Variation In Infants Research Articles

Clinical profile and thiamine transporter gene (SLC19A2 and SLC19A3) variations in infants with thiamine-responsive pulmonary hypertension and acute respiratory infection

Abstract Maternal thiamine deficiency is prevalent in low- and middle-income countries. Thiamine-responsive pulmonary hypertension (TRPHTN) in exclusively breastfed infants is reported in India. Thiamine transporter gene (ThTR) variations have not been studied. This study compared the presentation of exclusively breastfed infants with respiratory distress diagnosed as TRPHTN or acute respiratory infection (ARI). We investigated pathogenic variations in the SLC19A2 and SLC19A3 ThTr genes in a representative sample. Observational study. Tertiary care pediatric unit of a teaching hospital in southern India. Data collection was prospective. We included exclusively breastfed infants between 1 and 6 months of age with respiratory distress. Infants with PHTN in echocardiography and lactic acidosis (LA) received thiamine. TRPHTN was diagnosed based on response within 72 h. Infants with fever, chest findings, and positive microbiology were managed as ARI. The ThTr genes were sequenced and analyzed. Chi-square and stratified analysis were done to determine TRPHTN risk. Forty infants with TRPHTN and 42 with ARI were included. The median pulmonary arterial pressure in the TRPHTN group was 51.5 mmHg. Mild PHTN was seen in 65%, moderate in 22.5%, and severe in 12.5%. Cardiac failure (P < .001), stridor and aphonia (P < .001), encephalopathy (P = .024), LA (P < .001), and PHTN (P <.001) facilitated the diagnosis. The adjusted risk was 17.3 (95% confidence interval 7.8–38.3; P <.001). The ThTR sequencing showed wild-type genotypes. TRPHTN has a distinct, identifiable presentation. Lactate and pulmonary pressure estimations are useful investigations in thiamine deficiency endemic areas. We could not demonstrate a genetic variation that determines susceptibility.

Variations in infants' physical and social environments shape spontaneous locomotion.

Independent locomotion is associated with a range of positive developmental outcomes, but unlike cognitive, linguistic, and social skills, acquiring motor skills requires infants to generate their own input for learning. We tested factors that shape infants' spontaneous locomotion by observing forty 12- to 22-month-olds (19 girls, 21 boys) during free play. Infants were recruited from the New York City area, and caregivers reported that 25 infants were White, six were Asian, four were Black, and five had multiple races; four were Hispanic or Latino. All infants played in four conditions: two environmental conditions (gross-motor toys, fine-motor toys) crossed with two social conditions (alone, together with a caregiver). Infants moved more in the gross-motor toy conditions than in the fine-motor toy conditions. However, the effect of playing with a caregiver differed by toy condition. In the gross-motor toy conditions, playing with a caregiver did not affect how much infants moved, but in the fine-motor toy conditions, playing with a caregiver further depressed infant locomotion. Infants with more walking experience moved more with gross-motor toys but not with fine-motor toys. Differences in the amount of locomotion between conditions were related to how infants used toys and the interactions between infants and caregivers. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Maximal Mouth Opening in Infants: A Single-Group Prospective Cohort Study

BackgroundDetection of mandibular range of motion variations in infants may allow for early diagnosis of pathologic conditions to the temporomandibular joint. PurposeThe purpose of this study was to determine the normal ranges for maximal mouth opening (MMO) in healthy infants under 12 months of age. Study design, setting, sampleA single-group prospective cohort study of consecutive patients below 12 months of age was conducted in an outpatient setting at the Florida Craniofacial Institute in Tampa, Florida. Patients were excluded if they had trismus, presented with signs of obstructive sleep apnea, suffered a facial fracture, or were diagnosed with a craniofacial syndrome. Predictor/exposure/independent variableAge (in months) at the time of presentation, measured as a continuous variable. Main outcome variable(s)The main outcome variable was MMO. This was measured by placing a thumb and forefinger in the infant’s mouth and apply slight pressure to encourage maximal mouth opening. In older infants with erupted central incisors, MMO was measured from the gingival margins. CovariatesThe covariates were sex, race, and gestational age. AnalysesFindings were presented as means with 95% confidence intervals. A multivariate linear regression analysis was conducted to evaluate changes in MMO with increasing age. ResultsThe sample was composed of 151 infants with a mean age of 5.2 months (95% CI 4.8 to 5.6), and 33% were female. The mean MMO was 32.1 mm (95% CI 31.5 to 32.7). Results of the linear regression analysis showed MMO to significantly increase with increasing age, increasing at a mean rate of approximately 1 mm per month (coefficient 1.06, 95% CI 0.88 to 1.23, p<0.001). In neonates <1 month of age, the mean MMO was 22.0 mm (95% CI 20.4-23.6), compared to a mean of 36.7 mm (95% CI 34.8-38.6) in infants 11 months of age. Conclusions and RelevanceThe results of this study provide normative data of the association of age with MMO, which may be of value in assessing for infants with jaw mobility disorders.

