Kindergarten Visual-Perceptual and Motor Skills and Behavioral Traits Predict First-Grade Chinese Handwriting Legibility and Speed.

IMPORTANCE: Clarifying the relationship between kindergarteners' characteristics and their future handwriting performance is beneficial for the early detection of children at risk of handwriting difficulties. OBJECTIVE: To determine which visual-perceptual and motor skills and behavioral traits significantly predict kindergartners' Chinese handwriting legibility and speed in the first grade. DESIGN: One-year longitudinal, observational design. SETTING: Kindergarten and elementary schools. PARTICIPANTS: One hundred six kindergarten children (53 boys and 53 girls; ages 5 or 6 yr) were recruited. OUTCOMES AND MEASURES: The participants completed two subtests of the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, Test of Visual Perceptual Skills-Third Edition, Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery™ VMI), and the Attention-Deficit/Hyperactivity Disorder Test-Chinese Version in kindergarten. Their handwriting legibility (character accuracy and construction) and speed were assessed by investigator-developed Chinese handwriting tests in the first grade. RESULTS: Multivariate regression analyses indicated the independent predictive power of spatial relationships (p = .042) and inattention (p = .004) for character accuracy. Visual-motor integration (VMI; p = .008) and inattention (p = .002) were the key predictors of character construction. Manual dexterity (p = .001) was the only significant predictor of writing speed. CONCLUSIONS AND RELEVANCE: Kindergarteners who perform poorly in spatial relationships, VMI, manual dexterity, and attention are likely to have less legible Chinese handwriting and slow writing speed in first grade. Plain-Language Summary: Children's visual-perceptual and motor skills and behavioral traits in kindergarten can predict their Chinese handwriting legibility and speed in first grade. This study found that kindergarteners who performed poorly in spatial relationships, VMI, manual dexterity, and attention were likely to have less legible Chinese handwriting and slow writing speed in the first grade.

Developing a Nomogram Model to Predict the Risk of Poor Chinese Handwriting in First Grade.

IMPORTANCE: Few predictive models for later handwriting difficulties have been developed for kindergarteners. OBJECTIVE: To develop a nomogram for the purpose of detecting the risk of later poor Chinese handwriting among Taiwanese kindergarteners. DESIGN: One-year prospective longitudinal, observational study. SETTING: Kindergarten and elementary school. PARTICIPANTS: One hundred fifty-six kindergarteners were included. In first grade, they were grouped into the normal and poor handwriting groups on the basis of handwriting performance in first grade. OUTCOMES AND MEASURES: Participants received fine motor (FM), visual-perceptual (VP), and visual-motor integration tests in kindergarten and handwriting assessments in first grade. RESULTS: Logistic regression results indicated that younger age at school entry and lower scores on measures of FM and VP in kindergarten increased the risk for later poor handwriting. The area under the receiver operating characteristic curve in the nomogram built with these risk factors was .75, indicating that the nomogram had acceptable diagnostic value. CONCLUSIONS AND RELEVANCE: This nomogram could be used as a screening tool to detect kindergarteners at risk of poor Chinese handwriting in first grade. WHAT THIS ARTICLE ADDS: This study is the first to establish a nomogram constructed with significant predictors in kindergarten of a child's probability of poor handwriting later in first grade. This predictive nomogram may help occupational therapists, educators, and parents identify at-risk kindergarteners early for the purpose of early interventions to prevent later poor Chinese handwriting.

Home-based DIR/Floortime intervention program for preschool children with autism spectrum disorders: preliminary findings.

