Developmental outcome of preterm infants with intraventricular hemorrhage at one and two years of age

Around 1980, many perinatal centers began prospective cranial screening of preterm infants using portable ultrasonography at the bedside. This study examined developmental outcome at 1 and 2 years in relation to the presence and severity of neonatal intraventricular hemorrhage (IVH). It varies from earlier reports in the size of the sample, restriction to infants without periventricular leukomalacia (PVL), and an attempt to formulate a predictive model by examining development longitudinally. Parametric and nonparametric analyses demonstrated that IVH related to Bayley mental and motor scores and neurologic ratings at 1 year but not at 2 years. Developmental delay and/or neurologic abnormality were more prevalent in infants with severe IVH but were far from universal. Regression analyses on prediction from neonatal and 1-year performance to 2-year scores revealed significant associations between the 1- and 2-year measures but not the neonatal and outcome measures. A direct insult to the CNS such as IVH thus constitutes only a limited model of risk status.     

Prediction of five-year Stanford-Binet scores in preterm infants

The development of a group of 100 preterm infants, mean birth weight 1,877 grams, from a broad range of social class and ethnic backgrounds was followed from birth to age 5. Assessments in infancy were directed at medical problems and early perceptual, motor, social, and cognitive development. The child's performance on the Stanford-Binet test at age 5 could not be predicted from early hazardous events in the obstetrical or neonatal period. The results indicate that developmental outcome at age 5 could be predicted moderately from a single measure, infant visual attention, administered as early as term date. Prediction was improved by using a combination of assessments given during the first 9 months. Furthermore, prediction was significantly better for girls than for boys. Although moderate stability in performance was found for the group as a whole, prediction of an individual's performance resulted in a substantial number of children being misclassified. Social factors were more important than any other set of factors in relating to the child's mental performance at age 5.     

The organization of exploratory behavior in Down syndrome and nondelayed infants

The exploratory behaviors of a sample of 11 infants with Down syndrome and 11 nondelayed infants, matched on Bayley mental raw scores and gender, were analyzed. Transitional probabilities and z scores were computed for each possible behavior change as well as frequencies of each behavior. The analyses revealed significant differences in how the 2 samples distribute their exploratory activities. The significant transitional probabilities among the 6 behavioral states revealed a pattern of similarities and differences. In general, both groups of infants organized their exploratory activities in a similar manner. However, there were differences that appeared to depend on the level of exploratory sophistication. The results are discussed in the context of the similarities and differences between the samples.     

Imitation of televised models by infants

Studies indicate that infants in our culture are exposed to significant amounts of TV, often as a baby-sitting strategy by busy caretakers. The question arises whether TV viewing merely presents infants with a salient collection of moving patterns or whether they will readily pick up information depicted in this 2-D representation and incorporate it into their own behavior. Can infants "understand" the content of television enough to govern their real-world behavior accordingly? One way to explore this question is to present a model via television for infants to imitate. Infants' ability to imitate TV models was explored at 2 ages, 14 and 24 months, under conditions of immediate and deferred imitation. In deferred imitation, infants were exposed to a TV depiction of an adult manipulating a novel toy in a particular way but were not presented with the real toy until the next day. The results showed significant imitation at both ages, and furthermore showed that even the youngest group imitated after the 24-hour delay. The finding of deferred imitation of TV models has social and policy implications, because it suggests that TV viewing in the home could potentially affect infant behavior and development more than heretofore contemplated. The results also add to a growing body of literature on prelinguistic representational capacities. They do so in the dual sense of showing that infants can relate 2-D representations to their own actions on real objects in 3-D space, and moreover that the information picked up through TV can be internally represented over lengthy delays before it is used to guide the real-world action.     

Fetal drug exposure and its possible implications for learning in the preschool and school-age population

For the past 5 years there has been an exponential increase in the use of cocaine, phenylcyclidine hydrochloride (PCP), and other central nervous system (CNS) active drugs. A significant amount of this accelerated usage is in sexually active females, resulting in some urban hospitals reporting positive drug screens in over 16% of the infants born on their busy obstetrical service. There is a growing body of data showing that fetal exposure to cocaine, phenylcyclidine hydrochloride (PCP), and other CNS-active drugs results in infants and children with abnormal brain wave patterns, short-term neurologic signs, depression of interactive behavior, and poor organizational responses to environmental stimuli. Whether such neurologic findings will translate into a significant number of children with learning and behavioral problems needs to be the focus of long-term longitudinal studies of children with fetal drug exposure to cocaine, PCP, and other CNS-active drugs.     

