Vulnerable Infants Research Articles

Progress in neonate safety

Safety for neonatal intensive care unit (NICU) patients is essential for care of the most vulnerable infants and their families. Education and adaptation of practices that have evidence-based results can lead to improvement in outcomes, even for the most critically ill neonates.1 There are many reviews of quality improvement initiatives in NICUs to reduce complications.2–5 Adverse events can be reduced through quality-improvement methodology.6

POLICIES AND PRACTICES TO ADDRESS THE NEEDS OF HIGHLY VULNERABLE YOUNG CHILDREN AND THEIR FAMILIES

Although the global movement to support early childhood well-being has resulted in the development and expansion of many programs to support early development and learning, most of these programs fall short of meeting the needs of highly vulnerable young children and their families. This paper discusses the complex, multiple needs of these children and their families and the importance of providing them with the comprehensive, customized services needed to address the many challenges these families face, particularly challenges caused by poverty. It includes an examination of the characteristics of programs and services that appear to hold promise for meeting the needs of these families and improving outcomes for highly vulnerable infants and young children, and why such extra-strength programs and services are scarce. The paper then explores the ways in which social workers can engage at both the practice and the policy level to address inequality and other forms of injustice and ensure that these programs and services are sufficiently available to the young children and families who desperately need them.

Introduction of Special Section of Infant Mental Health Journal: Meeting the needs of vulnerable infants and families during COVID-19: Moving to a telehealth approach for home visiting implementation and research.

Parents of infants and young children who experience harsh circumstances are among those most vulnerable to the added stressors associated with COVID‐19. Home visiting models have been shown to enhance outcomes for parents and infants when delivered in person, but in many parts of the world, the pandemic rendered in‐person home visits difficult or impossible. In this special section, we examine adaptations made by home visiting programs to allow continued service delivery through telehealth, and strategies for assessing whether interventions maintain reach and fidelity when implemented remotely. In the first paper, Bullinger et al. (program implementers of SafeCare) provide evidence of the increased risk of maltreatment during COVID‐19 for many families, and thus the need for home visiting services. Rybińska et al., developers and implementers of Family Connects, present evidence regarding their success in reaching families through telehealth. Roben and colleagues, in the third paper, report that clinicians implementing Attachment and Biobehavioral Catch‐up through telehealth maintained fidelity at similar rates seen through in‐person implementation. Finally, Tabachnick et al. describe procedures for collecting physiological data from infants and parents while conducting assessments remotely.

Anatomopathological changes of the autonomic nervous system controlling the respiratory rhythm in sudden infant death: advances over the last 30 years

Sudden infant death syndrome (SIDS) is an irreparable loss for the parents and has life-long consequences for the grieved family Objective: This systematic review aims to compile all the researches conducted so far on the possible involvement of respiratory neuronal structures of brainstem in SIDS Methods: Studies were extracted by using MeSH words “Sudden infant death syndrome, neuropathology” on Pubmed database and also search through hand screening. Results: A total of 114 studies were identified which were later further screened for inclusion criteria such as SIDS cases, original articles and case reports and brain nuclei involved in SIDS, while review articles and editorials were excluded. After further screening 40 studies were shortlisted. All the data was analyzed through excel, yearwise, country wise comparison was also conducted. Maximum studies (24) were published from Italy, most publications were from 2010-2020 (27). Upon final screening according to the inclusion of neuronal brain nuclei studies in SIDS, 27 studies were finalized and used for analysis. Altogether there were 805 SIDS cases and 270 controls reported in these 27 studies. Alterations in the brain nuclei included arcuate nuclei, Dorsal raphe nuclei, preBötzinger complex, vagal nuclei, Kölliker-Fuse complex, Tractus solitarius, Parabrachial Kölliker-Fuse complex, Trigeminal nucleus, Parafacial/facial complex, Dentate gurus and others Conclusions: This study highlights the importance of further research in the underlying mechanisms of SIDS. It should be investigated at neuropathological as well as molecular level to understand the mechanisms. It may guide and help to identify the vulnerable infants and save their lives in future. Key words: Neuropathology, Sudden infant death syndrome, crib death, Cot death, brainstem, breathing

Transitioning to telehealth due to COVID-19: Maintaining model fidelity in a home visiting program for parents of vulnerable infants.

