Asian Infants Research Articles

Systematic review of Apgar scores & cyanosis in Black, Asian, and ethnic minority infants.

Apgar score and cyanosis assessment may disadvantage darker-skinned babies. This review explored cyanosis and Apgar score assessments in Black, Asian, or minority ethnic neonates compared to White neonates. Four databases were searched. Studies of any methodology were included. A narrative synthesis was undertaken. Ten studies were included. Three studies involving over 39 million neonates showed Apgar score ≤3 was predictive of neonatal mortality across all ethnicities. Black babies with Apgar score ≤3 had lower mortality rates before 28 days, however, variations in scoring practices were also observed. Three further studies (n = 39,290,014) associated low Apgar scores with poorer mental development up to 22 months, especially in mixed ethnicity and Black infants. One study reported inadequate training in assessing ethnic minority neonates. Cyanosis was the focus of three included studies (n = 455) revealing poor visual assessment of cyanosis across ethnicities. With pulse oximetry occult hypoxemia occurred slightly more frequently in Black neonates. Tongue color indicated oxygen requirement at birth, regardless of ethnicity. Apgar scores correlate well with neonatal mortality in all ethnicities, however scoring variations exist. Cyanosis assessment is challenging, with tongue and lips the best places to observe in the absence of pulse oximetry. Assessment of the color component of the Apgar score and of cyanosis visually are not accurate in babies with darker skin. Small racial differences may exist for pulse oximetry in neonates, but it is more reliable than visual assessment.

Examining racial and ethnic disparities in diagnosis and access to care in infantile atopic dermatitis in the United States: a retrospective cohort study.

Atopic dermatitis (AD) is an inflammatory skin disorder that is common in children and associated with medical and psychosocial comorbidities. Previous studies have shown that there exist significant racial disparities in healthcare utilization in children with AD; however, literature on disparities in dermatology access is limited. The primary aim of this study was to identify differences in diagnosis of AD and access to dermatologic care by race and ethnicity in infants with AD. We conducted a retrospective chart review of infants diagnosed with AD at Boston Children's Hospital from January 1, 2015 - December 31, 2019. Race and ethnicity were categorized as Native American or Alaska Native, Asian, non-Hispanic Black, Hispanic, Native Hawaiian or Other Pacific Islander, non-Hispanic white, and other. Outcomes included time to diagnosis and dermatology visit from rash onset and were analyzed utilizing a Kruskal-Wallis test. Severity of presentation at first dermatology visit, presentation to the emergency department (ED), medications prescribed, and follow up were analyzed using Chi-squared tests. Significantly more non-Hispanic white infants received a prescription by their pediatrician for AD than Hispanic infants (p = 0.002). Non-Hispanic Black and Asian infants waited longer to see a dermatologist after receiving a prescription for AD by their pediatrician compared to non-Hispanic white patients (p < 0.001; p = 0.007). Significantly more non-Hispanic Black and Hispanic infants presented to the ED for AD within the first year of life than non-Hispanic white patients (p < 0.001; p = 0.003). Our study suggests disparities in diagnosis and access to care for non-Hispanic Black and Hispanic infants with AD, with differences in prescriptions, time to see a dermatologist, and presentation to the ED compared to non-Hispanic white infants.

A Comparison of Infant Feeding Practices in South Asian-Born Mothers and Australian-Born Mothers Living in Australia.

South Asian infants and children have a higher predisposition to central adiposity, increasing their risk of metabolic diseases in childhood. Infant feeding practices are a key factor in reducing the risk of obesity in children. The current study aimed to compare infant feeding practices of South Asian-born mothers to Australin-born mothers. The 2010 Australian National Infant Feeding Survey data were used to compare infant feeding practices between South Asian-born mothers and Australian-born mothers with children aged up to 2 years. Chi-square and t-tests were conducted, as well as regression models, with adjustment for covariates, to assess individual infant feeding practices between the two groups. A total of 298 South Asian-born mothers and 294 Australian-born mothers were included. The age at which a child stopped receiving breast milk was lower among Australian-born mothers (3 months) compared with South Asian-born mothers (5 months, p < 0.001). A greater proportion of South Asian-born mothers reported that solids were introduced at or after 6 months of age compared to Australian-born mothers (86% vs. 69%, p < 0.001, respectively). South Asian-born mothers were engaging in some health-promoting infant feeding practices compared to Australian-born mothers; however, they were not meeting the infant feeding guidelines for exclusive breastfeeding and the introduction of solids. Further research is needed to better understand factors influencing infant feeding practices in South Asian-born immigrant mothers in Australia to determine whether culturally tailored interventions are needed to help these women achieve optimal feeding practices for their infants.

