Child Survival Research Articles

Reduced Intensity Haploidentical Bone Marrow Transplantation in Adults with Severe Sickle Cell Disease: BMT CTN 1507

Background: Allogeneic hematopoietic stem-cell transplantation has curative potential for sickle cell disease (SCD). Event-free survival (EFS) in children with SCD is >90% after a bone marrow transplant (BMT) from a myeloablative matched sibling donor (MSD). Unfortunately, <15% of patients with SCD have MSD, and myeloablative conditioning can be prohibitively toxic in adults with SCD. Reduced intensity HLA-haploidentical BMT with post-transplant cyclophosphamide (PTCy) has been shown in small studies to expand the donor pool with encouraging results. Still, concerns about graft failure and graft-versus-host disease (GVHD) persist. We present the results of a Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 1507, multi-center single-arm, phase-II, prospective clinical trial (clinicaltrials.gov #NCT03263559) of haploidentical-BMT with PTCy to estimate EFS at 2-years in adults with severe SCD. Pediatric stratum data is not included in the data presentation and will be available in 2-years. Study Design and Methods: Eligibility: SCD patients aged 15.00-45.99 years with prior stroke, recurrent ACS or pain, chronic transfusion regimen, or tricuspid valve regurgitant jet velocity (TRJV) ≥2.7 m/sec were eligible. Participants were required to have an HLA-haploidentical first-degree relative donor, willing and able to donate bone marrow. The primary objective was EFS (survival without primary or secondary graft failure or second infusion of stem cells) at 2 years after haploidentical-BMT. Secondary objectives included determining the impact on clinical and laboratory manifestations of SCD and other transplant outcomes at 2 years post haploidentical-BMT. The protocol was opened for enrollment on 10/5/2017, completed accrual on 01/6/2021, and data are current as of 8/2023. Preconditioning with hydroxyurea (HU) 30mg/kg/day (Day-70 to Day-10); Conditioning regimen included Thymoglobulin (rATG), Thiotepa, Fludarabine, Cyclophosphamide, and Total Body Irradiation (TBI). GVHD prophylaxis included PTCy, sirolimus, and mycophenolate mofetil, figure. Results: A total of 54 eligible participants enrolled from 19 sites; 42 (78%) proceeded to transplant. Amongst enrolled participants, 59.3% are male, 92.6% are Black, and 3.7% are Hispanic. 10 participants started HU but did not proceed to BMT, and 2 did not start HU or proceed to BMT. Reasons included donor issues (n=4), withdrawal of consent (n=2), insurance coverage (n=2), death (n=1), and other (n=3). 38/42 (90%) participants completed the study as planned; 2 participants withdrew consent, and 2 were lost to follow-up. The median age was 22.8 years at enrollment; 47/54 (87%) of enrolled participants had Hemoglobin SS disease, 40/54 (74.1%) had a Lansky/Karnofsky score of 90-100 at baseline, and 41/54 (75.9%) had an HLA match score of 4/8. Recurrent vaso-occlusive pain episodes (38.9%), acute chest syndrome (16.8%), and overt stroke (16.7%) were the most common indications for transplant. Only 13 (31%) participants achieved the intended 30 mg/kg/day dosing of HU preconditioning. Estimated 2-year EFS is 88% (95% CI: 73.5%, 94.8%); all except one qualifying event occurred within 12 months. The 2-year overall survival (OS) post-HU was 93.0% (95% CI: 79.8%, 97.7%), and the 2-year OS post-transplant was 95.0% (95% CI: 81.5%, 98.7%); 2 (4.8%) participants had primary graft failure, and 1 (2.4%) had secondary graft failure before day +100. The cumulative incidence of grades II-IV acute GVHD at day 100 was 26.2% (95% CI: 14.0%, 40.2%), and grades III-IV acute GVHD at day 100 was 4.8% (95% CI: 0.9%, 14.4%). There were two deaths in the first year post-BMT (1 -organ failure; 1-ARDS), none in the second year; 33 (78.6%) participants reported at least one re-admission post-BMT, mainly due to either bacterial infection (n=41) or viral reactivation (n=36), table. Conclusion: This multi-center phase-II trial of a reduced intensity haploidentical-BMT in adults with SCD shows durable donor engraftment at 2-years with low mortality. The 2-year EFS and OS are comparable to that reported after MSD myeloablative BMT. These results support haploidentical BMT with PTCy as a suitable and tolerable curative therapy for adults with SCD and severe end-organ toxicity such as stroke and pulmonary hypertension, a population typically excluded from participating in myeloablative gene therapy and gene editing trials.

