Respiratory Syncytial Virus (RSV) continues to pose a significant challenge, contributing to elevated hospitalization rates among children up to 5 years old, with a disproportionate burden on newborn and infants under 6 months old. The unique characteristics of the young immune system make it prone to altered responses to infections and vaccinations, requiring a tailored approach to disease prevention. The recent approval of the maternal RSV vaccine, (brand name ABRYSVO), represents a pivotal advancement in preventive strategies among newborns and infants, marking a milestone in RSV research as the first market-approved maternal vaccine. The present review examines clinical trial data on both recent and previous vaccine candidates, as well as the licensed vaccine, focusing on the prevention of RSV disease in newborns and young infants through the passive acquisition of antibodies following maternal immunization. Additionally, it evaluates the safety profile of these vaccines.

Background: This study explored maternal gut, breast milk and infant gut microbiomes as possi-ble mediators of the observed effects of a relaxation intervention which reduced maternal stress and promoted infant weight gain. Methods: A randomized controlled trial was conducted in healthy Chinese primiparous mother-infant pairs. Mothers were randomly assigned to interven-tion group (IG, listening to relaxation meditation) or control group (CG). Outcomes were differ-ences in microbiome composition and diversity in maternal gut, breast milk and infant gut at 1- and 8-weeks between IG and CG, assessed by 16S rRNA gene amplicon sequencing of fecal and breastmilk samples. Results: 38 mother-infant pairs were included in this analysis (IG=19, CG=19). Overall microbiome community structure in the maternal gut was significantly different between IG and CG at 1-week and the difference was more significant at 8 weeks (Bray-Curtis distance R2=0.04 vs. R2=0.13). Post-intervention, the α-diversity was significantly lower in IG breast milk (observed features: CG=295 vs. IG=255, p=0.032); the Bifidobacterium genera presented higher relative abundance. In parallel, significantly higher α-diversity was observed in IG infant gut (observed features: CG=73 vs. IG=113, p

It is documented that maternal diseases or treatments influence a newborn’s clinical status at birth; autoimmune diseases with circulating antibodies are often clinically expressed transiently in newborns due to the crossover of the specific IgG through the placenta during pregnancy. The offspring can inherit maternal genetic anomalies, but clinical expression usually becomes patent later in life. If prenatal medical history is not available or if signs or symptoms of a mother’s disease are revealed for the first time during pregnancy or postpartum, their effects on the newborn may be misattributed. In this article, we present three cases of pregnant women, without any known pathology before or during pregnancy, who gave birth to very sick preterm newborns that required admission to the Neonatal Intensive Care Unit (NICU). The neonates’ complications were considered initially as consequences of prematurity or infection, but later investigations revealed transient autoimmune disease in two of the cases (myasthenia gravis and hyperthyroidism) and a severe form of thrombophilia in the third case. In all cases, mothers were asymptomatic and unaware of their subclinical disease. Preemies’ diagnosis has contributed to the identification of their mothers’ pathology and adequate treatment was prescribed with favourable short- and long-term outcomes. In one of the cases (myasthenia gravis) both mother and child had associated infectious diseases in the perinatal period that complicated the clinical picture and created problems of diagnosis. This article intends to emphasize the paramount importance of prenatal care, for both mother and newborn. Repeated medical visits and investigations throughout the pregnancy are a good opportunity to detect subclinical diseases or predispositions. As newborns usually develop non-specific signs, one should have experience and pay attention to differentiate among etiologies. Our paper takes a reversed approach to the usual medical diagnosis pathway: from infant to mother instead of mother towards the infant, proving that inter-speciality collaboration can work bi-directionally.

The COVID-19 pandemic period, from 2020 - 2022 had a significant impact on maternal infant health with mothers impacted more than their infants. We questioned whether there have been any lingering effects from the pandemic. We examined intermediate and long-term pandemic effects of maternal and neonatal outcomes before, during and after the COVID-19 pandemic period. We reviewed mother-infant pairs from three epochs: 1) the pre-COVID-19 period, 2) the COVID-19 pandemic period, and 3) the post-pandemic period. The Case Mix Index (CMI) for the neonates from all 3 epochs were detailed. Post-pandemic we noted a rising trend of LGA infants (10%), and an increase in SGA infants (13%). For women in 2023 we noted an increase in hypertension, preeclampsia, diabetes, and a higher BMI than the pre- pandemic period. There have also been more congenital anomalies (9%), and neonatal CMI increased in the post-pandemic period. Well after the pandemic period, maternal-infant health continues to be affected. For women, increase in hypertension and diabetes during pregnancy is concerning. For the infants, being LGA or SGA may have long-term consequences. The post-pandemic increase in infants with congenital anomalies compared to the pre-pandemic era is an area that needs ongoing review.

The recently approved maternal vaccination against respiratory syncytial virus (RSV) can reduce its burden among infants. Vaccine hesitancy/resistance can undermine the beneficial impact of RSV vaccination. The aim of this study was to assess the willingness of pregnant women in Jordan to receive RSV vaccination and its associated determinants. Face-to-face interviews were conducted in obstetrics/gynecology clinics in Jordan during January-February 2024, with convenience sampling. Attitude to RSV vaccination was assessed using the previously validated ABCDEF scale. A total of 404 pregnant women participated in the study with a mean age of 30 years. A majority of the participants showed willingness to receive RSV vaccination (n=313, 77.5%), with hesitancy among 25 participants (6.2%), and resistance among 66 participants (16.3%). Variables that were significantly associated with a higher RSV vaccine acceptance in multivariate analysis were: age <30 years (aOR: 2.45, p=0.010), undergraduates (aOR: 3.27, p=0.026), being a healthcare worker (aOR: 4.50, p=0.036), and the history of previous COVID-19/influenza vaccine uptake (aOR: 2.47, p=0.045). Two out of the six ABCDEF constructs were significantly associated with RSV vaccine acceptance, namely the “Advice” construct (aOR: 10.38, p<0.001) and the “Fear” construct (aOR: 21.49, p<0.001). This study highlighted the multifaceted nature of attitude towards maternal RSV vaccination among pregnant women. The study showed the role of demographic variables, prior vaccination experience, trust in credible health institutions and vaccine safety, and fear of RSV disease consequences in infants in shaping maternal attitude to RSV vaccination. Addressing these factors can help to effectively promote RSV vaccine uptake, subsequently helping to protect infants from the significant RSV disease burden.

Introduction and Background: Bangladesh as a country could prove its development potential over the past several years with its thriving economic growth and also with a significant level of positive changes made possible in its significantly important health and social indicators including MMR, IMR, Child nutrition, fertility regulation, child survival and Infectious disease prevalence. ^1,2,3 The country could make a commendable contribution in achieving Global development goal (MDG) at a significant level and also aiming to continue its effort to sustain that status quo and also making progressive changes consistently to be contributory to SDG goals and indicators towards positive development.^2,3 Purpose: This lyrical critic is an attempt to uphold the facts and evidences embedded in social development reality where the implementations are in constant challenge with urgency, need and continuity. Methodology: A quick and intensive desk review and web search made to capture the insights from secondary data facts, stories, evidences, news features and the findings blended with personal insights and experiences. Finally, compilation of insights and views through a laid over narrative analytics and described in a descriptive lyrical format. Purposefully ignored the figure and quantity data reflection in the write up as this write up is considered more as a social development lyric rather than a scientific write up. Conclusion: Our diversified marginalized community people are of vital importance from a social inclusion and exclusion point of view, to look into this more deeply whether they are socially, epidemiologically, statistically, economic indicator wise fall into the embracing practice of our democracy and inclusion culture of addressing the marginalized. This posed our country in a very challenging situation, a dilemma in between morality vs reality, emotion vs equity, social response vs political standpoint and so on. With a long end history of community responsive and socially sensitive works within /among our generalized poor, poverty stricken and marginalized people group, where the sustainable and ethically driven, gender sensitive social empowerment is still a far cry! The diversity in nature always claims to add on beauty, tranquility and completeness towards the sense of Equity management, but it’s very true that this diversity word has a very opposite and different connotation while it is relevant to diversity in marginalization and appears in a more critical and complex dynamics to seek solution. Therefore, the ultimate empowerment of community specially the marginalized people remain entrapped into the social development process of enduring response in embracing urgency in community care where the right response may not get right weightage into the community development priority response and also the development actors priority agenda.

Maternal obesity and over/undernutrition can have a long-lasting impact on offspring health during critical periods in the first 1000 days of life. Children born to mothers with obesity have reduced immune responses to stimuli which increase susceptibility to infections. Recently, maternal western-style diets (WSD), high in fat and simple sugars, have been associated with skewing neonatal immune cell development, and recent evidence suggests that dysregulation of innate immunity in early life has long-term consequences on metabolic diseases and behavioral disorders in later life. Several factors contribute to abnormal innate immune tolerance or trained immunity, including changes in gut microbiota, metabolites, and epigenetic modifications. Critical knowledge gaps remain regarding the mechanisms whereby these factors impact fetal and postnatal immune cell development, especially in precursor stem cells in bone marrow and fetal liver. Components of the maternal microbiota that are transferred from mothers consuming a WSD to their offspring are understudied and identifying cause and effect on neonatal innate and adaptive immune development needs to be refined. Tools including single-cell RNA-sequencing, epigenetic analysis, and spatial location of specific immune cells in liver and bone marrow are critical for understanding immune system programming. Considering the vital role of immune function plays in offspring health, it will be important to understand how maternal diets can control developmental programming of innate and adaptive immunity.

Collecting relevant data is an important aspect in allowing evaluation of the performance of systems, methods, algorithms, and techniques developed in the research process. Researchers at the South African Scientific and Industrial Research Council perfoemd a study to identify biometric(s) that can be used to identify and verify young children from birth to 16 years old. Three types of biometrics were considered in this study as a resukt of a comprehensive preliminary research, namely, fingerprins, iris and ear shap. This paper presents challenges identified and lessons learned during the in trying to collect data for scientific research that require interaction with children of different ages and their parents in different environments. . The study is primarily based on researcher’s experiences. Some of the discussion points discussed are of global relevance to children and general human beings, while others relate to South Africa in particular. The discussion aims to share knowledge and experience, hoping that this will help researchers prepare for a trouble-free child data collection process in the future. Keywords: Baby biometrics; long-term data collection, baby fingerprints, baby iris, baby ears

Humans are evolutionary-driven to adult mating and conceive social expectations on the quality of their affiliations. The genetic susceptibility to adverse environments in critical periods can alter close relationships. The current research investigates how the promoter region of the Serotonin Transporter Gene (5-HTTLPR) and perceived caregiving behavior in childhood could influence the social expectations on close adult relationships. For this purpose, 5-HTTLPR data was collected from the buccal mucosa of 65 Italian individuals (33 males). The participants filled a) the Parental Bonding Instrument (PBI) to provide the levels of care and overprotection from mother and father, and b) the Experience in Close Relationships-Revised (ECR-R) to report the social expectations on the intimate relationship assessed in terms of anxiety and avoidance from the partner. An interaction effect between 5-HTTLPR and PBI dimensions on the ECR-R scores was hypothesized. Results confirmed that the interplay between the genetic groups and history of maternal overprotection predicted avoidance experienced in romantic relationships in adulthood. Moreover, both adult anxiety and avoidance felt in an intimate relationship were found to covary as a function of maternal overprotection. The present work proposes further evidence of the genetic and parental mechanisms regulating social expectations involved in close relationships.

Objective: In this pilot study, we described the gross motor development of infants aged 4 to 24 months with congenital heart disease (CHD) and assessed through a systematic develop­mental screening programme, with individualised motor interventions. Methods: Thirty infants who had cardiac repair underwent gross motor evaluations using the AIMS at 4 months, and the Bayley-III at 12 and 24 months. Results: Based on AIMS, 80% of 4-month-old infants had a delay in gross motor development and required physical therapy. Gross motor abilities significantly improved by 24 months. Infants who benefited from regular physiotherapy tended to show better improvement in motor scores. Conclusion: Our study highlights the importance of early motor screening in infants with CHD and suggests a potential benefit of early physical therapy in those at-risk. Further research is needed to assess the effectiveness of systematic developmental screening and individualized inter­vention programmes at identifying at risk patients, and their impact on developmental outcomes.

During the last few decades, the main focus of numerus studies has been on the human breast milk microbiota and its influence on the infant intestinal microbiota and overall health. The presence of lactic acid bacteria in breast milk affects both the quantitative and qualitative composition of the infant gut microbiota. The aim of this study was to assess the dominant cultivable rod-shaped lactic acid bacteria, specific for breast milk of healthy Bulgarian women and fecal samples of their infants over the first month of life, in 14 mother-infant tandem pairs. Additionally, we evaluated strain diversity among the dominant newly isolated species. 68 gram-positive and catalase negative strains were subjected to identification by using MALDI-TOF technique. Predominant culturable populations belonging to the rod-shaped lactic acid bacteria have been identified as Lacticaseibacillus rhamnosus, Limosilactobacillus fermentum, Lacticaseibacillus paracasei and Limosilactobacillus reuteri. Also, we confirmed the presence of Lactiplantibacillus plantarum and Lactobacillus gasseri. 27 isolates were selected as representatives and analyzed by 16S rDNA sequencing for strain identity confirmation and a phylogenetic tree based on 16S rDNA gene sequence was constructed. Comparative analysis by four RAPD primers revealed genetic differences between newly isolated L. rhamnosus strains. This pilot study provides data for the current first report concerning investigation on characteristic microbiota of human breast milk and infant feces in Bulgaria.

Pregnancy at advanced maternal age is considered a risk factor for adverse maternal, fetal, and neonatal outcomes. Here we investigated whether maternal age could be associated with differences in the blood levels of newborn screening (NBS) markers for inborn metabolic disorders on the Recommended Universal Screening Panel (RUSP). Population-level NBS data from screen-negative singleton infants were examined, which included blood metabolic markers and covariates such as gestational age, birth weight, age at blood collection, infant sex, parent-reported ethnicity, and maternal age at delivery. Marker levels were compared between maternal age groups (age range: 15-44 years) using effect size analyses, which controlled for group size differences and potential confounding from other covariates. Our results showed that 13% of the markers had maternal age-related differences including newborn metabolites with either increased (C14, C16, C18, C18:1, C3DC) or decreased (C5OH) levels at advanced maternal age group (≥35 years, absolute Cohen’s d ≥ 0.2). The increased C3DC levels in this group correlated with a higher false-positive rate in newborn screening for malonic acidemia (p-value < 0.001), while no significant difference in screening performance was seen for other markers. Maternal age at delivery is associated with inborn metabolic differences and should be considered together with other clinical variables in genetic disease screening.