Improved detection of cystic fibrosis by the California Newborn Screening Program for all races and ethnicities.

Newborn screening (NBS) for cystic fibrosis (CF) is universal in the United States. Protocols vary but include an immunoreactive trypsinogen (IRT) level and CFTR variant panel. California CF NBS has a 3-step screening: IRT level, variant panel, and CFTR sequencing if only one variant identified on panel. This was a cohort study of infants with CF born in California (2007-2021) to examine racial and ethnic differences in having a false-negative NBS result for CF and at which step the false-negative occurred. We examined how different CFTR variant panels would improve detection of variants by race and ethnicity: original 39-variant panel, current 75-variant panel, and all 402 disease-causing CFTR variants in the CFTR2 database. Of the 912 infants born in California with CF, 84 had a false-negative result: 38 due to low IRT level and 46 with a high IRT value (but incomplete variant detection). Asian (OR 6.3) and Black infants (OR 2.5) were more likely to have a false-negative screening result than non-Hispanic white infants. The majority of false-negative screening (but CF diagnosis) cases among American Indian/Native Alaskan and non-Hispanic White infants were due to low IRT levels. The majority of Asian and Hispanic infants with false-negative screening had no variants detected. Detection of two CFTR variants was improved with the 75-variant panel in Black, Hispanic, and non-Hispanic White infants and with the 402-variant panel in Black, Hispanic, non-Hispanic White, and other race infants. Larger CFTR panels in NBS improved the detection of CF in all races and ethnicities.

Feasibility and Safety of the Early Introduction of Allergenic Foods in Asian Infants with Eczema.

There is a lack of data regarding the early introduction of the consumption of allergenic food among Asian infants. We examined infants who had early-onset eczema before 6 months of age and received instructions from certified allergists for the early introduction of hen's eggs, milk, wheat, peanuts, and tree nuts. The consumption rates of hen's eggs were 100% at 24 months. For peanuts and walnuts, the consumption rate was moderate at 12 months (48.5% and 30.3%, respectively), but by 24 months, it had progressed to 78.8% and 81.3%, respectively. In contrast, cashews remained at lower levels than other allergens at 20.7% at 12 months and 41.4% at 24 months. No adverse events related to early introductions occurred. In infants with eczema, allergenic foods could be introduced early and well tolerated in Asian infants. However, having eczema may indicate a predisposition to food allergies, so caution is necessary when introducing allergenic foods. The early introduction of peanuts and tree nuts was still more challenging in real-world practice in Asia as well as in Western countries.

