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Plain language summary: Over one‐quarter of women in the UK have a caesarean birth (CB). More than one in 20 of these births occurs near the end of labour, when the cervix is fully dilated (second stage). In these circumstances, and when labour has been prolonged, the baby's head can become lodged deep in the maternal pelvis making it challenging to deliver the baby. During the caesarean birth, difficulty in delivery of the baby's head may result – this emergency is known as impacted fetal head (IFH). These are technically challenging births that pose significant risks to both the woman and baby. Complications for the woman include tears in the womb, serious bleeding and longer hospital stay. Babies are at increased risk of injury including damage to the head and face, lack of oxygen to the brain, nerve damage, and in rare cases, the baby may die from these complications. Maternity staff are increasingly encountering IFH at CB, and reports of associated injuries have risen dramatically in recent years. The latest UK studies suggest that IFH may complicate as many as one in 10 unplanned CBs (1.5% of all births) and that two in 100 babies affected by IFH die or are seriously injured. Moreover, there has been a sharp increase in reports of babies having brain injuries when their birth was complicated by IFH. When an IFH occurs, the maternity team can use different approaches to help deliver the baby's head at CB. These include: an assistant (another obstetrician or midwife) pushing the head up from the vagina; delivering the baby feet first; using a specially designed inflatable balloon device to elevate the baby's head and/or giving the mother a medicine to relax the womb. However, there is currently no consensus for how best to manage these births. This has resulted in a lack of confidence among maternity staff, variable practice and potentially avoidable harm in some circumstances. This paper reviews the current evidence regarding the prediction, prevention and management of IFH at CB, integrating findings from a systematic review commissioned from the National Guideline Alliance. [ABSTRACT FROM AUTHOR]

Gastro‐oesophageal reflux (GOR) and food allergy (FA) are common conditions, especially during the first 12 months of life. When GOR leads to troublesome symptoms, that affect the daily functioning of the infant and family, it is referred to as GOR disease (GORD). The role of food allergens as a cause of GORD remains controversial. This European Academy of Allergy and Clinical Immunology (EAACI) position paper aims to review the evidence for FA‐associated GORD in young children and translate this into clinical practice that guides healthcare professionals through the diagnosis of suspected FA‐associated GORD and medical and dietary management. The task force (TF) on non‐IgE mediated allergy consists of EAACI experts in paediatric gastroenterology, allergy, dietetics and psychology from Europe, United Kingdom, United States, Turkey and Brazil. Six clinical questions were formulated, amended and approved by the TF to guide this publication. A systematic literature search using PubMed, Cochrane and EMBASE databases (until June 2021) using predefined inclusion criteria based on the 6 questions was used. The TF also gained access to the database from the European Society of Paediatric Gastroenterology and Hepatology working group, who published guidelines on GORD and ensured that all publications used within that position paper were included. For each of the 6 questions, practice points were formulated, followed by a modified Delphi method consisting of anonymous web‐based voting that was repeated with modified practice points where required, until at least 80% consensus for each practice point was achieved. This TF position paper shares the process, the discussion and consensus on all practice points on FA‐associated GORD. [ABSTRACT FROM AUTHOR]

The World Association for Infant Mental Health (WAIMH) decided to compose a position paper on infants' rights in wartime, as there is still a general lack of attention paid to the impact of war‐related traumas on infants' development and psychological health. Though there are numerous areas of violent conflicts around the globe, there have been few published studies that relate specifically to infants. Consequently, humanitarian aid programs tend to overlook infants' psychological needs and to pay more attention to those of older children. This position paper first reviews the studies identified through a literature search, about the impact of war‐related traumas during pregnancy and postnatal periods, then describes the existing recommendations that have been added to the Children Rights Convention and their implications for infant mental health clinicians. [ABSTRACT FROM AUTHOR]

To fully understand the role of diet diversity on allergy outcomes and to set standards for conducting research in this field, the European Academy of Allergy and Clinical Immunology Task Force on Diet and Immunomodulation has systematically explored the association between diet diversity and allergy outcomes. In addition, a detailed narrative review of information on diet quality and diet patterns as they pertain to allergic outcomes is presented. Overall, we recommend that infants of any risk category for allergic disease should have a diverse diet, given no evidence of harm and some potential association of benefit in the prevention of particular allergic outcomes. In order to harmonize methods for future data collection and reporting, the task force members propose relevant definitions and important factors for consideration, when measuring diet diversity in the context of allergy. Consensus was achieved on practice points through the Delphi method. It is hoped that the definitions and considerations described herein will also enable better comparison of future studies and improve mechanistic studies and pathway analysis to understand how diet diversity modulates allergic outcomes. [ABSTRACT FROM AUTHOR]

It is well‐established that food proteins, such as egg, soya, cow's milk and wheat, are detectable in breastmilk for many hours or days after ingestion. Exposure to these proteins is important to the process of developing tolerance but can also sometimes elicit IgE‐mediated and non–IgE‐mediated allergic symptoms in breastfed infants. Non–IgE‐mediated allergy, outside of food protein‐induced allergic proctocolitis and eosinophilic oesophagitis, is not well understood, leading to variations in the diagnosis and management thereof. A primary objective of the European Academy for Allergy and Clinical Immunology is to support breastfeeding in all infants, including those with food allergies. A Task Force was established, to explore the clinical spectrum of non–IgE‐mediated allergies, and part of its objectives was to establish diagnosis and management of non–IgE‐mediated allergies in breastfed infants. Eight questions were formulated using the Patient, Intervention, Comparison, Outcome (PICO) system and Scottish Intercollegiate Guideline Network (SIGN) criteria for data inclusion, and consensus was achieved on practice points through the Delphi method. This publication aims to provide a comprehensive overview on this topic with practice points for healthcare professionals. [ABSTRACT FROM AUTHOR]

This paper celebrates the life and legacy of psychiatrist and Jungian author Anthony Stevens, who passed away at age 90 on July 13, 2023. It outlines Stevens's origins as a research fellow in Greece, where his work on infant attachment led to a lifelong dedication to establishing the biological and evolutionary foundation of psychiatry. It details his instrumental role in the debate about the theory of archetypes and describes the current state of the literature including the responses and reactions to Stevens's biological innatist position. The paper concludes with a career retrospective in which Stevens's major works are introduced and briefly described. [ABSTRACT FROM AUTHOR]

Optimal complementary feeding between the ages of 6 and 23 months provides children with the required range of nutritious and safe foods while continuing to be breastfed to meet their needs for essential nutrients and develop their full physical and cognitive potential. The rates of exclusive breastfeeding in the first 6 months of life have increased from 32% in 2008 to 60% in 2022 in Kenya. However, the proportion of children between 6 and 23 months receiving a minimum acceptable diet remains low and has declined from 39% in 2008 to 31% in 2023. The Kenyan Ministry of Health, GAIN and UNICEF collaborated to understand the drivers of complementary feeding practices, particularly proximal determinants, which can be directly addressed and acted upon. A secondary analysis of household surveys and food composition data was conducted to outline children's dietary patterns within the different regions of Kenya and the extent to which the affordability of animal‐source foods could be improved. Ethnographic data were analyzed to identify socio‐cultural barriers to optimal complementary feeding. Furthermore, we outlined the critical steps for developing user‐friendly and low‐cost complementary feeding recipes. The results of all the analyses are presented in five of the six papers of this Special Issue with this additional paper introducing the Kenyan context and some of the critical findings. The Special Issue has highlighted multidimensional barriers surrounding the use and availability of animal‐source foods. Furthermore, it emphasizes the need for a multi‐sectoral approach in enacting policies and programmes that address these barriers. [ABSTRACT FROM AUTHOR]

This paper addresses how walking‐with an infant makes mothering worlds legible. Employing the active verb 'worlding', it illustrates how walking‐with contributes to the emergent, embodied and relational nature of mothering as a story in motion and how we make sense of becoming a mother. The walking in this study takes place in and through (sub)urban landscapes, and how we negotiate our maternal bodies through these spaces, at a very particular moment in time (COVID‐19 lockdowns), is imbricated in our worldings. Walking‐with is used to not only explain the interembodiment of mother and child but also the wider milieu of 'withs' to demonstrate the corporeal and relational experience of walking. Walking‐with a baby, particularly with a postpartum body, is hard work, messy and unpredictable, yet that is not to say the analysis leads to a negative perspective. When walking‐with a baby is understood as 'worlding‐with' we can develop a more affirmative understanding of mothering. By using creative analytical practice a walking‐with story was developed drawing on data collected from walking mothers and autoethnography of my own walking‐with experiences. The story makes it possible to develop a legibility that captures the contradictory experiences of mothering in motion. Creative analytical practice highlights that storying, walking and mothering is never a complete. [ABSTRACT FROM AUTHOR]

An important cause of stunting is limited consumption of complementary foods, in terms of both quantities and nutrients. Although existing studies show a positive association between fathers' engagement and children's diet, programmes designed to improve complementary feeding practices often only target mothers. In response to this, maternal behaviour change communication (BCC), paternal BCC and food voucher programmes were designed and implemented in Ethiopia using a clustered randomized controlled trial design. The paternal BCC programme included gender‐equal messages to increase fathers' participation in childcare, household labour and decision making. The research reported in this paper is an examination of the BCC programmes, characterizing the behavioural, normative and control beliefs of both mothers and fathers in BCC households compared to those in control households. In this study, a total of 40 participants were included, with 13 mother–father pairs in the BCC + food voucher group, and seven pairs in the control group. Each participant was interviewed separately. We found that BCC mothers showed more gender‐equal tendencies than the control mothers despite being more rural in location. By contrast, the beliefs of BCC and control fathers were similar overall, suggesting men are more resistant to gender‐equal BCC. More work is needed to develop and test effective methods for changing fathers' beliefs and practices. Key messages: Mothers in behaviour change communication (BCC) group mothers held more gender‐equal beliefs than control mothers, while BCC and control fathers shared similar views, suggesting a male resistance to gender equality.Mothers found fathers' involvement in childcare socially acceptable but often perceived them as inexperienced, which limited their participation.Control mothers' traditional view on household chores maintained the conventional labour division, influencing fathers' involvement.Fathers typically resisted maternal control of resources; however, they agreed that the more knowledgeable should lead decision‐making. BCC mothers showed greater confidence in making household decisions as effectively as fathers. [ABSTRACT FROM AUTHOR]

