Infant Outcomes Research Articles

Association between Time with Open Ductus Arteriosus and Outcomes in Congenital Diaphragmatic Hernia.

While a patent ductus arteriosus (PDA) helps offload the right ventricle in the acute congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension, its role on long-term outcomes in CDH has not been investigated. Our objective was to examine associations of the PDA with long-term clinical outcomes in CDH. A single-center retrospective descriptive study of 122 CDH patients dichotomized by duration with PDA, as ≤14 versus >14 postnatal days (PND) and ≤30 versus >30 PND. Fisher's exact test, Wilcoxon rank-sum test, and multiple linear and logistic regression analyses were used for analyses. In unadjusted and adjusted for CDH severity comparisons, patients with PDA >14 PND and >30 PND had a higher risk of death, longer length of stay, mechanical ventilation duration, and need for tracheostomy, diuretics, and PH medications at discharge. A PDA beyond the newborn period is associated with adverse outcomes in infants with CDH.

Neonatal Sequential Organ Failure Assessment Score Predicts Respiratory Outcomes in Preterm Newborns with Late-Onset Sepsis: A Retrospective Study.

Neonatal sequential organ failure assessment (nSOFA) score predicts mortality in preterm newborns. The aim of the study was to assess whether nSOFA score could predict respiratory outcomes in preterm infants with late-onset sepsis (LOS). This retrospective, observational, single-center study enrolled infants with gestational age <32 weeks born between January 2016 and June 2023 who experienced an episode of LOS during NICU stay. The primary outcome was death or bronchopulmonary dysplasia (BPD); secondary outcomes were BPD, death or mechanical ventilation (MV) on day 5 after the onset of LOS, and MV on day 5 after the onset of LOS. The nSOFA score was assessed at the onset of LOS and after 6 ± 1, 12 ± 3, and 24 ± 3 h. Neonatal SOFA score was significantly higher in patients who developed each outcome versus those who did not at all timings. Maximal nSOFA score during the first 24 h after onset of LOS was an independent predictive factor for death or BPD (p = 0.007), BPD (p = 0.009), and death or MV on day 5 (p = 0.009), areas under the curve (AUC) were 0.740 (95% CI: 0.656-0.828), 0.700 (95% CI: 0.602-0.800), and 0.800 (95% CI: 0.710-0.889), respectively. Maximal nSOFA score also predicted moderate to severe BPD (p = 0.019) and death or moderate to severe BPD (p < 0.001). Maximal nSOFA ≥4 was associated with odds ratio (OR) of 7.37 (95% CI: 2.42-22.44) for death or BPD, 4.86 (95% CI: 1.54-15.28) for BPD, and 7.99 (95% CI: 3.47-18.36) for death or MV on day 5. AUC of the predicting model was 0.895 (95% CI: 0.801-0.928) for BPD, 0.897 (95% CI: 0.830-0.939) for death or BPD, 0.904 (95% CI: 0.851-0.956) for MV on day 5, 0.923 (95% CI: 0.892-0.973) for death or MV on day 5. Maximal nSOFA score during the first 24 h after the onset of LOS predicts respiratory outcomes and allows identification of patients who may crucially benefit from lung-protective measures.

Neurodevelopmental Outcome in Infants of Gestational Diabetic Mother in a Tertiary Care Hospital, Dhaka, Bangladesh