Micronutrient intake from complementary foods of Asian New Zealand infants

The complementary feeding period (6-23 months of age) is when solid foods are introduced alongside breastmilk or infant formula and is the most significant dietary change a person will experience. The introduction of complementary foods is important to meet changing nutritional requirements(1). Despite the rising Asian population in New Zealand, and the importance of nutrition during the complementary feeding period, there is currently no research on Asian New Zealand (NZ) infants’ micronutrient intakes from complementary foods. Complementary foods are a more easily modifiable component of the diet than breastmilk or other infant milk intake. This study aimed to compare the dietary intake of micronutrients from complementary foods of Asian infants and non-Asian infants in NZ. This study reported a secondary analysis of the First Foods New Zealand cross-sectional study of infants (aged 7.0-9.9 months) in Dunedin and Auckland. 24-hour recall data were analysed using FoodFiles 10 software with the NZ food composition database FOODfiles 2018, and additional data for commercial complementary foods(2). The multiple source method was used to estimate usual dietary intake. Ethnicity was collected from the main questionnaire of the study, answered by the respondents (the infant’s parent/caregiver). Within the Asian NZ group, three Asian subgroups were identified – South East Asian, East Asian, and South Asian. The non-Asian group included all remaining participants of non-Asian ethnicities. Most nutrient reference values (NRV’s)(3) available for the 7-12 month age group are for total intake from complementary foods and infant milks, so the adequacy for the micronutrient intakes from complementary foods alone could not be determined. Vitamin A was the only micronutrient investigated in this analysis that had an NRV available from complementary foods only, allowing conclusions around adequacy to be made. The Asian NZ group (n = 99) had lower mean group intakes than the non-Asian group (n = 526) for vitamin A (274µg vs. 329µg), and vitamin B12 (0.49µg vs. 0.65µg), and similar intakes for vitamin C (27.8mg vs. 28.5mg), and zinc (1.7mg vs. 1.9mg). Mean group iron intakes were the same for both groups (3.0mg). The AI for vitamin A from complementary foods (244µg) was exceeded by the mean intakes for both groups, suggesting that Vitamin A intakes were adequate. The complementary feeding period is a critical time for obtaining nutrients essential for development and growth. The results from this study indicate that Asian NZ infants have lower intakes of two of the micronutrients of interest than the non-Asian infants in NZ. However, future research is needed with the inclusion of infant milk intake in these groups to understand the total intake of the micronutrients. Vitamin A intakes do appear to be adequate in NZ infants.

Race and Ethnicity, Deprivation, and Infant Mortality in England, 2019-2022

England has one of the highest infant mortality rates in Europe. Much of the variation in infant mortality rates between races and ethnicities may be due to socioeconomic factors, but how deprivation and race and ethnicity are associated with infant mortality is unclear. To investigate the association of infant race and ethnicity with the infant mortality rate in England, adjusted for preterm birth and level of deprivation. This cohort study included children who died younger than 1 year of age, born at or after 22 weeks' gestation, occurring from April 1, 2019, to March 31, 2022, in England. Characteristics of the infant were derived from death notifications. The racial and ethnic groups were derived from National Health Service data and were reported by the parents and characterized using the Office of National Statistics classification: Asian or Asian British (Bangladeshi, Chinese, Indian, Pakistani, or any other Asian background), Black or Black British (African, Caribbean, or any other Black background), multiracial (White and Asian, White and Black African, White and Black Caribbean, or any other multiracial background), White or White British (British, Irish, any other White background, or Gypsy or Irish Traveler), and other (Arab or any other racial or ethnic group). Risk of death for all racial and ethnic groups and relative risk of death compared with the reference group (White) were calcuated. Analyses were repeated, adjusting for deprivation, gestational age of infants, and region of England. A total of 5621 infants who died younger than 1 year of age were reported to the National Child Mortality Database. A total of 2842 of 5130 infants (55.4%) were male; the median gestational age was 33 weeks (IQR, 25-38 weeks); of 5149 infants, 927 (18.0%) were Asian, 448 (8.7%) were Black, 3318 (64.4%) were White, 343 (6.7%) were multiracial, and 113 (2.2%) were from other racial and ethnic groups; and the median deprivation score was 4 (IQR, 3-5). In the unadjusted analysis, the relative risk of death compared with White infants was higher for Black (1.93 [95% CI, 1.75-2.13]) and Asian (1.67 [95% CI, 1.55-1.80]) infants. The population attributable risk fraction for all mortality rates among infants who were not White was 12.0% (95% CI, 10.3%-13.8%) (unadjusted), 9.8% (95% CI, 8.0%-11.7%) (adjusted for deprivation), 7.7% (95% CI, 5.9%-9.5%) (adjusted for gestational age at birth), and 12.8% (95% CI, 11.0%-14.5%) (adjusted for region of England). This cohort study suggests that the proportion of infants who died before 1 year of age is associated with race and ethnicity, with a population attributable risk fraction of 12.0%. An overconservative adjustment for deprivation did not explain the overall patterns seen. Approximately half the population attributable risk fraction may be due to increased risk of preterm birth in Asian and Black communities. Work is needed to identify what can be done to reduce this incidence of infant mortality.

