First-born Infants Research Articles

Effects of prenatal small-quantity lipid-based nutrient supplements on pregnancy, birth, and infant outcomes: a systematic review and meta-analysis of individual participant data from randomized controlled trials in low- and middle-income countries

BackgroundUndernutrition during pregnancy increases the risk of giving birth to a small vulnerable newborn. Small-quantity lipid-based nutrient supplements (SQ-LNSs) contain both macro- and micronutrients and can help prevent multiple nutritional deficiencies. ObjectivesWe examined the effects of SQ-LNSs provided during pregnancy compared with 1) iron and folic acid or standard of care (IFA/SOC) or 2) multiple micronutrient supplements (MMSs) and identified characteristics that modified the estimates of effects of SQ-LNSs on birth outcomes. MethodsWe conducted a 2-stage meta-analysis of individual participant data from 4 randomized controlled trials of SQ-LNSs provided during pregnancy (n = 5273). We generated study-specific and subgroup estimates of SQ-LNS compared with IFA/SOC or MMS and pooled the estimates. In sensitivity analyses, we examined whether the results differed depending on methods for gestational age dating, birth anthropometry, or study design. ResultsSQ-LNSs (compared with IFA/SOC) increased birth weight [mean difference: +49 g; 95% confidence interval (CI): 26, 71 g] and all birth anthropometric z-scores (+0.10–0.13 standard deviation); they reduced risk of low birth weight by 11%, newborn stunting by 17%, newborn wasting by 11%, and small head size by 15%. Only 2 trials compared SQ-LNSs and MMSs; P values for birth outcomes were >0.10 except for head circumference (e.g., z-score for gestational age: +0.11; 95% CI: −0.01, 0.23). Effect estimates for SQ-LNSs compared with IFA/SOC were greater among female infants and, for certain outcomes, among mothers with body mass index <20 kg/m2, inflammation, malaria, or household food insecurity. Effect estimates for SQ-LNSs compared with MMSs were greater for certain outcomes among female infants, first-born infants, and mothers <25 y. ConclusionsSQ-LNSs had positive impacts on multiple outcomes compared to IFA/SOC, but further research directly comparing SQ-LNSs and MMSs is needed. Targeting SQ-LNSs to vulnerable subgroups may be worth considering. Clinical Trial RegistryThis study was registered at PROSPERO as CRD42021283391.

Patterns of lexical and syntactic adjustment in early infant-directed speech related to language development in Hungarian

ABSTRACT Infant-directed speech (IDS) is known to be characterised by phonetic and prosodic cues along with reduced vocabulary and syntax compared to adult-directed speech (ADS). However, there is considerable variation between mothers in the degree of lexical and syntactic reduction of their IDS. The present study aims to investigate the correspondences of the inter-individual variation of maternal IDS at 6 and 18 months with infants’ language development at 18 months. 109 dyads of mothers and their firstborn infants participated in the study. Mothers’ ID and AD storytelling based on standard picture stimuli were recorded at 6 and 18 months of their infants’ age. We analysed measures of speech quantity (number of utterances and words), syntactic complexity (mean length of utterance), and lexical diversity (type-token ratio). Language growth was measured bimonthly using the Hungarian adaptation of the MacArthur-Bates CDI W&G form. The results did not reveal any association between characteristics of mothers’ ID narratives and their infants’ concurrent language skills at 18 months. However, we found a longitudinal link between a distinct pattern of linguistic simplification in maternal ID storytelling at 6 months and the development of expressive vocabulary in infants at 18 months. Infants whose mother tends to reduce both lexical and syntactic complexity of ID narratives the most are more likely to exhibit higher language outcomes. Further research is warranted to explore the background factors and longer-term effects of this maternal strategy.

Parental positive affect and negative affect in same- and different-sex parent families: no associations with parental gender and caregiving role.

