搜索结果：Pediatrics, Perinatology and Child Health

Tajikistan has accomplished reductions in maternal, newborn, and child mortality over the past decades through targeted policies and interventions. Challenges remain in providing quality healthcare due to limited resources, geographic barriers, and inadequate infrastructure. We aimed to evaluate the impact of a quality improvement (QI) initiative implemented in ten district hospitals from 2021 to 2024 to improve maternal, newborn, and childcare to accelerate progress towards achieving the Sustainable Development Goals. A baseline assessment was conducted in 2021, with an endline assessment in 2023, using updated WHO quality assessment tools. A multidisciplinary team of national and international experts evaluated hospital performance across three domains: support systems, clinical management, and organisation of care. Data was collected through observations, interviews, and medical record reviews. Project interventions included working with hospital-level Quality Improvement committees, capacity building in effective perinatal care, and the use of the WHO Pocketbook of Hospital Care for Children. Regular supportive supervision and half-yearly collaborative quality improvement meetings were held among the ten hospitals. We graphically displayed, analysed, and summed the assessment scores. We observed notable improvements in the quality of hospital care, with most facilities progressing from substandard to better-performing categories. Seven out of ten hospitals demonstrated advancements in their maternity and neonatal units, with improvements in clinical management and hospital support systems, including access to drugs and equipment. Challenges remained in paediatric care, with only two of ten hospitals showing improvements in infrastructure and laboratory services, and none improving drug availability. Improvements in infection prevention and control were minimal; however, four in ten hospitals managed to improve their practices despite challenges with resource availability, infrastructure, and current protocols. Comprehensive QI interventions can raise standards of care in resource-limited settings like Tajikistan. Despite measurable progress, systemic barriers persist, with weak infrastructure, unstable workforce, and limited infection prevention and control, requiring targeted investment and political commitment. Sustained success depends on equitable resource allocation, robust monitoring systems, and the promotion of a non-punitive, systems-oriented culture. Scaling up this initiative nationwide is critical to achieving long-term improvements in health.

Maternal, newborn, and child mortality rates in the Kyrgyz Republic are high compared to other countries in the European Region of the World Health Organization (WHO). Global evidence suggests that at least half of the maternal and newborn deaths could be prevented with improved quality of healthcare. To address this, we undertook a quality improvement project over two years in ten pilot hospitals of the Kyrgyz Republic. We assessed the quality of care for maternal, newborn, and child health using WHO tools at the beginning and end of the project. We evaluated the availability and appropriate use of resources, case management, and key hospital policies. We used a standardised scoring system from 0 to 3, with colour coding scores and a display of trends (improved, deteriorated, remained the same). After the baseline assessment, we conducted a complex improvement process including the development of hospital quality improvement plans, updating clinical guidelines, training activities in priority topics, supportive supervision, and semi-annual collaborative quality improvement meetings between hospitals. The baseline assessment revealed many areas of suboptimal care across the hospitals and technical areas. The endline assessment showed improvements in case management practices (baseline mean (x̄) = 1.6 vs. endline x̄ = 1.9) and policies and organisation of services (baseline x̄ = 1.7 vs. endline x̄ = 1.9). No improvement was achieved in hospital support services (baseline x̄ = 1.7 vs. endline x̄ = 1.8). Eight out of ten hospitals demonstrated overall improvement progress across categories; the two remaining hospitals showed no improvement. A complex intervention process focussed on updating clinical guidelines, selected capacity-building activities, supportive supervision, and semi-annual collaborative meetings led to quality improvements in maternal, newborn, and child health. The improvements achieved were still not reaching international standards, highlighting the need for a comprehensive and system-wide approach to quality improvement.

