Search

Aflatoxin exposure has been implicated in adverse human health outcomes in areas where the toxin is prevalent in foods [1]. Consequently, many people may be chronically exposed to large amounts [...]

Rubella virus is a leading cause of vaccine-preventable birth defects. Infection during pregnancy can result in miscarriage, fetal death, stillbirth or a constellation of birth defects, known as congenital rubella syndrome (CRS), which includes cataracts, deafness, heart defects and developmental delay. A single dose of rubella-containing vaccine can provide lifelong protection against rubella. The Global Vaccine Action Plan 2011-2020 set a target to achieve elimination of rubella in at least 5 of the 6 WHO regions by 2020, and rubella elimination is a critical goal of the Immunization Agenda 2030. This report updates a previous report and describes progress towards rubella and CRS elimination in 2012-2022. During this period, the number of WHO Member States that included rubella-containing vaccine (RCV) in their immunization schedules increased from 132 (68%) to 175 (90%), and the percentage of the world's infants were vaccinated against rubella increased from 40% to 68%. The reported number of rubella cases decreased by 81%, from 93 816 in 2012 to 17 407 in 2022. Verification of rubella elimination was achieved in 98 (51%) of 194 countries by 2022, an increase from 84 (43%) countries in 2019. Despite significant progress in introduction of RCV into routine immunization programmes worldwide, nearly 25 million infants annually still do not receive RCV. Nevertheless, the increasing number of countries that have achieved and sustained rubella elimination, even in complex settings, represents progress towards global rubella elimination. L'infection par le virus de la rubeole est l'une des principales causes de malformations congenitales evitables par la vaccination. Lorsqu'elle survient pendant la grossesse, elle peut entrainer une fausse couche, la mort foetale, une mortinaissance ou une constellation de malformations congenitales (notamment cataracte, surdite, malformations cardiaques et retards de developpement) connue sous le nom de syndrome de rubeole congenitale (SRC). Une dose unique de vaccin a valence rubeole peut conferer une protection a vie contre la rubeole. Parmi les cibles fixees dans le Plan d'action mondial pour les vaccins 2011-2020 figurait l'elimination de la rubeole dans au moins 5 des 6 Regions de l'OMS a l'horizon 2020. L'elimination de la rubeole fait en outre partie des objectifs cles du Programme pour la vaccination a l'horizon 2030. Le present rapport actualise les informations fournies dans le rapport precedent et decrit les progres accomplis vers l'elimination de la rubeole et du SRC dans la periode 2012-2022. Au cours de cette periode, les nombre d'Etats Membres de l'OMS ayant inclus le vaccin a valence rubeole (RCV) dans leur calendrier de vaccination a progresse, passant de 132 (68%) a 175 (90%); et le pourcentage de nourrissons dans le monde vaccines contre la rubeole est passe de 40% a 68%. Le nombre de cas notifies de rubeole a recule de 81%, passant de 93 816 en 2012 a 17 407 en 2022. En 2022, l'elimination de la rubeole avait ete verifiee dans 98 (51%) des 194 Etats Membres de l'OMS, contre 84(43%) en 2019. Toutefois, meme si l'introduction du RCV dans les programmes de vaccination systematique a fortement progresse a l'echelle mondiale, pres de 25millions de nourrissons sont encore prives de ce vaccin chaque annee. Le nombre croissant de pays ayant reussi a eliminer durablement la rubeole, meme parmi ceux confrontes a des situations complexes, temoigne neanmoins des progres realises vers l'elimination de cette maladie a l'echelle mondiale., Introduction Rubella virus is a leading cause of vaccine-preventable birth defects and can cause epidemics. Rubella virus infection usually produces a mild febrile rash illness in children and adults; however, [...]

