First Month Of Life Research Articles

Postpartum depression: Impact on pregnant women and the postnatal physical, emotional, and cognitive development of their children. An ecological perspective.

Maternal mental health problems during pregnancy, childbirth, and the postpartum period are a challenge for public health. Not recognizing them hinders a timely diagnosis and treatment and has an impact on the mother and the establishment of the fundamental bond of the mother-child dyad. We must recognize the risk factors (age, socioeconomic status, mental health history, family dysfunction, unfavorable environment), clinical manifestations, and screening tools. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affect fetal neurodevelopment and condition child developmental outcomes. Here we describe the negative impact of postpartum depression during the first months of life, which affects mother-child bonding, postnatal development (emotional, behavioral, cognitive, language), and the maintenance of breastfeeding. We also recognize protective factors that mitigate its effects. It is essential to establish preventive strategies and interdisciplinary diagnostic and therapeutic approaches to minimize the risks to the mother and her children.

Characteristics of infant formula consumed in the first months of life and allergy in the EDEN mother-child cohort.

The evidence regarding the association between infant formula (IF) composition and the prevention of allergy and respiratory diseases remains sparse and inconclusive. This study aimed to evaluate whether some IF characteristics were associated with the risk of allergy or respiratory diseases in childhood. Among1243 formula-fed children from the EDEN mother-child cohort, IF characteristics concerning long-chain polyunsaturated fatty acids (LCPUFAs) enrichment, prebiotic/probiotic enrichment, and hydrolysis of proteins were identified from the ingredients list. Eczema, wheezing, food allergy, asthma, and allergic rhinitis up to age 8 years were prospectively collected and summarized into four allergic and respiratory multimorbidity clusters. Associations between 4-month IF characteristics and risk of allergy or respiratory diseases were tested using logistic regressions adjusted on main confounders. The consumption of LCPUFA-enriched formula was not linked to allergic and respiratory multimorbidity clusters, but to a lower risk of any allergy, eczema, and wheezing. Probiotic-enriched formula consumption was associated with a lower risk of belonging to the 'Allergy without asthma' cluster (odds ratio [OR][95% confidence interval,CI] = 0.63 [0.40-0.99]), and consumption of a formula enriched in Bifidobacterium lactis was associated with a lower risk of any allergy (OR[95% CI] = 0.59 [0.41-0.85]). Partially hydrolysed formula (pHF) consumption was associated with a higher risk of belonging to the 'Allergy without asthma' cluster (OR[95%CI] = 2.73 [1.65-4.51]). This study confirms the positive association between pHFconsumption and the risk of allergy found in previous observational studies and suggests that consumption of LCPUFA-enriched or probiotic-enriched formula was associated with a lower risk of allergy.

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The diagnosis of biliary atresia was ultimately made in an infant who still presented with jaundice after his first month of life and had previously been misdiagnosed with breast milk jaundice.The authors underline that biliary atresia should always be suspected in an infant with persistent jaundice after the third week of life.

MULTIFOCAL ATRIAL TACHYCARDIA AND HYPERTROPHIC CARDIOMYOPATHY IN THREE PATIENTS WITH COSTELLO SYNDROME

Abstract Introduction Costello syndrome is a rare disease, caused by mutation of the HRAS gene, associated with intellectual disability, growth retardation, facial dimorphisms. Cardiac abnormalities, mainly cardiac hypertrophy and multifocal atrial tachycardia, are present in 1/3 of patients. Clinical Cases From 2019 to 2023, 3 newborns with Costello syndrome came under our observation. M.M. showed respiratory distress, hypotonia and dysmorphic notes; genetic analysis highlighted the pathogenic variant c.64C>A (p.Gln22Lys). On the echocardiogram, septal hypertrophic cardiomyopathy was found with left outflow obstruction and mitral insufficiency. Therapy with propranolol was undertaken. Holter ECG never revealed arrhythmias. At the last check–up, SIV hypertrophy, continent mitral valve, free left ventricular outflow. The second patient, O.L., arrived at 10 days of age following a run of supraventricular tachycardia. He had bilateral clubfoot and facial dimorphisms. The echocardiogram was normal. On Holter ECG atrial tachycardia interrupted by rare sinus beats. Therapy with flecainide was undertaken, without benefit. Subsequently, was undertaken amiodarone, then associated with digitalis. She was discharged with satisfactory control of the average ventricular rate, but later due to the appearance of chaotic atrial arrhythmia, propranolol was added; on the Holter ECG in triple therapy, periods of sinus rhythm alternating with short episodes of atrial tachycardia were observed. Genetic analysis revealed the pathogenic variant c.34G>A, p.(Gly12Ser) of the HRAS gene. The third patient, F.A., presented atrial tachycardia. Flecainide therapy had transient benefit. Subsequently propranolol was added, without benefit. Therapy with amiodarone was initiated. Transesophageal electrophysiological study demonstrated multifocal atrial tachycardia, unresponsive to overdrive pacing. Partial control of the average ventricular rate was achieved in triple therapy. On the echocardiogram, mild concentric hypertrophy and dysplastic pulmonary valve. Genetic testing detected the c.35G>C, p(Gly12Ala) variant of the HRAS gene. Conclusions Costello syndrome requires cardiac monitoring for the possible presence of multifocal atrial tachycardia and hypertrophic cardiomyopathy. Arrhythmia, which can also occur independently of hypertrophy, can be self–limited in the first months of life with aggressive pharmacological treatment but can persist or worsen in ¼ of patients.

