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Objective:  This study aimed to compare rehospitalization rates, diagnoses, and well-baby nursery (WBN) length of stay (LOS) among rehospitalized infants born during the COVID-19 pandemic to those born prior., Study Design:  A retrospective comparison of 215 infants rehospitalized from March 1, 2019, to March 1, 2021, was performed in an urban academic center. Rates of readmission were determined for all infants using an unadjusted odds ratio. Among infants rehospitalized at ≤30 and ≤7 days, key cohort characteristics were analyzed using chi-square analysis, Fisher's exact test, independent t -test, and nonparametric testing as applicable. Differences in readmission diagnoses determined by International Classification of Diseases (ICD) code and chart review were evaluated with multivariable logistic regression comparing infants born during the pandemic to the year prior., Results:  Pandemic infants had a 51% increased odds of rehospitalization ≤7 days of discharge from WBN compared with prepandemic infants (95% confidence interval [CI]: 1.09-2.09). Rehospitalized infants born during the pandemic had shorter WBN LOS; infants rehospitalized ≤30 days had LOS of 54.3 ± 18.6 versus 59.6 ± 16.2 hours ( p  = 0.02) and infants rehospitalized ≤7 days had LOS of 53.8 ± 17.8 versus 60.8 ±17.0 hours ( p  = 0.02). The pandemic group of infants had a 3.5 increased odds of being readmitted for hyperbilirubinemia compared with other diagnoses after adjusting for biological sex, ethnicity, percent weight lost at time of discharge, gestational age, and mode of delivery (CI 1.9, 6.4)., Conclusion:  Rehospitalization ≤7 days post-WBN discharge was more common in infants born during the pandemic. Infants rehospitalized during the pandemic were more likely to have shorter WBN LOS and to be rehospitalized for hyperbilirubinemia. Retrospective analyses limit conclusions about causation but suggest that being born during the pandemic increased risk of rehospitalization for hyperbilirubinemia among infants in urban, under resourced setting warranting further investigation., Key Points: · Newborns rehospitalized during the pandemic had a shorter newborn nursery stay.. · Newborns in the pandemic had a higher rate of rehospitalization within 7 days of birth compared to year prior.. · More infants who required readmission during the pandemic were hospitalized for hyperbilirubinemia.., Competing Interests: None declared., (Thieme. All rights reserved.)

Almond band canker and prune Cytospora canker have become more severe in the last decade, especially in young orchards, in California. To test our hypothesis that young trees from nurseries could carry the canker-causing pathogens at latency phase to new orchards through transplanting, a multiyear survey on latent infection of canker-causing pathogens of budwood and young trees of almond and prune nurseries in California was conducted. A total of more than 1,730 samples including shoots of rootstocks and scions and grafting union cuttings were collected from 11 nurseries. A real-time quantitative PCR assay was applied to quantify the latent infection levels by six canker-causing pathogen taxa: Botryosphaeria dothidea and species of Cytospora , Diplodia , Lasiodiplodia , Neofusicoccum , and Phomopsis. For almond, the average incidences of latent infection caused by Lasiodiplodia spp. (43.6%) and Neofusicoccum spp. (24.2%) were significantly greater than those by the other four pathogen taxa. The molecular severity (MS) of latent infection caused by Neofusicoccum spp. (3.6) was significantly greater than those caused by other pathogen taxa, except for Lasiodiplodia spp. (2.6). For prune, the average incidence of latent infection caused by Cytospora spp. (13.5%) was significantly higher than those caused by B. dothidea (1.5%) and Diplodia spp. (1.3%) but not significantly higher than those caused by Lasiodiplodia spp. (6.9%), Neofusicoccum spp. (6.3%), and Phomopsis spp. (7.7%), respectively. Moreover, the average MS values caused by Cytospora spp. (3.8) and Neofusicoccum spp. (3.2) were the highest followed by those caused by B. dothidea (1.4), Lasiodiplodia spp. (2.2), and Phomopsis spp. (2.3). Different almond varieties showed various levels of susceptibilities to different canker-causing pathogens. This study concluded that Lasiodiplodia and Neofusicoccum are the predominant pathogen species in almond, and Cytospora is the most important canker-causing pathogen species in prune in nurseries. These findings confirmed the observations of predominancy of canker-causing pathogens in almond and prune orchards in California., Competing Interests: The author(s) declare no conflict of interest.

A survey of the flori-horticultural nurseries in eastern India found Phytophthora nicotianae to be the most widespread Phytophthora species associated with different foliar symptoms of nursery plants and identified the presence of P. palmivora in eastern Indian nurseries for the first time. The survey also led to the first worldwide finding of P. nicotianae on Dipteracanthus prostratus (Poir.) Nees; Ocimum tenuiflorum L. (syn. Ocimum sanctum L.); Philodendron xanadu Croat, Mayo & J. Boos; and Pyrostegia venusta (Ker-Gawl.) Miers and P. palmivora on Episcia cupreata (Hook.) Hanst., as well as the first report from India of P. nicotianae on Spathiphyllum wallisii Regel; Anthurium andraeanum Linden ex André; and Adenium obesum (Forsk.) Roem. & Schult. Sensitivity to commercial fungicides Glazer 35WS, Rallis India (metalaxyl, FRAC code 4); Ridomil Gold, Syngenta (mefenoxam + mancozeb); Revus, Syngenta (mandipropamid, FRAC code 40); Aliette Bayer (fosetyl-Al, FRAC code 33); Acrobat, BASF (dimethomorph, FRAC code 40); and Amistar, Syngenta (azoxystrobin, FRAC code 11) was analyzed, showing EC 50 values ranging from 0.75 to 16.39 ppm, 0.74 to 1.45 ppm, 2.43 to 17.21 ppm, 63.81 to 327.31 ppm, 8.88 to 174.69 ppm, and 0.1 to 1.13 ppm, respectively, with no cross-resistance of the isolates to the fungicides. The baseline information produced about these Phytophthora spp. from ornamental and horticultural host associations could help prevent the pathogens from becoming primary drivers of new disease outbreaks and their large-scale distribution beyond their natural endemic ranges., Competing Interests: The author(s) declare no conflict of interest.