Nurture Early for Optimal Nutrition (NEON) participatory learning and action women’s groups to improve infant feeding and practices in South Asian infants: pilot randomised trial study protocol

IntroductionFeeding practices developed in early life can impact a child’s nutrition, growth, dental health, cognitive development and lifetime risk of chronic diseases. Substantial evidence suggests ethnic health inequalities, and non-recommended...

Nationwide Analysis of the Outcomes and Mortality of Hospitalized Infants with Concomitant Diagnosis of COVID-19.

Coronavirus disease 2019 (COVID-19) generally causes milder illness in the pediatric population. However, infants represent a higher-risk population with evolving symptomatology and severity. There is a paucity of large population-based data on the impact of COVID-19 on hospitalized infants. In this large cohort study, the National Inpatient Sample database was queried for all infant hospital admissions between January and December 2020 in the United States, with and without a diagnosis of COVID-19 based on ICD-10-CM U07. The mortality and morbidity of infants with and without COVID-19 were evaluated. Parent-reported race and outcomes were also analyzed. A weighted total of 3,754,236 infants who were hospitalized were identified, of which 4,265 patients (0.11%) had a concomitant diagnosis of COVID-19. Infants with COVID-19 had similar mortality and extracorporeal membrane oxygenation utilization. Infants with concomitant COVID-19 had a higher rate of respiratory failure, congestive heart failure, acute kidney injury, and coagulopathy. Compared with Caucasian infants and Asian infants, Hispanic and African American infants were more likely to have COVID-19 hospital admissions than hospitalizations without COVID-19 diagnosis. Patients with lower median household income represented the majority of the COVID-19 hospitalization. The infants with COVID-19 were more likely to have Medicaid or Medicare insurance and less likely to have private insurance. In this large cohort of hospitalized infants with COVID-19, the infection was associated with complications, including respiratory failure and endotracheal intubations but not associated with a higher risk for mortality. Infants from racial minorities and lower socioeconomic strata carry the highest burden of COVID-19 infection. · Infants with COVID-19 represent a higher-risk group with evolving symptomatology and severity.. · Infants with COVID-19 had similar mortality rates and extracorporeal membrane oxygenation utilization as those without COVID-19.. · Racial minorities and lower socioeconomic strata carry the highest burden of COVID-19 infection..

Association Between Maternal Breastmilk Microbiota Composition and Rotavirus Vaccine Response in African, Asian, and European Infants: A Prospective Cohort Study.

Maternal breastmilk is a source of pre- and pro-biotics that impact neonatal gut microbiota colonization. Because oral rotavirus vaccines (ORVs) are administered at a time when infants are often breastfed, breastmilk microbiota composition may have a direct or indirect influence on vaccine take and immunogenicity. Using standardized methods across sites, we compared breastmilk microbiota composition in relation to geographic location and ORV response in cohorts prospectively followed from birth to 18 weeks of age in India (n = 307), Malawi (n = 119), and the United Kingdom ([UK] n = 60). Breastmilk microbiota diversity was higher in India and Malawi than the UK across 3 longitudinal samples spanning weeks of life 1 to 13. Dominant taxa such as Streptococcus and Staphylococcus were consistent across cohorts; however, significant geographic differences were observed in the prevalence and abundance of common and rare genera throughout follow up. No consistent associations were identified between breastmilk microbiota composition and ORV outcomes including seroconversion, vaccine shedding after dose 1, and postvaccination rotavirus-specific immunoglobulin A level. Our findings suggest that breastmilk microbiota composition may not be a key factor in shaping trends in ORV response within or between countries.

