Months Of Age In Children Research Articles

ASSESSMENT OF NITRIC OXIDE METABOLISM, MALONDIALDEHYDE, SIALIC ACIDS , AND ENOS GENE VARIANTS (RS1799983) IN NEWBORNS WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY FOLLOWING L-CARNITINE ADMINISTRATION

In Ukraine, conditions arising during the perinatal period accounted for 57.9% of infant mortality under 1 year of age in 2021, compared to 55.6% in 2017. Hypoxic-ischemic encephalopathy (HIE) remains a leading cause of neurological complications and disability, particularly in low-income countries, where its incidence reaches 10-20 cases per 1,000 newborns. Despite advances in medical care, the risk of irreversible brain damage from HIE remains high. The processes associated with HIE are marked by oxidative stress and disrupted ionic homeostasis, leading to neuroapoptosis and necrosis of brain cells. Objective: to investigate metabolic changes in newborns with HIE by assessing nitric oxide, malondialdehyde, sialic acids, eNOS gene variants, and the impact of L-carnitine on metabolite concentrations. Materials and Methods. The study included 30 neonates. The main group consisted of 16 children with HIE, monitored in an outpatient follow-up clinic and receiving levocarnitine. The comparison group included 14 randomly selected relatively healthy neonates without HIE. Levels of nitrites, nitrates, malondialdehyde, and sialic acids in urine were assessed during the early neonatal period and at 6-9 months of age in children with HIE. In the comparison group, metabolite levels were measured at 6-9 months of age. Results. The study revealed increased nitrite (1.71 vs. 2.7; p=0.003) and nitrate (3.72 vs. 5.42; p=0.010) levels in newborns with HIE, indicating activation of nitric oxide metabolism. Malondialdehyde levels decreased following L-carnitine treatment, suggesting reduced oxidative stress. Genetic analysis showed a higher frequency of the 894GT genotype in the eNOS gene among newborns with reduced sialic acid concentrations (0.2 vs. 0.59; p=0.008). Conclusion. L-carnitine shows potential neuroprotective effects in the treatment of HIE by stabilizing mitochondrial function and reducing oxidative stress. Further studies are needed to optimize therapeutic strategies.

Impact of oral azithromycin and intermittent preventive treatment with sulfadoxine-pyrimethamine regimen on child mortality in Sierra Leone: trial protocol for a randomised, two-arm, double-blinded, placebo-controlled clinical trial (ICARIA)

BackgroundAzithromycin has been shown to be beneficial in preventing infectious diseases, including malaria, infectious diarrhoea and pneumonia. A cluster randomised control trial on azithromycin MDA in children in Niger, Malawi and Tanzania found a reduction in all-cause under-five (U5) mortality in communities who received azithromycin compared to placebo. However, the reduction was largest and statistically significant only in Niger. The purpose of this trial is to evaluate the impact of azithromycin plus intermittent preventive treatment in infants (IPTi), recently renamed by the World Health Organisation as perennial malaria chemoprevention (PMC), with sulfadoxine-pyrimethamine (SP) on all-cause mortality up to 18 months of age in children living in areas of high mortality burden through the Expanded Program on Immunisation (EPI) in Sierra Leone.MethodsThe Improving Care through Azithromycin Research for Infants in Africa (ICARIA) trial is a phase III two-arm, individually randomised, double-blinded, placebo-controlled trial administering oral AZI (20 mg/kg bodyweight) at three time points to children attending EPI visits in Sierra Leone. A total of 20,560 infants attending the first EPI contact at around 6 weeks of age are recruited and randomised to AZI or placebo in a 1:1 ratio. The second and third AZI/placebo doses are given at 9 and 15 months of age. The primary outcome of the trial is all-cause mortality rate at 18 months of age assessed through mortality surveillance. Other trial outcomes include the impact on antimicrobial resistance, and on the immune response to certain key routine EPI immunisations, the safety of the intervention, the prevalence of SP resistance markers and the feasibility, and acceptability of adding AZI to the EPI programme.DiscussionThe trial will provide the evidence needed to inform policy regarding the adoption and large-scale implementation of AZI in areas of high-mortality burden in sub-Saharan Africa.Trial registrationClinicalTrials.gov NCT04235816. Registered on 22 January 2020.Pan-African Clinical Trials Registry PACTR202004540256535. Registered on 14 April 2020.

