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INTRODUCTION Paediatric HIV acquisitions have declined significantly, largely due to the expansion of antenatal‐care/prevention of vertical transmission (ANC/PVT) programmes [1]. The population of children who are HIV‐exposed and uninfected (CHEU) [...], : Introduction: Children who are HIV‐exposed and uninfected (CHEU) are a growing population at potential risk of poor neurocognitive development. We tested a nurturing care intervention on children's neurocognitive development and maternal depressive symptoms (primary) with mediation through caregiving activities (secondary). Methods: This study was conducted among six intervention and nine comparison antenatal‐care/prevention of vertical transmission (ANC/PVT) HIV clinics in eSwatini. We enrolled pregnant women and measured infant development at 9 and 18 months. mothers2mothers (m2m) designed and implemented the clinic‐home‐community‐based intervention. We measured infants’ neurodevelopment, maternal depressive symptoms and caregiving activities with the Mullen Scales of Early Learning (MSEL), Edinburgh Postnatal Depression Scale, HOME Inventory and Family Care Indicators. We fitted linear mixed effects regression models with clinic random effects to compare intervention versus comparison arms, and generalised structural equation models to evaluate mediation, adjusting for confounders. Results: Mother‐infant pairs (n = 429) participated between January 2016 through May 2018. Socio‐demographic characteristics were balanced between arms except for higher rates of peri‐urban versus rural residence and single versus married mothers in the comparison group. The 18 month retention was 82% (180/220) intervention, 79% (166/209) comparison arm, with 25 infant deaths. Intervention MSEL scores were significantly, and modestly, higher in receptive language (55.7 [95% CI 54.6, 56.9] vs. 53.7 [95% CI 52.6, 54.8]), expressive language (42.5 [95% CI 41.6, 39.8] vs. 40.8 [95% CI 39.8, 41.7]) and composite MSEL (85.4 [95% CI 83.7, 84.5] vs. 82.7 [95% CI 81.0, 84.5]), with no difference in maternal depressive symptoms or in observations of mother‐child interactions. Intervention book‐sharing scores were higher (0.63 vs. 0.41) and mediated the effect on MSEL scores (indirect effect, p‐values ≤ 0.024). The direct effects on visual reception and expressive language scores were significantly higher in the intervention compared to the comparison arm (coefficients 1.93 [95% CI 0.26, 3.60] and 1.66 [95% CI 0.51, 2.79, respectively]). Conclusions: Nurturing care interventions can be integrated into ANC/PVT clinic‐home‐community programmes. The intervention, mediated through interactive caregiving activities, increased language development scores among CHEU. Partnering with a local team, m2m, to design and implement a culturally relevant intervention illustrates the ability to impact parent‐child play and learning activities that are associated with children's neurodevelopment.

Introduction Infections in extremely low birth weight (ELBW) infants remain a leading cause of mortality and neurodevelopmental impairment (Stoll et al. 2015; Cheong et al. 2020). One novel approach for [...], Lactoferrin as a nutritional enteral supplement has emerged as a novel preventative therapy against serious infections in preterm infants, although neonatal studies have demonstrated variable results, in part due to the lack of pharmacokinetic data and differences in the products tested. We conducted a prospective, dose escalation (100, 200, and 300 mg*[kg.sup.-1]*day (-1)) safety study of bovine lactoferrin (Glanbia Nutritionals, USA) dissolved in sterile water (100 mg*mL (-1)) for 30 days in preterm infants with birth weight Key words: lactoferrin, preterm infants, safety, infection prevention. La lactoferrine en tant que complement nutritionnel enteral est apparue comme une nouvelle therapie preventive contre les infections graves chez les prematures, bien que les etudes neonatales aient demontre des resultats variables, en partie en raison du manque de donnees pharmacocinetiques et des differences entre les produits. Les auteurs ont mene une etude prospective, a doses croissantes (100, 200 et 300 mg[kg.sup.-1][jour.sup.-1]), sur l'innocuite de la lactoferrine bovine (Glanbia Nutritionals, E.-U.) dissoute dans de l'eau sterile (100 mg*[mL.sup.-1]) pendant 30 jours chez des prematures Mots-cles: lactoferrine, nourrissons prematures, innocuite, prevention des infections.

