Age Infants Research Articles

Associations of per- and polyfluoroalkyl substances with human milk metabolomic profiles in a rural North American cohort.

Per- and polyfluoroalkyl substances (PFAS) are a class of persistent synthetic chemicals that are found in human milk and are associated with negative health effects. Research suggests that PFAS affect both lactation and the human metabolome. We measured perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) in the milk of 425 participants from the New Hampshire Birth Cohort Study using liquid chromatography-tandem mass spectrometry (LC-MS/MS). A nontargeted metabolomics assay was performed using LC with high-resolution MS, and metabolites were identified based on in-house database matching. We observed six metabolic profiles among our milk samples using self-organizing maps, and multinomial logistic regression was used to identify sociodemographic and perinatal predictors of these profiles, including infant sex, parity, participant body mass index, participant age, education, race, smoking status, gestational weight gain, and infant age at time of milk collection. Elevated PFOA was associated with profiles containing higher amounts of triglyceride fatty acids, glycerophospholipids and sphingolipids, and carnitine metabolites, as well as lower amounts of lactose and creatine phosphate. Lower concentrations of milk PFOS were associated with lower levels of fatty acids. Our findings suggest that elevated PFOA in human milk is related to metabolomic profiles consistent with enlarged milk fat globule membranes and altered fatty acid metabolism. Further, our study supports the theory that PFAS share mammary epithelial membrane transport mechanisms with fatty acids and associate with metabolic markers of reduced milk production.

Post‐term births as a risk factor for small for gestational age births and infant mortality in Brazil, Mexico, and Palestinian refugees: An analysis of electronic birth records

AbstractBackgroundPost‐term pregnancy, defined as reaching or exceeding 42 + 0 weeks of gestation, is known to be associated with unfavourable birth outcomes. High‐income countries have responded to this risk by widely adopting labour induction protocols in late‐term, but many low‐ and middle‐income countries have not. However, understanding underlying mechanisms linking post‐term births to adverse newborn and infant outcomes remains limited.ObjectiveTo investigate the (a) prevalence of post‐term, (b) the risk factors associated with post‐term (c) the association between post‐term births and the risk of small‐for‐gestational‐age (SGA) neonates and of infant mortality in middle‐income settings.MethodsWe used existing electronic datasets from the general population of Brazil, Mexico, and Palestinian refugees. Regression models were used to explore the associations between post‐term birth and SGA and infant mortality.ResultsWe analysed 21,335,033 live births in Brazil (2011–2018), 23,416,126 in Mexico (2008–2019), and 966,102 in Palestinian refugees (2010–2020) (N = 45,717,261). Post‐term deliveries accounted for 3.1% of births in Brazil, 1.2% in Mexico, and 2.1% in Palestinian refugees. Post‐term births had approximately three times the risk of resulting in SGA neonates compared to term births. Additionally, post‐term neonates exhibited a 15% to 40% increased risk of infant mortality compared to term infants. Notably, post‐term SGA neonates faced a significantly increased risk of infant mortality compared to term appropriate for gestational age neonates.ConclusionsThese findings emphasise the critical significance of implementing induction strategies to prevent post‐term pregnancies and mitigate the associated risks of SGA neonates and subsequent infant mortality. Moreover, the study highlights the importance of accurately determining gestational age and using INTERGROWTH‐21st charts to improve the identification of SGA cases, enabling targeted interventions. This is especially relevant because post‐term SGA neonates may not exhibit low birthweight (a commonly used risk marker) and, therefore, may miss out on required specialised attention.

Longitudinal evaluation of hemodynamic blood and echocardiographic biomarkers for the prediction of BPD and BPD-related pulmonary hypertension in very-low-birth-weight preterm infants.

