Comparison of C-MAC Miller blade video laryngoscope with conventional Miller blade in infants undergoing elective surgery- A prospective randomised trial.

Background and Aims: Endotracheal intubation (ET) in infants is considered a challenging task over the decades. Infants have short safe apnoea time, and this difficulty has been vanquished to some extent by using the videolaryngoscopes (VLs), but there exists a dearth of research particularly in this vulnerable subset. Therefore, this trial was conducted to evaluate intubation times obtained with C-MAC VL and conventional Miller laryngoscopes in infants. Methods: A total of 80 infants aged between 1 month and 1 year with American Society of Anesthesiologists physical status I-II requiring ET were randomised in two groups; the C-MAC VL or Miller laryngoscope ML. Anaesthesia was induced with sevoflurane 1-8% and atracurium 0.5 mg/kg IV. The primary outcome was evaluated as the total time taken to intubate. Secondary outcomes were time to achieve best glottic view (TBGV), tube insertion time (TIT), percentage of glottic opening (POGO) score, number of attempts and intubation difficulty score (IDS). Results: The median (interquartile range) of time taken for ET was less in VL; 22.5 (20.75-26) compared to ML; 26 (21.75-31). TBGV was achieved early in VL group than the ML group (6.03 ± 1.33s/7.88 ± 2.44) respectively (P-value < 0.001). POGO was better in VL (99.12 ± 4.795s) compared to ML (85.50 ± 31.13s). IDS was less in the VL group (0.07 ± 0.27) than in ML (0.70 ± 1.14). Other parameters, such as the number of attempts, bougie usage, adverse effects and TIT, were comparable across the two groups. Conclusion: When compared to the ML group, the C-MAC VL group exhibited a decreased intubation time, early TBGV, better POGO score, reduced IDS and subjective intubation difficulty. As a result, we consider VL to be a more efficacious device for intubating the trachea in infants.

Minimum acceptable diet and its associated factors among children aged 6-23 months in Lalibela, northeast Ethiopia: a community-based cross-sectional study.

The first 2 years of life are a critical window of opportunity for ensuring optimal child growth and development. In Ethiopia, the magnitude of the minimum acceptable diet ranges from 7 to 74⋅6 %. The evidence revealed the variation and unrelated data on the prevalence of minimum acceptable diet. Therefore, the present study aimed to assess the minimum acceptable diet and its associated factors among children aged 6-23 months in Lalibela town administration, northeast Ethiopia. A community-based cross-sectional study was conducted in Lalibela town administration, northeast Ethiopia among 387 mothers/caregivers with children aged 6-23 months from May 1 to 30, 2022. The data were entered by Epidata version 3.1 and analysed by SPSS version 25.0. A multivariable binary logistic regression model was fitted to identify factors associated with minimum acceptable diet. The degrees of association were assessed using an adjusted odds ratio with a 95 % confidence interval and P-value of 0⋅05. The magnitude of minimum acceptable diet in the study area was 16⋅7 % (95 % confidence interval: 12⋅8-20⋅6 %). Sex of child, getting infant and young child feeding counselling at antenatal care, infant feeding practice-related knowledge and childhood illness are the variables that were found to be an independent predictor of minimum acceptable diet. Health facilities should strengthen infant feeding counselling starting from antenatal care visits during pregnancy for the recommended minimum acceptable diet is crucial.

An ensemble multi-stream classifier for infant needs detection.

In this paper, we propose a novel multi-stream video classifier for infant needs detection. The proposed system is an ensemble-based system that combines several machine learning to improve the overall result of the state-of-the-art algorithms. It is a multi-stream in the sense that it combines the output predictions of both audio and images of infants from every single classifier employed in the system for a unified result. This produces better performance and results compared to the previous other research techniques, which relied on only one of these modalities. For training and testing the proposed system, from the Dunstan Baby Language video collection, we built three separate datasets for videos, images, and sounds encompassing the five primary infant needs that require predicting. These are: hunger, have wind, uncomfortable (require diaper change), wants to burp or tired, with a total of 3348 samples. We used four different ensemble algorithms for the best reachable performance. The proposed algorithm improves the overall accuracies of each single classifier from a low of 51% to a high of 99%. The proposed method also improves the accuracy of the classification process by about 9% compared to the state-of-the-art approaches, which was 90%.

What is needed by parents of constipated infants and toddlers: A cross-sectional study in China.

