A retrospective cohort study analyzing the changes in early childhood development during the COVID-19 pandemic.

OBJECTIVE: To investigate early childhood development (ECD) outcomes in different subgroups before and during the COVID-19 pandemic. STUDY DESIGN: A retrospective cohort study of children 3-58 months of age whose caregivers completed a Survey of Well-being of Young Children (SWYC) as part of a well child visit (WCC). The data were divided into two phases: pre-pandemic (September 2018 - February 2020), and during pandemic (September 2020 - February 2022). The difference in the proportion of forms with Meets Expectations interpreted scores on the SWYC Developmental Milestones pre-pandemic versus during the pandemic timeframe overall and among subgroups were reported. Hypotheses were tested using logistic regression with repeated measures. RESULTS: 14,550 patients were included in the sample for analysis with 52,558 SWYC form observations. There was no difference in the odds of a Meets Expectations interpreted score before and after the pandemic for the entire sample, OR 0.99 (95 % CI: 0.94-1.04). There was evidence of decreased odds of an interpreted score of Meets Expectations for the following subgroups: male, Hispanic/Latino ethnicity, ages of 24, 30 or 36 months at WCC, Medicaid insurance, 2nd HOUSES Quartile, requiring interpreter, single parent household, young maternal age, maternal substance abuse, and race identified as Native Hawaiian/Pacific Islander, American Indian/Native Alaskan or Other. CONCLUSION: Decreased odds of meeting developmental milestones during the pandemic were evident in certain high risk sub-groups revealing unequal distribution of suboptimal developmental outcomes within our population during the pandemic that may be exacerbating existing inequities impacting development in children.

Association of Weight Trajectory With Severe Obesity: A Case-Control Study.

Background: Early childhood weight trajectory is associated with future risk for obesity. However, little is known about the association of birth weight and weight trajectories before age 5.5 years with severe adult obesity. Methods: This study used a nested case-control design of 785 matched sets of cases and controls matched 1:1 on age and gender from a 1976 to 1982 birth cohort in Olmsted County, Minnesota. Cases with severe adult obesity were defined as individuals with a BMI ≥40 kg/m2 after 18 years of age. There were 737 matched sets of cases and controls for the trajectory analysis. Weight and height data from birth through 5.5 years were abstracted from the medical records, and weight-for-age percentiles were obtained from the CDC growth charts. Results: A two-cluster weight-for-age trajectory solution was identified as optimal, with cluster 1 having higher weight-for-age before age 5.5 years. While there was no association between birth weight and severe adult obesity, the odds of being in cluster 1, which includes children with higher weight-for-age percentiles, was significantly increased for cases compared with controls [odds ratio (OR) 1.99, 95% confidence interval (CI) 1.60-2.47]. The association between cluster membership and case-control status persisted after adjusting for maternal age and education (adjusted OR 2.08, 95% CI 1.66-2.61). Conclusions: Our data suggest that early childhood weight-for-age trajectories are associated with severe obesity status in adult life. Our results add to growing evidence that it is critical to prevent excess early childhood weight gain.

Effect of Electronic Health Record Prompts on the Frequency of Blood Lead Tests.

INTRODUCTION/OBJECTIVES: Elevated blood lead levels can cause impaired cognition and behavioral problems in children. Screening is important for identifying children with elevated blood lead levels, but many children who qualify for screening do not get tested. We aimed to see if the addition of prompts in the electronic health record (EHR) would lead to differences in blood lead tests ordered for children with government insurance. METHODS: In May 2018, a prompt was added to our institutional EHR that reminded primary care practitioners to recommend lead testing for patients with government insurance. For this retrospective observational pre-post comparative study, we reviewed the rate of blood lead test orders and completed collection before and after the prompt was introduced. RESULTS: The number of blood lead tests ordered did not increase after prompts were introduced in the EHR; rather, the lead screening rates at 12-month well-child visits decreased from 63.6% to 53.8% (P = .008). The 24-month visit data did not change significantly for the number of lead tests ordered before and after the prompt was introduced in the EHR. The number of lead tests completed showed a significant decrease after the prompt was introduced for the 12-month visit (P < .001) but no significant change for the 24-month visit (P = .70). CONCLUSIONS: This study showed that the addition of prompts in the EHR was not associated with an increase in the number of blood lead level tests ordered. Further research is needed to determine factors that could affect lead screening rates.

