Early Childhood Health Research Articles

Duration of Neonatal Antibiotic Exposure in Preterm Infants in Association with Health and Developmental Outcomes in Early Childhood

Over 90% of preterm neonates are, often empirically, exposed to antibiotics as a potentially life-saving measure against sepsis. Long-term outcome in association with antibiotic exposure (NABE) has insufficiently been studied after preterm birth. We investigated the association of NABE-duration with early-childhood developmental and health outcomes in preterm-born children and additionally assessed the impact of GA on outcomes. Preterm children (GA < 30 weeks) participating in a multicenter cohort study were approached for follow-up. General expert-reviewed health questionnaires on respiratory, atopic and gastrointestinal symptoms were sent to parents of children > 24 months’ corrected age (CA). Growth and developmental assessments (Bayley Scales of Infant and Toddler Development (BSID) III) were part of standard care assessment at 24 months’ CA. Uni- and multivariate regressions were performed with NABE (per 5 days) and GA (per week) as independent variables. Odds ratios (OR) for health outcomes were adjusted (aOR) for confounders, where appropriate. Of 1079 infants whose parents were approached, 347 (32%) responded at a mean age of 4.6 years (SD 0.9). In children with NABE (97%), NABE duration decreased by 1.6 days (p < 0.001) per week of gestation. Below-average gross-motor development (BSID-III gross-motor score < 8) was associated with duration of NABE (aOR = 1.28; p = 0.04). The aOR for constipation was 0.81 (p = 0.04) per gestational week. Growth was inversely correlated with GA. Respiratory and atopic symptoms were not associated with NABE, nor GA. We observed that prolonged NABE after preterm birth was associated with below-average gross-motor development at 24 months’ CA, while a low GA was associated with lower weight and stature Z-scores and higher odds for constipation.

Maternal pregnancy-related anxiety and children’s physical growth: the Ma’anshan birth cohort study

BackgroundEpidemiological studies have identified maternal antenatal anxiety and several adverse birth outcomes, but limited studies have focused on the relationship with the long-term physical growth of children. The study aimed to assess the influence of maternal pregnancy-related anxiety on physical growth in children at different exposure periods during pregnancy.Methods3,154 mother-child pairs were included based on the Ma’anshan birth cohort study. Maternal prenatal anxiety was obtained by administering a questionnaire using the pregnancy-related anxiety questionnaire (PRAQ) scale during the 1st, 2nd and 3rd trimesters of pregnancy. Body fat (BF) (48 to 72 months) and Body Mass Index (BMI) (birth to 72 months) were collected repeatedly for children. Group-based trajectory models were applied to fit the different trajectories of BMI and BF.ResultsMaternal anxiety in the 2nd (OR = 0.81; 95% CI: 0.68 to 0.98; P < 0.025) and 3rd (OR = 0.80; 95% CI: 0.67 to 0.97; P = 0.020) trimesters was associated with a decreased risk of rapid weight gain (RWG) in the first year of life. Children aged 48 to 72 months of mothers with anxiety in the 3rd trimester had lower BMI (β = -0.161; 95% CI, -0.293 to -0.029; P = 0.017) and BF (β = -0.190; 95% CI, -0.334 to -0.046; P = 0.010), and these children were less likely to develop a very high BMI trajectory (OR = 0.54; 95% CI: 0.34 to 0.84; P = 0.006), and a high BF trajectory (OR = 0.72; 95% CI: 0.53 to 0.99; P = 0.043). Similar associations were found between maternal anxiety in both 2nd and 3rd trimesters and children’s physical growth.ConclusionsOffspring of mothers with prenatal anxiety in the 2nd and 3rd trimesters predicts poorer growth in infancy and preschool age. Early improvement and treatment of prenatal anxiety could benefit physical health and development in early childhood.