Head circumference growth in children with Autism Spectrum Disorder: trend and clinical correlates in the first five years of life.

Macrocephaly is described in almost 15% of children with Autism Spectrum Disorder (ASD). Relationships between head growth trajectories and clinical findings in ASD children show a high degree of variability, highlighting the complex heterogeneity of the disorder. The aim of this study was to measure differences of the early growth trajectory of head circumference (HC) in children with ASD and macrocephaly compared to ASD normocephalic children, examining clinical correlates in the two groups of patients. HC data were collected from birth to 5 years of age in a sample of children with a confirmed diagnosis of ASD. Participants were classified into two groups: ASD macrocephaly (ASD-M, Z-scores ≥1.88 in at least two consecutive HC measurements), and ASD non-macrocephaly (ASD-N). Based on the distribution of HC measurements (Z-scores), five age groups were identified for the longitudinal study. Developmental and behavioral characteristics of the ASD-M children compared to the ASD-N group were compared by using standardized scores. 20,8% of the children sample met criteria for macrocephaly. HC values became indicative of macrocephaly in the ASD-M group at the age range from 1 to 6 months, and persisted thereafter throughout the first five years of age. ASD-M children showed significantly higher developmental quotients of Griffiths III B and D subscales compared to ASD-N group. No significant differences in the severity of ASD symptoms assessed by ADOS-2 were observed between ASD-M and ASD-N groups. In this study HC size from birth to 5 years links to accelerated HC growth rate as early as the first 6 months of age in children with ASD and macrocephaly, preceding the onset and diagnosis of ASD. We found that in early childhood, children with ASD-M may exhibit some advantages in language and social communication and emotional skills without differences in autism severity, when compared with age-matched normocephalic ASD children. Longitudinal analyses are required to catch-up prospectively possible relationships between head size as proxy measure of brain development and neuro-developmental and behavioral features in children with ASD.

Prenatal predictors of ambulation without assistance by 30 months of age in children following prenatal repair of open spina bifida, a systematic review and meta‐analysis

AbstractObjectivesWe aimed to investigate prenatal predictors for ambulation without assistance in children following prenatal repair of open spina bifida (OSB).MethodsA systematic search was conducted in three databases until June 2022. We included articles reporting on prenatal repair of open spina bifida (OSB) and ambulation outcomes. The random‐effect model was used. Effect sizes are presented as odds ratio (OR), using the Mantel–Haenszel test, with 95% confidence interval (CI).ResultsFive studies encompassing 460 pregnancies that underwent prenatal repair of OSB of which a total of 234 had data on ambulation and were included. The follow‐up age for all included studies was 30 months. Two studies were open repairs, two were fetoscopic repairs, and one included both open and fetoscopic repairs. Of the 234 included population, ambulation without assistance occurred in 159/234, 68% (95% CI 58, 76), and ambulation with assistance occurred in 75/234, 32% (95% CI 23.6, 41.6). Significant prenatal preoperative predictors that are negatively associated with ambulation without assistance were lateral ventricle (LV) width ≥15 mm (OR: 0.29; 95% CI 0.12, 0.69, I2 = 0.0%; p < 0.0001), lesion level T12‐L2 (OR: 0.22; 95% CI 0.07, 0.7; I2 = 65%, p = 0.01), and severe hindbrain herniation (OR: 0.28; 95% CI 0.1, 0.77; I2 = 0.0%; p = 0.01). Factors including gestational age at surgery (p = 0.5), Myeloschisis (p = 0.4), talipes (p = 0.29), and gestational age at birth (p = 0.95) were not significantly associated with ambulatory status.ConclusionFollowing the prenatal repair of OSB, preoperative factors that are negatively associated with walking without assistance were preoperative LV width ≥15 mm, lesion level T12‐L2, and preoperative severe hindbrain herniation. These results provide pertinent counselling points for parents with pregnancies affected by OSB considering a prenatal repair.