Supplemental Material for Variations in Infants’ Physical and Social Environments Shape Spontaneous Locomotion

Supplemental Material for Variations in Infants’ Physical and Social Environments Shape Spontaneous Locomotion

Comparing Word Diversity Versus Amount of Speech in Parents’ Responses to Infants’ Prelinguistic Vocalizations

Our prior research posits that the prelinguistic vocalizations of infants may elicit caregiver speech which is simplified in its linguistic structure. Caregivers’ speech clearly contributes to infants’ development; infants’ communicative and cognitive development are predicted by their ambient language environment. There are at least two sources of variation in infants’ language environment: 1) the number and 2) the diversity of words infants hear. We compare the change in the total number of words (tokens) to the diversity of words against one another. Distributions of words of differing sizes are difficult to compare to one another because the size of the distribution largely determines the word diversity of the distribution. A novel approach to minimizing the challenges of comparing distributions of words is applied to data which were previously reported. We also conducted a new simulation study to estimate the probability that these results are expected by chance. We found that the linguistic structure of caregivers’ responses to infants’ prelinguistic vocalizations has fewer word types as compared to infant-directed but noncontingent speech. Our new method shows that contingent word distributions remain simplified as the number of total words sampled increases. By vocalizing, infants elicit caregiver speech, which is simpler in structure and may be easier to learn.

Toward a dimensional model of risk and protective factors influencing children's early cognitive, social, and emotional development during the COVID-19 pandemic.

Variation in infants' home environment is implicated in their cognitive and psycho-social development. The pandemic has intensified variations in home environments through exacerbating socioeconomic inequalities, and increasing psychological stressors for some families. This study investigates the effects of parental (predominantly maternal) mental health, enriching activities and screen use on 280 24- to 52-month-olds' executive functions, internalising and externalising problems, and pro-social behaviour; with socioeconomic status and social support as contextual factors. Our results indicate that aspects of the home environment are differentially associated with children's cognitive and psycho-social development. Parents who experienced sustained mental distress during the pandemic tended to report higher child externalising and internalising problems, and executive function difficulties at follow-up. Children who spent more time engaged in enriching activities with their parents showed stronger executive functions and social competence six months later. Screen use levels during the first year of the pandemic were not associated with outcomes. To mitigate the risk of persistent negative effects for this 'pandemic generation' of infants, our study highlights the importance of supporting parents' mental health. As our results demonstrate the impact of social support on mental health, investing in support services and interventions promoting building support networks are likely to be beneficial.

One lung ventilation in left sided cystic hygroma: Anaesthesia challenges

Cystic hygroma [CH], also called as cavernous lymphangioma is a histologically benign congenital tumor of lymphatic origin. Its presence in the cervical region,most common site [25%] poses multiple challenges to the anaesthetist which includes tumor extension in oral and thoracic cavity, restricted neck movements, airway management, haemorrhage, post-operative respiatory obstruction and coexisting anomalies [down syndrome, turner syndrome, and congenital cardiac defects]. The recommended treatment is surgical excision which can be achieved with no mortality and little morbidity. The advantages of video assisted thoracoscopic surgery (VATS) in children have led to its increased usage over the years. VATS, however requires an efficient technique for one lung ventilation. Today there is an increasing interest in developing the technique for lung isolation to meet the anatomic and physiologic variations in infants and children. Significant differences exist between airways of the neonate and the adult. Anaesthetic management of the airway is challenging in neonates and young infants with large neck mass like huge cystic hygroma because these patients are at risk for sudden complete airway occlusion resulting in hypoventilation and hypoxemia. We report a successful anaesthesia management in an infant undergoing video assisted thoracoscopic excision of cystic hygroma in left side of neck which was extending to anterior mediastinum under general anaesthesia.