Background and Objectives: Marijuana use has increased nationally and is the most common federally illicit substance used during pregnancy. This study aimed to describe hospital practices and nursery director knowledge and attitudes regarding marijuana use and breastfeeding and assess the association between breastfeeding restrictions and provider knowledge, geographic region, and state marijuana legalization status. We hypothesized that there would be associations between geography and/or state legalization and hospital practices regarding breastfeeding with perinatal marijuana use., Methods: A cross-sectional, 31-question survey was sent electronically to the 110 US hospital members of the Academic Pediatric Association's Better Outcomes through Research for Newborns (BORN) network. Survey responses were analyzed using descriptive statistics to report frequencies. For comparisons, χ2 and Fisher exact tests were used to determine statistical significance., Results: Sixty-nine (63%) BORN nursery directors across 38 states completed the survey. For mothers with a positive cannabinoid screen at delivery, 16% of hospitals universally or selectively restrict breastfeeding. Most (96%) nursery directors reported that marijuana use while breastfeeding is "somewhat" (70%) or "very harmful" (26%). The majority was aware of the potential negative impact of prenatal marijuana use on learning and behavior. There were no consistent statistical associations between breastfeeding restrictions and provider marijuana knowledge, geographic region, or state marijuana legalization status., Conclusions: BORN newborn clinicians report highly variable and unpredictable breastfeeding support practices for mothers with perinatal marijuana use. Further studies are needed to establish evidence-based practices and to promote consistent, equitable care of newborns with perinatal marijuana exposure., (Copyright © 2024 by the American Academy of Pediatrics.)

Objective: To nutritionally analyse lunches provided for 3-4-year-old children attending school nurseries. Energy and nutrient content are compared with nutrient frameworks underpinning voluntary guidelines for early years settings (EYS) and mandatory standards for infant schools (4-7-year-olds)., Design: A cross-sectional study, recording all main meals, vegetarian meals, jacket potato options, sandwich options and all desserts and accompaniments provided over 5 consecutive days in each school. Two portions of each meal were collected each day and weighed. Recipe and portion weight data were entered into nutrient analysis software., Setting: School nurseries where lunch was provided by the school., Subjects: Nine schools, providing a total of 161 meals., Results: Lunches contained more energy (1881 kJ/450 kcal), fat (15·5 g), free sugars (10·5 g) and Na (424 mg) than suggested by the nutrient framework for EYS. Carbohydrate (60·6 g), protein (16·8 g), fibre (6·7 g), Fe (2·4 mg), Zn (2·0 mg), Ca (202 mg), vitamin A (304 µg) and vitamin C (19 mg) also exceeded minimum recommendations. Compared with a revised nutrient framework for infant schools, energy was within range, whilst saturated fat, free sugars and Na were above maximum recommendations for this age group, and Zn was below. Sandwich meals were lower in vitamin C ( P < 0·001- P = 0·05) and Fe ( P = 0·012- P = 0·017) and higher in Na ( P < 0·001- P = 0·003) and Ca ( P < 0·001- P = 0·05)., Conclusion: Lunches provided for children attending school nurseries are more in line with the framework for 4-7-year-olds. Free sugars, saturated fat and Na are areas of concern consistent with previous studies. Protein is three times more than recommended. Large portions of cakes and biscuits contribute to excess energy provision.

Port areas are subjected to multiple anthropic pressures that directly impact residing marine communities and deprive them of most of their essential ecological functions. Several global projects aim to rehabilitate certain ecosystem functions in port areas, such as a fish nursery function, by installing artificial fish nurseries (AFN). In theory, AFNs increase fish biodiversity and juvenile fish abundance in port areas, but studies on this subject remain scarce. Thus, the present study aimed to examine whether the use of such AFNs could restore part of the nursery function of natural habitats by increasing fish and juvenile abundance, and by decreasing predation intensity compared to bare docks. Two years of monitoring on AFNs showed they hosted 2.1 times more fish than on control docks and up to 2.4 more fish juveniles. Fish community structures were influenced by both treatment (AFN and Control) and year of monitoring. In general, AFNs hosted a greater taxonomic diversity of fish than controls. The predation intensity around these structures was significantly lower in the AFNs than in controls. Part of the definition of a fish nursery was thus verified, indicating that AFNs might be an effective restoration tool. However, we also noted that total fish abundance and Young of the Year (YOY) abundance decreased in controls, possibly due to a concentration effect. Further detailed monitoring is necessary to distinguish between these effects., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: One in seven UK children have obesity when starting school, with higher prevalence associated with deprivation. Most pre-school children do not meet UK recommendations for physical activity and nutrition. Formal childcare settings provide opportunities to deliver interventions to improve nutritional quality and physical activity to the majority of 3-4-year-olds. The nutrition and physical activity self-assessment for childcare (NAP SACC) intervention has demonstrated effectiveness in the USA with high acceptability in the UK. The study aims to evaluate the effectiveness and cost-effectiveness of the NAP SACC UK intervention to increase physical activity, reduce sedentary time and improve nutritional intake., Methods: Multi-centre cluster RCT with process and economic evaluation. Participants are children aged 2 years or over, attending UK early years settings (nurseries) for ≥ 12 h/week or ≥ 15 h/week during term time and their parents, and staff at participating nurseries. The 12-month intervention involves nursery managers working with a Partner (public health practitioner) to self-assess policies and practices relating to physical activity and nutrition; nursery staff attending one physical activity and one nutrition training workshop and setting goals to be achieved within 6 months. The Partner provides support and reviews progress. Nursery staff receive a further workshop and new goals are set, with Partner support for a further 6 months. The comparator is usual practice. Up to 56 nurseries will be stratified by area and randomly allocated to intervention or comparator arm with minimisation of differences in level of deprivation., Primary Outcomes: accelerometer-assessed mean total activity time on nursery days and average total energy (kcal) intake per eating occasion of lunch and morning/afternoon snacks consumed within nurseries., Secondary Outcomes: accelerometer-assessed mean daily minutes of moderate-to-vigorous physical activity and sedentary time per nursery day, total physical activity on nursery days compared to non-nursery days, average serving size of lunch and morning/afternoon snacks in nursery per day, average percentage of core and non-core food in lunch and morning/afternoon snacks, zBMI, proportion of children who are overweight/obese and child quality-of-life. A process evaluation will examine fidelity, acceptability, sustainability and context. An economic evaluation will compare costs and consequences from the perspective of the local government, nursery and parents., Trial Registration: ISRCTN33134697, 31/10/2019., (© 2023. The Author(s).)

