Hormonal stimulation and paternal experience influence responsiveness to infant distress vocalizations by adult male common marmosets,Callithrix jacchus

Parental experience and hormones play a large role in the common marmoset (Callithrix jacchus) father's care of their offspring. We tested the effect of exogenous estradiol or testosterone on the responsiveness of common marmosets to respond to infant distress vocalizations and whether males who haven't become fathers yet (paired males) would have increased responsiveness to infant distress calls with either steroid or whether parental experience is the most important component for the onset of paternal care. Sixteen male marmosets (8 fathers, 8 paired males) received a vehicle, low dose or high dose of estradiol and additional 16 males were tested with testosterone at three doses for their response either to a vocal control or a recording of an infant distress call for 10 min. Without steroid stimulation fathers were significantly more likely to respond to the infant distress stimulus than paired males. Low dose estradiol stimulation resulted in a significant increase in fathers' behavioral response towards the infant distress stimulus but not in paired males. Fathers also showed a significant increase in infant responsiveness from the vehicle dose to the estradiol low dose treatment, but not to the estradiol high dose treatment. Testosterone treatment did not show significant differences between infant responsiveness at either dose and between fathers and paired males. We suggest that neither steroid is involved in the onset of paternal care behaviors in the marmoset but that estradiol may be involved in facilitating paternal motivation in experienced fathers.     

Glycochenodeoxycholate induces rat alveolar epithelial type II cell death and inhibits surfactant secretion in vitro

Bile acid-induced lung injury has become an important topic for neonatologists after the discovery of a high incidence of infant respiratory distress syndrome complicated from maternal intrahepatic cholestasis. To explore the molecular pathway of bile acid-induced lung injury, we investigated the cytotoxicity of the glycochenodeoxycholate (GCDC) to alveolar epithelial type II cells (AECII), as the main component of bile acid. The results demonstrated that glycochenodeoxycholate induced oxidative stress, mitochondrial damage, and increased caspase activity in the primary cultured AECII. Moreover, ROS scavengers and caspase inhibitors could rescue cell death induced by GCDC in rat AECII. Our results also indicated that GCDC inhibited AECII surfactant secretion. In conclusion, this study suggested that cell death prevention and cell therapy should be considered as therapeutic strategies for infant respiratory distress syndrome complicated from maternal intrahepatic cholestasis.     

An infant with diaphragmatic eventration and respiratory distress

The authors report a rare case of partial diaphragmatic eventration in a 4-month-old infant with recurrent wheezing and low serum IgA values. Because of persistent respiratory symptoms after therapy with inhaled short-acting beta2 agonists and inhaled nebulized corticosteroids, surgery was undertaken to correct the defect. Despite surgery, the clinical symptoms did not improve. Consequently, gatroesophagel reflux was considered and the diagnosis was confirmed with pH-metry, after which the infant was started on a protonic pump inhibitor therapy (PPI), achieving clinical improvement. Our experience suggests that in infants with congenital diaphragmatic eventration who present with respiratory distress gastro-oesophageal reflux should be suspected, and PPI therapy should be started before planning surgery.     

Maternal mental health and its association with infant growth at 6 months in ethnic groups: results from the Born-in-Bradford birth cohort study

Objective

To identify factors associated with infant growth up to 6 months, with a particular focus on maternal distress, and to explore the effect of ethnicity on any relation between maternal distress and infant growth.

Methods

Cohort study recruiting White and Pakistani women in the United Kingdom (UK). Infant growth was measured at birth and 6 months. Standard assessment of mental health (GHQ-28) was undertaken in pregnancy (26–28 weeks gestation) and 6 months postpartum. Modelling included social deprivation, ethnicity, and other known influences on infant growth such as maternal smoking and alcohol consumption.

Results

Maternal distress improved markedly from pregnancy to 6 months postpartum. At both times Pakistani women had more somatic and depression symptoms than White women. Depression in pregnancy (GHQ subscale D) was associated with lower infant growth at 6 months. Self-reported social dysfunction in pregnancy (GHQ subscale C) was associated with lower gestational age.. Pakistani women reported higher GHQ scores during pregnancy associated with smaller infants at birth. They lived in areas of higher social deprivation, reported less alcohol consumption and smoking postnatally, all independent influences on growth at 6 months.

Conclusions

Maternal mental health in pregnancy is an independent influence on infant growth up to 6 months and is associated with ethnicity which was itself associated with deprivation in our sample. There is a complex relationship between symptoms of maternal distress, ethnicity, deprivation, health behaviours, and early infant growth. Measures should include both emotional and somatic symptoms and interventions to reduce risks of poor early growth need to include psychological and social components.     

