Child Health Research Articles

Hypoglycaemia in screening oral glucose tolerance test in pregnancy with low birth weight fetus

Maternal hypoglycemia, a condition characterized by lower than normal blood glucose levels in pregnant women, has been increasingly associated with adverse pregnancy outcomes, including low birth weight (LBW) in neonates. LBW, defined as a birth weight of less than 2500 g, can result from various factors, including maternal nutrition, health status, and metabolic conditions like hypoglycemia. Maternal hypoglycemia may affect fetal growth by altering the supply of essential nutrients and oxygen to the fetus, leading to restricted fetal development and growth. This condition poses significant risks not only during pregnancy but also for the long-term health of the child, increasing the likelihood of developmental delays, health issues, and chronic conditions later in life. Research in this area has focused on understanding the mechanisms through which maternal hypoglycemia influences fetal development, with studies suggesting that alterations in placental blood flow and nutrient transport, as well as direct effects on fetal insulin levels and metabolism, may play a role. Given the potential impact of maternal hypoglycemia on neonatal health outcomes, early detection and management are crucial to minimize risks for LBW and its associated complications. Further investigations are needed to fully elucidate the complex interactions between maternal glucose levels and fetal growth, as well as to develop targeted interventions to support the health of both mother and child. Understanding these relationships is vital for improving prenatal care and outcomes for pregnancies complicated by hypoglycemia.

Artificial intelligence in applied family research involving families with young children: A scoping review

AbstractObjectiveThis scoping review systematically examined the applied family science literature involving families raising young children to understand how relevant studies have applied artificial intelligence (AI)‐facilitated technologies.BackgroundFamily research is exploring the application of AI. However, there is a critical need for a review study that systematically examines the varied use of AI in applied family science to inform family practitioners and policymakers.MethodComprehensive literature searches were conducted in nine databases. Of the 10,022 studies identified, 21 met inclusion criteria: peer‐reviewed journal article; published between 2014–2024; written in English; involved the use of AI in collecting data, analyzing data, or providing family‐centered services; included families raising young children 0–5 years; and was quantitative in analysis.ResultsMost studies focused on maternal and child health outcomes in low‐ and middle‐income countries. All studies identified were in the AI use domain of data analysis, with 76% of the studies having a focus on identifying the most important predictors. Random forest performed as the best machine learning model. Only one study directly mentioned the ethical use of AI.ConclusionOverall, the applied family science evidence base that employs AI is limited in size and scope, with most studies using AI for data analysis purposes with limited ethical considerations.ImplicationsAI models in applied family science can inform family services and policies aimed at promoting family and child health. However, thoughtful consideration of AI ethics and fairness is needed to prevent the negative social impacts of AI on marginalized groups of families and their young children.

Parental Factors Related to COVID-19 Prevention Behavior in Children with Intellectual Disability: Partial Least Square Structural Equation Modeling

Efforts to prevent COVID-19 in children with intellectual disability require the role of parents. Even though the vaccine has been implemented, the most important effort is to implement health protocols. Implementing health protocols cannot be separated from knowledge, attitudes, intentions, subjective norms, and social support from parents. This research aims to determine the influence of knowledge, attitudes, intentions, subjective norms, and social support on the COVID-19 prevention behavior of parents of children with intellectual disability. This type of research is descriptive correlational research, and the developed model is validated using the partial least squares structural equality modeling (PLS-SEM) approach based on data collected from 100 parents of children with intellectual disabilities taken using purposive sampling at Semarang Municipal Special Schools.The study results show that parental characteristics, namely education, influence attitudes, which can ultimately affect parental intentions. Parental education also affects social norms, namely social support and subjective norms, which can determine COVID-19 prevention behavior. Parental education is a priority in public health strategies because it can directly shape attitudes, intentions, and social norms that can improve the health of children with intellectual disabilities. Health programs and education for parents must be focused and carried out consistently and continuously.

