Survival Of Infants Research Articles

Evolution of Exclusive Breastfeeding Practices According to Continuous Demographic and Health Surveys (DHS-C) from 2010-2011 to 2019 and Associated Factors in Senegal

Introduction: The first two years of a child's life are particularly important. Inadequate breastfeeding practices during this period considerably compromise the health, development and survival of infants, children and mothers. Several studies have assessed the impact of breastfeeding on infant mortality. The objectives of our study were to investigate changes in exclusive breastfeeding practices during the first six months of life according to DHS data from 2010-2011 to 2019 and to identify the various associated factors. Methodology: This is a quantitative analysis of secondary data based on cross-sectional data from the DHS from 2010-2011 to 2019 on changes in exclusive breastfeeding practices for infants under six months of age. Our study focused on women aged 15 to 49 years interviewed during the DHS and residing in Senegal at the time of the various surveys who had children under two years of age. Data were collected on exclusive breastfeeding rates in different years, the socio-demographic and gyneco-obstetric characteristics of mothers, and the characteristics of newborn children. A multivariate analysis was performed to identify factors associated with exclusive breastfeeding. Results: showed that exclusive breastfeeding rates remained below 50% from 2010-11 to 2019. Analysis by region showed a disparity between the different regions. The associated factors were: ethnic group: Wolof are less likely to practice EBF with an adjusted AOR of 0.59 with a CI<sub>95</sub>: [0.38, 0. 90], maternal literacy: mothers who could not read were less likely to perform EBF with an adjusted AOR of 0.71 and a CI<sub>95</sub>: [0.53-095], birth order: mothers with 6 or more children were more likely to perform EBF, with an AOR of 3.20 and a CI<sub>95</sub>: [1.68-6.17], maternal occupation: Working mothers were less likely to practice EBF than non-working mothers, with an AOR of 0.60 and a CI<sub>95</sub> [0.46-0.79], access to the media: Mothers with access to the media were less likely to practice assisted fertilization, with an AOR of 0.57 and a CI<sub>95</sub>: [0.37-0.90] and use of modern contraception: Mothers using modern contraception were less likely to practice exclusive breastfeeding, with an AOR of 0.53 and a CI<sub>95</sub>: [0.38-0.72]. Conclusion: Despite all the efforts made by the Senegalese government and its technical and financial partners, rates are still low. To strengthen the practice of exclusive breastfeeding, it is important and urgent to design and implement innovative evidence-based interventions covering the different levels of the socio-ecological model (individuals, families, communities and public policies).

Developmental origins of exceptional health and survival: A four-generation family cohort study.

Previous researched has demonstrated potent health and survival advantages across three-generations in longevity-enriched families. However, the survival advantage associated with familial longevity may manifest earlier in life than previously thought. We conducted a matched cohort study comparing early health trajectories in third-generation grandchildren (n = 5,637) and fourth-generation great-grandchildren (n = 14,908) of longevity-enriched sibships to demographically matched births (n = 41,090) in Denmark between 1973 and 2018. Lower risk was observed across a range of adverse early life outcomes in the grandchildren, including infant mortality (Hazard Ratio (HR) = 0.53, 95% CI [0.36, 0.77]), preterm birth (Odds Ratio (OR) = 0.82, [0.72, 0.93]), small for gestational age (OR = 0.83, [0.76, 0.90]) and neonatal respiratory disorders (OR = 0.77, [0.67, 0.88]). Relative advantages in parental education and maternal smoking were observed in both generations to a similar degree. However, a much smaller reduction in infant mortality was observed in the great-grandchildren (HR = 0.90, [0.70, 1.17]) and benefits across other outcomes were also less consistent, despite persisting socioeconomic and behavioural advantages. Lastly, maternal, and paternal lines of transmission were equipotent in the transmission of infant survival advantages. Descendants of longevity-enriched sibships exhibit a broad health advantage manifesting as early the perinatal period. However, this effect is strongly diluted over successive generations. Our findings suggest that exceptional health and survival may have early developmental components and implicate heritable genetic and or epigenetic factors in their specific transmission. Previous researched has demonstrated potent health and survival advantages across three-generations in longevity-enriched families. However, the survival advantage associated with familial longevity may manifest earlier in life than previously thought.In our study of third and fourth-generation descendants of longevity-enriched sibships, we observed a broad infant health and survival advantage reflected by protection against a diverse range of adverse birth outcomes.These advantages were strongly attenuated between the third and fourth generations, independent of otherwise stable socioeconomic and behavioural parental advantages, as well as maternal and paternal lines of transmission.Our findings suggest that familial aggregation of exceptional health and survival may have early life developmental components and triangulate to implicate heritable genetic and or epigenetic factors in their transmission.