Multifocal hepatic hemangiomas (MHHs) are the most common benign vascular tumours of the liver that are detected in children with concomitant multiple infantile hemangiomas. They still pose a diagnostic problem for GPs and are thus often detected far too late, due to their low prevalence rates. MHHs are usually undetectable at birth, usually detected within the first few weeks of life when the lesions proliferate. The heterogeneity of the lesions and the presence of comorbidities make often the management of infantile hepatic hemangiomas a true challenge, also for highly specialised medical professionals. Ultrasound (USG) should be the imaging examination performed in the first instance in search for vascular anomalies in children. In pharmacotherapy, the first choice treatment is propranolol and prednisone, administered orally. Invasive treatment is usually indicated in symptomatic or progressive multiple hepatic hemangiomas only. Recently published studies show a significant decrease in the incidence rate of the disease, which now ranges between 11% and 18% for treated and untreated hepatic hemangiomas, respectively.

Maternal infectious disease may pose considerable challenges to the fetal health due to the distribution of important elements of the sanguine and lymphatic system from the mother via the umbilical cord. The mother and the fetus have a degree of interdependence that is similar to the one between the eukaryotic cell and the mitochondrion, particularly during the first half term of the pregnancy, which explains the increased appetite of the expecting mother during the first stages of the fetal development. There is a solid bridge between the adaptive immune system and the encephalon that was only discovered a few decades ago. As a result, scientists may still be in the introductory stages of research, and there might be a significant and profound degree of association between the immune system and a healthy neurological development. There is a significant link between the onset of significant maternal infectious disease and the onset of neurodevelopmental disease in the fetus, and virtually all immune cells play major roles in the promotion and inhibition of neurogenesis alike. Likewise, there is a probability that maternal infectious diseases during pregnancy represent a risk factor of fetal neurodevelopmental disease, as a pressurised development of the adaptive immune memory could result in a pressurised or inhibited neurological development, which both can result in a delayed development of certain sub-regions of the brain. For example, the fetus may display poorer social abilities and sharp analytical skills later in life, which is an important sign of neurodevelopmental disease. A pressurised development of the adaptive immune memory could not require the development of a significant form of disease, but rather just a sharp rate of immune preparation against several important pathogenic agents during the introductory stages of life, when the encephalon experiences the sharpest increase rate in development. The problem per se is not the process of immunisation, but a much sharper process of immunisation over the first stages of life in case of an exposure to one dangerous pathogen or more numerous kinds of pathogens and antigens that normally cause moderate disease morbidity. The more dangerous the microbe is, the sharper the development of the adaptive immune memory will be, and the same happens in the case of an increased number of infectious microbes and antigens that infected the cells of the mothers and the fetuses in cause, and this may, in the majority of the situations, still be the case even if the pathogens are already significantly weakened or lifeless, given that the gain of adaptive immune memory alone constitutes an important factor of neurogenesis and an increased rate of neurological development, and that the infant will become almost or fully protected against the pathogens in cause, despite not having had experienced the disease beforehand. In this case, neurodevelopmental delays are possibly not caused by an impaired neurogenesis, but by an excessive one, whilst maternal infection-associated neurodevelopmental delays may be caused by an impaired neurogenesis. Nevertheless, the aetiology of immunity-related neurodevelopmental delays may be more complex in nature and implicate a chronological and spatial sequence of induced excedentary and deficitary rates of neurogenesis, hence reflecting the incredibly complex nature and various forms of neurodevelopmental disease. It is important to mention that a single dose of infant immunisation brings significantly lower risks of adverse neurological events than the onset of a significant maternal infectious disease during pregnancy. The objective of paediatric neuro-immunological studies may be to improve the understanding of the association between a healthy immune developmental rate and a balanced ratio of the developmental rates of important brain regions and sub-regions.

Background. It is well established that human milk feeding contributes in limiting lung disease among vulnerable neonates. The primary aim of this research was to compare the need for mechanical ventilation of human milk-fed sick neonates with that of formula-fed sick neonates. Methods. All late preterm and full term infants from a single center with findings of sepsis, from 2002 to 2017, were identified. Data regarding infant feeding during hospital admission were recorded. Multivariate logistic regression analyses were performed to assess the impact of the type of milk on ventilation support and main neonatal morbidities. Results. The total number of participants was 322 (human milk group = 260, exclusive formula group = 62). On bivariate analysis, 72% of human milk-fed neonates did not need oxygen therapy nor respiratory support versus 55% of their formula-fed counterparts (P<0.0001). Accordingly, invasive mechanical ventilation was required by 9.2% of human milk-fed infants versus 32% of their formula-fed counterparts (P=0.0085). These results hold true in multivariate analysis, indeed human milk-fed neonates were more likely to require less respiratory support (OR=0.44; 95% CI: 0.22, 0.89) when compared to those who were exclusively formula-fed. Conclusion. Human milk feeding might minimize exposure to mechanical ventilation.

Infant foods and formulae may contain toxic substances and elements which can be neo-formed contaminants or derived from raw materials or processing. The content of minerals, toxic elements and hydroxymethylfurfural in infant foods and formulae were evaluated. The effect of storage temperature on HMF formation in infant formulae and its potential as a quality parameter was also evaluated. Prune-based foods contained the highest HMF content. HMF significantly increased when storage temperature was elevated to 30 ℃ for 21 days. All trace elements were present in adequate amounts while the concentration of nickel was higher when compared to those of other studies. The study indicates that HMF can be used as quality indicator for product shelf-life and that the concentrations of minerals and toxic elements vary greatly due to the diverse compositions of foods and formulae. Such contaminants need to be monitored as infants represent a vulnerable group compared to adults.

Access to maternal healthcare services is a challenge in most low and middle-income countries. South Africa is one of the countries striving to improve the accessibility of maternal healthcare services. Although South Africa has put some interventions to improve the accessibility of maternal healthcare services, vulnerable women including women with disabilities are still facing numerous challenges when trying to access maternal healthcare services. The aim of the study was to explore the experiences of women with disabilities in the province of KwaZulu-Natal in South Africa in accessing public maternal healthcare services. Twelve women with disabilities (four with physical impairments, four with hearing impairments and four with visual impairments) were interviewed for this study. Data were transcribed verbatim and analysed utilising the Framework of Assessing Access to Maternal Healthcare Services by Peters et al. 2008. The study found that narrow passages and information in inaccessible formats were a challenge for women with visual impairments. The women with hearing impairments had challenges in communication as most facilities did not have sign language interpreters, negative attitudes of health care workers and being ignored when they asked for help. The women with physical impairments encountered inaccessible buildings, narrow passages, small consultation rooms and equipment which is not adjustable such as beds and scales.

Postpartum depression (PPD) can interfere with the establishment of affective bonds between infant and mother, which is important for the cognitive, social-emotional, and physical development of the child. Rates of PPD have increased during the COVID-19 pandemic, likely due to the added stress and limited support available to new parents. The present study examined whether parenting-related stress, perceived bonding impairments, quality of observed mother-infant interactions and salivary oxytocin levels differ between depressed and non-depressed mothers, along with differential impacts of COVID-19 on depressed mothers. Participants included 70 mothers (45 depressed, 25 controls) with infants aged 2-6 months. All data were collected remotely to ease participant burden during the pandemic. Depression was associated with experiences of heightened parenting-related stress and bonding difficulties. These differences were not observed during mother-infant interactions or in salivary oxytocin levels. Differences in COVID-related experiences were minimal, though depressed mothers rated slightly higher stress associated with returning to work and financial impacts of the pandemic. Findings highlight the importance of early intervention for PPD to mitigate long-term effects on mothers, children, and families. Additionally, they underscore the need for an early intervention to support the developing mother-infant dyad relationship during this crucial time.

The prevalence of stunting in young Indonesian children is the highest among Southeast Asian Nations, and is associated with poor growth during the prenatal and early postnatal periods. A maternal mentoring program was developed for Indonesian women to improve birth outcomes. A cluster randomized control trial (CRCT) was conducted in three sub-districts of the Special Re-gion of Yogyakarta, Indonesia. A total of 384 eligible participants were randomly allocated to either intervention (received maternal mentoring program and standard care; n=189) or control (received standard care only; n=195). The maternal mentoring program provided preconception health education; health monitoring; and text message reminders for preconception women. Fetal growth was measured between gestational weeks 27-30 using estimated fetal weight generated from ultrasonographic measurement. Birth weight was measured within 24 hours of birth. A structured questionnaire captured women’s’ demographics, pregnancy readiness, and body mass index (BMI. After adjustment, fetal weight was 14% (95% CI: 5.1-23.0) higher in the intervention group than in the control group, and the average weight-for-length Z-score at birth was 0.16 (95% CI: 004-0.30) higher in the intervention group than in the control group. A maternal mentoring program was associated with improved fetal growth and birth weight in this population.

It is estimated that almost 4% of all neonatal intensive care unit admissions are attributed to Candida spp. infections. Clinical diagnosis of invasive fungal infection (IFI) is not easy as signs and symptoms are commonly vague. Mannan antigen (MA) in neonates is not well studied and the aim of this study was to evaluate the use of MA (Platelia™ Candida Ag Plus kit, Bio-Rad) in a neonatal unit. This is a prospective case-control study, which compared the performance of MA between neonates who had rectal Candida colonization with non-colonized controls. We cultured 340 rectal swabs of neonates and 39 of them were positive for Candida albicans colonization. MA was checked in 25 C. albicans colonized and in 30 non-colonized neonates with similar postnatal age and gender distribution. During the hospitalization period there was not any IFI in the neonatal population. MA was negative in all non-colonized neonates (30/30, 100% specificity) and in 24 out of 25 colonized neonates (96% specificity). However, the one infant with positive rectal colonization and MA had recent Candida mucositis. The results indicate a high specificity of the assay even in neonates colonized with Candida. Further investigation in neonates with IFI is required in order to determine the sensitivity of the method.

Bifidobacterium are a beneficial and dominant member of the breast-fed infant gut microbiome. However, the health benefits of Bifidobacterium are partially species dependent. Here we characterize the species and subspecies of Bifidobacterium present in breastfed infants around the world. Across populations, three distinct patterns of Bifidobacterium colonization emerged: 1) Dominance of Bifidobacterium longum subspecies infantis, 2) Prevalent Bifidobacterium of multiple species, and 3) Frequent absence of Bifidobacterium. These patterns appear related to country history of breastfeeding, with infants in countries with historically high rates of long duration breastfeeding more likely to be colonized by B. longum subspecies infantis compared with infants in countries with histories of shorter duration breastfeeding. These findings highlight the need to consider historical and cultural influences on gut commensal survival influence present day colonization patterns in order to understand epidemiological transmission patterns of Bifidobacterium and other major gut commensals.

Acetaminophen use during pregnancy and early childhood was accepted in the 1970s, but is now a subject of considerable concern. Careful analysis shows that initial acceptance of the drug was based on false assumptions and ignorance of the impact of the drug on brain development. Fourteen studies now indicate that prenatal exposure to acetaminophen is associated with neurodevelopmental problems. Based on corrections for confounding factors applied to the analyses of available data, it can be concluded that prenatal exposure to acetaminophen causes statistically significant risks of one subtype of autism spectrum disorder (ASD), developmental delays, and attention deficit hyperactivity disorder. In contrast, data regarding postnatal exposure to acetaminophen are limited, and several factors impede a classic multivariate analysis of data to resolve the issue. However, circumstantial evidence regarding postnatal exposure to the drug is abundant, and it can be concluded beyond a reasonable doubt that postnatal exposure to acetaminophen in susceptible children is responsible for many if not most cases of ASD. Circumstantial evidence includes at least three otherwise unexplained temporal relationships, data from laboratory animal studies, several miscellaneous and otherwise unexplained correlations, and the lack of alternative suspects that fit the evidence-derived profile.

Background: Although widely believed to be safe for use in infants and children when used as directed, increasing evidence indicates that early life exposure to paracetamol (acetaminophen) may cause long-term neurodevelopmental problems. Further, recent studies in animal models demonstrate that cognitive development is exquisitely sensitive to paracetamol exposure during early development. In this study, evidence for the claim that paracetamol is safe was evaluated using a systematic literature search. Methods: Publications on PubMed between 1974 and 2017 that contained the keywords “infant” and either “paracetamol” or “acetaminophen” were considered. Of those initial 3096 papers, 218 were identified that made claims that paracetamol was safe for use with infants or children. From these 218, a total of 103 papers were identified as sources of authority for the safety claim. Results and Conclusions: A total of 52 papers contained actual experiments designed to test safety, and had a median follow-up time of 48 hours. None monitored neurodevelopment. Further, no trial considered total exposure to drug since birth, eliminating the possibility that the effects of drug exposure on long-term neurodevelopment could be accurately assessed. On the other hand, abundant and sufficient evidence was found to conclude that paracetamol does not induce acute liver damage in babies or children when used as directed.

Human milk (HM) is the gold standard for feeding infants but has been associated with slower growth in preterm infants compared with preterm formula. This systematic review and meta-analysis summarises the post-1990 literature to examine the effect of HM feeding on growth during the neonatal admission of preterm infants with birth weight ≤1500g and/or born ≤28 weeks’ gestation. Medline, PubMed, CINAHL and Scopus were searched, and comparisons grouped as: exclusive human milk (EHM) vs exclusive preterm formula (EPTF), any HM vs EPTF and higher vs lower doses of HM. We selected studies that used fortified HM and compared that with a PTF; studies comparing unfortified HM and term formula were excluded. Experimental and observational studies were pooled separately. The GRADE system was used to evaluate risk of bias and certainty of evidence. Forty-four studies were included with 37 (n =9,963 infants) included in the meta-analyses. In general, due to poor quality studies, evidence of the effect of any HM feeds or higher versus lower doses of HM was inconclusive. There was a possible effect that lower doses of HM compared with higher doses of HM improved weight gain during the hospital admission, and separately, a possible effect of increased head circumference growth in infants fed EPTF vs any HM. The clinical significance of this is unclear. There was insufficient evidence to determine the effects of an exclusive HM diet on any outcomes.

Infant cry is evolutionarily, psychologically, and clinically significant. During the last 60 years, several researchers and clinicians assessed the possibility of investigating the acoustical properties of cry for medical purposes. However, there is a lack of standardization in conducting and reporting cry-based studies. In this work, methodologies and procedures employed in infant cry analysis are reviewed, and best practices for reporting studies are provided. First, available literature on vocal and audio acoustic analysis have been examined to identify critical aspects of participant information, data collection, methods, and data analysis. Then, 180 peer-reviewed research articles have been assessed to certify the presence of identified critical information. Results show a general lack of critical description. Researchers in the field of infant cry need to agree on a standard set of criteria to report experimental studies, to better demonstrate the validity of the methods and obtained results.

