Accommodative esotropia during the first year of life

Two infants developed accommodative esotropia during their first six months of life. One infant, whose age at onset was 4 1/2 months, had 4.50 diopters of hyperopia. The second infant, whose age at onset was 5 months, had 3.50 diopters of hyperopia. In both infants, the eyes completely aligned with hyperopic correction. Two points are stressed. First, when the amount of hyperopia exceeds +3.00, consideration should be given to an accommodative element as the cause of the esotropia, even if the child is only 4 to 6 months old. Second, even with small angles of esotropia, an accommodative element should be considered, if there is a substantial amount of hyperopia.     

Respiratory mechanics of the horse during the first year of life

This study investigated the developmental changes in the mechanical properties of the respiratory system in growing horses. Pulmonary mechanics and lung volumes were serially measured in anesthetized foals during the first year of life. Quasi-static pressure-volume curves were generated, and functional residual capacity (FRC) was measured using a closed nitrogen equilibration technique. At birth, chest wall compliance normalized to body weight was substantially less than that reported in other less precocious newborn species, while lung compliance normalized to body weight was similar to values reported for other species. Characteristics of the transition from the neonatal to adult respiratory system in the foal included a decrease in the ratios of chest wall to lung compliance (Cw/CL) and the unstressed volume of the chest wall to TLC, and a constant FRC/TLC throughout most of the study period. The somatic growth of the foal and its respiratory system were uneven processes, with increases in lung volume lagging increases in overall body size.     

Psychophysiological correlates of emotional reactivity during the first year of life.

Emotional reactivity is an important dimension thought to underlie individual differences in infant temperament. In a series of studies, we have examined the relation between behaviors reflecting this dimension and measures of heart rate variability. In the current study, longitudinal behavioral data on two groups of infants selected for their pattern of heart period variability are presented: those with high vagal tone (high heart rate variability) and those with low vagal tone (low heart rate variability) at 14 months of age. The data suggest that infants with high vagal tone were more reactive to both positive and negative events at 5 months and more sociable and approachful at 14 months. Infant reactivity to mildly stressful events seems to be a stable dimension during the first year, and there is a strong association between differences in reactivity and the degree to which the autonomic nervous system is influenced by vagal tone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spontaneous intracranial hemorrhage of structural origin during the first year of life

Symptomatic intracranial hemorrhage (ICH) in term infants is not common, but when it occurs it is usually secondary to trauma, coagulation disorders and/or hypoxia. The possibility of a structural cause for an infantile ICH is unfortunately not seriously considered until very late. In this paper we report the cases of five full-term infants, each of whom developed ICH secondary to a structural lesion during the 1st year of life. Three presented during the newborn period. A congenital saccular aneurysm of the middle cerebral artery in an 8-month old male infant; a posterior fossa arteriovenous malformation in a 2-week old female neonate; a deep parietal cavernous angioma in a 6.5-month-old male infant; a temporoparietal low-grade astrocytoma in a 12-day old male neonate and a temporoparietal desmoplastic ganglioglioma in a 9-day-old male neonate were the structural lesions that were causative for hemorrhage. In all cases but one, the diagnosis was reached by computerized tomography and/or magnetic resonance imaging. All infants underwent surgery for the removal of the hematoma and of the lesion causative for the bleed. All are alive at 19, 3, 11.5, 10, and 5 years, respectively. We discuss the diagnosis of ICH with special emphasis on contemporary imaging modalities and stress the benefits of aggressive and timely surgical treatment. We then consider a concise analysis of the world literature on the occurrence of structural causes of ICH during infancy.     

Morbidity during the first year of life in small for gestational age infants

OBJECTIVE: To study the effect of early postnatal dexamethasone (days 1-3) on the incidence and severity of chronic lung disease in preterm infants with respiratory distress syndrome. METHODS: A multicentre, randomised, placebo controlled, blinded study was carried out in 18 neonatal intensive care units in Israel. The primary outcome measure was survival to discharge without requirement for supplemental oxygen therapy beyond 28 days of life. The secondary outcome measures were requirement for mechanical ventilation at 3 and 7 days, duration of ventilation or oxygen therapy, need for subsequent steroids for established chronic lung disease and incidence of major morbidities. RESULTS: The study consisted of 248 infants (dexamethasone n = 132; placebo n = 116). No differences were found in the outcome variables except for a reduction in requirement for mechanical ventilation at age 3 days in treated infants (dexamethasone 44%, placebo 67%; P = 0.001). Gastrointestinal haemorrhage, hypertension, and hyperglycaemia were more common in treated infants, but no life threatening complications, such as gastrointestinal perforation, were encountered. CONCLUSIONS: These data do no support the routine use of early postnatal steroids, but may justify further study in a selected, high risk group of infants.     