Risk factors and birth outcomes of preterm birth subtypes: a case-control study of singleton natural pregnancy

ObjectiveThe objective of the study was to identify the risk factors correlated with spontaneous preterm birth (SPTB) and iatrogenic preterm birth (IPTB), as well as to compare the pregnancy outcomes...

Laying the foundations for high-quality mortality surveillance in Sierra Leone: Early learnings from the Child Health and Mortality Prevention Surveillance (CHAMPS) Network

Background More than four million child deaths occur annually; most are neither adequately documented nor investigated. The Child Health and Mortality Prevention Surveillance (CHAMPS) program was launched in Sierra Leone (SL) to generate high-quality data to determine definitive causes of stillbirths and under-five mortality (U5M) to inform decision-makers. Despite the multiple challenges of a greenfield research site, we highlight the experience of setting up a high-quality mortality surveillance (MS) system, including the viability of Minimal Invasive Tissue Sampling (MITS). Methods To establish the MS program, we implemented qualitative research and community entry, a sensitive system for timely identification and notification of deaths and followed CHAMPS standard operating procedures for investigating deaths and assigning accurate and definitive causes of death. CHAMPS in SL was implemented in four phases during 2017-2019 by a consortium. Enrolled stillbirths and U5M underwent verbal autopsy, clinical-data-abstractions, MITS, microbiology, molecular and histopathological diagnoses, and Determination of Cause of Death (DeCoDe). Results CHAMPS achieved a 93% consent rate, capitalizing on existing Ministry of Health infrastructure, community involvement, and local ownership. As of December 2022, 3,433 deaths were registered, with 1,056 (31%) eligible for enrolment. Of 439 cases DeCoDed, 402 (92%) of case-families had received feedback on the cause of death. Using findings and recommendations from the DeCoDe experts, CHAMPS is implementing interventions to reduce stillbirths and U5M at CHAMPS SL, including clinical review meetings, provision of emergency drugs and routine child death audits. Conclusion Implementing innovative MS in a challenging context, such as SL, is possible. Building on local knowledge and infrastructure has enabled the CHAMPS project to achieve remarkably high consent rates, given the cultural, religious and sensitivity challenges surrounding seeking consent for MITS from caregivers who have just lost a child. The programme has invested significantly in upscaling local technical capacity for surveillance and laboratory diagnostics.

The effect of CFTR modulators on growth, body composition and bone health in children and adolescents with cystic fibrosis

The effect of CFTR modulators on growth, body composition and bone health in children and adolescents with cystic fibrosis

Improving treatment plan and mental health in children with abdominal infection for broad-spectrum bacterial infections

BACKGROUND Pediatric abdominal infection is a common but serious disease that requires timely and effective treatment. In surgical treatment, accurate diagnosis and rational application of antibiotics are the keys to improving treatment effects. AIM To investigate the effect of broad-spectrum bacterial detection on postoperative antibiotic therapy. METHODS A total of 100 children with abdominal infection who received surgical treatment in our hospital from September 2020 to July 2021 were grouped. The observation group collected blood samples upon admission and sent them for broad-spectrum bacterial infection nucleic acid testing, and collected pus or exudate during the operation for bacterial culture and drug sensitivity testing; the control group only sent bacterial culture and drug sensitivity testing during the operation. RESULTS White blood cell count, C-reactive protein, procalcitonin, 3 days after surgery, showed better postoperative index than the control group (P < 0.05). The hospital stay in the observation group was significantly shorter than that in the control group. The hospitalization cost in the observation group was significantly lower than that in the control group, and the difference between the two groups was statistically significant (P < 0.05). CONCLUSION Early detection of broad-spectrum bacterial infection nucleic acids in pediatric abdominal infections can help identify pathogens sooner and guide the appropriate use of antibiotics, improving treatment outcomes and reducing medical costs to some extent.