Association between preterm infant body composition in the first 3months of life and preschool age: a cohort study.

Compared with full-term infants, preterm infants have fat-free mass deficit in the first months of life, which increases the risk of metabolic diseases in the future. In this cohort of children born under 32-week gestational age or less than 1500g, we aimed to evaluate the associations of body composition at term equivalent age and in the first 3months of life with fat-free mass and fat mass percentage at 4 to 7years of life. Body composition assessments by air displacement plethysmography and anthropometry were performed at term, at 3months of corrected age, and at 4 to 7years of age. Multiple linear regression analysis was used to observe the associations between body composition at these ages. At term, fat mass percentage showed a negative association and fat-free mass a positive association with fat-free mass at 4 to 7years. The fat-free mass at 3months and the gain in fat-free mass between term and 3months showed positive associations with fat-free mass at 4 to 7years. Conclusion: Body composition at preschool age is associated with fat-free mass in the first 3months of life, a sensitive period for the risk of metabolic diseases. What is Known: • Preterm infants have a deficit in fat-free mass and high adiposity at term equivalent age compared to full-term infants. • Fat-free mass reflects metabolic capacity throughout life and therefore is considered a protective factor against the risk of metabolic syndrome. What is New: •Fat-free mass gain in the first 3months of corrected age is associated with fat-free mass at preschool and school ages. •The first 3months of life is a sensitive period to the risk of metabolic diseases.

Causes and clinical symptoms of anaphylactic reactions in children: experience of the first «Pediatric Moscow Anaphylaxis Registry» in the Russian Federation

BACKGROUND: In Russian, there was a problem of the lack of registry of anaphylaxis, as the most important tool for monitoring this group of patients. Since 2022, the first "Pediatric Moscow Anaphylaxis Registry" has started working at the Morozov Children's Hospital. AIMS: Analysis of data from the Pediatric Moscow Anaphylaxis Registry to determine frequency, causes andclinical characteristics of anaphylaxis among children of the Moscow region. MATERIALS AND METHODS: Statistical analysis of the questionnaire data of 69 children aged 0-18, who were prospectively included in the Register during emergency hospitalization due to anaphylaxis, was carried out. RESULTS: The incidence of anaphylaxis among children hospitalized with acute allergic reactions from May 2022 to September 2023 was 5.8%. Higher percentage of anaphylaxis (38%) were observed among adolescents aged 13-18, three patients developed anaphylaxis in the first year of life (minimum age 1 month). Boys (70%) prevailed among patients under the age of 13, and girls (56%) prevailed among adolescents aged 13-18 (p=0.042). 75% anaphylaxis developed at home. Food anaphylaxis was dominant (75%-91%). Tree nuts were the most common trigger of food anaphylaxis – 35%, and confectionery products - 17%. 56% of children experienced symptoms from 4 or more organ systems, the most common symptoms were: skin/mucous (94%), respiratory (78%) and laryngeal symptoms (64%). Emergency care, diagnosed anaphylaxis in 22%, administration of epinephrine was 54%. The frequency of epinephrine use among children under 3 years was lower compared to adolescents aged 13-18 (25% vs 76%, p=0.003). CONCLUSIONS:Data from the "Pediatric Moscow Register of Anaphylaxis" showed a high incidence of anaphylaxis among patients with acute allergic reactions. More than 1/3 of anaphylaxis occurs in adolescents aged 13-18 years, anaphylaxis occurs in the first month of life. Most often, anaphylaxis occurs at home, which requires training patients to eliminate the trigger. The dominant cause of anaphylaxis in children in the Russian, regardless of age, are food allergens, tree nuts induce food anaphylaxis in more than 1/3 of cases. The emergency care diagnoses anaphylaxis in 22% of cases, epinephrine is administered in 54%, minimal use of epinephrine was among children under 3 years of age.