Vitamin E and C levels in infants during the first year of life

The considerably lower vitamin E level found in cord blood and in newborns at birth than those found in the venous blood of mothers at delivery are not yet fully explained. In a group of 217 not selected newborns, we attempted to establish the relation between vitamin E and C levels at delivery and the changes during the first year of life. The mean serum vitamin E level rose from 0.37 mg/ml at 3 days to 0.80 mg/100 ml at 6 months and to 0.72 mg/100 ml at 12 months. On the other hand vitamin C mean levels lowered from 0.93 mg/100 ml in cord blood to 0.77 mg/100 ml at 6 months and to 0.73 mg/100 ml at 12 months. The rise of vitamin E values could be explained by the early use of infant solid foods with high vitamin and mineral content and by the increase of serum lipoproteins. Except at 3 days after delivery there were no individual values of serum vitamin E below the acceptable 0.35 mg/100 ml limit. However, serum vitamin C levels compatible with a moderate risk were very often observed, i.e., in 27.1% of infants at 6 months and in 30.5% at 1 year. Thus, vitamin E intake in infants was satisfactory with the usual diet but not vitamin C for which blood levels were not adequate. In view of these findings it appears necessary to evaluate periodically the vitamin E as well as vitamin C status in the infant population.     

Candida endocarditis in the first year of life

Candida is an increasing problem as a causal agent of nosocomial infection in neonates and infants. We report 15 cases of infective endocarditis caused by Candida spp treated at the Hospital Infantil de Mexico between 1980 and 1991. The diagnosis of endocarditis was established by the identification of Candida in at least two blood cultures and echocardiographic assessment. From 110 cases of systemic candidiasis during the eleven years period of study, fifteen patients presented endocarditis (13.6%), all had a central venous catheter. Three had antecedent of congenital heart disease. Candida isolation was obtained an average of 28 days after admission. The major clinical findings were: fever in 13 patients, respiratory distress and cardiac murmurs observed in nine respectively. Thrombocytopenia was present in eight children. The echocardiographic evaluation showed vegetations located in the superior vena cava in six, right atrium in five, tricuspid valve in two, inferior vena cava and right ventricle in one respectively. Three cases were subjected to surgical treatment. Nine patients died for a case fatality rate of 60%. The echocardiographic evaluation practiced in all patients with suspicion of systemic candidiasis is critical for the prognosis. The identification of endocardiac involvement coupled with the opportune administration of antifungal therapy and surgical treatment may improved the survival.     

Nasopharyngeal colonization in southern Israel with antibiotic-resistant pneumococci during the first 2 years of life: relation to serotypes likely to be included in pneumococcal conjugate vaccines

Nasopharyngeal carriage of Streptococcus pneumoniae was studied in 162 healthy infants at ages 2, 4, 6, 7, 12, and 13 months and in an additional 352 healthy children at ages 12, 15, 18, 21, and 24 months. Carriage was 26%, 39%, and 62% at 2, 12, and 24 months, respectively, and the respective resistance to > or = 1 antibiotic was 11%, 19%, and 27%. The presence of an older sibling or antibiotic treatment during the month preceding the culture was associated with carriage of resistant pneumococci in infants, whereas attendance at large day care centers was associated with carriage during the second year of life. Antibiotic resistance was detected in all 7 serotypes included in the candidate pediatric conjugate vaccines and was significantly more prevalent among vaccine-type pneumococci than among non-vaccine-type pneumococci. The use of conjugate vaccines may reduce the spread of resistant pneumococci.     

Attachment, maternal sensitivity, and infant temperament during the first year of life.

