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Gastroesophageal reflux symptoms in infants in a rural population: longitudinal data over the first six months
Robert S Van Howe, Michelle R Storms
BMC Pediatrics , 2010, DOI: 10.1186/1471-2431-10-7
Abstract: In a prospective cohort study in the rural Upper Peninsula of Michigan, 128 consecutive maternal-infant pairs were followed for six months and administered the Infant Gastroesophageal Reflux Questionnaire Revised (I-GERQ-R) at the one-month, two-month, four-month, and six-month well-child visits.The I-GERQ-R scores decreased with age. Average scores were 11.74 (SE = 5.97) at one-month, 9.97(4.92) at two-months, 8.44(4.39) at four-months, and 6.97(4.05) at six months. Symptoms associated with colic were greatest at one month of age.Symptoms of gastroesophageal reflux as measured by the I-GERQ-R decrease with age in the first six months of life in otherwise healthy infants; however the I-GERQ-R may have difficulty differentiating gastroesophageal reflux disease from colic in those under 3 months of age.Gastroesophageal reflux (GER) can be a normal physiological process that occurs in healthy infants, children, and adults. GER occurs when gastric contents move into the esophagus as the result of transient relaxations of the lower esophageal sphincter (LES), an abrupt decrease in LES pressure to the level of intragastric pressure unrelated to swallowing, or when the LES tone does not compensate for changes in abdominal pressure[1]. The definition of gastroesophageal reflux disease (GERD), especially in infants, is nebulous. Recently, an expert panel opined that GERD occurred when the reflux of gastric contents is the cause of "troublesome symptoms" and/or complications. "Troublesome" was defined as having "an adverse effect on the well-being" of the patient. The panel did not endorse any objective measures for diagnosing GERD[2].Another expert panel concluded that there was no evidence to support an empiric trial of acid suppression in infants with symptoms associated with GER[3]. Despite this, many physicians, seeing that parents are concerned or upset by their infant's continual spitting up, are now prescribing both histamine type 2 blocking agents and proton pump inh
Regurgitation in healthy and non healthy infants
Flavia Indrio, Giuseppe Riezzo, Francesco Raimondi, Luciano Cavallo, Ruggiero Francavilla
Italian Journal of Pediatrics , 2009, DOI: 10.1186/1824-7288-35-39
Abstract: Regurgitation is defined as the passage of refluxed gastric content into the oral pharynx whilst vomiting is defined as expulsion of the refluxed gastric content from the mouth. The frequency of regurgitation may vary largely in relation to age and younger infants up to first month of age are more frequently affected by regurgitation. Gastroesophageal reflux (GER) is the backward flow of stomach contents up into the esophagus or the mouth. It happens to everyone. In babies, a small amount of GER is normal and almost always goes away by the time a child is 18 months old. The consensus statements that comprise the definition of gastroesophageal reflux disease (GERD) in the pediatric population were developed through a rigorous process [1]. Consensus items of particular note were: (i) GERD is present when reflux of gastric contents causes troublesome symptoms and/or complications, but this definition is complicated by unreliable reporting of symptoms in children under the age of approximately 8 years; (ii) histology has limited use in establishing or excluding a diagnosis of GERD; its primary role is to exclude other conditions; (iii) Barrett's esophagus should be defined as esophageal metaplasia that is intestinal metaplasia positive or negative; and (iv) extraesophageal conditions may be associated with GERD, but for most of these conditions causality remains to be established. The prevalence and natural history of gastroesophageal reflux in infants have been poorly documented. In a recent pediatric prospective survey, the 12% of Italian infants satisfied the Rome II criteria for infant regurgitation. Eighty-eight percent of the infants who had completed two-years follow-up period had improved at the age of 12 months. Only one apart 210 infants turned out to have GERD [2].Diagnostic investigation of infants who regurgitate, but gain weight satisfactorily and do not exhibit other signs or symptoms is not indicated in clinical practice. The North American Society for P
Cochlear Implantation after Bacterial Meningitis in Infants Younger Than 9 Months  [PDF]
B. Y. Roukema,M. C. Van Loon,C. Smits,C. F. Smit,S. T. Goverts,P. Merkus,E. F. Hensen
International Journal of Otolaryngology , 2011, DOI: 10.1155/2011/845879
Abstract: Objective. To describe the audiological, anesthesiological, and surgical key points of cochlear implantation after bacterial meningitis in very young infants. Material and Methods. Between 2005 and 2010, 4 patients received 7 cochlear implants before the age of 9 months (range 4–8 months) because of profound hearing loss after pneumococcal meningitis. Results. Full electrode insertions were achieved in all operated ears. The audiological and linguistic outcome varied considerably, with categories of auditory performance (CAP) scores between 3 and 6, and speech intelligibility rating (SIR) scores between 0 and 5. The audiological, anesthesiological, and surgical issues that apply in this patient group are discussed. Conclusion. Cochlear implantation in very young postmeningitic infants is challenging due to their young age, sequelae of meningitis, and the risk of cochlear obliteration. A swift diagnostic workup is essential, specific audiological, anesthesiological, and surgical considerations apply, and the outcome is variable even in successful implantations.