PENGARUH PENGETAHUAN DAN SIKAP BIDAN TERHADAP TINDAKAN BIDAN DALAM INISIASI MENYUSUI DINI (IMD) PADA IBU BERSALIN

Based on the results of the Indonesian Demographic and Health Survey (SDKI) in 2017, the Infant Mortality Rate (IMR) shows 24 per 1000 live births, the Neonatal Mortality Rate (AKN) is 15 per 1000 live births and the Infant Mortality Rate (AKABA) is 32 per 1000 live births. However, the mortality rate for neonates, infants and toddlers is expected to continue to decline. Interventions that can support child survival are shown to be able to reduce IMR to 10 per 1000 live births and IMR to 16 per 1000 live births in 2024. Meanwhile, in accordance with sustainable development targets. AKABA is expected to reach 18.8 per 1000 live births in 2030. In recent years, the government has begun to aggressively promote the provision of IMD from the first hour of birth for babies aged 0-6 months. This effort received very good support and broad coverage, one of which was from the Association of Indonesian Breastfeeding Mothers (AIMI), the aim of the research was to determine the influence of Midwives' Knowledge and Attitudes on Midwives' Actions in Early Breastfeeding Initiation in Maternity Women. This research method uses a systematic literature review of 6 articles, carried out via the Google Scholar search engine using Indonesian, in selecting research articles using inclusion criteria, namely the theme of the article content, time period, year of publication, language, subject, method, sample and type of article. , for exclusion criteria including the theme of the article content, time period, type of article. The results of the research showed that 4 articles stated that there was an influence of knowledge and attitudes on IMD measures for mothers in labor, while 2 studies stated that there was no influence of knowledge and attitudes towards IMD measures for mothers in labor. Conclusions from the research include the influence of midwives' knowledge and attitudes on midwives' actions in IMD for women giving birth. Suggestions for midwives can increase their knowledge and attitudes by attending higher education, training, workshop, seminars and seeking information about IMD.

The Role of Faith-based Organisations in Childhood Malaria Management among Mothers of Under-five Children in Osogbo, Nigeria

Malaria remains a major health challenge in Nigeria despite efforts at reducing its prevalence. Previous studies on malaria focused mainly on the biomedical aspects. However, little is known about the role of faith-based organisations in malaria management. Health Belief Model (HBM) provided the framework explaining mothers understanding of malaria illness, while exploratory and descriptive designs were utilized. The study was conducted among selected mothers of under-five children in Osogbo using the qualitative method comprising twelve focus group discussions (FGDs); six among mothers 15-35years (three each among literates and non-literates); six among mothers 35years and above (three each among literates and non-literates mothers). Qualitative data were content analysed. Malaria treatment behaviour of the mothers was a complex process, assisted by faith-based organisations through the provision of insecticides treated net (ITNs), awareness campaigns, routine immunization of pregnant mothers, and more. However, hording militated against the effective use of ITNs by mothers in malaria management. This finding corroborates common understanding that faith-based organisations play important role in malaria management by actually providing biomedically accepted resources which led to the reduction of mosquito spread, hence increases the chances of the survival of both children and mothers. Therefore, increased collaboration between government and faith-based organisations is needed to improve malaria management facilities and avail mothers with appropriate education on malaria management strategies to reduce complications from malaria.

Under-5, infant, and neonatal mortality trends and causes of death, 1991–2022: Findings from death surveillance in Xicheng district of Beijing, China

Overall, China has made substantial progress in improving child survival over the past few decades, but a detailed understanding of child mortality trend at local level is limited. This study aimed to present a comprehensive analysis of under-5, infant, and neonatal mortality rates and its trend in Xicheng district of Beijing, China. We used the surveillance data of under-5 children reported by Preventive Health Department of Xicheng District Community Health Service Center from 1991 to 2022. The data was collected based on the Child Death Reporting Card of the Beijing Under-5 Mortality Rate Surveillance Network. Data check was performed by each community health service center and related medical institutions. We extracted data included maternal age, date of death, date of birth, gender, census register, classification of any causes of death, and utilization of healthcare services before death and doubly input it in the Excel 2016 program. Categorization of the causes of death was adapted by the International Categorization of Diseases (ICD-10). Mortality rates and distribution of the leading causes of death were analyzed with descriptive statistics and the Pearson’s Chi-square test using SAS 14.0 software. The Chi-square trend test was used to explore the trends in mortality. Interrupted time series analysis (ITSA) was conducted to assess the impact of the two-child policy on mortality using STATA statistical packages. From 1991 to 2022, totally, there were 166,061 live births and 793 (4.78 ‰) under-5 deaths. The mortality rates of under-5 children, infants and neonates in Xicheng district decreased from 14.75 ‰, 11.25 ‰ and 8.00 ‰ to 1.03 ‰, 0.83 ‰ and 0.41 ‰ respectively. All mortality rates showed an overall significant decline trend (χ2 trend for neonatal = -15.8136, P trend for neonatal < 0.001; χ2 trend for infant = -17.6652, P trend for infant < 0.001; χ2 trend for under-5 = -18.9103, P trend for under-5 < 0.001). The leading causes of death among under-5 children were congenital heart disease (1.65 ‰), birth asphyxia (1.44 ‰), and other congenital abnormalities (except congenital heart disease and down's syndrome) (1.36 ‰). ITSA results showed that the two-child policy did not change the overall decreased trend of child mortality rates. Future preventive measures for child healthcare should give a priority for congenital heart disease, birth asphyxia, and other congenital abnormalities.

