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@#Becoming a parent is a significant life transition accompanied by various experiences and emotions that may be both fulfilling and rewarding, as well as challenging and stressful for both the mother and father. Mercer's theory of becoming a mother provides a framework for mothers' adaptation and role attainment throughout the perinatal period. However, a theoretical gap exists surrounding fathers' adaptability and role attainment, as fathers are frequently forgotten, and their experiences are overlooked. Although becoming a father can be a rewarding or satisfying experience that results in positive changes in men's lives, some fathers experience concerns and contradictions as a result of a shift in their roles, responsibilities, and social expectations, which result in maladaptation and mental health challenges. Given the significance of fathers in the family, community, and society, this concept analysis aimed to bridge the gap by proposing a theory that will guide fathers in successfully adapting to and reaching a solid role identity. The concept analysis methodology from Walker and Avant (2011) was utilized to define the concept of paternal adaptation and role attainment, attributes, antecedents, consequences, cases, and empirical referents. This paper concludes that perinatal fathers' adaptability and role attainment improve psycho-emotional, cognitive, relational, and behavioral outcomes, improving paternal-maternal-infant quality of life and developmental products when influenced by positive personal resources, adequate family, friends support, and community resources. Given the implications of paternal maladaptation on the family, a theoretical framework for fathers is crucial. Hence, the theory of paternal adaptation and role attainment is proposed.
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Pregnancy , Mothers , Fathers , MotivationABSTRACT
Objective:To investigate the risk factors for the occurrence and poor in-hospital prognosis in patients with peripartum cardiomyopathy (PPCM).Methods:The clinical data of 35 patients with PPCM and 35 healthy pregnant women in Xuanwu Hospital, Capital Medical University and Beijing Friendship Hospital Affiliated to Capital Medical University from January 2003 to January 2022 were retrospectively analyzed. The personal histories, laboratory examination, imaging examination, cardiac function outcome, etc were collected. According to the left ventricular ejection fraction (LVEF) at discharge, the patients with PPCM were divided into in-hospital recovery group (LVEF≥50%, 18 cases) and prolonged disease group (LVEF<50%, 17 cases). Multivariate Logistic regression analysis was used to analyze independent risk factors of poor in-hospital prognosis in patients with PPCM.Results:Among 35 patients with PPCM, the age was (29.81 ± 5.37) years old, 17 cases (48.57%) complicated with gestational hypertension, 6 cases (17.14%) complicated with gestational diabetes mellitus, 24 cases (68.57%) of New York Heart Association (NYHA) cardiac function classification was Ⅲ to Ⅳ class, and 4 cases died (11.43%). The gestational age in patients with PPCM was significantly shorter than that in healthy pregnant women: (36.26 ± 4.27) weeks vs. (38.54 ± 4.59) weeks, the rates of multiple pregnancy and gestational hypertension were significantly higher than those in healthy pregnant women: 17.14% (6/35) vs. 2.86% (1/35) and 48.57% (17/35) vs. 11.43% (4/35), and there were statistical differences ( P<0.05 or <0.01). Compared with hospital recovery group, the patients in protracted disease group had shorter gestational age, larger left ventricular end-diastolic diameter, higher serum creatinine, C-reactive protein and amino-terminal pro-brain natriuretic peptide (NT-proBNP), worse NYHA cardiac function classification, and there were statistical differences ( P<0.05 or <0.01); but there were no statistical difference in LVEF at the first diagnosis and troponin I between two groups ( P>0.05). Multivariate Logistic regression analysis result showed that elevated creatinine was an independent risk factor for poor in-hospital prognosis in patients with PPCM ( OR = 4.554, 95% CI 1.536 to 13.684, P = 0.018). Conclusions:The gestational hypertension may be a risk factor for PPCM. The gestational hypertension, earlier onset time, enlarged left ventricular end-diastolic diameter, high NT-proBNP, high C-reactive protein, high creatinine and high cardiac function NYHA classification may be risk factors for poor in-hospital prognosis in patients with PPCM; and elevated creatinine is an independent risk factor for poor in-hospital prognosis in patients with PPCM.
