) and 12 who had not (C), with the children in both groups being of equivalent ages, sex, and socio-economic background. The Home Observation for Measurement of the Environment (HOME) test provided a documentary Record of the stimuli provided by the environment. Student's t-test for independent samples was used to compare the mean scores on the HOME test of both groups, considering the level of significance to be α=0.05. RESULTS: differences in the HOME scores, with the BW group obtaining higher scores than the control group (p=0.014), with a low magnitude effect (d=0.24). CONCLUSIONS: the use of a children's baby walkers in the period before learning to walk by infants with normal development may be associated with more stimulating home environments.