Relation between birth weight and blood pressure: longitudinal study of infants and children

OBJECTIVE

To study the relation between birth weight and systolic blood pressure in infancy and early childhood.

DESIGN

Longitudinal study of infants from birth to 4 years of age.

SETTING

A middle class community in the Netherlands.

PARTICIPANTS

476 Dutch infants born in 1980 to healthy women after uncomplicated pregnancies.

MAIN OUTCOME MEASURES

Systolic blood pressure and body weight measured at birth and at 3 months and 4 years of age; the relation between systolic blood pressure and birth weight as estimated by multiple regression models that include current weight and previous blood pressure and control for gestational age, length at birth, and sex.

RESULTS

Complete data were available on 392 infants. At 4 years of age the relation between blood pressure and birth weight appeared to be U shaped; low and high birthweight infants had raised blood pressure. Current weight and previous blood pressure were also positively associated with blood pressure at that age. Low birthweight infants (birth weight < 3100 g) had a greater gain in blood pressure and weight in early infancy. High birthweight infants (birth weight > or = 3700 g) had high blood pressure at birth, and weight and blood pressure tended to remain high thereafter.

CONCLUSIONS

Even among normal infants there seem to be subgroups defined by birth weight in which blood pressure is regulated differently. Future investigations are needed to examine the physiological basis of these differences. Studies of correlates of adult disease related to birth weight should investigate mechanisms related to increased risk separately in infants of low and high birth weight.

Neurodevelopmental testing of children born to human immunodeficiency virus type 1 seropositive and seronegative mothers: a prospective cohort study in Kigali, Rwanda

OBJECTIVE

The results of developmental testing of 218 children born to human immunodeficiency virus (HIV)-seropositive mothers and infected or uninfected themselves were compared with those of 218 children born to HIV-seronegative mothers in an ongoing cohort study in Kigali, Rwanda.

METHODS

When the children were 6, 12, 18, and 24 months of age, a specific neurodevelopmental examination was performed blindly by study physicians assessing gross motor development, fine motor development, language acquisition, and social contacts.

RESULTS

Only one acute severe HIV-related encephalopathy was identified among the 50 infected children. The proportion of abnormal neurologic examinations in HIV-infected children varied from 15% to 40% according to age and was always higher than in HIV-uninfected children born to HIV-seropositive and seronegative mothers (< or = 5% or less of abnormal examinations at each time period). After excluding those children with clinical acquired immunodeficiency syndrome (AIDS) from the analysis, the proportion of abnormal examinations in infected children was 12.5% at 6 months, 16% at 12 months, 20% at 18 months, and 9% at 24 months of age and was still more frequent than in HIV-uninfected children. The developmental delay was principally due to significantly lower gross motor scores.

CONCLUSIONS

HIV-1-infected children are more frequently developmentally delayed than uninfected children during the first 2 years of life in this African population. This developmental delay is related to the AIDS stage of pediatric HIV infection.

Genetic analysis of patterns of growth in infant recumbent length

A genetic basis to growth and development has been demonstrated in many heritability studies of anthropometrics. Although such measures describe the extent of growth at particular times, they do not fully address the process of growth. We applied a three-parameter curve-fitting function to serial measures of recumbent length from 569 infants (birth to 2 years of age) in 188 families enrolled in the Fels Longitudinal Study. This yielded three growth pattern parameters that represented estimated recumbent length at birth (parameter 1), rate of growth (parameter 2), and intrinsic rate of change in growth (parameter 3). The growth pattern parameter estimates for each individual were examined in a series of genetic analyses using a maximum-likelihood method for pedigree data. Significant heritabilities were found for all three growth pattern parameters: parameter 1, h2 = 0.83 +/- 0.12; parameter 2, h2 = 0.67 +/- 0.18; and parameter 3, h2 = 0.78 +/- 0.17. In addition, genotype by sex interaction was indicated for growth pattern parameters 2 and 3, suggesting that the genes influencing rate of growth and intrinsic rate of change in growth are themselves influenced by the sex of the individual.

The age-range illusion in developmental research on the structure of abilities: a comment on Lis and Magro

The general effect of age range on findings from studies of the structure of intellectual abilities in children is considered. Two topical examples of the effect in the work of Lis and Magro and that of Demetriou and Efklides are considered.