Continuum of care for maternal and child health and child undernutrition in Angola

BackgroundContinuum of care (CoC) for maternal and child health provides opportunities for mothers and children to improve their nutritional status, but many children remain undernourished in Angola. This study aimed to assess the achievement level of CoC and examine the association between the CoC achievement level and child nutritional status.MethodsWe used nationally representative data from the Angola 2015–2016 Multiple Indicator and Health Survey. Completion of CoC was defined as achieving at least four antenatal care visits (4 + ANC), delivery with a skilled birth attendant (SBA), child vaccination at birth, child postnatal check within 2 months (PNC), and a series of child vaccinations at 2, 4, 6, 9 and 15 months of child age. We included under 5 years old children who were eligible for child vaccination questionnaires and their mothers. The difference in CoC achievement level among different nutritional status were presented using the Kaplan-Meier method and examined using the Log-Lank test. Additionally, the multivariable logistic regression analysis examined the associations between child nutritional status and CoC achievement levels.ResultsThe prevalence of child stunting, underweight and wasting was 48.3%, 23.2% and 5.9% respectively. The overall CoC completion level was 1.2%. The level of achieving CoC of mother-child pairs was 62.8% for 4 + ANC, 42.2% for SBA, 23.0% for child vaccination at birth, and 6.7% for PNC, and it continued to decline over 15 months. The Log-Lank test showed that there were significant differences in the CoC achievement level between children with no stunting and those with stunting (p < 0.001), those with no underweight and those with underweight (p < 0.001), those with no wasting and those with wasting (p = 0.003), and those with malnutrition and those with a normal nutritional status (p < 0.001). Achieving 4 + ANC (CoC1), 4 + ANC and SBA (CoC 2), and 4 + ANC, SBA, and child vaccination at birth (CoC 3) were associated with reduction in child stunting and underweight.ConclusionsThe completion of CoC is low in Angola and many children miss their opportunity of nutritional intervention. According to our result, improving care utilization and its continuity could improve child nutritional status.

A nationwide birth cohort in Japan showed increased risk of early childhood hospitalisation in infants born small for gestational age.

To examine associations between children being born small for gestational age and childhood hospitalisation following term and preterm births. This study included 34 564 children from a nationwide population-based longitudinal survey starting in 2010, comprising 32 603 term births and 1961 preterm births. Children's hospitalisation history was examined during two observational periods, 6-18 and 6-66 months of age. Logistic regression analysis was conducted, adjusting for child and parental confounders, with children born appropriate for gestational age as reference. Children born small for gestational age were more likely to be hospitalised during early childhood than those born appropriate for gestational age. The odds ratio (95% confidence interval) for hospitalisation from 6 to 66 months of age was 1.19 (1.05-1.34) in term children born small for gestational age and 1.47 (1.05-2.06) for preterm children born small for gestational age, compared with those born appropriate for gestational age. The risk of hospitalisation from 6 to 66 months of age in children born small for gestational age was observed for bronchitis/pneumonia. We observed the adverse effects of small for gestational age on hospitalisation during early childhood in both term and preterm births, particularly for bronchitis and pneumonia.

Mobile phone text messaging plus motivational interviewing versus usual care: study protocol for a randomized controlled trial to evaluate effects on breastfeeding, child health, and survival outcomes, among women living with HIV (MTI-MI)

BackgroundMany infants in low-resourced settings at high risk of infectious disease morbidity and death are deprived of the immunological and nutritional benefits of breast milk, through an attenuated duration of breast milk exposure. South Africa has one of the lowest exclusive breastfeeding rates in Africa, with 8% of infants under 6 months of age. We assume that breastfeeding is sustained among women living with HIV receiving weekly text messages and motivational interviewing and that this contributes to improved infant health outcomes.Objectives(1) To evaluate the effectiveness of a combined intervention of mobile phone text messaging and motivational interviewing in promoting (a) exclusive breastfeeding and (b) any form of breastfeeding, until 6 months of child age, compared to usual care, among mothers living with HIV. (2) To evaluate the effectiveness of a combined intervention on (a) reduction in all-cause hospitalization and mortality rates and (b) improvements in infant linear growth, compared to usual care, among HIV-exposed infants aged 0–6 months.MethodsWe are conducting a clinical trial to determine whether text messaging plus motivational interviewing prolongs breastfeeding and improves infant health outcomes. We are recruiting 275 women living with HIV and their HIV-exposed infants at birth and randomly assign study interventions for 6 months.Statistical methodsBreastfeeding rates are compared between the study groups using a standard proportion test and binomial regression. Survival endpoints are presented using Kaplan–Meier survival curves and compared between the study groups using the Cox proportional-hazards regression model. The count endpoint is analysed using the Poisson random-effects model and mean cumulative function. We use mixed linear regression models to assess the evolution of infant growth over time. The maximum likelihood method will be used to handle missing data.DiscussionThe study findings may facilitate decision-making on (1) whether implementation of the breastfeeding policy achieved the desired outcomes, (2) interventions needed to sustain breastfeeding, and (3) whether the interventions do have an impact on child health.Trial registrationClinicalTrials.gov NCT05063240. Pan African Clinical Trial Registry PACTR202110870407786. Oct. 1, 2021.

