Karen M. Finello

The premature small-for-gestational-age infant during the first year of life: comparison by birth weight and gestational age

To determine the effect of intrauterine growth retardation on the outcome of the premature infant, we compared a group of 35 premature, small-for-gestational-age (SGA) infants with two groups of premature, appropriate-for-gestational-age (AGA) infants: one with similar birth weight (AGA-BW group) and the other with similar gestational age (AGA-GA group). Groups were matched by year of birth, race, gender, and socioeconomic status. Infants were free of major congenital anomalies and intrauterine infection. They were evaluated at term, at 20 and 40 weeks, and at 1 year corrected age. The SGA infants had a lower mean developmental quotient than the two groups of AGA infants. The SGA infants had significantly smaller body dimensions at birth, more nursery complications, and a higher incidence of major neurologic problems than their AGA-GA matches but were comparable to the AGA-BW matches. Poor growth constitutes an additional risk factor to prematurity. The results highlight the importance of comparing premature SGA infants with premature AGA infants of similar gestational age rather than similar birth weight.

Biological factors and crime: Implications for forensic psychiatry☆

To summarize, we can say that (1) Criminal behavior, especially chronic criminal behavior, seems to be partly genetically predisposed; (2) An important task at this point is to attempt to determine the biological factors which predispose people to crime; and (3) We have related some tentative initial steps being taken in the study of the autonomic nervous system as one possible heritable, biological basis for the failure of normal social learning forces in inhibiting criminal behavior. Early in this paper we discussed the tenability of asserting criminal responsibility on individuals whose criminal behavior has a partly genetic etiology. But this special consideration seems to set biological factors apart as being in some unique causal category. In fact, genetic, physiological, and biochemical factors are causal agents in the same sense as family, social class, or neighborhood factors. Of course, criminal behavior (like all other behavior) must be caused; one class of causal variables is the biological category. The legal doctrine of responsibility is not challenged by identifying biological factors as partially determining crime any more than it is by findings of social causation. Only in cases in which abnormal biological factors are exceptionally powerful influences might responsibility be challenged. Such cases will be quite rare.

Prediction of Neurodevelopmental Outcome in Infants with and Without Bronchopulmonary Dysplasia

In a group of 236 very low birth weight (VLBW) surviving infants, 60 had developed bronchopulmonary dysplasia (BPD) in the nursery. When compared with the 176 infants without BPD, infants with BPD were smaller, more immature, with lower one- and five-minute Apgar scores. Infants with BPD had a greater incidence of cardio-pulmonary and central nervous system (CNS) complications in the nursery. On follow-up, 25 (42%) of these infants were abnormal developmentally compared to 7% of infants without BPD (p less than .001). When comparisons were made within the group of infants with BPD, very few differences were found in maternal or infant risk factors between the normal and abnormal infants. The infants with BPD who had poor outcome more often had seizures and severe intraventricular hemorrhage (IVH). The infants with BPD who had good outcome were more often small for gestational age (SGA) and resuscitated with intubation at birth. They had apnea in the nursery more frequently than did abnormal infants with BPD. We conclude that VLBW infants with BPD are at greater risk for poor neurodevelopmental outcome than those without BPD. The risk for the infant with BPD relates to CNS complications rather than to chronic lung disease.

Unique System of Care Issues and Challenges in Serving Children Under Age 3 and their Families

This article addresses the primary modifications necessary for system change to better meet the mental health needs of children under the age of three. The role of risk and resiliency factors in the young child, family and community and the necessity for a comprehensive community infant-family mental health system with a focus on the whole family are addressed. Barriers to care within early childhood systems of care are examined, including stigma, community referral and collaboration, diagnostic concerns during infancy, issues around family engagement, empowerment and partnership, funding of comprehensive and well coordinated infant-family services, workforce capacity and evaluation. Recommendations for implementation of system changes at the community and federal levels are proposed.

Children of schizophrenic women: early factors predictive of schizophrenia

The present report reviews some findings of a 20-year longitudinal study of Danish children at risk for schizophrenia. Early factors predictive of later schizophrenia in high-risk children, including infant temperament and the effect of perinatal complications, are reviewed. In addition, the role of maternal absence as a stressor is examined. Findings related to sex differences in the vulnerability of high-risk children to later pathology are discussed. Possible interactions of these factors and maternal psychopathology are briefly explored.

EFFECT OF INTRAUTERINE GROWTH RETARDATION ON PREMATURE INFANTS OF SIMILAR GESTATIONAL AGE

Previous evaluation of 35 SGA and AGA very low birth weight infants (VLBW) of similar birth weight (BW) showed differences in developmental quotient but none in neurologic outcome at one year of age (Ped. Res. 20:165A, 1985). To determine the effect of gestational age (GA) on the outcome of the VLBW infant, 20 SGA infants were compared to 20 AGA infants matched for GA, year of birth, race, gender and socio-economic status. Anomalies and intrauterine infections were excluded. SGA infants had a mean GA of 30.8 wks and a mean BW of 1006g. AGA infants had a mean GA of 30.6 wks and a mean BW of 1294g. All infants were evaluated at term, at 20 and 40 wks corrected for prematurity. Results showed that at birth the SGA infants were lighter, shorter with smaller head circumference (p<.005). In the nursery the SGA infants required respiratory assistance for longer periods (p<.005) and remained in the hospital longer (p<.001). More SGA infants were classified as neurologically suspect and abnormal at 20 wks. (p<.01) and at 40 wks. (p<.005). The Gesell developmental quotient was lower in the SGA infants reaching significance at 40 wks (p<.001). At one year of age 30% of the SGA and 5% of the AGA demonstrated neuromotor handicaps (p<.05). In conclusion, comparing the neurodevelopraental outcome of the VLBW infants by similar GA rather than by BW demonstrated the increased risk of intrauterine growth retardation for the immature brain.