Plasma colloid osmotic pressure in healthy infants
Jeffrey B Sussmane, de Maria Soto, Dan Torbati
Critical Care , 2001, DOI: 10.1186/cc1043
Abstract: Plasma COP was measured in 37 male and female healthy infants from 1 to 11 months old. For this purpose, 1 ml blood was collected during the patient's regularly scheduled visit if the patient required any type of blood test for routine laboratory analyses.Plasma COP levels correlated slightly with increasing age from 1 to 9 months old (linear regression analysis; r2 = 0.1, P < 0.049). We found no correlation between plasma COP and body weight at the same age (r2 = 0.05, P = 0.155). The mean and standard deviation of COP in all infants was 25.1 ± 2.6 mmHg, which is almost identical to an average COP of 25 mmHg in healthy adult subjects. Arbitrary division of the infants into three different age groups (1–3 months [n = 11], 5–8 months [n = 13] and 9–11 months [n = 13]) showed an average increase of approximately 2 mmHg in COP of 9-month-old to 11-month-old infants, compared with 1-month-old to 3-month-old infants (one-way analysis of variance; P = 0.26). There was no gender difference in the COP level (unpaired t-test), with an average of 25.1 ± 2.4 mmHg in 19 male infants compared with 25.2 ± 2.9 in 18 female infants. The 95% confidence interval for COP in both male and female infants (n = 37) was between 24.3 to 26.0 mmHg, ranging from 19.5 to 30.3 mmHg, with a median value of 25.2 mmHg.The data accept the null hypothesis that the COP range in infants younger than 1 year old is similar to those observed in adult subjects. Our observations, compared with previously reported neonatal COP values, suggest that there is a sharp increase in COP within the first months after birth.Plasma COP is generated by the plasma proteins, particularly albumin, and is known to vary during various neonatal diseases [1,2,3,4]. Lower plasma COP favors a fluid shift from intravascular space into interstitial space, with subsequent formation of peripheral and pulmonary edema [3,4,5,6,7,8]. To stabilize the intravascular volume and prevent or reverse the events leading to peripheral and pul
The foot posture index, ankle lunge test, Beighton scale and the lower limb assessment score in healthy children: a reliability study
Angela M Evans, Keith Rome, Lauren Peet
Journal of Foot and Ankle Research , 2012, DOI: 10.1186/1757-1146-5-1
Abstract: A repeated measures, same-subject design assessed the intra- and inter-rater reliability of measures of foot posture, joint hypermobility and ankle range: the Foot Posture Index (FPI-6), the ankle lunge test, the Beighton scale and the lower limb assessment scale (LLAS), used by two examiners in 30 healthy children (aged 7 to 15 years). The Oxford Ankle Foot Questionnaire (OxAFQ-C) was completed by participants and a parent, to assess the extent of foot and ankle problems.The OxAFQ-C demonstrated a mean (SD) score of 6 (6) in adults and 7(5) for children, showing good agreement between parents and children, and which indicates mid-range (transient) disability. Intra-rater reliability was good for the FPI-6 (ICC = 0.93 - 0.94), ankle lunge test (ICC = 0.85-0.95), Beighton scale (ICC = 0.96-0.98) and LLAS (ICC = 0.90-0.98). Inter-rater reliability was largely good for each of the: FPI-6 (ICC = 0.79), ankle lunge test (ICC = 0.83), Beighton scale (ICC = 0.73) and LLAS (ICC = 0.78).The four measures investigated demonstrated adequate intra-rater and inter-rater reliability in this paediatric sample, which further justifies their use in clinical practice.Outcome measures are important when evaluating effectiveness of treatment and progress towards a final goal in paediatric populations. A Cochrane systematic review published by us recently highlighted the importance of the use of reliable and validated outcome measures [1]. However, the current evidence around the use of reliable outcome measures in paediatric populations is sparse.In the paediatric health care setting, measuring children's progress towards individual outcomes is increasingly important. Such measurements must be individual, in view of the diversity of developmental disabilities, goals, and interventions. The heterogeneity of the population often induces researchers to use generic standardised measurement tools or health-related quality of life measures; however, many are limited in terms of specificity a
Contrast sensitivity threshold measured by sweep-visual evoked potential in term and preterm infants at 3 and 10 months of age
Oliveira, A.G.F.;Costa, M.F.;Souza, J.M. de;Ventura, D.F.;
Brazilian Journal of Medical and Biological Research , 2004, DOI: 10.1590/S0100-879X2004000900014
