National Institute Of Child Health Research Articles

Predicting Vibrio cholerae infection and symptomatic disease: a systems serology study.

Vibriocidal antibodies are currently the best characterised correlate of protection against cholera and are used to gauge immunogenicity in vaccine trials. Although other circulating antibody responses have been associated with a decreased risk of infection, the correlates of protection against cholera have not been comprehensively compared. We aimed to analyse antibody-mediated correlates of protection from both V cholerae infection and cholera-related diarrhoea. We conducted a systems serology study that analysed 58 serum antibody biomarkers as correlates of protection against V cholerae O1 infection or diarrhoea. We used serum samples from two cohorts: household contacts of people with confirmed cholera in Dhaka, Bangladesh, and cholera-naive volunteers who were recruited at three centres in the USA, vaccinated with a single dose of CVD 103-HgR live oral cholera vaccine, and then challenged with V cholerae O1 El Tor Inaba strain N16961. We measured antigen-specific immunoglobulin responses against antigens using a customised Luminex assay and used conditional random forest models to examine which baseline biomarkers were most important for classifying individuals who went on to develop infection versus those who remained uninfected or asymptomatic. V cholerae infection was defined as having a positive stool culture result on days 2-7 or day 30 after enrolment of the household's index cholera case and, in the vaccine challenge cohort, was the development of symptomatic diarrhoea (defined as two or more loose stools of ≥200 mL each, or a single loose stool of ≥300 mL over a 48-h period). In the household contact cohort (261 participants from 180 households), 20 (34%) of the 58 studied biomarkers were associated with protection against V cholerae infection. We identified serum antibody-dependent complement deposition targeting the O1 antigen as the most predictive correlate of protection from infection in the household contacts, whereas vibriocidal antibody titres ranked lower. A five-biomarker model predicted protection from V cholerae infection with a cross-validated area under the curve (cvAUC) of 79% (95% CI 73-85). This model also predicted protection against diarrhoea in unvaccinated volunteers challenged with V cholerae O1 after vaccination (n=67; area under the curve [AUC] 77%, 95% CI 64-90). Although a different five-biomarker model best predicted protection from the development of cholera diarrhoea in the challenged vaccinees (cvAUC 78%, 95% CI 66-91), this model did poorly at predicting protection against infection in the household contacts (AUC 60%, 52-67). Several biomarkers predict protection better than vibriocidal titres. A model based on protection against infection among household contacts was predictive of protection against both infection and diarrhoeal illness in challenged vaccinees, suggesting that models based on observed conditions in a cholera-endemic population might be more likely to identify broadly applicable correlates of protection than models trained on single experimental settings. National Institute of Allergy and Infectious Diseases and National Institute of Child Health and Human Development, National Institutes of Health.

PD18-11 IMPACT OF STATE IN-VITRO FERTILIZATION MANDATES ON MALE INFERTILITY CARE

You have accessJournal of UrologyCME1 Apr 2023PD18-11 IMPACT OF STATE IN-VITRO FERTILIZATION MANDATES ON MALE INFERTILITY CARE James Dupree, Rodney L. Dunn, Phyllis Yan, David Suh, Erica Marsh, Edward C. Norton, Vanessa Dalton, and Marissa S. Weiss James DupreeJames Dupree More articles by this author , Rodney L. DunnRodney L. Dunn More articles by this author , Phyllis YanPhyllis Yan More articles by this author , David SuhDavid Suh More articles by this author , Erica MarshErica Marsh More articles by this author , Edward C. NortonEdward C. Norton More articles by this author , Vanessa DaltonVanessa Dalton More articles by this author , and Marissa S. WeissMarissa S. Weiss More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003273.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: By 2019, 11 states had passed laws mandating insurance coverage for infertility care, including in-vitro fertilization (IVF). These mandates vary in their coverage for male infertility care, with five states (AR, HI, IL, MD, RI) mandating IVF coverage but not coverage for male infertility care. Our objective was to evaluate the use of IVF and three common male infertility procedures (varicocelectomy, testicular/epididymal biopsy, and vasectomy reversal) in three groups of states: 1) states mandating IVF coverage and male infertility care, 2) states mandating IVF coverage but not male infertility care, and 3) states without IVF mandates. METHODS: We obtained nationwide insurance claims from over 80 million individuals from 2003 to 2019 from Optum® ClinformaticsTM Data Mart. We identified IVF cycles using the Current Procedural Terminology (CPT) code for oocyte retrieval and excluded oocyte retrievals performed for fertility preservation. We identified varicocelectomy, testicular/epididymal biopsy, and vasectomy reversal using their respective CPT codes. States were categorized into three groups: 1) states mandating IVF coverage and male infertility care (CT, MA, NJ, NY, DE 2018-19, UT 2018-19); 2) states mandating IVF coverage but not male infertility care (AR, HI, IL, MD, RI); and 3) all remaining states, including both DE and UT from 2003-2017. Within each group of states, we calculated the use rates and 95% confidence intervals (CIs) of IVF cycles per 100,000 women aged 21-44 and of varicocelectomy, testicular/epididymal biopsy, and vasectomy reversal per 100,000 men. RESULTS: IVF use was highest in Group 1 states and lowest in Group 3 states (Table 1). Varicocelectomy and testicular/epididymal biopsy use was 43% to 89% higher in Group 1 states than in Group 2 and 3 states. Use of vasectomy reversal—a procedure not typically covered by insurance regardless of state mandates—was only 14% higher in Group 1 states than in Group 3 states. The overall use of male infertility procedures was similar in Group 2 and 3 states. CONCLUSIONS: There is decreased use of male infertility procedures in states whose IVF mandates do not include coverage for male infertility care. Policymakers considering new state mandates for IVF should include coverage for male infertility care to facilitate access to effective male infertility treatments. Source of Funding: Eunice Kennedy Shriver National Institute of Child Health & Human Development - 1R01HD103603-01A1 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e507 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information James Dupree More articles by this author Rodney L. Dunn More articles by this author Phyllis Yan More articles by this author David Suh More articles by this author Erica Marsh More articles by this author Edward C. Norton More articles by this author Vanessa Dalton More articles by this author Marissa S. Weiss More articles by this author Expand All Advertisement PDF downloadLoading ...

