Health and the use of health care services in 5-year-old very-low-birth-weight infants.

AIM: We aimed to study the effect of prematurity, time of birth and level of birth hospital on morbidity and the use of health care services at age 5. METHODS: This national study included all very-low-birth-weight infants (VLBWI, <32 gestational weeks or birth weight < or =1500 g) born in Finnish level II or III hospitals in 2001-2002 (n = 918), and full-term controls (n = 381). Parental questionnaires and register data were used to compare morbidity, and the use of health care services between VLBWI and full-term controls, and within VLBWI according to the time of birth and birth hospital level. RESULTS: Cerebral palsy, retinopathy of prematurity, other ophthalmic problems, respiratory infections, asthma or chronic lung disease, and inguinal hernia were overrepresented in VLBWI compared with the controls. VLBWI had more outpatient and inpatient days than the controls. The time of birth and birth hospital level were not associated with the use of services or with prematurity-related morbidity. CONCLUSION: Although morbidity and the use of health care services were increased in the surviving VLBWI, the average use of services was relatively small at age 5. In surviving VLBWI, the time of birth and the birth hospital level did not affect morbidity or the use of services.

Children younger than 4 years and their substance-dependent mothers in the child welfare clinic.

AIM: To explore the prevalence of substance dependency among mothers of small children and to evaluate the value of a routine-style maternal report on social support, child's somatic health history and child caregiving experiences to differentiate the substance-dependent group from the non-dependent group. METHODS: Mothers (n = 413) of children less than 4 y in the child welfare clinics filled in the Substance Abuse Subtle Screening Inventory (SASSI, Miller 1985) and questionnaires concerning social support, somatic history of the child, difficulties in social environment and in caring for the child. RESULTS: The prevalence of substance dependency was 5.8%. The maternal perceptions of the child's somatic history could not differentiate the dependent from the non-dependent group, while the child caregiving difficulties were more often present in the group of substance-dependent mothers. The combined group of substance dependency and substance use was significantly associated with low social support and difficulties in social environment. CONCLUSIONS: The prevalence of substance dependency among mothers of small children is considerable and significantly associated with child caregiving difficulties and low social support, while the perceptions on the somatic health of the child did not differentiate the dependent from the non-dependent group. This suggests the value of considering the maternal experiences in caring for the child and well-being of the mother during check-ups in the child welfare clinic in order to identify the mother-child pairs at risk.

Excessively crying infant in the family: mother-infant, father-infant and mother-father interaction.

METHOD: We studied mother-infant, father-infant and mother-father interaction in 32 families with an excessively crying infant and in 30 control families. The group with excessive criers was divided further into subgroups of severe colic (n=13) and moderate colic (n=19). The three dyads of the family were video-recorded when the infants were an average of 5 weeks old. The assessment was carried out during the infant's feeding, nappy change and discussion between the parents. During the assessment, only four infants were crying. The Parent Child Early Relational Assessment Scale and the Beavers Scale were used. RESULTS: The main findings suggest that both parents of colicky infants had less optimal parent-child interaction compared with the control parents. The problems in the interaction were most pronounced between the fathers and infants in the severe colic group. The father-infant interaction was less optimal in 13 items of 65 (20%) in the severe colic group, in one item of 65 (2%) in the moderate colic group and in none of the items in the control group. The mother-infant interaction was less optimal in six items out of 65 (9%) in the severe colic group, in three items out of 65 (5%) in the moderate colic, and in none of the items in the control group. Severely colicky infants were also less competent in interacting with their parents. In addition, interaction between the parents was more often dysfunctional in the severe colic group. CONCLUSIONS: The problems in early family interaction may threaten the well-being of families with excessively crying infants and they therefore deserve special attention from the health care professionals.

The balance of the autonomic nervous system is normal in colicky infants.