Scarce knowledge about the impact of metabolism-disrupting chemicals (MDCs) on steatotic liver disease limits opportunities for intervention. We evaluated pregnancy MDC-mixture associations with liver outcomes, and effect modification by folic acid (FA) supplementation in mother-child pairs. We studied &#x223c;200 mother-child pairs from the Mexican PROGRESS cohort, with 43 MDCs measured during pregnancy (estimated air pollutants, blood/urine metals or metalloids, urine high- and low-molecular-weight phthalate [HMWPs, LMWPs] and organophosphate-pesticide metabolites), and serum liver enzymes (ALT, AST) at &#x223c;9 years post-parturition. Outcomes included elevated liver enzymes in children and established clinical scores for steatosis and fibrosis in mothers (i.e. ALT, FLI, HSI, FIB-4). Bayesian-weighted quantile sum regression assessed MDC-mixture associations with liver outcomes. We further examined chemical-chemical interactions and effect modification by self-reported FA supplementation. In children, many MDC-mixtures were associated with liver injury. Per quartile HMWP-mixture increase, ALT increased by 10.1% (95% CI 1.67%, 19.4%) and AST by 5.27% (95% CI 0.80%, 10.1%). LMWP-mixtures and air pollutant-mixtures were associated with higher AST and ALT, respectively. Air pollutant and non-essential metal/element associations with liver enzymes were attenuated by maternal cobalt blood concentrations (p-interactions <0.05). In mothers, only the LMWP-mixture was associated with odds for steatosis (odds ratio = 1.53, 95% CI 1.01-2.28 for HSI >36, and odds ratio 1.62, 95% CI 1.05-2.49 for AST:ALT <1). In mothers and children, most associations were attenuated (null) at FA supplementation &#x2265;600 &#x3bc;g/day (p-interactions <0.05). Pregnancy MDC exposures may increase risk of liver injury and steatosis, particularly in children. Adequate FA supplementation and maternal cobalt levels may attenuate these associations. The effects of environmental chemical exposures on steatotic liver diseases are not well understood. In a parallel investigation of mothers and children, we found that pregnancy exposures to metabolism-disrupting chemicals may increase the risk of liver injury and steatosis, especially in the child, and that these associations could be attenuated by higher folic acid and/or cobalt levels. These findings can inform policies to decrease environmental chemical pollution and contribute to the design of clinical interventions addressing the metabolic dysfunction-associated steatotic liver disease epidemic.

The SUNFLOWER study was initiated in Japan and South Korea to clarify the course of X-linked hypophosphatemic rickets/osteomalacia (XLH); delineate its physical, mental, and financial burdens; and collect information on treatment. Here, we report cross-sectional data at the time of patient enrollment to better understand the real-world management and complications in patients with XLH and examine the effect of XLH on quality of life (QOL). This is an ongoing, longitudinal, observational cohort study of patients with a diagnosis of XLH. Data from 147 patients (118 in Japan and 29 in South Korea) were evaluated. In total, 77 children (mean age, 9.7&#xa0;yr; 67.5% female) and 70 adults (mean age, 37.6&#xa0;yr; 65.7% female) were enrolled. PHEX gene mutations were confirmed in 46/77 (59.7%) children and 37/70 (52.9%) adults. Most patients in both age groups were receiving a combination of phosphate and active vitamin D at baseline. The mean height Z-score was -2.21 among adults (male: -2.34; female: -2.14). The mean Rickets Severity Score in children was 1.62. Whereas children appeared to have low pain levels (mean revised faces pain scale score, 1.3), adults reported mild-to-moderate pain (mean Brief Pain Inventory pain severity, 2.02). Mean QOL in children (assessed using the 10-item short-form health survey for children) was low, with a score below normative level for physical functioning. In adults, results from the Western Ontario and McMaster Universities osteoarthritis index indicated the presence of pain, stiffness, and decreased physical function. The respective mean total days/year of work/school non-attendance due to symptoms/complications and management of XLH were 0.7 and 3.0 among adults, and 6.4 and 6.1 among children. Our findings reconfirmed a relationship between disease and QOL in patients with XLH. We anticipate that these data will be important in enabling clinicians to understand the daily reality of patients with XLH.

