Perinatal Factors Research Articles

The Relationship Between Prenatal, Perinatal, and Postnatal Factors and ADHD: The Role of Nutrition, Diet, and Stress.

Attention-Deficit Hyperactive Disorder (ADHD) is a neurobehavioral syndrome affecting children aged 6-17 with symptoms manifesting before age 12. ADHD presents heterogeneously and is associated with various psychiatric disorders. The cause remains elusive, but genetic and environmental factors, brain region maturation delays, and neurotransmitter dysregulation are implicated. Effective treatment requires a multi-disciplinary approach, primarily involving pharmacological and behavioral intervention. Stimulants like methylphenidate and amphetamines are first-line medications, but non-stimulants may be considered for some patients. However, stimulants face challenges related to misuse, dependence, and long-term tolerability issues. The etiology of ADHD involved genetic predisposition, environmental influences, and prenatal, perinatal, and postnatal factors. Prenatal causes encompass maternal diet, alcohol consumption, viral infections, and stress. Postnatal factors include head trauma, meningitis, toxin, nutritional deficiencies, as well as iodine deficiency and hypothyroidism. The gut microbiome's role in ADHD is emerging, influencing neurodevelopment through microbiota-gut-brain axis. Understanding these diverse etiological factors is essential for comprehensive ADHD management.

Designing a regional clinical service for people with early-onset type 2 diabetes in England.

To design a regional clinical service for people with early-onset type 2 diabetes (EOT2D) in Leicester, Leicestershire and Rutland (England). A literature search was undertaken to identify important considerations. A working group of key stakeholders was formed to design a triage system and service pathway. Electronic medical records (EMRs) were searched (15th November 2023) to assess feasibility of the pathway and adapt accordingly. A literature search identified important considerations: High risk of complications; large proportion from minority ethnic and socioeconomically deprived backgrounds; significant psychological burden; stigma and other social challenges; and misclassification and miscoding. Novel clinical risk criteria were developed, implementable in EMRs, to match intervention-intensity to clinical need. Specialist clinics were planned, one for people at the highest-clinical risk, another for women with adverse perinatal risk factors. A healthcare professional training package was developed to increase awareness of the unmet clinical needs of people with EOT2D and to upskill in provision of holistic care. Subsequent EMR searches supported the need for our service. Due to the large numbers with HbA1c ≥86mmol/mol (10.0%; n=299; 10.8% of total), these people were prioritised for clinic access. We opted for specialist nurse/educator support to practices with clustering of patients and to financially incentivise referrals from primary care into services. We showcase a service specifically for people with EOT2D based on the literature, a broad range of stakeholder involvement and utilising a locally-sourced data-driven approach. We further discuss areas for development and recommendations based on the challenges we encountered.

Perinatal Hypoxia and Immune System Activation in Schizophrenia Pathogenesis: Critical Considerations During COVID-19 Pandemic

Schizophrenia, a severe psychiatric, neurodevelopmental disorder affecting about 0.29-1 % of the global population, is characterized by hallucinations, delusions, cognitive impairments, disorganized thoughts and speech, leading to significant social withdrawal and emotional blunting. During the 1980s, considerations about diseases that result from complex interactions of genetic background and environmental factors started to appear. One of the critical times of vulnerability is the perinatal period. Concerning schizophrenia, obstetric complications that are associated with hypoxia of the fetus or neonate were identified as a risk. Also, maternal infections during pregnancy were linked to schizophrenia by epidemiological, serologic and genetic studies. Research efforts then led to the development of experimental models testing the impact of perinatal hypoxia or maternal immune activation on neurodevelopmental disorders. These perinatal factors are usually studied separately, but given that the models are now validated, it is feasible to investigate both factors together. Inclusion of additional factors, such as metabolic disturbances or chronic stress, may need to be considered also. Understanding the interplay of perinatal factors in schizophrenia's etiology is crucial for developing targeted prevention and therapeutic strategies.

Incidence and Genetic Risk of Juvenile Idiopathic Arthritis in Norway by Latitude.

