26
|
|
27
|
Christensson K, Cabrera T, Christensson E, Uvnäs-Moberg K, Winberg J. Separation distress call in the human neonate in the absence of maternal body contact. Acta Paediatr 1995; 84:468-73. [PMID: 7633137 DOI: 10.1111/j.1651-2227.1995.tb13676.x] [Citation(s) in RCA: 147] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Few studies have used the baby's cry as a means of evaluating the quality of neonatal care. In this randomized trial the newborn's cry was registered during the first 90 min after birth when infants were cared for either: (a) skin-to-skin with the mother; (b) in a cot; or (c) in a cot for the first 45 min of the 90-min observation period and then skin-to-skin with the mother. The results suggested that human infants recognize physical separation from their mothers and start to cry in pulses. Crying stops at reunion. The observed postnatal cry may be a human counterpart to the "separation distress call" which is a general phenomenon among several mammalian species, and serves to restore proximity to the mother. Our results suggest that in human newborns this cry is not dependent on earlier social experience and may be a genetically encoded reaction to separation. The findings are compatible with the opinion that the most appropriate position of the healthy full-term newborn baby after birth is in close body contact with the mother.
Collapse
|
28
|
|
29
|
Roberts JA, Marklund BI, Ilver D, Haslam D, Kaack MB, Baskin G, Louis M, Möllby R, Winberg J, Normark S. The Gal(alpha 1-4)Gal-specific tip adhesin of Escherichia coli P-fimbriae is needed for pyelonephritis to occur in the normal urinary tract. Proc Natl Acad Sci U S A 1994; 91:11889-93. [PMID: 7991552 PMCID: PMC45341 DOI: 10.1073/pnas.91.25.11889] [Citation(s) in RCA: 298] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Nonobstructive acute pyelonephritis in humans is most often caused by P-fimbriated Escherichia coli. P-fimbriae are heteropolymeric fibers carrying a Gal(alpha 1-4)Gal-specific PapG adhesin at its distal end. The pyelonephritic strain DS17 expresses P-fimbriae from a single gene cluster. A mutant strain, DS17-8, which expresses P-fimbriae tacking the PapG adhesin, was constructed by allelic replacement introducing a 1-bp deletion early in the papG gene. In cynomolgus monkeys, DS17 and DS17-8 were equally able to cause bladder infection, whereas only the wild-type strain DS17 could cause pyelonephritis as monitored by bacteriological, functional, and histopathological criteria. Since DS17, but not DS17-8, adheres to renal tissue, these data underscore the critical role of microbial adherence to host tissues in infectious disease and strongly suggest that the PapG tip adhesin of P-fimbriae is essential in the pathogenesis of human kidney infection.
Collapse
|
30
|
Winberg J. What hygiene measures are advisable to prevent recurrent urinary tract infection and what evidence is there to support this advice? Pediatr Nephrol 1994; 8:652. [PMID: 7696096 DOI: 10.1007/bf00869076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
|
31
|
Abstract
We studied the involvement of naturally occurring odours in guiding the baby to the nipple. One breast of each participating mother was washed immediately after delivery. The newborn infant was placed prone between the breasts. Of 30 infants, 22 spontaneously selected the unwashed breast. The washing procedure had no effect on breast temperature. We concluded that the infants responded to olfactory differences between the washed and unwashed breasts.
Collapse
|
32
|
Kjellmer I, Winberg J. The neurobiology of infant-parent interaction in the newborn: an introduction. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1994; 397:1-2. [PMID: 7981468 DOI: 10.1111/j.1651-2227.1994.tb13258.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
33
|
Winberg J. Management of primary vesico-ureteric reflux in children--operation ineffective in preventing progressive renal damage. Infection 1994; 22 Suppl 1:S4-7. [PMID: 8050791 DOI: 10.1007/bf01716025] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Four studies comprising 606 children and with a follow-up of 4-5 years have shown that operation and long-term antibiotic prophylaxis are equally ineffective in preventing post-infectious, progressive renal damage in children with grade III-IV reflux. To consider only the grade of reflux in the choice of management is too simple an approach. Other aspects of the complex biology of UTI should also be considered. Another important aspect concerns the organization of the care. Efficient and robust routines for a thorough follow-up and measures to guarantee immediate diagnosis and treatment of recurrent infections in children known to be at risk may be more important for the preservation of the kidneys than a stereotyped policy of operation or "endless" antibiotic prophylaxis. Specialized teams should be used as in the treatment of other long-term diseases. Parents should be educated and made active participants in the supervision of children at risk. Controlled multicentre studies are powerful scientific instruments, but appear to have too little impact on clinical practice. The responsibility of clinical scientists to make important results known and understood among those concerned is discussed from the ethical point of view.