Factors associated with early initiation of breastfeeding in central Saudi Arabia: a hospital-based survey

BackgroundEarly initiation of breastfeeding is central to the success of infant feeding. The World Health Organization (WHO) therefore recommends breastfeeding within the first hour of birth and has set a target to increase the rate to 70% globally by 2030. This suggests the necessity of systematic investigations to capture trends in early initiation of breastfeeding to avail health systems of up-to-date information in the interest of appropriate policy making. Hence, this study was designed to investigate the factors associated with early initiation among mothers who delivered babies in public healthcare facilities in the Al-Qassim Region, Saudi Arabia.MethodsThe research was a hospital-based, cross-sectional study which featured the recruitment of 546 mothers from March 2021 to June 2021 in five public hospitals. A questionnaire was the tool used for data collection and this was administered via face-to-face, structured interviews. Data were analyzed using binary logistic regression including unadjusted (UOR) and adjusted odds ratio (AOR) with a 95% confidence interval (CI).ResultsThe prevalence of early initiation of breastfeeding was 23.1% (120 of 519 respondents). Maternal and paternal socio-demographic variables, household characteristics, parity, age of the previous child, breastfeeding the previous child or otherwise and the sex of the newborn were not associated with the early initiation of breastfeeding. Mode of delivery and antenatal education about breastfeeding were significant factors. Postnatal care practices were also significant: the provision of help in positioning babies for breastfeeding (AOR 3.5; 95% CI 1.62, 7.57), 24-hour rooming-in (AOR 6.26; 95% CI 1.31, 29.8) and encouragement to practice early initiation of breastfeeding (AOR 3.05; 95% CI 1.71, 5.43) were good, better and the best factors associated with early initiation of breastfeeding respectively.ConclusionThe prevalence of early initiation of breastfeeding is poor and represents a threat to child survival in the study area. Postnatal care practices are crucial factors strongly predisposing mothers to early initiation of breastfeeding and should therefore be institutionalized in health policy frameworks to promote the same in Saudi Arabia.

Comparison of door-to-door and fixed-point delivery of azithromycin distribution for child survival in Niger: A cluster-randomized trial.

Recent evidence indicates mass azithromycin distribution reduces under-5 mortality. This intervention is being considered for child survival programs in high mortality sub-Saharan African settings. The delivery approach used in prior studies required a full-time census and distribution team, which is not feasible for most programs. To determine the optimal programmatic approach to delivery, this study aimed to compare treatment coverage, costs, and acceptability of different delivery approaches with existing community health workers (CHWs). This cluster-randomized trial included rural and peri-urban communities in Dosso, Niger (clinicaltrials.gov, NCT04774991). A random sample of 80 eligible communities was randomized 1:1 to biannual door-to-door or fixed-point delivery of oral azithromycin to children 1-59 months old over 1 year. Data analysts alone were masked given the nature of the intervention. The primary outcome was community-level treatment coverage defined as the number of children treated recorded by CHWs divided by the number of eligible children determined using a post-distribution census. Costs were monitored through routine administrative data collection and micro-costing. The census included survey questions on intervention acceptability among caregivers, community leaders, and CHWs. After randomization, 1 community was excluded due to inaccuracies in available administrative data, resulting in 39 communities receiving door-to-door delivery. At the second distribution, community-level mean treatment coverage was 105% (SD 44%) in the door-to-door arm and 92% (SD 20%) in the fixed-point arm (Mean difference 13%, 95% CI -2% to 28%, P-value = 0.08). The total cost per dose delivered was $1.91 in the door-to-door arm and $2.51 in the fixed-point arm. Indicators of acceptability were similar across stakeholder groups in both arms, with most respondents in each group indicating a preference for door-to-door. Overall, door-to-door delivery is the preferred approach to azithromycin distribution in this setting and might reach more children at a lower cost per dose delivered than fixed-point. Trial Registration: clinicaltrials.gov NCT04774991.

The relationship between the intestinal microbiome and body mass index in children with cystic fibrosis

BackgroundThe nutritional status of children with cystic fibrosis (CF), as assessed by their body mass index percentile (BMIp), is a critical determinant of long-term health outcomes. While the intestinal microbiome plays an important role in nutrition, little is known regarding the relationship of the microbiome and BMIp in children with CF. MethodsPediatric patients (< 18 years old) with CF and healthy comparison patients (HCs) were enrolled in the study and stool samples obtained. BMIp was categorized as Green Zone (BMIp > 50th), Yellow Zone (BMIp 25th–49th) and Red Zone (BMIp < 25th). Intestinal microbiome assessment was performed via 16S rRNA gene sequencing; microbial richness, diversity, and differential species abundance were assessed. ResultsStool samples were collected from 107 children with CF and 50 age-matched HCs. Compared to HCs, children with CF were found to have lower bacterial richness, alpha-diversity, and a different microbial composition. When evaluating them by their BMIp color zone, richness and alpha-diversity were lowest in those in the Red Zone. In addition, an unclassified amplicon sequence variant (ASV) of Blautia, a known butyrate-producing anaerobe, was of lowest abundance in children in the Red Zone. ConclusionChildren with CF have a dysbiotic intestinal microbiome with specific changes that accompany changes in BMIp. Longitudinal assessments of the microbiome and its metabolic activities over time are needed to better understand how improvements in the microbiome may improve nutrition and enhance long-term survival in children with CF.

