Breathing patterns in term infants delivered by caesarean section.

AIM: To compare the breathing patterns of infants born by elective caesarean section to those infants delivered by caesarean section after a failed trial of labour. METHODS: Healthy term infants born by caesarean section were studied. The study group (n = 13) had no trial of labour, whereas infants in the control group (n = 13) failed a trial of labour. Polysomnographic study was performed at 36 h of age. Heart and respiratory rate, type and duration of apnoeas, arterial oxygen saturation and lower limb movements were analysed. RESULTS: Term infants born by elective caesarean section had a shorter duration of pregnancy and weighed less. Their heart rate was faster, they had more mixed apnoeas, and during quiet sleep they had more central apnoeas of longer duration. CONCLUSION: Cardiorespiratory patterns in infants delivered by elective caesarean section are different from those delivered by caesarean section after a failed trial of labour.

Neurobehavioral and cognitive performances of children exposed to low-dose radiation in the Chernobyl accident: the Israeli Chernobyl Health Effects Study.

Exposure to low levels of ionizing radiation after the Chernobyl accident in the Ukraine could potentially have influenced the neurobehavioral and cognitive performances of exposed children. A cohort study of adolescents who were children at the time of the accident and who subsequently emigrated to Israel was conducted in 1998-2001. A total of 1,629 children (59% of all 2,769 invited) were included in the study (41% from higher contamination areas, 25% from lower contamination areas, 34% from noncontaminated areas). Mean scores of the Raven Standard Progressive Matrices Test were highest in children in all exposure groups whose parents had a high level of education. No overall relation was found between the cognitive function scores of the child and his/her putative radiation exposure level. Conners' test T scores did not differ significantly by level of exposure. Mothers of all exposure groups who were pregnant at the time of the accident gave their children significantly higher Conners' test scores than did those who were not pregnant. Scores for hyperactivity and attention-deficit/hyperactivity disorder were significantly higher among those who were in utero at the time of the accident. These results do not show differences of neurobehavioral or cognitive performance in exposed versus nonexposed children. There is a possible behavioral effect among offspring of pregnant mothers or mothers of very young children in all exposure levels.

Sidestream end-tidal capnometry as related to infant's position and maturation.

UNLABELLED: The objective of this study was to investigate the effect of body position on sidestream, end-tidal carbon dioxide (EtCO2) wave measurements in maturing infants. Sidestream EtCO2 wave patterns were analysed longitudinally in 20 preterm infants (born at > or = 32 wk) at 32-37 wk gestation, and in 39 full-term controls. Capnography measurements included maximal EtCO2, inspired CO2 and frequency of apnoea events (>3 s) in the supine, supine with inclination, side and prone positions. Apnoea frequency decreased during maturation, and was less prevalent in the prone than in the supine and side positions in preterm as well as in term infants (p < 0.05). No clinically significant apnoea episodes were found in our cohort. EtCO2 in term infants was lower than that in preterm infants (p < 0.05) and was not affected by sleep position in the most premature (<33 wk) and in term infants (>36 wk). EtCO2 was higher in the prone position than in supine or side positions in infants between 33 and 35 wk gestation (p < 0.01). CONCLUSION: Short apnoeic episodes decrease during maturation, and are less prevalent in the prone position in maturing infants (32-37 wk). Only modest changes in EtCO2 were recorded in the different positions during maturation.

Capnography in spontaneously breathing preterm and term infants.

OBJECTIVE: To investigate sidestream EtCO2 wave patterns as related to prematurity. DESIGN: The EtCO2 wave pattern was analyzed longitudinally in 20 sequential preterm, 32-37 weeks of gestation and 39 fullterm controls. Infants with a cardiorespiratory disease, neurological deficit or a metabolic disorder were not included in the study. Sidestream EtCO2 was employed. Wave patterns were identified and baseline expiratory/inspiratory length and wave amplitude were measured. RESULTS: Two predominant (about 75%) wave patterns were identified: (i) (with plateau) significantly more prevalent among infants born at term as compared with preterm infants across their postconceptional ages (PCA) (P=0.005-0.04), (ii) (plateau free) significantly more prevalent among the youngest preterm infants as compared with the fullterm controls. Expiratory length was significantly correlated with respiratory rate (RR) across ages (P=0.01-0.001) whereas inspiratory length was correlated with RR among the two youngest groups of infants only (P=0.002 and 0.004). Wave patterns were not found to be affected by environmental temperatures, blood pressure, body weight, haemoglobin level, aminophylline or O2 supplementation. CONCLUSION: These findings suggest that EtCO2 wave pattern distribution among preterm infants is distinctly different from that of term controls, regardless of PCA, while inspiration is related to the degree of maturity. Alveolar pathology could probably be missed by sidestream capnography.