Background: Childhood functional constipation is a worldwide problem that affects the intestinal function of children and the quality of life of their families. Treatment and management of the disease need to be carried out at home by parents. Assessment of caregiving needs is an important link in planning and implementing the intervention. This study aimed to assess the caregiving needs of parents of FC infants and toddlers. Methods: The researchers recruited convenience samples of parents from an outpatient pediatric constipation clinic of a children's medical center. Totally 211 fathers/mothers were recruited. Nursing needs were measured by a questionnaire, and associations between nursing needs and potential factors were examined using multiple regression analysis. Results: The vast majority of participants (88.7%) expressed the need of receiving support from professionals, and only 44 (20.85%) had obtained help from medical staff. The needs of parents mainly include information needs, health needs, psychological needs, and social needs. Of all the needs, the highest score was for information needs (3.87 ± 0.69), followed by the dimension of health needs (3.74 ± 0.82). Results showed statistically significant differences in parental education, place of residence, age of children, duration of FC, defecation frequency, difficulty of defecation, and stool traits in nursing needs (p < 0.05). The regression model explained 64.2% of the variance of nursing needs. Conclusions: Information needs were the major concern for parents, and the unmet needs of parents should be addressed during treatment and care. When developing care plans and providing health education, it should be adjusted according to the specific conditions of the child and parents to improve the compliance of the parents with treatment and care.

The Impact of Early Enteral Nutrition on Post-operative Hospital Stay and Complications in Infants Undergoing Congenital Cardiac Surgery: A Systematic Review and Meta-analysis.

Introduction: The congenital cardiac diseases (CHDs) are the leading cause of death in children. The CHDs detection and management have greatly improved over the past few decades. This review aimed to assess the effectiveness of early enteral nutrition (EEN) on postoperative outcomes in infants undergoing congenital cardiac surgery. Methods: Electronic databases PubMed, Clinical Key, UpToDate, the Cochrane Library, and Google Scholar were searched for studies published in the English language, between 2004 and 2021. This review carried out based on PRISMA statement and studies qualities assessed using "Downs and Black score". Hospital stay, intensive care unit (ICU) stay, mechanical ventilation support, aortic cross clamping and cardiopulmonary bypass were as primary outcomes. Similarly infections, vomiting and mortality were as secondary outcomes of included studies. Results: This review consists of 887 infants from 10 studies. Of these, 470 infants were assigned to the intervention group and 417 to the control group. The post-operative hospital stay shorted in the EEN group than the control group (SMD=-0.63, 95% CI: -1.03 to -0.22, P=0.0, I2=87%). Similarly, EEN group lessen the ICU stay (SMD=-0.15, 95% CI: -0.42, 0.11, P=0.0, I2=71%), mechanical ventilation support (SMD=-0.31, 95% CI: -0.51, -08, P=0.08, I2=47%), aortic cross clamping (SMD=-0.92, 95% CI: -0.31, 2.4, P=0.00, I2=96%), and cardiopulmonary bypass (SMD=-0.0, 95% CI: -0.42 to 43, P=0.00, I2=71%). Secondary postoperative complications such as infections (RR=0.68, 95% CI: 0.43 to 1.08, P=0.40, I2=3%). vomiting (RR=1.47, 95% CI: 0.80 to 2.69, P=0.90, I2=0%) and postoperative mortality (RR=0.42, 95% CI: 0.03 to 5.82, P=0.00: I2=80%) significantly reduced. Conclusion: Postoperative outcomes were improved in the intervention group compared to the control group, including shorter hospital stays, ICU stays, mechanical ventilation, and less postoperative complications.

Pneumococcal Conjugate Vaccines Are Protective Against Respiratory Syncytial Virus Hospitalizations in Infants: A Population-Based Observational Study.