Neonatal hyperbilirubinaemia requiring phototherapy treatment is a common problem impacting the length of hospital stay and rates of hospital readmission. Previous guidelines included guidance for initiating phototherapy treatment but not for discontinuing phototherapy treatment during initial newborn admission.In response to dissatisfaction from trainees, staff and families regarding the variable approach to discontinuing phototherapy among attending nursery providers, we used quality improvement methodologies to increase utilisation of a rebound hyperbilirubinaemia calculator as a more consistent method for guiding the timing of phototherapy discontinuation. The aim was to increase utilisation of the rebound hyperbilirubinaemia calculator for newborns treated with phototherapy in two newborn nurseries to >90% within 2 years.Sequential interventions focused on increasing provider awareness of the rebound hyperbilirubinaemia calculator and making the calculator simple to access and use.At the university medical centre nursery, the use of the calculator increased from 8.7% to 100%, exceeding the project goal. In the community hospital nursery, there was a statistically significant increase in the rate of utilisation from 3.7% to 79.4%, but this fell slightly below the goal of >90%.Electronic Health Record integration, along with education and addition of prompts to providers, increased utilisation of a rebound hyperbilirubinaemia calculator as a consistent approach for guiding decisions about discontinuing phototherapy treatment in newborns., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Nanoparticles (NPs) have been widely used in agriculture, and lanthanum oxide nanoparticles (La 2 O 3 ) NPs can regulate plant growth. La 2 O 3 NPs treatment was hypothesized to affect the accumulation and distribution of substances in rice seedlings under wet and dry nursery conditions. The objective of the present study was to ascertain the effects of La 2 O 3 NPs foliar spray on the morphology and physiology of fragrant rice seedlings under wet and dry nursery conditions. Seedlings of two fragrant rice cultivars, namely 'Xiangyaxiangzhan' and 'Yuxiangyouzhan,' were grown under wet and dry nursery conditions with La 2 O 3 NPs treatments at three concentrations (CK, La 2 O 3 NPs 0 mg L -1 ; T1, La 2 O 3 NPs 20 mg L -1 ; and T2, La 2 O 3 NPs 40 mg L -1 ). The results showed that the seedling-raising method was significantly associated with La 2 O 3 NPs application (P < 0.05), affecting the leaf area of both cultivars. Changes in plant morphological parameters, such as dry weight and root-shoot ratio, were the reasons for the differences in cultivars in response to La 2 O 3 NPs application. Changes were also observed in the plant morphological and physiological parameters of leaf area, specific leaf area, chlorophyll contents, antioxidant properties, and activities of nitrogen metabolism enzymes. The relationship between morphological and physiological processes in fragrant rice was investigated to test the hypothesis. In both wet and dry nursery methods, the T2 concentration of La 2 O 3 NPs was beneficial for rice seedlings and significantly increased their leaf area due to changes in morphological and physiological parameters. Therefore, the results of this study provide a theoretical basis for expanding the research on La 2 O 3 NPs application in rice, as well as relevant references for strengthening rice seedlings in the nursery, which has a positive effect on the grain yield improvement in fragrant rice., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Zostera muelleri is an abundant seagrass species distributed through intertidal and shallow subtidal waters on the subtropical coasts of Australia. The vertical distribution of Zostera is likely defined by tidal influences, particularly desiccation and light reduction stresses. These stresses were expected to affect the flowering of Z. muelleri; however, it is difficult to quantify the effects of tidal inundation with field studies due to multiple confounding environmental factors affecting flowering (e.g., water temperature, herbivory, nutrients). A laboratory aquarium experiment compared the effects of two levels of tidal height (intertidal and subtidal) and light intensity (shaded and unshaded) on flowering timing, abundance, the ratio between flowering shoots and vegetative shoots, the morphology and duration of flower development. The earliest and greatest flowering intensity was recorded in the subtidal-unshaded group, with no flowers observed in the intertidal-shaded group. Notably, the peak flowering time was the same across shaded and unshaded treatments. Shading prolonged the timing of the first flowering and reduced the density of flowering shoots and spathes, while tidal inundation had a more significant effect on the density of flowering shoots and the density of spathes. Results showed that Z. muelleri could flower under low light conditions or tidal stress but not when exposed to both stresses simultaneously in a laboratory 'nursery setting'. Therefore, applying subtidal-unshaded conditions appears to be beneficial for seagrass nurseries aimed at improved flower abundance despite the plants previously being collected from and adapted to intertidal meadows. Further studies that explore the suitable conditions for triggering and optimising the flowering will be beneficial in designing cost-effective seagrass nurseries., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

In France, women can be incarcerated during pregnancy and can keep their babies with them in prison up to the age of 18 months. The small number of nurseries in France and their unequal geographic distribution as well as the high percentage of foreign prisoners often result in women's isolation from their usual cultural environment. Family members and cultural community play a crucial role in the process of mothering. The aim of this study is to explore through these mothers' narratives how they experience the cultural aspects of this process in the prison environment. We conducted semi-structured interviews to collect the experience of 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data. Four different themes emerged: prison: repression of cultural practices, prison: a culture of its own, loss of traditional culture, and cultural hybridization. The specific environmental architecture and operating rules in prison nurseries may induce acute repression regarding cultural ways of mothering. Considering both cultural permeability specific to the peripartum period during which women tend to more easily embrace cultural aspects from their environment, and family distance which restrains cultural transmission, these mothers gather multiple factors of vulnerability for full prisonization, as a form of forced assimilation to prison culture. But a sort of specific hybrid prison culture around motherhood seems to emerge instead, in a process similar to creolization., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Some slug species are considered a nuisance in agriculture and horticulture worldwide, causing economic losses to growers. Phasmarhabditis is a genus of bacteria-feeding nematodes that can parasitize slugs and snails and thus potentially serve as a biological control agent. Canada had no record of Phasmarhabditis until a survey conducted in 2019 reported a Canadian strain of Phasmarhabditis californica from a single Arion rufus slug. To build on this discovery, we surveyed three major agricultural sites, ten greenhouses, and nurseries in Alberta from June to September 2021 to collect pest slug species and investigate their associated nematodes, specifically P. californica. Slugs were collected from the field and returned to the laboratory to check for emerging nematodes on White traps. We collected 1331 slugs belonging to nine species, with Deroceras reticulatum being the most common. Only 45 (3.38%) slug samples were positive for nematodes, and the majority were identified to species level: Alloionema appendiculatum, Caenorhabditis briggsae, Caenorhabditis elegans, Panagrolaimus subelongatus, and Mesorhabditis spiculigera. We did not isolate P. californica from any of the slugs collected from these survey sites, which included the original site where P. californica was discovered. However, four D. reticulatum slugs retrieved from a residential garden sample were infected with P. californica. These findings suggest the possibility of a fragmented distribution of P. californica across Alberta. Future research should focus on extensively surveying agriculture and horticulture sites and residential gardens in different provinces across Canada.

