Cause Of Infant Death Research Articles

Exploring Nurses' Confidence in Providing Support to Bereaved Families following Stillbirth Fetal Loss

Introduction: Stillbirth fetal loss (SFL) is a significant cause of infant death in the US, with 23,000 reported in 2017. Negative psychological and emotional repercussions of SFL, for parents and nurses, may be mitigated by nurses’ preparedness to provide bereavement support (BS). Several studies exploring BS for miscarriage-related fetal loss were found. However, studies exploring SFL BS and nurses’ preparedness for providing SFL BS are sparse. The purpose of this study was to assess nurses’ confidence and knowledge for providing BS to families experiencing stillbirth fetal loss.

Epidemiology of sudden infant death syndrome in Mexico, 2005-2020.

Sudden Infant Death Syndrome (SIDS) constitutes one of the main causes of mortality in children under one year of age in developed countries; it's frequency to varies geographically. In Mexico the real incidence of SIDS is not known. National databases of deaths in children under one year of age, from 2005 to 2020, were analyzed, due to Sudden Unexpected Infant Death (SUID) [SIDS (R95), accidental suffocation in a sleeping environment (W75), and other ill-defined and unspecified causes of mortality (R99), according to the International Classification of Diseases, tenth revision (ICD 10)]. Mortality rates per year of occurrence due to SUID and their subcategories were calculated. Simple frequencies of SIDS were obtained per year and month of occurrence, state of residence, age, place of death, and access to social security services. In the study period 473,545 infant deaths occurred; 7,714 (1.62%) deaths were due to SUID; of these, 6,489 (84%) were due to SIDS, which is among the 10 leading causes of infant death in Mexico. The average mortality rate for SUID was 22.4/100,000 live births, for SIDS was 18.8/100,000 live births. Mortality rates within the states were variable, ranging from 2.4/100,000 to 105.1/100,000 live births. In 81% of SIDS records there was no autopsy; 38% of deaths due to SIDS occurred in infants under one month of age, up to 87% of deaths occurred in families without social security services or it was unknown, and 76.2% of deaths occurred at home. Deaths were more frequent during the last months of autumn and during winter. In Mexico there is an underregistry of SIDS as cause of death, along with other SUID categories. Health workers need to be trained to improve diagnosis and data registration, including the practice of autopsies; additionally, it is necessary to implement a public health campaign.

Analysis Of Bilirubin and Hemoglobin in Newborn Infants

One of the causes of infant death outside the womb is hyperbilirubinemia. This hyperbilirubinemia is a clinical phenomenon often found in newborns in the first week of life. In laboratory examination, the determination of hemoglobin level is an indicator that is widely used to determine the prevalence of anemia. This study uses an observation method with a descriptive approach. The data collection of this research was carried out at RSIA Pertiwi Makassar City in May 2021. The sample in this study was secondary data for all newborns. The results of this study were obtained from 40 newborns (85%) who had hyperbilirubinemia. As many as 6 newborns (15%) did not have hyperbilirubinemia while from 25 newborns, 9 newborns (36%) had anemia, and as many as 16 newborns. Born (64%) did not have anemia. Keywords: Bilirubin, Hemoglobin, And Newborn

The Predictive Role of Maternal Biological Markers and Inflammatory Scores NLR, PLR, MLR, SII, and SIRI for the Risk of Preterm Delivery.