婴幼儿先天性心脏病术后床边胸片的临床应用评价

评价床边胸片在婴幼儿先天性心脏病术后的临床应用价值,总结其常见并发症以提高阅片正确率。方法:55例先天性心脏病术后婴幼儿患者,男34例,女24例,年龄1月至36月(平均12．8月),其术后均使用移动X线机摄取床边胸片,总结分析术后胸片新出现的异常表现。结果:55例先天性心脏病惠儿术后床边胸片中,发现31例新出现异常X线表现,发生率为56．4%。其中胸腔积液12例;气胸9例,其中4例合并皮下气肿;肺不张5例;左下肺炎3例;肺水肿1例;膈肌抬高1例。婴幼儿先天性心脏病术后最常见的并发症中前三位的依次为:胸腔积液、气胸和肺不张,分别占38．7%、29．0%、16．1%。结论:床边胸片是及时全面了解先天性心脏病患儿术后胸部出现新异常的重要和有效的检查手段,且简便易行,能将婴幼儿不能主诉的影响减至最低,从而为临床提供及时的诊疗依据。     

Focus: The Science of Stress: Can Maternal Prenatal Self-Reported and Physiological Distress Predict Postnatal Caregiving Practices?

Maternal prenatal distress is associated with child outcomes, including health, neurocognitive, and socio-emotional development. Knowledge on underlying mechanisms is limited, yet relevant for prevention and intervention. This study investigated whether maternal prenatal distress predicts specific caregiving practices that are known for their effects on child outcomes. Caregiving practices studied were maternal caregiving quality and the initiation and course of breastfeeding and room-sharing. We hypothesized that more maternal prenatal distress would be associated with altered caregiving practices. Participants were 174 healthy mother-child dyads. During the 37^th week of pregnancy maternal self-reported distress was assessed using questionnaires, and physiological stress by collecting saliva cortisol. Maternal caregiving quality was observed in postnatal week 5 during infant bathing. Weekly diaries on breastfeeding and daily diaries on room-sharing were completed during the first 6 postnatal months. In a regression analysis, no associations between maternal prenatal distress and caregiving quality were found. Multilevel analyses indicated that maternal prenatal evening cortisol was positively related to the initiation of breastfeeding and room-sharing. Replications are warranted, but these results suggest that breastfeeding and room-sharing initiation may be part of a mechanism underlying links between maternal prenatal physiological stress and child outcomes. As other prenatal cortisol markers and self-reported distress were not found to be related to the caregiving practices, it is likely that alternative mechanisms (co-)exist in explaining links between maternal prenatal distress and child outcomes. Future replication research including child outcomes and (other) potential mechanisms will inform prevention and intervention programs fostering healthy pregnancies and child development.     

Maternal prenatal depressive symptoms predict infant NR3C1 1F and BDNF IV DNA methylation

Prenatal maternal psychological distress increases risk for adverse infant outcomes. However, the biological mechanisms underlying this association remain unclear. Prenatal stress can impact fetal epigenetic regulation that could underlie changes in infant stress responses. It has been suggested that maternal glucocorticoids may mediate this epigenetic effect. We examined this hypothesis by determining the impact of maternal cortisol and depressive symptoms during pregnancy on infant NR3C1 and BDNF DNA methylation. Fifty-seven pregnant women were recruited during the second or third trimester. Participants self-reported depressive symptoms and salivary cortisol samples were collected diurnally and in response to a stressor. Buccal swabs for DNA extraction and DNA methylation analysis were collected from each infant at 2 months of age, and mothers were assessed for postnatal depressive symptoms. Prenatal depressive symptoms significantly predicted increased NR3C1 1F DNA methylation in male infants (β = 2.147, P = 0.044). Prenatal depressive symptoms also significantly predicted decreased BDNF IV DNA methylation in both male and female infants (β = −3.244, P = 0.013). No measure of maternal cortisol during pregnancy predicted infant NR3C1 1F or BDNF promoter IV DNA methylation. Our findings highlight the susceptibility of males to changes in NR3C1 DNA methylation and present novel evidence for altered BDNF IV DNA methylation in response to maternal depression during pregnancy. The lack of association between maternal cortisol and infant DNA methylation suggests that effects of maternal depression may not be mediated directly by glucocorticoids. Future studies should consider other potential mediating mechanisms in the link between maternal mood and infant outcomes.     

A methodological note on the relationship between infant mortality and socioeconomic status with evidence from San Antonio, Texas.