Gestational Diabetes Mellitus Is Associated with Altered Abundance of Exosomal MicroRNAs in Human Milk

PurposeHuman milk (HM) is a unique biological fluid that is enriched with a variety of factors, including microRNAs (miRNAs) that potentially provide both short- and long-term benefits to the infants. miRNAs are packaged within exosomes, making them bioavailable to infants. Gestational diabetes mellitus (GDM) may affect the abundance of exosomal miRNAs in HM, providing a mechanism for growth and adiposity variation in infants of mothers with GDM in early life. Therefore, the purposes of this study were to examine the impact of GDM on select miRNAs (miRNA-148a, miRNA-30b, miRNA-let-7a, and miRNA-let-7d) involved in metabolism and to examine the association of these miRNAs with measures of infant body composition in the first 6 months of life. MethodsMilk samples were collected from a cohort of 94 mothers (62 mothers without GDM and 32 mothers with GDM) matched on body mass index strata at 1 month post partum. miRNA abundance was measured by real-time polymerase chain reaction. Linear regression models were used to examine potential differences in miRNA abundance in women with and without GDM, testing associations between miRNA abundance and infant growth and body composition measures from 1 to 6 months. FindingsThe abundances of miRNA-148a, miRNA-30b, miRNA-let-7a, and miRNA-let-7d were reduced in milk from mothers with GDM. Independent of GDM status, higher maternal diet quality was associated with increased abundance of each of the measured miRNAs. miRNA-148a was negatively associated with infant weight, percentage of body fat, and fat mass, whereas miRNA-30b was positively associated with infant weight and fat mass at 1 month of age. There was no association of milk miRNA-148a and miRNA-30b with infant weight at 1 month of age or with body composition measures at 3 months of age; however, miRNA-148a was negatively associated with infant weight at 6 months of age. ImplicationsIf supported by randomized dietary supplementation or other intervention trials, HM miRNAs may be a therapeutic target to mitigate risk of metabolic outcomes in offspring of women with GDM.

The geography of ethnoracial low birth weight inequalities in the United States

In this article, we describe, decompose, and examine correlates of the geography of ethnoracial inequalities in low birth weight (LBW) in the United States. Drawing on the population of singleton births to U.S.-born White, Black, Latinx, and Native American parents in the first decade of the twenty-first century (N = 28.2 million births), we calculate county-level LBW rates and rate ratios. Results demonstrate a stark racial hierarchy in which Black infants experience the most significant disadvantage, but we also document substantial local-level variation organized in what we call a regionalized patchwork of inequality, with high-disparity counties bordering low-disparity counties coupled with regional clustering. Examining the component parts of local disparities – the LBW rates for Whites and groups of color - we find strong evidence that spatial variation in ethnoracial LBW inequalities is driven by greater variation in infants of color's health across counties relative to Whites. Further, LBW rates for groups of color are only weakly to moderately correlated with Whites' LBW rates, indicating that the same contexts can produce racially divergent health outcomes. Examining contextual factors that predict LBW disparities, we find that more segregated, socioeconomically unequal, and urban counties have larger LBW disparities. We conclude by positing an approach to health disparities that conceptualizes ethnoracial differences in health as fundamentally relational and spatial phenomena produced by systems of White advantage.

Maternal care, infant fear memory retention, and the moderating role of variations in separation-induced ultrasonic vocalizations.

Individual differences in parental care predict variations in offspring anxiety across species. Here, we examined whether between- and within-litter variations in maternal licking (a measure of rodent maternal care) predict infant rats' retention of an aversive association (a predictor of later anxiety-like behavior) and whether the relationship between maternal licking and infant fear memory is moderated by variations in infants' solicitation of maternal care. Unique marks were drawn on each pup, coded for fading, and touched up daily across the first week of life. Mark fading was used as an index of maternal licking where greater fading suggested more maternal licking the previous day. Separation-induced ultrasonic vocalizations (USVs) were recorded to measure individual differences in solicitation of maternal care. Infants were fear conditioned at postnatal day (P) 17 and tested for fear of the conditioned stimulus (CS) 1 week later. Across litters, mark fading negatively predicted CS-elicited fear at test for male, but not female, offspring. This relationship was moderated by number of USVs emitted at P1, such that mark fading only predicted CS-elicited fear for males that emitted a low number of USVs. These results suggest that offspring solicitation may moderate the relationship between maternal care and fear/anxiety.