In many countries, preterm birth, defined as birth before 37 completed weeks of gestation, is the primary cause of infant death and morbidity. An increasing body of research suggests that inflammation (both clinical and subclinical) plays a significant role in inducing preterm labor or developing pregnancy problems that lead to premature birth. Consequently, the purpose of this research was to determine the predictive value of the Neutrophil-Lymphocyte Ratio (NLR), derived Neutrophil-Lymphocyte Ratio (dNLR), Monocytes-to-Lymphocyte Ratio (MLR), Platelets-to-Lymphocyte Ratio (PLR), Systemic immune-inflammation index (SII), and systemic inflammatory response index (SIRI), for premature delivery. A retrospective study analyzed a total of 243 eligible pregnancies that resulted in a preterm birth during 2020 and 2021. A control group without a history of preterm birth was matched by age and trimester of laboratory analysis at a 1:1 ratio. Although the number of comorbidities was similar among study groups, the body-mass index estimated for the week of gestation was significantly higher among the patients from the prematurity group, as well as the prevalence of urinary tract infections and smoking. Laboratory data showed that patients with a preterm birth had significantly higher white blood cell count and monocytes, but significantly lower lymphocytes, platelets, and hemoglobin. The NLR, dNLR, PLR, and MLR scores showed to be significantly higher among patients from the prematurity group, but SII and SIRI were not significantly different between the study groups. It was observed that the AUC values of NLR, dNLR, PLR, and MLR were higher than 0.600, respectively NLR had the highest value among the tested scores (AUC = 0.694) and the highest sensitivity in this study (71%). The highest sensibility was achieved by dNLR, with 70%, and an AUC value of 0.655 (p-value = 0.022). PLR had the second-highest AUC value (0.682) and the best score in terms of sensitivity (70%) and sensibility (69%) (p-value = 0.015). Lastly, MLR had the lowest significant AUC score (0.607) and lowest sensitivity/sensibility. The significant cut-off values for the inflammatory scores were 9.0 for NLR, 9.8 for dNLR, 250 for PLR, and 4.07 for MLR. After evaluating the importance of these inflammatory scores, further clinical applications should be conducted to confirm the results and improve therapy and care to reduce the burden of premature deliveries.

Quality of Life of Children Born With a Congenital Heart Defect

(Abstracted from J Pediatr 2022;244:148–153) Congenital heart defects are the most common cause of infant death linked to congenital malformations (CHDs). This group of congenital disorders therefore remains a cause for concern, despite improvements in medical and surgical management that have resulted in higher survival rates.

Parental Knowledge on Prevention of SUID

Abstract Background According to the 2018 America’s Health Ranking Annual Report, the U.S. infant mortality rate (IMR) was 5.9 deaths per 1,000 live infant births, which placed the U.S. at No. 33 out of 36 countries with the world’s largest economies in 2018. The IMR in Georgia has been on the rise since 2014. Even though there was a sharp decline in sudden unexpected/unexplained causes of death (SUID) beginning in 1990, the decrease has considerably slowed down since 1999. In 2017, the top ten leading causes of infant death were responsible for 67.8% of all infant deaths in the United States. Sudden Infant Death Syndrome (SIDS) and death from unintentional injuries were in third and fourth place. Therefore, the purpose of this research is to utilize qualitative research guided by the Socio-Ecological model to understand better how prepared first-time mothers are to take care of their infant upon hospital release. Methods An intensity sampling was utilized to recruit participants. The inclusion criteria for the participants included first-time mothers with children under one year of age, women, Georgia residents over 18 years of age, and English speaking. A semi-structured guide was based on research queries and the ideological concepts of the Socio-Ecological Model. For the qualitative data examination, the thematic analysis was performed. All the interviews were transcribed verbatim and coded by using the program NVivo 11. Results A total of 25 women participated in the study. We will finish the data analysis by the end of May, 2022. The results of this qualitative study will help to fully understand the knowledge, perceptions, skills, and confidence of mothers about infant care. Conclusions The study’s results will help develop an information guide on primary infant care. Besides, health professionals and community organizations can utilize the study results to determine the information and support needed for new mothers. Key messages • The results of this qualitative study will help to fully understand the knowledge, perceptions, skills, and confidence of mothers about infant care. • This study’s results will help develop an information guide (electronic or/and printed) on primary infant care based on first-time mothers’ needs.