We aimed to investigate the incidence of juvenile idiopathic arthritis (JIA) in the three geographic regions of Norway and whether potential regional incidence differences are explained by environmental or genetic factors across regions. We conducted a register-based cohort study including all Norwegian children born from 2004 to 2019, with follow-up throughout 2020. The JIA diagnosis, defined by at least two International Classification of Diseases, Tenth Revision codes for JIA, was validated against medical records. The incidence rate (IR) and hazard ratio (HR) for JIA were estimated for all Norway and for the North, Mid, and South regions. In a subsample from the Norwegian Mother, Father, and Child Cohort Study (MoBa), the genetic risk for JIA was assessed in the three regions. After median 9.1 (range 0.3-16.0) years of follow-up, we identified 1,184 patients with JIA and 910,058 controls. The IR for JIA/100,000 person-years was 14.4 in all of Norway, 25.9 in the North region, 17.9 in the Mid region, and 12.5 in the South region. The HR (95% confidence interval [CI]) of JIA in the North region was 2.07 (1.77-2.43) and in the Mid region HR 1.43 (95% CI 1.23-1.67) compared with the South region. Adjustments for perinatal factors, socioeconomic status, and early antibiotic exposure did not change our estimates substantially. In MoBa (238 patients with JIA, 57,392 controls), the association between JIA and region of birth was no longer significant when adjusting for genetic factors. We found a higher incidence of JIA with increasing latitude without evidence for available environmental factors explaining the observed gradient. In contrast, genetic factors modified the association, but further studies are warranted.

Diagnostic Utility of Cord Thyroid-Stimulating Hormone (TSH) in Congenital Hypothyroidism and Its Association With Perinatal Factors: A Study From a Tertiary Referral Centre in Hyderabad, India

Diagnostic Utility of Cord Thyroid-Stimulating Hormone (TSH) in Congenital Hypothyroidism and Its Association With Perinatal Factors: A Study From a Tertiary Referral Centre in Hyderabad, India

Impact of persistent pulmonary hypertension on cerebral oxygenation in infants with neonatal encephalopathy.

Persistent pulmonary hypertension of the newborn (PPHN) affects systemic oxygenation and may worsen brain injury in infants with neonatal encephalopathy (NE). Evidence suggests that higher cerebral regional oxygenation (crSO2) indicates derangement in cerebral autoregulation, energy metabolism, and blood flow following NE. Our aim was to evaluate the impact of PPHN on crSO2, in infants with NE treated with therapeutic hypothermia (TH). We retrospectively evaluated infants with NE and PPHN vs without PPHN, between 2018-2022. Linear regression analysis was performed to evaluate the impact of PPHN on crSO2 and total MRI score, adjusted for perinatal factors. 164 infants were analyzed, including 19(12%) with PPHN and 145(88%) without. PPHN-infants had significantly higher crSO2 during rewarming and post-rewarming compared to non-PPHN infants (87 ± 6 vs 80 ± 6, p = 0.001; 87 ± 5 vs 80 ± 7, p = 0.008, respectively), and a significantly higher total MRI score [7(2-19) vs 1(0-3), p < 0.001]. PPHN was significantly associated with higher crSO2 during rewarming (b = 6.21, 95% CI 2.37-10.04, p = 0.002) and post-rewarming (b = 8.60, 95% CI 2.28-14.91, p = 0.009), and total MRI score (b = 7.42, 95% CI 4.88-9.95, p < 0.001). PPHN was associated with higher crSO2 during and after rewarming, and worse brain MRI score, indicating a significant impact of PPHN on brain injury in infants with NE undergoing TH. Cerebral oxygenation was significantly higher in infants with neonatal encephalopathy (NE) and persistent pulmonary hypertension (PPHN) compared to infants without PPHN, during the rewarming and post-rewarming periods of therapeutic hypothermia (TH). PPHN is associated with brain injury in infants with NE undergoing TH. In infants with NE and PPHN, monitoring of cerebral oxygenation would help detect infants at higher risk of adverse outcomes.