Editorial introductions.

Current Opinion in Obstetrics and Gynecology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of obstetrics and gynecology is divided into ten sections that are reviewed once a year. Each section is assigned one or more Section Editors. They are the leading authorities in their area, who identify the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Deirdre LyellDeirdre LyellDr Lyell is a Professor of Obstetrics and Gynecology in the Division of Maternal-Fetal Medicine at Stanford University, USA, where she serves as the Associate Division Director, Director of the Program in Placental Disorders, and Program Director of the Maternal-Fetal Medicine Fellowship. Dr Lyell is a member of the Child Health Research Institute at Stanford, the March of Dimes Prematurity Research Center at Stanford, and conducts research in clinical obstetrics. From 2013–2016 she served as an alternate P.I. to the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Maternal-Fetal Medicine Unit (MFMU) Network, USA. In 2010 she formed the Program in Placental Disorders at Stanford, a multidisciplinary patient care and research program for women with placenta accreta and cofounded a Placenta Accreta Special Interest Group that meets annually at the Society for Maternal-Fetal Medicine meeting. Dr Lyell earned a Bachelors of Arts and Sciences in History and Biology from Stanford University and a Medical Degree from the George Washington University School of Medicine, USA. She completed residency training in Obstetrics and Gynecology at Brigham and Women's and Massachusetts General Hospitals, USA, and fellowship in maternal-fetal medicine at Stanford University. She is certified by the American Board of Obstetrics and Gynecology in obstetrics and gynecology and maternal-fetal medicine. Mark BoddyMark BoddyDr Mark Boddy received his bachelor's degree from Georgia State University, USA. He received his medical degree from the Medical College of Georgia prior to completing a residency in obstetrics and gynecology at Atlanta Medical Center, USA. He subsequently completed a fellowship in maternal fetal medicine at The George Washington University School of Medicine, USA. He practiced for 17 years in a hospital-based setting while also serving as a Regional Perinatal Director for the State of Georgia. Currently, Dr Boddy is an Associate Clinical Professor at Stanford University School of Medicine, USA and the Medical Director of the Stanford Children's Healthcare Perinatal Diagnostic Center in Salinas, California, USA. His interests include prenatal diagnosis, improving quality of care and patient safety. Martha RodeMartha RodeDr Martha Rode received her bachelor's degree in biology at Harvard University, USA, before attending medical school at the University of California, Los Angeles, USA. She then completed residency and a maternal-fetal medicine fellowship at the University of Pennsylvania in Philadelphia, USA. She has since worked in both academic and hospital-based practices on both the East Coast and Northern California Bay Area in USA. She is currently a Clinical Associate Professor at Stanford Medical School, USA, serving as the Medical Director of the Perinatal Diagnostic Center in Santa Cruz. Her interests include perinatal diagnosis and high-risk obstetrics as well as community physician outreach and continued education. Jane ChuehJane ChuehDr Jane Chueh received her bachelor's degrees in biology and humanities at Stanford University, USA. She attended medical school at University of California San Diego, USA and completed her residency at University of Washington, USA and her fellowships in maternal fetal medicine and clinical genetics at University of California San Francisco, USA. She has worked in both academic and hospital-based practices in the Northern California Bay Area. Currently she is a Clinical Professor at Stanford Medical School, serving as the Director of Prenatal Diagnosis and Therapy at Stanford Children's Health. She enjoys practicing prenatal diagnosis and high-risk obstetrics, collaborating in research projects related to ultrasound and simulation teaching, and mentoring Stanford undergraduates and medical students. Amy VoedischAmy VoedischAmy J Voedisch, MD, MSc, NCMP is a Clinical Associate Professor in the Division of Family Planning, in the Department of Obstetrics and Gynecology at Stanford University, USA. Dr Voedisch attended the Mayo Medical School in Rochester, Minnesota, USA, and completed her OB-GYN residency at Kaiser Permanente Santa Clara, USA. She then went on to a fellowship in family planning at Stanford University, becoming an expert in reproductive health services, with a focus on increasing access to contraception in underserved international areas. She also earned her master's degree in clinical sciences research during her fellowship. Dr Voedisch is an expert in perimenopause and menopause and is a North American Menopause Society Certified Menopause Practitioner (NCMP).