PATHOMORPHOLOGICAL CHANGES IN THE BRONCHI AND LUNG PARANCHYMA IN RESPIRATORY DISTRESS SYNDROME DEPENDING ON THE GESTATION TIME IN NEWBORNS

The aim of this study was to identify the type of pathomorphological alterations in the lung tissue and bronchial wall of neonates that, based on gestational age, died from different types of pneumopathy. The study uses materials from the corpses of 74 newborns who passed away from various forms of pneumopathy in the Samarkand region's perinatal center. The bodies of the newborns were autopsied and studied in the pathoanatomical department of the Samarkand regional multidisciplinary hospital. Based on the distinct nosological forms of pneumopathy in neonates and their respective periods of maturity, the following groups were identified from the material: 1) Primary lung atelectasis by gestation: 22–28 weeks, 29–31 weeks, and 32–37 weeks. 2) Hyaline membrane disease, contingent on infant survival. Third, pneumopathy with an edematous-hemorrhagic form of pathology, which is also dependent on the period of neonatal life. An autopsy examining the lungs of infants whose primary diagnosis was primary pulmonary atelectasis revealed macroscopically reduced volume, cyanotic, inactive lungs with pointed, flat edges that did not fill the pleural cavities to capacity. Conclusions: Thus, hyaline membrane disease and primary atelectasis are the predominant morphological forms of pneumopathy in premature newborns.

Contribution of vaccination to improved survival and health: modelling 50 years of the Expanded Programme on Immunization

WHO, as requested by its member states, launched the Expanded Programme on Immunization (EPI) in 1974 to make life-saving vaccines available to all globally. To mark the 50-year anniversary of EPI, we sought to quantify the public health impact of vaccination globally since the programme's inception. In this modelling study, we used a suite of mathematical and statistical models to estimate the global and regional public health impact of 50 years of vaccination against 14 pathogens in EPI. For the modelled pathogens, we considered coverage of all routine and supplementary vaccines delivered since 1974 and estimated the mortality and morbidity averted for each age cohort relative to a hypothetical scenario of no historical vaccination. We then used these modelled outcomes to estimate the contribution of vaccination to globally declining infant and child mortality rates over this period. Since 1974, vaccination has averted 154 million deaths, including 146 million among children younger than 5 years of whom 101 million were infants younger than 1 year. For every death averted, 66 years of full health were gained on average, translating to 10·2 billion years of full health gained. We estimate that vaccination has accounted for 40% of the observed decline in global infant mortality, 52% in the African region. In 2024, a child younger than 10 years is 40% more likely to survive to their next birthday relative to a hypothetical scenario of no historical vaccination. Increased survival probability is observed even well into late adulthood. Since 1974 substantial gains in childhood survival have occurred in every global region. We estimate that EPI has provided the single greatest contribution to improved infant survival over the past 50 years. In the context of strengthening primary health care, our results show that equitable universal access to immunisation remains crucial to sustain health gains and continue to save future lives from preventable infectious mortality. WHO.