Maternal caregiving and DNA methylation in human infants and children: Systematic review.

The integration of behavioral epigenetics' principles (eg, DNA methylation) into the study of human infants' development has mainly focused on the effects of early adverse exposures, paying less attention to protective caregiving experiences. The present review focused on DNA methylation linked to variations in maternal behavior in human infants and children. Literature search occurred on three databases (PubMed, Scopus and Web of Science) and 11 records were selected. Key variables were abstracted from each article including: sample size and characteristics, time and type of maternal caregiving behavior exposure, time and locus of methylation biomarker, presence/absence, time and type of adverse exposure. Six out of eleven records documented the predictive effect of maternal caregiving on DNA methylation, whereas the remaining five reported on the role of maternal behavior as an influencing factor of the adversity-to-methylation link. Consistent with evidence from the animal model, the quality of maternal caregiving in humans (a) might be associated with variations in DNA methylation status of specific genes involved in socio-emotional development and (b) might partially buffer the association between early adversities and epigenetic variations in infants and children. Current evidence suggests that the quality of maternal caregiving can contribute to behavioral development trajectories of human infants and children at least partially through epigenetic regulation. Open questions and methodological aspects are discussed to guide future human developmental research in behavioral epigenetics.

Training of 7-month-old infants’ manual object exploration skills: Effects of active and observational experience

In the present study, a fine motor training was developed and evaluated in which infants were trained to manually explore objects in an advanced manner. Fifty 7-month-old infants were randomly assigned to three different training conditions: (1) to an active manual exploration training, in which they learned to explore objects efficiently, (2) to an observational manual exploration training, in which they observed how an adult performed sophisticated actions on objects, or (3) to a control group receiving no training. The results impressively indicate that infants with a low level of object exploration skill prior to the training showed the most training effects as compared to infants with proficient object exploratory actions. Interestingly, this differential training effect was true for both the active and observational training, highlighting the role of social learning in infancy. Importantly, our study shows for the first time the impact of normal individual variation in infants’ manual object exploration skills on the effects of a fine motor training.

Caloric compensation ability around the age of 1 year: Interplay with the caregiver-infant mealtime interaction and infant appetitive traits

Previously, we demonstrated that infants' caloric compensation ability decreases between 11 and 15 months old. Here, we explored whether the inter-individual variation in infants' caloric compensation ability is associated with caregiver-infant interaction during laboratory test meals or with infant appetitive traits. To describe caregiver-infant interaction, we recorded feeding in laboratory ad libitum meals when the infants were 11 and 15 months old by using a connected weighing scale. We extracted the weight of each offered spoonful and the time interval between two spoonfuls. The caloric compensation score (COMPX) was assessed during the same meals. At 11 and 15 months old, the caregiver rated their infant's appetitive traits by completing the CEBQ-T. Student's t tests were applied to test the relationships between the variables describing the caregiver-infant interaction and the COMPX score. The relationships between the COMPX score or its change and the infants' appetitive traits were assessed with Kendall correlations. Regarding appetitive traits, the more the caloric compensation ability decreased between 11 and 15 months old, the more the infants were perceived as food responsive between these ages (τ = −0.36, p = 0.01, n = 28). At 11 months old, when the time interval between two spoonfuls was positively associated with the previous spoonful weight (i.e., a longer time interval after a larger spoonful weight), the infants exhibited a better caloric compensation ability (t = −2.1, p = 0.04, n = 38). Moreover, this study provides new evidence regarding the importance of a responsive feeding style by suggesting that adapting the feeding pace to the spoonful weight could be a favourable practice associated with better caloric compensation ability by the end of the first year. Trial registrationThis trial was registered at clinicals.gov as NCT03409042 (https://clinicaltrials.gov/ct2/show/NCT03409042).

