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Cochlear implants (CIs) have demonstrated a clear functional benefit in children with severe-to-profound sensorineural hearing loss (SNHL) and thus have gained wide acceptance for treating deafness in the pediatric population. When evaluating young children for cochlear implantation, there are unique considerations beyond the standard issues addressed during surgery in adults. Because of advances in genetic testing, imaging resolution, CI technology, postimplant rehabilitation, and other factors, issues related to CI surgery in children continue to evolve. Such factors have led to changes in candidacy guidelines, vaccine requirements, and lowering of age requirement for surgery. In addition, differences in the anatomy and physiology of infants require special attention to ensure safety when operating on young children. This review summarizes these issues and provides guidance for surgeons treating children with SNHL. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine associations between parent reports of bottle-feeding behaviors and infant non-nutritive suck (NNS) on a pacifier as well as oral feeding skills during bottle-feeding. A prospective study was conducted. Full-term infants with no prior diagnosed feeding disorders were recruited at 3-months. Parents reported their infant's bottle-feeding behaviors using the Neonatal Eating Assessment Tool-Bottle-Feeding (NeoEAT-Bottle-Feeding), consisting of five domains: Infant Regulation, Energy and Physiologic Stability, Gastrointestinal Tract Function, Sensory Responsiveness, and Compelling Symptoms of Problematic Feeding. Infant NNS was measured using a custom pacifier, pressure transducer device, which yields the following NNS variables: duration (sec), frequency (Hz), amplitude (cmH20), cycles per burst, cycle amount, and burst amount. The Oral Feeding Skills (OFS) scale was used to measure the initial volume, transfer volume, proficiency, and rate of milk transfer during bottle feeding. Fifty-two infants (58% male) with reported prior bottle experience completed this study. NeoEAT-Bottle-Feeding Total score was significantly positively associated with NNS burst duration and NNS cycles per burst. The NeoEAT-Bottle-Feeding Energy and Physiologic Stability domain was significantly positively correlated with NNS cycles per burst. NeoEAT-Bottle-Feeding Gastrointestinal Tract Function domain score was significantly positively correlated with NNS duration, amplitude, and cycles per burst. There were no significant associations between NeoEAT-Bottle-Feeding domains and the OFS scale. The findings demonstrate that parent reports of problematic feeding at 3 months of age are associated with aspects of infant NNS physiology and not with oral feeding metrics during bottle-feeding. Parent reports of bottle-feeding behaviors, particularly pertaining to gastrointestinal issues, were associated with aspects of infant NNS. These data together will allow for a more nuanced understanding of infant feeding and will be beneficial in determining if infants have a feeding delay. [ABSTRACT FROM AUTHOR]

Background: Infants with single‐ventricle (SV) physiology undergo the 3‐stage Fontan surgery. Norwood patients, who have completed the first stage, face the highest interstage mortality. The Berlin Heart EXCOR (BH), a pediatric pulsatile ventricular assist device, has shown promise in supporting these patients. However, clinical questions regarding device configurations prevent optimal support. Methods: We developed a combined idealized mechanics‐lumped parameter model of a Norwood patient and simulated two additional patient‐specific cases: pulmonary hypertension (PH) and post‐operative treatment with milrinone. We quantified the effects of BH support across different device volumes, rates, and inflow connections on patient hemodynamics and BH performance. Results: Increasing device volume and rate increased cardiac output, but with unsubstantial changes in specific arterial oxygen content. We identified distinct SV–BH interactions that may impact patient myocardial health and contribute to poor clinical outcomes. Our results suggested BH settings for patients with PH and for patients treated post‐operatively with milrinone. Conclusions: We present a computational model to characterize and quantify patient hemodynamics and BH support for infants with Norwood physiology. Our results emphasized that oxygen delivery does not increase with BH rate or volume, which may not meet patient needs and contribute to suboptimal clinical outcomes. Our findings demonstrated that an atrial BH may provide optimal cardiac loading for patients with diastolic dysfunction. Meanwhile, a ventricular BH decreased active stress in the myocardium and countered the effects of milrinone. Patients with PH showed greater sensitivity to device volume. In this work, we demonstrate the adaptability of our model to analyze BH support across varied clinical situations. [ABSTRACT FROM AUTHOR]

Background: Childbirth has become increasingly medicalised, which may impact on the mother's birth experience and her newborn infant's physiology and behaviour. Although associations have been found between a mother's subjective birth experience and her baby's temperament, there is limited qualitative evidence around how and why this may occur. Objectives: This qualitative study aimed to explore mothers' childbirth and postnatal experiences, perceptions of their baby's early behavioural style, and whether they saw these as related. Methods: A qualitative semi-structured interview schedule collected rich in-depth data. Twenty-two healthy mothers over 18 years of age and with healthy infants aged 0–12 months born at term, were recruited from Southwest regions of England and Wales. Thematic analysis was performed on the data. Results: Mothers experienced childbirth as a momentous physical and psychological process. However, they did not necessarily perceive the birth as affecting their baby's early behaviour or temperament. While some mothers drew a direct relationship, such as linking a straightforward birth to a calm infant, others did not make an explicit connection, especially those who experienced a challenging birth and postnatal period. Nevertheless, mothers who had a difficult or medicalised birth sometimes reported unsettled infant behaviour. It is possible that mothers who feel anxious or depressed after a challenging birth, or those without a good support network, may simply perceive their infant as more unsettled. Equally, mothers who have been well-supported and experienced an easier birth could be more likely to perceive their baby as easier to care for. Conclusions: Childbirth is a physical and psychological event that may affect mother-infant wellbeing and influence maternal perceptions of early infant temperament. The present findings add to prior evidence, reinforcing the importance of providing good physical and emotional support during and after childbirth to encourage positive mother-infant outcomes. [ABSTRACT FROM AUTHOR]

An increase in the birth rate of premature and low birth weight children at the current level of medical development requires the development of fundamental ideas about the physiology of the cardiovascular system in a history of preterm birth from the point of view of pre- and postnatal ontogenesis. For practicing neonatologists, pediatricians, therapists, cardiologists, reproductologists, etc., it is necessary to improve the traditional ideas about the mechanisms of damage to the cardiovascular system in this category of patients. Because it is established that this clinical subgroup is characterized by increased risks of early onset of pathology of the heart and blood vessels, as well as a high mortality rate in adulthood. Pathological changes of the cardiovascular system in conditions of prematurity can occur at various levels of integration of the body (molecular, subcellular, cellular, organ, functional systems, organismal). The use of modern noninvasive technology of "spot tracing" makes it possible to study the features of segmental deformation and the variety of forms of left ventricle (LV) torsion mechanics during postnatal growth and development in prematurely born children. Optimization of research and diagnostic processes in the field of mechanics of the infant heart in the prenatal and postnatal periods from the point of view of progressive data on anatomy, histology, and clinical biochemistry allows us to study the nature of various contractile–rotational models, as well as reasonably assume the contribution of the fibrous skeleton of the infant heart to the formation of "childhood types" of left ventricular twisting. The search and development of informative criteria for the early diagnosis of latent subclinical heart dysfunction in childhood, taking into account the possibilities of non-invasive ultrasound technology of spot tracing (analysis of types of rotational movement, determination of areas of reduced longitudinal deformation of the LV), based on the current provisions of evidence-based medicine, have become quite possible in modern conditions and are demonstrated by the authors in this review. The information offered to the readers will allow them to expand the understanding of the physiology and pathophysiology of the infant heart with a history of premature birth, bearing in mind the fact that prematurity is considered a chronic condition. [ABSTRACT FROM AUTHOR]

