Risk factors for the time to development of retinopathy of prematurity in premature infants in Iran: a machine learning approach.

BACKGROUND: Retinopathy of prematurity (ROP), is a preventable leading cause of blindness in infants and is a condition in which the immature retina experiences abnormal blood vessel growth. The development of ROP is multifactorial; nevertheless, the risk factors are controversial. This study aimed to identify risk factors of time to development of ROP in Iran. METHODS: This historical cohort study utilized data from the hospital records of all newborns referred to the ROP department of Farabi Hospital (from 2017 to 2021) and the NICU records of infants referred from Mahdieh Hospital to Farabi Hospital. Preterm infants with birth weight (BW) ≤ 2000 g or gestational age (GA) < 34 wk, as well as selected infants with an unstable clinical course, as determined by their pediatricians or neonatologists, with BW > 2000 g or GA ≥ 34 wk. The outcome variable was the time to development of ROP (in weeks). Random survival forest was used to analyze the data. RESULTS: A total of 338 cases, including 676 eyes, were evaluated. The mean GA and BW of the study group were 31.59 ± 2.39 weeks and 1656.72 ± 453.80 g, respectively. According to the criteria of minimal depth and variable importance, the most significant predictors of the time to development of ROP were duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of Total Parenteral Nutrition (TPN), mother age, birth order, number of surfactant administration, and on time screening. The concordance index for predicting survival of the fitted model was 0.878. CONCLUSION: Our findings indicated that the duration of ventilation, GA, duration of oxygen supplementation, bilirubin levels, duration of antibiotic administration, duration of TPN, mother age, birth order, number of surfactant administrations, and on time screening are potential risk factors of prognosis of ROP. The associations between identified risk factors were mostly nonlinear. Therefore, it is recommended to consider the nature of these relationships in managing treatment and designing early interventions.

Neonatal Risk Factors for Growth Retardation in Infants With Congenital Heart Disease.

BACKGROUND: While the association of congenital heart disease (CHD) and growth retardation (GR) is known, data remain limited. This study investigated the incidence of GR and its neonatal risk factors in patients with CHD using nationwide population-based claims data. METHOD: The study population was extracted from Korean National Health Insurance Service claims data from January 2002 to December 2020. We included patients diagnosed with CHD under one year of age. GR was defined as an idiopathic growth hormone deficiency or short stature on the claims data. We investigated the neonatal risk factors for GR. RESULTS: The number of patients diagnosed with CHD within the first year of birth was 133,739. Of these, 2,921 newborns were diagnosed with GR. The cumulative incidence of GR was 4.8% at 19 years of age for individuals diagnosed with CHD at infancy. In the multivariable analysis, the significant risk factors for GR were preterm birth, small for gestational age, low birth weight, respiratory distress, bronchopulmonary dysplasia, bacterial sepsis, necrotizing enterocolitis, feeding problems and cardiac procedure. CONCLUSION: Several neonatal conditions were significant risk factors for GR in CHD patients, and appropriate monitoring and treatment programs are required in CHD neonates with these factors. Considering this study is limited to claims data, further studies are warranted, including genetic and environmental factors affecting GR in CHD patients.

Accuracy of diagnosing acute kidney injury by assessing urine output within the first week of life in extremely preterm infants.