Perinatal Risk Factors in Single-suture Craniosynostosis: A Systematic Review and Meta-analysis.

To our knowledge, there has not been a review article summarizing the current evidence with regard to perinatal risk factors, and our aim is to perform a systematic review and meta-analysis of the evidence of perinatal risk factors in single suture craniosynostosis to inform our practice and identify any need for further research in this area. Our target population was pediatric single-suture craniosynostosis patients, and the intervention was perinatal risk factors. The comparison group was an age and sex-matched control group without craniosynostosis and the outcome we investigated was presence of single suture craniosynostosis. The literature search was done using OVID MEDLINE, Pubmed, and Embase databases from 1946 to 2023. A PRISMA flowchart was created, and statistical analysis was performed using RevMan pooled odds ratios, and 95% CIs were used to combine results from individual studies. Our initial search identified 625 abstracts and these were narrowed down to 16 articles, which were included in the final selection for the review. Out of these, 13 were used for the quantitative meta-analysis. Our meta-analysis showed a possible association between craniosynostosis and the following perinatal risk factors; presence of maternal thyroid disease, maternal age greater than 29, paternal age greater than 29, maternal smoking, gestational age above 37 weeks, and maternal underweight (BMI<18.5). Further prospective studies are warranted to investigate definite associations. The next step is to set up a multicenter prospective study among a craniofacial unit network.

Parity-Driven Disparities in Placenta Previa: A Comprehensive Analysis of Obstetric and Perinatal Factors

OBJECTIVE: This retrospective cohort study aimed to investigate the incidence of known risk factors for placenta previa in primiparous patients and assess the maternal and fetal outcomes associated with this condition in a tertiary hospital setting. STUDY DESIGN: Data were collected from electronic medical records of pregnant women with confirmed placenta previa who were monitored at our clinic and delivered between January 2016 and June 2024. Demographic characteristics, obstetric history, and perinatal outcomes were analyzed. Statistical analysis was conducted using SPSS version 22, and comparisons between multiparous and nulliparous women were made using appropriate tests. RESULTS: A total of 674 pregnant women were included in the study, comprising 542 multiparous and 132 nulliparous women. Significant differences were observed between the two groups in terms of anesthesia type, transfusion rates, operation duration, and hemoglobin levels. Neonatal outcomes, including APGAR scores, showed variations between multiparous and nulliparous women. However, certain outcomes such as birth weight did not differ significantly between the groups. CONCLUSION: This study provides valuable information on maternal and neonatal outcomes associated with placenta previa in multiparous and nulliparous women. The findings highlight the complex interplay between maternal parity, anesthesia choice, and clinical outcomes and underscore the importance of tailored management approaches in this population.

Prenatal and Early-Life Anti-Infectives and Obesity at Age 7 Years.

To examine associations of prenatal and early-life anti-infective exposures with obesity at 7 years. In this nationwide, registry-based, prevalence study, we included all children with an anthropometric assessment at age 7 years from the Children's Database and linked their data with Danish population-based registries from 2001 to 2018. We defined exposure to anti-infectives (anti-bacterials, anti-virals, and anti-fungals) by outpatient dispensings or by infection diagnoses at hospital encounters. The earliest date defined the exposure timing category: prenatal (-9 months- < 0 months), infancy (0- < 2 years), and early childhood (2- < 5 years). We computed prevalence ratios (aPRs) for associations of anti-infective exposure with obesity prevalence at 7 years of age, adjusting for maternal and perinatal factors. We included 460 363 children (51% boys). Prevalence of obesity at 7 years of age was 38% higher (aPR = 1.38, 95% confidence interval (CI): 1.27-1.49) among children exposed to any anti-infective, 21% higher (aPR = 1.21, 95% CI: 1.12-1.31) among children exposed to anti-infectives in infancy, and 14% higher (aPR = 1.14, 95% CI: 1.03-1.26) among children exposed to anti-infectives in early childhood. Exposure to anti-bacterials was associated with obesity in a similar time-dependent pattern [prenatal: aPR = 1.39 (95% CI: 1.29-1.50), infancy: aPR = 1.21 (95% CI: 1.12-1.30), and early childhood: aPR = 1.14 (95% CI: 1.03-1.25)]. For anti-virals and anti-fungals, exposure during infancy and early childhood was associated with larger aPRs than prenatal exposure. Furthermore, obesity prevalence increased monotonically with number of the anti-infective prescriptions. These findings suggest that prenatal and early-life exposure to anti-infectives increases the risk of childhood obesity and that the magnitude of the associations depends on anti-infective type, timing, and dose.