Association of State-Level Tax Policy and Infant Mortality in the United States, 1996-2019

Infant mortality in the United States is highest among peer nations; it is also inequitable, with the highest rates among Black infants. The association between tax policy and infant mortality is not well understood. To examine the association between state-level tax policy and state-level infant mortality in the US. This state-level, population-based cross-sectional study investigated the association between tax policy and infant mortality in the US from 1996 through 2019. All US infant births and deaths were included, with data obtained from the National Center for Health Statistics. Data were analyzed from November 28, 2021, to July 9, 2022. State-level tax policy was operationalized as tax revenue per capita and tax progressivity. The Suits index was used to measure tax progressivity, with higher progressivity indicating increased tax rates for wealthier individuals. The association between tax policy and infant mortality rates was analyzed using a multivariable, negative binomial, generalized estimating equations model. Since 6 years of tax progressivity data were available (1995, 2002, 2009, 2012, 2014, and 2018), 300 state-years were included. Adjusted incidence rate ratios (aIRRs) were calculated controlling for year, state-level demographic variables, federal transfer revenue, and other revenue. Secondary analyses were conducted for racial and ethnic subgroups. There were 148 336 infant deaths in the US from 1996 through 2019, including 27 861 Hispanic infants, 1882 non-Hispanic American Indian or Alaska Native infants, 5792 non-Hispanic Asian or Pacific Islander infants, 41 560 non-Hispanic Black infants, and 68 666 non-Hispanic White infants. The overall infant mortality rate was 6.29 deaths per 1000 live births. Each $1000 increase in tax revenue per capita was associated with a 2.6% decrease in the infant mortality rate (aIRR, 0.97; 95% CI, 0.95-0.99). An increase of 0.10 in the Suits index (ie, increased tax progressivity) was associated with a 4.6% decrease in the infant mortality rate (aIRR, 0.95; 95% CI, 0.91-0.99). Increased tax progressivity was associated with decreased non-Hispanic White infant mortality (aIRR, 0.95; 95% CI, 0.91-0.99), and increased tax revenue was associated with increased non-Hispanic Black infant mortality (aIRR, 1.04; 95% CI, 1.01-1.08). In this cross-sectional study, an increase in tax revenue and the Suits index of tax progressivity were both associated with decreased infant mortality. These associations varied by race and ethnicity. Tax policy is an important, modifiable social determinant of health that may influence state-level infant mortality.

Racial Differences in Retinopathy of Prematurity

ABSTRACT Purpose To delineate racial differences in the incidence and time course of ROP in a large cohort of premature infants. Methods The secondary analysis of data from the two Postnatal Growth and ROP Studies (G-ROP-1 and G-ROP-2) that were collected in 41 hospitals in North America from 2006 to 2017. According to self-reported maternal race, premature infants were classified into 3 groups: White (N = 5580), Black (N = 3252), and Asian (N = 353). Incidence, severity, and time course of ROP; plus disease; and postnatal weight gain rate were compared among racial groups. Results Black infants had significantly smaller BW (mean 1035 vs. 1131 vs.1144 grams, P < .001) and lower GA (28.2 vs. 28.6, vs. 29.1 weeks, P < .001) than White and Asian infants. However, Black infants had lower incidences of severe ROP (11.1% vs. 12.4% vs. 11.9%), ROP (42.1% vs. 43.2% vs. 30.6%), and plus disease (3.6% vs. 6.3%, vs. 5.9%) than White and Asian infants (BW and GA adjusted risk ratio for Black vs. White 0.69 for severe ROP, 0.83 for ROP, 0.44 for plus disease, all P < .0001). Mean daily-weight-gain on days of life 11–20 and 21–30 were similar across groups (P > .05), but lower in Black and Asian infants on days 31–40 (P < .001). There were no differences in the timing of severe ROP and ROP across racial groups. Conclusions Despite relatively lower GA, BW, and daily-weight-gain, Black preterm infants had lower incidences of ROP and plus disease than White preterm infants. The mechanisms for these differences require further investigation.