As robotic‐assisted (RAL) surgery expanded to treat pediatric congenital disease, infant anatomy and physiology posed unique challenges that prompted adaptations to the technology and surgical technique, which are compiled and reviewed in this manuscript. From the beginning, collaboration with anesthesia is critical for a safe, efficient case including placement of an endotracheal tube rather than a laryngeal mask (LMA) and placement of a nasogastric tube and/or rectal tube to relieve distended stomach or bowel, respectively. Furthermore, end‐tidal CO2 (EtCO2) is important for monitoring and predicting the effects of pneumoperitoneum on caridiovascular physiology, incranial pressure, and risk of acidosis and hypercarbia. Positioning can further exacerbate these effects and affect intra‐abdominal working space. For infant robotic pyeloplasty and heminephrectomy, a "beanbag" is commonly used for stabilization in the lateral decubitus position. We advise against the use of a "baby bump" because it brings the bowels and vasculature more anterior than expected. Pnuemoperitoneum pressure of 8–10 mmHg during port placement maximizes safety, but thereafter, the pneumoperitoneum pressure can be minimized to 6–8 mmHg during the procedure without compromising the visual field. Port sites should be marked after insufflation, followed by the open Hasson technique for peritoneal access and port placement under direct vision with intussusception of the trocars to avoid vascular or bowel injury. Additional tips can be obtained through this manuscript, immersive fellowships, and mini‐fellowships. Ulitmately, infant robotic surgery has the potential to benefit many children but is presently limited by the lack of pediatric‐specific robotic technology and its associated costs. [ABSTRACT FROM AUTHOR]

The objective of this study was to verify the effects on 4- to 18-month-old babies' NPMD after the family-centered Kids Intervention Therapy – Aquatic Environment (KITE) programme. This quasi-experimental study involved 61 families. The NPMD was assessed with Alberta Infant Motor Scale (AIMS), Denver II Developmental Screening Test, context assessment with questionnaire and Affordance in the Home Environment for Motor Development – Infant Scale (AHEMD-IS), and quality of life (QOL) assessment with Pediatric Quality of Life Inventory™ Infant Scales (PedsQL™). 24 babies in the intervention group (IG) participated in the KITE session twice a week for 4 weeks. 37 children participated in the control group. The IG sample had improved NPMD in post-intervention (p = 0.001) and retention (p = 0.002), with a large intervention effect (η = 0.178/0.156). The IG improved in the QOL physical capacity domain (p = 0.023), with a medium effect (d = 0.573). There were no differences between the groups regarding the stimulation received at home, which reinforces the effects of the KITE. It is concluded that the KITE had positive effects on the NPMD and QOL physical capacity domain in the participating. [ABSTRACT FROM AUTHOR]

This study was designed as a prospective, randomized controlled trial. A total of 90 preterm infants who underwent retinopathy of prematurity (ROP) examinations were categorized into three groups, a control group, a white noise group (WN), and a classical music group (CM), each comprising 30 preterm infants. The study data were obtained using an information form and the Premature Infant Pain Profile. During (WN: 9.70±3.02; CM: 11.2±2.28) and after the examination (WN: 3.60±2.11; CM: 3.77±1.83), the preterm infants in the WN and CM groups had lower mean pain scores and heart rates (181.17±15.76 and 3150.10±17.03 vs. 173.30±20.66 and 146.67±18.17, respectively; p<0.001) and higher mean oxygen saturation values (93.60±3.87 and 97.83±1.93 vs. 95.73±2.52 and 98.27±1.82, respectively; p<0.05) than those in the control group; the differences were statistically significant. The WN and CM listened to by the preterm infants during ROP examinations had positive effects on pain and heart rate and oxygen saturation values. [ABSTRACT FROM AUTHOR]

Excessive accumulation of fluid may result in interstitial edema and multiorgan dysfunction. Over the past few decades, the detrimental impact of fluid overload has been further defined in adult and pediatric populations. Growing evidence highlights the importance of monitoring, preventing, managing, and treating fluid overload appropriately. Translating this knowledge to neonates is difficult as they have different disease pathophysiologies, and because neonatal physiology changes rapidly postnatally in many of the organ systems (i.e., skin, kidneys, and cardiovascular, pulmonary, and gastrointestinal). Thus, evaluations of the optimal targets for fluid balance need to consider the disease state as well as the gestational and postmenstrual age of the infant. Integration of what is known about neonatal fluid overload with individual alterations in physiology is imperative in clinical management. This comprehensive review will address what is known about the epidemiology and pathophysiology of neonatal fluid overload and highlight the known knowledge gaps. Finally, we provide clinical recommendations for monitoring, prevention, and treatment of fluid overload. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) in children with Transposition of Great arteries (TGA) undergoing Arterial Switch operation (ASO) is an important complication in the post-operative period associated with worse outcomes. AKI in children post open cardiac surgery has been well studied, with lesser data in literature pertaining to TGA and its sub-types specifically. This was a prospective, observational study enrolling infants with TGA undergoing ASO at a single center over a span of a decade from January 2010 to December 2020. The infants were followed during the duration of ICU and hospital stay, with documentation of baseline and intraoperative parameters as well as post-operative course. Out of 145 infants enrolled in the study, 83.1% developed AKI with majority (83.9%) having stage 1 AKI. Higher odds of AKI were seen in infants requiring Norepinephrine [odds ratio − 16.76 (95% CI 2.19–128.2), p < 0.001] and those who developed gram-negative infections [2.81 (1.04–7.56), p − 0.036]. Infants with AKI had significantly higher vasoactive-inotropic support at day 1 than those without AKI [16 (12.5–21.50 vs 13 (10.25–15.75), p − 0.014]. Seventeen infants in the AKI group (14%) died as opposed to none in the non-AKI group (p = 0.076). Median hours of ventilator support required were significantly higher in those with AKI than those who did not develop AKI (48 vs 45.5 p = 0.015). The infants with ASO + ASD + PDA (53% of neonates who died) were younger, had less weight at admission, more gram-negative sepsis and need for dopamine, as compared to ASO + VSD + ASD (23.5% of mortality) and ASO + ASD + VSD + aortic arch repair (23.5% of mortality). AKI in infants with TGA undergoing ASO is common and associated with poorer outcomes. In this subpopulation, AKI development is associated most commonly with hemodynamic instability and infections. This is the first study, looking at outcomes of TGA depending on the sub-types of ASO surgeries done in the infants [ASO with ASD + PDA or ASD + VSD or ASD + VSD + Arch Repair]. [ABSTRACT FROM AUTHOR]

This study tested whether newborn attention and arousal provide a foundation for the dynamics of respiratory sinus arrhythmia (RSA) in mother–infant dyads. Participants were 106 mothers (Mage = 29.54) and their 7‐month‐old infants (55 males and 58 White and non‐Hispanic). Newborn attention and arousal were measured shortly after birth using the NICU Network Neurobehavioral Scale. Higher newborn arousal predicted a slower return of infant RSA to baseline. Additionally, greater newborn attention predicted mothers' slower return to baseline RSA following the still‐face paradigm, and this effect only held for mothers whose infants had lower newborn arousal. These findings suggest that newborn neurobehavior, measured within days of birth, may contribute to later mother–infant physiological processes while recovering from stress. [ABSTRACT FROM AUTHOR]

