Infant Head Research Articles

Comparison of the effects of different infant formulas on the growth and development and intestinal flora of infants.

The purpose of this study was to compare the effects of different infant formulas on the growth and development, sleep, allergy symptoms, and intestinal flora of infants. A total of 428 infants participated in the study. Breastfeeding (BF) was used as the control, and the remaining subjects were randomly assigned to the full goat milk protein formula group (FGM), partial goat milk protein formula group (PGM), and cow milk formula group (M). During the 6-month feeding experiment, data on the growth, sleep, allergy symptoms, and intestinal flora of infants were collected using questionnaires, anthropometric measurements, and biochemical examinations. In general, the basic information of the participants was consistent among the groups. There were no differences in infant weight, length, or head circumference among the groups (p > .05). The sleep time of infants in the formula-fed groups was longer than that of the breastfeeding group at baseline (p < .05), but there were no differences at mid-term or outcome (p > .05). The incidence of allergic symptoms continued to decrease, and the total scores of allergic symptoms did not differ among the groups (p > .05). The relative abundance of intestinal Bifidobacteriaceae in the PGM group was lower than that in the other groups (p < .05). There was no difference in the β-diversity of intestinal flora between formula-fed and breastfed infants (p > .05). There were strong correlations in the composition of the main intestinal flora at the family level between the formula and breastfeeding groups. This study showed that within 6months of feeding, there were no significant differences in the growth and development, allergic symptoms, or intestinal flora of the infants among the groups.

Correlation of Maternal Prenatal Vitamin D Level with Postnatal Infant Growth in Length and Head Circumference: A Cohort Study on Vitamin D Status and Its Impact During Pregnancy and Childhood in Indonesia.

ObjectiveTo determine the correlation of first trimester maternal 25-(OH)-D level with postnatal infant growth in Indonesia.Materials and MethodsA cohort of 116 mother–infant pairs from Indonesia was prospectively studied. 25-(OH)-D level was measured in maternal serum at 10–14 weeks of gestation and in umbilical cord blood shortly after birth. The newborns were observed longitudinally for 24 months. Length and head circumference were measured at birth and at ages 3, 6, 12, and 24 months. Spearman correlation and multiple linear regression analyses were performed.ResultsMean 25-(OH)-D levels in the prenatal maternal serum and umbilical cord blood were 17.55 ± 7.33 ng/mL and 16.27 ± 6.14 ng/mL, respectively. Prenatal maternal 25-(OH)-D level weakly correlated with infant length (r = −0.35) and head circumference (r = –0.21) z-scores at age 3 months. Umbilical cord blood 25-(OH)-D level did not correlate with infant length or head circumference at any time point. Multiple linear regression showed an independent association between prenatal maternal 25-(OH)-D level and infant length z-score at age 3 months (p = 0.01, SE β = 0.02, and coefficient β = −0.06).ConclusionFirst trimester maternal serum 25(OH)D level correlated with infant length and head circumference at age 3 months.

Examining localization error in MEG for the complex auditory brainstem response (cABR) across early development

The complex auditory brainstem response (cABR) has gained wide research interest over the last decade as it is argued to reflect early sensory encoding of complex sounds, such as speech, along the auditory pathway. Recent adoption of cABR recording in MEG, instead of 3 EEG electrodes, allows further examination of the underlying sources. In adults, while the onset component of cABR to transient events (e.g., consonants) can be reliably localized to the auditory brainstem, the frequency-following component to longer periodic events (e.g., vowels, lexical tones) may contain contribution from auditory cortex. This study thus expands to evaluate the localization accuracy of both onset response and FFR through simulation, both of which are crucial for speech. Simulated source activities are placed in the auditory brainstem versus superior temporal gyrus. Using the forward model, the activities are projected to MEG sensor space with realistic room noise and head movement. The simulated sensor space signal then undergoes inverse modeling to calculate source activation. Differences between the simulated source activity versus calculated source activity are calculated to reflect localization accuracy. This process is repeated using infant head models at 3, 6, 9, and 12 months and adult head model to examine changes across ages.

