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Abstract Background Extant obesity efforts have had a limited impact among low-income underserved children, in part because existing programs are limited in terms of their short duration and low dosage, limited accessibility and sustainability; and failure to address barriers faced by diverse low-income families. Methods This two-arm, parallel, randomized controlled trial (RCT) tests whether delivering obesity prevention, as part of an ongoing home visitation program (HVP), is an effective approach for primary (infants) and secondary (mothers) obesity prevention among low-income, underserved families. This RCT further examines the role of maternal and social factors as key mechanisms of transmission of infants' obesity risk, and the real-life costs of delivering obesity prevention as part of HVPs. Specifically, 300 low-income mothers/infants (6mo at baseline) participating in the Healthy Families America home visitation program in Antelope Valley (CA) will be recruited and enrolled in the study. Home visitors serving families will be randomly assigned to deliver the standard HVP curriculum with or without obesity prevention as part of their weekly home visits for two years. Anthropometric, metabolic and behavioral assessments of mothers/infants will be conducted at enrollment and after 6 and 18 months of intervention. Discussion This study addresses the need to develop interventions targeting at-risk infants before they become obese. The proposed research is timely as the Institute of Medicine, the United States Department of Agriculture, and the Department of Health and Human Services are revising their recommendations to address key factors influencing obesity risk in children from birth to 24 months of age. [ABSTRACT FROM AUTHOR]

Several studies have demonstrated the effect of probiotics on prevention of diseases in infants. However, the mechanisms remain not fully addressed. In the present study a modified standard ileal efflux medium (SIEM) was exploited in an in vitro analysis and the effect of Lactobacillus plantarum ST-III on the composition of infant gut microbiota was examined in I-chip analysis followed by qPCR confirmation. Also, the effect of ST-III, when administered in combination with breast milk and infant formula, was investigated. The results showed that ST-III could reduce the overall amount of Enterobacteria and Bacteroidetes bacteria, yet increase the abundance of Lactobacillus and certain Bifidobacterium species. Notably, some species/genus of bacteria of medical significance, e.g., Alcaligenaceae sutterella and Desulfovibrio bacteria were inhibited by ST-III. Moreover, co-administration of breast milk or infant formula could increase the abundance of ST-III, suggesting a synergistic effect between ST-III and infant formula and breast milk. [ABSTRACT FROM AUTHOR]

Enterococcus faecium WEFA23 is a potential probiotic strain from Chinese infants with the ability to decrease cholesterol levels. Aiming to explore the mechanism of E. faecium WEFA23 in lowering cholesterol in vivo, we examined the gene transcriptions related to cholesterol metabolism, the composition of bile acids in feces, the synthesis of trimethylamine N-oxide (TMAO) in liver, and the composition of the gut microbiota of rats. We found that E. faecium WEFA23 enhanced the synthesis of bile acids by promoting cholesterol excretion, upregulating the genes transcript level relevant to cholesterol decomposition and transportation, and downregulating the genes involved in cholesterol synthesis. In addition, E. faecium WEFA23 not only downregulated the transcript levels of farnesoid X receptor and fibroblast growth factor 15 as well as flavin-containing monooxygenase 3, but also decreased the TMAO production followed by increasing the CYP7A1 transcript level. Furthermore, when orally administered to rats for 35 d, E. faecium WEFA23 improved the gut microbiota diversity of rats fed a high-fat diet. Therein, the ratio of Bacteroidetes to Firmicutes and the abundance of Rikenellaceae increased, whereas the number of Veillonellaceae decreased. These results suggest that reduction of cholesterol level by E. faecium WEFA23 might be related to the changes in the gut microbiota. Our finding provides important information on lowering cholesterol by E. faecium and reveals that Enterococcus spp. might have the potential to decrease the TMAO level. [ABSTRACT FROM AUTHOR]

The article reports that the British Society for Allergy & Clinical Immunology (BSACI) has published guidance for healthcare professionals of Great Britain to prevent food allergy in higher risk infants. Also discussed are suggestions for introducing potential allergenic foods into the infant diet reducing food allergy risks and an accompanying information sheet for parents.

A review of the conundrum called mild hypoxic-ischemic encephalopathy (HIE) is provided. During the past decades, the definition of HIE has evolved to accommodate the short window of time required for the initiation of therapeutic hypothermia. Also, neurological evaluations have changed with the use of simpler staging systems that can be applied within the first 6 h of life. In this review, we discuss the challenges in the identification of newborns with "mild HIE" within 6 h after birth, the limitations in the existing early biomarkers of brain injury, and the current knowledge gaps in the long term neurodevelopmental outcomes of infants diagnosed with mild HIE. Progress in the understanding of mild HIE and its sequelae continues to be hindered by the lack of a standardized definition for mild HIE that will reliably identify at-risk infants who may benefit from neuroprotective strategies. [ABSTRACT FROM AUTHOR]

Background: Randomised controlled trials (RCTs) have shown an advantage of continuous subcutaneous insulin infusion (CSII) over multiple daily injections (MDI) in the general type 1 diabetes mellitus (T1DM) population. RCT data on T1DM management in pregnancy remain limited. Objective: We performed a systematic review of both RCTs and non-RCTs evaluating CSII vs MDI in T1DM-complicated pregnancy. Study design: Electronic databases were searched for studies comparing CSII with MDI in T1DM-complicated pregnancy. Methods: A meta-analysis provided point estimates with 95% confidence intervals (CI). Continuous outcomes were reported as weighted mean differences (WMD) or standardised mean differences (SMD), and dichotomous data as relative risk (RR). Results: The search identified 47 studies, including 43 non-RCTs, reporting on 7824 pregnancies. The meta-analysis showed a lower HbA1c level with CSII vs MDI in the first trimester (WMD: -0.45%; 95%CI: -0.62, -0.27). This difference decreased in subsequent trimesters. Compared to MDI, therapy with CSII resulted in higher gestational weight gain (GWG) (WMD: 1.02 kg; 95%CI: 0.41, 1.62), and lower daily insulin dose requirements in the first (SMD: -0.46; 95%CI: -0.68, -0.24) and subsequent trimesters. Moreover, infants from the CSII group were more likely to be large for gestational age (LGA) (RR: 1.16; 95%CI: 1.07, 1.24) and less likely to be small for gestational age (SGA) (RR: 0.66; 95%CI: 0.45; 0.97). Conclusions: In T1DM-complicated pregnancy, CSII compared to MDI therapy resulted in better first trimester glycaemic control; this difference decreased in subsequent trimesters. CSII therapy was associated with lower insulin requirements, higher GWG and altered risk for infants being LGA and SGA. [ABSTRACT FROM AUTHOR]

Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in infancy with a complex pathology. In adults, the clinical severity of AD has been associated with increases in T helper cell type (Th) 2, Th22, and Th17 serum markers, including high levels of CC chemokine ligand (CCL) 17 and CCL22 chemokines. Objective: To explore the possible association between serum chemokine levels and AD severity in infants with moderate-to-severe AD and elevated immunoglobulin E (IgE). subjects and methods: Serum samples (n = 41) obtained from a randomized, double- blind, and clinical dietary intervention study were used to study biomarkers in infants with AD. Baseline- and post-intervention samples (4 months) were used, six chemokines and nine ratios thereof were analyzed using Luminex and correlated to AD severity. In the initial study, the infants were randomized to receive extensively hydrolyzed wheybased formula without (control) or with short-chain galacto-oligosaccharides/long-chain fructo-oligosaccharides (9:1) and Bifidobacterium breve M-16V (active). results: 31 Infants up to 11 months of age, with an objective-SCORAD score (oSCORAD) ≥ 20 and elevated total-IgE and/or specific-IgE levels were included. In time, the median oSCORAD decreased in both groups by -8 (control, p < 0.05; active, p < 0.01). Irrespective of dietary intervention, several changes in Th2 chemokines(CCL17 and CCL22), inflammatory chemokine (CCL20), and the Th1 chemokine, CXC chemokine ligand (CXCL) 9, were detected over time. Overall CCL17 correlated to oSCORAD (r = 0.446, p < 0.01). After 4 months of dietary intervention, CXCL9 was higher (p < 0.01) in the active group compared with control [active, 2.33 (1.99-2.89); controls, 1.95 (1.77-2.43) log 10 median (range)]. In addition, a reduction in Th2/Th1 chemokine ratios for CCL17/CXCL9, CCL22/CXCL9, CCL20/CXCL10, and CCL20/ CXCL11 was detected associated with the active intervention. conclusion: While this study is small and exploratory in nature, these data contribute to immune biomarker profiling and understanding of AD in infants. [ABSTRACT FROM AUTHOR]