Background In Australian remote communities, First Nations children with otitis media (OM)-related hearing loss are disproportionately at risk of developmental delay and poor school performance, compared to those with normal hearing. Our objective was to compare OM-related hearing loss in children randomised to one of 2 pneumococcal conjugate vaccine (PCV) formulations. Methods and findings In 2 sequential parallel, open-label, randomised controlled trials (the PREVIX trials), eligible infants were first allocated 1:1:1 at age 28 to 38 days to standard or mixed PCV schedules, then at age 12 months to PCV13 (13-valent pneumococcal conjugate vaccine, +P) or PHiD-CV10 (10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine, +S) (1:1). Here, we report prevalence and level of hearing loss outcomes in the +P and +S groups at 6-monthly scheduled assessments from age 12 to 36 months. From March 2013 to September 2018, 261 infants were enrolled and 461 hearing assessments were performed. Prevalence of hearing loss was 78% (25/32) in the +P group and 71% (20/28) in the +S group at baseline, declining to 52% (28/54) in the +P groups and 56% (33/59) in the +S group at age 36 months. At primary endpoint age 18 months, prevalence of moderate (disabling) hearing loss was 21% (9/42) in the +P group and 41% (20/49) in the +S group (difference -19%; (95% confidence interval (CI) [-38, -1], p = 0.07) and prevalence of no hearing loss was 36% (15/42) in the +P group and 16% (8/49) in the +S group (difference 19%; (95% CI [2, 37], p = 0.05). At subsequent time points, prevalence of moderate hearing loss remained lower in the +P group: differences -3%; (95% CI [-23, 18], p = 1.00 at age 24 months), -12%; (95% CI [-30, 6], p = 0.29 at age 30 months), and -9%; (95% CI [-23, 5], p = 0.25 at age 36 months). A major limitation was the small sample size, hence low power to reach statistical significance, thereby reducing confidence in the effect size. Conclusions In this study, we observed a high prevalence and persistence of moderate (disabling) hearing loss throughout early childhood. We found a lower prevalence of moderate hearing loss and correspondingly higher prevalence of no hearing loss in the +P group, which may have substantial benefits for high-risk children, their families, and society, but warrant further investigation. Trial registration ClinicalTrials.gov NCT01735084 and NCT01174849, Author(s): Amanda Jane Leach 1,*, Nicole Wilson 1, Beth Arrowsmith 1,2, Jemima Beissbarth 1, Kim Mulholland 3,4,5, Mathuram Santosham 6,7, Paul John Torzillo 8,9, Peter McIntyre 10,11, Heidi Smith-Vaughan 1, [...]

Background We aimed to provide data on the normal blood pressure of haemodynamically stable neonates. Our study uses retrospective, real-life oscillometric blood pressure measurement values to determine the expected blood pressure in different gestational age, chronological age and birth weight groups. We also investigated the effect of antenatal steroid on neonatal blood pressure. Methods Our retrospective study (2019-2021) was carried out in the Neonatal Intensive Care Unit of the University of Szeged, Hungary. We involved 629 haemodynamically stable patients and analysed 134,938 blood pressure values. Data were collected from electronic hospital records of IntelliSpace Critical Care Anesthesia by Phillips. We used the PDAnalyser program for data handling and the IBM SPSS program for statistical analysis. Results We found a significant difference between the blood pressure of each gestational age group in the first 14 days of life. The systolic, diastolic and mean blood pressure rise are steeper in the preterm group than in the term group in the first 3 days of life. No significant blood pressure differences were found between the group with a complete antenatal steroid course and those who received incomplete steroid prophylaxis or did not receive antenatal steroids. Conclusion We determined the average blood pressure of stable neonates and obtained normative data by percentiles. Our study provides additional data on how blood pressure varies with gestational age and birth weight. Graphical abstract, Author(s): Judit Klara Kiss [sup.1] , Anna Gajda [sup.1] , Judit Mari [sup.1] , Judit Nemeth [sup.1] , Csaba Bereczki [sup.1] Author Affiliations: (1) grid.9008.1, 0000 0001 1016 9625, Department [...]