Background: Diabetes Mellitus (DM) is one of the most common metabolic complications of pregnancy, with negative influences on maternal and fetal health. Infants of Diabetic Mothers (IDMs) are prone to develop both early and late complications. Evidences shows that diabetes in pregnancy have strong association with long-term adverse effects on brain development in babies born to mothers with gestational diabetes mellitus. Very few studies were done in this subcontinent regarding association of gestational diabetes mellitus and infant’s neurodevelopmental outcome. This study will help to find out this associations and thus to reduce poor neurodevelopmental outcome in infants of diabetic mothers by early detection and providing proper early childhood stimulation. Objective: To assess the neurodevelopmental outcome of infants born to mother with gestational diabetes mellitus. Methodology: This prospective observational study was conducted in the department of Neonatology and Institute of Pediatric Neurodisorder and Autism (IPNA), BSMMU, from March 2022 to September 2023. Neonates (N= 52) born at or after 34 weeks of gestation and born to gestational diabetic mother were enrolled in this study. Consent was taken from guardians. The newborns fulfilling the inclusion criteria were followed up for neurodevelopmental assessment at their 9 months of age by clinical psychologists assigned from Institute of Pediatric Neurodisorder and Autism (IPNA), BSMMU, who were blinded about infant’s diagnosis. Bayley scales of infant and toddler development (BSID III) was used for developmental assessment. In the Bayley III, cognitive development, expressive and receptive language and fine and gross motor development all were evaluated at 9 months of age. All data were recorded in a preformed questionnaire and analyzed by Statistical Package for Social Sciences (SPSS), version 25. Results: According to inclusion and exclusion criteria 58 newborn were enrolled and their blood samples were sent at 24 to 48 hours of age to see the laboratory parameters of metabolic and hematological profile. Among them 6 patients lost to follow up, so 52 infants were followed up for neurodevelopmental outcome at 9 months of age. Among the baseline characteristics of mother and neonate 48% mother needed drugs for glycemic control, while others were on dietary modification and 75% of the mothers had good glycemic control. Most of the neonate were born at term and were age appropriate, 18 patients needed NICU admission. Among the neonatal laboratory parameters hyperbilirubinemia was most common (30.8%) and hypoglycemia was second most common found in 15.4% of newborns. The most common morbidity was sepsis (17.3%). Overall adverse neurodevelopmental outcome was found among 14 (26.9%) neonate and 38 (73.1%) neonates had favorable outcome. Use of drugs and poor maternal glycemic control were found statistically significant in between adverse and favorable groups. (p-value- 0.041 and 0.000). Among the neonatal clinical parameters only hypoglycemia was found statistically significant in between these two groups. (p-value- 0.014) Multivariate logistic regression among these predictive factors showed only maternal poor glycemic control was significantly associated with adverse neurodevelopmental outcome (p-value=0.001). Conclusion: Maternal gestational diabetes can adversely affect on their infants neurodevelopment. Among the adverse outcome of three domains language delay was most common. Neonatal hypoglycemia, maternal poor glycemic control and use of drugs for GDM are significant predictors of adverse neurodevelopmental outcome in infants of gestational diabetic mother. Among them maternal poor glycemic control was significantly associated with adverse neurodevelopmental outcome.

Family Nurture Intervention and mother-preterm infant autonomic emotional connection in the neonatal intensive care unit: A review.

We review methods and outcomes of a novel parenting intervention, Family Nurture Intervention (FNI), that promotes early mother-infant autonomic co-regulation and emotional connection in the neonatal intensive care unit (NICU). FNI involves individualised mother-infant calming sessions combined with maternal emotional expression. Two parallel group randomised controlled trials have evaluated FNI. The first,recruited 150 preterm newborns (26-34 weeks GA) and their mothers, randomised into two groups: FNI (n = 78) and Standard Care (SC) only (n = 72). Dyadic, infant and maternal outcomes were assessed at discharge, 18-months and 4-5 years corrected age. The second,recruited 135 infants from two level 4 NICUs (FNI n = 66, SC n = 69) with similar outcomes assessed at discharge/term equivalent. Relative to SC, FNI infants showed improved development and relational health through 5 years. At term age, FNI infants had better autonomic regulation and more mature brain activity and cortical connectivity on EEG. FNI mothers also reported fewer anxiety and depression symptoms post-discharge. At 18-month, FNI infants obtained higher cognitive and language scores, and lower attention and social behaviour scores than SC infants. FNI improves the early life development and relational health of high-risk preterm infants. Further research is important to assess its efficacy in other high-risk populations and contexts.

Does in utero exposure to chemical hair relaxers have a negative impact on birth weight or other birth outcomes for infants compared with infants without this exposure?

Does in utero exposure to chemical hair relaxers have a negative impact on birth weight or other birth outcomes for infants compared with infants without this exposure?