Collapse
|
34
|
Winberg J. [No to unnecessary treatment of ureteral reflux]. LAKARTIDNINGEN 1993; 90:3927. [PMID: 8231552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
35
|
Winberg J, Herthelius-Elman M, Möllby R, Nord CE. Pathogenesis of urinary tract infection--experimental studies of vaginal resistance to colonization. Pediatr Nephrol 1993; 7:509-14. [PMID: 8251310 DOI: 10.1007/bf00852528] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The review summarizes studies of vaginal colonization resistance against Escherichia coli in a primate model. The genital flora surrounding the urethral orifice exerts a strong colonization resistance. Amoxicillin profoundly disturbs the normal vaginal microflora, reduces its adherence to vaginal epithelial cells in vivo and promotes a persistent vaginal E. coli colonization. Certain cephalosporins may have a similar effect. The induced ecological changes mimic those seen in patients with recurrent urinary tract infections (UTI). Amoxicillin also promotes the spread of E. coli from rectum to vagina, which may be of clinical significance. Trimethoprim and nitrofurantoin do not have these effects. The natural colonization resistance could not clearly be correlated with the presence of lactobacilli, which were only transiently reduced by amoxicillin. The colonization resistance against E. coli could only partly be restored by vaginal instillation of lactobacilli, but was fully restored by flushing of the whole vaginal flora from a healthy monkey. Clinical observations suggest that accumulation of E. coli around the urethral orifice increases the risk of UTI. We conclude that antibiotics and other compounds that interfere with the normal genital flora may increase the risk of UTI. This should influence the choice of antibiotics in the treatment of UTI.
Collapse
|
36
|
Winberg J. [Vesico-ureteral reflux in children. Surgery does not prevent renal damage--it is time to abandon surgical method!]. LAKARTIDNINGEN 1993; 90:2843-4. [PMID: 8377555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
37
|
Winberg J, Gezelius L, Guldevall L, Möllby R. Cephadroxil promotes vaginal colonization with Escherichia coli. Infection 1993; 21:201-5. [PMID: 8225621 DOI: 10.1007/bf01728887] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The aim of this study was to examine whether a vaginal Escherichia coli colonization, mimicking the one seen in UTI-prone females, could be induced by local cephadroxil administration. When five adult cynomolgus monkeys were given a vaginal flush with a P-fimbriated E. coli strain, none became persistently colonized. When such colonization attempts were preceded by cephadroxil administration a persistent colonization occurred in 9/10 experiments. Cephadroxil also promoted a spread of fecal E. coli strains to the vagina. Reduction of the anaerobic vaginal flora can explain the breakdown of the colonization resistance. Clinical observations suggest that accumulation of E. coli around the urethral orifice increases the risk of UTI. Therefore antibiotics which promote such colonization may increase the risk for UTI in susceptible patients. From this point of view antibiotics such as cephadroxil may be less suitable for treatment of UTI-susceptible patients.