The Importance of Neurosurgical Intervention and Surgical Timing for Management of Pediatric Patients with Myelomeningoceles in Bangladesh

ObjectiveReports on the management and survival of children with myelomeningocele defects in Bangladesh are limited. This study describes the characteristics and outcomes of these children, focusing on the timing of surgical repair and factors affecting survival. MethodsWe enrolled patients with myelomeningoceles in a case-control study on arsenic exposure and spina bifida in Bangladesh. Cases were subsequently followed at regular intervals to assess survival. Demographic, clinical, and surgical characteristics were reviewed. Univariate tests identified factors affecting survival. ResultsBetween 2016-2022, we enrolled 272 patients with myelomeningocele. Postnatal surgical repair was performed in 63% of cases. However, surgery within 5 days after birth was infrequent (<10%) due to delayed presentation, and there was a high rate (29%) of preoperative deaths. Surgical repair significantly improved patient survival (p<0.0001). Older age at time of surgery was also associated with improved survival rates, which most likely represents that those who survived to older ages prior to surgery accommodated better with their lesions. Patients who presented with ruptured lesions had lower survival rates. ConclusionsTimely neurosurgical repair of myelomeningoceles in Bangladesh is hindered by late patient presentation, resulting in a high preoperative patient death rate. Neurosurgical intervention remains a significant predictor of survival. Increased access to neurosurgical care and education of families and non-neurosurgical providers on the need for timely surgical intervention are important for improving the survival of infants with myelomeningoceles.

Pregnant women with COVID-19 ARDS on the intensive care unit

Pregnant women with coronavirus disease 2019 (COVID-19) are at increased risk of severe disease progression. Comorbidities, such as chronic arterial hypertension, diabetes mellitus, advanced maternal age and high body mass index, may predispose to severe disease. The management of pregnant COVID-19patients on the intensive care unit (ICU) is challenging and requires careful consideration of maternal, fetal and ethical issues. Description and discussion of intensive care treatment strategies and perinatal anesthesiological management in patients with COVID-19 acute respiratory distress syndrome (CARDS). We analyzed the demographic data, maternal medical history, clinical intensive care management, complications, indications and management of extracorporeal membrane oxygenation (ECMO) and infant survival of all pregnant patients treated for severe CARDS in the anesthesiological ICU of aGerman university hospital between March and November 2021. The cohort included 9 patients with amean age of 30.3 years (range 26-40years). The gestational age ranged from 21 + 3 weeks to 37 + 2 weeks. None of the patients had been vaccinated against SARS-CoV‑2. Of the nine patients seven were immigrants and communication was hampered by inadequate Central European language skills. Of the patients five had aPaO2/FiO2 index < 150 mm Hg despite escalated invasive ventilation (FiO2 > 0.9 and a positive end-expiratory pressure [PEEP] of 14 mbar) and were therefore treated with repeated prolonged prone positioning maneuvers (5-14 prone positions for 16 h each, atotal of 47prone positioning treatments) and 2 required treatment with inhaled nitric oxide and venovenous ECMO. The most common complications were bacterial superinfection of the lungs, urinary tract infection and delirium. All the women and five neonates survived. All newborns were delivered by cesarean section, two patients were discharged home with an intact pregnancy and two intrauterine fetal deaths were observed. None of the newborns tested positive for SARS-CoV‑2 at birth. High survival rates are possible in pregnant patients with CARDS. The peripartum management of pregnant women with CARDS requires close interdisciplinary collaboration and should prioritize maternal survival in early pregnancy. In our experience, prolonged prone positioning, an essential evidence-based cornerstone in the treatment of ARDS, can also be safely used in advanced stages of pregnancy. Inhaled nitric oxide (iNO) and ECMO should be considered as life-saving treatment options for carefully selected patients. For cesarean section, neuraxial anesthesia can be safely performed in patients with mild CARDS if well planned but the therapeutic anticoagulation recommended for COVID-19 may increase the risk of bleeding complications, making general anesthesia amore viable alternative, especially in severe disease.