Pediatric home care--designing unique care for kids

There is a growing need for pediatric home care services but selecting a provider is difficult. Pediatric home care calls for special abilities and qualifications, for numerous reasons.

Reflecting on scientific thinking: children's understanding of the hypothesis-evidence relation

3 experiments were carried out to examine children's understanding of the role of covariation evidence in hypothesis formation. Previous research suggested that it is not until 8 to 11 years of age that children begin to understand how a given pattern of covariation supports a particular hypothesis about which factor is causally responsible for an observed effect. Experiments 1 to 3 employed a different (fake evidence) technique than previous research and showed that by 6 years of age most children understand how evidence would lead a story character to form a different hypothesis than the subject's own. Experiment 3 showed that most 6- and young 7-year-olds understand how a character's future actions (e.g., choice of an object) and predictions of future outcomes depend on the hypothesis he or she holds.

The paediatric registry of the European Dialysis and Transplant Association: 20 years' experience

The first publication of the paediatric registry of the European Dialysis and Transplant Association appeared in 1971. Since then nearly 50 further articles have appeared and this paper provides a full bibliography as well as tracing the changes in the provision of care, methods and results of treatment of end-stage renal disease in childhood over the last 20 years.

[Mental development of 'meanings' related to scripts: 'dining' script as an example]

The purpose here is to investigate how the process of relating 'meanings' to scripts is influenced by the developmental changes of concepts about these activities, with an example of 'dining'. Based on previous studies that the concept of 'dining' develops from physiological function orientation to social function orientation, second, fourth, and sixth graders, and college students were asked to plan 'dining' with a physiological goal or a social one. The results are as follows. (1) Generated plans became more connected with goals developmentally in both social and physiological context. (2) Second graders who attached much importance to physiological function of 'dining' were apt to generate plans with physiological meanings even in social goal context.

Heritability of social anxiety: a brief review

Although recent advances have greatly improved the treatment of and prognosis for social phobia, its etiology remains relatively unexplored. One promising area of investigation is the role of intergenerational transmission. This paper provides an overview of twin and family studies of social anxiety, specifically focusing on questions of evidence for heritability, relative contributions of genetic versus environmental factors, and the implications of variations in diagnostic definitions, e.g., social phobia versus shyness.

Pubertal development in thalassaemic patients after allogenic bone marrow transplantation

To obtain further insight into gonadal function, a series of 50 prepubertal patients with beta-thalassaemia major (24 boys and 26 girls) aged from 12.6 to 18 years (mean 15 years) who had received a bone marrow transplantation (BMT) during childhood or the peripubertal period, at the age of 3.6-14.5 years (mean 10.8 years), were periodically re-evaluated at intervals of 6-12 months. The last evaluation was done 1-9 years (mean 4.2 years) after BMT. At each examination we measured height, pubertal stage, plasma gonadotrophins (LH and FSH) before and after the GnRH stimulation test (i.v.), sex steroids (total and free testosterone in males, and 17 beta-oestradiol in females), serum ferritin and bone age. Fourty percent of patients entered or passed through puberty normally despite clinical and hormonal evidence of gonadal dysfunction in most of them. A correlation was not found between the pubertal stage and age at BMT, and no statistical difference between patients who did not enter into puberty and patients with spontaneous pubertal development was found in serum ferritin levels. Our data confirm that gonads in male and female thalassaemic patients are exposed to the cytotoxic effects of the preparative transplant regime with alkylating agents. In some patients absence of pubertal development was due to gonadotrophin insufficiency, probably secondary to previous iron overload. These findings emphasize the need for a vigilant long-term follow up study of thalassaemic patients who have had BMT.

Intake and growth of breast-fed and formula-fed infants in relation to the timing of introduction of complementary foods: the DARLING study. Davis Area Research on Lactation, Infant Nutrition and Growth

We examined if the timing of introduction of solid foods was related to growth, intake, morbidity, activity or motor development among infants either breast fed or formula fed until > or = 12 months of age. Breast-fed infants given solids before 6 months of age (earlysol) consumed less breast milk at 6 and 9 months of age than those given solids > or = 6 months (latesol); thus total energy intake did not differ between groups. Z scores for weight, length and weight-for-length at 1-18 months did not differ between groups. Latesol infants gained less weight from 6 to 9 months but not during any other interval. Neither activity level nor morbidity differed between groups, but several developmental milestones occurred earlier in the earlysol versus the latesol group, probably due to reverse causation. Among formula-fed infants, timing of introduction of solid foods was not related to intake, growth, activity or morbidity. We conclude that solid foods given before 6 months of age generally replace the milk source among breast-fed but not formula-fed infants.