A systematic review of self-regulation measures in children: Exploring characteristics and psychometric properties

Self-regulation, which encompasses cognitive, behavioural, and emotional domains, poses challenges in consistent measurement due to diverse definitions and conceptual complexities. In recognition of its profound impact on long-term mental health and wellbeing in children, this systematic review examined available self-regulation measures for children and young people between 1 and 18 years of age. The systematic review followed the COSMIN taxonomy and reported on the measurement tools’ characteristics and psychometric properties. The methodology and reporting were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and checklist. The protocol for this review was registered with PROSPERO (Number CRD42020155809). A search of six databases (Embase, MEDLINE, PsycINFO, Scopus, CINAHL and ERIC) was performed, and grey literature was searched to identify studies on the psychometric properties of measures assessing all three domains (cognitive, behavioural, and emotional) of self-regulation. The types of psychometric properties were examined against the COSMIN taxonomy of measurement properties. A total of 15,583 studies were identified, and 48 of these met the criteria that reported psychometric properties of 23 self-regulation measures assessing all three domains of self-regulation. Most measures relied on self-reports for ages 11–17, and all had limited psychometric evaluation. The Emotion Regulation Checklist was the most studied measure. Notably, none of the studies evaluated measurement error. The content validity was inadequately evaluated, particularly in terms of comprehensiveness and comprehensibility. Future research should focus on developing measures for young children, evaluating measurement error, and enhancing content validity for comprehensive understanding and effective intervention.

Mental health of Irish adolescents following the COVID-19 pandemic: results from a population-based cross-sectional survey.

This study provides data on the prevalence of mental health problems among adolescents in Ireland in 2021, toward the end of the COVID-19 pandemic. The importance of having recent, large-scale, mental health data for adolescents has been heightened by COVID-19, the increased demand for child and adolescent mental health services, and the rapidly changing adolescent environment. As part of the Planet Youth study, a cross-sectional survey of adolescents (N = 4,404), mostly aged 15-16, was conducted between September and December 2021. Participants were recruited from 40 schools and non-traditional educational centres across 3 regions in Ireland, one predominantly urban (North Dublin) and two predominantly rural (Cavan, Monaghan). A range of mental health outcomes were self-reported: a single-item question on mental health; the Strengths & Difficulties Questionnaire (SDQ); depressive and anxiety symptoms from the Symptom Check List 90; the Adolescent Psychotic-like Symptom Screener; and lifetime self-harm, suicidal ideation, and attempt. Over a quarter of adolescents described their mental health as 'bad' or 'very bad' (29%), and had SDQ total problem scores over 20 (26%). Over a third (39%) reported self-harming, 42% reported suicidal ideation, and 11% reported attempting suicide, in their lifetime. Gender-diverse youth (non-binary, trans, and undisclosed) had higher rates of poor mental health outcomes compared to cis-gendered youth (male/female), and females had higher rates of most mental health outcomes compared to males. Many of these estimates suggest a deterioration from previous epidemiological studies. While our findings do not definitively prove youth mental health has worsened over time, these findings are highly concerning. We propose a close monitoring of mental health in future surveys of this population and encourage initiatives to improve the capacity and quality of youth mental health services.

Policies to Curb Fossil Fuel Pollution and Mitigate Climate Change Benefit Child and Adult Health, and the Economy, but Assessments Can do Better

Abstract

A survey of the psychiatric care provided for children and young people in general hospital settings in New Zealand

Objective The aim of this study was to conduct an in-depth survey of psychiatric care provided for children and young people (CYP) in general hospital settings in New Zealand (NZ). Method As part of a larger national survey of Consultation-Liaison Psychiatry (CLP) services across the lifespan, a 44-question survey was emailed to clinicians who were involved in providing psychiatric care for CYP at each of the 24 public general hospitals with specialist paediatric services. Results Responses were obtained from all four paediatric CLP teams that cover the four specialist children’s hospitals, and 16 of the 23 child and adolescent community mental health services that provide hospital inreach. These services were found to be under-resourced, utilise variable service models, and rely heavily on inreach. Conclusion Escalating presentation rates for young people and increasingly complex paediatric presentations pose major challenges for the psychiatric care of CYP in general hospital settings. Utilising international staffing standards and service models, proposals are made to evolve more consistent and effective paediatric CLP services in NZ.