Determinants of child survival practice among caregivers in internally displaced persons' camps in Abuja Municipal Area Council, Nigeria.

Child survival remains a major public health challenge in the sub-Saharan region of Africa, especially Nigeria. The Boko Haram crisis, which has aggravated this, has led to the displacement of many people in the north-eastern region, including children under five. This study investigated the determinants of child survival practice among caregivers in internally displaced persons' (IDP) camps in Abuja Municipal Area Council (AMAC), Nigeria. A cross-sectional design was used to collect data on determinants of child survival practice from 312 caregivers in five purposively selected IDP camps in AMAC using the snowball sampling technique. Data were analysed using univariate, bivariate, and multivariate statistics at 5% level of significance. The mean age of respondents was 29.6 ± 6.72 years. There was a significant (p < 0.05) relationship between the predisposing, reinforcing, enabling and environmental factors studied and child survival practice. Findings also indicated that all factors were significant (p < 0.05) predictors of child survival practice with the reinforcing factor being the major predictor (ß = 0.38; t = 6.08). Attention needs to be paid to all factors, particularly the reinforcing factor of social support in order to promote optimal child survival practice among caregivers in AMAC IDP camps. Collaboration with social work professionals would be an added benefit to enhance social support.

A surveillance for advanced liver disease and characterization of hyperechogenic lesions after Fontan surgery in a prospective cohort of cases with congenital univentricular heart

Abstract Background The congenital univentricular heart (UH) is a rare disease corrected with the palliative Fontan’s intervention, that restores the survival of most child and young patients up to adultwood. Unlikely, these patients develop a series of complications, among all, the Fontan associated liver disease (FALD), that causes the occurrence of liver cirrhosis and hepatocellular carcinoma (HCC), that negatively impacts the life expectancy in the majority of cases. Purpose Our primary aim was to identify the presence of severe FALD in our patients by liver fibrosis and portal hypertension scores (FORNS, liver and spleen-platelet score or LSPS and SSPS), and by liver (LS) and spleen (SS) stiffness measurement in relation to time since Fontan, and secondarly to characterize all the abdominal-US hyperechogenic lesions (US-HL) according to the LI-RADS (LR) CT/MRI categories. Method One-hundred-46 outpatients (83 m/63 f, aged 25,2±11.0 yrs) born with UH corrected with Fontan circuit have been recruited prospectively from 2019 to 2023 (FUmean 24.5±15.1 mos). Each patient underwent a complete clinical history and instrumental examination, by imaging obtained with US, CT and MRI, a specific lab-test profile, and the LS and SS evaluation by transient elastography (VCTE, Fibroscan). ROC curves were built to select the scores cut-off proved to be the most accurate to diagnose and grade FALD. Based on the presence of US-HL found in 43 cases (29,5%), we grouped: 23 cases with LR-1 or 2 (benign), 15 with LR-3 (suspect) and 5 with LR-4 or 5 (malign). Results Features for definition of failing-Fontan appeared in 17.5%, 47.5% and 80% of cases with &amp;lt;15; 15-25 or &amp;gt;25yrs since Fontan surgery, respectively (p&amp;lt;0.01). All the scores used (FORNS with cut-off ≥4, LSPS ≥1.4, SSPS ≥2.3, LS ≥20.2 and SS ≥30.7) showed high sensitivity and specificity, improving FALD diagnostic accuracy and staging (all p&amp;lt;0.001). Moreover by identification of selective criteria related to advanced liver disease and portal hypertension, we applied a novel risk-score for failing-Fontan, that predicted a low-moderate risk profile (HR 0.30;CI 0.18-0.52) in 72 patients and a high risk profile (HR 3,29,CI 1.93-5.60) in 74 (51%). During FU, 13 patients (8.9%) died, 5 received OHT (3.4%) and 5 had HCC occurrence (3.4%). Finally, cases with US-HL stratified by classes LR-3-4-5 (20 cases, 46.5%) appeared significantly associated with a more advanced FALD (16/4, 75% vs. 68/58, 46%; p=0,004) and a longer time since Fontan (26.3±9.4 vs. 19.8±10.8; p=0,025). Conclusion The novel risk score proposed may help to predict the development of cirrhosis in high risk patients and focussed on the need for surveillance by imaging methods to characterized the US-HL, that appeared at risk of malignity (nodule size &amp;gt;20mm and/or presence of wash-out into portal-hepatocellular phase or into LR ≥3 classes).

Higher Survival With the Use of Extracorporeal Cardiopulmonary Resuscitation Compared With Conventional Cardiopulmonary Resuscitation in Children Following Cardiac Surgery: Results of an Analysis of the Get With The Guidelines-Resuscitation Registry.