The “long arm” of adverse childhood experiences on adult health depreciation in China

BackgroundThe effects of childhood adversity on health may persist into the middle and old-aged. The assessment of the long-term effect of adverse childhood experiences (ACE) on adult health depreciation promotes a paradigm shift from current factors in health to early causation shaping health life course trajectories. ObjectiveDetermine whether the direct and significant dose-response effect between childhood adversity and health depreciation holds true, and to examine whether socioeconomic status (SES) in adulthood can diminish the negative effects of ACE. MethodsA sample of 6344 nationally representative respondents (48 % were male; Mage = 64.48 years old, SD = 9.6 years old) was obtained. Adverse childhood experiences were collected from a Life History survey in China. Health depreciation was assessed by years lived with disabilities (YLDs) based on the Global Burden of Disease (GBD) disability weights. Ordinary least squares and matching methods (propensity score matching and coarsened exact matching) were used to test the relationship and treatment effect between ACEs and health depreciation. Mediating effect coefficients test and the Karlson-Holm-Breen (KHB) examined the mediating effect of socioeconomic status in adulthood. ResultsCompared to respondents without ACE, respondents who experienced 1 ACE increased YLD 15.9 % (p < 0.01); 2 ACEs by 32.8 % (p < 0.01); 3 ACEs by 47.4 % (p < 0.01), and 4+ ACEs by 71.5 % (p < 0.01) higher YLDs. The mediating effect of SES in adulthood was only between 3.9 % and 8.2 %. The interaction effect between ACE and adult socioeconomic status was not significant. ConclusionThe “long arm” of ACE on health depreciation exhibited a significant dose-response relationship. Policies and measures aimed at reducing family dysfunction and strengthening early childhood health interventions can facilitate the reduction of health depreciation in middle and old age.

Physical activity in infancy and early childhood: a narrative review of interventions for prevention of obesity and associated health outcomes.

In the context of the childhood obesity epidemic, this narrative review aims to explore opportunities to promote physical activity (PA) between birth and age 5 years as well as the health outcomes associated with PA in early childhood. Although early childhood is an ideal time to promote healthy habits, guidelines for PA have often ignored early childhood given the limited evidence for children <5 years old. Herein we discuss and highlight infant, toddler and preschool age interventions to promote PA and prevent obesity both in the short and long-term. We describe novel and modified interventions to promote improved early childhood health outcomes, encompassing cardiorespiratory, muscle, and bone strengthening components necessary for short-term motor development and long-term health. We call for new research aimed at developing and testing innovative early childhood interventions that may be performed in home or childcare settings, monitored by parents or caregivers.

Prevention of mental illness within public health: An analysis of progress via systematic literature review and a pathway forward

Primary prevention is the cornerstone of public health. Prevention is especially important for chronic diseases of significant burden such as mental illnesses because many of them have limited treatment options, an onset in childhood or in adolescence, and are linked to adverse childhood experiences requiring a focus on early childhood and maternal-child health (MCH). Despite this need, there appears to be a paucity of research into prevention of mental illnesses within public health. To confirm this, we performed a systematic literature review to quantify the proportion of articles in public health that focus on prevention of mental illness versus intervention for these illnesses after their onset, and the proportion of published articles within MCH that focus on mental health. Between November 2019 and August 2021, we reviewed 211,794 published articles from 147 Scimago-ranked English public health journals with no limit on year of publication. As hypothesized, a very small portion (2.2%) of mental health articles included primary prevention and a small portion of MCH articles (7.8%) included mental health. These results are consistent with the existence of a research gap in mental illness prevention within the public health field. Given the early onset of mental illness, the importance of early childhood experiences in the later development of mental illness, and the importance of the social-emotional connection between mother and child for building resilience, public health professionals must incorporate evidence from the field of MCH to develop and assess more primary prevention programs for mental illness.

Intratracheal budesonide mixed with surfactant to increase survival free of bronchopulmonary dysplasia in extremely preterm infants: study protocol for the international, multicenter, randomized PLUSS trial

