Young Children Research Articles

Factors Compel Young Generation to Indulge in Cell Phone Use

Background: Cell phone is very important and wonderful communicative tools used by all age group people especially young generation. Extra sense of security and safety is probably one of the main reasons parents even consider getting a younger child a cell phone. This study was designed to assess perception of the people about young generations indulge in cell phone use. Methods: This descriptive cross-sectional study was conducted among 725 respondents selected purposively from areas of Dhaka North City and Dhaka South City Corporation. Relevant data were collected through face-to-face interview with the help of semi-structured questionnaire. Results: Among the total 725 respondents 63.0% were male and the rest 37.0% were female. In Bangladesh the sex ratio is 0.98 (980 males per 1,000 females). Regarding education, it was seen that most were literate (97.2%) having education from non-formal to graduation and above. Majority of the respondents (60.6%) were graduates and above and 20.8% passed higher secondary education. The literacy rate of Bangladesh in the urban area is 81.28 % while in rural area it is 71.56. The rate is higher among the male population which is 76.56%, while among female population it is 72.82%. Adult literacy rate is the percentage of people ages 15 and above whom can both read and write with understanding a short simple statement about their everyday life. One fifth (20.6%) of the respondents were service holders, 17.1% were students, 15.7% were doctors, and 14.1% were businessmen. Conclusion: Cell phone becomes most popular in adolescence students for special feature like social networking and gaming service. Although cell phone is useful and convenient, adolescences are dependent on cell phone more and more for unnecessary communication. Considering its negative impact of cell phone over use on physical and psychosocial health, public health programs should develop preventive strategies. JOPSOM 2023; 42(2): 1-6

The Combination of GS-441524 (Remdesivir) and Ribavirin Results in a Potent Antiviral Effect Against Human Parainfluenza Virus 3 Infection in Human Airway Epithelial Cell Cultures and in a Mouse Infection Model

Human parainfluenza virus type 3 (HPIV-3) can cause severe respiratory diseases, particularly in young children, the elderly and immunocompromised. There are no approved antiviral drugs against this virus. We report that the combination of ribavirin with either remdesivir or its parent nucleoside GS-441524 results in a pronounced antiviral effect against HPIV-3 in LLC-MK2 cells and in human airway epithelial cells grown at the air–liquid interface. In AG129 mice intranasally inoculated with HPIV-3, the combined treatment with ribavirin and GS-441524 decreased infectious viral lung titers by >2.5 log10 to undetectable levels in 4 out of 11 mice and by 1.6 log10 in the remaining 7 mice as compared with the vehicle. The lungs of all mice that received the combined treatment appeared histologically normal or virtually normal, whereas 8 of 11 vehicle-treated mice presented with bronchopneumonia. By contrast, ribavirin alone did not result in a reduction in infectious viral lung titers; GS-441524 alone reduced infectious viral lung titers by 1.2 log10. Moreover, several mice in the single-treatment groups exhibited severe lung pathology. These findings may warrant exploring this combination in patients with severe HPIV-3 infections and possibly also against infections with other viruses that are susceptible in vitro to these two drugs.

An Open Randomized Controlled Trial Comparing Group and Individual Parent-Child Interaction Therapy for Preschoolers with Attention-Deficit/hyperactivity Disorder

ABSTRACT Background Parent-Child Interaction Therapy (PCIT), an evidence-based treatment for children with disruptive behavior, has limited research investigating its efficacy for children with attention-deficit/hyperactivity disorder (ADHD). Objective This study compared group and individual PCIT for young children with ADHD with and without co-occurring disruptive behavior disorders (DBDs). Method This open randomized controlled trial examined group and individual PCIT for 4–6-year-old children (n = 128) with ADHD with and without co-occurring DBDs at pre-treatment, post-treatment, one- and two-year follow-up. Results Parent-reported disruptive behavior and ADHD symptomatology decreased following treatment, regardless of diagnosis or format, with improvements maintained at follow-up. For children with ADHD only, individual PCIT resulted in higher rates of reliable change in disruptive behavior compared to group PCIT. Individual and group PCIT appear to be effective treatments for children with ADHD with or without DBDs. Most children experienced clinically significant ADHD symptom improvement following PCIT, though rates of reliable improvement in disruptive behavior appear greater in children with ADHD only. Conclusions These findings highlight the potential utility of PCIT in both individual and group formats for treating childhood ADHD symptoms and co-occurring disruptive behavior. While this study suggests PCIT may be beneficial as a treatment option for children with ADHD, potentially reducing reliance on medication-based treatments, further research is needed to confirm these results and their generalizability to non-parental contexts.