Improving parent-child interaction and play are important outcomes for children with autism spectrum disorder (ASD). Play is the primary occupation of children. In this pilot study conducted in Taiwan, we investigated the effects of the developmental, individual difference, and relationship-based (DIR)/Floortime home-based intervention program on social interaction and adaptive functioning of children with ASD. The participants were 11 children with ASD, ages from 45-69 months, and their mothers. Mothers were instructed the principles of the approach by an occupational therapist. All 11 children and their mothers completed the 10-week home-based intervention program, undergoing an average of 109.7 hr of intervention. Children made significant changes in mean scores for emotional functioning, communication, and daily living skills. Moreover, the mothers perceived positive changes in their parent-child interactions. The findings of this pilot study contribute to knowledge regarding the effects of home-based DIR/Floortime intervention program on increasing the social interaction and adaptive behaviors of children with ASD in Taiwan.

Higher risk for poor handwriting in Taiwanese children born late preterm.

BACKGROUND: Late-preterm and early-term births constitute a significant proportion of live births. However, handwriting skills of these two populations remain unclear. We aimed to investigate their risk for poor Chinese handwriting in grade two. METHODS: In this observational study, 185 second graders born late preterm (34+0-36+6 weeks' gestation, n = 54), early term (37+0-38+6 weeks' gestation, n = 56), and full term (39+0-41+6 weeks' gestation, n = 75) without any intervention or diagnosis related to developmental delays were included. Their handwriting performance was rated by class teachers using the Chinese Handwriting Evaluation Form (CHEF), which is a standardized handwriting scale including five handwriting dimensions (construction, accuracy, directionality, speed, and pencil grasp). RESULTS: After controlling for demographic risk factors, the late-preterm born group had a greater risk of having worse performance in the full form (adjusted odds ratio [aOR] = 3.93; p = .038) and construction dimension (aOR = 4.77; p = .009) of the CHEF than peers born at full term, whereas the risks were comparable for the early- and full-term born groups (aOR = 0.14-1.90; p = .073-0.453 in the handwriting dimensions). CONCLUSIONS: Late-preterm but not early-term born children were found to be at higher risk for poor Chinese handwriting in grade two. They particularly have difficulty with spatial construction including size, spacing, and alignment of Chinese characters and components that may influence handwriting legibility.

Factors affecting early feeding performance in preterm infants below 32 weeks gestation.

OBJECTIVE: To identify the influence of various physiological and behavioral factors on feeding performance of preterm infants in the transition to full oral feeding. METHODS: We retrospectively reviewed data from a feeding assessment conducted on 24 preterm infants born at 25-31 weeks without severe brain complications. RESULTS: Prolonged oxygen use and low current weight are two adverse factors for feeding efficiency (volume of milk ingested orally per minute in the initial 5 min of feeding) and proficiency (percentage of prescribed volume ingested orally over the entire feeding). Young post-menstrual age, low baseline oxygen saturation and high feeding efficiency were risk factors for oxygen desaturation during the initial feeding. CONCLUSION: Proper feeding strategies are needed for preterm infants with those disadvantageous factors to improve their early feeding performance.

Musculoskeletal symptoms and associated risk factors among office workers with high workload computer use.

OBJECTIVE: Although the prevalence of reported discomfort by computer workers is high, the impact of high computer workload on musculoskeletal symptoms remains unclear. The purpose of this study was to investigate the prevalence of musculoskeletal symptoms for office workers with high computer workload. The association between risk factors and musculoskeletal symptoms was also assessed. METHODS: Two questionnaires were posted on the Web sites of 3 companies and 1 university to recruit computer users in Tainan, Taiwan, during May to July 2009. The 12-item Chinese Health Questionnaire and Musculoskeletal Symptom Questionnaire were chosen as the evaluation tools for musculoskeletal symptoms and its associated risk factors. Chinese Health Questionnaire greater than 5 and computer usage greater than 7 h/d were used to as the cutoff line to divide groups. Descriptive statistics were computed for mean values and frequencies. χ(2) Analysis was used to determine significant differences between groups. A 0.05 level of significance of was used for statistical comparisons. RESULTS: A total of 254 subjects returned the questionnaire, of which 203 met the inclusion criteria. The 3 leading regions of musculoskeletal symptoms among the computer users were the shoulder (73%), neck (71%), and upper back (60%) areas. Similarly, the 3 leading regions of musculoskeletal symptoms among the computer users with high workload were shoulder (77.3%), neck (75.6%), and upper back (63.9%) regions. High psychologic distress was significantly associated with shoulder and upper back complaints (odds ratio [OR], 3.46; OR, 2.24), whereas a high workload was significantly associated with lower back complaints (OR, 1.89). Females were more likely to report shoulder complaints (OR, 2.25). CONCLUSIONS: This study found that high psychologic distress was significantly associated with shoulder and upper back pain, whereas high workload was associated with lower back pain. Women tended to have a greater risk of shoulder complaints than men. Developing an intervention that addresses both physical and psychologic problems is important for future studies.