Association of maternal urinary fluoride concentrations during pregnancy with size at birth and the potential mediation effect by maternal thyroid hormones: The Swedish NICE birth cohort

BackgroundObservational studies have indicated that elevated maternal fluoride exposure during pregnancy may impair child neurodevelopment but a potential impact on birth outcomes is understudied. ObjectivesTo evaluate the impact of gestational fluoride exposure on birth outcomes (birth size and gestational age at birth) and to assess the potential mediating role of maternal thyroid hormones. MethodsWe studied 583 mother-child dyads in the NICE cohort in northern Sweden. Maternal fluoride exposure was assessed by measuring urinary concentrations at late pregnancy (median: 29th gestational week) using an ion selective electrode. Plasma levels of free and total thyroxine (fT4, tT4) and triiodothyronine (fT3, tT3), and thyroid stimulating hormone (TSH) were measured with electrochemiluminescence immunoassays. The infant's weight, length, head circumference, and gestational age at birth were extracted from hospital records. ResultsMedian urinary fluoride concentration was 0.71 mg/L (5th-95th percentile 0.31–1.9 mg/L; specific gravity adjusted). In multivariable-adjusted regression models, every 1 mg/L increase of maternal urinary fluoride was associated with a mean increase in birth weight by 84 g (95%CI: 30, 138), length by 0.41 cm (95%CI: 0.18, 0.65), head circumference by 0.3 cm (95%CI: 0.1, 0.4), and with increased odds of being born large for gestational age (OR = 1.39, 95%CI: 1.03, 1.89). Every 1 mg/L increase of maternal urinary fluoride was also associated with a mean increase of the plasma fT3:fT4 ratio (B = 0.007, 95%CI: 0.000, 0.014), but not with the hormones or TSH. In mediation analyses, the maternal fT3:fT4 ratio did not explain the urinary fluoride-birth size relationships. DiscussionGestational urinary fluoride concentrations were associated with increased size at birth and even with increased odds of being born large for gestational age. The fluoride-related associations with increased size at birth were not explained by changes in maternal thyroid hormone levels.

Placental delayed villous maturation is associated with fetal congenital heart disease

The placenta is crucial for the overall development and lifelong health of the fetus. Abnormal placental development and function occur in pregnancies with fetal congenital heart disease. However, studies that use standardized diagnostic criteria and incorporate control populations are lacking. This limits the generalizability of current research and the ability to determine the specific placental abnormalities associated with congenital heart disease. This study applied consensus statement guidelines (known as the Amsterdam criteria) for placental pathology interpretation to compare the frequency and pattern of abnormalities in pregnancies with fetal congenital heart disease to demographically matched control pregnancies and evaluate for differences in placental abnormalities by cardiac physiology. A single-center retrospective cohort study was conducted from January 2013 to June 2019. Infants with a prenatal diagnosis of moderate-severe congenital heart disease who were born at ≥37 weeks of gestation were included. A control group born at ≥37 weeks of gestation but without fetal congenital heart disease or other major pregnancy complications was matched to the congenital heart disease group on maternal race and ethnicity and infant sex. Using the Amsterdam criteria, placental pathology findings were categorized as delayed villous maturation, maternal vascular malperfusion, fetal vascular malperfusion, and inflammatory lesions. The frequency of placental abnormalities was compared between groups, and logistic regression was performed to evaluate the association of clinical and sociodemographic factors with delayed villous maturation, maternal vascular malperfusion, and fetal vascular malperfusion. There were 194 pregnancies with fetal congenital heart disease and 105 controls included, of whom 83% in the congenital heart disease group and 82% in the control group were of non-Hispanic White race and ethnicity. Compared with controls, pregnancies with fetal congenital heart disease had higher rates of delayed villous maturation (6% vs 19%; P<.001) and maternal vascular malperfusion (19% vs 34%; P=.007) but not fetal vascular malperfusion (6% vs 10%; P=.23). Infants with congenital heart disease with 2-ventricle anatomy displayed the highest odds of delayed villous maturation compared with controls (odds ratio, 5.5; 95% confidence interval, 2.2-15.7; P<.01). Maternal vascular malperfusion was 2.2 times higher (P=.02) for infants with 2-ventricle anatomy and 2.9 times higher (P=.02) for infants with single-ventricle physiology with pulmonic obstruction. Within the congenital heart disease group, delayed villous maturation was associated with higher maternal body mass index, polyhydramnios, larger infant birth head circumference, and infant respiratory support in the delivery room, whereas maternal vascular malperfusion was associated with oligohydramnios. In multivariable models adjusting for cardiac diagnosis, associations of delayed villous maturation persisted for infant birth head circumference (odds ratio, 1.2; 95% confidence interval, 1.0-1.5; P=.02) and infant respiratory support in the delivery room (odds ratio, 3.0; 95% confidence interval, 1.3-6.5; P=.007). Pregnancies with fetal congenital heart disease displayed higher rates of delayed villous maturation and maternal vascular malperfusion than controls, suggesting that placental maldevelopment may relate to maternal factors. Future investigations are needed to determine the association of these abnormalities with postnatal infant outcomes.