Leading causes of death in Tunisia, 2020

Abstract Background Mortality data represent a primary source of information for monitoring a population health status over years. In Tunisia, the national Information System on Causes of Death (ISCD) lacks completeness (average coverage rate of 40%); however, in order to examine covid-19’s effect on mortality data, the ISCD was reinforced. We aimed to give an overview of leading causes of death in Tunisia for 2020. Methods Data were obtained from Medical Certificates of Cause Of Death (MCCOD) sent by municipalities to the National Institute of Health in accordance with the legislative framework. Causes of Death (CoD) coding process was performed based on the International Classification of Diseases, Tenth Revision (ICD-10). The underlying cause of death was identified based on IRIS software, and mortality statistics were presented based on the world health organization cause-of-death lists for tabulating mortality statistics. Data analysis was performed using SPSS software. Results A total of 46.420 MCCOD among 75.365 deaths officially declared by the National Institute of Statistics, were analyzed (coverage rate of 61.2%). The 10 leading causes of death for both sexes, in rank order were: diabetes mellitus, cerebrovascular diseases, covid-19, ischemic heart diseases, external causes of death, digestive and pulmonary malignant neoplasms, conditions of neonatal period, hypertensive diseases, and influenza and pneumonia. Leading causes of infant deaths were: certain conditions originating in perinatal period, congenital malformations, deformations and chromosomal abnormalities, diseases of respiratory system, certain infectious and parasitic diseases, and diseases of nervous system. Conclusions The COVID-19 pandemic was an opportunity to improve the Tunisian ISCD’s coverage rate. However, efforts should be maintained to optimize system completeness, and decision makers should be more sensitized regarding the urgent need for system digitalization. Key messages • Mortality statistics have shown that covid-19 ranks third among leading causes of death in Tunisia for 2020; and non communicable disease accounted for 6 out of 10 leading causes of deaths. • The ISCD coverage rate was improved in 2020 reaching 61.2%; however the system digitalization is an essential and sustainable solution to optimize completeness.

Complex Neuropsychiatric and Laboratory-Instrumental Diagnostics in Determination of Tactics of Therapeutic Management of Patients with Spinal Muscular Atrophy: Regional Experience

INTRODUCTION: Spinal muscular atrophy (SMA) is a rare hereditary disabling disease and the most common hereditary cause of infant deaths. The timely comprehensive diagnosis of SMA permits to plan therapeutic tactics and preserve the quality of patients life. One of the objectives of the given work is a review of the actual literature data on etiopathogenesis, clinical presentation, valid diagnosis and modern effective tactics of SMA management.
 AIM: To evaluate the management tactics of patients with SMA taking into account neuropsychiatric symptoms, to analyze problems of proposal and organization of measures aimed at improvement of the quality of medical care, on the basis of the practical experience of the Samara region and with consideration of the current state of the problem.
 MATERIALS AND METHODS: In the work, the data of the archive of Seredavin Samara Regional Clinical Hospital were analyzed, 132 medical histories of 77 patients were processed with discharge dates from January 2008 to February 2022 with the following diagnoses (according to the code of the International Classification of Diseases and Health Related Problem, 10th revision (ICD-10)): G12.0 (spinal muscular atrophy, type I [WerdnigHoffmann disease], G12.1 (other hereditary SMA), G12.8 (other SMA and related syndromes) and G12.9 (unspecified SMA). The analysis of the results of clinical, laboratory, instrumental and neuropsychiatric diagnostic methods was performed in comparison with the tactics of therapeutic management of these patients. For statistical processing of the data, methods of descriptive statistics were used.
 RESULTS: Socio-demographic data. As of February 2022, 58 patients were registered (mean age 38.4 (41.3) years, of them 32 (55.2%) were individuals of female gender including 21 children (mean age 12.3 (7.4) years, 14 (24.1%) girls), with the following diagnoses according to ICD-10: G12.0 (n = 7; 12.0%; only children), G12.1 (children: n = 14; 24.1%; adults: n = 29; 50.0%), G12.8 (n = 6; 10.3%; only adults), G12.9 (n = 2; 3.4%; only adults). Clinical data. Motor disorders from a mild proximal lower paraparesis (n = 13; 22.4%) to pronounced tetraparesis (n = 7; 12.0%). The study of mental status was limited to evaluation of the state of consciousness and effectiveness of contact. Data on therapy. Until 2021, symptomatic therapy of SMA was conducted in the region, since March 2021, 8 children (13.8% of the total sample) aged 7.3 (8.8) years received nusinersen, another 8 children (13.8%) aged 9.5 (6.9) years received risdiplam; parents of 3 more children (5.2%) refused taking drugs. Of adult patients (n = 37; 63.8%; 35.3 (23.6) years) with confirmed SMA 5q (n = 10; 17.2%, 35.3 (19.0) years), 1 patient received nusinersen, the rest 9 patients (15.5%) did not receive therapy, 3 (5.2%) were achieving the right to receive drugs (at the moment of the analysis).
 CONCLUSION: The data analysis revealed deficit of early SMA diagnosis (at the moment of the diagnosis, all the patients were already having pronounced symptoms), of assessment of affective and cognitive disorders, monitoring of treatment effectiveness (absence of validated scales for motor skills assessment), and also showed low availability of treatment for adult patients, which requires reorganization of care of patients with SMA in the region taking into account the revealed factors).