Even though its development starts early in utero, neonatal skin is still immature at birth relative to adult and undergoes a maturation process extending to the first years of life. It is now established that the stratum corneum is thinner and dryer and that skin contains less natural moisturizing factors and lipids in newborns compared to children and adults. Moreover, it has been shown that skin surface area expansion is not linear throughout life and is peaking perinatally, suggesting that baby skin has a higher epidermal cellular turnover. Despite growing resources showing differences between adult and infant skin physiology, molecular and metabolic specificities of baby skin are still poorly understood. To address this critical knowledge gap, we performed an integrative transcriptomic and metabolomic study comparing human primary foreskin and abdominal keratinocytes from male babies and female adults, respectively. Based on state‐of‐the‐art integrative frameworks, our analyses revealed a major shift in the global energetic metabolism in baby foreskin keratinocytes compared to adult abdominal keratinocytes, highlighting increased amino acid metabolism and mitochondrial oxidative phosphorylation in baby cells to fuel the citric acid cycle, while showing glycolysis as the major cell energy source in adult cells. [ABSTRACT FROM AUTHOR]

The resurgence of interest in the interrelationship and interdependence between the physiological and psychological aspects of being human (i.e. in wholistic health) and concern regarding attachment issues and dynamics also questions and bespeaks both of the quality of care given to newborns and the impact this care has on their ability to develop healthy attachments and personalities. This article addresses these issues in relation to how newborns are physically handled at birth and the impact that this has on their physical and psychological wellbeing--most specifically, how the obstetrical and postpartum procedures affect the connective tissues which have been found through research to be not only physiological in substance but also psychological in nature. [ABSTRACT FROM AUTHOR]

Various developmental aspects of respiratory physiology put infants and young children at an increased risk of respiratory failure, which is associated with a higher rate of critical incidents during anesthesia. The immaturity of control of breathing in infants is reflected by prolonged central apneas and periodic breathing, and an increased risk of apneas after anesthesia. The physiology of the pediatric upper and lower airways is characterized by a higher flow resistance and airway collapsibility. The increased chest wall compliance and reduced gas exchange surface of the lungs reduce the pulmonary oxygen reserve vis‐à‐vis a higher metabolic oxygen demand, which causes more rapid oxygen desaturation when ventilation is compromised. This review describes the various developmental aspects of respiratory physiology and summarizes anesthetic implications. [ABSTRACT FROM AUTHOR]

[Display omitted] • SCFAs, crucial for health, result from bacterial fermentation of dietary fibres. • CE-C4D method for SCFAs analysis in infants' faeces was developed. • Polybrene dynamic capillary coating enables the separation of SCFAs isomers. • Analysis of faeces gives insight into microbial metabolism in infants' intestines. Short-chain fatty acids (SCFAs) are a major group of products produced during colonic bacterial fermentation of nondigestible carbohydrates demonstrating several important functions, e.g. regulating the immune system activity or the lipid metabolism. A detailed profile and concentration characterization of SCFAs in infant faeces is essential for expanding knowledge regarding the role of SCFAs in infant physiology and pathophysiology. This research presents the development and validation of a capillary electrophoresis method with a contactless capacitively coupled conductivity detector (CE-C4D) for the analysis of SCFAs and succinic and lactic acids in infant faeces. The study focused on optimizing the background electrolyte, mainly dynamic capillary coating with polybrene, and utilizing cyclodextrins to achieve efficient separation. Validation parameters, such as linearity (0.993 – 0.998), limits of detection and quantification (LOD: 0.10 – 0.89 μg/mL; LOQ: 0.35 – 2.97 μg/mL), intra- and inter-day precision (1.71 – 5.69 % and 1.11 – 12.5 %, respectively), injection repeatability (0.91 – 5.70 %), trueness (-12.8 – 3.80 %), and matrix effect (78.8 – 108.6 %), were assessed and the method was found suitable for the purpose. The demonstrated method was successfully applied to determine nine organic acids in faecal samples. [ABSTRACT FROM AUTHOR]

Maternal caregiving plays a crucial role in children's development, and research on the role of stress in maternal caregiving is important in understanding how stress affects maternal behavior and the subsequent impact on child development (e.g. Alink et al. 2009; Deater-Deckard & Sewell, 2015; Repetti et al. 2002). Stress is a common experience for parents, particularly during the early years of parenting and adolescence. However, it is not yet clear how stress impacts caregiving quality, and the mechanisms by which it can impact the next generation. A better understanding of these dynamics is the focus of this proposed symposium. Our symposium brings together early and mid-career academics from the fields of neuroscience, clinical psychology, and child and family studies that approach the topic from different angles. Lisa Loheide-Niesmann, PhD student at Radboud University, conducts research on the effects of mothers' childhood trauma experiences on children's early moral development. She will present a study on the associations between maternal childhood trauma on children's endocrine and behavioural responses to witnessing distress in others. The second speaker, dr. Madelon Hendricx-Riem, assistant professor at Radboud University with a background in the neuroendocrinology of parent-child relationships, investigated the consequences of self-reported parental caregiving in women's responses to stress, and the buffering role of oxytocin. The findings from her study show that women's childhood experiences of insensitive parenting impact on their stress response and that oxytocin may function as motivator for affiliative disposition during stress. Nina Bruinhof will present on the dynamic interaction of stress contagion between a mother and infant. Her study examines the potential pathway of maternal stress affecting infant physiology and behavior through changes in daily caregiving behavior, an unexplored but very relevant mechanism Finally, Karen Yirmiya studies the effect of severe stress in the form of war-related trauma on mothers and children, the quality of caregiving and the development of psychopathology. Her longitudinal study examines the complex interplay between maternal and child hair and salivary cortisol in the context of trauma exposure, highlighting the crucial role of maternal biomarkers and behavior during adolescence, a critical period of neural reorganization and personal growth. Together, these presentations provide valuable insights into the current research on the neuroendocrinology of parenting and child development, and demonstrate the multidisciplinary nature of this field. This symposium highlights the practical implications of this research for clinical practice, bridging the gap between research and practice to promote positive outcomes for families. The research presented in this symposium is important for several reasons. First, it is crucial for understanding how stress affects maternal behavior and the subsequent impact on child development. This research can help identify the mechanisms by which stress affects maternal caregiving, which is important for the development of theories on how the early rearing environment shapes child development. Second, the research presented in this symposium may help in identifying potential targets for intervention, and inform policies and programs aimed at supporting families. By supporting mothers experiencing stress and mitigating any negative effects on parenting behavior, we can promote healthy child development and improve outcomes for families. We therefore think our symposium is a great fit for the theme of ISPNE 2023: From basic science to better health. [ABSTRACT FROM AUTHOR]

Objective: Adopted children tend to show an increased risk for a variety of psychopathological outcomes, even when adoption occurs at birth, which some suggest is a result of nonrandom assignment of adoptees and parents. This study uses a nonhuman primate model, in which adoptions were randomly assigned, to investigate the behavioral and physiological outcomes associated with at-birth adoption.Method: Immediately following birth, rhesus monkey infants were randomly assigned to be reared by either their biological mother (n = 113) or by an unrelated, lactating, adoptive mother (n = 34). At 6 months of age, infant behavior and physiology were assessed during a stressful series of mother-infant separations. Four years later, stress-related behaviors were measured following confrontation by an unfamiliar intruder, an ecologically meaningful stressor.Results: When compared to infants reared by their biological mothers, adopted infants exhibited more behavioral withdrawal and higher plasma adrenocorticotropic hormone (ACTH) concentrations in response to separation. These behavioral differences persisted 4 years later during a stressful intruder challenge, with adoptees exhibiting more behavioral withdrawal, stereotypies, and impulsive approaches of the potentially aggressive intruder.Conclusion: Compared to infants reared by their biological mothers, adopted infants exhibited more behavioral inhibition, impulsivity, and higher ACTH concentrations, even when subjects were randomly assigned to be adopted or to remain with their biological mother. To the extent that these findings generalize to humans, they suggest that the overall risk for psychopathology in adopted individuals persists even after random assignment to adoption conditions. [ABSTRACT FROM AUTHOR]