The infant health movement was launched nearly 50 years ago with the publication of the now classic paper, Ghosts in the Nursery: A psychoanalytic approach to the problems of impaired infant‐mother relationships, written by Selma Fraiberg, Edna Adelson, and Vivian Shapiro (1975). This paper offers us lessons for infant mental health practice that have been proven true time and again over the last 50 years. These lessons both underscore the factors essential to clinical progress across a range of interventions, and remind us of the significant challenges we face in these times of massive, global trauma and oppression, extreme economic hardship, and systemic racism. This commentary reviews the key lessons of Fraiberg and her colleagues' classic paper, addresses some of the challenges inherent in retaining the breadth and substance of Fraiberg's model in contemporary practice, and proposes a model for conceptualizing infant and early childhood mental health practice that is geared toward building the relational foundations of reflection (Slade, 2023). [ABSTRACT FROM AUTHOR]

Tinea capitis is a common disease in children but rare in newborns younger than 1 month of age. Only 29 cases of tinea capitis in newborns have been described in indexed literature from 1990 until now. While antifungal agents can be used topically and systemically, systemic antifungal therapy is generally accepted as the treatment of choice for tinea capitis due to limited penetration of topical agents into the hair follicle. However, there is a lack of data on the use of systemic antifungal agents in newborns, and there are reports of successful treatment of tinea capitis in newborns using only topical therapy. In this paper, we present a case of tinea capitis in a 29‐day‐old female baby and review the previous 29 reported cases. [ABSTRACT FROM AUTHOR]

The shaken baby syndrome was originally proposed in the 1970s without any formal scientific basis. Once data generated by scientific research was available, the hypothesis became controversial. There developed essentially two sides in the debate. One side claimed that the clinical triad of subdural haemorrhage, retinal haemorrhage, and encephalopathy, or its components, is evidence that an infant has been shaken. The other side stated this is not a scientifically valid proposal and that alternative causes, such as low falls and natural diseases, should be considered. The controversy continues, but the contours have shifted. During the last 15 years, research has shown that the triad is not sufficient to infer shaking or abuse and the shaking hypothesis does not meet the standards of evidence‐based medicine. This raises the issue of whether it is fit for either clinical practice or for the courtroom; evidence presented to the courts must be unassailable. What this paper adds: There is insufficient scientific evidence to assume that an infant with the triad of subdural haemorrhage (SDH), retinal haemorrhage, and encephalopathy must have been shaken.Biomechanical and animal studies have failed to support the hypothesis that shaking can cause SDH and retinal haemorrhage.Patterns of retinal haemorrhage cannot distinguish abuse.Retinal haemorrhages are commonly associated with extracerebral fluid collections (including SDH) but not with shaking.Infants can develop SDH, retinal haemorrhage, and encephalopathy from natural diseases and falls as low as 1 foot.The shaking hypothesis and the literature on which it depends do not meet the standards of evidence‐based medicine. [ABSTRACT FROM AUTHOR]

The Kenyan Ministry of Health (MOH) and a consortium of nutritionists, researchers and communication, and design specialists developed a novel approach to create an evidence‐based recipe book promoting complementary feeding (CF) in Kenya. The ADAPT approach includes five steps: applied research (A), dialogue with stakeholders (D), adapted behaviour change communication (BCC) theories (A), purpose‐driven visual communication (P), and tailoring to priority audiences (T). Through this approach, the recipe book addresses key knowledge gaps using behaviour change theories and visual communication best practice to increase accessibility, acceptability, retention and motivation for behaviour change. The book addresses barriers to CF identified through formative applied research. Dialogue with stakeholders helped ensure cultural appropriateness and the book's alignment with MOH recommendations and key messages. The book uses behaviour change theories to approach the reader in a respectful way that motivates behaviour change. The use of consistent, purpose‐driven visuals helps ensure key messages are easily understood and accessible to all caregivers regardless of literacy level. The book's tone and content are tailored to its audiences’ attributes, needs and preferences. This five‐step process inspired the development of ADAPT, a novel approach that integrates behaviour change and visual communication for greater impact. This paper outlines how the consortium used the ADAPT approach to develop an evidence‐based book that thoughtfully and holistically addresses a wide range of barriers, provides practical solutions and increases self‐efficacy around CF. It offers a blueprint for public health practitioners from any field who are interested in using visual behaviour change communication to promote healthy behaviour. [ABSTRACT FROM AUTHOR]

Aim: To assess case fatality rate (CFR), infant mortality, and long‐term neurodevelopmental disorders (NDDs) after invasive group B streptococcal (GBS; Streptococcus agalactiae) infection in infants. Method: Children born in Norway between 1996 and 2019 were included. Data on pregnancies/deliveries, GBS infection, NDDs, and causes of death were retrieved from five national registries. The exposure was culture‐confirmed invasive GBS infection during infancy. Outcomes were mortality and NDDs, the latter at a mean age of 12 years 10 months. Results: Among 1 415 625 live‐born children, 866 (87%) of 1007 infants diagnosed with GBS infection (prevalence 0.71 per 1000) were included. The CFR was 5.0% (n = 43). GBS infection was associated with higher infant mortality (relative risk 19.41; 95% confidence interval [CI] 14.79–25.36) than the general population. Among survivors, 169 (20.7%) children were diagnosed with any NDD (relative risk 3.49; 95% CI 3.05–3.98). In particular, GBS meningitis was associated with high risks of attention‐deficit/hyperactivity disorder, cerebral palsy, epilepsy, hearing impairment, and pervasive and specific developmental disorder. Interpretation: The burden of invasive GBS infection during infancy is considerable and continues to affect children beyond infancy. These findings emphasize the need for new preventive strategies for disease reduction, and the need for survivors to be directly included into early detection pathways to access early intervention if required. What this paper adds: The burden of invasive group B streptococcal (GBS) infection in Norway is considerable.Of GBS infection survivors, 20.7% were diagnosed with neurodevelopmental disorders (NDDs) at mean age 12 years 10 months.Infants with GBS meningitis were more often diagnosed with NDDs.Absolute risks associated with GBS infections were highest for pervasive and specific developmental disorder, cerebral palsy, and attention‐deficit/hyperactivity disorder. [ABSTRACT FROM AUTHOR]

This article is a commentary on a special issue of the International Journal of Methods in Psychiatric Research that focuses on developmental perspectives on psychopathology, specifically irritability and related dimensions. The papers in the special issue discuss improvements in measurement during the first 5 years of life through adolescence and highlight the importance of infancy and preschool years in the development of psychopathology. The papers also address the nature of developmental risk, measurement challenges in young children, and the relationship between early irritability and later psychopathology. The authors emphasize the importance of age-specific measures and longitudinal approaches in studying early life psychopathology. [Extracted from the article]

Aim: To summarise and critique existing knowledge and evidence relating to the utility, and post‐insertion complications surrounding tunnelled non‐cuffed central venous catheters (tncCVCs) in infants. Methods: A scoping review of original research studies reporting the use of, and post‐insertion complications associated with, tncCVCs in infants was completed. MeSH terms were used to formulate a systematic search, and data were extracted using a customised data extraction form. Data were analysed descriptively across key themes based on the research questions. Study quality was evaluated using the Mixed Methods Appraisal Tool. Results: The systematic search generated 3994 studies, of which 9 studies met final inclusion criteria. Studies included 644 tncCVCs in infants based in the USA, Europe and Australia. Most studies were retrospective cohort studies. The most common vein of insertion, where individually specified, was the internal jugular (n = 177). Tunnel length, where reported, was 2.5–5 cm. Infection rates were most commonly reported (eight studies), with results ranging from 0 to 12.8%, and device dislodgements of up to 20% reported. Participant follow‐up and definition of complications varied greatly between studies. Study quality across all papers was sound. Conclusions: This review has identified only a small number of studies, with small participant numbers, reporting the performance of tncCVCs in infants. Definitions of complications measured varied significantly between studies, and vastly different patient follow‐up protocols were reported. Further larger‐scale studies on the performance of tncCVC, employing internationally recognised reporting standards is warranted to ensure clinicians can make informed choices for medication and infusion delivery. [ABSTRACT FROM AUTHOR]

Reflective supervision and consultation (RS/C) is regarded as best practice within the infant/early childhood mental health field. Benefits of RS/C on the early childhood workforce and children and families have been demonstrated through case studies, conceptual pieces, and individual research studies. However, findings across studies have not been summarized using gold‐standard methodology, thus the state of existing empirical support for RS/C is unclear. This systematic review examined the collective evidence for RS/C across diverse early childhood‐serving programs. Electronic databases were searched to identify studies investigating associations between RS/C and professionals' reflective capacity and well‐being, child/family outcomes, and implementation factors. Twenty‐eight papers were identified. Studies showed positive associations between RS/C and early childhood‐serving professionals' reflective capacity and well‐being, with qualitative studies reporting more consistent results than studies using quantitative methods. Many methodological limitations were identified, including incomplete reporting of study designs and participant characteristics, variability in outcome measures, and lack of randomization and comparison groups. Furthermore, few studies examined child and family outcomes. Therefore, while RS/C shows great promise, it was difficult to ascertain its overall effectiveness from an empirical standpoint. Establishing RS/C as an empirically supported approach will be possible with more rigorous research. [ABSTRACT FROM AUTHOR]

