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Diarrhea is a major health problem in Ethiopia, and the Amhara Regional State is experiencing the highest prevalence rate of diarrhea. Therefore, this study was designed to assess the prevalence and risk factors attributed to diarrhea among children under-five in the Amhara Regional State. The study employed descriptive statistics and multivariable logistic regression analysis to identify the main statistically significant associated factors of diarrhea using Stata version 14. The overall prevalence rate of experiencing diarrhea was 17.7% [95% CI: 15.4, 20.2] in the Amhara Regional State. The multivariable logistic regression model analysis indicated that the risk factors are fourth and above birth order [AOR = 2.95, 95% CI (1.483, 5.85)], gender of child (being male) [AOR = 1.66, 95% CI (1.144, 2.41)], no education level of mother's [AOR = 4.7, 95% CI (1.01, 22.0)], being age of child 7-11 [AOR = 3.33, 95% CI (1.58, 7.01)] and 12-23 month [AOR = 2.17, 95% CI (1.11, 4.22)], mother's age at 15-19 years [AOR = 12.2, 95% CI (2.986, 50.2)], mother's age at 20-24 years [AOR = 6, 95% CI (1.758, 20.8)], and mother's age at 25-29 years [AOR = 4.48, 95% CI (1.41, 14.2)], and five and greater than family size [AOR = 0.53; 95% CI (0.343, 0.84)] were statistically significant associated with a higher risk of diarrhea. The prevalence of diarrhea in the Amhara Regional State was higher than that at the national level. The study identified gender of a child, education level of the mother's, birth order, family size, mother's age, and child's age as risk factors for diarrhea in children under-five., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics approval and consent to participate Ethics review and participant agreements were not required because the study was a secondary data analysis of publicly accessible survey data from the MEASURE DHS program. It was possible to download and use the requested DHS Program and the data from http://www.dhsprogram.com.The dataset files do not contain names for specific household addresses. Consent for publication Not applicable., (© 2024. The Author(s).)

Maple Syrup Urine Disease (MSUD, OMIM# 248600) is an autosomal recessive inborn error of metabolism characterized by elevated branched chain amino acids (BCAA) leucine/isoleucine and valine in blood of affected children. The phenotypic and genotypic spectrum of MSUD is largely unreported in Egypt. We recruited ten patients (4 males/6 females, 2weeks-12years) from nine unrelated families with clinical and biochemical evidence of MSUD. We performed Sanger sequencing for the three most-commonly responsible genes: BCKDHA, BCKDHB and DBT and conducted exome sequencing for unresolved cases. Through Sanger sequencing, we detected eight homozygous pathogenic/likely pathogenic variants (four in BCKDHB, three in BCKDHA and one in DBT gene) in eight different families. The proband of family VI, who had no significant genetic findings by Sanger, had a peculiar phenotype and atypical radiological findings. His exome sequencing revealed a previously reported homozygous likely pathogenic variant in the RARS2 gene (NM_020320.5:c.1026G > A;p.(Met342Ile)) causing the mitochondrial-encephalopathy disorder pontocerebellar hypoplasia, type 6 (OMIM# 611523). Furthermore, the copy-number-variant analysis of the exome data revealed a biallelic duplication affecting exons 2-6 of the BCKDHB gene (GRCh38: Chr.6-g.80127496:80171441dup) evaluated as variant of uncertain significance but expected to cause a breakpoint and may disrupt gene function, which can explain the markedly elevated BCAA levels in the patient's blood. In conclusion, we expanded the genotypic and phenotypic spectrum of the disease and showed that aggressive intervention with specific treatment in the first few days of life resulted in normal development even in a developing country setting. Inclusion of MSUD in the national newborn screening program in Egypt is highly recommended., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics declaration The study was conducted in accordance with the Declaration of Helsinki for studies involving human participants and was approved by the institutional research ethics committees at the Faculty of Medicine, Cairo University (#Approval code: #N-138-2021). Written informed consent was obtained from the parents/legal guardians of all study participants., (© 2024. The Author(s).)

Existing evidence regarding the impact of continuity of care (COC) in asthma patients is limited, and its quality is low to moderate. This study aimed to investigate associations between relational COC within primary care and asthma-related hospitalizations in children using a robust methodology. This study is a population-based cohort study that utilized a national claims database in South Korea. The study comprised 136,296 individuals under 20 years old who were newly diagnosed with asthma between 2015 and 2016. These were classified into high, medium, and low continuity groups based on the continuity of care index (COCI). The primary outcome measure was the incidence of asthma-related hospitalizations. During a two-year follow-up period, 10,922 patients (8.01%) were hospitalized: 2520 (5.59%) in the high-continuity group, 3188 (6.98%) in the medium-continuity group, and 3867 (8.48%) in the low-continuity group. After adjusting for confounding covariates, patients in the low- and medium-continuity groups exhibited significantly higher risks of hospital admission (adjusted hazard ratio (aHR) = 1.30 [95% confidence interval = 1.24-1.37] and aHR = 1.14 [1.08-1.20], than those in the high-continuity group. Sensitivity and subgroup analyses findings were consistent. In a young population with asthma increased continuity of primary care was associated with less hospitalization., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Cardiac biomarkers are being increasingly applied in pediatric populations, including those with cardiogenic and non-cardiogenic myocardial injury disease. The upper reference limits of biomarkers are an important reference for disease diagnosis and health evaluation. However, the upper reference limits of pediatric cardiac biomarkers remains unknown. A total of 1,797 serum samples were collected prospectively from healthy respondents aged 0 to 18 years old. These samples were analyzed using Roche cobas e411 to determine the concentrations of hs-cTnT, CK-MB mass, and NT-proBNP. The upper reference limits and 90% confidence interval were calculated according to Clinical and Laboratory Standards Institute C28- A3 guidelines. The study successfully established the upper reference limits for hs-cTnT, CK-MB mass, and NT-proBNP in healthy children and adolescents aged 0 to 18. The hs-cTnT, CK-MB mass, and NT-proBNP levels were visibly higher in neonatal serum. With the increase in age, hs-cTnT, CK-MB mass, and NT-proBNP decline gradually. They decrease quickly in the first year after birth and decrease slowly after 1 year old. Gender differences were observed in the concentrations of hs-cTnT and CK-MB mass among healthy children and teenagers aged 10 to 18 and 13 to 18. Specifically, boys had relatively higher concentrations of hs-cTnT and CK-MB mass. However, no gender difference was found in NT-proBNP concentration. The concentrations of hs-cTnT, CK-MB mass, and NT-proBNP were simultaneously tested in healthy Chinese children for the first time. The specific upper reference limits of age and gender in pediatrics were established. The results provide comprehensive references for medical institutions specializing in children's healthcare, which are conducive to preliminary screening, diagnosis, and treatment of pediatric cardiovascular diseases., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The early microbiota of neonates is crucial for developing the postnatal immune system and establishing normal physiological, metabolic, and neurological functions. This study aimed to investigate the factors influencing the diversity of the neonatal oral microbiome, including mother-to-newborn microbial transmission. The study includes a prospective cohort comprising 73 mothers and 87 neonates and a retrospective cohort comprising 991 mothers and 1,121 neonates. Samples from the maternal cervix and neonatal gastric, bronchial, and oral cavities were analyzed using culture-based methods. Neonatal oral swab samples were also analyzed using 16S rRNA gene sequencing to characterize microbial diversity and composition. Similar genera were detected in the neonatal gastric, bronchial, and oral samples, and the neonatal gastric culture was the most similar to the maternal cervical culture. In addition to mother-to-newborn microbial transmission, various natal factors including birth type, birth weight, delivery mode, maternal chorioamnionitis, maternal diabetes and the presence of microbes in other sites influenced neonatal oral microbiome diversity. Among these factors, the birth type was the most significant, and preterm neonates exhibited decreased oral microbiome diversity, with fewer beneficial bacteria and more pathogens. These findings could serve as a baseline for research on the establishment of the oral microbiota in preterm neonates and its health implications., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Creative music therapy (CMT) has been shown to promote the development of brain function and structure in preterm infants. We aimed to investigate the effect of CMT on cerebral oxygenation and perfusion to examine how the brain reacts to CMT. Absolute levels of cerebrovascular oxygen saturation (StO 2 ) were measured in clinically stable preterm-born neonates (n = 20, gestational age: ≥30 weeks and < 37 weeks) using two near-infrared spectroscopy (NIRS)-based tissue oximeters over the right prefrontal cortex and left auditory cortex. We applied the systemic physiology augmented functional NIRS approach. Each CMT session lasted 55 min and involved 9 intervals, including two 10-minute intervals during which the music therapist hummed and held the neonate. We found that CMT-induced changes in cerebrovascular StO 2 , perfusion and systemic physiology (i) could be classified into two groups (group 1: increase in StO 2 during the first singing interval, group 2: decrease in StO 2 ), (ii) differed in female neonates compared to male neonates, and (iii) correlated with individual blood haematocrit levels. Our exploratory study (i) demonstrates the impact of CMT on the neonate's physiology and (ii) highlights the need to analyze functional NIRS measurements in neonates separately according to their response pattern to avoid erroneous conclusions, e.g. when only the group average of the signal change is determined., Competing Interests: Declarations Competing interests F.H., T.K., T.R., T.R., B.C.H.V., E.O., H.Z, H.U.B., U.W. and D.B. declare no conflict of interest. D.O. and S.K. are affiliated with and MW is co-founder and president of the board of OxyPrem AG (a University of Zurich spin-off that produces an improved version of the near-infrared spectroscopy oximeters employed in the study). S.K., D.O., and M.W. had no influence on how the data were analyzed by F.S. F. S. provided scientific consulting for companies producing fNIRS devices (NIRx GmbH, Berlin, Germany; Kernel, Culver City, Los Angeles, USA)., (© 2024. The Author(s).)