Associations of Maternal Nutritional Status and Supplementation with Fetal, Newborn, and Infant Outcomes in Low-Income and Middle-Income Settings: An Overview of Reviews

Background/Objectives: Despite advances in maternal nutritional knowledge, the effect of maternal diet, micronutrient status and undernutrition, and the effect of maternal supplementation on fetal, neonatal and infant outcomes still have gaps in the literature. This overview of reviews is intended to assess the available information on these issues and identify the main maternal nutritional factors associated with offspring outcomes in low- and middle-income countries as possible targets for public health interventions. Methods: The literature search was performed in Medline (PubMed) and Cochrane Library datasets in June 2024. Pre-specified outcomes in offspring were pooled using standard meta-analytical methods. Results: We found consistent evidence on the impact of maternal undernutrition indicated by low body mass index (BMI), mid-upper arm circumference (MUAC), and stature, but not of individual micronutrient status, on intrauterine-growth retardation, preterm birth, low birth weight, and small for gestational age, with research showing a possible effect of maternal undernutrition in later child nutritional status. Studies on micronutrient supplementation showed possible beneficial effects of iron, vitamin D, and multiple micronutrients on birthweight and/or decreasing small for gestational age, as well as a possible effect of calcium on preterm birth reduction. Interventions showing more consistent beneficial outcomes were balanced protein-energy and lipid base supplements, which demonstrated improved weight in newborns from supplemented mothers and a decreased risk of adverse neonatal outcomes. Conclusions: Further research is needed to identify the benefits and risks of maternal individual micronutrient supplementation on neonatal and further child outcomes.

Sulfur hexafluoride multiple breath washin and washout outcomes in infants are not interchangeable.

Objective.Sulfur hexafluoride (SF6) multiple-breath washout (MBW) assesses ventilation inhomogeneity, as an early marker of obstructive respiratory diseases. Primary outcomes are customarily washout-derived, and it is unclear whether the preceding SF6-washin can provide similar estimates. We aimed to assess comparability of primary SF6-MBW outcomes between washin and washout phases of infant SF6-MBW data measured with the WBreath (ndd Medizintechnik AG, Zurich, Switzerland) and Spiroware (Eco Medics AG, Duernten, Switzerland) MBW-setups, respectively. &#xD;Approach.We assessed mean relative differences in lung clearance index (LCI) and functional residual capacity (FRC) between the washin and washout of existing SF6-MBW data from healthy infants and infants with cystic fibrosis (CF). We assessed whether these differences exceeded the mean relative within-test between-trial differences of washout-derived outcomes, which can be attributed to natural variability. We also explored non-physiological factors using a pediatric lung simulator. &#xD;Main results.LCI and FRC from washin and washout were not comparable, for both setups. The mean difference (SD) in LCI between washin and washout was 2.3(10.8)% for WBreath and -9.7(8.0)% for Spiroware, while in FRC it was -4.7(7.8)% for WBreath and -2.3(9.7)% for Spiroware. These differences exceeded the within-test between-trial differences in washout-derived outcomes. Outcomes from washin and washout were also not comparable in a pediatric lung simulator.&#xD;Significance.Outcomes of the washin and washout were not comparable due to an interplay of physiological and non-physiological factors, and cannot be used interchangeably.

A Scoping Review on Understanding Climate Change’s Effects on Pregnancy in Coastal Regions

Introduction: Pregnancy increases vulnerability to environmental stressors. Climate change heightens risks for pregnant women, leading to adverse maternal and infant outcomes. Coastal regions, prone to sea-level rise, rising temperatures, saltwater intrusion, and extreme weather, face significant health impacts. This review summarises the effects of climate change on pregnant women in these areas, emphasising the need for targeted interventions to mitigate these risks. Discussion: This scoping review was conducted using the advanced Arksey and O’Malley framework. Utilizing several keywords, including 'climate change,' 'adverse pregnancy,' 'pregnant outcome,' 'coastal,' and 'island,' a thorough exploration was conducted on PubMed, ScienceDirect, Scopus and ProQuest. A thorough review of 660 articles from 2020–2024 on those online databases identified 34 relevant studies. The findings show that coastal residents face environmental challenges such as rising temperatures, air pollution, cyclones, hurricanes, ozone exposure, floods, and highly saline water. Prolonged exposure to these conditions exacerbates health risks. Climate change is linked to adverse pregnancy outcomes, including low birth weight, small gestational age, stillbirth, preterm birth, neonatal health problems, and increased the risk of pregnancy complications and miscarriages. Conclusion: Climate change significantly affects pregnant women, causing complications and adverse outcomes throughout pregnancy. Addressing these issues requires comprehensive policies and intervention programs. These insights provide a foundation for policymakers to develop strategies that support and protect pregnant women in vulnerable regions. Household-level efforts, such as providing a comfortable living environment, can help reduce the climate change impacts.