The certified child life specialist: A novel resource in the pediatric primary care clinic for managing children's pain during routine immunizations.

This study evaluated the effect of the Certified Child Life Specialist (CCLS) on pediatric pain and pain management during routine immunization administration in the pediatric primary care clinic. Children 4-12 years of age (n = 125) presenting for a well child physical examination at a rural primary care clinic were selected to receive standard nursing care or standard nursing care plus CCLS support during routine immunization administration. Patient reported pain was measured using the Faces Pain Scale-Revised (FPS-R), and patient behavioral responses were measured during immunization administration using the Children's Emotional Manifestation Scale (CEMS). The performance of psychosocial interventions and administration of topical pain-relieving interventions were measured between both groups. CCLS support was associated with fewer negative emotional behaviors during immunization administration among 7- to 12-year-old children and a significantly higher provision of psychosocial interventions and topical pain-relieving interventions among all ages. This study demonstrates that the presence of a CCLS can increase the provision of psychosocial and pain-relieving interventions and reduce distress during immunization administration in a busy pediatric primary care clinic.

What factors do patients consider when choosing a hand surgeon?

This study evaluated what patients consider in choosing a surgeon. A survey was given to 303 patients. Most found their hand surgeon through a medical or family/friend referral (p < .05). Surgeon credentials and accepted insurance were statistically more likely to be rated first (p<.001). We recommend educating referring physicians about our practices.

The Association Between Parent and Child ACEs is Buffered by Forgiveness of Others and Self-Forgiveness.

The purpose of the present study was to examine intergenerational transmission of adverse childhood experiences (ACEs) from parents to children and examine the buffering influence of forgiveness of oneself and others. Participants were 150 parents and children enrolled in Head Start in an upper midwestern, rural state who volunteered to complete questionnaires measuring ACEs and levels of forgiveness of oneself and others. Multiple correlation and regression were used to examine the associations between parent-reported parent and child ACEs and self-forgiveness and forgiveness of others. Analyses revealed that parental ACEs and child ACEs were positively correlated. Parents with low and medium levels of self-forgiveness and forgiveness of others had a stronger positive correlation between their own experience of ACEs and their child's, whereas, for parents with high levels of self-forgiveness and forgiveness of others, the correlation between parent and child ACEs was reduced statistically to zero. The cycle of intergenerational transmission of ACEs may be interrupted, or at very least notably buffered, by forgiving oneself and others.

Translation of a family-based behavioral intervention for adolescent obesity using the RE-AIM framework and common steps from adaptation frameworks.

Interventions for adolescent weight management that are ready to use in clinical settings are needed to address the obesity epidemic and improve the health and wellbeing of affected adolescents. This report describes the systematic process our team followed to adapt an evidence-based intervention (EBI) for adolescent weight management from its randomized control trial protocol to a package for delivery in a group-based telehealth format within a medical center. The EBI adaptation was clinician initiated, prompted by identified practice needs, and involved collaboration of the clinical team with the EBI developer. The process was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and followed key steps for adapting EBIs to new contexts. RE-AIM-aligned adaptations included telehealth delivery and broader inclusion criteria, separate clinical and research evaluation batteries, adaptations to fit the clinical practice, practical fidelity checklists to guide and record session delivery, and continuous quality improvement processes aimed to facilitate program longevity and family engagement. The process culminated in a package of adapted intervention materials deemed by stakeholders as appropriate to the practice and congruent with the EBI model. This report provides a much-needed practical demonstration of the translation of an EBI for adolescent weight management from research protocol to group telehealth delivery in a medical center. Key lessons include the value of clinician-researcher collaboration, the breadth of resources needed to adapt EBIs for real-world delivery, and the importance of considering delivery context in implementation and evaluation decisions, including defining inclusion criteria, staffing, and outcomes assessments.