The Relationship Between Diet, Gut Microbiota, and Serum Metabolome of South Asian Infants at 1 Year

BackgroundDiet is known to affect the gut microbiota and the serum metabolome in adults, but this has not been fully explored in infants. Infancy is an important developmental period that may influence a person’s long-term health. Infant development can be affected by diet, which also interacts with the developing gut microbiota. ObjectivesThis study aimed to explore the associations between diet, the gut microbiota, and the serum metabolome of 1-y-old infants with the overarching goal of identifying serum biomarkers of diet and/or the gut microbiota. MethodsWe derived dietary patterns of 1-y-old infants (n = 182) participating in the Canadian South Asian Birth Cohort (START) study. We compared gut microbiota α-diversity and β-diversity and taxa relative abundance from 16S rRNA gene profiles with dietary patterns (PERMANOVA, Envfit) and investigated diet–serum metabolite associations using a multivariate analysis (partial least squares–discriminant analysis) and univariate analysis (t test). We explored the effect of nondietary factors on diet–serum metabolite relationships by incorporating diet, the gut microbiota, and maternal, perinatal, and infant characteristics in a multivariable forward stepwise regression. We replicated this analysis in White European infants, from the CHILD Cohort Study (n = 81). ResultsA dietary pattern characterized by formula consumption and negatively associated with breastfeeding most strongly predicted variation in the gut microbiota (R2 = 0.109) and serum metabolome (R2 = 0.547). Breastfed participants showed higher abundance of microbes from the genera Bifidobacterium (3.29 log2-fold) and Lactobacillus (7.93 log2-fold) and higher median concentrations of the metabolites S-methylcysteine (1.38 μM) and tryptophan betaine (0.43 μM) than nonbreastfed participants. Formula consuming infants showed higher median concentrations of branched-chain/aromatic amino acids (average 48.3 μM) than non–formula-consuming infants. ConclusionsFormula consumption and breastfeeding most strongly predicted the serum metabolites of 1-y-old infants, even when the gut microbiota, solid food consumption, and other covariates were considered.

Adverse birth outcomes in New York City women: Revisiting the Hispanic Paradox

In the United States, African American or non-Hispanic Black infants experienced worst birth outcomes whereas Hispanic and Asian infants have intermediate or similar outcomes compared with non-Hispanic white infants. The findings of better birth outcomes for Hispanic women have been coined the “Hispanic Paradox” given their low education, income, and access to care. New York City (NYC) has a great racial/ethnic diversity with implications for neighborhood racial/ethnic composition on birth outcomes by protecting women from psychosocial stress via social support that may buffer against racial/ethnic discrimination and/or racism. Data from 2012 to 2018 were used to examine the association of NYC women's race/ethnicity and neighborhood racial/ethnic minority composition with adverse birth outcomes (low birthweight [LBW], small for gestational age [SGA], preterm birth and infant mortality); and whether the association between mother's race/ethnicity and each birth outcome differed by neighborhood racial/ethnic composition. Multilevel logistic regression was used to control for the clustering of outcomes within neighborhoods. Black, Asian, and American Indian women have poorer birth outcomes than white women. Infants of Mexican American, Central American, and South American women were less likely to be of LBW whereas the opposite was true for infants of Cuban and other Hispanic women compared with infants of white women. When compared with white women, Mexican American, and South American women were less likely to have an SGA infant whereas Puerto Rican and other Hispanic women were more likely to have an SGA infant. All Hispanic women were more likely to have a preterm birth than white women whereas for infant mortality, greater odds of dying were observed for infants of Puerto Rican, Dominican, and other Hispanic women. Higher neighborhood racial/ethnic minority composition was associated with greater odds of having an adverse outcome. Finally, we observed heterogeneity of the associations between mother's race/ethnicity and birth outcomes by neighborhood racial/ethnic minority composition.

Breastfeeding duration is associated with higher adiposity at 6-8 months of age.