Aim: To determine whether isolated low‐grade germinal matrix‐intraventricular haemorrhages (LG‐GMH‐IVH) and low‐grade punctate cerebellar haemorrhages (LG‐CBH) contribute to the neurodevelopment of infants born preterm with very low birthweight (VLBW). Method: A prospective observational cohort study was conducted on infants born with VLBW hospitalized from January 2012 to July 2017 who had undergone serial cranial ultrasounds since birth and magnetic resonance susceptibility‐weighted imaging of the brain at term‐corrected age. Only those with VLBW carrying isolated LG‐GMH‐IVH (grades 1 or 2) or isolated LG‐CBH (punctate cerebellar haemorrhages ≤4 mm in diameter) or absence of lesions (no‐lesion) were enrolled and followed up to 3 years. The Griffiths Mental Development Scales, Extended and Revised version (GMDS‐ER), were used to assess neurodevelopment, considering unsatisfactory scores less than 85. Behaviour, according to the criteria of the International Classification of Diseases, 10th Revision, and rehabilitation data were noted. Results: Two‐hundred and forty infants with VLBW were enrolled: 34 with LG‐GMH‐IVH, 17 with LG‐CBH, and 189 as no‐lesion. The LG‐GMH‐IVH and LG‐CBH groups scored worse than the no‐lesion group on all GMDS‐ER scores for 1 year, 2 years, and 3 years. The LG‐CBH group scored lower than the LG‐GMH‐IVH group for total GMDS‐ER scores at 1 year and 2 years but not at 3 years. At 3 years, compared with the LG‐CBH group, those with LG‐GMH‐IVH received less and later physical therapy, with more frequent attention problems. The odds ratio for unsatisfactory GMDS‐ER scores corrected for gestational age was 5.75 for LG‐CBH (95% confidence interval 1.92–17.25; p = 0.002) and 2.67 for LG‐GMH‐IVH (95% confidence interval 1.16–6.13; p = 0.02). Interpretation: Low‐grade haemorrhages affect the neurodevelopment of very‐low‐birthweight infants. Early rehabilitation might have contributed to their development. What this paper adds: Low‐grade haemorrhages seem to have an independent role in the adverse neurodevelopment of infants born extremely preterm.Infants born preterm with low‐grade germinal matrix‐intraventricular haemorrhage (LG‐GMH‐IVH) are indicated for physical therapy at a later age than those with low‐grade punctate cerebellar haemorrhage (LG‐CBH).Compared with LG‐CBH, LG‐GMH‐IVH is associated with a greater extent of attention problems at 3 years corrected age. [ABSTRACT FROM AUTHOR]

The relationship between infant feeding patterns and the later development of food allergies has been the focus of much debate and research over the last decade. National recommendations have been made by many countries on how to feed infants to reduce the risk of food allergy but due to the lack of firm evidence the recommendations differ widely. This review has been developed as part of EuroPrevall, a European multicentre research project funded by the European Union, to document the differing feeding recommendations made across Europe, to investigate the current evidence base for any allergy prevention feeding recommendations and to identify areas where further research is needed. This review will also provide information which, when combined with the infant feeding data collected as part of EuroPrevall, will give an indication of compliance to national feeding guidelines which can be utilised to assess the effectiveness of current dissemination and implementation strategies. [ABSTRACT FROM AUTHOR]