Lissencephaly, Pachygyrias, Band Heterotopias, RELN Pathway, and ARX Mutations (Incomplete Neuron Migration)

AbstractLissencephaly (LIS) is a group of malformations of cortical development consisting of a defective neuronal migration that results in lack of formation of the normal cerebral convolutions. It includes a spectrum of defect with varying degrees of severity, from agyria and pachygyria to subcortical band heterotopia. The etiopathogenesis of LIS includes both genetic and environmental factors. Although nongenetic forms of LIS have been reported, genetic causes are certainly more frequent and to date 19 LIS-SBH-associated genes have been identified. Most common mutations involve LIS1, DCX, ARX, and RELN genes. Clinically affected individuals present with early hypotonia, which can progress to limb spasticity, seizures, and psychomotor retardation. Convulsive episodes usually appear early (first months of life) and include infantile spasms, akinetic or myoclonic seizures, up to the development of complex epileptic syndromes, including atypical absences, myoclonia, and partial or tonic–clonic seizures. Several clinical entities are associated with classical LIS, including the following: isolated lissencephaly sequence (ILS); Miller–Dieker syndrome (MDS; OMIM 247200); subcortical band heterotopia (OMIM 300067); X-linked LIS with abnormal genitalia; and LIS with cerebellar hypoplasia. Diagnosis primarily depends on genetic and neuroimaging. Magnetic resonance imaging (MRI) is the gold standard, and it detects the presence of thick cortical cortex, its location, and the layers' architecture. Based on neuroimaging, it is possible to distinguish six subtypes of gyral malformations. Clinical and therapeutic management of these patients is challenging, considering the necessity to face drug-resistant epilepsy, intellectual disability, spasticity, and dysphagia and feeding problems. At the present moment, no gene-specific treatment for LIS is available.

The Association of Longer Breastfeeding Duration and Socioeconomic, Pregnancy, Childbirth and Postpartum Characteristics.

Background and Objectives: Breastmilk is the safest and most suitable food for an infant, playing the role of their first vaccine and containing all the essential nutrients for the first months of life. The World Health Organisation recommends exclusive breastfeeding for the first 6 months of life and continued breastfeeding while introducing a child to complementary foods until 2 years and beyond. According to Latvian statistics from 2022, only 27.4% of babies were breastfed for 12 months. The aim of this study was to determine the socio-economic factors and factors related to pregnancy, childbirth and postpartum that influence breastfeeding for more than 6 months in Latvia. Materials and Methods: Data were used from the cross-sectional survey "Research on factors and behaviours affecting the sexual and reproductive health of the population of Latvia", which was conducted in 2023. A study sample was randomised and stratified by gender and five age groups. The analyses in this study are based on a sample of women who had given birth at least once (n = 1407), and the dependent variable was the duration of breastfeeding their last child. Binary logistic regression was conducted to identify the associated factors. Results: The point prevalence of longer duration of breastfeeding for the last child was 47.9% (n = 674). The odds of longer breastfeeding duration were higher among mothers who did not smoke during pregnancy (vs. smokers, aOR 2.1, p < 0.001), of Latvian nationality (vs. Russian, aOR 1.3, p = 0.03), who had two childbirth (vs. one, aOR 1.5, p = 0.003), who had the highest level of education (vs. primary education, aOR 2.0, p = 0.03), started breastfeeding immediately after the birth (vs. later than the first day, aOR 1.7, p = 0.01) or on the first day (vs. later, aOR 1.6, p = 0.01). Conclusions: We documented socio-demographic pregnancy and childbirth factors associated with longer breastfeeding durations. Efforts to promote breastfeeding practices should target mothers from the most vulnerable groups.