Investigating the impact of severe maternal SARS-CoV-2 infection on infant DNA methylation and neurodevelopment.

Maternal infections during pregnancy can increase the risk to offspring of developing a neurodevelopmental disorder. Given the global prevalence and severity of infection with Severe Acute Respiratory Syndrome related Coronavirus 2 (SARS-CoV-2), the objective of this study was to determine if in utero exposure to severe maternal SARS-CoV-2 infection alters infant neurodevelopmental outcomes at 12 months and to identify potential biological markers of adverse infant outcomes. Mother-infant dyads exposed to severe SARS-CoV-2 infection (requiring hospitalization) during pregnancy and age and sociodemographic matched control dyads were recruited from Monash Medical Centre, Australia in 2021/22 and prospectively assessed over 12 months. Maternal serum cytokine levels and Edinburgh Postnatal Depression Scale (EPDS) scores were assessed at birth. DNA methylation was assessed from infant buccal swabs at birth (Illumina EPIC BeadChip). Infant neurodevelopmental outcomes at 12 months were assessed using the Ages and Stages Questionnaire (ASQ-3). Mothers exposed to severe SARS-CoV-2 exhibited elevated serum IL-6 and IL-17A and higher EPDS scores than controls at birth. Infants exposed to severe SARS-CoV-2 in utero demonstrated over 3000 significant differentially methylated sites within their genomes compared to non-exposed (adjusted p-value < 0.05), including genes highly relevant to ASD and synaptic pathways. At 12 months, severe SARS-CoV-2 exposed infants scored lower on the ASQ-3 than non-exposed infants, and communication and problem-solving scores negatively correlated with maternal IL-6 levels at birth. DNA methylation changes therefore unveil potential mechanisms linking infection exposure to delayed neurodevelopment and maternal serum IL-6 levels may be a potential biomarker of child developmental delay. Mothers exposed to severe SARS-CoV-2 infections show elevated pro-inflammatory cytokines. Infants exposed in utero to severe SARS-CoV-2 infection show altered DNA methylation at birth and delayed development at 12 months of age. Created in Biorender.com.

Enhancement of Family-Centred Care Is Associated with a Reduction in Postmenstrual Age at Discharge in Preterm Infants

Background/Objectives: Long hospitalisation has been recognized as an independent risk factor for poor neurodevelopmental outcomes of preterm infants. Systematic training and early inclusion of parents in their preterm infant’s care is a strategy to shorten the length of hospital stay. We implemented an enhanced stepwise family-centred care program and assessed its effects on postmenstrual age (PMA) at discharge and parental satisfaction. Methods: This prospective single-centre longitudinal cohort study was carried out in a German level III neonatal unit from October 2020 to May 2023. Five consecutive 6-month cohorts (1 baseline and 4 intervention cohorts, 169 infants and their caregivers) were analysed. Results: Mean PMA at discharge did not change in the total cohort but declined significantly in patients without neonatal morbidities from baseline to cohort 4 (37.2 ± 1.4 to 36.1 ± 1.6 weeks; p = 0.036). Concomitantly, discharge with tube feeding raised from 2.4% to 74.1% (p &lt; 0.001) and discharge with home monitoring raised from 9.8% to 74.1% (p &lt; 0.001), while unplanned readmissions remained unchanged (p = 0.44). Parental satisfaction with time point of discharge increased non-significantly from baseline to cohort 4 (75.8% vs. 95.7%; Chi2 0.22). Conclusions: Discharge of preterm infants at a significantly lower PMA is feasible through enhancement of family-centred care and is very well accepted by parents.

Maternal depressive symptoms in and beyond the perinatal period: Associations with infant and preschooler sleep.