Autism in the Haifa area--an epidemiological perspective.

BACKGROUND: Autism is a pervasive developmental disorder. The incidence rate and other related epidemiological characteristics of the Israeli population are not available. OBJECTIVES: To assess the incidence rate of autism in the Haifa area and to compare family characteristics with previous reports from other countries. METHODS: We approached facilities in the Haifa area that are involved with the diagnosis and treatment of autism. The study group comprised children born between 1989 and 1993. Records of the children were scrutinized and 69% of the mothers were interviewed. Live-birth cohorts of the same years were employed for incidence computation. RESULTS: An incidence rate of 1/1,000 was derived. Male to female ratio was 4.2:1. Pregnancy and perinatal periods were mostly uneventful. A low prevalence of developmental and emotional morbidity was reported for family members. CONCLUSIONS: The epidemiological characteristics found in the Haifa area are similar to those reported from non-Israeli communities. This finding supports an underlying biological mechanism for this disorder. These data can be used for future trend analyses in Israel.

Neurodevelopmental and behavioural characteristics in learning disabilities and attention deficit disorder.

Specific learning disability in childhood is frequently associated with attention deficit disorder. The distinction between children with and without such comorbidity is often difficult to make. Our aim was to delineate the neurocognitive and behavioural differences between children with specific learning disabilities, with and without attention deficit. Students diagnosed with learning disability, mean age 8.3, 1.4 SD (N-50), and students with learning disability and attention deficit disorder, mean age 8.7, 1.4 SD (N-50), were assessed. The Paediatric Early Elementary Examination and the Aggregate Neurobehavioural Student Health Education Review were administered and their scores as well as pattern of correlations within and between domains were analysed. Only few differences in neurocognitive functions between these groups were evident. Most neurocognitive domains were similarly intercorrelated in the two groups. However, recall was correlated with other neurocognitive domains only among the children with learning and attention deficits. A proportion of significant correlations between neurocognitive and behavioural domains was found among the children with learning disability and attention deficit disorder, but not among the children with learning disability only. It appears that while neurocognitive profiles are similar in these two groups, their interrelationship with behavioural patterns differ. These findings give support to the neurological origin of attention deficit disorder related behaviours among learning disabled children. Different interventions should therefore be considered for each of these entities.

Object concept and sleep regulation.

The association between infants' cognitive development and sleep regulation was investigated in 83 infants not at risk. It was found that 9-mo.-old infants with a more advanced object concept had significantly fewer sleep difficulties compared to infants with lower level of object permanence.

The relationship between gastroesophageal reflux and apnea in infants.

OBJECTIVE: To determine the prevalence and relationship between apnea and gastroesophageal reflux (GER) among infants with apparent life-threatening events. METHODS: We evaluated 67 infants of ages up to 6 months who had an idiopathic apparent life-threatening event as determined by polysomnography and pH monitoring. RESULTS: No reflux (pH < 4 for more than 6 seconds) was evident in 32 infants. Fourteen others had such prolonged reflux that the relationship between apnea and reflux could not be evaluated. The 21 remaining infants who had episodes of apnea and reflux constituted the study group. In 81% of the apneic episodes, no relationship to GER was noted. Apnea preceded reflux in 93.6% of the episodes, and only 6.4% of the apneic episodes followed reflux. When apnea preceded reflux, the apnea was obstructive in 66.8% of episodes and mixed in 33.2%. Central apnea was not recorded preceding reflux. CONCLUSIONS: Episodes of apnea were seldom associated with GER. However, in those instances when apnea and reflux were associated, the predominant sequence of events was obstructive apnea and to a lesser extent mixed apnea followed by reflux.

Growth patterns among infants with language deficits: a case-control study.

We compared growth parameters in infants with language delay to those in children with global delay and to typical controls. Thirty infants with expressive language delay and 36 with combined expressive and receptive language delay were compared with 27 infants with general development delay and with 124 controls. Data on weight, height, head circumference, and feeding behavior were obtained from birth up to age 78 weeks, and converted to percentiles. Medical and sociodemographic data were also evaluated. The weight curves in the combined expressive and receptive language delay group were significantly lower than in the comparison groups, but no cases of failure to thrive were noted. Height and head circumference curves in the combined expressive and receptive language delay group were also lower than in the typical controls. Infants with combined expressive and receptive language delay were lighter and shorter than controls. However, none of the parameters were more than two standard deviations below the mean. It is possible that this finding is of constitutional origin.