Positive and negative parental affect influence developing parent-child attachment relationships, especially during infancy as well as children's social-emotional, academic, and behavioral functioning later in life. Increasingly, because both mothers and fathers can play central caregiving roles, the parenting qualities of both parents demand consideration. Therefore, this study investigated whether parental gender and caregiving role were associated with mothers' and fathers' positive affect and negative affect during interactions with their 4-month-old firstborn infant, while determining whether parenting stress, infant temperament, having a singleton/twin, and living in the Netherlands, France, or the United Kingdom were related to parental positive affect and negative affect. In all, 135 different-sex, same-sex male, and same-sex female couples (113 fathers and 157 mothers, comprising 147 primary, and 123 secondary caregivers) who conceived through artificial reproductive techniques were studied. The couples were videorecorded at home while in feeding, cleaning, and playing contexts to assess the levels of positive and negative parental affect. In addition, the couples completed questionnaires about their caregiving role, parenting stress, and the infants' temperament. Mixed linear models indicated that the levels of positive and negative parental affect toward the infant in all contexts were not related to parental gender, caregiving role, the interaction between parental gender and caregiving role, parenting stress, infant temperament, or singleton/twin status. However, the target parental behaviors were related to the country of origin, suggesting differences among Dutch, French, and British parents. Overall, we found no evidence that gender or caregiving roles were associated with the levels of positive and negative affect shown by the parents.

Is lower fetal heart rate variability a susceptibility marker to the impact of negative coparenting on infant regulatory capacity?

Lower fetal heart rate variability (FHRV) may be a prenatal endophenotypic susceptibility marker and increase the impact of both positive and negative coparenting on infant regulatory capacity. This study analyzed the moderator role of FHRV in the association between positive and negative coparenting and infant regulatory capacity at 3 months. The sample comprised 86 first-born infants and their mothers and fathers recruited at a public Health Service in Northern Portugal. FHRV was recorded during routine cardiotocography examination at the third trimester of gestation. Mothers and fathers reported on coparenting and infant regulatory capacity at 2 weeks and 3 months postpartum. FHRV moderated the association between mother's and father's negative coparenting at 2 weeks postpartum and infant regulatory capacity at three months. Infants with low FHRV presented higher regulatory capacity when mothers or fathers reported less negative coparenting, while lower regulatory capacity when mothers or fathers reported more negative coparenting, than infants with high FHRV. Findings suggested lower FHRV as a prenatal endophenotypic susceptibility marker that increases the impact of negative coparenting on infant regulatory capacity.

Positive coparenting previous to the COVID-19 pandemic can buffer regulatory problems in infants facing the COVID-19 pandemic.

Coparenting can be a development-enhancing or risk-promoting environment for infant regulatory capacity, mainly in the presence of adversity. This study aimed to analyze the association between positive and negative coparenting previous to the COVID-19 pandemic and infant regulatory capacity in the presence of the COVID-19 pandemic, an adverse condition. A sample of 71 first-born infants and their mothers and fathers from a longitudinal cohort in Portugal were assessed at 2weeks postpartum before the COVID-19 pandemic and again at 6months postpartum, before (n=35) or during the COVID-19 pandemic (n=36). Parents completed measures of positive and negative coparenting and infant regulatory capacity in both assessment waves. Results revealed that the presence of the COVID-19 pandemic moderates the association between mothers' and fathers' positive coparenting previous to the COVID-19 pandemic and infant regulatory capacity at 6months. The association between positive coparenting and regulatory capacity was stronger in infants facing the COVID-19 pandemic, than in infants who did not face the COVID-19 pandemic. Positive coparenting previous to the COVID-19 pandemic may be a development-enhancing environment for infant regulatory capacity in the presence of the COVID-19 pandemic. Positive coparenting may buffer regulatory problems in infants facing adverse conditions.

Fetal heart rate variability and infant self-regulation: the impact of mother’s prenatal depressive symptoms

ABSTRACT Background Foetal heart rate (FHR) variability is considered a marker of foetal neurobehavioral development associated with infant self-regulation and thus may be an early precursor of the adverse impact of mother’s prenatal depressive symptoms on infant self-regulation. Objective This study analysed the mediator role of FHR variability in the association between mother’s prenatal depressive symptoms and infant self-regulation at three months. Methods The sample comprised 86 first-born infants and their mothers. Mothers reported on depressive symptoms at the first trimester of pregnancy and on depressive symptoms and infant self-regulation at three months postpartum. FHR variability was recorded during routine cardiotocography at the third trimester of pregnancy. A mediation model was tested, adjusting for mother’s postnatal depressive symptoms. Results Higher levels of mother’s prenatal depressive symptoms were associated with both lower FHR variability and lower infant self-regulation at three months. FHR variability was associated with infant self-regulation and mediated the association between mother’s prenatal depressive symptoms and infant self-regulation at three months. Conclusion Findings suggested FHR variability as an early precursor of infant self-regulation that underlies the association between mother’s prenatal depressive symptoms and infant self-regulation. Infants of mothers with higher levels of prenatal depressive symptoms could be at risk of self-regulation problems, partially due to their lower FHR variability.