Breastfeeding (BF) has been identified as a protective factor against childhood obesity. However, evidence ofthe association between BF duration and adiposity remains inconclusive. Few studies have been conducted among Southeast Asian infants that have measured body composition during infancy using the gold standard stable isotope method. This study aimed to evaluate the association between BF duration and body composition during infancy. Healthy full-term Thai infants aged 6-8 months (n = 60) receiving exclusive or predominant BF for at least 3 months were recruited. Skinfold thickness (SFT) was measured by well-trained investigators. Body composition was assessed by the deuterium dilution technique. Infants with longer BF duration (>6 months; mean 7.5 ± 0.5 months, n = 29) had a higher subscapular SFT z-score than those with shorter BF duration (≤6 months; mean 5.3± 0.9 months, n = 31) by 0.48 (95% confidence interval [CI]: 0.01-0.94). After adjustment for age and sex, BF duration and age at introduction of complementary feeding (CF) were positively associated with fat mass and fat mass index at 6-8 months. One month increase in BF duration and CF age was associated with a 0.37 (95% CI: 0.05, 0.69) kg/m2 and 0.76 (95% CI: 0.18, 1.34) kg/m2 increase in the fat mass index, respectively. After adjusting for infant body mass index (BMI) during the earlier infancy period, the strength of the association was attenuated. This finding may reflect reverse causality where infants with lower BMI received formula or CF earlier. A longitudinal study with follow-up into childhood is warranted to confirm the effects of BF on adiposity in infancy and childhood.

Race and Ethnicity in Neonatal Group B Streptococcal Disease in England: 2016-2020.

Race and Ethnicity in Neonatal Group B Streptococcal Disease in England: 2016-2020.

Developing a community facilitator-led participatory learning and action women's group intervention to improve infant feeding, care and dental hygiene practices in South Asian infants: NEON programme.

The Nurture Early for Optimal Nutrition (NEON) study is a multiphase project that aims to optimize feeding, care and dental hygiene practices in South Asian children &lt;2 years in East London, United Kingdom. The multiphase project uses a participatory learning and action (PLA) approach facilitated by a multilingual community facilitator. In this paper, we elaborate on the process and results of the Intervention Development Phase in the context of the wider NEON programme. Qualitative community-based participatory intervention codevelopment and adaptation. Community centres in East London and online (Zoom) meetings and workshops. In total, 32 participants registered to participate in the Intervention Development Phase. Four Intervention Development workshops were held, attended by 25, 17, 20and 20 participants, respectively. Collaboratively, a culturally sensitive NEON intervention package was developed consisting of (1) PLA group facilitator manual, (2) picture cards detailing recommended and nonrecommended feeding, care and dental hygiene practices with facilitators/barriers to uptake as well as solutions to address these, (3) healthy infant cultural recipes, (4) participatory Community Asset Maps and(5) list of resources and services supporting infant feeding, care and dental hygiene practices. The Intervention Development Phase of the NEON programme demonstrates the value of a collaborative approach between researchers, community facilitators and the target population when developing public health interventions. We recommend that interventions to promote infant feeding, care and dental hygiene practices should be codeveloped with communities. Recognizing and taking into account both social and cultural norms may be of particular value for infants from ethnically diverse communities to develop interventions that are both effective in and accepted by these communities. Considerable efforts were placed on Patient/Participant and Public Involvement and Engagement. Five community facilitators were identified, each of which represented one ethnic/language group: (i) Bangladeshi/Bengali and Sylheti, (ii) Pakistani/Urdu, (iii) Indian/Gujrati, (iv) Indian/Punjabi and(v) Sri Lankan/Tamil. The community facilitators were engaged in every step of the study, from the initial drafting of the protocol and study design to the Intervention Development and refinement of the NEON toolkit, as well as the publication and dissemination of the study findings. More specifically, their role in the Intervention Development Phase of the NEON programme was to: 1. Support the development of the study protocol, information sheets and ethics application. 2. Ensure any documents intended for community members are clear, appropriate and sensitively worded. 3. Develop strategies to troubleshoot any logistical challenges of project delivery, for example, recruitment shortfalls. 4. Contribute to the writing of academic papers, in particular reviewing and revising drafts. 5. Develop plain language summaries and assist in dissemination activities, for example, updates on relevant websites. 6. Contribute to the development of the NEON intervention toolkit and recruitment of the community members. 7. Attend and contribute to Intervention Development workshops, ensuring the participant's voices were the focus of the discussion and workshop outcomes.