Maintaining treatment fidelity when implementing evidence‐based interventions is a significant challenge. The inability to deliver in‐person services due to the COVID‐19 pandemic critically challenged the foundation of implementation fidelity for home visiting programs across the globe. The Attachment and Biobehavioral Catch‐Up (ABC) program is an evidence‐based home visiting intervention designed to increase sensitivity in parents of infants who have experienced early adversity. ABC's community effectiveness is due to rigorous fidelity monitoring and supervision. Fidelity is measured by microanalytic coding of parenting opportunities and “in‐the‐moment” commenting, the active ingredient of ABC. In this study, we examined intervention fidelity among parent coaches implementing ABC through telehealth. Random 5‐min clips from 510 telehealth ABC session videos conducted by 91 parent coaches at 48 agencies were coded for their frequency and quality of in‐the‐moment comments. On average, parent coaches were able to exceed in‐person commenting fidelity standards when implementing ABC through the telehealth format. The active fidelity monitoring and supervision inherent to ABC's dissemination afforded a smooth transition to implementing ABC through telehealth while adhering to fidelity standards. Procedural and clinical challenges to telehealth implementation are discussed, along with future directions for telehealth program effectiveness.

46 ‘Born Too Soon’ Virtual Simulation for Ambulance Services On Premature Babies Born Unexpectedly in the Community

Premature infants are at risk of death or neurodevelopmental impairment unless prompt effective care is delivered The aim of the study was to introduce a recurring virtual simulation workshop for WMAS on optimizing the initial care for vulnerable premature infants born unexpectedly in the community.Our local WMAS lead identified a training need through informal feedback from paramedics about the lack of training and confidence in dealing with premature births. Our workshop, designed to address this need, begins with an overview of prematurity. A simulation session follows, demonstrating basic Neonatal Life Support skills using equipment available to pre-hospital teams, focussing on thermoregulation. It concludes with a question-and-answer session. To enhance pre-hospital thermal care, we also put forward a successful business case for heated gel mattresses to be introduced across the WMAS and incorporated training for its use in the workshop.Two virtual training workshops have been delivered so far. In 2020, seven paramedics attended, and two completed the feedback and found the session valuable. After advertising, a second workshop was delivered in March 2021. Over 330 WMAS personnel registered, 219 attended and 132 gave feedback. There were representatives of various grades from 16 hubs across the region. Before the session, 12.2% of participants reported feeling somewhat confident/confident attending unplanned premature births of infants <32 weeks’ gestation. Following the session, this improved to 66.7% of participants. Attendees commented on how ‘useful’, ‘fabulous’ and ‘fantastic’ they found the session. The sharp rise in interest in this virtual workshop confirms the training need whilst the positive feedback highlights the effectiveness of the virtual simulation workshop. With enhanced technical support, we will improve the learning experience of participants in the future. This project also led to the successful introduction of heated gel mattresses which are now carried on every WMAS ambulance. We expect that with increased staff training and confidence, the incidence of babies admitted with hypothermia following an unexpected birth in the community will improve with time. Our vision is to expand this project to other regions to empower pre-hospital staff to support premature infants born unexpectedly in the community and improve outcomes.

Rotavirus Vaccine Safety and Effectiveness in Infants With High-Risk Medical Conditions.