Perinatal risk factors in ex-preterm and/or low birthweight Colombian young adults: a retrospective cohort study on auditory and visual impairments

Advances in neonatal care have increased survival rates for premature or low birth weight (LBW) infants but raised concerns about long-term neurosensory and psychomotor challenges. Objective: to investigate perinatal factors linked to visual and auditory problems in ex-preterm or LBW young adults, assessing their long-term quality of life. Participants from a 20-year-old randomised controlled trial comparing Kangaroo-Mother Care (KMC) to conventional care were re-enrolled. A group of 50at term individuals without risk factors was assessed as a reference group. 5.9% of participants had functional visual issues and 8.1% experienced hearing problems. Those with hearing or visual impairments had longer hospital stays and more neonatal complications. Correlations were found between Griffiths auditory sub-scale results at 6 months and long-term auditory outcomes. Only 27.5% of those with deafness had access to cochlear implants or hearing aids, resulting in lower IQ scores, learning difficulties, and increased risk of depression and self-harm. Participants with visual impairments exhibited lower IQ scores, self-esteem, and HOME test acceptance. However, they did not differ from the group with normal vision in terms of quality of life, depression, or attachment scores. All participants, whether they had issues or not, rated their quality of life higher than their parents did. Preterm or LBW infants with visual and hearing deficits are more likely to face cognitive and emotional challenges in adulthood. This study underscores the importance of a multidisciplinary approach to promptly address these vulnerabilities, reducing the risk of long-term neurodevelopmental and functional issues. The Grand Challenge Canada, Fulbright Colciencias and Colombia Cientifica - Alianza, The World Bank, managed by the Colombian Administrative Department of Science, Technology and Innovation (COLCIENCIAS).

Cerebral palsy: potential risk factors and functional status among children under three years, a case-control study in northwest Iran

BackgroundCerebral palsy (CP) is one of the most common motor-postural disorders in childhood. It occurs due to impairment in the developing brain—before, during, or after birth—and has a significant burden on the public health system. This study aimed to investigate the potential risk factors and detect the associated CP-related disorders.MethodsThis case-control study was conducted on 46 children with CP and 175 matched healthy children less than three years old who referred to the Children’s Hospital, Tabriz, Iran in 2022. Then, a checklist related to the mother’s medical history during current and previous pregnancies, a questionnaire related to perinatal factors of the newborn, types of CP, concurrent disorders, the Gross Motor Function Classification System (GMFCS), and Age and Stage Questionaire (ASQ) were completed. Data was analyzed using Statistical Package for the Social Sciences) SPSS(-21 software by descriptive and analytical statistics consisted of Chi-square, Independent t-test, and Binary logistic regression.ResultsFinally, 35 children with CP and 122 healthy children completed the study and were analyzed. The mean (standard deviation: SD) age of children in the CP group was 15.3 (6.2) and in the healthy group was 14.4 (6.6) months (p = 0.635). Spastic CP (82.9%) was the common type, and the most common prevailing form of the involved limb was quadriplegia (54.3%). The severity of the functional disorder in 39.3% of CP cases was at levels 4 and 5 (severe form). The most prevalent comorbidities were inability to walk (31.4%), speech delay (22.9%), epilepsy (11.4), and strabismus (8.6%). Children with CP had abnormal development in gross motor (82.9%), problem-solving (68.6%), personal-social (65.7%), fine motor (60%), and communication (54.3%). Moreover, duration of pregnancy (p = 0.023), birth weight lower than 2500 g (p = 0.002), problems in the current pregnancy [adjusted odds ratio (aOR) [95% CI]: 3.06 (1.87 to 8.54); p = 0.013] and problems in previous pregnancy ([aOR (95% CI): 4.8 (1.6 to 14.2); p = 0.005) were potential risk factors.ConclusionDue to accompanying movement, vision, and speech problems, especially high developmental disorders in children with CP, necessary measures to prevent the identified risk factors are very important.