Child protection reports and removals of infants diagnosed with prenatal substance exposure

BackgroundA frequent response for prenatal substance exposure (PSE) is intervention by child protective services (CPS). Previous research has examined differences in reports to CPS regarding PSE by substance exposure and by maternal race. However, little is known regarding the frequency of immediate removals by CPS relating to PSE and maternal race.MethodsWe investigated hospital reports to CPS and CPS removals of PSE infants by using linked birth, hospital discharge, and CPS records for all children born in Washington State between 2006 and 2013 (N = 760,863). We identified PSE using diagnostic codes, calculated prevalence by substance type and maternal race, and tested for differences by interactions of race and substance using multinomial logistic regression.ResultsPrevalence of PSE births varied by race with 8.1% of Native American, 2.8% of black, 1.9% of white, and 0.8% of Hispanic births diagnosed with PSE. Opioids was the most common type of PSE diagnosis at 48.2%. The majority of PSE infants (86.7%) were not removed by CPS but variations by substance type were observed. Of the interactions in the multinomial logistic regression model, only black infants exposed to alcohol were more likely to result in reports to CPS without removal than the referent group of white infants exposed to opioids.ConclusionsFindings indicate that most infants diagnosed with PSE were not removed by CPS and minority PSE infants were not reported to CPS or removed by CPS more than white infants. Racial differences identified in the prevalence of PSE present opportunities for targeted prevention efforts.     

The relationship between neonatal characteristics and three-month mother-infant interaction in high-risk infants

The behavior of 4 groups of infants--healthy term, healthy preterm, sick preterm, and sick full-term--was assessed in the neonatal period using the Neonatal Behavioral Assessment Scale (NBAS). At 3 months postterm, infants and their mothers were observed and videotaped in a free-play session. Both the NBAS and mother-infant interaction data were analyzed to assess the effects of maturity (term vs. preterm), illness (sick vs. healthy), and their interaction. Results revealed that illness of the infant affected both NBAS performance and maternal behavior during the interaction at 3 moths. Infants who were ill performed poorly on the NBAS orientation dimension; this dimension was found to be significantly associated with maternal and infant behaviors at 3 months. These data demonstrate an association between early infant characteristics and subsequent mother and child interactive behaviors. They also identify postnatal illness as an important influence on the development of the mother-infant dyad.     

Toward a Democratic Ethnotheory of Parenting for Families and Policymakers: A Developmental Systems Perspective

Objective. This study examines ethnic group differences in the relation between parents' use of physical discipline and children's externalizing behavior problems in younger children and assesses both same-source and distinct-source data. Design. One hundred and twelve mothers of African American (N = 63) and European American (N = 49) children were interviewed regarding their parenting strategies and their child's behavior. Preschool teacher ratings of child behavior were obtained. Results. Regression analyses revealed significant main effects for gender and discipline on externalizing behavior problems. All 2-way interactions with ethnicity were significant, but only when predicting teacher-rated behavior problems. Post-hoc analyses showed that for African American men, there was a significant negative correlation between mother-reported physical discipline and teacher-rated externalizing behavior problems. Similar correlations for African American women and the European American gender groups were not significant. Conclusions. These findings show ethnic differences in the relation between physical discipline and externalizing behavior problems for young children when distinct-source information is obtained. The study extends the literature by showing this effect is particularly strong for boys.     

Emotion socialization and expressive development in preterm and full-term infants

The expressive behaviors of full-term and preterm infants and their mothers were examined during face-to-face interaction when the infants were approximately 2 1/2, 5, and 7 1/2 months old. Videotapes of the sessions were coded on a second-to-second basis using Izard's discrete emotion coding system. Overall, infants showed a linear increase in positive effect, especially interest and joy, and a corresponding decrease in negative affect, especially pain and knit brow, with age; decrease in negative affect was accounted for largely by the preterm infants. In terms of maternal responses, there was an increase in contingent responding to infant interest expressions and a decrease in contingent responding to infant pain expressions over time, especially in the case of the preterm infant. The data set as a whole was examined further to establish the directionality of influence between mothers and infants in change patterns over time. There was evidence of learning effects in infants as a function of maternal modeling and contingency patterns. Anomalies in maternal responses to preterm infant affect expressions were observed. Mothers of these infants displayed significantly less matching or imitation of their infant's facial expressions, showed random rather than contingent responsiveness to sadness, and a significant ignoring response to infant anger. These differences were attributed to differences in gazing patterns and negative emotion expression in preterm infants. The results are discussed within a framework of emotion socialization that recognizes bidirectionality of influence in the emotional patterns of mothers and infants.     

