Early Months Of Life Research Articles

Timing Of Primary Surgery for cleft palate (TOPS): protocol for a randomised trial of palate surgery at 6 months versus 12 months of age

IntroductionCleft palate is among the most common birth abnormalities. The success of primary surgery in the early months of life is crucial for successful feeding, speech, hearing, dental development and...

Vitamin D supplementation –Is it the time to stop wasting money on vitamin D?

In recent years, vitamin D has received increased attention, as a number of studies have shown its link to the pathogenesis of various diseases. Apart from its benefits on bone health, vitamin D supplementation has been shown beneficial in reducing risk for many chronic diseases including autoimmune diseases, type 2 diabetes, heart disease, many cancers and infectious diseases. Vitamin deficiency has been associated with increased risk of elevated blood pressure, heart attack and stroke in studies. The relationship between vitamin D deficiency and the increased incidence of upper respiratory infections, asthma and eczema, among children, has been observed in several studies. Recent meta-analyzes showed a relationship between vitamin D administration during the early months of life and a lower incidence of type 1 diabetes later in life. Therefore, it is not surprising that Vitamin D supplementation is used to prevent and treat a wide range of diseases, and the use has increased considerably in the last decade.

Very Early Identification and Intervention for Infants at Risk of Neurodevelopmental Disorders: A Transdiagnostic Approach

AbstractNeurodevelopmental disorders (NDDs) begin in the earliest months of life, but the clinical manifestations of many such disorders—including intellectual disability, autism spectrum disorder, attention‐deficit hyperactivity disorder, and fetal alcohol spectrum disorder—are often not seen until much later. Theoretically, very early intervention provides the best chance for optimizing outcomes for children at risk. However, opportunities for early intervention may be thwarted by a dependence on assessing overt phenotypic or behavioral symptoms that often emerge later in childhood. In this article, we examine the utility of a transdiagnostic, dimensional approach to very early identification and intervention for infants at risk of NDDs. We consider how insights from epidemiology, systems biology, and developmental neuroscience may be integrated to aid identifying at‐risk infants and developing targeted, adaptive interventions. We also highlight directions for research.

Epidemiology of rotavirus gastroenteritis and need of high rotavirus vaccine coverage with early completion of vaccination schedule for protection against rotavirus diarrhea in India: A narrative review

Rotavirus is a leading cause of severe pediatric diarrhea worldwide, with about 199,000 childhood deaths in 2015, of which 90% in low-income countries. India alone accounts for 22% of the global rotavirus gastroenteritis (RVGE)-related deaths among children below 5 years of age. The World Health Organization recommends introducing rotavirus vaccines (RVVs) as a priority in developing countries where high rates of RVGE are observed. To have the desired impact, RVV should be administered the earliest possible, ideally before the first episode of RVGE. In India, four RVVs are available for use in infants ≥6 weeks of age: the single-strain, two-dose, live-attenuated human RVV Rotarix; the five-strain, three-dose, human-bovine reassortant RVV Rotateq; the single-strain, three-dose, naturally reassortant human-bovine RVV Rotavac; and the five-strain, three-dose, human-bovine RVV Rotasiil; all of them proven to be efficacious and well tolerated. Whereas Rotarix and Rotateq have shown high efficacy/effectiveness against severe RVGE in developed countries (≥90%), they have been observed to be lower in developing countries (~40%-70%). Rotavac and Rotasiil have shown similar efficacy in low-income settings, but further studies are needed to assess their effectiveness. Rotarix and Rotateq have not shown increased intussusception (IS) risk in clinical trials. Postmarketing surveillances were able to show a very tiny increased risk of IS after the first dose of vaccine, but the extensive benefits of rotavirus vaccination far outweigh the low-level risk of IS. In India, where the disease is a major problem and occurs in very early months of life, RVVs should have high coverage and vaccination schedule should be completed as early as possible (≥6 weeks of age) to maximize the vaccine impact.