Protein quality of human milk fortifier in low birth weight infants: effects on growth and plasma amino acid profiles

Serum preprandial essential amino acid, urea and prealbumin concentrations, and growth rates were studied in appropriate for gestational age low birth weight infants fed one of three regimens: (1) human milk enriched with human milk protein (n = 17); (2) bovine whey protein hydrolysate (n = 18; and (3) a mixture of bovine proteins, peptides and amino acids designed to have an amino acid composition close to that of human milk proteins (n = 18). Energy and nitrogen intakes were similar in all groups. Growth rates and gross metabolic responses did not differ between the feeding groups. There were also no differences in the amino acid profiles between those infants fed human milk protein fortifier and mixed bovine protein fortifier. Infants fed the whey fortifier had significantly higher threonine concentrations in comparison to those fed exclusively human milk protein (287 +/- 63 mumol/l vs 168 +/- 26 mumol/l) whereas the levels of some other essential amino acids (i.e. valine, leucine, lysine, histidine, phenylalanine and tryptophan) were lower. The results indicate that growth rates and gross metabolic indices do not depend on the protein quality of human milk fortifiers. However, the addition of well balanced mixtures of bovine proteins to human milk results in amino acid profiles similar to those observed in LBW infants fed similar amounts of human milk proteins.

Mother-child relationships as sources of support or stress: a comparison of competent, average, aggressive, and anxious dyads

We tested the proposition that mother-child relationships can be sources of support or stress, by comparing patterns of mother-child interactions in a problem-solving task that children completed with their own and with an unfamiliar mother. 4 groups of preschoolers (n = 30 in each group)--identified on the basis of teacher ratings as socially competent, average, aggressive, or anxious--participated. Mothers of competent and average children were highly positive and reciprocal toward their own and unfamiliar children. Mothers of aggressive and anxious children were only positive and reciprocal toward unfamiliar children but generally indiscriminate (aggressive group) or aversive and negatively reciprocal (anxious group) toward their own. Children in all 4 groups tended to be reciprocal toward their own mothers, but only competent and average children were reciprocal toward unfamiliar mothers also. Aggressive and anxious children generally responded to unfamiliar mothers by ignoring or actively rejecting their overtures. Results (1) indicate that the relationship with the primary caregiver may serve as a major source of support or stress in the preschool years; (2) focus attention on the dynamic organization of interactions rather than on the presence or frequency of particular behaviors, indicating that a dynamic of reciprocity enables children and mothers to adapt positively to the ever changing demands of new social situations; (3) point to the need to develop new means of assessing relationships to better understand how they influence development; and (4) highlight the importance of incorporating transactional models in the diagnosis and treatment of childhood dysfunctions rather than accounting for them solely in terms of limited skills in parents or children.

Influence of age, sex, balance, and sport participation on development of catching by children grades K-8

The purpose of this study was to examine the contributions of age, sex, balance, and sport participation on development of catching by children in Grades K to 8. The subjects were 380 boys and 337 girls (ages 4 to 14) enrolled in a medium-sized school system in southeastern Maine. Each subject was individually assessed on catching and static and dynamic balance. In addition, all subjects completed a survey relative to their participation in school or community-sponsored sports. To assess the independent effects of age, sex, static balance, dynamic balance, and participation in sports within each grade, data were subjected to multiple-regression analysis. Mature catching development was influenced by sex; boys performed better at all grades except in Grade 8 all girls and boys showed mature catching patterns.

A longitudinal study of changes in children's thought content in response to frustration on the Children's Picture-Frustration Study

A longitudinal design examined changes in the 11 response types on the Children's Form of the Picture-Frustration (P-F) Study. Eighty-six children were retested on the instrument after a 5-year interim. Children showed changes reflecting an increase in verbal aggression and an increase in making amends for wrongdoing. They showed decreases in unfocused emotional outbursts and apologies. The findings add to the literature on children's emotional development of aggression and guilt and on the validity of the instrument.