Introduction: The shaping of the human intestinal microbiota starts during the intrauterine period and continues through the subsequent stages of extrauterine life. The microbiota plays a significant role in the predisposition and development of immune diseases, as well as various inflammatory processes. Importantly, the proper colonization of the fetal digestive system is influenced by maternal microbiota, the method of pregnancy completion and the further formation of the microbiota. In the subsequent stages of a child's life, breastfeeding, diet and the use of antibiotics influence the state of eubiosis, which determines proper growth and development from the neonatal period to adulthood. The literature data suggest that there is evidence to confirm that the intestinal microbiota of the infant plays an important role in regulating the immune response associated with the development of allergic diseases. However, the identification of specific bacterial species in relation to specific types of reactions in allergic diseases is the basic problem. Background: The main aim of the review was to demonstrate the influence of the microbiota of the mother, fetus and newborn on the functioning of the immune system in the context of allergies and asthma. Methods: We reviewed and thoroughly analyzed the content of over 1000 articles and abstracts between the beginning of June and the end of August 2024. Over 150 articles were selected for the detailed study. Results: The selection was based on the PubMed National Library of Medicine search engine, using selected keywords: "the impact of intestinal microbiota on the development of immune diseases and asthma", "intestinal microbiota and allergic diseases", "the impact of intrauterine microbiota on the development of asthma", "intrauterine microbiota and immune diseases", "intrauterine microbiota and atopic dermatitis", "intrauterine microbiota and food allergies", "maternal microbiota", "fetal microbiota" and "neonatal microbiota". The above relationships constituted the main criteria for including articles in the analysis. Conclusions: In the present review, we showed a relationship between the proper maternal microbiota and the normal functioning of the fetal and neonatal immune system. The state of eubiosis with an adequate amount and diversity of microbiota is essential in preventing the development of immune and allergic diseases. The way the microbiota is shaped, resulting from the health-promoting behavior of pregnant women, the rational conduct of the medical staff and the proper performance of the diagnostic and therapeutic process, is necessary to maintain the health of the mother and the child. Therefore, an appropriate lifestyle, rational antibiotic therapy as well as the way of completing the pregnancy are indispensable in the prevention of the above conditions. At the same time, considering the intestinal microbiota of the newborn in relation to the genera and phyla of bacteria that have a potentially protective effect, it is worth noting that the use of suitable probiotics and prebiotics seems to contribute to the protective effect.

Children with medical complexity (CMC) are a high-risk population for many reasons including polypharmacy, which predisposes to medication errors. Parental comprehension of discharge medications is essential to reducing the risk for medication errors in CMC. The aim of this study was to determine whether parental health literacy is associated with comprehension of discharge medications among CMC. This was an observational cross-sectional study of English- and Spanish-speaking parents (n&#x2009;=&#x2009;60) of CMC younger than 18&#xa0;years admitted to the pediatric intensive care unit or acute care floor of 2 affiliated hospitals. Surveys were self-administered at time of discharge. Newest vital sign is a validated tool that identifies patients at risk for low health literacy. A score less than or equal to 3 indicated low health literacy. Comprehension was a composite score encompassing 6 domains (medication name, indication, dose, frequency, duration, and side effects) and was measured as a continuous variable. Simple and multiple linear regression models assessed the association between health literacy and comprehension, accounting for covariates. The unadjusted parental comprehension score was 1.16 higher (SE 0.33) in caregivers with appropriate health literacy (P&#x2009;<&#x2009;.01). Health literacy explained 17% of the variance in comprehension. Once adjusting for income, the association between health literacy and comprehension was no longer significant (P&#x2009;=&#x2009;.05). Low parental health literacy is associated with worse comprehension of discharge medications for parents of CMC, but the relationship is confounded by income. Initiatives to improve medication comprehension with special attention to health literacy and social determinants of health may help address this problem.

Epidemiological studies report associations between antibiotics given during pregnancy, childbirth, and infancy and subsequent risk for childhood infections. The specific role of intrapartum and neonatal antibiotic exposures is not well-described. Retrospective cohort study of healthy term infants through 6 years of age. The primary exposure was perinatal antibiotics, defined as intravenous intrapartum antibiotic administration during the admission for childbirth or administered to the infant &#x2264;3 days after birth. The primary outcome was infection-related inpatient encounters. Adjusted multivariable-adjusted Cox proportional hazards and marginal means/rates models were used to investigate the association between exposure and outcome. A secondary analysis examined the association between early infant antibiotics administered during the first three months after birth, including perinatal antibiotics, and the outcome. Of 13,919 infants, 3936 (28%) had perinatal antibiotic exposure. 1294 (9.3%) children had 1619 inpatient encounters, of which 988 (61%) were infection-related. Infection-related inpatient encounters occurred in 265 (6.7%) children exposed to perinatal antibiotics, compared to 584 (5.8%) unexposed children (risk difference 1.2%, 95% CI 0.3-2.1%, p = 0.005). In multivariable-adjusted models, perinatal antibiotic exposure was not associated with infection-related inpatient encounters [Cox model: aHR 1.16, 95% CI 0.95, 1.51, p = 0.15; marginal rates/means model: aHR 1.22, 95% CI 0.98, 1.51, p = 0.08]. Early infant antibiotics were also not associated with the outcome. In this study of 13,919 newborns across 24 primary pediatric practices, perinatal or early infant antibiotic exposure was not associated with subsequent early childhood hospitalization for infectious diseases. Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, funding (K23 HD088753) supported this study.