Playing With Story Workshop in the Literacy Classroom

ABSTRACTMaking connections between children's existing means of expression (play, art, and movement) and the intricacies of print is a necessary and time‐honored approach to writing instruction in the early years of school, yet, after kindergarten, one that is easily overlooked. In this article, we examine an approach to writing instruction for first‐grade children that brings together play and written composition. Story Workshop can be a highly accessible, scaffolded means for developing young children's writing practices and skills. However, it is not an approach that is widely adopted in first‐grade classrooms. The authors consider why this might be by examining the structure of Story Workshop as set out by the Opal School and offering examples of two classroom educators who have fruitfully adapted the approach for their first‐grade learners.

Italian Coma Recovery Scale for Pediatrics (CRS-P): Preliminary Validation in a Sample of Young Children with Typical Development

Background/Objectives: Guidelines for the diagnosis of children with disorder of consciousness (DoC) in pediatric age have not been defined yet. Assessment tools designed for adults have generally not been standardized for pediatrics, which could lead to misdiagnosis due to the limited behavioral repertoire of children. This study aims at examining the basic psychometric properties of the Italian Coma Recovery Scale for Pediatrics (CRS-P) in typically developing children. Methods: A total of 64 typically developing children aged 3 months to 5:7 years were administered the CRS-P. Performance was examined across the age range, and for the two behaviors indicating emergence to a conscious state, namely functional object use (FOU) and functional communication (FC). Results: Inter-rater reliability ranged from 0.95 to 1 for subscale and total scores. All children aged ≥34 months scored at the CRS-P ceiling. All children ≥ 14 months met the criteria for FOU and all children ≥ 34 months met those for FC. Children as early as 3 months of age displayed behaviors discriminating between vegetative state (VS) and minimally conscious state (MCS) in the Visual and Motor subscales. Language-based behaviors of MCS in other subscales were consistently displayed by older children. Conclusions: Typically developing children met the criteria for all items of the Italian CRS-P by 34 months, which suggests caution in adopting the scale at a younger age. However, the features of the distinct stages of DoC could be captured earlier, based on the various subscales. Modifications should be made to some items to improve diagnostic accuracy.

Systematic Review: Fragile X Syndrome Across the Lifespan with a Focus on Genetics, Neurodevelopmental, Behavioral and Psychiatric Associations

Background/Objectives: Fragile X syndrome (FXS) is one of the most common genetic causes of intellectual developmental disability and autism spectrum disorder (ASD), second only to Down’s syndrome and associated with a broad range of neurodevelopmental, behavioral, and psychiatric challenges. FXS may be present in infants or young children with characteristic dysmorphic features, developmental delays, and behavioral challenges. The diagnosis of FXS is confirmed by the molecular genetic testing of the FMR1 gene encoding fragile X messenger RNA-binding protein (FMRP), involved in regulating the translation of multiple mRNAs which play a key role in neuronal development and synaptic plasticity. Understanding the genetic cause, pathophysiology, and natural history of FXS is crucial for identifying commonly associated comorbidities, instituting effective therapeutic interventions, and improving long-term outcomes. Methods: This systematic review employed a comprehensive literature search using multiple electronic databases including PubMed, Web of Science, and Scopus with keywords related to fragile X syndrome, lifespan, genetics, neurodevelopmental, behavioral, and psychiatric disorders. Results: FXS is associated with an increased risk for specific neurodevelopmental, or psychiatric disorders. Symptoms and challenges associated with FXS vary based on multiple factors, including genetic differences, age, sex, comorbid conditions, various environmental influences, the availability of support, and opportunities for therapeutic interventions. Knowledge of these associations helps guide caregivers and clinicians in identifying potentially treatable conditions that can help to improve the lives of affected patients and their families. Conclusions: The focus of this article is to explore and describe the genetic underpinnings of FXS, identify associated developmental, behavioral, and psychiatric conditions over the lifespan, and provide a review of clinical features, therapeutic interventions including investigational treatments, and current research updates.

Association Between Early Childhood P300 Deficits and Risk for Preadolescence Depressive Disorder Mediated by Responsiveness to PCIT-ED Treatment.