Objectives: Late preterm and term infants comprise 97.3% of annual births in the United States. Admission criteria and the availability of medical interventions in well newborn nurseries are key determinants of these infants remaining within a mother-infant dyad or requiring a NICU admission and resultant separation of the dyad. The objective of this study was to identify national patterns for well newborn nursery care practices., Methods: We surveyed a physician representative from each nursery in the Better Outcomes through Research for Newborns Network. We described the admission criteria and clinical management of common newborn morbidities and analyzed associations with nursery demographics., Results: Of 96 eligible nursery representatives, 69 (72%) completed surveys. Among respondents, 59 (86%) used a minimal birth weight criterion for admission to their well newborn nursery. The most commonly used criteria were 2000 g (n = 29, 49%) and 1800 g (n = 19, 32%), with a range between 1750 and 2500 g. All nurseries used a minimal gestational age criterion for admission; the most commonly used criterion was 35 weeks (n = 55, 80%). Eleven percent of sites required transfer to the NICU for phototherapy. Common interventions in the mother's room included dextrose gel (n = 56, 81%), intravenous antibiotics (n = 35, 51%), opiates for neonatal abstinence syndrome (n = 15, 22%), and an incubator for thermoregulation (n = 14, 20%)., Conclusions: Wide variation in admission criteria and medical interventions exists in well newborn nurseries. Further studies may help identify evidence-based optimal admission criteria to maximize care within the mother-infant dyad., (Copyright © 2023 by the American Academy of Pediatrics.)

Background: In England, the emergence the more transmissible SARS-CoV-2 variant Alpha (B.1.1.7) led to a third national lockdown from December 2020, including restricted attendance at schools. Nurseries, however, remained fully open. COVID-19 outbreaks (≥ 2 laboratory-confirmed cases within 14 days) in nurseries were investigated to assess the risk of SARS-CoV-2 infection and cumulative incidence in staff and children over a three-month period when community SARS-CoV-2 infections rates were high and the Alpha variant was spreading rapidly across England., Methods: This was a cross-sectional national investigation of COVID-19 outbreaks in nurseries across England. Nurseries reporting a COVID-19 outbreak to PHE between November 2020 and January 2021 were requested to complete a questionnaire about their outbreak., Results: Three hundred and twenty-four nurseries, comprising 1% (324/32,852) of nurseries in England, reported a COVID-19 outbreak. Of the 315 (97%) nurseries contacted, 173 (55%) reported 1,657 SARS-CoV-2 cases, including 510 (31%) children and 1,147 (69%) staff. A child was the index case in 45 outbreaks (26%) and staff in 125 (72%) outbreaks. Overall, children had an incidence rate of 3.50% (95%CI, 3.21-3.81%) and was similar irrespective of whether the index case was a child (3.55%; 95%CI, 3.01-4.19%) or staff (3.44%; 95%CI, 3.10-3.82%). Among staff, cumulative incidence was lower if the index case was a child (26.28%; 95%CI, 23.54-29.21%%) compared to a staff member (32.98%; 95%CI, 31.19-34.82%), with the highest cumulative incidence when the index case was also a staff member (37.52%; 95%CI, 35.39-39.70%). Compared to November 2020, outbreak sizes and cumulative incidence was higher in January 2021, when the Alpha variant predominated. Nationally, SARS-CoV-2 infection rates in < 5 year-olds remained low and followed trends in older age-groups, increasing during December 2020 and declining thereafter., Conclusions: In this cross-sectional study of COVID-19 outbreaks in nurseries, one in three staff were affected compared to one in thirty children. There was some evidence of increased transmissibility and higher cumulative incidence associated with the Alpha variant, highlighting the importance of maintaining a low level of community infections., (© 2022. The Author(s).)

Objective: To implement a quality improvement (QI) scorecard as a tool for enhancing quality and safety efforts in level 1 and 2 community hospital nurseries affiliated with Nationwide Children's Hospital., Study Design: A QI scorecard was developed for data collection, analytics, and reporting of neonatal quality metrics and cross-sector collaboration. Newborn characteristics were included for risk stratification, as were clinical and process measures associated with neonatal morbidity and mortality. Quality and safety activities took place in community hospital newborn nurseries in Ohio, and education was provided in both online and in-person collaborations, followed by local team sessions at partner institutions. Baseline (first 12 months) and postbaseline comparisons of clinical and process measures were analyzed by logistic regression, adjusting for potential confounders., Results: In logistic regression models, at least 1 center documented improvements in each of the 4 process measures, and 3 of the 4 centers documented improvements in compliance with glucose checks obtained within 90 minutes of birth among at-risk infants., Conclusion: Collaborative QI projects led to improvements in perinatal metrics associated with important outcomes. Formation of a center-driven QI scorecard is feasible and provides community hospitals with a framework for collecting, analyzing, and reporting neonatal QI metrics., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Previous research determined that Fusarium acuminatum and F . avenaceum are important causal agents of a canker disease in bareroot-propagated fruit and nut trees in California that emerges during cold storage or after transplanting. The disease largely disappeared after 2001, but it reemerged in 2011 in almond trees in at least one nursery. This motivated further study of the etiology and epidemiology of the disease by undertaking studies to determine distribution of the pathogens throughout almond nursery propagation systems and trace possible sources of inoculum. Research initiated in 2013 detected pathogenic Fusarium spp. throughout the almond propagation system, including in healthy trees, in soils, on wheat rotation crops, on equipment, and in the cold-storage facility air. In addition to the two Fusarium spp. implicated previously, F . brachygibbosum and a new Fusarium species, F . californicum , were found to be pathogenic on almond trees. Multilocus sequence typing and somatic compatibility testing confirmed that isolates within a species collected from different materials in the nursery were all highly genetically similar and likely of one clonal lineage. These findings affirm that equipment surfaces, wheat rotation crops, soil, cold-storage facility air, and asymptomatic almond tree materials (i.e., rootstock cuttings, budwood, and scions) can potentially contribute inoculum to increase disease prevalence and severity.

