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Introduction: There is an increase in cases of mothers using opioids during pregnancy in the United States but research investigating mothers’ psychosocial environments along with individual variability among this high-risk group of women is scarce. Methods: This mixed-methods study aims to examine the complex interplay of contextual risks and experiences of opioid-using mothers. A sample of 50 opioid-using biological mothers of infants diagnosed with neonatal opioid withdrawal syndrome (NOWS) were studied using a set of standardized and open-ended questions, along with medical records extraction. Results: A high-risk subgroup of 36 mothers was identified using cluster analysis, characterized by a distinct profile of psychosocial risk. Thematic content analysis revealed four themes: (1) barriers to communication and mistrust of health professionals, (2) limitations of access to health care and the amplification of disadvantages related to COVID-19, (3) lifelong consequences of adverse childhood experiences (ACEs), and (4) intimate partner violence and its influence on drug use. Conclusion: Our findings highlight important information toward health services provision for opioid-using women of childbearing age. Efforts to reduce opioid usage in mothers need to consider psychosocial and contextual risks.

BACKGROUND:Inhaled nitric oxide (iNO) therapy is an off-label medication in infants METHODS:The Pediatrix Medical Group Clinical Data Warehouse was queried for the years 2009–2013 to describe first exposure iNO use among all admitted neonates stratified by gestational age.RESULTS:Between 2009 and 2013, the rate of iNO utilization in 23- to 29-week neonates increased from 5.03% to 6.19%, a relative increase of 23% (confidence interval: 8%–40%; P = .003). Of all neonates who received iNO therapy in 2013, nearly half were CONCLUSIONS:The rates of off-label iNO use in preterm infants continue to rise despite evidence revealing no clear benefit in this population. This pattern of iNO prescription is not benign and comes with economic consequences.

This report describes a toddler who presented to the emergency department with reported leg weakness and a petechial rash who ultimately was diagnosed with severe ascorbic acid deficiency (scurvy) due to restricted dietary intake. The diagnosis was delayed, and this report highlights the role of a detailed dietary history as part of the diagnostic process.

BACKGROUND AND OBJECTIVE: Previous studies suggest that former late preterm infants are at increased risk for learning and behavioral problems compared with term infants. These studies have primarily used referred clinical samples of children followed only until early school age. Our objective was to determine the cumulative incidence of attention deficit/hyperactivity disorder (ADHD) and learning disabilities (LD) in former late preterm versus term infants in a population-based birth cohort. METHODS: Subjects included all children born 1976 to 1982 in Rochester, MN who remained in the community after 5 years. This study focused on the comparison of subjects in 2 subgroups, late preterm (34 to RESULTS: We found no statistically significant differences in the cumulative incidence of ADHD or LD between the late preterm (N = 256) versus term (N = 4419) groups: ADHD (cumulative incidence by age 19 years, 7.7% vs 7.2%; P = .84); reading LD (14.2% vs 13.1%; P = .57); written language LD (13.5% vs 15.7%; P = .36), and math LD (16.1% vs 15.5%; P = .89). CONCLUSIONS: These data from a population-based birth cohort indicate that former late preterm infants have similar rates of LD and ADHD as term infants.

To determine whether an electronic data surveillance system, or Data Sniffer (DS), could reduce the rate of hyperoxic episodes (HEs) among premature neonates being managed by a standardized respiratory treatment protocol (RTP).A total of 86 infants born at29 weeks of gestation were included in the study. The rates of HEs were compared among four epochs (E) as follows: E1: no RTP, no DS; E2:with RTP, no DS; E3: with RTP, with DS; E4: with RTP, no DS.After implementing the RTP in E2, the rate of HEs was 44% lower than that of E1. Activating the DS in E3 further reduced HEs by 26%, whereas its deactivation in E4 resulted in a rebound in HEs to baseline rates; P0.0001 for each comparison.The implementation of an electronic data monitoring system was associated with less frequent episodes of hyperoxia among premature neonates.

A housing-based socioeconomic index (HOUSES) was previously developed to overcome an absence of socioeconomic status (SES) measures in common databases. HOUSES is associated with child health outcomes in Olmsted County, Minnesota, USA, but generalisability to other geographic areas is unclear. To assess whether HOUSES is associated with asthma outcomes outside Olmsted County, Minnesota, USA. Using a random sample of children with asthma from Sanford Children’s Hospital, Sioux Falls, SD, USA, asthma status was determined. The primary outcome was asthma control status using Asthma Control Test and a secondary outcome was risk of persistent asthma. Home address information and property data were merged to formulate HOUSES. Other SES measures were examined: income, parental education (PE), Hollingshead and Nakao–Treas index. Of a random sample of 200 children, 80 (40%) participated in the study. Of those, 13% had poorly controlled asthma. Addresses of 94% were matched with property data. HOUSES had moderate–good correlation with other SES measures except PE. Poor asthma control rates were 31.6%, 4.8% and 5.6% for patients in the lowest, intermediate and highest tertiles of HOUSES, respectively (P=0.023). HOUSES as a continuous variable was inversely associated with poorly controlled asthma (adjusted odds ratio (OR)=0.21 per 1 unit increase of HOUSES, 95% confidence interval (CI), 0.05–0.89, P=0.035). HOUSES as a continuous variable was inversely related to risk of persistent asthma (OR: 0.36 per 1 unit increase of HOUSES, 95% CI, 0.12–1.04, P=0.06). HOUSES appears to be generalisable and available as a measure of SES in asthma research in the absence of conventional SES measures. Socioeconomic status, as predicted by property data, is associated with how well children manage their asthma symptoms. Young Juhn at the Mayo Clinic in Rochester, Minnesota, USA, previously developed and validated the HOUsing-based index of SocioEconomic Status (HOUSES) in Minnesota and Missouri. The metric correlated with various health effects, including risk of obesity and exposure to cigarette smoke. To assess whether HOUSES was also predictive of health status among children with asthma, the researchers looked at a random sample of 58 children treated for the lung condition at a hospital in South Dakota. Eight of these children had poorly controlled asthma, six of whom came from the lowest socioeconomic bracket, as measured by HOUSES. The study indicates that HOUSES is a useful indicator of asthma outcomes and it confirms the tool's accuracy in another region of the United States.

In 2005, therapeutic hypothermia (TH) was used in few American neonatal intensive care units (NICUs) with great variability in practices. We hypothesized that TH would be used with greater frequency and uniformity today.We surveyed directors of 797 NICUs queried in our prior study to determine attitudes toward and practices of TH.Of the 781 participants with valid addresses, we received completed surveys from 330 (42.3%). There was an increase in the number of respondents who believed that TH is effective (85% versus 31%, p 0.0001). More NICUs used TH (50% versus 6%, p 0.0001) and nearly all not offering TH transferred eligible neonates to centers that did (97% versus 29%, p 0.0001). There has been increased standardization of TH practices with regard to enrollment criteria, duration, and methods of monitoring.TH has become standard of care for the treatment of HIE in the United States. Most NICUs that use TH adhere to protocols, but variation still exists in TH practices.