Approximately one in five adolescents in the USA have or are at significant risk for health problems associated with higher weight, such as type 2 diabetes and high cholesterol. Health behavior scientists have developed promising programs to support adolescents in establishing and maintaining eating and activity habits for healthy weight management. However, such programs are not widely available. To increase access to effective interventions, science-developed programs for this age group need to be translated to ready-to-use packages suitable to real-world settings such as health care centers. This paper describes the systematic process our team followed to translate an adolescent weight management program from its research study form to an intervention package for delivery in a group-based telehealth format within a medical center. We describe the changes made to the intervention resulting from this process. We also present our plans for evaluating the performance of the adapted intervention. Key lessons from this work include the value of clinician-researcher collaboration, the breadth of resources needed to adapt science-developed interventions for real-world delivery, and the importance of considering delivery context when planning how to run and evaluate the program, including defining inclusion criteria, staffing, and outcomes assessments.

What is New in Pediatric Orthopaedic: Basic Science.

BACKGROUND: An understanding of musculoskeletal basic science underpins most advancements in the field of orthopaedic surgery. Knowledge of biomechanics, genetics, and molecular pathways is integral to the understanding of the pathophysiology of disease and guides novel treatment options to improve patient outcomes. The purpose of this review is to provide a comprehensive and current overview of musculoskeletal basic science relevant to pediatric orthopaedic surgery. METHODS: Comprehensive Pubmed database searches were performed for all English language articles published between January 2016 and November 2021 using the following search terms: basic science, pediatric orthopaedics, fracture, trauma, spine, scoliosis, DDH, hip dysplasia, Perthes, Legg-Calve-Perthes, clubfoot, and sports medicine. Inclusion criteria focused on basic science studies of pediatric orthopaedic conditions. Clinical studies or case reports were excluded. A total of 3855 articles were retrieved. After removing duplicates and those failing to meet our inclusion criteria, 49 articles were included in the final review. RESULTS: A total of 49 papers were selected for review based on the date of publication and updated findings. Findings are discussed in the subheadings below. Articles were then sorted into the following sub-disciplines of pediatric orthopaedics: spine, trauma, sports medicine, hip, and foot. CONCLUSIONS: With this review, we have identified many exciting developments in pediatric orthopaedic trauma, spine, hip, foot, and sports medicine that could potentially lead to changes in disease management and how we think of these processes. LEVEL OF EVIDENCE: Level V.

The Relationship between Bacterial Load and Initial Run Time of a Surgical Helmet.

Background: Periprosthetic joint infection (PJI) is a complication of arthroplasty surgery with significant morbidity and mortality. Surgical helmets are a possible source of infection. Pre-existing dust and microorganisms on its surface may be blown into the surgical field by the helmet ventilation system. Methods: Twenty surgical helmets at our institution were assessed through microscopy and polymerase chain reaction testing. Helmets were arranged with agar plates under the front and rear outflow vents. Helmets ran while plates were exchanged at different time points. Bacterial growth was assessed via colony counts and correlated with fan operating time. Gram staining and 16S sequencing were performed to identify bacterial species. Results: The primary microbiological contaminate identified was Burkholderia. There was an inverse relationship between colony formation and fan operating time. The highest number of colonies was found within the first minute of fan operating time. There was a significant decrease in the number of colonies formed from the zero-minute to the three (27 vs 5; P = <.01), four (27 vs 3; P = <.01), and five-minute (27 vs 4; P = <.01) time points for the front outflow plates. A significant difference was also observed between the one-minute and four-minute time points (P = .046). Conclusion: We observed an inverse relationship between bacterial spread helmet fan operation time, which may correlate with dispersion of pre-existing contaminates. To decrease contamination risk, we recommend that helmets are run for at least 3 min prior to entering the operating room.

GPS Tracking of Free-Roaming Cats (Felis catus) on SARS-CoV-2-Infected Mink Farms in Utah.

