Cohort Of Babies Research Articles

Relationship between prenatal metals exposure and neurodevelopment in one-year-old infants in the CLIMB study.

Prenatal metals exposure and its effects on infant neurodevelopment have garnered significant attention. However, most studies focus on individual metals, neglecting combined effects. We aimed to assess the effects of both single and combined prenatal metals exposure on one-year-old infants' neurodevelopment. This study included 189 mother-infant pairs from the Complex Lipids in Mothers and Babies (CLIMB) cohort. The concentrations of 21 metallic elements and 2 metalloids in umbilical cord blood (UCB) serum were measured using inductively coupled plasma mass spectrometry (ICP-MS). Neurodevelopment was measured using Chinese version of Bayley Scales of Infant Development (BSID) for the Psychomotor Development Index (PDI) and the Mental Development Index (MDI). Multiple statistical methods, including linear models, restricted cubic splines (RCS), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). After adjusting for potential confounders, prenatal arsenic (As) and strontium (Sr) levels were associated with lower PDI scores (As: β = -2.324; 95 % CI: -4.61, -0.04; Sr: β = -2.426; 95 % CI: -4.67, -0.18) by linear regression, while Sr was associated with lower MDI scores (β = -2.841; 95 % CI: -5.44, -0.25). RCS models revealed nonlinear dose-response relationships between manganese (Mn) and calcium (Ca) with PDI, and for Mn, As, and zirconium (Zr) with MDI. Interactions between certain metals were also identified. Metals mixture had an overall negative effect on both PDI and MDI scores, with Mn being the primary contributor. Prenatal exposure to selected metals or metal mixtures is associated with poorer neurodevelopment in one-year-old infants.

Clinical and angiographic outcomes of intracranial aneurysms treated with low-profile braided or laser-cut stents: a propensity score-matched analysis.

To compare the embolization outcomes and complications of the LEO Baby and Neuroform Atlas stents in the endovascular treatment of intracranial wide-neck aneurysms. We identified patients with intracranial aneurysms treated with LEO Baby (n=163) or Atlas (n=65) stent-assisted coiling between October 2018 and February 2023. A retrospective analysis of demographics, aneurysm characteristics, embolization outcomes, and procedure-related complications was performed. Propensity score matching analysis with a ratio of 1:2 was used to balance the patient selection bias that existed between the two cohorts. Compared to the Atlas cohort, the LEO Baby cohort had a higher rate of immediate successful embolization (95.6% vs. 78.5%, P<0.001) and a lower rate of incomplete embolization at midterm follow-up (4.0% vs. 18.6%, P=0.006), but there was no significant difference for either after matching for a 1:2 propensity score (P=0.091 and P=0.081, respectively). Procedure-related complications were 10.4% (17/163) in the LEO Baby cohort and 7.7% (5/65) in the Atlas cohort. At midterm angiographic follow-up, recanalization occurred in 0.8% (1/124) of the LEO Baby cohort and 4.7% (2/43) of the Atlas cohort. Complication and recanalization rates for both stents were not statistically different before (P=0.701 and P=0.332, respectively) and after (P>0.999 and P>0.999, respectively) propensity score matching. Both LEO Baby and Atlas are safe and effective in the treatment of intracranial aneurysms, and they are similar in terms of aneurysm embolization outcomes and complication rates.

Automated Segmentation of Fetal Intracranial Volume in Three-Dimensional Ultrasound Using Deep Learning: Identifying Sex Differences in Prenatal Brain Development.