(1) To describe sleep in infancy and early childhood among children born to mothers with and without clinically significant depressive symptoms, and (2) to explore the relationships between maternal depressive symptoms and sleep patterns and problems during infancy and early childhood. Secondary analysis of longitudinal data from the Moe Kura: Mother and Child, Sleep and Wellbeing in Aotearoa/New Zealand study. Data was collected in pregnancy (T1), 12 weeks postpartum (T2), and 3 years post-birth (T3). Participants were 262 Māori and 594 non-Māori mother-child dyads. Chi-square and Independent T-tests measured bivariate associations between maternal mood (T1, T2, T3) and child sleep characteristics (T2, T3). Binary logistic regression models examined longitudinal and concurrent associations between maternal depressive symptoms and infant and preschooler sleep. Adjusted models accounted for key socio-demographic variables, as well as infant sleep variables in preschooler models. Bivariate associations were found between prior and concurrent depressive symptomology and many of the infant and preschooler sleep outcomes. In adjusted models, prenatal depressive symptoms remained independently associated with shorter-than-recommended sleep durations in preschoolers. In these models, concurrent depression was also associated with night waking, night LSRSP, and perceived sleep problems at 12 weeks postpartum, and CSHQ-determined and perceived sleep problems at 3 years post birth. Longitudinal and cross-sectional associations were found between maternal depressive symptoms and child sleep. Sleep appears to be one pathway by which maternal depression confers risk for suboptimal child health outcomes. Findings support the need for earlier and better maternal mental health services.

Maternal pre-pregnancy weight and infant spontaneous movement: is there an association?

Abstract Introduction Maternal pre-pregnancy overweight status might create a chronic systemic inflammatory environment for the foetus, impairing neurons development. The Motor Optimality Score-Revised (MOS-R) is an established tool to assess infant spontaneous movement at 3-5 months helping predict later neurodevelopmental outcomes in infants, including language, minor neurological dysfunction or learning difficulties at school age. The aim of our study was to investigate if maternal BMI together with other characteristics were potentially associated with MOS-R score at 3-5 months in a sample of newborns representative of physiologic full-term pregnancies. Methods 128 mother-children couples were enrolled in the Hospital of Modena, Italy. Mothers’ socio-demographic characteristics and BMI pre and during pregnancy were collected. MOS-R was assessed in infants within 9-18 weeks post term age (Median 13, IQR 12-14). Descriptive statistics, bivariate associations and multivariate analysis were performed. Results In our sample, 94.5% of infants (44% females) had a MOS-R≥25 (optimal score), 3.9% a MOS-R between 23-24 and 1.6% a MOS-R&amp;lt;23. In bivariate analyses pre-pregnancy BMI≥25 and weight gain higher than recommended during pregnancy were associated with MOS-R&amp;lt;25 (p &amp;lt; 0.05); being unemployed before and during pregnancy and having pregnancy during COVID lockdown were associated with reduced “age adequate movement repertoire” subcategory (p &amp;lt; 0.05). In multivariate analysis, pre-pregnancy BMI≥25 remained the only factor significantly associated with lower scores (p &amp;lt; 0.05). Discussion Our sample of healthy infants showed a typical range of spontaneous movements reflecting neural integrity. However, lower MOS-R scores were associated with pre-pregnancy overweight. This finding reinforce the importance of enhancing public health actions targeted at keeping a weight in the normal range to protect from a large number of unhealthy conditions both the mother and the offspring. Key messages • Pre-pregnancy weight appears associated with infant spontaneous movement in 3-5 months infants. • Public health actions targeted at keeping female weight in the normal range must be strengthen.

Antibiotic use in the first 1000 days and maternal-infant outcomes: results from the MAMI-MED cohort

Abstract Introduction Antibiotic use within the initial thousand days of life could potentially lead to a range of negative health outcomes for both mothers and infants. This study seeks to identify the primary factors influencing antibiotic use and examine the associations with adverse neonatal outcomes, specifically focusing on neonatal intensive care unit (NICU) admissions. Methods Data were gathered from pregnant women and their offspring enrolled in the ‘MAMI-MED’ study at ARNAS Garibaldi Nesima in Catania (Italy), from December 2020 to January 2024. Information regarding antibiotic exposure and maternal-infant health outcomes was collected through follow-up questionnaires administered at birth, one year, and two years postpartum. Results Among 1492 women (average age: 31 years) included in the study, 20.4% reported using antibiotics during pregnancy. The mean age of antibiotic users during pregnancy was significantly higher compared to non-users (p = 0.008). Among the 304 women who used antibiotics during pregnancy, 45.5% did so during the third trimester, 41.4% during the second trimester, and 13.1% during the first trimester. Furthermore, 47.1% of women reported antibiotic use at delivery or postpartum. Of the 904 children studied, 63% were administered at least one antibiotic between birth and the first year of age. A greater proportion of newborns admitted to the NICU were born to mothers who used antibiotics during the second trimester of pregnancy compared to those who used antibiotics during other trimesters (p = 0.013). Conclusions Comprehensive research is needed to delve deeper into the intricate factors influencing maternal antibiotic use. This should thoroughly explore socio-demographic variables, such as income level, education, and access to healthcare. Understanding these multifaceted influences can provide valuable insights into designing tailored public health interventions aimed at promoting prudent antibiotic use during pregnancy. Key messages • Different factors influence maternal antibiotic use. • Tailored public health interventions aimed at promoting prudent antibiotic use during pregnancy are needed.