A Study of Epileptic Discharges in Early Infancy.Purpose:The aim of this study was to clarify the characteristics of epileptic discharges in early infancy. A retrospective electroclinical study was conducted on high-risk infants, and the relationship between their postconceptional ages and the chronological and/or topographical appearance of epileptic discharges was evaluated.Subjects and Methods:Forty-two infants born with severe perinatal complications at Okayama University Hospital from 1997 to 2001 were included in the study. EEGs were recorded at least twice for each infant, with at least one EEG recorded before and one EEG recorded after the corrected age of 6 months. The subjects were divided into two groups, according to the gestational age at birth. Group A contained those born at<34 weeks of gestation, and group B contained those born at>34 weeks of gestation.Results:Twenty-nine subjects were born at<34 weeks of gestational age and belonged to group A. The mean gestational age was 28.4 weeks. Twenty-three of them had extremely low birth weights of<1,000 g. The remaining 13 subjects belonged to group B, with birth weights ranging from 1,564 to 3,850 g (mean: 2,744.1 g). Infants in group B had various perinatal complications, including severe asphyxia, meningocele, and hemimegalencephaly. Nineteen of the 42 subjects (45.2%) had epileptic discharges during the follow-up period. Twelve of these 19 subjects evolved to West syndrome (63.2%), 4 had localization-related epilepsy (including 2 infants with hemimegalencephaly; 21.0%), and 3 showed transient EEG abnormalities (15.8%). The other 23 cases without epileptic discharges had no clinical seizures except 2 infants who had simple febrile convulsions. The initial epileptic discharges on EEGs were observed at postconceptional ages ranging from 36.1 to 97.7 weeks. Sixteen of the 19 cases had initial epileptic discharges before 65 weeks of postconceptional age. The localization of epileptic discharges was also investigated in 17 of 19 subjects whose first EEG findings were hypsarrhythmia. In 5 of 8 subjects (62.5%) with initial epileptic discharge before 50 weeks of postconceptional age, the epileptic discharges were observed in the frontal regions. In 7 of 9 subjects (77.8%) with initial epileptic discharge was after 50 weeks of postconceptional age, the epileptic discharges were located in the occipital regions. These topographical characteristics of the epileptic discharges were observed not only in infants who later developed West syndrome but also in infants who later developed localization-related epilepsy. However, 2 subjects with hemimegalencephaly had independent multifocal epileptic discharges at an extremely early stage of less than 40 weeks of postconceptional age. Of 12 subjects who later developed West syndrome, 10 subjects belonged to group A, and the remaining 2 subjects belonged to group B with hypoxic-ischemic encephalopathy due to severe asphyxia. Changes in epileptic discharges were also evaluated in all subjects with West syndrome. Focal cortical discharges appeared at ages ranging from 41 to 64 weeks postconception (mean: 52.0 weeks). These focal cortical discharges then changed to hypsarrhythmia at ages ranging from 51 to 82 weeks postconception (average: 63.4). These changes occurred irrespective of gestational age at birth and the age at onset of epileptic discharges.Conclusions:In the present study, the distribution of epileptic discharges in early infancy was related to postconceptional age. Evolution to hypsarrhythmia was also related to the postconceptional age of infants who developed West syndrome. Localization of Epileptiform Discharges Detected with Continuous EEG/ fMRI Recording.Purpose:A combination of EEG and functional magnetic resonance imaging (MRI) (EEG/ fMRI) has become a promising alternative for identifying brain areas involved in epileptic activation with high spatial resolution. We recently established a technique of continuous EEG/ fMRI recording called thestepping-stone samplingmethod (SSS method)[Anami K, et al. Stepping stone sampling for retrieving artifact-free EEG during functional magnetic resonance imaging.NeuroImage(in press)], which enables blood oxygen level–dependent (BOLD) signal sampling of the whole processes of epileptiform discharges in anfMRI run. This method allows event-relatedfMRI style analysis and has a potential capability of describing a BOLD signal-change curve relevant to an epileptic discharge. The purpose of this study was to delineate the areas of BOLD activation related to epileptiform discharges, by using the continuous EEG/ fMRI recording, and to compare thefMRI results with clinical EEG findings.Methods:Six patients with partial epilepsy (five frontal lobe epilepsy, one temporal lobe epilepsy) were studied. In each patient, two or three runs offMRI were performed on a 1.5-Tesla MRI scanner (Siemens Vision Plus) in the interictal state. 420 EPI volume scans (21-slice volume, 64× 64 matrix, 60-mm thickness, 0.6-mm gap, TR: 2,000 ms) were acquired continuously over a period of 14 min per run. Nine-channel scalp EEG was simultaneously recorded in the scanner. After artifact correction, EEG data were estimated retrospectively to identify epileptic discharges and the correspondingfMRI volume scan numbers. ThefMRI data were analyzed with SPM99. After realignment and smoothing, a regressor was made based on these volume scan numbers for statistical analysis by using a general linear model. The resulting SPM{ t}was thresholded at p<0.005 (uncorrected).Results:Four patients showed a focal spike-related BOLD activation concordant with the EEG focus. In three of them, an additional BOLD activation was detected in the cortex distant from the EEG focus. One patient showed extensive BOLD activation in bilateral cerebral hemispheres related to polyspikes arising from bilateral frontal regions. The remaining one patient showed no BOLD activation with few sampled spikes.Conclusions:We demonstrated interictal epileptic activation in partial epilepsy by using EEG/ fMRI by the SSS method. In addition to the EEG foci, activation was found in other sites of the brain. These results suggest that the present method may detect secondary activation, besides primary activation related to epileptiform discharges. Determination of Language Dominance with Synthetic Aperture Magnetometry: Comparison with Wada Test and Degree of Handedness.Purpose:Language dominance is an essential piece of information for the surgical treatment of the intractable epilepsy. Recently, synthetic aperture magnetometry (SAM), a spatial filtering for the analysis of magnetoencephalography (MEG) based on adaptive beamformer, was developed. This method enables supersensitive detection of the electrical activity inside the brain, as if an electrode were inserted (SAM virtual sensor). This method also enables delineation of the activated volume of the brain as a topographic image by statistically discriminating the event-related synchronization (ERS) or desynchronization (ERD; SAM statistical method). In this study, we visualized the spatiotemporal process of cortical activation by language task by using the SAM statistical method and compared the results with those of Wada test and handedness to estimate if this noninvasive method could substitute for the Wada test.Methods:Sixteen neurosurgical patients participated in this study. MEG study for patients in this institute is approved as an Advanced Medical Treatment and regulated by the Ministry of Health, Labor, and Welfare. Handedness was judged by the Edinburgh inventory test. One hundred 3-character Japanese hiragana semantic words were presented serially at the center of the liquid crystal monitor for 3 s, with an interval of 3 s. The subjects were instructed to read them only once without phonation, immediately after each word was presented. MEG signal data of 5,000-ms duration with a 2,500-ms prestimulus interval were collected for each of the 100 trials. Volumes of interest (VOIs) for SAM analysis were set at 5-mm intervals covering the entire brain. Differences of the signal power for each VOI between the active state (0–1,000 ms after stimulus) and the control state (1,000–0 ms before stimulus) were analyzed statistically for each frequency band (alpha to high gamma) and displayed on the individual magnetic resonance (MR) images as the statistical significance of ERD or ERS. By this method, language dominance was judged according to the laterality of significant ERD or ERS at the inferior or middle frontal cortex, which is assumed as the motor language area, and categorized in three types: type 1, ERD in 13- to 25-Hz or 25- to 50-Hz frequency bands; type 2, ERD in the adjacent frequency bands (3–8 Hz, 8–13 Hz, or 50–100 Hz); and type 3, obscure dominance. The results were compared with those of the Wada test.Results:Focal distributions of ERD and ERS were detected in the language-related areas with temporal specificity: bilateral calcarine sulcus, dorsolateral region of middle frontal gyrus, opercular and triangular region of inferior frontal gyrus, temporooccipital base, angular gyrus, and posterior region of middle or superior temporal gyrus. Laterality of ERD categorized as type 1 was consistent with the language dominance determined by Wada test in eight right-handed and three left-handed patients. Type 2 ERD was observed in four right-handed patients and was consistent with the Wada test. Only one in 16 was categorized as type 3. Laterality of ERD or ERS in other regions such as the occipital, parietal, and temporal lobes was not always consistent with the results of the Wada test.Discussion:With the SAM statistical method, we demonstrated regional activation of language-related cortices with spatiotemporal separation. Our previous study in normal subjects indicated that type 1 ERD in dorsolateral frontal cortex was most consistent compared with other frequency bands and among language-related cortices. Similarly, in the patients, type 1 and type 2 ERD together account for 93% (15 of 16) and were consistent with the Wada test without exception.Conclusions:Our noninvasive MEG-SAM method might be a substitute for the semiinvasive Wada test in determining language dominance. Ictal Scalp EEG in Mesial Temporal Lobe Epilepsy with Unitemporal Versus Bitemporal Interictal Epileptiform Discharges.Purpose:To assess the lateralizing value and propagation patterns of ictal scalp EEG in mesial temporal lobe epilepsy patients with unitemporal (UIEDs) and bitemporal independent interictal epileptiform discharges (BIEDs) and mesial temporal sclerosis or lesions.Methods:We retrospectively analyzed ictal scalp EEG in 287 seizures of 48 patients who had undergone anterior temporal lobectomy. Patients were classified into a UIED group (n= 32) and a BIED (n= 16) group (unitemporal,>90% IEDs over one temporal lobe). Seizures and individual patients were lateralized on the basis of their associated ictal scalp EEG patterns according to a predefined lateralization protocol. An ictal pattern was considered correctly lateralized if it corresponded to the side of surgery. We investigated ictal scalp EEG propagation patterns and calculated a spike ratio by dividing the number of IEDs ipsilateral to the side of surgery by the total number of IEDs recorded independently on both temporal lobes.Results:In UIED patients, seizures were lateralized in 75.1% by the pattern at onset (PAO) and in an additional 19.4% by a later significant pattern (LSP). In BIED patients, seizures were lateralized in 71.0% by the PAO and in an additional 9.3% by an LSP. Ictal patterns were correctly lateralized significantly more often in UIED patients (93.8%) compared with BIED patients (62.5%). Correct lateralization occurred in 93.5% of seizures in the UIED group, but only in 57.0% of seizures in the BIED group. Scalp ictal EEGs, when lateralized at onset or later, were significantly more likely to predict the correct side for surgery in patients with UIED (98.9%) than in patients with BIED (71.0%). Switch of lateralization and bilateral independent onset were seen more frequently in the BIED group, whereas the maintenance of ictal discharges in the unilateral temporal lobe or hemisphere through the whole tracing occurred more frequently in the UIED group. Spike ratio was significantly higher in seizures that were correctly lateralized as compared with seizures incorrectly lateralized or nonlateralized.Conclusions:Interpretation of ictal scalp EEG by both PAO and LSP has more lateralizing value. UIEDs predict ipsilateral lateralization of ictal scalp EEG and the surgery side. Interpretation of ictal scalp EEG must be considered more cautiously in patients with BIEDs. BIEDs suggest bitemporal excitability or epileptogenesis, reflecting bilateral susceptibility to seizure generation or rapid seizure propagation to the contralateral temporal lobe. Nursing for Patients Not Complying with Long-Term Intracranial EEG Monitoring.Purpose:Long-term intracranial EEG monitoring (LTIEEG) is one of the important procedures of the epilepsy surgery program. However, some patients became reluctant to continue this procedure, even though they have given informed consent beforehand. We examined retrospectively the states of noncompliance of these patients.Methods:Among 82 patients older than 18 years who underwent LTIEEG (usually 2 weeks) during the past 5 years, 15 patients (18%; 10 men and five women; ages ranged from 20 to 48 years; mean, 29 years; frontal lobe epilepsy, two; occipital lobe epilepsy, three; temporal lobe epilepsy, 10) became restless or were reluctant to continue monitoring. The states of noncompliance were divided into (I) irritability (such as agitating, restless, or aggressive behavior); (II) mood alteration (such as depressive, unstable, or apathetic emotion); (III) somatization (headache, nausea, or other various somatic complaints); and (IV) confusion (confused behavior or paranoid–hallucinatory states). The time of appearance was divided into (a) initial, (b) middle, and (c) late stage. The triggering factors were retrospectively investigated. Demographics including psychiatric history, intellectual status, and previous behavior traits were examined.Results:The states of noncompliance were in I, eight subjects; II, six; III, six; and IV, five. The time of appearance of the first noncompliance was in a, nine subjects; b, four; and c, two. Seven patients had triggering factors, comprising increased/intensified seizures in six and infection in one; and five of them showed confusion. Irritability was often observed in patients with personality disorder (five patients) or a history of mood disorder (one patient) and appeared from the initial stage in them. The other states appeared in various stages. IQs of nine patients were<70, but the pattern of noncompliance did not depend on the intellectual status. Although individual and intensive nursing was provided, five patients required tranquilizers, and nine necessitated attendance of family members, even if briefly.Conclusions:Although LTIEEG is a demanding procedure, some patients, especially those with personality disorders, became irritable from the beginning, even after giving consent. Mood alteration and somatization disorders appeared in various stages of monitoring. Confusion could result from increased or intensified seizures. These observations suggest that nurses should be ready for various modes of noncompliance and should plan countermeasures before monitoring. EEG Abnormalities in Children with First Unprovoked Seizure.Purpose:To study EEG abnormalities in children with a first unprovoked seizure.Methods:In a prospective cohort study, EEG findings were studied from 63 children with a first unprovoked afebrile seizure seen at a private Epilepsy Center for Children in Mumbai, India, over the period of June 2001 to May 2002. Eligible candidates were children aged between 2 months and 10 years. Children with status, cluster of seizures within 24 h, and those with prior neonatal seizures, febrile seizures, posttraumatic seizures, or other provoked seizures that now had a first unprovoked seizure also were included. A seizure was considered unprovoked when no identifiable proximate insult could be found. Children with typical absence seizures, myoclonic seizures, and infantile spasms as well as those with first generalized tonic–clonic (GTC) seizure but with prior absence or myoclonic seizures were excluded. Seizures were classified as GT, GTC, GC, atypical absence, atonic (sudden fall), simple partial, complex partial, partial with secondary generalization, unconsciousness, or unclassifiable. An electroencephalogram (EEG) was performed in all. More than 95% of EEGs were interictal, obtained 48 h after the seizures. An attempt was made to obtain both awake and asleep recordings in all. In younger and neurologically impaired children, only sedated sleep recordings could be obtained. All EEGs were interpreted by the first author. EEGs were classified as normal or abnormal. Specific epileptiform abnormalities such as focal spikes, multifocal spikes, centrotemporal spikes, generalized spike-and-wave complexes, and background abnormalities, such as background asymmetry and slowing, were coded separately.Results:Characteristics of study group: The study group included 63 children, 32 (50.79%) boys and 31 (49.20%) girls. The mean age at the time of first seizure was 6.14 years. Fifteen (23.80%) of the children were younger than 3 years; 30 (47.61%) were between 3 and 10 years; and 18 (28.57%) were older than 10 years at the time of their first seizure. Twenty-eight (44.4%) of the children had a generalized first seizure, and 19 (30.15%) had a partial seizure with or without secondary generalization. EEG characteristics: EEGs were available in all, and 35 (55.5%) had an abnormal EEG. EEG abnormalities included focal spikes (n= 20), multifocal spikes (n= 7), generalized spike-and-wave discharges (n= 1), continuous spikes and waves during sleep (CSWS; n= 1), and background abnormalities (n= 11; asymmetry, six; slowing, five). Five children with slowing also had focal spikes. EEG abnormalities were seen in an equal percentage of cases with GTC (59.09%) and partial seizures (58.82%). Of four children with seizure clusters, EEGs were normal in three (75%). Although abnormalities were more common in children older than 3 years (older than 3 years, 58.3%; younger than 3 years, 4 6.6%); the incidence of abnormal EEGs in younger children was much higher than that described in the literature. Records, including both awake and sleep tracings, were available in 27 (42.8%) cases. Only sleep tracings were available in 27 (42.8%) and only awake in nine (14.2%). Seventeen (62%) of the 27 patients with awake and asleep tracings had abnormal EEGs, whereas 12 (44.4%) sleep records and six (66.6%) of awake records were abnormal. Background abnormalities (n= 11, 31.4%) were common and better seen when awake recording was available along with sleep tracing.Conclusions:Children with even a single unprovoked seizure have a high incidence of EEG abnormalities, and the awake recording is valuable to bring out background abnormalities. Electrical Status During Slow-Wave Sleep (ESES): A Review of Fifteen Pediatric Cases from India.Purpose:To review the clinical and electrographic features of electrical status during slow-wave sleep (ESES) by using short-term EEG monitoringMethods:The study was done by using short-term (3 h) EEG recording with polygraphic variables of awake and sleep states. ESES is an EEG-defined syndrome, and stringent EEG criteria for inclusion were followed by using spike-and-wave index occupying≥85% of recorded sleep, less frequent or ceasing to be continuous in the awake state, and findings present on more than two occasions. Each case was assessed for the type, frequency of seizures, neuropsychological testing, neuroimaging with computed tomography (CT) or magnetic resonance imaging (MRI), and followed up closely for a period of 6 months to 6 years with repeated EEG at 1- to 3-month intervals.Results:Of 2,080 patients with pediatric epilepsy older than 10 years, typical ESES (n= 15) form the basis of study with an incidence of 0.72%. Excluded from study were seven cases; atypical ESES was observed in six cases, three with asymmetrical ESES and three with a spike–wave index of 50–60% of the sleep record; and a single case with transient, drug-induced ESES. Age at onset was between 7 months and 6 years, with a preponderance of male patients (10 of 15); eight had normal development before seizure onset (idiopathic), whereas seven were symptomatic. History of febrile seizures was present in two, and one had a family history of epilepsy. Language dysfunction was noted (n= 4), two with delayed speech development but normal motor milestones, one with autistic features, and one had total aphasia for 22 days before ESES, but not the Landau–Kleffner syndrome. Cases were categorized as per the seizure semiology; group 1 with infrequent nocturnal seizures (n= 2), group 2 with absence and motor seizures (n= 7), and group 3 with myoatonic falls (n= 6). None had tonic seizures. Regardless of seizure frequency, detection of ESES coincided with neuroregression in all. Before ESES, nine of 15 cases had seizures, and EEGs showed multifocal spikes predominantly in the frontotemporal region with secondary bilateral synchrony and later progressed to ESES syndrome. The remaining six cases showed ESES at the time of presentation. None had remission of ESES, even after 6 years of follow-up, the oldest case being age 13.5 years. Remission of seizures was observed in four cases, even though the EEGs persisted in showing ESES.Conclusions:ESES is associated with deterioration of neurologic function, irrespective of seizure control, and if strict criteria are used, one can eliminate other conditions, with the EEG showing a pattern simulating ESES. ESES is usually self-limiting and normally remits by adolescence. However, a longer follow-up is required to establish this entity. Diagnosis of ESES can be made on a brief sleep recording, but an overnight sleep recording would be essential if discharges are<85% and at follow-up to review the progress. ESES is a definitely identifiable, specific, sleep-related syndrome that may be overlooked if a sleep recording during routine EEG is not carried out. The neurologic dysfunction and regression is uniformly reported in all series and provides a clue to the emergence of this syndrome. A dilemma exists with regard to morphology and evolution of the spike–wave discharges, the percentage of SW index, day-to-day variations in the same person, and the lack of definitive treatment to suppress these discharges. [ABSTRACT FROM AUTHOR]

