Human milk, breastfeeding, and early neurodevelopmental outcomes for infants with critical CHD.

Human milk improves neurodevelopment for preterm infants, but relationships between human milk and neurodevelopment for infants with critical CHD are unknown. We aimed to (1) explore associations between human milk/direct breastfeeding and neurodevelopment at 1-year and 2-year follow-up and (2) describe patterns of human milk (maternal, donor) and commercial formula during hospitalisation in the first year of life.This retrospective cohort study included infants who underwent surgery for CHD < 6 months old. The primary outcome was neurodevelopment via Bayley Scales of Infant Development-IV. Analysis included adjusted linear regression for associations between exclusive human milk while inpatient during the first 6 months or any direct breastfeeding while inpatient during the first year of life and 1-year Bayley-IV scores. Models were adjusted for race, insurance type, genetic diagnosis, and length of stay.Of 98 eligible infants, 40% followed up at 1 year; 27% at 2 years. There were differences in follow-up related to demographics (race, ethnicity) and social determinants of health (insurance type, distance from clinic). In adjusted models, infants who directly breastfed had 13.18 points higher cognition (95% CI: 0.84-25.53, p = 0.037); 14.04 points higher language (2.55-25.53, p = 0.018); and 15.80 points higher motor scores (3.27-28.34, p = 0.015) at 1-year follow-up. Infants fed exclusive human milk had 12.64 points higher cognition scores (-0.53-25.82, p = 0.059).Future investigation into nutrition and neurodevelopment in the context of critical CHD is warranted. As neurodevelopmental follow-up becomes standard of care in this population, efforts are needed to mitigate disparities in access to this care.

Prenatal Maternal Stress and Pediatric Asthma Across Development: Adolescent Female-Specific Vulnerability.

Prenatal maternal stress (PNMS) is linked to physical sequelae in offspring, including childhood asthma. This study sought to examine the roles of objective and subjective PNMS in the development of asthma at offspring ages 5 and 15. The sample included 815 mother-child dyads from the Mater Misericordiae Mothers' Hospital-University of Queensland Study of Pregnancy. PNMS was measured via retrospective self-report during pregnancy and 3-5 days after birth. Postnatal maternal stress was measured at offspring age 5. Objective PNMS was associated with elevated asthma risk at age 5 (OR 1.21, 95% CI 1.00, 1.45, p = 0.05), albeit not above concurrent postnatal stress. Sex moderated the association between PNMS and asthma at age 15, controlling for postnatal stress. Sex stratified analyses revealed a positive association between objective PNMS and age 15 asthma in females, but not males. Results provide evidence that PNMS may impact asthma outcomes in adolescence.

Intergenerational Impacts of Maternal Stress on Early Childhood Atopy in Black Americans.

OBJECTIVE: Black children are disproportionately affected by atopic diseases (i.e., atopic dermatitis, allergic rhinitis, asthma, and food allergies), with health disparities present in early life. Studies in White samples suggest that maternal stress confers risk for offspring atopy, yet little is known about these relationships in Black populations. This study seeks to (a) examine the relationship between self-reported and physiological indicators of maternal stress and offspring atopy and (b) explore warm and responsive caregiving as a potential protective factor in Black Americans. METHODS: A sample of 179 Black mother-child dyads of varying socioeconomic status participated in a prospective longitudinal study. Mothers completed self-reports of childhood trauma, prenatal stress, postnatal stress, and physician diagnosis of offspring atopy; provided blood samples to assess physiological responses to chronic stress exposure; and participated in a behavioral task with their infant. RESULTS: Maternal self-reports of childhood trauma, prenatal stress, and postnatal stress were not associated with offspring diagnosis of atopy by 2-3 years of age. Mothers who produced a smaller inflammatory response during pregnancy were more likely to have an offspring with atopy by 2-3 years of age. Warm and responsive parenting demonstrated a protective effect; the positive association between maternal stress and offspring atopy was less apparent in cases of mother-child interactions characterized by high levels warm and responsive parenting. CONCLUSION: Failure to replicate previous findings suggests that the maternal stress-offspring atopy relationship is complex. Future studies must examine the unique stressors in Black Americans, as well as caregiving as a potential protective factor.

The Unmet Needs of Patients with Food Allergies.

This article reviews the unmet needs of patients with food allergies. Anxiety is common among patients with food allergies and their caregivers, which naturally stems from the avoidance, exposure, and uncertainty involved in care. Anxiety associated with allergen avoidance can have both adaptive and detrimental effects on overall health. Anxiety has implications for transitioning the responsibility of health and well-being from caregivers to the patients. As more children with food allergies become adults with food allergies, this will be an urgent topic. Moreover, as more exposure-based therapies become available, understanding patients' psychological expectations and experiences of exposure is vital.

Anxiety and depressive symptoms in adolescents and young adults with epilepsy: The role of illness beliefs and social factors.

