Background: To this date most studies have been focused on the influence of clinical depression and psychotic reactions during the postnatal period on mother-infant interaction, therefore this study examined the effects of maternal depressive mood in the postnatal period on mother-infant verbal and non-verbal communication. Method: Seventy two mother-infant dyads participated in the study. Eighteen infants of mothers with depressive mood and 18 controls were seen when they were 6 months old; and eighteen infants of mothers with depressive mood and 18 controls were seen when they were 10 months old. The Edinburgh Postnatal Depression Scale (EPDS) was used as a mean to assess maternal depressive mood. Tactile, verbal, and gaze behaviours of mothers and their infants when playing face-to-face during pleasure- and surprise-eliciting situations were coded using micro-analytic techniques. The behaviours of infants of mothers with symptoms of depression were also coded during interactions with a female unfamiliar adult (stranger) during a pleasure-eliciting situation. Results: The patterns of communication in non-depressed mother-infant dyads were appropriate to infants’ developmental age. However, maternal symptoms of depression as outlined by the EPDS appeared to somewhat hinder mothers’ ability to attend to infants’ developmental needs and communicate appropriately through touch, speech, and gaze; as well as infants’ capacity for positive emotional regulation, exploration of the toy, and gaze directed to their mothers during play interactions. Conclusions: These results suggest that maternal depressive mood is potentially a risk factor for difficulties in mother-infant communication during the first year postpartum. The mothers’ mood state and their infants’ age influence the type, frequency, and duration of touch, speech, and gaze during early interactions. Such findings are discussed considering a bi-directional influence in the development of communicative responses between mothers and infants across time.

Bakgrund: I Sverige är barnhälsovården frivillig, att få ett hembesök när barnet är nyfött är ett erbjudande. Sedan år 2015 erbjuds föräldrar ytterligare ett hembesök när barnet är åtta månader. För att ge bra stöd till föräldrarna i deras egenvårdande roll är det viktigt att veta hur föräldrarna upplever hembesök från barnavårdcentralen (BVC). Syfte: Att undersöka föräldrars upplevelse och erfarenhet av hembesök från BVC. Metod: Data samlades in genom att lägga ut frågor på 2 föräldraforum under 3 månader och söka inlägg på 11 föräldraforum som svarade på studiens frågeställningar och som var skrivna år 2013 - 2016. Data analyserades med induktiv innehållsanalys. Resultat: Föräldrar hade varierade upplevelser av hembesök från BVC, från bekvämlighet, exempelvis upplevdes det som positivt att slippa ge sig ut i dåligt väder, till en känsla av att bli kontrollerad som förälder.  Många föräldrar kände inte till att BVC erbjuder 8-månaders hembesök, och en del kände inte till att BVC erbjöd hembesök överhuvudtaget. Flera föräldrar uttryckte en osäkerhet runt syftet med hembesök. Slutsats: Det är viktigt att distriktssköterskan har en bra rutin för hur, var och när informationen om hembesök skall ges för att informationen om hembesök skall nå fram till alla föräldrar. Informationen kan ha en stor betydelse för hur föräldrar kommer att uppleva hembesöket från BVC och om föräldrar tackar ja till hembesök. / Background: In Sweden, child healthcare is voluntary and home visit by a nurse when the baby is newborn is an offer. Since 2015, parents are offered a second home visit when the baby is eight months. To provide good support to the parents in their caring role it is important to know how the parents experience the home visits by the child health center (CHC). Objective: To investigate the parents' experience of home visits from CHC. Method: Data was collected by posting questions in two parent forums during 3 months and searching for posts in 11 parent forums from 2013 to 2016. Data was analyzed by inductive content analysis. Results: The parents had varying experiences of home visits; from comfort, for example was perceived as positive to avoid having to go out in bad weather, to a sense of being controlled as a parent. Many parents were unaware that the CHC offers a home visit at eight months, and some were unaware that home visits were offered at all. Several parents expressed an uncertainty about the purpose of the home visit. Conclusion: It is important that the district nurse has a good routine of how, where and when information about home visits is given to reach all parents. The information can have a significant impact on how parents will experience home visit from the CHC, and if they will accept home visits.