BACKGROUND: Neonatal acute kidney injury (AKI) is associated with increased mortality and is often assessed with the neonatal modified Kidney Disease: improving Global Outcomes (KDIGO) classification, which uses changes in serum creatinine levels. However, because this classification has many drawbacks, a novel method, the neonatal Risk, Injury, Failure, Loss, and End-Stage Kidney Disease (nRIFLE) classification for diagnosing neonatal AKI according to urine output (UO), was recently proposed. To date, no data on the incidence of AKI according to nRIFLE are available for extremely preterm infants (born at gestational age less than 28 weeks). This study was conducted to clarify the association between incidence of AKI and in-hospital mortality in extremely preterm infants. METHODS: Of 171 extremely preterm infants hospitalized from 2006 to 2020, 84 in whom indwelling bladder catheters were placed for UO measurements within 24 h of life were included. The incidence of AKI was assessed using the nRIFLE classification. In-hospital mortality was compared between patients with AKI and those without it. RESULTS: The incidence of AKI during the first week of life was 56% and that of in-hospital mortality was significantly higher in patients with AKI (25.5%) than in those without it (2.8%). The odds ratio was 12.3 with 95% confidence interval ranging from 1.5 to 100.0. CONCLUSION: The incidence of AKI according to nRIFLE was higher than reported in most previous studies using the neonatal modified KDIGO classification, suggesting that assessment by nRIFLE criteria using UO may improve diagnostic accuracy of AKI in extremely preterm infants.

The evaluation and management of neonatal brachial plexus palsy.

Neonatal brachial plexus palsy presents at birth and can be a debilitating condition with long-term consequences. Presentation at birth depends on the extent of nerve injury, and can vary from transient weakness to global paresis, with active range of motion affected. Serial clinical examination after birth and during the neonatal period (first month of life) is crucial to assess recovery and predicts long-term outcomes. This position statement guides the evaluation of neonates for risk factors at birth, early referral to a multidisciplinary specialized team, and ongoing communication between community providers and specialists to optimize childhood outcomes.

Epilepsy occurrence after neonatal morbidities in very preterm infants.

OBJECTIVE: This study investigated the incidence of epilepsy and identified neonatal risk morbidities for epilepsy in children born extremely preterm. METHODS: Of the 806 very preterm infants (birth weight < 1500 g, gestational age < 32 weeks) who survived and were discharged from the four neonatal intensive care units in southern Taiwan between 2003 and 2012, 686 (85.1%) had longitudinal neurodevelopmental follow-up assessments up to 5 years of age. RESULTS: Among the 686 very preterm children, 19 (2.8%) exhibited epilepsy at a mean age of 19 ± 14 months. The incidence of epilepsy was highest among infants with neonatal seizure (33%), followed by cystic periventricular leukomalacia (cPVL, 27%), high-grade intraventricular hemorrhage (IVH, 21%), and necrotizing enterocolitis (NEC) stage III (20%). NEC stage III, neonatal seizure, high-grade IVH, and cPVL were also independent neonatal risk morbidities for epilepsy. Furthermore, the incidence of epilepsy was 21.6% in preterm children with significant neonatal brain injury (SNBI; ie, high-grade IVH and cPVL), but only 1% in preterm children without SNBI. Among preterm children with SNBI, neonatal seizure was higher in preterm children with epilepsy than in those without epilepsy (23.1% vs 2.1%, P = .03). Among preterm children without SNBI, NEC stage III was higher in preterm children with epilepsy than in those without epilepsy (33.3% vs 1.8%, P < .01). The preterm children with epilepsy were prone to have neurodevelopmental disability regardless of whether they had neonatal brain injury, and drug-resistant epilepsy (42%), particularly those with neonatal high-grade IVH. SIGNIFICANCE: There is an elevated incidence of epilepsy among very preterm children, and particularly those with significant brain injury and/or severe NEC during the neonatal period. Very preterm children with epilepsy are prone to have neurodevelopmental disability and drug-resistant epilepsy.

[Modern approaches to predicting the development of active type 1 retinopathy of prematurity]. / Sovremennye podkhody k prognozirovaniiu aktivnoi retinopatii nedonoshennykh (1-i tip).