Gestational weight gain and dietary energy, iron, and choline intake predict severity of fetal alcohol growth restriction in a prospective birth cohort

Animal models have demonstrated that maternal nutrition can alter fetal vulnerability to prenatal alcohol exposure (PAE). Few human studies have examined the role of nutrition in fetal alcohol spectrum disorders (FASD). Our objectives were to examine whether fetal vulnerability to PAE-related growth restriction is modified by: 1) rate of gestational weight gain; or prenatal dietary intakes of 2) energy, 3) iron, or 4) choline. In a prospective longitudinal birth cohort in Cape Town, South Africa, 118 heavy-drinking and 71 abstaining/light-drinking pregnant women were weighed and interviewed regarding demographics, alcohol, cigarette/other drug use, and diet at prenatal visits. Infant length, weight, and head circumference were measured at 2 wk and 12 mo postpartum. Heavy-drinking mothers reported a binge pattern of drinking [Mean = 129mL (∼7.2 drinks)/occasion on 1.3 d/wk). Rate of gestational weight gain and average daily dietary energy, iron, and choline intakes were similar between heavy-drinking women and controls. In regression models adjusting for maternal age, socioeconomic status, cigarette use, and weeks gestation at delivery, PAE [ounces (30mL) absolute alcohol per day] was related to smaller 2-wk length and head circumference and 12-mo length, weight, and head circumference z-scores (β = -0.43 to -0.67; all P values<0.05). In stratified analyses for each maternal nutritional measure (inadequate compared with adequate weight gain; tertiles for dietary energy, iron, and choline intakes), PAE-related growth restriction was more severe in women with poorer nutrition, with effect modification seen by weight gain, energy, iron, and/or choline for several anthropometric outcomes. Gestational weight gain and dietary intakes of energy, choline, and iron appeared to modify fetal vulnerability to PAE-related growth restriction. These findings suggest a need for screening programs for pregnant women at higher risk of having a child with FASD to identify alcohol-using women who could benefit from nutritional interventions.

No association between infant growth and adherence to the dietary approaches to stop hypertension (DASH) diet in lactating women.

Breastmilk is considered an optimal food for infant development especially during the first 6 months of life. However, little evidence exists regarding maternal dietary intake and infant growth. We evaluated how adherence to the DASH diet in lactating women is associated with the infant weight, height and head circumference at birth, 2 and 4 months of age. A cross-sectional study. The present study was conducted with 292 lactating mothers and their infants. A validated and reliable 168-item food frequency questionnaire (FFQ) was used to assess mothers' dietary intakes. To evaluate adherence to the DASH diet among lactating mothers, we scored food items based on the Fung method. Lactating mothers in the highest tertile of adherence to the DASH diet consumed significantly lower amounts of fat, cholesterol, salt, red and process meats and higher amounts of vitamin C, B1, B9, whole grains, low-fat dairy, fruits, vegetables and dietary fiber compared to lactating mothers in the lowest tertile (P < 0.05). No significant association was found between mothers' adherence to the DASH dietary pattern and any of the infant growth indices (P > 0.05). Lactating mothers' adherence to the DASH diet was not associated with growth indices among exclusively breastfed infants.

CNN-Based Classification of Craniosynostosis Using 2D Distance Maps.