Abstract: although healthy preterm infants frequently seem to be more attentive to visual stimuli and to fix on them longer than full-term infants, no difference in visual acuity has been reported compared to term infants. we evaluated the contrast sensitivity (cs) function of term (n = 5) and healthy preterm (n = 11) infants at 3 and 10 months of life using sweep-visual evoked potentials. two spatial frequencies were studied: low (0.2 cycles per degrees, cpd) and medium (4.0 cpd). the mean contrast sensitivity (expressed in percentage of contrast) of the preterm infants at 3 months was 55.4 for the low spatial frequency (0.2 cpd) and 43.4 for the medium spatial frequency (4.0 cpd). at 10 months the low spatial cs was 52.7 and the medium spatial cs was 9.9. the results for the term infants at 3 months were 55.1 for the low spatial frequency and 34.5 for the medium spatial frequency. at 10 months the equivalent values were 54.3 and 14.4, respectively. no difference was found using the mann-whitney rank sum t-test between term and preterm infants for the low frequency at 3 or 10 months or for the medium spatial frequency at 3 or 10 months. the development of cs for the medium spatial frequency was equally fast for term and preterm infants. as also observed for visual acuity, cs was equivalent among term and preterm infants, suggesting that visual experience does not modify the development of the primary visual pathway. an earlier development of synapses in higher cortical visual areas of preterm infants could explain the better use of visual information observed behaviorally in these infants.
Contrast sensitivity threshold measured by sweep-visual evoked potential in term and preterm infants at 3 and 10 months of age  [cached]
Oliveira A.G.F.,Costa M.F.,Souza J.M. de,Ventura D.F.
Brazilian Journal of Medical and Biological Research , 2004,
Abstract: Although healthy preterm infants frequently seem to be more attentive to visual stimuli and to fix on them longer than full-term infants, no difference in visual acuity has been reported compared to term infants. We evaluated the contrast sensitivity (CS) function of term (N = 5) and healthy preterm (N = 11) infants at 3 and 10 months of life using sweep-visual evoked potentials. Two spatial frequencies were studied: low (0.2 cycles per degrees, cpd) and medium (4.0 cpd). The mean contrast sensitivity (expressed in percentage of contrast) of the preterm infants at 3 months was 55.4 for the low spatial frequency (0.2 cpd) and 43.4 for the medium spatial frequency (4.0 cpd). At 10 months the low spatial CS was 52.7 and the medium spatial CS was 9.9. The results for the term infants at 3 months were 55.1 for the low spatial frequency and 34.5 for the medium spatial frequency. At 10 months the equivalent values were 54.3 and 14.4, respectively. No difference was found using the Mann-Whitney rank sum T-test between term and preterm infants for the low frequency at 3 or 10 months or for the medium spatial frequency at 3 or 10 months. The development of CS for the medium spatial frequency was equally fast for term and preterm infants. As also observed for visual acuity, CS was equivalent among term and preterm infants, suggesting that visual experience does not modify the development of the primary visual pathway. An earlier development of synapses in higher cortical visual areas of preterm infants could explain the better use of visual information observed behaviorally in these infants.
Gross Motor Development of Low Birth Weight Infants With the History of Being in Aliasghar Hospital Corrected Aged 8 To 12 Months
Faranak Ali Abadi,Sepide Nazi,Bahare Maghfori
Modern Rehabilitation , 2011,
Abstract: Background and aim: The aim of this study was to compare the gross motor development between Low Birth Weight (LBW) infants and Normal Birth Weight infants (NBW) at the age of 8-12 months by using the Peabody Developmental Motor Scale-2 (PDMS-2).Material and Methods: This was a non experimental and cross sectional study which was conducted on 18 LBW infants with the history of being in Aliasghar hospital and 14 infants with the history of normal birth weight as a control group. Gathering the information was done by completing Questioner and then by using the Peabody Developmental Motor Scale-2 (PDMS-2). Finally the scores of the motor quotients were analyzed by independent T test statistical method.Results: There was a significant difference (p= 0.002) between the mean gross motor quotient of LBW (90.83) and NBW ( 106.78).Conclusion: This study showed that LBW infants attain low scores of gross motor skills in comparison with normal weight infants. It indicated that the LBW infants are more prone to motor development difficulties .
