Cause Of Infant Death Research Articles

Integrating Infant Safe Sleep and Breastfeeding Education Into an App in a Novel Approach to Reaching High-Risk Populations: Prospective Observational Study.

Sudden unexpected infant death (SUID) is a leading cause of death for US infants, and nonrecommended sleep practices are reported in most of these deaths. SUID rates have not declined over the past 20 years despite significant educational efforts. Integration of prenatal safe sleep and breastfeeding education into a pregnancy app may be one approach to engaging pregnant individuals in education about infant care practices prior to childbirth. This study aims to assess whether pregnant individuals would engage with prenatal safe sleep and breastfeeding education provided within a pre-existing pregnancy app. Secondary objectives were to compare engagement among those at high and low risk of losing an infant to SUID and to assess the importance of end user push notifications for engagement. This prospective observational study was conducted from September 23, 2019 to March, 22 2022; push notifications were removed on October 26, 2021. TodaysBaby (University of Virginia, Boston University, and Washington University), a mobile health program in which safe sleep and breastfeeding video education was originally provided via texts, was embedded into the MyHealthyPregnancy app (Naima Health LLC). Pregnant mothers who received prenatal care within the University of Pittsburgh Medical Center hospital system were randomized to receive either safe sleep or breastfeeding education beginning at the start of the third trimester of pregnancy and ending 6 weeks post partum. Pregnant persons were designated as high risk if they lived in the 5% of zip codes in Allegheny County, Pennsylvania with the highest rates of SUID in the county. The primary outcome was engagement, defined as watching at least 1 video either in response to a push notification or directly from the app's learning center. A total of 7572 pregnant persons were enrolled in the TodaysBaby Program-3308 with push notifications and 4264 without. The TodaysBaby engagement rate was 18.8% with push notifications and 3.0% without. Engagement was highest in the initial weeks after enrollment, with a steady decline through pregnancy and very little postpartum engagement. There was no difference in engagement between pregnant persons who were low and high risk. The most viewed videos were ones addressing the use of pacifiers, concerns about infant choking, and the response of the body to the start of breastfeeding. Integrating safe sleep and breastfeeding education within a pregnancy app may allow for rapid dissemination of infant care information to pregnant individuals. Birthing parents at high risk of losing an infant to SUID-a leading cause of infant death after 1 month of age-appear to engage with the app at the same rates as birth parents who are at low risk. Our data demonstrate that push notifications increase engagement, overall and for those in high-risk zip codes where the SUID education is likely to have the most impact.

Nonhuman primate models of pediatric viral diseases.

Infectious diseases are the leading cause of death in infants and children under 5 years of age. In utero exposure to viruses can lead to spontaneous abortion, preterm birth, congenital abnormalities or other developmental defects, often resulting in lifelong health sequalae. The underlying biological mechanisms are difficult to study in humans due to ethical concerns and limited sample access. Nonhuman primates (NHP) are closely related to humans, and pregnancy and immune ontogeny in infants are very similar to humans. Therefore, NHP are a highly relevant model for understanding fetal and postnatal virus-host interactions and to define immune mechanisms associated with increased morbidity and mortality in infants. We will discuss NHP models of viruses causing congenital infections, respiratory diseases in early life, and HIV. Cytomegalovirus (CMV) remains the most common cause of congenital defects worldwide. Measles is a vaccine-preventable disease, yet measles cases are resurging. Zika is an example of an emerging arbovirus with devastating consequences for the developing fetus and the surviving infant. Among the respiratory viruses, we will discuss influenza and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). We will finish with HIV as an example of a lifelong infection without a cure or vaccine. The review will highlight (i) the impact of viral infections on fetal and infant immune development, (ii) how differences in infant and adult immune responses to infection alter disease outcome, and emphasize the invaluable contribution of pediatric NHP infection models to the design of effective treatment and prevention strategies, including vaccines, for human infants.

Prediction of risk for early or very early preterm births using high-resolution urinary metabolomic profiling

