Neonatal respiratory therapy in the new millennium: Does clinical practice reflect scientific evidence?

Respiratory therapy has historically been considered the primary role of the physiotherapist in neonatal intensive care in Australia. In 2001 a survey was undertaken of all level three neonatal intensive care units in Australia to determine the role of the physiotherapist and of respiratory therapy in clinical practice. It appears that respiratory therapy is provided infrequently, with the number of infants treated per month ranging from 0 to 10 in 15 of the 20 units who provide respiratory therapy, regardless of therapist availability. The median number of respiratory treatments per month during the week was three, and on weekends it was one. Respiratory therapy was carried out by physiotherapists and nurses in 54.6% of units, by physiotherapists only in 36.4% of units, and by nurses only in the remaining 9% of units surveyed. There was also a diminution of the role of respiratory therapy in the extubation of premature infants. A review of the literature shows that overall the use of respiratory therapy reflects current evidence. The question remains whether it is possible to maintain the competency of staff and justify the cost of training in the current healthcare economic climate. It seems probable that the future role of physiotherapists in neonatal intensive care unit may be in the facilitation of optimal neurological development of surviving very low birth weight infants.

Motor and functional skills of children with developmental coordination disorder: A pilot investigation of measurement issues

This paper reports on the motor and functional outcomes of 20 children with developmental coordination disorder (DCD) aged 4-8 years consecutively referred to a pediatric physiotherapy service. Children with a Movement ABC (M-ABC) score less than the 15th percentile, and with no concurrent medical, sensory, physical, intellectual or neurological impairments, were recruited. The Motor Assessment Outcomes Model (MAOM) [Coster and Haley, Infants and Young Children 4 (1992) 11] provided the theoretical base for measurement selection, and preliminary findings at the activities and participation levels of the model are reported in this article. Children with DCD performed at the lower end of the normal range on the Pea-body Developmental Motor Scales (fine motor total score) (M = 85.65, SD = 12.23). Performance on the Visual Motor Integration Test (VMI) standard scores was within the average range (M = 96.15, SD = 10.69). Videotaped observations of the children's writing and cutting indicated that 29% were left-handed and that a large proportion of all children (31%) utilized unusual pencil grasp patterns and immature prehension of scissors. Measurement at the participation level involved use of the Pictorial Scale of Perceived Competence and Social Acceptance (PCSA) and Pediatric Evaluation of Disability Inventory (PEDI). Overall, these young children rated themselves towards the more competent and accepted end of the PCSA over the dimensions of physical and cognitive competence and peer and maternal acceptance. The PEDI revealed generally average performance on social (M = 49.98, SD = 16.62) and mobility function (M = 54.71, SD = 3.99), however, self-care function was below the average range for age (M = 38.01, SD = 12.19). The utility of the MAOM as a framework for comprehensive measurement of functional and motor outcomes of DCD in young children is discussed. (C) 2003 Elsevier B.V. All rights reserved.

Cerebral impedance and neurological outcome following a mild or severe hypoxic/ischemic episode in neonatal piglets

Multi-frequency bio-impedance has the potential to identify infants at risk of poor neurodevelopmental outcome following hypoxia by detecting cerebral edema. This study investigated the relationship between the severity of an hypoxic/ischemic episode, neurological outcome following the hypoxia and non-invasively measured cerebral bioelectrical impedance in piglets. One-day-old piglets were anaesthetised and ventilated. Hypoxia was induced by reducing the inspired oxygen concentration to 3-5%. Severe hypoxia was defined as hypoxia resulting in at least 30 min of low amplitude EEG (

Structural characterization of respiratory syncytial virus fusion inhibitor escape mutants: homology model of the F protein and a syncytium formation assay