The human brain undergoes major developmental changes during pregnancy. Three-dimensional (3D) ultrasound images allow for the opportunity to investigate typical prenatal brain development on a large scale. Transabdominal ultrasound can be challenging due to the small fetal brain and its movement, as well as multiple sweeps that may not yield high-quality images, especially when brain structures are unclear. By applying the latest developments in artificial intelligence for automated image processing allowing automated training of brain anatomy in these images retrieving reliable quantitative brain measurements becomes possible at a large scale. Here, we developed a convolutional neural network (CNN) model for automated segmentation of fetal intracranial volume (ICV) from 3D ultrasound. We applied the trained model in a large longitudinal population sample from the YOUth Baby and Child cohort measured at 20- and 30-week of gestational age to investigate biological sex differences in fetal ICV as a proof-of-principle and validation for our automated method (N = 2235 individuals with 43492 ultrasounds). A total of 168 annotated, randomly selected, good quality 3D ultrasound whole-brain images were included to train a 3D CNN for automated fetal ICV segmentation. A data augmentation strategy provided physical variation to train the network. K-fold cross-validation and Bayesian optimization were used for network selection and the ensemble-based system combined multiple networks to form the final ensemble network. The final ensemble network produced consistent and high-quality segmentations of ICV (Dice Similarity Coefficient (DSC) > 0.93, Hausdorff Distance (HD): HDvoxel < 4.6 voxels, and HDphysical < 1.4 mm). In addition, we developed an automated quality control procedure to include the ultrasound scans that successfully predicted ICV from all 43492 3D ultrasounds available in all individuals, no longer requiring manual selection of the best scan for analysis. Our trained model automatically retrieved ultrasounds with brain data and estimated ICV and ICV growth in 7672 (18%) of ultrasounds in 1762 participants that passed the automatic quality control procedure. Boys had significantly larger ICV at 20-weeks (81.7 ± 0.4 mL vs. 80.8 ± 0.5 mL; B = 2.86; p = 5.7e-14) and 30-weeks (257.0 ± 0.9 mL vs. 245.1 ± 0.9 mL; B = 12.35; p = 8.2e-27) of pregnancy, and more pronounced ICV growth than girls (delta growth 0.12 mL/day; p = 1.8e-5). Our automated artificial intelligence approach provides an opportunity to investigate fetal brain development on a much larger scale and to answer fundamental questions related to prenatal brain development.

Ear Problems Are Associated With Traumatic Dental Injuries Among Australian-Indigenous-Children.

The association between ear problems and traumatic dental injuries (TDIs) has not been examined in longitudinal cohort studies. The study aimed to estimate the effect of ear problems on TDIs in primary and permanent teeth among Australian Indigenous children. The Longitudinal Study of Indigenous Children is a study of two representative cohorts of Indigenous Australian children, aged from 6 months to 2 years (baby cohort) or from 3.5 to 5 years (child cohort) at baseline (2008). The children's mother/primary carer undertook a face-to-face interview in 2008, repeated annually for the next 9 years. Ear problems included runny ears, perforated eardrum, total deafness, deaf in one ear, hearing loss/partially deaf, and other ear problems. TDIs were teeth and oral soft and hard tissue injuries. Multivariate survival analysis using Cox proportional regression models estimated hazards ratio (HR) were used in the analysis. A total of 870 from baby cohort and 668 from child cohort Indigenous children, who had no TDIs at baseline were included in the analysis. The prevalence of TDIs was 9.2%, 11.1%, and 6.6% in the total, baby, and child cohorts, respectively. Multivariable models for TDIs indicate children with ear problems had nearly four times (total: HR = 3.72, 95% CI: 1.82-6.77), five times (baby cohort: HR = 4.76, 95% CI: 1.59-11.63), and more than 15 times (child cohort: HR = 16.2, 95% CI: 4.78-49.28) the average hazard over time, than those without ear problems. After adjusting for all covariates, children with ear problems had more than 22 times (HR = 22.03, 95% CI: 4.50-87.07) TDIs than those without ear problems in the child cohort. Mothers/primary carers with lower educational level was positively associated with the incidence of TDIs. Ear problems were a risk indicator for the increased incidence of TDIs in two large cohorts of Indigenous Australian children. Mothers/primary carers' educational level was a significant risk factor for TDIs.

Association of cord plasma metabolites with birth weight: results from metabolomic and lipidomic studies of discovery and validation cohorts.

