The aim of this study was to assess the influence of social environmental factors on school performance and behavioural problems among 14-year-old children who had been exposed to amphetamine during foetal life. The study group comprised a cohort of 65 children who had suffered intrauterine exposure to amphetamine due to maternal drug abuse. This group has been followed since birth and examined at regular intervals. Information regarding the academic performance of the children was gathered from the school authorities. The psychosocial environment of the children was determined through interviews and through information obtained from the social authorities. Of the 64 children who attended a school within the state school system, 10 (15%) were a year behind for their age. The mean grades were significantly lower than those of their classmates. Behavioural problems were mentioned in the social authority documentation of one-third of the children, regardless of whether the child was placed in a foster home or was residing with the biological mother. A positive significant correlation was found between maternal age and the outcome of the children, as well as between therapy during pregnancy and outcome, whilst several environmental factors, particularly during the child's first four years, correlate negatively to outcome. Psychosocial factors early in life influence the outcome at 14 years. The positive effect of intervention during pregnancy illustrates the importance of early identification preferable during pregnancy.
The adverse effects of amphetamine addiction during pregnancy and the neonatal period were studied in 69 Swedish women. Almost one-third of the women (Group I) succeeded in overcoming their addiction in early pregnancy. The women in Group I (n = 17), unlike those in Group II (n = 53), received the same amount of prenatal care as the average Swedish woman. An increased rate of preterm deliveries (25%) as well as a higher perinatal mortality (7.5%) was found in Group II. During the neonatal period an increased incidence of mother-infant separation was found since many of the infants (46%) were transferred to pediatric wards for medical and social reasons. All newborns in Group I and 74% of infants born to mothers with continuous amphetamine addiction throughout pregnancy remained in their mother's custody following discharge from the maternity clinic.
During the period 1973--1976, a significant decrease in perinatal mortality from 14.2 to 10.4/10 newborns occurred in Sweden. In the Stockholm area, the mean perinatal mortality during the same period varied significantly between the different maternity hospitals, even when pre-term and high risk pregnancies were excluded from the comparison. The majority of hospitals with fewer deliveries and without pediatric wards had a perinatal mortality above the mean. Some explanations of these differences were also looked for in differences between the total population of the referral area of each maternity hospital. In the referral areas of the hospitals with a perinatal mortality above the mean, there were higher percentages of low-income households and over-crowded dwellings and fewer professional people than in the other area. The results suggest a need for analysis of individually-based data to find etiological factors which account for differences in perinatal mortality.
The infant feeding pattern among 96 Turkish mothers living in a suburb of Istanbul and 30 living in a suburb of Stockholm, both with working class characteristics, was determined. The duration of breastfeeding among the Turkish immigrant group living in the Stockholm suburb was significantly reduced compared with the group with a similar social background but living in a native urban area. Infant feeding pattern among the Turkish immigrant mothers was more similar to that of Swedish populations. Attitudes to breastfeeding among the immigrant group had changed. Early weaning, reliance on commercially available infant foods and bottle feeding characterized their infant feeding practices. The majority of the infants of this group showed a tendency to overweight.
The prevalence of breastfeeding varies very much throughout the world. In some countries, such as in Scandinavia, it is extremely high, whereas it is rather low in many industrialized countries such as northern Italy. In urban areas of many developing countries the prevalence is extremely low, although it may be high in rural areas. For instance, in rural Guinea-Bissau in West Africa it is reported to be 100% at 3 mo of age, and this high prevalence may be explained by the fact that infants who have not been breastfed die before this age. In Sweden the prevalence at 2 mo of age was around 95% in 1945 (including infants fed by milk-mothers) but then gradually dropped until 1972, when it was as low as 20%. However, during the following 10-y period the prevalence gradually increased to around 80%. The main reasons for the decline most probably were that infant formulae, then considered to be safe, became available, that an increasing number of women started to work outside their homes, making formula feeding part of the feminist movement, and finally that no real attempts were made to promote breastfeeding in the maternity wards and well-baby clinics. The reverse trend started in 1972, when the attitude towards breastfeeding changed completely. Well-educated mothers became aware of the new discoveries of the importance of breastfeeding from immunological and nutritional points of view, and organized campaigns. Within a few years, the Swedish parliament passed a law which guaranteed all mothers paid leave from their work (80% of their salary) for 9 mo after childbirth, which has now been increased to 12 mo. The WHO/UNICEF code from 1980, which regulates the marketing of infant formula, has also probably played an important role. After a plateau for the prevalence of breastfeeding between 1982 and 1990, a further increase has taken place, particularly between 6 and 9 mo of age. Whereas the first phase in the increase of the prevalence of breastfeeding was, to a certain extent, the result of the concern of well-educated mothers, the second phase (1990-1998) may, at least partly, be explained by the fact that Swedish maternity wards then implemented the suggestion, launched by WHO/UNICEF, to create "baby-friendly" maternity hospitals with the aim of enabling all women to practise exclusive breastfeeding immediately after birth. Methods to stimulate lactation and proper nutritional suckling behaviour of the newborn were then developed.
Over a period of 15 years the incidence of neonatal septicemia seen at St Göran's Children's Hospital has increased both per 1000 births and per 100 admitted neonates. The spectrum of causative organisms has changed towards more Gram-positive organisms and fewer Gram-negative organisms. In the initial antibiotic treatment an aminoglycoside and ampicillin derivate will still be needed to give full coverage.
A study was performed in infants under the age of 12 months born during 1974 and admitted to St. Göran's Children's Hospital with symptoms suggestive of cow's milk allergy (CMA). The aims of the study were to determine the role of early exposure to cow's milk formulas as a predisposing factor to CMA and to estimate the incidence of CMA in infancy. Twenty-five infants fulfilled the criteria for CMA. Available records were reviewed and a careful history was obtained from the mothers on two occasions. The patient group was compared with a control group. Sixteen of the 25 infants were exposed to cow's milk protein during their first week in the nursery for newborns, 6 were exposed before the end of the fourth week of life, and 3 infants were apparently not exposed. All infants were breast fed 3 to 26 weeks before re-exposure and occurrence of symptoms. Infants with CMA were given cow's milk formulas during their first 4 weeks of life significantly more often than infants in the control group (p less than 0.01). The incidence of CMA was approximately 1 : 200. The first 4 weeks after birth seem to be a particularly vulnerable period. Hence, in order to prevent CMA, infant formula should not be given--even occasionally--during this period.
By record-linkage of the 1975 Swedish census and the Medical Birth Register of infants born in 1976, 1,161 infants were identified who were born to women coded as laboratory workers in the census. These infants were compared to all 98,354 infants born in Sweden in 1976. There was a higher than expected number of infants who died neonatally and/or had congenital malformations. Twenty-six singleton infants who either died or had serious malformations were selected for further study. To each of the cases, 2 controls were selected among the 1,161 infants. A questionnaire was sent to the 26 cases and 50 controls (2 cases had only 1 control each) asking about work during pregnancy. No specific type of laboratory work was found to be more common among the cases than controls.