Birth Weight in Consecutive Pregnancies and Maternal Cardiovascular Disease Mortality Among Spontaneous and Iatrogenic Term Births: A Population-Based Cohort Study.

Knowledge on the association between offspring birth weight and long-term risk of maternal cardiovascular disease (CVD) mortality is often based on firstborn infants without consideration of women's consecutive births. We studied long-term CVD mortality according to offspring birth weight patterns among women with spontaneous and iatrogenic term deliveries in Norway (1967-2020). We constructed birth weight quartiles (Qs) by combining standardized birth weight with gestational age in quartiles (Q1, Q2/Q3, and Q4) for the women's first 2 births. Mortality was estimated using Cox regression and expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). Changes in offspring birth weight quartiles were associated with long-term maternal CVD mortality. Compared with women who had 2 term infants in Q2/Q3, women with a first offspring in Q2/Q3 and a second in Q1 had higher mortality risk (HR=1.33, 95% CI: 1.18, 1.50), while risk was lower if the second offspring was in Q4 (HR=0.78, 95% CI: 0.67, 0.91). The risk increase associated with having a first infant in Q1 was eliminated if the second offspring was in Q4 (HR=0.99, 95% CI: 0.75, 1.31). These patterns were similar for women with iatrogenic and spontaneous deliveries. Inclusion of information from subsequent births revealed heterogeneity in maternal CVD mortality which was not captured when using only information based on the first offspring.

To Learn, Try Teaching

To Learn, Try Teaching

The Effects of the Infant Health Promotion Program for Mothers with Their Firstborn Infants

This study was intended to evaluate the effects of an Infant Health Promotion Program (IHPP) for mothers with their firstborn infants. This study employed a non-equivalent control group pretest-posttest design. The participants consisted of 17 mothers with their firstborn infants in the experimental group and 17 in the control group from two women's hospitals. The experimental group received eight sessions of the program for four weeks. The collected data were analyzed using the chi-square test and repeated-measures ANOVA using an SPSS/WIN ver. 22.0. The experimental group receiving the program had statistically significant higher levels of infant health promotion knowledge (F = 22.91, p < .001), social support (F = 27.64, p < .001), maternal role confidence (F = 8.25, p = .005) and health promotion behavior for infants (F = 16.85, p < .001) than the control group. The experimental group had a statistically significant lower level of parenting stress than the control group (F = 29.93, p < .001). The study's findings indicate that the IHPP is effective in improving health promotion knowledge, social support, and maternal role confidence and decreasing parenting stress among mothers with their firstborn infants. A method of delivering intervention, focused on readily accessible online platforms, coupled with intervention strategies grounded in the theory of self-efficacy, proves to be an advantageous approach for this particular target group.

Effects of New York state paid family leave on early immunizations

ObjectiveTo test whether introduction of New York Paid Family Leave (NY PFL) in 2018 is associated with the timeliness of immunizations among infants whose mothers reside in NY in one of the 57 counties outside of New York City (NYC). MethodsWe use difference-in-difference methods, comparing immunization outcomes before and after NY PFL went into effect among infants born to mothers who were employed during pregnancy, and thus likely to be affected by NY PFL, vs. mothers who were not employed during pregnancy and thus unlikely to be affected. Data come from two administrative sources: (1) NYS Vital Statistics birth data; and (2) the NYS Immunization Information System (NYSIIS). ResultsOur findings suggest that NY PFL is associated with small increases in the probability that firstborn infants have had all immunizations on time at the ages of two and four months. We do not find statistically significant effects of NY PFL on immunization outcomes among higher birth order children. ConclusionsOur findings suggest that NY PFL led to small improvements in the timeliness of early immunizations among firstborn infants.