Multimedia tablet or paper handout to supplement counseling during preterm birth hospitalization.

Parents of premature infants engage in shared decision-making regarding the care of their infant. The process of prenatal counseling typically involves a verbal conversation with a neonatal provider during hospitalization. Support people may not be available, and the pregnant person's memory is impaired by medications, pain, and stress. The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development have called for improvements to this process, including the development of educational aids. This study aimed to investigate whether a multimedia tablet would be more effective than a paper handout in supplementing verbal clinician counseling during preterm birth hospitalization. This was a randomized controlled trial including English-speaking pregnant people aged ≥18 years and hospitalized at 22 to 33 weeks' gestation for preterm birth. Exclusion criteria were known fetal or chromosomal anomaly and delivery before study completion. Pregnant people received either a multimedia tablet or a paper handout before verbal clinician counseling. Preintervention assessment included demographics and State-Trait Anxiety Inventory, and postintervention assessment included the Parent Knowledge of Premature Birth Questionnaire and State-Trait Anxiety Inventory. Continuous variables were analyzed by t-test and categorical variables by Fisher exact test. A total of 122 pregnant people referred for counseling were screened; 76 were randomized, and 59 completed the study. Demographics were similar between groups, except that pregnant people in the handout group were older (mean 32 vs 29 years; P=.03). The multimedia tablet group (n=32) was less likely to report reviewing all the educational material than the paper handout group (n=27) (41% vs 72%; P=.037). Both groups correctly answered a similar number of knowledge items (P=.088). Postintervention state anxiety decreased in both groups (P<.0001), with no difference between groups. Computerized tracking showed that the multimedia group spent a median of 37 minutes reviewing the tablet. Contrary to our hypothesis, a paper handout and multimedia tablet were equally effective in the labor unit for supplementing verbal preterm birth counseling, and both decreased parental anxiety.

Clinical Presentation, Complications and Outcome of Measles in Pediatric Population at Tertiary Care Hospital

Measles is highly contagious infection with person-to-person transmission through droplet infection in developing countries, which can lead to death in complicated cases. Bronchopneumonia, encephalitis, gastroenteritis with renal failure and electrolyte imbalance are common complications in pediatric age group. Objective: To determine complications of measles in hospitalized children at Tertiary Care Children Hospital. Methods: This cross-sectional study conducted at inpatient medical wards of National Institute of Child Health from July-Dec 2022. All patients hospitalized in study duration with the diagnosis of measles from 6 months till 12 years of age were enrolled. History, examination, laboratory tests, treatment and outcome were recorded and analyzed. Results: Children enrolled were 185, the mean age ± SD of presentation was 26.7 ± 27.1 months, with 56.8% males. Mean weight of patients was 10.48 ± 9.7kg. Common measles complications were bronchopneumonia 160(86.5%), acute diarrhea 64(34.6%) encephalitis 24(13%), myocarditis 16(8.6%), acute kidney injury 11(5.9%), and otitis media 18(9.7%). Conclusions: Most common clinical features were fever, maculopapular rash, cough and coryza. Bronchopneumonia was the main reason of hospitalization in majority of patients and leading cause of death in 13.5% of patients along with encephalitis and myocarditis. Additional strategies are required by government for elimination of vaccine preventable measles from Pakistan.

Frequency of Common Risk Factors of Pneumonia in Children Aged 2-59 Months: A Cross-Sectional Study

Aim:-To determine the frequency of common risk factors of pneumonia in children aged 2-59 months visiting tertiary care hospital Study design: A cross-sectional study Place and Duration: National Institute of Child Health (NICH) Karachi from February to July 2018 Methodology: A total of 157children with complaints of fever 102F (or 39C), cough and tachypnea (≥50br/min from 2 to 11 months of age and ≥40br/min from 12 to 59 months of age) of less than two weeks duration were included in this study. Data was collected from both out-patient and indoor departments with patients fulfilling inclusion criteria after taking informed consent from their mother and risk factors were evaluated as mentioned in proforma. Results: Inappropriate immunization, Lack of breastfeeding, Malnutrition and upper respiratory tract infection in the mother were the commonest risk factors associated with pneumonia comprising 77.7%, 73.9%, 64.3% and 15.3% respectively. Conclusion: Our data suggest that non-breastfeeding or lack of breastfeeding during the neonatal period, inappropriate immunization, malnutrition, and upper respiratory tract infection in the mother may substantially increase the incidence and duration of pneumonia in children. Keywords: Pneumonia, Immunization, Respiratory tract infection, Lack of breastfeeding, Malnutrition

A comparison of criteria for defining metabolic acidemia in live-born neonates and its effect on predicting serious adverse neonatal outcomes