UNLABELLED: Excessively crying, hard-to-soothe infants are described as colicky. The self-limiting course of infantile colic during early infancy suggests an etiology of transient developmental dysmaturation. It has been proposed that emotional characteristics such as temperament and self-soothing ability are correlated with the balance of the autonomic nervous system. Heart rate variability (HRV) analysis was used for evaluating the balance of the autonomic nervous system in colicky and control infants during and after the colicky period. HRV analysis was carried out on 12 colicky infants and 14 control infants at the age of 2 mo, and repeated on 10 colicky and 11 normal infants at the age of 7 mo. Measurements were performed during polygraphically confirmed slow-wave sleep (sleep stages 3 and 4). Three HRV frequency bands were defined, including a high (0.2-1.0 Hz), middle (0.12-0.2 Hz) and low (0.025-0.12 Hz) frequency variability. There were no differences between the study groups in any of the three HRV frequency bands analyzed. The high frequency variability increased significantly with age in both study groups (p = 0.009). CONCLUSION: The findings suggest that imbalance between the parasympathetic and the sympathetic nervous system is not associated with infantile colic and that, in accordance with previous findings, control of HRV shifts in a parasympathetic direction with increasing age during the first year of life.

Extent of fussing and colic type crying preceding atopic disease.

In a prospective follow up of 116 high risk infants, a 24 hour behavioural chart on seven consecutive days was analysed at seven and 12 weeks of age. Of children who manifested atopic disease at 2 years, 44/116 (38%), had shown significantly more fussing during the seventh, and colic type cry during the twelfth week than those who remained healthy (72/116, 62%).

Infants with colic have a normal sleep structure at 2 and 7 months of age.

OBJECTIVE: To compare nighttime sleep structure between infants with colic and a control group. STUDY DESIGN: Sleep and cry times of 15 infants with colic and 16 infants in a control group were recorded with the use of a daily diary at the ages of 5 weeks and 6 months. The diary was kept at home for a 1-week period. Overnight polygraphic sleep recordings in a sleep laboratory were performed when the infants were 2 months of age and were repeated for 11 infants with colic and 14 infants in a control group at 7 months of age. RESULTS: Daily sleep time was shorter in infants with colic compared with the control group at 5 weeks of age (P =.001). Polygraphic data showed a similar sleep structure between the study groups at 2 and 7 months of age. Infants with colic had somewhat more obstructive apneas during rapid eye movement sleep at the age of 2 months (P =.04), and they had fewer awakenings at the age of 7 months than the control group (P =.003). CONCLUSION: Infants with colic had normal sleep polygraphic finding at 2 and 7 months of age including sleep structure, movements, and breathing. Despite the shorter reported daily sleep times, the polygraphic data did not suggest infantile colic to be associated with a sleep disorder.

Infant massage compared with crib vibrator in the treatment of colicky infants.

OBJECTIVE: To evaluate the effectiveness of infant massage compared with that of a crib vibrator in the treatment of infantile colic. METHODS: Infants <7 weeks of age and perceived as colicky by their parents were randomly assigned to an infant massage group (n = 28) or a crib vibrator group (n = 30). Three daily intervention periods were recommended in both groups. Parents recorded infant crying and given interventions in a structured cry diary that was kept for 1 week before (baseline) and for 3 weeks during the intervention. Parents were interviewed after the first and third weeks of intervention to obtain their evaluation of the effectiveness of the given massage or crib vibration. RESULTS: At baseline, the mean amount of total crying was 3.6 (standard deviation: 1.4) hours/day in the massage group infants and 4.2 (2.0) hours/day in the vibrator group infants. The mean amount of colicky crying was 2.1 (standard deviation: 1.1) hours/day and 2.9 (1.5) hours/day, respectively. The mean number of daily intervention periods was 2.2 in both groups. Over the 4-week study, the amount of total and colicky crying decreased significantly in both intervention groups. The reduction in crying was similar in the study groups: total crying decreased by a mean 48% in the massage group and by 47% in the vibrator group, and colicky crying decreased by 64% and 52%, respectively. The amount of other crying (total crying minus colicky crying) remained stable in both groups over the intervention. Ninety-three percent of the parents in both groups reported that colic symptoms decreased over the 3-week intervention, and 61% of the parents in the massage group and 63% of the parents in the crib vibrator group perceived the 3-week intervention as colic reducing. CONCLUSIONS: Infant massage was comparable to the use of a crib vibrator in reducing crying in colicky infants. We suggest that the decrease of total and colicky crying in the present study reflects more the natural course of early infant crying and colic than a specific effect of the interventions.