Respiratory syncytial virus (RSV) is a ubiquitous human pathogen and the leading cause of lower respiratory tract infections in infants. Infection of cells and subsequent formation of syncytia occur through membrane fusion mediated by the RSV fusion protein (RSV-F). A novel in vitro assay of recombinant RSV-F function has been devised and used to characterize a number of escape mutants for three known inhibitors of RSV-F that have been isolated. Homology modeling of the RSV-F structure has been carried out on the basis of a chimera derived from the crystal structures of the RSV-F core and a fragment from the orthologous fusion protein from Newcastle disease virus (NDV). The structure correlates well with the appearance of RSV-F in electron micrographs, and the residues identified as contributing to specific binding sites for several monoclonal antibodies are arranged in appropriate solvent-accessible clusters. The positions of the characterized resistance mutants in the model structure identify two promising regions for the design of fusion inhibitors. (C) 2003 Elsevier Science (USA). All rights reserved.

Emergence of joint attention: Relationships between gaze following, social referencing, imitation, and naming in infancy

The authors investigated the extent to which the joint-attention behaviors of gaze following, social referencing, and object-directed imitation were related to each other and to infants vocabulary development in a sample of 60 infants between the ages of 8 and 14 months. Joint-attention skills and vocabulary development were assessed in a laboratory setting. Split-half reliability analyses on the joint-attention measures indicated that the tasks reliably assessed infants' capabilities. In the main analysis, no significant correlations were found among the joint-attention behaviors except for a significant relationship between gaze following and the number of names in infants' productive vocabularies. The overall pattern of results did not replicate results of previous studies (e.g., M. Carpenter, K. Nagell, & M. Tomasello, 1998) that found relationships between various emerging joint-attention behaviors.

Ações de prevenção da deficiência mental, dirigidas a gestantes e recém-nascidos, no âmbito da saúde pública da grande Vitória-ES

Fazer prevenção em Saúde Pública implica em conhecimento sistematizado para a proposição de programas e sua avaliação. Quanto à prevenção de Deficiência Mental, que atinge cerca de 10% da população, pouco se conhece no país. Adotando uma metodologia para levantamento de ações preventivas de DM em hospitais e unidades de saúde, junto a gestantes e recém-nascidos, foi possível descrever e analisar a atuação da rede pública de saúde da Grande Vitória/ES, indicando os níveis de prevenção mais atendidos. Foram levantadas as ações de prevenção (AP) de cinco hospitais públicos de grande porte, nove (31%) unidades de saúde e seis secretarias de saúde, entre 1996-97. Os dados de 25 entrevistas mostram que esses locais realizavam 51,5% das 433 AP possíveis (57,4% da prevenção primária e 45,5% da secundária). Particularizando a atuação de cada município e local pesquisado, os dados fornecem subsídios para análises e possíveis mudanças nos indicadores de saúde materno-infantil.

Interação mãe-bebê e uso de chupeta no contexto do nascimento pré-termo : cultura, representações sociais e processos proximais

