Suchergebnisse

Section 1. Current status of newborn infants and perinatal health in South Asia. ch. 1. Current state of the health of newborn infants in developing countries / Anthony Costello and Dharma Manandhar -- ch. 2. Recent trends in perinatal health in South Asia -- Section 2. Social, economic and cultural aspects of motherhood in South Asia. ch. 3. Social and developmental issues affecting the perinatal health of mothers and their infants / Hilary Standing and Anthony Costello -- ch. 4. Epidemiological trends in nutritional status of children and women in India / Harshpal Sachdev -- ch. 5. Women's work and maternal-child health: anthropological views on intervention / Catherine Panter-Brick -- ch. 6. Perinatal mortality in Nepal: implications for behaviour modification / Shyam Thapa -- ch. 7. Traditional and cultural aspects of neonatal care in developing countries / Shashi N.Vani -- Section 3. Cost-effective essential newborn care in poor communities: the evidence-base. ch. 8. Effective interventions in pregnancy to improve foetal growth / Amali Lokugamage and Charles H. Rodeck -- ch. 9. Hypothermia: epidemiology and prevention / Ragnar Tunell -- ch. 10. New methods for monitoring neonatal hypothermia and cold stress / Anthony Costello -- ch. 11. Birth asphyxia in developing countries: epidemiology, sequelae and prevention / Matthew Ellis -- ch. 12. Effective resuscitation / Siddarth Ramji -- ch. 13. Effective interventions to reduce neonatal mortality and morbidity from perinatal infection / Zulfiqar Ahmed Bhutta -- ch. 14. The importance of breastfeeding and strategies to sustain high breastfeeding rates / M. Q-K. Talukder -- ch. 15. Neonatal hypoglycaemia / Anthony Costello and Deb Pal -- ch. 16. Neonatal hyperbilirubinaemia in developing countries / Therese Hesketh -- ch. 17. Low birth weight newborns - the risks in infancy and beyond / Dipak K. Guha -- ch. 18. Does health education improve newborn care? / Alison Bolam, Dominique Tillen and Anthony Costello -- ch. 19. Community based strategies to improve newborn and infant care practices / Fehmida Jalil -- Section 4. Improving health service delivery. ch. 20. Special care of newborn at the district hospital / Dharma Manandhar -- ch. 21. Current controversies and recommendations for the care of high risk newborn infants / Meharban Singh -- ch. 22. Audit - a tool to improve the quality of perinatal care / Sophie Mancey-Jones -- ch. 23. Trained traditional birth attendants and essential newborn care in South Asia / Marta J. Levitt-Dayal -- ch. 24. TBA training: cost-effective? / Carole Presern -- ch. 25. What to do about referral and transfers of high risk mothers and newborns? / Daljit Singh -- ch. 26. Making perinatal services more user-friendly / Susan F. Murray -- ch. 27. How to improve information, education and communication for better newborn care -- Section 5. Challenges for future policy implementation and research. ch. 28. Challenges for future policy implementation and research / Anthony Costello and Sophie Mancey-Jones.

AbstractIn the first year of life, infants possess two cognitive systems encoding numerical information: one for processing the numerosity of sets of 4 or more items, and the second for tracking up to 3 objects in parallel. While a previous study showed the former system to be already present a few hours after birth, it is unknown whether the latter system is functional at this age. Here, we adapt the auditory‐visual matching paradigm that previously revealed sensitivity to large numerosities to test sensitivity to numerosities spanning the range from 2 to 12. Across studies, newborns discriminated pairs of large numerosities in a 3:1 ratio, even when the smaller numerosity was 3 (3 vs. 9). In contrast, newborn infants failed to discriminate pairs including the numerosity 2, even at the same ratio (2 vs. 6). These findings mirror the dissociation that has been reported with older infants, albeit with a discontinuity situated between numerosities 2 and 3. Two alternative explanations are compatible with our results: either newborn infants have a separate system for processing small sets, and the capacity of this system is limited to 2 objects; or newborn infants possess only one system to represent numerosities, and this system either is not functional or is extremely imprecise when it is applied to small numerosities.