Rotavirus vaccination has 87% to 100% effectiveness against severe rotavirus acute gastroenteritis (AGE) in healthy infants in high-income countries. Little is known whether infants with medical risk conditions (MRCs) are equally protected and if the vaccine is equally well tolerated. We conducted a quasi-experimental prospective multicenter before-after cohort study to assess the vaccine effectiveness (VE) and safety profile of the human rotavirus vaccine (HRV) among MRC infants that required prolonged or frequent postnatal care. The Netherlands has no national rotavirus immunization program, but HRV was implemented in routine care for MRC infants in 13 Dutch hospitals. Participants in the before and after cohort, HRV unvaccinated and vaccinated, respectively, were followed for occurrence of (rotavirus) AGE. VE of at least 1 dose was estimated by using time-to-event analysis for severe rotavirus AGE. Vaccine-related serious adverse event (AEs) after HRV were retrieved systematically from medical charts. Solicited AEs after vaccinations were prospectively collected and compared between vaccination time points with or without HRV. In total, 1482 high-risk infants with MRC were enrolled, including 631 in the before and 851 in the after cohorts; 1302 infants were premature (88.3%), 447 were small for gestational age (30.2%), and 251 had at least 1 congenital disorder (17.0%). VE against severe rotavirus AGE was 30% (95% confidence interval [CI]: -36% to 65%). Overall, the observed number of rotavirus hospitalizations was low and not significantly different between the cohorts (2 and 2, respectively). The rate of vaccine-related serious AE was 0.24 per 100 vaccine doses. The adjusted risk ratio for any AE after HRV vaccination compared with other routine vaccinations was 1.09 (95% CI: 1.05 to 1.12) for concomitant administration and 0.91 (95% CI: 0.81 to 0.99) for single HRV administration. Gastrointestinal AEs were 10% more frequent after HRV. In contrast to previous findings among healthy term infants, in routine use, HRV offered limited protection to vulnerable medical risk infants. HRV is generally well tolerated in this group in single administration, but when coadministered with routine vaccines, it is associated with higher risk of (mostly gastrointestinal) AE. Our study highlights the importance of studying vaccine performance in subgroups of medically vulnerable infants.

ASSESSMENT OF VACCINE WASTAGE IN A TERTIARY CARE CENTRE OF DISTRICT CUTTACK, ODISHA

BACKGROUND: Vaccine wastage is dened as loss by use, decay, erosion or leakage or through wastefulness. Vaccine wastage is an important factor in forecasting vaccine needs. Despite the concerted efforts of the government and other health agencies, a large proportion of vulnerable infants and children remain unimmunized in India and one of the rationales behind it is mismanagement of vaccine logistics. OBJECTIVE: To monitor Vaccine Wastage at the Immunization Clinic in a Tertiary Care Hospital. 2.To assess Vaccine Wastage Rate (VWR) and Vaccine Wastage Factor (VWF)or wastage multiplication factor of different vaccines administered. 3.To compare the VWR and VWF of different vaccines. METHODS: Record based descriptive study carried out in an Immunization clinic of a tertiary center at SCB Medical College, Cuttack. All children who got vaccinated in the immunization clinic between 1st April 2018 and 31st July 2018 were included in the study. Number of vaccine vials issued and number of children vaccinated for was obtained from immunization register. Vaccine wastage rates and Wastage factor were calculated. RESULTS: Vaccine wastage rate (VWR) and Wastage multiplication factor (WMF) was highest for BCG and was lowest for Pentavalent vaccine. VWF or WMF for vaccines of 10 dose preparations (BCG, DPT, DT and TT) was 2.0, i.e highest for BCG (3.4) and lowest for vaccines of 5 dose preparations (Measles), i.e 1.8. Wastage factor and wastage rate were higher in lyophilized vaccines (2.86 and 64.86% respectively) compared to that of liquid vaccines i.e. (1.40 and 28.36% respectively). CONCLUSION: Monitoring vaccine wastage is useful as a programme monitoring tool to improve programme quality and increase the efciency of the programme. Such monitoring can provide good guidance on the introduction of corrective actions to reduce wastage whenever necessary.