Duration and Voice Quality of Early Infant Vocalizations.

Infant vocal durations have been studied from a variety of perspectives, including medical, social, and linguistic. The resultant developmental profile across the first 6 months of life, however, is still far from clear. The purpose of this study was to evaluate the durational properties of infant vocalizations from the unique perspective of voice quality. By considering an infant's modal and nonmodal voice qualities, the developmental range of vocalizations produced by infants during the early months of life was captured. Four Australian English-speaking infants were recorded for approximately 1 hr per week during the first 6 months of life. A total of 6,309 vocalizations were perceptually identified and labeled according to voice quality. The duration of each vocalization was subsequently measured. A nonlinear curve was evident for the duration of all vocalizations combined. Duration increased significantly between Months 3 and 5. Modal voice was the only voice quality that displayed a linear increase in duration across the study. All other voice qualities displayed polynomial trends. Based on the current results, the inconsistent pattern of vocal duration development found previously can be reconciled when voice quality properties of vocalizations are taken into account. A nonlinear curve is evident when a broad corpus of infant vocalizations is used, whereas a narrow corpus containing predominantly modal vocalizations displays a linear trend. The results demonstrate the necessity of including nonmodal voice qualities in infant duration experiments so as to not overstate the linear nature of duration increases.

Auditory and language outcomes in children with unilateral hearing loss

ObjectivesChildren with unilateral hearing loss (UHL) are being diagnosed at younger ages because of newborn hearing screening. Historically, they have been considered at risk for difficulties in listening and language development. Little information is available on contemporary cohorts of children identified in the early months of life. We examined auditory and language acquisition outcomes in a contemporary cohort of early-identified children with UHL and compared their outcomes at preschool age with peers with mild bilateral loss and with normal hearing. DesignAs part of the Mild and Unilateral Hearing Loss in Children Study, we collected auditory and spoken language outcomes on children with unilateral, bilateral hearing loss and with normal hearing over a four-year period. This report provides a cross-sectional analysis of results at age 48 months. A total of 120 children (38 unilateral and 31 bilateral mild, 51 normal hearing) were enrolled in the study from 2010 to 2015. Children started the study at varying ages between 12 and 36 months of age and were followed until age 36–48 months. The median age of identification of hearing loss was 3.4 months (IQR: 2.0, 5.5) for unilateral and 3.6 months (IQR: 2.7, 5.9) for the mild bilateral group. Families completed an intake form at enrolment to provide baseline child and family-related characteristics. Data on amplification fitting and use were collected via parent questionnaires at each annual assessment interval. This study involved a range of auditory development and language measures. For this report, we focus on the end of follow-up results from two auditory development questionnaires and three standardized speech-language assessments. Assessments included in this report were completed at a median age of 47.8 months (IQR: 38.8, 48.5). Using ANOVA, we examined auditory and language outcomes in children with UHL and compared their scores to children with mild bilateral hearing loss and those with normal hearing. ResultsOn most measures, children with UHL performed poorer than those in the mild bilateral and normal hearing study groups. All children with hearing loss performed at lower levels compared to the normal hearing control group. However, mean standard scores for the normal hearing group in this study were above normative means for the language measures. In particular, children with UHL showed gaps compared to the normal hearing control group in functional auditory listening and in receptive and expressive language skills (three quarters of one standard deviation below) at age 48 months. Their performance in receptive vocabulary and speech production was not significantly different from that of their hearing peers. ConclusionsEven when identified in the first months of life, children with UHL show a tendency to lag behind their normal hearing peers in functional auditory listening and in receptive and expressive language development.