A multicenter evaluation of sweat chloride concentration and variation in infants with cystic fibrosis

Fifty-nineCF infants' sweat chloride concentrations were analyzed to answer the questions: What is the biological and analytical variation in sweat chloride concentrations collected from the 32 infants homozygous for the F508 deletion? Do sweat chloride concentrations change in the first year of life beyond the variance previously established for adults with similar CFTR mutations? The biological and analytical variation of the infants' sweat chloride concentration was similar to that seen in adult CF patients. While there was a statistically significant difference between sweat chloride concentration in early (89.8 mmol/L) and late (95.0 mmol/L) infancy, this change is not likely clinically significant. This suggests that sweat chloride concentrations in CF patients do not change in a meaningful way during the first year of life. Determining variability in infants with CF is the necessary first step for future design of clinical trials of CFTR modulators in younger patients.

Robust stability and physiological correlates of infants' patterns of regulatory behavior in the still-face paradigm at 3 and 9 months.

This study examined the stability of three patterns of infant regulatory behavior identified in the face-to-face still-face (FFSF) paradigm at 3 and 9 months-social-positive oriented, distressed-inconsolable, and self-comfort oriented-and whether variations in infants' heart-rate were correlated with them. Although some studies have examined the stability of discrete infant behaviors, none have investigated the stability of early regulatory patterns across FFSF episodes over time. Healthy full-term infants and their mothers (N = 112) were videotaped in the FFSF when infants were 3 and 9 months old. Infants' regulatory patterns were scored with the Coding System for Regulatory Patterns in the FFSF. Infants' heart-rate level during each episode of the FFSF was also assessed. The social-positive-oriented pattern was the most prevalent at both ages. Cross-tabulation analysis showed a robust stability (Cohen's κ = .72) of the regulatory patterns from 3 to 9 months. The heart-rate level of infants with a social-positive-oriented pattern at 3 and 9 months showed recovery to baseline levels following the still-face. In contrast, the heart-rate level of infants with a distressed-inconsolable pattern at 9 months increased from the still-face to the reunion episode, whereas the heart-rate level of infants with a self-comfort-oriented pattern at 9 months did not change from the still-face to the reunion episodes. These results suggest that infants exhibit distinct organized regulatory patterns as early as 3 months that are stable over a 6-month interval and associated with variations in infants' physiological responses across FFSF episodes at both ages. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Growth velocity of children and its affective factors in northwestern Iran: A longitudinal study using marginal models.

Background: Child growth is an important health indicator in human’s lifespan. Evaluating growth variations in infants and children is highly important. This study was conducted to evaluate the risk factors of child growth retardation and determine childhood growth velocity in Zanjan province, Iran. Methods: This longitudinal study was conducted on 7892 children aged 0 to 2 years in Zanjan province in 2013. The sampling method was multi-stage cluster sampling. To determine the growth velocity, 2- pointed model was used. We applied the marginal models of generalized equation estimators (GEE). The related curves were obtained using LOWESS method, and data were analyzed using R Version 2.14.1. Results: In this study, 3879 (49%) of the participants were female, and the mean age of mothers was 27.1±5.4 years. Growth velocity had a significant association with gender, mother’s residency, multiple pregnancies, gestational age, and exclusive breastfeeding (p<0.001). A significant association was observed between gender and weight growth velocity (p<0.001). Moreover, exclusive breastfeeding had a significant association with weight growth velocity (p<0.001). Conclusion: Growth velocity in girls was slightly higher than in boys, however, no considerable difference was found between height growth velocity of girls and boys. The findings of this study also indicated that each month increase in exclusive breastfeeding leads to less growth velocity in children. So, exclusive breastfeeding is strongly recommended to prevent childhood obesity.

Prediction of Fluid Responsiveness Using Pulse Pressure Variation in Infants Undergoing Ventricular Septal Defect Repair with Median Sternotomy or Minimally Invasive Right Thoracotomy.