Correlates of protection (CoPs) can play a significant role in vaccine development by assisting the selection of vaccine candidates for clinical trials, supporting clinical trial design and implementation, and simplifying tests of vaccine modifications. Because of this important role in vaccine development, it is essential that CoPs be defined by well-designed immunogenicity and efficacy studies, with attention paid to benefits and limitations. The respiratory syncytial virus (RSV) field is unique in that a great deal of information about the humoral response is available from basic research and clinical studies. Polyclonal and monoclonal antibodies have been used routinely in the clinic to protect vulnerable infants from infection, providing a wealth of information about correlations between neutralizing antibodies and disease prevention. Considerations for the establishment of future CoPs to support RSV vaccine development in different populations are therefore discussed. [ABSTRACT FROM AUTHOR]

Introduction: Prevention of parent-to-child transmission (PPTCT) program aims at reduction of HIV transmission through vertical route. Although medical intervention reduces chance of HIV transmission substantially, several demographic factors are often contributory. Minimum literacy is required for HIV-infected individuals to understand the course of medicine and to ensure compliance to the treatment which may have impact on vertical transmission. The objective of this study is to analyze relationship between maternal education and possibility of her babies to get HIV infected. Materials and Methods: A retrospective cohort study was carried out through analysis of secondary data during the period from April 13 to September 16 from all stand-alone integrated counseling and testing centers in West Bengal. A total number of 326 HIV-exposed babies, whose 6th week HIV-Polymerase Chain Reaction (PCR) reports are available and both the mother-baby received PPTCT services, were recruited in the study, and their maternal literacy status was substantiated and analyzed. Results: HIV positivity among HIV-exposed babies was found to be 6.67% whose mothers were illiterate as compared to 5.55% whose mothers were literate up to primary standard and 3.93% whose mothers were educated up to secondary standard. HIV positivity among the exposed babies whose mothers studied higher secondary standard or above showed zero HIV positivity. Chi-square was done to ascertain statistical significance but result was inconclusive although the trend shows increasing chance of HIV-exposed babies to get infected with decreasing literacy. Conclusion: Maternal literacy status favorably influences vertical transmission of HIV. [ABSTRACT FROM AUTHOR]

Lay Summary: Adaptive immune proteins in mothers' milk are more variable than innate immune proteins across populations and subsistence strategies. These results suggest that the immune defenses in milk are shaped by a mother's environment throughout her life. Background and objectives: Mother's milk contains immune proteins that play critical roles in protecting the infant from infection and priming the infant's developing immune system during early life. The composition of these molecules in milk, particularly the acquired immune proteins, is thought to reflect a mother's immunological exposures throughout her life. In this study, we examine the composition of innate and acquired immune proteins in milk across seven populations with diverse disease and cultural ecologies. Methodology: Milk samples (n = 164) were collected in Argentina, Bolivia, Nepal, Namibia, Philippines, Poland and the USA. Populations were classified as having one of four subsistence patterns: urban-industrialism, rural-shop, horticulturalist-forager or agro-pastoralism. Milk innate (lactalbumin, lactoferrin and lysozyme) and acquired (Secretory IgA, IgG and IgM) protein concentrations were determined using triple-quadrupole mass spectrometry. Results: Both innate and acquired immune protein composition in milk varied among populations, though the acquired immune protein composition of milk differed more among populations. Populations living in closer geographic proximity or having similar subsistence strategies (e.g. agropastoralists from Nepal and Namibia) had more similar milk immune protein compositions. Agropastoralists had different milk innate immune protein composition from horticulturalist-foragers and urban-industrialists. Acquired immune protein composition differed among all subsistence strategies except horticulturist-foragers and rural-shop. Conclusions and implications: Our results reveal fundamental variation in milk composition that has not been previously explored in human milk research. Further study is needed to understand what specific aspects of the local environment influence milk composition and the effects this variation may have on infant health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine the factors associated with nutritional rickets among infants in Peshawar and its surrounding. Methods: This descriptive cross-sectional study was conducted at Khyber Teaching Hospital Peshawar, Pakistan among mothers and their infants. Clinical and biochemical examination of all infants were performed. Results: A total of 65 infants were included. There were 42 (65%) infants from urban while 23 (35%) cases from rural areas. Out of 65 cases, 47 (72%) were breast feeding and none of them (0%) benefited by sunlight. Among these 47 breastfed infants, 42 (89%) had lactating mother those were malnourished and only 5 (11%) nutritional rickets were found in breast feeding infants of nourished mother. Radiological abnormalities of rickets were found in 23 (55%) infants of malnourished mother and none in nourished mother. Conclusion: Nutritional Rickets is prevale nt problem among infants and a great risk in those who along with their malnourished mothers are deprived exposure to sun shine. [ABSTRACT FROM AUTHOR]

Gut microbial ecology and function are dynamic in infancy, but are stabilized in childhood. The ‘new friends’ have a great impact on the development of the digestive tract and host immune system. In the first year of life, especially, the gut microbiota dramatically changes through interactions with the developing immune system in the gut. The process of establishing the gut microbiota is affected by various environmental factors, with the potential to be a main determinant of life-long health. In this review, we summarize recent findings regarding gut microbiota establishment, including the importance of various factors related to the development of the immune system and allergic diseases later in life. [ABSTRACT FROM AUTHOR]

Background Maternal immunization against pertussis is a potential strategy to protect young infants from severe disease. We assessed factors associated with intention to accept pertussis vaccination among pregnant women in Karachi, Pakistan. Methods We conducted a cross-sectional survey between May and August 2013 in pregnant women who visited healthcare centers in urban slums of Karachi city. Women completed a survey examining socio-demographic factors, vaccination history, knowledge on pertussis disease, perception of vaccine recommendation sources, and potential influences on vaccine decision-making. Results Of the 283 participants, 259 (92%) provided their intention to either accept or decline pertussis vaccination. Eighty-three percent women were willing to accept the pertussis vaccine if offered during pregnancy. About half (53%) of the participants had ever heard of pertussis disease. Perceptions of pertussis vaccine efficacy, safety, and disease susceptibility were strongly associated with intention to accept pertussis vaccine ( p < 0.01). Healthcare providers, Ministry of Health, and mass media were considered as highly reliable sources of vaccine recommendation and associated with intention to accept antenatal pertussis vaccination ( p < 0.001). Healthcare provider recommendation was a common reason cited by respondents for pregnant women to accept antenatal pertussis vaccination ( p = 0.0005). However, opinion of primary decision-makers in the family (husbands and in-laws) was a crucial reason cited by respondents for pregnant women to reject pertussis vaccination in pregnancy ( p = 0.003). Conclusion Antenatal pertussis vaccination initiatives in South Asia should strongly consider inclusion of family members, healthcare providers, national health ministries, and mass media to help implement new vaccination programs. [ABSTRACT FROM AUTHOR]

The article discusses the development of monoclonal antibody MEDI8897 as a potential respiratory syncytial virus (RSV) prophylaxis for all infants. It mentions that the prevention of RSV illness in all infants is considered as a major public health priority wherein palivizumab is the only approved agent for RSV prophylaxis. It notes that the pharmacokinetics of palivizumab in infants supports the development of MEDI8897 as a cost-effective option to protect all infants from RSV disease.