Background: The first 2 years of life are the window of opportunity to promote healthy feeding practices. Thus, the present study aimed to assess the impact of a health workers training in infant dietary guidelines on energy intake and anthropometric measurement into childhood. Methods: Cluster randomised field trial (NCT00635453) was conducted in Porto Alegre, Brazil. Healthcare centres were randomised into intervention (n = 9) and control (n = 11) groups. In intervention sites, health workers were trained to promote healthy feeding practices based on the Brazilian guideline for children's nutrition. Pregnant women who were in the last trimester of pregnancy were registered as potential mothers who would receive dietary counselling from the health workers. Energy and macronutrient intake and anthropometric measurements were obtained from children at ages 6 months, 12 months, 3 years and 6 years from low‐income families. Results: At age 3 years, intervention group had lower consumption of energy [−92.5 kcal; 95% confidence interval (CI) = −153.5 to −31.5], carbohydrates (−11.9 g; 95% CI = −19.9 to −2.3), and total fat (−3.9 g; 95% CI = −6.2 to −1.2), compared to the control group. At 6 years of age, children in the intervention group had lower waist circumference (−1.3 cm; 95% CI = −2.7 to −0.0), triceps (−1.3 mm; 95% CI = −2.5 to −0.0) and subscapular skinfolds (−1.3 mm; 16 95% CI = −2.6 to −0.0) thickness measurements compared to those in the control group. Conclusions: The health workers training to promote infant healthy feeding practices resulted in lower energy, carbohydrates and fat intake at 3 years and lower waist circumference, triceps and subscapular skinfolds measurements at 6 years. [ABSTRACT FROM AUTHOR]

Introduction: Long-chain polyunsaturated fatty acids (LC-PUFAs) are critical for infant growth and development, particularly arachidonic acid (ARA, C20:4n-6) and docosahexaenoic acid (DHA, C22:6n-3). ARA and DHA are components of cell membrane phospholipids and play an important role in cell division, differentiation, and signaling; and DHA is the n-3 fatty acid predominant in the developing brain and retina. During the third trimester of pregnancy, LC-PUFAs increase substantially in fetal circulation, and a "biomagnification" process in the fetal brain is observed. Moreover, LC-PUFAs are precursors of eicosanoids and metabolites, which modulate the intensity and duration of the immune response. LC-PUFA synthesis implies complex desaturation and elongation processes on their principal precursors, linoleic acid (LA) (18:3 n-6) (series n-6) and α-linolenic acid (LNA) (20:3 n-3) (series n-3), where fatty acid desaturases (FADS) and elongases (ELOVL) are competing. It is important to notice that during the first months of life, as a consequence of low enzymatic activity, LC-PUFA synthesis from LA and LNA is reduced, especially in those infants carrying variations in the FADS and ELOVL genes, which are involved in LC-PUFA synthesis, and so they are unable to supply their own DHA and ARA needs. Homozygote infants for FADS haplotype A (97 % of the Latinoamerican population) show low levels of ARA (only 43 %) and DHA (only 24 %) when compared to those carrying haplotype D (more prevalent in Europe, Africa and Asia). Human milk is the only source of LA, LNA, ARA, and DHA for the neonate and infant till complementary feeding (CF) is introduced. Infants fed with infant formulas must receive enough amounts of LA, LNA, ARA, and DHA to cover their nutritional requirements. The new guidelines by the European Food Safety Authority (EFSA) (2016) recommend that infant formulas and follow-on formulas must contain 20-50 mg of DHA/100 kcal (0.5-1 % of total fatty acids, which is higher than in human milk and the majority of infant formulas in the market), and it is not necessary to add ARA. This new regulation, which is already applicable since February 2020, has resulted in profound controversy because there is no scientific evidence about its appropriateness and safety for healthy children. Then, different international expert groups have revised the research already published about the effects of ARA and DHA addition to infant formulas, and discussed different emerging questions from this European directive. The expert group led from the University of Granada (Spain) recommends the addition of ARA in similar or higher concentrations than those of DHA, at least equal to those present in human milk (0.3 % of total fatty acids), although preferably 0.5 % and up to around 0.64 % of total fatty acids, since new studies confirm the optimal intake of ARA and DHA during the different developmental stages. This recommendation could be of particular importance for infants carrying the haplotype A of FADS. [ABSTRACT FROM AUTHOR]

[Display omitted] The vast majority of drugs are not designed or developed for pediatric and infant populations. Peptide drugs, which have become increasingly relevant in the past several decades, are no exception. Unfortunately, nearly all of the 60+ approved peptide drugs are formulated for injection, a particularly unfriendly mode of administration for infants. Although three peptide drugs were recently approved for oral formulations, this major advance in peptide drug delivery is available only for adults. In this review, we consider the current challenges and opportunities for the oral formulation of peptide therapeutics, specifically for infant populations. We describe the strategies that enable oral protein delivery and the potential impact of infant physiology on those strategies. We also detail the limited but encouraging progress towards 1) adapting conventional drug development and delivery approaches to infants and 2) designing novel infant-centric formulations. Together, these efforts underscore the feasibility of oral peptide delivery in infants and provide motivation to increase attention paid to this underserved area of drug delivery and formulation. [ABSTRACT FROM AUTHOR]

The maternal deprivation hypothesis was arguably the most discussed debate in midcentury psychiatry. Combined with the gender ideology prevalent in America and Britain, it solidified the idea that the mother-child relationship had formative influence on personality development. This essay explores the formation of this hypothesis by situating its knowledge claims against an institutional innovation set to prevent juvenile delinquency and promote mental hygiene, the establishment of child guidance clinics on both sides of the Atlantic in the late 1920s. It then tracks the development of investigative agendas by child guidance practitioners, examining the practices they adopted to construct psychological knowledge claims in conformity with preventive objectives and positivist standards. Shifting the historiographical focus toward the clinical scenes in which psychological assertions were made, the essay examines how investigators sought to determine the "pathogenic" influence of early parental environment by way of estimating its emotional qualities. It argues that it was this positivist-determinist effort to achieve preventive goals that foregrounded the role of the mother in the etiology of personality disturbance and marked the knowledge field that came to be called the maternal deprivation debate. [ABSTRACT FROM AUTHOR]

The current study is the first to examine the role of exploration in play milestones development using a multi–measure micro–analytic approach. Fifteen infants, between the ages of 8 and 17 months, were observed in their natural home environment once a month for a one–hour session; their spontaneous mouthing and fingering and their play level with objects were recorded. Four types of play acts were coded: single–object play, single–object sequences, multi–object play, and multi–object sequences. The relative degree of usage of each type of behaviour at each month was examined. The results show that a combination of mouthing and fingering supported most play acts. Mouthing alone supports the simplest type of play act while fingering supports an advanced type that involves a single or several objects combined in sequences of actions. The benefits of exploring the object orally and manually in the development of play behaviour are discussed. [ABSTRACT FROM AUTHOR]

