Infant

We make one important note here regarding nomenclature. Early explanations of CIDNP invoked an Overhauser-type mechanism, implying a dynamic process similar to spin relaxation hence the word dynamic m the CIDNP acronym. This is now known to be incorrect, but the acronym has prevailed in its infant fomi. 

Phenylpyruvic acid can cause mental retardation m infants who are deficient m the enzymes necessary to convert l phenylalanine to l tyrosine This disorder is called phenylketonuria, or PKU disease PKU disease can be detected by a simple test rou tmely administered to newborns It cannot be cured but is controlled by restricting the dietary intake of l phenylalanine In practice this means avoiding foods such as meat that are rich m l phenylalanine... 

C-6 Hydroyylation. This biotransformation is more predominant in infants than in adults, and can prevent other metabohc transformations. 

Glucuronidation. Complexation of the steroid to glucuronic acid, most predominantiy via the C-3 hydroxyl, leads to a considerable portion of the excreted metabohtes of ah. glucocorticoids. In infants, sulfurylation (formation of a sulfate ester) is also predominant (16). 

Products prepared from soy protein products and resembling chicken, ham, frankfurters, and bacon are available commercially. Soy protein isolates are used in place of milk proteins or sodium caseinate in products such as coffee creamers, whipped toppings, yogurt, and infant formulas (see Dairy substitutes). Soy protein products also are used in snacks and in baked foods. 

Infants maybe sensitive to doses of vitamin A [11103-57-4] in the range of 75,000—200,000 lU (22.5—60 mg), although the toxic dose in adults is probably 2—5 million lU (90.6—1.5 g). Intakes in this range from normal food suppHes without oral supplements are simply beyond imagination (79). Vitamin D [1406-16-2] toxicity is much more difficult to substantiate clinically. Humans can synthesize active forms of the vitamin in the skin upon irradiation of 7-dehydrocholesterol. Toxic symptoms are relatively nonspecific, and dangerous doses seem to He in the range of 1000—3000 lU/kg body wt (25—75 flg/kg body wt) (80). Cases of toxicity of both vitamins E and K have been reported, but under ordinary circumstances these vitamins are considered relatively innocuous (81). 

Of the water-soluble vitamins, intakes of nicotinic acid [59-67-6] on the order of 10 to 30 times the recommended daily allowance (RE)A) have been shown to cause flushing, headache, nausea, and moderate lowering of semm cholesterol with concurrent increases in semm glucose. Toxic levels of foHc acid [59-30-3] are ca 20 mg/d in infants, and probably approach 400 mg/d in adults. The body seems able to tolerate very large intakes of ascorbic acid [50-81-7] (vitamin C) without iH effect, but levels in excess of 9 g/d have been reported to cause increases in urinary oxaHc acid excretion. Urinary and blood uric acid also rise as a result of high intakes of ascorbic acid, and these factors may increase the tendency for formation of kidney or bladder stones. AH other water-soluble vitamins possess an even wider margin of safety and present no practical problem (82). 

Diagnosis and alleviation of the cause, if possible, is of primary importance. Often, however, this is not possible and therapy is used to alleviate the inconvenience and pain of diarrhea. These compounds usually only mask the underlying factors producing the problem. Diarrhea may cause significant dehydration and loss of electrolytes and is a particularly serious problem in infants. Antidiarrheals do not usually prevent the loss of fluids and electrolytes into the large bowel and, although these may prevent frequent defecation, often the serious imbalance of body electrolytes and fluids is not significantly affected. 

Gelatin can be a source of essential amino acids when used as a diet supplement and therapeutic agent. As such, it has been widely used in muscular disorders, peptic ulcers, and infant feeding, and to spur nail growth. Gelatin is not a complete protein for mammalian nutrition, however, since it is lacking in the essential amino acid tryptophan [73-22-3] and is deficient in sulfur-containing amino acids. 

A considerable assumption in the exponential distribution is the assumption of a constant failure rate. Real devices demonstrate a failure rate curve more like that shown in Eigure 9. Eor a new device, the failure rate is initially high owing to manufacturing defects, material defects, etc. This period is called infant mortaUty. EoUowing this is a period of relatively constant failure rate. This is the period during which the exponential distribution is most apphcable. EinaHy, as the device ages, the failure rate eventually increases. 