Preschool-onset major depressive disorder (PO-MDD) is an impairing pediatric mental health disorder that impacts children as young as three years old. There is limited work dedicated to uncovering neural measures of this early childhood disorder which could be leveraged to further understand both treatment responsiveness and future depression risk. Event-related potentials (ERPs) such as the P300 have been employed extensively in adult populations to examine depression-related deficits in cognitive and motivational systems. Few studies examine the prospective relationships between depression and P300, especially in young children. Moreover, limited research examines the relationship between P300 with psychotherapy treatment responsiveness in youths. The current study sought to examine the prospective relationships between pre-intervention P300 (i.e., choice-locked) elicited from the doors task in depressed preschool children (i.e., PO-MDD; ages 3-to-6) with reductions in depressive symptoms after completing an 18-week long dyadic psychotherapy intervention (n = 59). We also explored relations to risk for depression assessed at a follow-up visit during preadolescence (ages 8-to-12; n = 82). Those with PO-MDD exhibiting reduced choice (doors)-locked P300 demonstrated worse treatment response to psychotherapy and were more likely to meet criteria for depression during preadolescence. Moreover, the relationship between pre-intervention P300 and later preadolescence depression was significantly mediated by response to treatment. These findings suggest that deficits in brain systems linked to the choice-locked P300 component (i.e., cognitive and motivational) might be indicative of non-responsiveness to early dyadic psychotherapeutic intervention efforts for depression which impacts risk for recurrent patterns of depression in youths.

The Epidemiology and Clinical Burdens of Human Parainfluenza Virus Infections Amongst Hospitalized Children Under 5 Years of Age in Jordan: A National Multi-Center Cross-Sectional Study

Human parainfluenza virus (HPIV) is a major cause of respiratory illnesses in children under five years, with clinical manifestations ranging from mild upper respiratory tract infections to severe lower respiratory tract diseases. This multi-center, cross-sectional study investigated the burden, clinical features, and predictors of respiratory viral infections in hospitalized children across four sites in Jordan. Nasopharyngeal specimens from 1000 eligible children were analyzed. In this article, we focused on HPIV infections. The overall HPIV positivity rate was 22.6%, with HPIV-3 accounting for 90.3% of cases. Significant geographic variability was observed, with higher positivity rates in the southern region. HPIV-positive cases frequently presented with symptoms like nasal congestion, tachypnea, and poor feeding. Co-infections with respiratory syncytial virus (RSV) or influenza were associated with worse outcomes, including an increased need for invasive ventilation. The logistic regression identified male gender, asthma, and respiratory acidosis as predictors of complications. Geographic differences in HPIV prevalence and severity were notable, emphasizing the influence of environmental and socioeconomic factors. These findings underscore the urgent need for enhanced HPIV surveillance, targeted public health interventions, and vaccine development to mitigate the disease burden. This study provides critical insights that guide healthcare strategies and improve outcomes in young children at risk of severe HPIV infections.

Molecular Mechanisms of Vascular Tone in Exercising Pediatric Populations: A Comprehensive Overview on Endothelial, Antioxidative, Metabolic and Lipoprotein Signaling Molecules

Vasoactive molecules are central regulators of vascular tone, angiogenesis and inflammation. Key molecular agents include nitric oxide (NO), endothelin-1 (ET-1), prostacyclin, free triiodothyronine (fT3), leptin, low-density lipoprotein (LDL), high-density lipoprotein (HDL), superoxide dismutase (SOD), and glutathione peroxidase (GPX). Dysregulation of these compounds can lead to endothelial dysfunction, an early predictor of atherosclerosis and cardiovascular diseases (CVD). Maintaining endothelial health is thus essential for vascular homeostasis and cardiovascular risk prevention. Regular exercise serves as a vital protective measure against CVD and the risk of cardiovascular conditions. However, young athletes often significantly exceed recommended levels of training load, engaging in highly intensive training that leads to substantial physiological adaptations. Despite this, research on the impact of exercise on vasoactive substances in children and adolescents, particularly young athletes, is limited and inconsistent. Most studies focus on those with pre-existing conditions, like obesity or diabetes mellitus. Existing findings suggest exercise may favorably affect vascular biomarkers in youth, but methodological variations hinder consistent conclusions. This literature review examines 68 studies on the effects of exercise on vascular molecules in children and adolescents, young athletes, and children and adolescents with pre-existing conditions, offering deeper insights into how exercise may influence vascular health at the molecular level.