Metabolic acidemia is a known risk factor for serious adverse neonatal outcomes in both preterm and term infants. This study aimed to evaluate the clinical significance of delivery umbilical cord gas measurements with regard to serious adverse neonatal outcomes, and to determine if distinct thresholds for defining metabolic acidemia differ in their ability to predict such adverse neonatal complications. This is a retrospective cohort study of singleton live-born deliveries between January 2011 and December 2019. Stratification according to gestational age at birth (≥35 and <35 weeks of gestation) was performed, and comparisons of maternal characteristics, obstetrical complications, intrapartum events, and adverse neonatal outcomes were made between neonates with metabolic acidemia and those without. Metabolic acidemia (based on delivery umbilical cord gas analyses) was defined using both American College of Obstetricians and Gynecologists and Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria. The primary outcome of interest was hypoxic-ischemic encephalopathy requiring whole-body hypothermia. A total of 91,694 neonates born at ≥35 weeks of gestation met the inclusion criteria. By American College of Obstetricians and Gynecologists criteria, 2659 (2.9%) infants had metabolic acidemia. Neonates with metabolic acidemia were at markedly increased risk for neonatal intensive care unit admission, seizures, need for respiratory support, sepsis, and neonatal death. Metabolic acidemia by American College of Obstetricians and Gynecologists criteria was associated with an almost 100-fold increased risk of hypoxic-ischemic encephalopathy requiring whole-body hypothermia (relative risk, 92.69; 95% confidence interval, 64.42-133.35) in neonates born at ≥35 weeks of gestation. Diabetes mellitus, hypertensive disorders of pregnancy, postterm deliveries, prolonged second stages, chorioamnionitis, operative vaginal deliveries, placental abruption and cesarean deliveries were associated with metabolic acidemia in neonates born ≥ 35 weeks of gestation. The highest relative risk was in those diagnosed with placental abruption (relative risk, 9.07; 95% confidence interval, 7.25-11.36). The neonatal cohort born <35 weeks of gestation had similar findings. When comparing those infants born ≥ 35 weeks of gestation with metabolic acidemia by American College of Obstetricians and Gynecologists criteria vs Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria, the Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria identified more neonates at risk for serious adverse neonatal outcomes. In particular, 4.9% more neonates were diagnosed with metabolic acidemia, and 16 more term neonates were identified as requiring whole-body hypothermia. Mean 1-minute and 5-minute Apgar scores were similar and reassuring among neonates born at ≥35 weeks of gestation with and without metabolic acidemia as defined by both American College of Obstetricians and Gynecologists and Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria (8 vs 8 and 9 vs 9, respectively; P<.001). Sensitivity and specificity were 86.7% and 92.2%, respectively, with the Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria, and 74.2% and 97.2% with the American College of Obstetricians and Gynecologists criteria. Infants with metabolic acidemia identified on cord gas collection at delivery are at considerably greater risk of serious adverse neonatal outcomes, including an almost 100-fold increased risk of hypoxic-ischemic encephalopathy requiring whole-body hypothermia. Use of the more sensitive Eunice Kennedy Shriver National Institute of Child Health and Human Development criteria for defining metabolic acidemia identifies more neonates born at ≥35 weeks of gestation at risk for adverse neonatal outcomes, including hypoxic-ischemic encephalopathy requiring whole-body hypothermia.

Effect of pregnancy versus postpartum maternal isoniazid preventive therapy on infant growth in HIV-exposed uninfected infants: a post-hoc analysis of the TB APPRISE trial

Isoniazid preventive therapy (IPT) initiation during pregnancy was associated with increased incidence of adverse pregnancy outcomes in the TB APPRISE trial. Effects of in utero IPT exposure on infant growth are unknown. This post-hoc analysis used data from the TB APPRISE trial, a multicentre, double-blind, placebo-controlled trial, which randomised women to 28-week IPT starting in pregnancy (pregnancy-IPT) or postpartum week 12 (postpartum-IPT) in eight countries with high tuberculosis prevalence. Participants were enrolled between August 2014 and April 2016. Based on modified intent-to-treat analyses, we analysed only live-born babies who had at least one follow-up after birth and compared time to infant growth faltering between arms to 12 weeks and 48 weeks postpartum in overall and sex-stratified multivariable Cox proportional hazards regression. Factors adjusted in the final models include sex of infant, mother's baseline BMI, age in years, ART regimen, viral load, CD4 count, education, and household food insecurity. Among 898 HIV-exposed uninfected (HEU) infants, 447 (49.8%) were females. Infants in pregnancy-IPT had a 1.47-fold higher risk of becoming underweight by 12 weeks (aHR 1.47 [95% CI: 1.06, 2.03]) than infants in the postpartum-IPT; increased risk persisted to 48 weeks postpartum (aHR 1.34 [95% CI: 1.01, 1.78]). Maternal IPT timing was not associated with stunting or wasting. In sex-stratified analyses, male infants in the pregnancy-IPT arm experienced an increased risk of low birth weight (LBW) (aRR 2.04 [95% CI: 1.16, 3.68), preterm birth (aRR 1.81 [95% CI: 1.04, 3.21]) and becoming underweight by 12 weeks (aHR 2.02 [95% CI: 1.29, 3.18]) and 48 weeks (aHR 1.82 [95% CI: 1.23, 2.69]). Maternal IPT timing did not influence growth in female infants. Maternal IPT during pregnancy was associated with an increased risk of LBW, preterm birth, and becoming underweight among HEU infants, particularly male infants. These data add to prior TB APPRISE data, suggesting that IPT during pregnancy impacts infant growth, which could inform management, and warrants further examination of mechanisms. The TB APPRISE study Supported by the National Institutes of Health (NIH) (award numbers, UM1AI068632 [IMPAACT LOC], UM1AI068616 [IMPAACT SDMC], and UM1AI106716 [IMPAACT LC]) through the National Institute of Allergy and Infectious Diseases, with cofunding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (contract number, HHSN275201800001I) and the National Institute of Mental Health.