This review provides updated knowledge on the long-term outcomes among children with antenatally diagnosed urinary tract dilatation (UTD), previously often referred to as antenatal hydronephrosis. Different definitions of UTD exist, which makes comparison between studies and generalized conclusions difficult. Roughly, one-third of antenatally diagnosed UTD, defined as a renal pelvis anterior posterior diameter (APD) of [greater than or equal to] 4 mm in the second trimester and/or [greater than or equal to] 7 mm in the third trimester, will resolve before birth, another third will resolve within the first years of life, and in the remaining cases, UTD will persist or a congenital abnormality (CAKUT) will be diagnosed postnatally. The risk of a postnatal CAKUT diagnosis increases with the degree of prenatal and postnatal dilatation, except for vesicoureteral reflux (VUR), which cannot be predicted from the degree of UTD. Urinary tract infections (UTIs) occur in 7-14% of children with UTD during the first years of life. The risk of UTI is higher in children with traditional risk factors for UTI, such as dilated VUR, hydroureteronephrosis, female gender, and intact foreskin. Continuous antibiotic prophylaxis may be considered in selected patients during the first years of life. In long-term follow-ups, permanent kidney damage is diagnosed in approximately 40% of children with moderate or severe UTD, but hypertension, proteinuria, and/or reduced eGFR are uncommon (0-5%). In children with mild UTD, the long-term outcome is excellent, and these children should not be subjected to unnecessary examinations and/or follow-up., Author(s): Maria Herthelius [sup.1] [sup.2] Author Affiliations: (1) grid.24381.3c, 0000 0000 9241 5705, Astrid Lindgren Children's Hospital, K88, Karolinska University Hospital, , 141 86, Stockholm, Sweden (2) grid.4714.6, 0000 0004 [...]

Background The Cardio-Renal Pediatric Dialysis Emergency Machine (CA.R.P.E.D.I.E.M.®) device is a continuous kidney replacement therapy (CKRT) equipment dedicated to neonates and small infants. This study aimed to assess the effectiveness, feasibility, outcomes, and technical considerations relating to CARPEDIEM® use. Methods This retrospective multicenter study included 19 newborns and six infants receiving CARPEDIEM® in five French pediatric and neonatal intensive care units. Laboratory parameters were collected at the initiation and end of the first CARPEDIEM® session. Results are presented as median [IQR] (range). Results At initiation, age was 4 days [2-13] (1-1134) with a body weight of 3.3 kg [2.5-4] (1.3-11.1). Overall, 131 sessions and 2125 h of treatment were performed. Treatment duration per patient was 42 h [24-91] (8-557). Continuous veno-venous hemofiltration (CVVH) was performed in 20 children. Blood flow rate was 8 mL/kg/min [6-9] (3-16). The effluent flow rate for CVVH was 74 mL/kg/h [43-99] (28-125) and net ultrafiltration (UF) 6 mL/kg/h [2-8] (1-12). In the five children treated by hemodialysis, the blood and dialysate flow rates were 6 mL/kg/min [5-7] (4-7) and 600 mL/h [300-600] (120-600), respectively, while session duration was 8 h [6-12] (2-24). Most infants required a catheter between 4.5 and 6.5 French. Hemodynamic instability with a need for volume replacement occurred in 31 sessions (23%). Thrombocytopenia was observed in 29 sessions (22%). No hemorrhage occurred; all the patients survived the sessions, but only eight patients (32%) were alive at hospital discharge. Conclusions These data confirm that the use of CARPEDIEM® is safe and effective in critically ill neonates and infants. Graphical abstract, Author(s): Jennifer Battista [sup.1] , Daniele De Luca [sup.2] , Sergio Eleni Dit Trolli [sup.3] , Lise Allard [sup.4] , Justine Bacchetta [sup.5] , Nourredine Bouhamri [sup.6] , Carole Enoch [...]

Background Sepsis and acute kidney injury (AKI) are associated with mortality in the newborn intensive care unit (NICU). There is a paucity of studies that describe AKI and fluid overload in neonatal sepsis and their association with mortality. Methods Retrospective study of neonates with culture positive sepsis admitted to the NICU between June 2020 and June 2021 was conducted. Primary outcome was in-hospital mortality according to AKI as defined by the neonatal modified Kidney Diseases Improving Outcomes criteria. Secondary outcomes were early fluid overload and vasopressor use. Results Thirty-three percent of neonates had AKI with sepsis, and 57% of cases were severe AKI. AKI was associated with mortality after adjusting for variables that were different between survivors and non-survivors (aOR 5.7 [95% CI 1.1-36], p = 0.04). Early fluid overload occurred in 27% of neonates who were at higher risk of having AKI with sepsis (OR 7.4 [95% CI 1.6-26.0], p = 0.01) and higher risk of mortality (aOR 17.8 [95% CI 2-7545], p = 0.02). Conclusions AKI and early fluid overload are associated with mortality in sepsis in our retrospective cohort. Mitigating AKI and early fluid overload in sepsis might be a fruitful strategy in reducing mortality with sepsis. Graphical Abstract A higher resolution version of the Graphical abstract is available as Supplementary information, Author(s): Faris N. Al Gharaibeh [sup.1] [sup.2] , Shruthi Mohan [sup.3] , Michael A. Santoro [sup.4] , Cara L. Slagle [sup.1] [sup.2] , Stuart L. Goldstein [sup.2] [sup.5] Author Affiliations: [...]