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OBJECTIVES@#To evaluate the clinical effectiveness of integrated management during the perinatal period for fetuses diagnosed with total anomalous pulmonary venous connection (TAPVC) by prenatal echocardiography.@*METHODS@#Clinical data of 64 cases of TAPVC fetuses diagnosed by prenatal echocardiography and managed with integrated perinatal care in Qingdao Women and Children's Hospital from January 2017 to December 2021 were retrospectively analyzed. Integrated perinatal care included multidisciplinary collaboration among obstetrics, fetal medicine, ultrasound, pediatric cardiology, pediatric anesthesia, and neonatology.@*RESULTS@#Among the 64 TAPVC fetuses, there were 29 cases of supracardiac type, 27 cases of intracardiac type, 2 cases of infracardiac type, and 6 cases of mixed type. Chromosomal analysis was performed in 42 cases, and no obvious abnormalities were found. Among the 64 TAPVC fetuses, 37 were induced labor, and 27 were followed up until term birth. Among the 27 TAPVC cases, 2 cases accepted palliative care, 2 cases were referred to another hospital for treatment and lost to follow-up, while the remaining 23 cases underwent primary repair surgery. One case died within 6 months after the operation due to low cardiac output syndrome, while the other 22 cases were followed up for (2.1±0.3) years with good outcomes (2 cases underwent a second surgery within 1 year after the first operation due to anastomotic stenosis or pulmonary vein stenosis).@*CONCLUSIONS@#TAPVC fetuses can achieve good outcomes with integrated management during the perinatal period.
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Female , Humans , Pregnancy , Infant, Newborn , Echocardiography , Heart Defects, Congenital/surgery , Pulmonary Veins/surgery , Retrospective Studies , Scimitar Syndrome/surgeryABSTRACT
@#Obective To analyze the risk factors during pregnancy and perinatal period leading to attention deficit hyperactivity disorder (ADHD) in children using scoping review. Methods The literatures related to the risk factors of children's ADHD during pregnancy and perinatal period were searched from CNKI, Wanfang Data, PubMed and Web of Science, from the establishment to July 1st, 2021. The content of author, country, publication time, research object, age, sample size, inclusion time, study design, diagnostic criteria, evaluation tools and related risk factors were extracted. Results A total of 2 721 articles were returned, and 35 articles were finally included, from eleven countries. Most of the articles came from journals related to pediatrics, psychiatry, neurology and epidemiology. The researches were mainly concentrated from 2008 to 2021, mainly were controlled studies and cohort studies. The researches mainly involved the methods of diagnosis, evaluation of risk factors during pregnancy and perinatal period, and related risk factors. The diagnostic criteria of ADHD mainly were the Diagnostic and Statistical Manual of Mental Disorders and International Disease Classification Standards, combined with the questionnaires used by parents and teachers to make the final diagnosis. The risk factors during pregnancy and perinatal period were extracted from medical records of birth, birth records, maternal medical history, perinatal hospitalization and outpatient records, and maternal drug use records during pregnancy, or questionnaire survey (parents/newborns). The risk factors for ADHD in children during pregnancy and perinatal period might be divided into four aspects: maternal factors, intrauterine factors, environmental factors and perinatal accidents. Among them, the maternal factors included young mother, obesity, poor living behavior, substance exposure, medical history, and nutrient deficiency during pregnancy; intrauterine factors included poor fetal development in the mother's uterus, miscarriages and the number of pregnancies; environmental factors included living environment and social environment; perinatal accidents included childbirth accidents and poor health of newborns. Conclusion The pregnancy and perinatal risk factors related to ADHD in children mainly include maternal factors, intrauterine factors, environmental factors and perinatal accidents. The poor mental health of mothers during pregnancy is the main risk factor leading to children's ADHD.
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The perinatal period is the key period for the development of brain and central nervous system, and different events in this period will have a profound influence on brain development. Glucocorticoids, antibiotics, magnesium sulfate, caffeine, pulmonary surfactant, and mild hypothermia treatment are commonly used drugs or treatment methods in the perinatal period and are closely associated with the prognosis of neonatal neurodevelopment. This article reviews the latest research on the effect of perinatal treatments on neonatal neurodevelopment, so as to provide a reference for clinical decision making.