Introduction Lactoferrin (LF) is a bioactive protein present in milk and other secretions; it has anti-infective, anti-inflammatory, and immune-modulating properties that are important for the premature infant that is at [...], We previously conducted two randomized controlled trials with bovine lactoferrin (bLF) for the prevention of lateonset sepsis (LOS) in infants with a birth weight Key words: lactoferrin, sepsis, neonatal, randomized controlled trial. Les auteurs ont precedemment mene deux essais controles randomises sur la lactoferrine bovine (bLF) pour la prevention de la septicemie tardive chez les nourrissons d'un poids a la naissance inferieur a 2500 g (etude 1) et inferieur a 2000 g (etude 2). L'objectif de cette etude etait de determiner l'effet de la bLF sur la prevention de la septicemie tardive probable ou prouvee par culture chez les nourrissons d'un poids a la naissance inferieur a 1500 g dans les deux etudes, et de determiner l'effet de la bLF en fonction de la consommation de lait humain. Les deux devis experimentaux comportaient des criteres d'inclusion et d'exclusion similaires, la meme dose de bLF [200 mg*[(kg de masse corporelle).sup.-1]*[jour.sup.-1]] et le meme controle (maltodextrine). Ils ont ajuste des modeles de regression de Cox a plusieurs variables pour estimer l'effet de la bLF sur le risque de developpement du resultat composite, en tenant compte des covariables. Ils ont inclus 335 nouveau-nes ayant un poids moyen a la naissance de 1162 [+ or -] 244 g; 27,5 % pesaient moins de 1000 g. Trente-trois premiers episodes de septicemie tardive sont survenus dans le groupe bLF et 48 dans le groupe de controle (19,5 % contre 28,9 %). La bLF exercait un effet protecteur sur le risque de developpement de la septicemie tardive, avec un rapport de risque de 0,64 (% 95 IC = 0,41-0,99; p = 0,048), particulierement chez les nourrissons de moins de 1000 g, avec un rapport de risque de 0,46 (% 95 IC = 0,22-0,96; p = 0,039) et chez les nourrissons a faible consommation de lait humain, avec un rapport de risque de 0,40 (% 95 IC = 0,19-0,84 ; p = 0,015). La supplementation en bLF protege les nourrissons de moins 1500 g contre la septicemie tardive, en particulier les nourrissons qui ne recoivent pas de lait humain. Mots-cles : lactoferrine, septicemie, neonatal, essai controle randomise.

Author(s): Cheryl Zlotnick [sup.1] , Tammy Tam [sup.2] , Yu Ye [sup.2] Author Affiliations: (1) CHORI Children's Hospital Oakland Research Institute, UCSF Benioff Children's Hospital Oakland, 0000 0004 0433 7727, [...], Introduction In 2007, the California signed legislation mandating a dental visit for all children entering kindergarten or first grade; no such mandate was made for physician visits. This study examines the impact of this policy change on the risk factors associated with obtaining pediatric dental and physician health care visits. Methods Every 2 years, California Health Interview Survey conducts a statewide survey on a representative community sample. This cross-sectional study took advantage of these data to conduct a "natural experiment" assessing the impact of this policy change on both pediatric physician and dental care visits in the past year. Samples included surveys of adults and children (ages 5-11) on years 2005 (n = 5096), 2007 (n = 4324) and 2009 (n = 4100). Results Although few changes in risk factors were noted in pediatric physician visits, a gradual decrease in risk factors was found in pediatric dental visits from 2005 to 2009. Report of no dental visit was less likely for: younger children (OR -0.81, CI 0.75-0.88), insured children (OR 0.34, CI 0.22-0.53), and children who had a physician's visit last year (OR 0.37, CI 0.25-0.53) in 2005. By 2007, absence of insurance was the only risk factor related to having no dental visit (OR 0.34, CI 0.19-0.61). By 2009, no a priori measured risk factors were associated with not having a dental visit for children aged 5-11 years. Conclusions A statewide policy mandating pediatric dental visits appears to have reduced disparities. A policy for medical care may contribute to similar benefits.

