Search

Parents of children with autism spectrum disorder (ASD) show increased levels of parenting stress, but only one study has examined this association before a diagnostic evaluation. We conducted a cross-sectional study of parenting stress in 317 low SES parents with children at-risk for ASD before a diagnostic evaluation. Multiple regression modeling evaluated the associations between parenting stress and parent and child factors. Parenting stress was negatively associated with social support and positively associated with active avoidance coping and parental worry. However, parenting stress was not associated with the child's ASD symptom severity or adaptive functioning, except for self-direction. Findings suggest parenting stress among parents of children at risk of ASD should be assessed prior to diagnosis. [This study was conducted in collaboration with the Developmental and Behavioral Pediatrics Research Network (DBPNet).]

Author(s): Matthew J. Drago [sup.1] [sup.4] , Veronika Shabanova [sup.2] , Daniela Hochreiter [sup.3] , Matthew Grossman [sup.3] , Mark Mercurio [sup.1] Author Affiliations: (1) grid.47100.32, 0000000419368710, Department of Pediatrics, [...], Objectives Opioid exposed infants born to incarcerated women represent a vulnerable and understudied subset of infants with neonatal abstinence syndrome (NAS). The impact of maternal incarceration on length of stay (LOS) for infants with NAS is unknown. We hypothesized that infants with NAS born to incarcerated women have longer hospitalizations compared to infants with NAS born to non-incarcerated women. Methods This is a retrospective cohort study of infants with NAS born between 2011 and 2018 at the primary delivery site for Connecticut&apos;s only women&apos;s prison. Opioid exposed infants were assessed by Finnegan Scores for withdrawal and received morphine as a first line agent and phenobarbital as a second line agent. LOS was compared using Poisson regression. Results Of 206 infants identified, 166 were included in the analysis, with 28 born to incarcerated women and 138 to non-incarcerated women. Incarcerated women were more likely to report prenatal alcohol use, 14.3% vs 2.2% p = 0.016 and benzodiazepine use 21.4% vs 7.3% p = 0.032. Infants of incarcerated women were less likely to be fed breast milk at discharge, 3.6% vs 37% p < 0.001. Adjusted mean LOS was longer among infants born to incarcerated women, 18.5 vs 16.6 days (p = 0.009). Conclusions for Practice Infants with NAS born to incarcerated women in Connecticut had longer LOS, lower rates of being fed breast milk, and different prenatal substance exposures than infants with NAS born to non-incarcerated women. Supporting the maternal-infant dyad until infant discharge may mitigate the potential negative impact of maternal incarceration on the care of infants with NAS.

Objective: Predicting neonatal survival is essential for targeting interventions to reduce neonatal mortality. Pacific Islanders have been underrepresented in existing prediction tools and have unique, maternal obesity-related risk factors for both preterm birth and neonatal mortality. Using neonatal sex, birth weight, and gestational age, we developed a graphical tool for neonatal survival among Pacific Islander singletons in the United States. Methods: Birth-infant death data files from the United States National Center for Health Statistics were used (2014–2018). Pacific Islander mothers and singletons without congenital anomalies born between 22–36 gestational weeks were included. Poisson regression models were used to predict neonatal mortality (<28 days of life) rate including neonatal sex, birth weight, and gestational age in weeks as predictors. Predicted survival rates in the graphical tool were calculated as "1 minus mortality rate". Results: Of the 5192 included neonates, the neonatal mortality rate was 2.0%; 43.5% of mothers had pre-pregnancy obesity, and 16.5% of neonates were born large-for-gestational age. Birth weight and gestational age had a non-linear association with neonatal death, and their interaction was included in the model. Retaining neonatal sex, models with gestational age at birth or both birth weight and gestational age at birth performed better than the model with birth weight only. Conclusion: This is the first graphical tool for neonatal survival prediction among preterm-born Pacific Islander singletons in the United States. Using only neonatal sex, birth weight, and gestational age, this graphical tool is a straightforward reference for survival among groups of neonates with similar characteristics. [ABSTRACT FROM AUTHOR]

Background: Paid parental leave policies may promote breastfeeding, which can have short- and long-term health benefits for both members of the birthing person-infant dyad. In the United States, where 56% of the workforce qualifies for unpaid federal medical leave, certain states have recently enacted paid parental and family leave policies. We aimed to assess the extent to which living in states with versus without paid family leave was associated with feeding regimens that included breastfeeding. Methods: In this cross-sectional analysis of the 2021 National Immunization Survey-Child, we assessed feeding outcomes: (1) exclusively breastfed (only fed breastmilk—never infant formula—both before and after six months of age), (2) late mixed breastfeeding (formula after six months), (3) early mixed breastfeeding (breastfed, formula before six months), and (4) never breastfed. We conducted Pearson χ2 to compare social-demographic characteristics and multivariable nominal regression to assess extent to paid family leave was associated with breastfeeding regimens, compared with never breastfeeding. Results: Of the 35,995 respondents, 5,806 (25% of weighted respondents) were from states with paid family leave policies. Compared with never breastfeeding, all feeding that incorporated breastfeeding—exclusive breastfeeding, late mixed feeding (breastfed, formula introduced after six months), and early mixed feeding (breastfed, formula introduced before six months)—were more prevalent in states with paid family leave policies. The adjusted prevalence ratio (aPR) and differences in adjusted prevalence compared with never breastfeeding in states with versus without paid family leave policies were: aPR 1.41 (95% CI 1.15, 1.73), 5.36% difference for exclusive breastfeeding; aPR 1.25 (95% CI 1.01, 1.53), 3.19% difference for late mixed feeding, aPR 1.32 (95% CI 1.32, 1.97), 5.42% difference for early mixed feeding. Conclusion: States with paid family leave policies have higher rates of any breastfeeding and of exclusive breastfeeding than states without such policies. Because all feeding types that incorporate breastfeeding were higher in states with paid family leave policies, expansion of paid family leave may improve breastfeeding rates. [ABSTRACT FROM AUTHOR]