Background. Pertussis is estimated to cause 2 percent of childhood deaths globally and is a growing public health problem in developed countries despite high vaccination coverage. Infants are at greatest risk of morbidity and mortality. Maternal vaccination during pregnancy may be effective to prevent pertussis in young infants, but population-based estimates of disease burden in infants are lacking, particularly in low-income countries. The objective of this study was to estimate the incidence of pertussis in infants less than 6 months of age in Sarlahi District, Nepal. Methods. Nested within a population-based randomized controlled trial of influenza vaccination during pregnancy, infants were visited weekly from birth through 6 months to assess respiratory illness in the prior week. If any respiratory symptoms had occurred, a nasal swab was collected and tested with a multitarget pertussis polymerase chain reaction (PCR) assay. The prospective cohort study includes infants observed between May 2011 and August 2014. Results. The incidence of PCR-confirmed Bordetella pertussis was 13.3 cases per 1000 infant-years (95% confidence interval, 7.7-21.3) in a cohort of 3483 infants with at least 1 day of follow-up. Conclusions. In a population-based active home surveillance for respiratory illness, a low risk for pertussis was estimated among infants in rural Nepal. Nepal's immunization program, which includes a childhood whole cell pertussis vaccine, may be effective in controlling pertussis in infants. [ABSTRACT FROM AUTHOR]

Cytomegalovirus (CMV) acquisition and inflammation were evaluated in 231 human immunodeficiency virus (HIV)-exposed uninfected (HEU) and 100 HIV-unexposed Zimbabwean infants aged 6 weeks. The HEU and HIV-unexposed infants had a similarly high prevalence of CMV (81.4% vs 74.0%, respectively; P = .14), but HEU infants had higher CMV loads (P = .005) and >2-fold higher C-reactive protein (CRP) concentrations (P < .0001). The CMV-positive HEU infants had higher CRP than the CMV-negative HEU infants; this association disappeared after adjusting for maternal HIV load. Overall, CMV acquisition is high in early life, but HEU infants have higher CMV loads and a proinflammatory milieu, which may be driven partly by maternal HIV viremia. [ABSTRACT FROM AUTHOR]

Background. All US women are recommended to receive a tetanus, diphtheria, and acellular pertussis (Tdap) vaccine at 27-36 weeks gestation during each pregnancy to reduce the risk of pertussis to their infants. The impact of this strategy on severity of disease among infected infants has not been evaluated. Methods. We use a retrospective cohort study design evaluating whether pertussis-infected infants born in 2011-2015 whose mothers received Tdap vaccine during pregnancy had less severe pertussis, resulting in a lower risk of hospitalization or intensive care unit admission compared with infants born to unvaccinated mothers. Results. Infected infants of vaccinated mothers were significantly less likely to be hospitalized and had significantly shorter hospital stays compared with infants born to unvaccinated mothers, after adjustment for chronological and gestational age and receipt of diphtheria and tetanus toxoids and acellular pertussis vaccine. Unadjusted and adjusted vaccine effectiveness for preventing hospitalization among infants with pertussis was 72% (95% confidence interval [CI], 49%-85%) and 58% (95% CI 15%-80%), respectively. No infants born to vaccinated mothers required intubation or died of pertussis. Conclusions. Infants with pertussis whose mothers received Tdap during pregnancy had a significantly lower risk of hospitalization and intensive care unit admission and shorter hospital stays. Prenatal Tdap vaccination is a critical strategy for reducing the morbidity and mortality from pertussis. [ABSTRACT FROM AUTHOR]

Background. Most severe and fatal cases of pertussis occur in infants <8 weeks of age, before initiation of the primary pertussis vaccine series.Women are recommended to receive tetanus, diphtheria, and acellular pertussis (Tdap) vaccine at the start of the third trimester of each pregnancy to optimize transplacental transfer of antibodies to the fetus. This recommendation was made by the Advisory Committee for Immunization Practices based on immunogenicity data, and no studies in the United States have yet evaluated the effectiveness of this strategy in reducing pertussis incidence in infants. Methods. We evaluated a cohort of mothers with documented Tdap vaccination histories in the California Immunization Registry to determine whether infants whose mothers received Tdap vaccine at 27-36 weeks gestation had a lower risk of pertussis at <8 weeks of age than infants born to women who received Tdap vaccine within 14 days post partum. Results. Tdap vaccination received at 27-36 weeks gestation was found to be 85% (95% confidence interval, 33%-98%) more effective than postpartum Tdap vaccination at preventing pertussis in infants <8 weeks of age . Vaccination at 27-36 weeks gestation was more effective at preventing pertussis in infant than vaccination during the second trimester. Conclusions. Tdap vaccination at 27-36 weeks gestation was 85% more effective than postpartum vaccination at preventing pertussis in infants <8 weeks of age. Efforts should be made by prenatal care providers to provide Tdap vaccine to pregnant women during routine prenatal visits at the earliest opportunity between 27 and 36 weeks gestation. [ABSTRACT FROM AUTHOR]

Objective Vaccination of pregnant women against seasonal influenza is recommended in France since 2010. We currently do not have any vaccination coverage (VC) data to assess the implementation of this recommendation. Methods Vaccinoscopie ® is an annual study conducted online using a self-administered questionnaire. A section dedicated to parents’ vaccination was included in 2014 and aimed at interviewing 300 mothers of infants aged < 12 months to assess their opinion of vaccination with regard to their last and future pregnancies. The study also aimed to measure the influenza VC of these mothers during their last pregnancy. Results While 56% of mothers reported to have been informed of the importance of vaccination by a healthcare professional (HCP) during their last pregnancy, only 11% reported having been informed of the importance of influenza vaccination. Overall, 49% of mothers reported willing to be vaccinated during their next pregnancy to protect their baby, if the vaccination were to be recommended by a HCP. However, this rate was only 32% for influenza vaccination. In contrast, 52% of mothers reported willing to be vaccinated against pertussis during pregnancy if the vaccination were to be recommended by a HCP. The influenza VC estimates in pregnant women was 7%. Conclusion Although influenza vaccination has been recommended for all French pregnant women for the past five years, HCPs rarely recommend this vaccination – hence, the low VC. Informing and raising awareness among HCPs seems to be crucial to improve this coverage. [ABSTRACT FROM AUTHOR]

The effectiveness of maternal immunization in preventing infant pertussis was first demonstrated in England, 1 year after the program using diphtheria–tetanus–5-component acellular pertussis–inactivated polio vaccine (dT5aP-IPV) was introduced in 2012. Vaccine effectiveness against laboratory-confirmed pertussis has been sustained >90% in the 3 years following its introduction, despite changing to another acellular vaccine with different antigen composition. Consistent with this, disease incidence in infants <3 months of age has remained low despite high activity persisting in those aged 1 year and older. Vaccine effectiveness against infant deaths was estimated at 95% (95% confidence interval, 79%–100%). Additional protection from maternal immunization is retained in infants who received their first dose of the primary series. There is no longer evidence of additional protection from maternal vaccination after the third infant dose. Although numbers are small and ongoing assessment is required, there is no evidence of increased risk of disease after primary immunization in infants whose mothers received maternal vaccination. [ABSTRACT FROM AUTHOR]