Background and Objectives: Antibiotic overuse is associated with adverse neonatal outcomes. Many medically underserved centers lack pediatric antibiotic stewardship program (ASP) support. Telestewardship may mitigate this disparity. Authors of this study aimed to determine the effectiveness and safety of a nursery-specific ASP delivered remotely., Methods: Remote ASP was implemented in 8 medically underserved newborn nurseries using a stepped-wedge, cluster-randomized design over 3 years. This included a 15-month baseline period, a 9-month "step-in" period using random nursery order, and a 12-month postintervention period. The program consisted of education, audit, and feedback; and 24/7 infectious diseases provider-to-provider phone consultation availability. Outcomes included each center's volume of antibiotic use and the proportion of infants exposed to any antibiotics. Safety measures included length of stay, transfer to another facility, sepsis, and mortality., Results: During the study period, there were 9277 infants born (4586 preintervention, 4691 postintervention). Infants exposed to antibiotics declined from 6.2% pre-ASP to 4.2% post-ASP (relative risk 0.68 [95% confidence interval, 0.63% to 0.75%]). Total antibiotic use declined from 117 to 84.1 days of therapy per 1000 patient-days (-28% [95% confidence interval -22% to -34%]. No safety signals were observed. Most provider-to-provider consultations were <5 minutes in duration and occurred during normal business hours., Conclusions: The number of infants exposed to antibiotics and total antibiotic use declined in medically underserved nurseries after implementing a remote ASP. No adverse safety events were seen, and the remote ASP time demands were manageable. Remote stewardship may be a safe and effective strategy for optimizing antibiotic use in medically underserved newborn nurseries., (Copyright © 2022 by the American Academy of Pediatrics.)

Background: About 47% of children < 5 years of age are stunted in Guatemala. In this study, the investigators aimed to compare growth and cognitive outcomes between children in second grade that attended five Guatemala City Municipal Nurseries (GCMN) vs. same sex, grade, and age-matched children. Methods: A cross-sectional design nested in a retrospective cohort was implemented between 2015 and 2019. Children that attended the GCMN and matched controls completed a math test and validated receptive language and fluid intelligence tests. The primary caregivers completed a sociodemographic survey. General and generalized linear mixed effect models were used to compare children that attended the GCMN vs. controls. The models were adjusted by maternal education, sex, asset score, and other relevant covariates. Results: Children that attended the GCMN exhibited greater math and fluid intelligence scores relative to the controls in the adjusted models (ß = 6.48; 95% CI (2.35−10.61)) and (ß = 1.20; 95% CI (0.12−2.29)), respectively. Lower odds of stunting were significant for children who went to any early childcare institution (AOR = 0.28; 95% CI (0.09−0.89)). Conclusions: The importance of integrating nutrition and high-quality early childhood education interventions in cognitive and growth outcomes is highlighted in this study. The GCMN model may be a scalable model in similar low-resource settings.

Large scale ex situ propagation of coral colonies for reef restoration is a relatively new and developing field. One of the many advantages of utilizing ex situ coral nurseries is the ability to optimize water quality conditions for coral health and survival. Slight alterations in environmental parameters (light, pH, temperature etc.) can affect the health and grow-out time of cultured coral, ultimately influencing production rates. However, corals are also subjected to pests associated with culture facilities such as ciliates, cyanobacterial blooms, and infectious diseases. Therefore, adjusting environmental parameters to optimize coral growth for a shorter ex situ residency time will lead to greater survival and faster restoration. Studies indicate that some coral species demonstrate parabolic tissue growth in response to increasing sea-surface temperatures until the maximum temperature tolerance is reached, whereafter they bleach. To maximize coral growth in Mote Marine Laboratory's ex situ system, we tested the effect of two water temperature treatments (high temperature: 29.5 ± 0.03 °C; control: 25.2 ± 0.08 °C) on two coral species commonly used in reef restoration. To quantify this, we used four replicates of three genotypes each of Montastraea cavernosa ( n = 12) and Acropora palmata ( n = 12). Two-dimensional tissue area was recorded monthly using ImageJ and survival rates within each treatment were documented for 7 months. Results found that M. cavernosa had greater growth rates and equal survivorship in the high temperature treatment compared to the control treatment. A. palmata grew faster and had equal survivorship in the control treatment compared with the high temperature treatment. These results suggest that temperature preferences exist among coral species within ex situ systems and restoration practitioners should consider species-specific temperature regimes to maximize ex situ coral growth rates. This information is critical for optimizing production when corals are in the grow-out stage and should also be considered when designing ex situ systems to ensure temperature regulation can be controlled on a species-specific basis., Competing Interests: The authors declare that they have no competing interests., (© 2022 Merck et al.)

Background: Many variables can influence the process of motherhood, including environmental precarity and personal adversity. One about which little is known is the impact of incarceration on women during or after pregnancy. In France, pregnant women or those with children up to 18 months old can be incarcerated with their child in specific units called nurseries. We sought to explore incarcerated women's experience of motherhood in prison environments and its potential consequences on the construction of their identity as mothers., Method: We conducted semi-structured interviews to collect the experience of the process of motherhood among 25 mothers and 5 pregnant women in 13 different prison nurseries in France and used interpretative phenomenological analysis to explore the data., Results: Four different themes emerged: prison conflates their status as inmates and as mothers; it limits their freedom as mothers; it disrupts their family structure; and motherhood may help distinguish them from other inmates., Conclusion: Incarceration of pregnant women or young mothers in prison nurseries might disrupt the process involved in becoming mothers, causing their identities as prisoners to englobe their identities as mothers and resulting in inappropriate parenting support by prison staff. A professional specialized in peripartum issues should help each woman disentangle her identity as inmate and mother and enable her placement at the facility best adapted to her individual needs as a mother. In any case, if prison must continue to be possible, it must always be a last alternative for women with young children., (© 2021. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

The detrimental impact of currently disproportionate amounts of digital food advertising for processed foods high in sugar, salt, and fat (HSSF) on children's food intake and dietary health is well-documented. The potential of digital healthy food advertising to encourage healthy eating in children is much less researched. A pre-test post-test control group design was used to compare the effect of specifically designed, television-style advertisements for healthy food versus toys on 172 three-to seven-year-old children's exclusively healthy food intake (vegetable, fruit, whole-grain) in five nurseries in Germany. Within- and between-group comparisons demonstrated the effectiveness of healthy food advertising exposure to increase children's healthy food intake. Three exposures to a 1-min-advertisement for healthy food were sufficient to increase children's healthy food intake by as much as three portions. Children in the control condition ate less healthy foods following viewing of a control advertisement (a matched toy advertisement). We concluded that digital healthy food advertising is likely to increase children's healthy food intake sufficiently to help children meet daily recommended amounts of vegetables, fruit, or whole-grain bread, and that this encouragement may be required as decreases in healthy food intake were found when healthy foods were merely available., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: There have been no reports on both anaphylaxis incidence rate in schools, kindergarten, and nurseries, or how teachers have treated these children. This study was a fact-finding survey aimed at determining if appropriate responses to anaphylaxis onset were implemented in Oita Prefecture, Japan., Methods: The Oita Prefectural Allergy Control Committee administered a questionnaire using Google forms to all public and private schools, public and private kindergartens, certified child-care facilities, and day-care centers in the prefecture., Results: Responses to the questionnaire were obtained from 597 institutions, of which 125 890 children were affiliated with the responding institutions. Forty-eight children developed symptoms for which an adrenaline auto-injector was recommended in an Oita guideline. Among these children, three used the adrenaline auto-injector, three were prescribed the adrenaline auto-injector but were unable to use it, 27 were unable to use it as they were not prescribed an adrenaline auto-injector, and the final 15 responded that they handled their symptoms via another method because none of the above options apply., Conclusions: Most children who developed symptoms which an adrenaline auto-injector was recommended had no prescription for an adrenaline auto-injector. There is thus a need for appropriate response training to anaphylaxis whether or not an adrenaline auto-injector was prescribed., (© 2021 Japan Pediatric Society.)