Background: Although AIDS-related deaths have reduced with increased access to antiretroviral care, cardiovascular disease-related morbidities among persons living with HIV are rising. Contributing to this is the higher incidence of Hypertension among Persons Living with HIV. The duration of exposure to the virus and antiretroviral drugs plays a vital role in the pathogenesis, putting perinatally infected children and adolescents at higher risk than behaviorally-infected ones, supporting the calls for increased surveillance of Hypertension among them. Despite the availability of guidelines to support this surveillance, the blood pressure (BP) of adolescents living with HIV (ADLHIV) is not checked during clinical visits. This study aims to assess the effect of a theory-based intervention on healthcare workers' adherence to the guidelines for hypertension screening among adolescents. Methods: A multi-facility cluster-randomized study will be conducted. The clusters will be 20 antiretroviral therapy sites in the Greater Accra Region of Ghana with the highest adolescent caseload. Data will be extracted from the folders of adolescents (10–17 years) who received care in these facilities six months before the study. The ART staff of intervention facilities will receive a multicomponent theory of planned behaviour-based intervention. This will include orientation on hypertension risk among ADLHIV, provision of job aids and pediatric sphygmomanometers. Six months after the intervention, the outcome measure will be the change from baseline in the proportion of ADLHIV whose BP was checked during clinical visits. The calculated sample size is 400 folders. Implications of findings: This study will generate evidence on the effectiveness of a multicomponent theory-based intervention for improving the implementation of clinical practice guidelines. Trial registration: PACTR202205641023383. [ABSTRACT FROM AUTHOR]

Background: Antiretroviral therapy (ART)‐associated metabolic abnormalities, including impairment of glucose metabolism, are prevalent in adults living with HIV. However, the prevalence and pathogenesis of impaired glucose metabolism in children and adolescents living with HIV, particularly in sub‐Saharan Africa, are not well characterized. We investigated the prevalence of impaired glucose metabolism among children and adolescents living with perinatally infected HIV in Ghana. Methods: In this multicentre, cross‐sectional study, we recruited participants from 10 paediatric antiretroviral treatment clinics from January to June 2022 in 10 facilities in Greater Accra and Eastern regions of Ghana. We determined impaired glucose metabolism in the study sample by assessing fasting blood sugar (FBS), insulin resistance as defined by the homeostatic model assessment for insulin resistance (HOMA‐IR) index and glycated haemoglobin (HbA1c) levels. The prevalence of impaired glucose metabolism using each criterion was stratified by age and sex. The phenotypic correlates of glucose metabolism markers were also assessed among age, sex, body mass index (BMI) and waist‐to‐hip ratio (WHR). Results: We analysed data from 393 children and adolescents living with HIV aged 6–18 years. A little over half (205/393 or 52.25%) of the children were female. The mean age of the participants was 11.60 years (SD = 3.50), with 122/393 (31.00%) aged 6–9 years, 207/393 (52.67%) aged 10–15 years, and 62/393 (15.78%) aged 16–18 years. The prevalence rates of glucose impairment in the study population were 15.52% [95% confidence interval (CI): 12.26–19.45], 22.39% (95% CI: 18.54–26.78), and 26.21% (95% CI: 22.10–30.78) using HbA1c, HOMA‐IR, and FBS criteria, respectively. Impaired glucose metabolism detected by FBS and HOMA‐IR was higher in the older age group, whereas the prevalence of abnormal HbA1c levels was highest among the youngest age group. Age and BMI were positively associated with FBS and HOMA‐IR (p < 0.001). However, there was negative correlation of WHR with HOMA‐IR (p < 0.01) and HbA1c (p = 0.01). Conclusion: The high prevalence of impaired glucose metabolism observed among the children and adolescents living with HIV in sub‐Saharan Africa is of concern as this could contribute to the development of metabolic syndrome in adulthood. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to examine the association between rate of gestational weight gain (GWG) and preterm birth (PTB) classified by pre‐pregnancy BMI among Pacific Islander individuals in the United States. Methods: Pacific Islander mothers (n = 55,975) and singleton infants (22–41 gestational weeks) without congenital anomalies were included using data from the National Center for Health Statistics (2014–2018). PTB was compared by pre‐pregnancy BMI among women in each stratum of rate of GWG using Cox proportional hazards models. Results: Compared with mothers with a rate of GWG within the guidelines, mothers with a rate of GWG below the guidelines and either pre‐pregnancy underweight (adjusted hazard ratio [aHR] = 1.84, 95% CI: 1.10–3.06), healthy weight (aHR = 1.38, 95% CI: 1.15–1.65), obesity class I (aHR = 1.22, 95% CI: 0.97–1.52), or obesity class II (aHR = 1.43, 95% CI: 1.05–1.96) had an increased risk of PTB; mothers with a rate of GWG above the guidelines and either pre‐pregnancy underweight (aHR = 1.57, 95% CI: 0.92–2.69) or obesity class II (aHR = 1.31, 95% CI: 0.98–1.76) had an increased risk of PTB. Conclusions: The association between rate of GWG below or above the guidelines and PTB differs by pre‐pregnancy BMI among Pacific Islander individuals. [ABSTRACT FROM AUTHOR]