Fluid management is challenging in infants after cardiopulmonary bypass. Pulse pressure variation (PPV) derived from pressure recording analytical method (PRAM) is based on lung-heart interaction during mechanical ventilation. A prospective observational study conducted in operating room tested PPV to predict fluid responsiveness in ventricular septal defect infants. Infants in open chest conditions with median sternotomy (n=26) or minimally invasive right thoracotomy (n=29) undergoing ventricular septal defect repair were enrolled. After cardiopulmonary bypass and modified ultrafiltration, all patients received fluid challenge. PPV was recorded using PRAM along with heart rate, diastolic blood pressure, stroke volume index (SVI), and cardiac index (CI) before and after volume replacement. Patients were considered as responders to fluid loading when CI increased ≥15%. In infants with median sternotomy, 12 were responders and 14 non-responders. PPV in responders was higher than that in non-responders (24.7±6.4 vs. 16.6±5.0%, P<0.01). Area under the curve was 0.85 (95% confidence interval, 0.69-1, P=0.001) and cutoff value 19% with a sensitivity of 92% and a specificity of 71%. In infants with minimally invasive right thoracotomy, 16 were responders and 13 non-responders. PPV in responders was higher than that in non-responders (25.0±6.8 vs. 18.2±5.3, P<0.01). Area under the curve was 0.83 (95 confidence interval, 0.66-0.98, P=0.001) and cutoff value 18% with a sensitivity of 94% and a specificity of 69%. PPV sensitively predicts fluid responsiveness in ventricular septal defect infants after surgical repair in open chest conditions both with median sternotomy and minimally invasive right thoracotomy.

Methylation of the Glucocorticoid Receptor (NR3C1) in Placenta Is Associated with Infant Cry Acoustics.

Epigenetic mechanisms regulating expression of the glucocorticoid receptor gene (NR3C1) promoter may influence behavioral and biological aspects of stress response in human infants. Acoustic features of infant crying are an indicator of neurobehavioral and neurological status not yet investigated in relation to epigenetic mechanisms. We examined NR3C1 methylation in placental tissue from a series of 120 healthy newborn infants in relation to a detailed set of acoustic features extracted from newborn infant cries. We identified significant associations of NR3C1 methylation with energy variation in infants' cries as well as with the presence of very high fundamental frequency in cry utterances. The presence of high fundamental frequency in cry (above 1 kHz) has been linked to poor vocal tract control, poor regulation of stress response, and may be an indicator or poor neurobehavioral integrity. Thus, these results add to evidence linking epigenetic alteration of the NR3C1 gene in the placenta to neurodevelopmental features in infants.

Child and Adolescent Sleep Patterns and Early School Start Times: Recognizing the Role of the Pediatric Nurse

Child and Adolescent Sleep Patterns and Early School Start Times: Recognizing the Role of the Pediatric Nurse

G169(P) Exploring ethnic variation in infants with congenital heart defects undergoing paediatric cardiac surgery

<h3>Introduction</h3> North American researchers have reported ethnic differences in the prevalence and short-term outcomes of congenital heart defects (CHDs), which may reflect genetic variation, environmental exposures or healthcare access. It is unclear whether ethnic differences in CHD frequency and outcomes also exist in the UK population and healthcare system. <h3>Aim</h3> To examine national paediatric cardiac surgical audit data for ethnic differences in the frequency of different CHD subtypes, associated comorbidities and short-term outcomes for infants operated in the first year of life. <h3>Methods</h3> Individual records from the national congenital cardiac surgical audit (NICOR) of UK infants aged under 12 months who had a cardiac surgery or intervention between 01/01/2005 and 31/12/2010, were matched with intensive care admission records in the Paediatric Intensive Care Audit Network (PICANET) and linked records were obtained for 8481 (86%) of operated infants. Census-derived categories for ethnic classification were used. <h3>Results</h3> Children who were operated within the first year of life for major CHD represented 2.2 (95% Confidence Intervals [CI] 2.2, 2.3) per 1000 live births. Compared with children of white ethnicity, children of Asian ethnicity were more likely to have cardiac surgery (2.3 [2.3, 2.4] and 3.2 [3.0, 3.5] per 1000 live births respectively) in the first year of life. CHD subtypes that were significantly over-represented within the Asian ethnic group included single ventricle (SV), transposition of the great arteries, pulmonary atresia, tetralogy of Fallot (TOF) and septal defects; in the Black ethnic group, atrioventricular septal defect and SV were over-represented, while TOF and aortic stenosis were under-represented. Preterm birth occurred in 14% of babies, almost twice the general population rate, and associated non-cardiac anomalies were reported in 21% of affected infants, however no significant ethnic variation was observed. There were 246 deaths during the first year after hospital discharge following surgery but no significant ethnic differences in short-term mortality were identified. <h3>Conclusion</h3> The risk of CHD intervention in infants aged under one year varied by ethnic group, and children of Asian ethnicity were at greater risk. No ethnic differences in short-term post-discharge mortality were identified, however longer-term outcomes should be explored.