Although recent behavioral and neural research indicates that infants represent the body's structure, how they engage self-representations for action is little understood. This study addressed how the human face becomes a reaching space. Infants (N = 24; 2-11 months) were tested longitudinally approximately every 3 weeks on their ability to reach to a vibrating target placed at different locations on the face. Successful reaches required coordinating skin- and body-based codes for location, a problem known as tactile remapping. Findings suggest that a functional representation of the face is initially fragmented. Infants localized targets in the perioral region before other areas (ears/temples). Additionally, infants predominantly reached ipsilaterally to targets. Collectively, the findings illuminate how the face becomes an integrated sensorimotor space for self-reaching. [ABSTRACT FROM AUTHOR]

Infants with hypoplastic left heart are at increased risk of adverse events including mortality when they undergo procedures with general anesthesia in the inter-stage period after stage I Norwood. This is primarily caused by an imbalance between pulmonary and systemic blood flows augmented by decreased function of the single ventricle. These factors can be aggravated by general anesthesia, hence the increased risk. Many of these infants experience feeding dysfunction and require a gastrostomy to optimize nutrition. We report a case of open gastrostomy in an infant with Norwood physiology under spinal anesthesia with an excellent outcome. [ABSTRACT FROM AUTHOR]

The early onset of weaning in modern humans has been linked to the high nutritional demand of brain development that is intimately connected with infant physiology and growth rate. In Neanderthals, ontogenetic patterns in early life are still debated, with some studies suggesting an accelerated development and others indicating only subtle differences vs. modern humans. Here we report the onset of weaning and rates of enamel growth using an unprecedented sample set of three late (~70 to 50 ka) Neanderthals and one Upper Paleolithic modern human from northeastern Italy via spatially resolved chemical/isotopic analyses and histomorphometry of deciduous teeth. Our results reveal that the modern human nursing strategy, with onset of weaning at 5 to 6 mo, was present among these Neanderthals. This evidence, combined with dental development akin to modern humans, highlights their similar metabolic constraints during early life and excludes late weaning as a factor contributing to Neanderthals' demise. [ABSTRACT FROM AUTHOR]

Incorporating systematic evidence with clinical expertise is a key element in the quest to improve quality of care and patient outcomes. The evidence supporting skin‐to‐skin contact in the first hour after birth is robust and includes significantly improved outcomes for both mother and infant. This paper compares available iterative data about newborn behaviour in the first hour after birth to further describe the observable behaviour pattern and to provide clinical insight for further research. Although the evidence for positive outcomes through skin‐to‐skin contact are robust, there is a dearth of research specifically focused on clinical practice. The methodology considers the four available data sets that used Widström's 9 stages, which consists of studies from Japan, Sweden, Italy and the United States, examining the parameters of each stage across settings from around the world. This research provides an expanded understanding of the timing of the newborn's progression through Widström's 9 observable stages. We found that newborns in all four data sets began with a birth cry and continued through the remaining stages of relaxation, awakening, activity, rest, crawling, familiarization, suckling and sleeping during the first hours after birth and consolidated the data into a Sign of the Stages chart to assist in further research. The evidence supports making a safe space and time for this important newborn behaviour. Clinical practices should encourage and protect this sensitive period. [ABSTRACT FROM AUTHOR]

A 2017 Nature report was widely touted as hailing the arrival of the artificial womb. But the scientists involved claim their technology is merely an improvement in neonatal care. This raises an under‐considered question: what differentiates neonatal incubation from artificial womb technology? Considering the nature of gestation—or metaphysics of pregnancy—(a) identifies more profound differences between fetuses and neonates/babies than their location (in or outside the maternal body) alone: fetuses and neonates have different physiological and physical characteristics; (b) characterizes birth as a physiological, mereological and topological transformation as well as a (morally relevant) change of location; and (c) delivers a clear distinction between neonatal incubation and ectogestation: the former supports neonatal physiology; the latter preserves fetal physiology. This allows a detailed conceptual classification of ectogenetive and ectogestative technologies according to which the 2017 system is not just improved neonatal incubation, but genuine ectogestation. But it is not an artificial womb, which is a term that is better put to rest. The analysis reveals that any ethical discussion involving ectogestation must always involve considerations of possible risks to the mother as well as her autonomy and rights. It also adds a third and potentially important dimension to debates in reproductive ethics: the physiological transition from fetus/gestateling to baby/neonate. [ABSTRACT FROM AUTHOR]

The current study focuses on infants' sleep-wake states in group child care and relations of those states to infant-caregiver interactions. Qualitative case studies were conducted with four infants (3–7 months old) in an infant room at a child care centre. Video-recordings were the main format for data collection with the four infants and video recordings were made for a period of 3–5 h on each infant on a weekly basis for 11–12 weeks. Video recordings were transcribed using the InqScribe transcription software. Infant states identified in this research are important in the synchrony of infant-caregiver interactions, and have implications for caregivers' awareness of the impact of their actions associated with infant states. Caregivers took active roles in infant state modulation as it related to the infants' smooth or interrupted state transitions in the group care context. This research represents an effort to broaden and stimulate discussions on newer issues for enhancing infant child care practices and skills. [ABSTRACT FROM AUTHOR]

Background: The first 1000 days of life, from conception to the second birthday, offer a unique window of opportunity for optimal growth, critical for future health. The primary aim of this study was to analyze growth of children between 12 and 24 months age in Tanzanian children, and to explore possible predictors for growth.Methods: Observational, cross-sectional study performed between March and April 2017. Eligible children, and their mothers, attended routine follow-up at two health clinics in Tanga, Tanzania. At the study day, the child's weight and height were recorded. The mothers answered a structured interview regarding breastfeeding, immunization and socioeconomic conditions.Results: We recruited 300 mother-child pairs. Median [interquartile range (IQR)] age at study visit was 16 (14-20) months. Mothers reported that 170 (57%) of their children were exclusively breastfed for a minimum of 6 months; median (IQR) 6 (4-6) months. Using the World Health Organization (WHO) standard growth curves, mean weight-for-age Z-score was -0.30 and mean length-for-age Z-score was -0.47. Children whose mothers had higher education had higher Z-scores for weight and length compared to children of mothers with lower education. Education remained the most important predictor for growth also after adjusting for other variables. Overall, 48/300 (16%) were moderate-severe stunted and 25/300 (8.4%) had moderate-severe underweight.Conclusion: Children aged 12-24 months in this region of Tanzania had weight and height below the WHO standard. Higher educated mothers had children with better growth parameters. Duration of exclusive breastfeeding was long, but did not predict growth parameters. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections (HAIs) occur frequently in intensive care units (NICUs). The aim of this study was to analyze the results of surveillance of HAIs in a III level NICU in Naples, Italy during 2013–2017 and to compare with those obtained during 2006–2010. Methods: The surveillance included 1265 neonates of all birth weight (BW) classes with > 2 days NICU stay. Infections were defined using standard Centers for Disease Control and Prevention definitions adapted to neonatal pathology. Results: A total of 125 HAIs were registered during 2013–2017 with a frequency of 9.9% and an incidence density of 3.2 per 1000 patient days. HAIs occurred in all BW classes with a decreasing trend from the lowest to the highest BW classes (p = < 0.001). Central line-associated blood stream infection (CLABSI) was the most frequent infection (69.6%), followed by ventilator associated pneumonia (VAP) (20%), urinary tract infection (UTI) (8.8%) and necrotizing enterocolitis (NEC) (1.6%). Also, CLABSI and VAP incidence density decreased from lower to highest BW classes showing a significant trend (p = 0.007). Most frequent pathogens responsible for CLABSI were: Coagulase-negative staphylococci (CONS) (25.3%), Candida parapsilosis (21.8%), Pseudomonas aeruginosa (5.7), Escherichia coli and Klebsiella pneumoniae (6.8%). No microbiological diagnosis was achieved for 20.7% of CLABSI. Pseudomonas aeruginosa (28%), Stenotrophomonas maltophilia (20%), and CONS (20%) were the most frequent pathogens responsible for VAP. CLABSI incidence density showed no differences between 2006 and 2010 and 2013–2017, while VAP incidence density for the 751–100 g BW class was higher during 2006–2010 than during 2013–2017 (p = 0.006). A higher incidence of the CLABSI caused by Gram positive bacteria (p = 0.002) or by undetermined etiology (p = 0.01) was observed during 2013–2017 than during 2006–2010, while a significant lower incidence of VAP caused by Gram-negative bacteria was found during 2013–2017 than during 2006–2010 (p = 0.007). Conclusion: HAIs in the NICU developed in all BW classes with a decreasing trend from the lowest to the highest BW classes in both study periods. Differences in the aetiology of CLABSI and VAP were found between the two study periods. This reinforces the importance of HAIs surveillance protocol in the NICU, which monitors microbiological isolates and use of medical devices for all BW classes of neonates. [ABSTRACT FROM AUTHOR]