Theresa.J.Ochoa@uth.tmc.edu / Article / BACKGROUND: Diarrheagenic Escherichia coli strains are being recognized as important pediatric enteropathogens worldwide. However, it is unclear whether there are differences in age-related susceptibility to specific strains, especially among infants. METHODS: We conducted a passive surveillance cohort study of diarrhea that involved 1034 children aged 2-12 months in Lima, Peru. Control stool samples were collected from randomly selected children without diarrhea. All samples were analyzed for common enteric pathogens and for diarrheagenic E. coli with use of multiplex real-time polymerase chain reaction. RESULTS: The most frequently isolated pathogens in 1065 diarrheal episodes were diarrheagenic E. coli strains (31%), including enteroaggregative (15.1%) and enteropathogenic E. coli (7.6%). Diarrheagenic E. coli, Campylobacter species, and rotavirus were more frequently isolated from infants aged >or=6 months. Among older infants, diffusely adherent E. coli and enterotoxigenic E. coli were more frequently isolated from diarrheal samples than from control samples (P <.05). Children aged >or=6 months who were infected with enterotoxigenic E. coli had a 4.56-fold increased risk of diarrhea (95% confidence interval, 1.20-17.28), compared with younger children. Persistent diarrhea was more common in infants aged <6 months (13.5% vs 3.6%; P <.001). Among children with diarrheagenic E. coli-positive samples, coinfections with other pathogens were more common in children with diarrhea than in control children (40.1% vs 15.6%; P <.001). CONCLUSIONS: Diarrheagenic E. coli strains were more frequently isolated in samples from older infants. In this setting with high frequency of pathogen exposure and high frequency of breastfeeding, we hypothesize that the major age-related differences result from decreased exposure to milk-related protective factors and from increased exposure to contaminated food and water.

This study is an investigation of factors which determine father involvement in infant caretaking activities. Concerns involved fathers' past parental relationships, fathers' preparation for childbirth, sex of the infant, complexity of the caretaking task, fathers' participation in childbirth, fathers' desire for a male or female infant, and amount of early physical contact between father and infant. Data indicated significant relationships between father participation and the sex of the child, complexity of the caretaking activity, and amount of early physical contact between the father and infant. Data indicated no significant relationships between father participation and fathers' past parental relationships, fathers' preparation for childbirth, fathers' participation in childbirth, and fathers' desires for a male or female infant.

Previous research has found that hand preference can be detected reliably in infants as young as 6 months of age through the use of reach-grasp tasks. While many studies have targeted their efforts at discerning hand preference in infants younger than 12-months of age, a lack of knowledge about hand preference during the ages of 1-2 years remain. The aim of the present study was to investigate whether 12-month-old infants demonstrate a clear hand use preference during unimanual reaching and grasping. Participants consisted of 54 healthy, full term 12-month-old infants (+2/-2 weeks). Goal objects were placed at a reachable distance, in front of the infants and randomly allocated to either left, midline or right positions. Infant hand choices and the success of each grasp were coded offline from video recordings made of the reach-grasp sessions and an overall lateralisation index (LI) was calculated later for each infant. The results demonstrated that the 12-month-old infants were generally right-preferred. Additionally, almost double the frequency of grasps were accounted for by right hand grasps. Further, a significant right hand preference was found when children reached across the midline to grasp objects. The findings imply that hand preference may be readily observed in the prehension activities of 12-month-old infants, and particularly prominent when reaching across the midline.