Developmental regression in autism: maternal perception.

Developmental regression among children with autism is a common phenomenon of unknown origin. The purpose of this study was to identify the differences between children with autism who reportedly regressed with those who did not regress. A representative group of 39 mothers were interviewed (40 children--1 pair of twin girls) about familial, pregnancy, perinatal, as well as medical history and developmental milestones. The study focused on mothers' perceptions of developmental regression. Nineteen children (47.5%) regressed in verbal and nonverbal communication and social but not in motor abilities. Mean age of regression was 24 months, with 11 children who regressed before and 8 after this age. No significant differences were reported by mothers of children who did or did not regress. More mothers of children who regressed, than those of children who did not, expressed guilt feelings regarding the development of autism, and almost all of them had an "explanation" for the possible mechanisms that might have influenced their children's developmental course. In conclusion, developmental regression in our population appears to be a typical event in the natural course of autism. There is little difference between those children who regressed and those who did not regress in maternal perceptions and reports of development, family, and medical history.

Sleep position, bedding and heating practices in high- and low-risk ethnic groups for unexpected death in infancy (UDI).

UNLABELLED: In a previous study, a significant increased risk for unexpected death in infancy (UDI) among Arab infants as compared to Jews (RR: 5.2) was found. The incidence has significantly decreased in both groups during the 'back to sleep' campaign. The objective of this study was to compare the prevalence of three risk factors, i.e. positioning, night dressing/covering and heating practices in these ethnic groups. A community sampling procedure was employed, resulting in the participation of 264 Jewish and 146 Arab mothers of infants between 1 and 4 months, born at term and with no chronic illness at the time of the study. A questionnaire in Arabic and Hebrew was designed, pertaining to sleep positioning at the time of the study and of the previous infant, prior to the SIDS prevention campaign, as well as clothing and heating practices. Significantly, more Arab infants were put to sleep in a supine or side position as compared to Jewish infants both during the study (p = 0.002) as well as prior to the SIDS campaign (p = 0.001). No ethnic difference was related to clothing practices. Open heating, however, was significantly more common in the Arab sector (p = 0.001). A logistic procedure for each of the practices indicated that ethnicity is related significantly to both sleep position (p = 0.002) and beating practices (p = 0.001). Prone sleep positioning was still prevalent (32.2%) more so among Jews (35.2%) than Arabs (27%). CONCLUSION: Sleep positioning and overdressing do not appear to be the major attributable risk factors for UDI among Arab infants as compared to Jews. The compliance with positioning recommendations is lower than expected in both ethnic groups.

Physical abuse--physicians knowledge and reporting attitude in Israel.

UNLABELLED: The objective of this study was to assess knowledge and attitudes towards physical child abuse among pediatricians and family physicians in northern Israel. METHODS: An interview consisting of multiple choice questions and vignettes were employed. A stratified sample of 107 physicians from hospitals and community clinics and of different disciplines and educational cultural backgrounds was surveyed. RESULTS: Child abuse diagnosis was considered infrequently or not at all by 43% of the participants and a proportion of them were hesitant in their reporting intentions. A low consistency in the approach to diagnosis and management was found. Medical discipline, sex and age of the physician as well as level of knowledge and the family's socioeconomic status were not significantly related to reporting behaviors. A significant effect of medical training/cultural background (p = 0.01) and medical discipline (p = 0.04) on knowledge of child abuse were found. No relationship between knowledge and reporting behaviour was found. CONCLUSION: The results of this study are a reason for concern. A more active role of medical schools and health administrations in abuse-oriented education and training effort is required, particularly in societies in transition.

Infants with a thumb-in-fist posture.