AbstractThe event‐related potential (ERP) effect of mismatch negativity (MMN) was the first electrophysiological probe to evaluate cognitive processing (change detection) in newborn infants. Initial studies of MMN predicted clinical utility for this measure in identification of infants at risk for developmental cognitive deficits. These predictions have not been realized. We hypothesized that in sleeping newborn infants, measures derived from wavelet assessment of power in the MMN paradigm would be more robust markers of the brain's response to stimulus change than the ERP‐derived MMN. Consistent with this premise, we found increased power in response to unpredictable and infrequent tones compared to frequent tones. These increases were present at multiple locations on the scalp over a range of latencies and frequencies and occurred even in the absence of an ERP‐derived MMN. There were two predominant effects. First, theta band power was elevated at middle and late latencies (200 to 600 ms), suggesting that neocortical theta rhythms that subserve working memory in adults are present at birth. Second, late latency (500 ms) increased power to the unpredictable and infrequent tones was observed in the beta and gamma bands, suggesting that oscillations involved in adult cognition are also present in the neonate. These findings support the expectation that frequency dependent measures, such as wavelet power, will improve the prospects for a clinically useful test of cortical function early in the postnatal period.

This article presents moral philosophical arguments regarding life-saving medical treatment that may be more available to infants without disabilities than to infants with intellectual disabilities. The ideas are that children with disabilities are a burden to their families and to society and that a happy life may not be attainable for these children and their families. I argue that human well-being is not based merely on individual characteristics, but is a result of the individual's relation to other people. Further, children with disabilities are not inevitably a burden to their families or society. Accordingly, intellectual disability is not a sufficient reason for withholding life-saving treatment.

Diagnosing epilepsy on a small child is a challenge. A child's brain undergoes tremendous changes during the first years, creating new neural connections every second. It follows from this that what the parents and the physician may regard as abnormal behavior, can be perfectly normal. However, in some cases the abnormal behavior may be caused by epilepsy. In that case, either a detailed description of the seizure or, preferably, an eye-witness' recording of it is invaluable in terms of making an accurate diagnosis. Naturally, an EEG is also needed. Obtaining relevant, detailed information from parents is not always a straightforward matter. In order to enable collecting more accurate information about episodes that are potentially epileptic, new practices and technologies are needed. In the following viewpoint we present what can be called the missing piece of software.

Approximately 1.5 million neonates receive general anesthesia each year for a surgical procedure. Despite this being an essential practice, a number of recent studies now indicate that anesthetic exposure could cause toxicity and neuronal apoptosis in the developing brain. This could potentially influence long-term neurodevelopmental outcome, especially premature infants in need of multiple surgical procedures. Most anesthetic drugs routinely administered to neonates have not been adequately tested for safety or efficacy. Given the number of confounders, dosing is often extrapolated from adults. This is concerning since many different drugs can be administered concurrently, with few of these agents actually approved for use by the Food and Drug Administration. Since 1997, legislation has been passed in the United States and abroad encouraging more drug investigation in infants and children. This has resulted in over 500 labeling changes to products regarding safety and efficacy in various pediatric age groups. However, only three drugs routinely used as anesthetic agents in newborn infants have had any updated labeling (none in very premature infants). This "off-label" use without adequate testing must be addressed. Therefore, more clinical trials of common anesthetic agents used alone and in combination in neonates are urgently needed.

Several previous experiments have found that newborn and young infants will spend more time looking at attractive faces when these are shown paired with faces judged by adults to be unattractive. Two experimental conditions are described whose aim was to find whether the 'attractiveness effect' is affected by the orientation of the facial stimuli. Pairs of attractive and less attractive faces (as judged by adults) were shown to newborn infants (mean age 2 days 20.5 hours), where each pair was presented both upright and inverted through 180°. In the former (upright) condition, but not the latter (inverted) condition, the infants looked longer at the attractive faces, and the difference in attractiveness preference between the conditions was statistically significant. These findings are clear evidence that infants' early representation of faces contains information about faces that is orientation‐specific. The results are discussed in terms of innate facial representations and rapid learning about faces in the hours from birth.