Australia's 2019/20 bushfire season was one of the most severe on record, from both land mass burned and the economic impact. This extreme weather season allowed the researchers to examine the effect of high PM 2.5 exposure during high bushfire days on birthweight and gestational age. It is well known that bushfire smoke is harmful to human health. However, the impact this has on the developing fetus is not yet clear. 25,346 births were assessed, their exposure calculated based on location data, and outcomes analyzed. Mothers exposed to high PM 2.5 (measured by a 24-hour average PM 2.5 greater than 25 µg/m 3 ) demonstrated a significant birthweight reduction of 0.77 g per day of exposure. Those who were also self-identified as having smoked at any time during their pregnancy were at higher risk, with a 1.33 g reduction in birthweight per day of exposure. Gestational age was reduced by 0.01 days per day of exposure in the total cohort, with no significant difference demonstrated in those who smoked. The compounded effects of high PM 2.5 exposure may result in birthweight reduction, with neonates born to mothers who smoked at increased risk., Competing Interests: Declarations Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

The performance gains achieved by deep learning models nowadays are mainly attributed to the usage of ever larger datasets. In this study, we present and contrast the performance gains that can be achieved via accessing larger high-quality datasets versus the gains that can be achieved from harnessing the latest deep learning architectural and training advances. Modelling neonatal EEG is particularly affected by the lack of publicly available large datasets. It is shown that greater performance gains can be achieved from harnessing the latest deep learning advances than using a larger training dataset when adopting AUC as a metric, whereas using AUC90 or AUC-PR as metrics greater performance gains are achieved from using a larger dataset than harnessing the latest deep learning advances. In all scenarios the best performance is obtained by combining both deep learning advances and larger datasets. A novel developed architecture is presented that outperforms the current state-of-the-art model for the task of neonatal seizure detection. A novel method to fine-tune the presented model towards site-specific settings based on pseudo labelling is also outlined. The code and the weights of the model are made publicly available for benchmarking future model performances for neonatal seizure detection., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics Statement This study has the full ethical approval from the Clinical Ethics Committee of the Cork Teaching Hospitals., (© 2024. The Author(s).)

To analyze the causes, locations, associated injuries, and relevant factors of lower limb and pelvic fractures in hospitalized children in China to provide a theoretical basis for reducing the incidence of such fractures. A retrospective analysis of children with lower limb and pelvic fractures admitted to 27 tertiary children's hospitals affiliated with China's Futang Research Center of Pediatric Development between December 1, 2015, and December 31, 2019, was conducted. Inpatient cases were analyzed in the following age groups: Infants (< 2 years), Preschool children (2-5 years), School children (6-11 years), and Adolescents (12-18 years). This study included 10,808 pediatric patients (7152 males, 3656 females). The proportion of preschool children of lower limb and pelvic fractures was the highest. The 10,808 patients sustained a total of 14,398 fractures. The shafts of the femur, tibia, and fibula, the distal tibia, distal fibula, and the pelvis were the six most common locations. Of the 734 pelvic fractures in children and adolescents, the top three locations were the ilium, pubic bone, and the ischium. Of the total patients, 9599 underwent surgery, while 1209 received non-surgical treatment. The three most common causes of pediatric lower limb and pelvic fractures were falling over, traffic accidents, and falling from a height. Among the 1806 concomitant traumas, respiratory traumas was the most common, mainly pulmonary contusion. The most common concomitant traumas of nervous, digestive and urinary system were scalp hematoma, liver injury and kidney injury respectively. The analysis of the location, age, causes, and concomitant injuries of lower limb and pelvic fractures showed that the most common fracture requiring hospitalization was tibia fracture, which was most common in preschool children. The most common cause of injury in preschool children was traffic accident. In addition, children are susceptible to accidental injuries from multiple sources in life, which can cause serious consequences of multi-system injuries., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics approval This study was carried out in full compliance with the Declaration of Helsinki. This study has been approved by the Medical Ethics Committee of the Shenzhen Children’s Hospital (No. 202000302). Consent to participate Informed consent was waived because of the register design of this study, which did not involve any additional risk for patients. The need for written informed consent was waived by the Shenzhen Children’s Hospital ethics committee due to retrospective nature of the study., (© 2024. The Author(s).)

Prenatal exposure to heavy metals such as Lead (Pb), arsenic (As), cadmium (Cd), and selenium (Se) is associated with various adverse pregnancy outcomes. This study examines the association between early pregnancy maternal blood levels of these metals and adverse pregnancy outcomes, while also addressing the differences between low-risk and high-risk groups based on having a history of preterm birth (PTB). This prospective cohort study recruited parous women during first trimester, categorized into low-risk and high-risk groups. Participants completed a questionnaire, and heavy metal levels were measured in blood samples. Pregnancy outcomes including PTB, low birth weight (LBW), gestational age at delivery, birth weight and head circumference were recorded following delivery. Multivariable analyses were conducted to evaluate the independent associations between heavy metal levels and pregnancy outcomes, while adjusting for maternal age, BMI, employment, smoking, fertility treatments and education. Among 404 participants, the mean (± SD) levels were Pb: 3.12 ± 1.82 µg/L, As: 0.41 ± 0.4 µg/L, Cd: 0.26 ± 0.34 µg/L, and Se: 119.84 ± 21.05 µg/L. Significant differences in Pb, Se, Cd and As levels were observed between the low-risk and high-risk groups, with higher levels in the low-risk group. However, no significant associations were found between heavy metal levels and any of the study outcomes in either univariable comparison or multivariable models. These findings highlight the need for further research to understand the potential impact of these metals on pregnancy, considering population-specific factors and exposure timing., Competing Interests: Declarations Competing interests The authors declare no competing interests. Ethics declaration The study protocol was approved by the institutional review board (Soroka University Medical Center IRB committee, #0390-20-SOR). The study has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments (Helsinki Declaration 1975, revision 2013). All participants gave signed informed consent at recruitment., (© 2024. The Author(s).)