Order within chaos: potential migratory strategies and individual associations in fin whales feeding off Iceland

BackgroundThe life cycle of most baleen whales involves annual migrations from low-latitude breeding grounds to high latitude feeding grounds. In most species, these migrations are traditionally considered to be carried out according to information acquired through vertical social learning during the first months of life and made individually. However, some recent studies have suggested a more complex scenario, particularly for the species of the Balaenoptera genus.MethodsHere, we studied the variation of δ15N and δ13C values along the growth axis of the baleen plate from 24 fin whales feeding off western Iceland to delve into their pattern of movements and to identify potential associations between individuals. The segment of baleen plate analyzed informed about at least two complete migratory cycles. We performed cluster analyses through two different methodologies and, whenever possible, we genotyped 20 microsatellite loci to determine potential existence of kinship.ResultsResults of the of δ15N and δ13C values agree with a dispersion strategy in the winter breeding grounds. However, and despite the overall large variability, several pairs or groups of individuals with no kinship showed highly similar isotopic patterns for two consecutive years for both δ15N and δ13C values.ConclusionsOur results suggest that, notably, some whales without kinship share the same migratory regime and destinations. We hypothesize that this could reflect either: (i) the sharing of particularly beneficial migratory regimes, and/or (ii) long-term association between individuals.

Neurological findings and a brief review of the current literature in a severe case of Aicardi-Gutières syndrome due to IFIH1 mutation.

Aicardi-Goutières syndrome (AGS) is a rare genetic early-onset progressive encephalopathy with variable clinical manifestations. The IFIH1 mutation has been confirmed to be responsible for type I interferon (IFN) production and activation of the Janus kinase (JAK) signaling pathway. We herein stress neurological observations and neuroimaging findings in a severe case report of an infant with AGS type 7 due to an IFIH1 mutation who was diagnosed in first month of life. We also review neurological characteristics of IFIH1 mutations through recent literature.

Clinicopathological profile and management challenges of congenital encephaloceles in a tertiary hospital in southwest Nigeria.

A congenital encephalocele is the herniation of intracranial contents through skull defects of various sizes. Depending on the site, content, and size, it is associated with significant morbidity and mortality in children. There is a paucity of recent and comprehensive local clinical data regarding this anomaly. Understanding the peculiarities, clinical-pathologic profiles, and management challenges will help prevent and effectively manage congenital encephalocele to improve outcomes. This was a retrospective study of all cases of congenital encephalocele managed between July 2000 and December 2023 at a tertiary hospital in the southwest region of Nigeria. Relevant demographic, clinicopathological, and management data were retrieved and analysed. There were 31 females and 11 males. Their ages ranged from 3hours to 24years. Sixteen (35.3%) were delivered in a non-health facility. Birth asphyxia was reported in 5 babies. Few mothers (4.8%) used preconception folic acid. Anaemia (n = 5) and sepsis (n = 4) were the common preoperative morbidities. All patients had definitive surgery, with 18 operated on within the first month of life. Cerebrospinal fluid (CSF) leak was the most common postoperative complication and was significantly observed in the sincipital group (p = 0.018). Thirty-one patients (73.8%) presented for follow-up after surgery, and the mean follow-up duration was 26.6weeks. Mortality was recorded in a patient (2.4%) due to Klebsiella meningitis. Congenital encephaloceles are relatively common in our setting. Therefore, there is a need to address the associated poor maternal and neonatal health conditions. Early surgery can be performed with a favourable outcome.

Survival Analysis of Low-Birth-Weight Neonates in NICU At Dr. Wahidin Sudirohusodo Hospital Makassar, Indonesia

Background: Currently, children face the highest risk of death during the neonatal phase. UNICEF data shows that in 2022, globally, approximately 2.3 million children died in the first month of life, accounting for about 6,400 neonatal deaths per day. The aim is determining the survival proportion of neonates, hazard ratios, and maternal factors influencing the survival of low-birth-weight neonates. Methodology: A retrospective cohort study design using secondary data from 183 medical records of low-birth-weight neonates from 2020 to 2022. Kaplan-Meier analysis and life table were used to observe the time frame and survival proportion, as well as differences among independent variable groups. Cox regression analysis was conducted to estimate hazard ratios and the influence of independent variables. Results: Gestational age (p=0.028, HR=2.7948, CI 95% = 1.1197-6.9757), ANC visits (p=0.000, HR=2.7057, CI 95% = 1.6320-4.4857), and maternal employment status (p=0.023, HR=2.6546, CI 95% = 1.1430-6.1651) are statistically significant variables that influence the survival of low-birth-weight neonates. Conclusions: The survival proportion of low-birth-weight neonates is 60.80%. Gestational age, ANC visits, and maternal employment status significantly contribute to the survival of low-birth-weight neonates.

