Esse estudo tem como tese que o comportamento de recém nascidos e bebês é ativo, ou seja, guiado a uma meta específica e baseado no conhecimento a respeito do ambiente ao seu redor. Também é assumido que essa capacidade de adaptação se fortaleça ao longo dos 4 primeiros meses após o nascimento. Foram investigadas as atividades manuais de recém nascidos e bebês, tendo em vista que as mãos são uma importante ferramenta de percepção e interação com o ambiente. Assim, os objetivos do estudo foram: a) descrever o comportamento de apertar ao longo dos 4 primeiros meses após o nascimento; e b) identificar acoplamentos entre apertos manuais e o contexto ambiental durante os quatro primeiro meses após o nascimento. Os resultados mostraram que os bebês alteraram a organização temporal dos apertos diferentemente nas situações de contingência e não contingência, um indicativo inicial do comportamento ativo nos apertos manuais / This thesis searched for evidences that newborns and infants behaviour are active, in the other words, intentional, guide by a goal and based in environment knowledge. Also, it is suggested that the adaptation capacity improve around the first 4 months of age Thereunto, the manual activities were investigate, because the hand is an important font of perception and interaction with the environment. So, the goals of the study were: a) to describe neonate and infant clutches around four first months after birth; and b) to verify the coupling between clutches and environmental outcomes during the first four months after birth. The results showed that infants could alter the temporal organization of clutches differently in contingent and no contingent conditions, an initial indicative of active clutch behaviour in young infants

Background and Aim: Preterm infants frequently receive blood transfusion (BT) during their stay in the neonatal unit. The aim of this study was to measure the effect of BT on cerebral and gut blood flow and oxygenation in preterm infants in relation to postnatal age. Another aim of the study was also to investigate the influence of measured pre-transfusion RCV on gut perfusion in preterm infants receiving first blood transfusion for clinical indication using NIRS and Doppler ultrasound scan. Methods: Preterm infants admitted to neonatal unit were recruited to three postnatal age groups: 1 to 7 days (group 1; n=20), 8 to 28 days (group 2; n=21) & ≥29 days of life (group 3; n=18). Pre and post-BT Anterior Cerebral artery (ACA) Time Averaged Mean Velocity (TAMV) and Superior Vena Cava (SVC) flow were measured to assess cerebral blood flow. Pre and post-BT Superior mesenteric artery (SMA) peak systolic velocity was measured to assess gut or splanchnic blood flow. Cerebral and gut Tissue Haemoglobin Index (THI), Oxygenation Index (TOI) were measured from 15-20 minutes before to 15-20 minutes post-BT using NIRS. Cerebral and gut fractional tissue oxygen extraction (FTOE) was calculated from the TOI and saturation of oxygen (SaO2). Vital parameters and blood pressure (BP) were also measured continuously from overhead monitors. Pretransfusion red cell volume (RCV) was measured by fetal haemoglobin (HbF) dilution method and compared with the cerebral and gut perfusion and oxygenation changes following blood transfusion. The cerebral and gut perfusion and oxygenation were also measured over a three hour period in 12 control infants not receiving blood transfusion. Results: There were 71 infants included in the study; of them 59 were study infants receiving blood transfusion and 12 were control infants. Amongst the vital parameters, mean BP increased significantly, and there was no significant change in heart rate (HR), respiratory rate (RR) or SaO2 following BT. Pre-transfusion ACA TAMV was higher in Group 2 and 3 compared to Group 1 (p < 0.001) which remained significant after multivariate analysis (p < 0.05). Pretransfusion ACA TAMV decreased significantly (p≤0.04) in all 3 postnatal age groups; pre-transfusion SVC flow decreased significantly in Group 1 (p=0.03) and Group 3 (p < 0.001) following transfusion. Pre-transfusion cTOI was significantly lower in Group 3 compared to Group 1 (p=0.02) which remained significant after multivariate analysis (p < 0.011). The cTHI (p < 0.001) and cTOI (p < 0.05) increased significantly post-transfusion in all three postnatal age groups. PDA had no effect on these measurements. Pre-transfusion SMA PSV increased with postnatal age (group 3 vs. group 1: p < 0.01; CI 0.6 to 0.1), proportion of feeds (> 50% feeds: 0.91±0.4 vs. < 50% feeds: 0.71±0.4 m/sec, p < 0.01); and decreased with presence of PDA (closed PDA: 0.94±0.4 vs. open PDA: 0.68±0.3 m/sec, p=0.006, CI 0.07 to 0.45); but remained unaltered following transfusion. The pre-transfusion sTOI varied with postnatal age (Group 2:44.6 vs. Group1: 36.7%; p=0.03, CI -0.6 to -15.2) on univariate analysis but was not significantly different on multivariate analysis; pre-transfusion sTOI was not influenced by feeds or presence of PDA. The sTHI and sTOI increased (p < 0.01) and sFTOE decreased (p < 0.01) significantly following transfusion in all postnatal age groups.