Community Health Worker Service: addressing the needs of Gypsy/Travellers in Scotland

Abstract Background Members of the Gypsy/Traveller community in the United Kingdom face significant health inequalities compared to the general population, including lower life expectancy, higher rates of morbidity and suicide and poorer infant and child outcomes. This study evaluated the implementation of community-based lay workers in Scotland - the Gypsy/Traveller Community Health Worker (CHW) service. Methods This multi-method qualitative study (December 2021 to August 2023) included 16 individual interviews, five focus groups, one workshop, two informal discussions, and one site visit. Participants were stakeholders, CHWs, and members of the Gypsy/Traveller community. Additionally, 116 documents were analysed. The framework method, Proctor’s implementation outcomes and thematic analysis were used for data analysis. Results CHWs reached approximately 1,000 individuals across six National Health Services (NHS) Boards. The implementation outcomes showed that the intervention was accepted and feasible. A third-sector organization (Black and Minority Ethnic Carers of People Project - MECOPP), played a crucial role in successfully delivering the CHW service. This innovative intervention employed members of the Gypsy/Traveller community as lay healthcare workers to break down barriers to accessing healthcare and other services (e.g., uptake of cervical screening, vaccination, housing, and sanitation). The CHWs were trusted, ensured healthcare information was culturally appropriate and successfully addressed discriminatory behaviours in health and social care. Limited resources pose challenges to the sustainability of the service. Conclusions The Gypsy/Traveller CHW service enhanced prevention, acted as a bridge between communities and health systems and addressed the wider determinants of health. The Gypsy/Traveller community still faces discriminatory, racist, and stigmatising behaviours, which further impede the quality, delivery, and accessibility of care. Key messages • The Community Health Worker service was acceptable and feasible in the Gypsy/Traveller community, acting as a bridge between community and health systems and increasing access to services. • Community Health Worker Service is an important strategy for delivering healthcare support through their sector organizations to address historical discrimination against minority ethnic groups.

Role of early postnatal aEEG and brain MRI in predicting neurodevelopmental outcome in preterm infants at the age of 1 year

BackgroundPreterm birth is a principal reason for perinatal morbidity and mortality increasing the incidence of severe neurodevelopmental deficits. There is growing proof that early postnatal amplitude-integrated electroencephalography (aEEG) has a prognostic value for neurodevelopmental consequence in preterm born neonates. Furthermore, MRI has been widely utilized to enhance comprehension of the brain substrate responsible for neurodevelopmental abnormalities. Thus, this study aims at evaluating the role of early postnatal aEEG and brain MRI in forecasting neurodevelopmental consequence in preterm infants at the age of 1 year.MethodsA cohort study performed in the neonatal intensive care unit of a tertiary hospital during the duration from October 2021 to June 2023 including 60 preterm neonates < 32 weeks of gestation. All cases were monitored by aEEG within the 1st 72 h of life for at least 4 h, and then brain MRI and aEEG were done at term equivalent age (TEA) of 40 weeks. Regarding the neurodevelopmental outcome, our cases were assessed by Bayley scale III screening test at the age of 1 year.ResultsOf the study participants, 41.7% were males, and 58.3% were females with a mean gestational age of 30.40 ± 0.94 weeks and mean weight of 1.36 ± 0.17 kg. aEEG showed that 83.3% of the cases had continuous normal background activity at TEA, and MRI showed that 75% of the cases were normal. Comparing between non-affected and affected groups as categorized by Bayley scale regarding aEEG and MRI findings, there was greatly statistically significant difference between the two groups (P < 0.001). Brain MRI showed higher sensitivity and accuracy than aEEG.ConclusionBrain MRI at TEA is more sensitive and accurate than aEEG to predict the neurodevelopmental outcome. aEEG at TEA is more predictor for neurodevelopmental outcome than at birth. The combination of both aEEG and brain MRI at TEA gives more prediction about the degree of affection in neurodevelopmental outcome in preterm infants.