Influenza virus infection causes severe respiratory illness in people worldwide, disproportionately affecting infants. The immature respiratory tract coupled with the developing immune system is thought to synergistically play a role in the increased disease severity in younger age groups. Although vaccines remain the best solution for protecting this vulnerable population, no vaccines are available for those under 6 months, and for infants aged 6 months to 2 years, the vaccine elicits a dampened immune response. Dampened immune responses may be due to unique features of the infant immune system and a lack of pre-existing immunity. Unlike older children and adults, the infant immune system is Th2 skewed and has less antigen presenting cells and soluble immune factors. Paradoxically, we know that a person’s first infection with the influenza virus during infancy or childhood leads to the establishment of life-long immunity toward that particular virus strain. This is called influenza imprinting. To provide better protection against influenza virus infection and disease in infants, more research must be conducted to understand the imprinting event. We contend that by understanding influenza imprinting in the context of the infant immune system and the infant’s immature respiratory tract, we will be able to design more effective influenza vaccines for both infants and adults. Working through the lens of imprinting, using infant influenza animal models such as mice and ferrets, which have proven useful for infant immunity studies, we will gain a better understanding of imprinting and its implications regarding vaccine design. This review examines literature regarding infant immune development, current vaccine strategies, respiratory development, and the importance of researching the imprinting event in infant animal models to develop more effective and protective vaccines for young children.

Obesity is a complex chronic disease characterized by excess of body fat. It represents a significant public health problem due to the health-related risk factors. There are growing evidences showing that maternal obesity can program the offspring, which influence neonatal phenotype and predispose offspring to a higher prevalence of metabolic disorders such as obesity. This increased risk may also be epigenetically transmitted across generations. Thus, there is an urgent need to find effective reprogramming approaches in order to resume normal fetal development. Polyphenols are bioactive compounds found in fruits and vegetables that exert their anti-obesity effect through its powerful anti-oxidant and anti-inflammatory activities. Polyphenols supplementation has been proven to counteract the deleterious effects of maternal obesity programming on offspring. Indeed, some polyphenols can cross the placenta and protect the fetal predisposition against obesity. The present review summarizes the effects of dietary polyphenols on obesity-induced maternal reprogramming as an offspring anti-obesity approach.

(1) Background: Sudden Infant Death Syndrome (SIDS) represents unexplained and sudden deaths during the sleep of infants under one year of age, despite thorough investigation. Screening for prolonged QTc or Long QT Syndrome (LQTS) should be conducted on all newborns to reduce the incidence of SIDS. Neonatal electrocardiogram (ECG) could identify congenital heart defects (CHD) early, especially those not detected at birth. Infants with prolonged QT intervals typically undergo genetic analysis for Long QT Syndrome; (2) Methods: The study involved infants aged 20-40 days, born clinically healthy, with initial ECG screening. Infants with prenatal diagnoses or signs/symptoms of CHD identified immediately after birth, as well as those who underwent ECG or echocardiogram for other clinical or historical indications, were excluded from the study. The data were analyzed using SPSS version 22.0; (3) Results: Of the 42,200 infants involved, 2,245 were enrolled, with 39.9% being males. Subsequently, 164 children (37.8% males) with prolonged QT intervals underwent further diagnostic investigations. Genetic mutations were identified in 11 out of 18 tested children. The most common mutations were LQT1 (54.5%), LQT2 (36.4%), and LQT3 (1 patient). Medications used included propranolol (39.8%), nadolol (22.2%), inderal (11.1%), metoprolol (11.1%), and no treatment (16.7%). The most common abnormalities were focal right bundle branch block (54.5%), left axis deviation (9.2%), and nonspecific ventricular repolarization abnormalities (7.1%). Multiple anomalies were found in 0.47% of children with focal right bundle branch block. Structural abnormalities were associated with specific features in 267 patients (11.9%), primarily isolated patent foramen ovale (PFO) at 61.4%; (4) Conclusions: The screening has proven effective in early diagnosing Long QT Syndrome and other cardiac rhythm anomalies, with additional benefits in detecting mutations and/or QTc prolongations in family members. Identifying other ECG abnormalities and congenital heart malformations further enhances the benefits of the screening.

Low 25 OH vitamin D (25(OH)D) in preterm infants is a risk factor of bronchopulmonary dysplasia (BPD), but increased supplementation failed to demonstrate beneficial effect on BPD. In neonatal animal models, deficiency and excessive vitamin D exposure have been associated with increased mortality and lung histological alterations evocative of BPD. Our hypothesis is that 25(OH)D levels ≥ 120nmol/L is also a risk factor for BPD or death. This retrospective single-center cohort study included all infants born <31 weeks gestational age without major malformation with at least a determination of 25(OH)D <36 weeks corrected age and no determination <50 nmol/L. Routine 25(OH)D determination was performed at 1 month and monthly thereafter. A total of 175 infants were included. Infants with BPD or who died had a significantly lower term and weight, but a similar frequency of 25(OH)D ≥120nmol/L (50.5% vs 43.9%, p=0.53). The logistic regression identified weight (OR 0.997, 95%CI [0.995-0.998]) and term (OR 0.737, 95%CI [0.551-0.975]) as significantly associated with BPD or death; the occurrence of excessive 25(OH)D was not significantly associated (OR 1.029, 95%CI [0.503-2.093]). The present study did not demonstrate any significant association between excessive 25(OH)D after one month of age and BPD or death.

Background: Rectal prolapse is usually self-limiting in early childhood. Laparoscopic rectopexy has become a safe and effective method for treating children with rectal prolapse recurrence, especially those older than 4 years of age. We present the clinical case of an infant with recurrent rectal prolapse and secondary complications. The infant required surgical intervention with laparoscopic rectopexy after the failure of conservative management. Case presentation: A 2-year- and 7-month-old infant with a 15-month history of rectal prolapse who did not respond to conservative management developed bloody diarrhea, intestinal infection and electrolyte imbalance. Laparoscopic surgical correction was performed via anterior ventral rectopexy, and the results were satisfactory. Conclusion: Infants with recurrent rectal prolapse and associated complications who do not respond to conservative measures may benefit from laparoscopic rectopexy.

Abstract: Background: The birthrate of Black preterm (BPT) infant is 65% higher than White preterm (WPT) infants with BPT mortality 2.3 times higher. The incidence of culture positive sepsis is as high as 41% in preterms. This study aimed to examine infections and mortality in BPTs and WPTs. Methods: We enrolled 362 preterms born < 32 weeks gestational age (GA) between 2019-2023 in 5 neonatal intensive care unit (NICU)s to study onset of infections, and dispositions; RedCap data were analyzed for descriptive statistics. Results: 226 BPTs (63.5%) and 107 WPTs (30.8%) enrolled, with 29 other than White or Black, 50.5% female, mean GA of 27.67 weeks and 986.74 grams birthweight. Of 426 suspected infections evaluated in enrolled infants, there were 7 infants with early onset sepsis (EOS) and 39 infants with late onset sepsis (LOS). The incidence of EOS was 1.9% overall, 2.2% in BPTs vs 0.9% in WPTs. LOS incidence was 10.8% overall, 11.9% in BPTs and 9.3% in WPTs. Both BPT and WPT infants had ~ 8% gram-positive LOS events and 3% gram-negative LOS events; however, 82% of all gram-negative LOS episodes occurred in BPTs. There were 27 urinary tract infections and 78% were in BPTs. Two cerebral spinal fluid cultures were positive in BPTs. Necrotizing enterocolitis was diagnosed in 5.8% of the sample, with an incidence of 6.1% in BPTs versus 4.7% in WPTs. Death occurred in 6.0% of the enrolled infants with the rate of death being slightly higher in BPTs (7.0%) versus WPTs (5.6%). Conclusions: BPTs had a higher rate of positive cultures, double the gram-negative infections, a much higher rate of urinary tract infec-tions and a higher rate of mortality than their WPT counterparts. This study emphasizes higher risk of morbidity and mortality for BPTs.

After approximately 6 months of age, term breastfed infants are increasingly depending on other sources of iron to avoid iron deficiency anemia. The appropriate complementary feeding must include a balance composition of foods containing an adequate amount of macro- and micronutrients to reduce the risk of iron deficiency anemia. This study aims to compare the anemia and growth status of infants receiving commercial fortified infant cereals (FIC) with infants not receiving them. We use all complete multiple Demographic Health Surveys (DHS) from 2005 to 2018 to understand global infant feeding patterns. To better control for the strong household wealth effect in nutritional choices and possibly health awareness, we use propensity score technique as applied in outcome research to better control the effect of covariates. After matching and controlling for confounders, we did find a significant association between reduced risk of anemia and consumption of FIC. After matching and adjusting for confounders the small but positive effects of consumption of FIC on Height for age z-score and Weight for Height Z-score are no longer statistically significant.

Abstract: Supplementation of infant formula with ingredients potentially able to manage, in a way positive for the host, the gut microbiota of infants, is nowadays widely used by infant food producers. The impact of this class of compounds, named prebiotics, on gut microbiota composition, was initially measured on the enrichment of Bifidobacterium and Lactobacillus spp., but the use of culture-independent analytical techniques has allowed to establish that a larger number of intestinal microorganisms are affected by the ingestion of prebiotics. However, despite a relevant number of scientific publications, actually there is no consensus on the amount of prebiotics to be administered daily, the potentially different actions exerted by prebiotics which differ in biochemical structures, as well as the impact of different percentages of the same prebiotics when used in mixtures and/or combination. This paper is aimed to critically review the available data on the use of prebiotics in infant formula, with special attention paid to identify a link between, the dosage used, the mixture composition and the observed outcomes, keeping in mind the influences in nutrition quality and growth influence.

This article focuses on the economic dimensions of maternal health, highlighting the benefits of investing in maternal healthcare and the policy implications for sustainable development. Through a comprehensive review of the literature, the article explores the economic impact of maternal health, including its effects on human capital, productivity, and healthcare costs. It emphasizes the importance of addressing social determinants such as access to healthcare services, education, employment, income, and geographical disparities. By prioritizing maternal health, societies can unlock the economic potential of women, promote inclusive growth, and reduce gender disparities. The article discusses policy interventions, including the importance of healthcare infrastructure, financial support for maternal healthcare, and promoting gender equality. It also emphasizes the need for future research to quantify the economic benefits and evaluate the cost-effectiveness of different interventions. Overall, the article underscores the economic imperative of investing in maternal health and provides valuable insights for policymakers and researchers seeking to enhance maternal health outcomes and promote sustainable economic development.

The study evaluated the functional and sensory properties of infant complementary foods formulated from millets, orange-flesh sweet potatoes, carrots, periwinkle and oyster. Experimental/cross-sectional design was used. Millet, orange-flesh sweet potato (OFSP), carrots, periwinkle and oyster were purchased, processed into flour using standard methods. The complementary food was formulated on protein basis for infants 6–12 months. The formulated foods were millet/OFSP flours (70:30), millet/OFSP/carrot/periwinkle (49:29:7:15), and millet/OFSP/carrot/oyster (65:20:5:10). Functional properties were carried out using standard methods. Sixty nursing mothers attending Orogbum Health Centre were systematically sampled for the sensory evaluation. ANOVA was used for the study. The result showed packed density (0.77 g/mL) was significantly higher (p < 0.05) in food formulated from millets/OFSP than in millet/OFSP/carrot/oyster (0.68 g/mL). Loosed density was lowest (0.40 g/mL) in millet/OFSP/carrot/oyster. Carr index from ranged from 42.23 in millet/OFSP/carrot/oyster to 44.41 in millet/OFSP. Wettability was highest (45.03) in millet/OFSP/carrot/periwinkle compared to wettability value (26.53) for millet/OFSP. Solubility ranged from 18.36 to 46.62, with the highest (46.62) in millet/OFSP/carrot/periwinkle. The peak viscosity of the infant complementary food samples ranged from 64.53 rapid visco analyzer units (RVU) to 89.33 RVU. The infant complementary food formulated from millet/OFSP had significantly higher (p < 0.05) acceptability score (6.35).

This is a single center retrospective study to assess safety and tolerability of continuous inhaled iloprost use as rescue therapy for refractory pulmonary hypertension (PH) in critically ill neonates and infants. Retrospective chart review was performed on 58 infants and data was collected at baseline, 1, 6, 12, 24, 48, and 72 hours of iloprost initiation. Primary outcomes were change in heart rate (HR), fraction of inspired oxygen (FiO2), mean airway pressures (MAP), blood pressure (BP) and oxygenation index (OI). Secondary outcomes were need for extracorporeal membrane oxygenation (ECMO) and death. 51 patients treated for > 6 hours were analyzed in 2 age groups, neonate (≤28 days: n=32) and infant (29-365 days: n=19). FiO2 (p

Children from rural areas face numerous possibilities for neurodevelopmental conditions that may compromise their well-being and optimal development. Neuropsychology and electroencephalography (EEG) have shown strong agreement in detecting correlations between these two variables and suggest an association with specific environmental and social risk factors. The present meta-analysis aims to integrate the qualitative and quantitative EEG findings, their relationship with cognitive impairment in children living in vulnerable or rural environments, and the main risk factors influencing EEG abnormalities. The method for this purpose was based on a systematic string-based review from Ebscohost and Web of Science, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Qualitative and quantitative analyses were conducted from the outcomes that complied with the selected criteria. A total of 92 records were identified; however, only 20 were eligible, considering 11 for qualitative and 9 for quantitative analysis. The findings highlight a significant amount of literature on EEG and its relation with cognitive impairment from studies in children with epilepsy and malnutrition. In general, there is evidence about the advantages of implementing EEG diagnosis and research techniques in children living under risk conditions. Further research is needed to better describe and integrate the state of the art regarding EEG features extraction.

COVID-19 infection in the pediatric population usually leads to a mild illness, however, a rare but serious complication of MIS-C has been seen in children. MIS-C usually presents 2-4 weeks after COVID-19 infection or exposure, and rare reports have been documented in neonates. Vaccinations for COVID-19 have been approved for children 6 months and above in the United States, and recent reports suggest significantly low prevalence and risk of complications of MIS-C in vaccinated children compared to unvaccinated children. Vaccinations for COVID-19 are safe and recommended during pregnancy and prevent severe maternal morbidity and adverse birth outcomes. Evidence from other vaccine-preventable diseases suggests that through passive transplacental antibody transfer, maternal vaccinations are protective against infections in infants during the first 6 months of life. Various studies have demonstrated that maternal COVID-19 vaccination is associated with the presence of anti-spike protein antibodies in infants, persisting even at 6 months of age. Further, completion of a 2-dose primary mRNA COVID-19 vaccination series during pregnancy is associated with reduced risk for COVID-19–associated hospitalization among infants aged 6 months or less. Therefore, it can be hypothesized that maternal COVID-19 vaccination can reduce the risk of and severity of MIS-C in infants. In this article, we review the literature to support this hypothesis.