Birth weight is a good predictor of fetal intrauterine growth and long-term health. Although several studies have evaluated the relationship between metabolites and birth weight, no prior study has comprehensively investigated the metabolomic and lipidomic and further validated and quantified meaningful metabolites. Firstly, a pseudotargeted metabolomics approach was applied to detect 2418 metabolites in 504 cord blood samples in the discovery set enrolled from the Wuhan Healthy Baby Cohort (HBC), China. Metabolome-wide association scan (MWAS) analysis and pathway enrichment were applied to discover metabolites and metabolic pathways that were significantly associated with birth weight for gestational age (BWGA) z-score. Logistic regression models were used to analyze the association of metabolites in the most significantly associated pathways with small for gestational age (SGA) and low birth weight (LBW). Subsequently, 350 cord blood samples in a validation cohort were subjected to targeted analysis to validate the metabolites screened from the discovery cohort. In the discovery set, 513 metabolites were significantly associated with BWGA z-score (PFDR <0.05), of which 298 KEGG-annotated metabolites were included in the pathway analysis. The primary bile acid biosynthesis pathway was the most relevant metabolic pathway associated with BWGA z-score in our study. Elevated cord plasma primary bile acids were associated with lower BWGA z-score and higher odds of SGA or LBW in the discovery and validation cohorts. In the validation set, a 2-fold increase in taurochenodeoxycholic acid (TCDCA) and taurocholic acid (TCA) was associated with 0.10 (95% CI: 0.00, 0.20) and 0.18 (95 %CI: 0.04, 0.31) decrease in BWGA z-score, respectively, after adjusting for covariates. In addition, a 2-fold increase in cord plasma TCDCA and TCA was associated with an adjusted odds ratio of 1.52 (1.00, 2.30) and 1.77 (1.05, 2.98) for SGA, respectively. The adjusted ORs for a 2-fold increase in TCDCA and TCA concentrations were 2.39 (95% CI 1.00, 5.71) and 3.21 (0.96, 10.74) for LBW, respectively. The results indicate a significant association between primary bile acids and lower BWGA z-score, as well as higher risk of SGA and LBW. Abnormalities of primary bile acid metabolism may play an important role in restricted fetal development. This article is protected by copyright. All rights reserved.

Associations of prenatal blood pressure trajectory and variability with child neurodevelopment at 2 years old

BackgroundThe patterns of blood pressure (BP) change throughout the pregnancy were related to adverse birth outcomes. However, little is known about the long-term effect of BP change patterns on child neurodevelopment. This study aimed to explore the relationship between the BP trajectory and BP variability during pregnancy and early childhood neurodevelopment.MethodA total of 2797 mother-newborn pairs were derived from the Wuhan Healthy Baby Cohort Study. BP was measured during each antenatal visit, and Mental and Psychomotor Development Indexes (MDI and PDI) were assessed using the Bayley Scales of Infant Development (BSID) when the children were 2 years old. Delayed neurodevelopment was defined as scores of PDI or MDI less than − 1SD relative to the mean score of the study population. A group-based multi-trajectory model was adopted to identify multi-trajectories of systolic blood pressure (SBP) and diastolic blood pressure (DBP). Visit-to-visit BP variability was assessed by the coefficient of variation (CV), standard deviation (SD), and average real variability (ARV). Generalized linear models and multivariate logistic regressions were used to assess the associations of BP trajectories and variability with BSID scores and delayed neurodevelopment, respectively.ResultsFive distinct trajectories for SBP and DBP were identified, namely, “Low-increasing,” “Low-stable,” “Moderate-decreasing,” “Moderate-increasing,” and “High-stable” groups. Compared with the “Low-stable” group, the children whose mothers’ BP fell into the other four groups had lower PDI scores, and mothers in the “Low-increasing,” “Moderate-increasing,” and “Moderate-decreasing” groups had 43% (OR: 1.43, 95% CI: 1.01, 2.03), 48% (OR: 1.48, 95% CI: 1.05, 2.08) and 45% (OR:1.45, 95% CI: 1.03, 2.04) higher risk of having offspring with delayed psychomotor neurodevelopment, respectively. High DBP variability was associated with lower BSID scores, and delayed psychomotor neurodevelopment (OR = 1.46, 95% CI: 1.10, 1.92 for DBP-SD; OR = 1.53, 95% CI: 1.16, 2.02 for DBP-CV).ConclusionOur findings suggest that BP change patterns assessed by multi-trajectory and visit-to-visit variability were associated with lower BSID scores and delayed neurodevelopment. Health professionals should be aware of the influence of BP level and its oscillations during pregnancy on the risk of delayed neurodevelopment.