Stunting among children is a reflection of the chronic malnutrition caused by a complex set of behavioural, demographic, and socioeconomic factors. This long-term detrimental exposure to chronic malnutrition is disproportionately higher among social and economically deprived groups, leading to significant differentials in the prevalence of stunting across various social strata. Therefore, this study investigates the inequality of social groups in terms of the prevalence of stunting across Schedule Caste (SC)-Scheduled Tribe (ST) and non-SC-ST. The study used 1,93,886 children's data aged 0-59 months from the recent round of the National Family Health Survey. Descriptive statistics, multivariable logistic regression, F-test, t-test and chi-squared (χ²) test were applied to understand the prevalence, determinants, and associations, respectively. The Fairlie decomposition model was applied to quantify the factors contributing to the inequality of stunting across social groups. The results revealed that the prevalence of stunting was higher among SC-ST (39.60%) children compared to non-SC-ST (33.27%). In addition, children aged 15-30 months (AOR: 1.895, 95% CI: 1.843-1.949), and male (AOR: 1.074, 95% CI: 1.053-1.095), mothers had lower BMI (AOR: 1.543, 95% CI: 1.492-1.595), mothers who had no education (AOR: 1.595, 95% CI: 11.532-1.662), belongs to poorest wealth index (AOR: 1.857, 95% CI: 1.766-1.952), and the children belong to the household with unhygienic satiation practices (AOR: 1.097, 95% CI: 1.070-1.123) were more likely to be stunted. The decomposition results revealed that the variables included in the study could explain 68.9% of the stunting inequality between SC-ST and non-SC-ST groups. The household's wealth index is found to be a leading factor, which contributed nearly 41.3% of total stunting inequality exists between these two groups, followed by mothers' education (12.86%) and mothers' BMI (11.02%), sanitation facilities (4.26%), children's birth order (3.32%) and mother's type of delivery (1.49%). These findings emphasize the importance of targeted interventions. Prioritizing policies that address household economic enhancement, women's education and empowerment can be instrumental in reducing social group inequality and lowering the overall prevalence of stunting. Ensuring access to improved hygienic sanitation facilities in the household is equally important for achieving better health outcomes for the children., (© 2024. The Author(s).)

The impact of Bariatric Surgery (BS) on maternal and neonatal outcomes among pregnant women is not fully understood, especially in comparison to different weight categories. The primary aim of this study is to assess the factors associated to women who have undergone BS. The study also investigates the maternal and neonatal outcomes amongst this group in comparison to the three Body Mass Index (BMI) groups (women with obesity, overweight and normal weight). A 12-month population-based retrospective study was conducted using registry data from the PEARL-Peristat Study at the Women's Wellness and Research Center (WWRC) in Qatar from January 1, 2017, through December 31, 2017. Both univariate and multivariable regression analyses were employed to scrutinize risk factors and maternal and neonatal outcomes. The study included 6212 parturient women, of which 315 had a history of BS, while 5897 with no BS history. Qatari women, aged 35 and higher, with parity > 1, diabetes, and hypertension were more likely to be in the post-BS group. Women in the post-BS group were found to be more likely to have a cesarean delivery (37.5% vs. 24%, Adjusted Odds Ratio (aOR) = 1.59, CI 1.18-2.14), preterm babies (10% vs. 7%, aOR = 1.66, CI 1.06-2.59), and stillbirth (1.6% vs. 0.4%, aOR = 4.53, CI 1.33-15.50) compared to the normal weight women group. Moreover, post-BS women had a higher risk of low-birth-weight neonates than women with obesity (15% vs. 8%, aOR = 1.77, CI 1.153-2.73), overweight (15% vs. 7%, aOR = 1.63, CI 1.09-2.43), and normal weight (15% vs. 8%, aOR = 1.838, CI 1.23-2.75). Finally, women in the post-BS group were more likely to have low-birth-weight neonates amongst term babies than women with obesity and overweight. Pregnancies with post-BS should be considered a high-risk group for certain medical outcomes and should be monitored closely. These findings may guide the future clinical decisions of antenatal and postnatal follow-up for post-BS women., (© 2024. The Author(s).)

The association between early glycated hemoglobin (HbA1c) and the risk of neonatal respiratory distress syndrome (NRDS) with preterm premature rupture of membranes (PPROM) population remains largely unknown. The impact of diabetes mellitus (DM) on NRDS is also controversial. HbA1c was assessed in early and late pregnancy. Multivariate logistic regression and restricted cubic spline (RCS) analyses were performed to evaluate the association between the HbA1c and the incidence of NRDS in non-DM group. Propensity score matching (PSM) was performed to balance baseline characteristics between DM group and non-DM group. Among 536 patients with the mean age was 30.7 ± 5.1 years, 117 (21.8%) had DM. The RCS revealed that a linear relationship was found between HbA1c and the incidence of NRDS in non-DM group, with a threshold of approximately 5% (31 mmol/mol). The effect size and CI below and above the threshold value were 1.70 (1.24-2.31) and 1.26 (0.81-1.96), respectively. The ΔHbA1c (late HbA1c minus early HbA1c) was independently associated with incidence of NRDS in DM group. Before and after PSM, no significant association was not observed between DM and the incidence of NRDS. Our findings indicated that higher early HbA1c levels were associated with a risk of NRDS in women without diabetes. Women with diabetes who experience an increase in HbA1c level during pregnancy may be more likely to give birth to infants affected by NRDS., (© 2024. The Author(s).)

Postnatal care immediately after birth is a crucial component to save lives of mothers and the newborns. A paucity of evidence indicated that women's unwillingness to receive care after birth is a remained challenge in resource-limited settings in general and in Ethiopia in particular. This study aimed to assess the utilization of postnatal care within 48 h after birth and its determinants in northwest Ethiopia. A community-based cross-sectional study was conducted from October to November 2020. A total of 811 women who had birth within the last one year were involved in the study. Both random and fixed effects were reported using an adjusted odds ratio with a 95% confidence interval and p value of 0.05. The study revealed that 13.3% (95% CI 10.9-15.7%) of women attended postnatal care visits within 48 h after birth. Attending secondary and above education (AOR = 2.39; 95% CI 1.18, 4.84); health extension workers home visiting during pregnancy (AOR = 1.74; 95% CI 1.08, 2.82); birth order (AOR = 2.07; 95% CI 1.03, 4.14); place of delivery (AOR = 7.49; 95% CI 3.73, 15.06); and short distance to health facility (AOR = 4.19; 95% CI 1.64, 10.70) were significantly associated with postnatal care utilization within 48 h after birth. Postnatal care utilization within 48 h is low in rural northwest Ethiopia compared to findings from most resource-limited settings. The existing health system should consider multilevel intervention strategies focusing on maternal health education, engaging community health workers in health promotion, and ensuring physical accessibility of healthcare facilities to be more effective in improving postnatal care utilization within 48 h., (© 2024. The Author(s).)