Neonatal Intensive Care Units have experienced profound advances in technology and treatment modalities over the last two decades. Infants born at the edge of viability are now surviving despite prolonged hospitalizations. These infants born preterm are prone to a high degree of stress from life sustaining and routine interventions. Much focus has been directed toward addressing noxious environmental factors such as noise, light, and infectious disease; however, little has been done to examine the stress experienced by the professional caregiver who work in these environments. Environmental press theory, which focuses on the interplay between human beings and their surroundings, is explored as a way to provide insight into understanding and mitigating the stress experienced by health care providers working in the newborn intensive care. A proposal for a research study with a cross-over design was approved to study the effect of “four handed care” on infants’ physiologic responses (oxygenation, heart rate, and stress) and behavioral responses (state, stress and defense, self-regulatory and approach behaviors) to and recovery from endotracheal suctioning when compared to routine care. Results of this study demonstrated no significant differences were noted when heart rate (HR) or oxygen saturation (SpO2) taken at baseline were compared to HR and SpO2 obtained during and after suctioning while in the routine care condition. In the four-handed care condition, mean SpO2 increased from pre-observation 95.49 to during observation saturation 97.75 (p = 0.001). Salivary cortisol did not differ between groups at baseline or post-suctioning. There was no significant difference in behavior state between the two conditions at any time point. More stress and defense behaviors were seen post-suctioning when infants received routine care as opposed to four-handed care (p = .001) and more self-regulatory behaviors were exhibited by infants during (p = .019) and after suctioning (p = .016) when receiving four-handed care as opposed to routine care. There was no statistical difference in the number of monitor call-backs post-suctioning. In conclusion, four-handed care during suctioning was associated with a decrease in stress and defense behaviors and an increase in self-regulatory behaviors. These findings, while based on a small sample, provide modest evidence that the four-handed care intervention for suctioning should receive further testing. Interventions such as four-handed care that are theoretically developmentally supportive of the sick preterm infant, need further research attention before recommending widespread adoption.

MSc, Occupational Therapy, Faculty of the Health Sciences, University of the Witwatersrand / This study investigated the sensory processing of premature infants between 7-12 months of age at Chris Hani Baragwanath Hospital using the standardised Infant/Toddler Sensory Profile. The design of research that was primarily utilised in this study was quantitative, cross sectional, descriptive research. Results indicated that 50% of all the premature infants were found to be low threshold infants, and tended to be over responsive to auditory, visual and tactile sensory stimuli. The Sensory Profiles of infants who underwent different methods of neonatal care including kangaroo mother care (KMC), where mothers were involved in a fulltime twenty-four hour KMC programme, and those who received mainly conventional care (CC) were compared. The only score that differed significantly between infants receiving different types of care was tactile processing, with the CC infants having more typical tactile processing scores. These findings were contrary to other KMC research, which may have been affected by the reliability of using this measure with this study sample and the small sample size of infants who received CC.

MSc, Child Health Neurodevelopment, Faculty of Health Sciences, University of the Witwatersrand / Background: Prematurely born very low birth weight (VLBW) infants are at high risk for neurodevelopmental problems and require regular follow up. Within the South African context, one needs a reliable and user-friendly screening tool to identify those who require intervention. The Molteno Adapted Scale (MAS) is used for this purpose in many clinics, but it has never been validated. Aim: To assess if the MAS performed on young prematurely born infants reliably predicts the neurodevelopmental outcome at 2 years of age as determined by the Griffiths Mental Development Scales (GMDS). Methods: A retrospective study of records of VLBW infants between 1998 and 2006, from the Panorama Medi-Clinic Neonatal Intensive Care Unit follow up clinic. Infants with birth weights < 1500g and accurately assessed gestation < 34 weeks were included. Those who suffered brain insults e.g. meningitis, between the early assessments and the GMDS were excluded. For each child, quotients obtained from the MAS at early assessments were compared to quotients obtained on the GMDS after 2 years of age using Spearman correlations. Results: Fifty-two (27 boys) VLBW infants were included in the study, with a mean birth weight of 981.2 ± 225.5 g and mean gestation of 27.7 ± 1.9 weeks. Thirteen (25%) infants had cerebral palsy and two had visual impairment. MAS assessments were performed at mean ages of 5.1, 10.1 and 16.8 months and the GMDS at a mean age of 28.8 months. Correlations between the MAS and the GMDS ranged from 0.1 - 0.43 at the first assessment, 0.29 - 0.46 at the second assessment and 0.52 - 0.63 at the third assessment. Correlations were statistically significant for the Fine Motor quotient on the MAS at the first assessment, the General quotient and Personal Social quotient at the second assessment, and all quotients except Personal Social at the third assessment. Conclusion: Developmental quotients on the MAS at 5.1 and 10.1 months have a weak positive correlation with the GMDS at 28 months. The MAS at 16.8 months significantly correlated with the developmental outcome as assessed on the GMDS at a mean age of 28 months in prematurely born VLBW infants.

