International Child Care Practices Study: infant sleeping environment.

BACKGROUND: The International Child Care Practices Study (ICCPS) has collected descriptive data from 21 centres in 17 countries. In this report, data are presented on the infant sleeping environment with the main focus being sudden infant death syndrome (SIDS) risk factors (bedsharing and infant using a pillow) and protective factors (infant sharing a room with adult) that are not yet well established in the literature. METHODS: Using a standardised protocol, parents of infants were surveyed at birth by interview and at 3 months of age mainly by postal questionnaire. Centres were grouped according to geographic location. Also indicated was the level of SIDS awareness in the community, i.e. whether any campaigns or messages to "reduce the risks of SIDS" were available at the time of the survey. RESULTS: Birth interview data were available for 5488 individual families and 4656 (85%) returned questionnaires at 3 months. Rates of bedsharing varied considerably (2-88%) and it appeared to be more common in the samples with a lower awareness of SIDS, but not necessarily a high SIDS rate. Countries with higher rates of bedsharing appeared to have a greater proportion of infants bedsharing for a longer duration (>5 h). Rates of room sharing varied (58-100%) with some of the lowest rates noted in centres with a higher awareness of SIDS. Rates of pillow use ranged from 4% to 95%. CONCLUSIONS: It is likely that methods of bedsharing differ cross-culturally, and although further details were sought on different bedsharing practices, it was not possible to build up a composite picture of "typical" bedsharing practices in these different communities. These data highlight interesting patterns in child care in these diverse populations. Although these results should not be used to imply that any particular child care practice either increases or decreases the risk of SIDS, these findings should help to inject caution into the process of developing SIDS prevention campaigns for non-Western cultures.

Iron status in breast-fed infants.

Iron status of 30 infants who had been breast fed until their first birthday and who had never received cow milk, medicinal iron, or iron-enriched formula and cereals was investigated; 30% were anemic at 12 months of age. The duration of exclusive breast-feeding was significantly longer among nonanemic infants (6.5 vs 5.5 months). None of the infants who were exclusively breast fed for 7 months or more and 43% of those who were breast fed for a shorter time were anemic. Infants who were exclusively breast fed for a prolonged period had a good iron status at 12 and 24 months.

[A case of thyroid ectopia: its original diagnostic procedure]. / Un caso di ectopia tiroidea: originale iter diagnostico.

A case of thyroid ectopy in a 8-years-old girl is here described. The diagnostic course of this case is quite particular. In fact the first sign of the disease was a morphological evidence of thyroid sketch at the basis of the tongue. There has never been evidence of thyroid bad functioning.

[Comparison of plasma concentrations of amoxicillin administered by oral and venous routes in neonatal bacterial colonizations]. / Comparazione delle concentrazioni plasmatiche di amoxicillina somministrata per via orale e venosa nelle colonizzazioni batteriche neonatali.

The amoxicillin is a drug that for the incomplete capacity of intestinal absorption in newborn is give for intravenous way. The use of this way and the duration of treatment impose the separation of the newborn from mother and a proportionate preparation of the nurses for the execution of this therapy. We have compared, in newborn infants, with clinical and laboratory diagnosis of neonatal infection, the amoxicillin's plasmatic concentration after intravenous giving and oral giving, in relation to minimum inhibiting concentration the bacteria cause of neonatal infections. In our study (duration 10 months) the newborn infants were perfectly comparable for gestational age, Apgar's score, birthweight, breastfeeding. The newborn infants, at random, were divided in two groups; the first group (18 newborns) received drug for oral way, the second group (14 newborns) for intravenous way. The dosage was 40 mg/Kg/dose of amoxicillin. The duration of treatment was 4 days. Remarkable was the great individual variability of plasmatic concentration of amoxicillin independently from way of giving. The plasmatic concentrations were nearly similar except for the first half hour (plasmatic concentrations after oral giving was lower). The use of oral way is, therefore, favourable for the facility of giving and effective as the intravenous way in the control of neonatal infections.

Bioelectric brain maturation in fullterm infants and in healthy and pathological preterm infants at term post-menstrual age.

At the same post-menstrual age (39-41 weeks), EEG maturation assessed according to the Nolte and Haas method (Nolte, R. and Haas, H.G. (1978) Dev. Med. Child Neurol., 20, 167-182) was studied in 16 fullterm infants (FT), 17 healthy preterm infants (HP) and 18 pathological preterm infants (PP) affected by brain lesions (haemorrhage and/or leucomalacia). There were no significant differences in respect to EEG maturational codes, EEG types or bioelectrical age between the FT and HP groups. The preterm infants affected by brain lesions presented higher percentages of younger EEG codes (i.e. 36 weeks) in State 1 and a higher number of fluctuations between one maturation code and another in both State 1 and State 2, with respect to the HP group. Also, although the PP infants with young EEG codes did not present serious background EEG abnormalities, they did reveal minor EEG abnormalities, such as excessive asynchrony of the 'tracé alternant', lack of frontal sharp transients and monomorphic TA 'bouffees' with little activity at 2-6 c/s. However, no relationship between young EEG codes and onset-offset or duration of the states was found: young codes were often randomly distributed in successive State 1-State 2 epochs, regardless of groupings. Bioelectric age appropriate to the post-menstrual age precedes a normal development or only minor handicap at 24 months, while EEG immaturity of more than 2 weeks corresponds to later major handicaps. The prognostic value of EEG immaturity of between 1.1 and 2 weeks is uncertain.