Craniosynostosis is a condition associated with the premature fusion of skull sutures affecting infants. 3D photogrammetric scans are a promising alternative to computed tomography scans in cases of single suture or nonsyndromic synostosis for diagnostic imaging, but oftentimes diagnosis is not automated and relies on additional cephalometric measure-ments and the experience of the surgeon. We propose an alternative representation of the infant's head shape created from 3D photogrammetric surface scans as 2D distance maps. Those 2D distance maps rely on ray casting to extract distances from a center point to the head surface, arranging them into a 2D image grid. We use the distance map for an original convolutional neural network (CNN)-based classification approach, which is evaluated on a publicly available synthetic dataset for benchmarking and also tested on clinical data. Qualitative differences of different head shapes can be ob-served in the distance maps. The CNN-based classifier achieves accuracies of 100 % on the publicly available synthetic dataset and 98.86 % on the clinical test set. Our distance map approach demonstrates the diagnostic value of 3D photogrammetry and the possibility of automatic, CNN-based diagnosis. Future steps include the improvement of the mapping method and testing the CNN on more pathologies.

Individual and mixed metal maternal blood concentrations in relation to birth size: An analysis of the Japan Environment and Children’s Study (JECS)

Growth restriction in the prenatal period is a significant public health concern. Metals can negatively affect birth size, and pregnant women may be exposed to metal mixtures. Comprehensive studies analyzing the effects of combined metal exposure with accurate individual blood metal concentrations are limited. The current study investigated the associations between maternal metal exposure and birth size in a large, nationwide Japanese cohort using individual and mixed model approaches. Lead, cadmium, mercury, selenium, and manganese blood concentrations were measured in pregnant women in the Japan Environment and Children's Study (JECS). Measurements of infant birth size-including body weight, body length, and head and chest circumference-were collected. Linear and logistic regressions were used for birth size measurements and the odds of an infant being small in size for gestational age, respectively. Associations between combined metal mixtures and measurements at birth were evaluated using quantile g-computation and Bayesian kernel machine regression (BKMR). Of the 103,060 JECS pregnancies, 93,739 mother-infant pairs were analyzed. The linear regression models showed that lead, selenium, cadmium, and manganese-but not mercury-were associated with body weight. Cadmium was associated with length and chest circumference and mercury was associated with head circumference. Quantile g-computation revealed that manganese increased infant birth weight, length, head circumference, and chest circumference. Lead was the strongest negative factor for infant birth weight, length, head circumference, and chest circumference. The BKMR analysis revealed that the metals had an additive, rather than a synergistic effect. Metal exposure is associated with infant birth size, with lead and manganese playing a more significant role in Japan. The effects of prenatal combined metal exposure at low levels warrant public health attention.

The effect of gentle human touch on pain, comfort and physiological parameters in preterm infants during heel lancing

ObjectiveThis research was conducted to evaluate the effects of gentle human touch (GHT) on pain, comfort, and physiologic parameters in preterm infants during heel lancing. MethodThis prospective, assessor-blind, randomized controlled study was performed between August 10, 2021 and September 10, 2021 in the Neonatal Intensive Care Units (NICU) of a tertiary hospital in the Central Anatolia Region of Turkey. Fifty preterm infants were randomly appointed to GHT and control groups. The researcher applied GHT to the infants in the GHT group by placing one hand on the infant's head and the other hand on the lower abdomen covering the waist and hips for 15 min. Data were collected with a Questionnaire, Physiological Parameters Observation Form, Newborn Infant Pain Scale (NIPS), The Comfort Scale (COMFORT), and Pulse Oximeter. ResultsThe NIPS and COMFORT mean scores of preterm infants in the GHT group were lower during (p < 0.001, p < 0.05, respectively) and after heel lancing (p < 0.05, p < 0.001, respectively). There was no difference between the preterm infants' peak heart rate, respiratory rate, and SPO2 values in the GHT and control groups during and after heel lancing (p > 0.05). The study found that preterm infants in the GHT group had less crying time during the heel lancing (p < 0.001). ConclusionIt could recommend using in painful procedures because GHT may positively affect preterm infants' pain, comfort, and physiologic parameters. The results of this study will contribute to NICU nurses should include non-pharmacological methods such as GHT to decrease pain of preterm infants in procedural pain. Trial registrationClinicalTrials.gov (NCT05001191).