BackgroundBronchopulmonary dysplasia (BPD), an inflammatory-mediated chronic lung disease, is common in extremely preterm infants born before 28 weeks’ gestation and is associated with an increased risk of adverse neurodevelopmental and respiratory outcomes in childhood. Effective and safe prophylactic therapies for BPD are urgently required. Systemic corticosteroids reduce rates of BPD in the short-term but are associated with poorer neurodevelopmental outcomes if given to ventilated infants in the first week after birth. Intratracheal administration of corticosteroid admixed with exogenous surfactant could overcome these concerns by minimizing systemic sequelae. Several small, randomized trials have found intratracheal budesonide in a surfactant vehicle to be a promising therapy to increase survival free of BPD.MethodsAn international, multicenter, double-blinded, randomized trial of intratracheal budesonide (a corticosteroid) mixed with surfactant for extremely preterm infants to increase survival free of BPD at 36 weeks’ postmenstrual age (PMA; primary outcome). Extremely preterm infants aged < 48 h after birth are eligible if: (1) they are mechanically ventilated, or (2) they are receiving non-invasive respiratory support and there is a clinical decision to treat with surfactant. The intervention is budesonide (0.25 mg/kg) mixed with poractant alfa (200 mg/kg first intervention, 100 mg/kg if second intervention), administered intratracheally via an endotracheal tube or thin catheter. The comparator is poractant alfa alone (at the same doses). Secondary outcomes include the components of the primary outcome (death, BPD prior to or at 36 weeks’ PMA), potential systemic side effects of corticosteroids, cost-effectiveness, early childhood health until 2 years of age, and neurodevelopmental outcomes at 2 years of age (corrected for prematurity).DiscussionCombining budesonide with surfactant for intratracheal administration is a simple intervention that may reduce BPD in extremely preterm infants and translate into health benefits in later childhood. The PLUSS trial is powered for the primary outcome and will address gaps in the evidence due to its pragmatic and inclusive design, targeting all extremely preterm infants regardless of their initial mode of respiratory support. Should intratracheal budesonide mixed with surfactant increase survival free of BPD, without severe adverse effects, this readily available intervention could be introduced immediately into clinical practice.Trial registrationAustralian New Zealand Clinical Trials Registry (https://www.anzctr.org.au), ACTRN12617000322336. First registered on 28th February 2017.

Adapting Reach Up and Learn in Crisis and Conflict Settings: An Exploratory Multiple Case Study.

In 2019, >71 million children aged <5 had spent their entire lives in conflict-affected settings. Compounding adversities including violence, poverty, and displacement have immediate and long-term effects on early childhood development, health, behavior, and well-being. In response, adaptations of Reach Up have been implemented in conflict and crisis settings. This article uses exploratory multiple case study methodology, drawing from implementation and qualitative data from 3 interventions: a mobile phone-based intervention promoting nurturing care among Rohingya and crisis-affected host communities in Bangladesh; Reach Up amid acute violence and displacement in Northeast Syria; and Reach Up group sessions and home visits integrated with health services for an indigenous population in Venezuela. In Bangladesh, tailoring interactive voice response messages improved responsiveness to the developmental needs of young children, yet complementary in-person services were identified as a key program enhancement. In Syria, rapid adaptations of Reach Up addressed the needs of families in acute crisis, including social-emotional learning games for school-aged children. In Venezuela, Reach Up, coupled with complementary lactation counseling, yielded high rates of uptake and satisfaction, and children's language development was highlighted as a key area of growth. Recommendations to promote early childhood development in crisis and conflict settings include: (1) cultural adaptation based on a holistic understanding of children and caregivers' needs; (2) the integration of child and family safety and linkages with complementary services on the basis of community needs and priorities, and (3) the importance of designing for scale through blended models and costing analyses.

Internalization of Personal Hygiene and health in Early Childhood in the School and Family Environment

The purpose of this study is to provide an overview and strategies that can be carried out by teachers and parents in fostering children to maintain cleanliness and health. This research uses a qualitative approach and literature study. The data sources for this research are teachers and parents at the Cemerlang Insan Early Childhood Education Institute in Magetan and literacy studies that come from relevant studies. The results of this study indicate personal hygiene and health activities carried out at PAUD Insan Cemerlang Magetan consist of three parts, namely (1) Self-cleaning, (2) Consumption of nutritious food, and (3) Optimization of children's motor functions. Aspects of self-cleaning are carried out with several activities such as washing hands and feet, bathing, keeping hair and mouth clean. In the aspect of consumption of nutritious food, a balanced nutritional diet is carried out which prioritizes meeting the nutritional needs of children. Furthermore, to optimize children's motor function through regular exercise. Internalization of personal hygiene and health is carried out collaboratively by teachers and parents through three ways, namely habituation, setting an example and supervision.