The REDUCED trial: a cluster randomized trial for REDucing the Utilization of CEsarean delivery for Dystocia

To reduce cesarean delivery rates in nulliparous women, guidelines for diagnosing nonprogressive labor have been developed by the National Institute of Child Health and Human Development, the American College of Obstetricians and Gynecologists, and the Society for Maternal-Fetal Medicine. These are mainly based on data from the Consortium for Safe Labor study. The guidelines have not been tested in a clinical trial, so the efficacy and safety of this new approach is uncertain. This study aimed to assess whether adoption of new guidelines for diagnosing nonprogressing labor would reduce cesarean delivery rates. We conducted a cluster randomized controlled trial of a knowledge translation program of the guidelines in 26 Canadian hospitals (13 control sites and 13 intervention sites). The sites included all intrapartum care sites in Alberta that perform cesarean delivery and deliver at least 70 nulliparous women annually. The baseline period started on January 1, 2015. The intervention was initiated at the first intervention site in January 2017. The follow-up period began at the first intervention site in February 2017 and lasted till February 2020. The primary outcome was the rate of cesarean delivery in nulliparous women with vertex presentation in labor at term. The secondary outcomes included spontaneous vaginal birth and maternal and neonatal safety. The main data source for the primary and secondary outcomes was the Alberta Perinatal Health Program database. The cesarean delivery rates were assessed using repeated measures mixed effects logistic regression applied to individual births. The analysis was based on 45,193 deliveries at intervention sites and 43,725 deliveries at control sites. There was no evidence of a decrease in the rate of cesarean delivery in association with the intervention (baseline-adjusted odds ratio, 0.94; 95% confidence interval [0.85-1.05]; P=.259). The rate of spontaneous vaginal delivery increased slightly (baseline-adjusted odds ratio, 1.10; 95% confidence interval, [1.01-1.18]; P=.024). We did not observe any differences in adverse maternal or neonatal outcomes. Cesarean delivery rates in nulliparous women were not reduced by the application of recent guidelines for the diagnosis of nonprogressive labor. Spontaneous vaginal delivery-a secondary outcome-was increased in the intervention group. The intervention appears to be safe.

Exhaled Volatile Organic Compounds for Early Prediction of Bronchopulmonary Dysplasia in Infants Born Preterm

To investigate the predictive performances of exhaled breath volatile organic compounds (VOCs) for development of bronchopulmonary dysplasia (BPD) in infants born preterm. Exhaled breath was collected from infants born <30 weeks' gestation at days 3 and 7 of life. Ion-fragments detected by gas-Chromatography-mass-spectrometry analysis were used to derive and internally validate a VOC prediction model for moderate or severe BPD at 36 weeks postmenstrual age. We tested the predictive performance of the National Institute of Child Health and Human Development (NICHD) clinical BPD prediction model with and without VOCs. Breath samples were collected from 117 infants (mean gestation 26.8 [±1.5] weeks). Thirty-three percent of the infants developed moderate or severe BPD. The VOC model showed a c-statistic of 0.89 (95% confidence interval [CI] 0.80-0.97) and 0.92 (95% CI 0.84-0.99)) for the prediction of BPD at days 3 and 7, respectively. Adding the VOCs to the clinical prediction model in non-invasive supported infants resulted in significant improvement in discriminative power on both days (day 3: c-statistic 0.83 versus 0.92, p-value 0.04; day 7: c-statistic 0.82 versus 0.94, p-value 0.03). This study showed that VOC profiles in exhaled breath of preterm infants on non-invasive support in the first week of life differ between those developing and not developing BPD. Adding VOCs to a clinical prediction model significantly improved its discriminative performance.

Thirty-year follow-up of the NICHD Study of Early Child Care and Youth Development (SECCYD): the challenges and triumphs of conducting in-person research at a distance

PurposeThe purpose of the current study, The National Institute of Child Health and Human Development (NICHD) Study of Health in Early and Adult Life (SHINE), was to build on the...

The mechanisms of influence in intergenerational trauma transmission from mother to baby after the war in Bosnia-Herzegovina: what have we learned since then?