[Evoked auditory potentials in neonatal hyperbilirubinemia]. / I potenziali evocati uditivi nell'iperbilirubinemia neonatale.

Neonatal hyperbilirubinemia (greater than 20 mg%) is an audiological risk factor. In order to check early detection of bilirubin-induced neurological damage in the brainstem, 19 newborns were enrolled in the present study. The criteria was a bilirubin level ranging from 12 to 20 mg%. A likely mechanism for bilirubin intoxication may be the slowing and desynchronization of acoustic stimuli in the brainstem. Auditory brainstem responses were performed using non filtered clicks at 100 dB SPL (peak equivalent). Absolute and interpeak latencies of waves I and V were measured and correlated to bilirubinemia upon acoustic stimulation and maximal bilirubinemia observed during neonatal observation. Significant correlations were noted between bilirubinemia and V or V-I latencies. No significant correlation was observed between bilirubinemia and wave I latencies. Similar results were obtained in a restricted group of term neonates with hyperbilirubinemia. It is, thus, concluded that hyperbilirubinemia affects the upper auditory pathways.

[Griffith test in the evaluation of psychomotor development in the 1st year of life. A longitudinal study]. / Il test di Griffith per la valutazione dello sviluppo psicomotorio nel primo anno di vita. Studio longitudinal.

Griffith psychometric test has been experimented on a group of 20 healthy newborn infants, monitored during their 1st year of life with quarterly check-ups. It was clear that the development general rates were constantly higher than the original values reported by the English author. In particular, in 12 months old infants, the rates appeared significantly higher than the rates observed on the same Italian specimen in past periods. A transverse and longitudinal study of the psychomotor development of subjects included in the specimen has given the opportunity to verify some of his features. The development outlines, traced by employing the average rates relevant to the 5 different aspects monitored (motor, personal-social, language, eye-hand co-ordination, practical reasoning), appeared to be well-balanced, that is without dissynchronisms between the different scales. The only exception being the scale of the social behaviour, were the average rates appear to be sensibly higher at every age. Individual development outlines, on the contrary, appeared to be disjointed in all aspects (except for 4 cases). In the longitudinal analysis then, some noteworthy oscillations in both general and partial rates, were observed among the controls carried out in subsequent periods in all the subjects.

[Apnea during sleep and wakefulness in term newborns]. / Le apnee nel sonno e nella veglia del neonato a termine.

Apneas in the different sleep states are commonly observed in the full-term healthy newborn infant. Central and short apneas prevail whilst apneas greater than 15 sec. are rare; a marked incidence of short apneas (less than 10 sec.) was observed in active sleep, even though apneas are not exclusive of active sleep. There is a strong inter-individual variability of apnea incidence. Apnea incidence in a state is not positively correlated to apnea incidence in different behavioural states: on the contrary there seems to be an opposite correlation between incidence in AS and QS. Apnea occurrence is positively correlated, in individuals, to the periodic breathing percentage. Apneas number and their duration is markedly lowered already in the second month of life. Periodic breathing must be considered a feature of immaturity. Obstructive apneas are less frequent than central apneas: their survey requires sophisticated technics with the aid of simultaneous recording of several breathing parameters. Relationship between central apneas/ obstructive apneas and mixed apneas is not known. Certainly obstructive and mixed apneas occurrence has been underestimated because of technical difficulties deriving from their survey. The meaning of an incidence of short apneas markedly higher than normal in full-term newborn infants is controversial and not clear, individuals with long apneas and subjects with short apneas in excess have been considered infants at SIDS risk. It is not clear whether periodic breathing and apneas depend on a common pathogenesis; the correlation between high incidence of periodic breathing in postnatal period and SIDS risk is still controversial. Few Authors suggest to treat newborn infants with extended apneas in sleep and considerable percentage of periodic breathing with aminophylline. The relation between gastro-oesophageal reflux and apnea has been recently evidenced. Central apneas and obstructive apneas during breast and bottle feeding have also been documented. Differently from pre-term infant apneas, bradycardia, although not exceptional, is not frequent during apneas in full-term newborn infants.

[Up-date on the subject of neonatal convulsions]. / Attualità in tema di convulsioni neonatali.

New experimental, clinical and therapeutic results in the field of convulsive disorders of the newborn have recently come to light. Experimental studies on animals have shown that, contrary to what was assumed in the past, the immature brain is highly excitable, and during the first weeks of life excitation processes predominate over inhibitory processes. Over the last ten years, benign idiopathic convulsions in newborns, familial convulsions and benign convulsions on the fifth day of life, have been defined. Both types develop and disappear spontaneously during the first week of life and have a favourable prognosis, although they may appear at the start (especially the benign fifth-day convulsions) as status epilepticus. Recently, two types of convulsive status epilepticus in newborns have been identified: a severe idiopathic status epilepticus and focal status epilepticus. The myoclonic syndromes which occur during quiet sleep and which are not accompanied by EEG discharges should be distinguished from convulsions and do not require anti-convulsive therapy. The various EEG monitoring techniques have shown an unexpectedly high number of convulsions, especially in the form of sub-clinical convulsions and/or atypical convulsive seizures. The atypical seizures distinctly predominate in status epilepticus. The clinical evidence of the seizures in reduced by administration of anti-convulsants, which seem to block typical seizures and, viceversa, to be less active for atypical seizures and EEG seizures. In the therapeutic field, the use of phenobarbital and/or phenytoin at a high initial dosage (20 mg/kg) has been well affirmed. Drugs such as lidocaine and thiopental are currently being experimented and have given encouraging results in severe status epilepticus.