Context: In France, young children of incarcerated women live with their mothers in prison in specific units called nurseries, up to the age of 18 months. Only a few studies have examined the impact of this environment on these children. This study sought to explore through mothers' narratives how they perceive their children to experience this environment and how it affects their development., Method: We used semistructured interviews to collect the perceptions of 25 mothers about their children's experience of daily life in 12 different prison nurseries in France. Interpretative phenomenological analysis was used to explore the data., Results: According to mothers, prison is a sensorially aggressive environment for children that may impair the children's sensory abilities. The children's and mothers' emotional perceptions of anger, sadness, insecurity and imprisonment intertwine. Prison is home for these children, which leads them to establish strong bonds with this inside world-prison staff, other inmates-but to develop reluctances and concern about exploring the outside world., Conclusion: The prison's sensorial environment may overlay the sensorial environment created by the mother, interfering with early mother-child interactions and leading to emotional misattunement. The gap between what the mother and the child each feel to be their home, and the social group they feel they belong to, causes pain to the mothers. This could alter their mandate of being a protective shield that could reduce the traumatic potential of the carceral environment on their babies. These mothers' sentences must be reconsidered for the sake of their children., (© 2021 John Wiley & Sons Ltd.)

Administration of the birth dose of hepatitis B vaccine is an important step in reducing perinatally acquired hepatitis B infection, yet the USA is below the Healthy People 2020 goal for rate of administration.In response to updated Advisory Committee on Immunisation Practices recommendations to administer the dose within 24 hours of birth, we used quality improvement methodology to implement changes that would increase the vaccination rates of healthy newborns in our nurseries. The goal was to improve the proportion of infants who receive the hepatitis B vaccine within 24 hours of birth to >90% within a 2-year period, with a secondary goal of increasing vaccination rates prior to discharge from the nursery to >95%.Multiple Plan-Do-Study-Act (PDSA) cycles were performed. Initial cycles focused on increasing nurse and provider awareness of the updated timing recommendations. Later cycles targeted nursing workflow to facilitate timely administration of the vaccine. We implemented changes at our university medical centre and community hospital newborn nurseries.At the university medical centre nursery, both primary and secondary goals were met; the rate of hepatitis B vaccine administration within 24 hours increased from 81.7% to 96.2%, with vaccine administration prior to discharge increasing from 93.4% to 97.9%. In the community hospital nursery, the baseline rate of hepatitis B vaccine administration within 24 hours was 78.1%, and this increased to 85.8% with the interventions, falling short of the target of >90%. Vaccine administration prior to discharge increased from 87.2% to 92.0%, also not meeting the secondary target of 95%.Interventions that facilitated workflow had additional benefit beyond education alone to improve timing and rates of hepatitis B vaccine administration in both a university medical centre and community hospital nursery., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Screening-based intrapartum antibiotic prophylaxis (IAP) has reduced the prevalence of early-onset group B Streptococcus (GBS) infection in newborns. Nevertheless, early-onset disease still occurs despite IAP, and IAP is not effective in preventing late-onset disease. This study aimed to determine the prevalence and risk factors of GBS neonatal umbilical colonization managed by dry cord care in Japan., Methods: Of 735 healthy newborns in the well-baby nursery at Saitama City Hospital, 353 from whom umbilical bacterial swabs were obtained before discharge were included in the analysis. Maternal and neonatal clinical characteristics were retrospectively reviewed., Results: GBS was detected in 4.2% (15/353) of umbilical swabs; 13/15 (86.8%) were born to GBS-negative mothers. The median (IQR) age at umbilical swab collection was 4.0 (4.0-5.0) days. Comparison of clinical characteristics between GBS-positive and negative neonates revealed a significant difference in the proportion of vaginal deliveries (15/15 [100%] in GBS-positive neonates vs. 115/338 [34.0%] in GBS-negative neonates, p < 0.0001). Of 15 GBS-positive neonates, 10 (66.7%) were also co-colonized with other enteric bacteria such as Escherichia coli., Conclusion: Vaginal delivery was a risk factor associated with GBS neonatal umbilical colonization in Japanese neonates. Co-colonization with multiple enteric bacterial species implicates vertical transmission of GBS from undetected carrier mothers during passage through the birth canal., Competing Interests: Declaration of competing interest None., (Copyright © 2021. Published by Elsevier B.V.)

We investigated severe acute respiratory syndrome coronavirus 2 infections in primary schools, kindergartens, and nurseries in Germany. Of 3,169 oropharyngeal swab specimens, only 2 were positive by real-time reverse transcription PCR. Asymptomatic children attending these institutions do not appear to be driving the pandemic when appropriate infection control measures are used.