Pain Behavioural Response to Acoustic and Light Environmental Changes in Very Preterm Infants.

Noise and high light illumination in the neonatal intensive care unit (NICU) are recognized as stressors that could alter the well-being and development of vulnerable preterm infants. This prospective observational study evaluated the pain behaviours of very preterm infants (VPIs) to sound peaks (SPs) and light levels variations (LLVs) in the NICU. We measured spontaneously occurring SPs and LLVs in the incubators of 26 VPIs over 10 h. Their behavioural responses were analysed through video recordings using the “Douleur Aigue du Nouveau-né” (DAN) scale. We compared the maximum DAN scores before and after environmental stimuli and the percentage of VPIs with a score ≥ 3 according to the type of stimuli. A total of 591 SPs and 278 LLVs were analysed. SPs of 5 to 15 dBA and LLVs significantly increased the maximum DAN scores compared to baseline. The occurrence of DAN scores ≥ 3 increased with both stressors, with a total of 16% of SPs and 8% of LLVs leading to quantifiable pain behaviour. Altogether, this study shows that VPIs are sensitive to SPs and LLVs, with a slighter higher sensitivity to SPs. The mechanisms leading to pain behaviours induced by noise and light changes should be evaluated further in the context of VPIs brain development. Our results provide further arguments to optimize the NICU sensory environment of neonatal units and to adapt it to the expectations and sensory abilities of VPIs.

Complementary Feeding Hygiene Practice and Associated Factors Among Mothers with Children Aged 6–24 Months in Tegedie District, Northwest Ethiopia: Community-Based Cross-Sectional Study

Introduction: The hygienic practices of mothers during complementary feeding are crucial in the protection of vulnerable infants and children aged 6–24 months from childhood communicable diseases like diarrhea and malnutrition. However, sufficient evidence on the hygienic practices of mothers during complementary feeding and their associated factors is limited. Objective: To determine the levels of complementary feeding hygiene practice and its associated factors among mothers of children aged 6–24 months in the Tegedie district, northwest Ethiopia. Methods: A community-based cross-sectional study was conducted from March 17 to April 17, 2021, among 576 mothers with children aged 6–24 months in the Tegedie district, northwest Ethiopia. A multistage sampling technique was used to select the study participants. Data were gathered using a structured questionnaire administered by an interviewer and entered into Epi-data version 4.6 before being exported to SPSS version 20.0 for cleaning and further analysis. Bivariate and multivariable binary logistic regression analyses were employed to identify predictors of complementary feeding hygiene practice with p-value < 0.25 that entered into the multivariable logistic regression model. Then variables with a p-value of 0.05 in multivariable logistic regressions were considered statistically significant. Results: The prevalence of hygienic practice during complementary feeding of their children aged 6–24 months was 33.6%, with 95% (CI 29.7% to 37.6%) of them having good practice. Living in an urban area [AOR = 7.02, 95% CI: (4.14, 11.88)], the presence of a handwashing facility near the latrine [AOR = 3.02, 95% CI: (1.18, 7.70)], the presence of a separate area to store raw and cooked foods [AOR = 5.87, 95% CI: (2.84, 12.13)], and the presence of a three-compartment dish washing system [AOR = 5.70,CI: (3.41, 9.54)] were predictors of practicing good hygienic complementary feeding. Conclusion and Recommendation: The prevalence of good hygienic practices during complementary feeding among mothers is still low; the district health office and health extension workers should work to improve maternal hygienic practices during complementary feeding