Background: Pneumococcal conjugate vaccines (PCV) reduced the risk of respiratory syncytial virus (RSV) in a randomized clinical trial. We aimed to assess the real-world effectiveness of PCV on RSV-hospitalizations among Western Australian infants. Methods: We conducted a population-based cohort study of births during 2000-2012, using probabilistically linked individual-level immunization, hospitalization, respiratory microbiology testing, and perinatal data. We performed Cox proportional hazard models with time-varying exposure (receipt of infant PCV doses) against the first RSV-confirmed hospitalization 0-12 months adjusted for perinatal and sociodemographic factors. Results: From 360 994 children, 3-dose PCV coverage in Aboriginal infants ranged from 29% to 51% in 2001-2004 when PCV was funded for Aboriginal children only. Following universal funding in 2005, coverage increased to 85% for Aboriginal and 73% for non-Aboriginal infants. RSV-hospitalization rates were highest in young infants aged 0-5 months (22.5/1000 child-years) and >2 times higher in Aboriginal infants than in non-Aboriginal infants. Receipt of ≥3 PCV doses in the universal funded period was associated with a 30% reduction in RSV-hospitalization in Aboriginal infants (adjusted hazard ratio, aHR 0.70 [95% confidence interval, CI 0.46-1.06]) and 21% reduction in non-Aboriginal infants (aHR 0.79 [95% CI 0.63-0.99]) compared with unvaccinated infants. Conclusions: Prior to the introduction of RSV vaccines, our study suggests that universal childhood PCV vaccination may result in a reduction in severe RSV infections in children and may be important for countries that are yet to consider PCV programs.

Complete blood count parameters as biomarkers of retinopathy of prematurity: a Portuguese multicenter study.

PURPOSE: To evaluate complete blood count (CBC) parameters in the first week of life as predictive biomarkers for the development of retinopathy of prematurity (ROP). METHODS: Multicenter, prospective, observational study of a cohort of preterm infants born with gestational age (GA) < 32 weeks or birth weight < 1500 g in eight Portuguese neonatal intensive care units. All demographic, clinical, and laboratory data from the first week of life were collected. Univariate logistic regression was used to assess risk factors for ROP and then multivariate regression was performed. RESULTS: A total of 455 infants were included in the study. The median GA was 29.6 weeks, and the median birth weight was 1295 g. One hundred and seventy-two infants (37.8%) developed ROP. Median values of erythrocytes (p < 0.001), hemoglobin (p < 0.001), hematocrit (p < 0.001), mean corpuscular hemoglobin concentration (p < 0.001), lymphocytes (p = 0.035), and platelets (p = 0.003) of the group of infants diagnosed with ROP any stage were lower than those without ROP. Mean corpuscular volume (MCV) (p = 0.044), red blood cell distribution width (RDW) (p < 0.001), erythroblasts (p < 0.001), neutrophils (p = 0.030), neutrophils-lymphocytes ratio (p = 0.028), and basophils (p = 0.003) were higher in the ROP group. Higher values of MCV, erythroblasts, and basophils remained significantly associated with ROP after multivariate regression. CONCLUSION: In our cohort, the increase in erythroblasts, MCV, and basophils in the first week of life was significantly and independently associated with the development of ROP. These CBC parameters may be early predictive biomarkers for ROP.

The role of human milk feeds on inotrope use in newborn infants with sepsis.

Background: Regarding neonatal hypotension, there is no certainty as to whether inotrope properties are beneficial or whether they may be harmful. However, given that the antioxidant content of human milk plays a compensatory role in neonatal sepsis and that human milk feeding has direct effects in modulating the cardiovascular function of sick neonates, this research hypothesized that human milk feeds might predict lower requirements of vasopressors in the management of neonatal septic shock. Method: Between January 2002 and December 2017, all late preterm and full-term infants attending a neonatal intensive care unit, with clinical and laboratory findings of bacterial or viral sepsis, were identified in a retrospective study. During their first month of life, data on feeding type and early clinical characteristics were collected. A multivariable logistic regression model was constructed to determine the impact of human milk on the use of vasoactive drugs in septic newborns. Results: 322 newborn infants were eligible to participate in this analysis. Exclusively formula-fed infants were more likely to be delivered via C-section, to have a lower birth weight and a lower 1-minute Apgar score than their counterparts. Human milk-fed newborns had 77% (adjusted OR = 0.231; 95% CI: 0.07-0.75) lower odds of receiving vasopressors than exclusively formula-fed newborns. Conclusion: We report that any human milk feeding is associated with a decrease in the need for vasoactive medications in sepsis-affected newborns. This observation encourages us to undertake further research to determine whether human milk feeds mitigate the use of vasopressors in neonates with sepsis.

Human milk-associated bacterial communities associate with the infant gut microbiome over the first year of life.