T-Cell Immune Responses in Newborns and Long-Term Sequelae in Congenital Cytomegalovirus Infection (CYTRIC Study)

To assess the role of T-lymphocyte immune responses in newborns with congenital cytomegalovirus (CMV) infection (cCMV) and their potential association with the development of long-term sequelae. A multicenter, prospective study from 2017 to 2022 was conducted across eight hospitals in Spain. Blood samples were collected within the first month of life from neonates diagnosed with cCMV. Intracellular cytokine staining was employed to evaluate the presence of CMV-specific interferon-gamma (IFN-γ)-producing CD8+ and CD4+ T lymphocytes (CMV-IFN-γ-CD8+ / CD4+) using flow cytometry. The development of sequelae, including hearing loss and neurologic impairment, was assessed during follow-up. In total, 64 newborns were included; 42 infants (65.6%) had symptomatic cCMV. The median age at last follow-up visit was 25.3 months (IQR 20.1-34.4). Eighteen infants had long-term sequelae (28.1%), predominantly hearing loss (20.3%) and neurologic disorders (15.6%). No relationship was observed between total count or percentage of CMV-specific IFN-γ-CD8+ or CD4+ lymphocytes and long-term sequelae. Multivariable analysis demonstrated an association between lower total lymphocyte count and long-term sequelae (aOR 0.549, 95% CI: 0.323-0.833), which requires further study. CMV-specific IFN-γ-CD4+ and CD8+ T-lymphocyte responses in neonates with cCMV were not predictive of long-term sequelae.

Defining the cardiovascular phenotype of adults with Alström syndrome

Background>40% of infants with Alström Syndrome (AS) present with a transient, severe cardiomyopathy in the first months of life, with apparent recovery in survivors. One in five individuals then develop a later-onset cardiomyopathy but wide clinical variability is observed, even within the same family. The rationale for this study is to provide a comprehensive evaluation of the cardiovascular phenotype in adults with AS. MethodsAdults attending the National Centre for AS in England were studied. All patients underwent biochemical, 12- lead electrocardiography, echocardiography, and cardiovascular magnetic resonance imaging. Results47 adults with AS (64% male; mean age 33 years; 66% white British) were studied. Seven (15%) survived infantile cardiomyopathy and 23 (49%) developed adult-onset cardiomyopathy. Conventional risk factors for cardiovascular disease were present in 39 (83%). Abnormalities were present on biomarkers in 16 (34%), ECG 30 (64%), echocardiography 19 (40%) and CMR 31 (66%). Coronary artery imaging was performed in six (13%), with abnormalities in two. Cardiac, renal, and liver markers were more often impaired in older patients, with impaired left ventricular ejection fraction, reduced global longitudinal strain and late enhancement. 6 (13%) had severe pulmonary hypertension (mean pulmonary artery pressure 46 mmHg) due to left heart disease on invasive testing. ConclusionCardiomyopathy is common in adults with AS, complicated in a significant proportion by atherosclerotic coronary artery disease and restrictive cardiomyopathy, confirmed on CMR and invasive testing. With advancing age, cardiovascular complications are compounded by contemporaneous renal and liver disease.

Maternal and Infant Dietary Patterns Are Not Related to Food Allergy Risk in Singapore Children: GUSTO Cohort Study