Newer techniques to study neonatal hypoglycemia.

Severe neurological sequelae may occur after symptomatic neonatal hypoglycemia. New neuroimaging techniques allow both structural and functional detection of these disturbances. The new diagnostic modalities have shown also transient structural findings associated with neonatal hypoglycemia. The prognostic value of these techniques remains still obscure.

Differences in respiratory metabolism during treatment of hypoglycemia in infants of diabetic mothers and small-for-gestational-age infants.

We investigated oxygen consumption and carbon dioxide production during treatment of hypoglycemia in infants of diabetic mothers (IDM) (n=11) and small-for-gestational-age (SGA) infants (n=6). Healthy newborn infants served as controls (n=16). The infants in both groups received normal enteral feedings and they were treated with intravenous glucose at a rate adjusted to increase plasma glucose concentration above 45 mg/dL. Oxygen consumption (VO2) and carbon dioxide production (VCO2) were measured using indirect calorimetry and respiratory quotient (RQ) was calculated. Measurements were performed immediately after the correction of hypoglycemia (6-10 hr), and 24, 72, and 120 hr later. After initiation of treatment, and 24 hr later mean VCO2 and RQ were significantly higher in the IDM and the SGA infants than in healthy infants. 72 and 120 hr after the first measurement, the IDM did not differ from the healthy controls, whereas in the SGA infants mean VCO2 and VO2 were still significantly increased. In the SGA infants, the hypermetabolism was sustained during whole study period. Our results indicate that the metabolic defect resulting in hypoglycemia is different between the SGA and IDM infants. However, the treatment with supplemental glucose is necessary to both groups.

Family functioning 3 years after infantile colic.

Infantile colic causes stress to many families during the first weeks of an infant's life. In our previous studies, we found that families with severely colicky infants had more problems in their daily functioning than did families without colicky infants and that the affective state in these families was anxious and conflicted. These characteristics showed some stability from the colicky period to 1 year of age. In the present study, we examined the functioning of these families 3 years after the colicky period. The McMaster Family Assessment Device was used to evaluate the family interaction in 59 families with previously colicky infants and 58 control families. Three years after the colicky period, families with moderately and severely colicky infants did not differ significantly from control families with respect to psychological family characteristics.

Cerebral metabolic rate for glucose after neonatal hypoglycaemia.

OBJECTIVE: We studied the effect of neonatal hypoglycaemia on the local cerebral metabolic rate for glucose (LCMRglc). MATERIALS AND METHODS: Eight newborn infants with neonatal hypoglycaemia were studied. The LCMRglc in the whole brain, in five cerebral regions and in skeletal muscles were quantitated using positron emission tomography (PET) and 2-[18F]Fluoro-2-deoxy-D-glucose (FDG). The PET studies were performed at the age of 5.3 +/- 6.2 days during normoglycaemia. The LCMRglc of these infants were compared to the age-adjusted LCMRglc of eight infants with suspected hypoxic-ischaemic brain injury but with normal neurological development. RESULTS: After neonatal hypoglycaemia the age-adjusted LCMRglc in the whole brain was not lower than LCMRglc of the control infants (5.33 +/- 0.60 mumol/100 g/min vs. 6.71 +/- 0.60 mumol/100 g/min). Also the metabolic rate for glucose (MRglc) in the skeletal muscles was similar in hypoglycaemic and control infants (5.56 +/- 2.48 mumol/100 g/min vs. 6.99 +/- 2.41 mumol/100 g/min). CONCLUSION: MRglc in brain and in skeletal muscle seems to be normal after neonatal hypoglycaemia, although larger group of patients with more severe hypoglycaemia are needed to confirm this finding.