Fig. 9. Failure rate curve for r eal components. A, infant mortality B, period of approximately constant p. and C, old age.

Primary immunodeficiencies are uncommon, and may occur in 1 in 10,000 individuals (6). Many primary immunodeficiencies are hereditary and congenital, and first appear in infants and children. Primary immunodeficiencies are classified into four main groups (7) relating to the lymphocytes (B-ceUs, T-ceUs, or both), phagocytes, or the complement cascade (8). Primary deficiency diseases result from B-ceU defects in 50% of cases, from T-ceU defects in ca 10%, and from combined B- and T-ceU defects in ca 20%. Phagocytic disorders account for 18% and complement defects occur in 2% of all cases. 

Secondary immunodeficiencies (9) are much more common than primary ones and frequently occur as a result of immaturity of the immune system in premature infants, immunosuppressive therapy, or surgery and trauma. Illnesses, particularly when prolonged and serious, have been associated with secondary immunodeficiencies, some of which may be reversible. Acquked immune deficiency syndrome (AIDS) (10—12) may be considered a secondary immunodeficiency disease caused by the human immunodeficiency vimses HIV-1 or HIV-2. Hitherto unknown, the disease began to spread in the United States during the latter part of the 1970s. The agent responsible for this infection has been isolated and identified as a retrovims. 

The failure rate changes over the lifetime of a population of devices. An example of a failure-rate vs product-life curve is shown in Figure 9 where only three basic causes of failure are present. The quaUty-, stress-, and wearout-related failure rates sum to produce the overall failure rate over product life. The initial decreasing failure rate is termed infant mortaUty and is due to the early failure of substandard products. Latent material defects, poor assembly methods, and poor quaUty control can contribute to an initial high failure rate. A short period of in-plant product testing, termed bum-in, is used by manufacturers to eliminate these early failures from the consumer market. 

The ha2ard function is a constant which means that this model would be appHcable during the midlife of the product when the failure rate is relatively stable. It would not be appHcable during the wearout phase or during the infant mortaHty (early failure) period. 

This ha2ard function decreases with /5 < 1, increases with /5 > 1, and remains constant for /5 = 1. The value of P can give some indication of wearout or infant mortaUty. 

It was thought previously that there were no inborn odor preferences that these are learned from experience. However, studies at the MoneU Center have indicated that flavors consumed by a mother and transmitted into the milk influence the feeding behavior of her infant. When mothers consume gadic, their infants feed longer than when no gadic is consumed (7). 

The use of oxygen in pediatric incubators is an important factor in increasing the survival rate of premature infants who develop cyanosis. However, the use of oxygen is associated with risk of developing the visual defect known as retrolental fibroplasia (38). A careflil monitoring of arterial blood oxygen partial pressure is important. 

Pubhc concerns about pesticides in the diet of infants and children resulted in an expert committee convened by the U.S. National Academy of Sciences which devoted four years to the review of all available data. A consensus report was issued in 1993 (80). A number of recommendations for further work to more precisely define what constitutes the diet of infants and children were made. No risk could be estimated. The residue data reviewed by the panel were mainly from monitoring studies conducted by the PDA using multiresidue methods to analyze fresh produce and market basket samples collected from various geographic areas (81,82). These and other rehable scientific studies have demonstrated that relatively few food samples contain detectable residues. Most residues are far below estabhshed tolerances which are set above the maximum residue found in treated raw agricultural... 

Pesticides in the Diet of Infants and Children, Report of Board on Agriculture and Board on Environmental Studies and Toxicology, Commission on Life Sciences, U.S. National Research Council, National Academy Press, Washington, D.C., 1993, 386 pp. 

Other specialized appHcations of cardiac arrest devices include extracorporeal membrane oxygenation (ECMO) which occurs when the lungs of a premature infant caimot function properly. The market segments for cardiopulmonary support devices are potentially significant. 

Used in baked goods (breads, cakes, cookies, crackers, doughnuts), pasta products, emulsified and coarsely ground meat products, meat analogues, breakfast cereals, dietary foods, infant foods, confections, milk replacers, and pet foods. 

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