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Female , Humans , Infant, Newborn , Pregnancy , BrainABSTRACT
Objective:To investigate clinical features, treatment and prognosis of herpes zoster during pregnancy or the perinatal period.Methods:Clinical data were collected from female inpatients with herpes zoster during pregnancy or the perinatal period in the First Affiliated Hospital of Zhengzhou University from January 2011 to December 2020, and clinical characteristics, treatment and prognosis were retrospectively analyzed.Results:A total of 25 patients were included in the study, including 22 pregnant patients at 10 - 38 gestational weeks (1 in the first trimester, 13 in the second trimester, and 8 in the third trimester) and 3 patients during the first postpartum week; their age ranged from 22 to 37 years, and the disease course varied from 2 to 9 days. Skin lesions were located on the head and face in 8 cases, on the chest and back in 5, on the waist and abdomen in 7, on the upper limbs in 1, on the lower limbs in 3, as well as on the perineum in 1; 3 patients presented with disseminated herpes zoster. The patients all presented with erythema, papulovesicles and blisters, which were accompanied by bloody bullae in 4 patients, by bullae in 3, as well as by erosions and exudations in 6; 5 patients had fever, 7 had mild pain, 6 had moderate pain, and 11 had severe pain. Sixteen pregnant patients and 3 postpartum patients received antiviral therapy (oral or intravenous infusion of acyclovir, vidarabine monophosphate, foscarnet sodium-sodium chloride injection) , 24 patients were treated with neurotrophic drugs, 1 pregnant patient and 3 postpartum patients received analgesic treatment, and other treatments included anti-infective therapy, wet compress, infrared radiation, etc. Preterm delivery occurred in 1 pregnant patient, other pregnant patients had full-term deliveries, and no abnormalities were observed in neonates. Sequelae occurred in 3 pregnant patients, including pain in 1 and pruritus in 2.Conclusion:Among the 25 patients, the treatment of herpes zoster during pregnancy or the perinatal period showed no obvious effect on their fetuses or newborns.
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With the change of medical model, the impact of common psychological disorders on the occurrence, development and treatment has been paid more attention to. If the diagnosis is not timely, it can result in serious long-term effects on the wellbeing of women, their partners and infants. We reviewed the recent foreign studies on the common psychological problems of perinatal women and summarize the epidemiology, identification and interventions, so as to understand the impact on the offspring. It is of great significance to strengthen the training for health professionals in wider psychosocial assessment and to adopt effective intervention methods to alleviate the adverse psychological state of perinatal women.
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Introdução. O estresse dos pais devido à internação de um filho em Unidade de Terapia Intensiva Neonatal (UTIN) pode ter consequências físicas e emocionais importantes nos cuidadores. Objetivos. Analisar as relações entre o estresse dos pais e seus níveis de satisfação com o atendimento. Método. A amostra foi composta por 32 pais que tiveram seus filhos internados em UTIN. Os cuidadores preencheram um questionário sociodemográfico além dos instrumentos PSS: NICU e EMPATHIC-N. Os dados foram analisados a partir de estatística descritiva e inferencial. Resultados. Observou-se um estresse moderado a partir do instrumento PSS:NICU, especialmente nos domínios "Alteração no papel de pai/mãe" e "Número total de experiências" (p < 0,05). Também se detectou correlação positiva entre a idade dos pais e o nível geral de estresse (r = 0,34; p < 0,05). A satisfação dos pais apresentou níveis elevados em todos os domínios. Conclusão. Os dados indicaram que quanto maior a satisfação na avaliação das equipes, menor o estresse dos pais no ambiente da UTIN.
Introduction. Parents' stress due to the hospitalization of a child in a Neonatal Intensive Care Unit (NICU) can have important physical and emotional consequences on caregivers. Goals. To analyze the relationship between parents' stress and their levels of satisfaction with care. Method. The sample consisted of 32 parents who had their children hospitalized in NICUs. Caregivers completed a sociodemographic questionnaire in addition to the PSS instruments: NICU and EMPATHIC-N. Data were analyzed from descriptive and inferential statistics. Results. Moderate stress was observed from the PSS: NICU instrument, especially in the areas "Change in the role of father and mother" and "Total number of experiences" (p < 0.05). A positive correlation was also found between the parents' age and the general level of stress (r = 0.34, p < 0.05). Parents' satisfaction was high in all areas. Conclusion. The data indicated that the higher the satisfaction in the evaluation of the teams, the lower the stress of the parents in the NICU environment.