Zoonotic transmission of SARS-CoV-2 from infected humans to other animals has been documented around the world, most notably in mink farming operations in Europe and the United States. Outbreaks of SARS-CoV-2 on Utah mink farms began in late July 2020 and resulted in high mink mortality. An investigation of these outbreaks revealed active and past SARS-CoV-2 infections in free-roaming and in feral cats living on or near several mink farms. Cats were captured using live traps, were sampled, fitted with GPS collars, and released on the farms. GPS tracking of these cats show they made frequent visits to mink sheds, moved freely around the affected farms, and visited surrounding residential properties and neighborhoods on multiple occasions, making them potential low risk vectors of additional SARS-CoV-2 spread in local communities.

Priorities for rheumatic and musculoskeletal disease research in Ireland.

BACKGROUND: Research priority setting is a useful approach to decide which unanswered questions are most worth trying to solve through research. The aim is to reduce bias in the research agenda. Traditionally, research was decided by funders, policymakers, and academics with limited influence from other stakeholders like people living with health conditions, caregivers, or the community. This can lead to research gaps that fail to address these important stakeholder needs. The objective of this study is to identify the top research priorities for Rheumatic and Musculoskeletal Disease (RMD) research in Ireland. METHODS: The process framework included a design workshop, two online surveys and a review of the literature. PARTICIPANTS: 545 people completed the first survey to identify RMD research topics relevant to Ireland, of which 72% identified as a person living with RMD. 460 people completed the second survey to prioritise these research topics. RESULTS: The first survey had 2185 research topics submitted. These were analysed and grouped into 38 topic areas which were ranked in the second survey. The top three research priorities for RMD research in Ireland focused on preventing RMD progression, RMD diagnosis and its impact, and pain management. CONCLUSIONS: The prioritised research topics indicate important areas of RMD research for Ireland. Research funded in response to these co-created research priorities will have increased relevance and impact.

Risk of Posterior Interosseous Nerve Injury During Distal Biceps Tendon Repair Using a Cortical Button.

Purpose: To evaluate the possibility of posterior interosseous nerve (PIN) injury during cortical button deployment and seating associated with bicortical drilling and passage of the cortical button across the distal cortex when repairing a distal biceps rupture in a cadaveric model. Methods: Each cadaver was placed in the supine position with the arm extended. A single 4 cm transverse incision was made in the region of the radial tuberosity, 3-4 cm distal to the antecubital fossa flexion crease, and dissected down to the radial tuberosity. A #2 looped nonabsorbable suture was used to baseball stitch the musculotendinous junction to the distal 2.5 cm end of the tendon. A 3.2 mm cannulated drill bit (Arthrex) was used to create a bicortical drill hole in the center of the radial tuberosity aiming 30° ulnar to maximize the distance from the PIN. Fluoroscopy was used to confirm drill placement in the radial tuberosity for all specimens. The posterior aspect of the elbow in all cadavers was subsequently dissected out to directly visualize how far the cannulated drill was from the PIN. Results: Twelve cadavers, average age 57.4 years (range, 27-83 years), were dissected. During deployment, the cortical button contacted the PIN directly in 6 extremities. The cortical button came within 6 mm of the PIN in eleven extremities. In 8 specimens, the cortical button was within 2 mm of the PIN. The PIN was caught directly under the cortical button in one specimen. Conclusions: Placement of a biceps cortical button bicortically when repairing a distal biceps tendon may increase the risk of injury to the PIN during cortical button deployment and seating. Type of study/level of evidence: Therapeutic IV.

Association of Perinatal Factors With Severe Obesity and Dyslipidemia in Adulthood.