Like adults, young infants prefer attractive to unattractive faces (e.g. ; ). Older children and adults stereotype based on facial attractiveness ( ; ). How do preferences for attractive faces develop into stereotypes? Several theories of stereotyping posit that categorization of groups is necessary before positive and negative traits can become linked to the groups (e.g. ; ). We investigated whether or not 6-month-old infants can categorize faces as attractive or unattractive. In Experiment 1, we familiarized infants to unattractive female faces; in Experiment 2, we familiarized infants to attractive female faces and tested both groups of infants on novel faces from the familiar or novel attractiveness category. Results showed that 6-month-olds categorized attractive and unattractive female faces into two different groups of faces. Experiments 3 and 4 confirmed that infants could discriminate among the faces used in Experiments 1 and 2, and therefore categorized the faces based on their similarities in attractiveness rather than because they could not differentiate among the faces. These findings suggest that categorization of facial attractiveness may underlie the development of the ‘beauty is good’ stereotype. [ABSTRACT FROM AUTHOR]

In this article, the author describes psychoanalytic therapist Louis W. Sander's new ways of exploring the child-caretaker relationship. Nearly two decades ago in pioneering work on newborn state organization, Sander studied the infant-caretaker relationship by describing each infant's uniquely characteristic regulatory patterns in the context of his or her particular and unique care taking environment. Sander's ideas about the infant-caregiver system are profound in their implications for the new way: to investigate and understand development.

In this paper, we consider whether the field of infant and early childhood mental health (IECMH) needs its own code of ethics. We begin by describing unique features of infant and early childhood mental health (IECMH) and the diverse strategies that the field has developed to address complex clinical dilemmas, among them workforce development, clinical supports, policy statements, and statements of ethical values. Because of the field's interdisciplinary nature, we also consider how various contributing professions and organizations address ethical issues. While these are important resources that can inform ethical decision‐making, we identify some of the limitations of the current approaches. We argue that it is time for the field of IECMH to take an intentional, systematic approach to directly address the complex and unique ethical dilemmas faced by infant and early childhood mental health practitioners, and we grapple with some of the challenges developing such a code might entail. We suggest several avenues for better understanding the scope of ethical issues and ethical decision‐making processes in IECMH that could be used to support developing an ethics code that is responsive to the unique and challenging world of infant and early childhood mental health. [ABSTRACT FROM AUTHOR]

This paper describes a method for investigating clinical process, Layered Analysis, which combines therapist countertransference reports and multi‐faceted microanalytic research approaches. Findings from the application of Layered Analysis to video‐recorded micro‐events of rupture and repair in four psychoanalytic parent–infant psychotherapy sessions are presented. Layered analysis showed that countertransference and observation are complementary perspectives, which enable concomitant study of interactive events, conscious internal experiences, as well as nonconscious and unconscious elements of therapeutic interaction. Interactional rupture and repair were found to constitute co‐constructed micro‐events that occurred fleetingly and often implicitly, and differed in the structure, coherence and flow of interactions and in the relationship between verbal and nonverbal communication. Furthermore, interactional ruptures were found to sometimes 'get into' the therapist and transiently disrupt their self‐organization, such that the therapist became a locus of disruption for the patient(s), actively contributing to the rupture, which thus became embedded in the therapeutic system. Interactive repair was found to be most often initiated by the therapist and to be underpinned by the therapist re‐establishing self‐regulation, through metabolizing embodied and verbal aspects of the rupture. Studying such processes can enhance our understanding of clinical process, inform therapist training and clinical supervision, and contribute to clinical outcomes. [ABSTRACT FROM AUTHOR]

Ethics is concerned with the basis for moral judgments of "right" and "wrong" and is central to the clinical endeavor. Many clinicians integrate ethical estimations into their work without much conscious awareness. However, explicit use of ethical principles and frameworks can help navigate clinical decision‐making when there is a sense of moral conflict or ambiguity about the "right" course of action. This article aims to highlight the key concepts and principles in clinical ethics as they apply to IECMH practice and stimulate a bigger conversation in the profession around how to support each other to maintain high ethical standards in working with young children and their families. Specifically, the authors consider the relevance of Beauchamp and Childress' four principles framework (respect for autonomy, beneficence, non‐maleficence, and justice), and address some of the special ethical challenges in the field, namely, the vulnerability of the infant, the need for a competent workforce, caring for caregivers, and the problem of multiple patients. Finally, the role of infant rights is briefly explored, noting the significant interest and debate that has been generated by the publication of the World Association of Infant Mental Health's Position Paper on the Rights of Infants. [ABSTRACT FROM AUTHOR]

Aim: To investigate the association between morphine exposure in the neonatal period and neurodevelopment at 2 and 5 years of age while controlling for potential confounders. Method: We performed a retrospective, single‐centre cohort study on 106 infants (60 males, 46 females; mean gestational age 26 weeks [SD 1]) born extremely preterm (gestational age < 28 weeks). Morphine administration was expressed as cumulative dose (mg/kg) until term‐equivalent age. Neurodevelopmental outcome was assessed at 2 years with the Bayley Scales of Infant and Toddler Development, Third Edition, Dutch version and at 5 years with the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, Dutch version. Multiple linear regression analysis was used to assess the association between morphine exposure and outcome. Results: Sixty‐four out of 106 (60.4%) infants included in the study received morphine. Morphine exposure was not associated with poorer motor, cognitive, and language subscores of the Bayley Scales of Infant and Toddler Development, Third Edition, Dutch version at 2 years. Morphine exposure was associated with lower Full‐Scale IQ scores (p = 0.008, B = −9.3, 95% confidence interval [CI] = −15.6 to −3.1) and Performance IQ scores (p = 0.005, B = −17.5, 95% CI = −27.9 to −7) at 5 years of age. Interpretation: Morphine exposure in infants born preterm is associated with poorer Full‐Scale IQ and Performance IQ at 5 years. Individualized morphine administration is advised in infants born extremely preterm. What this paper adds: A significant association between morphine exposure and neurodevelopmental impairment at 5 years was observed.Higher exposure to painful and stressful procedures during the neonatal period was associated with poorer abilities at 5 years of age.Differently from previous studies on morphine, this association was also considered in the statistical analysis.A more individualized morphine administration is advised in infants born extremely preterm to counteract the negative effects of high stress without affecting neurodevelopment. [ABSTRACT FROM AUTHOR]