Introduction: Microbial communities inhabiting the human infant gut are important for immune system development and lifelong health. One critical exposure affecting the bacterial colonization of the infant gut is consumption of human milk, which contains diverse microbial communities and prebiotics. We hypothesized that human milk-associated microbial profiles are associated with those of the infant gut. Methods: Maternal-infant dyads enrolled in the New Hampshire Birth Cohort Study (n = 189 dyads) contributed breast milk and infant stool samples collected approximately at 6 weeks, 4 months, 6 months, 9 months, and 12 months postpartum (n = 572 samples). Microbial DNA was extracted from milk and stool and the V4-V5 region of the bacterial 16S rRNA gene was sequenced. Results: Clustering analysis identified three breast milk microbiome types (BMTs), characterized by differences in Streptococcus, Staphylococcus, Pseudomonas, Acinetobacter, and microbial diversity. Four 6-week infant gut microbiome types (6wIGMTs) were identified, differing in abundances of Bifidobacterium, Bacteroides, Clostridium, Streptococcus, and Escherichia/Shigella, while two 12-month IGMTs (12mIGMTs) differed primarily by Bacteroides presence. At 6 weeks, BMT was associated with 6wIGMT (Fisher's exact test value of p = 0.039); this association was strongest among infants delivered by Cesarean section (Fisher's exact test value of p = 0.0028). The strongest correlations between overall breast milk and infant stool microbial community structures were observed when comparing breast milk samples to infant stool samples collected at a subsequent time point, e.g., the 6-week breast milk microbiome associated with the 6-month infant gut microbiome (Mantel test Z-statistic = 0.53, value of p = 0.001). Streptoccous and Veillonella species abundance were correlated in 6-week milk and infant stool, and 4- and 6-month milk Pantoea species were associated with infant stool Lachnospiraceae genera at 9 and 12 months. Discussion: We identified clusters of human milk and infant stool microbial communities that were associated in maternal-infant dyads at 6 weeks of life and found that milk microbial communities were more strongly associated with infant gut microbial communities in infants delivered operatively and after a lag period. These results suggest that milk microbial communities have a long-term effect on the infant gut microbiome both through sharing of microbes and other molecular mechanisms.

Integration of HIV care into maternal and child health services in the global IeDEA consortium.

The WHO recommends the integration of routine HIV services within maternal and child health (MCH) services to reduce the fragmentation of and to promote retention in care for pregnant and postpartum women living with HIV (WWH) and their infants and children exposed to HIV (ICEH). During 2020-2021, we surveyed 202 HIV treatment sites across 40 low- and middle-income countries within the global International epidemiology Databases to Evaluate AIDS (IeDEA) consortium. We determined the proportion of sites providing HIV services integrated within MCH clinics, defined as full [HIV care and antiretroviral treatment (ART) initiation in MCH clinic], partial (HIV care or ART initiation in MCH clinic), or no integration. Among sites serving pregnant WWH, 54% were fully and 21% partially integrated, with the highest proportions of fully integrated sites in Southern Africa (80%) and East Africa (76%) compared to 14%-40% in other regions (i.e., Asia-Pacific; the Caribbean, Central and South America Network for HIV Epidemiology; Central Africa; West Africa). Among sites serving postpartum WWH, 51% were fully and 10% partially integrated, with a similar regional integration pattern to sites serving pregnant WWH. Among sites serving ICEH, 56% were fully and 9% were partially integrated, with the highest proportions of fully integrated sites in East Africa (76%), West Africa (58%) and Southern Africa (54%) compared to ≤33% in the other regions. Integration was heterogenous across IeDEA regions and most prevalent in East and Southern Africa. More research is needed to understand this heterogeneity and the impacts of integration on MCH outcomes globally.

Use of Continuous Ketamine Infusion as an Adjunctive Agent in Young Infants With Refractory and Super Refractory Status Epilepticus: A Case Series.