IntroductionAfter the war in Bosnia-Herzegovina that lasted from 1992 to 1995, the populations gradually rebuilt their lives haunted by the spectrum of personal and collective painful souvenirs. Regarding the children who were born after the war, some mothers would rather not talk about it to protect their children from what they might be feeling while others would definetely share what they have experienced to protect their children. Because the intergenerational transmission of war trauma from mother to baby has been poorly explored among populations who recently lived in a warzone, we seeked to highlight the particularity of the interpersonal relations between the mother and her child in connection with maternal psychotrauma, by searching the factors of influence on the functioning of the dyad.ObjectivesThe main objective of this study is to determine and conceptualize the modes of transmission of trauma from the study of mother-baby interactions in a Bosnian environment, after the war in Bosnia-Herzegovina.MethodsIn 2003, 40 mothers and their babies aged 2 to 36 months living in Sarajevo were enrolled in the study. Among these mothers, 31 lived in or near the warzone and 9 were either displaced in other areas of the country or were refugees in foreign countries. We assessed the level of severity of post-traumatic stress disorder (PTSD) using the Clinician Administered PTSD Scale (Blake et al, 1998). In order to examine the quality of the mother-child dyads of mothers who lived through the war, we videorecorded a 10-minute free play of 23 dyads in their home environment. Then the interactions were coded using the National Institute of Child Health and Human Development observation grid by two independent raters.ResultsThe results showed that all mothers who lived through the war presented post-traumatic symptoms but only half of them showed a PTSD. Videotaped observations of mother-child interactions during playtimes revealed that their interactions are less linked to the mother’s PTSD than to the influence of PTSD on maternal attitudes and thereby extending to those of their infant. They are less sensitive to their children’s signals. They are also more intrusive and detached. Overall, they are more focused on themselves than on their child when they are interacting. As a result, their children are more focused on play and less actively engaged in communicating with their mothers.ConclusionsThe interactions between the mother and her child cover a set of relatively complex processes during which the two partners influence each other. When a mother lives through the war, she will pass on to her child an often painful life story. And thus, it is not only the content but also the way she transmits it that influences how the child receives the objects of the transmission.Disclosure of InterestNone Declared

Association between Diabetes in Pregnancy and Shoulder Dystocia by Infant Birth Weight in an Era of Cesarean Delivery for Suspected Macrosomia.

We estimated the association between diabetes and shoulder dystocia by infant birth weight subgroups (<4,000, 4,000-4,500, and >4,500 g) in an era of prophylactic cesarean delivery for suspected macrosomia. A secondary analysis from the National Institute of Child Health and Human Development U.S. Consortium for Safe Labor of deliveries at ≥24 weeks with a nonanomalous, singleton fetus with vertex presentation undergoing a trial of labor. The exposure was either pregestational or gestational diabetes compared with no diabetes. The primary outcome was shoulder dystocia and secondarily, birth trauma with a shoulder dystocia. We calculated adjusted risk ratios (aRRs) with modified Poison's regression between diabetes and shoulder dystocia and the number needed to treat (NNT) to prevent a shoulder dystocia with cesarean delivery. Among 167,589 assessed deliveries (6% with diabetes), pregnant individuals with diabetes had a higher risk of shoulder dystocia at birth weight <4,000 g (aRR: 1.95; 95% confidence interval [CI]: 1.66-2.31) and 4,000 to 4,500 g (aRR: 1.57; 95% CI: 1.24-1.99), albeit not significantly at birth weight >4,500 g (aRR: 1.26; 95% CI: 0.87-1.82) versus those without diabetes. The risk of birth trauma with shoulder dystocia was higher with diabetes (aRR: 2.29; 95% CI: 1.54-3.45). The NNT to prevent a shoulder dystocia with diabetes was 11 and 6 at ≥4,000 and >4,500 g, versus without diabetes, 17 and 8 at ≥4,000 and >4,500 g, respectively. Diabetes increased the risk of shoulder dystocia, even at lower birth weight thresholds than at which cesarean delivery is currently offered. Guidelines providing the option of cesarean delivery for suspected macrosomia may have decreased the risk of shoulder dystocia at higher birth weights. · >Diabetes increased the risk of shoulder dystocia, even at lower birth weight thresholds than at which cesarean delivery is currently offered.. · Cesarean delivery for suspected macrosomia may have decreased the risk of shoulder dystocia at higher birth weights.. · These findings can inform delivery planning for providers and pregnant individuals with diabetes..