Prevalence and Initial Diagnosis of Cerebral Palsy in Preterm and Term-Born Children in Taiwan: A Nationwide, Population-Based Cohort Study.

The aim of this long-term longitudinal study in Taiwan was to estimate and compare the prevalence of cerebral palsy (CP) and to identify the age of CP diagnosis of term-born and preterm children with different birthweights. Records of 1494 extremely low birth weight (ELBW, <1000 g), 3961 very low birth weight (VLBW, 1000-1499 g), 19,612 low birth weight (LBW, 1500-2499 g) preterm, and 100,268 matched term-born children were retrieved from Taiwan's National Health Insurance Research Database. According to a 12-year retrospective data review, the results showed the highest prevalence of CP in preterm ELBW children (147.3 cases per 1000 neonatal survivors), followed by preterm VLBW (97.2 cases), preterm LBW (27.7 cases), with the lowest prevalence in term-born children (2.5 cases). Regardless of the birthweight group, 90% of preterm children with CP were diagnosed by 4 years of age, but it was 7 years before 90% of term-born children with CP were diagnosed. After removing the children whose CP was caused by brain infections, injuries, or cerebrovascular accidents after 4 months of age, there were similar mean ages at the initial CP diagnosis (1.58-1.64 years of age) across birthweight groups born prematurely, but initial diagnosis occurred at an older age (2.41 years of age) in term-born children. The results indicate that birthweight is reversely correlated with the prevalence of CP in preterm children. Although the three preterm birthweight groups received different types of developmental follow-up programs after birth, it did not influence their age at the initial diagnosis of CP. Furthermore, we suggest that follow-up for at least 4 years after birth for preterm children, and 7 years for term-born children, is optimal for estimating CP prevalence. In order to identify and provide early intervention for term-born children with CP earlier, it is suggested that parents routinely fill out a self-reported motor developmental screening questionnaire and pediatricians conduct a motor developmental examination on term-born children at each time of scheduled vaccination injections.

Atypical Sensory Processing and Its Correlation with Behavioral Problems in Late Preterm Children at Age Two.

This study aimed to compare the prevalence rate of atypical sensory processing in late preterm (LP) and term children at two years of age and to further investigate the co-occurrence of atypical sensory processing and behavioral problems (internalizing/externalizing) in both groups of children. A total of 104 children (52 LP and 52 sex- and birth order-matched term children) were included. The primary caregivers were asked to complete the Infant/Toddler Sensory Profile-Chinese version and the Child Behavior Checklist 1.5-5Y-Chinese version (CBCL-C/1.5-5). We found that the LP group had a similar prevalence rate of atypical sensory processing to the term group. However, neonatal intensive care unit experience (r = -0.356, p = 0.013, with visual processing) and days of ventilation and supplementary oxygen (r = -0.392, p = 0.004, with low registration) after birth were significantly correlated with the atypical sensory processing of LP children. Both LP and term children with behavioral problems seemed to have a higher prevalence rate of atypical sensory processing than their peers without behavioral problems. However, when Bonferroni correction was used to control for the statistical errors of multiple comparisons, only in the LP group did the co-occurrence of atypical sensory processing (auditory and oral sensory processing and sensation avoiding) and behavioral problems reach significance. In conclusion, the influence of late preterm birth on sensory processing may become subtle at age two, with the exception of those LP children experiencing complicated medical management after birth. A high level of co-occurrence of atypical sensory processing and behavioral problems suggests that the administration of a sensory processing assessment may be helpful to clarify the cause of problematic behavior and to recommend an appropriate intervention for LP children with behavioral problems.