CLOTHES DEVELOPMENT BASED ON METHODS OF HANDLING OF PREMATURE BABIES IN THE INTENSIVE CARE UNIT

The health of children born prematurely remains a significant challenge, but clothing products designed considering medical requirements and handling methods used in the intensive care unit, may contribute to the reduction of neonatal mortality. Assistants in the therapy unit implement practices based on the needs of vulnerable infants, from the very first second of life. This pilot clinical study was conducted in a specialised on neonatal intensive care unit, at the IMSP Municipal Clinical Hospital Gheorghe Paladi from Chisinau. Informed consent of parents and/or careers was required. All users (nurses and doctors) were informed about the product and instructed regarding dressing and undressing process. This controlled study was conducted under the supervision of doctors and nurses. As the study was exploratory in nature, aspects of grounded theory have been used for qualitative data collection. The sample studied consists of preterm infants less than 30 weeks GA, admitted by UTIN in 2018. The population eligible for qualitative data collection was made up of neonatology nurses from the clinic. To obtain a heterogeneous sample, aspects such as age, work experience, environment, and education were considered. The method of observation and subsequent testing used of the newly designed products and every manipulation under medical conditions was intensely studied. Local reactions, if any, due to the texture and quality of the textile material that come into contact with the baby's skin, were also carefully monitored. The process of dressing and stripping off the products, carrying out medical manipulations (in case of neonatal emergencies), were also carefully observed for developing ease of use clothes.

Hypoglycemic status in low birth weight neonates during first 24 hours of life after birth

Objective: The study aimed to determine the frequency of hypoglycemia in low birth weight neonates during the first 24 hours of life after birth.
 Materials and Methods: This cross-sectional study was conducted from 1st March 2016 to 31st August 2016 in the NICU and postnatal ward of POF Hospital, Wah Cantt. All the babies with birth weight less than 2.5 kg including preterm and term were included in the study. After the aseptic measure blood, sugar was checked and a value less than 45 mg/dl was labelled as hypoglycemia.
 Results: Out of 96 neonates,51 (53%) were male and 45 (47%) were female. The minimum weight of the patient was 1.6kg and the maximum was 2.40 kg. Hypoglycemia was noted in 49 (51%) babies after 2 hours of birth whereas 36 (37.5%) had hypoglycemia at 4 hours and 13 (13.5 %) had at 24 hours. 68 (70.8%) babies included in the study were appropriate for gestational age (AGA) and 28 (29.1%) babies were small for gestational age (SGA). After 2 hours of birth, hypoglycemia was present more in SGA babies i.e.20 (71.4%) as compared to AGA babies i.e. 29 (42.6%) which had statistical significance also (p-value 0.01).
 Conclusion: Neonatal hypoglycemia is a well-recognized complication in newborns and low birth weight infants are more susceptible to hypoglycemia. Early identification of vulnerable infants and the use of preemptive measures can result in better outcomes.

Population Pharmacokinetics Modeling of Vancomycin Among Chinese Infants With Normal and Augmented Renal Function.

There have been good amounts of population pharmacokinetics (PPK) models of vancomycin for Chinese pediatric patients, but none of them had a special focus on modeling infant population with different levels of renal function. Since renal function variability is prominent among infant population and the clearance (CL) of vancomycin is heavily related to renal excretion, it is important to establish precise PPK models based on individual renal function levels. We employed a PPK approach to develop three models of vancomycin in parallel for Chinese pediatric patients with normal renal function [estimated glomerular filtration rate (eGFR) between 30 and 86 ml/min/1.73 m2, Model 1], with augmented renal function (eGFR ≥ 86 ml/min/1.73 m2, Model 2), or with all levels of renal function (Model 3). Three one-compartment models with first-order elimination kinetics were established. The predictive ability of Model 1 and Model 2 among each certain population is comparable with that of Model 3 with no statistical difference. Our study revealed that among the infant population with augmented renal function, only body weight was included as a covariate, which indicated that for an infant whose eGFR ≥ 86 ml/min/1.73 m2, taking blood sample is not compulsory for predicting vancomycin blood concentration, which avoids unnecessary injury to vulnerable infants.