Mainly at an early stage of postnatal neonatal care in VLBW preterm infants, several biomarkers were found to be associated with the combined endpoint BPD/death and BPD-PH. New candidates of blood biomarkers (NTproBNPZlog, ET-1, and CA125) and echocardiographic markers (TAPSE, PAAT/RVET) might serve as innovative predictors for BPD, BPD-PH, and adverse outcomes in VBLW infants. • VLBW infants are at risk for the development of BPD and BPD-related PH, which both are main contributors for short and long-term morbidity and mortality. Several studies in the past focused on the evaluation of circulating blood biomarkers and biomarkers from echocardiographic assessment of these infants. But to date, there is still a lack on longitudinal prospective studies especially in VLBW infants. • For the first time, this set of selected blood biomarkers (with the first description of Zlog-transformed NTproBNP and CA125 in preterm infants) and several echocardiographic markers were analyzed in a prospective longitudinal study from birth until 36 weeks post menstrual age in VLBW infants. Our data help clinicians to identify preterm infants at risk for BPD, BPD-PH and death and to offer new candidates of biomarkers. This might help to facilitate decision making and guidance of therapy in these highly vulnerable patients.

Need for national guidance regarding proactive care of infants born at 22-23 weeks' gestation.

With recent rapid improvements in neonatal intensive care, the limit of viability has shifted downward to 22-23 weeks' gestation. The younger the gestational age of preterm infants, the higher the risk of survival despite severe neurodevelopmental impairments. For infants born at 22-23 weeks' gestation, the limit of viability, neurodevelopmental outcomes, and survival rates may be determined by the quality of proactive care. Owing to the high risk of severe neurodevelopmental impairment in 22-23 weeks' gestation, proactive care is sometimes withheld according to ethical or legal considerations, and there are significant differences in the provision of proactive care and survival rates across countries or institutions. Additionally, there are differing or even lacking guidelines regarding the care of these infants across countries and institutions. Japan and Sweden are countries with well-established national guidance and proactive care for infants born at 22-23 weeks' gestation, resulting in higher survival rates among them. In Korea, where there is an extreme shortage of neonatologists, maternal transfer before delivery at 22-23 weeks' gestation to high-activity regions with appropriate neonatal intensive care unit resources, such as adequate personnel and facilities similar to the centralized care model seen in Sweden, is crucial for improving the survival rates of infants born at 22-23 weeks' gestation. The survival of these infants largely depends on the quality of proactive care provided. This rate is not static and can be improved through proactive case management based on national guidance and the implementation of enhanced neonatal intensive care practices, including centralization of care.

Neurodevelopmental Outcomes After Multiple General Anaesthetic Exposure Before Five Years Of Age - A Cohort Study.

The GAS trial demonstrated evidence that most neurodevelopmental outcomes at 2 years and 5 years of age in infants who received a single general anaesthetic (GA) for elective inguinal herniorrhaphy were clinically equivalent when compared to infants who did not receive GA. More than 20% of the children in the trial had at least one subsequent anaesthetic exposure after their initial surgery. Using the GAS database, this study aimed to address whether multiple (2 or more) GA exposures compared to one or no GA exposure in early childhood were associated with worse neurodevelopmental outcomes at 5 years. Children with multiple GA exposures and children with one or no GA exposure were identified from the GAS database. The primary outcome was the full-scale intelligence quotient (FSIQ) on the Wechsler Preschool and Primary Scale of Intelligence third edition (WPPSI-III) at 5 years of age. Secondary outcomes included neurocognitive tests addressing all major developmental domains and caregiver-reported questionnaires assessing emotional and behavioural problems. Complete assessment was available from a total of 90 children in the multiple GA group and 141 children in the 0 or 1 GA group. Compared with children with a single or no GA exposure, multiply exposed children scored on average almost 6 points lower (mean: -5.8, 95% CI: -10.2 to -1.4, p= 0.011) in WPPSI-III FSIQ. They also demonstrated lower verbal and performance IQ scores and more emotional, behavioural, and executive function difficulties. However, significant residual confounding cannot be excluded from the results due to the observational nature of this study. Multiple GA exposure before 5 years of age was associated with reduced performance in general intelligence score and some domains of neurodevelopmental assessments. The clinical significance of our results must be cautiously interpreted in light of several sources of limitations including small sample size and unadjusted residual confounding. This study illustrates the limitations of trial data sets that may not be fit for the purpose for the secondary analysis.