Objetivo: Investigar a avaliação de mães de recém-nascidos pré-termo (RNPT) egressos de unidades de terapia intensiva neonatal (UTIN) quanto à interação mãe-bebê e uso de chupeta nos primeiros dois anos. Método: O planejamento do estudo longitudinal foi baseado na Teoria Bioecológica do Desenvolvimento Humano, com foco nos processos proximais (PP), utilizando entrevistas gravadas com 62 mães de RNPT no contexto da UTIN e 33 aos seis, 12, 18 e 24 meses de idade do bebê, considerando Grupo-A (chupeta) e Grupo-B (não usou chupeta). Resultados: A vivência em UTIN foi considerada evento impactante na vida das mães, mas expectativas futuras para a relação mãe-bebê foram positivas. A tentativa de oferta da chupeta foi 96,2% e seu uso aos seis meses foi 50% (n=52), significativamente associado com prematuridade pela relação peso/idade-gestacional (p-valor=0,044), dificuldades para estabelecer aleitamento materno exclusivo (AME) (p=0,012) e primiparidade (p=0,02). Apresentaram relação com menor frequência de chupeta: AME ≥3 meses (p=0,026) e tempo de aleitamento materno ≥6 meses. A chupeta configurou-se como uma das representações sociais sobre objetos de bebê, elaboradas pelas participantes aos 12 meses de idade do bebê. Características de temperamento calmo/tranquilo da mãe foram mais frequentes no Grupo-A e o temperamento nervoso/agitado/irritado no Grupo-B (p-valor=0,041). No Grupo-A predominou o temperamento do bebê calmo/fácil-de-cuidar/independente, enquanto no Grupo-B as características de temperamento agitado/bagunceiro/teimoso/agressivo (p-valor=0,026), associado também à necessidade de várias tentativas de oferta da chupeta (p-valor=0,006). No Grupo-A, o número de pessoas para apoio social foi uma ou duas (77,8%), enquanto no Grupo-B foram três a sete (66,7%), p-valor=0,001. A contribuição da chupeta como auxiliar nos PP foi indiferente para mães que controlavam o hábito, enquanto o uso irrestrito facilitava a resolução do choro, liberando a mãe para outras tarefas, atuando como limitador dos PP. A análise da evolução e complexidade dos PP demonstrou não haver interferência pelo uso da chupeta, tendo sido mais efetivos quando as mães tinham maior escolaridade e nas classes econômicas A e B. Conclusão: Aspectos culturais influenciaram na oferta da chupeta, mas sua aceitação ocorreu principalmente em RNPT pequeno para idade gestacional, diante das dificuldades para AME, menor extensão do apoio social e temperamento do bebê calmo/fácil-de-cuidar/independente, também associado à aceitação mais fácil da chupeta. O uso irrestrito da chupeta demonstrou atuar como limitador dos processos proximais.

Avaliação da reatividade de anticorpos anti-Toxoplasma gondii pela técnica de citometria de fluxo como indicadores de lesão ocular em soros de recém-nascidos com toxoplasmose congênita

A retinocoroidite é a manifestação mais comum causada pela infecção congênita por Toxoplasma gondii. Devido a gravidade das lesões oculares que podem até levar à perda completa da visão, a detecção precoce da toxoplasmose congênita e da lesão ocular são essenciais para o tratamento. Este trabalho possuiu o objetivo de avaliar a aplicabilidade da pesquisa de anticorpos IgG e das subclasses IgG1, IgG2, IgG3 e IgG4 anti-T. gondii por citometria de fluxo como marcador laboratorial das diferentes formas de lesões retinocoroidais na toxoplasmose congênita. Foram analisadas 88 amostras de soro de recém-nascidos com toxoplasmose congênita, sendo 25 sem lesão ocular (SL), 10 com lesão ocular ativa (RA), 26 com lesão ocular ativa e cicatricial (RAC) e 27 com lesão ocular cicatricial (RC). Foram também utilizadas 19 amostras de soro de recém-nascidos não infectados que apresentaram IgG positivo após o nascimento (NI). Essas amostras foram obtidas a partir de soros de recémnascidos participantes de um programa de triagem neonatal realizado em Minas Gerais realizado nos anos de 2006 e 2007. Os resultados demonstraram que os recém-nascidos com toxoplasmose congênita apresentam maior reatividade de anticorpos IgG total e subclasses IgG1, IgG2 e IgG3 do que indivíduos não infectados. No grupo não infectado, o único anticorpo com mais de 50% de indivíduos com alta reatividade de anticorpos foi IgG4. Ao comparar os grupos de indivíduos com toxoplasmose congênita, foi observado que o grupo RAC, seguido de RC, apresentou maior reatividade principalmente para os anticorpos IgG1 e IgG3 comparado aos recém-nascidos dos grupos RA e SL, enquanto que pacientes do grupo RA apresentaram maior reatividade para IgG4 do que indivíduos dos outros grupos. IgG1 foi a única subclasse capaz de diferenciar os grupos NI, SL dos grupos RAC e RC. Também foi avaliado o índice de avidez de IgG total, que não permitiu estabelecer nenhum critério de diferenciação das formas de lesão ocular causadas pelo T. gondii. Portanto, a citometria de fluxo demonstrou que pode ser um método laboratorial complementar para ser utilizado como indicador das diferentes lesões oculares causadas pela toxoplasmose congênita.