PURPOSE: To develop a mathematical model for predicting the development of threshold stages (type 1) of active retinopathy of prematurity (ROP) based on neonatal risk factors in premature infants. MATERIAL AND METHODS: The study observed 69 premature infants from a perinatal center with gestation age of 22-31 weeks and birth weight of 499-1500 grams. Patients were divided into 2 groups depending on the type of ROP: the main group - 40 infants with a threshold stage (type 1) of ROP, requiring laser treatment; the control group - 29 children with spontaneous regression of the initial (1-2) stages (type 2) of the disease. A model for predicting the development of ROP threshold stage was built using mathematical justification. RESULTS: The study established potential predictors of type 1 ROP: staying in the intensive care unit for more than 30 days (p=0.011); duration of child's staying on mechanical ventilator more than 30 days (p=0.002); parenteral nutrition for more than 13 days (p=0.013); presence of respiratory distress syndrome of 3rd degree (p<0.001); presence of bronchopulmonary dysplasia (p=0.034). These predictors were used to design a mathematical model for predicting the development of threshold stages of ROP. CONCLUSION: The proposed prognostic model of type 1 active ROP is characterized by high information content and can be recommended for use in clinical practice of neonatal medical institutions.

Risk Factors for Neonatal Venous and Arterial Thromboembolism in the Neonatal Intensive Care Unit-A Case Control Study.

OBJECTIVE: To identify risk factors associated with venous and arterial thrombosis in sick neonates admitted to the neonatal intensive care unit. STUDY DESIGN: A case-control study was conducted at 2 centers between January 2010 and March 2014 using the Children's Hospital Neonatal Database dataset. Cases were neonates diagnosed with either arterial or venous thrombosis during their neonatal intensive care unit stay; controls were matched in a 1:4 ratio by gestational age and presence or absence of central access devices. Bivariable and conditional logistic regression analyses for venous and arterial thrombosis were performed separately. RESULTS: The overall incidence of neonatal thrombosis was 15.0 per 1000 admissions. A higher proportion of neonates with thrombosis had presence of central vascular access devices (75% vs 49%; P < .01) were of extremely preterm gestational age (22-27 weeks; 26% vs 15.0%; P <.05) and stayed ≥31 days in the neonatal intensive care unit (53% vs 32.9%; P <.01), when compared with neonates without thrombosis. A final group of 64 eligible patients with thrombosis and 4623 controls were analyzed. In a conditional multivariable logistic regression model, venous thrombosis was significantly associated with male sex (AOR, 2.12; 95% CI, 1.03-4.35; P = .04) and blood stream infection (AOR, 3.47; 95% CI, 1.30-9.24; P = .01). CONCLUSIONS: The incidence of thrombosis was higher in our neonatal population than in previous reports. After matching for central vascular access device and gestational age, male sex and blood stream infection represent independent risk factors of neonatal venous thrombosis. A larger cohort gleaned from multicenter data should be used to confirm the study results and to develop thrombosis prevention strategies.

Umbilical lactate as a measure of acidosis and predictor of neonatal risk: a systematic review.

BACKGROUND: Umbilical cord lactate is one approach to measuring acidosis and intrapartum hypoxia, knowledge of which may be helpful for clinicians involved in the care of women and newborns. OBJECTIVE: To synthesise the evidence on accuracy of umbilical cord lactate in measuring acidosis and predicting poor neonatal outcome. SEARCH STRATEGY: Studies published and unpublished between 1990 and 2014 from PubMed/Medline, EMBASE, Cochrane Central Register of Controlled Trials, and clinicaltrials.gov were assessed. SELECTION CRITERIA: Cross-sectional and randomised studies that assessed fetal acidosis (using lactate as the index test) with or without an assessment of neonatal outcome. DATA COLLECTION AND ANALYSIS: Correlations between index and reference test(s) were recorded, as were the raw data to classify the predictive ability of umbilical lactate for neonatal outcomes. Meta-analysis of correlation was performed. We plotted estimates of the studies' observed sensitivities and specificities on Forest plots with 95% confidence intervals (CI). Where possible, we combined data using meta-analysis, applying the hierarchical summary receiver operating characteristics model and a bivariate model. MAIN RESULTS: Twelve studies were included. Umbilical lactate correlated with pH [pooled effect size (ES) -0.650; 95% CI -0.663 to -0.637, P < 0.001], base excess (ES -0.710; 95% CI -0.721 to -0.699, P < 0.001), and Apgar scores at 5 minutes (ES 0.300; 95% 0.193-0.407, P < 0.001). Umbilical lactate had pooled sensitivity and specificity for predicting neonatal neurological outcome including hypoxic ischaemic encephalopathy of 69.7% (95% CI 23.8-94.4%) and 93% (95% CI 86.8-96.3%). AUTHORS' CONCLUSION: Umbilical cord lactate is a clinically applicable, inexpensive and effective way to measure acidosis and is a tool that may be used in the assessment of neonatal outcome. TWEETABLE ABSTRACT: Umbilical cord lactate: a clinically applicable, inexpensive, effective way to measure intrapartum acidosis.