Clinical and neuroimaging patterns of perinatal intracranial haemorrhage in fetuses and term-born neonates: a prospective observational cohort study.

To characterise perinatal, clinical and neuroimaging patterns and aetiology of perinatal intracranial haemorrhage (pICH), and to assess potential differences between cases diagnosed antenatally and postnatally. Prospective, observational, single-centre study of 110 consecutive cases of pICH identified in the fetal or neonatal period or diagnosed with presumed pICH between 2014 and 2023. Prematurity-related cases were excluded. Antenatal and postnatal MRI data were analysed for patterns and mechanisms of haemorrhage and their potential aetiology. Potential associations between pICH with perinatal and clinical risk factors were also explored. Fifty-nine of the 110 included cases (53.6%) were diagnosed antenatally (termination of pregnancy, n=22), and postnatal data on 81/88 (92%) children were available. Intraventricular haemorrhage (IVH) was the most common haemorrhage type (83/110 (75.5%)) and was more common prenatally (p=0.004). Subpial haemorrhage was exclusively diagnosed postnatally (p<0.001), and it was more commonly detected in primigravida women (p=0.013). The germinal matrix was the most common origin of IVH (n=56, 50.9%) occuring more frequently prenatally (p<0.001), whereas sinus venous thrombosis-related IVH was more commonly detected postnatally (p=0.002). Subdural haemorrhage was associated with haematological abnormalities (p=0.023). Genetic disorders caused 31.9% of the cases (15 of 47 tested cases). Genetic disorders and associated congenital anomalies were more common in the prenatally diagnosed group (p=0.038 and p=0.04, respectively). The patterns and pathogenesis of pICH appear to be different for prenatally and postnatally diagnosed cases and for types of haemorrhages. Given the important role of genetic factors in prenatal intracranial haemorrhage, next-generation sequencing is indicated in these cases.

Desempeño cognitivo y académico en escolares con antecedentes perinatales y vulnerabilidad social en un hospital público de la provincia de Buenos Aires

Cognitive Development (CD) and Academic Performance (AP) of children who presented perinatal and social vulnerability risk factors are a topic of interest in health and education. Therefore, the aim of this research is to characterize CD and AP of a population with these characteristics, which was accompanied by professional interventions from the transdisciplinary follow-up team.Information was collected from pediatric and psychopedagogical medical records of thirty patients. The WISC IV Intelligence test was used; school reports were requested, and a socio-economic level survey was administered, which included information regarding stimulating learning at home.Most of the children showed average levels in CD and good AP. Socio-environmental factors and received interventions associated with them were identified. Early transdisciplinary interventions (ETI), contextualized and long-term, are favorable for DC and DA. Consequently, they should be considered in follow-up programs for similar populations.

Association between infant feeding behavior and maternal choice of breastfeeding type