Prenatally transmitted viruses can cause severe damage to the developing brain. There is unexplained variability in prenatal brain injury and postnatal neurodevelopmental outcomes, suggesting disease modifiers. Of note, prenatal Zika infection can cause a spectrum of neurodevelopmental disorders, including congenital Zika syndrome. Currently, there is no preventative treatment or cure. The Prenatal Infection and Neurodevelopmental Genetics (PING) Consortium aims to identify modulators of brain injury and adverse neurodevelopmental outcomes for Zika and other prenatal viral infections. The Consortium pools information from eight multi-site studies conducted at 23 research centers in six countries to build a growing clinical and genomic repository, which is being mined for modifiers of virally induced brain injury. Partners include Children's National Hospital (USA), Instituto Nacional de Salud (Colombia), the Natural History of Zika Virus Infection in Gestation program (Brazil), Zika Instituto Fernandes Figueira (Brazil), the Centers for Disease Control and Prevention, and the National Institutes of Health. We have enrolled 4102 mothers and 3877 infants with 3063 biological samples and clinical data covering over 80 phenotypic fields and 5000 variables. Thus far, we have performed whole exome sequencing on 1226 participants. Here, we present the Consortium's formation and overarching study design. The PING Consortium brings together investigators and institutions to determine the causes of virally induced brain injury and neurological deficits. The clinical and genomic repository, with data from over 8000 patients, will serve as a foundation for a variety of basic and clinical studies.

Few studies have evaluated the association between the duration of mothers' digital media use (including mobile phones, tablets, and PCs) while with their children and children's development. Using data from the Japan Environment and Children's Study, we explored this relationship through multiple regression analysis. Self-administered questionnaires measured the duration of mothers' digital media use. Developmental outcomes were assessed using the Kyoto Scale of Psychological Development 2001 (KSPD), administered to two-year-olds by trained examiners. The KSPD assessed three domains: postural-motor (fine and gross motor abilities), cognitive-adaptive (non-verbal cognitive capacity and visual-spatial comprehension), and language-social (interpersonal relationships, socialization, and verbal abilities). The analysis included 3,786 mother-child pairs with complete exposure data, outcomes, and covariates. The children of mothers who used digital media for one hour or more exhibited lower language-social development quotients compared with those whose mothers did not use digital media while with them. Furthermore, the children of mothers who used digital media for two hours or more showed a lower total developmental quotient compared with those whose mothers did not use digital media. The use of digital media by mothers for more than one hour per day while with their children is thus negatively associated with language development in two-year-olds, while use for more than two hours is negatively associated with children's development.

Placenta accreta spectrum (PAS) is a complex, life-threatening condition that demands a multidisciplinary approach involving obstetrics, maternal-fetal medicine, and various surgical and medical specialties. Effective management relies on multispecialty collaboration and consensus, supported by standardized protocols, to optimize outcomes, guide informed clinical decisions, and mitigate the risks associated with PAS. To examine clinical practice guidelines for PAS inclusive of high-income countries and low- to middle-income countries (LMICs) identifying areas of consensus and gaps in guidance. A comprehensive search of PubMed, GIN Library, and ECRI Guidelines Trust identified all PAS-related clinical practice guidelines published from January 1, 2014, to January 31, 2024. Additional searches included professional societies' designated websites and cited references. Two independent reviewers screened the guidelines, resolving conflicts through cross-referencing. Initially, 2 independent reviewers provided structured review and feedback to refine, correct, or highlight areas of consensus, disagreement, or insufficient evidence. Any instances of nonagreement were adjudicated by majority panel agreement, arising from a panel of 15 to 18 experts, all authors of PAS guidelines. Agreement scores for each recommendation area (eg, epidemiology, diagnosis, and antenatal management) were categorized as high agreement (&#x2265;75%), poor consensus (<50% or &#x2265;30% insufficient evidence), and high levels of insufficient evidence (&#x2265;50% of recommendations with insufficient evidence) based on a priori score criteria. A total of 14 guidelines from 18 articles from national and international societies were included. High agreement was noted in areas such as specialized expertise (100%), antenatal management (88.9%), diagnosis (76.9%), and epidemiology (75.0%). Poor consensus characterized cesarean hysterectomy management (38.5% insufficient evidence and 23.0% disagreement), conservative techniques (33.3% insufficient evidence and 11.1% disagreement), and fertility counseling (30.0% insufficient evidence and 10.0% disagreement). Despite the high risk of anemia, consensus was lacking on iron supplementation strategies. Recommendations for thromboembolism prevention varied, with some guidelines favoring pharmacologic interventions and others advocating for nonpharmacologic measures. Hemorrhage management and postnatal management recommendations, including iron supplementation and thromboembolism prevention, were characterized by high levels of insufficient evidence (55.6% and 57.1%, respectively). Only 1 article (5.6%) specifically addressed LMICs, highlighting substantial underrepresentation. This systematic review of PAS guidelines identified significant discrepancies and insufficient evidence in key aspects of care. The findings underscore the urgent need for further research and quality measures to enhance standardized approaches and improve patient outcomes. The limited availability of recommendations applicable to LMICs highlights the critical need for tailored guidance that accounts for resource constraints and clinical access challenges unique to these settings.