Background: As a nutritious food‐providing protein, essential fatty acids, vitamin D, iodine and choline eggs have historically been central to an infant weaning diet. However, food poisoning scares and allergy concerns have contributed to low consumption among infants aged 6–12 months. Methods: This paper presents a secondary data analysis of infant egg exposure and intake using three weaning data sets: a 7‐day food frequency questionnaire (n = 297), a 24‐h recall (n = 180) and a 3‐day weighed food diary (n = 71). Egg introduction, frequency of consumption and intake in grams were analysed for infants aged 6–8, 9–10 and 11–12 months). Comparisons were made by whether infants were following a baby‐led approach to weaning (where infants self‐feed family foods) or a traditional approach where pureed foods are given alongside finger foods. Data were collected in the United Kingdom between 2015 and 2018. Results: Our data showed that despite introduction being recommended from the start of weaning at 6 months of age by the Department of Health, just 54% of infants aged 6–8 months had ever been offered eggs. Average egg intake was one to two times per week, increasing with age. However, in terms of frequency and grams consumed, our data suggest a small increase in consumption compared with previous research, although limitations of our smaller sample size should be noted. Finally, a baby‐led approach was associated with increased exposure and consumption; baby‐led infants consumed eggs twice as frequently as spoon‐fed infants. Conclusions: The findings have important implications for public health messaging and for supporting families in introducing solid foods. Key points: Despite introduction being recommended from the start of weaning at age 6 months, just 54% of infants aged 6–8 months had ever been offered eggs.Only 40% of infants aged 6–8 months and about two‐thirds of those aged 9–12 months had consumed eggs in the last week. Those who had consumed eggs most commonly did so once or twice a week.Infants following a baby‐led weaning approach who self‐feed family foods were introduced to eggs at an earlier stage of weaning and consumed eggs twice as frequently as spoon‐fed infants. [ABSTRACT FROM AUTHOR]

Reflective practices provide a supportive base through which preservice infant and early childhood teachers and allied professionals can achieve knowledge, skills, and professional dispositions to support young children and their families. This paper is a program description that describes the rationale for infusing reflective practices into the learning goals for preservice early childhood training, highlighting the specific reflection skills from the Infant and Early Childhood Mental Health Competency Guidelines. We describe how one university early childhood training program promotes student reflection skills referencing three distinct perspectives: (1) why reflection is essential to developing knowledge and skills; (2) the role group reflection plays in sustaining deep knowledge and skill development for students and faculty; (3) how faculty promote students' awareness of the connection between personal experience and professional dispositions through reflection during practicum experiences. The benefits and challenges of embedding reflective practices in preservice early childhood training are also discussed. [ABSTRACT FROM AUTHOR]

Jacquet erosive dermatitis (JED) is a rare, severe form of napkin dermatitis associated with friction and irritant exposure in the napkin area. The condition typically causes erosions and erythematous punched‐out ulcerations. We present two cases of JED in infants associated with the use of a common brand barrier cream Curash. This appeared to present following a change of several active ingredients. [ABSTRACT FROM AUTHOR]

This paper investigates the prospects of a distinctively Plotinian argument for God's existence. Specifically, this paper assesses Plotinus' argument for the One/Good (Enneads; V.1,V.4), a principle rooted in Plato's Republic (509b6‐9), as a philosophical motivation for an argument for God's existence. While the appropriative task of using Plotinus' argument for natural theological purposes is not original to this work, this project remains in its philosophical infancy. It is to this end that the Plotinian background from which the argument proceeds is articulated, and thereafter contextualised in Edward Feser's Plotinian argument. This work defends Feser against two objections he does not consider, concluding that the appropriative strategy is successful and is a significant contribution to natural theology. [ABSTRACT FROM AUTHOR]

This paper examines the evidence of children's agency in research about infants, toddlers and technologies. It finds that an implicit reliance on technological determinism as a theoretical perspective for positioning technologies relative to young children's development tends to shape research in terms of understanding the impact of technologies on young children. Drawing on critical constructivism as a philosophical stance on technologies, this paper argues that children's agency with technologies may be further investigated in terms of practice architectures to better understand the social mediation of infant and toddler interactions and engagements with technologies. [ABSTRACT FROM AUTHOR]

The multiple protective functions of the skin derive from the interactions between epithelial skin and immune cells as well as the commensal microbiota. Developed in the last trimester of intra‐uterine life, the skin barrier adapts dynamically after birth. Specific differences in the structure and physiology have been disclosed between infant and adult skin. The stratum corneum of infants is thinner and structured by thicker corneocytes with a more anisotropic surface in comparison to adult skin. Lower levels of the natural moisturizing factor and its constituents, together with the increased protease activity in the epidermis result in dry baby skin and ongoing adaptation of the desquamation to the extra‐uterine environment. Infant epidermis is characterized by an accelerated proliferation rate and clinically competent permeability barrier in term neonates, despite the higher baseline values of transepidermal water loss in infants. The skin surface of newborns is less acidic, which could increase susceptibility to diaper and atopic dermatitis. Immediately after birth, skin is colonized by commensal bacteria—a process dependent on the mode of delivery and of major importance for the maturation of the immune system. Skin bacterial diversity and dysbiosis have been related to different pathology such as atopic and seborrheic dermatitis. This paper focuses on the ongoing structural, functional and biochemical adaptation of the human skin barrier after birth. We discuss the interactions on the 'skin barrier/ microbiota/ immune system' axis and their role in the development of competent functional integrity of the epidermal barrier. [ABSTRACT FROM AUTHOR]

This paper will describe the spiritual states of "oneness" experienced by Andean shamans in relation to oceanic states in early infancy and working with trauma in Jungian analysis. The author's work exploring implicit energetic experience with Andean shamans will be referenced with comparisons made to depth psychology, in both theory and in practice. Definitions of Q'echua terms describing different psychic meditative states that Andean shamans enter into will be provided as Andean medicine people have a much more developed language for conceptualizing these experiences. A clinical vignette will be presented that demonstrates how the spaces of implicit connection that occur between an analyst and analysand in the analytic setting can be a catalyst for healing. [ABSTRACT FROM AUTHOR]

Aim: To determine the risk patterns associated with transient hearing impairment (THI) and permanent hearing loss (PHL) of infants born very preterm who failed hearing screenings. Method: We enrolled 646 infants (347 males, 299 females) born at no more than 30 weeks' gestation between 2006 and 2020 who received auditory brainstem response screening at term‐equivalent age. Audiological examinations of infants who failed the screening revealed THI, when hearing normalized, or PHL, defined as a persistent unilateral or bilateral hearing threshold above 20 dB. Principal component analysis (PCA) was used to characterize risk patterns. Results: Among the 646 infants, 584 (90.4%) had normal hearing, 42 (6.5%) had THI, and 20 (3.1%) had PHL. Compared with the group with normal hearing, the THI and PHL groups had significantly higher rates of neurodevelopmental impairment at 24 months corrected age. PCA of risk patterns showed the THI group and especially the PHL group had more severe haemodynamic and respiratory instability. Moreover, severe intraventricular haemorrhage (IVH) was also a risk for PHL. Propensity score matching revealed an association of haemodynamic and respiratory instability with PHL. Interpretation: In infants born preterm, the severity and duration of haemodynamic and respiratory instability are risk patterns for both THI and PHL; severe IVH is an additional risk for PHL. What this paper adds: Neurodevelopmental delay was more common in infants born preterm who failed hearing screening.Principal component analysis revealed the risk patterns associated with hearing impairment.Haemodynamic–respiratory instability was associated with transient and permanent hearing impairment outcomes.Severe haemodynamic–respiratory instability and intraventricular haemorrhage was associated with permanent hearing loss. [ABSTRACT FROM AUTHOR]

In order to improve the analysis effect of risk factors for blood transfusion in preterm infants, this paper studies the natural gradient algorithm based on statistical analysis methods and analyzes the data processing effect of the algorithm. Moreover, this paper combines the analysis of risk factors for blood transfusion in preterm infants to build a factor analysis system based on statistical analysis algorithms and intelligent algorithms, and combines back propagation (BP) neural networks to build the statistical intelligence model. In addition, this paper designs experiments to verify the performance of the statistical intelligence model constructed in this paper, combines statistical methods to perform data processing, and analyzes experimental results through control experiments. From the experimental research results, it can be known that the statistical processing method of risk factors proposed in this paper has a certain effect. Simultaneously, through a large amount of data training research and analysis, it is confirmed that the system constructed in this paper has good data processing effects and can be applied to practice. [ABSTRACT FROM AUTHOR]