Families were examined at 6, 9, and 12 months in an intensive longitudinal study that included Home Behavior Attachment Q-sorts, laboratory Strange Situation assessment, home observations of infant temperament behavior on 24 occasions, observations of maternal parenting sensitivity on 12 occasions, and maternal reports of infant temperament. Maternal sensitivity was modestly related to Q-sort security and unrelated to Strange Situation classification. In contrast, observed infant temperament was more strongly related to both maternal sensitivity and Q-sort security. The relation between home and laboratory assessment of attachment security, which was at the level found in prior work ( e.g., B. E. Vaughn & E. Waters, 1990 ), remained after the effects of observed and mother reported infant temperament were partialed. Our data highlight the need to consider other factors besides maternal sensitivity in the explanation of variability in the attachment status of l-year-olds. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Aortic coarctation and complex heart disease. Surgical treatment during the first year of life

During the five years 1990 through 1994, 70 neonates and infants had surgery for coarctation of the aorta. 30 patients with complex coarctation of the aorta underwent a first stage correction with supplementary ductus ligation and pulmonary artery banding as needed. The mode of surgical repair of coarctation was end-to-end anastomosis in ten patients and patch graft in 20 patient. Mean follow-up was 766 (range 3-1812) days. Mortality after primary procedure was 16.6% (5/30) and after secondary procedure 11.1% (2/18). Three surviving patient developed recoarctation, but only one patients needed re-operation. In spite of improvement in neonatal cardiac surgery, we conclude that a staged approach is still the current treatment in most cases of complex coarctation of the aorta.     

Assessment of mastery motivation during the first year of life: Contemporaneous and cross-age relationships.

Assessed 68 firstborns at 6 and 12 mo with 12 mastery tasks chosen to elicit 3 aspects of mastery motivation: effect production, practicing sensorimotor skills, and problem solving. Ss were also administered the Bayley Scales of Infant Development (BSID). The significant contemporaneous and cross-age relationships suggest complex interactions at 6 and 12 mo between each S's developmental level, nature of the task, and mastery motivation. The cross-age relationships indicate a developmental progression in mastery behavior during the 1st yr. This progression is one in which a highly motivated child is persistent in producing effects at 6 mo, becomes persistent in practicing sensorimotor skills, and engages in exploration of problem-solving tasks at 12 mo. The relationships with the BSID suggest that mastery motivation and developmental competence are interrelated and that mastery becomes more differentiated with age. (31 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Correlates of social problem solving during the first year after traumatic brain injury in children.

Effects of pediatric traumatic brain injury (TBI) on social problem-solving were examined in a longitudinal study of 103 children with moderate-to-severe TBI (n = 52) or orthopedic injury (OI; n = 51) using the Interpersonal Negotiation Strategies task (INS). Children solved age-appropriate hypothetical social conflicts, with responses for four problem-solving steps scored by developmental level. The OI group performed better than the TBI group, but rate of change in performance over time did not differ between groups, suggesting improvement in children with TBI was not due to recovery from injury. Strong relations between INS performance and memory and language skills emerged, but emotional processing was only weakly related to INS performance. Frontal focal lesions influenced INS performance in younger (but not older) children with TBI. Diffusion tensor imaging (DTI), revealed strong relationships between the INS and increased apparent diffusion coefficient (ADC) measures indexing connectivity in the dorsolateral and cingulate regions in both TBI and OI groups, and in the temporal and parietal regions in the TBI group. These findings inform studies of social problem-solving skills during the first year post TBI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bone modeling indexes at onset and during the first year of follow-Up in insulin-dependent diabetic children

INTRODUCTION: Low-molecular weight heparin-induced cutaneous necrosis is exceptional. Pathogenesis remains unclear. We report an exceptional case with elective localization of the necrotic areas in insulin lipodystrophic tissue. CASE REPORT: A 69-year old patient developed areas of skin necrosis after starting enoxaparin therapy. These areas were located far from the points of injection and focalized on skin areas where the patient had been injecting insulin daily for the last four years. These areas had an aspect of insulin lipodystrophy. Biopsy specimens showed leukocytoclastic vasculitis. There were no associated biological anomalies. One month later, prick-tests were made with different low-molecular weight heparins and calcium heparinate in a lipodystrophic area together with an enoxaparin control test in healthy skin. The only positive test was for enoxaparin in an insulin lipodystrophic area (hard erythema at 24 hours). Histology at 72 hours demonstrated leukocytoclastic vasculitis. DISCUSSION: Six cases of cutaneous necrosis induced by low-molecular weight heparin have been reported, including three cases with enoxaparin. Two pathophysiological mechanisms could be involved: (i) localized heparin-dependent platelet aggregation, or (ii) vasculitis induced by type III hypersensitivity reaction. In our case, the leukocytoclastic aspect of the vasculitis was compatible with an immune complex hypersensitivity reaction. The localization of the necrotic areas would be explained by enoxaparin-induced preferential deposit of immune complexes in the vascular turbulences present in lipodystrophic areas.     