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Background: Perinatal loss is one of the most traumatic life events. It is indeed a great psychological and emotional shock to not only the mother and father but the entire family and society as a whole. The perinatal mortality rate (PMR) is an important indicator of the quality of obstetric care during pregnancy. Perinatal deaths result largely from obstetric complications that can be prevented with proper antenatal care and quality neonatal services. The study was aims to study the factors related with perinatal loss and its prevention in future pregnancy.Methods: It was a prospective analytical study. All patients with IUFD, stillbirths and early neonatal loss were studied. Postpartum both mother and father were counselled. Detailed history and thorough physical examination were conducted. Data was recorded and tabulated, observation made and compared with results of various studies.Results: The results showed that the incidence of IUFD was 3.7% and early neonatal death was 10.8% per total admissions. The perinatal mortality rate was 63.62 per 1000 live births. Perinatal mortality rate was inversely related to the number of antenatal visits taken by the patient. Lack of antenatal care results in perinatal deaths probably due to failure of early identification and management of maternal problems that impact negatively on perinatal outcome. Even in advanced economies with sophisticated diagnostic and monitoring equipment, lack of antenatal care categorizes a pregnant woman as a high-risk pregnancy.Conclusions: There is a need for awareness regarding importance of antenatal care and institutional delivery. Perinatal mortality is an important indicator of maternal care, health and nutrition. It also reflects the quality of Obstetric and Pediatric care available. Every effort must be made to reduce perinatal mortality.
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OBJECTIVE: To observe the impact of acupuncture on myofascial trigger points(MTrPs),low-frequency electrical stimulation and manipulative stretch reduction on sacroiliac joint on perinatal period separation of symphysis pubis.METHODS: Totally 100 cases of perinatal separation of pubic symphysis in Huai'an Women and Children Health Hospital from January 2013 to July 2016 were selected.They were randomly divided into comprehensive treatment group,electrical stimulation group,manipulative reduction group,pelvic belt group and control group,20 cases in each group.The comprehensive treatment group was given acupuncture on myofascial trigger points,low-frequency electrical stimulation and manipulative stretch reduction on sacroiliac joint,the other three treatment groups were treated with their respective monotherapy,and the control group only received the brake observation.The NRS pain score and clinical efficacy were compared among the groups.RESULTS: Six days after treatment,18 cases,7 cases,4 cases,0 case and 0 case were cured in the five groups,respectively.Six weeks after treatment,20 cases,13 cases,11 cases,4 cases and 0 case were cured in the five groups,respectively.Six months after treatment,20 cases,18 cases,15 cases,13 cases and 9 cases were cured in the five groups,respectively.The treatment effect of the comprehensive group was the best,followed by the electric stimulation group,and then manipulation reduction group.CONCLUSION: acupuncture on myofascial trigger points and electrical stimulation combined with manipulative stretch reduction can not only quickly relieve the pain of patients in a short time,but also quickly make the pubic symphysis form return to normal.It has a high treatment efficiency and is less painful.So it has a high clinical value.
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Perinatal period spans from conception till one-year post-partum. Pregnancy and post-partum ischaracterised by significant biological changes in a woman’s body including changes in blood pressure,blood volume, coagulability of blood and changes in immunity causing onset or relapse of certain medicaland neurological conditions, which can face diagnostic and treatment challenges during this period. We aimto present a series of 3 cases which presented with psychiatric symptoms but on further evaluation werefound to have neurological diagnosis – Cavernous Venous Thrombosis [CVT], Posterior ReversibleEncephalopathy Syndrome [PRES] & Tuberculoma.
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AIM To investigate the toxicity of Buxue Shengru Granules (BSG,Astragali Radix,Angelicae sinensis Radix,Paeoniae Radix alba,etc.) to perinatal SD rats and their offspring to determine its safety.METHODS The respective BSG administration of 0,1,3,10 g/kg to the four groups rats,each with twenty-four female rats,started from the day 15 of gestation (GD15) through weaning when they were procured for the identification of the general condition,body weight and food ingestion.The offspring had their postnatal appearance observed the physiological development,reflexes development,behavior and fertility detected as well.RESULTS BSG gave neither significant influence on the rats' general condition,time of birth,body weight,and histological changes of organs during perinatal period;nor remarkable impact on the offspring's growth,development,nerves,endocrine,and reproductive system.CONCLUSION Data on BSG to rats maternal weight gain and food intake and to their offspring developmental landmarks,sexual maturation,or reflexes suggest that BSG gives no perinatal toxicity.