BackgroundPreterm birth (PTB) is a serious health problem. PTB complications is the main cause of death in infants under five years of age worldwide. The ability to accurately predict risk for PTB during early pregnancy would allow early monitoring and interventions to provide personalized care, and hence improve outcomes for the mother and infant.ObjectiveThis study aims to predict the risks of early preterm (< 35 weeks of gestation) or very early preterm (≤ 26 weeks of gestation) deliveries by using high-resolution maternal urinary metabolomic profiling in early pregnancy.DesignA retrospective cohort study was conducted by two independent preterm and term cohorts using high-density weekly urine sampling. Maternal urine was collected serially at gestational weeks 8 to 24. Global metabolomics approaches were used to profile urine samples with high-resolution mass spectrometry. The significant features associated with preterm outcomes were selected by Gini Importance. Metabolite biomarker identification was performed by liquid chromatography tandem mass spectrometry (LCMS-MS). XGBoost models were developed to predict early or very early preterm delivery risk.Setting and participantsThe urine samples included 329 samples from 30 subjects at Stanford University, CA for model development, and 156 samples from 24 subjects at the University of Alabama, Birmingham, AL for validation.Results12 metabolites associated with PTB were selected and identified for modelling among 7,913 metabolic features in serial-collected urine samples of pregnant women. The model to predict early PTB was developed using a set of 12 metabolites that resulted in the area under the receiver operating characteristic (AUROCs) of 0.995 (95% CI: [0.992, 0.995]) and 0.964 (95% CI: [0.937, 0.964]), and sensitivities of 100% and 97.4% during development and validation testing, respectively. Using the same metabolites, the very early PTB prediction model achieved AUROCs of 0.950 (95% CI: [0.878, 0.950]) and 0.830 (95% CI: [0.687, 0.826]), and sensitivities of 95.0% and 60.0% during development and validation, respectively.ConclusionModels for predicting risk of early or very early preterm deliveries were developed and tested using metabolic profiling during the 1st and 2nd trimesters of pregnancy. With patient validation studies, risk prediction models may be used to identify at-risk pregnancies prompting alterations in clinical care, and to gain biological insights of preterm birth.

Infant Mortality in the United States: Provisional Data From the 2023 Period Linked Birth/Infant Death File.

This report presents provisional 2023 data on infant mortality rates using the U.S. linked birth/infant death files. Infant mortality rates are shown by infant age at death, maternal race and Hispanic origin, maternal age, gestational age, sex of the newborn, maternal state of residence, and the 10 leading causes of infant death. Data are from the period linked birth/infant death files, which link infant deaths with the corresponding birth certificates. Comparisons are made between provisional 2023 and final 2022 data. The linked birth/infant files are based on 100% of birth certificates and 98%-99% of infant death certificates registered in all states and the District of Columbia. For 2023, 1.2% of infant deaths remained unlinked. Infant deaths in states with less than 100% of infant death records linked to their respective birth records are weighted. In 2023, the U.S. provisional infant mortality rate was 5.61 infant deaths per 1,000 live births, unchanged from the rate in 2022. From 2022 to 2023, changes in the neonatal mortality rate (from 3.59 to 3.65) and the postneonatal mortality rate (from 2.02 to 1.96) were not statistically significant. Changes in infant mortality rates were not significant by most of the characteristics examined: maternal race and Hispanic origin, maternal age, gestational age, sex, or the 10 leading causes of infant death. By state, infant mortality rates increased in Nevada and Washington and declined in New Mexico and West Virginia.

Sociodemographic and Pathological Study of Sudden Death Among Neonates and Infants: An Autopsy Based Study

Children dying within the first year of life is referred to as infant mortality and is an important key indicator for a country’s health and standard of living. Every year, there is an estimated 4.5 million infant deaths around the world, accounting for almost 75% of deaths in children younger than 5 years. The studies based on infant deaths are relatively less in number worldwide.This study investigates the sociodemographic and pathological aspects of infant deaths through autopsy data. The objective of the study was to evaluate the pathology and causes of infant/neonatal deaths and analyze related social and demographic factors. A cross-sectional descriptive autopsy study was conducted at the Government Medical College, Kozhikode, covering 66 medicolegal infant death cases from April 2018 to October 2022. Data were collected via questionnaires and analyzed using SPSS software. Respiratory infections (37.14%) were the leading cause of infant deaths, while perinatal complications and congenital abnormalities each accounted for 25% of neonatal deaths. Most deaths occurred in the postneonatal period (77.1%), predominantly among male infants (63%) from rural areas (84.3%). Key findings included consolidation and bronchopneumonia in lung examinations. Significant associations were found with various factors, including the period of infancy, delivery type, co-sleeping history, and prior hospitalizations. Birth weight and histopathological lung findings were linked to sudden infant death syndrome (SIDS).

Dimethyl Fumarate Strongly Ameliorates Gray and White Matter Brain Injury and Modulates Glial Activation after Severe Hypoxia-Ischemia in Neonatal Rats.

Neonatal hypoxia-ischemia is a major cause of infant death and disability. The only clinically accepted treatment is therapeutic hypothermia; however, cooling is less effective in the most severely encephalopathic infants. Here, we wanted to test the neuroprotective effect of the antioxidant dimethyl fumarate after severe hypoxia-ischemia in neonatal rats. We used a modified Rice-Vannucci model to generate severe hypoxic-ischemic brain damage in day 7 postnatal rats, which were randomized into four experimental groups: Sham, Sham + DMF, non-treated HI, and HI + DMF. We analyzed brain tissue loss, global and regional (cortex and hippocampus) neuropathological scores, white matter injury, and microglial and astroglial reactivity. Compared to non-treated HI animals, HI + DMF pups showed a reduced brain area loss (p = 0.0031), an improved neuropathological score (p = 0.0016), reduced white matter injuries by preserving myelin tracts (p < 0.001), and diminished astroglial (p < 0.001) and microglial (p < 0.01) activation. After severe hypoxia-ischemia in neonatal rats, DMF induced a strong neuroprotective response, reducing cerebral infarction, gray and white matter damage, and astroglial and microglial activation. Although further molecular studies are needed and its translation to human babies would need to evaluate the molecule in piglets or lambs, DMF may be a potential treatment against neonatal encephalopathy.