Approach to Complementary Feeding and Infant Language Use: An Observational Study.

Emerging research suggests that a more infant-led approach to complementary feeding may confer benefits for child language, but these findings are based on parent report studies. Using an observational approach this study examines whether different complementary feeding experiences relate to infant language exposure and language use. Fifty-eight parents recorded a typical infant mealtime in the home (mean infant age = 14 months, SD = 4.15). Observations were coded to measure the prevalence of infant-led and parent-led feeding using the Family Mealtime Coding Scheme. Caregiver language use (word types and token directed at the child, mean length of utterances in child-directed speech, responsiveness and initiations) and the number of infant vocalisations were coded in ELAN using CHAT conventions and parents completed the MacArthur Communicative Development Inventory short form as a measure of child language. Greater observed infant self-feeding was significantly associated with greater observed exposure to language from caregivers (r = 0.312 percentage of infant self-feeding correlated with caregiver word types directed at the child) and a greater number of infant vocalisations (r = 0.320 percentage of infant self-feeding correlated with number of child vocalisations produced). Structural Equation Modelling showed the relationship between infant self-feeding and infant vocalisations to be significantly mediated by enhanced quality and quantity of caregiver child-directed speech (model fit: χ2 [5] = 5.01, p = 0.415, CFI = 1.00 [NF = 0.98], RMSEA = 0.006). Differences in the approach to complementary feeding may shape infant's experiences in ways that support language exposure and use. Autonomy associated with infant self-feeding may enhance opportunities for social interaction.

Prenatal iodine intake and infant temperament in a multiethnic US cohort.

Maternal iodine plays a central role in fetal neurodevelopment. It is recommended that pregnant women consume sufficient levels of iodine to accommodate increased need for mother and fetus. We examined associations among prenatal dietary and supplemental iodine intake and infant temperament. The PRogramming of Intergenerational Stress Mechanisms (PRISM) study is an ongoing longitudinal pregnancy cohort. Data from 2011 to 2020 were used for this study. Women completed the Block98 FFQ ascertaining prenatal dietary and supplemental iodine intake and the Infant Behavior Questionnaire-Revised at infant age 6 months to ascertain infant temperament (Surgency/Extraversion, Negative Affectivity and Orienting/Regulation). USA. Mother-child dyads (n 892). Women were primarily Black/Hispanic Black (44 %) and non-Black Hispanic (35 %) with 46 % reporting household income < $25 000/year. Nearly half had an estimated average requirement (EAR) < 160 µg/d (49 % based on dietary intake; 43 % based on diet and supplements). Girls born to women with an EAR ≥ 160 µg/d compared to girls born to women below this level had higher unadjusted extraversion scores for dietary plus supplemental intake (β = 0·23 (0·13, 0·33)); decreased to β = 0·05 (-0·08, 0·19) after adjusting for covariates. Boys born to women with an EAR ≥ 160 µg/d (based on diet and supplements) as compared to boys born to women below this level had statistically non-significant higher unadjusted negative affective score (β = 0·06 (-0·08, 0·20)) that became significantly lower upon covariate adjustment (β = -1·66 (-1·97, -1·35)). A significant proportion of these women reported suboptimal prenatal iodine intake. Suboptimal prenatal iodine intake may have implications for child neurodevelopment evident as early as infancy.