PRENATAL FACTORS FOR NEONATAL JAUNDICE

Objective: To establish the role of prenatal factors for neonatal jaundice (NJ) in newborns (NB). Material and methods: Retrospective study covering 566 mothers and their newborns, patients of University Hospital Medica Ruse, Bulgaria, from 01.01.2017 to 31.10.2020. The data were obtained from the documentation of the mother. Bilirubin (BR) levels were monitored by transcutaneous measurement with a KJ-8000 bilirubinometer . Results: Significantly higher levels of BR are registered in NBs, whose mothers aged ≤20 years. History of NJ in siblings and hyperbilirubinemia in subsequent NB are moderately strongly correlated (p=0.025). First-born infants have significantly lower BR levels (p=0.037). The BR levels of NBs whose mothers were at risk of premature birth were significantly higher. In infants of mothers with Preeclampsia, lower levels of BR are registered. We found a negative linear relationship between thyroid gland pathology and BR levels. We found a positive relationship between maternal urinary tract pathology and the manifestation of hyperbilirubinemia in NBs. A negative correlation was observed between maternal anemic conditions and NB hyperbilirubinemia. NBs of mothers with inflammatory diseases of the female reproductive system have significantly higher levels of BR. Conclusion: Prenatal factors influencing NJ are maternal parity and age, as well as a history of jaundice in siblings. Inflammatory diseases of the reproductive system affect the degree of bilirubinemia, pathology of the urinary system increases its frequency. Well-controlled thyroid function and balanced iron supplementation in pregnant women help to better balance the metabolism of BR in full-term NBs. Preeclampsia diminishes the incidence of hyperbilirubinemia in full-term infants.

Predictors of delayed vaccination in infants born in Tuscany, Italy: an area based cohort study

Abstract Background Timely vaccination is essential to protect infants from vaccine-preventable diseases. The aim of the study was to evaluate the determinants of vaccination timeliness for hexavalent (HEXA) and measles-mumps-rubella (MMR) vaccines. Methods The study is part of the PREHMO project funded by Tuscany Region, Italy. Data on the 2017 and 2018 full birth cohorts of Tuscany (N = 41,493) were retrieved from the Birth Registry and linked to those of the Vaccine Registry up to 24 months after birth. Sociodemographic and at birth characteristics of mothers and infants were retrieved. The primary outcome was the timeliness of HEXA 1st and 3rd doses, and MMR 1st dose. Timeliness was defined as the administration of the dose a day after the period recommended by the vaccination schedule. Multiple logistic regression models were performed. Results For all the vaccines considered, a significantly increased risk of delayed vaccination was observed in preterm infants and in infants born in hospital of second level of newborn care, while infants conceived by assisted reproductive technologies and first-born infants showed a significantly decreased risk for delayed vaccination. Multiple births, small for gestational age status, maternal unemployment, and rural residence were significantly associated with an increased risk of delayed HEXA-1 vaccination (OR 1.31, 95%CI 1.13-1.51; OR 1.12, 95%CI 1.03-1.22; OR 1.06, 95%CI 1.01-1.13; and OR 1.1, 95%CI 1.03-1.16). As for MMR vaccination, a low maternal education was significantly associated with high risk of delay (OR 1.12, 95%CI 1.06-1.18), while rural residence, maternal foreign nationality and female sex were significantly associated with a decreased risk of delay (OR 0.91, 95%CI 0.87-0.96; OR 0.82, 95%CI 0.78-0.87; and OR 0.95, 95%CI 0.91-0.99). Conclusions Several common and vaccine-specific predictors of vaccination timeliness were identified. Strategies to improve a timely vaccination should take into account these predictors. Key messages • Several maternal and infants factors may influence vaccination timeliness of routine immunization in childhood. • Tailored vaccination strategies are needed to improve vaccination timeliness in infants at high-risk of delayed vaccination.

Comparing speech acts and complexity of maternal speech to singleton and first-born dizygotic twin infants

ABSTRACT We compared speech acts and complexity of maternal speech to firstborn dizygotic twin and singleton infants. Nine twins and nine singletons were video-recorded at home in spontaneous face-to-face interactions with their mothers, from the 2nd to the 6th month. Continuous micro-analysis revealed that (a) open-ended questions, direct requests, disapprovals and complex utterances predominated in mothers’ speech of singletons compared to twins; and (b) mothers of singletons and mothers of twins showed age-related variations in questions and in certain forms of complexity, respectively. In the framework of the theory of innate intersubjectivity, these results show that mothers of twins and mothers of singletons share the ability to adjust sensitively to their young infants’ expressive behaviours.

Maternal speech to singleton and first-born dizygotic twin infants: a four-month longitudinal and naturalistic study

ABSTRACT We compared maternal speech in interactions of mothers with their firstborn dizygotic twin and singleton infants. Nine twins and nine singletons were video-recorded at home in spontaneous face-to-face interactions with their mothers, from the 2nd to the 6th month. Continuous micro-analysis revealed that there are more quantitative and qualitative similarities than differences between singleton and twin mothers’ speech. Singleton and twin mothers are similar in the frequency of thematic sequences though duration of maternal speech favours singletons. Singleton mothers’ speech favours infant emotion and attention thematic sequences. However, singleton and twin mothers responded similarly to the rest infant internal states. Twin, but not singleton, mothers’ infant attention utterances differed at times when there are marked advances in the infants’ attentiveness. These results are discussed in relation to the theory of innate intersubjectivity and the sensitivity that twin mothers, similarly to singleton mothers, express to the young infants’ expressions.