Collapse
|
38
|
Christensson K, Siles C, Cabrera T, Belaustequi A, de la Fuente P, Lagercrantz H, Puyol P, Winberg J. Lower body temperatures in infants delivered by caesarean section than in vaginally delivered infants. Acta Paediatr 1993; 82:128-31. [PMID: 8477157 DOI: 10.1111/j.1651-2227.1993.tb12622.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Clinical experience suggests that infants delivered by caesarean section have difficulties maintaining normal body temperature during the first hours after birth. To test this hypothesis, body and skin temperatures were measured and compared in healthy full-term caesarean section and vaginally delivered newborn infants. The babies were studied during the first 90 min after birth. Axillary and skin temperatures were significantly higher in the vaginally delivered group than in infants delivered by caesarean section. Infants born by non-elective caesarean section were slightly warmer during the first 90 min after birth compared to infants born by elective caesarean section. There were no significant differences in temperatures between infants cared for in a cot as compared to those cared for in an incubator. An incubator creates a physical barrier between babies and parents and incubator care might cause parental anxiety. Thus the routine of putting healthy, full-term caesarean section infants in incubators can be abandoned from a thermoregulatory point of view.
Collapse
|
39
|
Uvnäs-Moberg K, Marchini G, Winberg J. Plasma cholecystokinin concentrations after breast feeding in healthy 4 day old infants. Arch Dis Child 1993; 68:46-8. [PMID: 8439200 PMCID: PMC1029168 DOI: 10.1136/adc.68.1_spec_no.46] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
The aim of the present study was to characterise plasma concentrations of cholecystokinin (CCK) after breast feeding in newborn infants. Fifty eight healthy full term exclusively breast fed infants were investigated at 4 (1) (2-6) days of age. Each infant contributed one blood sample collected just before, immediately after, or 10, 30, and 60 minutes after breast feeding. Plasma concentrations of CCK were measured with a technique consisting of high pressure liquid chromatography separation of gastrins and CCKs and consequent analysis with radioimmunoassay. Mean (SD) preprandial plasma concentrations of CCK (CCK8+CCK-33,39) were 68 (17) pmol/l. A significant increase was seen immediately after breast feeding, which was followed by a decline at 10 minutes and a secondary rise was seen at 30 and 60 minutes. The first peak is likely to be due to a suckling related activation of the vagal nerve and the second to a stimulatory effect of food on CCK-producing cells. An inverse relationship between basal concentrations of CCK and age of the infant was found. In rats peripheral injections of CCK reduce food intake and cause postprandial sedation and sleepiness via activation of an afferent vagal mechanism. CCK release in response to breast feeding may therefore in addition to exerting stimulatory effects on digestion and metabolism contribute to relaxation and sleepiness seen after breast feeding. The high CCK concentrations seen in younger infants may help the infant to remain satiated and calm despite receiving very little food during the first days of life.
Collapse
|
40
|
Christensson K, Siles C, Moreno L, Belaustequi A, De la Fuente P, Lagercrantz H, Puyol P, Winberg J. [Temperature, metabolic adaptation and crying in healthy full-term newborn infants cared for skin-to-skin or in a crib]. JORDEMODERN 1992; 105:397-9. [PMID: 1464561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
41
|
|
42
|
Christensson K, Siles C, Moreno L, Belaustequi A, De La Fuente P, Lagercrantz H, Puyol P, Winberg J. Temperature, metabolic adaptation and crying in healthy full-term newborns cared for skin-to-skin or in a cot. Acta Paediatr 1992; 81:488-93. [PMID: 1392359 DOI: 10.1111/j.1651-2227.1992.tb12280.x] [Citation(s) in RCA: 195] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The aim of the present study was to compare temperatures, metabolic adaptation and crying behavior in 50 healthy, full-term, newborn infants who were randomized to be kept either skin-to-skin with the mother or next to the mother in a cot "separated". The babies were studied during the first 90 min after birth. Axillary and skin temperatures were significantly higher in the skin-to-skin group; at 90 min after birth blood glucose was also significantly higher and the return towards zero of the negative base-excess was more rapid as compared to the "separated" group. Babies kept in cots cried significantly more than those kept skin-to-skin with the mother. Keeping the baby skin-to-skin with the mother preserves energy and accelerates metabolic adaptation and may increase the well-being of the newborn.