Short communication: Predictors of time to dairy calf bucket training.

The time required to adequately bucket-train a dairy calf to drink its milk allotment is unknown. Additionally, factors that could predict calves who are slow to learn have not been identified. A prospective observational study was conducted to describe timing of bucket training and possible calf birth and colostrum quality factors that might predict calves requiring extra time to train. On one dairy farm, 1,235 calves were enrolled at birth in a prospective cohort study. Calving ease score, calf presentation at birth, twinning, calf sex, and dam parity were recorded by farm personnel. An as-fed colostrum sample for each calf was collected and evaluated for total solids, total plate bacterial count, and coliform bacterial count. Calf serum total protein values were obtained by d 2 to 3 of life. Calves were observed before the morning milk feeding for attitude/posture, and after feeding for assistance needed to drink milk from their bucket. Attitude/posture was significantly associated with whether a calf required assistance or not. Almost 60% (n = 724) of calves consumed their morning milk allotment (2 L) after d 3 of life without assistance. Significant factors associated with the odds of requiring assistance with drinking after 3 d of age included calf sex, being born a twin, and the week the calf was enrolled. Knowing how long it takes to train a calf to drink from a bucket could be useful in allocating the time or labor required to successfully train calves.

PREMATURITY, NEONATAL HEALTH STATUS, AND LATER CHILD BEHAVIORAL/EMOTIONAL PROBLEMS: A SYSTEMATIC REVIEW.

Preterm birth can impact on child development. As seen previously, children born preterm present more behavioral and/or emotional problems than do full-term counterparts. In addition to gestational age, neonatal clinical status should be examined to better understand the differential impact of premature birth on later developmental outcomes. The aim of the present study was to systematically review empirical studies on the relationship between prematurity, neonatal health status, and behavioral and/or emotional problems in children. A systematic search of the PubMed, PsycINFO, Web of Science, and LILACS databases for articles published from 2009 to 2014 was performed. The inclusion criteria were empirical studies that evaluated behavioral and/or emotional problems that are related to clinical neonatal variables in children born preterm. Twenty-seven studies were reviewed. Results showed that the degree of prematurity and birth weight were associated with emotional and/or behavioral problems in children at different ages. Prematurity that was associated with neonatal clinical conditions (e.g., sepsis, bronchopulmonary dysplasia, and hemorrhage) and such treatments as corticoids and steroids increased the risk for these problems. The volume and abnormalities of specific brain structures also were associated with these outcomes. In conclusion, the neonatal health problems associated with prematurity present a negative impact on later child emotional and adapted behavior.

Maternal and neonatal risk factors of asthma in children: Nationwide population based study.