Esse estudo tem como tese que o comportamento de recém nascidos e bebês é ativo, ou seja, guiado a uma meta específica e baseado no conhecimento a respeito do ambiente ao seu redor. Também é assumido que essa capacidade de adaptação se fortaleça ao longo dos 4 primeiros meses após o nascimento. Foram investigadas as atividades manuais de recém nascidos e bebês, tendo em vista que as mãos são uma importante ferramenta de percepção e interação com o ambiente. Assim, os objetivos do estudo foram: a) descrever o comportamento de apertar ao longo dos 4 primeiros meses após o nascimento; e b) identificar acoplamentos entre apertos manuais e o contexto ambiental durante os quatro primeiro meses após o nascimento. Os resultados mostraram que os bebês alteraram a organização temporal dos apertos diferentemente nas situações de contingência e não contingência, um indicativo inicial do comportamento ativo nos apertos manuais / This thesis searched for evidences that newborns and infants behaviour are active, in the other words, intentional, guide by a goal and based in environment knowledge. Also, it is suggested that the adaptation capacity improve around the first 4 months of age Thereunto, the manual activities were investigate, because the hand is an important font of perception and interaction with the environment. So, the goals of the study were: a) to describe neonate and infant clutches around four first months after birth; and b) to verify the coupling between clutches and environmental outcomes during the first four months after birth. The results showed that infants could alter the temporal organization of clutches differently in contingent and no contingent conditions, an initial indicative of active clutch behaviour in young infants

Research has shown that sleep disturbance (e.g., sleep latency, wakefulness after sleep onset [WASO]) negatively affects physical, emotional, and mental health. For many adults, the postpartum period is one that is particularly highlighted by sleep disturbance and fatigue. Postpartum mothers are also more vulnerable to psychiatric disorders such as depression. We sought to investigate whether the number of children and presence of an infant predicted clinically significant sleep disturbance, and subsequently, depressive symptoms, for both mothers and fathers. We found that having an infant was significantly associated with increased wife WASO, which in turn was associated with increased depressive symptoms for wives. Further, husband WASO was associated with decreased wife WASO which was similarly associated with decreased depressive symptoms for wives. Thus, by helping with nighttime care so that mothers can get more sleep fathers can greatly contribute to the physical and emotional health of mothers.

Our current ability to identify and appropriately treat infants who are at risk for developing various handicapping conditions is limited. Thus, research aimed at developing early diagnostic techniques and differential intervention programs for infants at risk for handicaps needs further attention. The purpose of this study was to determine if infants who suffered perinatal intraventricular hemorrhage and who received routine medical care plus sensorimotor intervention between 3 and 12 months of age, differed from similar infants who received only routine medical care. Twenty-four subjects (10 experimental and 14 control) who were patients in neonatal intensive care at University of Utah or Primary Children's Medical Centers constituted the study sample. Descriptive data specific to the birth and perinatal period were obtained on the infant and its mother. All infants were evaluated with the Battelle Developmental Inventory at 3 and 12-months corrected age. In addition, the Carey Infant Temperament Questionnaire was completed by the parent when the infant was 6 to 9 months corrected age, and the Parenting Stress Index was completed when the infants was 12 months corrected age. Experimental subjects and their parent(s) participated in an individualized sensorimotor intervention program, directed by a licensed physical therapist, for 1 hour per week on a bi-monthly basis. Parents reported spending an average of 20 minutes per day, 5 days per week, working on exercises with their infant at home throughout the 9- month program. A statistically significant positive relationship was found between developmental outcome and participation in sensorimotor intervention , as measured by the posttest Battelle. No significant differences between groups were found on levels of parenting stress. On each of the measures, stress levels were moderate. Continued enrollment and annual follow-up of subjects in the current study will allow for longitudinal evaluation of the effects of early sensorimotor intervention on development.

No description available.