Many young women were believed to die due to pregnancy and childbirth in the past, yet few cases of pregnant female burials have been reported in bioarcheological literature. Therefore, this paper reports the burial of an adult female (H49‐1) and her infant (H49‐2), who were buried together in an early Western Zhou pit at the Sanbulijia site, Jiaodong Peninsula, Shandong Province, China. It is the first reported case of obstetric death in thePre‐Qin Period in Shandong Province. The mother–child relationship was proved by ancient DNA evidence and archeological context. The infant's remains were placed between the adult's lower legs. Skeletal histological evidence suggests that the infant died during or shortly after childbirth. Sacroiliac fusion of individual H49‐1 may have resulted in dystocia. Furthermore, a special postmortem burial ritual—pit burial, was carried out for both the infant and the mother. H49 is the first Zhou Dynasty pit burial (multiple burial) with an exact radiocarbon date in the Shandong Peninsula. The case under review suggests that both the adult and the infant may have died due to special events, which may be related to obstetric death. [ABSTRACT FROM AUTHOR]

Infant and Early Childhood Mental Health Consultation (IECMHC) is a preventative, capacity‐building intervention in which mental health professionals partner with early childhood professionals to indirectly improve the environments and relationships that young children experience. Prior research has demonstrated that IECMHC is associated with positive outcomes for children, teachers, and classrooms. Over the past decade, IECMHC implementation and research have expanded, warranting an updated review. The current paper provides an update of the IECMHC evidence base. Included studies (n = 16) were systematically gathered, screened, and coded for context, intervention characteristics, methods and measures, outcomes across ecological levels, and alignment with the IDEAS Impact Framework's guiding questions. Our analysis replicates prior reviews, describing the positive impact of IECMHC on outcomes such as child externalizing behavior, teacher self‐efficacy, and teacher‐child interactions. Beyond updating prior reviews, this analysis describes emerging, nuanced findings regarding the mechanisms of change and the differential impact of IECMHC. We augment our review with descriptions of evaluations that did not meet our inclusion criteria (e.g., IECMHC in the home visiting context, unpublished evaluation reports) to provide context for our findings. Finally, we provide policy and practice implications and articulate an agenda for future research. [ABSTRACT FROM AUTHOR]

Aim: This paper summarises published evidence on the use of recorded music in high‐risk infants to reduce stress and improve neurodevelopment, forming recommendations for proposed clinical applications in neonatal intensive care units. Methods: We searched two comprehensive library catalogues and two databases for articles evaluating the impact of recorded music interventions on hospitalised preterm infants. Original and review papers published in English in the 10 years prior to this search were selected if the study included a component of recorded music interventions. Results: Most original studies (80.95%) and all literature reviews (100%) reported positive effects of recorded music interventions for preterm infants, primarily in the short term. No negative effects were reported. Evidence is emerging regarding the neurobiological mechanisms of recorded music on longer‐term effects on preterm infant neurodevelopment. Clinical applications were suggested drawing upon available evidence. Due to generally small sample sizes and variability in study design, unanswered questions remain. Conclusion: Carefully designed recorded music interventions appear to be safe, feasible and effective in reducing stress and improving neurodevelopment of hospitalised infants. Additional rigorous, well‐powered trials with relevant outcomes are needed to further refine specific elements for recorded music interventions to better inform practice. [ABSTRACT FROM AUTHOR]

This article presents abstracts of research papers presented at the 14th Annual Meeting of the Society for Psychophysiological Research. The paper on "Cardiac Components of the Defense in Infants," by W.K. Berg, found that the majority of studies of heart rate responses in alert infants report only deceleratory change, a component of the orienting response. The paper "Negative Slow Potentials Emitted by Participants in an EEG-Controlled Computer Game," by P.A. Brickett, found that CNV are produced prior to a required EEG response.

Aim: To study the association between the Hammersmith Infant Neurological Examination (HINE) at age 2 years and neurocognition at age 11 years in children born very preterm. We hypothesized that the HINE at 2 years would be associated with neurocognition, that is, neurological, motor, and cognitive outcomes at 11 years. Method: A total of 174 children (mean gestational age 29.0wks, SD 2.7; minimum 23.0, maximum 35.9; 95 [55%] males, 79 [45%] females) born very preterm (birthweight ≤1500g/gestational age <32wks), were included in a prospective cohort recruited from 2001 to 2006 in Turku, Finland. The HINE was performed at 2 years' corrected age. Neurocognition at 11 years was assessed with the Touwen neurological examination, Movement Assessment Battery for Children, Second Edition (MABC‐2), and full‐scale IQ (Wechsler Intelligence Scale for Children, Fourth Edition). Results: The HINE global score was associated with the results of the Touwen neurological examination (odds ratio [OR]=0.9, 95% confidence interval [CI] 0.8–0.9, p=0.001), MABC‐2 (β=1.4, 95% CI 0.7–2.2, p<0.001), and full‐scale IQ (β=1.2, 95% CI 0.8–1.7, p<0.001), even when adjusted. When children with cerebral palsy (CP) were excluded, the HINE was still associated with full‐scale IQ (unadjusted β=1.2, 95% CI 0.3–2.1, p=0.01). Interpretation: A higher HINE global score at 2 years was associated with better general intelligence at 11 years even in children without CP. The HINE may be a useful tool to detect children at risk for later cognitive impairment. What this paper addsA Hammersmith Infant Neurological Examination (HINE) global score at 2 years was associated with long‐term neurocognitive function.Severe cognitive impairment was significantly more common in 11‐year‐old children with complex minor neurological dysfunction compared to typically developing children.The HINE performed at 2 years detects risks of cognitive impairment at 11 years in children born very preterm.A higher HINE score at 2 years was associated with better general intelligence at 11 years. What this paper adds: A Hammersmith Infant Neurological Examination (HINE) global score at 2 years was associated with long‐term neurocognitive function.Severe cognitive impairment was significantly more common in 11‐year‐old children with complex minor neurological dysfunction compared to typically developing children.The HINE performed at 2 years detects risks of cognitive impairment at 11 years in children born very preterm.A higher HINE score at 2 years was associated with better general intelligence at 11 years. This article is commented on by Bos on page 891 of this issue. [ABSTRACT FROM AUTHOR]

Aim: We explored the ability of the Hammersmith Infant Neurological Examination (HINE) to identify typical and delayed cognitive performance in a large population of infants born preterm, both with and without cerebral palsy (CP). Method: We conducted a retrospective study of infants born preterm who had repeated HINEs between 3 and 12 months corrected age. At 2 years, cognition was assessed using the Mental Development Index (MDI; from the Bayley Scales of Infant Development, Second Edition) and the presence and severity of CP was determined. All children were classified as cognitively typical/mildly delayed or significantly delayed (MDI <70) and CP. The predictive validity of HINE scores for significantly delayed cognitive performance, in children with and without CP, was calculated using specific cut‐off scores according to age at assessment. Results: Of 1229 eligible infants (gestational age 25–36wks, mean [SD] 34.9 [2.3]; 646 males, 583 females), 1108 did not develop CP, 891 had an MDI that was typical/mildly delayed, and 217 had an MDI less than 70. Of the 121 infants who developed CP, the MDI was typical in 28, mildly delayed in 27, and less than 70 in 66. HINE scores showed a good sensitivity and specificity, especially after 3 months, for detecting significantly delayed cognitive performance in infants without CP. In those who developed CP, the score was associated with their cognitive level. Interpretation: The HINE provides information about the risk of delayed cognitive performance in infants born preterm with and without CP. What this paper addsThe Hammersmith Infant Neurological Examination (HINE) can be used in the first year to identify infants born preterm at risk for delayed cognitive performance.Age‐dependent HINE cut‐off scores are proposed for detecting increased risk of delayed cognitive performance. What this paper adds: The Hammersmith Infant Neurological Examination (HINE) can be used in the first year to identify infants born preterm at risk for delayed cognitive performance.Age‐dependent HINE cut‐off scores are proposed for detecting increased risk of delayed cognitive performance. This article's abstract has been translated into Spanish and Portuguese. Follow the links from the abstract to view the translations. This article is commented on by Bos on page 891 of this issue. [ABSTRACT FROM AUTHOR]

This paper considers whether the psychotic illness of a mother impacts on the development of the mentalizing capacity of her offspring and the consequences this may have for clinical practice as a child psychotherapist. It focuses on the current theoretical understanding that the secure state of mind of a mother with respect to attachment, as well as her mentalizing ability, influences the development of the child's mentalizing skills. After summarizing and evaluating evidence associated with the attachment behaviour and mentalizing capacity of a psychotic mother, the paper gives evidence that there is a strong association between mothers on the psychotic continuum and insecure‐avoidant or disorganized attachment behaviour and impairment of the reflective function. This puts the infant at elevated risk of not fully developing mentalizing abilities. The issue of acquiring hypermentalization or undermentalization patterns is highlighted. In clinical practice, marked mirroring and transparency about the therapist's mental state allow the client to feel seen and to discover his or her own inner experiences in relation to external reality. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the sensitivity, specificity, and predictive value of the Hand Assessment for Infants (HAI) in identifying infants at risk of being diagnosed with unilateral cerebral palsy (CP), and to determine cut‐off values for this purpose. Method: A convenience sample of 203 infants (106 females, 97 males) was assessed by the HAI at 3, 6, 9, and 12 months. Sensitivity, specificity, predictive values, and likelihood ratios were calculated using receiver operating characteristic curve analysis. Cut‐off values were derived for different ages. The clinical outcome (unilateral CP yes/no) at 24 months or more served as an external criterion to investigate the predictive validity of HAI. Results: Half of the infants developed unilateral CP. The area under the curve ranged from 0.77 (95% CI [confidence interval] 0.63–0.91) to 0.95 (95% CI 0.90–1.00) across HAI scales and age intervals. Likewise, sensitivity ranged from 63% to 93%, specificity from 62% to 91%, and accuracy from 73% to 94%. Interpretation: HAI scores demonstrated overall accuracy that ranged from very good to excellent in predicting unilateral CP in infants at risk aged between 3.5 and 12 months. This accuracy increased with age at assessment and the earliest possible prediction was at 3.5 months of age, when appropriate HAI cut‐off values for different ages were applied. What this paper addsThe Hand Assessment for Infants (HAI) predicts unilateral cerebral palsy (CP) with high accuracy.HAI cut‐off values can guide clinical practice for early identification and diagnosis of unilateral CP. What this paper adds: The Hand Assessment for Infants (HAI) predicts unilateral cerebral palsy (CP) with high accuracy.HAI cut‐off values can guide clinical practice for early identification and diagnosis of unilateral CP. [ABSTRACT FROM AUTHOR]