Infants' spontaneous and voluntary movements mirror developmental integrity of brain networks since they require coordinated activation of multiple sites in the central nervous system. Accordingly, early detection of infants with atypical motor development holds promise for recognizing those infants who are at risk for a wide range of neurodevelopmental disorders (e.g., cerebral palsy, autism spectrum disorders). Previously, novel wearable technology has shown promise for offering efficient, scalable and automated methods for movement assessment in adults. Here, we describe the development of an infant wearable, a multi-sensor smart jumpsuit that allows mobile accelerometer and gyroscope data collection during movements. Using this suit, we first recorded play sessions of 22 typically developing infants of approximately 7 months of age. These data were manually annotated for infant posture and movement based on video recordings of the sessions, and using a novel annotation scheme specifically designed to assess the overall movement pattern of infants in the given age group. A machine learning algorithm, based on deep convolutional neural networks (CNNs) was then trained for automatic detection of posture and movement classes using the data and annotations. Our experiments show that the setup can be used for quantitative tracking of infant movement activities with a human equivalent accuracy, i.e., it meets the human inter-rater agreement levels in infant posture and movement classification. We also quantify the ambiguity of human observers in analyzing infant movements, and propose a method for utilizing this uncertainty for performance improvements in training of the automated classifier. Comparison of different sensor configurations also shows that four-limb recording leads to the best performance in posture and movement classification. [ABSTRACT FROM AUTHOR]

Aim: Inappropriate auditory stimulants lead to neonatal stress and changes in physiological parameters. Nowadays, particular emphasis is placed on the developmental aspects of the care of preterm infants. The lullaby is a suitable auditory stimulus for preterm infants, which as a subtype of developmental care decreases stress responses. This study investigates the effects of lullabies in the mothers' own voices on preterm infants' physiological parameters. Materials and Methods: This single group study is a randomized clinical trial. Forty study-qualified hospitalized infants were included in the study, during a lullaby stage and a non-lullaby stage. Their physiological parameters including respiratory rate, heart rate and oxygen saturation level were recorded. Their mothers' lullabies were played for them during the lullaby stage. No intervention was performed in the non-lullaby stage and only the infants' variables were recorded. Infants were assessed for four successive days, two days for each stage. Data was collected and recorded every 2 minute. Data was statistically analysed after gathering and entering into the SPSS.22 by means of Friedman's and paired sample t-test. Results: In this study of 40 case studies, 45% were female and 55% were male, with an average gestational age of new-borns of 32.43 weeks and mean birth weight of 2,189.36 gr. In the intervention group, during the time that the lullaby was played, mean rates of heart beat were significantly decreased (p=0.03) and SaO2 was increased (p=0.039), which were significantly different from their base recorded levels at the beginning and those of the control stage, but there was no significant difference between two stages in the mean of respiratory rates (p=0.070). Conclusion: Since a mother's lullaby has significant effects on physiological parameters, we hope that nurses will tell mothers to use the lullaby as a supportive developmental care for infants to assist improving the physiological state of preterm new-borns. [ABSTRACT FROM AUTHOR]

The newborn period poses the most vulnerable time in the development of epileptic seizures. The main predisposing factor is an increased neuronal excitability resulting from the incomplete maturation of a premature brain. From this point of view, premature newborns are at the highest risk of developing neonatal seizures. Early initiation of rational dia-gnostic and therapeutic intervention is often complicated by the vague or absent clinical manifestation of neonatal seizures. The variability of their clinical picture is reflected in the new draft of Neonatal Seizure Classification by International League Against Epilepsy (ILAE) from 2018. Timely dia-gnosis and initiation of adequate therapy with regard to etiology is, from the prognosis viewpoint, crucial. The strongest predictor of prognosis is etiology, as well as gestational age, initial findings during the neurological examination and ictal and interictal electroencephalographic features. [ABSTRACT FROM AUTHOR]

Neonates are exposed to pain as a result of routinely applied painful procedures which in many cases are poorly managed. There are numerous non-pharmacologic interventions that could help manage procedural pain. There still a lack of evidence supporting the use of several non-pharmacologic interventions, such as facilitated tucking by parents (FTP) for neonatal pain management. A randomized controlled three-group experimental design was used to compare the effectiveness of oral dextrose water D10%W vs. FTP among neonates whose ages ranged from 24 to 48 hours. Three phases of (baseline, during, and after) heel stick procedures were videotaped. Pain responses were measured using a behavioral pain scale, as well as physiological pain responses (heart rate, respiratory rate, and oxygen saturation). A total of 135 neonates were included in the study. Both D10W and FTP groups were found to be effective in reducing behavioral scores (P=0.00). And physiological pain scores, including heart rate (P= 0.009), respiratory rate (P=0.01), and oxygen saturation (P=0.002) as compared to control group. However, immediately (20sec) after the procedure, the total pain score was significantly lower in dextrose group compared to the other two groups (m= 2.8, SD= 0.7). D10%W and FTP had pain-relieving effects as compared to control in neonates who are 38-40 ± 2 weeks of gestation and are undergoing heel stick procedure. However, an added advantage for D10%W, in these times, is reducing physical contact between neonate and parent during limited access of parent to NICUs units as a result of COVID 19 transmission. [ABSTRACT FROM AUTHOR]

Congenital heart disease (CHD) is a significant cause of infant death in the developed world. For this reason, screening for CHD forms part of the newborn physical examination (NPE) that occurs within 72 hours of birth. This article reviews the challenges faced by the examiner in the detection of CHD in the newborn. This includes relevant anatomy and physiology of the newborn circulation and the presentation of heart murmurs. The usefulness of additional screening tools is also discussed. Four-limb blood pressure (BP) is found to be unhelpful as a screening tool, whereas the use of pulse oximetry is supported by research evidence. [ABSTRACT FROM AUTHOR]

The article presents abstracts on papers related to motor development including "Dynamic gait adaptation in young children as a function of age and task demands," by Karl S. Rosengren and John D. Polk, "Configuring cognition within the infant's embodied architecture; upper- and lower-body coordination for reaching," by Jean-Paul Boudreau, and "Embodied changes in reaching and the brain as infants learn to walk," by Daniela Corbetta and Martha A. Bell.