Impact of scaling up of kangaroo mother care on neonatal mortality among babies born with birth weight

ObjectiveTo assess the impact of scaling up of kangaroo mother care (KMC) on neonatal mortality among babies born with birth weight <2000 g across an entire district in southern India.Design,...

The association between academic achievement goals and adolescent depressive symptoms: a prospective cohort study in Australia

Students define academic competence across two axes: developing skills and understanding (mastery) versus comparisons with peers (performance), and achieving goals (approach) versus avoiding failure (avoidance). We aimed to examine the longitudinal association between achievement goals and adolescent depressive symptoms. We analysed data from the Kindergarten (recruited at age 4-5 years; born between March, 1999, and February, 2000; recruited from March, 2004 to November, 2004) and Baby (recruited at age 0-1 years; born between March, 2003, and February, 2004; recruited from March, 2004 to January, 2005) cohorts of the Longitudinal Study of Australian Children. Participants were identified through the Medicare enrolment database and sampled using a randomised selection stratified by postcode to represent the Australian population. Achievement goals were measured at age 12-13 years with the Achievement Goal Questionnaire (ranges from 1 to 7 on each of the four subscales), and depressive symptoms with the Short Mood and Feelings Questionnaire (score ranges from 0 to 26, with higher scores indicating more severe symptoms) at ages 14-15 years (both cohorts) and 16-17 years (Kindergarten cohort only). Analyses were linear multilevel and traditional regressions, with confounder adjustment, for participants with available data on the exposures, confounders, and outcome. We included 3200 participants (1585 female and 1615 male) from the Kindergarten cohort and 2671 participants (1310 female and 1361 male) from the Baby cohort. A 1-point increase in mastery-approach goals was associated with decreased depressive symptom severity score (Kindergarten, -0·33 [95% CI -0·52 to -0·15]; Baby, -0·29 [-0·54 to -0·03]), while a 1-point increase in mastery-avoidance goals was associated with increased depressive symptom severity score (Kindergarten, 0·35 [95% CI 0·21 to 0·48]; Baby, 0·44 [0·25 to 0·64]). A 1-point increase in performance-avoidance goals was associated with increased depressive symptom severity score in the Kindergarten cohort but not the Baby cohort (Kindergarten, 0·26 [95% CI 0·11 to 0·41]; Baby, -0·04 [-0·27 to 0·19]). We found little evidence of an association between depressive symptom severity and performance-approach goals. Depressive symptoms in adolescents were associated with their achievement goals, which could be targetable risk factors for future trials to investigate whether school-based interventions that aim to enhance factors consistent with mastery goals (ie, learning skills and understanding the subject, rather than assessing competence in comparison to peers) could prevent depression in adolescents. Sir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society.

Retinopathy of prematurity in triplets - Indian twin city ROP study report number 12.

To evaluate the incidence and severity of retinopathy of prematurity (ROP) amongst surviving triplets. Records of preterm babies born to mothers with triplet pregnancies were retrieved from our Indian twin city ROP study database between 1 Jan 2000 and 31 Dec 2020 and analyzed. 253 surviving triplet babies born to 108 mothers were evaluated. 48 out of 108 (44%) mothers received treatment for infertility. Data was available and analyzed for 242 babies (484 eyes). Mean gestational age was 31.76 ± 3.74 weeks (26- 38 weeks). The mean birth weight was 1.44 ± 0.37 kg (0.57-2.76 kg). At the first screening, incomplete vascularization was noted in 67% (131 babies;322 eyes) of which ROP was diagnosed in 14% (28 babies; 56 eyes). Among them, only 18 babies (53%) were the smallest birth weight babies in each of the triplet sets. Treatment with laser or bevacizumab was performed in 14 babies (5.8%), one eye of one baby additionally needed vitreoretinal surgical intervention. Good anatomical outcomes in terms of regression of ROP without sequelae were achieved in all babies. The present study reveals low incidence and favorable outcomes of ROP in triplet pregnancies in a large cohort of babies from a middle-income country. Our cohort did not show any difference in the treatment-requiring ROP among the larger or smaller birth weight babies of the same gestational age. In multiple pregnancies, gestational age remains a critical factor for ROP development; however, this does not necessitate modifying screening or treatment criteria in such triplet pregnancies.