The most cost-effective data collection method is electroencephalography (EEG) to obtain meaningful information about the brain. Therefore, EEG signal processing is very important for neuroscience and machine learning (ML). The primary objective of this research is to detect neonatal seizures and explain these seizures using the new version of Directed Lobish. This research uses a publicly available neonatal EEG signal dataset to get comparative results. In order to classify these EEG signals, an explainable feature engineering (EFE) model has been proposed. In this EFE model, there are four essential phases and these phases: (i) automaton and transformer-based feature extraction, (ii) feature selection deploying cumulative weight-based neighborhood component analysis (CWNCA), (iii) the Directed Lobish (DLob) and Causal Connectome Theory (CCT)-based explainable result generation and (iv) classification deploying t algorithm-based support vector machine (tSVM). In the first phase, we have used a channel transformer to get channel numbers and these values have been divided into three levels and these levels are named (1) high, (2) medium and (3) low. By utilizing these levels, we have created an automaton and this automaton has three nodes (each node defines each level). In the feature extraction phase, transition tables of these nodes has been extracted. Therefore, the proposed feature extraction function is termed Triple Nodes Automaton-based Transition table Pattern (TATPat). The used EEG signal dataset contains 19 channels and there are 9 (= 3 2 ) connection in the defined automaton. Thus, the presented TATPat extracts 3249 (= 19 × 19 × 9) features from each EEG segment. To choose the most informative features of these 3249 features, a new feature selector which is CWNCA has been applied. By cooperating findings of this feature selector and the presented DLob, the explainable results have been obtained. The last phase is the classification phase and to get high classification performance from this phase, an ensemble classifier (tSVM) has been presented and the classification results have been obtained using two validation techniques which are 10-fold cross-validation (CV) and leave-one subject-out (LOSO) CV. The proposed EFE model generates a DLob string and by using this string, the explainable results have been obtained. Moreover, the presented EFE model attained 99.15% and 76.37% classification accuracy deploying 10-fold and LOSO CVs respectively. According to the classification performances, the recommended TATPat-based EFE is a good model at EEG signal classification. Also, the presented TATPat-based EFE model is a good model for explainable artificial intelligence (XAI) since TTPat-based EFE is cooperating by the DLob., (© 2024. The Author(s).)

Objective: To describe breastfeeding-supportive practices in U.S. maternity hospitals with advanced neonatal care units (ANCU)., Study Design: Using 2022 mPINC data, we calculated the percent of hospitals reporting (1) breastfeeding-supportive practices for "most" (≥80%) mother-baby dyads in ANCUs, by hospital demographic characteristics and (2) infant receipt of mother's own milk or donor milk at any time while in the ANCU, by ANCU level., Results: More than 90% of hospitals reported that "most" mothers (≥80%) were advised on some breastfeeding-supportive practices. Fewer hospitals reported that "most" mothers expressed milk within one hour of birth (37%) or that kangaroo care was practiced for "most" eligible newborns (63%). Receipt of mother's own milk varied by unit level and state., Conclusion: Breastfeeding-supportive practices requiring the technical competency of healthcare providers (e.g., early milk expression, kangaroo care) are less likely to be implemented in ANCU settings compared to practices centered around providing advice or education., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objective: To assess the impact of prophylactic dextrose gel on short-term outcomes in infants at risk for hypoglycemia., Methods: Retrospective, single-center, observational study of neonates at risk for hypoglycemia -infants of diabetic mothers, large and small for gestational age infants, born between January 2015 and May 2023. Infants were categorized into two groups for analysis. 1. Pre- dextrose gel (01/2015 to 04/2018, n = 788) and 2. Dextrose gel (01/2019 to 05/2023, n = 1495). Infant demographic data and outcome variables were compared between the two groups., Results: 2283 infants were eligible. Prophylactic dextrose gel use was associated with decreased admission rates to NICU secondary to hypoglycemia (2.7% vs. 6.5%), reduced incidence of hypoglycemia (32% vs. 43.3%), and higher exclusive breastmilk use at discharge (47% vs. 37.3%)., Conclusion: The use of prophylactic dextrose gel in certain high-risk newborns was associated with improved patient outcomes., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Natural disasters trigger complex chains of events within human societies 1 . Immediate deaths and damage are directly observed after a disaster and are widely studied, but delayed downstream outcomes, indirectly caused by the disaster, are difficult to trace back to the initial event 1,2 . Tropical cyclones (TCs)-that is, hurricanes and tropical storms-are widespread globally and have lasting economic impacts 3-5 , but their full health impact remains unknown. Here we conduct a large-scale evaluation of long-term effects of TCs on human mortality in the contiguous United States (CONUS) for all TCs between 1930 and 2015. We observe a robust increase in excess mortality that persists for 15 years after each geophysical event. We estimate that the average TC generates 7,000-11,000 excess deaths, exceeding the average of 24 immediate deaths reported in government statistics 6,7 . Tracking the effects of 501 historical storms, we compute that the TC climate of CONUS imposes an undocumented mortality burden that explains a substantial fraction of the higher mortality rates along the Atlantic coast and is equal to roughly 3.2-5.1% of all deaths. These findings suggest that the TC climate, previously thought to be unimportant for broader public health outcomes, is a meaningful underlying driver for the distribution of mortality risk in CONUS, especially among infants (less than 1 year of age), people 1-44 years of age, and the Black population. Understanding why TCs induce this excess mortality is likely to yield substantial health benefits., (© 2024. The Author(s).)

Germinal matrix hemorrhage (GMH) is a devastating neurodevelopmental condition affecting preterm infants, but why blood vessels in this brain region are vulnerable to rupture remains unknown. Here we show that microglia in prenatal mouse and human brain interact with nascent vasculature in an age-dependent manner and that ablation of these cells in mice reduces angiogenesis in the ganglionic eminences, which correspond to the human germinal matrix. Consistent with these findings, single-cell transcriptomics and flow cytometry show that distinct subsets of CD45 + cells from control preterm infants employ diverse signaling mechanisms to promote vascular network formation. In contrast, CD45 + cells from infants with GMH harbor activated neutrophils and monocytes that produce proinflammatory factors, including azurocidin 1, elastase and CXCL16, to disrupt vascular integrity and cause hemorrhage in ganglionic eminences. These results underscore the brain's innate immune cells in region-specific angiogenesis and how aberrant activation of these immune cells promotes GMH in preterm infants., (© 2024. The Author(s).)

Background: Given the importance of infancy for establishing growth trajectories, with later-life health consequences, we investigated longitudinal body composition among infants from six economically and ethnically diverse countries., Methods: We recruited mother-infant dyads using the WHO Multicenter Growth Reference Study criteria. We measured fat-free mass (FFM) in 1393 (49% female) infants from birth to 6 months of age (Australia, India, and South Africa; n = 468), 3-24 months of age (Brazil, Pakistan, South Africa, and Sri Lanka; n = 925), and derived fat mass (FM), fat mass index (FMI), and fat-free mass index (FFMI). Height-for-age (HAZ), weight-for-age (WAZ), and weight-for-length (WHZ) Z-scores were computed. Sex differences were assessed using a t-test, and country differences using a one-way analysis of covariance. We further compared subsamples of children with average (-0.25 > HAZ < +0.25), below-average (≤-0.25) and above-average (≥+0.25) HAZ., Results: HAZ performed well between 0 and 6 months, but less so between 3 and 24 months. The stunting prevalence peaked at 10.3% for boys and 7.8% for girls, at 24 months. By 24 months, girls had greater FMI (10%) than boys. There were significant differences in FFM (both sexes in all countries) and FM (Brazilian boys, Pakistani and South African girls) by 24 months of age between infants with average, above-average, and below-average HAZ., Conclusion: In a multi-country sample representing more ideal maternal conditions, body composition was heterogeneous even among infants who exhibited ideal length. Having a mean HAZ close to the median of the WHO standard for length reduced FFM between-country heterogeneity but not FM, suggesting that other factors may influence adiposity., (© 2024. The Author(s).)