Author(s): Sushmita Banerjee [sup.1] , Pathum Vindana Dissanayake [sup.2] , Asiri Samantha Abeyagunawardena [sup.2] Author Affiliations: (1) grid.414710.7, Institute of Child Health, , Kolkata, West Bengal, India (2) grid.11139.3b, 0000000098168637, [...], Renal diseases are often treated with immunosuppressive medications, placing patients at risk of infections, some of which are vaccine-preventable. However, in such patients vaccinations may be delayed or disregarded due to complications of the underlying disease process and challenges in its management. The decision to administer vaccines to immunosuppressed children is a risk-benefit balance as such children may have a qualitatively diminished immunological response or develop diseases caused by the vaccine pathogen. Vaccination may cause a flare-up of disease activity or provocation of graft rejection in renal transplant recipients. Moreover, it cannot be assumed that a given antibody level provides the same protection in immunosupressed children as in healthy ones. We have evaluated the safety and efficacy of licensed vaccines in children on immunosuppressive therapy and in renal transplant recipients. The limited evidence available suggests that vaccines are most effective if given early, ideally before the requirement for immunosuppressive therapy, which may require administration of accelerated vaccine courses. Once treatment with immunosuppressive drugs is started, inactivated vaccines are usually considered to be safe when the disease is quiescent, but supplemental doses may be required. In the majority of cases, live vaccines are to be avoided. All vaccines are generally contraindicated within 3-6 months of a renal transplant.