Abstract Introduction Feeding in infants is a fundamental process influenced by the mother-child relationship during the early months of life. The regulation of feeding behavior, and hunger and satiety cues may be interpreted by the mother, potentially relating to the type of feeding chosen. Objectives To determine the association between infant feeding behavior and the type of breastfeeding chosen by the mother. Methods A cross-sectional and prospective study was conducted, including mothers with children aged between 6 and 18 months. Those with medical contraindications for immediate postpartum breastfeeding or with suspension of exclusive breastfeeding during the first 6 months of life due to medical prescription were excluded. The Baby Eating Behavior Questionnaire was used to evaluate the baby’s enjoyment of food, appetite response, eating speed, and satiety response. Results 108 mothers were included, with 87% in agreement with exclusive breastfeeding (EBF), 43.3% using breastfeeding as the primary feeding method, and only 33.3% practicing EBF during the first 6 months. Food response (FR) scored 19.6 (±4.3), enjoyment of food (EF) 17.6 (±2.1), satiety response (SR) 7.1 (±2.0), eating speed (ES) 8.8 (±2.3), and appetite (AP) 4.2 (±0.7). Comparing FR, EF, SR, ES, and AP scores between those who practiced EBF and those who did not showed p &amp;gt; 0.05. sociodemographic characteristics, perinatal factors, stance on EBF, number of hours per day with the child, feeding location, poor technique, breastfeeding pain and lack of medical guidance, all showed p &amp;gt; 0.05 when comparing between those who practiced EBF and those who did not; in contrast to perceiving that the baby wanted to breastfeed (2.5/1.0-6.2), having time to feed (3/1.2-7.2) and having no health problems (10/1.2-78.7) all with p-value &amp;lt;0.05. Conclusions The mother’s perception identifying the baby’s desire to breastfeed, having time to feed the baby and not having health problems favor exclusive breastfeeding. Key messages • Maternal perception plays an important role in deciding to give SCI, so it is the physician’s job to educate the mother so that she has additional arguments for choosing SCI. • The infant’s feeding behavior does not have a significant impact on the mother’s behavior in choosing SCI feeding.

Neonatal screening for hearing loss and its associated factors: A pediatric hospital experience

Abstract Introduction Hearing impairment affects 0.6% of children worldwide, with 60% of cases being preventable. Identifying risk factors for hearing impairment would facilitate early detection and better patient prognosis. Objectives To identify factors associated with abnormalities in auditory screening in a pediatric hospital. Methods A cross-sectional study was conducted on patients assessed in the early hearing detection program at the Pediatric Tower of the High Specialty Hospital of Veracruz, Mexico, between June 2022 and 2023. Screening was performed using otoacoustic emissions initially. Those with abnormalities underwent two retests, and those positive in all three evaluations underwent confirmatory testing. Newborn screening was conducted at discharge for healthy neonates and after reaching a weight of over 1.8 kg and more than 34 gestational weeks for preterm infants. For term and low-birth-weight babies, screening occurred when they reached 2 kg, considering positive results in any of the three tests indicative of altered screening and probable hearing impairment. Results A total of 2731 patients were fully evaluated, with 1416 (51.8%) being male, and a median Apgar score of 9 at 5 minutes. The incidence of hearing impairment was 0.7%, comprising 19 patients. Evaluation of sex, 5-minute Apgar score, weight, gestational age, congenital malformations, history of neonatal asphyxia, hyperbilirubinemia, sepsis, TORCH infections, family history of hearing impairment, maternal exposure to ototoxic drugs, substances, COVID-19, gestational diabetes, or maternal hypertension obtaining values of p &amp;gt; 0.05 in each of them. Conclusions The prevalence of hearing loss is similar to that reported in the literature. In our population, auditory screening abnormalities are not associated with classic perinatal factors, indicating the complexity of contributors to neonatal hearing impairment. Key messages • The neonatal screening program plays a fundamental role in identifying patients with hearing loss even without any clinical factor that arouses suspicion of hearing loss. • Early diagnosis will favor timely care for patients with hearing loss, favoring their development with adequate care to improve their quality of life.

Cerebral palsy characteristics in term-born children with and without detectable perinatal risk factors: A cross-sectional study.

https://onlinelibrary.wiley.com/doi/10.1111/dmcn.16111

Kidney volume and function of low-birth-weight children at 5years: impact of singleton and twin birth.