Collapse
|
43
|
Herthelius-Elman M, Möllby R, Nord CE, Winberg J. Lack of effect of trimethoprim and nitrofurantoin on colonization resistance in the vagina of monkeys. Infection 1992; 20:105-10. [PMID: 1582681 DOI: 10.1007/bf01711078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The effects of trimethoprim and nitrofurantoin, two antibiotics often used for treatment and long-term prophylaxis of urinary tract infections, on colonization resistance in the vagina of monkeys were investigated. Female monkeys were flushed intravaginally with one of the antibiotics or buffered saline or amoxicillin (controls) for six days. During or after this antibiotic administration a pyelonephritogenic Escherichia coli, strain DS17, was flushed into the vagina. A persistent colonization was obtained in two of eight trimethoprim experiments and a transient colonization in one trimethoprim and two of seven nitrofurantoin experiments. These results did not differ significantly from those of the buffer control experiments. Neither the number of anaerobic bacteria nor the composition of the anaerobic microflora was much affected by these antibiotic agents, while amoxicillin both reduced the number of anaerobic bacteria and promoted E. coli colonization. We conclude that trimethoprim and nitrofurantoin exert a limited effect on the microecology and the colonization resistance in the vagina. From an ecological aspect both drugs seem to be good choices for treatment and prophylaxis of urinary tract infections.
Collapse
|
44
|
Herthelius-Elman M, Möllby R, Nord CE, Winberg J. The effect of amoxycillin on vaginal colonization resistance and normal vaginal flora in monkeys. J Antimicrob Chemother 1992; 29:329-40. [PMID: 1592701 DOI: 10.1093/jac/29.3.329] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Previous studies have shown that vaginal colonization resistance in monkeys can be eliminated by amoxycillin and restored by flushing vaginal flora from a healthy monkey into the vagina of a monkey colonized with Escherichia coli. The hypothesis that the effect of amoxycillin resulted from elimination of parts of the normal flora was tested in the present study. Nine monkeys were flushed vaginally with amoxycillin daily for six days. The number of anaerobic bacteria decreased during amoxycillin administration, as did the number of species isolated. The most obvious effects were observed among the genera Bacteroides and Peptostreptococcus, while Lactobacillus spp. were less affected. Restoration of the flora after amoxycillin administration was slow in most of the monkeys. During amoxycillin administration, all monkeys became colonized spontaneously with E. coli. This was not, however, associated with increased adherence in vitro. The colonization persisted throughout the study period (29 days). It was concluded that amoxycillin disturbs vaginal colonization resistance by eliminating at least part of the normal vaginal flora, thereby promoting periurethral colonization with enterobacteria.
Collapse
|
45
|
Jacobson SH, Eklöf O, Lins LE, Wikstad I, Winberg J. Long-term prognosis of post-infectious renal scarring in relation to radiological findings in childhood--a 27-year follow-up. Pediatr Nephrol 1992; 6:19-24. [PMID: 1536735 DOI: 10.1007/bf00856822] [Citation(s) in RCA: 100] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In a previous report the long-term prognosis of 30 patients with renal scarring after pyelonephritis in childhood was described. In this study, we have related the extent of renal scarring present in childhood to the conditions in early adulthood. A radiological progression of scarring from childhood to adulthood was seen in one-third of the kidneys. The 7 patients with bilateral scarring in childhood had a smaller renal area, lower glomerular filtration rate and higher plasma vasopressin at follow-up than 13 healthy controls. The 20 patients who had unilateral scarring in childhood had a smaller renal area, lower glomerular filtration rate, higher diastolic blood pressure and higher plasma renin at follow-up than controls; 4 had hypertension. The most important finding was that children with unilateral disease are at risk of serious long-term complications. Filtration fraction at follow-up was higher in patients with extensive renal scarring in childhood compared with those with a normal renal area or small scars in childhood (r = -0.43, P less than 0.05). This may indicate glomerular hyperfiltration by remnant glomeruli. This paper emphasizes t the potential seriousness of childhood urinary tract infections especially when early infantile infections are overlooked. A follow-up of more than 4 decades may be necessary before the ultimate prognosis can be established, especially in patients with unilateral renal disease. It is advised that most patients with post-infectious renal scars are followed as high-risk patients, and that treatment continuity is established between paediatricians, nephrologists and, when required, obstetricians.