A number of previous studies have concluded from social area analyses of medium-size cities that there is no longer a significant correlation between socioeconomic status (SES) and infant mortality in the U.S. To determine if these findings were an artifact of too small samples, the total, neonatal, and postneonatal infant mortality rates were analyzed for 115 census tracts of San Antonio, Texas. The SES of each tract was measured by a score reflecting equally the variables of income, education, and occupation, and allowed assignment of the tracts to 1 of 4 socioeconomic rankings. All 3 infant mortality rates rose as SES decreased, with the most marked relationship being between SES and postneonatal rates. It was also found that of the 3 variables used to measure SES, income bore the strongest relationship to infant mortality. In general it should be noted that social area analysis of infant mortality is limited by the extreme reductions of sample size when additional variables are induced.     

Prenatal wrongful death

In Tebbutt v. Virostek (1985), the New York Court of Appeals dismissed a suit for emotional distress caused by the stillbirth of an infant allegedly resulting from medical malpractice. Steinbock argues that parents should be able to recover for emotional anguish in cases like Tebbutt. Some states currently allow them to do so by recognizing prenatal wrongful death suits, which focus on the unborn. Steinbock maintains that a better legal approach would be to allow recovery for the negligent infliction of emotional distress upon the parent(s). She presents a six-part argument that discusses: (1) the facts of Tebbutt; (2) wrongful death actions and their extension to the unborn; (3) prenatal torts and prenatal wrongful death; (4) the recognition of harms or wrongs to nonviable fetuses; (5) the legal implications of recognizing fetal personhood; and (6) recognizing parental rights in cases like Tebbutt without recognizing the fetus as a person.     

Focus: The Science of Stress: Social Fear in US Infants: The Roles of Hair and Salivary Cortisol

Elevated social fear in infancy poses risk for later social maladjustment and psychopathology. Hair cortisol concentration (HCC), an index of cumulative cortisol exposure, and diurnal salivary cortisol slope, a biomarker of acute stress regulation, have been associated with social fear behaviors in childhood; however, no research has addressed their relations in infancy. Elucidating potential biomarkers of infant social fear behaviors, as well as environmental factors associated with these biomarkers, may grant insights into the ontogeny of fear behaviors that increase risk for internalizing and externalizing psychopathologies later in life. The current study used multiple linear regression to examine if infant HCC, infant diurnal cortisol slope, and income-to-needs ratios (ITN) were differentially associated with observed social fear responses to a Stranger Approach task at 12 months. Using a sample of 90 infants (M_age = 12.26m, SD = 0.81m, 50% female), results indicated that increased infant HCC was associated with increased distress vocalizations during the Stranger Approach task, while steeper diurnal cortisol slope was associated with fewer distress vocalizations. Ordinary least squares path analyses did not reveal group differences between economically strained and non-strained infants in how cortisol measures and social fear responses related. Findings underscore very early psychobiological correlates of fearfulness that may increase risk for fear-related disorders and adverse mental health symptomology across childhood.     

I Can't Take My Eyes Off of You: Attentional Allocation to Infant,Child, Adolescent and Adult Faces in Mothers and Non-Mothers

It has been reported previously that infant faces elicit enhanced attentional allocation compared to adult faces in adult women, particularly when these faces are emotional and when the participants are mothers, as compared to non-mothers [1]. However, it remains unclear whether this increased salience of infant faces as compared to adult faces extends to children older than infant age, or whether infant faces have a unique capacity to elicit preferential attentional allocation compared to juvenile or adult faces. Therefore, this study investigated attentional allocation to a variety of different aged faces (infants, pre-adolescent children, adolescents, and adults) in 84 adult women, 39 of whom were mothers. Consistent with previous findings, infant faces were found to elicit greater attentional engagement compared to pre-adolescent, adolescent, or adult faces, particularly when the infants displayed distress; again, this effect was more pronounced in mothers compared to non-mothers. Pre-adolescent child faces were also found to elicit greater attentional engagement compared to adolescent and adult faces, but only when they displayed distress. No preferential attentional allocation was observed for adolescent compared to adult faces. These findings indicate that cues potentially signalling vulnerability, specifically age and sad affect, interact to engage attention. They point to a potentially important mechanism, which helps facilitate caregiving behaviour.     