Effectiveness of cheek and jaw support to improve feeding performance of preterm infants.

OBJECTIVE: We examined the effects of cheek and jaw support on the feeding ability of inefficient feeders born prematurely. METHOD: Twenty preterm infants served as their own controls. Each infant received either intervention (feeding with oral support) or control (feeding without oral support) for 2 consecutive feedings per day on 2 consecutive days. RESULTS: Infants displayed a greater intake rate during the intervention feedings, both during the first 5 min (p = .046) and throughout the entire feeding (p = .023). The percentage of leakage during the first 5-min feeding was smaller in the intervention condition than in the control condition (p = .040). No significant differences were found between the two conditions in the sucking, physiological, and alertness variables. CONCLUSION: Findings confirm oral support as a safe and effective strategy to improve the feeding performance of preterm infants who are poor feeders.

The Beneficial Effects of Massage on Motor Development and Sensory Processing in Young Children with Developmental Delay: A Randomized Control Trial Study.

Purpose: We investigated the effects of massage on young children with developmental delay but no clear diagnosis (e.g., cerebral palsy, genetic diseases, or autism). Methods: Thirty-six children with DD, at 1-3 years of age, were randomly assigned to the massage (n = 18) or control group (n = 18) after being stratified by age and motor developmental quotient. The two groups continued to receive routine rehabilitation intervention, whereas the massage group additionally received 20 min of massage twice a week for 12 weeks. The Comprehensive Development Inventory for Infants and Toddlers - Diagnostic Test, the Infant/Toddler Sensory Profile - Chinese version, anthropometric measures, and a sleep questionnaire were administrated before and after the massage intervention. Results: The results of analysis of covariance revealed that the massage group exhibited a greater improvement in the total motor score (p = 0.023), gross motor score (p = 0.047), and sensory sensitivity behavior (p = 0.042). Conclusion: These findings suggest that massage can effectively enhance motor and sensory processing in children with DD.

Relationship between umbilical cord blood insulin-like growth factors and anthropometry in term newborns.

BACKGROUND: Birth size is associated with long-term morbidity. Insulin-like growth factor (IGF) system is the most important endocrine factor influencing fetal growth. During rapid somatic growth, free-to-total IGF-I ratio is increased, resulting in higher IGF-I bioavailability. The purpose of this study was to investigate the association of free-to-total IGF-I ratios, IGF-II, and IGF-binding protein (IGFBP)-3 umbilical cord levels with anthropometric data of term neonates. METHODS: Umbilical venous plasma samples were obtained from 95 term neonates and analyzed by enzyme-linked immunosorbent assay. RESULTS: The large-for-gestational age (LGA) neonates had higher free IGF-I, total IGF-I, and IGFBP-3 levels than small-for-gestational age (SGA) neonates (P < 0.01, 0.001, 0.01, respectively) and higher total IGF-I and IGFBP-3 levels than appropriate-for-gestational age (AGA) neonates (P < 0.05, 0.01, respectively). The free-to-total IGF-I ratios and IGF-II levels were not different among SGA, AGA, and LGA neonates. Free IGF-I, total IGF-I, and IGFBP-3 levels were positively correlated with birth weight (r = 0.34, P < 0.001; r = 0.41, P < 0.001; r = 0.25, P < 0.05, respectively). Multiple linear regression analyses revealed that only total IGF-I levels was the independent predictive variable for birth weight. CONCLUSIONS: Our data suggest total IGF-I is the most important factor in the IGF system for determining fetal growth, at least near term gestation. Free-to-total IGF-I ratios may mostly be determined by total IGF-I. If birth size is associated with adult chronic metabolic diseases, total IGF-I may be involved in the pathogenesis.