The ultra-processing of food has become a much more important aspect of dietary patterns and dietary quality in terms of its impact on body weight, diet related diseases, health, and well-being in the past decades. NOVA is a set of guidelines developed that classifies diet quality by degree of food processing. The NOVA guidelines distinguish four categories: unprocessed /minimally processed foods; culinary ingredients; processed foods; and ultra-processed foods. Numerous studies have found an association of ultra-processed foods and health conditions such as obesity and metabolic syndrome. This study analyzed the associations between maternal diet quality as measured by NOVA and maternal anthropometric and neonatal body composition outcomes. The optimal method of nutrition intervention and education for this special population remains unknown; using NOVA may provide researchers with a different lens to assess diet quality and health care professionals with additional vocabulary to convey more tailored messages regarding optimal nutrition strategies for mother and offspring. Using data collected from a large randomized controlled intervention trial at pre and post intervention, this study aimed to compare the NOVA guidelines assessment of maternal diet quality to the parent study assessment of diet quality, the Healthy Eating Index (HEI), using statistical correlations. Secondly, this study aimed to look at the relationship of ultra-processed food intake to the maternal gestational weight gain experience using a logistic regression. Thirdly, this dissertation aimed to explore the relationship between maternal ultra-processed food intake and neonatal lean mass as measured by quantitative magnetic resonance (QMR) and fat free mass as measured by air displacement plethysmography (ADP: PEAPOD). In terms of maternal outcomes, the study found that NOVA and HEI were significantly correlated at pre intervention but not at post intervention. The odds of gaining excessive gestational weight decreased as maternal ultra-processed food intake increased - which was not in the hypothesized direction - when using study participant data. However, the odds of gaining excessive gestational weight increased as maternal ultra-processed food intake increased - which was in the hypothesized direction - when using the Institute of Medicine weight gain recommendations. Also, while obesity did not predict excessive gestational weight gain, those with obesity ultra-processed food intake did predict gestational weight gain. These various inconsistencies are likely due to the instability of the dietary intake data because only one 24 -hour dietary recall was obtained from mother. In addition, the mothers’ diets were very healthy to begin with, where ultra-processed food intake formed about 45% of calories both pre and post intervention, when the national average is 57%. Race was also significant predictors of gestational weight gain for the mothers. Being non-white significantly increased the odds of gaining excessively as did the interaction of having obesity and eating more ultra-processed foods. In terms of neonatal outcomes, findings from this study suggest that length and fat mass are significant predictors of lean mass in neonates. In terms of the impact of maternal ultra-processed food intake, the higher the consumption of ultra-processed food, the greater the neonatal lean mass, which this was not in the hypothesized direction. However, the association was minimal with very small beta weights and regression line, when plotted was quite flat, so that the finding is not clinically meaningful. It remains important to know whether maternal ultra-processed food intake influences gestational weight gain and the body composition of the neonate. Thus, future research should include using similar data analyses on a population with a more nationally representative diet, a larger sample size, and a more robust measure of dietary intake such as three 24-hour recalls. Given that a similar recent study found ultra-processed food to be highly predictive of maternal and neonatal outcomes, and many other studies have demonstrated that ultra-processed food is related to several health conditions in many countries that this study did not measure, it seems prudent for healthcare providers to take advantage of prenatal visits as a window of opportunity to encourage the consumption of unprocessed and minimally foods and help women make informed decisions regarding ultra-processed foods.