Who performs neonatal hip assessment: is there a cause for concern?

ObjectiveThe UK falls behind other European countries in the early detection of developmental dysplasia of the hip (DDH) and screening strategies differ for early detection. Clinical detection of DDH is...

Inspired oxygen fraction thresholds to accurately predict surfactant administration in neonatal RDS is gestational age strata: A pragmatic, multi‐center study

AbstractObjectiveCurrent international guidelines on neonatal respiratory distress syndrome (RDS) recommend continuous positive airway pressure (CPAP) stabilization as primary treatment. Some guidelines recommend surfactant replacement for babies requiring FiO2 &gt; 0.3 regardless of gestational age (GA). We explore the accuracy of alternative inspired oxygen fraction (FiO2) thresholds as early predictors of surfactant replacement in babies stratified by GA.Study DesignPragmatic, observational study in 12 Italian and Spanish neonatal intensive care units. This is a secondary analysis of data from two cohorts of preterm babies with RDS, stratified by GA (25°− 276; 28°−306; 31°−336) and stabilized on CPAP. FiO2 was collected soon after stabilization and its accuracy to predict subsequent surfactant administration by a rigorously masked physician was assessed.ResultsWe enrolled 412 preterm infants. FiO2 was collected within 2 h of life of life. A cut off of FiO2 &gt; 0.30 failed to identify 50.3% of infants who were later given surfactant by a masked physician. A FiO2 = 0.29 threshold improved sensitivity values to 0.85, 0.79, and 0.61 for the three GA ranges while maintaining specificity of ≥85%. A FiO2 = 0.26 threshold gave sensitivity = 0.83 specificity = 0.79 with GA dependent differences (250−276 sensitivity = 0.90 specificity = 0.80; 280−306 sensitivity = 0.84 specificity = 0.78; 310−336 sensitivity = 0.73 specificity = 0.80).ConclusionsFiO2 is a GA dependent predictor of early surfactant administration. Its accuracy increases when used at lower levels than currently recommended by international guidelines (236 words).

The Pandemic and Preschoolers: COVID Kids and How Libraries Can Support Them

Librarians around the nation must learn how to address preschoolers in a post-pandemic world.In an article called “COVID Babies,” Adam Clark explores various ways that the pandemic has affected children’s development. Clark begins with a vignette about a two-year-old named Charlie who is in speech therapy to help him learn to speak more than one-word utterances. Nancy Polow, one of the speech pathologists interviewed in the article, notes, “I have never seen such an influx of infants and toddlers unable to communicate. We call these children COVID babies.”Shuffrey et al. studied two cohorts of babies born shortly after the pandemic began: those whose mothers had COVID-19 while pregnant and those whose mothers did not have COVID-19 while pregnant. Compared to an older cohort of children born before the pandemic, both pandemic-era cohorts showed significantly lower scores on gross motor, fine motor, and social skills than the pre-pandemic cohort. While exposure to the virus in utero does not seem to be implicated, the researchers speculated that the stress that pregnant mothers experienced during the first part of the pandemic might have contributed to some of the developmental lags they saw. They urge long-term monitoring of children born during the pandemic to better understand the impact of being gestated and born during this time period.