Effect of the INSIGHT Firstborn Parenting Intervention on Secondborn Sleep.

The Intervention Nurses Start Infants Growing on Healthy Trajectories (INSIGHT) responsive parenting (RP) intervention for first-time mothers improved firstborn infant sleep compared with controls. The goals of this analysis were to test intervention spillover effects on secondborn siblings and examine birth order differences in infant sleep. Secondborns (n = 117) of INSIGHT mothers were enrolled in an observational cohort, SIBSIGHT. The Brief Infant Sleep Questionnaire was collected at 3, 16, and 52 weeks. Generalized linear mixed models assessed differences among secondborns by firstborn randomization, as well as birth order differences at 16 and 52 weeks. The RP group secondborns slept 42 minutes longer at night (95% confidence interval [95% CI]: 19-64) and 53 minutes longer total (95% CI: 17-90) than control secondborns. RP secondborns were more likely to self-soothe to sleep (odds ratio [OR] = 2.0, 95% CI: 1.1-3.7) and less likely to be fed back to sleep after waking (OR = 0.5, 95% CI: 0.3-0.9) than secondborns of control mothers. RP secondborns were more likely to have a bedtime ≤8 pm at 3 (OR = 2.9, 95% CI: 1.1-7.7) and 16 weeks (OR = 4.7, 95% CI: 2.0-11.0). Few differences in sleep parenting practices were observed when comparing siblings within families. Secondborns slept 37 minutes longer than firstborns at 16 weeks (CI: 7-67, P = .03). The INSIGHT RP intervention for first-time mothers had a spillover effect to secondborns, positively impacting sleep duration and behaviors. Intervening with first-time mothers benefits both firstborns and subsequent children.

Correlates and predictors of parenting self-efficacy in new fathers.

Parenting self-efficacy is a critical determinant of high-quality parenting behavior, but this aspect of parenting cognitions has been understudied for fathers. Longitudinal data from a sample of 182 fathers of firstborn infants in dual-earner families were used to assess how expectant fathers' rearing history, personality and personal characteristics, and family relationships were associated with their initial levels of parenting self-efficacy in the early postpartum period. Expectant fathers completed surveys assessing their rearing history, personality, and personal characteristics during the third trimester of pregnancy and reported on their perceptions of coparenting and parenting self-efficacy at three months postpartum. Results of hierarchical regression analyses showed that new fathers were at risk for lower parenting self-efficacy when they had greater attachment anxiety and neuroticism, believed that mothers are inherently better caretakers, and planned to use their own fathers as models for childrearing. In contrast, new fathers had greater parenting self-efficacy when they perceived their coparenting relationships with children's mothers more positively. These findings inform theory about the development of fathers' parenting cognitions and behavior and practice with expectant and new fathers, and, if replicated in a larger, more representative sample, may be used to identify expectant fathers at risk for low parenting self-efficacy and in the design of policy initiatives to enhance father-child relationships. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Infants' object interactions are long and complex during everyday joint engagement.

As infants interact with the object world, they generate rich information about object properties and functions. Much of infant learning unfolds in the presence of caregivers, who talk about and act on the objects of infant play. Does mother joint engagement correspond to real-time changes in the complexity and duration of infant object interactions? We observed 38 mothers and their first-born infants (cross-sectional, 13, 18, and 23 months) during 2h of everyday activity as infants freely navigated their home environments. Behavioral coding explored thousands of infant object interactions within and outside mother joint engagement. Object interactions involving exclusively simple play were shorter than complex play bouts. Critically, mothers' multimodal input (i.e., touching/gesturing toward and talking about the focal object) corresponded with more complex and longer play bouts than when mothers provided no input. Bouts involving complex play and multimodal input lasted 7.5 times longer than simple play bouts absent mother input. Moreover, "action-orienting talk" (e.g., "Twist it", "Feed dolly"), rather than talk per se, corresponded with longer bout duration and complexity. Notably, the association between joint engagement and play duration was not a function of mothers having more time to join. Analyses that eliminated short infant bouts and considered the timing of mothers' behaviors confirmed that mother input "extended" the duration of play bouts. As infants actively explore their environments, their object interactions change moment to moment in the presence of mothers' multimodal engagement.

Interpregnancy Weight Change Among Mothers of a Child with a Major Congenital Anomaly: A Danish Nationwide Cohort Study.