Untargeted Lipidomic Profiling of Amniotic Fluid Reveals Dysregulated Lipid Metabolism in Healthy Normal-Weight Mothers with Fetal Macrosomia

Background: Alterations in maternal lipid metabolism have been elucidated by several studies in relation to macrosomia. However, the lipidome of the intrauterine compartment associated with macrosomia, particularly in early pregnancy, remains largely unknown. Objectives: (1) To compare the lipidomic profile of early 2nd trimester amniotic fluid (AF) of healthy mothers with normal body mass index who gave birth to large-for-gestational age (LGA) versus appropriate-for-gestational age (AGA) infants; and (2) to examine if insulin and glucose concentrations in AF were associated with the AF lipidomic profile. Methods: In this nested case–control study, bio-banked AF samples were collected from pregnant women undergoing routine amniocentesis at 12–22 weeks of gestation. A subsample of 15 LGA infants (cases) were contrasted with 15 AGA infants (controls). An untargeted lipidomics analysis using liquid chromatography quadrupole time-of-flight mass spectrometry was conducted. Univariate and multivariate statistical analyses (principal component analysis and partial least-squares discriminant analysis) were used to extract differentially abundant (DA) features with high variable importance in projection (VIP) scores. Results: LGA AF was characterized by elevations of 30 phosphatidic acid species. Among other DA features, sphingomyelin (SM 14:0;O2/20:1) had the highest VIP score and was markedly elevated in LGA AF. Neither insulin nor glucose was associated with 2nd trimester AF lipidomic profiles in these healthy, normal-weight mothers. Conclusion: These findings provide evidence of early dysregulated lipid metabolism in healthy, normal-weight mothers with LGA infants.

Quantification of persistent organic pollutants in breastmilk and estimated infant intake, Norway.

Persistent organic pollutants (POPs) are environmental contaminants that can accumulate in human tissues and pose potential health risks. Despite global efforts to reduce their prevalence, follow-up studies are needed to see if the measures are successful. Since most infants in Norway are breastfed for the first 6 months of life, monitoring POP contamination in breastmilk is important for children's health and development. This study aims to evaluate the current levels of various POPs in women's breastmilk in Innlandet County, Norway. A cross-sectional study was conducted measuring concentrations of 35 different POPs, including polychlorinated biphenyls (PCBs), chlordanes (ChlDs), hexachlorocyclohexanes (HCHs), dichlorodiphenyltrichloroethanes (DDTs), Mirex, and brominated flame retardants in 120 breastmilk samples. The study analysed the impact of maternal age, parity, pre-pregnancy BMI, and infant age on POPs levels and compared the estimated daily intake per body weight of infants to existing health guidelines. The detected percentages for PCBs were 100%, for DDTs 98.3%, and for ChlDs 98.3%. The highest median concentration was found for ΣPCBs (26.9 ng/g lw). Maternal age, parity, and infant age were significant determinants of POP concentrations. Most infants exceeded the health-based guidance values for ΣPCB, and 6.4% percent did so for ΣHCHs. Despite lower POPs concentrations in breastmilk than in earlier studies, many breastfed infants are still exposed to levels exceeding health-based guidance values. Although the study's design had limitations, the study provides updated population-based data on POPs in breastmilk. Continued monitoring and research are necessary to understand and mitigate potential health risks associated with POPs.

Infantile Pasteurella multocida Meningitis: Case Report and Review of the Literature

Background: Pasteurella multocida is a rare cause of deep-seated pediatric infections including osteomyelitis and meningitis. We report a case of P. multocida meningitis from Queensland, with a comprehensive review of literature. Methods: Three databases were searched for infants &lt; 12 months of age with confirmed P. multocida meningitis. Mode of transmission, clinical and laboratory features, imaging, treatment and complications were reviewed. Logistic regression analysis was performed to evaluate predictors for outcomes including short-term neurologic complications, any long-term complications and mortality. Results: A total of 74 infants were included, with most cases occurring from indirect household animal contact (42/74; 61%). Bacteremia (38/74; 51%) and seizures (15/74, 20%) were common complications with mortality in 6 children (8%). Young infant age appeared to be the single most important risk factor for bacteremia. Conclusions: Infantile P. multocida meningitis although rare has potentially devastating complications. Younger infants are more likely to develop concomitant bacteremia. Household hand hygiene is imperative after trivial interactions with pets.