Background. Infants are at greatest risk for severe pertussis. In 2006, the Advisory Committee on Immunization Practices recommended that adolescents and adults, especially those with infant contact, receive a single dose of Tdap (tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine). To assess the effectiveness of cocooning, we conducted a case-control evaluation of infant close contacts. Methods. Pertussis cases aged <2 months with onset between 1 January 2011 and 31 December 2011 were identified in Emerging Infections Program Network sites. For each case, we recruited 3 controls from birth certificates and interviewed identified adult close contacts (CCs) or parents of CCs aged <18 years. Pertussis vaccination was verified through medical providers and/or immunization registries. Results. Forty-two cases were enrolled, with 154 matched controls. Around enrolled infants, 859 CCs were identified (600 adult and 259 nonadult). An average of 5.4 CCs was identified per case and 4.1 CCs per control. Five hundred fifty-four (64.5%) CCs were enrolled (371 adult and 183 non-adult CCs); 119 (32.1% of enrolled) adult CCs had received Tdap. The proportion of Tdap-vaccinated adult CCs was similar between cases and controls (P = .89). The 600 identified adult CCs comprised 172 potential cocoons; 71 (41.3%) potential cocoons had all identified adult CCs enrolled. Of these, 9 were fully vaccinated and 43.7% contained no Tdap-vaccinated adults. The proportion of fully vaccinated case (4.8%) and control (10.0%) cocoons was similar (P = .43). Conclusions. Low Tdap coverage among adult CCs reinforces the difficulty of implementing the cocooning strategy and the importance of vaccination during pregnancy to prevent infant pertussis. [ABSTRACT FROM AUTHOR]

This systematic review to support the 2019 US Preventive Services Task Force Reaffirmation Recommendation Statement on ocular prophylaxis for gonococcal ophthalmia neonatorum summarizes published evidence on the benefits and harms of ocular topical medication to prevent gonococcal conjunctival infection in newborns. [ABSTRACT FROM AUTHOR]

Aim: We previously reported a protective effect of maternal omega-3 fatty acid supplements on the development of immunoglobulin E (IgE)-associated disease in infancy. This study assessed omega-3 long-chain polyunsaturated fatty acids (LCPUFA) in maternal milk in relation to omega-3 LCPUFA supplementation and the development of allergic disease in their infants.Methods: This study randomised 95 pregnant women at risk of having an allergic infant, to daily supplements of 2.6 g omega-3 LCPUFA or a placebo of 2.7 g soya bean oil from gestational week 25 until 3 months of lactation. Breast milk samples were collected as colostrum, at one and 3 months. Milk fatty acids were related to allergic outcome in the infants at 24 months.Results: Omega-3 milk fatty acids were higher in women who received omega-3 supplements than the placebo group (p < 0.01). Higher proportions of milk eicosapentaenoic acid and docosahexaenoic acid and a lower arachidonic/eicosapentaenoic acid ratio were associated with an absence of IgE-associated disease in the infants. None of the children developed IgE-associated atopic eczema above a level of 0.83 mol% eicosapentaenoic acid in colostrum. [Correction added on 7 July 2016, after online publication: In the preceding sentence, the correct word should be "above" instead of "below" and this has been amended in this current version.] CONCLUSION: High omega-3 LCPUFA milk levels in mothers who received omega-3 LCPUFA supplements were related to fewer allergies in their children. [ABSTRACT FROM AUTHOR]

Persons with haemophilia, living with their condition from infancy, require attention from a biopsychosocial approach, in which both the biological and the biographical dimension are addressed. These patients and their environment may benefit greatly from having professionals to help them manage, pre-emptively if possible, to adapt to the disease, cope with the experience of suffering and overcome the difficulties caused by chronicity. The ultimate goal of the interventions was to achieve the best quality of life possible with tailored objectives throughout the patient's life, including disease control, addressing the particular difficulties, and achieving optimal empowerment. This article aims to describe the role of Health Psychology and its professionals in supporting the young patient with haemophilia and provide a brief guide that might be useful for health professionals involved in his care. From the psychological perspective, this paper focuses on communication of diagnosis, the role and support of the family, issues during infancy, childhood and adolescence and how the healthcare team can address them to provide successful support. [ABSTRACT FROM AUTHOR]

Background/Objectives Developmental changes of structures in neonatal and infant skin have not been well characterized. The purpose of this study was to clarify changes in skin structures during neonatal and infant growth in vivo. Methods Fifteen healthy, full-term neonates (seven girls, eight boys) were studied. The measurements were performed 4 to 7 days (neonate) and 1, 3, and 6 months after birth on the buttock, upper thigh, and ventral forearm skin using a confocal laser scanning microscope. Developmental changes in dermoepidermal junction structures, stratum corneum thickness, epidermal thickness, and microvascular development were investigated. Results A significant decrease in stratum corneum thickness was observed over the 3 months after birth. Dermal papillae were not observed in neonatal skin but were observed gradually over the next 3 months. Epidermal thickness, determined from the skin surface to the bottom of the epidermal layer, increased significantly from 4 to 7 days to 1 month of age, indicating the formation of dermal papillae and rete ridges. Complicated microvascular structures were observed in neonatal skin but disappeared gradually and were observed only at the dermal papillae at 3 months of age. Conclusions Our results reveal that infant skin is in a developmental stage structurally up to 3 months of age, paralleling skin functional and developmental maturation. [ABSTRACT FROM AUTHOR]

Background European roundtable meeting recommendations on bathing and cleansing of infants were published in 2009; a second meeting was held to update and expand these recommendations in light of new evidence and the continued need to address uncertainty surrounding this aspect of routine care. Methods The previous roundtable recommendations concerning infant cleansing, bathing, and use of liquid cleansers were critically reviewed and updated and the quality of evidence was evaluated using the Grading of Recommendation Assessment, Development and Evaluation system. New recommendations were developed to provide guidance on diaper care and the use of emollients. A series of recommendations was formulated to characterize the attributes of ideal liquid cleansers, wipes, and emollients. Results Newborn bathing can be performed without harming the infant, provided basic safety procedures are followed. Water alone or appropriately designed liquid cleansers can be used during bathing without impairing the skin maturation process. The diaper area should be kept clean and dry; from birth, the diaper area may be gently cleansed with cotton balls/squares and water or by using appropriately designed wipes. Appropriately formulated emollients can be used to maintain and enhance skin barrier function. Appropriately formulated baby oils can be applied for physiologic (transitory) skin dryness and in small quantities to the bath. Baby products that are left on should be formulated to buffer and maintain babies' skin surface at approximately pH 5.5, and the formulations and their constituent ingredients should have undergone an extensive program of safety testing. Formulations should be effectively preserved; products containing harsh surfactants, such as sodium lauryl sulfate, should be avoided. Conclusion Health care professionals can use these recommendations as the basis of their advice to parents. [ABSTRACT FROM AUTHOR]

Inborn errors of metabolism (IEM) include a large number of genetic disorders caused by lack of functional proteins that result in a blockage of the corresponding metabolic pathway essential for cellular life. IEM are rare or even very rare conditions, whereas with a collective incidence comprised from 1:800 to 1:2,500 live births. Approximately half of all IEM can be treated biochemically, although the success of such treatment is variable. IEM (especially in the neonatal age) may have a rapid evolution to severe and irreversible neurological and mental deficits, coma, and death. Early diagnosis, allowing presymptomatic treatment, can ameliorate prognosis, prevent severe permanent sequelae, and in certain cases avoid death. To ensure accurate diagnosis, effective treatment, and appropriate follow-up, preventive medicine have implemented for IEM screening programs as a powerful tool of secondary prevention. In this respect, expanded newborn screening programs have increased dramatically in the past decade although the number of diseases included in the screening panel varies from state to state. As a consequence, some nations screen for only one or two IEM, some others for several more (up to a few dozen IEM) leading to an inequality of preventive measures in such as delicate fields. Criteria to support and include screening for a specific condition in each country stand from legislation, financial costs prevalence of the disease in that country, availability of treatments, and dedicated funding sources. Currently, lack of sound and complete evidence, as well as different interpretations of the best evidence available, could also be among the factors contributing to the different screening panels across diverse countries worldwide. Within this view, the recommendable approach to assess current newborn screening programs should be based on the methodologies of health technology assessment, taking into account health economics evidence and ethics applied to well-being policies. [ABSTRACT FROM AUTHOR]