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Objective To explore the pathophysiology and MRI features of hypoxic-ischemic brain damage in premature and the correlation with the degree of hypoxia,and to improve the understanding of this disease.Methods Thirty patients with clinically diagnosed hypoxic-ischemic brain damage in preterm infants were examined by MRI and the MRI findings were analyzed. Results Of the 30 children, 7 cases suffered from single subventricular hemorrhage; 6 cases had subventricular hemorrhage combined with a small amount of hemorrhage in the periventricular white matter; 4 cases had subarachnoid hemorrhage and intraventricular hemorrhage;2 cases had subarachnoid hemorrhage;9 cases had periventricular white matter injury; 2 cases had hemorrhagic cerebral infarction. Conclusion MRI findings of hypoxic-ischemic brain damage in premature infants are complex and diverse,and are associated with multiple signs.There is no specific relationship between MRI signs and the degree of perinatal hypoxia.MRI can accurately detect the lesion,and provide a reliable imaging basis for clinical diagnosis and treatment.
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Human gut microbiota contains around 1014 colonized intestinal microbes.Gut microbiome outnumbers the human gene pool by ten to one.Therefore,it's generally considered to be our "second gene pool".Several research have clarified that the cycle of "maternal intestinal microbes-placental microbes-fetal intestinal microbes" plays a critical role in the neurological and immune regulation and metabolism in infants,which may contribute to the furtherance of research on gut microbes.We summarized the factors affecting the colonization of maternal and fetal gut microorganisms during perinatal period from recent research.
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As a routine scanning method of magnetic resonance imaging nowadays , susceptibility weighted imaging provides very important diagnostic information for daily medical treatment in clinical departments such as neurology , neurosurgery, and emergency departments.With the continuous improvement and upgrading , the scope of its clinical application has been further expanded , such as analysis of quantitative susceptibility mapping , perinatal fetal monitoring and neonatal disease diagnosis , guiding clinical therapy strategies and so on.Owing to the great potential and scientific value of this technology , its future development prospects will be new sequence improvement , multiple body parts'application, functional image research, etc.
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Objective To investigate the relationship between frequencies of prenatal care and neonatal low birth weight (LBW) among women of childbearing age from the rural areas of Shaanxi province.Methods A questionnaire survey was conducted among the childbearing-aged women from the rural areas.Samples were selected through multi stage stratified random sampling method.The childbearing aged women were in pregnancy or having had definite outcomes of pregnancy.Measurement of data was described by median ± standard deviation,and chi square test was used to compare the rates.Neonatal low birth weight and frequencies of prenatal care were dependent variables and independent variables grouped into the generalized Poisson regression model.Confounding factors were under control.Results The overall incidence rate of LBW was 3.75％ among 18 911 rural women of childbearing age during 2010-2013.Frequencies on pregnancy care were up to 15 times (0.70％),with a minimum of 0 (0.70％),an average of 5.65± 2.74 times (including ≥ 10 times accounted for 12.37％;≥7 times accounted for 28.52％;≥5 times accounted for 62.80％ and ＜4 times accounted for 21.49％).After controlling confounding factors,results from the generalized Poisson regression analysis revealed that the difference was statistically significant when compared to the reference group.The incidence of neonatal LBW in the ＜4 group was 1.61 times of the one in the ＞7 group (OR=1.61,95％CI:1.31-2.00) while in the ＜4 group it was 1.23 times of the 4-7 group (OR=1.23,95％ CI:1.04-1.45).Conclusion In the rural areas of Shaanxi province,the incidence of neonatal LBW was gradually reduced through the increasing number of frequencies on prenatal care,among women of childbearing age.