Introduction: Neonates in a NICU experience pain. Based on the cardiovascular and nociceptive systems link, a Newborn Infant Parasympathetic Evaluation (NIPE) monitor was designed to assess pain. The use of α 2 -agonists as analgesic-sedative drugs has increased in neonates. Given their effect on the autonomic system, we hypothesized that their use may alter NIPE's measurement capacity., Methods: Data were prospectively collected. The included patients were evaluated using combined pain assessment systems., Results: Sixteen newborns requiring sedoanalgesia underwent a total of 84 pain assessments. A good correlation was found between the NIPE-index and the COMFORT-neo and the crSO2 (cerebral regional oxygen saturation). No correlation was found in premature infants. By sedation group, the correlation remained in those receiving α 2- agonist., Conclusion: NIPE is a reliable tool for pain assessment. Further studies in premature infants are needed. The use of α 2- agonist does not alter the measuring capacity of NIPE. The correlation between NIPE-index and crSO2 was also demonstrated., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: To determine whether random cortisol levels obtained in neonates to assess for secondary adrenal insufficiency (AI) after prolonged steroid exposure are predictive of central AI., Study Design: Data were collected on neonates born 2017-2022 who received ≥10 consecutive days of systemic steroids and had cortisol measured thereafter. Data were then collected on whether those neonates developed signs of AI or had a failed adrenocorticotropic hormone (ACTH) stimulation test., Results: Of the 71 cortisol levels (in 67 neonates) that were analyzed, there was no difference in cortisol levels between neonates who developed AI (median cortisol level of 6.5 mcg/dl) and those who did not (median of 9.2 mcg/dl), or between those who failed their ACTH stimulation test or passed it, using Wilcoxon ranked sum tests., Conclusion: These findings demonstrate that cortisol levels may not be helpful in identifying AI in neonates exposed to prolonged steroids., (© 2024. The Author(s).)

Objectives: We prospectively compared cerebral oxygen saturation (CrSO2) and pain score changes during procedures in late preterm (LPT) versus term infants., Methods: Near-infrared spectroscopy, pulse oximetry, Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile-Revised (PIPP-R) scores were assessed and CrSO2 data analyzed., Results: Thirty infants in each group were evaluated. LPT infants displayed a milder significant drop in Minimum post-procedural CrSO2 and smaller Maximum-Minimum post-procedural CrSO2 disparity. CrSO2 minute changes between the groups were non-significant. Moderate correlations were observed in both groups between NIPS and Minimum post-procedural CrSO2, and a moderate correlation was found in the Maximum-Minimum post-procedural CrSO2 difference in LPT infants. No correlation between PIPP-R and CrSO2 values was noted., Conclusion: LPT and term infants demonstrated decreased CrSO2 in response to painful procedures. Correlations between CrSO2 and PIPP-R or NIPS scores were poor to moderate, reflecting the complex nature of these associations relative to gestational age., (© 2024. The Author(s).)

Our objective is to analyse the observations related to intrauterine volvulus and assess how clinical manifestations and treatment strategies impact prognosis. We conducted a comprehensive search on Pubmed and ClinicalTrials.gov from inception to July 2022, using search terms like "intrauterine volvulus" or "foetal volvulus," supplemented by manual scrutiny of reference lists in relevant texts and articles. Our review encompassed 57 case reports/case series, involving 88 cases. The presence of foetal bradycardia during prenatal visits (p = 0.002) and the existence of meconium cyst or pseudocyst (p = 0.038) significantly influence survival rates. Preterm labour occurred more frequently among cases resulting in mortality (54% vs 21%; p = 0.055). Our study's limitations include the inability to access all reported cases and reliance solely on available data. We advocate for vigilant monitoring of foetuses exhibiting signs of intestinal obstruction, and consideration of an emergent caesarean section as a pre-emptive measure before foetal biophysical profile deterioration worsens., (© 2024. The Author(s).)

Objective: To investigate the effects of breast milk on cortical pain response and behavioral response in newborns during heel-prick procedure., Study Design: A prospective, randomized controlled trial was conducted on healty-term newborns, undergoing heel blood sampling. Infants were randomly assigned to study group with receive orally 2 ml breast milk (n = 45) or a control group with no intervention (n = 45). A near-infrared spectroscopy device was used to monitor regional cerebral oxygen saturation (rScO 2 ), while neonatal pain expression was assessed by Neonatal Pain, Agitation, and Sedation Scale (N-PASS)., Results: The N-PASS score (p = 0.001) and the crying time (p = 0.017) were significantly lower in the study group compared to the control group. Although the mean rScO 2 values decreased in both groups during the procedure, the percent change in rScO 2 was not significant difference between two groups., Conclusion: Breast milk administration decreases behavioral responses to a noxious stimulus without reducing the cortical response to pain., Clinical Trial Registration: This trial was registered under ClinicalTrials.gov identifier no. NCT05961904., (© 2024. The Author(s).)

Objectives: The impact of exclusive human milk diet (EHMD) on postnatal growth remains controversial. This study aims to investigate the association between EHMD and short-term growth., Methods: This multicenter retrospective study aims to compare growth between the EHMD and non-EHMD groups among infants <32 weeks of gestation. Primary outcomes include weight, length, and head circumference growth trajectories between birth and 34 weeks postmenstrual age. Sensitivity and subgroup analyses were performed., Results: An EHMD was independently associated with poorer length growth, especially in infants born at ≥28 weeks' gestation or those exposed to hypertensive disorders of pregnancy. While initiating fortification at <26 kcal/oz on an EHMD showed inferior growth, initiating fortification at ≥26 kcal/oz was associated with improved weight growth, and similar length and head circumference growth when compared to the non-EHMD group., Conclusions: An EHMD with initial fortification at ≥26 kcal/oz may be implemented to avoid bovine milk exposure while sustaining comparable growth., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: To explore the association between antenatal magnesium sulfate (MgSO 4 ), mortality and incidence of intraventricular hemorrhage (IVH) in very low birth weight (VLBW) infants., Study Design: Retrospective, cohort study of infants <32 weeks' GA born at centers of NEOCOSUR Network between January 2015 and December 2020. Subjects were categorized as exposed vs non-exposed to antenatal MgSO 4 . Primary outcomes were death, incidence of severe IVH (Grade III-IV) and severe IVH/death. Secondary outcomes included relevant morbidities., Results: 7418 VLBW infants were eligible. Antenatal MgSO 4 was associated with a significantly decreased death rate after admission (aOR 0.67 [95% CI, 0.49-0.94]) and severe IVH/ death (aOR 0.68 [95% CI, 0.50-0.93]). No significant reduction in severe IVH was observed (aOR 1.11 [95% CI, 0.72-1.71]). No differences between groups were observed in rates of morbidities., Conclusion: Antenatal MgSO 4 was associated with a decreased death rate after admission and in severe IVH/ death., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: Couplet care is an innovative approach to provide postpartum care in the neonatal intensive care unit (NICU) with little known about its impact on infant feeding outcomes and maternal stress., Study Design: We compared breastfeeding outcomes and maternal NICU-related stress among mother-infant dyads based on exposure to couplet care in a prospective cohort study., Result: Among 19 couplet-care exposed (CCE) dyads and 19 traditional postpartum care dyads, CCE mothers had lower self-reported stress related to parent-infant relationship as compared to traditional care (P < 0.001). CCE infants received relatively more feeds at the breast (P < 0.001), more breastmilk feeds (P = 0.002), and fewer feeds by staff (P < 0.001). Adjusted for gestational age, marital status, and infant length of stay, couplet care was associated with being in a higher tertile of percent breastmilk feeds (aOR 7.29, 95% CI 1.45-36.65)., Conclusion: NICU couplet care was associated with improved parental stress and breastfeeding outcomes during hospitalization., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: Evaluate the impact of 40% oral dextrose gel (DG) for management of neonatal hypoglycemia (NH) on the incidence of multiple hypoglycemic events in the well-baby nursery., Study Design: A retrospective chart review of 738 at-risk infants in 2 cohorts before (Cohort 1) and after (Cohort 2) DG implementation. Primary outcome was the incidence of ≥2 hypoglycemic episodes. Secondary outcomes were number of lowest median glucose level, and incidence of NICU admission., Results: There were 384 and 354 at-risk newborns in Cohorts 1 & 2. The incidence of developing ≥2 hypoglycemia episodes significantly decreased following DG implementation [62(42.5%) vs 29(25.9%), p = 0.0058]. There were no differences in lowest glucose level [37 (14-45) vs 37 (10-45), p = 0.31], and NICU admission rate [31 (21.2%) vs 21 (18.8%), p = 0.62]., Conclusions: Implementation of DG lowers the incidence of subsequent hypoglycemia episodes., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: Double-blind randomized control trial of early addition of a bovine milk-derived human milk fortifier (HMF) in very low birth weight (VLBW) infants (NCT05228535)., Methods: VLBW infants were randomized to receive bovine milk-derived HMF with first feedings or delayed fortification at 80 ml/kg/day. Anthropometrics were assessed weekly through 36 weeks postmenstrual age (PMA). Unadjusted and adjusted (race, gender, gestational age, and birth weight) differences between study arms were examined using two-sample t-test and ANCOVA, respectively., Results: Fifty-two VLBW infants (57% female, 60% Black) were enrolled. Baseline demographics did not differ between groups. Weight velocity at DOL 28 did not differ between study arms. Secondary outcomes including NPO occurrence, incidence of metabolic acidosis, NEC, retinopathy, or late-onset sepsis did not differ between groups., Conclusion: Immediate fortification of enteral feedings with a bovine milk-derived HMF appears safe and well-tolerated although no clear growth benefit could be established., (© 2024. The Author(s).)