Background: Breast feeding is the most natural way of feeding the infants and help to reduce child mortality and morbidity and millions of deaths could be prevented each year if mothers were aware of benefits of exclusive breast feeding for 4 -6 months and early initiation of breast feeding. Objective:To evaluate the awareness regarding breast feeding and complementary feeding in mothers of severely malnourished children. Study Design: This is a descriptive /cross sectional study. Place and duration of study: This study was conducted at the department of preventive pediatrics Children hospital and institute of child health, Multan from March 2013 to September 2013. Materials and Methods:This study included a total of 100 females that were the mothers of malnourished children visiting the follow up room of department of preventive pediatrics Children hospital and institute of child health, Multan. A questionnaire was designed and others were interviewed in detail after taking proper consent. Results:In this study, the mean age of the sample was25years +/_3 years. 70 % females (70/100) were from urban areas while 30 %(30/100) were from rural areas. Of the 100 respondents 54%( 54/100) of mothers were illiterate and this study showed that 99% (99/100) considered breast milk safe and effective than other feeds but practically only 23%(23/100) babies were breast fed while 77%(77/100) were bottle fed. Pre-lacteal feed was given by 82% (82/100). According to 58% (58/100) mothers there should be a early initiation of breast feeding, while 57% (57/100) were un aware of the facts that clostrum should be given while 43 %(43/100)of then considered it unhealthy and non effective,82%(82/100) considered 4 months a period of exclusive breast feeding,61% (61/100) were counseled by doctors regarding the benefits of breast feeding,50%(50/100) were aware of the use of exclusive breast feeding as a contraceptive tool and 34 % (34/100) were aware of its importance for the prevention of breast cancer. Conclusion:The findings of the study indicated the various important policy implications for the intervention of breastfeedig. Strategies to encourage mothers to follow breastfeeding recommendations should concentrate on improving their knowledge. [ABSTRACT FROM AUTHOR]

The article discusses research which examined the guidelines on food allergy prevention. Topics discussed include an overview of changes in rules covering food introduction and allergy in infants and exception of infants with older siblings with peanut allergy on the advice to no longer delay introducing allergenic foods.

Background: A pneumococcal conjugate vaccine (PCV) has been part of the Danish childhood immunization programme since October 2007. It is administered at the ages of 3, 5 and 12 months and healthy infants younger than 90 days are consequently not vaccinated. Initially the PCV-7 vaccine was used but this was replaced by the PCV-13 in April 2010. Vaccination coverage in Denmark is approximately 90 %.The aim of this study was to present multilocus sequence typing (MLST) profiles of Streptococcus pneumoniae isolates from Danish infants (0-90 days) with invasive pneumococcal disease (IPD) in the period 2003-2013. Findings: 32 IPD isolates were investigated for their MLST profiles. The identified sequence types (STs) had previously been observed in other European countries. Among the clones were ST 306 (serotype 1), ST 180 (serotype 3) and ST 191 (serotype 7F). Conclusions: The ST profile distribution in this study is similar to that observed in other European studies and show a variety of STs. Our data show that the majority of STs found in Denmark is also observed in other European countries, indicating that the IPD isolates were from clones generally circulating in Europe. [ABSTRACT FROM AUTHOR]

Background: Under modern health care, human breast milk is considered the healthiest form of milk for babies. It also promotes the 1 health of bothmother and infant and helps to prevent disease. WHO states that, the vastmajority ofmothers can and should breast feed, just as the vastmajority of infants can and should be breast 5 fed. Purpose: The current study has aimed to determine the breastfeeding successamong postnatalmothers. Methods: A descriptive survey approach was conducted on 50 postnatal mothers who were in the postnatal wards of a selected hospital.Observational checklistwith 26 itemswere utilized to collect data. Results: Through descriptive analysis itwas found thatmajority (44%) ofmotherswere in the age group of 20 - 25 years. Majority (68%) were Hindus. In type of delivery 84%had full termnormal delivery.With regards to parity, 44%weremultis. In relation to sex of the baby, 68%were females. The condition of themother and the baby after deliverywas good and normal in 100%. An observational checklist on breastfeeding success shows that the success rate on breastfeedingwas high. Therewere 4 items such as getting ready to feed, Latching on, Feed itself and after feed and each itemhad 4 to 8 specific items on observational checklists on breastfeedingwhich indicates that in most of the mothers breastfeeding was a success. By inferential statistics it was found that type of delivery is associated with breast feeding (P < 0.05). Since all other p values aremore than 0.05 there was no association between those selected demographic variables with breast feeding at 5%level of significance. Conclusion: Breast feeding is an age-old practice amongmost of the post-natalmothers to feed their young ones. In India,most of the mothers, practice giving breastmilk to babies for about 1 to 2 years. Assistance by the healthworkers is notmuch sought asmost of the bystanders assist themothers in breast feeding. In the present study also,we have come acrossmothers successfully breastfeeding their babies and they are contented. [ABSTRACT FROM AUTHOR]

Background. Cotrimoxazole preventive therapy (CPT) is recommended for all human immunodeficiency virus (HIV)-exposed infants to avoid opportunistic infections. Cotrimoxazole has antimalarial effects and appears to reduce clinical malaria infections, but the impact on asymptomatic malaria infections is unknown. Methods. We conducted an observational cohort study using data and dried blood spots (DBSs) from the Breastfeeding, Antiretrovirals and Nutrition study to evaluate the impact of CPT on malaria infection during peak malaria season in Lilongwe, Malawi. We compared malaria incidence 1 year before and after CPT implementation (292 and 682 CPT-unexposed and CPT-exposed infants, respectively), including only infants who remained HIV negative by 36 weeks of age. Malaria was defined as clinical, asymptomatic (using DBSs at 12, 24, and 36 weeks), or a composite outcome of clinical or asymptomatic. Linear and binomial regression with generalized estimating equations were used to estimate the association between CPT and malaria. Differences in characteristics of parasitemias and drug resistance polymorphisms by CPT status were also assessed in the asymptomatic infections. Results. CPT was associated with a 70% (95% confidence interval, 53%-81%) relative reduction in the risk of asymptomatic infection between 6 and 36 weeks of age. CPT appeared to provide temporary protection against clinical malaria and more sustained protection against asymptomatic infections, with no difference in parasitemia characteristics. Conclusions. CPT appears to reduce overall malaria infections, with more prolonged impacts on asymptomatic infections. Asymptomatic infections are potentially important reservoirs for malaria transmission. Therefore, CPT prophylaxis may have important individual and public health benefits. [ABSTRACT FROM AUTHOR]

Breastfeeding is known as the most efficient way to prevent infectious disease in early life. Maternal anti-microbial immunoglobulins transfer through milk confers passive immunity to the breastfed child while his immune system is maturing. Maternal milk also contains bioactive factors that will stimulate this maturation. From the literature on breastfeeding prevention of immune-mediated disease and more specifically from our experiments conducted in the field of allergic disease prevention, we propose that breastfeeding may also induce antigen-specific immune responses in the breastfed child. We found that early oral antigen exposure through breast milk leads to tolerance or immune priming depending on the nature of the antigen transferred and accompanying maternal milk cofactors. Here, we will discuss our data in the light of prevention of infectious disease and will propose that possible milk transfer of microbial antigen could affect actively the immune response in breastfed children and thereby their long-term susceptibility to infectious disease. Further research in this direction may lead to novel strategies of early life vaccination, taking advantage of the possibility to stimulate antigen-specific immune responses through breast milk. [ABSTRACT FROM AUTHOR]