Assessment of Dietary Intake and Nutritional Status of Children (0-23 Months) Accessing Care in Community Infant and Young Child Feeding (C-IYCF) Practices in Hasiya Bayero Pediatric Hospital Kano

Introduction: Infant and young child feeding (IYCF) practices have substantial outcomes for the growth, development, and survival of infants and children during the first two years of age and throughout their lifetime. The study aimed to assess the dietary intake and nutritional status of children (0–23 months) registered for care in Hasiya Bayero Pediatric Hospital Kano. Methodology: A cross-sectional study was conducted among 125 randomly selected caregiver-child pairs accessing care in the hospital. A validated semi-structured questionnaire was used to collect information on socio-demographic and dietary intake information from the respondents. Anthropometric indices of weight for age, length for age, and weight for length measurements were used to assess the nutritional status of children. Result: Female caregivers were the most participants in this study 122 (98.2%). For marital status, almost all 124 (99.4%) of the mothers were married and only 1 each of the mothers reported to be single and being widowed. About 76 (60.8%) of the study population attended secondary education. The major occupation of the caregivers is trading in 92.4%. Dietary intake consists mainly of legumes in 30.0% and cereals in 56.5%. Only 39.0% portion of the population met the minimum World Health Organization (WHO) recommendation of dietary diversity and over 79.8% of the caregivers were still breastfeeding during the period of the study, 18% of them initiated breastfeeding within 1 h of birth and only 16.2% exclusively breastfed their children; majority 70.6% of the caregivers breastfed on demand while with a small proportion of 26.1% and 3.3% responded to breastfeeding when convenient and breastfeeding at a scheduled time respectively. Conclusion: The study revealed that the nutritional status of the children was poor. Up to 60 (51.2%), 98 (88.3%), and 74 (65.1%) of the infants were wasted, underweight, and stunted, respectively. The study also revealed that the nutritional status of the children (WLZ, WAZ, and LAZ) was significantly related to the dietary diversity at p = 0.002, p = 0.001, and p = 0.019, respectively. This study revealed poor IYCF practices in Hasiya Bayero Pediatric Hospital Kano. Therefore, more attention needs to be paid to the specific behaviors surrounding feeding practices and other constraints to children accessing care in Hasiya Bayero Pediatric Hospital Kano.

Partner-Based HIV Treatment for Seroconcordant Couples Attending Antenatal and Postnatal Care in Rural Mozambique: A Cluster Randomized Controlled Trial.

There is evidence that a supportive male partner facilitates maternal HIV testing during pregnancy, increases maternal antiretroviral therapy initiation and adherence, and increases HIV-free infant survival. Most male partner engagement clinical strategies have focused on increasing uptake of couple-based HIV testing and counseling. We delivered a couple-based care and treatment intervention to improve antiretroviral therapy adherence in expectant couples living with HIV. We implemented a cluster randomized controlled trial for seroconcordant couples living with HIV, comparing retention (using a patient's medication possession ratio) in HIV care for a couple-based care and treatment intervention vs. standard of care services in rural Mozambique. The intervention included couple-based treatment, couple-based education and skills building, and couple-peer educator support. We recruited 1080 couples to participate in the study. Using a linear mixed effect model with a random effect for clinic, the intervention had no impact on the medication possession ratio among women at 12 months. However, the intervention increased men's medication ratio by 8.77%. Our unadjusted logistic regression model found the odds of an infant seroconverting in the intervention group was 30% less than in the control group, but the results were not statistically significant. Our study found no difference in maternal outcomes by study arm, but our intervention resulted in an improved medication possession ratio among male partners. We provide a community/clinic-based treatment framework that can improve outcomes among male partners. Further work needs to be done to improve social support for pregnant women and to facilitate prevention of vertical transmission to infants among couples living with HIV.

Long-term outcomes of very low birth weight infants with intraventricular hemorrhage: a nationwide population study from 2011 to 2019.