Early Newborn Metabolic Patterning and Sudden Infant Death Syndrome

Sudden infant death syndrome (SIDS) is a major cause of infant death in the US. Previous research suggests that inborn errors of metabolism may contribute to SIDS, yet the relationship between SIDS and biomarkers of metabolism remains unclear. To evaluate and model the association between routinely measured newborn metabolic markers and SIDS in combination with established risk factors for SIDS. This was a case-control study nested within a retrospective cohort using data from the California Office of Statewide Health Planning and Development and the California Department of Public Health. The study population included infants born in California between 2005 and 2011 with full metabolic data collected as part of routine newborn screening (NBS). SIDS cases were matched to controls at a ratio of 1:4 by gestational age and birth weight z score. Matched data were split into training (2/3) and testing (1/3) subsets. Data were analyzed from January 2005 to December 2011. Metabolites measured by NBS and established risk factors for SIDS. The primary outcome was SIDS. Logistic regression was used to evaluate the association between metabolic markers combined with known risk factors and SIDS. Of 2 276 578 eligible infants, 354 SIDS (0.016%) cases (mean [SD] gestational age, 38.3 [2.3] weeks; 220 male [62.1%]) and 1416 controls (mean [SD] gestational age, 38.3 [2.3] weeks; 723 male [51.1%]) were identified. In multivariable analysis, 14 NBS metabolites were significantly associated with SIDS in a univariate analysis: 17-hydroxyprogesterone, alanine, methionine, proline, tyrosine, valine, free carnitine, acetyl-L-carnitine, malonyl carnitine, glutarylcarnitine, lauroyl-L-carnitine, dodecenoylcarnitine, 3-hydroxytetradecanoylcarnitine, and linoleoylcarnitine. The area under the receiver operating characteristic curve for a 14-marker SIDS model, which included 8 metabolites, was 0.75 (95% CI, 0.72-0.79) in the training set and was 0.70 (95% CI, 0.65-0.76) in the test set. Of 32 infants in the test set with model-predicted probability greater than 0.5, a total of 20 (62.5%) had SIDS. These infants had 14.4 times the odds (95% CI, 6.0-34.5) of having SIDS compared with those with a model-predicted probability less than 0.1. Results from this case-control study showed an association between aberrant metabolic analytes at birth and SIDS. These findings suggest that we may be able to identify infants at increased risk for SIDS soon after birth, which could inform further mechanistic research and clinical efforts focused on monitoring and prevention.

Community partnership approaches to safe sleep (CPASS) program evaluation

BackgroundSudden unexpected infant death (SUID) continues to be a leading cause of death in infants in the United States (US), with significant disparities by race and socio-economic status. Infant safe sleep behaviors are associated with decreasing SUID risk, but challenges remain for families to practice these routinely. The objective of this program was to implement and evaluate a novel approach for an infant safe sleep pilot program built upon partnerships between hospitals and community-based organizations (CBOs) serving pregnant and parenting families in at-risk communities.MethodsCommunity Partnership Approaches to Safe Sleep (CPASS) was a prospectively implemented infant safe sleep program. CPASS included children’s hospitals partnered with CBOs across five US cities: Portland, OR, Little Rock AR, Chicago, IL, Birmingham, AL, and Rochester, NY. The program consisted of (1) monthly learning community calls; (2) distribution of Safe Sleep Survival Kits; and (3) surveys of sites and families regarding program outcomes. Survey measures included (1) site participation in CPASS activities; (2) recipients’ use of Safe Sleep Kits; and (3) recipients’ safe sleep knowledge and behaviors.ResultsCPASS learning community activities were consistently attended by at least two representatives (1 hospital-based, 1 CBO-based) from each site. Across the five sites, 1002 safe kits were distributed over 9 months, the majority (> 85%) to families with infants ≤ 1 month old. Among participating families, 45% reported no safe sleep location before receipt of the kit. Family adherence to nighttime safe sleep recommendations included: (1) no bedsharing (M 6.0, SD 1.8, range 0–7); (2) sleep on back (M 6.3, SD 1.7, range 0–7); and (3) sleep in a crib with no blankets/toys (M 6.0, SD 2.0, range 0–7). Site interviews described how participation in CPASS influenced safe sleep conversations and incorporated local data into counseling. Hospital-CBO relationships were strengthened with program participation.ConclusionsThe CPASS pilot program provides a new, innovative model built on hospital-community partnerships for infant safe sleep promotion in SUID-impacted communities. CPASS reached families before their infant’s peak age risk for SUID and empowered families with knowledge and resources to practice infant safe sleep. Important lessons learned included improved ways to center and communicate with families.