A microbiota intestinal humana é um ecossistema complexo que abriga centenas de espécies bacterianas e que de um modo geral convive harmonicamente com o hospedeiro. Essa interação promove o desenvolvimento e estimulação do sistema imune. A microbiota tem papel primordial na saúde humana por produzir nutrientes, participar no metabolismo de carboidratos e por competir com bactérias patogênicas na colonização do ambiente intestinal. Ela alcança sua estabilidade em torno do segundo ano de vida. O tipo de parto, de alimentação, as condições sanitárias, sociais e os elementos do hospedeiro, como fatores genéticos, peristaltismo e pH intestinal, influenciam na sua composição. Quando há a instalação de infecções intestinais ou uso de antimicrobianos e de imunossupressores ocorre o desequilíbrio desse sistema. Esse estudo tem como objetivo avaliar o estabelecimento e a diversidade da microbiota intestinal em onze crianças a partir do segundo dia até o décimo segundo mês de vida. As amostras fecais das crianças foram coletadas no segundo e sétimo dias de vida e mensalmente do primeiro ao décimo segundo meses de vida. As análises de \"fingerprinting\" foram realizadas pelo método de eletroforese em gel com gradiente desnaturante (DGGE) usando os iniciadores para a região V3 do gene 16S rRNA. Os perfis de similaridade foram feitos a partir da construção de dendrogramas e para avaliar as relações entre as amostras temporais das crianças e o perfil de bandas obtido com o DGGE foram feitas análises de correspondência. A análise do \"fingerprinting\" mostrou que cada criança apresentou um padrão de colonização distinto. Apesar de compartilharem algumas características como a forma de nascimento, quadro sócio-econômico e terem condições sanitárias semelhantes, observaram-se diferenças no processo de estabelecimento da microbiota de cada uma delas, o que pode ser devido aos fatores individuais e particularidades da alimentação, do uso de medicamentos e das intercorrências infecciosas. As análises de correspondência mostraram agrupamentos temporais, onde as amostras mais tardias (a partir de 10 meses até 12 meses de idade) estão muito relacionadas entre si indicando o início da estabilização da microbiota ao final do 1º ano de vida. O uso da técnica de \"fingerprinting\" por DGGE permitiu uma análise global dos estágios diferentes no estabelecimento da microbiota intestinal. / The human intestinal microbiota is a complex ecosystem that homes hundreds of bacterial species, which generally live in harmony with the host. This interaction promotes the development and stimulation of the immune system. The microbiota plays a major role in human health by producing nutrient involved in carbohydrate metabolism and competes with pathogenic bacteria in the colonization of the intestinal environment. The stability is achieved around the second year of life. The type of delivery, food, sanitation, and social elements of the host, such as genetic factors, peristaltism and intestinal pH, influence their composition. The imbalance of this system happens due the installation of intestinal infections, in the use of antibiotics and immunosuppressants. The aim of this study is to evaluate the establishment and the diversity of the intestinal microbiota of eleven children from the second day of life until the twelfth month of life. The fecal samples were collected from children in the second and seventh days of life and monthly from the first month to the twelfth month of life. Analyses of fingerprinting was performed by the method of denaturing gradient gel electrophoresis (DGGE) using the primers for the V3 region of the 16S rRNA gene. The similarity profiles were made with the construction of dendrograms and to evaluate the relationships between the temporal samples of children and the profile obtained from the DGGE bands were made the correspondence analysis (CA). The fingerprinting analysis showed that each child had a distinct pattern of bands. Although sharing some characteristics such as delivery mode, socio-economic context and similar health conditions were observed differences in the process of establishment of the microbiota of each, which may be due to individual factors, the use of medicine and infectious complications. The correspondence analysis showed temporal clusters, where the later samples (from 10 months to 12 months of age) are closely related to each other indicating the beginning of the stabilization of the microbiota at the end of the first year of life. Using the technique of fingerprintin by DGGE allowed a comprehensive analysis of different stages in the intestinal microbiota establishment.