Background: To determine vitamin D supplementation frequency among infants, factors that influence adherence, and reasons for discontinuation of initiated vitamin D. Methods: This cross-sectional study was conducted using a questionnaire administered to the mothers via a face-to-face interview on 560 infants aged from 1 to 24 months admitted to outpatient clinics from June to December 2017. Results: A total of 351 infants were administered vitamin D, and the rate of supplementation in the first year of life was 83%, while it was only 28% between 13 and 24 months. The rate of vitamin D supplementation was higher among infants who were exclusively formula-fed (p<.05). When the data were analyzed using logistic regression analysis, only visit family physicians seems to be a statistically significant independent variable in increasing supplementation (p<.05). Compared with family refusal, the rate of discontinuation of vitamin D by the healthcare providers was higher after the first year of life (p<.05). The rates of vitamin D discontinuation by healthcare providers, especially by nurses who considered the duration of supplementation adequate, were statistically significantly higher when compared with the fontanel closure and other reasons (p<0.05). Conclusions: The rate of vitamin D supplementation was higher among families who visited family physicians, which suggests the importance of well-baby visits. Since vitamin D supplementation was less common among exclusively breastfed infants, mothers should be educated. Healthcare professionals need further education about the importance of vitamin D supplementation and indications for discontinuation.

Postpartum depression (PPD), a condition that affects up to the 15% of mothers in high-income countries, reduces attention toward the needs of the child and it is among the first causes of infanticide. PPD is usually identified using self-report measures and therefore the diagnosis may not always be valid. Previous studies highlighted the presence of significant differences in the acoustical properties of the vocalizations of children of depressed and healthy mothers. In this study, cry episodes of infants of depressed and non-depressed mothers are analyzed to investigate the possibility that a machine learning model can identify PPD in mothers from the acoustical properties of infants' vocalizations. Acoustic features (F0, F1-4, Intensity) are first extracted from recordings of crying infants, then novel cloud-based artificial intelligence models are employed to identify maternal depression versus non depression from estimated features. Trained model shows that commonly adopted acoustical features can be successfully used to individuate Post-Partum Depressed mothers with very high accuracy (89.5%).

Human milk is recommended for feeding preterm infant. Yet the potential impact of specific breast-milk lipid components on the initial growth rate of very-preterm infants has received scant attention. The current pilot study aims to determine whether breast-milk lipidome had any impact on the early growth pattern of preterm infants fed their own mother’s milk. A prospective monocentric observational birth cohort was established, enrolling 147 preterm infants, who received their own mother’s breast-milk throughout hospital stay. Among that cohort, infants who experienced slow (n=15) or fast (n=11) growth were selected, based on the change in their weight Z-score between birth and hospital discharge (-1.54± 0.42 and -0.48± 0.19 Z-score, respectively). Liquid chromatography-high resolution-mass spectrometry was used to obtain lipidomic signatures in breast-milk. Multivariate analyses made it possible to identify breast-milk lipid species that allowed clear-cut discrimination between the 2 infants’ groups. Validation of the selected biomarkers was performed by means of various multidimensional statistical techniques, false-discovery rate and ROC curve computation. Breast-milk associated with fast growth contained more medium chain-saturated fatty acid and -sphingomyelin, dihomo-γ-linolenic acid (DGLA)-containing phosphethanolamine, and less oleic acid-containing triglyceride and DGLA-oxylipin. Their predictive ability of preterm early-growth rate was validated in presence of confounding clinical factors.

Pregestational diabetes mellitus, if not well controlled, determines maternal and fetal complications. According to the new diagnostic criteria for gestational diabetes the diagnosis of diabetes mellitus can also occur in early pregnancy (overt diabetes ).The aim of this study was to determine pregnancy outcomes in women with overt type 2 diabetes. In this retrospective study we selected women with type 2 diabetes, pregestational or overt diabetes, who had at least one pregnancy followed in the period 2010-2022 at the Diabetic Care Unit of Padova.We analyzed 83 pregnancies in 68 diabetic patients; overt diabetes was diagnosed in 21,7% of pregnancies . 95% of patents with overt diabetes was immigrate . None of patients with overt type 2 diabetes planned their pregnancy, while pregnancy was planned in 26,3% of patients with pregestationalType 2 diabetes. Pre-pregnancy and first trimester glycemic control was worst in patients with overt diabetes(HbA1c 9.7± 3.1% vs 7.3% ± 2.3%, p< 0.044 at first visit; 8.1±1.9%, and 7.0±1.6%, p< 0.037 in the first trimester) with respect to type 2 diabetic mothers.As for maternal outcomes, 16,6% of pregnancy ended in miscariage and 5,5% of women developed gestational hypertension . 16,6% of newborn were LGA and 11,1% were affected by congenital anomalies. The high rate of congenital malformations in overt diabetes pregnancies is probably due to the worse metabolic control during the first trimester of pregnancy, when the organogenesis of the fetus takes place. So it is essential to identify these patients in the preconception phase so they can conceive in good glycemic control.

Background: The rising prevalence of obesity has a significant impact on obstetrics practice regarding maternal and perinatal complications includes recurrent miscarriage, pregnancy-induced hypertension, preeclampsia, gestational diabetes, and prolonged labor. Objective: To assess the impact of obesity on pregnancy and neonatal outcomes among Saudi women. Methods: The study was conducted at King Abdul-Aziz Medical City, Jeddah. Design: A cross-sectional retrospective design. A total number of 186 participants were recruited from July to Dec.2018 according to eligibility criteria. The data were collected retrospectively by a review of the chart records of the labor and delivery department. Results: The mean (SD) age of participants was 31.94(5.67) years old; two-thirds were in obesity class1. There was a significant association between obesity and pre-existing thyroid disease and induced hypertension class3. However, episiotomy showed that obesity class3 was significantly different from obesity class2. Conclusion: This study concludes obesity affects the outcomes of pregnant Saudi associations between obesity and preeclampsia, perineal tears, and episiotomy variables, and other variables reflect no associations. Recommendations: Further studies are needed to generalize the results. This study endorses the pregnant women start the antenatal follow-up from 1st trimester so, the data will be available on the system for research.

The rising prevalence of obesity has a significant impact on obstetrics practice regarding maternal and perinatal complications includes recurrent miscarriage, pregnancy-induced hypertension, preeclampsia, gestational diabetes, and prolonged labor. Objective: To assess the impact of obesity on pregnancy and neonatal outcomes among Saudi women. Methods: The study was conducted at King Abdul-Aziz Medical City, Jeddah. Design: A quantitative research, cross-sectional retrospective design. A total number of 186 participants were recruited from July to Dec.2018 according to eligibility criteria. The data were collected retrospectively by a review of the chart records of the labor and delivery department. Results: The mean (SD) age of participants was 31.94(5.67) years old; two-thirds were in obesity class1. There was a significant association between obesity and pre-existing thyroid disease and induced hypertension class3. However, Episiotomy showed that obesity class3 was significantly different from obesity class2. Conclusion: This study concludes obesity affects the outcomes of pregnant Saudi associations between obesity and preeclampsia, perineal tears, and episiotomy variables, and other variables reflect no associations. Recommendations: Further studies are needed to generalize the results. This study endorses the pregnant women start the antenatal follow-up from 1st trimester so, the data will be available on the system for research.

Mycotoxins are toxic secondary metabolites secreted mainly by molds. The contamination of the raw materials used in the production of infant flours by these mycotoxins presents a risk to the health of infants and young children who are the main consumers of these flours. The objective of this study was to determine the prevalence of mycotoxins in raw materials and in infant flours from Burkina Faso. Analyses were carried out on 39 samples of raw materials and 26 samples of infant flour collected from artisanal and semi-industrial production units. The contents of AFB1, AFB2, AFG1, AFG2, FB1 and OTA were determined by LCMS/MS. The results indicated a variability in the contents of total aflatoxins (AFs), FB1 and OTA within the samples of raw materials. Also, 79.49% of the raw materials contaminated by total aflatoxins were above the maximum limit value and 61.54% of these raw materials had AFB1 levels above the recommended limit value. The highest levels of AFs were found in peanuts and maize. OTA was very present in soybean samples. The occurrence of mycotoxins was highly variable in infant flours within the same production unit (p &lt; 0.001). and between different units (p &lt; 0.001). Infant flours produced by artisanal production units had higher AFB1 contents than those produced by semi-industrial units. The need to control these mycotoxins is essential in order to considerably reduce their contamination and exposure in infants and young children and to preserve their health.

Intimate partner violence (IPV), particularly sexual and emotional violence, against Black mothers who acquire human immunodeficiency virus (HIV) during childbearing age is a significant health and social concern worldwide requiring targeted interventions and precautions. IPV against women increases the chances of early mixed feeding, putting infants at high risk of mother-to-child transmission of HIV and increased infant morbidities. Although violence complicates many Black mothers’ lives, there is limited research evidence about the critical intersections of violence, HIV, and Black motherhood. Women's fears associated with IPV make them less likely to disclose their positive HIV status to their partners which subsequently prevents them from using the recommended guidelines for safe infant feeding practices. This review aims to explore the critical intersections between IPV and HIV and the impact of both on the infant feeding practices of Black mothers living with HIV. Furthermore, the theme of IPV and how it overlaps with other factors such as HIV-positive status and gender dynamics to compromise the Black motherhood experience are the focus of this narrative review of existing literature. Understanding the intersection of IPV and other factors influencing infant feeding practices among women living with HIV will help inform programming and policy interventions for HIV-positive Black mothers who may be experiencing IPV during the perinatal period.

In Burkina Faso, the infant flours produced are intended for weaning-age and malnourished children. This study was to evaluate the management of infant flour production in Ouagadougou. A survey was conducted among the production units to determine the raw materials used in the production of infant flours, the production processes, the methods of conservation of raw materials and infant flours, the types of infant flours produced as well as their packaging. The results showed that 45.45% of the production units surveyed were of the semi-industrial type against 54.54% from the artisanal and CREN types. Among the raw materials, the most used cereals were millet, sorghum and maize. As for legumes, peanuts and soybeans were the most used at respectively 35% and 31%. For the conservation of raw materials, 85.71% of infant flour producers had storage warehouses and 66% used storage pesticides. These flours produced were intended for children of wean age (37.14%) and children in nutritional recovery (62.86%). Flours were stored in an airy (94.29%), dry area/environment (88.57%) and in the presence of light (91.43%). All the results of this survey reflect that efforts are still expected to further improve the nutritional and sanitary quality of the infant flours produced.

BACKGROUND: It has been known for decades that breastfeeding leads to a lower risk of asthma, respiratory infections, or metabolic syndrome at school age. In addition, evidence is now accumulating on the influence of breast milk on the shape, volume, or function of the heart and lungs. Within this field of research into the effects of breast milk on the structure of the heart and lungs, we have set out to analyze the differential electrocardiographic characteristics of schoolchildren who were once breastfed. METHOD: Observational cross-sectional study including 138 children aged 6 or 12 consecutively presenting to a well-child clinic between May and December 2022. Inclusion criteria: the ability to perform reproducible ECG records, the feasibility of weighing and measuring patient, and breastfeeding data collected from birth. RESULTS: Using the 40º cut-off value for the mean P-wave axis among schoolchildren, 76% of never breastfed children in our sample have a P-wave axis in a more vertical position than the mean as compared to 58% of ever-breastfed children (OR:2.25;95%CI:3.13-1.36); there was no other significant difference between infant feeding groups in somatometric characteristics or ECG parameters, CONCLUSION: We found a significant difference of the mean values of the P-wave axis between never and ever breastfed children. Although this report should be approached cautiously, these findings add to the renewed interest in discerning developmental interventions to improve cardiovascular health.

Psychomotor developmental delay in infants includes failure to acquire abilities such as sitting, walking, grasping objects and communication at the ages when most infants have acquired these abilities. Known risk factors include a large number of aspects of family environment, socioeconomic position, problems in pregnancy and birth, and maternal health. It is clinically useful to be able to screen for developmental delay so that healthcare interventions can be considered. The present research used machine learning (random forest) to create an algorithm predicting psychomotor delay in 9-month-old infants using information ascertainable at birth and in early infancy. The dataset was the UK longitudinal Millennium Cohort study. Fifty-two predictors measuring socioeconomic indicators, paternal, family and social support for the mother, beliefs about good parenting, maternal health, pregnancy and birth were included in the initial algorithm. Feature reduction showed that of the 52 variables, birthweight, family income and parents’ ages had the highest feature importance scores and could alone correctly predict developmental delay with over 99% sensitivity and 100% specificity. The relationships between delay and some of the predictors, particularly income, were nonlinear and complex. The results suggest that the risk of psychomotor developmental delay can be identified in early infancy using machine learning, and that the best predictors are factors present prior to birth. Surprisingly, the most important factors included in the present study did not include illnesses during pregnancy such as eclampsia and infections.

Babies born prematurely are at risk of experiencing visual disturbances, hearing loss, disabilities, the risk of infection and even death. Care for premature babies requires serious attention for both health workers and parents. The role of parents is very important both during hospitalization and at home. Therefore, in order to improve the abilities of parents, it is necessary to make educational efforts with the right method.ObjectivesThis literature review aims to provide an overview of educational methods that nurses can use to improve the ability of parents to care for or care for the development of premature babies. The method used is to search for literature that fits the established theme using 5 data based, namely Scopus, ProQuest, Science Direct, Elsevier Clinicaly for Nursing and Web of Science. The strategy used in finding literature that fits the theme and is used in this literature review uses the PICOS framework. Then conducted a review with the PRISMA method. The literature selection results obtained 572 publications, after going through the selection obtained 11 literatures that match the theme, with 11 educational methods. These methods can be grouped into ideas, namely increasing parental involvement during treatment, using technology, stress management and continuous monitoring. The ability of parents to care for premature babies is needed in order to minimize complications in infants, reduce morbidity, avoid disabilities, increase growth and development of premature babies optimally and reduce parental stress levels, increase parental confidence and good parents' self-efficacy. Choosing the right educational method can improve the ability of parents to properly care for and provide developmental care for premature babies.

Congenital malformations are functional and structural alterations in embryonic or foetal development resulting from a variety of factors including maternal health status. This study aimed to investigate the association between maternal birth weight (MBW) and the prevalence of congenital malformations in the offspring using data from a nationwide birth cohort study in Japan including 103,060 pregnancies. A binary logistic regression model with adjustment for various covariates revealed that MBW of &lt;2,500 g (low MBW) was associated with increased risk of congenital heart disease (adjusted odds ratio: 1.388, [95% confidence interval: 1.075–1.792]), angioma (1.491 [1.079–2.059]), and inguinal hernia (1.746, [1.189–2.565]), while MBW of ≥4,000 g (high MBW) with congenital anomalies of the urinary tract (2.194, [1.261–3.819]), and arrhythmia (1.775, [1.157–2.725]), compared with those with MBW of 3,000-3,499 g. Low MBW was associated with cleft lip and/or palate (1.473, [1.052–2.064]), congenital heart disease (1.615, [1.119–2.332]), genital organs(1.648, [1.130–2.405]), hypospadias (1.804, [1.130–2.881]), and inguinal hernia (1.484, [1.189–1.851]) in male infants and CAKUT (1.619, [1.154–2.273]) in female infants, whereas high MBW was associated with congenital heart disease(1.745, [1.058–2.877]) and CAKUT (2.470, [1.350–4.517]) in male infants. The present study is the first to demonstrate a link between MBW and congenital malformations in Japanese children. While these results must be interpreted with caution, MBW should be considered a major predictor of congenital malformation risk.