Predictors of milk cortisol in North American women.

Human milk content varies across mother-child dyads, environments, and populations. Among the hormones in milk is cortisol, a glucocorticoid; its impact on the breastfeeding child is unknown. Milk cortisol may constitute a signal to the child's developing physiology which can shape characteristics (e.g., growth, temperament) to prevailing environmental conditions. This exploratory study evaluated the maternal, breastfeeding, and infant characteristics associated with milk cortisol. We evaluated archived milk specimens for cortisol using enzyme immunoassay and employed an information-theoretic approach to assess associations between milk cortisol and participant characteristics with linear regression modeling. Because we employed secondary data, information for some variables likely to impact milk cortisol variation (e.g., time of day, socioeconomic status, maternal or infant body mass index, milk energy density) was unavailable. Participants were 48 lactating mothers from upstate New York, aged 21-40 years. Milk cortisol ranged from 0.098 to 1.007 μg/dL. Child age ranged from 1 to 26 months. In linear regression employing best fit modeling criteria, milk cortisol increased with child age (B: 0.069; p: .000; a 7.1% increase in milk cortisol for each month of child age), while child symptoms of illness (B: -0.398; p: .057; a 33% decrease) and consumption of complementary foods (B: -.525; p: .020; a 41% decrease) were associated with lower milk cortisol. We speculate that increasing milk cortisol with child age plays a role in signaling development (e.g., as increasing independence increases risk for injury and other negative health outcomes), independent of the maternal stressors we could capture.

The association between Staphylococcus aureus colonization on cheek skin at 2 months and subsequent atopic dermatitis in a prospective birth cohort.

Staphylococcus aureus may worsen already established atopic dermatitis (AD), but its primary role in the aetiopathogenesis and severity of AD is unclear. To compare the prevalence of S. aureus colonization in early infancy in children who developed AD during the first 2 years of life with children who did not. In this prospective birth cohort study, which included 450 infants, we analysed bacterial swabs collected from cheek skin at 0 and 2 months of age. The development of AD, and its severity, was diagnosed by a physician and monitored prospectively for 2 years. Information on parental atopy, filaggrin gene mutation status and use of antibiotics and emollients was included in the analyses. At birth, the occurrence of S. aureus colonization was similar in infants who developed subsequent AD and those who did not. At 2 months of age, S. aureus colonization was more common in children who later developed AD (adjusted hazard ratio 1.97, 95% confidence interval 1.21-3.19; P = 0.006). No association was found between S. aureus colonization and AD severity or age at onset. It remains unknown whether colonization with S. aureus may directly increase the risk of AD, or whether it should be considered as secondary to skin barrier impairment or a skewed immune activity, but according to our findings, S. aureus colonization is more commonly increased at 2 months of age in children who later developed AD.

What Are the Effects on Palate of Early Lip Surgery in Children With Cleft Lip and Palate? Cross-Sectional Evaluation From 5-Year-Old.

This study aimed to evaluate the postsurgical effects from 5 years on the palate after surgical repair of the lip at 3 or 9 months of age in children with cleft lip and palate. Eighty-four digitized dental impressions were divided into the following groups: group 1 (G1): lip surgery at 3 months of life; group 2 (G2): lip surgery at 9 months of life; group 3 (G3): without orofacial cleft. Five angular (C'IC, ICM, IC'M', CMM', and C'M'M) and 3 linear parameters (C-C', c-c', and M-M') were evaluated. Statistical analysis was applied with α=5%. Intraclass Correlation Coefficient was significantly smaller in G1 than in G3 ( P =0.005), while IC'M' was significantly smaller in G3 than in G1 ( P <0.001). C'M'M was significantly smaller in G1 than in G2 and G3 ( P <0.001). The distances C-C' and c-c' were significantly smaller in G1 than in G2 and G3 ( P <0.001). There was a statistically significant difference in both G1 and G2 ( P <0.001, in all) in the analysis of palatal symmetry. Linear regression analysis showed that the, 11.2% of outcomes determined by c-c' distance can be explained by the age of lip repair ( P =0.013). In conclusion, lip surgery at 3 months of life showed a tendency toward more restriction in 5-year postsurgery palate development. The age of cheiloplasty is one of the factors that can influence palatal development; however, other factors may be associated and should be studied.