This series of studies investigated the sensitivity of mothers towards the behaviour of their preverbal infants. More specifically, the investigation examined the consistency with which mothers identified what they considered to be communicative acts by their infants aged 6, 9, and 12 months, and the contingency and appropriateness of their maternal responses. The ability of other female adults to identify the same infant acts as communicative as the mothers was also investigated. In Studies one and two, 35 infants and their mothers were videotaped in a laboratory setting. Three weeks after the videotaping session, the mothers were asked to view a five-minute section and code the stream of infant behaviour into periods when they believed that their infant was engaging in communicative behaviours ('on' events) and periods when they considered that the infants were not ('off' events). This process was repeated three months after the first coding. At each coding session the mothers coded the videotape twice. Each mother's coded records were compared, in pairs, within and across coding sessions and the observed levels of agreement were calculated. A randomization procedure using 1000 iterations of the whole 'on' and 'off' events was used to determine the meaningfulness of the observed level of agreement between pairs of codings by providing distributions of chance levels of agreement with which the observed levels could be compared. Levels of agreement that exceeded chance values (p equals or is less than .05) were taken as evidence of consistency of maternal response. Consistency in the identification of communicative acts by other female adults (OAs) was investigated using a sample of 12 of the videotapes. Each videotape was coded by three separate OAs. The significance of the observed levels of agreement between the mother's coding and those of the OAs was determined using the randomization procedure. The results indicated that at each infant age, mothers were able to identify consistently their infant's communicatively salient behaviours, even over inter-coding intervals of three months. Further, both OAs and mothers identified the same infant behaviours as communicative. The third study investigated the abilities of a different sample of mothers and infants to describe the topography and meaning of their infants' behaviours during the 'on' events. Mothers' descriptions of their infants' behaviour during the 'on' events were also used to describe changes in the criteria that they used to identify infant behaviours as communicatively salient. Results indicated that the complexity of the criteria that the mothers used changed across infant age. First, mothers of younger infants were more likely, than mothers of older infants, to describe a single infant behaviour as being communicatively salient. The latter were more likely to identify two or three co-occurring infant behaviours as salient. Second, when more than one infant behaviour was identified in an 'on' event, the mothers of the older infants were more likely than the mothers of younger infants to state that all of the behaviours that they identified were communicatively important. These findings were interpreted to mean that mothers of older infants required more complex constellations of behaviour during the 'on' events in order to identify those behaviours as communicative. Study 4 investigated the contingency and appropriateness of the mothers' responses to the segments of their infants' behaviour that they identified as being communicative. Across infant age, findings indicated that the mothers' verbal responses to their infants were contingent upon whether they considered that their infants were engaged in communicatively salient behaviours. During periods of infant behaviour that the mothers identified as being communicative, mothers talked significantly more to their infants than they did when their infant's behaviour was considered to be non-communicative. Further, mothers' verbal responses were interpreted as being appropriate in two ways. First, during the 'on' events, changes occurred over infant age in the balance between the use of utterances designed to attract and maintain the attention of the infant (Attentional Directives) and those designed to provide comment on infant behaviour (Feedback). This shift is in keeping with widely reported changes in infant behaviour as children grow older (i.e., older infants' play a greater role in initiating and maintaining episodes of interaction). Second, during periods when the mothers considered that their infants were not communicating ('off' events) they rarely used 'Feedback' verbal responses. During 'off' events, mothers maintained high levels of 'Attentional Directive' talk, irrespective of infant age. Taken collectively, these studies provide evidence that supports the view that mothers are sensitive to what they consider to be communicative behaviours by their infants in terms of the consistency, contingency and appropriateness of their behaviour. The unique features of this investigation, the generality of the findings and the implications for future research are discussed in the final chapter.