PURPOSE: This study examined (1) the prevalence of anxiety and depressive symptoms among adolescents and young adults (AYA) with epilepsy and (2) demographic and medical characteristics, illness beliefs, and social factors associated with anxiety and depressive symptoms to guide intervention development. METHODS: A community-based sample of AYA with epilepsy (n = 179, ages 13-24 years, 39% male) completed online questionnaires measuring anxiety symptoms (GAD-7), depressive symptoms (PHQ-9), illness beliefs (helplessness; acceptance; perceived benefits), and social factors (family functioning; social stigma; connectedness). Participants also reported medical information (epilepsy type; years since diagnosis; time since last seizure; current medications). RESULTS: Prevalence of clinically significant symptoms of anxiety and depression, 36% and 35%, respectively, was high compared to population prevalence. In multivariable regression models, demographic and medical factors explained only 2% of the variance in depressive symptoms and 6% in anxiety symptoms. Illness beliefs and social factors accounted for a majority of the explanatory power of both models (partial R2 = 0.37 for anxiety; 0.44 for depression). Specifically, acceptance, family functioning, and social stigma accounted for the greatest variance (p's < 0.01). CONCLUSIONS: This study found a high prevalence of anxiety and depressive symptoms among AYA with epilepsy. Epilepsy variables (seizure type, medications, and years since diagnosis) were not associated with these psychological symptoms. Rather, the majority of variance in symptoms was accounted for by potentially modifiable beliefs and social factors. Interventions that promote illness acceptance, enhance family functioning, and reduce social stigma may ameliorate psychological distress among AYA with epilepsy.

Selective inflammatory propensities in adopted adolescents institutionalized as infants.

This study examined whether early life adversity (ELA) limited to infancy was associated with an increase in circulating levels of proinflammatory cytokines and cellular cytokine responses to three stimulants [lipopolysaccharide (LPS), phytohemagglutinin (PHA), and phorbol myristate acetate plus ionomycin (PMA/IO)]. Participants were previously institutionalized (PI) youth (N = 45, 56 % female) who had spent their first years in institutional care (e.g., orphanages, baby homes) before being adopted into well-resourced homes (median age at adoption = 13 mos) and non-adopted comparisons (NA; N = 38, 55 % female). Their age range was 13.3-21.2 years (M = 16.3 years). This analysis followed up an earlier report on these youth (Reid et al., 2019a) that identified an increase in terminally differentiated CD8 + CD57 T cells among the PI relative to the NA youth. Cytokine levels in circulation were not highly correlated and thus examined separately. PI youth had higher circulating levels of Tumor Necrosis Factor-alpha (TNFα), but not Interleukin-1ß (IL-1ß) or Interleukin-6 (IL-6). Cytokine responses to in vitro activation within each stimulant condition were highly correlated and were thus combined to generate an index of the inflammatory reaction to each stimulant. Using Multivariate Analysis of Covariance, there was a highly significant multivariate effect of group, which was carried primarily by the PMA/IO condition, with PI youth exhibiting a larger inflammatory response than NA youth. Tests of mediation showed that both the early rearing effects on circulating TNFα and the composite inflammatory index of PMA/IO responsiveness were mediated in the statistical model by the percentage of CD8 + CD57+ TEMRA cells in circulation, a marker of replicative senescence in T cells. Sex differences were also found in circulating levels of IL-6 and TNFα, with males having higher levels than females.

The development of stress reactivity and regulation during human development.

Adverse experiences during childhood can have long-lasting impacts on physical and mental health. At the heart of most theories of how these effects are transduced into health impacts is the activity of stress-mediating systems, most notably the hypothalamic-pituitary-adrenocortical (HPA) axis. Here we review the anatomy and physiology of the axis, models of stress and development, the development of the axis prenatally through adolescence, the role of experience and sensitive periods in shaping its regulation, the social regulation of the axis at different points in development, and finally conclude with suggestions for future research. We conclude that it is clear that early adversity sculpts the stress system, but we do not understand which dimensions have the most impact and at what points in early development. It is equally clear that secure attachment relationships buffer the developing stress system; however, the mechanisms of social buffering and how these may change with development are not yet clear. Another critical issue that is not understood is when and for whom adversity will result in hypo- vs hyperactivity of stress-mediating systems. These and other issues are important for advancing our understanding of how early adversity "gets under the skin" and shapes human physical and mental health.

Medical Risk and Resilience in Adolescents and Young Adults With Epilepsy: The Role of Self-Management Self-Efficacy.