Extracorporeal membrane oxygenation to support cardiopulmonary resuscitation (CPR) is increasingly used in children suffering cardiac arrest after cardiac surgery. However, its efficacy in promoting survival has not been evaluated. We compared survival of pediatric cardiac surgery patients suffering in-hospital cardiac arrest who were resuscitated with extracorporeal CPR (E-CPR) to those resuscitated with conventional CPR (C-CPR) using propensity matching. Retrospective study using multicenter data from the American Heart Association Get With The Guidelines-Resuscitation registry (2008-2020). Multicenter cardiac arrest database containing cardiac arrest and CPR data from U.S. hospitals. Cardiac surgical patients younger than 18 years old who suffered in-hospital cardiac arrest and received greater than or equal to 10 minutes of CPR. None. Among 1223 patients, 741 (60.6%) received C-CPR and 482 (39.4%) received E-CPR. E-CPR utilization increased over the study period ( p < 0.001). Duration of CPR was longer in E-CPR compared with C-CPR recipients (42 vs. 26 min; p < 0.001). In a propensity score matched cohort (382 E-CPR recipients, 382 C-CPR recipients), E-CPR recipients had survival to discharge (odds ratio [OR], 2.22; 95% CI, 1.7-2.9; p < 0.001). E-CPR survival was only higher when CPR duration was greater than 18 minutes. Propensity matched analysis using patients from institutions contributing at least one E-CPR case ( n = 35 centers; 353 E-CPR recipients, 353 C-CPR recipients) similarly demonstrated improved survival in E-CPR recipients compared with those who received C-CPR alone (OR, 2.08; 95% CI, 1.6-2.8; p < 0.001). E-CPR compared with C-CPR improved survival in children suffering cardiac arrest after cardiac surgery requiring CPR greater than or equal to 10 minutes.

Children's right to play in times of war

AbstractThis paper discusses children's right to play and its bioethical importance for children affected by war. Against the background of the current military conflicts, it analyses physical, psychological, and institutional factors that limit children's right to play in a situation involving armed conflict. Considering that the lack of institutional support of play for children affected by war constitutes a failure to fulfil our societal and political obligation under Article 31 of the United Nations Convention on the Rights of the Child, this paper analyses the understanding of play adopted in this legal instrument. In line with the distinctions made in the Convention, it discusses the importance of play for children's life and survival, for their health and well‐being, as well as for the recovery of trauma experienced by children affected by armed conflict. It thereby aims to contribute to the recognition and protection of this right on the grounds of bioethics and healthcare.

Abstract 17070: Dyslipidemia Prevalence Among a Diverse Cohort of Childhood, Adolescent and Young Adult Cancer Survivors

Background: In the general population, dyslipidemia impacts 36% of adults between the ages of 20 and 29 years. Among survivors of childhood, adolescent, and young adult-onset cancer (C-AYAs), the prevalence of dyslipidemia in racially diverse cohorts as well as our understanding of which measured fats are most commonly abnormal are limited. Question: Among a diverse group of C-AYAs, what is the prevalence of dyslipidemia and which fats are most contributory? Methods: Individuals diagnosed with cancer at age ≤39 years and treated with anthracycline based chemotherapy between 2010-2022 were identified. Depending on age at time of collection, post-treatment lipid panels were analyzed according to AAP (&lt;20 years) or ACC/AHA (≥20 years) guidelines. Non-fasting panels were included, in accordance with ACC/AHA guidelines. The prevalence of dyslipidemia and median values for measured fats were determined. Non-parametric testing was used to examine associations between dyslipidemia, age, and race. Results: Among a diverse (40% Black, 52% White) cohort of C-AYAs (227 total) with a median current age of 25 years (interquartile range (IQR) 20-36 years) and median total doxorubicin isotoxic equivalents of 200mg/m 2 (IQR 120-300 mg/m 2 ), the prevalence of dyslipidemia was 55%. Prevalence of dyslipidemia was not associated with race (Black 55%, White 64%, Other 44%, p=0.281) or age (&lt;20 years 51%, ≥20 years 64%, p = 0.055). Among Black and White subjects, HDL was most commonly abnormal (Black 42%, White 38%), followed by triglycerides (TG) (Black 29%, White 41%). Median TG levels were significantly lower among Black individuals ≥20 years compared with White individuals (117 mg/dL vs 143 mg/dL, p = 0.030). Conclusions: Among a diverse group of C-AYAs, dyslipidemia was highly prevalent even at a younger age (&lt;20 years). Race was not associated with prevalence of dyslipidemia. Dyslipidemia was primarily driven by HDL and TG abnormalities, fats associated with metabolic syndrome.