Bedsharing between infants and parents interacts with many factors to increase the risk of SIDS, eg maternal smoking, alcohol or drug consumption, overtiredness, excessive bedding and younger infant. However, bedsharing also encourages breastfeeding, settles babies, reduces parental tiredness and increases mother-baby interactions. We studied infants in the natural setting of their own home, in their usual situation (bedsharing or cot-sleeping) to identify risks and benefits, and to understand how bedsharing could be made safer for all infants. Methods: Overnight home video and physiological recordings of 40 bedshare infants (5-27 weeks), were compared with 40 cot infants matched for age and study season. Video data provided a log of infant/parent sleep positions, movements and interactions. The physiological recordings measured respiratory pattern, respiratory airflow, inspired CO2, oxygen saturation (SaO2), heart rate and core, peripheral and environmental temperatures. Results: All infants maintained normal core temperatures overnight although bedshare infants had a higher shin temperature [35.43 vs 34.60°C at 2hrs after sleep onset (difference 0.83, 95% CI: 0.18 to 1.49)]. Bedshare infants had thicker bedding (RR:2.35 (95% CI:1.76 to 3.14) and more face covered time [0.9h/night vs 0.2 (RR:5.62, 95% CI: 3.08 to 10.25)]. Awakenings in the bedshare group were more common, of shorter duration, and caused less change in infant temperatures. Exposure to >3% CO2 occurred in 18 bedshare infants and 1 swaddled, cot-sleep infant. The maximum exposure time was the same for both groups (60mins). These levels of CO2 significantly (p<0.05) elevated breathing rate and maintained normal SaO2. Central apnoeas of 5-10 seconds resulted in drops in SaO2 <90% (BS mean 6.8/night vs cot: 3.1, p<0.001). SaO2 rarely fell below 85% and heart rate did not ever fall below 90bpm. Bedshare infants commonly slept on their side, while cot infants slept supine. Prone sleeping was rare (BS:5 infants, 1.6-3.5h/night vs cot:2, 8.9-10.2) and for bedshare infants involved sleeping on mother�s chest. Bedshare infants woke and fed more frequently (mean wake times/night: 4.6 vs 2.5), but total sleep time was not different. Maternal checks were more frequent in the bedshare group (median:10, IQ range:7-23, max:55) than cot ( 4, 3-6, 16) and bedshare mothers frequently responded to infant initiated movements. During bedsharing baby and mother usually slept facing each other, touching, with infants at mothers� breast level. Father (or sibling) contact was rare. Conclusions: Bedshare infants sleep in a warmer environment and experience more potentially dangerous events such as head-covering and rebreathing. However, all infants in this study maintained normal rectal temperature and SaO2 suggesting they were protected by homeostatic responses. Infant safety is also facilitated by frequent maternal checking and maternal responses to infant movements. The mother-infant proximity during bedsharing allows prompt responses, reduces time infants are upset, and minimises disruption from frequent breast feeding - aspects valued by many. It is not known if infants of smoking mothers or parents with impaired responses eg due to alcohol, respond adequately to the potentially dangerous situations identified. Outcome: The results of this study will be used to formulate recommendations to parents for improving the safety of bedsharing.

The central nervous system (CNS) develops in a temporally and spatially organised manner. Any adverse events happening during the critical periods of early brain formation may lead to arrest in the process or injury to specific developed structures. Infants born at less than 30 weeks of gestation and those with intra-partum asphyxia are at risk of motor delay. The cause of this delay may be related to injuries in the brain such as the motor cortex, basal ganglia and cerebellum, all of which are essential in controlling movements. According to the dynamical systems theory of motor development, other than the CNS, body systems within the infant such as the musculoskeletal system, and external to the infant such as environmental enrichment and supportive child-rearing practice also have a decisive role in motor development in infants. / Paediatric physiotherapists have been involved in the management of these infants since birth. A number of well-established assessment tools are used to assess these infants’ motor functions. Most of these tools typically do not describe the movement patterns of infants but emphasise the achievement of age-specific motor milestones. The Alberta Infant Motor Scale (AIMS) is one of the few tools that acknowledge the importance of movement quality. / The overall aim of the present research was to examine the impact of adverse events in early infancy, including birth prior to 30 weeks of gestation and intra-partum asphyxia, on motor development of infants during the first two years of (corrected) age. One hundred and twenty infants were recruited, including 58 preterm infants, 10 infants with post-asphyxia neonatal encephalopathy (NE) and 52 term born infants as the control group. All the infants were assessed using the AIMS at 4, 8, 12 and 18 months of (corrected) age. / The preterm group scored significantly lower on various sub-scores of the AIMS at all age levels than the control group. Uneven progression in the sit subscale from 4 to 8 months corrected age (CA) was found in the preterm infants, possibly due to a dominant extensor strength, inadequate tonus and postural control in the trunk. At 12 and 18 months CA, limited variations in movements were evident in some preterm infants in the crawling, sitting and standing positions. The ten infants with post-asphyxia NE showed scattered motor development, related mostly to the severity of their NE. The moderate NE group had the most varied motor outcomes ranging from normal to suspected mild cerebral palsy. / The AIMS was shown to be a valid assessment tool in the preterm population although limitations in its use were found at 4 months CA and when the infants walked or were close to independent ambulation. The present results show that motor performance of typically and non-typically developing infants should be investigated longitudinally as variations are the characteristic of early development. The dynamical systems theory provides a more satisfactory explanation of the motoric differences in infants in this study. All these findings have great implications for the clinical management of these at risk infants.

Thesis (B.A.)--Haverford College, Dept. of Economics, 2007. / Includes bibliographical references.