OBJECTIVE: Medical factors that put adolescents and young adults (AYA) with epilepsy at risk for poor health-related quality of life (HRQOL) are well-established. Less known is whether medical risk is associated with decreases in global psychological well-being and how self-management self-efficacy might contribute to resilience. The current study seeks to (a) examine the relationship between medical risk and both HRQOL and psychological well-being in AYA with epilepsy and (b) investigate the potential moderating role of self-management self-efficacy. METHODS: A sample of 180 AYA with epilepsy, aged 13-24 years, was recruited from clinic and community settings and completed questionnaires. A medical risk gradient composed of seizure frequency, antiepileptic drugs, and other health problems was created. HRQOL, psychological well-being, and self-management self-efficacy were assessed. RESULTS: Medical risk was negatively associated with HRQOL, such that youth with greater risk scores reported lower HRQOL (r = -0.35, p < .01). However, there was no significant relationship between medical risk and psychological well-being (r = -0.08, p = .31). Self-efficacy was positively correlated with HRQOL and well-being (r = 0.50, p < .01; r = 0.48, p < .01). A moderation effect was detected, such that the positive effect of self-efficacy on HRQOL differed across medical risk levels. IMPLICATIONS: Cultivating psychological strengths, as opposed to solely addressing medical problems, may be a promising intervention target when treating AYA with epilepsy, including those navigating healthcare transitions. Self-efficacy predicted HRQOL at most levels of risk, suggesting an important modifiable intrinsic factor that may promote resilience.

Early-Life Somatic Complaints: Longitudinal Associations with Maternal and Child Psychopathology.

OBJECTIVE: Somatic complaints, often associated with concurrent and future internalizing symptoms and disorders in adult samples, were examined longitudinally from preschool to school age in a sample of children at an increased familial risk for psychopathology. The behavioral correlates and sex differences of somatic complaints and the persistence of these complaints across early childhood were examined. METHOD: A longitudinal sample of 185 mothers completed a laboratory visit when children were preschool aged and an online follow-up when children were school aged. Mothers were assessed for psychopathology, and mothers and secondary caregivers reported on children's somatic complaints, anxiety, and depression at both time points. RESULTS: A high rate of child's somatic complaints was noted in this sample, with similar rates in males and females. Regression analyses revealed that somatic complaints at preschool predicted somatic complaints, anxiety, and depression at school age, and sex did not moderate these relationships. Overall, maternal psychopathology predicted somatic complaints, but findings were inconsistent across reporters, time points, and types of maternal psychopathology. Evidence for maternal reporting bias was mixed. CONCLUSION: The association between preschool-age somatic complaints and school-age internalizing symptoms suggests the potential utility of early detection and treatment of somatic complaints, particularly for young children at an increased familial risk for developing internalizing disorders. Pediatric primary care is an ideal setting for these early intervention efforts.

Correction to: Early Life Stress and Childhood Aggression: Mediating and Moderating Effects of Child Callousness and Stress Reactivity.

The article "Early Life Stress and Childhood Aggression: Mediating and Moderating Effects of Child Callousness and Stress Reactivity", written by Dominika A. Winiarski, Melissa L. Engel, Niranjan S. Karnik and Patricia A. Brennan, was originally published electronically on the publisher's internet portal (https://link.springer.com/article/10.1007/s10578-018-0785-9) on 13 February 2018 without open access.

Early Life Stress and Childhood Aggression: Mediating and Moderating Effects of Child Callousness and Stress Reactivity.

Early life stress (ELS) has been implicated in the development of aggression, though the exact mechanisms remain unknown. This study tested associations between ELS, callousness, and stress reactivity in the prediction of school-age and persistent early childhood aggression. A longitudinal sample of 185 mother-child dyads completed a lab visit and mothers completed an online follow-up when children were preschool-aged and school-aged, respectively. Physiological and behavioral measures of stress reactivity were collected during the preschool period. Ratings of child aggressive behavior, ELS, and callousness were collected as well. The results suggested that ELS was related to measures of both school-age and persistent early childhood aggression, and that callousness had a mediating role in this process. Cortisol reactivity also moderated the association between ELS and persistent childhood aggression, such that the ELS-aggression relationship was stronger among children who had higher levels of cortisol reactivity during the preschool period. Clinical implications are discussed.

Pulse oximetry screening: a review of diagnosing critical congenital heart disease in newborns.

Congenital heart disease (CHD) is one of the most common birth defects, with an incidence of nine out of every 1,000 live births. The mortality of infants with CHD has decreased over the past 3 decades, but significant morbidity and mortality continue to occur if not diagnosed shortly after birth. Pulse oximetry was recommended as a screening tool to detect critical CHD in 2011 by the American Academy of Pediatrics and the American Heart Association. Pulse oximetry is a tool to measure oxygen saturation, and based on the presence of hypoxemia, many cardiac lesions are detected. Due to its ease of application to the patient, providing results in a timely manner and without the need for calibrating the sensor probe, pulse oximetry offers many advantages as a screening tool. However, pulse oximetry has also important limitations of which physicians should be aware to be able to assess the significance of the pulse oximetry measurement for a given patient. This review aims to highlight the benefits and shortcomings of pulse oximetry within the context of screening for critical CHD and suggests future avenues to cover existing gaps in current practices.