BackgroundWe previously reported that delayed allergenic food introduction in infancy did not increase food allergy risk until age 4 y within our prospective cohort. However, it remains unclear whether other aspects of maternal or infant diet play roles in the development of childhood food allergy. ObjectivesWe examined the relationship between maternal pregnancy and infant dietary patterns and the development of food allergies until age 8 y. MethodsAmong 1152 Singapore Growing Up in Singapore Towards Healthy Outcomes study mother–infant dyads, the infant’s diet was ascertained using food frequency questionnaires at 18 mo. Maternal dietary patterns during pregnancy were derived from 24-h diet recalls. Food allergy was determined through interviewer-administered questionnaires at regular time points from infancy to age 8 y and defined as a positive history of allergic reactions, alongside skin prick tests at 18 mo, 3, 5, and 8 y. ResultsFood allergy prevalence was 2.5% (22/883) at 12 mo and generally decreased over time by 8 y (1.9%; 14/736). Higher maternal dietary quality was associated with increased risk of food allergy (P ≤ 0.016); however, odds ratios were modest. Offspring food allergy risk ≤8 y showed no associations with measures of infant diet including timing of solids/food introduction (adjusted odds ratio [aOR]: 0.90; 95% confidence interval [CI]: 0.42, 1.92), infant’s diet quality (aOR: 0.93; 95% CI: 0.88, 0.99) or diet diversity (aOR: 0.84; 95% CI: 0.6, 1.19). Most infants (89%) were first introduced to cow milk protein within the first month of life, while egg and peanut introduction were delayed (58.3% introduced by mean age 8.8 mo and 59.8% by mean age 18.1 mo, respectively). ConclusionsApart from maternal diet quality showing a modest association, infant’s allergenic food introduction, diet quality, and dietary diversity were not associated with food allergy development in this Asian pediatric population. Interventional studies are needed to evaluate the efficacy of these approaches to food allergy prevention across different populations.

Neurodevelopment of children exposed to prolonged anesthesia in infancy: GABA study interim analysis of resting-state brain networks at 2, 4, and 10-months old

BackgroundPrevious studies have raised concerns regarding neurodevelopmental impacts of early exposures to general anesthesia and surgery. Electroencephalography (EEG) can be used to study ontogeny of brain networks during infancy. As a substudy of an ongoing study, we examined measures of functional connectivity in awake infants with prior early and prolonged anesthetic exposures and in control infants. MethodsEEG functional connectivity was assessed using debiased weighted phase lag index at source and sensor levels and graph theoretical measures for resting state activity in awake infants in the early anesthesia (n = 26 at 10 month visit, median duration of anesthesia = 7 [2, 7 h]) and control (n = 33 at 10 month visit) groups at ages approximately 2, 4 and 10 months. Theta and low alpha frequency bands were of primary interest. Linear mixed models incorporated impact of age and cumulative hours of general anesthesia exposure. ResultsModels showed no significant impact of cumulative hours of general anesthesia exposure on debiased weighted phase lag index, characteristic path length, clustering coefficient or small-worldness (conditional R2 0.05–0.34). An effect of age was apparent in many of these measures. ConclusionsWe could not demonstrate significant impact of general anesthesia in the first months of life on early development of resting state brain networks over the first postnatal year. Future studies will explore these networks as these infants grow older

A Prospective Cross-Sectional Study on the Vitamin D Status of Neonates and the Impact of Neonates' Standard Vitamin D Supplementation on Neonatal Morbidities.

(1) Background: This study aimed to determine whether standard-dose vitamin D supplementation could provide adequate levels in exclusively breastfed infants born with different cord 25(OH)D levels and to evaluate related neonatal morbidities. (2) Methods: A prospective cross-sectional study was designed in term infants. Three groups were formed based on cord 25(OH)D levels; Group1 Deficiency:25(OH)D < 12 ng/mL, Group2 Insufficiency:25(OH)D = 12-19 ng/mL, and Group3 Optimum:25(OH)D = 20-100 ng/mL. Cord and 1st month 25(OH)D levels, after receiving standard-dose vitamin D prophylaxis, neonatal outcomes and anthropometric measurements were compared. (3) Results: The study involved 86 infants. Group1 Deficiency had also significantly lower 25(OH)D levels at 1st month compared to the others (p < 0.001). There was a significant positive correlation between cord and 1st month 25(OH)D levels (r = 0.78, p < 0.001). Despite the fact that the mother's age and clothing style were similar, Group1 Deficiency mothers had higher parity numbers and used less vitamin D during pregnancy (p = 0.03, p = 0.04). Neonatal outcomes analysis revealed that newborns in Group1 Deficiency experienced more respiratory distress, transient tachypnea, and early-onset sepsis, as well as more and longer hospital stays in the first-month of life (p < 0.05). (4) Conclusions: Infants with low cord 25(OH)D levels had also lower 25(OH)D values in the 1st month of life and experienced higher rates of neonatal morbidities. Given its numerous biological activities and impact on neonatal morbidities, determining an individualized dose of vitamin D supplementation may be more accurate than using the standard approach.