Chinese handwriting performance in preterm children in grade 2.

BACKGROUND: First graders born prematurely perform poorly on handwriting speed and legibility. However, whether there are specific legibility factors in which preterm children demonstrate difficulty remains unknown. In addition, handwriting performance beyond the first grade and the influence of sex on handwriting performance in preterm children are still unclear. We aimed to investigate the influence of prematurity and sex on multiple dimensions of handwriting in grade two and to identify the contributors to performance. METHODS: Sixty-three preterm (34 boys and 29 girls) and 67 full-term (27 boys and 40 girls) peers in grade two were included. Class teachers were asked to complete the Chinese Handwriting Evaluation Form. A subgroup of 39 preterm children received assessments on intelligence, visual perception, tactile and kinesthetic sensation, and fine motor skills. Their inattention behavior was rated using a maternal self-report with a behavioral scale. RESULTS: Boys born prematurely exhibited poorer performance in the speed dimension than full-term boys (p = 0.008), whereas there was comparable performance in the two groups of girls (p = 0.221). In the dimensions related to legibility, preterm boys (32.4%) had a higher percentage of children with difficulty in the construction dimension than the other groups (preterm girls: 6.9%, full-term boys: 7.4%, full-term girls: 5.0%). However, no group difference was found in the dimensions of accuracy and directionality. Of the sensory-perceptual-motor factors, attention was the most significant predictor of accuracy in performance (p = 0.046) and speed dimensions (p = 0.001) in preterm children. CONCLUSIONS: Boys appear to be vulnerable to the adverse impacts of preterm birth in terms of performance in the dimensions of speed and construction in grade two. Based on the significant contribution of attention to handwriting performance in preterm children, assessment and intervention in the area of attention is strongly suggested for preterm children with handwriting problems.

Association of umbilical cord plasma acid-labile subunit of the insulin-like growth factor ternary complex with anthropometry in term newborns.

BACKGROUND: Birth size can affect neonatal morbidity and mortality. The insulin-like growth factor (IGF) system is the most important endocrine factor influencing fetal growth. In the circulation, IGFs (mostly IGF-I) are bound to IGF-binding protein 3 (IGFBP-3) and an acid-labile subunit (ALS) to form a ternary complex. The ALS protects IGFs from decay and facilitates their endocrine activity. However, the function of ALS in fetal growth has not yet been fully determined. METHODS: Venous umbilical plasma samples were obtained from 98 term neonates and analyzed using enzyme-linked immunosorbent assays. The ALS, IGF-I, and IGFBP-3 umbilical cord plasma levels were analyzed for their association with anthropometric measurements of the neonates. RESULTS: The ALS, IGF-I, and IGFBP-3 cord plasma levels were positively correlated with birth weight (r = 0.42, p < 0.001; r = 0.43, p < 0.001; and r = 0.27, p < 0.01, respectively) and placental weight (r = 0.37, p < 0.001; r = 0.31, p < 0.01; and r = 0.30, p < 0.01, respectively). In addition, the ALS cord plasma levels were also positively correlated with head circumference (r = 0.29, p < 0.01). Multiple linear regression analyses showed that both ALS and IGF-I cord plasma levels were independent predictive variables for birth weight (p < 0.01 and p < 0.005, respectively). The ALS cord plasma levels were the only independent predictive variables, however, for head circumference and placental weight (p < 0.01 and p < 0.05, respectively). CONCLUSION: The ALS umbilical cord plasma levels are one important factor, in addition to IGF-I, in the IGF system for predicting birth anthropometry, at least for near-term gestation. Our results suggest that the influence of ALS on the IGF system may develop prior to birth and affect fetal growth.

Association between mechanical ventilation and neurodevelopmental disorders in a nationwide cohort of extremely low birth weight infants.