Background: Maternal mortality remains dire in Nigeria, claiming 40,000 lives yearly due to pregnancy complications. Factors like limited healthcare access, poverty, and early marriage worsen the crisis. Despite efforts to improve skilled birth attendance, Nigeria struggles to meet MDG targets, underscoring the urgent need for more effective interventions. Objectives: The objective of the study is to assess and understand the knowledge of community members regarding the risk factors influencing maternal mortality in the Ede South Local Government Area of Osun State, Nigeria. Methodology: A descriptive cross-sectional study was conducted. The study methodology involves employing the Leslie Kish formula to select 185 participants from the Ede South Local Government Area in Osun State, Nigeria. The selection process involved the use of a systematic sampling technique to ensure a representative sample based on population demographics and characteristics, ensuring a balanced and accurate selection process. Quantitative data was collected through a self-administered questionnaire and analysed using SPSS version 21. Results: The study encompassed 185 participants. 64.9% females with a mean age of 27.3 + 8.3 years. Among them, 60.5% were single, 46.6% being students, 55.7% held a BSc degree, 64.9% were Yoruba and 61.1% identified as Christian. 91.4% were aware about maternal mortality, 74.6% recognized maternal deaths in reproductive-aged women. Participants identified that maternal deaths mostly occur during labour (91.4%). Direct causes, such as bleeding (88.1%), unsafe abortion (88.6%), infection (49.2%), and hypertension (64.9%), were recognized. Results indicated substantial awareness concerning specific risk factors: lack of education (98.9%), poverty (91.6%), poor health care services in facilities (94.0%), alcohol consumption (87.6%) and poor transportation (78.4%). Conclusion: Findings revealed good awareness of maternal deaths and critical factors such as ANC impact and direct causes of maternal mortality like bleeding and unsafe abortion. However, gaps persisted in SDG awareness, suggesting the need for targeted interventions to enhance overall understanding and address identified knowledge gaps.

The maternal death rate remains high in South Africa despite the availability of many existing strategies to improve the quality of service. A 30% increase in maternal mortality rate was reported between 2020-2021, with Limpopo ranking fourth highest out of nine provinces. Vhembe district remained number three with a high maternal death rate. This study explored strategies to reduce the maternal death rate and improve the provision of quality maternal healthcare services in selected hospitals of Vhembe district, Limpopo province. One hospital was purposively sampled from every four municipalities. A qualitative approach using phenomenological design was employed. Twenty-eight participants were sampled using a convenience sampling method. The semi-structured interview guide was used to collect data. An audio recorder was also used until data saturation. Data saturation was reached at the 20th participant, but the researcher continued until 28 sampled participants were interviewed. Interpretative phenomenological analysis was used following the analytical stages of interpretative data analysis. The study proposal was ethically cleared by the University of Venda Ethics Committee (FHS/22/PH/08/3108). Results indicate that despite implementing strategies to improve maternal healthcare services and reduce the maternal death rate, several factors, such as lack of material resources, shortage of staff, incompetent staff, and poor infection control, affect the quality of maternal health service in Vhembe district. Limpopo Department of Health and hospital management should ensure that hospitals have all necessary resources and support healthcare professionals through in-service training to ensure the functionality of existing strategies.

Background: Immunization prevents over 4-6 million deaths each year worldwide. Ensuring mother satisfaction is an important means of preventing the death of children caused by communicable diseases. However, in Ethiopia, there is paucity of evidence on maternal satisfaction with immunization services. Thus, this study is aimed at assessing the level of maternal satisfaction with childhood immunization services and associated factors among children’s caregivers. Methods: A facility-based cross-sectional study was conducted among 556 systematically selected children’s caregivers in public health facilities at Gondar Town from May through June, 2022. Data were collected using a pretested structured questionnaire. P≤ 0.25 during the bivariate binary logistic regression analysis was included in the multivariate analysis. From the multivariable analysis, variables with p ≤ 0.05 were declared statistically significant. Results: The prevalence of maternal satisfaction towards childhood immunization services was 69.3%(95%CI: 65.5, 73.1%). Of mothers, 45.3% had adequate knowledge, while 43.9% had favorable attitude. Mothers 19-24 years old [AOR = 5.29; 95%CI:2.58,10.86], mothers who waited less than one hour [AOR = 3.03; 95%CI: 1.92,4.77], mothers less than thirty minutes waiting in health facility[AOR=1.98;95%CI:1.24,3.15], mother feel happy during service[ AOR=4.00; 95%CI: 2.53,6.34], mothers adequate knowledge [AOR=2.91; 95%CI: 1.79, 4.73] and had favorable attitude [AOR=3.64; 95%CI: 2.25, 5.91] were significantly associated with maternal satisfaction during childhood immunization services.Conclusions: The overall level of mothers’ satisfaction with childhood immunization services was considerably lower as compared with other studies. Thus, the town health office and concerned stakeholders need more efforts to improve mothers’ satisfaction with childhood immunization services.

Traditional Health Practitioners (THPs) are considered as the entry level of care in African societies and play an important role in the delivery of health services to the population. A phenomenological qualitative study was carried out among pur-posefully selected THPs in Mthatha to understand their roles and the challenges they face in providing maternal health services. The study included a focus group discussion with seven participants, which yielded three themes and seven sub-themes. The content analysis of descriptive data from the focus group discussion revealed threats posed by unregistered and counterfeit THPs to the lives of pregnant women in rural settings. THPs' wide range of services allowed pregnant women to receive prenatal, antenatal, and postnatal care in close proximity. This level of care, however, was characterized by high levels of secrecy and counterfeit practitioners who used human body parts, which jeopardized the practice and made it unpopular. Traditional health practice must be protected through registration of THPs and the establishment of functional referral pathways between THPs and conventional health services.

Background: Disability and caste are two different forms of oppression, however Dalits and people with disabilities commonly face similar types of marginalities. Dalit women with disabilities may experience double discrimination because of the intersectionality of disability and caste. This study examines whether the disability and caste identity of women together affects and compounds the utilization of maternal healthcare services. Methods: A cross-sectional survey was conducted using a semi-structured questionnaire among a total of 354 Dalit and non-Dalit women, with and without a disability aged between 15 – 49 years. Maternal healthcare service utilization was assessed by Ante-Natal Care (ANC), health facility (HF) delivery, and Post-Natal Care (PNC) during the last pregnancy. Logistic regression was performed to detect the predictors of service utilization and identify whether disability and caste were associated with service utilization. First, disability and caste were fitted separately in models. Secondly, the intersectionality of disability and caste was tested by the inclusion of disability*caste interaction term. Finally, the confounding effect of socio-demographic factors was investigated. Results: Out of surveyed women, 73% had 4+ ANC visits, 65% had HF delivery and 29% had a PNC visit during their last pregnancy. Women with a disability had lower odds of HF delivery (OR 0.50, CI 0.30 – 0.84) and PNC (OR 0.47, CI 0.25 – 0.88) than women without a disability. Adjustment for women’s age and household wealth explained associations in HF delivery by women with disabilities. There was no association between caste and service utilization. Disability overrode caste and there was no other evidence of effect modification by women’s caste status in the utilization. However, a weak interaction effect in the utilization of ANC services was found in the caste group by their education (OR 0.19, 95% CI 0.05 – 0.74). Conclusions: Disabled women – whether Dalit or non-Dalit - had lower rates of utilizing all maternal healthcare services than non-disabled women. However, Dalit women with disabilities were more likely to receive PNC than non-Dalit women with disabilities. Increasing equity in maternal healthcare service utilization requires that traditional approaches to service development and program intervention to be re-examined and more nuanced interventions considered to ensure improved access and outcome among all vulnerable groups.

Smoking during pregnancy remains one of the most significant risk factors for poor birth outcomes. The Loma Linda University Health Comprehensive Tobacco Treatment Program (CTTP) is the largest maternal tobacco cessation program in San Bernardino County – the largest county in the contiguous US. CTTP is an eight week, incentivized, behavioral intervention for tobacco cessation for pregnant smokers. As part of program evaluation, we used a retrospective cohort design to assess smoking abstinence and to identify predictors of relapse/smoking after enrollment. Among CTTP cohort enrollees (n=233) from 2012-2013 we found: 1) a 28.4% 8 week point prevalence abstinence (PPA), and at a median of 9 months of follow-up after the PPA, 81.6% continued to indicate tobacco cessation, and 2) a high rate of relapse or loss to follow-up (56%). Our modeling of relapse/smoking after enrollment indicated that this was higher in young mothers, non-Hispanic mothers (White, Black), first/third trimester mothers, and rural mothers. The evaluation identified efficacy of the behavioral model at 8 weeks, but that relapse/smoking was occurring in disparity populations. Formative research is needed to expand the programmatic outreach and enrollment of mothers wanting to quit smoking.

Recent policy and service provision recommends a woman-centered approach to maternity care and encourages the development of personalized models of clinical assistance. As ethnicity has been recognized as determinant in the risk calculation of some obstetric complication, our aim was to assess costs for birth assistance according to the maternal ethnicities. In a five-year period (2012-16) all women admitted for delivery at the Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Rome, Italy were investigated. Economic evaluations were performed by using the ‘diagnosis-related group’ (DRG) approach. Cost analysis was completed by including maternal ethnicity, delivery mode and perinatal complications. A total of 18,093 patients were involved in the analysis. An overall care expense of €42.663.481 was calculated. Caucasian was the main ethnicity (90.7%), leaving the minority groups to 9.3%. Vaginal delivery (VD) was the most common mode of delivery in all ethnic clusters, with a global rate of 59.6%. Not including Asiatic women, increased CS rates were recorded in all minority ethnic groups (Maghreb (51.5%) and Afro-Caribbean (47.8%)). A double incidence of complicated VD was observed in the minority groups, primarily among Afro-Caribbean (69.9%), followed by Asiatic (64.1%), Maghreb (63.2%) and Latin-America (62.7%) patients. By logistic regression, Afro-Caribbean delivering women had a significant increased risk of complicated CS among all subgroups. Minority groups (Afro-Caribbean, in particular) increase the health care cost for birth assistance due to higher incidence of adverse perinatal outcomes.

Air pollution has become a growing invisible killer in recent years and is major cause of morbidity and mortality globally. India stands 10th among the highly polluted countries with an average PM10 level of 134μg/m3 per year. It is also reported that 99% of India's population comes across air pollution level that exceed the World Health Organization Air Quality Guideline (AQG), PM2.5 permissible levels of 10 μg/m3. Maternal exposure to air pollution has a serious health outcome to the offspring because it can affect embryonic phases of development during the gestation period. Fetus is more prone to air pollution effect during embryonic developmental phases due to oxidative stress as antioxidant mechanisms are lacking at that stage. Any injury during this vulnerable period (embryonic phase) will have long-term impact on offspring health both in early and later in life. Epidemiological studies have revealed that maternal exposure to air pollution increases the risk of developing airways disease in offspring due to impaired lung development in utero. In this review, we discuss cellular mechanisms involved in maternal exposure to air pollution and how it can impact development of airways disease in offspring. Better understanding of these mechanisms in context of maternal exposure to air pollution can offer newer avenue to prevent development of airways disease in offspring.

Abstract: Background: Bangladesh has achieved remarkable progress in reducing maternal mortality, yet postpartum deaths remain a significant issue. Emphasis on quality postnatal care (qPNC) is crucial, as increased coverage alone has not sufficiently reduced maternal morbidity and mortality. Methods: This study included data from the Bangladesh Maternal Mortality Survey of 32,106 mothers who delivered within three years prior to the survey. Descriptive statistics were used to report coverage and components of postnatal care stratified by covariates. Log-linear regression models were used to assess the determinants of quality postnatal care among facility and home births. Results: From 2010 to 2016, postnatal care coverage within 48 hours of delivery by a qualified provider rose from 23% to 47%. 94% of facility births received timely PNC, contrasted with only 6% for home births. Despite the increased coverage, quality of care remained as low as 1% for home births and 13% for facility births. Key factors affecting qPNC utilization included socio-demographic factors, pregnancy complications, delivery method, financial readiness, and mobile ownership. Conclusion: Importantly, deliveries assisted by skilled birth attendants correlated with higher quality postnatal care. The study reveals a significant gap between the coverage and quality of postnatal care in rural Bangladesh, especially for home births. It underscores the need for targeted interventions to enhance qPNC.

Millions of children in developing countries face preventable deaths due to inadequate vaccination and malnutrition, in part due to insufficient monitoring and the absence of official identification. A reliable fingerprint recognition system can be a practical solution to address this issue. However, the scarcity of longitudinal fingerprint datasets for young children leads to unresolved questions regarding the earliest age for fingerprint biometric use, the frequency of enrollment required for reliable recognition, and the methods to accommodate agerelated changes. A few recent studies introduced high-resolution fingerprint scanners and showed promising recognition performance for young children. However, these studies were conducted on a small dataset over a shorter period with limited diversity; further evaluation of their finding is essential. This study assessed the effectiveness of a high-resolution contactless scanner in a controlled, diverse longitudinal dataset of children (0-15 years). Our results indicate that infants can be enrolled at five days old and reliably recognized after two months with a TAR= 100% @ FAR = 0.1%, and children aged 4-15 years can be recognized after one year with a TAR= 98.72% @ FAR = 0.1%.

Microplastics are small plastic pieces with sizes less than 5 mm. They are becoming a global concern due to the potential risk to human health. The potential risks of microplastics may be greater for infants because they do not have sufficiently developed metabolizing enzymes, have a lower ability to remove them, high sensitivity of target organs. Infants should be breastfed for the first six months of life. Breast milk is considered to be the most complete and suitable source of nutrition. However, if breastfeeding during this period is not possible, it is necessary to use formulas designed for infant initial feeding. Infants may be exposed to higher levels of MPs through infant foods or plastics products. The aim of this study is to describe the possible sources of exposure to microplastics such as human placenta, plastic feeding bottles, toys as well as the presence of released microplastics in infants feces, breast milk and infant formulas. There is still not enough data available from the studied area. Therefore, it is necessary to pay increased attention to minimizing the negative effects of microplastics on human health.

: Forty-nine children who started wearing cartilage conduction hearing aids (CC-HA) before elementary school graduation (including 17 cases of bilateral hearing loss and 32 cases of unilateral hearing loss) were followed up and examined. The wearing and utilization status of CC-HA, as well as the progress to date, were evaluated. In addition, 33 participants who purchased CC-Has were interviewed to assess the wearing effect. Eleven of the 17 children with bilateral hearing loss and 25 of the 32 children with unilateral hearing loss have continued using CC-HA. In terms of wearing effect, a good wearing effect was reported, even by those with one-sided hearing loss. In cases where it is difficult to wear CC-HAs stably with pasting or ear tips, it is possible to fix them stably using commercially available hair bands and eyeglass vines. In two cases, CC-HAs were worn from the age of 0. With ingenuity and appropriate educational and medical support, it is possible to wear CC-HA from infancy.