Abstract 14502: Contemporary Practices and Outcomes in Primary Pulmonary Vein Stenosis: A PVS Network Study

Background and Study Aim: Pediatric pulmonary vein stenosis (PVS) remains a disease associated with high mortality, with studies primarily limited to single center reports. Using the PVS Network Registry, we report on contemporary practices and outcomes for a large cohort of children with primary PVS across North America. Methods: Children with a diagnosis of primary PVS (congenital, normal pulmonary venous connections) in the retrospective PVS Network Registry (2009-2019, n=600, 19 institutions) were analyzed using descriptive statistics, survival analysis and Cox regression analysis. Results: In the PVS Network Registry cohort, 393 patients had a diagnosis of primary PVS. In the primary PVS cohort, 199 (50%) were male, 105 (27%) had a genetic diagnosis and 192 (49%) were premature (median 29 (22-37) weeks). Medical therapies were used in 53(14%) patients, with Imatinib being most common (58%). Pulmonary hypertension medications were used in 182 (46%) patients, with sildenafil most reported (90%). Surgical and catheter-based interventions for PVS were performed in 334 (85%) patients. 203 (60%) patients had at least one PVS surgery and 231(71%) had at least one PVS catheter intervention. At the time of first procedure for PVS, 133 (39%) had bilateral disease, while 100 (30%) had ≥3 pulmonary veins involved. The median age was 0.54 years (IQR 0.91). Catheter based interventions were more common on the left PVs (60%). Repeat procedures were common (53%) with the majority being catheter reinterventions (78%), with an average of 3.24 (±2.75) catheter procedures per patient. The overall survival for children with primary PVS was 76% and 71% at 1 and 2 years. In children with ≥4 veins involved, survival was 59% and 52% at 1 and 2 years. Older age at intervention was protective (HR 0.66, P&lt;0.02), while ≥3 vein involvement was associated with poor outcome (HR 1.8, p=0.05). Conclusion: This is the largest primary PVS cohort reported and demonstrates overall 1 year survival of 76%, however, children with multivessel disease remain at high risk. Reinterventions are common, with many undergoing repeat catheterization procedures in our cohort. The PVS Network retrospective cohort provides insights into clinical practices and will provide benchmarking for future studies.

Abstract 330: Severe Adverse Safety Events in Pediatric Out-of-Hospital Cardiac Arrest Resuscitation

Introduction: Survival for children with out-of-hospital cardiac arrest (OHCA) remains poor in spite of improvements in adult OHCA survival. Hypothesis: We hypothesized that severe adverse safety events (ASEs) are common during pediatric OHCA resuscitation and that specific patterns can be identified. Methods: Retrospective cohort study of patient care reports from 51 Emergency Medical Services (EMS) agencies across the US for children less than 18 years of age with an OHCA where resuscitation was attempted by EMS providers between 2013-2019. Results: We evaluated 1,019 encounters of EMS-treated pediatric OHCA; 46% were under 12 months of age. At least one severe ASE occurred in 610 patients (60%), and 310 patients (30%) had two or more. Children under 28 days of age had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (30%), ventilation (14%), and vascular access (19%). Logistic regression modeling found that the only factor consistently associated with severe ASEs was young age. Birth-related OHCA had 4-fold greater odds of a severe ASE compared to adolescents (95% CI 1.7-10.7) and neonates with non-birth-related OHCA had 3.2-fold greater odds of a severe ASE (95% CI 1.1-9.0). Conclusions: In this large geographically diverse cohort of children with EMS-treated OHCA, 60% experienced at least one severe ASE. The odds of a severe ASE were over 3-fold higher for neonates than adolescents, and even higher when the cardiac arrest was birth-related. Given the national increase in out of hospital births and ongoing poor outcomes of OHCA in young children, these findings are an important and urgent call to action to focus on improving care delivery and training.

Association between mass media exposure and infant and young child feeding practices in India: a cross-sectional study

The first two years of life is a critical window for good nutrition. Promoting infant and young child feeding (IYCF) practices in the first two years can help improve child survival and promote healthy growth and development. Assessment of IYCF practices is important, especially in developing countries like India where optimal IYCF practices can potentially prevent 12% of all deaths under 5 years of age, to promote awareness and intervene appropriately. The objective of our study is to generate evidence for the association between different types of mass media and appropriate IYCF practices in India, including optimal breastfeeding and appropriate complementary feeding practices. A positive association between them can point to intervention at scale. We analyzed data from India’s National Family Health Survey 5 (NFHS-5), 2019–2021. Multivariable logistic regression was used to examine the association of appropriate IYCF practices with mass media exposure. After controlling for demographics and socioeconomic status, the analyses showed that, overall, women who had exposure to television followed by newspaper and movies, had higher odds of adopting the recommended IYCF practices. The results also showed that the association of media exposure varied for different IYCF practices by geography. For instance, in the rural areas, television exposure was positively associated with all the IYCF practices, but in the urban areas, television exposure was positively associated with only early initiation of breastfeeding [OR 1.25; (95% CI 1.1–1.42)]. The study strengthens our understanding that an appropriate selection of mass media channels for intervention programs can promote IYCF practices at scale. Appropriately selecting the type of mass media to create awareness about different IYCF practices, in specific urban–rural settings, could help customize intervention programs to successfully influence IYCF behaviors.