Advancements in neonatal care have increased preterm infant survival but paradoxically raised intraventricular hemorrhage (IVH) rates. This study explores IVH prevalence and long-term outcomes of very low birth weight (VLBW) infants in Korea over a decade. Using Korean National Health Insurance data (NHIS,2010-2019), we identified3372 VLBW infants with IVH among 4,129,808 live births.Health-related claims data, encompassing diagnostic codes, diagnostic test costs, and administered procedures were sourced from the NHIS database.The results of the developmental assessments are categorized into four groups based on standard deviation (SD) scores.Neonatal characteristics and complications were compared amongthe groups. Logistic regression models were employed to identify significant changes in the incidence of complications and to calculate odds ratios with corresponding 95% confidence intervals for each risk factor associated with mortality and morbidity in IVH.Long-term growth and developmentwere compared between the two groups(years2010-2013 and 2014-2017). IVH prevalence was 12% in VLBW and 16% in extremely low birth weight (ELBW) infants. Over the past decade, IVH rates increased significantly in ELBW infants (P = 0.0113), while mortality decreased (P = 0.0225). Major improvements in certain neurodevelopmental outcomes and reductions in early morbidities have been observed among VLBW infants with IVH. Ten percent of the population received surgical treatments such as external ventricular drainage (EVD) or a ventriculoperitoneal (VP) shunt, with the choice of treatment methods remaining consistent over time. The IVH with surgical intervention group exhibited higher incidences of delayed development, cerebral palsy, seizure disorder, and growth failure (height, weight, and head circumference) up to 72months of age (P < 0.0001). Surgical treatments were also significantly associated with abnormal developmental screening test results. The neurodevelopmental outcomes of infants with IVH, especially those subjected tosurgical treatments, continue to be a matter of concern. It is imperative to prioritize specialized care for patients receiving surgical treatments and closely monitor their growth and development after discharge to improve developmental prognosis. Supplementary file2 (MP4 77987 kb).

Socioeconomic Determinants of Maternal and Child Healthcare Utilization and Infant Survival: A Case Study of Kijumo Village, Uganda

This study examines the socioeconomic determinants of maternal and child healthcare utilization and its impact on infant survival in Kijumo Village, Uganda. Through a survey of 70 mothers, data was collected on demographic characteristics, healthcare service utilization, and infant survival. Regression analyses were conducted to explore the relationship between socioeconomic factors, healthcare utilization, and infant survival. Results indicate a significant association between maternal education, household wealth, and infant survival. Moreover, healthcare service utilization was influenced by factors such as distance to healthcare centers and economic constraints. The findings underscore the need for targeted interventions to improve healthcare access and utilization in underserved communities like Kijumo Village. Keywords: Maternal and child healthcare, healthcare utilization, socioeconomic determinants and infant survival.

Modeling time to death for under-five children in Malawi using 2015/16 Demographic and Health Survey: a survival analysis

BackgroundMalawi has one of the highest under-five mortality rates in Sub Sahara Africa. Understanding the factors that contribute to child mortality in Malawi is crucial for the development and implementation of effective interventions to reduce child mortality. The aim of this study is to use survival analysis in modeling time to death for under-five children in Malawi. In turn, identify potential risk factors for child mortality and inform the development of interventions to reduce child mortality in the country.MethodThis study used data from all births that occurred in the five years leading up to the 2015/16 Malawi Demographic and Health Survey. The Frailty hazard model was applied to predict infant survival in Malawi. In this analysis, the outcome of interest was death and it had two possible outcomes: "dead" or "alive". Age at death was regarded as the survival time variable. Infants who were still alive at the time of the study as of the day of the interview were considered as censored observations in the analysis.ResultsA total of 17,286 live births born during the 5 years preceding the survey were analysed. The study found that the risk of death was higher among children born to mothers aged 30–39 and 40 or older compared to teen mothers. Infants whose mothers attended fewer than four antenatal care visits were also found to be at a higher risk of death. On the other hand, the study found that using mosquito nets and early breastfeeding were associated with a lower risk of death, as were being male and coming from a wealthier household.ConclusionThe study reveals a notable decline in infant mortality rates as under-five children age, underscoring the challenge of ensuring newborn survival. Factors such as maternal age, birth order, socioeconomic status, mosquito net usage, early breastfeeding initiation, geographic location, and child's sex are key predictors of under-five mortality. To address this, public health strategies should prioritize interventions targeting these predictors to reduce under-five mortality rates.

Post-discharge home kangaroo mother care follow-up study in rural Gujarat.