Collapse
|
46
|
Winberg J. Is routine circumcision advised in boys with obstructive uropathy in order to prevent urinary tract infection? Pediatr Nephrol 1991; 5:178. [PMID: 2031829 DOI: 10.1007/bf01095946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
47
|
Widstrom AM, Matthiesen AS, Winberg J, Uvnas-Moberg K. Maternal somatostatin levels and their correlation with infant birth weight. Int J Gynaecol Obstet 1990. [DOI: 10.1016/0020-7292(90)90637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
48
|
Jacobson SH, Eklof O, Eriksson CG, Lins LE, Tidgren B, Winberg J. Development of hypertension and uraemia after pyelonephritis in childhood: 27 year follow up. Int J Gynaecol Obstet 1990. [DOI: 10.1016/0020-7292(90)90968-q] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
49
|
Widström AM, Wahlberg V, Matthiesen AS, Eneroth P, Uvnäs-Moberg K, Werner S, Winberg J. Short-term effects of early suckling and touch of the nipple on maternal behaviour. Early Hum Dev 1990; 21:153-63. [PMID: 2311552 DOI: 10.1016/0378-3782(90)90114-x] [Citation(s) in RCA: 121] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The objective was to evaluate the effects of suckling within 30 min after birth when skin-to-skin body contact for mothers and infants was held constant in both cases (n = 32) and control groups (n = 25). Mother-infant interaction during breast-feeding, infants' time spent in nursery and different aspects of breast-feeding were evaluated. Prolactin and gastrin were measured in maternal serum before and after breast-feeding on day 4 post partum. The aim to evaluate effects of early post delivery suckling failed since only six of the 32 case infants did suck at this time. In spite of this, we found three significant differences among cases and controls. In the case group where all infants had touched or licked the areola and nipple, the mothers left the infants in the nursery for a significantly shorter time and significantly more mothers talked to their infants during the short breast-feeding observation. Median gastrin levels were significantly lower in cases than in controls both before (P less than 0.01) and after (P less than 0.03) breast-feeding. In conclusion, the infant's early touch of the mother's areola and nipple seemed to have positively influenced the mother/infant relationship during the first four days after birth. It was also associated with lower maternal gastrin levels which suggests that maternal neuroendocrine functions were also influenced. Ten months after birth, we found no differences between cases and controls.
Collapse
|
50
|
Uvnäs-Moberg K, Widström AM, Werner S, Matthiesen AS, Winberg J. Oxytocin and prolactin levels in breast-feeding women. Correlation with milk yield and duration of breast-feeding. Acta Obstet Gynecol Scand 1990; 69:301-6. [PMID: 2244461 DOI: 10.3109/00016349009036151] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aim of the present study was to examine suckling-related plasma levels of oxytocin and prolactin in early and established lactation and to correlate hormone profiles to success of lactation performance. Fifty-five primiparous women participated in the study. From each, 18 blood samples were drawn in connection with breast-feeding on day 4 post partum and after 3-4 months. Oxytocin and prolactin levels were determined with radio-immunoassay. Basal levels of both hormones were significantly higher 4 days post partum than 3-4 months later and after weaning. Basal prolactin levels fell significantly within 24 h of weaning. Oxytocin and prolactin levels rose in response to breast-feeding--an effect which persisted during the lactation period. The suckling-induced release of prolactin--but not that of oxytocin--was related to basal hormone levels. Basal as well as stimulated oxytocin levels obtained 4 days and 3-4 months post partum correlated significantly, indicating that each woman has an individual, characteristic level of this hormone. Milk yield did not correlate with oxytocin or prolactin levels, but prolactin levels recorded 3-4 months post partum did correlate with the remaining period of breast-feeding. In addition, mothers who breast-fed exclusively 3-4 months post partum had significantly higher oxytocin and prolactin levels than those who gave supplementary feed. There was a significant correlation between oxytocin levels at 4 days and birth weight of the infant.
Collapse
|