BACKGROUND: Small population group-based cohorts have found that perinatal factors may contribute to the development of asthma in children. We aimed to investigate maternal and neonatal risk factors for the asthma phenotypes using two databases from the Taiwan's Maternal and Child Health Database (TMCHD) and the National Health Insurance Research Database (NHIRD). METHODS: Perinatal data was obtained from 2004 to 2008 in the TMCHD and linked the NHIRD to obtain relevant medical information regarding maternal and neonatal risk factors of three asthma phenotypes which were identified as transient early asthma, persistent asthma, and late-onset asthma. A multivariate logistic regression analysis was conducted to adjust for covariates. RESULTS: The percentage of non-asthmatic patients was 77.02% and asthmatic (transient early asthma, late onset asthma, and persistent asthma) patients were 8.96%, 11.64%, and 2.42%, respectively. Maternal risk factors-including Cesarean section, maternal asthma, maternal allergic rhinitis (AR), and premature rupture of membranes-and neonatal risk factors, such as male gender, gestational age 29-37 weeks, ventilator use, antibiotics use, AR, and atopic dermatitis, were associated with the development of these three asthma phenotypes. Twins and a gestational age of 28 weeks or less premature were associated with the development of transient early asthma and persistent asthma, but not late onset asthma. Triplets and above were associated with the development of transient early asthma, but not late onset or persistent asthma. CONCLUSION: Various asthma phenotypes have different risk factors; therefore, their distinct risk factors should be identified in order to early diagnosis and treatment.

Mother's knowledge and attitude regarding recognition of neonatal signs of danger.

Neonates are at risk for various health problems leading to morbidity and mortality that occur significantly in the developing countries. Reducing neonatal morbidity and mortality requires the immediate caregiver's recognition of suggestive neonatal signs of danger (NSD). Generally, reducing neonatal morbidity and mortality requires immediate caregiver's recognition of suggestive NSD and visiting the nearby clinic. The study aimed to assess mothers' knowledge and attitudes regarding the recognition of neonatal danger signs. This is a descriptive cross-sectional hospital-based study conducted at three hospitals located in Khartoum State. The data were collected using a structured interview questionnaire, from a sample, which consisted of 188 participants. The majority of the study population (72%) of the respondents had very poor knowledge about NSD. Fever was the commonest NSD recognised by most of the participant. Most of the study population had positive attitudes toward initiating the management of neonatal risk signs, which include: neonatal jaundice (82%), hypothermia (52.66%), convulsions (71.8%) and fast and difficult breathing (75%) at home. The results also showed that more than half of the participants (54.8%) had negative attitudes regarding the management of diarrhoea at home. The majority of mothers in our study had very poor knowledge about NSD.

Cumulative risk factors and mental health of mothers of infants admitted to the neonatal intensive care unit.

Purpose: The present study examined predictive linkages between multiple risk factors and their contribution to the development of anxiety and depression in Puerto Rican mothers of infants admitted to the Neonatal Intensive Care Unit (NICU).Method: The scales used were: the Hamilton Anxiety Rating Scale, the Edinburgh Postpartum Depression Scale, the Hollingshead, and a Demographic Questionnaire was constructed to obtain information about mother and infant characteristics.Results: Both the cumulative psychosocial risk factor (B = 0.267, p = .011) and the cumulative neonatal risk factor (B = -0.220, p = .039) were significant predictors of mothers' anxiety.Discussion: It could be beneficial to create psychosocial interventions in the NICU to address parents' needs and promote emotional resilience. Also, training staff to provide an adequate explanation to mothers, regarding the infants' recovery process is of particular importance.

[Teenage Pregnancies and Birth]. / Teenagerschwangerschaften und Geburt: Spezifische Probleme bei Neugeborenen.

The number of teenage pregnancies in Austria has been decreasing for years. The remaining cases require the close cooperation of obstetricians, neonatologists, families, and social workers. With optimized support the risk of neonatal complications is only slightly raised. However, inadequate pregnancy support increases the risk of premature birth, low birthweight, and associated secondary complications such as infant respiratory distress syndrome and brain hemorrhage. Preventive measures such as information about contraception, regular pregnancy checks, and psychosocial supervision are essential.

Maternal risk factors and neonatal outcomes associated with low birth weight in a secondary referral hospital in Ghana.