Glucose Oral Solution as A Pain-Relieving Agent In Infantile Colic: A Double Blinded Randomized Clinical Trial

Background Infantile colic (IC) is a common painful disorder within early months of life. There is no definitive therapeutics for IC. In present study aimed to assess pain-relieving potential of glucose administration in infantile colic. Materials and Methods This was a double blinded randomized clinical trial performed during May 2015-June 2017 in pediatric ward of Amir-Al-Momenin Hospital, Zabol city, Iran. Overall, 72 infants were randomly assigned to either glucose or simethicone groups (36 infants per group). Treatments were continued for 28 days with either 25% or 30% glucose solution and 2.5 mg/kg simethicone. Outcomes were assessed at the end of the intervention (28 days). Statistical analysis was done in SPSS version 22.0. Results Males and females constituted 20 (55.5%), and 16 (45.5%) in glucose administrated, and 23 (63.8%) and 13 (36.2%, P=0.4) in simethicone group respectively. The mean age (days) was 19.1±3.8 and 20.2±4.9 for glucose and simethicone administrated groups, respectively (P=0.2). The crying times per day significantly reduced in both groups (mean reduction in crying times of 3.7±2.1, and 6.3±2.1 hours in glucose and simethicone groups, respectively). Moreover, 25% and 44.4% of infants in glucose and simethicone groups achieved ≥ 50% reduction in crying time, respectively (P=0.06). According to the glucose dose, infants who received 30% glucose solution significantly revealed higher ratio of ≥ 50% reduction in crying time (47.3%) than those received 25% glucose solution in which no cases fulfilled this outcome (P<0.0001). Conclusion Glucose may be a useful candidate to be considered as a pain-relieving agent in infantile colic.

Characterization of domestic pig spermatogenesis using spermatogonial stem cell markers in the early months of life

In pigs, spermatogonial stem cells (SSCs), which include gonocytes and undifferentiated spermatogonia, are classically defined as being present till up to 2 months of life. However, knowledge about this transition from gonocytes to undifferentiated spermatogonia in pigs is limited. In this study, we characterized pig SSCs in neonatal (n = 6), one-month-old (1-mo-old, n = 6), two-month-old (2-mo-old, n = 6), and adult testes (n = 6) anatomically, histologically, and immunohistologically. Anatomically, testicular circumference (TC) was measured at each development stage. Histologically, the presence or absence of seminiferous lumen was confirmed, and seminiferous tubule diameter (SD) was measured. Immunohistologically, changes in expression of pluripotent markers: DBA, UCHL1, ZBTB16, and POU5F1, were evaluated. For the analyses, cells positive for DBA, ZBTB16, UCHL1, and Vimentin per 150 round seminiferous tubules of cross sections from each testis were counted to evaluate the total number of positive cells, and then the positive cells per 100 Sertoli cells (UCHL1+/Sertoli, DBA+/Sertoli, and ZBTB16+/Sertoli) were calculated to compare the four developmental stages. Anatomically, piglet testes became larger with increasing age. Histologically, there was no seminiferous lumen in piglet testes, and only a single layer of cells was observed within the seminiferous tubules. Immunohistologically, the average number of DBA+/Sertoli, which indicates the number of gonocytes, was significant lowerthan that of UCHL1+/Sertoli (P < 0.05), which indicates the number of total SSCs in neonatal testes, suggesting that spermatogenesis had already started at birth. In 2-mo-old testes, although the average number of UCHL1+/Sertoli was the same as that in neonatal and 1-mo-old testes, the average number of DBA+/Sertoli decreased rapidly to an undetectable level. Moreover, the numbers of ZBTB16+/Sertoli and DBA+/Sertoli in neonatal testes were similar, and the number of ZBTB16+/Sertoli in 1-mo-old testes was significantly lower than that of DBA+/Sertoli (P < 0.05). Since ZBTB16 may be a marker for stable gonocytes or spermatogonia, the multiplication of the SSCs in neonatal testes may not be very vigorous, and this may be accelerated around one month of age. Consequently, our study clarified that differentiation of pig SSCs starts during the fetal period; then, transition of SSCs from gonocytes to undifferentiated spermatogonia is accelerated at one month of age and finally completed at two months of age.