Coorte retrospectiva de crianças e adolescentes, infectados pelo HIV por transmissão vertical, no Espírito Santo : comorbidades, mortalidade e sobrevida

INTRODUÇÃO: O diagnóstico e terapia antirretroviral precoce em lactentes, infectados pelo HIV por transmissão vertical, reduz a progressão do HIV e comorbidades que podem levar ao óbito. OBJETIVO GERAL: Avaliar o perfil clínico e epidemiológico em uma coorte de crianças e adolescentes com aids, infectados por transmissão vertical do HIV, por um período de onze anos, atendidos em hospital estadual de referência, no Estado do Espírito Santo. OBJETIVOS ESPECÍFICOS: 1. Descrever a frequência das comorbidades diagnosticadas após o diagnóstico de HIV e verificar sua distribuição, segundo dados demográficos, epidemiológicos e clínicos, e segundo a classificação dos casos em uma coorte de crianças e adolescentes com aids. 2. Avaliar os fatores preditores de risco de progressão para aids e óbito e causas de morte. 3. Estimar a taxa de sobrevida. MÉTODOS: Coorte retrospectiva de crianças e adolescentes infectados pelo HIV, por transmissão vertical (TV), atendidas no Serviço de Atendimento Especializado (SAE) do Hospital Infantil Nossa Senhora da Glória (HINSG), de janeiro 2001 a dezembro 2011, em Vitória – ES/Brasil. A coleta de dados foi realizada em protocolo específico padronizado, e dados sobre as comorbidades, mortalidade e sua causa básica foram obtidos dos prontuários médicos, da Declaração de Óbito e do banco de dados SIM (Sistema de Informação sobre Mortalidade). O diagnóstico de aids e comorbidades foi de acordo com CDC (Centers for Disease Control and Prevention)/1994. RESULTADOS: Foi arrolado um total de 177 pacientes, sendo 97 (55%) do sexo feminino; 60 (34%) eram menores de1ano, 67 (38%) tinham de 1 a 5 anos e 50 (28%) tinham6 anos ou mais de idade no ingresso ao serviço. A mediana das idades na admissão foi de 30 meses (Intervalo Interquartis (IIQ) 25-75%: 5-72 meses). Em relação à classificação clínico-imunológica, 146 pacientes (82,5%) apresentavam a forma moderada/grave no momento do ingresso no Serviço e 26 (14,7%) foram a óbito. Os sinais clínicos mais frequentes foram hepatomegalia (81,62%), esplenomegalia (63,8%), linfadenopatia (68,4%) e febre persistente (32,8%). As comorbidades mais frequentes foram anemia (67,2%), pneumonia/sepses/meningite - primeiro episódio (64,2%), OMA/sinusite recorrente (55,4%), infecções bacterianas graves recorrentes (47,4%) e dermatites (43,1%). Encontrou-se associação entre classificação clínico-imunológica grave e ingresso no serviço com menos de um ano de idade com algumas comorbidades (p<0,001). O tempo total do acompanhamento dos pacientes foi de 11 anos, com mediana de cinco anos (IIQ: 2-8 anos). No final do período estudado, 132 (74,6%) pacientes estavam em acompanhamento, 11 (6,2%) foram transferidos para outros serviços eem oito (4,5%) houve perda de seguimento. Quanto ao óbito, observou-se uma redução de casos ao longo do tempo. A maioria dos pacientes que foram a óbito deu entrada no serviço com classificação clínica imunológica grave (77%-20/26), apresentava anemia moderada/grave e estava em uso de terapia antirretroviral (TARV) por mais de 3 meses (17/24-71%).Os principais fatores de risco para o óbito foram: faixa etária < 1 ano (p=0,005), pneumonia por P. jirovecii (p=0,010), percentual de linfócito T CD4+ nadir <15% (p=0,012), anemia crônica (p=0,012), estágio clínico imunológico grave (p=0,003), infecções bacterianas graves recorrentes(p=0,003) e tuberculose (p=0,037). Ter iniciado TARV antes dos 6 meses de vida (diagnóstico e tratamento precoces) foi associado à sobrevida(OR 2,86, [Intervalo de Confiança (IC) de 95%: 1,12-7,25] p=0,027).O principal diagnóstico registrado para os óbitos foram infecções bacterianas graves (12/21-57%). Foi encontrada uma elevada taxa de sobrevida, com 85,3% de probabilidade de sobrevivência por mais de 10 anos (IC 95% 9,6-10,7). CONCLUSÕES: A maioria das crianças teve diagnóstico tardio da infecção pelo HIV aumentando o risco de progressão para aids e óbito por falta de tratamento precoce. A tendência de mortalidade das crianças infectadas pelo HIV se mostrou uma constante com queda nos dois últimos anos do estudo, e ainda persistem as infecções bacterianas como maior causa de óbito. Portanto, melhoria no cuidado pré-natal e acompanhamento pediátrico com vista ao diagnóstico precoce das crianças infectadas verticalmente devem fazer parte do cuidado integral à criança com aids, o que poderia reduzir a mortalidade destas crianças.