Objective: To describe the Bayley Scales of Infant Development 3rd Edition (Bayley-III) of infants discharged home receiving tube feeds., Study Design: Retrospective review of infants discharged with nasogastric or gastrostomy tube feeds and completed a Bayley-III assessment at 2-3-years of age through a neonatal follow-up program. Results were reported using descriptive statistics., Results: Of infants discharged with nasogastric feeds, median Bayley-III scores were in the low-average to average range, and full oral feeds were achieved in 75%. Of infants discharged with gastrostomy tube feeds, median Bayley-III scores were in the extremely low range, and full oral feeds were achieved in 36%. Our data set did not demonstrate a distinct patient demographic that correlated to the type of feeding tube at discharge., Conclusion: Neurodevelopmental outcome at 2-3 years does not appear to be negatively impacted by the decision to discharge an infant from the NICU with home NG feedings., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Necrotizing enterocolitis (NEC) continues to be a leading cause of morbidity and mortality in preterm infants. As modern medicine significantly improves the survival of extremely premature infants, the persistence of NEC underscores our limited understanding of its pathogenesis. Due to early delivery, a preterm infant's exposure to amniotic fluid (AF) is abruptly truncated. Replete with bioactive molecules, AF plays an important role in fetal intestinal maturation and preparation for contact with the environment, thus its absence during development of the intestine may contribute to increased susceptibility to NEC. Human milk (HM), particularly during the initial phases of lactation, is a cornerstone of neonatal intestinal defense. The concentrations and activities of several bioactive factors in HM parallel those of AF, suggesting continuity of protection. In this review, we discuss the predominant overlapping bioactive components of HM and AF, with an emphasis on those associated with intestinal growth or reduction of NEC., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: The aim of this study was to determine the effect of breastfeeding training given with virtual reality (VR) to postpartum mothers after cesarean section delivery on breastfeeding success and breastfeeding self-efficacy., Study Design: The research was designed as a prospective randomized controlled study. In total, 66 women were included in the study, with 31 in the control group and 35 in the intervention group. The study included mothers who had no vision or hearing impairments and no neurological disorder, who had received breastfeeding counseling during pregnancy, and who had given birth by cesarean delivery to a healthy baby. The control group received standard breastfeeding training while the intervention group watched a breastfeeding video with VR in the 4th and 24th hours after cesarean delivery. Research data were collected with the sociodemographic information form, LATCH Breastfeeding Charting System and Documentation Tool and the Breastfeeding Self-Efficacy Scale., Results: As a result of the research, the women in the intervention group were found to have higher mean scores for the Breastfeeding Self-Efficacy Scale in the 4th and 24th hours compared to the control group. Mean LATCH scores were also higher in the intervention group compared to the control group. There were linear correlations between the Breastfeeding Self-Efficacy Scale scores and LATCH Scale scores., Conclusion: Breastfeeding self-efficacy and breastfeeding success of mothers who received breastfeeding training with VR at 4th and 24th hours after cesarean delivery were higher than mothers who received standard breastfeeding training., Clinical Trials Number: NCT06256822., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: Preterm infants need enrichment of human milk (HM) for optimal growth. This study evaluated a novel, point-of-care human milk concentration (HMC) process for water removal from fresh HM samples by passive osmotic concentration., Study Design: Nineteen fresh HM samples were concentrated by incubation with the HMC devices for 3 h at 4 °C. Pre- and post-concentration HM samples were compared by HM properties for: pH, osmolality, macronutrients, enzyme activity, bioactive, and total cell viability., Results: Passive osmotic concentration reduced HM volume by an average of 16.3% ± 3.8% without a significant effect on pH or cell viability. Ten of the 41 HM components did not differ significantly (p > 0.05) between pre- and post-concentration samples. Twenty-three increased within the expected range by volume reduction. Six increased more than expected, two less than expected, and none decreased significantly., Conclusion: Passive osmotic concentration of fresh HM can concentrate HM components by selective removal of water. HM osmolality and pH remained within neonatal feeding parameters., (© 2024. The Author(s).)