Maternal exploitation: impact of maternal food snatching behaviour on the growth of their offspring in Japanese macaques.

There is little information on maternal behaviour that deprives offspring of food, but some Japanese macaque, Macaca fuscata, mothers have been observed to snatch food from their offspring and eat it. This study investigated maternal food snatching behaviour (MFSB) and its impact on the growth of their offspring in provisioned, free-ranging Japanese macaques. The amount of food a mother snatched from her offspring was estimated to be 51.2% by dry weight compared to the amount of solid food an infant of the same age took in. Body mass growth of affected infants indicated a below-average mass gain. The study suggests that MFSB might be a pathological behaviour and provides the first detailed account of parental exploitation in animals.

Impact of Postpartum Hospital Length-of-Stay on Infant Gut Microbiota: A Comprehensive Analysis of Vaginal and Caesarean birth

BackgroundThe primary concern with prolonged hospitalization following birth is the risk of acquiring hospital-acquired infections (HAIs) caused by opportunistic bacteria, which can alter the early establishment of gut microbiota. ObjectiveThis study aimed to assess the association between postpartum hospital length-of-stay (LOS) and the composition of gut microbiota at 3 and 12 months of age according to birth mode. MethodsA total of 1313 Canadian infants from the CHILD Cohort Study were involved in this study. Prolonged hospital LOS was defined as > 2 days following vaginal and > 3 days after caesarean section (CS) birth. Infants' gut microbiota was characterized by Illumina 16S rRNA sequencing of faecal samples at 3-4 months and 12 months. FindingsFollowing a prolonged hospital LOS, vaginally-delivered (VD) infants with no maternal intrapartum antibiotic (IAP) exposure had a higher abundance of bacteria in their gut known to cause HAIs, including Enterococcus at 3 and 12 months, Citrobacter at 3 months and C. difficile at 12 months. Enterococcus or Citrobacter abundance at 3 months significantly mediated the association between LOS, and low abundance of Bacteroidaceae, or higher Enterococcaeae/Bacteriodaceae or Enterobacteriaceae/Bacteroidaceae abundance ratios at 12 months of age in VD infants without IAP exposure. HAI-causing Enterobacteriaceae were also more abundant in later infancy with a longer hospital LOS following CS. In the absence of exclusive breastfeeding for 3 months or any breastfeeding at 12 months, the Porphyromonadaceae (of Bacteroidota) become depleted in CS infants with a prolonged LOS. ConclusionsProlonged hospital stay after birth is associated with infant gut dysbiosis.

Risk factors for and short-term prognosis of intrauterine infection in preterm infants.

To identify the risk factors for and short-term prognosis of intrauterine infection (IUI) in preterm infants. We retrospectively collected clinical data regarding preterm infants (28+0-36+6 weeks of gestational age) with IUI from the neonatal intensive care unit of our hospital between June 2017 and June 2022. The pathologic characteristics of the infants were classified using the Redline criteria, and the resulting groups were compared with respect to their clinical characteristics, indicators of infection, complications, and mortality rates. Three hundred thirty (78.1%) of the 422 enrolled neonates showed signs of histologic IUI; 51.8% showed histologic chorioamnionitis alone, and 48.2% showed both histologic chorioamnionitis and funisitis. The independent risk factors identified for IUI were maternal prenatal invasive manipulation, premature rupture of membranes (>18 hours before labor), and prenatal C-reactive protein concentration. The infants with IUI showed higher incidences of respiratory distress syndrome, bronchopulmonary dysplasia, retinopathy of prematurity, and prolonged mechanical ventilation. Low gestational age and low birth weight of preterm infants were significantly associated with a higher incidence of histologic IUI, more severe inflammation, and a higher incidence of complications. Histologic IUI is associated with high complication and mortality rates in preterm infants, as is an increasing severity of inflammation.

Disorders of gut-brain interaction are common diagnoses among infants and toddlers in gastroenterology practices in Latin America.

