Methods. Data were collected prospectively as part of the ongoing Australian and New Zealand Neonatal Net- work audit of high-risk infants (birth weight of <1500 g or gestational age [GA] of <32 weeks) admitted to a level III neonatal unit in Australia or New Zealand. Prenatal and perinatal factors to 1 minute of age were examined for the subset of infants with GA of <29 weeks who survived to 36 weeks’ postmenstrual age and were exam- ined for ROP (n ⴝ 2105). The factors significantly asso- ciated with stage 3 or 4 ROP were entered into a multi- variate logistic regression model.
The limitations of this systematic review include the overall poor methodological quality of the included stud- ies, with differing study designs and analytic methods, and extreme diversity of measurements among different stud- ies. Definitions of prenatal or perinatal adversities differed between studies, and were most commonly retrospectively ascertained. Finally, as the clinical symptoms of TS wax and wane during the disease course, the measurement of tic severity at a single point of time does not truly repre- sent disease severity for patients. Although it is difficult to draw a valid conclusion from this literature, many pre- and perinatal adversities were reported to be associated with the onset of TS, the presence of comorbidities, and the severity of tics and comorbidities. Future studies are likely to make a significant contribution, especially if they include population derived cohorts, use data on perinatal events that was obtained prospectively, and use methods to control for multiple hypothesis testing. Standards for defining pre and perinatal events should be adhered to, and TS symptom severity should be measured at multiple time points if this outcome is being considered.
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return to functional bowel (due to chronic intestinal in ﬂ ammation) and the occurrence of bowel atresia (BA; requiring intestinal surgery in ∼ 10% – 20% of cases) are the main factors affecting length of hospital stay (LOS) as well as total parenteral nutrition (TPN) dependence and associated neonatal complications (ie, recurrent sepsis, TPN cholestasis, adhesive bowel obstruction). 2,4–6 Different surgical techniques (primary vs staged closure) to repair this abdominal wall defect did not show signi ﬁ cant differences in outcomes. 2
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Background: Prenatal stress and other prenatal risk factors (e.g. intimate partner violence) have a negative impact on mother ’ s health, fetal development as well as enduring adverse effects on the neuro-cognitive, behavioral and physical health of the child. Mothers of low socio-economic status and especially those living in crime-ridden areas are even more exposed to a host of risk factors. Societies of extreme violence, poverty and inequalities, often present difficulties to provide adequate mental health care to the most needed populations. The KINDEX, a brief standardized instrument that assesses 11 different risk factors was used by midwives to identify pregnant women at-risk, in a suburban area with one of the highest levels of domestic violence in Lima. The instrument was designed to be used by medical staff to identify high-risk child-bearing women and, based on the results, to refer them to the adequate psychological or social support providers. The aim of this study is to assess the feasibility of psychosocial screening using the KINDEX in a Latin American Country for the first time, and to explore the relationship of the KINDEX with thee major risk areas, maternal psychopathology, perceived stress and traumatic experiences.
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Hearing loss in children constitutes a considerable handicap because it is an invisible disability and compromises optimal development and personal achievement of a child. The period from birth to 5 years of life is critical for the development of speech and language; therefore, there is need for early identification and assessment of hearing loss and early rehabilitation in infants and children. Cochlear implants are the treatment of choice for patients with severe to profound sen- sorineural hearing loss. The goal of the present study was to investigate the different hearing im- pairment etiologies of patients implanted in cochlear implant program. The hospital based inter- ventional study was conducted in the Department of Otorhinolaryngology, SMS Medical College, Jaipur from July 2011 to Dec. 2013. Present study included 60 prelingually deafened patients who attended ENT OPD and underwent cochlear implant. The most common cause of deafness in our study was acquired (56.66%), which predominantly included perinatal risk factors (64.70%), fol- lowed by prenatal risk factors (41.17%). The second common cause was hereditary (26.66%), followed by unknown (16.66%). Infection and ototoxic drug history were the most common risk factors in prenatal and postnatal group. The most common perinatal cause was low birth weight and prematurity.