Background: Treating respiratory distress in newborns is expensive. We compared the cost-effectiveness of 2 common noninvasive therapies, nasal continuous positive airway pressure (CPAP) and nasal high-flow (nHF), for newborn infants cared for in nontertiary special care nurseries., Methods: The economic evaluation was planned alongside a randomized control trial conducted in 9 Australian special care nurseries. Costs were considered from a hospital perspective until infants were 12 months of age. A total of 754 infants with respiratory distress, born ≥31 weeks' gestation and with birth weight ≥1200 g, <24 hours old, requiring noninvasive respiratory support and/or supplemental oxygen for >1 hour were recruited during 2015-2017. Inpatient costing records were obtained for 753 infants, of whom 676 were included in the per-protocol analysis. Two scenarios were considered: (1) CPAP versus nHF, with infants in the nHF group having "rescue" CPAP backup available (trial scenario); and (2) CPAP versus nHF, as sole primary support (hypothetical scenario). Effectiveness outcomes were rate of endotracheal intubation and transfer to a tertiary-level NICU., Results: As sole primary support, CPAP is more effective and on average cheaper, and thus is superior. However, nHF with back-up CPAP produced equivalent cost and effectiveness results, and there is no reason to make a decision between the 2 treatments on the basis of the cost or effectiveness outcomes., Conclusions: Nontertiary special care nurseries choosing to use only 1 of the modes should choose CPAP. In units with both modes available, using nHF as first-line therapy may be acceptable if there is back-up CPAP., Competing Interests: POTENTIAL CONFLICTS OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Objective: The aim of this study was to elucidate vaccine effectiveness (VE) during varicella outbreaks in schools and nurseries in Japan., Methods: An outbreak was defined as emergence of three or more cases of varicella within 21 days at the same institute. Clinical information such as varicella vaccination status, and history of varicella was collected. If a child had varicella during the outbreak, information about absences, fever, and disease severity was collected., Results: From September 2018 to January 2020, four outbreaks were reported around our institute from three elementary schools and one nursery. A total of 676 children were analyzed in this study. Seventy-six children (11.2%) were unvaccinated, 309 (45.7%) had received one dose of vaccine, and 291 (43.0%) had received two doses. Most children in Pre-K2 (1-2 years old) to Pre-K6 (5-6 years old), who were the targets of the national immunization schedule, received two doses. Meanwhile, most children older than third grade received single dose. Seventy-five children (11.1%) had varicella. Varicella prevalence from Pre-K5 to the third grade was greater than 10%. The adjusted VEs of single- and two-dose of varicella vaccine were 57.8% and 89.0%. The number of days absent was significantly longer in unvaccinated children than single-dose recipients (P = 0.0145). Unvaccinated children had significantly more severe skin eruptions than single-dose recipients (P = 0.0046) and two-dose recipients (P = 0.0258)., Conclusions: Although VEs of single-dose varicella vaccination during outbreaks was not high, the VE of two-dose vaccination was similar to that in a previously reported case-control study., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Large quantities of spent coffee grounds (SCG) are generated the last decades, and their recycling is of research interest challenge. In the present study, SCG was tested to substitute peat (P) in substrate mixtures for the production of Brassica seedlings. Seeds of cauliflower, broccoli, and cabbage were placed in substrate mixtures containing 0-2.5-5-10% SCG. The mixture of SCG with peat affected several physicochemical characteristics of the growing media, providing also considerable amount of mineral elements for the seedling growth needs. Seed emergence was stimulated in 2.5-5% of SCG for cauliflower and at 2.5% of SCG for cabbage, while 10% of SCG decreased the percentage and increased the mean emergence time of the examined species. Plant biomass and leaf number were increased at 2.5% SCG for broccoli and cabbage but maintained at cauliflower when compared with control. The SCG at 10% decreased stomatal conductance of broccoli and cabbage (including 2.5-5% SCG in cauliflower) while chlorophyll content was increased at 10% of SCG media. The incorporation of SCG impacted the mineral content accumulated in plants with increases in nitrogen, potassium, and phosphorus and decreases in magnesium and iron content. Total phenolics and antioxidant activity (DPPH, FRAP) decreased at ≥ 5% SCG at cauliflower and cabbage or unchanged for broccoli when compared with the control. The cabbage seedlings grown in 10% SCG media subjected to stress with increases in the production of hydrogen peroxides and lipid peroxidation, and reflected changes in the antioxidant enzymatic metabolism (catalase, superoxide dismutase). The present study demonstrates that SCG (up to 5%) can be used for seed germination biostimulants and/or partially substitute the peat for Brassica seedling production.

Background: Chloropicrin (PIC) mixtures of 1,3-dichloropropene and chloropicrin (DD:PIC), dazomet, and metam sodium (MS) have been applied as chemical alternatives to methyl bromide (MB) in Spanish strawberry nurseries since MB was banned as a soil fumigant in 2005. These chemical alternatives were applied to soil in two Spanish strawberry nurseries between 2003 and 2017 to test their efficacy against the main crown and root disease and soil fungal populations in comparison with the use of MB and PIC (MB:PIC). These chemicals were applied at several doses with different application methods under plastic films. Crown and root disease incidence was calculated as the percentage of plants with symptoms caused by soil-borne pathogens. Soil fungal populations were estimated as colony forming units per gram of dry soil., Results: All chemicals significantly reduced soil-borne fungal disease incidence and fungal population in both nurseries over the years. Phytophthora cactorum and Fusarium spp. were the main pathogens causing soil-borne diseases, followed by Verticillium spp. MB:PIC remained the treatment that best controlled P. cactorum. MS and DD:PIC controlled Fusarium disease to a lesser extent than MB:PIC and dazomet in both nurseries. MB:PIC and PIC were the two treatments that most reduced Verticillium spp. The population of Verticillium spp. declined and the presence of other species such as Colletotrichum spp. and Rhizoctonia spp. was minimal during the study., Conclusion: Chemicals are necessary to obtain healthy strawberry plants. The use of chemical alternatives to MB has resulted in changes in the incidence of soil-borne diseases and soil fungal populations in strawberry nurseries. Dazomet was an effective alternative to MB as a soil-borne disease control, except against Verticillium spp. MB alternatives in strawberry nursery soils have caused Fusarium spp. to displace Verticillium spp., (© 2020 Society of Chemical Industry.)