Long-term neurodevelopmental follow-up of children exposed to pravastatin in utero

Preeclampsia, especially before term, increases the risk of child neurodevelopmental adverse outcomes. Biological plausibility, preclinical studies, and pilot clinical trials conducted by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Obstetric-Fetal Pharmacology Research Centers Network support the safety and use of pravastatin to prevent preeclampsia. This study aimed to determine the effect of antenatal pravastatin treatment in high-risk pregnant individuals on their child's health, growth, and neurodevelopment. This was an ancillary follow-up cohort study of children born to mothers who participated in the Obstetric-Fetal Pharmacology Research Centers Network pilot trials of pravastatin vs placebo in individuals at high risk of preeclampsia (ClinicalTrials.gov; identifier NCT01717586). After obtaining written informed consent (and assent as appropriate), the parent was instructed to complete the Child Behavior Checklist. To assess the child's motor, cognitive, and developmental outcomes, a certified and blinded study psychologist completed child motor, cognitive, emotional, and behavioral assessments using validated tools. Given the small number of individuals in the studies, the 10- and 20-mg pravastatin groups were combined into 1 group, and the results of the pravastatin group were compared with that of the placebo group. Of 40 children born to mothers in the original trial, 30 (15 exposed in utero to pravastatin and 15 to placebo) were enrolled in this follow-up study. The time of follow-up, which was 4.7 years (interquartile range, 2.5-6.9), was not different between children in the pravastatin group and children in the placebo group. There was no difference in the child's body mass index percentiles per sex and corrected age, the rates of extremes of body mass index percentiles, or the report of any other medical or developmental complications between the 2 groups. No child born in the pravastatin group had any limitation in motor assessment compared with 2 children (13.3%) who walked with difficulty and 4 children (26.7%) who had reduced manual abilities in the placebo group. Moreover, children born to mothers who received pravastatin had a higher general mean conceptual ability score (98.2±16.7 vs 89.7±11.0; P=.13) and a lower frequency (15.4% vs 35.7%; P=.38) of having a score of <85 (ie, 1 standard deviation lower than the mean) compared with those in the placebo group. Finally, there was no difference in the parents' report on the Child Behavior Checklist between the 2 groups. This study reported on the long-term neuromotor, cognitive, and behavioral outcomes among children exposed to pravastatin in utero during the second and third trimesters of pregnancy. Although the data were limited by the original trial's sample size, no identifiable long-term neurodevelopmental safety signal was evident with the use of pravastatin during pregnancy. This favorable neonatal risk-benefit analysis justifies continued research using pravastatin in clinical trials.

Growth Characteristics in Children with Congenital Adrenal Hyperplasia Visiting Tertiary Care Hospital, Karachi

Objective: To determine the growth characteristics in children with congenital adrenal hyperplasia visiting tertiary care hospital Karachi.&#x0D; Study Design: Cross-Sectional study.&#x0D; Place and Duration of Study: Paediatrics Department, National Institute of Child Health, Karachi Pakistan, from Nov 2018 to May 2019.&#x0D; Methodology: All patients who visited the OPD were included in the study. Growth characteristics like underweight, normal BMI, overweight, obese and short stature were recorded. This information, along with the age of diagnosis, family history of CAH, parental consanguinity, family history of CAH or any abortion or prenatal death, were noted.&#x0D; Results: The mean age of the patients was 7.40±2.34 years. Out of 69 congenital adrenal hyperplasia patients, 41(59.4%) were males, and 28(40.6%) were females. The short suture was noted in 53(76.8%) patients. 19(27.5%) were underweight, 6(8.7%) were normal weight, 10(14.5%) were overweight, and 34(49.3%) patients w ere obese.&#x0D; Conclusion: A significant effect of congenital adrenal hyperplasia was documented in the children.

Association of newer definitions ofbronchopulmonary dysplasia with pulmonary hypertension and long-term outcomes.

The definition of bronchopulmonary dysplasia (BPD) has been evolved recently from definition by the National Institute of Child Health and Human Development in 2001 (NICHD 2001) to the definition reported in 2018 (NICHD 2018) and that proposed by Jensen et al. in 2019 (NICHD 2019). The definition was developed based on the evolution of non-invasive respiratory support and to achieve better prediction of later outcomes. Our objective was to evaluate the association between different definitions of BPD and occurrence of pulmonary hypertension (PHN) and long term outcomes. This retrospective study enrolled preterm infants born at < 32 weeks of gestation between 2014 and 2018. The association between re-hospitalization owing to a respiratory illness until a corrected age (CA) of 24 months, neurodevelopmental impairment (NDI) at a CA of 18-24 months, and PHN at a postmenstrual age (PMA) of 36 weeks was evaluated, with the severity of BPD defined based on these three definitions. Among 354 infants, the gestational age and birth weight were the lowest in severe BPD based on the NICHD 2019 definition. In total, 14.1% of the study population experienced NDI and 19.0% were re-hospitalized owing to a respiratory illness. At a PMA of 36 weeks, PHN was identified in 9.2% of infants with any BPD. Multiple logistic regression analysis showed that the adjusted odds ratio (OR) for re-hospitalization was the highest for Grade 3 BPD of the NICHD 2019 criteria (5.72, 95% confidence interval [CI]: 1.37-23.92), while the adjusted OR of Grade 3 BPD was 4.96 (95% CI: 1.73-14.23) in the NICHD 2018 definition. Moreover, no association of the severity of BPD was found in the NICHD 2001 definition. The adjusted ORs for NDI (12.09, 95% CI: 2.52-58.05) and PHN (40.37, 95% CI: 5.15-316.34) were also the highest for Grade 3 of the NICHD 2019 criteria. Based on recently suggested criteria by the NICHD in 2019, BPD severity is associated with long-term outcomes and PHN at a PMA of 36 weeks in preterm infants.