Realistic 3D infant head surfaces augmentation to improve AI-based diagnosis of cranial deformities

Evaluation of the head shape of newborns is needed to detect cranial deformities, disturbances in head growth, and consequently, to predict short- and long-term neurodevelopment. Currently, there is a lack of automatic tools to provide a detailed evaluation of the head shape. Artificial intelligence (AI) methods, namely deep learning (DL), can be explored to develop fast and automatic approaches for shape evaluation. However, due to the clinical variability of patients’ head anatomy, generalization of AI networks to the clinical needs is paramount and extremely challenging. In this work, a new framework is proposed to augment the 3D data used for training DL networks for shape evaluation. The proposed augmentation strategy deforms head surfaces towards different deformities. For that, a point-based 3D morphable model (p3DMM) is developed to generate a statistical model representative of head shapes of different cranial deformities. Afterward, a constrained transformation approach (3DHT) is applied to warp a head surface towards a target deformity by estimating a dense motion field from a sparse one resulted from the p3DMM. Qualitative evaluation showed that the proposed method generates realistic head shapes indistinguishable from the real ones. Moreover, quantitative experiments demonstrated that DL networks training with the proposed augmented surfaces improves their performance in terms of head shape analysis. Overall, the introduced augmentation allows to effectively transform a given head surface towards different deformity shapes, potentiating the development of DL approaches for head shape analysis.

Size-specific dose estimates for pediatric head CT protocols based on the AAPM report TG-293

PurposeTo establish the Size Specific Dose Estimate (SSDE) typical values for pediatric head CT examinations based on the AAPM report TG-293; to provide a new stratification based on the water-equivalent diameter (Dw), given that SSDE is related to the head size. Methods296 Head CT scans of pediatric patients collected using a dose monitoring software were retrospectively analysed. Typical values were derived stratifying data by age in three methods: the first proposed by the European Guidelines on Diagnostic Reference Levels for Pediatric Imaging (RP185), the second by the National Istisan Report 20/22 and a local one related to the clinical protocols (LStrata). For each scan, a self-developed Matlab routine calculated the water-equivalent diameter (Dw) and related SSDE values with the conversion factors fH16and fB16provided by the AAPM reports TG-293 and TG-204, respectively. Eventually, a Dwstratification was introduced starting from a measure of the lateral dimension of the head. ResultsSSDE based on TG-204 overestimatesthe dose up to 12%. Four Dwgroups were identified thanks to the good correlation between the head lateral dimension andDw: Dw < 14 cm, 14 ≤ Dw < 16 cm, 16 ≤ Dw< 17 cm, Dw≥ 17 cm. The Dw-stratified dosimetric indices presentgreater variability than those grouped by age because of the large variability of the size of the infant's head. ConclusionsThe variability of the SSDE metric underlines that age-optimized protocols are not when size is considered.

1051-P: Elevated Cord Serum Adiponectin Concentration Is Associated with Increased Risk for Fetal Overgrowth

Adiponectin is an important adipokine that promotes insulin sensitivity and stimulates glucose and lipids metabolism. Whether maternal and fetal adiponectin influence fetal growth is not fully understood. We examined the association of maternal (at entry and 3rd trimester, 16 and 30 weeks of gestation) and cord serum adiponectin levels with fetal growth in a nested case-control study in 100 healthy mother (age 21.5±5 yr., BMI 25.7±7) and infant pairs selected from a large prospective cohort. The samples included large for gestational age (LGA, n=32) , small for gestational age (SGA, n=26) and appropriate for gestational age (AGA, n=42) newborns. Adiponectin levels (µg/ml) were analyzed by ELISA. Multivariate analyses adjusted for potential confounding variables were performed. Adiponectin level in cord serum was 2.75 and 3.3-fold higher than that in maternal serum at entry and 3rd trimester respectively (p&amp;lt;0.00for each) . Maternal and cord serum adiponectin were not significantly correlated at entry (r=-0.065, p&amp;gt;0.05) and in the third trimester (r=0.066, p &amp;gt;0.05) . Fetal adiponectin was significantly and positively correlated with infant birth weight, birth length, head and chest circumferences (r=0.254 to 0.337, p&amp;lt;0.to p&amp;lt;0.0001) . Moreover, the highest tertile of fetal adiponectin (highest tertile, &amp;gt;78.0) was associated with an increased risk of LGA (AOR 3.13, 95% CI 1.18, 8.31) , and a reduced risk of SGA (AOR 0.20, 95% CI 0.05, 0.77) . In contrast, maternal adiponectin levels at entry and 3rd trimester were not associated with infant birth weight or sizes (r=-0.132 to 0.146, p&amp;gt;0.for each) . Differences in maternal adiponectin among 3 groups of LGA, SGA and AGA were not statistically significant (p&amp;gt;0.05) . Our data suggest that increased cord adiponectin level is associated with an increased risk of LGA in healthy pregnant women. It may implicate that maternal and fetus adiponectin have opposite roles in regulating and maintaining a normal fetal growth. Disclosure X.Chen: None. J.A.Whiting: None. Funding National Institutes of Health (R01MD007828)