Developmental impairment in children exposed during pregnancy to maternal SARS-COV2: A Brazilian cohort study

To determine the effects of in-utero exposure to maternal SARS-CoV-2 infection on offspring's neurodevelopment during the first year of life. We performed a prospective cohort of babies exposed to SARS-CoV-2 during pregnancy, and a control group (CG) of unexposed babies in a low-income area in Brazil. Children's neurodevelopment was assessed using the guide for Monitoring Child Development in the Integrated Management of Childhood Illness context for both groups (at 1,2,3,4,5,6, 9, and 12 months), and the Ages & Stages Questionnaire (ASQ-3) for the exposed group (EG) (at 4, 6 and 12 months). We followed 137 children for 1 year, 69 in the COVID-19-EG, and 68 in the CG. All mothers were unvaccinated at the time of cohort inclusion, and maternal demographics were similar in the two groups. 20.3% of EG children and 5.9% of the CG received a diagnosis of neurodevelopmental delay within 12 months of life (P=0.013, relative risk=3.44; 95% confidence interval, 1.19- 9.95). For the EG, the prevalence of neurodevelopment impairment using Ages & Stages Questionnaire was 35.7% at 4 months, 7% at 6 months, and 32.1% at 12 months. SARS-CoV-2 exposure was associated with neurodevelopmental impairment, and specific guidelines are needed for the follow-up of these high-risk children to mitigate the long-term effects on children's health.

The Association between Prenatal Exposure to Per- and Polyfluoroalkyl Substances and Respiratory Tract Infections in Preschool Children: A Wuhan Cohort Study.

This study investigates the association between prenatal exposure to per- and polyfluoroalkyl substances (PFASs) and the incidence and frequency of respiratory tract infections (RTIs) in preschool children. We selected 527 mother-infant pairs from Wuhan Healthy Baby Cohort (WHBC), China. Ten PFASs were measured in umbilical cord serum, and we collected data on common RTIs in preschool children aged 4 years through a questionnaire. Associations of single PFASs with the incidence and frequency of RTIs were analyzed via Logistic regression and Poisson regression, while the collective effect was assessed by weighted quantile sum (WQS) regression. Furthermore, stratified and interaction analyses were performed to evaluate if there were sex-specific associations. We found a positive correlation between perfluorododecanoic acid (PFDoDA) and the incidence of tonsillitis, with several PFASs also showing positive associations with its frequency. Moreover, perfluorotridecanoic acid (PFTrDA) showed a positive link with the frequency of common cold. The results of WQS regression revealed that after adjusting for other covariates, PFASs mixture showed a positive association with the incidence of tonsillitis, the frequency of common cold, and episodes. In particular, perfluoroundecanoic acid (PFUnDA), PFDoDA, PFTrDA, perfluorodecanoic acid (PFDA) and 8:2 chlorinated polyfluorinated ether sulfonic acid (8:2 Cl-PFESA) had the most significant impact on this combined effect. The results suggest that both single and mixed exposures to PFASs may cause RTIs in preschool children. However, there was no statistically significant interaction between different PFASs and sex.

O4 - Insights gained from the first three years of a newly established publicly funded homebirth program

O4 - Insights gained from the first three years of a newly established publicly funded homebirth program

Hair and cord blood element levels and their relationship with air pollution, dietary intake, gestational diabetes mellitus, and infant neurodevelopment

Exposure to a range of elements, air pollution, and specific dietary components in pregnancy has variously been associated with gestational diabetes mellitus (GDM) risk or infant neurodevelopmental problems. We measured a range of pregnancy exposures in maternal hair and/or infant cord serum and tested their relationship to GDM and infant neurodevelopment. A total of 843 pregnant women (GDM=224, Non-GDM=619) were selected from the Complex Lipids in Mothers and Babies cohort study. Forty-eight elements in hair and cord serum were quantified using inductively coupled plasma-mass spectrometry analysis. Binary logistic regression was used to estimate the associations between hair element concentrations and GDM risk, while multiple linear regression was performed to analyze the relationship between hair/cord serum elements and air pollutants, diet exposures, and Bayley Scales of infant neurodevelopment at 12 months of age. After adjusting for maternal age, BMI, and primiparity, we observed that fourteen elements in maternal hair were associated with a significantly increased risk of GDM, particularly Ta (OR=9.49, 95% CI: 6.71, 13.42), Re (OR=5.21, 95% CI: 3.84, 7.07), and Se (OR=5.37, 95% CI: 3.48, 8.28). In the adjusted linear regression model, three elements (Rb, Er, and Tm) in maternal hair and infant cord serum were negatively associated with Mental Development Index scores. For dietary exposures, elements were positively associated with noodles (Nb), sweetened beverages (Rb), poultry (Cs), oils and condiments (Ca), and other seafood (Gd). In addition, air pollutants PM2.5 (LUR) and PM10 were negatively associated with Ta and Re in maternal hair. Our findings highlight the potential influence of maternal element exposure on GDM risk and infant neurodevelopment. We identified links between levels of these elements in both maternal hair and infant cord serum related to air pollutants and dietary factors.