Cost-effectiveness of low-dose aspirin for the prevention of preterm birth: a prospective study of the Global Network for Women's and Children's Health Research

Premature birth is associated with an increased risk of mortality and morbidity, and strategies to prevent preterm birth are few in number and resource intensive. In 2020, the ASPIRIN trial showed the efficacy of low-dose aspirin (LDA) in nulliparous, singleton pregnancies for the prevention of preterm birth. We sought to investigate the cost-effectiveness of this therapy in low-income and middle-income countries. In this post-hoc, prospective, cost-effectiveness study, we constructed a probabilistic decision tree model to compare the benefits and costs of LDA treatment compared with standard care using primary data and published results from the ASPIRIN trial. In this analysis from a health-care sector perspective, we considered the costs and effects of LDA treatment, pregnancy outcomes, and neonatal health-care use. We did sensitivity analyses to understand the effect of the price of the LDA regimen, and the effectiveness of LDA in reducing both preterm birth and perinatal death. In model simulations, LDA was associated with 141 averted preterm births, 74 averted perinatal deaths, and 31 averted hospitalisations per 10 000 pregnancies. The reduction in hospitalisation resulted in a cost of US$248 per averted preterm birth, $471 per averted perinatal death, and $15·95 per disability-adjusted life year. LDA treatment in nulliparous, singleton pregnancies is a low-cost, effective treatment to reduce preterm birth and perinatal death. The low cost per disability-adjusted life year averted strengthens the evidence in support of prioritising the implementation of LDA in publicly funded health care in low-income and middle-income countries. Eunice Kennedy Shriver National Institute of Child Health and Human Development.

Comparison of Four Intrapartum Cardiotocography Classifications for Predicting Neonatal Acidemia at Birth.

To compare diagnostic values of four intrapartum cardiotocography (CTG) classifications in predicting neonatal acidemia at birth. Retrospective case-control study. Forty-three CTG traces with an umbilical artery pH < 7.00 (study group) and 43 traces with a pH ≥ 7.00 (control group) were analyzed. Inclusion criteria were singleton pregnancy, cephalic presentation, admission to labour ward during active phase of first stage of labour, and gestational age 37+0 to 41+6 weeks. Exclusion criteria were suspected intrauterine growth restriction, oligohydramnios, polyhydramnios, pregestational or gestational insulin-dependent diabetes mellitus, and preeclampsia. Last 30-60 minutes before delivery of CTG traces was classified retrospectively according to four classification systems-International Federation of Gynecology and Obstetrics (FIGO), Royal College of Obstetricians and Gynaecologists (RCOG), National Institute of Child Health and Human Development (NICHD), and the 5-tier system by Parer and Ikeda. Predictive value of each classification for neonatal acidemia was assessed using receiver operating characteristics (ROC) analysis. FIGO, RCOG, and NICHD classifications predicted neonatal acidemia with areas under the ROC curves (AUC) of 0.73, 95% confidence interval (CI) 0.63-0.84; 0.72, 95% CI 0.60-0.83; and 0.69, 95% CI 0.57-0.80, respectively. The five-tier system by Parer and Ikeda had significantly better predictive value with an AUC of 0.96, 95% CI 0.91-1.00. The 5-tier classification system proposed by Parer and Ikeda for assessing CTG in labour was superior to FIGO, RCOG, and NICHD intrapartum CTG classifications in predicting severe neonatal acidemia at birth.

A machine learning pipeline to classify foetal heart rate deceleration with optimal feature set

Deceleration is considered a commonly practised means to assess Foetal Heart Rate (FHR) through visual inspection and interpretation of patterns in Cardiotocography (CTG). The precision of deceleration classification relies on the accurate estimation of corresponding event points (EP) from the FHR and the Uterine Contraction Pressure (UCP). This work proposes a deceleration classification pipeline by comparing four machine learning (ML) models, namely, Multilayer Perceptron (MLP), Random Forest (RF), Naïve Bayes (NB), and Simple Logistics Regression. Towards an automated classification of deceleration from EP using the pipeline, it systematically compares three approaches to create feature sets from the detected EP: (1) a novel fuzzy logic (FL)-based approach, (2) expert annotation by clinicians, and (3) calculated using National Institute of Child Health and Human Development guidelines. The classification results were validated using different popular statistical metrics, including receiver operating characteristic curve, intra-class correlation coefficient, Deming regression, and Bland-Altman Plot. The highest classification accuracy (97.94%) was obtained with MLP when the EP was annotated with the proposed FL approach compared to RF, which obtained 63.92% with the clinician-annotated EP. The results indicate that the FL annotated feature set is the optimal one for classifying deceleration from FHR.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.

Interdisciplinary feeding clinic during the coronavirus disease 2019 pandemic: Implementing telehealth and social determinants of health screening.