A transversal pilot study of oropharyngeal carriage of Kingella kingae in healthy children younger than 6 months.

The aim of this pilot study was to investigate the extent of oropharyngeal Kingella kingae carriage during the first 6 months of life. We conducted a monocentric transversal pilot study on healthy children younger than 6 months in order to define the oropharyngeal carriage rate. Participants were recruited between December 2013 and September 2015 among children without symptoms or signs of invasive infections. We demonstrated an oropharyngeal carriage rate of 0.67% in children younger than 6 months. Due to the really low carriage rate, it was not possible to draw statistically significant conclusion about any other characteristic of our population. The present study suggests that the oropharyngeal carriage of Kingella kingae among a Swiss population of healthy infants younger than 6 months is exceptional. The scarcity of colonization and disease in the early months of life suggests thus that defense against mucosal carriage and invasive infection is above all provided by vertically acquired immunity. Limited exposure of the neonates due to limited social contacts may also represent another factor avoiding neonates' mucosal Kingella kingae carriage.

Cortical responses to shape-from-motion stimuli in the infant.

Our ability to extract three-dimensional (3-D) object structure from motion-carried information is a basic visual capacity that is fundamental to object perception. Despite a rich body of behavioral work demonstrating that infants are sensitive to motion-carried information from the early months of life, little is known about the cortical networks that support infants' use of motion-carried information to extract 3-D object structure. This study assessed patterns of cortical activation in infants aged 4 to 6 months as they viewed two types of visual stimuli: (a)shape-from-motion (SFM) displays, where coherent motion of randomly distributed dots gave rise to the percept of 3-D shape and (b)random motion (RM) displays, where dots' motions lacked a coherent structure and gave rise to the percept of randomly moving dots. Functional near-infrared spectroscopy was used to assess activation in occipital, inferior parietal, and posterior temporal cortex. The optical imaging data revealed differential responding to SFM and RM in lower level object processing areas than typically observed in the adult. Possible explanations for this pattern of results are considered.

Infant and Young Child Feeding (IYCF) Practices by Rural Mothers of Bangladesh

Background: Infant and young child feeding (IYCF) practices play vital role for the growth &amp; development in the early months of life. Objective: The purpose of the present study was to determine and to identify the patterns and influencing factors of feeding practices in infant and young children of 0-2 years old in Bangladesh. Methodology: A descriptive type of cross sectional study was carried out to assess the pattern of infant &amp; young child feeding practices by the rural mothers of Bangladesh with a sample size of 450 during the months of January to December of 2015.Result: Out of 450 children, 51.1% are female &amp; 48.9% are male. The proportions of infants with early initiation of breastfeeding (13.6%) and exclusive breastfeeding fewer than six months (57.3%) and infants who received complementary feeding at the age of 6–8 months (55.7%) were low. It showed that 90.4% of mothers have knowledge on exclusive breast feeding but only 57.3% of them have practiced it for 4-6 months. It further revealed that only 8.4% of mothers &amp; 13.6 % of fathers were illiterate. The main problems revealed from the study were late initiation of breastfeeding, low rates of exclusive breastfeeding, and inappropriate complementary feeding practices. It further revealed that 69.3% of the respondents had two or less children and 30.7% had three or more children.Conclusion: Majority of the respondents have the knowledge on complementary feeding, knowledge on preparation of complementary feeding, knowledge on preparation of food by grains, knowledge on preparation of food by milk and milk products and knowledge on preparation of food by meat, fish, poultry, liver.Journal of National Institute of Neurosciences Bangladesh, 2016;2(1):19-25