Objective: To investigate the relationship between insulin-like growth factor 1 (IGF-1), insulin-like growth factor binding protein 3 (IGFBP-3) and long-term growth, body composition, and neurodevelopment in preterm infants., Study Design: Prospective data were collected from ≤32 weeks gestational age infant cohort (N = 50). IGF-1 and IGFBP-3 concentrations were measured at 1 week (early) and 35 weeks (late) post-menstrual age (PMA). Growth, body composition, and neurodevelopment outcomes were measured at 4 and 12 months PMA. Relationships were measured by linear regression analysis., Results: Early IGFBP-3 concentration was positively associated with neurodevelopment at 12 months PMA. Early IGF-1 concentration was positively associated with weight at 4 months PMA, head circumference at 12 months PMA, and body mass index at 12 months PMA. Late IGFBP-3 concentration was positively associated with weight at 4 months PMA., Conclusion: Further investigation of these associations may lead to novel biomarkers and/or treatments to optimize health outcomes in preterm infants., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: To compare the time to oral feeds in infants born to mothers with and without diabetes., Study Design: Retrospective study of infants born at or after 34 weeks gestational age and admitted between 1/1/2020 to 01/31/2022. Time to full oral feedings was compared between infants born to mothers with and without diabetes (267 versus 918) Continuous and binomial variables were analyzed with the Mann Whitney U test and the Chi-Square test respectively. Linear regression was then conducted to explore identified potential relationships from these analyses., Result: Comparison of groups via univariate analysis revealed a mean difference of two more days to establish full oral feedings (p = 0.0001). Maternal pregestational diabetes (PGDM) and obesity (Body mass index; BMI > 30 kg/m 2 ) were associated with longer time for infants to complete oral feeds (p 0.034 and 0.013 respectively)., Conclusion: Infants born to mothers with diabetes took longer to achieve full oral feedings., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: Intraventricular hemorrhage (IVH) is a common cause of preterm brain injury. Fresh parent's own milk (POM) contains pluripotent stem cells (SCs) that produce neuronal cells in-vitro. The permeable neonatal blood brain barrier potentially allows SC delivery. We performed the first prospective trial (clinicaltrials.gov NCT04225286) of feasibility of intranasal POM (IPOM) in preterm infants with IVH and described SC content of POM samples., Study Design: 37 Infants (mean gestation 27.7 ± 2.6 weeks, birthweight 1030 ± 320 g) with IVH (35.1% grade IV) were recruited from two tertiary Toronto NICUs. IPOM was given ideally twice daily until 28 days of age. Tolerance and adverse reactions were collected and 162 administering providers surveyed., Results: There were no major adverse reactions. Provider surveys suggested acceptability, although potential provider and subject stress requires further study. Milk cell analysis suggests wide variability between parents., Conclusions: This phase 1 study demonstrated IPOM was tolerated and feasible in preterm infants., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Objective: Reflecting disparities across the US, in 2015 publicly insured patients of the NorthShore Community Health Center (NSCHC) in Evanston, Illinois had lower breastfeeding rates than commercially insured patients. We used the Replicating Effective Programs framework to describe the design and implementation of a clinically-integrated breastfeeding peer counseling (ci-BPC) program to address these disparities., Study Design: Patient focus groups and surveys informed program design, and a multidisciplinary clinical support team developed workflows that integrated the breastfeeding peer counselor (BPC) into the clinic and the postpartum unit., Results: ci-BPC improved breastfeeding intensity and duration by providing every NSCHC patient with (1) prenatal lactation education; (2) hands on lactation care in the hospital; and (3) on-demand postpartum support. Total cost per patient was $297-386. The program was sustained after demonstrating potential cost-savings., Conclusion: An evidence-based, multidisciplinary collaboration resulted in a sustainable clinically integrated breastfeeding peer counseling program that improved breastfeeding outcomes., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Background/objective: Available evidence on infant body composition is limited. This study aimed to investigate factors associated with body composition at 6 and 24 months., Subjects/methods: Multicenter study with data from a 0 to 6-mo cohort (Australia, India and South Africa) and a 3 to 24-mo cohort (Brazil, Pakistan, South Africa, and Sri Lanka). For the 0-6-mo cohort, body composition was assessed by air-displacement plethysmography (ADP) and for the 3-24-month cohort by the deuterium dilution (DD) technique. Fat mass (FM), fat-free mass (FFM), FM index (FMI), and FFM index (FFMI) were calculated. Independent variables comprised the Gini index of the country, maternal and infant characteristics, and breastfeeding pattern at 3 months. For the 3-24-mo cohort, breastfeeding, and minimum dietary diversity (MDD) at 12 months were also included. Crude and adjusted analyses stratified by sex were conducted by multilevel modelling using mixed models., Results: At 6 months, every 1 kg increase in birth weight was associated with an increase of 0.716 kg in FFM and 0.582 kg/m 2 in FFMI in girls, whereas in boys, the increase was of 0.277 kg in FFM. At 24 months, compared to those weaned before 12 months, girls still breastfed at 12 months presented a decrease of 0.225 kg in FM, 0.645 kg in FFM and 0.459 kg/m 2 in FFMI, and in boys the decreases were of 0.467 kg in FM, 0.603 kg in FFM and 0.628 kg/m 2 in FFMI., Conclusion: Birth weight and breastfeeding are independent predictors of body composition in early life, irrespective of sex., (© 2023. The Author(s).)

Objective: We examined associations between fat free mass (FFM) and fat mass (FM) accretion during the first 1000 days of life and neurodevelopment in term-born, low-risk infants from Karachi, Pakistan., Design: Prospective, observational study nested within the larger Multi-Center Body Composition Reference Study. FFM, FM, and fat% were estimated using measured deuterium dilution method. Neurodevelopmental outcomes were assessed at 24 months on the INTER-NDA (INTERGROWTH-21st Project Neurodevelopment Assessment) (n = 132)., Results: Children with gross motor delays had significantly lower FFM at 18 months (8.01 ± 0.97 kg vs. 7.55 ± 0.20 kg). Children with positive and negative behavior problems had significantly higher fat% at 24 months (20.62 ± 4.30% vs. 18.23 ± 5.46%) and 20.89 ± 4.24% vs. 18.54 ± 5.38%). No associations remained significant after adjusting for covariates. Trajectory modeling showed that between 12 and 18 months, negative behavior scores changed by 13.8 points for every standard deviation change in fat accretion., Conclusions: Our findings highlight the importance of balancing neurodevelopment and metabolic risk when designing nutritional interventions for young children., (© 2023. The Author(s).)

Background: Failure to reach full oral feeding remains a significant barrier for premature infants to discharge home. Postmenstrual age (PMA) at first oral feeding is significantly associated with the length of hospital stay (LOS)., Methods: Single-center QI to introduce oral feeding to infants on high-flow nasal cannula (HFNC) by reducing the flow to 2 L during feeds., Global Aim: To reduce PMA at first oral feeding and reduce the LOS., Smart Aim: To introduce oral feeds in 40% of infants who are on ≤4 L HFNC by the end of 12 months., Results: Over 12 months, SMART aim reached with 100% enrollment. PMA at first oral feeding decreased from a median of 42.4w ((IQR) (40,46.6) to 37.8w (35.8,43.2), PMA at discharge decreased from 47w (44.6,50.7) to 42.6w (41.3,48.8)., Conclusion: Allowing oral feeding in infants while on HFNC is feasible. This approach can significantly reduce PMA at first and full oral feeding., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Providing all infants with the best start to life is a universal but challenging goal for the global community. Historically, the size and shape of infants, quantified by anthropometry and commencing with birthweight, has been the common yardstick for physical growth and development. Anthropometry has long been considered a proxy for nutritional status during infancy when, under ideal circumstances, changes in size and shape are most rapid. Developed from data collected in the Multicentre Growth Reference Study (MGRS), WHO Child Growth Standards for healthy infants and children have been widely accepted and progressively adopted. In contrast, and somewhat surprisingly, much less is understood about the 'quality' of growth as reflected by body composition during infancy. Recent advances in body composition assessment, including the more widespread use of air displacement plethysmography (ADP) across the first months of life, have contributed to a progressive increase in our knowledge and understanding of growth and development. Along with stable isotope approaches, most commonly the deuterium dilution (DD) technique, the criterion measure of total body water (TBW), our ability to quantify lean and fat tissue using a two-compartment model, has been greatly enhanced. However, until now, global reference charts for the body composition of healthy infants have been lacking. This paper details some of the historical challenges associated with the assessment of body composition across the first two years of life, and references the logical next steps in growth assessments, including reference charts., (© 2023. The Author(s).)

Background: We aimed to systematically review articles that reported selenium (Se) concentrations in human milk (HM)., Methods: using PRISMA guidelines we searched MEDLINE and Embase using the terms "human milk and Selenium". All clinical trials and systematic reviews were retrieved., Results: Out of 1141 articles, we reviewed 76 full-text articles, excluding 26. Thus, 50 articles were included in meta-analyses. Most studies (N = 31) did not specify whether milk was from mothers of preterm (PT) or fullterm (T) infants. In the other 19 studies, 1 examined PT-EHM, 15 T-EHM, and 3 both PT-EHM and T-EHM. In most studies, Se concentrations were highest in colostrum or until 3 months of lactation, then declined. Metaanalyzed means of PT-EHM or T-EHM provide estimates of Se intake a little higher than those reported to date, but still lower than current recommendations of intake., Conclusion: This study provides clinicians with useful estimates of Se intake in breast-fed infants., (© 2024. The Author(s).)

