Jo-Ann B Bier

Breast-feeding of very low birth weight infants

Twenty very low birth weight infants (birth weight < 1500 gm) were assessed to compare the clinical effects of breast and bottle feedings. The infants started breast-feeding during the same week that they started bottle feedings. Five breast-feedings and five bottle feedings for each infant were observed. Axillary temperature and weight before and after feedings were measured, and oxygen saturation, respiratory rate, and heart rate were monitored and recorded every 2 minutes during the feeding periods. The results showed no difference in oxygen saturation during breast-feeding (p = 0.056) but a lower incidence of oxygen desaturation (< 90%) (21% vs 38% in breast-feeding vs bottle feeding, respectively; p < 0.025). Infants with bronchopulmonary dysplasia had higher oxygen saturation during breast-feeding than during bottle feeding (p < 0.025), but weight gain during breast-feeding sessions was less (median, no gain vs 31 gm, p < 0.001). We conclude that (1) very low birth weight infants can tolerate both breast and bottle feedings at the same postnatal age; (2) very low birth weight infants are less likely to have oxygen desaturation to less than 90% during breast-feeding; and (3) weight gain is less during breast-feeding, probably because of lower intake, and may require more lactation counseling or supplementation of the feedings.

The vulnerable preschool child: The impact of biomedical and social risks on neurodevelopmental function

The scope of preschool children with biological risk and social disadvantage is large and includes over 1 million (28%) newborns per year. Currently in 1996, 7% of children are born with low birth weight, 1% are born with very low birth weight, 20% have alcohol exposure, and 10% have other drug exposure. Poverty is dynamic and impacts on 25% of children less than 6 years old with increased frequency in children who are minority, have mothers with less than a high school education, or are unmarried. There has been a markedly increased survival in very low birth weight and extremely low birth weight infants in the past 10 years. Outcomes of these neonatal populations reveals that parenchymal brain injury is the major predictor of cerebral palsy which occurs in 7% to 10% of very low birth weight survivors. However, poverty is the major predictor of low IQ. Fetal alcohol syndrome occurs in 1.9 per 1,000 births and is most often associated with mild mental retardation and educational underachievement. Studies investigating cocaine revealed that it is a multifactorial problem overlapping with polysubstance abuse and other risk factors for social disadvantage. The overwhelming number of children do not have cerebral palsy or severe mental retardation. The long-term impact is more subtle and needs more systematic analysis as well as critical evaluation of cognitive impairments and educational under-achievement. Hypoxic ischemic encephalopathy (HIE) cannot be determined by one biological measure. Though multiple disability occurs in 70% of children with Sarnat stage 3 HIE, 30% of survivors are not disabled. Children with mild to moderate HIE have long-term outcomes that are influenced by 9- to 12-month neurodevelopmental status and social disadvantage. By combining strategies to lessen biological risks and enhance developmentally appropriate environments, long-term outcomes of preschool children can be optimized.

Neurodevelopmental Outcome of Infants Born to Mothers Using Illicit Drugs During Pregnancy 1210

Neurodevelopmental Outcome of Infants Born to Mothers Using Illicit Drugs During Pregnancy 1210

LANGUAGE PROBLEMS IN CHILDREN REFERRED FOR ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD). † 803

ADHD is a common condition with a prevalence reported to be 3-5% of school age children. These children frequently have language problems in association with ADHD. Importantly, the frequency of language difficulties in those children who are evaluated for, but do not meet ADHD diagnostic criteria, is unknown. Accordingly, we evaluated forty-five children (37 male, 8 female) between the ages of 6 and 10 years (mean age 8±1 yrs) referred to a tertiary care center for evaluation of possible ADHD (R/O ADHD group) for the presence of language difficulties. Twenty children (12 male, 8 female; mean age 8±1) with no history of attentional problems or hyperactivity served as controls (Cntrl group). We hypothesized that there would be a higher incidence of language difficulties in the R/O ADHD group compared with controls, whether or not the children were diagnosed with ADHD. All children in the R/O ADHD group were administered the CELF-R Language Screening Test(CELF-R) and the WISC-III intelligence scale. The Connors Scales were completed by their parents and teachers. Children in the Cntrl group were administered the CELF-R and the K-BIT Intelligence Screening Test. The diagnosis of ADHD was based on the Diagnostic and Statistical Manual - IVth edition criteria. Mean IQ score in the R/O ADHD group and mean screening IQ score were within the average range. There was no difference in gender, age, or Hollingshead SES score (36±13 and 39±14) between the groups. Results of the CELF-R are shown: Table

PREDICTORS OF HOME CARDIORESPIRATORY MONITOR USE IN INFANTS PRESENTING WITH APPARENT LIFE THREATENING EVENTS (ALTE). † 527

Infants presenting with ALTE are frequently discharged with home cardiorespiratory monitoring. While reassuring to many parents, home monitoring may increase psychosocial and financial stress. Although not proven to predict adverse outcomes, pneumogram evaluation is often used to select patients for monitoring. Accordingly, we sought to determine the clinical and pneumogram characteristics of ALTE patients discharged with and without home monitoring. Data was collected on 32 consecutive infants with ALTE who had 6 channel pneumogram evaluations. Pneumogram evidence of central apnea was defined as an event >15 seconds during the 12 hour period. Monitoring was recommended in 19 (59%) infants including 4 infants whose ALTE required CPR. Clinical and 12 hour pneumogram characteristics of infants with and without monitors are shown. Table

BREAST-FEEDING IMPROVES PHYSIOLOGIC STATES OF EXTREMELY-LOW-BIRTH-WEIGHT(ELBW) INFANTS (≤800 gms). † 598

BREAST-FEEDING IMPROVES PHYSIOLOGIC STATES OF EXTREMELY-LOW-BIRTH-WEIGHT(ELBW) INFANTS (≤800 gms). † 598