Bacille Calmette--Guérin (BCG) immunization provides variable protection against tuberculosis. Prenatal antigen exposure may have lifelong effects on responses to related antigens and pathogens. We therefore hypothesized that maternal latent Mycobacterium tuberculosis infection (LTBI) influences infant responses to BCG immunization at birth. We measured antibody (n = 53) and cellular (n = 31) responses to M. tuberculosis purified protein derivative (PPD) in infants of mothers with and without LTBI, in cord blood and at one and six weeks after BCG. The concentrations of PPD-specific antibodies declined between birth (median [interquartile range (IQR)]) 5600 ng ml-1 [3300-11 050] in cord blood) and sixweeks (0.00 ng ml-1 [0-288]). Frequencies of PPD-specific IFN-γ-expressing CD4+T cells increased at one week and declined between one and six weeks ( p = 0.031). Frequencies of IL-2- and TNF-α-expressing PPD-specific CD4+T cells increased between one and six weeks ( p = 0.019, p = 0.009, respectively). At one week, the frequency of PPD-specific CD4+T cells expressing any of the three cytokines, combined, was lower among infants of mothers with LTBI, in crude analyses ( p = 0.002) and after adjusting for confounders (mean difference, 95% CI -0.041% (-0.082, -0.001)). In conclusion, maternal LTBI was associated with lower infant anti-mycobacterial T-cell responses immediately following BCGimmunization. These findings are being explored further in a larger study. [ABSTRACT FROM AUTHOR]

Streptococcus pneumonia (the pneumococcus) is the leading vaccine preventable cause of serious infections in infants under 5 years of age. The major correlate of protection for pneumococcal infections is serotype-specific IgG antibody. More recently, antibody-independent mechanisms of protection have also been identified. Preclinical studies have found that IL-17 secreting CD4+ Th17 cells in reducing pneumococcal colonisation. This study assessed IL-17A levels in children from Fiji with high and low pneumococcal carriage density, as measured by quantitative real-time PCR (qPCR). We studied Th17 responses in 54 children who were designated as high density carriers (N=27, >8.21x105 CFU/ml) or low density carriers (N=27, <1.67x105 CFU/ml). Blood samples were collected, and isolated peripheral blood mononuclear cells (PBMCs) were stimulated for 6 days. Supernatants were harvested for cytokine analysis by multiplex bead array and/or ELISA. Th17 cytokines assayed included IL-17A, IL-21, IL-22 as well as TNF-α, IL-10, TGF-β, IL-6, IL-23 and IFNγ. Cytokine levels were significantly lower in children with high density pneumococcal carriage compared with children with low density carriage for IL-17A (p=0.002) and IL-23 (p=0.04). There was a trend towards significance for IL-22 (p=0.057) while no difference was observed for the other cytokines. These data provide further support for the role of Th17-mediated protection in humans and suggest that these cytokines may be important in the defence against pneumococcal carriage. [ABSTRACT FROM AUTHOR]

The article explores the contribution of India to the field of newborn health. Topics covered include the prevention and treatment of newborn illnesses, a reduction in neonatal deaths and the promotion of community-based newborn care in the country. Also discussed are the access to skilled attendance at birth and the use of new technologies in newborn care.

The author focuses on the apparent life-threatening event (ALTE) in infants, the risk that they carry and their management. Topics discussed include the difficulties in diagnosis of ALTE, several disorders that can become ALTE including infections, congenital abnormalities, and epilepsy, and the neonatal and postnatal care of the infants. Also mentioned is the need to establish preventive measures for these events.

Background In October, 2012, a pertussis vaccination programme for pregnant women was introduced in response to an outbreak across England. We aimed to assess the vaccine effectiveness and the overall effect of the vaccine programme in preventing pertussis in infants. Methods We undertook an analysis of laboratory-confirmed cases and hospital admissions for pertussis in infants between Jan 1, 2008, and Sept 30, 2013, using data submitted to Public Health England as part of its enhanced surveillance of pertussis in England, to investigate the effect of the vaccination programme. We calculated vaccine effectiveness by comparing vaccination status for mothers in confirmed cases with estimates of vaccine coverage for the national population of pregnant women, based on data from the Clinical Practice Research Datalink. Findings The monthly total of confirmed cases peaked in October, 2012 (1565 cases), and subsequently fell across all age groups. For the first 9 months of 2013 compared with the same period in 2012, the greatest proportionate fall in confirmed cases (328 cases in 2012 vs 72 cases in 2013, -78%, 95% Cl -72 to -83) and in hospitalisation admissions (440 admissions in 2012 vs 140 admissions in 2013, -68%, -61 to -74) occurred in infants younger than 3 months, although the incidence remained highest in this age group. Infants younger than 3 months were also the only age group in which there were fewer cases in 2013 than in 2011 (118 cases in 2011 vs 72 cases in 2013), before the resurgence. 26 684 women included in the Clinical Practice Research Datalink had a livebirth between Oct 1, 2012 and Sept 3, 2013; the average vaccine coverage before delivery based on this cohort was 64%. Vaccine effectiveness based on 82 confirmed cases in infants born from Oct 1, 2012, and younger than 3 months at onset was 91% (95% Cl 84 to 95). Vaccine effectiveness was 90% (95% Cl 82 to 95) when the analysis was restricted to cases in children younger than 2 months. Interpretation Our assessment of the programme of pertussis vaccination in pregnancy in England is consistent with high vaccine effectiveness. This effectiveness probably results from protection of infants by both passive antibodies and reduced maternal exposure, and will provide valuable information to international policy makers. Funding Public Health England. [ABSTRACT FROM AUTHOR]

Objective: To study the effect of 2 weeks of prophylactic zinc supplementation on incidence and duration of acute respiratory infections. Design: Randomized double blind controlled trial. Setting: Community based; urban resettlement area in North- East Delhi, India. Participants: 272 children aged 6-11 months with acute respiratory infections. Children receiving zinc supplement within the past 3 months, severely malnourished, immuno-deficient, on steroid therapy, with severe illness requiring hospitalization, or children of families likely to migrate from the study area were excluded. Intervention: Placebo (syrup base) or zinc (20 mg/5 mL elemental zinc as zinc sulfate) orally given for a period of 2 weeks. Main outcome measure(s): Incidence, type and duration of acute respiratory infections, and adverse effects. Results: No effect on incidence of acute respiratory infections was noted. Adecrease of 15% (0.78-0.94) in days and 12% (0.78-0.94) in duration of episode in acute respiratory infections was observed. Incidence of acute lower respiratory infections decreased by 62% (0.26-0.36) and the effect remained forfull five months of follow up. There were no drop outs due to side effects. Conclusions: Prophylactic zinc supplementation for two weeks may reduce the morbidity due to acute lower respiratory infections but not overall rate of acute respiratory infections in infants aged 6-11 months in similar populations. [ABSTRACT FROM AUTHOR]