Narratives of Chinese kindergarteners with Autism spectrum disorder: Comparison with typically developing children

ABSTRACT Autism spectrum disorder (ASD) is an early-onset neurodevelopmental disorder characterised by highly heterogeneous language abilities. These variations necessitate sensitive and comprehensive assessments, with narrative analysis being an effective method. This study aimed to examine the micro- and macrostructural aspects of narratives of Mandarin-speaking children with ASD. 19 children with ASD (mean age = 5.57 years; standard deviation [SD] = 1.09) and 19 age-matched typically developing (TD) children (mean age = 5.14 years; SD = 0.09) were enrolled in this study. The Narrative Assessment Protocol (NAP-2) was used to obtain the children’s narrative samples. Children’s wordless picture book-based narrations were analysed for story length (total number of words and utterances), linguistic abilities (mean length of utterances, mean length of the five longest utterances, number of different words, and vocabulary diversity), and NAP-2 scores (total scores, story grammar, storytelling convention, simple sentence structure, complex sentence structure, word and phrase). After applying Bonferroni’s adjustment (α = 0.0042), no significant differences were observed in linguistic performance or story length between the two groups. However, children with ASD showed significantly lower total scores (t = 3.25, p = 0.002), story grammar scores (t = 3.17, p = 0.003), and storytelling convention scores (t = 3.04, p = 0.004). These findings suggest that young Chinese children with ASD may exhibit comparable microstructural narrative abilities but face significant challenges in macrostructural narrative skills, such as organising episodic structures. This underscores the need for targeted interventions to enhance the macro-narrative skills in this population.

Longitudinal measures of peripheral optical quality in young children.

To assess longitudinal changes in optical quality across the periphery (horizontal meridian, 60°) in young children who are at high (HR) or low risk (LR) of developing myopia, as well asa small subgroup of children who developed myopia over a 3-year time frame. Aberrations were measured every 6 months in 92 children with functional emmetropia at baseline. Children were classified into HR or LR based on baseline refractive error and parental myopia. Zernike polynomials were calculated for 4 mm pupils, accounting for the elliptical shape of the pupil in the periphery. Various metrics were computed, including Strehl Ratioswith only high-order aberrations (HO-SR). Primary spherical aberration (SA), horizontal coma and defocus were also analysed given their relevance in emmetropisation. The areas under the image quality metrics for various regions of interest were computed. HO-SR were higher in children at HR and children with myopia, even when SA was removed from the Strehl Ratio (SR) calculation. SA was less positive in children at HR and children with myopia. Defocus was more negative in children at HR and children with myopia at all eccentricities and was even more negative when computed relative to the fovea, an effect that increased in the mid periphery. Relative peripheral defocus also became more negative over time in children at HR and children with myopia at the mid temporal retina. The other aberrations showed no significant changes in time overall. This longitudinal study showed differences in HO-SR, SA and defocus in the central and near-peripheral retina (±20°) of young children at HR before they develop myopia compared with children at LR for myopia. The results may indicate these eccentricities are significant in providing signals for emmetropisation. The small changes noted over time may indicate that the differences are a cause of myopia development.

Schistosomiasis treatment in young children: a welcome step towards deployment of the paediatric praziquantel formulation.

It is an awkward fact that effective public health control of schistosomiasis in Africa has yet to deliver a fully comprehensive intervention for appropriate anthelmintic treatment of those preschool-age children and infants with active infection(s) and/or insidious disease. Over the last decade, despite the steady progress of the Pediatric Praziquantel Consortium in developing a monoenantiomeric oral dispersible tablet, future challenges remain in securing its deployment and implementation at scale. This commentary provides a forward-looking critique for the international community, reminding us of this unfortunate treatment gap, and seeks to encourage commensurate action on ameliorating this overlooked medical inequity.