Determinants of death from malformations of the circulatory system

Abstract Background Congenital malformations (CMs) were the second cause of death in infants under the age of 1 year in North America and Europe in 2017, behind perinatal causes.Of the CMs, those of the circulatory system (MCSs) were the most lethal. Studies in Brazil, North America and England have reported higher mortality from MCS in the presence of prematurity, non-white skin color of the newborn, asphyxia, low birthweigth, advanced maternal age, and low maternal education level. The magnitudes of those associations vary. Those studies have investigated neither the risk of death from MCS, with control of the mediation provoked by those and other variables, nor the construction of a model to explain the relationship between variables and deaths. Objective To assess the associations of maternal geographic and socioeconomic factors, as well as gestational and birth factors, with deaths from MCSs in the first year of life in Brazil from 2006 to 2016, and to build an explanatory model of the relationship between variables and death. Methods Study of the Brazilian databases Information System on Live Births and Mortality Information System, which were linked by deterministic relationship and submitted to the cohort strategy. Crude and controlled relative risks were estimated. Acyclic graphs directed the creation of explanatory models of the relationship between maternal and fetal variables and the risks of death from MCSs and all causes. Results The deterministic linkage of 32,011,727 live birth certificates and 266,215 deaths yielded 248,027 linked pairs. Low birth weight (RR=14.38), asphyxia in the first (RR=5.95) and fifth minute (RR=11.86), maternal age ≥35 years (RR=1.66), male sex (RR=1.13), residing in the West-Central Brazil (RR=1.22) and small number of prenatal visits (RR=2.24) increased the risk of death from MCSs. Prematurity and multiple-gestation pregnancy had effects on death mediated by low birth weight and asphyxia regardless of the cause of death. Maternal education level and skin color did not increase the risk of death from MCS but influenced deaths from other causes. Conclusion The explanatory model of the relation of maternal geographic and socioeconomic, gestational and birth factors with deaths in the first year of life in Brazil from 2006 to 2016 showed that the small number of prenatal visits, male sex, low birthweigth, and presence of asphyxia in the first and fifth minutes are variables with a direct effect on the risk of death regardless of the cause of death. Deaths from MCSs in the West-Central regions and maternal age ≥35 years pose a higher risk of death, but this effect was not evidenced for other causes of death. Better gestational care with an adequate number of prenatal visits would enable the early diagnosis of MCSs with proper life support and treatment. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Federal University of Rio de Janeiro

Maternal pre-existing diabetes and gestational diabetes and the prevalence of septal defects in the offspring