BACKGROUND: Perinatal factors including gestational age, birthweight, size for gestational age, delivery route, maternal parity, maternal age, maternal education, socioeconomic status, race, and sex, are associated with the future risk of obesity and co-morbid conditions. This study evaluated the relationship of birthweight for gestational age and perinatal factors with severe obesity and dyslipidemia in adulthood. METHODS: We conducted a population-based, retrospective birth cohort study of infants born to residents of Olmsted County, MN between 1976 and 1982. Outcomes were assessed after age 18 years until October 2020, including severe obesity (BMI ≥ 40 kg/m2) and dyslipidemia (total cholesterol ≥200 mg/dL, non-high density lipoprotein [non-HDL] cholesterol ≥145 mg/dL or HDL cholesterol <40 mg/dL). We obtained mother's age, education level, and parity as well as newborn sex, race, type of delivery, single/multiple birth, gestational age, and birthweight from birth certificate data. Individual-level socioeconomic status (SES) of the household at birth was determined with the HOUSES index. RESULTS: Of 10 938 birth cohort subjects, 7394 had clinic visits after age 18 years and were included, with 2630 having severe obesity (n = 798) or dyslipidemia (n = 2357) as adults. In multivariable models, female sex, singleton birth, less maternal education, and lower SES defined by HOUSES were independently associated with an increased risk of severe obesity in adulthood. Non-white race, singleton birth, and lower birthweight were independently associated with adult dyslipidemia. Birthweight for gestational age was not associated with severe obesity or dyslipidemia. CONCLUSION: Perinatal factors were associated with both severe obesity and dyslipidemia in adulthood. Lower SES at birth was predictive of severe obesity in adulthood, highlighting the opportunity to investigate modifiable perinatal social determinants to reduce the risk of severe obesity.

One-Year Prospective Association of BMI with Later Cognitive Development in Preschoolers.

This study examined the prospective relationships between preschoolers' body mass index (BMI) and cognitive development. BMI, cognitive (i.e., Brigance), sex, and age data were collected from seven cohorts of children attending Head Start from 2012 to 2018. Children (N = 324) with two years of complete data were included. After controlling for the first year cognitive development scores, age, gender, and the cohort, the BMI was predictive of lower cognitive development scores in year two (B = -0.06, ß = -0.14, t = -3.19, p = 0.002). Female sex (B = 2.69, ß = 0.10, t = 2.30, p = 0.022) and older age (B = 0.02, ß = 0.15, t = 3.20, p ≤ 0.001) were also shown to be statistically significant predictors of improved year two cognitive scores. The initial BMI scores were associated with poorer one year cognitive development scores in this sample of preschool children. Excessive body mass may contribute to numerous biological, psychological, and social factors that inhibit children with obesity from reaching their full cognitive potential, during a time in which brain development and cognitive skills development are at critical points of growth. Early childhood obesity interventions may have positive consequences for cognitive development, but additional prospective studies are needed to confirm these results.

Impact of Parental Adverse Childhood Experiences on Offspring Development in Early Head Start: Parental Adversity and Offspring Development.

Adverse childhood experiences (ACEs) are potentially traumatic events that can cause lifelong suffering, with 1 out of 2 children in the United States experiencing at least 1 ACEs. The intergenerational effect of ACEs has been described, but there's still paucity of knowledge of its impact on child development and behavior in children enrolled in Early Head Start (EHS) home visiting programs. A retrospective observational study was performed with 71 parents and 92 children participating in the EHS Home Visiting Program in Olmsted County from 2014 to 2019. Parents reported their own ACEs using a 10-item questionnaire. Children's social-emotional status was evaluated with Devereux Early Childhood Assessment Second Edition (DECA) and development was evaluated using the Brigance Early Childhood Screens III. Referrals of children by EHS staff to community agencies were recorded. The association between parental ACEs score, developmental outcomes and referrals was analyzed. Parental ACEs score of 4 or more was associated with failing at least 1 domain on the Brigance screen (P = .02) especially adaptive/cognitive domain (P = .05), and increased risk of referral to community resources (P < .001). However, there was no association between ACEs scores and failing DECA screens. We identified an intergenerational association between parental exposure to ACEs and risk for childhood developmental delay and referrals to community services. Parental adverse childhood experiences (ACEs) have intergenerational effects on offspring. In our study, parental ACEs are associated with offspring developmental delays and referral to community resources. Screening for parental adverse childhood experiences, a key social determinant of health, is imperative and should be incorporated into primary care and early childhood settings to identify children at risk for developmental delay.