Custody status was further investigated by omit- ting from the regression 3 postnatal variables that could be influenced by parental care-taking. Expo- sure to family violence or current drug abuse may be related to child custody (furthermore, it is likely that current drug abuse may be underreported and, hence, subject to significant misclassification). Even whole blood lead levels may be influenced by paren- tal inattention during the toddler years or residence in unsafe housing. In the series of simplified regres- sions that follow, prenatal risk factors, socioeco- nomic status, and child age and gender were in- cluded in the models predicting each of the TRF outcomes. Additionally, dummy variables were cre- ated to contrast the 4 custody status groups: always with the biologic mother, currently but not always with the biologic mother, previously but not cur- rently with the biologic mother, and never with the biologic mother. In the stepwise regressions pre- sented in Table 3, custody change (both sometimes with mother groups vs never a custody change) was a significant predictor of TRF Total Score, External- izing, and Aggression. Children with at least 1 cus- tody change had higher behavior scores. Prenatal cocaine exposure continued to predict the TRF Ex- ternalizing–Internalizing Difference, whereas prena- tal alcohol exposure remained significantly related to both Delinquent Behaviors and Attention Problems. Gender was also a significant predictor for the Total Score, Externalizing, Aggressive, Delinquent, and
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A total of 4206 pregnant women with indications of prenatal diagnosis came to Genetic laboratory and prenatal diagnosis center of Women & Chil- dren’s Health Care Hospital of Linyi, China form January 2016 to December 2017. They were per- formed amniocentesis under informed consent. The indications of prenatal diagnostic include: advanced maternal age, high-risk serological screening, abnormal non-invasive prenatal DNA test, ultrasonographic abnormal indications, pa- ternal/maternal carrying chromosome abnormali- ty, a history of intrauterine fetal death or aborted fetuses. The maternal age was range from 15 to 49 yr and the gestational week was range from 16 to 31weeks.
Alcohol use during pregnancy has been found to be correlated with many negative health outcomes for the neonate (e.g., physical and cognitive defects  and neuro- developmental abnormalities) , and for the mother (e.g., decreased production of breast milk) [11, 12]. Des- pite this and evidence to suggest that screening in itself can reduce alcohol consumption, rarely is alcohol screen- ing in widespread use in prenatal care settings [13–15]. In addition, a recent review of the current situation in less developed countries found that service systems for the treatment of alcohol use disorders, where available, focus on providing tertiary care services for the treatment of dependence, often with poor outcomes , and are de- signed for men, and Zambia is no exception. Standard tests for excessive alcohol consumption include brief alcohol intervention, motivational interviewing, public awareness campaigns and the provision of additional treatment to those who screen in need of additional services in prenatal care is established [17, 18].
We completed a detailed review of placental pathology and recognized risk factors for a series of selected patients with symptomatic neonatal stroke and suggested mechanisms un- derlying this disorder. The placenta may play an important role in throm- bus formation and cytokine release, contributing to other risk factors for neonatal stroke. Although this is an im- portant ﬁrst look at the placenta in this population, a larger, prospective study comparing placentas from healthy newborns to those of distressed new- borns is necessary to further establish the placenta as a causative factor in neonatal stroke.