BackgroundThe mother of an infant with a major congenital anomaly is at a higher risk of premature cardiometabolic disease, possibly from chronic caregiver stress and distraction from self-care, including maintaining a healthy lifestyle and body weight.ObjectiveTo compare the interpregnancy weight gain in women whose first infant had a major congenital anomaly vs those without an affected child.MethodsMultivariable linear regression compared women whose infant had an anomaly vs those whose infant did not, adjusting for interpregnancy time interval, demographics, smoking and health status at the first pregnancy.ResultsOf the 199,536 women who had two consecutive singleton births, 4035 (2.0%) had a child with an anomaly at the first birth. The mean (SD) maternal BMI at the start of the first pregnancy was 24.1 (4.7) and 23.7 (4.4) kg/m2 in women with, and without, an anomaly-affected newborn. By the start of the second pregnancy, 3 years later, they had gained a mean (SD) of 2.2 (5.5) and 1.8 (5.2) kg, respectively – an adjusted absolute higher gain of 0.26 kg (95% CI 0.10 to 0.42) in women with an anomaly-affected first-born infant compared to those with an unaffected pregnancy. The adjusted interpregnancy weight gain difference was greatest in women whose first-born infant had a multi-organ anomaly at 0.59 kg (95% CI 0.02 to 1.16). The adjusted odds ratio of moving from a normal BMI category of 18.5–24.9 kg/m2 in the first pregnancy, to an overweight or obese BMI category of 25+ kg/m2 in the second, was 1.18 (95% CI 1.06 to 1.32) comparing mothers with vs without an anomaly-affected child in the first pregnancy.ConclusionMothers of an infant with a major congenital anomaly have a modestly higher interpregnancy weight gain and tend to climb to a higher BMI category. The long-term implications of this greater weight trajectory require further study.

Longitudinal poly- and perfluoroalkyl substances (PFAS) levels in Dutch infants.

Per- and polyfluoroalkyl substances (PFAS) are a potential hazard for public health. These man-made-chemicals are non-degradable with an elimination half-life of multiple years, causing accumulation in the environment and humans. Rodent studies demonstrated that PFAS are harmful, especially when present during the critical window in the first months of life. Because longitudinal data during infancy are limited, we investigated longitudinal plasma levels in infants aged 3months and 2years and its most important determinants. In 369 healthy term-born Dutch infants, we determined plasma PFOS, PFOA, PFHxS, PFNA and PFDA levels at age 3months and 2years, using liquid chromatography-electrospray-ionization-tandem-mass-spectrometry (LC-ESI-MS/MS). We studied the associations with maternal and child characteristics by multiple regression models. At age 3months, median plasma levels of PFOS, PFOA, PFHxS, PFNA and PFDA were 1.48, 2.40, 0.43, 0.23 and 0.07ng/mL, resp. Levels decreased slightly until age 2years to 1.30, 1.81, 0.40, 0.21 and 0.08ng/mL, resp. Maternal age, first born, Caucasian ethnicity and exclusive breastfeeding were associated with higher infant's plasma levels at age 3months. Levels at 3months were the most important predictor for PFAS levels at age 2years. Infants with exclusive breastfeeding during the first 3months of life (EBF) had 2-3 fold higher levels throughout infancy compared to infants with exclusive formula feeding (EFF), with PFOA levels at 3months 3.72ng/mL versus 1.26ng/mL and at 2years 3.15ng/mL versus 1.22ng/mL, respectively. Plasma PFAS levels decreased only slightly during infancy. Higher levels at age 3months were found in Caucasian, first-born infants from older mothers and throughout infancy in EBF-infants. Our findings indicate that trans-placental transmission and breastfeeding are the most important determinants of PFAS exposure in early life.

Twin anemia polycythemia sequence (TAPS)

A 33-year-old monochorionic twin gravida was subjected to a cesarean section at 31 weeks’ gestation due to preeclampsia. The pregnancy was otherwise uneventful. The first-born infant (Figure 1) was pale, weighed 1095 g and had an AS of 8/9/9; the second-born twin (Figure 2) was plethoric, weighed 1465 g and had an AS of 9/10. Hb values for twin 1 and twin 2 were 5.8 g/dL and 24.9 g/dL and a reticulocyte count of 11.25% and 6.09%, respectively. The anemic infant was hypovolemic requiring two blood transfusions on day 1. A partial volume exchange transfusion was required for the polycythemic twin, since hematocrit increased to 73.7% on day 1 despite IV hydration.