Introduction Malaria remains a major threat to the health of some three billion people in 108 countries where the disease is endemic. (1) According to the World Health Organization (WHO), [...], Objective To investigate if the first national insecticide-treated bed-net campaign in Burkina Faso, done in 2010, was followed by a decrease in childhood malaria in a district with high baseline transmission of the disease. Methods We obtained data on the prevalence of Plasmodium falciparum parasitaemia in children aged 2 weeks to 36 months from malaria surveys in 2009 and 2011. We assessed morbidity in children younger than 5 years by comparing data from the Nouna health district's health management information system before and after the campaign in 2010. We analysed mortality data from 2008 to 2012 from Nouna's health and demographic surveillance system. Findings The bed-net campaign was associated with an increase in the reported use of insecticide-treated nets. In 2009,73% (630/869) of children reportedly slept under nets. In 2011, 92% (449/487) did. The campaign had no effect on the proportion of young children with P. falciparum parasitaemia after the rainy season; 52% (442/858) in 2009 and 53% (263/499) in 2011. Cases of malaria increased markedly after the campaign, as did the number of children presenting with other diseases. The campaign was not associated with any changes in child mortality. Conclusion The 2010 insecticide-treated net campaign in Burkina Faso was not associated with a decrease in care-seeking for malaria or all-cause mortality in children younger than 5 years. The most likely explanation is the high coverage of nets in the study area before the campaign which could have had an effect on mosquito vectors, limiting the campaign's impact. [TEXT NOT REPRODUCIBLE IN ASCII] Objectif Etudier si la premiere campagne nationale visant a utiliser des moustiquaires impregnees d'insecticide au Burkina Faso, menee en 2010, a ete suivie d'une baisse des cas de paludisme infantile dans un district ayant un taux eleve de transmission de la maladie. Methodes Nous nous sommes procure des donnees sur la prevalence de la parasitemie de Plasmodium falciparum chez les enfants ages de 2 semaines a 36 mois a partir des enquetes sur le paludisme menees en 2009 et 2011. Nous avons evalue la morbidite chez les enfants de moins de 5 ans en comparant les donnees du systeme d'information sanitaire du district de Nouna avant et apres la campagne de 2010. Nous avons analyse les donnees sur la mortalite de 2008 a 2012 provenant du systeme de surveillance sanitaire et demographique de Nouna. Resultats La campagne pour l'utilisation de moustiquaires a ete associee a une augmentation de l'utilisation de moustiquaires impregnees d'insecticide. En 2009, d'apres l'enquete menee, 73% des enfants (630/869) dormaient sous une moustiquaire. En 2011, ils etaient 92% (449/487). La campagne n'a pas eu d'effet sur la proportion de jeunes enfants presentant une parasitemie de P falciparum apres la saison des pluies: ils etaient 52% (442/858) en 2009 et 53% (263/499) en 2011. Les cas de paludisme ont sensiblement augmente apres la campagne, comme le nombre d'enfants atteints d'autres maladies. La campagne n'etait associee a aucun changement de la mortalite infantile. Conclusion La campagne de 2010 pour l'utilisation de moustiquaires impregnees d'insecticide au Burkina Faso n'a pas ete associee a une diminution des consultations pour paludisme ou de la mortalite, toutes causes confondues, chez les enfants de moins de 5 ans. L'explication la plus probable est liee au taux eleve d'utilisation de moustiquaires dans la zone etudiee avant la campagne, qui pourrait avoir eu un effet sur les moustiques vecteurs de la maladie et avoir limite l'impact de la campagne. [TEXT NOT REPRODUCIBLE IN ASCII] Objetivo Investigar si la primera campana nacional de mosquiteros tratados con insecticida en Burkina Faso, que se llevo a cabo en 2010, tuvo como resultado un descenso del paludismo infantil en un distrito con una referencia elevada de transmision de la enfermedad. Metodos Se obtuvieron datos sobre la prevalencia de parasitemia por Plasmodium falciparum en ninos de edad entre las 2 semanas y los 36 meses de encuestas sobre la malaria de 2009 y 2011. Se evaluo la morbilidad en ninos menores de 5 anos mediante la comparacion de los datos del sistema de gestion de Informacion sanitaria del departamento de salud de Nouna antes y despues de la campana de 2010. Se analizaron los datos de mortalidad desde 2008 hasta 2012 del sistema de vigilancia sanitaria y demografica de Nouna. Resultados La campana de distribucion de mosquiteros se relaciono con un aparente aumento del uso de redes tratadas con insecticida. En 2009, aparentemente el 73% (630/869) de los ninos dormia bajo mosquiteros. En 2011, lo hacia el 92% (449/487). La campana no tuvo efecto en la proporcion de ninos pequenos con parasitemia por R falciparum despues de la temporada de lluvias; el 52% (442/858) en 2009 y el 53% (263/499) en 2011. Los casos de malaria aumentaron notablemente despues de la campana, igual que lo hizo el numero de ninos que mostraban otras enfermedades. La campana no se relaciono con ningun cambio en la mortalidad Infantil. Conclusion La campana de distribucion de mosquiteros tratados con Insecticida realizada en 2010 en Burkina Faso no estuvo relacionada con un descenso en la atencion medica relacionada con la malaria o la mortalidad a causa de la misma en ninos menores de 5 anos. La explicacion mas logica es la gran cobertura de redes en el area del estudio antes de la campana, lo que podria haber tenido un efecto en los mosquitos vectores, limitando el impacto de la campana.

To the Editor: We recently reported that postvaccination serum samples from infants immunized with a novel, protein-based multicomponent meningococcal serogroup B (MenB) vaccine (Bexsero; GlaxoSmithKline Vaccines, Verona, Italy) have bactericidal [...]

Background Preventive chemotherapy (PC), the large-scale distribution of anthelminthic drugs to population groups at risk, is the core intervention recommended by WHO for reducing transmission of, and morbidity associated with, [...]