Prevalence and Trends of Not Receiving a Dose of DPT-Containing Vaccine Among Children 12–35 Months: An Analysis of 81 Low- And Middle-Income Countries

AbstractNot receiving a DPT-containing vaccine in early childhood indicates an absence of routine immunization, which puts children at an elevated risk of mortality, morbidity, and worse human development over the life course. We estimated the percentage of children 12–35 months who did not receive a dose of DPT-containing vaccine (termed zero-dose children) using household surveys from 81 low- and middle-income countries conducted between 2014 and 2023. For 68 countries with more than one survey (with the earlier survey conducted 2000–2013), we estimated the average annual percentage point change in prevalence of zero-dose children between the earliest and latest surveys. We also explored the association of zero-dose prevalence with postneonatal and child mortality, health expenditure, and Gavi-eligibility. Overall, 16% of children in our pooled sample had not received a dose of DPT-containing vaccine. There was a 0.8% point decline in zero-dose prevalence per year on average across the period studied. A single percentage point average annual decline in zero-dose prevalence was associated with an average annual decrease of 1.4 deaths in the postneonatal and childhood period per 1000 live births. Gavi-eligible countries had a much faster decline in zero-dose prevalence than other countries. Large gains have been made in reducing the percentage of children who did not receive a DPT-containing vaccine. Efforts to reduce the number of zero-dose children should focus on countries with high prevalence to achieve the Immunization Agenda 2030. Healthcare spending could be prioritized so that the prevalence of zero-dose children is reduced.

Factors related to parents’ perceptions of oral health for children with Down syndrome in Japan

Factors related to parents’ perceptions of oral health for children with Down syndrome in Japan

Charting the Ethical Frontier in Newborn Screening Research: Insights from the NBSTRN ELSI Researcher Needs Survey

From 2008 to 2024, the Newborn Screening Translational Research Network (NBSTRN), part of the National Institute of Child Health and Human Development (NICHD) Hunter Kelly Newborn Screening Program, served as a robust infrastructure to facilitate groundbreaking research in newborn screening (NBS), public health, rare disease, and genomics. Over its sixteen years, NBSTRN developed into a significant international network, supporting innovative research on novel technologies to screen, diagnose, treat, manage, and understand the natural history of more than 280 rare diseases. The NBSTRN tools and resources were used by a variety of stakeholders including researchers, clinicians, state NBS programs, parents, families, and policy makers. Resources and expertise for the newborn screening community in ethical, legal, and social issues (ELSI) has been an important area of focus for the NBSTRN and this includes efforts across the NBS system from pilot studies of candidate conditions to public health implementation of screening for new conditions, and the longitudinal follow-up of NBS-identified individuals to inform health outcomes and disease understanding. In 2023, the NBSTRN conducted a survey to explore ELSI issues in NBS research, specifically those encountered by the NBS community. Since NBS research involves collaboration among researchers, state NBS programs, clinicians, and families, the survey was broadly designed and disseminated to engage all key stakeholders. With responses from 88 members of the NBS community, including researchers and state NBS programs, the survey found that individuals rely most on institutional and collegial resources when they encounter ELSI questions. Most survey responses ranked privacy as extremely or very important in NBS research and identified the need for policies that address informed consent in NBS research. The survey results highlight the need for improved collaborative resources and educational programs focused on ELSI for the NBS community. The survey results inform future efforts in ELSI and NBS research in the United States (U.S.) and the rest of the world, including the development of policies and expanded ELSI initiatives and tools that address the needs of all NBS stakeholders.

Barriers and Enablers to Data-Based Decision Making in Australian Place-Based Community Initiatives: A Qualitative Study Informed by the COM-B Model and Theoretical Domains Framework

AbstractThis study investigated barriers and enablers to collecting, reporting, and using data and evidence-based lead indicators in decision-making. Four Australian place-based initiatives (PBI) focused on improving child health and reducing inequities participated. Eight interviews with PBI leaders revealed barriers and enablers aligned with all three Capability, Opportunity, and Motivation factors of the COM-B model of behaviour. Difficulties sharing data across services and with the PBI was a main barrier. Enablers were largely related to opportunity factors (e.g., data access) and demonstrating to service providers the benefits to families. Interventions targeting multiple barriers and enablers are needed for consistent, routine use of lead indicators.