Continuous ketamine infusions have been studied as an adjunctive agent for refractory status epilepticus (RSE) and super refractory status epilepticus (SRSE) in older children and adults. However, minimal information exists on the efficacy, safety, and dosing for continuous ketamine in young infants. We present the clinical course of 3 young infants with RSE and SRSE who received continuous ketamine in conjunction with other antiseizure medications. The condition of these patients was refractory to an average of 6 antiseizure medications before initiation of continuous ketamine infusion. For each patient, a continuous ketamine infusion was initiated at a rate of 1 mg/kg/hr with 1 patient requiring titration to a maximum of 6 mg/kg/hr. In 1 case, the concomitant use of continuous ketamine allowed for a reduction in the benzodiazepine continuous infusion rate. In all cases, ketamine was well tolerated especially in the setting of hemodynamic instability. Ketamine may provide a safe adjunct in the acute setting in severe RSE and SRSE. This is the first case series to document the use of continuous ketamine as a treatment modality in young infants with RSE or SRSE secondary to various underlying etiologies, without adverse events. Further studies are needed to evaluate the long-term safety and efficacy of continuous ketamine in this patient population.

Evaluation of clinical case definitions for respiratory syncytial virus lower respiratory tract infection in young children.

BACKGROUND: Various case definitions of respiratory syncytial virus lower respiratory tract infection (RSV-LRTI) are currently proposed. We assessed the performance of three clinical case definitions against the World Health Organization definition recommended in 2015 (WHO 2015). METHODS: In this prospective cohort study conducted in eight countries, 2401 children were followed up during 2 years from birth. Suspected LRTIs were detected via active and passive surveillance, followed by in-person clinical evaluation including single timepoint respiratory rate and oxygen saturation (by pulse oximetry) assessment, and nasopharyngeal sampling for RSV testing by polymerase chain reaction. Agreement between case definitions was evaluated using Cohen's κ statistics. RESULTS: Of 1652 suspected LRTIs, 227 met the WHO 2015 criteria for RSV-LRTI; 73 were classified as severe. All alternative definitions were highly concordant with the WHO 2015 definition for RSV-LRTI (κ: 0.95-1.00), but less concordant for severe RSV-LRTI (κ: 0.47-0.82). Tachypnea was present for 196/226 (86.7%) WHO 2015 RSV-LRTIs and 168/243 (69.1%) LRTI/bronchiolitis/pneumonia cases, clinically diagnosed by non-study physicians. Low oxygen saturation levels were observed in only 55/226 (24.3%) WHO 2015 RSV-LRTIs. CONCLUSION: Three case definitions for RSV-LRTI showed high concordance with the WHO 2015 definition, while agreement was lower for severe RSV-LRTI. In contrast to increased respiratory rate, low oxygen saturation was not a consistent finding in RSV-LRTIs and severe RSV-LRTIs. This study demonstrates that current definitions are highly concordant for RSV-LRTIs, but a standard definition is still needed for severe RSV-LRTI.

Male infants are at higher risk of neonatal mortality and severe morbidity.

BACKGROUND: While a male infant is usually born with a higher birthweight than his female counterpart, he is more at risk of variety of adverse perinatal outcomes. Indeed, throughout life, females exhibit a marked survival advantage compared to males. The aetiology for such pertinent sex disparity remains unclear and is likely multifactorial. AIMS: The aim of this study was to investigate obstetric and perinatal outcomes by infant sex from 28 weeks in a contemporary, large Australian birth cohort. MATERIALS AND METHODS: A 14-year retrospective cohort study of 130 133 births over 28 weeks gestation from a single tertiary centre. RESULTS: Male infants had overall higher rates of neonatal mortality (0.12% vs 0.06%, P < 0.001) and severe neonatal morbidity (12% vs 9.1%, P < 0.001) (adjusted odds ratio (aOR) 1.41, 95% CI 1.35-1.47). The odds of overall perinatal mortality (stillbirth and neonatal death) were higher for male infants (aOR 1.30, 95% CI 1.08-1.56). The difference in severe neonatal morbidity when stratified by gestational age at birth only remained significant from >35 weeks gestation. Regardless of infant sex, rates of neonatal mortality and morbidity were lowest at 39 weeks gestation. Rates of preterm birth and operative birth were also higher for male infants. CONCLUSIONS: Our study demonstrates significant disparities in clinical outcomes by infant sex with males at a disadvantage to female infants.

Effects of caffeine on diaphragmatic activity in preterm infants.