Effects of atypical patterns of fetal growth on newborn (NBAS) behavior

Newborn infants who showed anthropometric signs of atypical patterns of fetal growth were compared with infants of appropriate growth on the Neonatal Behavioral Assessment Scale (NBAS) and on recently developed supplementary items. The sample consisted of lower-socioeconomic-status families in San Juan, Puerto Rico, and included teenage and older mothers. Infants with atypical patterns of fetal growth showed lower scores than did infants of appropriate growth on the NBAS orientation, motor, and reflex clusters and on 15 of the 18 supplementary scores. Gestational age was covaried and showed independent effects on 6 items. Differential effects on measures of state and autonomic function were also found when the effects of the ponderal index were held constant. The results suggested that neonatal behavior is related to multiple indices of fetal growth patterns that may indicate early versus late nutritional insult. Supplementary NBAS items do not improve the discriminability of the NBAS but may help explain the basis for observed group differences.     

Continuous vowel discrimination in normal and at risk infants.

The present study investigated vowel discrimination in 2-week-old infants using a nonnutritive, high-amplitude sucking measure in a habituation-dishabituation paradigm. Infants were presented with pairs of vowel stimuli differing in equal logarithmic steps along the /i/ to /I/ continuum. Stimulus pairs of equal acoustic differences were selected to be either within or between the adult phonetic categories. Infants were divided into 3 experimental stimulus shift conditions: within category, between category, and control. Using a scoring system to asses perinatal events, half the infants in each condition were categorized as being at "higher risk" for developmental (p less than .05) were found between the control and both the within and between phonetic category conditions. No effects due to risk score population differences proved to be significant. These results indicate that 8-week-old infants discriminate the vowels /i/ and /I/ in a continuous as opposed to a categorical manner. Some differences were noted in response patterns between high- and low-risk score infants.     

Maternal interactional behavior with nonorganic failure-to-thrive infants: a case comparison study

Mothers of 47 6-month-old infants with early histories of nonorganic failure to thrive (NOFT) infants and a matched comparison group of physically healthy infants were observed in interactions with their infants in their homes one month following hospitalization. Mothers of NOFT infants were observed to have less adaptive social interactional behavior, less positive affective behavior, and demonstrated more arbitrary termination of feedings. No group differences were found in flexibility or sensitivity of maternal feeding, or in environmental circumstances such as number of persons present, noise level, or level of activity. These salient deficiencies in maternal interactional behavior may continue to disrupt the NOFT child's physical growth and psychological development following initial diagnosis and hospitalization. Additional studies are needed to identify patterns of maternal interactional behavior which influence psychological prognosis and to assess the responsiveness of maternal interactional behavior to intervention.     

Intervention with premature human infants.

Stimulation has been given to young infants to prevent the development disabilities often associated with prematurity. A review of these experimental programs reveals a lack of knowledge as to the ecology of the premature infant. This is indicated in the assumption that premature infants are sensorily deprived and by the arbitrary differences in the nature of stimulation techniques. Despite various problems in methodological and outcome assessment, stimulated infants tend to perform at higher levels than control-group infants on measures of sensorimotor and development. It is suggested that future research should be directed toward specifying the environment and processing capacities of the premature infant, and that intervention studies should make use of the 4-group design proposed by Solomon and Lessac (1968).     

Infant temperament and subject loss due to crying during operant conditioning

Infants who failed to complete a 2-day operant-conditioning task were compared with a stratified random sample of those who did on measures of infant temperament and several demographic characteristics. A discriminant-function analysis revealed that female infants who cried differed from female infants who did not cry on measures of duration of orienting and latency to approach sudden or novel stimuli. Reliable prediction of crying and noncrying could not, however, be made for males. No sex differences emerged in the incidence of crying or in the number of sessions completed. Partially successful females (i.e., those completing 1 of the 2 sessions) could reliably be discriminated from those who cried during the first session on measures of age at testing and maternal ratings of smiling behavior. The results of this study suggest that, as with habituation studies, subject loss in operant-conditioning studies is influenced by individual differences among the infants which may or may not adversely affect external validity.     

Effects of varying laboratory conditions on behavioral-state organization in two- and eight-week-old infants.