Association between breastfeeding and prevalence of allergies among children in the Academy Teaching Charity Hospital, Sudan.

Background: The role of breastfeeding in the primary prevention of allergic diseases remains controversial, with hardly any reported studies from developing countries. Objective: To evaluate the association between breastfeeding and the presence of allergies. Specifically, we aimed to demonstrate the association between the exclusivity of breastfeeding and the prevalence of allergies, including asthma, eczema, allergic rhinitis, and food allergy. Secondly, to ascertain the impact of feeding cow milk as complimentary feeding on the prevalence of atopy. Finally, we intended to substantiate the association between maternal education and breastfeeding awareness. Materials and Methods: A cross-sectional study was conducted; 182 participants were enrolled. A confidential, anonymous questionnaire was administered to the participantsf mothers (those attending Academy Charity Teaching Hospital with children aged six months to 10 years). Crude associations between exclusive or non-exclusive breastfeeding and atopic diseases were evaluated using Chi-Square Test by computing crude odds ratios (OR) and corresponding 95% Confidence Interval (CI) with α level of 0.05. Multiple logistic regression models were used to estimate the effect of exclusive breastfeeding on allergic diseases. The sample was adjusted for confounding factors such as gender, family history, number of siblings, and paternal and/or maternal smoking habits. Results: Of the 182 participants included in this study, 95(52.2%) were not exclusively breastfed, and 87(47.8%) were exclusively breastfed. The prevalence of allergic diseases in the children who received non-exclusive breastfeeding compared with those with exclusive breastfeeding showed a significantly higher prevalence of atopy [OR =3.6 95%CI: 1.87-6.94] with a p-value <0.001, even more, significant when the sample was adjusted for family history [OR =4.59 95%CI: 1.96-10.75] with a p-value <0.001. Moreover, milk administration as a complementary feeding type was not significantly associated with the development of atopy [OR =1.65 95%CI: 0.87-3.14] with a p-value of 0.14. Conclusion: There is evidence that exclusive breastfeeding is protective against atopy. Mothers should breastfeed mainly for the first six months of child age and continue with partial breastfeeding beyond that age.

Sentence Diversity in Spanish-English Bilingual Toddlers.

There remain few available tools to assess language development in Spanish-English dual language learner (DLL) toddlers in the United States. Of interest is the development of early sentences as children move from producing single words to producing multiword utterances. This study is the first to extend sentence diversity to the context of Spanish-English DLLs by describing development from 24 to 30 months of age in children with and without language delays (LDs). Spontaneous language samples were collected from Spanish-dominant DLL children and their mothers as they were observed during a free-play interaction. Existing sentence diversity protocols were adapted for the DLL context to describe children's flexibility in combining subjects and verbs to form utterances in Spanish and English. Children maintained an accurate separation in their grammars for subject-verb combinations in Spanish versus English. There was an overwhelming preference for Spanish subject-verb combinations with null subjects. The emergence of sentence diversity distinguished children with and without early LD unlike the emergence of word combinations. Consistent with prior research, findings showed that DLLs did not confuse grammatical structures across languages. Instead, they showed a differential pattern of results in each language, such that the strongest grammatical skills were evinced first in the dominant language. Sentence diversity shows promise for assessment and progress monitoring in Spanish-English DLLs in the United States.

P744 Safety of live vaccines in children exposed to biological agents for inflammatory bowel disease (IBD) in utero or during breastfeeding