Knowledge of molar incisor hypomineralization among physicians and dentists

Background: Molar incisor hypomineralization (MIH) is a global dental condition. Early intake of antibiotics can increase the risk of MIH. Purpose: To assess the knowledge of physicians and dentists on MIH and its associations with antibiotics exposure during early childhood. Methods: This cross-sectional study surveyed the above health professionals utilizing an electronically distributed questionnaire. The chi-square test was used to compare differences in levels of knowledge between the study groups. Results: There were 335 participants in the study; general physicians (n=79), pediatricians (n=98) and dentists (n=158). A significantly lower proportion of general physicians and pediatricians had knowledge of MIH compared to dentists (19% and 18% vs. 82%, respectively, P&lt;0.001). There was no statistically significant difference between all groups regarding their knowledge about the association between antibiotics prescribed during the first four years of life and MIH development (P=0.07). Conclusions: Physicians and pediatricians lacked knowledge about the dental condition of MIH. Most study respondents did not know the association between frequent antibiotic intake during early childhood and the development of MIH. Since medical practitioners are more likely to prescribe antibiotics and have a greater impact on early childhood health, raising awareness of MIH and its relationship with antibiotic exposure in early life among medical practitioners is essential.

An Innovative Well-Child Video Project to Teach Developmental Surveillance and Anticipatory Guidance.

Learning to implement developmental surveillance and anticipatory guidance are critical components of clinical nursing education. The purpose of the Well-Child Video Project was to provide nursing students opportunities to develop confidence in providing early childhood health supervision. The faculty team curated more than 100 video clips of children age 0 to 6 years demonstrating key developmental milestones. Nurse practitioner students (N = 33) enrolled in an online course participated in a collaborative learning activity and completed pre- and post-assignment surveys assessing their level of confidence and evaluating their engagement. Students reported increased confidence in their ability to perform developmental surveillance and deliver anticipatory guidance following the clinical learning activity. Students (93.75%) agreed that the video strategy enhanced their learning. The Well-Child Video Project served as a cost-effective, easily accessible, user-friendly digital resource for designing innovative learning activities to increase student engagement in practicing developmental surveillance and anticipatory guidance. [J Nurs Educ. 2023;62(7):412-415.].

Associations of activity, sedentary, and sleep behaviors with cognitive and social-emotional health in early childhood

BackgroundEarly childhood is important for cognitive and social-emotional development, and a time in which to promote healthy movement behaviors (sedentary behavior, physical activity, and sleep). Movement behaviors may have interactive influences on cognition and social-emotional factors in young children, but most previous research has explored them independently. The purpose of this study was to determine if movement behaviors are associated with measures of cognitive and social-emotional health in young children and if so, to describe optimal compositions of movement behaviors of a daily cycle for such outcomes.MethodsChildren (n = 388, 33 to 70 months, 44.6% female) from a clinical trial (ClinicalTrials.gov ID: NCT03285880, first posted September 18, 2017) wore accelerometers on their wrists for 24-h for 9.56 ± 3.3 days. Movement behavior compositions consisted of time spent in sedentary behaviors, light intensity physical activity, moderate to vigorous intensity physical activity (MVPA), and sleep. Outcomes were cognitive (receptive vocabulary, declarative and procedural memory, and executive attention) and social-emotional measures (temperament and behavioral problems). Compositional linear regression models with isometric log ratios were used to investigate the relations between the movement behavior composition and the cognitive and social-emotional health measures. If a significant association was found between the composition and an outcome, we further explored the “optimal” 24-h time-use for said outcome.ResultsMovement behavior compositions were associated with receptive vocabulary. The composition associated with the predicted top five percent of vocabulary scores consisted of 12.1 h of sleep, 4.7 h of sedentary time, 5.6 h of light physical activity, and 1.7 h of MVPA.ConclusionsWhile behavior compositions are related to vocabulary ability in early childhood, our findings align with the inconclusiveness of the current evidence regarding other developmental outcomes. Future research exploring activities within these four movement behaviors, that are meaningful to cognitive and social-emotional development, may be warranted.