Predictors of sleep disturbances in the first year of life: a longitudinal study

ObjectiveThe aim of this study was to identify early predictors of nocturnal awakenings and short sleep duration during the first year of life, in terms of sleep habits and patterns. We also analyzed the trend of nocturnal awakenings and total sleep duration from 3 to 12 months of age. MethodsThe parents of 704 infants (49.3% female) were interviewed during their first year of life. The interview included questions on infant sleep (eg, sleep habits, sleep duration, number of nocturnal awakenings) and maternal perception of infant sleep difficulties. ResultsThe study results indicate that most of the infants at risk, with three or more nocturnal awakenings or ≤10 h of total sleep duration in the early months of life, tend to display a similar pattern of sleep problems at 12 months. The main early predictors of sleep problems at 12 months were sleep duration, sleep initiation method, and nocturnal awakenings. More specifically, infants with three or more nocturnal awakenings or ≤10 h of total sleep duration at 12 months were those with a higher number of awakenings during the night and a shorter sleep duration, at both three and six months. In addition, infants at risk for sleep problems at 12 months had an independent sleep initiation method at three months, whereas these same infants had a nonindependent sleep initiation method at six months. ConclusionsOur study identified the early predictors of sleep problems at 12 months. Caregivers should identify these early symptoms in infants to prevent possible sleep difficulties in later years.

On the other hand: Increased cortical activation to human versus mechanical hands in infants

There is a large body of work demonstrating that infants are sensitive to the distinction between human and mechanical entities from the early months of life, and have different expectations for the way these entities move and interact. The current work investigates the extent to which the functional organization of the immature brain reflects these early emerging sensitivities. Infants aged 8months watched two kinds of hands (human or mechanical) engage in two kinds of events (one with a functional outcome and one without). Using functional near-infrared spectroscopy (fNIRS), we assessed hemodynamic activation in the left and right temporal and temporal-occipital cortex in response to these events. The neuroimaging data revealed a significantly greater increase in activation in the right middle-posterior temporal cortex to events executed by the human than the mechanical hand; the event in which the hand engaged (function or non-function) did not significantly influence hemodynamic responses. In comparison, the left middle-temporal cortex showed significantly greater activation to events executed by the human than mechanical hand, but only when the events were functionally relevant. That is, the left middle-posterior temporal cortex responded selectively to human (as compared to mechanical) agents, but only in the context of functionally relevant actions on objects. These results reveal that the immature brain is functionally specialized to support infants' processing of human and non-human agents as distinct entities. These results also shed light on the cognitive and cortical mechanisms that guide infants' learning about agentive action and object function.

Population Health and Paid Parental Leave: What the United States Can Learn from Two Decades of Research.

Over the last two decades, numerous studies have suggested that dedicated time for parents to be with their children in the earliest months of life offers significant benefits to child health. The United States (US) is the only wealthy nation without a formalized policy guaranteeing workers paid time off when they become new parents. As individual US states consider enacting parental leave policies, there is a significant opportunity to decrease health inequities and build a healthier American population. This document is intended as a critical review of the present evidence for the association between paid parental leave and population health.

Improving access to primary care for Aboriginal babies in Western Australia: study protocol for a randomized controlled trial.

BackgroundDespite a decade of substantial investments in programs to improve access to primary care for Aboriginal mothers and infants, more than 50 % of Western Australian Aboriginal babies are still not receiving primary and preventative care in the early months of life. Western Australian hospitals now input birth data into the Western Australian electronic clinical management system within 48 hours of birth. However, difficulties have arisen in ensuring that the appropriate primary care providers receive birth notification and clinical information by the time babies are discharged from the hospital. No consistent process exists to ensure that choices about primary care are discussed with Aboriginal families.Methods/DesignWe will undertake a population-based, stepped wedge, cluster randomized controlled trial of an enhanced model of early infant primary care. The intervention is targeted support and care coordination for Aboriginal families with new babies starting as soon as possible during the antenatal period or after birth. Dedicated health professionals and research staff will consult with families about the families’ healthcare needs, provide information about healthcare in the first 3 months of life, offer assistance with birth and Medicare forms, consult with families about their choice for primary care provider, offer to notify the chosen primary care provider about the baby’s health needs, and offer assistance with healthcare coordination at the time of discharge from the hospital.We will evaluate this model of care using a rigorous stepped wedge approach. Our primary outcome measure is a reduced hospitalization rate in infants younger than 3 months of age. Secondary outcome measures include completed Aboriginal and Torres Strait Islander child health screening assessments, immunization coverage, and satisfaction of the families about early infant primary care. We will also assess the cost effectiveness of the model of care.DiscussionThis study will be conducted over a 4-year period in partnership with birthing hospitals and primary care providers including Western Australian Aboriginal Community Controlled Health Services and the new Primary Health Networks. The results of our trial will be used to develop improved primary care models and to improve health outcomes for all Aboriginal infants. These are vital steps toward more equitable health service delivery for the Aboriginal and Torres Strait Islander children in Australia.Trial RegistrationAustralian New Zealand Clinical Trials RegistryRegistration number: ACTRN12615000976583 Date registered: 17 September 2015