Continuation of kangaroo mother care (KMC) at home is vital for improved infant survival and development. Hence, it is essential to understand potential enablers and barriers to home KMC provision. This observational study was conducted in rural Gujarat. KMC was initiated for all low-birth-weight (LBW) neonates during the hospital stay and were advised to continue home KMC on discharge. The mothers of these LBW neonates were interviewed using a structured questionnaire during follow-up visits or via telephone. A total of 100 mothers were interviewed, and 98 practiced home KMC. Mothers' mean age was 24.41 (±3.1) years, and infants' mean age was 3.48 (±1.81) months. The mean weight of neonates at discharge was 1.85 (±0.28) kg. Out of the 104 neonates (96 singleton pregnancies and four twins), 76 (73.07%) were pre-term. 31% mothers provided 4-6 hours of daily KMC. 60% provided KMC for less than 1 hour during each session, while 36% of mothers provided each KMC session for 1-3 hours. 74% of mothers received family support, and 62% faced difficulties in home KMC provision. 88% of mothers were homemakers, and 53% had other children to care for. 51% mothers pre-maturely discontinued KMC provision. 83% of the mothers reported fatigue or pain during KMC provision. Lack of family support, other household responsibilities, and other children to care for were major barriers leading to pre-mature discontinuation of home KMC.

Abstract 144: Sex bias in neuroblastoma: Worse outcomes for female patients are associated with dysregulation of DLK1 and H19

Abstract Neuroblastoma (NB) is a devastating neural crest-derived tumor primarily affects children under five. Forty percent of NB patients are classified as high-risk (HR), and less than half of them survive. HR disease is split into two equally sized groups: one exhibiting genetic amplification of the MYCN proto-oncogene (MA), and another where MYCN is non-amplified (MNon). Overall survival (OS) studies are often either poorly annotated or focused on outcomes across the entire patient group, which may mask differential outcomes or biases among NB subgroups. Here we report our assessment of OS among several genetic, histopathological, and sex-based subgroups in three different well annotated NB patient datasets. Our analysis reveals a previously unseen sex-bias in HR MNon patients, where female patients have significantly worse OS than males. This disparity carries into stage 4s NB, defined by high survival in infants despite the presence of broadly disseminated disease. In stage 4s patients across two studies, we observe no deaths among males (n=66) and 6 among females (n=48), again marking significantly worse OS in females. Expression analysis comparing male and female HR MNon patients identifies DLK1 and H19, two imprinted genes implicated in multiple malignancies, as frequently overexpressed in females. A similar pattern is seen in RNA seq analysis of human MA (n=4) and MNon (n=4) cell lines. In addition, both DLK1 and H19 are associated with worse prognosis in female but not male patients. We also report that depletion of either gene results in reduced growth in vitro. Moreover, the NB-related ATRX tumor suppressor has been shown to inhibit H19 via insertion of histone variant H3.3. We observe an inverse correlation between H3.3B and H19 expression in female HR MNon patients. Further, H19 levels increase upon ATRX depletion in human NB cells, suggesting that ATRX indeed regulates H19 in NB. These findings provide the first evidence of female-biased outcomes in NB and suggest functional involvement of DLK1, H19 and ATRX. Citation Format: Mariya Raleigh, Vishwa Patel, Lorraine R. Benhamou, Xin Shen, Dennis A. Sheeter, Erika C. Espinosa, Niharika Reddy Badi, Chase Calvert, Garrett Bourne, John T. Powers. Sex bias in neuroblastoma: Worse outcomes for female patients are associated with dysregulation of DLK1 and H19 [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 144.

Special economic zone and infant mortality: Evidence from China.

By exploiting the development of special economic zones (SEZs) in China as a quasi-natural experiment, this paper evaluates how such zones affect infant mortality. Difference-in-differences analysis reveals that SEZs significantly decrease the local infant mortality rate, and the impact is larger for male infants and infants with less-educated mothers. Further studies show that the SEZs, which acts as an economic growth shock, improve infant survival by increasing the local income. Furthermore, there is no supportive evidence that the SEZs significantly alter either women's fertility-associated behaviors or environmental pollution. These results highlight the previously ignored human capital-related consequences of place-based policies in China.