Clean and Healthy Living Behavior to Prevent Acute Respiratory Infection among Farmer's Families

Acute Respiratory Infection (ARI) cases in Indonesia and abroad are still a significant health problem. In Indonesia, ARI ranks first as a cause of death in infants and toddlers, with a mortality rate of around 20-30%. ARI can cause severe breathing difficulties, such as pneumonia, and ARI is also one of the leading causes of death in children under the age of five in developing countries. This study aims to analyze how to improve clean and healthy living behavior to prevent ARI in farmer families. The research method used was a literature review conducted through Google Scholar, PubMed, and Science Direct in the 2019-2024 range. The keywords used in the search for articles were "ARI, Respiratory Disorders," "Unhealthy Living Behavior, Reduced Working Period, Well Ventilated House," and "Farmer, Family". Researchers found ten studies that met the inclusion criteria in the review. Prevention of respiratory tract infections (URI) in farming families involves practicing healthy behaviors, such as washing hands with soap, maintaining environmental hygiene, and avoiding exposure to cigarette smoke. The articles highlight the importance of understanding knowledge and adherence to clean and healthy living behaviors (PHBS) in reducing the risk of ARI. However, therapeutic communication is also essential, through providing clear information and emotional support to change unhealthy behaviors. The article still has obstacles, such as the underutilization of sanitation clinics, which calls for a more intensive and focused therapeutic communication approach to overcome these obstacles. Factors that increase the risk of Acute Respiratory Infection (ARI) include cooking with biogas inside the house, high housing density leading to a lack of sanitation around the house, poor ventilation, heavy workload for farmers, which increases exposure to dust, smoke and toxic gases, intense smoking, lack of access or awareness of the benefits of local sanitation clinics, and lack of awareness of the importance of maintaining environmental sanitation. Nurses are expected to conduct community counseling to improve understanding of clean and healthy behavior in ARI prevention practices among farmers.

Infant Mortality in the United States, 2022: Data From the Period Linked Birth/Infant Death File.

This report presents final 2022 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined. Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2022 period linked birth/infant death file. The linked birth/infant death file is based on birth and death certificates registered in all 50 states and the District of Columbia. A total of 20,577 infant deaths were reported in the United States in 2022, up 3% from 2021. The U.S. infant mortality rate was 5.61 infant deaths per 1,000 live births, a 3% increase from the rate of 5.44 in 2021. The neonatal mortality rate increased 3% from 3.49 in 2021 to 3.59 in 2022, and the postneonatal mortality rate increased 4% from 1.95 to 2.02. The overall infant mortality rate increased for infants of American Indian and Alaska Native non-Hispanic, White non-Hispanic, and Dominican women in 2022 compared with 2021; changes in rates for the other race and Hispanic-origin groups were not significant. Infants of Black non-Hispanic women had the highest mortality rate (10.90) in 2022, followed by infants of American Indian and Alaska Native non-Hispanic and Native Hawaiian or Other Pacific Islander non-Hispanic (9.06 and 8.50, respectively), Hispanic (4.89), White non-Hispanic (4.52), and Asian non-Hispanic (3.51) women. Mortality rates increased from 2021 to 2022 among preterm (less than 37 weeks of gestation) infants (33.59 to 34.78) and for infants born term (37 to 41 weeks of gestation) (2.08 to 2.18). The five leading causes of infant death in 2022 were the same as in 2021. Infant mortality rates by state for 2022 ranged from a low of 3.32 in Massachusetts to a high of 9.11 in Mississippi.

Time to recovery and predictors among admitted preterm neonates in the neonatal intensive care units of public hospitals of Addis Ababa, Ethiopia, 2021

IntroductionEthiopia implemented measures to reduce preterm mortality, and much is currently being done to avoid preterm death, yet preterm death remains the top cause of infant death. As a result, evaluating median time of recovery and determinants will provide information to planners and policymakers to design strategies to improve preterm survival.MethodsHospital-based retrospective follow-up study was conducted in four selected public hospitals of Addis Ababa from September 2018 to August 2021. Data were collected using a pretested structured questionnaire. Epi-data 4.6 and STATA Version 16 were used for data entry and analysis. Kaplan-Meier survival curve, log-rank test, and median time were computed. To find predictors of time to recovery, a multivariable Cox proportional hazards regression model was fitted, and variables with a p-value less than 0.05 were considered statistically significant.ResultsA total of 466 preterm babies were included in the study of which 261 (56.1%) preterm neonates survived and were discharged from NICUs. The median time to recovery was 10 days (95% CI: 9–12). Low birth weight (Adjusted hazard-ratio [AHR]: 1.91, 95% CI: 1.2–3.06), normal birth weight (AHR: 2.09, 95% CI: 1.16–3.76), late preterm (AHR: 1.91, 95% CI: 1.02–3.55), no hospital-acquired infection (AHR: 2.19, 95% CI: 1.36–3.5), no thrombocytopenia (AHR: 1.96, 95% CI: 1.27–3.02), continuous positive airway pressure (AHR: 0.66, 95% CI: 0.48–0.91), and kangaroo mother care (AHR: 2.04, 95% CI: 1.48–2.81) were found to be independent predictors of time to recovery of preterm babies.Discussion/ConclusionThe recovery rate was found relatively low. Several predictors of preterm recovery time were discovered in the study. The majority of predictors were preventable or treatable. Therefore, emphasis should be given towards prevention and early anticipation, and management of these predictors. Studies to assess the quality of care and cause of low survival rate of preterm infants are recommended.