BACKGROUND: Caffeine is the first-choice drug for the treatment for apnea of prematurity (AOP) in preterm infants and it has been reported that it improves the diaphragm activity. The aim of this study was to evaluate by ultrasound possible changes in diaphragm contractility and motility induced by caffeine. METHODS: We studied 26 preterm infants with gestational age ≤34 weeks treated with caffeine for the prevention or treatment of AOP. Diaphragmatic ultrasound was performed 15 min (T0 ) before and 60 min (T60 ) after the loading (20 mg/kg) or maintenance (5 mg/kg) dose of caffeine. RESULTS: Diaphragmatic excursion (DE) and thickness at the end of inspiration (DT-in) and expiration (DT-ex), as well as peak velocity of the excursion at the end of inspiration (DT-in) and expiration (DT-ex) increased after administration of both loading and maintenance dose of caffeine. CONCLUSIONS: Ultrasounds confirmed that caffeine improves the activity of diaphragm in preterm infants improving its thickness, amplitude of excursions, and contraction velocity. These results are consistent with the effectiveness of caffeine in treating AOP and decreasing the risk of failure of noninvasive respiratory support in preterm infants with respiratory distress syndrome (RDS).

The sound of silence: Reconsidering infants' object categorization in silence, with labels, and with nonlinguistic sounds.

A large body of research based on a specific stimulus set (dinosaur/fish) has argued that auditory labels and novel communicative signals (such as beeps used in a communicative context) facilitate category formation in infants, that such effects can be attributed to the auditory signals' communicative nature, and that other auditory stimuli have no effect on categorization. A contrasting view, the auditory overshadowing hypothesis, maintains that auditory signals disrupt processing of visual information and, therefore, interfere with categorization, with more unfamiliar sounds having a more disruptive effect than familiar ones. Here, we used the dinosaur/fish stimulus set to test these contrasting theories in two experiments. In Experiment 1 (N = 17), we found that 6-month-old infants were able to form categories of these stimuli in silence, weakening the claim that labels facilitated their categorization in infants. These results imply that prior findings of no categorization of these stimuli in the presence of nonlinguistic sounds must be due to disruptive effects of such sounds. In Experiment 2 (N = 17), we showed that familiarity modulated the disruptive effect of nonlinguistic sounds on infants' categorization of these stimuli. Together, these results support the auditory overshadowing hypothesis and provide new insights into the interaction between visual and auditory information in infants' category formation.

A Retrospective Case Control Study Examining Procalcitonin as a Biomarker for Necrotizing Enterocolitis.

Abstract Background: Procalcitonin (PCT) is a biomarker for sepsis, but its utility has not been investigated in necrotizing enterocolitis (NEC). Necrotizing enterocolitis is a devastating multisystem disease of infants that in severe cases requires surgical intervention. We hypothesize that an elevated PCT will be associated with surgical NEC. Patients and Methods: After obtaining Institutional Review Board (IRB) approval (#12655), we performed a single institution retrospective case control study between 2010 and 2021 of infants up to three months of age. Inclusion criteria was PCT drawn within 72 hours of NEC or sepsis diagnosis. Control infants had a PCT drawn in the absence of infectious symptoms. Recursive partitioning (RP) identified PCT cutoffs. Categorical variable associations were tested using Fisher exact or χ2 tests. Continuous variables were tested using Wilcoxon rank sum test, Student t-test, and Kruskal-Wallis test. Adjusted associations of PCT and other covariables with NEC or sepsis versus controls were obtained via multinomial logistic regression analysis. Results: We identified 49 patients with NEC, 71 with sepsis, and 523 control patients. Based on RP, we selected two PCT cutoffs: 1.4 ng/mL and 3.19 ng/ml. A PCT of ≥1.4 ng/mL was associated with surgical (n = 16) compared with medical (n = 33) NEC (87.5% vs. 39.4%; p = 0.0015). A PCT of ≥1.4 ng/mL was associated with NEC versus control (p < 0.0001) even when adjusting for prematurity and excluding stage IA/IB NEC (odds ratio [OR], 28.46; 95% confidence interval [CI], 11.27-71.88). A PCT of 1.4-3.19 ng/mL was associated with both NEC (adjusted odds ratio [aOR], 11.43; 95% CI, 2.57-50.78) and sepsis (aOR, 6.63; 95% CI, 2.66-16.55) compared with controls. Conclusions: A PCT of ≥1.4 ng/mL is associated with surgical NEC and may be a potential indicator for risk of disease progression.

The longitudinal association between infant negative emotionality, childhood maltreatment, and ADHD symptoms: A secondary analysis of data from the Fragile Families and Child Wellbeing Study.