Addressing Child Mental Health Inequities Through Parental Mental Health and Preschool Attendance.

Prevention is key to reducing socioeconomic inequities in children's mental health problems, especially given limited availability and accessibility of services. We investigated the potential to reduce inequities for disadvantaged children by improving parental mental health and preschool attendance in early childhood. Data from the nationally representative birth cohort, Longitudinal Study of Australian Children (N = 5107, commenced in 2004), were used to examine the impact of socioeconomic disadvantage (0-1 year) on children's mental health problems (10-11 years). Using an interventional effects approach, we estimated the extent to which inequities could be reduced by improving disadvantaged children's parental mental health (4-5 years) and their preschool attendance (4-5 years). Disadvantaged children had a higher prevalence of elevated mental health symptoms (32.8%) compared with their nondisadvantaged peers (18.7%): confounder-adjusted difference in prevalence is 11.6% (95% confidence interval: 7.7% to 15.4%). Improving disadvantaged children's parental mental health and their preschool attendance to the level of their nondisadvantaged peers could reduce 6.5% and 0.3% of socioeconomic differences in children's mental health problems, respectively (equivalent to 0.8% and 0.04% absolute reductions). If these interventions were delivered in combination, a 10.8% (95% confidence interval: 6.9% to 14.7%) higher prevalence of elevated symptoms would remain for disadvantaged children. Targeted policy interventions that improve parental mental health and preschool attendance for disadvantaged children are potential opportunities to reduce socioeconomic inequities in children's mental health problems. Such interventions should be considered within a broader, sustained, and multipronged approach that includes addressing socioeconomic disadvantage itself.

Clustering of adverse health and educational outcomes in adolescence following early childhood disadvantage: population-based retrospective UK cohort study.

Disadvantage in early childhood (ages 0-5 years) is associated with worse health and educational outcomes in adolescence. Evidence on the clustering of these adverse outcomes by household income is scarce in the generation of adolescents born since the turn of the millennium. We aimed to describe the association between household income in early childhood and physical health, psychological distress, smoking behaviour, obesity, and educational outcomes at age 17 years, including the patterning and clustering of these five outcomes by income quintiles. In this population-based, retrospective cohort study, we used data from the Millennium Cohort Study in which individuals born in the UK between Sept 1, 2000, and Jan 1, 2002, were followed up. We collected data on five adverse health and social outcomes in adolescents aged 17 years known to limit life chances: psychological distress, self-assessed ill health, smoking, obesity, and poor educational achievement. We compared how single and multiple outcomes were distributed across early childhood quintile groups of income, as an indicator of disadvantage, and modelled the potential effect of three income-shifting scenarios in early childhood for reducing adverse outcomes in adolescence. We included 15 245 adolescents aged 17 years, 7788 (51·1%) of whom were male and 7457 (48·9%) of whom were female. Adolescents in the lowest income quintile group in childhood were 12·7 (95% CI 6·4-25·1) times more likely than those in the highest quintile group to have four or five adverse adolescent outcomes, with poor educational achievement (risk ratio [RR] 4·6, 95% CI 4·2-5·0) and smoking (3·6, 3·0-4·2), showing the largest single risk ratios. Shifting up to the second lowest, middle, and highest income groups would reduce multiple adolescent adversities by 4·9% (95% CI -23·8 to 33·6), 32·3% (-2·7 to 67·3), and 83·9% (47·2 to 120·7), respectively. Adjusting for parental education and single parent status moderately attenuated these estimates. Early childhood disadvantage is more strongly correlated with multiple adolescent adversities than any of the five single adverse outcomes. However, shifting children from the lowest income quintile group to the next lowest group is ineffective. Tackling multiple adolescent adversities requires managing early childhood disadvantage across the social gradient, with income redistribution as a central element of coordinated cross-sectoral action. UK Prevention Research Partnership.

Maternal social isolation and behavioral problems in preschool children: the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study.