Background Timely vaccination, i.e., the receipt of all scheduled vaccinations in an age-appropriate fashion, is critical for the prevention of deadly diseases in infants and achievement of the UN Millennium Development Goal to reduce infant mortality. Infants, especially in rural or underprivileged settings often receive delayed vaccinations leaving them susceptible to vaccine-preventable illnesses early in the first year of life. In this study, we examined rates of timely vaccination among 24,435 infants born in Gaibandha and Rangpur rural districts of Bangladesh from 2001 to 2007. Methods Vaccinations due by 14 weeks of age and administered through routine government immunization services were assessed using interviews with enrolled mothers between 11 and 18 weeks postpartum. We created a Timely Vaccination (TV) score to classify infants as vaccinated fully and on schedule (TV = 1) or not (TV = 0), and used multivariable logistic regression to identify maternal characteristics associated with infant's timely vaccination status. Results Our results suggest that only 19% of infants in this cohort received scheduled vaccinations on time by 11–18 weeks postpartum. Mothers’ engagement in paid employment [OR = 1.13, 95% CI: 1.03–1.23], receipt of tetanus toxoid vaccination [OR = 1.24, 95% CI: 1.11–1.38], history of antenatal care [OR = 1.22, 95% CI: 1.12–1.32], or higher socioeconomic status [OR = 1.07, 95% CI: 1.03–1.11] were positively associated with timely vaccination of their infants. Mother's perception of small infant size at birth was negatively associated with timely vaccination [OR = 0.89, 95% CI: 0.82–0.97]. Conclusion Timely vaccination coverage of infants in rural Gaibandha and Rangpur districts is extremely low. This analysis identifies important shortcomings associated with the 1-year vaccination benchmark of routine immunization performance and suggests the need for specific interventions based on potential maternal determinants as well as known system and programmatic barriers of timely vaccination among infants in rural Bangladesh. [ABSTRACT FROM AUTHOR]

Rotavirus acute gastroenteritis, continues to be one of the most common cause of morbidity in children younger than 2 years of age. However, it is not often to report outbreaks in neonatal intensive care units. The aim of this paper was to describe the epidemiological investigation of a Rotavirus outbreak, the viral transmission between infants and the control measures taken. Materials and Methods: An outbrake study was performed in a neonatal intermediate care unit due to the presence of Rotavirus gastroenteritis cases. Results: We identified 3 rotavirus gastroenteritis cases confirmed by direct antigen detection, the source could not be identified. Discussion: We considered a transmission mechanism of propagated source because infected people excreted large number of viral particles and cause widespread environmental contamination. Conclusion: Quickly case identification and implemented implementation of control measures prevent new cases and limits the spread of the outbreak. [ABSTRACT FROM AUTHOR]

Aim This study was undertaken to compare the immunogenicity of a three dose and five dose schedule of an oral live-attenuated human rotavirus vaccine, Rotarix® in south Indian infants. Method Healthy infants (N = 90), six to seven weeks of age were enrolled to receive three doses (n = 45) or five doses of Rotarix vaccine (n = 45) along with other scheduled vaccines, each dose separated by a four week interval. Blood samples were taken before vaccination and one month post-dose three in the Rotarix three dose group and one month post-dose five in the Rotarix five dose group; all were tested for anti-rotavirus IgA by an antibody sandwich enzyme immunoassay. Results At baseline, >50% of infants had >20 units of anti-rotavirus IgA. The seroconversion rates after three and five doses were low and not significantly different in the two groups. However, among vaccine responders, children seropositive at baseline showed a much greater absolute increase in IgA antibody levels than children seronegative at baseline. Conclusions Rotarix vaccine showed low immunogenicity in south Indian children and increasing the number of doses did not increase the proportion of infants seroconverting after vaccination. [ABSTRACT FROM AUTHOR]

Human milk oligosaccharides (HMOs) are a major constituent of human breast milk and play an important role in reducing the risk of infections in infants. The structures of these HMOs show similarities with blood group antigens in protein glycosylation, in particular in relation to fucosylation in Lewis blood group-type epitopes, matching the maternal pattern. Previously, based on the Secretor and Lewis blood group system, four milk groups have been defined, i.e. Lewis-positive Secretors, Lewis-positive non-Secretors, Lewis-negative Secretors and Lewis-negative non-Secretors. Here, a rapid one-dimensional 1H nuclear magnetic resonance (NMR) analysis method is presented that identifies the presence/absence of (α1-2)-, (α1-3)- and (α1-4)-linked fucose residues in HMO samples, affording the essential information to attribute different HMO samples to a specific milk group. The developed method is based on the NMR structural-reporter-group concept earlier established for glycoprotein glycans. Further evaluation of the data obtained from the analysis of 36 HMO samples shows that within each of the four milk groups the relative levels of the different fucosylation epitopes can greatly vary. The data also allow a separation of the Lewis-positive Secretor milk group into two sub-groups. [ABSTRACT FROM AUTHOR]

Background. In Uganda, the tuberculosis vaccine BCG is administered on the first day of life. Infants delivered at home receive BCG vaccine at their first healthcare facility visit at 6 weeks of age. Our aim was to determine the effect of this delay in BCG vaccination on the induced immune response.Methods. We assessed CD4+ and CD8+ T-cell responses with a 12-hour whole-blood intracellular cytokine/cytotoxic marker assay, and with a 6-day proliferation assay.Results. We enrolled 92 infants: 50 had received BCG vaccine at birth and 42 at 6 weeks of age. Birth vaccination was associated with (1) greater induction of CD4+ and CD8+ T cells expressing either interferon γ (IFN-γ) alone or IFN-γ together with perforin and (2) induction of proliferating cells that had greater capacity to produce IFN-γ, tumor necrosis factor α (TNF-α), and interleukin 2 together, compared with delayed vaccination.Conclusions. Distinct patterns of T-cell induction occurred when BCG vaccine was given at birth and at 6 weeks of age. We propose that this diversity might impact protection against tuberculosis. Our results differ from those of studies of delayed BCG vaccination in South Africa and the Gambia, suggesting that geographical and population heterogeneity may affect the BCG vaccine–induced T-cell response. [ABSTRACT FROM PUBLISHER]

ABSTRACT Recently, there has been considerable debate regarding the appropriate amount of iron fortification for commercial infant formula. Globally, there is considerable variation in formula iron content, from 4 to 12 mg iron/L. However, how much fortification is necessary is unclear. Human milk is low in iron (0.2-0.5 mg/L), with the majority of infant iron stores accumulated during gestation. Over the first few months of life, these stores are depleted in breastfeeding infants. This decline has been previously largely perceived as pathological; it may be instead an adaptive mechanism to minimize iron availability to pathogens coinciding with complementary feeding. Many of the pathogens involved in infantile illnesses require iron for growth and replication. By reducing infant iron stores at the onset of complementary feeding, infant physiology may limit its availability to these pathogens, decreasing frequency and severity of infection. This adaptive strategy for iron regulation during development is undermined by the excess dietary iron commonly found in infant formula, both the iron that can be incorporated into the body and the excess iron that will be excreted in feces. Some of this excess iron may promote the growth of pathogenic, iron requiring bacteria disrupting synergistic microflora commonly found in breastfed infants. Evolutionarily, mothers who produced milk with less iron and infants who had decreased iron stores at the time of weaning may have been more likely to survive the transition to solid foods by having limited iron available for pathogens. Contemporary fortification practices may undermine these adaptive mechanisms and increase infant illness risk. Am. J. Hum. Biol. 26:10-17, 2014. © 2013 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Controlling infectious disease without inducing unwanted inflammatory disease requires proper regulation of the innate immune response. Thus, innate immunity needs to be activated when needed during an infection, but must be limited to prevent damage. To accomplish this, negative regulators of innate immunity limit the response. Here we investigate one such negative regulator encoded by an alternative splice form of MyD88. MyD88 mRNA exists in two alternative splice forms: MyD88L, a long form that encodes a protein that activates innate immunity by transducing Toll-like receptor (TLR) signals; and a short form that encodes a different protein, MyD88S, that inhibits the response. We find that MyD88S levels regulate the extent of inflammatory cytokine production in murine macrophages. MyD88S mRNA levels are regulated by the SF3A and SF3B mRNA splicing complexes, and these mRNA splicing complexes function with TLR signaling to regulate MyD88S production. Thus, the SF3A mRNA splicing complex controls production of a negative regulator of TLR signaling that limits the extent of innate immune activation. [ABSTRACT FROM AUTHOR]