Addressing Disparities in Pediatric Congenital Heart Disease: A Call for Equitable Health Care.

While significant progress has been made in reducing disparities within the US health care system, notable gaps remain. This article explores existing disparities within pediatric congenital heart disease care. Congenital heart disease, the most common birth defect and a leading cause of infant death, has garnered substantial attention, revealing certain disparities within the US health care system. Factors such as race, ethnicity, insurance coverage, socioeconomic status, and geographic location are all commonalities that significantly affect health disparities in pediatric congenital heart disease. This comprehensive review sheds light on disparities from diverse perspectives in pediatric care, demonstrates the inequities and inequalities leading to these disparities, presents effective solutions, and issues a call to action for providers, institutions, and the health care system. Recognizing and addressing these disparities is imperative for ensuring equitable care and enhancing the long-term well-being of children affected by congenital heart disease. Implementing robust, evidence-based frameworks that promote responsible and safe interventions is fundamental to enduring change.

Infant Deaths After Texas’ 2021 Ban on Abortion in Early Pregnancy

Prior observational research has shown that infants born in states with more abortion restrictions are more likely to die during infancy. It is unclear how recent and more severe abortion bans in the US have impacted infant mortality. To examine whether Texas Senate Bill 8 (SB8), which banned abortions after embryonic cardiac activity and did not allow exemptions for congenital anomalies, is associated with infant mortality in the state of Texas. This population-based cohort study of all recorded infant deaths from the state of Texas and 28 comparison states used a comparative interrupted time series analysis with an augmented synthetic control approach and national birth certificate data from January 1, 2018, to December 31, 2022, to estimate the difference between the number of observed and expected infant and neonatal deaths and death rates among monthly cohorts exposed to Texas' SB8. Deaths in March 2022 were treated as the first cohort exposed to the Texas' SB8 abortion policy because these infants (if born full term) were approximately 10 to 14 weeks' gestation when SB8 went into effect on September 1, 2021. The exposure period was thus March through December 2022. Our outcomes were monthly counts and rates of infant (aged <1 year) and neonatal (aged <28 days) deaths in the exposure period in Texas. In secondary analyses, annual changes in cause-specific infant deaths between 2021 and 2022 in Texas and the rest of the US were examined. Between 2018 and 2022, there were 102 391 infant deaths in the US, with 10 351 of these deaths occurring in the state of Texas. Between 2021 and 2022, infant deaths in Texas increased from 1985 to 2240, or 255 additional deaths. This corresponds to a 12.9% increase, whereas the rest of the US experienced a comparatively lower 1.8% increase. On the basis of the counterfactual analysis that used data from Texas and eligible comparison states, an excess of 216 infant deaths (95% CI, -122 to 554) was observed from March to December 2022, or a 12.7% increase above expectation. At the monthly level, significantly greater-than-expected counts were observed for 4 months between March and December 2022: April, July, September, and October. An analysis of neonatal deaths found somewhat similar patterns, with significantly greater-than-expected neonatal deaths in April and October 2022. Descriptive statistics by cause of death showed that infant deaths attributable to congenital anomalies in 2022 increased more for Texas (22.9% increase) but not the rest of the US (3.1% decrease). This study found that Texas' 2021 ban on abortion in early pregnancy was associated with unexpected increases in infant and neonatal deaths in Texas between 2021 and 2022. Congenital anomalies, which are the leading cause of infant death, also increased in Texas but not the rest of the US. Although replication and further analyses are needed to understand the mechanisms behind these findings, the results suggest that restrictive abortion policies may have important unintended consequences in terms of trauma to families and medical cost as a result of increases in infant mortality. These findings are particularly relevant given the recent Dobbs v Jackson Women's Health Organization US Supreme Court decision and subsequent rollbacks of reproductive rights in many US states.