Previous studies have found that laboratory conditions influence sleep-waking behavior in older infants, children, and adults. The present study employed videotape recordings to monitor continuous 24-hr sleep-waking activity in 2- and 8-week-old infants before, during, and after 12 hr of polygraphic recordings. Sleep- and waking-state organization were affected by laboratory conditions. At both age levels, increased fussy-crying and decreased alertness occurred during the first 4 hr in the laboratory when they were video recorded only and during the first 4 hr that the leads were in place. Decreased fussy-crying and increased alertness were noted in the following periods, indicating adaptation. Latency to sleep was shorter, and drowsiness increased and active sleep decreased while the leads were in place. At 8 weeks, quiet sleep increased and active sleep decreased while the leads were in place. These data suggest that the unfamiliar laboratory conditions inherent in both observational and polygraphic studies are stressful and that time for adaptation is needed.     

Visual and cardiac responses to animate and inanimate faces by young term and preterm infants.

Infants' looking and looking-away behaviors, as well as cardiac responses to mothers' spontaneous and imitative and to dolls' animated and still faces, were recorded for 18 term and 18 preterm infants when they were 3 months old. Infants spent less time looking at their mothers' than at the doll's faces, and their heart-rate levels were elevated while looking at mothers' faces. These effects were most pronounced for the preterm infants whose inferior scores on the animate visual item of the Brazelton neonatal scale suggested a continuity of visual inattentiveness to animate stimuli. Both groups also looked at the inanimate more than the animate doll's face and evidenced lower heart-rate levels during that situation. An information-processing/arousal-modulation interpretation was made for infant looking-away behavior and elevated heart rate during the more arousing mother's-face situations.     

The rhythmic structure of mother-infant interaction in term and preterm infants

The purpose of this study was to quantify social interaction rhythms in 3- and 5-month-old term and preterm infants and their mothers. Infant-mother dyads were videotaped in a 3-min face-to-face paradigm. For each second of the interaction, separate scores were assigned to infant and mother indicating levels of affective involvement, creating 2 180-sec time series. Spectral and cross-spectral techniques were used to quantify periodicities in each member of the dyad and to estimate the synchrony or coherence of interactional rhythms between each infant and mother. Results showed the existence of periodicities in the behavior of each infant and mother at 3 and 5 months, with most subjects showing spectral peaks between .022 and .10 Hz. Increases from 3 to 5 months in behavioral periodicities were found for infants and mothers as well as for the coherence between infant-mother dyads. Term dyads showed higher coherence than preterm dyads at both 3 and 5 months. Term infants more often led the interaction at both ages. These results were taken as evidence that behavioral periodicities, which may be biologically based, underlie early mother-infant interaction and provide a temporal structure for the organization of cognitive and affective experience. Differences in synchrony between term and preterm infants may explain later reported differences in language between these groups.     

Differences between Japanese Infants and Caucasian American Infants in Behavioral and Cortisol Response to Inoculation

The behavioral and cortisol responses of Japanese infants and Caucasian American infants, 4 months of age, were observed during and following routine inoculation. The Caucasian American group showed a more intense initial affective response and a longer latency to quiet than the Japanese group; the Japanese group showed a greater cortisol response. A 4-group taxonomy was created based on high or low behavioral and cortisol response: high behavior–high cortisol, low behavior–low cortisol, high behavior–low cortisol, and low behavior–high cortisol. There were significant differences between the 2 groups of infants using this taxonomy: Infants in the Caucasian American group were more likely to fall in the high behavior–low cortisol group, while infants in the Japanese group were more likely to fall in the low behavior–high cortisol group.     

Neurobehavioral and neurophysiological assessment of healthy and "at-risk" full-term infants

The Neurological and Adaptive Capacity Score (NACS) and the auditory brainstem response (ABR) are measures that, respectively, provide neurobehavioral and neurophysiological information regarding the status of the central nervous system (CNS) in the neonatal period. We evaluated these measures as indices of CNS functioning in 15 neonates born at risk for neurological sequelae and 15 healthy controls. Significant group differences were observed on the NACS. The ABR failed to distinguish the groups, but abnormal responses were obtained from 1 severely asphyxiated infant. Measures used to define ABR abnormality were also correlated among risk infants. We concluded that the NACS is sensitive to mild but diffuse disturbances, whereas the ABR appears to reflect insults to the brainstem structures that are susceptible to damage from anoxia. Utilization of both tests provides more complete information regarding CNS integrity in neonates.