Determinants of micronutrient supplementation during pregnancy among women in three sub-Saharan African countries: a multilevel logistic regression model

BackgroundPoor maternal nutrition during pregnancy is a common cause of poor maternal and infant outcomes. Micronutrient deficiencies are common among pregnant women in low- and middle-income countries, including sub-Saharan Africa. Pregnant women are recommended to take micronutrients like iron or folic acid and deworming medication during pregnancy. Therefore, this study was conducted to assess micronutrient intake and its associated factors among pregnant women in three countries using the most recent demographic and health survey.MethodsWe used data from the most recent demographic and health surveys, which were carried out between 2019 and 2022 in three sub-Saharan African countries. The study included a weighted sample of 13,568 reproductive-age women who had given birth within the five years prior to the survey. Utilizing multilevel logistic regression, the factors associated with the dependent variable were identified. Model comparison and fitness were assessed using the deviance (-2LLR), likelihood ratio test, median odds ratio, and intra-class correlation coefficient. Ultimately, factors were deemed statistically significant if they had a p-value less than 0.05.ResultsThe pooled prevalence of micronutrient intake among pregnant women during pregnancy of last birth was 77.56% (95% CI: 76.85%–78.25%). Factors like age [AOR = 1.78; 95% CI (1.14, 2.77)], educational status [AOR = 1.49; 95% CI (1.23, 1.79)], marital status [AOR = 0.66; 95% CI (0.58, 0.75)], working status [AOR = 1.17; 95% CI (1.01, 1.34)], media exposure [AOR = 1.20; 95% CI (1.05, 1.38)], preceding birth interval [AOR = 1.17; 95% CI (1.01, 1.34)], number of ANC visits [AOR = 1.65; 95% CI (1.29, 2.10)], and residence [AOR = 1.19; 95% CI (1.03, 1.37)] were significantly associated with micronutrient intake among pregnant women.ConclusionsMore than three-fourths of the study subjects were micronutrient supplemented during their pregnancy. Improving women's education, disseminating nutrition information through media, providing more attention to young pregnant women who live in rural areas, increasing the number of ANC visits, and women's empowerment are strongly recommended.

A parent-administered sensorimotor intervention enhances oral feeding outcomes in infants who are born preterm: A randomized clinical study.

https://onlinelibrary.wiley.com/doi/10.1111/dmcn.16046

Enteral micronutrient supplementation and neurodevelopmental outcomes in preterm or low birth weight infants: A systematic review and meta-analysis.

The association of enteral micronutrient supplementation and the neurodevelopmental outcomes of preterm or low birth weight (LBW) infants is controversial. This research was prospectively registered (CRD42023454034). We searched MEDLINE, Embase, PsycInfo, ClinicalTrials. gov, and the Cochrane Library for randomised clinical trials (RCTs) or quasi-RCTs comparing any enteral micronutrients supplementation with placebo or no supplementation in preterm or LBW infants. The primary outcome was neurodevelopmental impairment (NDI), with secondary outcomes involving various neurodevelopmental tests and disabilities. There was no evidence of an association between enteral micronutrients supplementation and the risk of NDI (RR, 1.03; 95% CI, 0.93-1.14; moderate certainty evidence). There was no evidence that the supplemented groups enhanced cognitive (MD, 0.65; 95% CI, -0.37 to 1.67; low certainty evidence), language (SMD, -0.01; 95% CI, -0.11 to 0.09; moderate certainty evidence), or motor scores (SMD, 0.04; 95% CI, -0.06 to 0.15; very low certainty evidence) or IQ (SMD, -0.20; 95% CI, -0.53 to 0.13; very low certainty evidence). Subgroup analysis showed that multiple micronutrients supplementation improved expressive language score (MD, 1.42; 95% CI, 0.39-2.45), and zinc supplementation enhanced fine motor score (SMD, 1.70; 95% CI, 0.98-2.43). The overall heterogeneity was low. This study demonstrates that enteral micronutrient supplementation is associated with little or no benefits in neurodevelopmental outcomes for preterm or LBW infants. Well-designed RCTs are needed to further ascertain these associations.