A Review of Socioeconomic Factors Affecting Infant Survival in Indonesia

Infant survival is the infant's ability to survive until their first birthday. Indonesia has a high IMR. Previous research reported that socioeconomics is a crucial factor that must be discussed in solving the challenge of infant mortality in Indonesia, considering that Indonesia is a developing country with high socioeconomic disparities. This review aims to identify socioeconomic determinants affecting infant survival in Indonesia. According to Mosley and Chen's framework, the well-being and survival of infants are influenced by socioeconomic factors operating through proximate determinants identified at the individual, household, and community levels. The findings from this review are how socioeconomic variables are related to each other. Keywords: infant mortality, household, community

Effects of preterm birth, maternal ART and breastfeeding on 24-month infant HIV-free survival in a randomized trial.

IMPAACT 1077BF/FF (PROMISE) compared the safety/efficacy of two HIV antiretroviral therapy (ART) regimens to zidovudine (ZDV) alone during pregnancy for HIV prevention. PROMISE found an increased risk of preterm delivery (<37 weeks) with antepartum triple ART (TDF/FTC/LPV+r or ZDV/3TC/LPV+r) compared with ZDV alone. We assessed the impact of preterm birth, breastfeeding, and antepartum ART regimen on 24-month infant survival. We compared HIV-free and overall survival at 24 months for liveborn infants by gestational age, time-varying breastfeeding status, and antepartum ART arm at 14 sites in Africa and India. Kaplan-Meier survival probabilities and Cox proportional hazards ratios were estimated. Three thousand four hundred and eighty-two live-born infants [568 (16.3%) preterm and 2914 (83.7%) term] were included. Preterm birth was significantly associated with lower HIV-free survival [0.85; 95% confidence interval (CI) 0.82-0.88] and lower overall survival (0.89; 95% CI 0.86-0.91) versus term birth (0.96; 95% CI 0.95-0.96). Very preterm birth (<34 weeks) was associated with low HIV-free survival (0.65; 95% CI 0.54-0.73) and low overall survival (0.66; 95% CI 0.56-0.74). Risk of HIV infection or death at 24 months was higher with TDF-ART than ZDV-ART (adjusted hazard ratio 2.37; 95% CI 1.21-4.64). Breastfeeding initiated near birth decreased risk of infection or death at 24 months (adjusted hazard ratio 0.05; 95% CI 0.03-0.08) compared with not breastfeeding. Preterm birth and antepartum TDF-ART were associated with lower 24-month HIV-free survival compared with term birth and ZDV-ART. Any breastfeeding strongly promoted HIV-free survival, especially if initiated close to birth. Reducing preterm birth and promoting infant feeding with breastmilk among HIV/antiretroviral drug-exposed infants remain global health priorities.

Improving accuracy of outcome prediction for infants born extremely preterm using a digital tool: Translating 'NIC-PREDICT' into clinical practice, the first steps.

Many clinicians overestimate mortality and disability rates in infants born extremely preterm. We developed a digital tool ('NIC-PREDICT') that predicts infant mortality and survival with and without major disability in infants born 23-27 weeks' gestation. To determine if clinicians could use NIC-PREDICT accurately, and if their perceptions of infant outcomes improved after its release in 2021. Midwives, nurses, obstetricians, neonatologists and paediatricians working in tertiary and non-tertiary hospitals in Victoria were asked to use NIC-PREDICT to estimate three mutually exclusive outcomes: (i) mortality; (ii) survival free of major disability; and (iii) survival with major disability for six different scenarios where a liveborn infant was offered survival-focused care after birth. The proportions who completed the survey (responded to all six scenarios) and the proportions able to provide 100% accurate results for all scenarios were determined. Estimates of the three outcomes were compared with true rates. A total of 85 clinicians responded: 70 (82%) completed the survey, with an overall accuracy of 76%. Overall, predictions of mortality were accurate (mean difference from true value 0.7% (95% confidence interval (CI) -0.7, 2.1) P = 0.33), as were predictions of survival without major disability (mean difference - 0.7 (95% CI -3.0, 1.7) P = 0.58). However, survival with major disability was overestimated by 4.9% ((95% CI 1.7, 8.0) P = 0.003). Most perinatal clinicians who responded used NIC-PREDICT correctly to estimate expected outcomes in infants born extremely preterm who are offered intensive care. Undue pessimism about survival with major disability remains an ongoing concern.