Background There is a paucity of literature on the normative levels of plasma renin concentration (PRC) and serum aldosterone (SA) in premature neonates. This study aims to provide normative data on PRC and SA levels in preterm neonates in the first 2 weeks after birth and explore associations with maternal, perinatal, or postnatal factors. Methods Neonates born at 26- to 34-week gestation were recruited from two neonatal intensive care units in Canada and Australia. The direct renin assay PRC and SA were analyzed on day 1 and days 14-21 after birth to compare across categorical variables and to produce normative values. Results A total of 262 subjects were enrolled from the Canadian (29%) and Australian (71%) sites. The mean gestational age was 30 weeks, with a mean birth weight of 1457 g. The normative values of PRC and SA for neonates born between 26 + 0 and 29 + 6 weeks and 30 + 0 and 34 + 0 weeks of gestation were produced for day 1 and day 14-21 after birth. Both PRC and SA increased from day 1 to day 14-21. The more premature neonates reached a higher PRC on days 14-21 after birth but exhibited lower SA levels on day 1 after birth. When comparing gender, birth weight, and maternal risk factor categories, no statistical differences in PRC or SA were found. A small but significant decrease in PRC, but not SA, was noted for neonates with placental pathology. Conclusions This study produced normative values of PRA and SA in clinically stable preterm neonates that can be referenced for use in clinical practice. Graphical Abstract, Author(s): James Haiyang Xu [sup.1] , Erika Bariciak [sup.2] , Mary-Ann Harrison [sup.3] , Margaret Broom [sup.4] , Brigitte Lemyre [sup.2] , Richard J. Webster [sup.3] , Gabrielle Weiler [sup.1] [...]

Objectives To assess maternal knowledge, attitude, and practices toward vitamin D supplements in Saudi infants and toddlers. In addition, we investigated predictors of maternal knowledge, attitude, and practices related to vitamin D supplements. Methods Cross-sectional data of 156 Saudi infants and toddlers were collected from mothers via online survey. Data collected included sociodemographics, maternal knowledge, attitude, and practices toward vitamin D supplements. Results Our data show a limited maternal knowledge toward vitamin D. Maternal knowledge and attitude as well as maternal knowledge and practices were not correlated. Spearman correlation between maternal attitude and practices was positively low (r.sub.s= 0.47). Child's age and family monthly income predicted maternal knowledge towards vitamin D. Maternal age and maternal education level predicted maternal attitude toward vitamin D supplements. Order of the child, maternal age, and maternal employment status predicted maternal practices toward vitamin D supplements in infant and toddlers. Conclusions for Practice Maternal knowledge, attitude, and practices toward vitamin D supplements can be predicted by certain sociodemographic characteristics. Interventions that focus on improving maternal knowledge, attitude, and practices toward vitamin D supplements are urgently needed., Author(s): Walaa Abdullah Mumena [sup.1] , Mahitab Adly Hanbazaza [sup.2] Author Affiliations: (1) grid.412892.4, 0000 0004 1754 9358, Clinical Nutrition Department, College of Applied Medical Sciences, Taibah University, , P.O. [...]