Possible consequences of increasing life expectancy in Brazil: the perspective of a European historical demographer

Those over sixty years of age accounted for 6.6% of the total population of Brazil in 1985, in the Federal Republic of Germany this proportion was 20.3% in 1984. As early as 1950 it had been 14.5%. This proportion will not even be reached in Brazil in the year 2000 when persons aged sixty years and older are only projected to make up 8.8% of the total population. Similarly, in 1982/84 life expectancy at birth in the Federal Republic was 70.8 years for men and 77.5 for women; in Brazil the figures for 1980/85 were, by contrast, "only" 61.0 and 66.0. Against this background it is easy to understand why the discussion concerning an ageing society with its many related medical, economic, individual and social problems has been so slow in coming into its own in Brazil. As important as a more intensive consideration of these aspects may be in Brazil at present, they are, nevertheless, only one side of the story. For a European historical demographer with a long-term perspective of three of four hundred years, the other side of the story is just as important. The life expectancy which is almost ten years lower in Brazil is not a result of the fact that no one in Brazil lives to old age. In 1981 people sixty-five years and older accounted for 34.4% of all deaths! At the same time infants accounted for only 22.1% of total mortality. They are responsible, along with the "premature" deaths among youths and adults, for the low, "average" life expectancy figure. In Europe, by contrast, these "premature" deaths no longer play much of a role. In 1982/84 more than half of the women (52.8%) in the Federal Republic of Germany lived to see their eightieth birthdays and almost half of the men (47.3%) lived to see their seventy-fifth. Our biological existence is guaranteed to an extent today that would have been unthinkable a few generations ago. Then, the classic troika of "plague, hunger and war" threatened our forefathers all the time and everywhere. The radical transition from the formerly uncertain to a present-day certain lifetime, which is the result of the repression of "plague, hunger and war", led to unexpected consequences for our living together. Our forefathers were forced to live in closely knit Gemeinschaften in the interest of physical survival and to subordinate their egoistic goals to a common value, but now these pressures have, for the most part, fallen away. Correspondingly, this much more certain EGO has taken center stage. An ever greater number of us chooses to live life as single beings: the number of marriages is lower every year; the number of divorces is on the increase; in Berlin (West) more than half (sic! 52.3%) of all households are already composed on only one person. For the last dozen years the annual number of births in the Federal Republic has been insufficient to ensure population replacement. Not a population explosion but rather the opposite, a population implosion, is our problem. Human beings do not appear to be "social animals", as was axiomatically assumed for so long. They were only forced to behave as such for as long as "plague, hunger and war" forced them to do so. When these life endangering conditions no longer exist and life becomes certain even without their being integrated into a Gemeinschaft then humans suddenly show themselves more and more to be independent single beings. It is not the percentage of the population that is over sixty or sixty-five that is decisive in this context but rather how certain adults perceive their biological lives to be, since they are the ones who organize their lives, who build communities or who are ever more often willing only to enter into means-to-an-end personal unions without lasting or close ties and mutual responsibilities. There are many signs which seem to point to a development in this direction in Brazil as well. More and more adults in Brazil are caught up in the deep-seated transition from an uncertain to a certain lifetime. A third of them die after having reached their sixty-fifth birthday. It therefore seems to me to be high time that one began to give more consideration to the other side of the story in Brazil as well. And who is more suited intensively to consider the long-term perspectives than those engaged in the public health sector in whose competence, after all, such aspects, as "life certainty", "life expectancy" and "age at death" belong?