INTRODUCTION: Over the past decade, the incidence of low birth weight (LBW) in sub-Saharan Africa has not seen any decline and this is a matter of grave concern for healthcare providers, policymakers, and researchers. Therefore, this study aimed to assess the incidence of LBW and related maternal risk factors (during pregnancy or delivery) as well as neonatal outcomes. METHODS: An institutional-based retrospective cross-sectional study design was employed to select 1,017 mothers who delivered in the study hospital from January to December 2017 with singleton newborn babies without congenital diseases. Data were analysed using STATA version 14.1 (StataCorp. 2015. Stata Statistical Software: Release 14. College Station, TX: Stata Corp LP). Chi-square test of independence was used to test the association between the dependent variable (LBW) and risk factors of LBW. Bivariate and multivariable unconditional logistic regression was used to determine the factors associated with LBW. RESULTS: The incidence of LBW was 23.7%. The findings show that being married has a protective effect on LBW [AOR = 0.60 (95%CI: 0.40-0.90), p = 0.013] compared to single mothers. Neonates born between gestational age of 37-42 weeks had 85% lower odds of LBW [AOR = 0.15, (95%CI: 0.10-0.24), p < 0.001)]. Neonates with LBW had a higher risk of low Apgar score in the first minute compared to neonates with normal birth weight [AOR = 0.52 (95%CI: 0.37-0.73), p < 0.001]. Female neonates had 64% higher odds of LBW compared to their male counterparts [AOR = 1.64 (95%CI: 1.19-2.24), p = 0.002]. CONCLUSION: This study revealed a high incidence of LBW. Women's marital status (single mothers), gestational age (<37 weeks), neonatal sex (female), are independent risk factors associated with LBW, while a higher risk of an Apgar score of less than 7 in the first minute was an independent outcome of low birth weight births. The current study findings contribute to the growing literature on the influence of maternal and neonatal factors on LBW in resource-constrained settings. These findings could guide healthcare providers, hospital administrators, stakeholders, and policymakers to develop and implement appropriate clinical and public health strategies aimed at reducing LBW.

Maternal and neonatal risk factors for neonatal respiratory distress syndrome in term neonates in Cyprus: a prospective case-control study.

BACKGROUND: Neonatal respiratory distress syndrome (NRDS) is strongly associated with premature birth, but it can also affect term neonates. Unlike the extent of research in preterm neonates, risk factors associated with incidence and severity of NRDS in term neonates are not well studied. In this study, we examined the association of maternal and neonatal risk factors with the incidence and severity of NRDS in term neonates admitted to Neonatal Intensive Care Unit (NICU) in Cyprus. METHODS: In a prospective, case-control design we recruited term neonates with NRDS and non-NRDS admitted to the NICU of Archbishop Makarios III hospital, the only neonatal tertiary centre in Cyprus, between April 2017-October 2018. Clinical data were obtained from patients' files. We used univariate and multivariate logistic and linear regression models to analyse binary and continuous outcomes respectively. RESULTS: During the 18-month study period, 134 term neonates admitted to NICU were recruited, 55 (41%) with NRDS diagnosis and 79 with non-NRDS as controls. In multivariate adjusted analysis, male gender (OR: 4.35, 95% CI: 1.03-18.39, p = 0.045) and elective caesarean section (OR: 11.92, 95% CI: 1.80-78.95, p = 0.01) were identified as independent predictors of NRDS. Among neonates with NRDS, early-onset infection tended to be associated with increased administration of surfactant (ß:0.75, 95% CI: - 0.02-1.52, p = 0.055). Incidence of pulmonary hypertension or systemic hypotension were associated with longer duration of parenteral nutrition (pulmonary hypertension: 11Vs 5 days, p < 0.001, systemic hypotension: 7 Vs 4 days, p = 0.01) and higher rate of blood transfusion (pulmonary hypertension: 100% Vs 67%, p = 0.045, systemic hypotension: 85% Vs 55%, p = 0.013). CONCLUSIONS: This study highlights the role of elective caesarean section and male gender as independent risk factors for NRDS in term neonates. Certain therapeutic interventions are associated with complications during the course of disease. These findings can inform the development of evidence-based recommendations for improved perinatal care.

Risk factors for the development and progression of retinopathy of prematurity in preterm infants in Indonesia.