A Statewide Evaluation of the Breastfeeding Resource Nurse Model

ObjectiveTo evaluate a statewide initiative to increase the provisioning of human milk in NICUs. DesignA survey of nurses before participation in an educational session, immediately after education, and again 9 months later. SettingNurses from 22 hospitals throughout Florida. ParticipantsWe surveyed 121 participants, including some nurses who had prior breastfeeding education or certification as well as those without specialized breastfeeding training. InterventionAn educational project called the Breastfeeding Resource Nurse Master program was intended to educate NICU nurses to implement the “Ten Steps to Promote and Protect Human Milk and Breastfeeding in Vulnerable Infants.” MeasurementA quantitative needs assessment survey was administered to participants to determine current hospital practices, policies, and perceived areas for improvement. Pre- and immediate posttraining surveys assessed NICU nurses’ knowledge, attitudes, and beliefs about human milk feeding of critical care infants and their self-efficacy for implementing the program in their respective NICUs. A follow-up, open-ended survey was administered at 9 months to yield information on program implementation. ResultsNICU breastfeeding practices varied widely at baseline. Nurses’ scores for knowledge, beliefs, and behavioral intentions improved postsession, but the implementation of practice changes related to the Ten Steps for Vulnerable Infants proved difficult. Nurses identified insufficient time and resources as barriers to educating others and changing practice. ConclusionsPolicies and regulations that make hospitals accountable for increasing human milk provision to vulnerable infants may be necessary to ensure that hospitals devote adequate resources to implementing practice changes in this area.

Prevalence and associated factors of long-term growth failure in infants with congenital heart disease who underwent cardiac surgery before the age of one

Prevalence and associated factors of long-term growth failure in infants with congenital heart disease who underwent cardiac surgery before the age of one

Risk factors of infant mortality in rural The Gambia: a retrospective cohort study

ObjectiveThe main objective was to assess the risk factors for infant mortality among children living in the Health and Demographic Surveillance System (HDSS) in Farafenni, The Gambia. Our secondary objective...

Sex Differences in Gut Microbial Development of Preterm Infant Twins in Early Life: A Longitudinal Analysis.

Infant gut microbiota plays a vital role in immune response, mediates neurobehavioral development and health maintenance. Studies of twins’ gut microbiota found that gut microbiota composition and diversity tend to be mature and stable with increasing postnatal age (PNA). Preterm infant gut microbiome shifts dramatically when they were staying in the neonatal intensive care unit (NICU). Compositions and shifting characteristics of gut microbiota among neonatal preterm twins and triplets during their early life are still unknown, which impedes a better understanding of the mechanism underpinning neurobehavioral development and precise intervention/health of preterm neonates. This longitudinal cohort study used a twins/triplets design to investigate the interaction of genetic (e.g., male vs. female) and environmental factors influencing the development of the gut microbiome in early life. We included 39 preterm infants, 12 were Female twins/triplets (Female T/T) including 3 twins pairs and 2 triplets, 12 were male twins (Male T) including 6 twins pairs, and 15 were mixed-sex twins/triplets (Mix T/T) including 6 twins pairs and 1 triplet (8 females and 7 males) during the first four weeks of NICU stay. Weekly gut microbiota patterns between females and males were compared by linear discriminant analysis (LDA) effect size (LEfSe). Metagenomics function of gut microbiota was predicted by using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States (PICRUSt). Weekly function (KEGG pathways) differences between females and males were detected by using Statistical Analysis of Metagenomic Profiles (STAMP). Results found that female pairs and male pairs were significantly different in gut microbiome diversity, compositions, and predicted metabolic profiles, importantly, females and males were also significantly dissimilar within their co-twin/triplet pairs of the mixed-sex group, infants of co-twins/triplets shared more similar features than un-related infants from different twins’ pair. Future research developing personalized interventions for vulnerable high-risk infants should consider sex, and the interaction of sex and environmental factors.

Vaccination in pregnancy – The when, what and how?