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Objective To investigate the relationship between frequencies of prenatal care and neonatal low birth weight (LBW) among women of childbearing age from the rural areas of Shaanxi province.Methods A questionnaire survey was conducted among the childbearing-aged women from the rural areas.Samples were selected through multi stage stratified random sampling method.The childbearing aged women were in pregnancy or having had definite outcomes of pregnancy.Measurement of data was described by median ± standard deviation,and chi square test was used to compare the rates.Neonatal low birth weight and frequencies of prenatal care were dependent variables and independent variables grouped into the generalized Poisson regression model.Confounding factors were under control.Results The overall incidence rate of LBW was 3.75％ among 18 911 rural women of childbearing age during 2010-2013.Frequencies on pregnancy care were up to 15 times (0.70％),with a minimum of 0 (0.70％),an average of 5.65± 2.74 times (including ≥ 10 times accounted for 12.37％;≥7 times accounted for 28.52％;≥5 times accounted for 62.80％ and ＜4 times accounted for 21.49％).After controlling confounding factors,results from the generalized Poisson regression analysis revealed that the difference was statistically significant when compared to the reference group.The incidence of neonatal LBW in the ＜4 group was 1.61 times of the one in the ＞7 group (OR=1.61,95％CI:1.31-2.00) while in the ＜4 group it was 1.23 times of the 4-7 group (OR=1.23,95％ CI:1.04-1.45).Conclusion In the rural areas of Shaanxi province,the incidence of neonatal LBW was gradually reduced through the increasing number of frequencies on prenatal care,among women of childbearing age.
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The brain of neonates is growing and developing rapidly in perinatal period.Treatments in this period can have a direct or indirect effect on the developing brain.Steroids,indomethacin,magnesium sulphate,hypothermia,caffeine citrate,exogenous surfactant,nitric oxide,erythropoietin are common treatments administered during perinatal period.All those treatments are closely related to neurodevelopmental outcomes.We review these treatments on the developing brain.
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Objective To investigate the distribution and drug susceptibility of vaginal pathogens in pregnant women during perinatal period.Methods Vaginal discharge specimens of 10 800 women (5 400 were pregnant women during perinatal period,5 400 were non-pregnant women) were performed bacterial culture and drug susceptibility testing.Results The isolation rate of pathogens from 5 400 perinatal pregnant women was 26.00％ (n =1 404),including 759 strains of fungi,611 strains of gram positive cocci,32 strains of gram-negative bacilli,2 strains of Neisseria gonorrhoeae;among 5 400 non-pregnant women,the isolation rate of pathogens was 7.87％ (n=425),including 232 strains of fungi,182 strains of gram-positive cocci,5 strains of gram negative bacilli,and 6 strains of Neisseria gonorrhoeae.Resistance rates of Streptococcus agalactiae isolated from perinatal pregnant women to erythromycin and clindamycin were 84.85％ and 80.81 ％ respectively,resistance rate of Staphylococcus aureus to erythromycin was 40.91 ％,resistance rates of Escherichia coli to tetracycline and sulfamethoxazole/trimethoprim were 69.23 ％ and 53.85 ％ respectively,resistance rate of Neisseria gonorrhoeae to penicillin and sulfamethoxazole/trimethoprim was 100.00％.Conclusion Vaginal infection rate in perinatal pregnant women is higher than non-pregnant women,screening of vaginal pathogens in perinatal pregnant women should be strengthened,so as to ensure the safety of mothers and infants.
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Objective To analyze the serotypes and antimicrobial susceptibility profile of Group B Streptococcus (GBS) in perinatal pregnant women.Methods The vaginal and rectal specimens were collected from pregnant women at 35 to 37 weeks of pregnancy for culture and identification.The serotypes were analyzed using agglutination assay.Antimicrobial susceptibility testing was conducted by using Kirby-Bauer method,and interpreted according to 2009 CLSI breakpoints.The data were analyzed via WHONET 5.6 software.Results The prevalence of GBS was 10.4％ (264/2 533) in the 2 533 perinatal pregnant women.Serotype Ⅲ,Ⅰa and Ⅰb was identified in 54.9％ (84/153),17.6％ (27/153) and 13.1％ (20/153) of the GBS,respectively.All the GBS isolates were susceptible to penicillin,cefiriaxone and vancomycin.But 32.9％,68.1％ and 62.1％ of the isolates were resistant to levofloxacin,erythromycin and clindamycin,respectively.The antibiotic resistance rate of serotype Ⅲ isolates to the above three antibiotics was significantly higher than the other serotypes.Conclusions GBS may colonize both vagina and rectum of pregnant women.Vaginal and rectal secretions should be sampled simultaneously for better screening GBS.GBS serotype Ⅲ was the predominant serotype.Penicillin can be used as the first-choice treatment for GBS infections in pregnant women and newborns.GBS-positive pregnant women should be given the intervention treatment immediately to ensure the health of perinatal infants.