HEALTH RISK ASSESSMENT IN RURAL WOMEN ON EXPOSURE TO DOMESTIC INDOOR AIR POLLUTION BY COMBUSTION OF BIOMASS FUELS

Biomass fuels, derived from plants and animals, are intentionally burned by humans for various purposes, including cooking. However, the combustion of biomass fuels, such as wood, animal dung, and crop residues, often occurs in open fires, resulting in high indoor and outdoor air pollution. This poses significant health risks, particularly for women and young children. In this study conducted in villages around Meerut city in Western Uttar Pradesh, India, the focus was on rural integrated women's health, specifically those using biomass fuel for cooking. The research included three age groups of women exposed to biomass fuel and a control group using cleaner alternatives like LPG and biogas. Hematological parameters, including hemoglobin, red blood cell count, total leukocyte count, and platelet count, were analyzed to assess the impact of biomass fuel exposure on health. The study involved 180 women from 15 villages, and blood samples were collected to evaluate immunological, hematological, and biochemical parameters. Results indicated that women exposed to biomass fuel exhibited significant alterations in hematological parameters, including lower hemoglobin levels, reduced red blood cell counts, and changes in platelet counts. These findings suggest a potential association between biomass fuel exposure and health issues such as tuberculosis infection, decreased immunity, respiratory disorders, cataracts, liver dysfunction, kidney disorders, and anemia. The study emphasizes the detrimental effects of indoor air pollution from biomass fuel smoke on the health of rural women. The observed alterations in hematological parameters highlight the urgent need for interventions to reduce biomass fuel usage and mitigate health risks in these communities. This research contributes valuable insights into the complex relationship between indoor air pollution and its adverse health effects, particularly among women in rural settings.

Considerations and expectations for the administration of dispersible arpraziquantel to young children: a landscape analysis.

Schistosomiasis is a serious public health problem in many African countries and beyond. Preventive chemotherapy with praziquantel is a successful public health intervention that is recommended for all communities at risk, commonly reached through large-scale mass drug administration campaigns. However, preschool-age children are currently not routinely targeted for treatment due to operational challenges related to dosing and administration with the standard drug formulation. In response to the need for a suitable, child-friendly treatment, the multistakeholder Pediatric Praziquantel Consortium has developed a novel dispersible tablet with improved taste and smaller size. To prepare the introduction and inform future uptake of the novel paediatric formulation in endemic countries, we conducted a landscape analysis to explore perspectives, opinions and experiences of key stakeholders on operational and practical issues in relation to drug dosing and administration. Our findings confirm that child-friendly drug formulations mitigate several operational constraints related to the dosing and administration in young children. The introduction of this novel child health intervention into routine platforms and programs requires solid training and careful communication by engaging with communities, caregivers, healthcare workers and decision-makers to ensure acceptance and future uptake of treatment.

Behavioural interventions targeting the prevention and treatment of young children's mental health problems in low- and middle-income countries: a scoping review.

Globally, 10% of children and adolescents live with mental health problems and often lack high-quality care. Over 80% of people facing mental health issues reside in low- and middle-income countries (LMICs). Failing to address children's mental health may prolong these challenges into adulthood, impeding their chances for a healthy life. This scoping review aims to describe the types, implementation strategies, effectiveness, and gaps of existing interventions for preventing and treating mental health problems in early childhood (<10 years) in LMICs. The study employed a scoping review of experimental studies published 2007-2023. Major databases including PubMed, Embase, Web of Science, and PsycINFO were searched using key terms related to the population (children), intervention (mental and/or behavioural health programmes), and outcome (mental health problems). Three authors independently conducted search strategy, article screening, data extraction, and quality assessment. The findings were presented using descriptive analysis and narrative synthesis. Of 39 499 identified articles, 33 were included in the study, covering 7629 children and published between 2009-2022. Seventeen studies (51.5%) were from upper-middle-income countries, 13 (39.4%) were from lower-middle-income, and three (9.1%) were from low-income countries. Enrolment was community-based in 23 studies and health-facility based in 10 studies; the majority (79%) focused on children aged 3-8 years old. Almost two-third (63.6%) of studies were conducted in urban settings. Programmes encompassed various interventions such as parenting programmes (33.3%). A majority of studies (57.5%) employed group therapy for delivering the programme, with mental health professionals (21.2%) acting as the primary intervention providers. Interventions were primarily received by children (39.4%), followed by mothers/caregivers (33.3%). Most studies explored disruptive disorders (20 studies), social and behavioural problems (16 studies), and anxiety disorders (12 studies). Statistically significant intervention effects on child mental health outcomes were reported for 90% of published studies. Diverse behavioural programmes that improve the mental health of young children are available and effective in LMICs. Most interventions were delivered in urban settings and focus was on the use of health care professionals. Diverse intervention approaches, including parenting programmes and group therapy, were effective in addressing various mental health issues among young children.