Abstract Background Biological drugs used for IBD are detected in breast milk at a concentration below 10% of the maternal serum concentration and have therefore been considered as permitted drugs. However, warnings have recently been published regarding vaccination with live agents in children whose mothers receive infliximab during breastfeeding. Aim To assess the risk of serious adverse events related to the administration of live vaccines in children exposed to biological drugs in utero or whose mothers were receiving biological agents during breastfeeding. Methods Children born to IBD mothers from DUMBO registry of GETECCU were included. DUMBO is a prospective, observational and multicentre registry, which enrolls pregnant women with IBD over 5 years in 70 centres in Spain. Data on treatment during gestation, type of lactation, breastfeeding, end-date of breastfeeding, maternal treatments during breastfeeding and serious adverse events in children from birth are being prospectively included contacting with the mothers every-3-months. Following the Spanish immunization calendar, rotavirus vaccine is (voluntarily) administered at 2, 4 and 6 (3rd dose only with Rotateq®) months; measles, mumps and rubella (MMR) at 12 months and 3-4 years of age; and varicella at 15 months and 3-4 years of age. Results 526 newborns were included in the registry at the time of data analysis. A total of 205 (39%) had been exposed to biologics during pregnancy or breastfeeding (table 1): 80 (42%) during pregnancy, 7 (2%) during breastfeeding, and 109 (57%) during both. Newborn’s demographics and exposure to drugs during breastfeeding are summarized in table 2. Mean follow-up was 12 months; proportion of children breastfed during follow-up is shown in table 3a. The percentage of children who had been vaccinated according to the recommended schedule was above 95% at all visits (table 3b). Live vaccines administered to children exposed in utero to biologics during the 3rd trimester of gestation are shown in table 4a. From birth, 71% of infants were breastfed (52% exclusively breastfed). Live vaccines administered to children breastfed at least until month 6, until month 12 and until month 15 are summarized in table 4b. No serious adverse event related to live vaccine was reported in our cohort. Conclusion Administration of live virus vaccines from 12 months of age in children born to IBD mothers and exposed to biological drugs in utero or during breastfeeding seems safe and should not be recommended against vaccination or breastfeeding. Rotavirus vaccine (under 6 months of age) appears to be equally safe in these children.

Pre-pragmatic language use in toddlerhood: Developmental antecedents, aetiological factors, and associations to autism.

Pragmatic language is key for adaptive communication, but often compromised in neurodevelopmental conditions such as autism spectrum disorder (ASD). Decontextualized language-to talk about events and things beyond here and now-develops early in childhood and can be seen as a pre-pragmatic ability. Little is known about the factors that contribute to decontextualized language use in toddlers and whether these are different from factors contributing to general language development. We studied longitudinal associations between parent-rated core language and non-verbal socio-communicative abilities at 14months of age, and decontextualized language use at 24months of age in children with typical and elevated likelihood of ASD (total N=303). Using twin modelling, we also investigated genetic and environmental contributions on decontextualized language and grammar use in two-year-old twin pairs (total N=374). Core language ability was a strong predictor of later decontextualized language use in both children with and without an elevated likelihood of ASD. In contrast, social communication was only a significant predictor of decontextualized language use for children with low levels of core language. This pattern was specific to decontextualized language, and not replicated in prediction of concurrent grammatical ability. Further, there was a large genetic influence on decontextualized language at 2years of age, which mostly overlapped with the genetic influences on grammatical ability. Shared environment influences were significant for grammatical ability, but not found on decontextualized language. In children with an elevated likelihood of ASD, decontextualized language use was negatively associated with autistic symptoms. This study suggests that decontextualized language is developmentally associated with, yet dissociable from, more general language development measured as grammatical ability. Already at 2years of age, parental ratings of decontextualized language is associated to clinician-rated symptoms of ASD.

National, longitudinal NASCITA birth cohort study: prevalence of overweight at 12 months of age in children born healthy

ObjectiveTo estimate the prevalence of overweight at 12 months in an Italian birth cohort and to identify factors related to an increased likelihood of being overweight.MethodsThe Italian NASCITA birth cohort...

Women’s preferences of mode of delivery in rural and urban communities- gharbia governorate, Egypt

Background: The birth process carries many risks for women during pregnancy, delivery, and the postpartum period. The delivery route choice is critical to the mother's and child's health. The increasing rate of CS worldwide is an alarming concern for public health and obstetricians. Objective: To identify the frequencies and the determinants for the preferences of mode of delivery in urban and rural communities. Methods: The study was a cross-sectional study carried out on 304 mothers attending vaccination sessions for the scheduled vaccines in the second and ninth months of child age at Said Primary Healthcare Center, and Shobar Primary Healthcare Unit in Al-Gharbia Governorate, Egypt. The data was collected by interviewing the mothers using a predesigned tested questionnaire. Results: Regarding the preferred mode of delivery, CS were preferred by 40.2% and 15% of females in urban and rural communities. However, 83.6% were delivered by CS at the last pregnancy. Immediate contact with the baby, immediate breastfeeding, better care for the baby and hand no scar were the most significant determinants for VD. Being easier than VD and safer for the baby were the most significant determinants for CS. Urban residence, age >25 and living in a separate home, primiparity, no abortion, and previous CS delivery were the most significant determinants of delivery mode. Conclusion: The frequency of CS was higher than VD. Urban residence, age group 25- and living in shared home were the most important determinants for CS.