Mechanical ventilation for preterm infants independently contributes to poor neurodevelopmental performance. However, few studies have investigated the association between the duration of mechanical ventilation and the risk for various developmental disorders in extremely low birth weight (ELBW) (<1000g) infants. Using a large nationwide database, we did a 10-year retrospective follow-up study to explore the effect of mechanical ventilation on the incidence of cerebral palsy (CP), autism spectrum disorder (ASD), intellectual disability (ID), and attention-deficit/hyperactivity disorder (ADHD) in ELBW infants born between 1998 and 2001. Seven hundred twenty-eight ELBW infants without diagnoses of brain insults or focal brain lesions in the initial hospital stay were identified and divided into three groups (days on ventilator: ≦2, 3-14, ≧15 days). After adjusting for demographic and medical factors, the infants in the ≧15 days group had higher risks for CP (adjusted hazard ratio: 2.66; 95% confidence interval: 1.50-4.59; p<0.001) and ADHD (adjusted hazard ratio: 1.95; 95% confidence interval: 1.02-3.76; p<0.05), than did infants in the ≦2 days group. The risk for ASD or ID was not significantly different between the three groups. We conclude that mechanical ventilation for ≧15 days increased the risk for CP and ADHD in ELBW infants even without significant neonatal brain damage. Developing a brain-protective respiratory support strategy in response to real-time cerebral hemodynamic and oxygenation changes has the potential to improve neurodevelopmental outcomes in ELBW infants.

Higher prevalence of autism in Taiwanese children born prematurely: a nationwide population-based study.

The reported prevalence of autism in preterm and full-term children varies partially because of small sample sizes. Moreover, little is known about the specific factors that contribute to the risk of autism in preterm children. We aimed to compare the prevalence of autism in preterm and full-term children and to identify neonatal risk factors for autism in preterm children using a large national health system database. We analyzed data from 1078 early preterm (<28 weeks of gestation or birth weight<1000 g), 28,947 later preterm (28-36 weeks), and 1,104,071 full-term (≥ 37 weeks) children who were 8-11 years old in 2009. The descending order of prevalence was early preterm (2.2%), later preterm (1.3%), and full-term (0.6%). The prevalence of autism was approximately 2-4 times higher in preterm children than in children born at full-term. The male-female ratio (4:1) in preterm and full-term children was not significantly different. Most of the children were first diagnosed with autism between 3 and 6 years old. Preterm children with autism were not diagnosed earlier than were full-term children. Regression analysis showed that male gender, a very low birth weight, and neonatal cerebral dysfunction were risk factors for autism in the preterm group. We conclude that autism is more prevalent in preterm children. Preventing extremely preterm birth and significant early brain insults may be helpful in reducing the risk of autism in preterm children.

Associations among perinatal factors and age of achievement of full oral feeding in very preterm infants.

BACKGROUND: Progress to full oral feeding from a tube or parenteral feeding is a complex process for very preterm infants born before 32 weeks of gestation. The influence of infant characteristics and medical complications on feeding progression has not been studied thoroughly. The aim of this study was to constitute a regression model to estimate the postmenstrual age (PMA) of full oral feeding and the length of transition time from the initiation to completion of oral feeding. METHODS: A chart review was conducted on very preterm infants born between 2005 and 2010 in one medical center in Taiwan. All enrolled infants were able to take all nutrition by mouth before discharge. RESULTS: A total of 117 infants fulfilling the criteria were included. The mean PMAs for the initiation and completion of oral feeding were 33.9 ± 1.7 and 35.1 ± 2.0 weeks, respectively. Infants required 7.5 ± 6.6 days from initiation to full oral feeding. The results of a stepwise regression revealed that the reciprocal of birth weight (beta coefficient = 3.81, p < 0.001), moderate-severe bronchopulmonary dysplasia (beta coefficient = 1.21, p < 0.001), necrotizing enterocolitis (beta coefficient = 0.84, p < 0.005), and patent ductus arteriosus (beta coefficient = 0.69, p < 0.01) were predictors for the PMA of full oral feeding. The regression model incorporating those factors explained 62.5% of the variation in the feeding outcome (p < 0.001). Gender, multiple gestations, mild bronchopulmonary dysplasia, intraventricular hemorrhage, and sepsis had no effect on the feeding outcome. None of the explored factors were significantly correlated with transition time. CONCLUSION: A regression model incorporating significant predictors to estimate the PMA of full oral feeding in very preterm infants was suggested. It could enhance communication between health professionals and parents about the feeding progress of infants born very prematurely.