Aim: This systematic review evaluates the accuracy of clinical tools used at a corrected age of 6 months or younger to predict motor and cognitive delay (not cerebral palsy) at 24 months' corrected age, in infants born very preterm. Method: Six databases were searched. Quality was evaluated using the Quality Assessment of Diagnostic Accuracy Studies tool. Predictive analysis included calculation of sensitivity and specificity, inspection of summary receiver operating characteristics curves, and bivariate meta‐analysis. Results: Six assessments were identified in 10 studies of 992 infants. Overall prevalence of motor delay was 13.8% and cognitive delay was 11.7%. Methodological quality was variable for patient selection, reference standard, flow, and timing. All studies had a low risk of bias for the index test. General Movement Assessment (GMA) predicted motor and cognitive outcomes with good accuracy for mild, moderate, and severe delays (fidgety age: pooled diagnostic odds ratio=12.3 [5.9–29.8]; hierarchical summary receiver operating characteristics curve=0.733). The Hammersmith Infant Neurological Examination (HINE) demonstrated excellent predictive accuracy for severe motor delay (3mo and 6mo; sensitivity 93% [68–100%], specificity 100% [96–100%]) but showed limited ability to predict milder delays. Interpretation: In the population of infants born very preterm, few assessment tools used at 6 months or younger corrected age have proven predictive accuracy for cognitive and motor delay at 24 months' corrected age. Only the GMA and HINE demonstrated useful predictive validity. What this paper adds: General movements have predictive validity for both motor and cognitive dysfunction in infants born very preterm.The Hammersmith Infant Neurological Examination showed the highest predictive accuracy for severe motor delay.The General Movement Assessment was the best tool to predict mild‐to‐moderate motor and cognitive delays. What this paper adds: General movements have predictive validity for both motor and cognitive dysfunction in infants born very preterm.The Hammersmith Infant Neurological Examination showed the highest predictive accuracy for severe motor delay.The General Movement Assessment was the best tool to predict mild‐to‐moderate motor and cognitive delays. This article's abstract has been translated into Spanish and Portuguese. Follow the links from the abstract to view the translations. [ABSTRACT FROM AUTHOR]

The colloquial concept of 'baby brain' suggests that throughout pregnancy and into the immediate postpartum period, women have reduced cognitive abilities and are more distracted, forgetful, and incompetent. To date, a plethora of cognitive and neuropsychological research testing the cognitive functioning of pregnant women relative to other groups has yielded inconsistent and unclear findings. However, there is a notable lack of literature that adopts a social psychological perspective, critically assessing the contribution of social context to the 'baby brain' phenomenon. In this paper, we review the current 'baby brain' literature and outline two potential social perspectives that provide insights into this research area: stereotype threat theory and objectification theory. We argue that inconsistencies in the 'baby brain' cognitive literature may be impacted by under‐explored social phenomena, which may result from activation of stereotypes or objectifying cues throughout pregnancy and into early new motherhood. We end with suggestions for future social and personality psychological research directions in the area of 'baby brain'. [ABSTRACT FROM AUTHOR]

Aim: To report on psychomotor development and outcomes in term born neonates with non‐epileptic paroxysmal events (NEPEs). Method: From October 2017 to March 2019 we enrolled 38 consecutive term born neonates (22 males, 16 females; aged between 0–28d), born at the University Hospital San Marco in Catania, Italy, with NEPEs. We performed the Hammersmith Neonatal Neurological Examination scale (at enrolment), the Hammersmith Infant Neurological Examination (HINE) scale (at age 3, 6, 9, and 12mo), and the Griffiths scale (at age 12mo). Results: The age at onset of first paroxysmal manifestations ranged from birth to 4 days. We recorded a suboptimal global score in 18 out of 38 patients at enrolment and in 10 out of 38 patients at age 3 months (>70% of these infants were male); all events disappeared within 6 months of life. At age 6, 9, and 12 months, all infants scored within normal values on the HINE and Griffiths scale. Interpretation: Patients with NEPEs achieve neurodevelopment optimal scores within their first year of life. What this paper adds: Neonates experiencing non‐epileptic paroxysmal events (NEPEs) can be examined with the Hammersmith Neonatal Neurological Examination, Hammersmith Infant Neurological Examination, and Griffiths scale at follow‐up.Newborn infants with NEPEs achieve optimal scores within the first year of life. What this paper adds: Neonates experiencing non‐epileptic paroxysmal events (NEPEs) can be examined with the Hammersmith Neonatal Neurological Examination, Hammersmith Infant Neurological Examination, and Griffiths scale at follow‐up.Newborn infants with NEPEs achieve optimal scores within the first year of life. [ABSTRACT FROM AUTHOR]

Tasting as a social practice can be enacted on behalf of others through precisely positioned nonlexical vocalizations as gustatory mmms. This paper uses multimodal interaction analysis to detail the coordination of parents and infants while starting to feed solid foods; data are from families in Scotland. The analysis focuses on the organization of parental mmms in relation to eye gaze, sequentiality, and the temporal coordination of hands, food, and mouths to demonstrate their use in beginning, continuing, and refocusing on taste. The paper proposes that in order to fully understand the sociality of tasting, infant feeding research should include real‐time vocal and embodied behavior, which is also key to the functional analysis of sensoriality‐related vocalizations at the margins of language. [ABSTRACT FROM AUTHOR]

Looking times and gaze behavior indicate that infants can predict the goal state of an observed simple action event (e.g., object‐directed grasping) already in the first year of life. The present paper mainly focuses on infants' predictive gaze‐shifts toward the goal of an ongoing action. For this, infants need to generate a forward model of the to‐be‐obtained goal state and to disengage their gaze from the moving agent at a time when information about the action event is still incomplete. By about 6 months of age, infants show goal‐predictive gaze‐shifts, but mainly for familiar actions that they can perform themselves (e.g., grasping) and for familiar agents (e.g., a human hand). Therefore, some theoretical models have highlighted close relations between infants' ability for action‐goal prediction and their motor development and/or emerging action experience. Recent research indicates that infants can also predict action goals of familiar simple actions performed by non‐human agents (e.g., object‐directed grasping by a mechanical claw) when these agents display agency cues, such as self‐propelled movement, equifinality of goal approach, or production of a salient action effect. This paper provides a review on relevant findings and theoretical models, and proposes that the impacts of action experience and of agency cues can be explained from an action‐event perspective. In particular, infants' goal‐predictive gaze‐shifts are seen as resulting from an interplay between bottom‐up processing of perceptual information and top‐down influences exerted by event schemata that store information about previously executed or observed actions. Elsner and Adam review studies of action event perception in infants, with a focus on how infants predict the goals of an observed agent, as assessed through anticipatory eye movements. They conclude that infants must use learned 'event schemata' to make predictions about agent goals. [ABSTRACT FROM AUTHOR]

To undertake a literature search and critical appraisal of best available evidence to answer the clinical question: Does the addition of clonidine (I) to standard treatment with an opioid (C) improve outcomes (O) in infants with Neonatal Abstinence Syndrome? A search of both comprehensive (MedLine and Embase) and pre-filtered databases (Dynamed, UpToDate and TRIP), utilising Boolean Operators to combine search terms appropriately. Three relevant studies were identified. One paper describing the outcomes of a randomised controlled trial by Agthe et al. (2009) most accurately answered the clinical question posed. This paper was critically appraised, and evidence applied to the clinical scenario. The use of clonidine as an adjunct to opioid in the management of infants with NAS reduces the total number of treatment days and dose of opioid required to control symptoms. However, there is a higher risk of rebound in symptoms post-cessation of opioid and clinicians need to account for this in their discharge planning. More large scale, multi-centre high-quality research is needed to clarify the role of clonidine in the treatment of NAS: as monotherapy versus adjunct, the optimal dose and longer-term impact on neurodevelopment. [ABSTRACT FROM AUTHOR]

Aim: The aim of this systematic review was to evaluate the clinical characteristics of COVID-19 in neonates and children under one year of age.Methods: A systematic literature review of the MEDLINE, PubMed, CINAHL, Embase and EBSCO databases was carried out for studies from January 1, 2020, to April 7, 2020. We included all papers that addressed clinical manifestations, laboratory results, imaging findings and outcomes in infants and neonates.Results: Our search identified 77 peer-reviewed papers, and 18 papers covering 160 infants were reviewed. One paper was from Vietnam, and the other 17 were from China: eight were cross-sectional studies, eight were case reports, one was a case series, and one was a prospective cohort study. The most common clinical symptoms were fever (54%) and cough (33%). Most infants were treated symptomatically, with frequent use of various empirical medications. Infants and neonates tended to have more severe COVID-19 disease than older children: 11 (7%) were admitted to intensive care and one infant died. The mortality rate was 0.006%, with favourable outcomes in most cases.Conclusion: Infants and neonates were more vulnerable to more severe COVID-19 disease than older children, but morbidity and mortality were low. [ABSTRACT FROM AUTHOR]