When is a mug not a mug? Effects of content, naming, and instructions on children's drawings

Two hundred seventy 5-year-old children produced a copy drawing of a transparent glass mug with its handle turned away. In a factorial design three factors were manipulated to examine their additive or independent influence on the child's production of either view-specific or canonical (i.e., with the handle at the side) depictions: the content of the mug, the label used to describe it, and the explicitness of instruction. The results showed, first, that each of these variations in task demands exerted an influence on the canonicality/view-specificity of the children's drawings. Second, these influences were both facilitative and prohibitive. So, for example, general instructions prompted canonical drawings, while very explicit instructions elicited view-specific depictions. Third, each factor exerted an independent influence upon whether or not the handle was included--there were no interactions between factors on the production of the two types of picture. These results provide further evidence against simple associations between children's drawings and their cognitive abilities. They suggest that what children produce in studies of "drawing" may well simply inform us about the development of an understanding of adults' communicative intent.

Children's understanding of the relation between referential knowledge and referential behavior

Young children often confuse what is said and meant in referential communication. This study determines exactly what is confused by kindergarten children, second graders, and fourth graders. In each of four experiments, a story listener's referential knowledge variously came from object details in the context and in an utterance, and children were asked independently to judge knowledge sufficiency for identifying one referent in a display, and whether the knowledge came from the utterance alone. In Experiments 1 and 2, experimenter identification of the correct referent was manipulated to determine if children confuse internal representations of information knowledge and referential behavior, or behavior and the real world referent, in determining the listerner's knowledge. In other experiments, the consistency of referential behavior with the correct referent was manipulated to determine the basis of children's knowledge assessments. Overall the results show that children's say-mean confusion varies depending on situational factors and variably reflects children's use of internal representations and external referential behavior in assessing knowledge.

Lateral preference of preschool and primary school children

Cross-sectional development and consistency of four lateral preference behaviors (hand, foot, ear, eye) in 79 preschool and 131 primary school children were studied. Although predominant right-sidedness is manifested in the limbs and sensory organs, only handedness showed a significant increase over the age range studied (3 yr. to 9 yr., 11 mo.). Approximately 85% of children in preschool and 87% in primary school showed lateral consistency in the upper and lower extremities. The concordance between other sidedness behaviors reflected only chance associations in both samples. The results indicate that lateral preference behaviors in children are not unidimensional.

Development of infant contrast sensitivity to chromatic stimuli

We have monitored the development of contrast sensitivity to equiluminant red-green chromatic patterns by monitoring visual evoked potentials (VEPs) in 13 infants. The results confirm our previous report [Morrone, Burr and Fiorentini, Proceedings of the Royal Society B, 242 (1990a)] that, before 7-8 weeks of age, there was no response to purely chromatic stimuli, while at the same age luminance stimuli of 20% contrast produced reliable responses. At all ages (even before the onset of a chromatic response) the colour mixture to yield equiluminance was similar to that of adults, suggesting that the relative proportion and efficacy of medium- and long-wave cones is similar for infants as for adults. For both luminance and chromatic stimuli, amplitude increased roughly linearly with log-contrast, so sensitivity thresholds could be predicted by linear extrapolation to the abscissa. Detailed contrast sensitivity curves were measured for four infants at various ages. The results show that luminance and chromatic contrast sensitivity develop independently at different rates, probably reflecting differential development of postreceptoral neural mechanisms.

The sugar scoring system for the Bender-Gestalt test: an objective approach that reflects clinical judgment

Although several objective scoring systems have been developed for use with the abbreviated form of the Bender-Gestalt test of visuomotor development (Figures A, 1, 2, 4, 6, and 8), each has been criticized as being inadequate in some way or other. This paper reviews the inadequacies of these systems as described in the literature and presents the results of a small study designed to investigate the psychometric properties of a new objective scoring system, recently proposed by Sugar, which incorporates both quantitative and qualitative perspectives. The new system is shown to be psychometrically sound in validity and reliability. Additional advantages are described. The new system is recommended as a good, if not better, alternative to other, existing methods for scoring the Bender-Gestalt test.