Association between postterm birth and adverse growth outcomes in children aged 3-6 years: A national retrospective cohort study.

Gestational age significantly influences children's growth and development. Yet, the effect of postterm birth (gestation beyond 42 weeks) on children's growth outcomes remains underexplored. This study aimed to assess the impact of postterm birth on adverse growth outcomes in children using a nationally representative sample from China. A retrospective cohort study was conducted in China from 1 April 2018, to 31 December 2019. The final analysis included 141,002 children aged 3-6 years from 551 cities. Postterm birth was defined as children with postterm birth at a gestational age of 42 weeks or more. Obesity, overweight and thinness were assessed using body mass index-for-age (BMI-for-age) z-scores, based on the World Health Organization (WHO) Child Growth Standards. Generalised additive models were employed to investigate the non-linear relationship between maternal gestational age and BMI-for-age z scores. Poisson regression models and subgroup analyses with forest plots were performed to examine the associations between postterm birth and the risks of obesity, overweight and thinness in children. We included 141,002 mother-child pairs, of whom 7314 (5.2%) children were classified as postterm births. There exists a non-linear relationship between gestational age and BMI-for-age z scores. Children born postterm exhibited a 46% increased risk of obesity, a 27% increased risk of combined overweight/obesity and a 13% increased risk of thinness. Similar associations were observed in most cases when further sensitivity and subgroup analysis were conducted. Postterm birth was associated with elevated risks of obesity, overweight and thinness in children aged 3-6 years, independent of sex. These findings underscore the importance of further research across diverse populations to understand the implications of postterm births on child health outcomes.

Trends and disparities in ever-breastfeeding practice and early breastfeeding initiation in Ethiopia: a 20-year trend analysis from EDHS datasets

BackgroundEthiopia has had a long-standing national commitment to improving child health for the last five decades. However, evidence on trends of ever-breastfeeding and early initiation remained fragmented, and there existed a paucity of holistic evidence on the extent of the impacts of the policy and the associated factors. This study examined trends, disparities, and factors influencing ever-breastfed and early initiation in the last twenty years.MethodsThe Ethiopian Demographic and Health Surveys (EDHS 2000–2019) datasets were used and extracted for children aged 0–23 months and their mothers. Data analyses were performed using SPSS version 25. Trend and time-series analysis was used to visualize changes over time. Multivariable logistic regression was used to identify associated factors.ResultsPrevalence of ever-breastfeeding declined from 99.4% in 2000, to 84.01% in 2019; and early initiation showed inconsistency, increasing from 48.55% in 2000 to 69.57% in 2016 and remained unchanged (69.78%) in 2019. Maternal age, religion, and maternal healthcare utilization significantly influenced early initiation (p < 0.001). Both ever-breastfeeding and early initiation varied across regional states (< 0.001). Disparities in breastfeeding and early initiation were observed across socio-cultural settings and regional states (p < 0.05).ConclusionThe prevalence of ever-breastfeeding declined nationwide between 2000 and 2019, which was not uniform and early initiation showed inconsistency across socio-cultural settings and regional states. These findings highlight the need to revisit current policies and interventions. Further research is crucial to inform the development of regionally tailored and culturally sensitive strategies that promote equitable and sustained breastfeeding improvement across Ethiopia.