Abstract Background and introduction Maternal pre-existing and gestational diabetes affect approximately 6% of all pregnancies in Denmark and are well known risk factors for congenital heart disease (CHD). Worldwide, CHD is the most common congenital defect and a leading cause of infant death. The association between maternal diabetes, and CHD in the offspring has previously been studied, however, these studies have been limited by small study cohorts and/or registry studies without systematic transthoracic echocardiography (TTE) of the children. Purpose To assess the prevalence of atrial and ventricular septal defects (ASD and VSD) in children born to mothers with pre-existing or gestational diabetes by systematic TTE, in a large, population-based cohort of neonates. Method Systematic, standardized TTE was performed in neonates included in a population-based cohort study between 2016 and 2018. For the present study, the prevalence of VSD in cases and controls was assessed in the entire cohort of neonates who underwent TTE within 30 days of birth, and in whom information regarding maternal diabetes was available (n=24,921). The prevalence of ASD was assessed in a sub-cohort of neonates (n=12,682) with the same inclusion criteria and in whom an interatrial communication had been classified as ASD or patent oval foramen according to a validated algorithm. ASD was defined as an interatrial communication with a defect size ≥4mm, a location in the inferior 1/3 of septum, or multiple communications. VSD was defined as flow across the interventricular septum in colour Doppler mode in one or more views. VSDs were classified as either muscular, perimembranous, or subarterial. Information about maternal pre-existing and gestational diabetes was collected from review of the mother's medical records and from an Obstetrical Database maintained by the participating hospitals. Cases were compared with controls, which here consists of the full cohort for VSD and sub-cohort for ASD, respectively, after excluding cases. Results The median age at examination of the entire cohort was 11 days [interquartile range (IQR) 7; 14] and 48% were female. The prevalence of VSD in children with maternal diabetes was 3.1% compared with 3.3% among children of mothers without maternal diabetes, RR 1.00 (95% CI 0.99–1.01, p=0.771). There was no difference between cases and controls when comparing the prevalence of subtypes of VSD (table 1). In the sub-cohort of 12,682 neonates assessed for ASD (median age at examination 12 days [IQR, 8; 15], 48% female), the presence of an ASD was found in 7.3% of cases compared to 5.9% among controls, RR 0.81 (95% CI 0.59–1.13, p=0.214). Conclusion In a large population-based cohort of infants, we did not find an increased risk for ASD or VSD, nor any of the subtypes of VSD, among children born to mothers with pre-existing or gestational diabetes as compared to controls. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): The Capital Region of Denmarks Research Fund.The Research Council of Herlev and Gentofte Hospital.

Spinal muscular atrophy carrier frequency in Saudi Arabia.

Spinal Muscular Dystrophy (SMA) is one of the leading causes of death in infants and young children from heritable diseases. Although no large-scale popultion-based studies have been done in Saudi Arabia, it is reported that the incidence of SMA is higher in the Saudi population partly because of the high degree of consanguineous marriages. The final analysis included 4198 normal volunteers aged between 18 and 25 years old, 54.7% males, and 45.3% females. Whole blood was spotted directly from finger pricks onto IsoCode StixTM and genomic DNA was isolated using one triangle from the machine. To discern the SMN1 copy number independently from SMN2, Multiplex PCR with Dral restriction fragment analysis was completed. We used the carrier frequency and population-level data to estimate the prevalence of SMA in the population using the life-table method. This data analysis showed the presence of one copy of the SMN1 gene in 108 samples and two copies in 4090 samples, which resulted from a carrier frequency of 2.6%. The carrier frequency was twofold in females reaching 3.7% compared to 1.6% in males. 27% of participants were children of first-cousin marriages. We estimated the birth incidence of SMA to be 32 per 100,000 birth and the total number of people living with SMA in the Kingdom of Saudi Arabia to be 2265 of which 188 are type I, 1213 are type II, and 8,64 are type III. The SMA carrier rate of 2.6% in Saudi control subjects is slightly higher than the reported global frequency of 1.25 to 2% with links to the high degree of consanguinity.

Measurement of Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT), Fibrinogen Level, D-Dimer in Sudanese Infants and Children with Sepsis Khartoum State, 2022

Background: Sepsis is the most common worldwide cause of death in infants and children. It was Known that coagulative and inflammatory parameters were involved in the host’s defense against sepsis resulted from severe infection and inflammation. Materials and Methods: This was cross sectional study conducted at Albraa pediatric center, Khartoum, Sudan during the period from May 2022 to August 2022, to measure PT, APTT, fibrinogen level, D- dimer in Sudanese infants and children with sepsis. 50 patients were selected as a case group, and apparently healthy donors with no history of any coagulation problems or any chronic disease were selected as control group. 2.8 ml of venous blood samples were collected in Tri Sodium Citrate anticoagulant. The coagulation tests (PT, APTT, fibrinogen) were performed using semiautomatic device (coagulometer). I chroma was used for the D- dimer. Results When compared between case and control there was highly significant difference (p.value 0.000), in PT, APTT, fibrinogen and D- dimer. In addition, there was insignificant difference when the PT, APTT fibrinogen and D- dimer in cases compared with the gender, CRP and bacterial culture, and there was negative correlation between the parameters and the age except the D-dimer had appositive correlation. The most common types of isolated bacteria in sepsis patients is staphylococcus aureus. Conclusion: This study concluded that, PT, APTT, fibrinogen and D- dimer was significantly increased in patients with sepsis.