It is essential to clarify factors associated with mental health and behavioral problems in early childhood, because children are critical stages of life for mental health. We aimed to prospectively examine the associations between maternal social isolation and behavioral problems in preschool children. We analyzed data from 5842 mother-child pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study. The Lubben Social Network Scale-abbreviated version was used to assess social isolation (defined as scores < 12) one year after delivery. The Child Behavior Checklist 1½-5 was used to assess behavioral problems, and its subscales were used to assess internalizing and externalizing problems in children at 4years of age. Multiple logistic regression analyses were conducted to examine the associations between social isolation and behavioral problems, after adjustment for age, education, income, work status, marital status, extraversion, neuroticism, depressive symptoms, child sex, and number of siblings. Multiple logistic regression analyses were also conducted for internalizing problems and externalizing problems. The prevalence of maternal social isolation was 25.4%. Maternal social isolation was associated with an increased risk of behavioral problems in children: the odds ratio (OR) was 1.37 (95% confidence interval [CI] 1.14-1.64). Maternal social isolation was also associated with increased risks of internalizing problems and externalizing problems in children: the ORs were 1.33 (95% CI, 1.12-1.59) and 1.40 (95% CI, 1.18-1.66), respectively. In conclusion, maternal social isolation one year after delivery was associated with behavioral problems in children at 4years of age.

Clinical use and implementation of the diagnostic classification of mental health and developmental disorders of infancy and early childhood.

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC: 0-5) was developed to provide a framework for diagnosis of infants and young children, and a training curriculum supports implementation of the manual in clinical practice. This study surveyed 100 mental health clinicians (93% female and 53% Latinx/Hispanic) who had completed training in the DC: 0-5 classification system and worked with infants/young children and their families primarily in urban, public insurance-funded, community mental health settings in the United States. The survey explored their use of the diagnostic manual in clinical practice as well as supports and barriers to implementation. Survey results indicated a high level of adoption of the manual in clinical practice, although all five axes and the cultural formulation were used less often than the Axis I Clinical Disorders section. Barriers to implementation included systemic issues such as agency and billing requirements necessitating simultaneous use of other diagnostic manuals, lack of supports and expertise within their agency, and difficulty making time to fully utilize the manual. The findings suggest that policy and systems changes may be needed to enable clinicians to fully integrate the DC: 0-5 into their case conceptualizations.

Pemeriksaan Dan Pemantauan Kesehatan Gigi Dan Mulut Pada Anak Usia Dini Di TK Terpadu Alif Center Kabupaten Jombang

Health is highly essential, especially when it comes to issues with dental and oral health. Early dental and oral health care is important so that children develop the behaviors necessary to maintain cleanliness and good oral and dental health. In addition to assessing the children's oral and dental hygiene, this community activity strives to educate the public on the need of maintaining good dental and oral health. Based on community service findings, it was discovered that as many as 9 children (39%) had clean teeth and mouths. With this activity, it is intended that children may use the proper technique for brushing their teeth and can always improve oral and dental health. Additionally, it is intended that the school will be able to monitor kids thoroughly so that it can ensure their general wellbeing.&#x0D; Keywords: Early childhood, Dental and oral health examination and monitoring.

Perceived neighbourhood collective efficacy and adolescent health determinants: Investigating outdoor play as a mediator.

Research demonstrates that play is promotive of health and development in children across multiple domains. Outdoor play may be especially beneficial as environmental elements are conducive to recreation and relaxation. Maternal perception of neighbourhood collective efficacy (NCE), or sense of cohesion among residents, may be a form of social capital especially effective in promoting outdoor play, and thus healthy development. Yet little research has examined the long-term benefits of play beyond childhood. We utilized longitudinal data from the Fragile Families and Child Wellbeing Study (N = 4441) to evaluate outdoor play during middle childhood as a mediator between perceived NCE in early childhood and adolescent health determinants. Maternal self-reported perceived NCE at age 5, children's outdoor play was assessed at age 9 and adolescents' self-reported height, weight, physical activity and depressive and anxiety symptoms at age 15. Total play served as mediator between NCE and later adolescent health determinants. Perceived NCE in early childhood (age 5) significantly predicted more total play in middle childhood (age 9), which in turn predicted more physical activity and lower anxiety symptoms in adolescence (age 15). Consistent with a developmental cascades approach, maternal perceptions of NCE shaped children's engagement in outdoor play that may serve as a foundation for later emerging health behaviours.