OBJECTIVE: In early infancy the infant's thumb is not infrequently enclosed within the palm, ie, thumb-in-fist (TIF). This posture has received scant attention in the neurodevelopmental literature. Its prevalence, resolution, and clinical associations were investigated in this study. METHODOLOGY: Two hundred sequentially born, apparently healthy full-term newborn infants comprised the cohort. The whole study group was followed up until the disappearance of the TIF occurred. In the first 150 of the cohort, additional data on development and the neurological status were obtained at 12 months of life. RESULTS: In 125 infants (62.5%) of the total cohort, a TIF was noted. The mean age of disappearance was 1.5 months, and no TIF persisted after 7 months old. No relationship was noted between the TIF resolution and abnormal neurological signs or gross or fine motor development. The only association noted between age of resolution of the TIF and the neurodevelopmental status was a delay in language attainment at the 12-month screening. CONCLUSIONS: The TIF posture in infancy was noted in 65% of our cohort, and it had resolved in all infants by 7 months old. Therefore, a TIF posture after this age should alert the clinician to the possibility of possible neurological dysfunction. An unanticipated association of a delay in the 12-month language milestone attainment was noted in those infants with later resolution of the TIF posture. No data on language development in this group were obtained after 12 months old; therefore, the clinical significance of this finding is not yet elucidated.

Hand preference as related to development and behavior in infancy.

55 healthy infants were assessed for their developmental and behavioral patterns at the age of 9 mo. Hand preference was assessed at 20 mo. of age. The distribution of hand preference showed 12 were right-handed, 11 left-handed and 23 ambidextrous. This distribution appears shifted more to the left than that reported for older children. Although their data were based on different tests not appropriate for 9-mo.-old infants, ambidexterity appeared to reflect part of the hand-preference continuum. No significant relationship between hand preference and developmental attainments was noted. Perhaps a larger sample would provide a clear developmental behavioral pattern and hand preference in infancy.

Outcome of idiopathic apparent life-threatening events: infant and mother perspectives.

The objective of this study was to determine the neurodevelopmental and temperamental outcome of infants who suffered an idiopathic apparent life-threatening event (IALTE) and their mothers' perceptions of such an event, and to compare such infants with a matched group of babies hospitalized for nonthreatening events. Infants (N = 19) who were hospitalized at a mean age of 2.8 months for an IALTE with no underlying disease and matched controls hospitalized for an acute nonthreatening illness were sequentially recruited to the study at a mean age of 24 months (SD, 14 months). Physical, neurological, developmental, and temperamental status were assessed. Mothers' stress was assessed by their salivary cortisol response to the physical examination of their infants and completion of appropriate questionnaires assessing their infants' temperament. The investigators were not blinded to the assignment of the infants to each of the study groups. Infants' perceived "difficultness" was positively correlated with the time interval following the event (r = 0.5, P = 0.001), mothers' stress as related to their child (r = 0.4, P = 0.004), and mothers' cortisol response (r = 0.5, P = 0.01) among the study group mothers only. IALTE during early infancy was associated with developmentally and neurologically normal outcome in infancy. We conclude that mothers of infants with IALTE differed in the way they perceived their infants' temperament over time, and in their stress response compared to mothers of a control group of hospitalized children who had not experienced an IALTE.

Language deficit with attention-deficit disorder: a prevalent comorbidity.

The aim of this study was to delineate the prevalence and behavioral patterns of children with attention-deficit and language problems as compared to children with attention-deficit hyperactivity disorder (ADHD) only. Out of a cohort of 3208 children 6 to 11 years old, 5.2% were identified as having a primary ADHD. A teacher's behavioral questionnaire, pediatric interview and assessment, IQ, attention tests, and language evaluation were employed. A 45% rate of language problems was identified. This comorbidity is more prevalent among girls (P = .02). Sequencing and short-term memory were significantly related to attention-deficit and language problems, but the attention scores were not. Language performance was the best predictor of group assignment and was superior to IQ in that regard. Correlation analysis revealed a different behavioral pattern for the two groups. It appears that a significant proportion of children with ADHD have a language comorbidity not reflected by IQ assessments; therefore, language tests should be considered as part of their routine assessment. Children with attention-deficit and language problems appear to have a different neurocognitive pattern underlying their problems as compared with their peers with ADHD only.

The relationship between sleep and temperament revisited: evidence for 12-month-olds: a research note.

This study measured the sleep attributes of 30 normal 12-month-old children with a computerized movement detector (Actigraph). Data on the child's temperament was based on the Carey Toddler Temperament Questionnaire, which the mother completed. The main finding was that rhythmic children went to sleep earlier and had longer sleep duration; however, their sleep pattern was not more efficient compared to children with irregular rhythmicity. The results of the present study provide only limited evidence to the association between the regulation of sleep-wake cycles and the temperamental characteristics of the child. Hence it may be concluded that within non-referred low-risk infants, temperament does not discriminate between good and poor sleepers. Alternatively, however, the marginal relationship between sleep and temperament demonstrated in the present study may reflect the limitation of maternal perception as a source for temperament assessment.