Many studies have demonstrated the association between low birth weight (LBW) and chronic kidney disease, estimated glomerular filtration rate (eGFR) and kidney volume (KV). However, studies on twins and those investigating numerous perinatal factors beyond LBW, and their associations with various kidney parameters are scarce. A two-center cross-sectional study on five-year-old LBW children was conducted between 2021 and 2023. 110 children were enrolled (8 LBW, 58 very LBW (VLBW), 44 extremely LBW (ELBW)); 56 were twins. We examined associations between birth weight (BW), various prenatal, perinatal and postnatal factors, and eGFR, KV, tubular abnormalities and kidney ultrasound abnormalities, both in singletons and twins. In children with ELBW, eGFR correlated with BW (r = 0.55, P = 0.0018), while in those with BW ≥ 1000g, eGFR remained constant. Other factors associated with decreased eGFR were hypertensive disorder of pregnancy (93.86 vs. 87.26ml/min/1.73m2, P = 0.0285) in singletons, decreased growth velocity (β = 0.83, P = 0.0277) in twins, and lower total KV (tKV) and relative KV (rKV) in both singletons (r = 0.60, P < 0.0001 for tKV and r = 0.45, P = 0.0010 for rKV) and twins (β = 0.34, P < 0.0001 for tKV and β = 0.23, P = 0.0002 for rKV). Based on the multivariable models excluding KV, BW and gestational age were associated with eGFR in singletons, while male gender, BW, growth velocity, and coffee drinking during pregnancy were associated with eGFR in twins. However, in models that included KV, BW, gestational age and growth velocity were no longer significant. Total KV was associated with BW (r = 0.39, P = 0.0050 for singletons; β = 2.85, P < 0.0001 for twins), body mass index (r = 0.34, P = 0.0145 for singletons; β = 8.44, P < 0.0001 for twins), and growth velocity (β = 1.43, P = 0.0078). Twins born small for gestational age had lower tKV (70.88 vs 89.20ml, P < 0.0001). Relative KV showed similar associations. Relative kidney volumes were significantly lower for both kidneys compared to the reference population (55.02 vs 65.42ml/m2, P < 0.0001 for right kidney and 61.12 vs 66.25ml/m2, P = 0.0015 for left kidney); however, only 8.6% of children had rKV below 10th percentile. Many factors affect eGFR and KV, some of them differ between twins and singletons. Based on multivariable models, eGFR seems to be better predicted by KV than by BW and gestational age in LBW children. Relative kidney volumes were significantly lower in our cohort compared to the reference population, but only 8.6% of rKV were below 10th percentile.

Neurodevelopment of Children Born with Forceps Delivery-A Single Tertiary Clinic Study.

Background and Objectives: Forceps delivery is a crucial obstetrical technique that has become increasingly underutilized in favor of cesarean delivery, despite the numerous complications related to cesarean sections. The major concerns with regard to assisted vaginal birth (AVB) are safety and long-term consequences. We aimed to investigate a neurological outcome of neonates and children at the age of 7 who were born via forceps delivery. This would greatly improve informed decision making for both mothers and obstetricians. Materials and Methods: A single-arm cohort study was conducted from January 2012 to December 2016 among 49 women and their children born via forceps delivery at the Clinic for Gynecology and Obstetrics, University Clinical Center of Serbia. The Sarnat and Sarnat classification was used to evaluate the neurological status of neonates, and logistic regression analysis was employed to explore the association with perinatal factors. Long-term neurological outcomes were assessed using the Griffiths Mental Development Scale and a questionnaire for parents based on the Motor and Social Development (MSD) scale, which was derived from the Bayley-III Scale. Results: The main indication for forceps delivery was maternal exhaustion (79.6%), followed by fetal distress (20.4%). A pathological neurological status was observed in 16.3% of newborns, with pathological ultrasound of the CNS in 3%. A statistically significant association was observed with the Apgar score, with an odds ratio of 0.575 (95% CI: 0.407-0.813, p = 0.002) and perinatal asphyxia, with an odds ratio of 9.882 (95% CI: 1.111-87.902, p = 0.04). However, these associations were unlikely to be related to the mode of delivery. Long-term adverse neurological outcomes were seen in three cases, which accounts for 6.4%. These included mild disorders such as delayed milestone, speech delay, and motor clumsiness. Conclusions: The present study highlights the safety of forceps delivery regarding children's neurological outcomes at 7 years of age. This is an important contribution to the modern management of labor, especially in light of increasing rates of cesarean deliveries worldwide.