Coronavirus disease 2019 (COVID-19) was initially characterized as a respiratory illness. Neurological manifestations were reported mostly in severely affected patients. Routes for brain infection and the presence of virus particles in situ have not been well described, raising controversy about how the virus causes neurological symptoms. Here, we report the autopsy findings of a 1-year old infant with COVID-19. In addition to pneumonitis and multiple organ damage related to thrombosis, SARS-CoV-2 infected the choroid plexus, ventricles, and cerebral cortex. This is the first evidence of SARS-CoV-2 detection in an infant post-mortem brain.

Childhood overweight and obesity is a worldwide public health issue. Our objective was to describe planned, ongoing and completed randomized controlled trials (RCTs) designed for the prevention of obesity in early childhood. Two databases (World Health Organization International Clinical Trials Registry Platform, ClinicalTrials.gov) were searched to identify RCTs with the primary aim of preventing childhood obesity and at least one outcome related to child weight. Interventions needed to start in the first two years of childhood or earlier, continue for at least 6 months postnatally, include a component related to lifestyle or behaviors, and have a follow up time of at least 2 years. We identified 29 unique RCTs, implemented since 2008, with most being undertaken in high income countries. Interventions ranged from advice on diet, activity, sleep, emotion regulation and parenting education through individual home visits, clinic-based consultations or group education sessions. Eleven trials have published data on child weight related outcomes to date, though most were not sufficiently powered to detect significant effects. Many trials detected improvements in practices such as breastfeeding, screen time and physical activity in the intervention groups compared to the control groups. Further follow-up of ongoing trials is needed to assess longer-term effects.

Among humans, simply looking at infants can activate affiliative and nurturant behaviors. However, it remains unknown whether mere exposure to infants also activates other aspects of the caregiving motivational system, such as generalized defensiveness in the absence of immediate threats. Here, we demonstrate that simply viewing faces of infants (especially from the ingroup) may heighten vigilance against social threats and support for institutions that purportedly maintain security. Across two studies, participants viewed and rated one among several image types (between-subjects design): infants, adult males, adult females, and puppies in Study 1, and infants of varying racial/ethnic groups (including one's ingroup) and puppies in Study 2. Following exposure to one of these image types, participants completed measures of intergroup bias from a range of outgroups that differed in perceived threat, belief in a dangerous world, right-wing authoritarianism and social-political conservatism (relative to liberalism). In Study 1 (United States), stronger affiliative reactions to images of infants (but not adults or puppies) predicted stronger perceptions of a dangerous world, endorsement of right-wing authoritarianism, and support for social-political conservatism (relative to liberalism). Study 2 (Italy) revealed that exposure to images of ingroup infants (compared to outgroup infants) increased intergroup bias against outgroups that are characterized as threatening (immigrants and Arabs) and increased conservatism. These findings suggest a predisposed preparedness for social vigilance in the mere suggested presence of infants e.g., viewing images, even in the absence of salient external threats.

We aimed to evaluate the safety of maternal Tdap we assessed health events by examining the difference in birth and hospital-related outcomes of infants with and without fetal exposure to Tdap. This was a retrospective cohort study using linked administrative datasets. The study population were all live-born infants in New Zealand (NZ) weighing at least 400 grams at delivery and born to women who were eligible for the government funded, national-level vaccination program in 2013. Infants were followed from birth up to one year of age. There were a total of 69,389 eligible infants in the cohort. Of these, 8,299 infants were born to 8,178 mothers exposed to Tdap (12%), primarily between 28-38 weeks gestation as per the national schedule. Among the outcomes, we found a reduced risk for moderate to late preterm birth, low birth weight, small for gestational age, large for gestational age, respiratory distress syndrome, transient tachypnea of newborn, tachycardia or bradycardia, haemolytic diseases, other neonatal jaundice, anaemia, syndrome of infant of mother with gestational diabetes, and hypoglycemia in infants born to vaccinated mothers. There was no association between maternal Tdap and stillbirth, infant Apgar score at 5 minutes after birth, microcephaly, asphyxia, sepsis or infection, or hypoxic ischemic encephalopathy. Infant exposure to Tdap during pregnancy was associated with a higher mean birthweight (not clinically significant) and higher odds for ankyloglossia and neonatal erythema toxicum diagnoses. There were insufficient observations to allow examination of the effect of Tdap on extreme preterm and very preterm birth, and infant death. Overall, we found no outcomes of concern associated with the administration of Tdap during pregnancy.

Objectives: The aim of this study was to describe potential factors contributing to neonatal mortality in Takeo, Cambodia through assessment of verbal autopsies collected following newborn deaths in the community. The mortality review was nested within a trial of a behavioral intervention to improve newborn survival, and was conducted after the close of the trial, within the study setting. The World Health Organization standardized definition of neonatal mortality was employed, and two pediatricians independently reviewed data collected from each event to assign a cause of death. Results: Thirteen newborn deaths of infants born in health facilities participating in a community based, behavioral intervention were reported during February 2015–November 2016. Ten deaths (76.92%) were early neonatal deaths, two (15.38%) were late neonatal deaths, and one was a stillbirth. Five out of 13 deaths (38.46%) occurred within the first day of life. The largest single contributor to mortality was neonatal sepsis; six of 13 deaths (46.15%) were attributed to some form of sepsis. Twenty-three percent of deaths were attributed to asphyxia. The study highlights the continuing need to improve quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.: The study highlights the continuing need to improve both intrapartum and postnatal quality of care and infection prevention and control, and to fully address causes of sepsis, in order to effectively reduce mortality in the newborn period.

This randomized control trial aims to test the hypothesis that twice-daily nurse-administered saline enema(SE) is comparable to physician-administrated SE in very low birth weight infants (VLBW) with meconium obstruction of prematurity (MOP). MOP is defined as no bowel opening for 48 h, and treatment failure is defined as the need for additional intervention and safety. Twice-daily SE was administered by accredited nurses, surgeons/neonatologists using standardized protocols. The outcomes were comparability of nurse to physician-administered SE in terms of frequency of administration, catheter insertion length and volume of enema, daily maximum meconium output, and treatment failure, defined as the need for additional intervention. Safety outcomes were evaluated. Twenty-eight infants were managed with SE. 389 SE were administered, 96 and 293 in 750-999g and 1000-1500g birth weight groups, respectively. Nurses administered 72.9% and 81.5% of SE in 750-999g and 1000-1500g birth weight groups, respectively. Physicians performed the rest of the SE. Daily meconium output was comparable in nurse and physician-administered SE in both groups. There were no treatment failures or adverse events in both SE group. SE administered by nurses was found to be comparable in terms of safety, efficacy, and frequency of administration to that of physician-administered SE.

Pregnancy-related morbidity and mortality remains high across the United States and the majority of deaths are preventable. Misdiagnosis and delay in diagnosis are thought to be contributors to preventable harm. These diagnostic errors in obstetrics are understudied. We present selected research methods to ascertain rates of and harm associated with diagnostic errors, the challenges in investigating them, and present future steps toward achieving diagnostic excellence in obstetrics.

Hydrotherapy, including the use of therapeutic showers and bathtubs, has been studied for its potential benefits in labor pain management. Previous research has indicated that hydrotherapy can alleviate pain, but comparative studies between therapeutic showers and bathtubs are scarce. Objective: This study aims to compare the effects of therapeutic showers and bathtubs on pain perception, labor duration, use of epi-dural analgesia, and maternal and neonatal outcomes during labor. Methods: A total of 124 pregnant women were included in this study. Participants were divided into two groups: those who used a thera-peutic shower and those who used a bathtub during labor. Pain levels were measured using a visual analog scale (VAS). Labor duration, use of epidural analgesia, types of delivery, maternal outcomes (postpartum hemorrhage, perineal status, maternal hypotension, fever, and breastfeeding), and neonatal outcomes (APGAR scores, fetal heart rate, complications, and neonatal unit admissions) were recorded and analyzed. Results: Both the therapeutic shower and the bathtub effectively reduced pain perception, with the bathtub showing a greater reduction in VAS scores. The therapeutic shower group experienced a signifi-cantly shorter labor duration compared to the bathtub group. The majority of participants in both groups did not require epidural analgesia, with no significant differences between the groups. There were no sig-nificant differences in the types of delivery. Maternal outcomes indicated a lower incidence of perineal tears and episiotomies in the therapeutic shower group. Neonatal outcomes, including APGAR scores and fetal heart rate, were similar between the groups, with no significant differences in complications or neo-natal unit admissions. Conclusions: Both therapeutic showers and bathtubs are effective for pain relief during labor, with the bathtub showing a higher reduction in pain intensity. The therapeutic shower is as-sociated with a shorter labor duration and a lower incidence of perineal tears and episiotomies. Both meth-ods are safe for neonatal well-being, making hydrotherapy a viable non-pharmacological option for pain management in labor. However, the therapeutic shower may offer additional benefits in terms of labor du-ration and maternal outcomes.

The COVID-19 pandemic has raised concerns about its impact on maternal and neonatal health. This study aimed to investigate the influence of maternal COVID-19 infection during pregnancy on neonatal inflammatory parameters. A retrospective cohort study was conducted at Premiere Hospital in Timisoara between May 2021 and January 2022. Participants were categorized into two groups: the COVID-19 positive group, consisting of patients with confirmed SARS-CoV-2 in-fection during pregnancy, and the control group, which comprised COVID-19-free pregnant women. The primary outcome was the assessment of inflammatory markers (NLR, dNLR, PLR, and SII) in neonates born to mothers with COVID-19. The results suggest that maternal COVID-19 infection during pregnancy significantly impacts certain neonatal inflammatory parameters. Spe-cifically, newborns exposed to maternal COVID-19 exhibited elevated white blood cell counts, particularly when infection occurred during the first trimester. Lymphocyte counts were dimin-ished in neonates born to COVID-19-positive mothers, irrespective of infection trimester. Gesta-tional age played a role in altering neonatal immune profiles, with correlations observed between GA and parameters in the Control Group (COVID-19 negative during pregnancy). However, the influence of neonatal immunoreactivity on laboratory parameters remained generally non-significant after adjusting for GA and infection trimester. In conclusion, maternal COVID-19 infection during pregnancy has a discernible impact on neonatal inflammatory parameters, in-cluding WBC and lymphocyte counts, which may have clinical implications.

Early-life exposure to high-fat diet (HF) can program metabolic and cognitive alterations in adult offspring. Although the hippocampus plays a crucial role in memory and metabolic homeostasis, few studies reported the impact of maternal HF on this structure. We assessed the effects of maternal HF during lactation on physiological, metabolic and cognitive parameters in young adult offspring mice. To identify early-programming mechanisms in hippocampus, we developed a multi-omics strategy in male and female offspring. Maternal HF induced a transient increased body weight at weaning, a mild glucose intolerance only in 3-month-old male mice with no change in plasma metabolic parameters in adult male and female offspring. Behavioral alterations revealed by Barnes maze test were observed both in 6-month-old male and female mice. Multi-omics strategy unveiled sex-specific transcriptomic and proteomic modifications in the hippocampus of adult offspring. These studies that were confirmed by regulon analysis, showing that, although genes whose expression was modified by maternal HF were different between sexes, the main pathways affected were similar with mitochondria and synapses as main hippocampal targets of maternal HF. The effects of maternal HF reported here may help to better characterize sex-dependent molecular pathways involved in cognitive disorders and neurodegenerative diseases.

Maternal obesity is increasingly prevalent and is associated with elevated morbidity and mortality rates in both mothers and children. As the interface between the mother and fetus, the placenta has mediates the impact of the maternal environment on fetal development. Most of the literature data on the effects of maternal obesity on placental functions do not exclude potential confounding factors like metabolic diseases (e.g. gestational diabetes). Moreover, it is now clear that the placental response to maternal environment depends on the fetal sex. In this context, we reviewed how maternal obesity (in the absence of gestational diabetes) affects the human placenta in terms of (i) endocrine function, (ii) morphological characteristics, (iii) nutrient exchanges and metabolism, (iv) inflammatory/immune status, (v) oxidative stress, and (vi) transcriptome, with a focus on fetal sex specificities. A better understanding of sex-specific placental responses to maternal obesity is crucial for improving pregnancy outcomes and the health of mothers and children.

Background: Maternal influenza vaccination provides effective protection against influenza in-fections in pregnant women and new-borns. In India, the influenza vaccine has not yet been of-fered through immunization programs, owing to the lack of sufficient safety data for Indian pregnant women. Methods: This cross-sectional observational study enrolled 558 women ad-mitted to the obstetrics ward of a civic hospital in Pune. Study-related information was obtained from the participants through interviews using structured questionnaires and hospital records. Univariate and multivariate analysis were used and chi-square with unadjusted and adjusted odds ratio were estimated to account for vaccine exposure and the temporal nature of each out-come, respectively. Results: The protective effect of maternal influenza vaccination against delivering very low birth weight infants was observed. (aOR 2.29, 95% CI 1.03 to 5.58, p=0.03). No association was observed between maternal influenza vaccination for spontaneous abortion (OR 1.42, 95%CI 0.75, 2.68), chorioamnionitis (OR 0.60, 95% CI, 0.1, 3.63), gestational hypertension (OR 1.73, 95% CI 0.72, 4.16) and preterm birth (OR 1.64, 95% CI 0.91, 2.97). Interpretation: These results show that the in-fluenza vaccine administered during pregnancy is safe and has a lower risk of negative birth outcomes.

Serological human birth cohort studies have identified maternal infection during pregnancy as a risk factor for development of disorders such as Autism Spectrum Disorder and schizophrenia in offspring. Similarly, in experiments using animal models, maternal immune activation (MIA) has been shown to alter neuroanatomical and behavioral development in offspring. This study employs magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) in conjunction with behavioral assays to refine our understanding of the impact of MIA on neurobiological development in exposed animals. On gestational day nine, pregnant dams were injected with either polyinosinic:polycytidylic acid (POL) to induce MIA or saline (SAL) as a control. Whole-brain MRI, localized proton MRS, and behavioral tests (open field, three chambered social approach, and prepulse inhibition) were acquired at two timepoints, during adolescence (postnatal day [PND] 35) and adulthood (PND 60). Whole-brain voxel-wise volumetric analyses revealed that MIA offspring exhibited altered volume in the hippocampus and caudate putamen (CPu) between adolescence and early adulthood. MRS data were assessed at each timepoint separately; MIA offspring during early adulthood but not adolescence exhibited trending reductions in γ-aminobutyrate (GABA) (p = 0.06) and myo-inositol (Ins) (p = 0.08) compared to saline controls. However, these metabolite differences did not reach levels of significance, even before multiple comparison corrections. Open field testing revealed that during adolescence, MIA offspring displayed a more anxious phenotype than controls wherein they spent less time in the anxiogenic center zone of the open field arena (p < 0.007), but this difference normalized by adulthood. There were no significant differences in sociability preference, novelty preference, or prepulse inhibition comparing the groups. Results suggest that early gestational exposure to MIA results in subtle neuroanatomical changes in the trajectories of development, trending behavioral changes in adolescent offspring, and slight neurochemical changes in young adult offspring. Maternal infection alone may not be enough; additional genetic or environmental risk factors may be required to elicit the more typical symptoms of neuropsychiatric disorders.