Context Worldwide, rotavirus diseases are estimated to cause >500 000 deaths each year among children aged The SANEVA network Since 2006, several countries in the Region of the Americas have [...]

In accordance with its mandate to provide guidance to Member States on health-policy matters, WHO issues a series of regularly updated position papers on vaccines and combinations of vaccines against [...]

Author(s): Tim Ulinski [sup.1] Keywords: Keywords children; nephrotic syndrome; pneumococcal antibodies; pneumococcal vaccine Idiopathic nephrotic syndrome (INS) is the most frequent renal pathology in childhood (two to five children per [...], Children with idiopathic nephrotic syndrome are at risk of potentially severe pneumococcal infections, such as pneumonia, meningitis and peritonitis. This susceptibility is due to losses of immunoglobulin and complement system components. Strategies to reduce the risk of pneumococcal infections include antibiotic prophylaxis (abandoned as a result of an increased risk to select resistant strains) and antipneumococcal vaccination. Traditionally, vaccination was performed when the patient was in remission and on low-dose steroids. A recent study has demonstrated that nephrotic children on high-dose glucocorticoid therapy respond to a pneumococcal polysaccharide vaccine. The major advantage of this strategy is that patients who relapse during the tapering of steroids already have increased anti-pneumococcal antibodies at the time of relapse. Patients with steroid-dependent or -resistant forms of the nephrotic syndrome acquire high antibody levels even if early relapses delay the tapering of steroids or if immunosuppressive agents are introduced. The fear of vaccine-induced relapses creates hesitation concerning vaccination of children with idiopathic nephrotic syndrome in remission. 23-valent pneumoccal vaccine at disease onset may therefore increase the number of pneumococcal vaccinations in children with the nephrotic syndrome. Vaccination with a 23-valent pneumoccal vaccine at disease onset while the patient is proteinuric and on high-dose steroids is a safe strategy with a high antibody response.

Background Malaria prevention in Africa merits particular attention as the world strives toward a better life for the poorest. Insecticide-treated nets (ITNs) represent a practical means to prevent malaria in [...]

ABBREVIATIONS. SES, socioeconomic status; LOS, length of stay; HMO, health maintenance organization; HVMA, Harvard Vanguard Medical Associates; HPHC, Harvard Pilgrim Health Care; ROLOS, Reduced Obstetrical Length of Stay program; AMRS, [...], Objective. The purpose of this study was to evaluate the effects on breastfeeding rates of a private-sector early discharge program and a subsequent government mandate guaranteeing 48 hours of hospital coverage. Methods. Interrupted time-series analyses were conducted on retrospective data from the automated medical records of a large health maintenance organization in eastern Massachusetts. A population of 20 366 mother--infant pairs with normal vaginal deliveries between October 1990 and March 1998 was identified. This study period spanned the 2 interventions of interest: 1) the introduction of a new health maintenance organization protocol of 1 postpartum overnight hospitalization followed by a nurse home visit for normal vaginal deliveries, then 2) Massachusetts state minimum coverage legislation. Breastfeeding initiation and breastfeeding continuation among initiators (exclusive or with supplements) into the third month of life were determined through a text search of the first 90 days of infants' automated medical records. Results. Both policies had dramatic impacts on length of stay (LOS); postpartum LOS Conclusions. Early postpartum discharge with outpatient breastfeeding support and a home visitor program has no adverse effects on initiation or continuation of breastfeeding. Pediatrics 2003;111:519-524; breastfeeding, length of stay, maternity health services, health policy, research design.

In some countries childhood immunisation is compulsory but in the United Kingdom the decision on whether or not to immunise is made by the child's parents. Fears about the safety [...]

ATHEROSCLEROSIS FIRST APPEARS during childhood. (1) Therefore, interventions may need to be started much earlier, and targeted at biological pathways that determine disease susceptibility, to prevent adult cardiovascular disease. In [...]