Objective To determine home based newborn care practices in rural Nepal in order to inform strategies to improve neonatal outcome.Design Cross sectional, retrospective study using structured interviews.Setting Makwanpur district, Nepal.Participants 5411 married women aged 15 to 49 years who had given birth to a live baby in the past year.Main outcome measures Attendance at delivery, hygiene, thermal care, and early feeding practices.Results 4893 (90%) women gave birth at home. Attendance at delivery by skilled government health workers was low (334, 6%), as was attendance by traditional birth attendants (267, 5%). Only 461 (8%) women had used a clean home delivery kit, and about half of attendants had washed their,hands. Only 3482 (64%) newborn infants had been wrapped within half an hour of birth, and 4992 (92%) had been bathed within the first hour. 99% (5362) of babies were breast fed, 91% (4939) within six hours of birth. Practices with respect to colostrum and prelacteals were not a cause for anxiety.Conclusions Health promotion interventions most likely to improve newborn health in this setting include increasing attendance at delivery by skilled service providers, improving information for families about basic perinatal care, promotion of clean delivery practices, early cord cutting and wrapping of the baby, and avoidance of early bathing.

Mothers and their partners were interviewed in the Labor and Delivery units of two hospitals in Tennessee. An association was found between level of mother's concern about caring for her child and a mismatch between partners' expectations for father's helpful involvement in certain aspects of parenting. The perinatal period while parents are in health care settings provides opportune time for family life education approaches that explore couples' expectations for paternal involvement and their parenting concerns.

In this study the ability of newborn infants to learn arbitrary auditory–visual associations in the absence versus presence of amodal (redundant) and contingent information was investigated. In the auditory‐noncontingent condition 2‐day‐old infants were familiarized to two alternating visual stimuli (differing in colour and orientation), each accompanied by its 'own' sound: when the visual stimulus was presented the sound was continuously presented, independently of whether the infant looked at the visual stimulus. In the auditory‐contingent condition the auditory stimulus was presented only when the infant looked at the visual stimulus: thus, presentation of the sound was contingent upon infant looking. On the post‐familiarization test trials attention recovered strongly to a novel auditory–visual combination in the auditory‐contingent condition, but remained low, and indistinguishable from attention to the familiar combination, in the auditory‐noncontingent condition. These findings are a clear demonstration that newborn infants' learning of arbitrary auditory–visual associations is constrained and guided by the presence of redundant (amodal) contingent information. The findings give strong support to Bahrick's theory of early intermodal perception.

AIMS: To describe the pattern of hypothermia and cold stress after delivery among a normal neonatal population in Nepal; to provide practical advice for improving thermal care in a resource limited maternity hospital. METHODS: The principal government funded maternity hospital in Kathmandu, Nepal, with an annual delivery rate of 15,000 (constituting 40% of all Kathmandu Valley deliveries), severe resource limitations (annual budget Pounds 250,000), and a cold winter climate provided the setting. Thirty five healthy term neonates not requiring special care were enrolled for study within 90 minutes of birth. Continuous ambulatory temperature monitoring, using microthermistor skin probes for forehead and axilla, a flexible rectal probe, and a black ball probe placed next to the infant for ambient temperature, was carried out. All probes were connected to a compact battery powered Squirrel Memory Logger, giving a temperature reading to 0.2 degree C at five minute intervals for 24 hours. Severity and duration of hypothermia, using cutoff values of core temperature less than 36 degrees C, 34 degrees C, and 32 degrees C; and cold stress, using cutoff values of skin-core (forehead-axilla) temperature difference greater than 3 degrees C and 4 degrees C were the main outcome measures. RESULTS: Twenty four hour mean ambient temperatures were generally lower than the WHO recommended level of 25 degrees C (median 22.3 degrees C, range 15.1-27.5 degrees C). Postnatal hypothermia was prolonged, with axillary core temperatures only reaching 36 degrees C after a mean of 6.4 hours (range 0-21.1; SD 4.6). There was persistent and increasing cold stress over the first 24 hours with the core-skin (axillary-forehead) temperature gap exceeding 3 degrees C for more than half of the first 24 hours. CONCLUSIONS: Continuous ambulatory recording identifies weak links in the "warm chain" for neonates. The severity and duration of thermal problems was greater than expected even in a hospital setting where some of the WHO recommendations had ...