To assess the relative frequency and associated factors of disorders of gut-brain interaction (DGBIs) in outpatient gastrointestinal (GI) clinics in young children of Latin America. Cross-sectional study in 10 pediatric GI outpatient clinics (private and public) in five countries of Latin America (El Salvador, México, Colombia, Panamá, and Nicaragua). Parents of patients 1 month 4 years of age from outpatient clinics complete/d a diagnostic questionnaire for DGBIs per Rome IV criteria (QPGS-IV, Spanish version). We conducted descriptive analysis, two-sample t-tests and chi-square tests, univariate analyses, and logistic regression to evaluate risk factors. We collected data from 783 children. In total, 34.5% had a DGBI. Overall, functional constipation (FC) was the most common diagnosis (23.4%) in children of all ages (infants, 16.1%, 1-4-years-old, 32.7%). In infants, the second most common DGBI was regurgitation (6.6%) and in 1-4-years-old and cyclic vomiting syndrome (4.1%). The diagnosis of a DGBI was significantly associated with a family history of DGBIs (odds ratio [OR] 2.97, 95% confidence interval [CI] 1.61-5.57, p = 0.0001). Patients who identified as black (OR 2.25, 95% CI 1.28-3.92, p = 0.0021) or mixed race (OR 1.76, 95% CI 1.25-2.48, p = 0.0006) were also significantly associated with a higher likelihood of DGBIs. DGBIs are a common diagnosis in pediatric GI clinics of Latin America. Overall, FC was the most common DGBI.

Mothers Falling Asleep During Infant Feeding.

Falling asleep while feeding (FAF) infants is common. Our primary objectives were to examine (1) maternally reported prevalence of FAF and if planned; (2) association between FAF and sociodemographic factors, feeding method, and sleep location; and (3) if receipt of education about safe sleep and bedsharing risks was associated with FAF. In the Social Media and Risk-reduction Training study, US mothers of newborns were randomized to educational messaging promoting infant safe sleep or breastfeeding. We analyzed data from 1259 mothers who responded to the postpartum survey (mean infant age, 11.2 weeks). We used generalized estimating equation logistic regression models to examine the extent that sociodemographic characteristics, feeding type, usual nighttime feeding location, and intervention group were associated with FAF. A total of 28.2% of mothers reported FAF usually or sometimes in the last 2 weeks, 83.4% of whom reported that FAF was unplanned. There were no differences in the odds of FAF by sociodemographic factors. Compared with mothers whose nighttime feeding location was their bed, mothers who reported feeding in a chair were less likely to FAF (33.6% versus 16.8%; adjusted odds ratio, 0.41; 95% confidence interval, 0.31-0.56). FAF was reported less frequently by mothers who received safe sleep interventions (15.6%), compared with mothers who received breastfeeding interventions (33.0%; adjusted odds ratio, 0.40; 95% confidence interval, 0.25-0.65). FAF is reported commonly among US mothers and is predominantly unplanned. Mothers who received safe sleep messaging were less likely to report FAF. New parents need guidance on planning for optimal safety during infant feeding.

Echocardiographic findings in newborns with inadequate intrauterine growth during pregnancy