Case report of unusual presentation of marfanoid features in a 13-year-old boy with Gardner's syndrome

Gardner’s syndrome is a rare syndrome with autosomal dominant inheritance composed of a group of colonic and extracolonic disorders. Colonic disorders include intestinal polyps mainly adenomas, and extracolonic disorders include desmoid tumors, epidermoid cysts, and osteomas. Here, we present a 13-year-old boy, who was confirmed with Gardner’s syndrome; but, when we did physical examination, he revealed unusual extracolonic findings similar to that in Marfan syndrome, raising suspicion that the genetic mutation on the long arm of chromosome 5, which is responsible for Gardner’s syndrome, may also lead to some marfanoid abnormalities. Patients with Gardner’s syndrome may present at any age from early months of life up to late years. They have high probability of developing colonic cancer, because of colonic polyps that undergo malignant transformation, but, fortunately, colonic polyps show up late in life beyond other extracolonic disorders such as bone osteomas and desmoid tumors. This feature gives the chance for early diagnosis of patients with Gardner’s syndrome and allows undergoing early prophylactic surgical resection of polyps before transformation into malignant tumors.

From tin at home: the other side of the coin of the breastfeeding

The promotion of breastfeeding and the monitoring of the prevalence of breastfeeding at discharge of the newborn is one of the priorities of the health plan's integrated ToscanaRegion [1]. Since 2004, it implemented various measures to promote breastfeeding and has been involved in various investigations: “Birth Path” on a sample of 1,657 women who had given birth year previous [2], “Being a mother informed” on 2,324 pregnant women in birth centers Toscani, your raving two to three months after the childbirth[3]; and finally a survey conducted in 2010 in which 5,885 questionnaires were administered to parents who accompanied the children to make the first or second dose of vaccine required, in 44 vaccination centers AUSL championships in the region. Since 2008 data on the prevalence of breastfeeding are found on the Certificate of Assistance at Childbirth (Cedap) compiled before discharge. This will get annual data on the entire population. Comparing data obtained in the investigation there was an increase of exclusive breastfeeding at discharge 66% in 2001 to 76% in 2010. The increase was confirmed in 2012 by Cedap service where, it should be noted, a proportion of exclusive breastfeeding by 85 % with higher percentages to ‘80 % in the Baby-friendly Hospital of Tuscany. The practice of breastfeeding exclusively decreases greatly from the earliest months of life. In fact, in the survey of 2010, children breastfed exclusively were 57.5%, 17.8% is nursed in a complementary and 24.7% were not breastfed. It would seem that mothers have the perception of having “less milk” or feel disoriented by the sudden increase in demand from nurse, often it is the so-called “crisis of the third month” when the child begins to show more interest to the environment exterior that is highly stimulating; or a “growth spurt” due to the increased demand of the growing child and needs to encourage more breast attaching more often. His most distractibility breast is interpreted by the mother as a reluctance to suckle the breast and this affects the maternal perception of not having enough milk.