Iodine 131 in the treatment of large goiters

The treatment of large, complicated goiters with iodine 131 constitutes an interesting alternative to surgery. It is minimally invasive, safe, and effective in most cases, and is particularly valuable in elderly, fragile patients with multiple co-morbidities. Also, it does not preclude the possibility of surgery, should it become a necessary alternative, for whatever reason in the future. The precise pre-treatment evaluation includes thyroid scintigraphy, calculation of thyroid volume and tracheal surface measurement. Patients who are most at risk of acute complications (very small cross sectional tracheal area, underlying respiratory pathology, and hyperthyroidism) should be managed during hospitalization for possible respiratory distress, or rhythm disturbances induced by hormone release. The choice of the iodine 131 activity depends on individual routine practice, either standardized or modulated by thyroid mass. Administration may be repeated depending on the effect obtained and the cumulative dose. Efficacy in terms of volume reduction is practically constant at an early stage. Its effectiveness is difficult to predict, often less in the case of large size goiters. It can be improved by increasing iodine fixation, for example, using synthetic antithyroid drugs. Permanent hypothyroidism is the most frequent and minor complication of the treatment. It involves biological monitoring in order to introduce hormone replacement therapy to avoid thyroid growth stimulation and negate the benefits of radioiodine treatment.     

Pneumothorax after a clinical breast fine-needle aspiration of a lump in a patient with Poland's syndrome

We report the first case in the medical literature of a pneumothorax complicating fine needle aspiration cytology (FNAC) of a breast lump in a woman with a mild form of Poland's syndrome. The pneumothorax was treated conservatively. This is the first case of breast FNA-related pneumothorax seen in our clinical practice. We believe that the absence of pectoral muscles has increased the risk of this complication. We have also diagnosed an incidental screen-detected breast cancer affecting the ipsilateral breast in the same patient. We conclude that caution should be exercised when performing FNAC of breast lesions in patients with Poland's syndrome. The procedure should be preferably performed under image guidance in such patients in order to minimise the risk of this complication.     

Aeromedical transport: its hidden problems.

Air transport can move patients safely and rapidly over long distances. However, changes in altitude can have disastrous effects because diminished ambient air pressure may allow gases in closed spaces and tissues to expand rapidly. Even pressurized commercial aircraft do not maintain sea-level pressure: cabin pressures equal to those at yp to 8000 ft may be experienced, diminishing oxygen tension in proportion. Air transport is absolutely contraindicated for patients with untreated pneumothorax, gas gangrene, or air trapped in the cranium and those who have recently undergone abdominal surgery. Special considerations including a planned low-altitude flight are warrented for patients who are anemic, in respiratory or cardiac distress, or immobilized in casts, or who have been engaged in underwater diving immediately before the flight.     

Aluminum content of infant formulas used in Turkey

In the past few years, there has been an upsurge of interest in aluminum (Al) and human health. The well-recognized manifestations of systemic Al toxicity include fracturing osteomalacia, dialysis encephalopathy, and microcytic hypochromic anemia. The role of Al in causing childhood diseases is also becoming clearer, but the safe plasma level still remains to be determined in newborns, especially in premature newborns, implying that it should be kept low. Premature infants receiving iv fluid therapy show evidence of Al loading. Additionally, the infant-feeding mixtures, especially the soy-based infant formulas, tested may be a significant additional source of Al in the diet of infants with low birthweights, and in infants and in young children with impaired renal function. Careful clinical and biochemical monitoring is warranted to determine whether it will be necessary to eliminate Al contamination of both oral and parenteral preparations used in infants and children who may be at risk for Al intoxication. In this present study, the Al content of infant feeds was measured by electrothermal atomic absorption spectrophotometry, and also compared with those of breast milk, cow’s milk, milk powder, and some starches that are commonly used for preparation of infant feed in Turkey. Our results show that Al content of commercially available powdered infant formulas, most of which are imported from Europe, ranged from 1.211 to 10.925 μg/g. The mean value was higher than that of breast milk. It was also found that the Al content of cow’s milk in various containers was higher than that of breast milk. The highest Al level among cow’s milk samples was in the aluminized carton box. In the other products tested, such as milk powder, the starches contained Al at various levels. Among these, milk powder and rice flour contained a high level of Al.     

PULMONARY RESECTION IN TUBERCULOSIS

Newer surgical and anesthetic techniques and the use of streptomycin and para-aminosalicylic acid (PAS) have made possible increased success in pulmonary resection for tuberculosis. Especially in early cases, however, bed rest and pneumothorax or pneumoperitoneum should be given adequate trial before resection is decided upon. In all cases a thorough bronchoscopic examination should be made first and the findings carefully evaluated.Pulmonary resection may be advisable for lesions of certain kinds which do not respond well to thoracotomy; for lesions which have not responded to trial of other methods; for a lung destroyed by tuberculosis; and in cases of active disease in an unexpanded lung.The experience of the author and of others emphasizes the importance of correct postoperative care. Since tuberculosis is rarely limited to the resected area, at least six months'' rest in bed under medical supervision is necessary to permit cure of residual disease. Streptomycin with PAS is particularly valuable in the postoperative period; therefore indiscriminate use of it in earlier treatment should be avoided lest resistance develop.     