Rethinking transnational parenting: Chinese immigrant parents’ family separation during COVID-19

ABSTRACT Despite recent studies on cross-border immobility associated with COVID-19, little attention has been paid to the resulting prolonged separation of transnational families. This study attempts to fill this gap by examining the experiences of immigrant parents who were separated from their young children across national borders during the pandemic. Drawing on 42 in-depth interviews with parents of Chinese transnational families in Spain, this study examined the impact of global mobility restrictions related to the COVID-19 pandemic on transnational immigrant families’ separation experiences. Our findings indicate that following the disruptions caused by the pandemic, immigrant parents had to postpone family visits and reunification with their children, ultimately causing stress and frustration. The disruptive life experiences caused by COVID-19 have raised awareness of the distance between immigrant parents and led Chinese families to rethink their transnational parenting practices. This study contributes to our knowledge of transnational parent−child relationships and how they are shaped by (im)mobility regimes and state interventions in times of crisis. Beyond the context of COVID-19, this study calls to look beyond the current frameworks of structural constraints on immigration policies and extend attention to the uncertainties associated with the changing global context in which transnational parenting is embedded.

Adaptive cognitive control in 4 to 7-year-old children and potential effects of school-based yoga-mindfulness interventions: an exploratory study in Italy

IntroductionRecent findings showed that adaptive cognitive control (CC) can be instantiated by bottom-up mechanisms, including statistical contingency of event occurrence. However, the developmental evidence in this domain remains limited.MethodsTo address this gap, our study delves into the exploration of different mechanisms underlying adaptive CC in a substantial cohort of young children (211 participants aged between 4 and 7 years). We utilized the Dynamic Temporal Prediction (DTP) task and a modified version of the Flanker task to assess the effect of context predictability on motor preparation/inhibition and interference control, respectively. Furthermore, as part of an exploratory study designed to evaluate the feasibility of a school-based program in Italy, all children underwent a re-testing session after an 8-week intervention involving yoga-mindfulness.ResultsResults suggested that young children can exploit global probabilistic changes to optimize motor preparation/ inhibition while counterbalancing fatigue effects. Moreover, they successfully modulate interference control as a function of environmental contingencies, displaying more optimal conflict resolution when proactive control is engaged. Finally, we observed a post-intervention increase of the capability to implicitly adapt motor preparation/inhibition and a boosting effect on the interference control functions.DiscussionOverall, these findings confirmed that adaptive CC is already present in preschool-aged children, extending these results to include 4-years-olds. Additionally, school-based yoga-mindfulness programs are feasible and might improve children’s capability to flexibly and proactively adapt to environmental requests promoting cognitive proficiency.

Extended Treatment Duration of Artemether-Lumefantrine in Ugandan Children with HIV on Efavirenz-Based Antiretroviral Therapy: A Randomized Controlled Pharmacokinetic and Pharmacodynamic Trial.

Malaria and HIV co-infection are prevalent in sub-Saharan Africa causing significant drug interactions with co-treatment. We previously reported a 30%-70% reduction in exposure to the standard 3-day (6-dose) artemether-lumefantrine (AL) treatment for malaria when given with efavirenz-based HIV therapy, impacting malaria reinfection risk. We conducted a prospective, randomized study comparing the 3-day regimen to an extended 5-day (10-dose) regimen with pharmacokinetic sampling for artemether, dihydroartemisinin, lumefantrine, and desbutyl-lumefantrine (DBL) over 42 days. The primary outcome was comparative pharmacokinetics between regimens compared among children with HIV and among children without HIV receiving a 3-day regimen as controls (median age 5.3 years [range 1.4-13.9]; median weight 17.3 kg [range 8.7-39.1]). Children with HIV (n = 57; median age 10.8 years [range 3.4-17.1]; median weight 26.6 kg [range 14.6-54.5]) contributed 76 malaria episodes, with 71 included in the analysis. Another 97 children without HIV (median age 5.3 years [range 1.4-13.9]; median weight 17.3 kg [range 8.7-39.1]) contributed 114 episodes of malaria, with 109 included in the analysis. In the setting of efavirenz, artemether, dihydroartemisinin, lumefantrine, and DBL cumulative exposure was 2.09, 2.31, 1.90, and 1.65 fold higher with 5-day versus 3-day AL (all P <.001), and comparable to 3-day AL in children without HIV. The extended regimen in children with HIV did not result in a statistically significant reduction in recurrence risk at 28 or 42 days. Extending the duration of AL to 5 days compensated for a clinically significant reduction in all components of AL in the context of EFV-based antiretroviral therapy in young children.