BACKGROUND: Infant temperament predicts harsh parenting, and attention deficit/ hyperactivity disorder (ADHD) symptoms. Moreover, childhood maltreatment has consistently been associated with later ADHD symptoms. We hypothesized that infant negative emotionality predicted both ADHD symptoms and maltreatment, and that there was a bidirectional association between maltreatment experiences and ADHD symptoms. METHODS: The study used secondary data from the longitudinal Fragile Families and Child Wellbeing Study (N = 2860). A structural equation model was conducted, using maximum likelihood with robust standard errors. Infant negative emotionality acted as a predictor. Outcome variables were childhood maltreatment and ADHD symptoms at ages 5 and 9. RESULTS: The model demonstrated good fit (root-mean-square error of approximation = .02, comparative fit index = .99, Tucker-Lewis index = .96). Infant negative emotionality positively predicted childhood maltreatment at ages 5 and 9, and ADHD symptoms at age 5. Age 5 maltreatment/ADHD symptoms predicted age 9 ADHD symptoms/maltreatment. Additionally, both childhood maltreatment and ADHD symptoms at age 5 mediated the association between negative emotionality and childhood maltreatment/ADHD symptoms at age 9. CONCLUSIONS: Given the bidirectional relationship between ADHD and experiences of maltreatment, it is vital to identify early shared risk factors to prevent negative downstream effects and support families at risk. Our study showed that infant negative emotionality, poses one of these risk factors.

Clinical Characteristics and Prognosis of Infants and Children <3 Years of Age With Thyroglossal Duct Cyst Complicated With a Parapharyngeal Mass: A Case Series Study.

Thyroglossal duct cysts (TGDCs) are congenital and developmental abnormalities in infants and young children. This retrospective case series study examined the characteristics of 7 patients <3 years (mean age, 1.9 years) with TGDC complicated with a parapharyngeal mass treated at one hospital between January 2019 and 2022. Four patients had a painless mass around the neck, 2 had a painless mass associated with snoring, and 1 presented repeated swelling and pain. B-ultrasound suggested 6 cases of TGDC and 1 possible lymphangioma. All patients were treated with Sistrunk surgery to remove the TGDC. Six patients had no cyst recurrence during follow-up (6 months to 2 years). In conclusion, TGDC complicated with a parapharyngeal mass has complex and variable clinical manifestations. Completely removing the cyst while sparing thyroid cartilage and surrounding vascular and neuroanatomical structures is important to avoid complications. The patients are likely to be free from recurrence after surgery.

Effect of enhanced nutrition services with community-based nutrition services on the diet quality of young children in Ethiopia.

Poor diet quality related to inadequate complementary feeding is a major public health problem in low and middle-income countries including Ethiopia. Low dietary diversity has been linked to negative health outcomes in children. To provide a package of interventions to close nutritional gaps through agriculture, the Sustainable Undernutrition Reduction in Ethiopia (SURE) programme was set up as a multi-sectoral initiative and the results of combined effects of community-based and enhanced nutrition services, compared to community-based alone, on diet diversity and diet quality of complementary feeding of young children are presented. The study used pre- and post-intervention design. Baseline (n = 4980) data were collected from May to July 2016, and follow-up (n = 2419) data from December 2020 to January 2021. From 51 intervention districts having the SURE programme, 36 intervention districts were randomly selected for baseline and 31 for the follow-up survey. The primary outcome was diet quality: minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet (MAD). Comparing endline to baseline over the 4.5-year intervention, the use of standard community-based nutrition services of growth monitoring and promotion increased (16%-46%), as did enhanced nutrition services of infant and young child feeding counselling, and agricultural advising (62%-77%). Women involved in home gardening significantly increased (73%-93%); however, household production of food decreased yet consumption of most own-grown foods increased. Importantly, MAD and MDD increased four-fold. The SURE intervention programme was associated with improvements in complementary feeding and diet quality through enhanced nutrition services. This suggests programmes targeted at nutrition-sensitive practices can improve child feeding in young children.

Late aortic obstruction due to ductal vasoconstriction on pulmonic end after transcatheter patent ductus arteriosus closure in an extremely low-birth-weight infant.

Device-induced aortic obstruction is a known rare complication following transcatheter closure of patent ductus arteriosus in extremely low-birth-weight infants. Various mechanisms have been proposed. We report the first description of late aortic obstruction due to ductal vasoconstriction on pulmonic end causing device to be gradually pushed out of aortic end in a 980-gram premature infant.