Objective: Pumping studies in mothers of preterm infants are limited by self-reported pumping behaviors and non-objective measures of pumped milk volume and secretory activation (SA)., Methods: Non-randomized observational study of first 14 days postpartum in 29 mothers of preterm infants. Smart pumps measured and stored pumping behaviors and pumped milk volume. Selective ion electrodes measured sodium and sodium:potassium ratio to determine SA. Generalized estimating equations, cluster analyses and multivariate regression were used., Results: SA was delayed (median 5.8 days) and impermanent. Each additional daily pumping increased odds of SA within 2 days by 48% (p = 0.01). High-intensity pumping mothers (N = 17) had greater daily and cumulative pumped milk volume than low-intensity pumping mothers (N = 12). Pumping variables showed daily changes in the first week, then plateaued., Conclusion: The first week postpartum is critical for optimizing pumping behaviors. Accurate, objective measures of pumping behaviors, pumped milk volume and SA are a research priority., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Primary ciliary dyskinesia (PCD) is a rare, motile ciliopathy inherited through mostly autosomal recessive variants that results in chronic ear, sinus, and respiratory disease. Despite neonatal respiratory distress being a common presenting symptom in term infants with PCD, the diagnosis is often delayed due to non-familiarity of neonatal caregivers with phenotypic and diagnostic features of this disease. Organ laterality defects, prenatal cerebral ventriculomegaly, and a family history of suppurative respiratory disease may occur in PCD and should prompt neonatal testing for this condition. In this review of neonatal PCD diagnoses in a large PCD clinic, prevalence and details of neonatal PCD issues are presented, highlighting the typically delayed onset of neonatal respiratory distress and lobar atelectasis on chest radiography, specific presentations in premature neonates, and responses to perinatal therapies., (© 2024. Crown.)

In clinical nursing, neonatal pain assessment is a challenging task for preventing and controlling the impact of pain on neonatal development. To reduce the adverse effects of repetitive painful treatments during hospitalization on newborns, we propose a novel method (namely pain concept-cognitive computing model, PainC3M) for evaluating facial pain in newborns. In the fusion system, we first improve the attention mechanism of vision transformer by revising the node encoding way, considering the spatial structure, edge and centrality of nodes, and then use its corresponding encoder as a feature extractor to comprehensively extract image features. Second, we introduce a concept-cognitive computing model as a classifier to evaluate the level of pain. Finally, we evaluate our PainC3M on various open pain data sets and a real clinical pain data stream, and the experimental results demonstrate that our PainC3M is very effective for dynamic classification and superior to other comparative models. It also provides a good approach for pain assessment of individuals with aphasia (or dementia)., (© 2024. The Author(s).)

Pediatric skulls change rapidly in size and shape during development, especially for children up to 8 years of age. This project was developed to address the gap in understanding of the three-dimensional growth parameters of the human skull during this period and the impact these growth patterns have on fontanelle closure and suture formation. This study offers novel data on the dynamic changes in the anatomy of the skull with the intention of providing better guidance for pediatric surgical care. Craniometric landmarks defined on three-dimensional computed tomography reconstructions were used to map skull development in children aged 0 to 8 years old. A total of 364 datasets were analyzed and statistically representative 3D skulls with anatomical craniometric features such as head shape, bone size, suture and fontanelle closure time were generated for 17 age groups spanning birth to 8 years of age to provide a comprehensive neuroanatomical understanding of how the pediatric skull changes over time. This study indicates that the cranial bones follow a non-linear growth pattern, with the occipital and frontal bones driving the directionality of fontanelle closure and delivers a 3D visualization of the developmental characteristics of the skull providing a landmark resource for understanding the growth dynamics of the human skull. While clinical measurements remain valid approaches for the planning of surgical interventions, these 3D models may provide a more accurate planning paradigm., (© 2024. The Author(s).)

The aim of this work is the prediction of heat-related mortality for Germany under future, i.e. hotter, climate conditions. The prediction is made based on 2m temperature data from climate storyline simulations using machine learning techniques. We use an echo state network for linking the outputs of storyline climate simulations to the target data. The target data are all-cause mortality rates of Germany for all ages. The network is trained with present day climate model outputs. Model outputs of future, i.e. 2K and 4K warmer, storylines are used to predict mortality rates under such climatic conditions. We find that we can train an echo state network with recent temperature data and mortality and make plausible predictions about expected developments of mortality in Germany based on future climate storylines. The trained network can successfully predict mortality rates for future climate conditions. We find increased mortality during the summer months which is attributed to the presence of more severe heat waves. The mortality decrease found during winter can be explained milder winters leading to fewer deaths caused by respiratory diseases. However, mortality in winter is largely influenced by other factors such as influenza waves or vaccination rate and explainability due to temperature is limited., (© 2024. The Author(s).)

Retinopathy of Prematurity (ROP) is a critical eye disorder affecting premature infants, characterized by abnormal blood vessel development in the retina. Plus Disease, indicating severe ROP progression, plays a pivotal role in diagnosis. Recent advancements in Artificial Intelligence (AI) have shown parity with or surpass human experts in ROP detection, especially Plus Disease. However, the success of AI systems depends on high-quality datasets, emphasizing the need for collaboration and data sharing among researchers. To address this challenge, the paper introduces a new public dataset, FARFUM-RoP (Farabi and Ferdowsi University of Mashhad's ROP dataset), comprising 1533 ROP fundus images from 68 patients, annotated independently by five experienced childhood ophthalmologists as "Normal," "Pre-Plus," or "Plus." Ethical principles and consent were meticulously followed during data collection. The paper presents the dataset structure, patient details, and expert labels., (© 2024. The Author(s).)

Establishing normal values of left atrial (LA) phasic strains and strain rates is essential for distinguishing between normal and abnormal functions, determining the degree of abnormality, and understanding the clinical significance of reported values in pediatrics. This meta-analysis aimed to establish normal values of two-dimensional speckle-tracking echocardiography (2DSTE)-derived LA phasic strains and strain rates in the pediatric population and identify the sources of inter-study heterogeneity for these values. A comprehensive search of PubMed, Scopus, and Embase databases was conducted using keywords such as "left atrial/left atrium," "strain/speckle/deformation," and "echocardiography" combined with pediatric age categories. Inclusion criteria comprised English-language human studies involving healthy subjects under 18 years of age. Subjects were categorized as neonates (up to 1 month), infants (1-12 months), and children (1-18 years). A random-effects model was applied to determine 2DSTE-derived LA strains and strain rates, and a meta-regression analysis was performed to investigate inter-study heterogeneity. Our analysis included 17 studies involving 1448 healthy subjects. For children, the mean values of LA strains during the reservoir, conduit, and contraction phases were 47.3% (95% CI 42.5-52.1%), 32.8% (95% CI 27.8-37.8%), and 12% (95% CI 10.0-14.1%), respectively. The mean values for LA strain rates were 2.4 s -1 (95% CI 1.1-3.8 s -1 ), 4.3 s -1 (95% CI 0.6-8.0 s -1 ), and 2.4 s -1 (95% CI 0.4-4.5 s -1 ), respectively. Inter-study heterogeneity for 2DSTE-derived LA phasic strains and strain rates was attributed to factors such as the number of study participants, publication year, software utilized, gating methods, the number of analyzed segments, the geographical region of the study, and heart rate. This study established the normal range of 2DSTE-derived LA phasic strains and strain rates. Additionally, inter-study heterogeneity was found to be influenced by various demographic, physiologic, and methodological factors., (© 2024. The Author(s).)