Marshall H. Klaus

Maternal Behavior One Year After Early and Extended Post‐partum Contact

The observations of maternal behaviour in 28 human mothers of full‐term infants reported in this study are consistent with investigations in animals; measurable differences, lastingfor as long as one year, are apparent between mothers with early and extended contact and those separated from their infants in the early hours after birth. The awareness of a special attachment period shortly after birth—during which brief periods of partial or complete separation may drastically distort a mother animals feeding and caring for her infant—would lead a caretaker or naturalist to be extremely cautious about any intervention in the period after birth.

Mother-to-child speech at 2 years—effects of early postnatal contact

Ten primiparous mothers were randomly selected from two groups of women who had spent different amounts of time with their newborn infants. The speech behavior of the mothers in the two groups was compared while they were addressing their 2-year-old children in an informal play situation. Speech patterns of the mothers revealed that those who had been given extra contact with their infants during the neonatal period used significantly more questions, adjectives, words per proposition, and fewer comands and content words than did the control mothers. These observations suggest that the linguistic behavior of the young child may be shaped by hospital-care practices for mother and her infant.

Neonatal respiratory distress following elective delivery. A preventable disease

Twelve per cent of all infants with respiratory distress admitted to our neonatal intensive-care unit from November, 1973 to April, 1974, were born after elective intervention (15 cesarean sections and four vaginal inductions). All were white and 18/19 were private compared to yearly admissions of white (56 per cent) and private (57 per cent). Eighteen of 19 were admitted from the region via the transport service. Mean birth weight was 2.69 kilograms, with 18 infants over 2 kilograms. Pediatric gestational age from a physical and neurological evaluation ranged from 32 to 39 weeks (mean 36.2 weeks) in contrast to obstetric dating which ranged from 38 to 44 weeks (mean 39 weeks). The obstetric dating was 3 or more weeks greater than the pediatric age in 11 infants. Pulmonary disease included transient tachypnea (5) and respiratory distress syndrome (14). No prior documentation of pulmonary maturity had been obtained in any of these infants. Mean hospitalization was 23 days (range 1 to 140), with estimated costs of

Controlled trial of continuous negative external pressure in the treatment of severe respiratory distress syndrome

3,421 per baby. Two infants died. Respiratory distress following elective delivery remains a potent source of on-going perinatal morbidity. Regional programs must direct increased educational efforts to eliminate this preventable disease.

Neonatal pattern vision: a predictor of future mental performance?

A sequential controlled trial of continuous negative pressure versus oxygen in treatment of severe respiratory distress syndrome (Pa O 2 O 2 70 per cent or greater) was performed. CNP was applied by means of a newly designed, inexpensive plastic chamber. Twenty-nine infants with RDS who weighed >1,000 Gm. and who had no congenital malformations were studied; there were 14 in the oxygen-treated control group and 15 in the CNP-treated group. Following the study, seven additional infants were treated with CNP. Birth weights, sex, gestational ages, ages, and blood gases at the time of admission to the study were similar. Study failure was defined as a Pa O 2

Separation for childbirth: The effect on the sibling

The visual fixation responses of 33 high-risk neonates to patterned stimuli were rated as normal, suspect, or abnormal in an attempt to predict future intellectual performance. For comparison purposes, a neurologic examination was aslo administered. Follow-up studies based on autopsies and neurologic and psychological testing agreed with the neonatal visual preference ratings in 27 cases, but with the neurologic examination ratings in only 22 cases. This preliminary study suggests that neonatal visual testing is a promising technique for evaluating brain integrity in the newborn period.

Intermittent mask and bag therapy: An alternative approach to respirator therapy for infants with severe respiratory distress

The reactions of 14 young (one to three and one-half years) first born children to the routine two to six day separation associated with maternal childbirth were compared with 17 children permitted to visit their mothers in hospital for one hour per day. Behavior observations in the home one to two weeks after birth compared to those made two to four weeks before birth as well as maternal questionnaires revealed significant increases in tekmper tantrums, excessive activity and sleep problems in both groups. Children, however, who sisited were initially significantly more responsive to their mothers and new siblings.

EARLY MOTHER-INFANT CONTACT: EFFECTS ON BREASTFEEDING

Forty infants with severe idiopathic respiratory distress syndrome have been treated with intermittent mask and bag therapy as an alternative to the mechanical respirator. Twenty-four of the infants (60 per cent) survived. This survival rate compares favorably with that of infants treated with continuous respirator therapy, and pulmonary complications appear to be minimal. The procedure requires simple equipment and is easily taught to nurses and physicians. Mask and bag therapy appears to be an easily adapted and relatively safe alternative to the respirator in infants with the idiopathic respiratory distress syndrome.

LOW PREVALENCE OF ANEMIA AMONG NAVAJO CHILDREN

Several studies strongly suggest that there is a period shortly after childbirth which may be called a sensitive period that may be optimal for the development of a mothers affectional bond to her infants and which appears to significantly increase maternal breastfeeding and in developing countries subsequent infant health and weight gain. The hypothesis that during this early sensitive period reciprocal interactions occur between mother and infant that interlocks them and ensures the further development of attachment was tested in Guatemala using 1 basic study design in three different hospital samples consisting of a total of 168 poor urban primiparous mothers and their infants. Results indicated the infants whose mothers had early contact had gained significantly more weight by six months and 1 year. Although 100% of the mothers in both groups were breast-feeding at discharge differences were apparent at 1 month. The percentage of early contact mothers who were still breast-feeding was significantly greater than the control group at 6 and 12 months. The man length of breast-feeding for the experimental mothers was nearly twice as long as the controls. A review of other studies indicates that 5 of 6 separate studies reveal that early intimate contact between the mother and her infant is associated with significantly increased breast-feeding. These findings compel reconsideration of hospital practices that briefly separate mother and infant.

588 BEHAVIOR AND DEVELOPMENT OF IRON DEFICIENT ANEMIC IN- FANTS

Both historical and recent evidence has suggested that iron deficiency may be common among southwestern American indians. To assess the nutritional status of young Navajo indians, nutritional histories, heights, weights, and fingerstick blood samples were collected from 576 children from 6 months to 10 years of age. Using Harvard standards, 19% of heights and 9% of weights were <3rd percentile for age; only 2% of heights and 4% of weights were >97th percentile. Microhematocrit determinations demonstrated a very low prevalence of anemia: only 2% were >2 S.D. below the mean for age. Plasma iron levels were determined on 440 samples with a new spectrophotometric method using ferrozine and requiring 50μl of plasma. Less than 6% of the children had iron values <12.5μmol/l (70μg/dl). Although almost all hematocrit values were normal, children with lower hematocrits for age tended to have lower plasma irons (p<.001) and to be shorter (p<.001) and lighter (p<.03). A much higher proportion of children with iron deficiency anemia has been reported in other U.S. populations of similar economic level. The high prevalence of breastfeeding (46%), the use of iron fortified infant formulas (by history 75% of formula users), participation in food supplementation programs, and a cultural tradition that includes meat in childrens regular diet may be factors in the unusually low prevalence of nutritional anemia among these Navajo children.