Maternal anxiety and toddler depressive/anxiety behaviors: The direct and moderating role of children's focused attention

Attention mechanisms have a pertinent role in shaping developmental pathways to anxiety and depressive disorders. The current study examined the direct and interactive associations between maternal anxiety symptoms, children's focused attention, and children’s anxiety and depression behaviors in early toddlerhood. Participants were 150 mother-child dyads (50 % female) that were assessed at two time points. At 12 months of child age, mothers reported about their anxiety symptoms and children's focused attention. Children's focused attention was also observed and rated from an individual play task. At 18 months of age, mothers reported about children's anxiety and depression behaviors. Focused attention predicted child anxiety and depressive behaviors, with different patterns of associations between observed and reported measures of attention. There was also a significant interaction between maternal anxiety symptoms and observed children's focused attention. A positive association between maternal anxiety symptoms and child anxiety and depression symptoms was evident only for children with above-average levels of observed focused attention during play. Results suggest that different aspects of focused attention play a role in maternal reported anxiety and depression behaviors in early development and may modulate the intergenerational transmission of anxiety.

Developmental trajectories of toddler sleep problems: can a person-centered approach help identify children at risk?

Previous research examining toddler sleep problems has relied almost exclusively on variable-centered statistical approaches to analyze these data, which provide helpful information about the development of the average child. The current study examined whether person-centered trajectory analysis, a statistical technique that can identify subgroups of children who differ in their initial level and/or trajectory of sleep problems, has the potential to inform our understanding of toddler sleep problems and their development. Families (N = 185) were assessed at 12, 24, 30, and 36 months of child age. Latent class growth analysis was used to test for subgroups that differed in their 24-36 month sleep problems. Subgroups were compared on child 36-month externalizing, internalizing, and total problem behaviors, and on 12 month maternal mental health, inter-parental conflict, and maternal parenting behaviors. Results support a four-class solution, with "low, stable," "low, increasing," "high, increasing," and "high decreasing" classes. The classes whose sleep problems persisted or worsened over time had worse behavioral problems than those whose symptoms improved or remained stably low. Additionally, 12 month maternal depression and global symptom severity, intimate partner violence, and maternal harsh-intrusive parenting behaviors discriminated between the classes that had similar levels of 24 month sleep disturbance but who had diverging trajectories over time. This statistical approach appears to have the potential to increase understanding of sleep problem trajectories in the early years of life. Maternal mental health, intimate partner violence, and parenting behaviors may be clinically useful markers of risk for the persistence or development of toddler sleep problems.

The effect of azithromycin on structural lung disease in infants with cystic fibrosis (COMBAT CF): a phase 3, randomised, double-blind, placebo-controlled clinical trial