Neonates are a uniquely vulnerable population, compromised by immature physiology and critical illness if born premature. Furthermore, neonates have frequent exposures to drugs that lack adequate data on safety, efficacy, and appropriate dosing in this population. Key physiologic differences between neonates and older children and adults affect drug absorption, distribution, metabolism, and elimination. Adequate understanding and consideration of these differences is essential to ensure optimal dosing of therapeutic agents in this vulnerable population. Moreover, direct study of neonates through appropriately designed pharmacokinetic and pharmacodynamic studies can ensure the development of safe and effective therapeutics in our youngest populations of patients. [ABSTRACT FROM AUTHOR]

Background: It is well known that normal pregnancy exposes mothers to a diabetogenic state. The important role of adipose tissue in the regulation of insulin resistance has been repeatedly proven. This organ carries out the regulation of insulin resistance by producing adipocytokines involved in the pathogenesis of gestational diabetes mellitus (GDM). The present study aims to evaluate the effects of zinc supplementation on serum leptin, visfatin, tumor necrosis factor-α (TNF-α), adiponectin and zinc-α2-glycoprotein (ZAG) levels in pregnant women with impaired glucose tolerance test (IGTT) results. Methods: In this randomized, placebo-controlled, double-blind clinical trial, 46 pregnant women with impaired glucose tolerance test results were randomly distributed into zinc (n = 23) and placebo (n = 23) groups and received 30 mg zinc supplement per day in the form of zinc gluconate and placebo, respectively, for 8 consecutive weeks. The study was conducted in the Shabestar district of northwestern Iran. Results: Supplementation after adjusting for confounding variables resulted in a significant reduction in plasma leptin (p = 0.035) and TNF-α (p = 0.027) levels in the zinc group compared with the placebo group. Serum visfatin levels were significantly increased, and serum ZAG levels were significantly decreased in both groups. However, the changes in adiponectin concentration were not significant in either group after intervention nor were the anthropometric parameters in fetuses whose mothers received the zinc supplement. Conclusions: It seems that zinc supplementation may be considered as a complementary supplement together with the medical management of patients with IGT or GDM. However, further studies are needed before definite conclusions can be drawn. [ABSTRACT FROM AUTHOR]

Background and Objectives: The Chinese national standard of formula for 6-12-month-old infants (GB 10767- 2010) requires review and revision because it does not correspond to current scientific knowledge and data. The aim of this paper was to summarize the formula composition recommended for 6-12-month-old infants by a Chinese expert group.Methods and Study Design: Formula composition recommendations for 6-12-month-old infants were devised by a Chinese expert group based on a detailed systematic review, which included nutrient intake, nutrient content of Chinese women's breast milk, and the latest adequate intake and tolerable upper intake levels, also referencing the Codex Alimentarius recommendations and those of other countries and considering the practice in products on the market.Results: Compared with current standards, it was recommended that most compositional requirements be modified, including decreasing the maximum energy density from 85 to 75 kcal/100 mL, decreasing the protein content in milk-based formula from 2.9-5.0 g/100 kcal to 1.8-3.5 g/100 kcal, increasing the minimum content of lipids from 2.9 g/100 kcal to 3.5 g/100 kcal, providing the maximum amount of vitamins and minerals (including vitamin E, vitamin K, thiamin, riboflavin, vitamin B-6, vitamin B-12, niacin, folic acid, pantothenic acid, vitamin C, biotin, magnesium, calcium, phosphorus, and iodine), and changing the content of optional components such as taurine, docosahexaenoic acid, and arachidonic acid.Conclusions: These nutrient standard modifications based on recent evidence are expected to enhance feeding practices and further guarantee the health of 6-12-month-old infants in China. [ABSTRACT FROM AUTHOR]

Monitoring of respiratory rate (RR) is very important for patient assessment. In fact, it is considered one of the relevant vital parameters in critical care medicine. Nowadays, standard monitoring relies on obtrusive and invasive techniques, which require adhesive electrodes or sensors to be attached to the patient's body. Unfortunately, these procedures cause stress, pain, and frequently damage the vulnerable skin of preterm infants. This paper presents a “black-box” algorithm for remote monitoring of RR in thermal videos. “Black-box” in this context means that the algorithm does not rely on tracking of specific anatomic landmarks. Instead, it automatically distinguishes regions of interest in the video containing the respiratory signal from those containing only noise. To examine its performance and robustness during physiological (phase A) and pathological scenarios (phase B), a study on 12 healthy volunteers was carried out. After a successful validation on adults, a clinical study on eight newborn infants was conducted. A good agreement between estimated RR and ground truth was achieved. In the study involving adult volunteers, a mean root-mean-square error (RMSE) of ($0.31 \pm 0.09$) breaths/min and ($3.27 \pm 0.72$) breaths/min was obtained for phase A and phase B, respectively. In the study involving infants, the mean RMSE hovered around ($4.15 \pm 1.44$) breaths/min. In brief, this paper demonstrates that infrared thermography might become a clinically relevant alternative for the currently available RR monitoring modalities in neonatal care. [ABSTRACT FROM AUTHOR]

Objective  To measure sound and vibration in rotary wing air transport (RWAT) and ground ambulance transport (GAT), comparing them to current recommendations, and correlating them with physiological stability measures in transported neonates. Study Design  This is a prospective cohort observational study including infants ≤ 7 days of age transported over an 8-month period. Infants with neurologic conditions were excluded. Sound and vibration was continuously measured during transport. Transport Risk Index of Physiologic Stability (TRIPS) scores were calculated from vital signs as a proxy for physiological stability. Results  In total, 118 newborns were enrolled, of whom 109 were analyzed: 67 in RWAT and 42 in GAT. Peak sound levels ranged from 80.4 to 86.4 dBA in RWAT and from 70.3 to 71.6 dBA in GAT. Whole-body vibration ranged from 1.68 to 5.09 m/s 2 in RWAT and from 1.82 to 3.96 m/s 2 in GAT. Interval TRIPS scores for each infant were not significantly different despite excessive sound and vibration. Conclusion  Noise levels during neonatal transport exceed published recommendations for both RWAT and GAT and are higher in RWAT. Transported infants are exposed to vibration levels exceeding acceptable adult standards. Despite excessive noise and vibration, levels of physiological stability remained stable after transport in both RWAT and GAT groups. [ABSTRACT FROM AUTHOR]

Low-birth weight (LBW) infants have a major problem of sleep–awake and instability on physiological function. The objective of this study was to identify the effect of nesting with fixation and position on sleep–awake status and physiological function. This study used a crossover design and was conducted in a general hospital in Jakarta, involving 19 LBW infants who met the inclusion criteria. The intervention consisted of: nesting with fixation combined with prone position (NFPP) (A), nesting with fixation combined with quarter prone position (NFQP) (B), nesting with quarter prone position (NQP) (C), and control group (D). The results of this study showed that there was a significant difference between NFPP and NFQP compared to the control group in regard to quiet sleep and oxygen saturation (p <.05). Nesting with fixation combined with prone position was the most effective method to facilitate quiet sleep and the stability of SaO2 followed by nesting with fixation combined with quarter prone position as alternative intervention for LBW infant. Therefore, the application of nesting with fixation is needed. [ABSTRACT FROM AUTHOR]