Determinants of Kangaroo Mother Care Uptake for Small Babies Along the Health Facility to Community Continuum in Karnataka, India.

Kangaroo mother care (KMC) scale-up is a proposed strategy to accelerate reduction in neonatal mortality rates. We aimed to identify determinants of KMC uptake for small babies (less than 2,000 g birth weight) along the health facility to community continuum in Karnataka, India. From June 2017 to March 2020, data on characteristics of health facilities and health care workers (HCWs) from 8 purposively selected health facilities were assessed. Knowledge, attitude, and support the mothers received for KMC uptake were assessed once between 4 weeks and 8 weeks unadjusted age of the cohort of babies. Secondary data on KMC were obtained from the district-wide implementation research project database. Bivariate analysis was used to assess the association of characteristics of health facilities, HCWs, mothers, and small babies with the day of KMC initiation and its duration. Log-binomial regression analysis was then computed to identify determinants of KMC. We recruited 227 (91.5%) of 248 babies eligible to participate with a mean unadjusted age of 35.6 days (±7.5) and 1,693.9 g (±263.1 g) birth weight. KMC was initiated for 95.2% of 227 babies at the health facility; initiated at 3 days or earlier of life for 59.6% of 226 babies; and babies continued to receive KMC for more than 4 weeks (30.2 days [±8.4]) at home. Determinants of KMC initiation were HCWs' attitudes, initiation support at the health facility, and place of hospitalization. Determinants of KMC maintenance at the health facility were HCWs' skills and support the mother received at the facility after initiating KMC. Place of hospitalization and HCWs' knowledge determined KMC duration at home 1 week after discharge. These findings emphasize the importance of competent HCWs and support for mothers at the health facility for initiation and maintenance of KMC within the health facility and 1 week after discharge.

Associations of maternal pre-pregnancy body mass index and gestational weight gain with risk of offspring neurodevelopment at 2years: A Chinese birth cohortstudy.

In recent decades, there has been a surge in both obesity and developmental impairments. Only a few research have looked at the relationship between gestational weight growth and pre-pregnancy BMI in mothers and the neurobehavioral development of their infants. The current research investigates the associations among maternal pre-pregnancy BMI, GWG, and the risk of child neural development at 2 years of age depending on a Chinese birth prospective study. The study population was 3,115 mother-infant pairs were registered in the Wuhan Health Baby cohort between September 2013 and October 2018, and data from this cohort was used in this investigation. The Chinese classification was used to group maternal BMI before conception. Based on the 2019 Life Cycle Project-Maternal Obesity and Childhood Outcomes Study Group, categories for GWG were created. The outcome was an assessment of child neural development at age 2 which was measured by employing a Chinese translation of the Bayley scales (BSID-CR). The multivariate regression models were used to calculate the beta (β) coefficients and 95% confidence intervals (CIs) for estimating the associations between continuous Bayley scores and maternal pre-pregnancy BMI categories, as same as in GWG categories. Infants of overweight and obese moms exhibited lower MDI scores than those of mothers with normal pre-pregnancy BMI (β = -2.510, 95%CI = -4.821 to -0.200) in the entire sample. Meanwhile, we find among the normal pre-pregnancy BMI mothers, infants of inadequate GWG mothers had lower MDI scores (β = -3.952, 95%CI = -7.809 to -0.094) compared with the referenced adequate GWG mothers, as well as the infants of excessive GWG mothers among the underweight pre-pregnancy BMI mothers (β = -5.173, 95%CI = -9.803 to -0.543). The PDI scores of the infants were not affected by the maternal pre-pregnancy BMI or GWG. For Chinese babies aged 2 in this nationally representative sample, aberrant pre-pregnancy BMI and GWG can impair infants' mental development, but not psychomotor development. Such results are significant given the incidence of overweight and obesity as well as the long-term effects of early brain development. In this study we found optimal GWG recommendations proposed by 2019 Life Cycle Project-Maternal Obesity and Childhood Outcomes Study Group were more suitable for Chinese women than 2009 Institute of Medicine(IOM) guidelines. Additionally, women should be given general advice on how to achieve their ideal pre-pregnancy BMI and GWG.