BACKGROUND: Risk factors other than supplemental oxygen might play a role in the development of retinopathy of prematurity (ROP). In Indonesia ROP occurs in infants up to 34 weeks and 2000 g. Risk factors for the development of ROP in Indonesian NICUs have not been evaluated. Our aim was to identify other risk factors than the use of oxygen in the development and progression of ROP in preterm infants in Indonesia. METHODOLOGY: Data on 98 preterm infants with ROP and 77 controls were collected from four NICUs and two eye centers in Jakarta, Indonesia, between 2009 and 2014. We used multivariate logistic regression analysis to determine the relationship between infants and environmental variables and the development and progression of ROP. We obtained variables for ROP severity by using Cox regression analysis. RESULTS: Factors associated with the development of ROP were birthweight (BWt), intrauterine growth retardation (IUGR), exchange transfusion, duration of oxygen supplementation, minimum saturation monitor setting, and socioeconomic factors. Regarding the progression, gestational age (GA), out-born, duration of supplemental oxygen, minimum saturation monitor setting, and socioeconomic factors were identified as risk factors. CONCLUSION: The use and control of supplemental oxygen are the main risk factors for the development and progression of ROP in preterms in Indonesia. Additionally, we confirm that GA, BWt, and IUGR are risk factors. Moreover, we found exchange transfusion to be a risk factor, and we found a lower rate of ROP in infants from a lower socioeconomic background. These risk factors apply to infants with a GA up to 34 weeks and a BWt up to 2000 g.

Neonatal Risk, Maternal Sensitive-Responsiveness and Infants' Joint Attention: Moderation by Stressful Contexts.

Neonatal risk factors have been associated with atypical development in various areas of social communication, including joint attention (JA), but little is known about factors in the early caregiving environment that can modify the negative implications of neonatal risk. The present study examines the links between neonatal risk and infants' JA, while considering the mediating role of maternal sensitive-responsiveness and the moderating roles of stressful contexts. One hundred and eighty-two families with infants (50% female) born in a wide range of gestational ages and birthweights participated in the study. Neonatal risk was assessed shortly after birth using three indicators: birthweight, gestational age, and degree of medical risk. At age 6 months, maternal sensitive-responsiveness to infants' foci of attention was rated and maternal anxiety and household chaos were measured. Infants' JA behaviors were assessed at age 12 months. A moderated-mediation model revealed that maternal anxiety symptoms and household chaos moderated the links between neonatal risk, maternal sensitive-responsiveness, and infants' responding to JA. Specifically, neonatal risk was related to less maternal sensitive-responsiveness only when maternal anxiety symptoms were above average levels, but not when anxiety symptoms were low. Moreover, maternal sensitive-responsiveness was positively related to infants' responding to JA behaviors when household chaos was low but not when it was high. These findings highlight the complex nature of the links between infants' early biological risk and caregiving environments in the development of social communication skills.

Unexpected delivery: a case report of cryptic pregnancy in Nigeria.

The etiology of cryptic pregnancy has not been fully elucidated and there exist misconceptions about this phenomenon in our contemporary Nigerian society. This case presents the first case report of cryptic pregnancy in sub-Saharan Africa. A case of a 19 year old overweight female student who presented to the sick bay at 01: 30 hours with a 3-day history of lower back pain, abdominal discomfort and constipation. At the sick bay the general practitioner on call asked if she was pregnant and she vehemently said no, recounting that she sees her menstruation regularly. Abdominal examination however, revealed a gravid uterus of about 36 weeks and vaginal examination showed a fully dilated cervix. She was surprised, terrified and confused and only remembered having unprotected sexual intercourse many months earlier. Barely two hours later, she gave birth via spontaneous vaginal delivery, to a live female infant at 03: 14 hours. This case emphasizes the need for general practitioners and specialists in sub-Saharan Africa to be aware of the phenomenon of cryptic pregnancy, which involves women not being conscious of their gravid state until final weeks of gestation or at delivery, to reduce neonatal and maternal complications.