Bidirectional associations between sleep and anxiety among Chinese schoolchildren before and after the COVID-19 lockdown

The COVID-19 pandemic has critical implications for mental health in children. This study examined how the COVID-19 lockdown affected sleep duration and anxiety symptoms in Chinese school-aged children and the bidirectional association between sleep and anxiety before and during the COVID-19 lockdown. A school-based longitudinal cohort study was conducted to examine the relationship between sleep duration and anxiety scores before and after the COVID-19 lockdown from January to May 2020. Generalized estimating equations model was used to identify variables that contributed to the changes in sleep duration. The bidirectional relationship between sleep duration and anxiety symptoms was explored by cross-lagged analysis. 7681 children completed two waves of surveys were included in the analysis. The daily exercise duration, anxiety symptoms, and sleep duration decreased significantly during the lockdown compared with that before the lockdown. Based on generalized estimating equations model, older age, secondary school, and higher anxiety scores of participants were positively associated with sleep duration, while female and no COVID-19 infection history were negatively associated with it. Cross-lagged analysis showed higher anxiety score of children before the lockdown was significantly associated with shorter sleep duration during the lockdown; and shorter sleep duration of children before the lockdown was also significantly associated with a higher anxiety score during the lockdown. Under the context of the COVID-19 pandemic, there were longitudinal, bidirectional associations between children’s anxiety symptoms and sleep duration. For school students, mental health services and sleep education should be considered in the daily health education curriculum.

The Negative Impact of Maternal HIV Infection on Birth Outcomes—Myth or Reality?

Human Immunodeficiency Virus (HIV) infection during pregnancy poses significant risks to both maternal and child health, with potential adverse effects on perinatal outcomes. This study aimed to compare perinatal outcomes, including birth weight, length, Apgar scores, and prematurity rates, between HIV-exposed, uninfected (HEU) children and HIV-unexposed, uninfected (HUU) children. A total of 204 neonates were included in the study, comprising 102 born to HIV-positive mothers and 102 born to uninfected mothers. Our findings revealed significant differences in birth weight (p &lt; 0.001), length (p &lt; 0.001), and Apgar scores at both 1 min (p = 0.003) and 5 min (p &lt; 0.001) between HIV-exposed and -unexposed children. The HIV-exposed group exhibited lower birth weights and lengths, along with lower Apgar scores, indicating potential neonatal health challenges. No significant disparities were observed in the prematurity risk between the two groups (OR = 2.58, p = 0.126), but the risk of being born small for gestational age (SGA) in the case of HEU newborns was significantly high (OR = 17.41, p &lt; 0.001). The significant differences in birth weight, length, and Apgar scores underscore the need for tailored healthcare interventions and support for neonates born to HIV-positive mothers. These findings contribute to our understanding of the complex interplay between maternal HIV infection and perinatal outcomes, guiding healthcare professionals in delivering targeted care for this vulnerable population.

An Examination of Mental Health Rates in Children During the First Year of the COVID-19 Pandemic: Findings from the National Health Interview Survey 2019-2020.

The study objective was to examine the mental health of children during a time period that included the COVID-19 Lockdown. The sample included a cross-section of children aged 2 to 17 years (2019; n = 4, 194; 2020; n = 5,172), from the National Health Interview Survey. In multivariate models, survey years 2020 and 2019 were compared for significant changes in anxiety, depression, and social behaviors in children after adjustment for sociodemographic variables. Bivariate analysis also examined sociodemographic characteristics, health care utilization by anxiety, depression, and social behaviors, and examined differences in anxiety and depression from 2019 to 2020. In multivariate models, there was an increased risk of anxiety ((AOR = 1.3(1.0, 1.6)), depression ((AOR = 1.2 (1.0, 1.4)) and difficult social behaviors (AOR = 1.2 (1.0, 1.4) in children from 2019 to 2020. Girls were at increased risk compared to boys for anxiety and depression ((anxiety; AOR = 1.4 (1.2, 1.8), depression; AOR = 1.2 (1.0, 1.3)), however, girls were at decreased risk compared to boys for uncontrolled social behaviors (AOR = 0.51 (0.43, 0.61)). White children were at increased risk for anxiety and depression compared to all other race and ethnic groups. High rates of anxiety, depression and difficult social behaviors that preexisted the Covid-19 Lock Down, continued or increased during the Lockdown. Effective public health interventions could prevent further declines in mental health, and a potential trajectory into adulthood of poor physical and mental health.