Causes of infant deaths and patterns of associated factors in Eastern Ethiopia: Results of verbal autopsy (InterVA-4) study.

BackgroundIn a range of setting, detecting and generate empirical information on the cause of infant death and contributing risk factors at population level is basically utmost essential to take evidence-based measures in reducing infant morbidity and mortality. An electronic verbal autopsy is suitable tool and best alternative solution to determine individuals’ cause of death in a setting where the majority of deaths occur at home and civil registration systems do not exist. The present study was undertaken to find out cause of infant death, applying computer-based probabilistic model (InterVA-4) and analyze the patterns of association factors of mother’s and the deceased infant’s characteristics to the leading cause-specific infant mortality in Eastern Ethiopia.MethodsThe study employed a community-based prospective longitudinal survey, which was conducted with routinely enumeration of reported infant deaths for a period of two years (from September 2016 to August 2018) in Eastern part of Ethiopia. Using the two-stage cluster sampling technique, the study was undertaken in four randomly selected districts of West Hararghe zone and two districts of zone 3 in Oromia and Afar regional state, respectively. The study included a total of 362 infants who were deceased during the study period. Data was collected by trained enumerators by interviewing the mothers or guardians of the deceased infant using a 2014 standardize World Health Organization (WHO) Verbal Autopsy questionnaire. InterVA-4 model were used for processing and interpreting verbal autopsy data in order to arrive at the most likely causes of infant death. SPSS version 23 was also used for statistical analysis of frequency distribution and logistic regression for the association between covariates and outcomes.FindingsOf the overall (362) deceased infants’ during the study period, 53.0% of deaths occurred during neonatal time while 47.0% died in the post-neonatal period. Acute respiratory infection including neonatal and post-neonatal pneumonia (38.4%), birth asphyxia (16.4%), diarrheal diseases (16.3%), prematurity (7.4%) and malaria (4.3%) were found to be the leading causes of infant mortality in the study area. The independent factors strongly associated with probable ARI, including pneumonia related mortality as compared to all-causes of death were infants with maternal age lower than 20 years old (p = 0.001, AOR: 4.82, 95% CI: 1.88, 12.3) and infant being died outside of heath facilities (P = 0.007, AOR: 2.85, 95% CI: 1.33, 6.12). The post-neonatal period (P = 0.000, AOR: 15.5, 95% CI: 6.35, 37.8) and infant died in the wet season (P = 0.006, AOR: 2.38, 95% CI: 1.28, 4.44) had strong relationship with dying from diarrhea-related death than those infants died from all non-diarrhea. The death due to malaria robustly associated with infants whose mothers age between 20–35 years old (P = 0.024, AOR: 4.44, 95% CI: 1.22, 16.2) and infant who was dwelled in the districts of Afar region (P = 0.013, AOR: 4.08, 95% CI: 1.35, 12.4).ConclusionThe highest cause of infant mortality was associated with disease of respiratory system, particularly acute respiratory infection, including both neonates and post-neonatal pneumonia. Most of the infant deaths existed are as a result of diseases and conditions that are readily preventable or treatable cause, similar to those reported in worldwide, which have needs of further attention. The patterns of significant associated factors across cause-specific mortality against all-cause of death were dissimilar. Therefore, strengthen maternal and child health program with effective preventive interventions emphasizing on the most common cause of infant deaths and those factors contributing in raising mortality risk are required.