Performance Analysis of Optically Pumped 4He Magnetometers vs. Conventional SQUIDs: From Adult to Infant Head Models.

Optically pumped magnetometers (OPMs) are new, room-temperature alternatives to superconducting quantum interference devices (SQUIDs) for measuring the brain’s magnetic fields. The most used OPM in MagnetoEncephaloGraphy (MEG) are based on alkali atoms operating in the spin-exchange relaxation-free (SERF) regime. These sensors do not require cooling but have to be heated. Another kind of OPM, based on the parametric resonance of 4He atoms are operated at room temperature, suppressing the heat dissipation issue. They also have an advantageous bandwidth and dynamic range more suitable for MEG recordings. We quantitatively assessed the improvement (relative to a SQUID magnetometers array) in recording the magnetic field with a wearable 4He OPM-MEG system through data simulations. The OPM array and magnetoencephalography forward models were based on anatomical MRI data from an adult, a nine-year-old child, and 10 infants aged between one month and two years. Our simulations showed that a 4He OPMs array offers markedly better spatial specificity than a SQUID magnetometers array in various key performance areas (e.g., signal power, information content, and spatial resolution). Our results are also discussed regarding previous simulation results obtained for alkali OPM.

The effect of head positioning on brain tissue oxygenation in preterm infants: a randomized clinical trial study.

CNS injury in preterm infants is still one of the leading causes of mortality and morbidity. Routine care events might affect the perfusion and cerebral oxygenation of preterm infants. Although positioning the infant's head in a particular condition to improve brain oxygenation is included in many institutions, there is no robust clinical evidence to support this intervention's effectiveness. The present study aimed to determine the effect of head positioning on brain tissue oxygenation in preterm infants. This study is a randomized clinical trial. In the first 48 h after birth, 39 infants who met the study inclusion criteria underwent head positioning intervention. In this case, the infants were placed in the supine position, and every 2 h, the head position was changed continuously to one of six randomized modes [using random modes generated by SPSS]. During each head positioning, brain tissue oxygenation was recorded by NIRS. The findings showed a significant difference in brain tissue oxygen saturation among these positions (P < 0.001). Dunn's test showed that the brain tissue oxygen saturation in the third position (head rotates 45-60 degrees from the midline to the right and the head of the bed is zero degrees) was significantly lower than the baseline (P = 0.029; Mean difference = 2.3). Also, in the third position, compared to the first position (P = 0.002; Mean difference = 1.9) and compared to the fourth position (P = 0.003; Mean difference = -2.1), and in the second position compared to the first position (P = 0.046; Mean difference = 1.3), the brain tissue oxygen saturation of the infants was lower. Based on the results of the present study, head positioning was effective on brain tissue oxygenation in preterm infants in the first 48 h after birth; Therefore, it is recommended when possible, not to rotate the infant's head during the first 48 h after birth while the head of the bed is at 0°.

Adult Preferences of Infant Head Shapes: A Survey of Computerized Morphometric Models and Overview of Clinical Implications.

Adult Preferences of Infant Head Shapes: A Survey of Computerized Morphometric Models and Overview of Clinical Implications.

Tangential cranial gunshot wound in an infant in historical context: illustrative case.

BACKGROUNDMilitary neurosurgeons have long known that tangential cranial gunshot wounds can be associated with intracranial complications out of proportion to the external appearance of the injury. This phenomenon seems not to have been described in infancy.OBSERVATIONSAn infant suffered a massive, acute subdural hemorrhage from a contralateral tangential gunshot wound that did not facture the skull.LESSONSSimilar to adults, infants are subject to catastrophic intracranial injury from gunshots that do not penetrate the skull. The nature of the injury in this case reflected distinctive aspects of the tissue characteristics and proportions of the infant head.