Molar Incisor Hypomineralization: Etiology, Correlation with Tooth Number Anomalies and Implications for Comprehensive Management Strategies in Children from Transylvania.

This study investigates the etiology of enamel developmental defects, specifically Molar Incisor Hypomineralization (MIH), and explores correlations between MIH and dental anomalies such as hypodontia to improve interdisciplinary restorative and orthodontic treatments. Additionally, it assesses the influence of stress factors on the development of enamel defects. Conducted from July to September 2024, this study involved 57 patients aged 6 to 11 from an urban setting, divided into two groups: 32 with MIH and 25 controls, selected based on criteria of mixed dentition without systemic pathology or chronic medication. Clinical evaluations, including intraoral photographs and panoramic radiographs, were performed alongside a detailed questionnaire addressed to the mothers covering prenatal, perinatal, and postnatal factors. The average age of children with MIH was 7.5 years, in contrast to 7.04 years in the control group (p = 0.17). Significant differences were noted in maternal age, with MIH mothers older (35.56 years) than controls (29.36, p = 0.0001). The prevalence of MIH was higher in boys (66.7%) compared to girls (38.1%, p = 0.036). Factors such as prolonged labor, medication during birth, and early postnatal medication were significantly linked to MIH. The study shows a strong correlation with hypodontia, with a significantly higher incidence of tooth number anomalies (p = 0.009) in the study group. Overall, the study emphasizes the association of MIH with various maternal and birth-related factors and with hypodontia, highlighting the need for a comprehensive, multidisciplinary approach to diagnosis and treatment. Further research is recommended to investigate the relationship between stress factors and MIH.

Necrotizing enterocolitis following spontaneous intestinal perforation in very low birth weight neonates.

Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are severe gastrointestinal complications of prematurity. The clinical presentation and treatment of NEC and SIP (peritoneal drain vs laparotomy) can overlap; however, the pathogenesis is distinct. Therefore, a patient initially treated for SIP can subsequently develop NEC. This phenomenon has only been described in case reports, and no risk factor evaluation exists. We evaluate clinical characteristics, risk factors, and outcomes of patients treated for a distinct episode of NEC after SIP. We performed a retrospective review of very low birth weight (<1500 g) neonates who presented with pneumoperitoneum between 07/2004 and 09/2022. Data was obtained from two separate neonatal intensive care units that were part of the same institution. Patients with an initial preoperative, intraoperative, or pathological diagnosis of NEC were excluded. Patients with an intraoperative diagnosis of SIP or preoperative diagnosis of SIP successfully treated with a peritoneal drain (PD) were evaluated. Patients subsequently treated (medically or surgically) for NEC after SIP were then compared to SIP-alone patients. Clinical characteristics included demographics, gestational age (GA), birth weight (BW), perinatal risk factors (chorioamnionitis, steroids, indomethacin), postoperative feeding regimen, and length of stay (LOS) were compared. Of the 278 patients included, 31 (11.2%) patients had NEC after SIP. There was no difference in GA (25 weeks vs 25 weeks, p = 0.933) or BW (760 g vs 735 g, p = 0.370) between NEC after SIP vs SIP alone cohorts, respectively. Twenty (64%) of NEC after-SIP patients were previously treated with LP. NEC after SIP occurred with a median onset of 56 days. Pneumatosis was the most frequent (81%) presenting symptom and 12 (39%) patients had hematochezia. Four (12.9%) patients required LP for NEC and all had NEC intraoperatively and on pathology. A majority (77.4%) of patients were on breast milk (BM) at time of NEC diagnosis. NEC after SIP patients had lower maternal age at delivery (29.0 vs 25.0, p = 0.055) and the incidence of NEC after LP (primary or failed drain) was higher than PD alone (16.7% vs 6.2%, p = 0.007). NEC after SIP patients had longer LOS (135 vs 81, p < 0.001). We report an 11.2% incidence of NEC at a median of 56 days following successful treatment of SIP, resulting in increased LOS. SIP patients are a high-risk cohort and protocols to prevent this phenomenon should be investigated.