Family life 1 year after infantile colic.

OBJECTIVE: To determine the persistence of family psychological characteristics associated with infantile colic. DESIGN: A 1-year follow-up survey of families with colicky infants was carried out. The family interview was used to evaluate the psychological factors of colicky and control families. PARTICIPANTS: A total of 59 families with a colicky infant and 58 control families were enrolled in the initial evaluation in the population-based study. On the basis of a structured diary of the infant's crying, filled in by the parents, 3 groups of families were formed: severe colic group (n = 36), moderate colic group (n = 23), and control group (n = 58). The families were interviewed when the infants were 2 and 12 months old. The Beavers-Timberlawn Family Evaluation Scale and the Oulu Family Assessment Scale were used. Thirty-two families (89%) from the severe colic group, 17 (74%) from the moderate colic group, and 49 (84%) from the control group participated in the 1-year assessment. RESULTS: At the 1-year assessment, the structural profile of the families did not differ between the groups. However, families in the severe colic group had more difficulties in communication, more unresolved conflicts, more dissatisfaction, and greater lack of empathy than families in the other groups. Furthermore, there was less flexibility in both colic groups than in the control group. During the follow-up period, coalition between parents in the moderate colic group became stronger compared with the first assessment, and the atmosphere improved significantly in all 3 study groups. However, the amount of empathy decreased in the severe colic group. CONCLUSIONS: Our study shows that certain family characteristics associated with severe infantile colic persist. Families in the moderate colic group coped nearly as well as families in the control group. The family mood had improved a lot in all families when the infant was 1 year old.

Cerebral metabolic rate for glucose during the first six months of life: an FDG positron emission tomography study.

AIM: To measure the local cerebral metabolic rate for glucose (LCMRGlc) in neonatal brains during maturation using positron emission tomography (PET) and 2-[18F]fluoro-2-deoxy-D-glucose (FDG). METHODS: Twenty infants were studied using PET during the neonatal period. The postconceptional age ranged from 32.7 to 60.3 weeks. All infants had normal neurodevelopment and were normoglycaemic. The development of the infants was carefully evaluated (follow up 12-36 months) clinically, and by using a method based on Gesell Amatruda's developmental diagnosis. LCMRGlc was quantitated using PET derived from FDG kinetics and calculated in the whole brain and for regional brain structures. RESULTS: LCMRGlc for various cortical brain regions and the basal ganglia was low at birth (from 4 to 16 mumol/100 g/minute). In infants 2 months of age and younger LCMRGlc was highest in the sensorimotor cortex, thalamus, and brain stem. By 5 months, LCMRGlc had increased in the frontal, parietal, temporal, occipital and cerebellar cortical regions. In general, the whole brain LCMRGlc correlated with postconceptional age (r = 0.90; P < 0.001). The change in the glucose metabolic pattern observed in the neonatal brain reflects the functional maturation of these brain regions. CONCLUSION: These findings show that LCMRGlc in infants increases with maturation. Accordingly, when LCMRGlc is measured during infancy, the postconceptional age has to be taken into account when interpretating the results.

Infantile colic. Seasonal incidence and crying profiles.