Structural lung disease and neutrophil-dominated airway inflammation is present from 3 months of age in children diagnosed with cystic fibrosis after newborn screening. We hypothesised that azithromycin, given three times weekly to infants with cystic fibrosis from diagnosis until age 36 months, would reduce the extent of structural lung disease as captured on chest CT scans. A phase three, randomised, double-blind, placebo-controlled trial was done at eight paediatric cystic fibrosis centres in Australia and New Zealand. Infants (aged 3-6 months) diagnosed with cystic fibrosis following newborn screening were eligible. Exclusion criteria included prolonged mechanical ventilation in the first 3 months of life, clinically significant medical disease or comorbidities other than cystic fibrosis, or macrolide hypersensitivity. Participants were randomly assigned (1:1) to receive either azithromycin (10 mg/kg bodyweight orally three times per week) or matched placebo until age 36 months. Randomisation was done with a permuted block strategy and an interactive web-based response system, stratified by study site. Unblinding was done once all participants completed the trial. The two primary outcomes were the proportion of children with radiologically defined bronchiectasis, and the percentage of total lung volume affected by disease. Secondary outcomes included clinical outcomes and exploratory outcomes were inflammatory markers. Analyses were done with the intention-to-treat principle. This study is registered at ClinicalTrials.gov (NCT01270074). Between June 15, 2012, and July 10, 2017, 281 patients were screened, of whom 130 were enrolled, randomly assigned, and received first study dose. 68 participants received azithromycin and 62 received placebo. At 36 months, 88% (n=50) of the azithromycin group and 94% (n=44) of the placebo group had bronchiectasis (odds ratio 0·49, 95% CI 0·12 to 2·00; p=0·32), and total airways disease did not differ between groups (median difference -0·02%, 95% CI -0·59 to 0·56; p=0·96). Secondary outcome results included fewer days in hospital for pulmonary exacerbations (mean difference -6·3, 95% CI -10·5 to -2·1; p=0·0037) and fewer courses of inhaled or oral antibiotics (incidence rate ratio 0·88, 95% CI 0·81 to 0·97; p=0·0088) for those in the azithromycin group. For the preplanned, exploratory analysis, concentrations of airway inflammation were lower for participants receiving azithromycin, including interleukin-8 (median difference -1·2 pg/mL, 95% CI -1·9 to -0·5; p=0·0012) and neutrophil elastase activity (-0·6 μg/mL, -1·1 to -0·2; p=0·0087) at age 36 months, although no difference was noted between the groups for interleukin-8 or neutrophil elastase activity at 12 months. There was no effect of azithromycin on body-mass index at age 36 months (mean difference 0·4, 95% CI -0·1 to 0·9; p=0·12), nor any evidence of pathogen emergence with the use of azithromycin. There were few adverse outcomes with no differences between the treatment groups. Azithromycin treatment from diagnosis of cystic fibrosis did not reduce the extent of structural lung disease at 36 months of age; however, it did reduce airway inflammation, morbidity including pulmonary exacerbations in the first year of life and hospitalisations, and improved some clinical outcomes associated with cystic fibrosis lung disease. Therefore we suggest thrice-weekly azithromycin is a strategy that could be considered for the routine early management of paediatric patients with cystic fibrosis. Cystic Fibrosis Foundation.

Maternal Android Adiposity and Vitamin D Status in Lactation Are Positive Predictors of Child Adiposity and Vitamin D Status at 2 Years of Age: A Follow-Up Study From Montréal

Abstract Objectives Recent evidence suggests that fetal exposure to both maternal excess adiposity and low maternal vitamin D status is associated with body composition of the children. The objective was to explore whether maternal android adiposity and maternal serum 25-hydroxyvitamin D (25(OH)D) during early lactation relate to child adiposity and vitamin D status at 2 years of age. Methods The present study is a follow-up of a sub-group who completed a double-blinded randomized parallel group-controlled trial of vitamin D supplementation (400 or 1000 IU/d) across infancy (NCT02563015). In this follow-up, 68 (49%) children (37 males, 31 females) returned at 24 months of age; the study was closed at the onset of the COVID-19 pandemic precluding follow-up in the remainder. Body composition (dual-energy X-ray absorptiometry) and serum 25(OH)D (immunoassay) were measured at baseline (0.2–1.5 mo postpartum) in mothers and at 24 months of age in children. Data were analyzed using a linear fixed effects model with covariates (sex, skin tone, child age, maternal 25(OH)D concentrations, parental age, and maternal android fat mass) followed by Tukey post hoc tests adjusted for multiple comparisons. Results At baseline, mothers were 31.6 (range: 19.9, 41.4) years with mean serum 25(OH)D 66.0 ± 25.3 nmol/L, percentage fat mass was 33.8 ± 5.4% and android fat mass 217.9 ± 79.7 g. In children at 24-months, mean serum 25(OH)D was above the cut-point for sufficiency of 50 nmol/L and not different between males and females (males: 82.0 ± 17.6 and females: 76.5 ± 14.0 nmol/L, P = 0.16). Postpartum maternal serum 25(OH)D was a positive predictor of children's 25(OH)D concentrations (β = 0.25 ± 0.08 nmol/L, P = 0.0031) at 24 months. Similarly, postpartum maternal android fat mass was a positive correlate of children's android fat mass (β = 0.03 ± 0.01 g, P = 0.0201). Maternal gynoid fat mass was not related to children's gynoid fat mass (P = 0.76). Overall, female children had higher android and gynoid fat mass compared to male counterparts (P = 0.0348). Conclusions Maternal android adiposity and maternal serum 25-hydroxyvitamin D are separate important modifiable correlates of children adiposity and vitamin D status at 2 years of age. These findings reinforce the importance of maternal programming of body composition and vitamin D status in children. Funding Sources The Canadian Institutes of Health Research.