Adult male replacement and subsequent infant care by male and siblings in socially monogamous owl monkeys (<Emphasis Type="Italic">Aotus azarai</Emphasis>)

Owl monkeys (Aotus azarai) are small, territorial, socially monogamous primates that show intense infant care by the adult male in the group. It has been hypothesized that male care may be adaptive because it increases offspring survival and/or reduces the metabolic costs to the female of raising the offspring. Alternatively, males may provide care even when they are not related to the infants to increase future reproductive opportunities. We describe changes in infant care patterns that took place after the eviction of the resident male by a solitary male in an owl monkey population in the Argentinean Chaco. The resident male and mother provided all infant care during the first month of life of the infant, until the male was evicted. During the three-day male replacement event, care of the infant was shared among the mother, a four-year-old sister, and a one-year-old brother. The new male began contributing to infant care soon after entering the group, carrying, and interacting socially with the infant in much the same way as any male regularly does. However, despite receiving biparental care from both the original and new resident males, the infant disappeared at the age of four months and was presumed dead. These are the first reports of care by sibling and by non-putative fathers in wild owl monkeys. Given the significant amount of time that new pairs of owl monkeys spend before reproducing, it is possible that male care in owl monkeys functions as mating effort as much as or more than parenting effort.     

Emergency preparedness for those who care for infants in developed country contexts

Emergency management organisations recognise the vulnerability of infants in emergencies, even in developed countries. However, thus far, those who care for infants have not been provided with detailed information on what emergency preparedness entails. Emergency management authorities should provide those who care for infants with accurate and detailed information on the supplies necessary to care for them in an emergency, distinguishing between the needs of breastfed infants and the needs of formula fed infants. Those who care for formula fed infants should be provided with detailed information on the supplies necessary for an emergency preparedness kit and with information on how to prepare formula feeds in an emergency. An emergency preparedness kit for exclusively breastfed infants should include 100 nappies and 200 nappy wipes. The contents of an emergency preparedness for formula fed infants will vary depending upon whether ready-to-use liquid infant formula or powdered infant formula is used. If ready-to-use liquid infant formula is used, an emergency kit should include: 56 serves of ready-to-use liquid infant formula, 84 L water, storage container, metal knife, small bowl, 56 feeding bottles and teats/cups, 56 zip-lock plastic bags, 220 paper towels, detergent, 120 antiseptic wipes, 100 nappies and 200 nappy wipes. If powdered infant formula is used, an emergency preparedness kit should include: two 900 g tins powdered infant formula, 170 L drinking water, storage container, large cooking pot with lid, kettle, gas stove, box of matches/lighter, 14 kg liquid petroleum gas, measuring container, metal knife, metal tongs, feeding cup, 300 large sheets paper towel, detergent, 100 nappies and 200 nappy wipes. Great care with regards hygiene should be taken in the preparation of formula feeds. Child protection organisations should ensure that foster carers responsible for infants have the resources necessary to formula feed in the event of an emergency. Exclusive and continued breastfeeding should be promoted as an emergency preparedness activity by emergency management organisations as well as health authorities. The greater the proportion of infants exclusively breastfed when an emergency occurs, the more resilient the community, and the easier it will be to provide effective aid to the caregivers of formula fed infants.     

The evolutionary context of postnatal depression

“Postnatal depression” denotes the syndrome of dysphoria, debility, and anxiety that follows childbirth in about 10–20% of women (as variously estimated). Its etiology is seen to be lodged in a variety of psychosocial as well as biological factors, among which the isolating and pressured culture of contemporary society (especially for women/mothers) is commonly singled out as a powerful precipitator. This view is extended here through the evolutionary perspective which casts maternal distress as a set of adaptive responses with the function, in ancestral environments, of soliciting support for a mother who feels that her maternal responsiveness may be threatened. As continuous caretaking of the infant is the active expression of evolved maternal responsiveness, departures from this pattern result in anxiety and distress that seek resolution. Manifestations of maternal distress in contemporary society are dysfunctional, however, since the present social structure does not provide spontaneous and immediate support that can spring forth within small, closely knit social units. Furthermore, for present-day mothers distress is self-perpetuating since the ingrained tendency toward continuing responsiveness rarely finds practical expression and is thus converted into anxious vigilance and depression. This view generates the hypothesis that the emotional and cognitive contents of maternal vigilance are associated with the needs of the infant and will therefore be focused on crying and feeding. A number of qualitative studies of women’s experiences during the postpartum bear out this prediction and support the feasibility of the evolutionary hypothesis of “postnatal depression” as a set of adaptive responses, now out of place in a novel environment.