OBJECTIVES: To determine the occurrence of infantile colic and its seasonal variation in an unselected population and to evaluate the amounts of crying in colicky infants and noncolicky controls. DESIGN: Questionnaire survey and a prospective substudy of parental diaries of crying. SETTING: All families with a full-term, healthy-born infant in the Turku City (Finland) district during 1 year. PARTICIPANTS: Colic was defined as paroxysms of crying for 3 or more hours per day for 3 days or more per week during a period of at least 3 weeks. The questionnaires containing this definition were distributed to 1221 families in postpartum wards, and an invitation to a prospective follow-up study was presented to the families if their infant showed colicky symptoms. The incidence questionnaire was to be returned after 3 months. Six hundred four (49%) of the questionnaires were returned, and an additional 355 (29%) families were reached by phone. A total of 59 families with a colicky infant enrolled in the prospective substudy when the infants were at a median age of 5 weeks; age-matched controls were invited from the same population. RESULTS: The incidence of infantile colic was 13%; possible infantile colic was 8%. No seasonal variation was found. The mean amount of total crying was 241 min/d (95% confidence interval [CI], 216 to 266 minutes) in the colic group and 112 min/d (95% CI, 95 to 130 minutes) in the control group during the first recording week. The mean amount of colicky crying was 122 min/d (95% CI, 102 to 142 minutes) in the colic group and 19 min/d (95% CI, 12 to 26 minutes) in the control group. CONCLUSIONS: The incidence of colic was 13% with no seasonal variation. Parental perception of infantile colic correlated well with the amount of crying.

Cerebral circulation assessed by transcephalic electrical impedance during the first day of life--a potential predictor of outcome?

Pulsatile changes in intracranial blood volume (transcephalic electrical impedance, delta Z), arterial blood pressure (aBP) and respiration were studied during the first day after birth in 42 neonates with a birth weight of 1040-3850 g and gestational age of 26-36 weeks. The neurological outcome was assessed at 1 year of age to study the predictive ability of delta Z. delta Z, ECG, respirogram and direct aBP were recorded at 8-h intervals. Outcome was adverse in seven infants of whom two died from severe peri-intraventricular haemorrhage. PCO2 was higher (6.2 kPa) in the infants with adverse outcome than in those infants with favourable outcome (5.0 kPa) (P = 0.004). Blood glucose (4.5 vs. 3.3 mmol/l, P = 0.030) and first day administration of fluid (80 vs. 63 ml/kg/day, P = 0.003) behaved, respectively. Of the infants receiving dopamine therapy, 60% had adverse outcome while only 11% of those not receiving dopamine had adverse outcome (P = 0.016). Of the infants with high diastolic blood pressure levels, 32% had adverse outcome, while none with low diastolic blood pressure levels had adverse outcome (P = 0.031). Spectral analysis was used to examine signal variabilities in the frequency domain. During the first 24 h of life, the variabilities of aBP and respiration were equal in all the infants. The high-frequency delta Z signal variability (1.50-4.00 Hz, heart rate level) was found to be lower in the infants with adverse outcome (330 units) than in the infants with favourable outcome (1280 units, P = 0.017). The low delta Z variability allowed us to assume that there is a decrease of pulsatile cerebral blood flow (CBF) in the infants with adverse outcome. We speculate that this may result from the 'no reflow phenomenon', increased tissue pressure due to ischaemia and/or PIVH, the 'brain sparing effect' or constriction of main cerebral arteries due to increased pressure support or metabolic factors (PCO2, glucose). We believe that transcephalic impedance provides a potential cot-side method for monitoring cerebral circulation in the neonatal period with an ability to predict outcome.

Temperament and sleeping patterns in colicky infants during the first year of life.

A prospective study of 59 colicky infants and 58 age-matched controls assessed infants' temperament at the ages of 3 and 12 months and their sleeping patterns at the ages of 8 and 12 months. At age 3 months, the mothers regarded the colicky infants as more intense in their reactions, less persistent, more distractible, and more negative in their mood. At age 12 months, mothers regarded 23% of the colicky infants to be more difficult than average compared to 5% of controls. The mothers regarded their colicky infants as more active and less persistent. However, the Toddler Temperament Scale showed no difference between the groups in any area of temperament. No significant difference was found between the two groups in sleeping patterns. The discrepancy between infants' actual temperament and mothers' general perception of temperament may reflect the influence of infantile colic on the mother-infant relationship.