Range of motion following percutaneous fixation of pediatric supracondylar humerus fracture is independent of anterior osseous fragment resorption.

The objective of this study was to understand postoperative resorption of the anterior osseous fragment following closed reduction and percutaneous pinning (CRPP) of pediatric supracondylar humerus fractures and its effect on final range of motion (ROM). Eighty-six patients that underwent CRPP had sagittal and or axial plane deformities resulting in an anterior fragment. Humerocapitellar angle (HCA), anterior humeral line (AHL) and angle of rotation (AoR) were measured. A total of 11 (12.8%) patients failed to resorb the anterior fragment, 10 (90.9%) had satisfactory ROM. HCA initially was acceptable in 40 (46.5%) patients, and 37 (92.5%) demonstrated acceptable ROM. Final HCA was acceptable in 44 (51.2%) patients and 42 (95.4%) had acceptable final ROM. AHL was in the anterior third of the capitellum in 35 (40.6%) patients and 33 (94.3%) had acceptable ROM. Final AHL was in the anterior third of the capitellum in 43 (50.0%) patients and 41 (95.3%) had acceptable final ROM. No difference was found between acceptable ROM and HCA or AHL at either follow-up. Sixty-five and 21 patients had an AoR of 0° and between 23 and 36°, respectively. A total of 59 (90.7%) patients with an AoR of 0°, and 18 (85.7%) patients with an AoR of 23-36° displayed acceptable ROM. A total of 57 (87.7%) patients with an AoR of 0° and 18 (85.7%) with an AoR of 23-36° resorbed the anterior fragment. No association was found between rotational deformity and postoperative ROM or fragment resorption. Postoperative sagittal and axial plane alignment, HCA, AHL, AoR and resorption of the anterior osseous fragment does not correlate with final ROM.

Clubfoot Cast Simulation Using Pressure Sensors: A Novel Way to Teach the Ponseti Method.

OBJECTIVE: The standard of care in treating congenital clubfoot is the Ponseti method. Resident education of this skill traditionally involves direct casting of patients with attending feedback. With increased clinical time demands, mastery of the skill may not be achievable using direct resident - patient interactions. We describe a novel Ponseti cast simulator using pressure sensors to teach this skill. DESIGN: A novel Ponseti cast simulator was constructed using a standardized model and pressure sensors. A pre-training baseline (trial 1) and post education (trial 2) was made and scored using an objective structured assessment of technical skill (OSATS) checklist. Pressure sensors were placed at the first metatarsal and talar head to record cast forces. SETTING: The study was performed in the Department of Orthopedic Surgery at an academic tertiary care hospital. PARTICIPANTS: Study participants included 6 junior orthopedic residents defined as post-graduate year (PGY) 1 to 3, 6 senior orthopedic residents (PGY 4,5), and a board -certified pediatric orthopedic surgeon to serve as a control. RESULTS: Trial 1 OSATS scores were significantly higher in senior residents (9.7 ± 1.5) than junior residents (5.2 ± 1.2) (p = 0.004). Trial 2 OSATS scores were also significantly higher in senior residents than junior residents: 13.7 ± 1.4 vs. 5.8 ± 1.6 (p = 0.003). Additionally, senior residents significantly improved scores between the first 2 trials 9.7 ± 1.5 vs. 13.7 ± 1.4 (p = 0.003), while junior residents did not 5.2 ± 1.2 vs. 5.8 ± 1.6 (p = 0.4566). In addition, there were no significant differences between junior, and senior resident Trial 1 talar head pressures or first metatarsal pressures, or Trial 2 first metatarsal pressures. CONCLUSIONS: This is the first casting simulation model to use pressure sensors as a way to objectively measure cast application pressure. This simulator may be useful in an orthopedic training programs to teach Ponseti casting.

One Health Investigation of SARS-CoV-2 in People and Animals on Multiple Mink Farms in Utah.