The Relationship Of Mother's Knowledge And Characteristics On The Slowness Of The Process Of Early Breastfeeding Initiation in the Practiceof Midwifer Feronika Hutajulu

A mother can prevent her baby from dying in the first month of life if she breastfeeds her baby within 60 minutes after birth. However, the lack of knowledge and understanding of parents, doctors or health workers about the importance of IMD, as well as the reluctance to implement IMD, makes its implementation difficult. One of the reasons for the success or failure of IMD lies in the midwife. Because they are the ones who encourage and educate postpartum mothers to implement IMD. This research is included in the type of analytical research using a cross-sectional research design. The general aim of the research is to determine the relationship between maternal characteristics and early breastfeeding practices after giving birth. Meanwhile, specifically, this research seeks to identify the relationship between maternal knowledge, attitudes, age and parity of postpartum mothers who practice early breastfeeding at the Feronika Hutajulu Midwife Practice. Sampling was carried out using a non-probability sampling technique with a total sampling method of 26 people. Data collection uses a questionnaire. From analysis of research data using the chi-square test with a confidence level of 5% (a=0.05) knowledge data had a p value of 0.000, attitude data had a p value of 0.000, age data had a p value of 0.014, and parity data had a p value of 0.020. So it can be concluded that there is a relationship between maternal knowledge, maternal attitude, maternal age and maternal parity on the implementation of IMD.

A Retrospective Study on the Mortality Rate of Camel Calves, Leading Causes, and Associated Risk Factors in Borana Zone, Oromia Regional State, Ethiopia

Background: Camelus dromedarius (one-humped camel) is an important livestock species uniquely adapted to arid and hot environments. Purpose: This study aims to determine the mortality rate of camel calves and to investigate the potential risk factors associated with it. Methods: Retrospective data were collected through interviews with livestock owners using a semi-structured questionnaire from February 2020 to January 2021. During the study period, a total of 1,249 calves were born. This allowed for assessment of annual mortality rate and its main contributing factors. Results: The average annual mortality rate was 26% (1.29 ±1.77), while the overall mortality rate was 55% (1.30 ± 1.85). Malnutrition (5%), unexplained causes (6%), and diseases (24%) were the three leading causes of calf mortality. Diarrhea (57%), nonspecific diseases (45.4%), respiratory diseases (23%) were significant among the diseases. Mistakes in the management of young livestock included limiting access to colostrum and milk for human consumption, as well as poor care and health management. Conclusion: The results of this study suggested that the pastoral livestock production system used in Borena has a serious problem with calf mortality. The first month of life had the highest mortality rate of 26%. Diseases, starvation, and unexplained causes were the leading causes of calf mortality. In addition, calf mortality was associated with the timing of birth and colostrum feeding.

Development of a Standardized Algorithm for Management of Newly Diagnosed Anorectal Malformations.

Neonates with a new diagnosis of anorectal malformation (ARM) present a unique challenge to the clinical team. ARM is strongly associated with additional midline malformations, such as those observed in the VACTERL sequence, including vertebral, cardiac, and renal malformations. Timely assessment is necessary to identify anomalies requiring intervention and to prevent undue stress and delayed treatment. We utilized a multidisciplinary team to develop an algorithm guiding the midline workup of patients newly diagnosed with ARM. Patients were included if born in or transferred to our neonatal intensive care unit (NICU), or if seen in clinic within one month of life. Complete imaging was defined as an echocardiogram, renal ultrasound, and spinal magnetic resonance imaging or ultrasound within the first month of life. We compared three periods: prior to implementation (2010-2014), adoption period (2015), and delayed implementation (2022); p ≤ 0.05 was considered significant. Rates of complete imaging significantly improved from pre-implementation to delayed implementation (65.2% vs. 50.0% vs. 97.0%, p = 0.0003); the most growth was observed in spinal imaging (71.0% vs. 90.0% vs. 100.0%, p = 0.001). While there were no differences in the rates of identified anomalies, there were fewer missed diagnoses with the algorithm (10.0% vs. 47.6%, p = 0.05). We demonstrate that the implementation of a standardized algorithm can significantly increase appropriate screening for anomalies associated with a new diagnosis of ARM and can decrease delayed diagnosis. Further qualitative studies will help to refine and optimize the algorithm moving forward.