Balancing Benefits and Risks of Iron Fortification in Resource-Rich Countries

In the recommendations, the contrast in the iron exposure of formula-fed infants vs breastfed infants has primarily focused on the better bioavailability of the iron in breast milk. Although an absorption efficiency of approximately 50% is often quoted, some studies have actually reported absorption in the range of 12%-16%, 7,8 making that bioavailability distinction much less potent. This also suggeststhat absorptionof substantialamountsof dietary ironsimply isnot critical during the early monthsof life in healthy infants of normal birth weight. Among all the compositional differences between human milk and formula, the differences in iron content are the most extreme. Virtually all mammalian milks are low in iron, with the exception of rodents, inwhichpostnatalgrowth isextremely rapid.Itseemsimplausiblethatthisconservedbiologicalpatterniswithoutpurpose.Itis also clear that iron deficiency occurs in breastfed infants only after the very early months of life. The practical challenge is to identify when the birth iron endowment is exhausted, at which point the infant needs a source of iron from the diet. This article will discuss the potential advantages of a low iron intake for the infant and the potential adverse effects of drastically altering this, especially in the first 6 months of life. From the outset, two realities must be acknowledged. First, iron deficiency (especially without anemia) in infants remains common, particularly in high-risk groups, including older normal breastfed infants and premature and/or in low birth weight infants. Whether this mild iron deficiency has adverse effects on development is not known. Second, research on potential adverse effects of early and excessive iron exposure is limited, and the evidence base for caution is suggestive but not yet demonstrated by rigorously designed trials. Thus, this represents an emerging area of consideration, and, given the advances in understanding of iron metabolism, the interaction between iron and inflammation, and the importance of early influences on the immature gut and immune system, it is an area that warrants much stronger scientific investigation.

Education about crying in normal infants is associated with a reduction in pediatric emergency room visits for crying complaints.

The primary aim of this study was to determine whether there was any change in visits of 0- to 5-month old infants to the medical emergency room (MER) of a metropolitan pediatric hospital after province-wide implementation of a public health prevention program that teaches new parents about the properties of early crying in normal infants. Free-text descriptions of Presenting Complaint and Final Diagnosis on electronic MER clinic visit files were used to classify infants as cases of infant crying not due to disease. Annual crying case visits as a percent of MER visits were analyzed pre- and post-introduction of the prevention program. Before the program, crying case visits represented 724 of 20,394 MER visits (3.5%). The age-specific pattern of MER visits for crying peaked at 6 weeks and was similar to the previously reported age-specific pattern of amounts of crying in the community. After program implementation, crying cases were reduced by 29.5% (p < .001). The most significant reductions were for crying visits in the first to third months of life. The findings imply that improved parental knowledge of the characteristics of normal crying secondary to a public health program may reduce MER use for crying complaints in the early months of life.

Toxicity of aflatoxin B1 towards the vitamin D receptor (VDR)

This research describes an unexpected toxicity of the aflatoxin B1 towards the vitamin D receptors. Rickets is a childhood disease, and calcium deficiency is the aetiological cause in Africa, being primarily associated with nutritional problems; in this research the contribution of aflatoxin B1 exposure during the early months of life is an interesting factor to deepen in order to prevent liver damages or the development of rickets. The results show that the expression of vitamin D receptor in osteosarcoma cell line SAOS-2 is significantly down-modulated by exposure to aflatoxin B1. This seems to suggest that Aflatoxin B1, toxic towards the vitamin D receptor, interferes with the actions of the vitamin D on calcium binding gene expression in the kidney and intestine. Experimental data indicate a 58% and 86% decrease if the cells are exposed to 5 ng/mL and 50 ng/mL of aflatoxin B1, respectively. These results seem to indicate that natural occurrence of the aflatoxin B1 and allelic variant of vitamin D receptor on (F allele) increase the risk of developing rickets of African children.