Gastroesophageal reflux disease in Asian infants: Similar condition, different perceptions

Gastroesophageal reflux disease (GERD), a common problem in infancy, may lead to troublesome symptoms or complications such as oesophagitis or oesophageal stricturing in a small minority of infants.1 In the majority of cases, however, frequent regurgitations, the commonest symptoms of GERD, resolves with age spontaneously without any medical intervention.2,3 Only a small proportion requires dietary

Prevalence, risk factors and parental perceptions of gastroesophageal reflux disease in Asian infants in Singapore

Infant gastroesophageal reflux disease (GERD) is a significant cause of concern to parents. This study seeks to describe GERD prevalence in infants, evaluate possible risk factors and assess common beliefs influencing management of GERD among Asian parents. Mother-infant dyads in the Singapore PREconception Study of long-Term maternal and child Outcomes (S-PRESTO) cohort were prospectively followed from preconception to 12 months post-delivery. GERD diagnosis was ascertained through the revised Infant Gastroesophageal Reflux Questionnaire (I-GERQ-R) administered at 4 time points during infancy. Data on parental perceptions and lifestyle modifications were also collected. The prevalence of infant GERD peaked at 26.5% at age 6 weeks, decreasing to 1.1% by 12 months. Infants exclusively breastfed at 3 weeks of life had reduced odds of GERD by 1 year (adjusted odds ratio 0.43, 95% confidence interval 0.19-0.97, P=0.04). Elimination of "cold or heaty food" and "gas producing" vegetables, massaging the infant's abdomen and application of medicated oil to the infant's abdomen were quoted as major lifestyle modifications in response to GERD symptoms. Prevalence of GERD in infants is highest in the first 3 months of life, and the majority outgrow it by 1 year of age. Infants exclusively breastfed at 3 weeks had reduced odds of GERD. Cultural-based changes such as elimination of "heaty or cold" food influence parental perceptions in GERD, which are unique to the Asian population. Understanding the cultural basis for parental perceptions and health-seeking behaviours is crucial in tailoring patient education appropriately for optimal management of infant GERD.

Racial Disparities in Breastmilk Receipt and Extremely Low Gestational Age Neonatal Morbidities in an Asian Pacific Islander Population.

Racial disparities in breastmilk provision and neonatal morbidities of extreme prematurity have been documented in previous studies but are not as well-documented in Asian and Pacific Islander (API) infants. The objectives of this study were to evaluate a predominantly API neonatal intensive care unit (NICU) population for racial disparities in (1) the receipt of breastmilk within 24h of admission and at discharge and (2) neonatal morbidities among infants ≤ 28weeks gestational age. A retrospective chart review of 2528 infants from 2018 to 2020 born at the largest level 3 NICU in Honolulu, Hawai'i, was conducted. Multivariable logistic regression analysis was performed on NICU outcomes to calculate adjusted odds ratios (aOR) and confidence intervals (CI). Native Hawaiian (NH) (aOR 0.73 [0.54, 0.98]), Pacific Islander (PI) (aOR 0.57 [0.41, 0.79]), and Filipino infants (aOR 0.66 [0.49, 0.89]) were less likely to receive breastmilk at discharge compared to Asian infants. PI infants were also more likely to experience necrotizing enterocolitis (aOR 7.89 [1.07, 58.10]) and intraventricular hemorrhage (aOR 3.86 [1.15, 13.02]) compared to Asian infants. In a predominantly API population, disparities in breastmilk receipt and neonatal morbidities exist among NH, PI, and Filipino infants in the NICU. Our findings call for better understanding of the underlying inequities to guide directed efforts, including standardization of care through staff trainings on implicit biases and trauma-informed care, as well as provision of culturally sensitive education and lactation support for these patients.