Nutritional factors in milk from Brazilian mothers delivering small for gestational age neonates

The composition of breast milk from brazilian mothers delivering low birthweight infants and its adequacy as a source of nutrients for this group has not yet been fully elucidated. A total of 209 milk samples from 66 women were analysed. The mothers were divided into three groups: G1, mothers delivering term babies of low birthweight (TSGA, n=16); G2, mothers delivering preterm babies of appropriate birthweight (PTAGA, n=20); G3, mothers delivering term babies of appropriate birthweight (TAGA, n=30). The following factors were analysed: osmolarity, total proteins and protein fractions, creamatocrit, sodium, potassium, calcium and magnesium. Milk samples were collected 48 h and 7, 15, 30 and 60 days after delivery. The groups did not differ significantly in terms of osmolarity, total proteins and fractions, creamatocrit, calcium, magnesium or potassium throughout the study period. Sodium levels were higher in all samples from mothers of TSGA infants and in samples from mothers of PTAGA infants on the 7th, 15th and 30th days than in milk from the TAGA group. The authors consider the needs of the low birthweight and TAGA infants and that these high sodium levels may be necessary for growth of low birthweight infants.

Assessing morbidity in the paediatric community

INTRODUCTION: Morbidity information is easily available from medical records but its scope is limited to the population attended by the health services. Information on the prevalence of diseases requires community surveys, which are not always feasible. These two sources of information represent two alternative assessments of disease occurrence, namely demand morbidity and perceived morbidity. The present study was conceived so as to elicit a potential relationship between them so that the former could be used in the absence of the latter. METHODS: A community of 13,365 families on the outskirts of S. Paulo, Brazil, was studied during the period from 15/Nov/1994 to 15/Jan/1995. Data regarding children less than 5 years old were collected from a household survey and from the 2 basic health units in the area. Prevalence of diseases was ascertained from perceived morbidity and compared to estimates computed from demand morbidity. RESULTS: Data analysis distinguished 2 age groups, infants less than 1 year old and children 1 to less than 5. The most important groups of diseases were respiratory diseases, diarrhoea, skin problems and infectious & parasitical diseases. Basic health units presented a better coverage for infants. Though disease frequencies were not different within or outside these units, a better coverage was found for diarrhoea and infectious & parasitical diseases in the infant group, and for diarrhoea in the older age group. Equivalence between the two types of morbidity was found to be limited to the infant group and concerned only the best covered diseases. The odds of a disease being seen at the health service should be of at least 4:10 to ensure this equivalence. CONCLUSION: It was concluded that, provided that health service coverage is good, demand morbidity can be taken as a reliable estimate of community morbidity.