Aim: To asses the cardiac morphology and functional changes specific for newborns from intrauterine growth restriction (IUGR) pregnancies.Material and Method: A cohort of IUGR infants were evaluated by serial echocardiographies at delivery and at the first and six months follow-ups. IUGR newborn delivery status was compared to that of newborns in the control group according to gestational age (AGA).Results: Left heart measurements were significantly lower in IUGR newborns compared to AGA babies. Left ventricular size increased at follow-up inthe IUGR group (p<0.05). Systolic dysfunction (the myocardial performance index (MPI)> 0.47) was identified in 40% of the neonates in the IUGR group (16/40), respectively 4.76% in the control group. IUGR neonates had a significantly increased proportion of systolic malfunction (p=0.004).Conclusion:  IUGR patients had reduced left ventricle dimensions compared to AGA babies. The MPI stands out as a marker of leftheart function in newborns. Systolic dysfunction was a hallmark of the cardiac adaptation in IUGR neonates. [ABSTRACT FROM AUTHOR]

Aim: This study determined the use of standardised procedures for infant noninvasive blood pressure (NIBP) measurements in the Nordic countries and aimed to identify factors included in the standardisation and interpretation of NIBP measurements in infants.Methods: A cross-sectional electronic questionnaire survey was sent to 84 physicians in all 23 university hospitals in Sweden, Norway, Denmark, Finland and Iceland and was completed from February to March 2017. The survey contained respondent characteristics, the presence and description of standardised procedures for NIBP measurements, daily practice of NIBP measurements and methodological considerations and interpretation of NIBP measurements in a healthy six-month-old child.Results: We received responses from 55 of 84 physicians working in all 23 Nordic university hospitals, in paediatric cardiology (n = 22), general paediatrics (n = 16), paediatric nephrology (n = 14) and other fields (n = 3). Less than a quarter (23%) said their hospital issued specific NIBP procedures relating to infants and they referred to 19 different sources of information. The factors that were most commonly assessed for interpretation were age (100%), arousal state (78%) and cuff size (76%).Conclusion: Most of the university hospital units treating children lacked age-specific written procedures for measuring and interpreting infant NIBP, and there is a strong need for common Nordic guidelines. [ABSTRACT FROM AUTHOR]

Introduction: Growth and development are determined by genetic and environmental factors since the very early embryonic life. Long-term health risks, as obesity and other non-communicable diseases (NCD), could be programmed since these early stages. Early life, characterized by plasticity, is the ideal time to intervene and to prevent the risk of suffering a NCD (window of opportunity). Optimal nutrition during the first 1,000 days, since conception to the end of the second year of life, has a determinant role for long-term health. Pregnancy, infancy and toddler periods have specific nutritional requirements. Intestinal microbiota enhances maturation and functioning of the immune system. The interactions between host and intestinal microbiota are potential factors influencing early programming of the intestinal function. Alterations in intestinal colonization are associated to a higher risk of allergic diseases in childhood. Scientific evidence supports the fact that the first 1,000 days are crucial to achieve a better long-term health and represents a strategic period to intervene under the perspective of prevention and public health. [ABSTRACT FROM AUTHOR]

Employing an experimental design, mother-to-infant transmission of stress was examined. Mothers (N = 117) were randomized to either have a positive or conflictual discussion with their marital partners, after which infants (age = 6 months) participated in a fear and frustration task. Saliva samples were collected to assess maternal cortisol responses to the discussion and infant cortisol responses to the challenge task. Results indicate maternal cortisol reactivity and recovery to the conflict (but not positive) discussion predicted infant cortisol reactivity to the infant challenge. Mothers' positive affect during the discussion buffered, and intrusion during the free-play potentiated, mother-to-infant adrenocortical transmission. These findings advance our understanding of the social and contextual regulation of adrenocortical activity in early childhood. [ABSTRACT FROM AUTHOR]

Complementary foods that are deficient in both macronutrients and micronutrients coupled with a high burden of infections during the complementary feeding period are major underlying causes of child malnutrition in developing countries. Among the recent efforts to combat malnutrition by improving the quality of complementary foods in the developing world is the use of Moringa oleifera leaf powder (MLP) as a food fortificant. We conducted a randomized controlled trial to test the effect of feeding MLP‐fortified complementary food on hemoglobin concentration and growth of infants and young children after 4 months of feeding. Infants aged 8–12 months were randomly assigned to receive one of three study foods; Weanimix a cereal‐legume blend formulated with Moringa (MCL‐35g), MLP sprinkled on infants' usual complementary foods (MS‐5g) and the control food Weanimix without Moringa (CF‐35g). Blood samples for hemoglobin determination as well as dietary intake and anthropometric data were collected at baseline and endline for 237 infants who completed the study. Data analysis was performed with SPSS (version 20) and comparisons were done by analysis of covariance (ANCOVA). There were no significant differences in hemoglobin concentration or growth indicators at endline between the three study groups. Findings of this study indicated that feeding infants a 5 g daily dose of MLP, either as part of a cereal‐legume blend or as a supplement which was sprinkled on infants' usual complementary foods for 4 months, did not significantly improve infants' hemoglobin concentration or growth indicators. Feeding infants with complementary foods fortified with a daily dose of 5 g of Moringa oleifera Leaf Powder did not significantly improve either their hemoglobin concentrations or growth indicators after 4 months of feeding. [ABSTRACT FROM AUTHOR]

Background: The agreement between invasive and non-invasive blood pressure (BP) readings in the first days of life of preterm infants is contentiously debated. Objective: To compare mean, systolic and diastolic invasive (IBP) and non-invasive BP (NBP) readings obtained during routine care in the first four weeks of life of extremely preterm infants. Methods: We extracted pairs of IBP and NBP readings obtained from preterm infants born below 28 weeks of gestation from the local database. After exclusion of erroneous measurements, we investigated the repeated measures correlation and analyzed the agreement (bias) and precision adjusted for multiple measurements per individual. Results: Among 335 pairs of IBP and NBP readings obtained from 128 patients, we found correlation coefficients >0.65 for mean, systolic and diastolic BP values. The bias for mean BP readings was -0.4 mmHg (SD 6.1), for systolic BP readings 6.2 mmHg (SD 8.1), and for diastolic BP readings -4.3 mmHg (SD 6.5). Overestimation of systolic IBP and underestimation of diastolic IBP by the non-invasive measurement were found both in the group with gestational age from 23 to 25.9 weeks and in the group with gestational age from 26 to 27.9 weeks. Systolic NBP readings tended to exceed invasive readings in the range <50 mmHg (bias 9.9 mmHg) whereas diastolic NBP readings were lower than invasive values particularly in the range >30 mmHg (bias -5.5 mmHg). Conclusion: The disagreement between invasive and non-invasive BP readings in infants extends to the first four weeks of life. Biases differ for mean, systolic and diastolic BP values. Our observation implies that they may depend on the range of the blood pressure. Awareness of these biases and preemptive concomitant use of IBP and NPB readings may contribute to reducing over- or under-treatment. [ABSTRACT FROM AUTHOR]

Aim: Sensorial saturation (SS) is an analgesic approach to babies' pain that includes three types of stimulations: oral sugar, massage and caregivers' voice. The aim of this review is to assess its efficacy.Methods: We performed an analysis of scientific literature from 2001 to 2017, retrieving those clinical trials where SS had been compared with other analgesic treatments during procedural pain in babies.Results: We retrieved 14 studies. Pain sources were heel-prick in nine, eye examination and intramuscular shots in two each, and endotracheal aspiration in one. SS was the most effective treatment in all cases, except in endotracheal suctioning. No drawbacks were reported in any study using SS.Conclusion: SS is a safe and effective approach to neonatal pain due to heel-prick, more effective than oral sucrose or glucose in both term and preterm babies; it seems also effective in other types of acute procedural pain like eye examination or intramuscular injections, but more studies are needed to confirm these preliminary data. More studies are also needed to test SS efficacy for other procedures, and for older infants. [ABSTRACT FROM AUTHOR]