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In Table 2, we present the HRs for offspring ADHD by number of days of prenatal acetaminophen exposure, adjusted for each indication of use by stratification. We found that use of acetaminophen <7 days was negatively associated with offspring ADHD. For use >7 days, the HR for offspring ADHD increased with the number of days exposed. Prenatal use of acetaminophen for 29 or more days was associated with a substantially increased hazard rate of ADHD (HR = 2.20; 95% CI 1.50–3.24), even after adjusting for indications of use by stratification (Supplemental Table 6). The associations with use of 29 days or more did not differ across groups of indications (HR = 2.13–2.56). Acetaminophen use for fever and infections for 22 to 28 days was strongly associated with ADHD (HR = 6.15; 95% CI 1.71–22.05). Associations between paternal preconceptional use of acetaminophen and ADHD are presented in Table 3. Short-term paternal use was not negatively
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Risk factors for LBW vary by race/ethnicity and nativity (Table 1). For example, in all racial/ethnic groups, foreign-born women are less likely to be single mothers than their US-born counterparts. This difference is particularly strong among black women (ie, although only 35% of US-born black women are married, 63% of foreign-born black women are mar- ried). Regarding education, Hispanic women (both US-born and foreign-born) are more likely to have low education than women in any other racial/eth- nic group. Foreign-born Asian and Hispanic women are considerably more likely to have low education (0 –11 years) than their US-born counterparts (11.3% vs 4.8% among Asian women and 55.9% vs 23.7% among Hispanic women). Among all racial/ethnic groups, foreign-born women have much lower rates of smoking during pregnancy than their US-born counterparts. Use of adequate prenatal care does not exhibit strong differences between foreign-born and US-born women in any racial/ethnic group. With the exception of diabetes and placenta previa/abruption, medical risk factors tended to be lower among for- eign-born than US-born women.
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The data indicate that 10 to 20% of women experience a postpartum depressive episode . In theory any mother could be affected by PPD, regardless of her age, number of other children or race . Several studies have identified some risk factors for developing PPD. However, these studies have used only limited numbers of participants; therefore, the estimated prevalence of PPD varies greatly. Estimations of PPD prevalence depend mostly on the diagnostic method, the population examined, the time period studied, and the sampling bias . There are no standardized diagnostic tools. The frequently used Edinburgh Postnatal Depression Scale  is a nonspecific tool for both depression and anxiety symptoms, and there is an inconsistency in the use of cut-off score. Moreover, fewer than half of PPD cases are diagnosed in clinical practice . Therefore there is a need to improve case detection, identify risk populations, and implement evidence-based treatment .
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We observed that the association between cesarean section and LCP disease remains statistically significant after adjustment for other risk factors. The reason for cesarean section is not recorded in the register data, so it is not possible to explore fully the reasons underlying this association. It is conceivable that some conditions associated with impaired fetal development, which also increased LCP disease risk, resulted in delivery by cesar- ean section. Measures such as breech birth and trauma were not associated with LCP disease risk, suggesting that influences on earlier development, rather than peri- natal trauma, are involved in the etiology of the disease. Although we identified associations with smoking dur- ing pregnancy, earlier maternal smoking could theoret- ically influence fetal development through epigenetic mechanisms, altering gene expression through the pla- centa or the cytoplasm of the egg.
In general, it can be stated that the direct significance of some aspects of prenatal history (such as maternal emotional well-being) decrease during the first half year of infancy, while aspects of the postnatal child environ- ment (such as maternal attitudes toward infant-rearing) become more significant. This could be explained by the complex interplay between a child and his or her envir- onment over time, and the confounding effect of risk factors. Bidirectional effects of the child and of the environment are highlighted in transactional models  and are well-documented in various representative studies of experimental, quasi-experimental, and natura- listic design . However, our study also suggests that some negative aspects of prenatal history (such as poor quality of a couple’s relationship before pregnancy and negative or ambivalent reactions toward conception) could potentially have long-lasting effects, increasing the risk of continuity of infant difficult behaviors. It can be assumed that these outward factors could also be inter- related with maternal emotional well-being and produce a combined effect along with the mother ’ s long-lasting negative emotional state.