Tilapia lake virus (TiLV), a major pathogen of farmed tilapia, is known to be vertically transmitted. Here, we hypothesize that Nile tilapia (Oreochromis niloticus) broodstock immunized with a TiLV inactivated vaccine can mount a protective antibody response and passively transfer maternal antibodies to their fertilized eggs and larvae. To test this hypothesis, three groups of tilapia broodstock, each containing 4 males and 8 females, were immunized with either a heat-killed TiLV vaccine (HKV), a formalin-killed TiLV vaccine (FKV) (both administered at 3.6 ×106 TCID50 per fish), or with L15 medium. Booster vaccination with the same vaccines was given 3-weeks later, and mating took place 1 week thereafter. Broodstock blood sera, fertilized eggs and larvae were collected from 6-14 weeks post-primary vaccination for measurement of TiLV-specific antibody (anti-TiLV IgM) levels. In parallel, passive immunization using sera from the immunized female broodstock was administered to naïve tilapia juveniles to assess if antibodies induced in immunized broodstock were protective. The results showed that anti-TiLV IgM was produced in the majority of both male and female broodstock vaccinated with either the HKV or FKV and that and that these antibodies could be detected in the fertilized eggs and larvae from vaccinated broodstock. Higher levels of maternal antibody were observed in fertilized eggs from broodstock vaccinated with HKV than those vaccinated with FKV. Low levels of TiLV-IgM were detected in some of the 1-3-day old larvae but were undetectable in 7-14-day old larvae from the vaccinated broodstock, indicating a short persistence of TiLV-IgM in larvae. Moreover, passive immunization proved that antibodies elicited by TiLV vaccination were able to confer 85% to 90% protection against TiLV challenge in naïve juvenile tilapia. In conclusion, immunization of tilapia broodstock with TiLV vaccines could be a potential strategy for the prevention of TiLV in tilapia fertilized eggs and larvae, with HKV appearing to be more promising than FKV for maternal vaccination.

Brain development during the prenatal period is rapid and unparalleled by any other time during development. Biological systems undergoing rapid development are at higher risk for disorganizing influences. Therefore, certain prenatal exposures impact brain development, increasing risk for negative neurodevelopmental outcome. While prenatal exposures have been associated with cognitive and behavioral outcomes later in life, the underlying macroscopic brain pathways remain unclear. Here, we review studies investigating the association between prenatal exposures and infant brain development focusing on prenatal exposures via maternal physical health factors, maternal mental health factors, and maternal drug and medication use. Further, we discuss the need for studies to consider multiple prenatal exposures in parallel and suggest future directions for this body of research.

Postpartum hemorrhage is a complication during the puerperium that requires serious management, because it risks on threatening the mother's death. Currently, postpartum hemorrhage is still the main cause of maternal morbidity and mortality in the world. There is a need for a fast, precise and comprehensive handling effort involving all elements, such as the entire health team including doctors-nurses and families. The form of nursing intervention in postpartum hemorrhage patients can be in the form of nursing treatment or collaboration. The purpose of this review literature is to identify nursing treatment and nursing collaboration in postpartum hemorrhage patients as an effort to prevent maternal death. The writing method uses literature reviews by summarizing 10 articles publicated in 2019, 2020 and 2021 in 4 search data bases including Sciencedirect, Scopus, Proquest and Thompson. The review guidelines used are based on Prisma and the Joanna Briggs Institutute. The level of eligibility is identified through the title, abstract, research methodology and full text. The results of the reviews found are presented in a narrative form. The results of the review study found that there were 10 articles on postpartum hemorrhage management measures both in the effort of snoring treatment and collaboration including: optimizing the competence of service providers based on E_Learning , foot reflexology since the 4th stage of labor, 800 mcg sublingual Misoprostol, the use of the Digital Postpartum Hemorrhage Management Device ( DPHMD), bilateral-contralateral cervical clamps, suction tube uterine tampons, bilateral hypogastric artery (BHAL), evaluation of Shock Index, Carbetocin drugs and administration of Tranexamic acid 1 gram IV within 10 minutes of vaginal delivery. The conclusion of this review literature is that nursing treatment and nursing collaboration are proven to have a positive impact as an effort to prevent death in postpartum hemorrhage patients.

There is increasing evidence that the non-cooperative models describe household structures in developing countries more succinctly compared with the unitary model. Domestic violence against women, which is pervasive in Nigeria even though likely to be under-reported, will need to be understood within the framework of non-cooperative relationship between couples. In this study, we identify factors of domestic violence against women within couples who were currently in marital or cohabiting partnerships. Also, we investigate whether domestic violence influences the decision of women to terminate pregnancies. We use data from the 2018 Nigeria Demographic and Health Survey (NDHS). Multivariate logistic regressions were used to model the predictors of domestic violence, and its influence on the decision to terminate pregnancies among married women. Of the 8,910 married women interviewed for domestic violence, 35.33% had ever experienced a form of domestic violence. We discover that women: with higher education, that is not poor, and resides in urban areas have 44%, 18% and 15% reductions in the odds of experience domestic violence respectively. On the other hand, women who are employed, own land, having husbands/partners that are employed in the agricultural sector, and drink alcohol have 1.16, 1.2, 2.07, and 2.8 times increased odds of experiencing domestic violence accordingly. Also, we uncover that currently married women experiencing domestic violence have 1.25 times increased odds of terminating pregnancies compared with their counterparts that are not experiencing domestic violence. Effectively, poverty, low levels of education, residing in rural areas, drinking habit of husbands/partners, employment, marital capital, and land ownership status of women are risk factors of domestic violence against married women in Nigeria but can be affected by policies and programmes. Importantly, public actions to contain domestic violence in order to improve maternal health should be implemented in the context of the dynamics of a non-cooperative relationship existing between married couples.

The study explored the community perception of maternal deaths influenced by natural disaster, practice of maternal complications during natural disaster among the rural population in Bangladesh. It also explored the challenges faced by the community for providing health care and referring the complicated pregnant mothers during disaster. Three focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted in the marginalized rural communities in the flood-prone Khaliajhuri sub-district, Netrakona district, Bangladesh. Flood is one of the major risk factors for influencing maternal death. Pregnant mothers seriously suffer from maternal complication, lack of antenatal checkup and even any doctor during flood. During the time of delivery, it is difficult to find even a skilled attendant and referring the patient with delivery complications to the healthcare facility. Boat is the only mode of transport. Majority maternal deaths occur on the boats during transfer from the community to the hospital. The rural people feel that the maternal deaths influenced by natural disaster are the natural phenomena. It needs some pre-preparation to support pregnant women during the disaster. There is unawareness of maternal health, related care and complications during disaster among the local health service providers and volunteers.

Background User fee exemption for maternal and child health care service policy was introduced with a focus on providing free caesarean sections (CS) in Nigeria from 2011 to 2015. This policy had a positive impact on access to facility-based delivery, but its effect on socioeconomic and geographical inequality remains unclear. This study’s main objective is to examine access to birth by CS in the context of free maternal health care. Specifically, the study examines socio-demographic and geographical inequality in access to birth by CS among women who gave birth between 2011 and 2015 under the free maternal health care policy using a population-based survey data obtained from two of the six main regions of the country. Methods Data were obtained from 1227 women who gave birth during the period the policy was in operation selected using cluster random sampling between May and August 2016. Adjusted and unadjusted binary logistic regression models were used to examine whether there is socio-demographic and geographical inequality in access to birth by caesarean section. Results The overall caesarean section rate of 6.1% was found but varies by income (14.1% in monthly income of over $150 versus 4.9% in income of $150 and below), education (11.8% in women with higher education versus 3.9% among women with secondary education and less) and place of residence (7.8% in urban areas versus 3.6% in rural areas). Women who earn a monthly income of $150 or less were 48% less likely to have a birth by CS compared to those who earn more. Compared to women who were educated to tertiary level, women who had secondary education or less were 54% less likely to have birth by caesarean section. Conclusion This study shows that inequality in access to CS persists despite the implementation of free maternal health care services. Given the poor access to facilities with capabilities to offer CS in most rural areas, free maternal healthcare policy is not enough to make birth by CS universally accessible to all pregnant women in Nigeria.

In last decades, growing migration flows have modified the obstetric clinical care, requiring specific attention by health care systems. The aim was to describe the phenomenon focusing on miscarriage (pregnancy loss at <20 weeks). Patients admitted for care at miscarriage in a six-year period (2012-17) were revised. Miscarriage rates in all ethnic groups, dichotomized in early (within the first 12 weeks of gestation) and late (at <20 weeks) pregnancy loss. Associations between women's characteristics (age, parity, inter-pregnancy interval (IPI)) were explored to elucidate any differences. A total of 1,940 patients were included, segregated in early (n = 1769, 91.2%) and late (n = 171, 8.8%) pregnancy losses. Caucasian ethnicity was the most common (87.9%), leaving the minority groups to 12.1%. Maternal age was higher among Caucasians women than other subgroups, in contrast to Asiatic patients. Nulliparity was observed in 1045 (53.9%) patient, more widespread among Caucasian and Maghrebins. A positive obstetric history counting at least one miscarriage was frequent, ranging from 22.2% to 75%, in particular among Asiatic women, while the recurrence in Caucasians. In Afro-Carribeans the most relevant rate of late miscarriage was found. By multiple regression modelling, maternal age, nulliparity and Afro-Carribean were identified as determinants. Maternal ethnicity should be considered in the management of pregnancy losses in combination with already well-defined risk factors, including age at miscarriare and nulliparity.

(1) Background: Premature infants require mothers’ milk fortification to meet nutrition needs, but breast milk composition may be variable leading to a risk of inadequate nutrition. We aimed at determining factors influencing mothers’ milk macronutrients. (2) Methods: Milk samples were analyzed for the first 5 weeks after premature delivery, by infrared spectroscopy. Mothers’ nutritional intake data were obtained during standardized interviews with dieticians then analyzed with reference software. (3) Results: Composition of 367 milk samples from 81 mothers was (Median [range]g/100mL): Carbohydrates 6.8[4.4-7.3], lipids 3.4[1.3-6.4], proteins 1.3[0.1-3.1]. There was a relationship of milk composition with mothers’ carbohydrates intake only (r=0.164; p<.01). Postnatal age was correlated with milk proteins (r=-0.505 p<.001) & carbohydrates (r=+0.202, p<.001). Multiple linear regression analyses showed (coefficient) a relationship between milk proteins r=0.547 and postnatal age (-0.028), carbohydrates intake (+0.449) and the absence of maturation (-0.066); and between milk lipids r=0.295 and carbohydrates intake (+1.279) and smoking (-0.557). Finally, between milk carbohydrates concentration r=0.266 and postnatal age (+0.012) and smoking (-0.167). (4) Conclusions: Variability of mothers’ milk composition is differentially associated for each macronutrient with maternal carbohydrates intake, antenatal steroids, smoking, and postnatal age. Improvement in milk composition could be achieved by modification of these related factors.

In recent years, more attention has been paid to behavioral problems in children. However, for the most part, risk factors for these problems have yet to be determined. The current prebirth cohort study investigated the relationship between maternal calcium consumption during pregnancy and behavioral problems in five-year-old Japanese children. Subjects were 1199 mother-child pairs. Dietary intake was assessed using a diet history questionnaire. Emotional problems, conduct problems, hyperactivity problems, and peer problems were assessed using the Strengths and Difficulties Questionnaire. Logistic regression analysis was conducted to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for four behavioral problems under study according to the quartile of calcium intake, with the lowest quartile as the reference. Adjustment was made for maternal age, gestation at baseline, region of residence at baseline, number of children at baseline, maternal and paternal education, household income, maternal depressive symptoms during pregnancy, maternal alcohol intake during pregnancy, maternal smoking during pregnancy, child's age, child's birth weight, postnatal secondhand smoke exposure at home during the first year of life, and breastfeeding duration. Higher maternal calcium intake during pregnancy was independently associated with a decreased risk of childhood emotional and hyperactivity problems; the adjusted ORs between extreme quartiles (95% CIs, P for trend) were 0.46 (0.27–0.79, 0.01) and 0.60 (0.37–0.97, 0.046). No such inverse associations were observed for childhood conduct problems or peer problems. Maternal calcium intake during pregnancy may decrease the risk of childhood emotional and hyperactivity problems.

Human milk (HM) feedings are associated with reduced risks of neurodevelopmental and neurocognitive delays and systemic inflammatory diseases in infants born prematurely and/or at a low birth weight. Utilizing a neonatal piglet model, HM feedings were compared to bovine milk-derived infant formula (IF)-feedings with the aim of understanding the underlying mechanisms involved in reducing these risks. Six male piglets at postnatal-day (PD)2 were randomized into two feeding groups: HM-fed (n = 3) or IF-fed (n = 3) for 28 days. At 3- and 4-weeks-old, piglet memory and learning performance were assessed using novel object recognition (NOR). At PD30 piglets were euthanized, and whole brains were excised, weighed, and preserved for further analyses, and brain microglial morphology, and systemic inflammatory cytokines were quantified. During NOR, HM-fed piglets had significantly more non-novel revisits at both 3- and 4-weeks-old compared to IF-fed piglets. Microglia of HM-fed piglets had longer processes, more branch points, more endpoints, and a larger territorial volume compared to IF-fed piglets at PD30. In a neonatal piglet model, HM-feedings may improve cognition and reduce brain inflammatory response compared to IF-feedings.

Severe combined immunodeficiency disorders (SCID) are a genetically heterogeneous group of inherited defects characterized by severe abnormalities of immune system development and function that lead to a wide spectrum in clinical manifestations. A subgroup of patients presents a disabling and life-threatening clinical course. In these cases, allogeneic hematopoietic stem cell transplant provides a curative approach. The occurrence of SCID-associated lymphoproliferative disorders is rare and occur mostly in adenosine deaminase-deficient severe combined immunodeficiency disorders, after allogeneic hematopoietic stem cell transplant. Epstein Barr virus infection is present in the majority of individuals with primary immunodeficiency developing lymphoma, revealing compromised anti-tumour surveillance of virally transformed cells. Herein, we report a rare case of diffuse large B cell lymphoma occurring in an Epstein Barr virus negative, non-transplanted X-linked severe combined immunodeficiency 4-months-old infant, successfully treated with immunotherapy and allogeneic stem cell transplantation. This case suggests that Epstein Barr virus -independent mechanism of neoplastic transformation must take action in severe combined immunodeficiency associated lymphoma and unveils the curative potential of donor T cells after allogeneic transplantation.