Effect Of Breastfeeding Among Under 2 Years Children In Kaski District, Nepal

Background: Breastfeeding is one of the most important determinants of child survival, birth spacing, and the prevention of childhood infections. The beneficial effects of breastfeeding depend on its initiation, duration, and the age at which the breastfed child is weaned. Breastfeeding positively influences cognitive development. Methods: A descriptive cross-sectional study design was used to study impacts of breastfeeding among under 2 year’s children in Kaski district. Interview schedule as a structured questionnaire was used as data collection tool. Data was entered in Epi-data and analysis was performed with the help of the Statistical Package for Social Science. Results: The result showed nearly one-third (30.9%) of the respondents had fed bottle milk to their children. Majority (85.7%) of respondents had knowledge about effect of breastfeeding. Majority (78.9%) of the children were stunted and 27.8% of children are underweight. Very few (5.3%) of children were found wasted. Sex (p 0.044), suffering from disease (p 0.046), duration of breastfeeding (p 0.001), breastfeeding interval (p 0.001), breastfeeding time in day (p 0.001) were statistically associated with effect of breastfeeding. Height and weight, age and weight was found positively correlated (p&lt;0.05). Conclusion: The study showed child who were breastfed frequently were normal in weight; their physical development is found good. There is positive co-relation between height and weight as well as age and weight. BCC programme should be conducted for breastfeeding mothers on time, interval, duration of breastfeeding

The Human Initiative Organization as Initiation Child Protection in Bengkulu

This research is descriptive quantitative research. The research aims to understand the role of organisations human initiative in child protection in Bengkulu. This study using data collected primary and interviews. This study using the quantitative analysis, multiple linear regression analysis and analysis determined with the help of the SPSS 25 application. Populations in this study are the stewards and volunteers of the human organization's initialized 30 responders consist of 10 male responders 33.3 % and 20 female responders 66.7 %. The responders are the stewards or volunteers of the human initiative organization are college students from various study programs that have interest in the social services., empowerment and child education problems. The results of the research obtained were tested using test t and test f shows the impact of active roles, Participatory roles and passive roles against good child protection non-discrimination, The best interests of the child, The right to live, Survival and development, An award for the child's opinion. Research shows the average human organization's role in what appears to be an active role 21.97%, participatory role 21.67% and passive role 17.47%. In addition to child protection applied to non-discrimination 13.40 %, child's best interests 13.00 %, right to live 11.50 %, survival and development 12.80% and award to child 17%. An active role having influence stimultan against non-discrimination and a positive influence on the interests of children and the right to life and survival covering basic needs, education and social welfare or temporary habitation. We still do not have significantly affect the award stimultan in the opinion. It is grounded in part in accordance with the rules on the run / norm focus on children through the organization constructed with standardized child safe guarding policy and joint commitment through the HOME (hug, opportunity, mentality, education) and based on the style of leadership that is flexible and responsible in any decision making by approaching co-creation strategy. The role of participatory having influence in stimultan against non-discriminatory, the interests of children and having the right to life and significantly affect the child survival. Meanwhile the role of participatory have no influence on the interests of children and survival and awards toward the opinions of children significantly. It is caused by restriction existing programs as well as the awareness organization / volunteers related convention limited the rights of the child. In addition can look through the dynamic role owned in carrying out rights and obligations and needs conditional made by the organization of the needs in fulfilling formal (human needs, productivity and profitability of the organization and quality of human life) in Human Service Organizations. Passive roles have a significant impact on non-discrimination. However, it has no partial impact on non-discrimination. On the other hand, the passive role has a positive influence on the interests of the child and the rights of the child due to human initiative becomes a symbol/reference of the organization in the protection and enforcement of the rights of the child. In addition, passive roles have an influence on the right to life and survival of the child. Passive roles do not have a significant influence on the appreciation of the opinion of the child. This is because human initiative is defined as a symbol/reference organization on the standard of child service both normatively and comparatively for Pathfinding, Alignment and Empowering.

Determinant of Implanon discontinuation among women in southwest Ethiopia: unmatched case control study

BackgroundOver 4.5 million women worldwide have used Implanon. It plays an important role in reducing unwanted conceptions, lowering maternal mortality, and enhancing child survival. As a result, the availability of family planning programmes encourages women to begin using contraception and encourages women who are already using family planning to continue using it. The purpose of this study was to investigate the factors that lead to implanon cessation among women in southwest, Ethiopia.MethodsA facility-based unmatched case–control study was conducted from February 01 to March 02, 2023. It included 348 participants, 174 cases, and 174 controls. The cases were selected consecutively, and the controls were selected using a systematic random sampling method. Data was collected through a structured, face-to-face interview and entered into Epi-data version 4.6 and SPSS version 25.0 for analysis. The confidence interval (CI) of 95 and the strength of the association were measured using an adjusted odds ratio. A p-value of less than 0.05 was considered statistically significant.ResultWomen whose husbands have formal education [AOR = 0.33, 95% CI (0.121–0.0944)], women who have been counseled individually [AOR = 3.403 (1.390–8.3.32)], women who have been counseled for less than 5 min [AOR = 3.143, 95% CI (1.303–8.046)], and women who discuss Implanon insertion with their partner [AOR = 0.289, 95% CI (0.143–0.585)] were significantly associated with Implanon discontinuation.ConclusionImplanon discontinuation was predicted by the husband's education, the number of women counselled alone, the length of counselling, a conversation with the spouse, satisfaction with the service, and implanon side effects. The health care provider should increase counselling services, especially the length of implanon pregnancy, in accordance with the national family planning recommendations, to reduce early implanon removal.