From July−November 2020, mink (Neogale vison) on 12 Utah farms experienced an increase in mortality rates due to confirmed SARS-CoV-2 infection. We conducted epidemiologic investigations on six farms to identify the source of virus introduction, track cross-species transmission, and assess viral evolution. Interviews were conducted and specimens were collected from persons living or working on participating farms and from multiple animal species. Swabs and sera were tested by SARS-CoV-2 real-time reverse transcription polymerase chain reaction (rRT-PCR) and serological assays, respectively. Whole genome sequencing was attempted for specimens with cycle threshold values <30. Evidence of SARS-CoV-2 infection was detected by rRT-PCR or serology in ≥1 person, farmed mink, dog, and/or feral cat on each farm. Sequence analysis showed high similarity between mink and human sequences on corresponding farms. On farms sampled at multiple time points, mink tested rRT-PCR positive up to 16 weeks post-onset of increased mortality. Workers likely introduced SARS-CoV-2 to mink, and mink transmitted SARS-CoV-2 to other animal species; mink-to-human transmission was not identified. Our findings provide critical evidence to support interventions to prevent and manage SARS-CoV-2 in people and animals on mink farms and emphasizes the importance of a One Health approach to address emerging zoonoses.

Obesity, putative biological mediators, and cognitive function in a national sample of children and adolescents.

Childhood obesity has reached epidemic rates nationwide and may be associated with impaired cognitive function. A growing body of evidence suggests that poorer academic performance for children with obesity and overweight is related to declines in executive function skills. This study aimed to identify biological mediators between obesity and overweight and cognitive function among children and adolescents. A total of 3323 children aged 6-16 years from the Third National Health and Nutrition Examination Survey between 1988 and 1994 (NHANES III) was used to measure associations between measures of obesity and overweight, cognitive function (IQ test batteries), iron deficiency, inflammation (c-reactive protein), and glucose metabolism (glycosylated hemoglobin) using multiple mediation models. Approximately 15% of the children were overweight and 11% were obese. Results showed lower scores for children who were obese or overweight than children of normal weight on several IQ subtest batteries. Obesity and overweight were also associated with biological mediators such as iron deficiency, elevated c-reactive protein and glycosylated hemoglobin. Several biomarkers of iron status were also related to measures of cognitive function. Early declines in cognitive function are associated with biomarkers of iron deficiency and inflammation in children and adolescents, and while some biological linkages between obesity and overweight and cognitive function are identified herein, further study is needed to identify additional biological mediators between obesity and overweight and cognitive function in pediatric populations.

The Negative Impact of Maternal Perinatal Opioid Use on Neonatal Outcomes.

Objective: To compare outcomes among newborns of opioid-using and nonopioid drug-using mothers with those of control mothers who did not report substance use.Methods: Using the Rochester Epidemiology Project, newborns diagnosed with drug withdrawal syndrome (per ICD-9 or ICD-10 codes) from January 2010 through June 2017 were identified. For mothers, data collected included age, race, drug use, number of prenatal visits, and results of the urinary drug abuse survey, meconium test, and self-report survey. Demographic and perinatal data collected for newborns included birth date; sex; Apgar scores at 1, 5, and 10 minutes; neonatal intensive care stay; and vital status. Controls (n = 771) were similarly selected in regard to sex, birth date, and county.Results: Of 328 infants identified, 168 were born with opioid neonatal abstinence syndrome and 160 with a nonopioid withdrawal syndrome. Control mothers had more prenatal visits than mothers in the nonopioid and opioid groups. Newborns of control mothers had higher Apgar scores at 1 and 5 minutes than both substance-using groups. Opioid-using mothers were almost twice as likely to have newborns requiring intensive care and 3 times as likely to use benzodiazepines compared to the other substance-using mothers. Substance-using mothers had more premature babies than controls.Conclusions: Prenatal opioid use is a substantial risk factor for prematurity. Newborns diagnosed with neonatal abstinence syndrome are at risk of perinatal complications. Mothers using opioids during pregnancy also tend to use other substances. Longitudinal research should clarify how prenatal substance use interacts with other risk factors during a child's first years.