Congenital chylothorax in a late preterm infant and successful treatment with octreotide.

Chylothorax is defined as abnormal accumulation of lymphatic fluid in the pleural space and is a rare condition in neonates. Chylothorax causes respiratory and nutritional problems and a significant mortality rate. Octreotide is a long-acting somatostatin analog that can reduce lymphatic fluid production and has been used as a new strategy in the treatment of chylothorax. Here, we report a premature baby with severe bilateral pleural effusion diagnosed by prenatal ultrasound and subsequently confirmed to be congenital chylothorax after birth. This newborn baby was initially treated with bilateral chest tube insertion to relieve severe respiratory distress. However, the chylothorax recurred after a medium-chain-triglyceride-enriched formula was initiated. The accumulation of chylothorax diminished after the administration of octreotide. Therefore, octreotide may allow the patient to avoid invasive procedures, such as reinsertion of chest tubes or surgery.

Effects of prefeeding oral stimulation on feeding performance of preterm infants.

OBJECTIVE: To investigate the effects of a prefeeding oral stimulation program on the feeding performance of preterm infants. METHODS: A crossover design was used. Nineteen preterm infants who were in the transitional time to full oral feeding served as their own controls. A 5-min oral stimulation program was applied to infants prior to feeding in two of 4 feedings on two consecutive days. Feeding, behavioral state, and physiological parameters of infants in the intervention and control feeding conditions were compared using SPSS software. RESULTS: There were two significant findings: (1) Compared to the control condition, infants in the intervention condition achieved a greater intake rate in the initial 5 min of the feeding (P = 0.021). (2) After receiving oral stimulation, a higher percentage of infants moved to the drowsy or quiet alert state from sleep or restlessness before feeding, both on Day 1 (P= 0.016) as well as Day 2 (P = 0.016). No significant differences were found in other feeding parameters, feeding-induced physiological changes (peripheral oxygen saturation levels and pulse rate) and behavioral states between two feeding conditions. CONCLUSIONS: Oral stimulation had a modulating effect on the prefeeding behavioral states and short-lived beneficial effects on the feeding efficiency of preterm infants.

Association of cord plasma leptin with birth size in term newborns.

BACKGROUND: Leptin is secreted from adipose tissue and plays an important role in obesity. Recent studies have shown that the relationship between Leptin and body fat mass may have ethnic differences. The purpose of our study was to investigate the relationship between venous umbilical cord plasma Leptin and anthropometric markers in term healthy Taiwanese newborns. METHODS: Umbilical venous plasma samples were obtained from 98 term neonates (48 males and 50 females) and leptin Levels were analyzed by enzyme-linked immunosorbent assay. RESULTS: Umbilical cord plasma Levels of leptin were significantly higher in the female neonates than in males (p<0.001). The large-for-gestationaL age and appropriate-for-gestational age newborns had significantly higher Leptin cord plasma levels than the small-for-gestational age newborns (p<0.01 and p<0.05, respectively). In both male and female neonates, umbilical Leptin Levels showed significant positive correlations with birth weight and birth Length. Multiple Linear regression analysis revealed that birth weight was the only significant predictor of umbilical cord plasma Leptin levels in both male and female neonates. However, the slopes of the regressions between Leptin and birth weight in male and female neonates were not different. CONCLUSION: In Taiwanese healthy term neonates, leptin umbilical cord plasma Levels are associated with sex and birth weight of the neonate. The relationship between Leptin and birth weight may differ among different ethnic groups. These findings imply that the relationship between leptin and body fat mass may develop early in life.