HUBUNGAN PERSONAL HYGIENE IBU MENYUSUI DENGAN TINGKAT KEJADIAN DIARE PADA BAYI DI KELURAHAN SITIREJO 1 MEDAN KOTA

Diarrhea is a change in the shape and consistency of stools that are soft to liquid, defecate more than usual, namely 3 or more times a day. Diarrhea is the second leading cause of death in children under five years and kills around 760,000 children every year. Based on the percentage distribution of mortality in the world, diarrhea is still the main cause of death in infants by 15%. This type of research was an observational district with a cross-sectional approach which was carried out for 6 months starting from February in 2023. It was carried out in the Sitirejo 1 sub-district area of ​​Medan Kota. The sampling method used was using the Lemeshow and Iwanda formulas, so a sample of 51 breastfeeding mothers used univariate and bivariate analysis. The results showed that the age of most breastfeeding mothers was 21-30 years old 72.5%, at work the most respondents were housewives 58.8% of respondents and the most recent education was elementary school as many as 43.1% of respondents. In the cleanliness of the mother's nipples, 43 respondents (84.3%) were in the unclean category and produced a p=value of 0.001, in the mother's hand washing habits, 38 respondents (74.5%) did not wash their hands with a p=value of 0.013, 41 respondents (80.4%) opened baby clothes in the open category with a p=value of 0.027, 42 respondents (82.4%) opened baby food storage areas with a p=value of 0. 013, the cleanliness of the floor is included in the category of unclean as many as 39 respondents (76.5%) with a p=value of 0.011. So it can be concluded that the cleanliness of the mother's nipples, the place for storing baby clothes, the place for storing baby food and the cleanliness of the floor has a relationship with the incidence of diarrhea, therefore it is necessary to provide counseling, training and supervision that meets the mother's personal hygiene standards.

Loss of Htr1B Leads to a Failure in the Neonate Autoresuscitation Reflex

Sudden Infant Death Syndrome (SIDS) is the leading cause of death in infants under the age of 1, with an unknown etiology, that takes the lives of 3,400 infants per year in the US alone. Interestingly, SIDS cases show males predominance (60%), however this sexual disparity in is not fully understood. SIDS is believed to follow a triple risk hypothesis model where the infant has an innate vulnerability, is at a critical developmental period, and is challenged with an exogenous stressor. A leading hypothesis indicates many SIDS cases are mechanistically driven by a failure in the autoresuscitation reflex. The autoresuscitation reflex is a series of gasps that occur to revitalize normal cardiorespiratory function when an infant falls into a hypoxic coma, characterized by an apnea and bradycardia, due to severe hypoxic conditions (i.e., rebreathing while sleeping in face down or with the face blocked). Although the cause of failure in the autoresuscitation reflex for SIDS remains unknown, post-mortem studies have found abnormalities related to the central serotonin (5-HT) neurotransmitter system, including several 5-HT receptors (5-HTr’s). Follow up studies in animal models show that 5-HT system perturbations result in a significant survival decrease in neonatal animals during anoxic (3% CO2/balance N2) gas challenges that test the autoresuscitation function, including pharmacological receptor manipulations. Furthermore, adult animal studies report that 5-HT receptor stimulation alters various respiratory parameters (i.e., tidal volume, respiratory rate, gasping). What remains to be understood is the cellular and molecular mechanisms through which 5-HT plays a role in the autoresuscitation reflex and how those mechanism may be disrupted in SIDS. We hypothesize that Htr1B is required for successful autoresuscitation. To test this hypothesis, we utilized an automated closed loop robotic platform for neonate cardio-respiratory measurements ( Looper) to assay P7 Htr1B loss of function mice for their abilities to survive repeated anoxic gas challenges testing the autoresuscitation reflex. Using Looper, we find that the loss of Htr1B decreases survival to repeated anoxic challenges compared to wild type (WT) controls in both male and female mice. Additionally, a subset of male heterozygous Htr1B mice survive fewer challenges compared to WT mice, whereas others survive a similar number of challenges as WT mice; a phenotype not observed in female mice. Our data supports the hypothesis that modulations to the serotonin system via Htr1B is important in eliciting the autoresuscitation response. Future studies aim to investigate additional respiratory parameters from respiratory trace data, in addition to recovery parameters, and functionally mapping out where in the brainstem and what neuronal populations require the expression of this receptor for the autoresuscitation reflex. R01 HL161142. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Effects of gestational intermittent hypoxia on the autoresuscitation response following anoxia-induced apneas in neonatal mice