Birth Outcomes in Women Who Have Taken Hydroxycholoroquine During Pregnancy: A Prospective Cohort Study.

Findings from previous small studies have been reassuring regarding the safety of treatment with hydroxychloroquine (HCQ) during pregnancy. In one recent study, it was demonstrated that the frequency of major birth defects was increased in women who had received HCQ at a dose of ≥400 mg/day during pregnancy. This study was undertaken to examine pregnancy outcomes among women following the use of HCQ. The study cohort comprised pregnant women who were prospectively enrolled in the MotherToBaby/Organization of Teratology Information Specialists Autoimmune Diseases in Pregnancy Study and were receiving treatment with HCQ. For the control groups, disease-matched women without HCQ exposure and healthy women were randomly selected from the same source, with subject matching using a 1:1 ratio. Data were collected through interviews, medical records, and dysmorphology examinations. Pregnancy outcome measures included the presence or absence of major and minor birth defects, rates of spontaneous abortion, rates of preterm delivery, and infant growth measures. Between 2004 and 2018, 837 pregnant women met the criteria for study inclusion, including 279 women exposed to HCQ during pregnancy and 279 women in each unexposed control group. Sixty pregnant women (7.2%) were lost to follow-up. Among the women with live births, major birth defects occurred as a pregnancy outcome in 20 (8.6%) of 232 women with HCQ exposure in the first trimester, compared to 19 (7.4%) of 256 disease-matched unexposed controls (odds ratio [OR] 1.18, 95% confidence interval [95% CI] 0.61-2.26) and 13 (5.4%) of 239 healthy controls (adjusted OR 0.76, 95% CI 0.28-2.05). Risks did not differ in women who were receiving an HCQ dose of ≥400 mg/day. No pattern of birth defects was identified. There were no differences in the rates of spontaneous abortion or preterm delivery between groups. Occurrence of infant growth deficiencies did not differ in the HCQ-exposed group compared to the disease-matched unexposed control group, except in the infant's head circumference at birth (adjusted OR 1.85, 95% CI 1.07-3.20). In this study, there was no evidence of an increased risk of structural birth defects or other adverse outcomes among women receiving HCQ during pregnancy, with the exception of infant head circumference at birth. For pregnant women being treated with HCQ, these findings are reassuring.

Assessment of paediatric head shape and management of craniosynostosis.

The presentation of a child with an abnormal head shape can be challenging and should be met with an appropriate clinical approach. Craniosynostosis is a common cause of paediatric skull deformity and is best managed by a multispecialty tertiary referral unit with regular follow-up. As craniosynostosis frequently requires time-sensitive surgery, it is important to differentiate between craniosynostosis and common self-limiting conditions such as deformational plagiocephaly. The aim of this article is to outline the clinical approach to paediatric skull deformity in the general practice setting, and to highlight the importance of early referral if there is clinical suspicion of craniosynostosis. Parental concern regarding infant head shape is common. General practitioners (GPs) have an important role in assessment, diagnosis and referral for paediatric skull deformities. GPs are well placed to clinically differentiate between deformational plagiocephaly and craniosynostosis and provide timely referrals to optimise patient outcomes.

RGBD Infant Head Reconstruction for Cranial Vault Asymmetry Estimation

We present an RGBD infant head reconstruction method with a mobile phone depth sensor on a novel dataset. Acquiring 3D models from infants enables many important medical tasks such as automatic cranial asymmetry classification for plagiocephaly therapy progress estimation. Existing methods for 3D infant head reconstruction employ synchronized multi-view configurations or hand-held laser scanning methods making their widespread employment difficult. In contrast, RGBD reconstruction methods either rely on static scenes failing on this task due to rapid infant head movements or employ dynamic methods lacking the high fidelity surface reconstructions required for accurate cranial measurements. We propose a domain-specific 3D reconstruction method augmenting static RGBD methods focusing on the rigid parts of the head and exploiting scene knowledge about the data acquisition methodology. We evaluate our approach using provided ground truth anthropometric measurements of the biparietal diameter and report competitive accuracy.