Trimester-specific associations of maternal exposure to bisphenols with neonatal thyroid stimulating hormone levels: A birth cohort study

Growing evidence suggests that exposure to bisphenol A (BPA) during pregnancy could interfere with neonatal thyroid function. Bisphenol F (BPF) and bisphenol S (BPS) are increasingly used as the substitutes of BPA. However, little is known about the effects of maternal exposure to BPS and BPF on neonatal thyroid function. The current study was aimed to investigate the trimester-specific associations of maternal exposure to BPA, BPS, and BPF with neonatal thyroid stimulating hormone (TSH) levels. Between November 2013 and March 2015, a total of 904 mother-newborn pairs were recruited from the Wuhan Healthy Baby Cohort Study, providing maternal urine samples in the first, second, and third trimesters for bisphenol exposure assessment, and neonatal heel prick blood samples for TSH measurement. Multiple informant model and quantile g-computation were used to evaluate the trimester-specific associations of bisphenols individually and mixture with TSH, respectively. Each doubling concentration increase of maternal urinary BPA in the first trimester was significantly related to a 3.64% (95% CI: 0.84%, 6.51%) increment in neonatal TSH. Each doubling concentration increase of BPS in the first, second and third trimesters were associated with 5.81% (95% CI: 2.27%, 9.46%), 5.70% (95% CI: 1.99%, 9.55%), 4.36% (95% CI: 0.75%, 8.11%) higher neonatal blood TSH, respectively. No significant association between trimester-specific BPF concentration and TSH was observed. The relationships between exposures to BPA/BPS and neonatal TSH were more evident in female infants. Quantile g-computation indicated that maternal co-exposure to bisphenols in the first trimester was significantly associated with neonatal TSH levels in a non-linear fashion. Maternal exposure to BPA and BPS were positively associated with neonatal TSH levels. The results indicated the endocrine disrupting effect of prenatal exposure to BPS and BPA, which should be of particular concern.

NEONATAL HIP ASSESSMENT: PREDICTABLE FAILURE

The UK falls behind other European countries in the early detection of Developmental Dysplasia of the hip (DDH) and there remains controversy surrounding screening strategies for early detection. Clinical detection of DDH is challenging and recognised to be dependent on examiner experience. No studies exist assessing the number of personnel currently involved in such assessments.Our objective was to study the current screening procedure by studying a cohort of new-born babies in one teaching hospital and assess the number of health professionals involved in neonatal hip assessment and the number of examinations undertaken during one period by each individual.This was a retrospective observational study assessing all babies born consecutively over a 14-week period in 2020. Record of each initial baby check was obtained from Maternity or Neonatal Badger. Follow-up data on ultrasound or orthopaedic outpatient referrals were obtained from clinical records.1037 babies were examined by 65 individual examiners representing 9 different healthcare professional groups. The range of examinations conducted per examiner was 1- 97 with a mean of 15.9 examinations per person. 49% individuals examined 5 or less babies across the 14 weeks, with 18% only performing 1 examination. Of the 5 babies (0.48%) treated for DDH, one was picked up on neonatal assessment.In a system where so many examiners are involved in neonatal hip assessment the experience is limited for most examiners. It is unsurprising that high current rates of late presentation of DDH are observed locally, which are in accordance with published national experience.