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An understanding of the molecular mechanisms underly- ing developmental programming is only recently beginning to come into light. Investigation of the role of epigenetics in modulating postnatal phenotype holds great promise in under- standing the mechanisms underlying the link between early- life adversity and postnatal risk of disease and in advancing their diagnosis, prevention, and treatment. A collection of drugs targeting epigenetic regulation (DNMT inhibitors and histone deacetylase inhibitors) already exists at various stages of development, and although their effectiveness has yet to be maximized, they may show great promise in the treatment of complex disease such as the metabolic syndrome. 145
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RESULTS: The prevalence of birth defects classiﬁed as ARBDs by the IOM was low. Compared with abstinence, heavy PAE in the ﬁrst trimes- ter was associated with increased odds of birth defects classiﬁed as ARBDs (adjusted odds ratio: 4.6 [95% conﬁdence interval: 1.5–14.3]), with similar ﬁndings after validation through bootstrap analysis. There was no association between low or moderate PAE and birth defects. CONCLUSIONS: A fourfold increased risk of birth defects classiﬁed as ARBDs was observed after heavy PAE in the ﬁrst trimester. Many indi- vidual birth defects included in the IOM classiﬁcation for ARBDs either were not present in this cohort or were not associated with PAE. Large, population-based studies are needed to strengthen the evidence base for ARBDs. Pediatrics 2010;126:e843–e850
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Multiple reports of unselected women using group pre- natal care have significant numbers of racial and ethnic minority participants, including African Americans. When the analysis was limited to the two high-quality studies, the pooled rate of preterm birth for African Americans was 8.0% compared with 11.1% (pooled RR 0.55, 95% CI 0.34–0.88). This reduction was not seen for other racial or ethnic groups . Several studies con- tained cohorts that were made up primarily of African Americans, but often not 100%. Ford’s trial in Detroit had a cohort which was 94% African American but did not show significant benefits in that group in preterm birth reduction . Grady’s observational study which contained mostly African American women demon- strated lower rates of low birth weight and preterm birth but had uncharacteristically high rates of the outcomes in the control groups; preterm birth rate was 25% in the control women . Another retrospective review did show lower preterm birth rates in a group of African American women receiving group care, but the study had a high risk of bias . Some other studies that had majority popula- tions of African Americans did not show reduced preterm birth rates but did show that group care improved breast- feeding rates and satisfaction with care [10, 16, 29].
This case-control study using material from Swedish general population-based registers was designed specifi- cally to examine the hypothesis that maternal smoking during pregnancy is associated with an increased risk of LCP disease among offspring; we know of no other stud- ies that have investigated this hypothesis to date. We also evaluated the risk associated with birth weight, body size at birth, gestational age, presentation of the infant, delivery mode, Apgar score, maternal age, birth order, and history of earlier pregnancies. These measures were selected as relevant to fetal development and early trauma.
The following variables were analyzed: infant characteristics (age, gender, race or ethnicity, complex chronic condition, or technology dependence, eg, ventilator dependence, gastrostomy tube feeds), place of incident, whether an autopsy was performed, cause of death, sleep environment factors (sur- face sharing, object found in sleep en- vironment, sleep position, and sleep position change), and pregnancy char- acteristics (maternal medical problems, intimate partner violence, and sub- stance use or abuse). Data elements regarding the manner and cause of death from the death certi ﬁ cate were used to assign cases to 1 of 3 causes of death: SIDS, accidental suffocation and strangulation in bed (ASSB, which included asphyxia), and ill-de ﬁ ned (which included undetermined causes). ASSB encompassed any incidents of accidental suffocation by soft bedding (including pillow or mattress), over- lay, or wedging and entrapment, or strangulation in a sleep environ- ment. 6
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more (adjusted IRR: 1.29; 95% CI: 1.05–1.59). The risk was not associated with maternal weight gain during pregnancy (Table 6), and the associations remained unchanged after adjustment for gestational age and fetal growth measures. As with the influence of ma- ternal smoking, a stronger association with maternal BMI was seen in the period close to the time of birth (adjusted IRR: 1.37; 95% CI: 1.12–1.68 for the period between the age of 6 months and 4 years vs adjusted IRR: 1.05; 95% CI: .72–1.55 for the period between 5 and 12 years). Stratification of the analyses by either maternal prepregnancy BMI or weight gain during pregnancy did not show any difference in the asso- ciations between maternal smoking, alcohol, tea, and fruit intake and hospitalization with infectious dis- ease.