1) Background: Parents are increasingly fascinated by alternative weaning methods, such as ba-by-led or vegetarian weaning. However, international pediatric societies are still cautious to-wards alternative weaning methods, due to their significant risk of nutritional deficiencies. The aim of this study is to describe the attitude of Italian pediatricians towards unconventional weaning, with particular regard to vegetarian and baby-led. (2) Methods: A 20-question ques-tionnaire was sent to Italian pediatricians, from January to December 2019; (3) Results: Responses were received from 73/1000 (7.3%) pediatricians. The vast majority of surveyed pediatricians (78.1%) is familiar with baby-led and vegetarian weaning, but only 24.7% is in favor of their practice. A significant number of pediatricians (63.0%) received request from parents for an al-ternative weaning regimen. (4) Conclusions: The survey revealed a significant gap between pedi-atricians’ attitude and parental demand concerning unconventional weaning. This could signifi-cantly impair the alliance between parents and pediatricians with the risk to expose infants and children to severe nutritional deficiencies due to self-management by parents with poor surveil-lance from health professionals.

Objective: Racial/ethnic disparities in infant mortality (IM) continue to persist in the United States, with Black/African Americans (AA) being disproportionally affected with threefold increase in mortality compared to Whites. Epidemiologic data have identified maternal characteristics as risk IM such as eclampsia, maternal education, smoking, maternal weight, maternal SES, and family structure. Understanding the cause of causes including the method of labor and delivery and the racial heterogeneity may facilitate intervention mapping in narrowing the Black White IM risk differences. We aimed to assess the temporal/racial trends and the methods of delivery, mainly vaginal versus cesarean section (C-section) as exposure function of IM. Methods: The United States linked Birth/Infant Death records (2007-2016) were used with a cross-sectional ecologic design. The analysis involved chi squared statistic, incidence rate estimation, and period percent change. Results: Of the 40,445,070 births between 2007 and 2016, cumulative mortality incidence was 249,135 (1.16 per 1000). The IM rate was highest among Black/AA (11.41 per 1000), intermediate among Whites (5.19 per 1000), and lowest among Asian /Pacific Islanders (4.24 per 1000). The cumulative incidence rate difference, comparing vaginal to cesarean procedure was 1.73 per 1000 infants, implying excess IM with C-section. Compared to C-section, there was a 31% decreased risk of IM among mothers with vaginal delivery, rate ratio (RR) = 0.69, 95% CI 0.64-0.74. Racial disparities was observed in the method of delivery associated with IM. Black/AA mothers with vaginal delivery had a 6% decreased risk of IM compared to C-section, RR = 0.94, 95%CI 0.92-0.95, while Whites with vaginal delivery had a 38% decrease risk of IM relative to C-section, RR= 0.68, 95%CI 0.67-0.69, p<0.001. Conclusion: Infant mortality varied by race, with Black/AA disproportionally affected which is explained in part by labor and delivery procedures, suggesting reliable and equitable intrapartum assessment of Black/AA mothers during labor.

Aim: We estimated the correlation between serum bilirubin concentrations and insulin resistance in advanced maternal age without diabetes mellitus. Method: The cross-sectional study involved consecutive 50 women of advanced maternal age without diabetes mellitus, and insulin resistance (IR) was diagnosed according to the homeostatic model assessment insulin resistant (HOMA-IR) formula and the cut-off point was set to more than 2.5. Serum bilirubin and HOMA-IR were compared between the IR (+) and IR (-) groups. Results: We found that serum bilirubin levels in the IR subjects were significantly decreased compared to those without IR (p = 0.0252). Serum bilirubin concentrations were negatively correlated with the weight and the fasting insulin concentrations in all subjects (r=−0.282, p=0.047, r=-0.424, p=0.002). Additionally, serum bilirubin had a negatively correlation with HOMA-IR (r = -0.410, p = 0.003) in all subjects. The multiple linear regression analysis found that serum total bilirubin levels were independently correlated with HOMA-IR (beta = -0.392, p= 0.015) in these subjects. Conclusions: The study demonstrated that serum bilirubin concentrations had negatively correlation with insulin resistance in advanced pregnant women without diabetes mellitus, and decreased serum bilirubin may forebode increased gestational diabetes mellitus risk in our study population.

Maternal type 2 diabetes mellitus (T2DM) has been shown to result in fetal programming of the hypothalamus-pituitary-adrenal (HPA) axis, leading to adverse fetal outcomes. T2DM is preceded by prediabetes and shares similar pathophysiological complications. However, no studies have investigated the effects of maternal prediabetes on fetal HPA axis function and postnatal offspring development, hence this study. Pre-diabetic (PD) and non-pre-diabetic (NPD) female Sprague Dawley rats were mated with non-prediabetic males. After gestation, male pups born from the PD and NPD groups were collected. Markers of HPA axis function, adrenocorticotropin hormone (ACTH) and corticosterone were measured in all dams and pups. Glucose tolerance and expression of mineralocorticoid (MR) and glucocorticoid (GR) receptors were further measured in all pups at birth and their developmental milestones. The results demonstrated increased basal concentrations of ACTH and corticosterone in the dams from the PD group by comparison to NPD. Furthermore, the results show an increase in pups ACTH and corticosterone concentrations, impaired glucose tolerance and dysregulated MR and GR expression in the PD group at all developmental milestones. These observations reveal that pregestational prediabetes is associated with maternal dysregulation of the HPA axis, impacting offspring HPA axis development along with impaired glucose handling.

The field of human microbiome and gut microbial diversity research has witnessed a profound transformation, driven by advances in omics technologies. These advancements have unveiled essential connections between microbiome alterations and severe conditions, spurring the development of new frameworks through epidemiological studies. Traditionally, each individual was thought to harbor unique microbial communities acquired early in life, but recent research challenges this belief. The neonatal microbiome's onset, influenced by factors like delivery mode and maternal health, remains a subject of intense debate, hinting at potential intrauterine microbial processes. In-depth research reveals associations between microbiome profiles and specific health outcomes, ranging from obesity to neurodevelopmental disorders. Understanding these diverse microbiome profiles is essential for unraveling the intricate relationships between the microbiome and health outcomes.

Fragile X Syndrome (FXS) is a pervasive developmental disorder and the most common monogenic cause of autism spectrum disorder (ASD). Female heterozygous (HET) carriers play a major role in the transmission of the pathology and present several FXS- and ASD-like behavioral alterations. Despite their clear genetic origins, FXS symptoms are known to be modulated by environmental factors, e.g., the exposure to chronic stress, especially during critical life periods, such as pregnancy. Pregnancy, together with pups’ care, constitutes maternal experience, i.e., another powerful environmental factor affecting several neurobehavioral functions in females. Here we investigated the impact of maternal experience on the long-term effects of stress in Fmr1-HET female mice. Our findings demonstrated that the behavioral abnormalities of HET females, i.e., hyperactivity and memory deficits, were unaffected by stress or maternal experience. In contrast, stress, independently of maternal experience, induced the appearance of cognitive deficits in WT mice. Maternal experience increased anxiety levels in all mice and enhanced their corticosterone levels, concomitantly promoting the effects of stress on social communication and adrenal glands. Our results advance our understanding of the environmental modulation of the behavioral alterations observed in FXS mice and highlight the long-term impact of maternal experience and its interactions with chronic stress.

Background Obesity compromises the health of a woman's pregnancy and her newborn. Aim: To describe weight-gaining changes throughout pregnancy and evaluating outcomes for the mother and the baby. Methods A retrospective review of women who delivered singletons using Large Perinatal Registry. According to their BMI, patients were categorized into four categories: underweight, normal, overweight, and obese. Mode of delivery, gestational diabetes, hypertensive diseases, obstetric cholestasis, and postpartum hemorrhage were the main maternal outcome measures. The newborn outcome indicators were birth weight, NICU hospitalization, premature birth, and stillbirth. Results The study sample included 2,352 natives (25%) and 7,058 expatriates (75%). The majority of the sample (4726) were aged 20-29 years, 43.6% were aged 30-39 years, and 2.1% and 3.9% were aged 19 years and 40 years respectively. The incidence of hypertension, obstetric cholestasis, diabetes, postpartum hemorrhage, and cesarean section varied among the entire sample. In the underweight group, the incidence of CS was 15.7%, in the normal weight group (24.9%), in the overweight group (31.3%), and in the obese group (41%). Hypertensive disorders were 3 times more prevalent in obese women than in normal-weight women (2%), and 5.3% of obese women had PPH compared to 5. 6% of women of normal weight. The underweight groups gained the most weight during pregnancy, whereas the obese gained the least. Conclusions A significant proportion of pregnant women in our sample will become obese by the time of delivery. Obesity during pregnancy is associated with negative maternal and fetal outcomes.

Adequate access to drinking water for hydration and hygiene depends on many factors, such as water quality, accessibility, continuity of supply, and available quantity. We developed the Drinking Water Security Index (DWSI) to assess relative multifactorial drinking water security at different spatial and temporal scales. We apply this new index in Sudan to assess historical and future drinking water security at state, local, and maternity levels. State-level analyses found that the Red Sea and River Nile states are most vulnerable, with the lowest DWSI for both historical and future periods. The 1 km2 pixel level analysis shows large differences in water security within the major states. Analyses at maternity level showed that nearly 18.97 million people are affected by the 10% of maternities with lowest DWSI, a number projected to increase by 60% by 2030. Current and future water security indexes of maternities providing Emergency Obstetric and Newborn Care, were assessed to identify those where urgent action is needed to ensure quality health care in water secure conditions. This work provides useful information for stakeholders in the health and drinking water sectors in Sudan, to improve public health, reduce preventable mortality, and make the population more resilient to projected environmental changes.

Background: United Nations Sustainable Development Goals state that by 2030, the Global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. This research aims to study regional trends in maternal mortality in Africa. Methods: We extracted data for Maternal mortality rates per 100,000 births from the UNICE data bank from 2000 to 2017, being 2017 the last date available. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of -3.0% (95% CI -2.9;-3,2%). All regions showed significant downward trends, with the sharpest decreases in the South. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining sub-Saharan African regions are still far from achieving the goals. Conclusions: maternal mortality has decreased in Africa, especially in the South Africa region. The only region closed to the United Nations target is North Africa. The remaining sub-Saharan African regions are still far from achieving the goals. These results could be used for the development of Regional Policies.

Background: United Nations Sustainable Development Goals state that by 2030, the Global maternal mortality rate (MMR) should be lower than 70 per 100,000 live births. MMR is still one of Africa's leading causes of death among women. This research aims to study regional trends in maternal mortality in Africa. Methods: We extracted data for Maternal mortality rates per 100,000 births from the World Bank database from 1990-2015. Joinpoint regression was used to study the trends and estimate the annual percent change (APC). Results: Maternal mortality has decreased in Africa over the study period by an average APC of -2.6%. All regions showed significant downward trends, with the sharpest decreases in East Africa. Only the North African region is close to the United Nations' sustainable development goals for Maternal mortality. The remaining sub-Saharan African regions are still far from achieving the goals. Conclusions: maternal mortality has decreased in Africa, especially in East Africa. The only region closed to the United Nations target is North Africa. The remaining sub-Saharan African regions are still far from achieving the goals. These results could be used for the development of Regional Policies.

Background: The trends in the role of the germline in epigenetic transgenerational inheritance starts with the environmental factors acting on the first generation of a gestating mother. These factors influence the developing second-generation fetus by altering gonadal development, thereby reprogramming the primordial germ cell DNA methylation and leading to consequences that would be seen along generations. Objective: Despite these epigenetic factors now surfacing, the few available studies are on animal-based experiments and to make follow up on human intergenerational trials might take decades. To this response, this study aimed to determine the influence of parental energy, toxicant exposure, age and nutrient restriction on the early life of offspring growth in Gambia. Method: The study was on population-based observational study on parental energy influence, toxicant exposure, age, and nutrient restriction on offspring growth in Gambia. Results: This study showed that parents who worked in industrial areas were more likely to have offspring with poor psychosocial skills. In addition, mothers who are exposed to oxidative stress and high temperature are more likely to have offspring with poor psychosocial skills. Mothers who consumed a high protein diet were almost three more likely to have infants with good psychosocial skills in their offspring. Furthermore, there was a negative correlation between maternal stress during pregnancy and psychosocial skills of offspring. Conclusion: This study was able ascertain if maternal diet during gestation, toxicant exposure, maternal stress and parental smoking habits have influence on the early life of offspring. While the study is recommending a large sample size study to eliminate selection bias, there should be an increased level of awareness of mothers on their offspring's health and their husbands' lifestyles that might influence the adulthood health of offspring.

Possible alterations of maternal immune function due to psychological stress may reflect immunoactive factor levels in breast milk. This study aimed to assess the association between maternal distress and breast milk levels of secretory IgA (SIgA), IgM, IgG, and lactoferrin (LF). We hypothesized this association is moderated by maternal social support achieved from others during lactation. The study group included 103 lactating mothers and their healthy 5-months-old infants. Maternal distress was determined based on the State Anxiety Inventory and the level of salivary cortisol. Social support was assessed using Berlin Social Support Scales. Breast milk samples were collected to test for SIgA, IgM, IgG, and LF using the ELISA method. Milk immunoactive factors were regressed against maternal anxiety, social support, salivary cortisol, and infant gestational age using the general regression model. Maternal anxiety was negatively associated with milk levels of LF (β=-0.22, p<0.05) and SIgA (β=-0.29, p<0.01), while social support was positively associated with milk IgG (β=0.25, p<0.05). Neither anxiety nor social support was related to milk IgM. No association was found between the level of maternal salivary cortisol and immunoactive factors in milk. Our results suggest that maternal psychological well-being and social support may affect milk immune properties.

Background: Renewed measles outbreaks in recent years indicate that despite the routine availability of vaccines for a disease that is considered contagious, dangerous and deadly, many anti-vaccinationists do not vaccinate their children, which consequently endangers public health. This study aimed to investigate the factors that influence mothers to vaccinate their children, and whether the Health Belief Model (HBM) could predict compliance or non-compliance. Methods: This was a quantitative correlational research, utilizing a 40-item questionnaire administered to 181 mothers in Israel. Results: The findings indicated two main factors that affected mothers' intention to vaccinate their children against measles: first, their perception of the vaccine's advantages, and second, their perception of the severity of the disease. It was also found that the HBM variables significantly affected the intention to administer vaccines. Conclusion: Consequently, raising public awareness of the vaccine's advantages and importance to preventing mass infection, as well as attempts by the health system and practitioners to understand the motivations of anti-vaccinationists (including health beliefs and cultural sensitivities) could significantly increase the percentage of vaccinated children, and eradicate the measles epidemic.