Marc Weissbluth

Treatment of infantile colic with dicyclominehydrochloride

We performed a prospective, randomized, double-blind, placebo-controlled clinical trial of dicyclomine hydrochloride using specific diagnostic criteria for infantile colic: spells of unexplained irritability, agitation, fussiness or crying lasting greater than or equal to 3 hours/day, occurring greater than or equal to 3 days/week, and continuing for greater than or equal to 3 weeks. Dicyclomine eliminated colic in 15 of 24 (63%) infants, whereas placebo was effective in six of 24 (25%) (corrected X2 = 5.42, P = 0.02). The study also addressed the hypothesis that parental distress caused by infantile colic affects subsequent temperament and sleep patterns. The data fail to document easier temperaments or longer sleep durations at 4 months in infants whose colic ceased during treatment.

Night waking in 4- to 8-month-old infants

Parental reports of night waking and sleep patterns were obtained for 141 normal 4- to 8-month-old infants from middle-class families. A group of infants was identified who had a past history of colic and who were perceived to have a current night waking problem. These infants awoke more often than other infants and also had significantly briefer total sleep duration. Night waking was described as a problem in infant boys more often than in infant girls. A second group of infants who awoke frequently was reported to snore or mouth breathe when asleep. This group of infants did not have a past history of colic, was not perceived to have a night waking problem, and was not overly represented by boys. Ordinal position, fathers education level, gender, and method of feeding did not affect reported sleep patterns.

Home pneumograms in normal infants

To obtain age-specific normative data, we performed home cardiorespiratory recordings (pneumograms) in 56 normal infants at 1 month of age. A repeat pneumogram was performed at 3 months in 39 infants. Total sleep time was determined and all sleep intervals were summed and analyzed for five respiratory pattern variables: frequency of all apneic episodes greater than or equal to 6 seconds in duration (A6/D%), periodic breathing, longest apneic episode, and number of episodes greater than 11 and greater than 15 seconds. The normal infants at 1 and at 3 months were compared with 66 patients with apnea of infancy. Median A6/D% was 0.1 in the normal infants at 1 and 3 months, compared with 0.64 in those with apnea of infancy (P less than 0.001). Median periodic breathing was 0.4 and 0.2 episodes per 100 minutes in the normal infants at 1 and 3 months, respectively, compared with 1.25 in infants with apnea of infancy (P less than 0.001). Median longest apneic episode was 8.0 seconds in the normal infants at 1 and 3 months, compared with 11 seconds in those with apnea of infancy (P less than 0.001). No normal infant had an apneic episode greater than 15 seconds in duration, whereas the group with apnea of infancy had 0.4 +/- 1.0 episodes of apnea of greater than 15 seconds (P less than 0.01). Despite these significant group differences, use of these respiratory patterns either alone or in combination permitted only about 80% correct classification of normal infants and those with apnea of infancy.

Gastroesophageal Reflux: A Review

Gastroesophageal reflux (GER) may produce vomiting, failure to gain weight, esophagitis, heartburn, or pulmonary symptoms. Medical or surgical manage ment depends on the severity of the symptoms. Newer diagnostic procedures such as esophageal manometry, esophageal pH probes, and nuclear scans may confirm the presence of GER. The mechanism by which GER produces different symptoms is not well understood.

Infantile colic and Near-Miss Sudden Infant Death Syndrome

Frequent awakenings occur in infantile colic acid sleep-related respiratory control disorders. To evaluate the possibility that colic may be associated with impaired respiratory control, prevalence and clinical features of colic among infants who died from Sudden Infant Death Syndrome (SIDS), infants with a clinical diagnosis of Near-Miss Sudden Infant Death Syndrome (N-M SIDS), and a control group were retrospectively determined. Colic did not occur in any of the 17 infants in the control group who had normal ventilatory responses. Colic did occur in 14 (33%) of 42 infants with N-M SIDS who had impaired ventilatory responses. Ventilatory responses among the N-M SIDS infants were similar in those with and without colic. Four (27%) of the 15 SIDS victims had colic, but the spells had disappeared before their deaths. The proportion of infants with colic among the N-M SIDS infants is significantly greater than among control infants (p less than 0.05). In summary, colic related night wakings may represent an alternative and protective behavioral arousal mechanism in N-M SIDS infants, a group in which a variety of sleep-related respiratory control deficits have previously been documented.

Plasma progesterone levels, infant temperament, arousals from sleep, and the sudden infant death syndrome.

Abstract Endogenous plasma progesterone levels may influence relationships between infant temperament, sleep patterns, and respiratory control deficits. Elevated progesterone levels may account for the lethargic temperament observed among victims of Sudden Infant Death Syndrome.