Cognitive Outcomes and Delirium After Cardiac Neurodevelopmental Program Implementation for Children With Congenital Heart Disease

A recent advisory from the American Heart Association delineated the potential benefits of developmental care for hospitalized children with congenital heart disease (CHD) and a critical gap in research evaluating the association of such inpatient programs with neurodevelopmental outcomes. To investigate associations between the Cardiac Inpatient Neurodevelopmental Care Optimization (CINCO) program interventions, delirium, and neurodevelopment in young children (newborn through age 2 years) hospitalized with CHD. This cohort study used quality improvement data from inpatient cardiac units at a tertiary care children's hospital in the US. Participants were children aged 0 to 2 years who were admitted for at least 7 days from September 1, 2018, to September 1, 2023. The CINCO program was implemented on September 1, 2020, in 6-month plan-do-study-act phases. The 5 CINCO interventions were medical and/or nursing order panels, developmental kits, bedside developmental plans, caregiver mental health support handouts, and developmental care rounds. Number of days with delirium per patient, which was measured using the Cornell Assessment of Pediatric Delirium (a score higher than 9 indicated delirium). Neurodevelopment was measured using the Bayley Scales of Infant and Toddler Development, Fourth Edition (BSID-4). The full sample included 1331 qualifying admissions for 1019 unique pediatric patients (median [range] age at admission, 3.65 [0-34.62] months; 771 males [57.9%]), with a subcohort of 121 unique patients (median [range] age at admission, 0.00 [0-9.85] months; 77 males [63.6%]) whose initial hospitalization occurred before age 10 months and who underwent BSID-4 evaluation at age 12 months or older. The mean (SD) number of days with delirium per patient was stable for 2 years prior to CINCO implementation, decreased by 54.0% between phases 1 and 2 of the CINCO program (from 3.05 [0.60] to 1.38 [0.21]), and then remained stable over time. Each of the 5 CINCO interventions was associated with lower delirium after false discovery rate (FDR) correction (eg, medical and/or nursing order panel: B = -1.376 [95% CI, -1.767 to -0.986]; F2,1273 = 47.767; partial η2 = 0.036; P < .001). Mean (SD) BSID-4 cognitive index scores were stable for 2 years prior to implementation, higher between phases 1 and 2 of the program (from 81.67 [14.14] to 93.92 [19.43]), and then remained stable over time. Four of the 5 interventions were associated with higher BSID-4 cognitive scores after FDR correction (eg, bedside developmental plans: B = 8.585 [95% CI, 2.247-14.923]; F5, 101 = 7.221; partial η2 = 0.067; P = .008). Delirium was associated with lower BSID-4 cognitive scores. There were no associations between delirium and BSID-4 language or motor scores. This cohort study found that among hospitalized children with CHD, the implementation of an inpatient developmental care program was associated with reduced incidence of delirium and higher cognitive scores. Pediatric cardiac centers may consider adopting these low-cost, low-risk, generalizable program interventions.

Making connections for children and teachers: using classroom-based implementation supports for teaching Pyramid Model practices in Head Start programs

IntroductionIn partnership with an urban school district Head Start program, we created a set of intervention supports that built upon the strengths of the district program services already in place.MethodsWe conducted a randomized control trial to test the use of natural helpers (teachers, special education coaches, and curriculum specialists) participating in practice-based coaching and monthly communities of practice, to augment a districtwide universal social-emotional program, The Pyramid Model for Promoting Social and Emotional Competence in Infants and Young Children. Participants included 53 preschool teachers and 519 preschool children, across 26 classrooms, and 9 schools in a high poverty area of the district. Teachers were randomized to a waitlist control or intervention condition. Intervention teachers participated in practice-based coaching and monthly communities of practice over the course of two years.ResultsSignificant effects were found on participating intervention teachers’ observed increased implementation of positive social-emotional practices in the classroom, decreases in red flags (observed teaching behaviors counter to the Pyramid Model), and increased teacher reports of self-efficacy in the intervention group, compared to control teachers. No significant impacts on child classroom behavior problems, self-regulation, or approaches to learning skills were found for children enrolled in intervention classrooms, compared to children in the control classrooms.DiscussionFuture directions for research and implications for practice are discussed.