Increase in height during the first year after bone marrow transplantation reflecting nutritional status of children

We report a 75-year-old hypertensive man presented with unilateral MLF syndrome combined with ipsilateral blepharoptosis and trochlear nerve paresis due to midbrain infarction. He was admitted to our hospital for sudden onset of diplopia. Neurological examination revealed left ptosis, infraduction disorder of the left eye and left MLF syndrome. Horner's syndrome or other focal neurological signs were not observed; convergence was preserved. Hess-charts confirmed left superior oblique paresis and left internuclear ophthalmoplegia. Laboratory data were all normal. T2-weighted images of brain MRIs demonstrated a high-signal intensity lesion in the paramedian dorsal midbrain at the inferior colliculus level, anterior to the cerebral aqueduct. The oculomotor dysfunction and diplopia had disappeared at discharge, although slight ptosis persisted. It is likely that the lesion in our case affected the left MLF, the right trochlear nucleus or its fascicles and the left partial oculomotor fascicles. Cases with MLF syndrome associated with trochlear nerve palsy have been rarely reported. Our case suggests that the fibers controlling for the musculus levator palpebrae superioris are located more caudally in the oculomotor fascicles.     

Iron deficiency during the first year of age

Iron deficiency is the most common nutritional deficiency in late infancy. In healthy term infants iron stores are depleted at the age of four to six months and the infant becomes increasingly dependent on exogenous sources of iron. Furthermore, the iron content and bioavailability in a traditional weaning diet are low. The consequences of iron deficiency in late infancy span from pallor to risk of impaired psychomotor development. Approaches to prevent iron deficiency and problems associated with these approaches are reviewed, and general guidelines for a weaning diet as well as guidelines with special emphasis on preventing iron deficiency are given. The present article identifies infants at high risk of developing iron deficiency including: immigrants, infants from a deprived background, infants to whom cows' milk is introduced early and/or given in large quantities, and infants from families with unusual eating habits. Finally, the commonly employed clinical practice for treating iron deficiency is mentioned.     

Blood pressure levels of preterm infants in the first year of life

Systolic blood pressure was measured in 36 infants with median gestational age of 29 weeks (range 24-35 weeks) and birth weight of 1160 g (range 642-1500 g). Measurements were made at 1, 6 and 12 weeks, and subsequently at 12-weekly intervals during the first year of life. No infant developed chronic lung disease. Systolic blood pressure increased over the first 24 weeks (p < 0.001) to a mean value of 95 mmHg, but did not change significantly over the next 24 weeks. These data provide a reference range of blood pressure levels during the first year of life for infants born at an early gestational age.     

Effect of exogamy on morbidity among children during the first three years of life

The yeast Saccharomyces cerevisiae mRNA capping enzyme is composed of two subunits of alpha (52 kDa, mRNA guanylyltransferase) and beta (80 kDa, RNA 5'-triphosphatase). We have isolated the alpha subunit gene (CEG1) by immunological screening. In this report, with the aid of partial amino acid sequences of purified yeast capping enzyme, we isolated the gene, designated CET1, encoding the S. cerevisiae capping enzyme beta subunit. Amino acid sequence analysis revealed that the gene encodes for 549 amino acids with a calculated M(r) of 61,800 which is unexpectedly smaller than the size estimated by SDS-PAGE. Gene disruption experiment showed that CET1 is essential for yeast cell growth. The purified recombinant CET1 gene product, Cet1, exhibited an RNA 5'-triphosphatase activity which specifically removed the gamma-phosphate from the triphosphate-terminated RNA substrate, but not from nucleoside triphosphates, confirming the identity of the gene. Interaction between the Cet1 and the Ceg1 was also studied by the West-Western procedure using recombinant Ceg1-[32P]GMP as probe.