Abstract P269: Associations Between Neighborhood Socioeconomic Deprivation During Pregnancy and Offspring Early Anthropometric Outcomes

Introduction: Residing in areas with lower neighborhood socioeconomic position (NSEP) is associated with adverse birth outcomes like small for gestational age and low birthweight. Lower NSEP is also associated with higher weight status and blood pressure in adolescence. However, few studies have assessed NSEP and indicators of cardiometabolic health in early childhood. We examined associations between NSEP during gestation and changes in early childhood weight in a North Carolina (NC) birth cohort. Hypothesis: We hypothesized that lower gestational NSEP would associate with rapid infant weight gain and increased odds of having overweight in early childhood. Methods: The sample was from the Newborn Epigenetics STudy (NEST) cohort. 2,681 gestational parent-offspring pairs were recruited from prenatal visits at obstetrics care facilities in Durham County, NC and enrolled between 2005-2011. For this study, offspring were assessed at birth (N=1,058), 6 months (N=1,268), 1 year (N=1,268), 2 years (N=1,033), and 3 years (N=1,038). NSEP was measured as Neighborhood Deprivation Index (NDI) tertiles at the 2010 US census block group level in NC using parent residential address at enrollment (high NDI=low NSEP). Offspring anthropometric outcomes included: (1) having vs not having overweight (weight for length or body mass index percentiles ≥85 th ) at each study visit; and (2) having rapid vs non-rapid infant weight gain from birth to 6 months and birth to 1 year. Multilevel logistic regression models estimated odds ratios (OR) and 95% confidence intervals (CI) for the relationship between NDI (ref=low) and weight, adjusting for gestational parent age, race, marital status, and education. Results: On average, gestational parents were 28 years old with college degrees (35%), followed by high school or equivalent (22%), and identifying as non-Hispanic (NH) Black (43%), followed by NH White (34%). Prior to covariate adjustment, children residing in neighborhoods with high vs low NDI had greater odds of having overweight at 6 months (OR=1.57, 95% CI=1.10-2.25), 1 year (OR=2.01, 95% CI=1.49-2.71), 2 years (OR=1.78, 95% CI=1.25-2.49), and 3 years (OR=1.35, 95% CI=0.96-1.89) and of experiencing rapid infant weight gain from birth to 6 months (OR=1.03, 95% CI=0.79-1.33) and to 1 year (OR=1.62, 95% CI=1.25-2.09). Associations were attenuated after adjustment, but children residing in neighborhoods with high vs low NDI had greater odds of having overweight at 1 year (OR=1.53, 95% CI=1.09-2.15). Conclusions: Low NSEP may associate with higher early childhood weight. This has important implications for later developmental milestones and health outcomes in childhood. Several potential mechanisms could explain this association, including biological programming and limited neighborhood opportunities for movement and healthy eating. Future work exploring these and other mechanisms is warranted.

Preimplantation genetic testing and child health: a national register-based study.