Abstract Background Infants born small for gestational age (SGA) or diagnosed with fetal growth restriction (FGR) are at increased risk of neonatal mortality as well as cardiovascular disease later in life. Previous studies based on smaller cohorts (n&amp;lt;200) of newborns with SGA and FGR (n&amp;lt;200) have demonstrated structural and morphological alterations in the heart compared to infants born appropriate for gestational age (AGA). However, to our knowledge no previous study has systematically investigated the effect of SGA and FGR on echocardiographic parameters in the infant heart. Purpose To investigate whether echocardiographic parameters differ among infants born SGA or with FGR, in comparison to infants born AGA. Methods This study is a population-based cohort study of infants (n&amp;gt;25,000) offering postnatal cardiac examination including transthoracic echocardiography (TTE) between 2016-2018. We compared left ventricular (LV) TTE parameters in infants born SGA (birthweight ≥3rd and &amp;lt;10th percentile, n=2,106) and with FGR (birthweight &amp;lt;3rd percentile, n=972) with infants born AGA (birthweight ≥10th and &amp;lt;90th percentile, n=20,468) using a multiple linear regression analysis. We have investigated LV volumes, systolic function, diastolic function, and LV structure. All analyses were adjusted for sex, gestational age at birth, weight, length, and age at cardiac examination. Results Infants born SGA had higher heart rates compared with infants born AGA. Both infants born SGA and infants with FGR had significantly smaller LV dimensions including septal and posterior wall thicknesses (IVSd and LVPWd), and LV internal diameters (LVIDd and LVIDs). Infants born SGA had smaller end-diastolic and end-systolic volumes compared with infants born AGA (Table 1). Infants born SGA or with FGR had significantly higher mitral valve early peak velocities, compared with infants born AGA, and infants born SGA showed increased mitral valve atrial peak velocities indicating altered diastolic function (Table 1). Conclusion Infants born with inadequate intrauterine growth had smaller LV dimensions compared with infants born AGA, even when adjusting for infant size and age. Infants born SGA and with FGR both exhibited altered diastolic function. Longitudinal studies of children with inadequate intrauterine growth are needed to determine the impact on adult cardiac health.

Electrocardiographic findings in newborns with inadequate intrauterine growth during pregnancy

Abstract Background Infants born small for gestational age (SGA) or following fetal growth restriction (FGR) have an increased risk of neonatal mortality as well as cardiovascular disease later in life. Prenatal electrocardiograms (ECGs) in fetuses with FGR exhibit QT prolongation. However, neonatal alterations in the conduction system in infants born SGA or with FGR has not previously been assessed in a large cohort of infants. Purpose To investigate potential variations in electrocardiographic parameters between infants born SGA or diagnosed with FGR, in comparison to infants born appropriate for gestational age (AGA). Methods This study was based on data from a population-based cohort study of infants (n&amp;gt;25,000) with prenatal inclusion and postnatal cardiac examination including eight-lead ECG between 2016-2018. We conducted a multiple linear regression analysis to compare ECG parameters among infants with FGR (birthweight &amp;lt;3rd percentile, n=544) and SGA (birthweight ≥3rd and &amp;lt;10th percentile, n=1,384) to infants born AGA (birthweight ≥10th percentile and &amp;lt;90th percentile, n=14,076). Parameters of interest included: heart rate (HR), uncorrected and corrected (Bazzet and Fridericia) QT intervals, QRS duration, PR interval, QRS axis, maximum amplitudes of the R- and S-waves in V1 and V6. All analyses were adjusted for infant sex, gestational age at birth, and weight, length, and age at ECG examination. Results Infants born SGA or with FGR had higher HR and consequently shorter uncorrected QT intervals compared with infants born AGA (Table 1). Infants with FGR had significantly shorter corrected (Fridericias) QT intervals. Infants born SGA had smaller amplitudes of both the R- and S-wave in V6, and significantly larger amplitude of the S-wave in V1, compared with infants born AGA (Table 1). Conclusion ECGs from infants born SGA and infants with FGR differed from infants born AGA, including higher HRs and shorter uncorrected QT-intervals even after adjustments for infant size and age at the examination. Furthermore, we saw infants born SGA had reduced amplitudes of the S and R wave in the lateral lead (V6), and an increased amplitude of the S-wave in V1, compared with infants born AGA. Follow-up examinations of these infants could determine whether these alterations persist beyond the neonatal period, and to fully understand their implications of the cardiac function later in life.

Improvement in patient selection, management and outcomes in infant heart transplant from 2000 to 2020.