More than maternal sensitivity shapes attachment : infant coping and temperament

The aim of this longitudinal studywas to investigate the effect of a set of factors from multiple levels of influence: infant temperament, infant regulatory behavior, and maternal sensitivity on infant’s attachment. Our sample consisted of 48 infants born prematurely and their mothers. At 1 and 3 months of age, mothers described their infants’behavior using the Escala de Temperamento do Beb´e. At 3 months of age, infants’ capacity to regulate stress was evaluated during Tronick’s Face-to-Face Still-Face (FFSF) paradigm. At 9 months of age, mothers’ sensitivity was evaluated during free play using the CARE-Index. At 12 months of age, infants’ attachment security was assessed during Ainsworth’s Strange Situation. A total of 16 infants were classified as securely attached, 17 as insecure-avoidant, and 15 as insecure-resistant. Mothers of securely attached infantswere more likely than mothers of insecure infants to describe their infants as less difficult and to be more sensitive to their infants in free play. In turn, secure infants exhibited more positive responses during the Still-Face. Infants classified as insecureavoidant were more likely to self-comfort during the Still-Face and had mothers who were more controlling during free play. Insecure-resistant exhibited higher levels of negative arousal during the Still-Face and had mothers who were more unresponsive in free play. These findings show that attachment quality is influenced bymultiple factors, including infant temperament, coping behavior, and maternal sensitivity.

Risk factors for the increasing trend in low birth weight among live births born by vaginal delivery, Brazil

OBJECTIVE: To identify risk factors for low birth weight (LBW) among live births by vaginal delivery and to determine if the disappearance of the association between LBW and socioeconomic factors was due to confounding by cesarean section. METHODS: Data were obtained from two population-based cohorts of singleton live births in Ribeirão Preto, Southeastern Brazil. The first one comprised 4,698 newborns from June 1978 to May 1979 and the second included 1,399 infants born from May to August 1994. The risks for LBW were tested in a logistic model, including the interaction of the year of survey and all independent variables under analysis. RESULTS: The incidence of LBW among vaginal deliveries increased from 7.8% in 1978--79 to 10% in 1994. The risk was higher for: female or preterm infants; newborns of non-cohabiting mothers; newborns whose mothers had fewer prenatal visits or few years of education; first-born infants; and those who had smoking mothers. The interaction of the year of survey with gestational age indicated that the risk of LBW among preterm infants fell from 17.75 to 8.71 in 15 years. The mean birth weight decreased more significantly among newborns from qualified families, who also had the highest increase in preterm birth and non-cohabitation. CONCLUSIONS: LBW among vaginal deliveries increased mainly due to a rise in the proportion of preterm births and non-cohabiting mothers. The association between cesarean section and LBW tended to cover up socioeconomic differences in the likelihood of LBW. When vaginal deliveries were analyzed independently, these socioeconomic differences come up again.

Developmental and evolutionary assumptions in a study about the impact of premature birth and low income on mother–infant interaction

In order to study the impact of premature birth and low income on mother–infant interaction, four Portuguese samples were gathered: full-term, middle-class (n=99); premature, middle-class (n=63); full-term, low income (n=22); and premature, low income (n=21). Infants were filmed in a free play situation with their mothers, and the results were scored using the CARE Index. By means of multinomial regression analysis, social economic status (SES) was found to be the best predictor of maternal sensitivity and infant cooperative behavior within a set of medical and social factors. Contrary to the expectations of the cumulative risk perspective, two factors of risk (premature birth together with low SES) were as negative for mother–infant interaction as low SES solely. In this study, as previous studies have shown, maternal sensitivity and infant cooperative behavior were highly correlated, as was maternal control with infant compliance. Our results further indicate that, when maternal lack of responsiveness is high, the infant displays passive behavior, whereas when the maternal lack of responsiveness is medium, the infant displays difficult behavior. Indeed, our findings suggest that, in these cases, the link between types of maternal and infant interactive behavior is more dependent on the degree of maternal lack of responsiveness than it is on birth status or SES. The results will be discussed under a developmental and evolutionary reasoning