Background: The prevalence of substance use, both prescribed and non-prescribed, is increasing in many areas of the world. Substance use by women of childbearing age contributes to increasing rates of neonatal abstinence syndrome (NAS). Neonatal opioid withdrawal syndrome (NOWS) is a newer term describing the subset of NAS related to opioid exposure. Non-pharmacological care is the first-line treatment for substance withdrawal in newborns. Despite the widespread use of non-pharmacological care to mitigate symptoms of NAS, there is not an established definition of, and standard for, non-pharmacological care practices in this population. Evaluation of safety and efficacy of non-pharmacological practices could provide clear guidance for clinical practice., Objectives: To evaluate the safety and efficacy of non-pharmacological treatment of infants at risk for, or having symptoms consistent with, opioid withdrawal on the length of hospitalization and use of pharmacological treatment for symptom management. Comparison 1: in infants at risk for, or having early symptoms consistent with, opioid withdrawal, does non-pharmacological treatment reduce the length of hospitalization and use of pharmacological treatment? Comparison 2: in infants receiving pharmacological treatment for symptoms consistent with opioid withdrawal, does concurrent non-pharmacological treatment reduce duration of pharmacological treatment, maximum and cumulative doses of opioid medication, and length of hospitalization?, Search Methods: We used the standard search strategy of Cochrane Neonatal to search CENTRAL (2019, Issue 10); Ovid MEDLINE; and CINAHL on 11 October 2019. We also searched clinical trials databases and the reference lists of retrieved articles for randomized controlled trials (RCTs), quasi-RCTs, and cluster trials., Selection Criteria: We included trials comparing single or bundled non-pharmacological interventions to no non-pharmacological treatment or different single or bundled non-pharmacological interventions. We assessed non-pharmacological interventions independently and in combination based on sufficient similarity in population, intervention, and comparison groups studied. We categorized non-pharmacological interventions as: modifying environmental stimulation, feeding practices, and support of the mother-infant dyad. We presented non-randomized studies identified in the search process narratively., Data Collection and Analysis: We used standard methodological procedures expected by Cochrane. We used the GRADE approach to assess the certainty of evidence. Primary outcomes in infants at risk for, or having early symptoms consistent with, opioid withdrawal included length of hospitalization and pharmacological treatment with one or more doses of opioid or sedative medication. Primary outcomes in infants receiving opioid treatment for symptoms consistent with opioid withdrawal included length of hospitalization, length of pharmacological treatment with opioid or sedative medication, and maximum and cumulative doses of opioid medication., Main Results: We identified six RCTs (353 infants) in which infants at risk for, or having symptoms consistent with, opioid withdrawal participated between 1975 and 2018. We identified no RCTs in which infants receiving opioid treatment for symptoms consistent with opioid withdrawal participated. The certainty of evidence for all outcomes was very low to low. We also identified and excluded 34 non-randomized studies published between 2005 and 2018, including 29 in which infants at risk for, or having symptoms consistent with, opioid withdrawal participated and five in which infants receiving opioid treatment for symptoms consistent with opioid withdrawal participated. We identified seven preregistered interventional clinical trials that may qualify for inclusion at review update when complete. Of the six RCTs, four studies assessed modifying environmental stimulation in the form of a mechanical rocking bed, prone positioning, non-oscillating waterbed, or a low-stimulation nursery; one study assessed feeding practices (comparing 24 kcal/oz to 20 kcal/oz formula); and one study assessed support of the maternal-infant dyad (tailored breastfeeding support). There was no evidence of a difference in length of hospitalization in the one study that assessed modifying environmental stimulation (mean difference [MD) -1 day, 95% confidence interval [CI) -2.82 to 0.82; 30 infants; very low-certainty evidence) and the one study of support of the maternal-infant dyad (MD -8.9 days, 95% CI -19.84 to 2.04; 14 infants; very low-certainty evidence). No studies of feeding practices evaluated the length of hospitalization. There was no evidence of a difference in use of pharmacological treatment in three studies of modifying environmental stimulation (typical risk ratio [RR) 1.00, 95% CI 0.86 to 1.16; 92 infants; low-certainty evidence), one study of feeding practices (RR 0.92, 95% CI 0.63 to 1.33; 49 infants; very low-certainty evidence), and one study of support of the maternal-infant dyad (RR 0.50, 95% CI 0.13 to 1.90; 14 infants; very low-certainty evidence). Reported secondary outcomes included neonatal intensive care unit (NICU) admission, days to regain birth weight, and weight nadir. One study of support of the maternal-infant dyad reported NICU admission (RR 0.50, 95% CI 0.13 to 1.90; 14 infants; very low-certainty evidence). One study of feeding practices reported days to regain birth weight (MD 1.10 days, 95% CI 2.76 to 0.56; 46 infants; very low-certainty evidence). One study that assessed modifying environmental stimulation reported weight nadir (MD -0.28, 95% CI -1.15 to 0.59; 194 infants; very low-certainty evidence) and one study of feeding practices reported weight nadir (MD -0.8, 95% CI -2.24 to 0.64; 46 infants; very low-certainty evidence)., Authors' Conclusions: We are uncertain whether non-pharmacological care for opioid withdrawal in newborns affects important clinical outcomes including length of hospitalization and use of pharmacological treatment based on the six included studies. The outcomes identified for this review were of very low- to low-certainty evidence. Combined analysis was limited by heterogeneity in study design and intervention definitions as well as the number of studies. Many prespecified outcomes were not reported. Although caregivers are encouraged by experts to optimize non-pharmacological care for opioid withdrawal in newborns prior to initiating pharmacological care, we do not have sufficient evidence to inform specific clinical practices. Larger well-designed studies are needed to determine the effect of non-pharmacological care for opioid withdrawal in newborns., (Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Background and Objectives: Donor milk use has increased among very preterm infants because of mounting evidence of health benefits; however, the extent that donor milk is used among healthy term infants in level 1 nurseries is unclear. We aimed to determine (1) national prevalence of and (2) hospital factors associated with donor milk use in level 1 nurseries., Methods: Among 3040 US birthing hospitals, we randomly selected hospitals from each of 4 US regions (119 in northeast, 120 in Midwest, 116 in west, and 103 in south) for a total of 458 hospitals. We surveyed the nursing leaders of these hospitals from October to December 2017 regarding routine use of donor milk in the level 1 nursery (yes or no). To estimate national prevalence, we weighted responses according to the number of birthing hospitals within each region. We examined relationships between routine donor milk use in the level 1 nursery and hospital characteristics using multivariable logistic regression., Results: In total, 214 of 458 (47%) nursing leaders responded. The national prevalence of routine donor milk use in level 1 nurseries was 17.6%. Eighty-five percent of donor milk programs were ≤5 years old. Donor milk use occurred more often in hospitals with ≥1500 annual births (41.7%), compared to ≤500 annual births (6.3%) (adjusted odds ratio 7.8; 95% confidence interval 1.8-34.4), and in the west (30.9%), compared to the northeast (10.5%) (adjusted odds ratio 4.1; 95% confidence interval [1.1-14.9])., Conclusions: Although there is limited evidence to support donor milk for healthy infants in the nursery, nearly one-fifth of level 1 US nurseries routinely used donor milk in 2017., Competing Interests: POTENTIAL CONFLICT OF INTEREST: Dr Perrin serves on the board of directors of the Human Milk Banking Association of North America. Drs Parker and Belfort serve on the research board of Mother’s Milk Bank Northeast. These are all unpaid positions. The other authors have indicated they have no potential conflicts of interest to disclose, (Copyright © 2020 by the American Academy of Pediatrics.)