Cochlear Implantation after Bacterial Meningitis in Infants Younger Than 9 Months  [PDF]
B. Y. Roukema,M. C. Van Loon,C. Smits,C. F. Smit,S. T. Goverts,P. Merkus,E. F. Hensen
International Journal of Otolaryngology , 2011, DOI: 10.1155/2011/845879
Abstract: Objective. To describe the audiological, anesthesiological, and surgical key points of cochlear implantation after bacterial meningitis in very young infants. Material and Methods. Between 2005 and 2010, 4 patients received 7 cochlear implants before the age of 9 months (range 4–8 months) because of profound hearing loss after pneumococcal meningitis. Results. Full electrode insertions were achieved in all operated ears. The audiological and linguistic outcome varied considerably, with categories of auditory performance (CAP) scores between 3 and 6, and speech intelligibility rating (SIR) scores between 0 and 5. The audiological, anesthesiological, and surgical issues that apply in this patient group are discussed. Conclusion. Cochlear implantation in very young postmeningitic infants is challenging due to their young age, sequelae of meningitis, and the risk of cochlear obliteration. A swift diagnostic workup is essential, specific audiological, anesthesiological, and surgical considerations apply, and the outcome is variable even in successful implantations. 1. Introduction Current standards for cochlear implantation in infants with severe congenital sensorineural hearing loss (SNHL) advocate an age at implantation between 9 and 12 months. On the one hand, a growing body of evidence indicates that hearing rehabilitation is more effective when the patient is implanted at a young age [1–4]. On the other hand, a certain period of time is needed to determine a reliable hearing threshold, to allow for improvement of hearing due to maturation of the auditory system after birth, and to test the performance of the patient with hearing aids [5]. Furthermore, the benefits of cochlear implantation before the age of 9 months should be weighed against the higher risk of anesthesia at this young age [5]. In case of sensorineural hearing loss caused by acute bacterial meningitis, different considerations apply. A swift diagnostic workup is imperative because of the risk of cochlear fibrosis and subsequent obliteration of the cochlear lumen, which may occur within weeks after the onset of meningitis, especially if the meningitis is caused by pneumococci [6, 7]. This diagnostic workup should include a thorough evaluation of the hearing as well as adequate imaging of the cochlea in order to assess the need and feasibility of cochlear implantation. In infants that suffer from postmeningitic SNHL, this may lead to an indication for cochlear implantation at an age younger than 9 months. If so, this patient group presents the cochlear implant (CI) team with a very specific
The effect of poverty on developmental screening scores among infants
Paiva, Giselle Souza de;Lima, Ana Cláudia Vasconcelos Martins de Souza;Lima, Marilia de Carvalho;Eickmann, Sophie Helena;
Sao Paulo Medical Journal , 2010, DOI: 10.1590/S1516-31802010000500007
Abstract: context and objective: child development is negatively influenced by multiple risk factors associated with poverty, thus indicating the importance of identifying the most vulnerable groups within populations that are apparently homogeneous regarding their state of socioeconomic deprivation. this study aimed to identify different levels of poverty in a population of low socioeconomic condition and to ascertain their influence on infants' neuropsychomotor development. design and setting: cross-sectional study conducted at four family health units in the health district iv in the city of recife, brazil. methods: the sample comprised 136 infants aged 9 to 12 months, which represented 86% of all the infants in this age group, registered at the units studied. socioeconomic status was assessed through a specific index and child development through the bayley iii screening test. results: around 20% of the families were in the lowest quartile of the socioeconomic level index and these presented the highest frequency of infants with suspected delay in receptive communication. maternal and paternal unemployment negatively influenced receptive communication and cognition, respectively. not possessing a cell phone (a reflection of low socioeconomic status) was associated with worse cognitive performance and gross motricity. male infants showed a higher frequency of suspected delay in receptive communication. conclusions: infants of more precarious socioeconomic status more frequently present suspected developmental delay. development monitoring and intervention programs should be encouraged for this subgroup, thereby providing these children with a better chance of becoming productive citizens in the future.
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