Scarring and selection effects on children surviving elevated rates of postneonatal mortality in sub-Saharan Africa

Infants in sub-Saharan Africa face adversity: Infections and undernutrition are major causes of infant deaths and can cause physiological damage with long-lasting adverse scarring effects on the human development of the survivors, for example, in terms of health and education. However, selective mortality of more vulnerable children at very high levels of adversity in early life can leave the surviving population to appear on average healthier. This paper estimated the nonlinear effects of postneonatal mortality rate—a proxy for adversity, particularly infections and undernutrition—in a 50 km radius, occurring over the period of infancy, on the subsequent height-for-age and school attendance of the surviving children. The results indicated that an adverse environment in infancy negatively affected height-for-age at age 1–4 years: At relatively low levels of adversity (at the 10th percentile of postneonatal mortality rate), an additional postneonatal death per 100 person-years decreased height-for-age of the survivors by almost 2% of the mean deficit in height (relative to a common growth standard) when comparing siblings born into different levels of adversity. At high levels of adversity, no effect was found for height-for-age while a small positive association was observed for school attendance at age 7–16 years. The results indicated that selective mortality may have canceled out (or even dominated in the case of school attendance) observable scarring effects following high levels of postneonatal mortality rate in sub-Saharan Africa.

Infant Safe Sleep Knowledge, Attitudes, and Behaviors by Physicians at an Academic Children's Hospital.

Sudden unexpected infant death (SUID) is the leading cause of death for infants. Physician advice on safe sleep is an important source of information for families. We sought to evaluate the safe sleep knowledge, attitudes, and behaviors of physicians by distributing a cross-sectional survey at a freestanding children's hospital. The survey included demographics, knowledge items, attitudinal assessment, and frequency of providing safe sleep guidance. Multivariable linear regression and logistic regression were used to evaluate associations between variables. 398 physicians were surveyed with 124 responses (31%). Females, those who received safe sleep training, and those who see infants in daily practice had higher knowledge scores. Physicians with higher knowledge scores had more positive attitudes toward safe sleep and provided safe sleep education to patients more often. Our study underlies the importance of education and repeated exposure in forming positive attitudes toward safe sleep recommendations and leads to increased provision of safe sleep guidance.

The The relationship between mother's knowledge with the incidence of diarrhea : A cross sectional study in toddlers

Diarrhea is the most common cause of infant death. The mother is the person closest to the child and has an important role in maintaining and maintaining the health of the child, so a good mother's knowledge is needed to prevent diarrhea in children. This study aims to study the relationship of mother's knowledge with the incidence of diarrhea in infants in the working area of Tebing Tinggi Health Center, Empat Lawang District. The design used in this study is an analytic survey design that uses a cross sectional study design. The population in this study were all mothers who have toddlers aged 0-5 years who came for treatment at Tebing Tinggi Health Center, Empat Lawang in July-August 2019. Sampling in this study used 81 Simple Random Sampling techniques. This research uses primary data and secondary data. Data analysis was performed univariately and bivariately. The results showed there is a significant relationship between the relationship between maternal knowledge about diarrhea and the incidence of diarrhea in infants in the working area of Tebing Tinggi Health Center, Four Lawang Regency, with a moderate relationship category. It is expected that the puskesmas can provide health education to the community about diarrhea through counseling activities, distributing leaflets and nut book explaining diarrhea

A proof-of-concept study to construct Bayesian network decision models for supporting the categorization of sudden unexpected infant death

Sudden infant death syndrome (SIDS) remains a leading cause of infant death in high-income countries. Supporting models for categorization of sudden unexpected infant death into SIDS/non-SIDS could reduce mortality. Therefore, we aimed to develop such a tool utilizing forensic data, but the reduced number of SIDS cases renders this task inherently difficult. To overcome this, we constructed Bayesian network models according to diagnoses performed by expert pathologists and created conditional probability tables in a proof-of-concept study. In the diagnostic support model, the data of 64 sudden unexpected infant death cases was employed as the training dataset, and 16 known-risk factors, including age at death and co-sleeping, were added. In the validation study, which included 8 new cases, the models reproduced experts’ diagnoses in 4 or 5 of the 6 SIDS cases. Next, to confirm the effectiveness of this approach for onset prediction, the data from 41 SIDS cases was employed. The model predicted that the risk of SIDS in 0- to 2-month-old infants exposed to passive smoking and co-sleeping is eightfold higher than that in the general infant population, which is comparable with previously published findings. The Bayesian approach could be a promising tool for constructing SIDS prevention models.