Immunization is a fundamental component of preventive healthcare. This gain special significance in pregnancy. Maternal antigen-specific IgG, is actively transported across the placenta during pregnancy. This significantly, contributes to infant immunity in the first few months of life. Vaccination during pregnancy has the potential to indirectly protect the most vulnerable infants during the first few months of life, when vaccine responses are generally poor and it is difficult to achieve rapid protection through immunization. This is especially relevant when there is prior exposure to infection in woman or vaccine administration. A vaccine given during pregnancy in these women would result in a booster response and a relatively high level of IgG protecting their children in initial few months of life. Passive antibody transfer from mother to fetus can protect fetuses from infection until their own immunization schedule is initiated.Lack of administration of appropriate vaccination to women during pregnancy lead to an increase in maternal and fetal morbidity and mortality from preventable infections like influenza, pertussis. Various preventable infections can lead to intensive care unit admission for mothers, preterm birth, and low birth weight babies.Recent covid pandemic has brought issue of vaccine use in pregnancy at forefront of all expectant mothers.Immunization with inactivated virus, bacterial vaccine and toxoids showed no evidence of adverse fetal effects.As a rule, live attenuated vaccines are not recommended in pregnancy.This paper gives snapshot of all vaccines, which can be used in pregnancy along with brief details regards various bacterial and viral infections , their common clinical features and effects on pregnancy outcome as well as fetus. This is will provide a useful guide for healthcare providers.

High Mobility Group Box 1 in Pig Amniotic Membrane Experimentally Infected with E. coli O55.

Intra-amniotic infections (IAI) are one of the reasons for preterm birth. High mobility group box 1 (HMGB1) is a nuclear protein with various physiological functions, including tissue healing. Its excessive extracellular release potentiates inflammatory reaction and can revert its action from beneficial to detrimental. We infected the amniotic fluid of a pig on the 80th day of gestation with 1 × 104 colony forming units (CFUs) of E. coli O55 for 10 h, and evaluated the appearance of HMGB1, receptor for glycation endproducts (RAGE), and Toll-like receptor (TLR) 4 in the amniotic membrane and fluid. Sham-infected amniotic fluid served as a control. The expression and release of HMGB1 were evaluated by Real-Time PCR, immunofluorescence, immunohistochemistry, and ELISA. The infection downregulated HMGB1 mRNA expression in the amniotic membrane, changed the distribution of HMGB1 protein in the amniotic membrane, and increased its level in amniotic fluid. All RAGE mRNA, protein expression in the amniotic membrane, and soluble RAGE level in the amniotic fluid were downregulated. TLR4 mRNA and protein expression and soluble TLR4 were all upregulated. HMGB1 is a potential target for therapy to suppress the exaggerated inflammatory response. This controlled expression and release can, in some cases, prevent the preterm birth of vulnerable infants. Studies on suitable animal models can contribute to the development of appropriate therapy.

Prevalence of Malnutrition and Associated Factors of Stunting among 6-23-Month-Old Infants in Central Rural China in 2019.

This study aimed to evaluate the prevalence of malnutrition and to investigate the associated factors of stunting among 6–23-month-old infants in poor rural areas of central China. The China Nutrition Improvement Project on Children in Poor Areas was conducted in 56 national-level poor counties of seven provinces in 2019. We performed a multivariate binary logistic regression analysis to determine the associated factors of stunting. This cross-sectional study included 17,193 infants. The overall prevalence of stunting was the highest (3.9%), followed by overweight (3.0%), underweight (2.1%), wasting (2.0%), and obesity (0.5%). Girls [OR = 0.55, 95% CI (0.46, 0.65)], infants meeting requirements of minimum diversity diet [OR = 0.81, 95% CI (0.67, 0.98)], and mothers with middle-school or high-school education and above decreased the prevalence of stunting. Infants with diarrhea in two weeks [OR = 1.26,95% CI (0.98, 1.62)] were at higher odds of stunting. The malnutrition status in the study areas was improved, and vulnerable infants were found to need additional and earlier monitoring to detect and fundamentally prevent undernutrition.