24 Adaptive Functioning and Academic Achievement in Survivors of Childhood Acute Lymphoblastic Leukemia

Objective:Executive functioning (EF) and socioeconomic status (SES) are associated with functional outcomes (adaptive functioning and academic achievement) in healthy controls and pediatric populations with executive dysfunction. However, these relationships have yet to be investigated in survivors of childhood acute lymphoblastic leukemia (ALL), a population with EF impairment resulting from disease and treatment characteristics. The objective of this study was to examine the associations of functional outcomes with EF and SES (neighborhood-specific variables and academic support) in survivors of childhood ALL.Participants and Methods:Forty-four participants (38.6% female, 72.7% non-Hispanic White, ages 6-17) previously diagnosed with low-risk or standard-risk pre-B cell ALL and treated with chemotherapy-only were included. Participants were evaluated on performance-based measures of EF (cognitive flexibility, verbal fluency, working memory, and processing speed) and academic achievement (word reading and math calculation), and parent-ratings of EF and adaptive functioning. All measures were expressed as T-scores with lower scores indicating better performance. Neighborhood-specific variables were based on participants’ zip codes and census block group, and included area deprivation index (ADI) and child opportunity index (COI). Lower ADI and COI indicate lesser deprivation and greater opportunity. Individualized education plan (IEP) status was used as a proxy of academic support, coded dichotomously as with or without IEP. Percentages of participants showing impairments in functional outcomes were calculated using a cutoff of &gt; 1 SD above the normative mean. Partial correlations were conducted while controlling for age at evaluation, age at diagnosis, sex, and verbal IQ, to examine whether participants with poorer performance-based and parent-rated EF would show reduced functional outcomes. Multiple regression analyses were conducted to evaluate whether neighborhood-specific variables and IEP status would predict functional outcomes while controlling for covariates.Results:Compared to population norms, survivors of childhood ALL showed worse functional outcomes. Within adaptive functioning, 45.5% of participants showed impairment in activities of daily living and leadership. Adaptive functioning was significantly positively correlated with parent-rated, but not performance-based, EF (r=0.694, p&lt;0.001). Compared to female survivors, male survivors were at increased risk for adaptive functioning difficulties (r=-0.401, p&lt;0.05). Impairments for word reading and math calculation were 25% and 41.7%, respectively. Greater math calculation was associated with better verbal fluency (r=0.378, p&lt;0.05) and processing speed (r=0.439, p&lt;0.05). Older participants at evaluation (/3=-0.580, p&lt;0.001) and those without IEP support (ß=0.465, p&lt;0.05) showed better word reading. Lower ADI predicted better verbal fluency (ß=0.282, p=0.041), however, neighborhood-specific variables were not associated with functional outcomes.Conclusions:Prior findings indicate that performance-based measures and parent-ratings assess different constructs of EF. Thus, adaptive functioning may relate more to the behavioral construct of EF than its cognitive construct. Current findings also suggest that male survivors are at increased risk for reduced adaptive functioning, consistent with recent reports that male survivors of ALL are at greater risk for specific neurocognitive outcomes. Overall, functional outcomes may be more strongly related to EF than neighborhood-specific variables. Long-term goals include early screening of adaptive and academic difficulties, targeted intervention, and neuropsychological monitoring to support pediatric survivors’ neurocognitive and psychosocial development.

WASH practices increased the prevalence of malnutrition among under-five children (6–59 months) in an urban slum area in Ibadan, Nigeria

Abstract Access to safe water, proper sanitation, and hygienic practices are fundamental to the growth and survival of children. This study assessed the relationship between water, sanitation, and hygiene (WASH) practices and the nutritional status of children aged 6–59 months in the Beere/Oja-Oba community, Ibadan, Oyo State. This cross-sectional study involved 200 mothers/caregivers with under-five children. WASH practices were assessed using an interviewer-administered questionnaire. Anthropometric measurements were taken and analyzed using WHO Anthro. Data were analyzed using SPSS at p &amp;lt; 0.05. The mean age of the children was 24.91±10.52, and the majority were females (77.5%). Prevalence of stunting (44.0%), wasting (37.5%), and underweight (34.0%) were high among the children. Well (71.5%) and tap/borehole (74.0%) were the major sources of domestic and drinking water respectively, and required 5–15 min (36.9%) to source. The occurrence of diarrhea was high (48.5%) among the children. Time to drinking water source and washing a child's hands before feeding were WASH practices significantly associated with stunting (p = 0.000) and underweight (p = 0.003) among the children from lower socio-economic households (p = 0.045). Access to unsafe water was significantly associated with child malnutrition. There is a need to educate and encourage mothers/caregivers to improve their hygiene practices in the community.