IMPORTANCE Immunization schedules with pneumococcal conjugate vaccine (PCV) differ among countries regarding the number of doses, age at vaccinations, and interval between doses. OBJECTIVE To assess the optimal primary vaccination schedule by comparing immunogenicity of 13-valent PCV (PCV13) in 4 different immunization schedules. DESIGN, SETTING. AND PARTICIPANTS An open-label, parallel-group, randomized clinical trial of healthy term infants in a general community in the Netherlands conducted between June 30, 2010, and January 25, 2011, with 99% follow-up until age 12 months. INTERVENTIONS Infants (N = 400) were randomly assigned (1:1:1:1) to receive PCV13 either at ages 2, 4, and 6 months (2-4-6); at ages 3 and 5 months (3-5); at ages 2, 3, and 4 months (2-3-4); or at ages 2 and 4 months (2-4), with a booster dose at age 11.5 months. MAIN OUTCOMES AND MEASURES Primary outcome measure was antibody geometric mean concentrations (GMCs) against PCV13-included serotypes 1 month after the booster dose measured by multiplex immunoassay. Secondary outcomes included GMCs measured 1 month after the primary series, at 8 months of age, and before the booster. RESULTS The primary outcome, GMCs at 1 month after the booster dose, was not significantly different between schedules for 70 of 78 comparisons. The 2-4-6 schedule was superior to the 2-3-4 schedule for serotypes 18C (10,2 µg/mL [95% CI, 8.2-12.7] vs 6.5 µg/mL [95% CI, 5.4-7.8]) and 23F (10.9 µg/mL [95% CI, 9.0-13.3] vs 7.3 µg/mL [95% CI, 5.8-9.2]) and superior to the 2-4 schedule for serotypes 6B (8.5 µg/mL [95% CI, 7.1-10.2] vs 5.1 µg/mL [95% CI 3.8-6.7]), 18C (6.6 µg/mL [95% CI, 5.7-7.7]), and 23F (7.2 µg/mL [95% CI, 5.9-8.8]). For serotype 1, the 3-5 schedule (11.7 µg/mL [95% CI09.6-14.3]) was superior to the other schedules. Geometric mean concentrations for all 13 serotypes ranged between 1.6 and 19.9 µg/mL. Secondary outcomes demonstrated differences 1 month after the primary series. The 2-4-6 schedule was superior compared with the 3-5, 2-3-4, and 2-4 schedules for 3, 9, and 11 serotypes, respectively. Differences between schedules persisted until the booster dose. CONCLUSIONS AND RELEVANCE The use of 4 different PCV13 immunization schedules in healthy term infants resulted in no statistically significant differences in antibody levels after the booster dose for almost all serotypes. The choice of PCV schedule will require a balance between the need for early protection and maintaining protection between the primary series and the booster. TRIAL REGISTRATION trialregister.nl Identifier: NTR2316 [ABSTRACT FROM AUTHOR]

Objective: To determine the outcomes of retinopathy of prematurity (ROP) screening at a tertiary government hospital. Method: Medical records of premature infants who underwent ROP screening at a tertiary government hospital from January 2008 to July 2012 were obtained. Eventual outcomes of the ROP screening were collated and analyzed. Results: A total of 194 premature infants (388 eyes) were included in the study. Forty six (23.71%) infants developed some form of ROP of which 41 (90.21%) had bilateral disease. Of the 388 eyes, 92 (23.71%) were diagnosed with ROP. Thirty-five eyes (38.08%) with ROP were classified as stage 2, 23 (25.00%) stage 1, and 13 (14.13%) stage 3. Twelve eyes (13.04%) diagnosed with ROP received treatment that included laser therapy in 4 eyes (33.33%), intravitreal bevacizumab injection in 4 eyes (33.33%), cryotherapy in one eye (8.33%), and laser therapy plus intravitreal bevacizumab injection in 3 eyes (25%). Seven eyes (7.60%) required treatment but parents did not comply. Sixteen patients (10.81%) without ROP and 27 patients (57.61%) with ROP had follow-up examinations. Of the 54 eyes with ROP that were followed up, only 26 eyes had refraction. Twelve eyes (46.15%) were hyperopic, 12 (46.15%) myopic, and two (7.69%) emmetropic. Among 16 eyes without ROP with follow-up examination, 14 eyes (87.50%) had hyperopia and two (12.50%) myopia. The follow-up rate for this study was 22.16%. Conclusion: There was a low follow-up rate for premature babies screened for ROP at a tertiary government center. No association was found between presence of ROP and refractive outcomes, and between refractive outcomes and treatment received. [ABSTRACT FROM AUTHOR]

Objective: To determine the 4-year prevalence and outcome of initial screening for retinopathy of prematurity (ROP) among newborn infants in a tertiary hospital. Methodology: Medical records of infants screened for ROP at a tertiary hospital were reviewed. Findings on initial examination and outcomes on follow-up were recorded. Prevalence was determined using frequencies and percentages. Statistical analyses correlating ROP to age of gestation and birth weight were done using chi square. Results: Fifty eyes of 25 infants, 9 boys and 16 girls with mean birth weight (BW) of 1318 grams and mean age of gestation (AOG) of 31 weeks, were included in the study. Nine eyes were positive for ROP with a prevalence of 18%. One eye had stage 4 zone II ROP with plus disease. Three eyes had stage 3 ROP with plus disease. Five eyes had Stage 1 zone III ROP. Regression was noted on follow-up after treatment. Statistical analysis revealed no significant correlation between BW and ROP staging (?2= 6.50) but significant correlation between AOG and ROP staging (?2= 13.69). Conclusion: Despite the increasing prevalence of retinopathy of prematurity worldwide, only a small number of infants were identified on initial screening at a tertiary hospital from 2008 to 2012. Some of these patients came back for follow up and showed significant improvement from baseline after treatment. There was a significant correlation between AOG and ROP staging. [ABSTRACT FROM AUTHOR]

Objective: To assess the level of awareness and practice patterns of pediatricians in various government and private hospitals in the Philippines regarding retinopathy of prematurity (ROP). Methods: This is a prospective, multicenter, cross-sectional study of the practice profile and awareness of pediatricians of the Philippine Pediatric Society (PPS) ROP screening recommendations. Six hundred self-administered questionnaires were distributed to pediatricians from 40 randomly selected government and private hospitals in the Philippines between July and September 2013. Frequency distribution for each data was noted. Association of referral rates, distribution of barriers, and availability of protocol among the subgroups were analyzed using chi square. Results: A total of 409 eligible surveys were analyzed with a response rate of 68.1%. 92% of the respondents referred their at-risk preterm babies to ophthalmologists for ROP screening. Of those who referred, 57% considered a cut-off value of less than 32 weeks age of gestation, and 45% considered a cut-off value of less than 1500g birth weight. 47% referred at 4-6 weeks post-natal age, and 48% had a protocol for ROP screening. Only 19% were aware of the PPS ROP screening recommendations. The major barrier encountered was the inability of the families to follow up after discharge (41%). Higher referral rates were noted from private institutions (p=0.013) and tertiary hospitals (p=0.019), including those with a protocol on ROP screening (p=0.002). Conclusion: Majority of the respondents referred their at-risk preterm babies for ROP screening. A significant proportion was unaware of the PPS ROP screening guidelines. More than half do not have an established protocol. There were variations in practice patterns of the pediatricians in referring babies at-risk for ROP. Based on these, there is still a need to increase awareness among pediatricians. A uniform, national, published guideline on ROP screening, establishment of referral systems, and training of qualified ophthalmologists are recommended. [ABSTRACT FROM AUTHOR]