Objectives To propose a measure for adverse maternal experiences (AMEs) and examine if AMEs are independently associated with delivery of a neonatal abstinence syndrome (NAS) diagnosed infant. Methods Using the Pregnancy Risk Assessment Monitoring System (PRAMS) stressful life events questions, we constructed a composite measure of AMEs. We conducted a retrospective analysis of linked Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012-2018 using the composite measure. Our analytic sample included 6358 singleton deliveries. We calculated prevalence of NAS and AMEs and prevalence odds ratio (POR) for delivery of an NAS-diagnosed infant adjusting for maternal sociodemographic characteristics, pre-pregnancy depression, prescription medicine 12 months prior to pregnancy, and smoking during pregnancy. Results The overall prevalence of NAS in Delaware during 2012-2018 was 2.2% (95% CI 1.8-2.6); 9.5% (95% CI 8.7-10.2) of women reported AMEs. After adjustment, women with AMEs had 1.1 times greater odds (aPOR 2.1; 95% CI 1.3-3.3) to deliver a NAS-diagnosed infant as compared with women without AMEs. Conclusions Although the cross-sectional nature of the study limits drawing any causal inferences, there are co-occurring factors that support plausibility of an association between AMEs and delivering NAS-diagnosed infants. Addressing AMEs, mental health and substance use screening and treatment as part of preconception and prenatal care may mitigate risks., Author(s): Khaleel S. Hussaini [sup.1] [sup.2] , George Yocher [sup.2] Author Affiliations: (1) grid.27235.31, Division of Reproductive Health, Field Support Branch, Centers for Disease Control and Prevention, U.S. Department of [...]

Objective To examine whether exposure to safe sleep recommendations using a blog format changed infant sleep practices. Methods We conducted a pilot randomized controlled trial via Qualtrics, a web-based platform, with a national sample of parents of children < 1 year old. Survey questions about infant sleep practices included: bed-sharing, location, position and objects present. Safe sleep was defined as not bed-sharing, in a crib, bassinet or playard, back positioning, and no other objects present except pacifiers. Participants were randomized to read one of the following: (1) pediatrician blog post, (2) parent blog post, or (3) no blog post. The blog posts contained the same content about infant sleep but varied by identified authorship. All participants received links to online content about safe sleep. Participants received a follow-up survey 2-4 weeks later with the same questions about infant sleep practices. We compared responses in pre- and post-surveys by type of blog post exposure using multivariable logistic regression models. Results The average infant age (n = 1500) was 6.6 months (Standard Deviation 3.3). Most participants (74%) were female; 77% were married; 65% identified as white Non-Hispanic, 12% were black and 17% were Hispanic. 47% (n = 711) completed both surveys. We identified no differences in the odds of any of the four safe sleep practices after exposure to safe sleep recommendations in blog post format. Conclusion Although in-person advice has been associated with improved safe sleep practices, we did not identify changes in infant sleep practices after exposure to safe sleep advice using blog posts., Author(s): Mersine A. Bryan [sup.1] [sup.2] , Yolanda N. Evans [sup.1] [sup.2] , Aubrey Gower [sup.1] , Megan A. Moreno [sup.3] Author Affiliations: (1) grid.34477.33, 0000000122986657, Department of Pediatrics, University [...]

Background This study determined the relationship between physical activity (PA), circulating lipids throughout pregnancy and infant anthropometric outcomes at birth and 2 weeks of age. Methods Women (N = 234) with normal weight (NW, BMI 18.5-24.9 kg/m.sup.2) and with overweight and class I obesity (OW/OB, BMI 25-35 kg/m.sup.2) were categorized into high and low PA based on average cohort steps during pregnancy (8099 steps/day). Circulating fasting lipids were measured at each trimester. Standardized methods were used to obtain anthropometrics measures. Infant body composition was estimated by quantitative nuclear magnetic resonance (EchoMRI-AH small; ECHO Medical Systems). Results Women with NW who had higher activity had lower circulating triglycerides (TG) and total cholesterol (TC) levels at 12 weeks compared to women with NW and low activity (p < 0.05). Women with OW/OB and high activity level throughout pregnancy had lower circulating TG, and low density lipoprotein (LDL), at 12 weeks, lower LDL at 24 weeks, and lower TG at 36 weeks compared to the women with OW/OB who had low activity levels (p < 0.05). For children born to women with OW/OB, maternal circulating TG and LDL were most associated with infant anthropometrics at 2 weeks of age. Conclusion This study supports that higher PA during pregnancy is associated with lower lipid levels throughout pregnancy with a greater effect size in women with OW/OB. Maternal lipids were associated with anthropometrics and infant body composition at two weeks of life in women with OW/OB., Author(s): Sarah Sobik [sup.1] [sup.2] , Clark R. Sims [sup.1] [sup.2] , Meghan Crimmins [sup.1] , Milan Bimali [sup.4] , D. Keith Williams [sup.1] [sup.3] , Aline Andres [sup.1] [sup.2] [...]