Introduction: Sudden infant death syndrome (SIDS) is the leading cause of death in infants from one month to one year of age. Smoking is a significant risk factor in SIDS, and smoking probably causes intermittent hypoxia in the fetus. Therefore, we modeled the effects of intermittent hypoxia during gestation in mice to determine if gestational intermittent hypoxia would adversely affect the capacity of neonatal mice to autoresuscitate effectively after exposure to anoxic stimuli. A degraded capacity to autoresuscitate could explain, in part, why infants born to mothers who smoke have an increased risk of dying from of SIDS. The primary objective of this study was to investigate the effects of intermittent gestational hypoxia on the autoresuscitation responses to anoxia-induced apneas in neonatal mice. Our hypothesis was that pups born to intermittently hypoxic dams would struggle more to recover from anoxic apneas — would have impaired cardiorespiratory responses to anoxic stress compared to the control mice born to dams exposed to room air during gestation. Methods: We studied C57Bl/6 dams who previously had one litter to prove their capability to breed and rear pups. Dams were placed in either an hypoxic or room air chamber at approximately embryonic day 5 (E5; fifth day of pregnancy). The fractional inspired oxygen concentration (FIO2) was reduced to 11% for 10 minutes, three times per hour, with 10 minute periods of 21% oxygen between them. Each hour of intermittent hypoxia was followed by an hour breathing 21% FiO2. The room air control chamber was maintained at a constant FIO2 of 21% with inflows of compressed air that mimicked the noise and flow of nitrogen in the hypoxic chamber. The dams spent the entirety of their pregnancies in the environmental chambers. Once the pups were delivered, the cages were placed in room air, housing environments. The pups were allowed to stay with their mothers until approximately post-natal day 8 (P8). On P8, each pup was fitted into a head out plethysmograph to measure respiratory flow using a pneumotachograph. We recorded respiratory activity, ECG activity, and body movements (using a piezo sensitive film). The pups were maintained at ~34 degrees C in the pneumotachographic chamber. We measured the highest respiratory rate, highest heart rate, longest apnea, gasp latency, mean heart rate recovery, and mean respiratory rate recovery. Results: The mean heart rate recovery and mean longest apnea (in seconds) doubled in the mice exposed to gestational intermittent hypoxia compared to pups born to dams exposed to room air during gestation. The mean heart rate recovery and mean longest apnea in gestationally hypoxic pups was 41.0 +/- 13.7 seconds and 22.05 +/- 12.0 seconds, respectively. The mean heart rate recovery and mean longest apnea in normal, room air-exposed pups was 22.4 +/- 11.1 seconds and 10.3 +/- 7.0 seconds, respectively. The longest apnea in gestational intermittent hypoxic pups was significantly longer than in control pups (53.0 +/- 13.7 seconds and 19.1 +/- 15.0 seconds). Pups exposed to gestational intermittent hypoxia also had increased mean respiratory rate recovery times and gasp latency times (start of apnea until the first gasp). The average body weight of hypoxic pups was 4.3 grams while the average body weight for the normal pups was 4.9 grams. Conclusion: Gestational intermittent hypoxia was associated with delayed and prolonged the autoresuscitation responses in neonatal mice following acute anoxic exposure. We hypothesize that this is due to changes in the brain’s serotonin system. We are investigating how intrauterine hypoxia may decrease serotonin and serotonergic signaling pathways as changes in serotonergic function may degrade the capacity of mice to autoresuscitate following anoxic gas exposure. NIH/NICHD. HD100823 and NIH/NICHD. HD 107060. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Butyrylcholinesterase Is Not Required for the Neonatal Autoresuscitation Reflex

Sudden Infant Death Syndrome (SIDS) is the leading cause of infant death under the age of one year of age, taking the lives of more than 1,400 infants annually, and comprising approximately 41% of all Sudden Unexpected Infant Death (SUID) cases. SIDS etiology remains vastly unknown but is best explained via a triple risk model that proposes SIDS occurs in a vulnerable infant during a critical developmental period when triggered by an external stressor. In SIDS it is hypothesized that there is first a failure in arousal followed by failure in the protective autoresuscitation reflex; a defense mechanism for an infant that is in a hypoxic coma, that promotes deep gasping to attempt to restart cardiovascular function. Many SIDS case studies reveal associations with genetic variants and abnormal biomarkers; however, it is unclear whether these variants are causal. Recently a case study identified a broad association between reduced blood BChE activity and SIDS cases, yet the functional relationship between BChE and respiratory regulation remains to be investigated. We aimed to functionally test the relationship between BChE and the neonatal autoresuscitation reflex utilizing a rapid pipeline for precision genetic modeling and high-throughput functional testing developed by the Ray Lab. BChE loss of function mice, generated through targeted genetic editing, were tested for neonatal autoresuscitation on our automated closed loop phenotyping platform, Looper. Postnatal day 7-8 mice were exposed to 3% CO2 and 97% N2 stimuli to induce a state of hypoxia resulting in detection of bradycardia, initial hyperventilation, hypoventilation, and apnea followed by restoration of room air conditions to facilitate the autoresuscitation reflex and cardio-respiratory recovery. Male and female mice were exposed to repeated anoxic gas challenges and allowed to autoresuscitate until death occurred. Data suggest that loss of BChE function does not affect neonatal autoresuscitation. BChE knockout mice and heterozygous mice survived similar amounts of anoxic challenges as wild type controls. No sex differences were observed between the number of anoxic challenges survived in males and females for all genotypes. Our data demonstrate the first functional assessment of BChE in neonatal cardio-respiratory regulation and the autoresuscitation response and highlight that BChE is not required for successful neonatal autoresuscitation. Additional analyses of respiratory parameters from respiratory trace data for BChE loss of function mice will aid in a further understanding if BChE loss of function is implicated in other aspects respiratory regulation. Funding: Precision Core funding U54 OD030165. NIH/NHLBI R01HLN161142-01 and R01HL130249-07. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

FAKTOR – FAKTOR YANG BERHUBUNGAN DENGAN KEJADIAN DIARE PADA BALITA DI RT/007 RW/008 DESA AIR DINGIN KECAMATAN BUKIT RAYA PEKANBARU