Is preimplantation genetic testing (PGT) associated with adverse perinatal outcome and early childhood health? Children born after PGT had comparable perinatal outcomes to children born after IVF/ICSI and comparable findings regarding early childhood health. PGT is offered to couples affected by monogenic disorders (PGT-M) or inherited chromosomal aberrations (PGT-SR), limiting the risk of transferring the disorder to the offspring. PGT, an invasive technique, requires genetic analysis of one or up to ten cells from the embryo and is combined with IVF or ICSI. Several studies, most of them small, have shown comparable results after PGT and IVF/ICSI concerning perinatal outcome. Only a few studies with limited samples have been published on PGT and childhood health. We performed a register-based study including all singletons born after PGT (n = 390) in Sweden during 1 January 1996-30 September 2019. Singletons born after PGT were compared with all singletons born after IVF/ICSI (n = 61060) born during the same period of time and with a matched sample of singletons (n = 42034) born after spontaneous conception selected from the Medical Birth Register. Perinatal outcomes, early childhood health, and maternal outcomes were compared between pregnancies after PGT and IVF/ICSI as well as between pregnancies after PGT and spontaneous conception. Primary outcomes were preterm birth (PTB) and low birthweight (LBW) whereas childhood morbidity was the secondary outcome. Data on women who went through PGT and gave birth were obtained from the local databases at the two PGT centres in Sweden, whereas data on IVF treatment for the IVF/ICSI group were obtained from the national IVF registers. These data were then cross-linked to national health registers; the Medical Birth Register, the Patient Register, and the Cause of Death Register. Logistic multivariable regression analysis and Cox proportional hazards models were performed with adjustment for relevant confounders. The mean follow-up time was 4.6 years for children born after PGT and 5.1 years for children born after spontaneous conception, whereas the mean follow-up time was 9.0 years for children born after IVF/ICSI. For perinatal outcomes, PTB occurred in 7.7% of children after PGT and in 7.3% of children after IVF/ICSI, whereas the rates were 4.9% and 5.2% for LBW (adjusted odds ratio (AOR) 1.22, 95% CI 0.82-1.81 and AOR 1.17, 95% CI 0.71-1.91, respectively). No differences were observed for birth defects. In comparison to spontaneous conception, children born after PGT had a higher risk for PTB (AOR 1.73, 95% CI 1.17-2.58). Regarding early childhood health, the absolute risk of asthma was 38/390 (9.7%) in children born after PGT and 6980/61060 (11.4%) in children born after in IVF/ICSI, whereas the corresponding numbers were 34/390 (8.7%) and 7505/61060 (12.3%) for allergic disorders. Following Cox proportional hazards models, no significant differences were found for these outcomes. Sepsis, hypothyroidism, attention deficit hyperactivity disorder, autism spectrum disorders, mental retardation, cerebral palsy, and epilepsy were diagnosed in a maximum of three PGT children. No PGT children died during the follow-up period. Regarding maternal outcomes, the rates of placenta praevia and caesarean delivery were significantly higher after PGT in comparison to spontaneous conception (AOR 6.46, 95% CI 3.38-12.37 and AOR 1.52, 95% CI 1.20-1.92, respectively), whereas no differences were seen comparing pregnancies after PGT and IVF/ICSI. The rather small sample size of children born after PGT made it impossible to adjust for all relevant confounders including fertilization method and culture duration. Moreover, the follow-up time was short for most of the children especially in the PGT group, probably lowering the absolute number of diagnoses in early childhood. The results are reassuring and indicate that the embryo biopsy itself has no adverse effect on the perinatal, early childhood, or maternal outcomes. Although the results are comparable to IVF/ICSI also regarding early childhood outcome, they should be taken with caution due to the low number of children with diagnoses and short follow-up time. Long-term follow-up studies on children born after PGT are scarce and should be conducted considering the invasiveness of the technique. The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (LUA/ALF 70940), the Board of National Specialised Medical Care at Sahlgrenska University Hospital and Hjalmar Svensson Research Foundation. There are no conflicts of interest to declare. N/A.

Knowledge and Attitude of Mothers Regarding Early Childhood Health Protocol Implementation During the Covid-19 Pandemic

Aim: Since Sars-CoV-2, a new strain of the coronavirus, has become a global pandemic, we need to take precautionary measures and establish health procedures. The study aimed to determine the relationship between knowledge and mothers' attitudes regarding the application of health protocols for early childhood during the Covid-19 pandemic at Majalengka Regency. Method: This cross-sectional study was conducted in 2021 with a sample size of 51 mother-and-child pairs from kindergartens in the Majalengka Regency of West Java. Knowledge and attitude measurement using good validity and reliability reported questionnaires. Result: The results of the mother's knowledge were good, namely 82.4%, while the level of knowledge was sufficient at 17.6%. The results of the mother's attitude supported 56.9% and did not support 43.1%. The cross-tabulation results obtained a p-value of 0.714, which is greater than 0.05, meaning there is no relationship between knowledge and mothers' attitudes about the application of health protocols in early childhood. Conclusion: Based on the study result, family members and nurses in public health centers can increase counseling regarding health protocols for early childhood mothers. They need to work with health workers or local health agencies to counsel and motivate mothers to increase attitudes toward implementing health protocols in early childhood during the Covid-19 pandemic.