Variation in maternal lactation practices associated with changes in diurnal maternal inflammation

While the importance of human milk in shaping infant immune function is well established, the impact of at-the-nipple (ATN) breastfeeding on maternal immune status has been understudied. Since lactation evolved to support infant survival and boost maternal fitness, we predict that ATN breastfeeding will confer benefits on maternal immune function. We measure the absolute and relative frequency of different infant feeding methods (ATN breastfeeding, pumping, donated milk, other supplementation) used by postpartum women in Seattle, WA (USA). We implement Bayesian modeling to estimate the effects of ATN breastfeeding on diurnal change in secretion rate of “pro-inflammatory” salivary cytokines and C-reactive protein (CRP). Our results show that most mothers in our sample used a variety of infant feeding methods, with pumping as the most common alternative to ATN breastfeeding. We find that ATN breastfeeding is associated with non-linear effects on diurnal IL-8 and CRP. Furthermore, we find that women who report zero versus ubiquitous ATN breastfeeding exhibit opposing diurnal patterns in CRP secretion rate. This study provides evidence that variation in maternal lactation practices corresponds to differences in maternal immune responses, highlighting how measuring lactation as a continuous variable can further enhance understanding of postpartum maternal physiology.

Staged repair of borderline hypoplastic heart disease with early biventricular conversion

ObjectiveIn select patients with borderline ventricular hypoplasia, we adopted a strategy of initial single-ventricle palliation followed by staged or direct biventricular conversion by 2 years of age. MethodsBetween 2018 and 2023, 14 newborns with borderline hypoplastic heart disease deemed high risk for primary biventricular repair underwent palliative procedures as a neonate/infant, followed by staged or direct biventricular conversion. ResultsOf the 14 patients, 6 had borderline left ventricles and 8 had borderline right ventricles. Index neonatal operations were performed in 12 patients and included the Norwood operation (n = 5), pulmonary artery band (n = 3), ductal stent (n = 3), and hybrid Norwood (n = 1). Five patients underwent direct biventricular conversion, and the remaining 9 patients underwent staged ventricular recruitment operations at a mean age of 6 months (range, 3-11 months). Ventricular recruitment operations included atrial septation with or without ventricular rehabilitation, atrioventricular valve repair, or outflow tract operations. At a mean duration of 8 months (range, 4-10 months) after ventricular recruitment, there was a significant increase in chamber volume, aortic valve, and mitral valve size in patients with borderline left ventricles, and a normalization of the right ventricle:left ventricle end-diastolic volume ratio in patients with borderline right ventricles. To date, 13 of 14 patients have undergone successful biventricular conversion at a mean age of 16 months (range, 4-31 months). ConclusionsIn select newborns with borderline hypoplastic heart disease, single-ventricle palliation followed by staged or direct biventricular conversion may increase infant survival while allowing for early attainment of a biventricular circulation.

Differences in Motor Development between Preterm Infants and Full-Term Preschool Children.

Although advances in obstetric and neonatal care have improved the survival of preterm infants, many studies document the increased risk of motor and sensory neurodevelopmental abnormalities that can hinder school progress. The aim of this study was to analyze the differences in gross and fine motor development in children born preterm and full term aged 3 to 6 years using the Peabody Developmental Motor Scales 2 (PDMS-II). Fifteen preterm and fifteen term children, matched for age and sex, participated in this study. They were evaluated with the PDMS-II scale. The scores obtained in the PDMS-II scale showed statistically significant differences (p < 0.05) in all subscales except for the "grasping" subscale. No dissimilarities were found between children who attended an early intervention program and those who did not participate, nor was there any correlation between week of gestation and birth weight and motor development in preschool. The results obtained show that differences are found with respect to motor development, with lower scores for those born preterm compared to children born at term. No statistically significant difference was found between preterm children who attended early intervention and those who did not. No correlation was found between motor development at preschool age and birth weight and gestational age.