The study's primary outcome was to evaluate if post-transplant survival has improved over the last 2 decades. Secondary outcomes were the infant's waitlist mortality, waitlist time and identifying factors that affected the infant's survival. United Network for Organ Sharing (UNOS) database was queried for infants (age ≤ 1) who were listed for heart transplantation between 2000 and 2020. The years were divided into 3 eras (Era 1 2000-2006, Era 2 2007-2013 and Era 3 2014-2020). Non-parametric tests, Chi-Squared, Log-Rank test and Cox-Proportional hazard ratio were used for analysis (α = 0.05). 4234 infants were listed for heart transplants between 2000 and 2020. At the time of listing, Infants in era 3 were more likely to be heavier [in kg (P < 0.001)] and had better renal function (P < 0.001). Additionally, they were less likely to be on dialysis (P < 0.001), on a ventilator (P < 0.001) and on extracorporeal membrane oxygenation (P < 0.001). There has been a significant increase in left ventricular assist device use (P < 0.001), though there was no difference in waitlist (0.154) or post-transplant survival (0.51). In all 3 eras, waitlist survival (P < 0.001) and post-transplant survival (P < 0.001) have improved significantly. Congenital heart disease and extracorporeal membrane oxygenation were associated with worse waitlist survival in all 3 eras (P < 0.05). Infants are now waiting longer on the waitlist (in days) (33 Era 1 vs 46 Era 2 vs 67 Era 3, P < 0.001). Infant heart transplant outcomes have improved, but they are now waiting longer on the waitlist. Further improvement in increasing the donor pool, expert consensus on listing strategies and donor utilization is needed to improve outcomes.

The role of prenatal depression and infant negative emotionality on maternal mind-mindedness

Mind-mindedness (MM) promotes children’s socio-cognitive skills and attachment, yet relatively less is known about the earliest precursors of MM. This longitudinal study examined the role of prenatal depression, alone and in combination with infant negative emotionality on MM. Turkish mothers completed depression questionnaires in pregnancy and at 9 months postnatally. MM and infant negative emotionality were coded from observational tasks at infant age 12-13 months. A total of 50 dyads (56% boys) participated at all time points. A statistically significant interaction was detected such that prenatal depression predicted less appropriate MM when infants were low in negative emotionality. Yet, this relation was non-significant for distress-prone infants. Findings suggest that MM has its origins in antenatal experiences, moderated by child characteristics, with implications for the relational nature of MM. Findings also have significance for early childhood professionals to facilitate MM among mothers with prenatal depression.

Maternal pre-pregnancy body mass index and gestational weight gain on adverse birth outcomes in Chinese newborns: a retrospective study

BackgroundMaternal and child health is an important measure of national well-being. This study further explored the individual and combined effects of maternal pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) on adverse birth weight-related outcomes.MethodsA retrospective study was carried out at a maternal and child health hospital from 2018 to 2021, and a total of 17,506 eligible women were invited to participate. The associations of pre-pregnancy BMI and GWG with adverse birth outcomes were examined by using restricted cubic spline regression and binary logistic regression.ResultsPre-pregnancy BMI and GWG had non-linear associations with low birth weight and macrosomia. They were associated with an increased risk of macrosomia (Pre-pregnancy BMI for OR = 1.170, 95%CI:1.144 to 1.197, P < 0.001, and GWG for OR = 1.071, 95%CI:1.054 to 1.089, P < 0.001) and large for gestational age infant (LGA) (Pre-pregnancy BMI for OR = 1.125, 95%CI:1.111 to 1.141, P < 0.001, and GWG for OR = 1.045, 95%CI:1.036 to 1.054, P < 0.001). The high risk of low birth weight and preterm birth was observed among the group of women with inadequate GWG. The risks of macrosomia and LGA increased with pre-pregnancy BMI from low weight to overweight and obesity, and GWG from inadequate to overabundance, while small for gestational age infant was more prevalent in the low pre-pregnancy BMI group.ConclusionsPre-pregnancy BMI and GWG exhibited non-linear associations with low birth weight and macrosomia. The various combinations of pre-pregnancy BMI and GWG had different effects on adverse birth weight-related outcomes.