Exploring the effects of mental health on bonding and caregiving among pregnant and postpartum persons with likely depression and/or PTSD in South Africa: A qualitative analysis.

Perinatal mental health disorders place a particularly high public health burden on South Africa (SA) via negative health outcomes for the birthing parent and adverse health outcomes for infants (e.g., low birth weight, preterm deliveries, malnourishment) as well as emotional and behavioral problems in children. Depression, posttraumatic stress disorder (PTSD), and other mental health disorders may also compromise engagement in HIV prevention behaviors during the perinatal period, when HIV acquisition risk increases. This is particularly important in SA, where almost a quarter of women between ages 15 to 49 have HIV. There is little research exploring the anticipated impacts mental health symptoms have on one's ability to emotionally connect or caregive after delivery; this critical information will enable providers to support women and their mental health during the transition from pregnancy to postpartum. HIV-negative pregnant persons were recruited from an antenatal clinic in Cape Town as a part of a larger study investigating mental health barriers to pre-exposure prophylaxis (PrEP) uptake during pregnancy. Participants qualified for an in-depth interview based on elevated symptoms of depression and/or PTSD. The interviews explored the likely impact of their mental health symptoms on their baby's wellbeing, their ability to bond with their baby, and their ability to meet their baby's needs. Following the principles of thematic analysis, we identified three main themes that described these relationships: (1) a strong perceived connection between maternal mental health and baby's wellbeing; (2) perceived strains on bonding with the baby; and (3) negative impact of mental health on likelihood of completing parenting tasks. This study will inform future mental health programming to prepare pregnant persons with mental health symptoms for a successful postpartum period with respect to bonding and caring for their infant.

10 Optimizing implementation and continuous monitoring of a newborn screening program for severe combined immunodeficiency

Abstract Background Severe Combined Immunodeficiency (SCID) is an inborn error of immunity characterized by severely low T cell levels and function. Early diagnosis is essential to prevent serious infections and improve outcomes. Newborn screening (NBS) for SCID provides a way to detect SCID and other conditions associated with T cell lymphopenia in the neonatal period. Objectives 1) Optimize the implementation of a NBS program for SCID in British Columbia (BC), Canada; and 2) create a systematic method for monitoring the diagnoses and outcomes of infants with a positive screen to facilitate continuous improvement of the NBS program. Design/Methods An interdisciplinary working group comprised of immunologists, biochemical geneticists, and hematopathologists met at regular intervals prior to and after implementing NBS for SCID in BC. We developed an algorithm for the evaluation and initial management of infants with an abnormal NBS for SCID based on literature review and local expert consensus. Using a REDCap database, we tracked the prevalence, evaluation, diagnoses and outcomes of infants with a positive NBS. The database also monitored diagnoses and outcomes of children referred to Immunology outside of the NBS program. Plan-do-study-act cycles included creation of clinical and educational guidelines on SCID, optimization of abnormal NBS cut-off values, and reflex chromosomal microarray (CMA) testing of infants with confirmed T cell lymphopenia. Results Between October 3, 2022 and June 16, 2023, 28,816 initial samples were tested, and 30 infants had a positive screen for SCID. Of the 30 infants, 10 were ultimately diagnosed with conditions associated with T cell lymphopenia. Diagnosis led to avoidance of live viral vaccines and implementation of infection precaution measures. No infants experienced complications related to live viral vaccine administration, compared to 1 case in the preceding 12 months prior to NBS implementation. In February 2023, the threshold for an abnormal NBS was adjusted to achieve the goal positive screen frequency of 0.1%. Performing reflex CMA testing on infants with confirmed T cell lymphopenia led to rapid diagnosis of chromosomal microdeletion syndromes, avoiding unnecessary second tier testing. Since implementing NBS for SCID in BC, there have been no cases of SCID diagnosed outside of the NBS program. Conclusion Establishing an interdisciplinary working group and clinical database facilitated the smooth integration and continuous improvement of NBS for SCID in BC. This model can be applied to other healthcare systems to support teams and ensure the best possible outcomes for affected patients.