In Indonesia, diarrheal disease is one of the causes of death in infants. Diarrhea is one of the most common diseases affecting children worldwide. The aim of the study was to determine the factors associated with the incidence of diarrhea in toddlers at RT007 RW008 Airdinding Village, Bukit Raya District, Pekanbaru in 2024. This research method used an analytical survey approach with a cross sectional design. The population in this study were all babies who visited the Simpang Tiga Health Center as many as 126 toddlers. Sampling was carried out by Probability Sampling with a total of 95 samples. Primary data collection using a questionnaire. Univariate analysis described the frequency distribution of each variable while bivariate analysis used the Chi-Square test. The results of univariate analysis showed a history of non-exclusive breastfeeding 51.6%, 65.3% less knowledge of mothers, 57.9% personal hygiene and 67.4% history of diarrhea and the results of bivariate analysis showed that there were three variables of history of exclusive breastfeeding with p value = 0.0016, mother's knowledge p = 0.000 and maternal personal hygiene with p = 0.000 means that Ho is rejected and Ha is accepted. It is suggested that health workers at the Simpang Tiga Health Center provide promotions that should be focused on eliminating various inaccurate assumptions about diarrhea. Diarrhea prevention promotion materials should include the influence of the environment and breastfeeding on the occurrence of diarrhea with the process of activities being carried out in an integrated manner with the planning of other programs.

Current follow-up results of Cyanotic Congenital Heart Diseases detected during Pregnancy in a specific Region

Background/Aims: Congenital heart disease (CHD) is the main cause of death in infants among congenital anomalies. Fetal echocardiography is important for the diagnosis and treatment plan of congenital heart diseases in the prenatal period. This study aimed to retrospectively screen the follow-up and treatment results of cyanotic CHD patients detected on fetal echocardiography. Methods: Fetal echocardiography results were scanned from the hospital record system. Data of fetuses with major cardiac anomalies and cyanotic CHD were examined retrospectively. Results: Fetal echocardiography was performed on 420 pregnant women between July 2020 and April 2023. Major cardiac anomalies and cyanotic heart disease were detected in the fetuses of 40 pregnant women (9.5%) out of 420. The median age of the pregnant women was 29 (19-41 years). The median gestational age at check-up was 23 weeks (22-28 weeks). 9/40 pregnant women (22.5%) had risk factors. The most common cyanotic congenital heart diseases were hypoplastic left heart syndrome (HLHS) and unbalanced complete atrioventricular septal defects (AVSDs) with obstructive lesions of the right or left ventricle. Three fetuses (7.5%) with heart failure findings died intrauterine. Two fetuses with HLHS and critical aortic stenosis (AS) died before being operated on. A patient with complete AVSD, hypoplasia of the left heart chambers, AS, and severe aortic coarctation died due to sepsis during the post-operative follow-up period. Chromosome analysis was performed in 8 patients. Down syndrome was detected in 3 of the patients with complete AVSD. 22q11 deletion and DiGeorge Syndrome were detected in 2 patients with tetralogy of Fallot. Conclusions: Congenital heart diseases and rhythm problems can be safely detected with fetal echocardiography. It is beneficial to perform a fetal echo scan at the appropriate gestational week, especially in fetuses with risk factors and in whom the four chambers view cannot be seen.

Clinical and economic burden of respiratory syncytial virus in children aged 0–5 years in Italy

BackgroundRespiratory syncytial virus (RSV) is among the leading causes of hospitalization due to lower respiratory tract infections (LRTIs) in children younger than 5 years worldwide and the second cause of infant death after malaria. RSV infection occurs in almost all the infants before the second year of life with variable clinical severity, often requiring medical assistance. This analysis investigated patients aged 0–5 years with RSV infection focusing on epidemiology, clinical features, and economic burden of RSV-associated hospitalizations in a setting of Italian real clinical practice.MethodsAn observational retrospective analysis was conducted on administrative databases of healthcare entities covering around 2.6 million residents of whom 120,000 health-assisted infants aged < 5 years. From 2010 to 2018, pediatric patients were included in the presence of hospitalization discharge diagnosis for RSV infections, and RSV-related acute bronchiolitis or pneumonia. Epidemiology, demographics, clinical picture and costs were evaluated in RSV-infected patients, overall and stratified by age ranges (0–1, 1–2, 2–5 years) and compared with an age-matched general population.ResultsOverall 1378 RSV-infected children aged 0–5 years were included. Among them, the annual incidence rate of RSV-related hospitalizations was 175–195/100,000 people, with a peak in neonates aged < 1 year (689–806/100,000). While nearly 85% of infected infants were healthy, the remaining 15% presented previous hospitalization for known RSV risk factors, like preterm birth, or congenital heart, lung, and immune diseases. The economic analysis revealed that direct healthcare costs per patient/year were markedly higher in RSV patients than in the general population (3605€ vs 344€).ConclusionsThese findings derived from the real clinical practice in Italy confirmed that RSV has an important epidemiological, clinical, and economic burden among children aged 0–5 years. While the complex management of at-risk infants was confirmed, our data also highlighted the significant impact of RSV infection in infants born at term or otherwise healthy, demonstrating that all infants need protection against RSV disease, reducing then the risk of medium and long-term complications, such as wheezing and asthma.