Resuscitated Sudden Cardiac Arrest of a Neonate with Congenital LQT Syndrome-Associated Torsades de Pointes: A Case Report and Literature Review

Sudden infant death syndrome (SIDS), the most common cause of infant death in developed countries, is attributed to diverse trigger factors. Malignant cardiac dysrhythmias are potentially treatable etiologies, and congenital long QT syndrome (LQTS) is the most common cardiac ionic channelopathy confronted. β-Blockers or class Ib agents are the drugs of choice for the control of arrhythmias, and an implantable cardioverter defibrillator (ICD) should be considered for secondary prevention in survivors of lethal cardiac death. We report the case of a 4-day old neonate, later genetically confirmed as LQT type 3 (LQT3), who survived a pulseless torsades de pointes (TdP) attack and was successfully treated with propranolol, mexiletine, and ICD implantation.

Relationship between maternal heavy metal exposure and congenital heart defects: a systematic review and meta-analysis.

Congenital heart defects (CHDs) are one of the major causes of death in infants and young children, and heavy metal exposure during pregnancy is one of the possible risk factors. However, the effect of heavy metal exposure on CHDs is still controversial. We searched English (PubMed, Web of Science) and Chinese (CNKI and WanFang database) databases for relevant articles. The summarized effect sizes and 95% confidence intervals (CIs) were calculated by pooling estimates using the random-effects model. Egger's test was used to estimate publication bias. Heterogeneity among studies was indicated by p-values and I2. Finally, we conducted subgroup analyses to elucidate the causes of heterogeneity. Thirteen studies were included in this meta-analysis. A positive association between maternal exposure to heavy metals and CHDs was found. Pooling odds ratios (ORs) for arsenic, cadmium, mercury, and lead were 2.12, 1.30, 1.22, and 2.30, respectively for total CHDs. Regarding CHD subtypes, arsenic was associated with an increased risk of septal defects (OR: 1.82), barium with left ventricular outflow tract obstruction (LVOTO) (OR: 1.15) and septal defects (OR: 1.21), and lead with conotruncal defects (OR: 2.34) and LVOTO (OR: 1.93). A heterogeneous relationship was found between studies using different methods of measurement, which were mainly due to differences in actual exposure levels to heavy metals. This meta-analysis suggests significant associations between arsenic, cadmium, mercury, and lead exposure during pregnancy and an increased risk of specific CHDs in offspring. These findings underscore the importance of heavy metal exposure during pregnancy in the risk of CHDs in offspring.

P.084 5q spinal muscular atrophy Canadian Paediatric Surveillance Program – 2020-2021 results

Background: Spinal muscular atrophy (SMA) is the leading genetic cause of infant death and the second most common autosomal recessive disorder; most cases are due to homozygous deletion of SMN1 gene. Methods: This study uses the Canadian Paediatric Surveillance Program to determine the minimum annual incidence of 5q-SMA from birth to 18 years of age in Canada. The protocol can be accessed at www.cpsp.cps.ca/surveillance. Results: Eighteen cases were reported in 2020-2021. Ten (55%) cases were reported from Ontario and the remaining cases were reported from Atlantic Canada and Western Canada. Their median age was 11 months (IQR 4–21); 61% were male. The most common presenting symptoms were hypotonia and delayed motor milestones in 12 (86%) and 10 (71%) cases respectively. On average, the diagnosis was delayed after onset of symptoms by three months for SMA Type 1, by eight months for Type 2, and by 18 months for Type 3. Twelve (86%) cases received nusinersen as their first disease-modifying treatment. Conclusions: Early recognition and newborn screening are essential to reduce diagnostic delay and enable timely treatment of SMA. Other data sources including the Canadian Neuromuscular Disease Registry and molecular genetic laboratories will be used to estimate the annual incidence of pediatric SMA in Canada.