We aimed to determine the association between maternal bonding difficulty in the postpartum period and children's neurodevelopment, considering maternal psychological distress and child sex-specific differences. To evaluate the relationship, the dataset of the Japan Environment and Children's Study was used, as well as the Mother-to-Infant Bonding Scale (MIBS), the six-item version of the Kessler Psychological Distress Scale (K6) for mothers, and the Ages and Stages Questionnaires Third Edition for children aged 2 to 4 years. Maternal MIBS and K6 were administered at 1 year postpartum. Data from 24,798 boys and 24,025 girls were analyzed. Multivariate logistic regression analyses, with the reference groups being those with maternal MIBS scores &#x2264;4 and K6 scores &#x2264;4, were performed. The Benjamini-Hochberg procedure was employed to account for multiple testing. In boys, maternal bonding difficulty (MIBS score &#x2265;5) without psychological distress (K6 score &#x2264;4) was associated with a screen-positive result for neurodevelopmental delay in all five domains (communication, gross motor, fine motor, problem-solving, and personal-social) at ages 2 to 4 years. In girls, maternal bonding difficulty without psychological distress was associated with a screen-positive result for neurodevelopmental delay in all five domains at 2 years of age. However, at age 4 years, maternal bonding difficulty without psychological distress was no longer associated with a screen-positive result for problem-solving delay in girls. The association of maternal bonding difficulty without psychological distress at 1 year postpartum with screen-positive result for problem-solving delay persisted in boys, but at age 4 years in girls, the association no longer existed.

Maternal prenatal and postnatal psychological distress, including depression and anxiety are risk factors for the development of autism spectrum disorder (ASD) in children. However, there is inconsistent knowledge regarding the period in pregnancy during which psychological distress may influence this risk, and the associated sex-specific differences. We evaluated the association between the six-item Kessler Psychological Distress Scale (K6) for mothers and ASD in 6-year-old children, using the Japan Environment and Children's Study dataset. In total, 32,417 boys and 30,996 girls were included in the analysis. The K6 was administered during the first half of pregnancy (medians of 15&#xa0;weeks); the second half of pregnancy (medians of 27&#xa0;weeks); and at 1&#xa0;year postpartum, and multivariate logistic regression analyses were performed on the group with a K6 score&#x2009;&#x2264;&#x2009;4 as reference. In boys, maternal psychological distress in the first half of pregnancy and at 1&#xa0;year postpartum were associated with ASD. In girls, maternal psychological distress coexisting during pregnancy and at 1&#xa0;year postpartum was associated with ASD.

To examine the prevalence of large-for-gestational age (LGA) and macrosomia in 23 countries between 2000 and 2021. Descriptive multi-country secondary data analysis. Subnational, population-based cohort studies (k&#x2009;=&#x2009;45 for LGA, k&#x2009;=&#x2009;25 for macrosomia) in 23 low- and middle-income countries (LMICs). Liveborn infants. We conducted a secondary analysis of individual-level data from the Vulnerable Newborn Measurement Collaboration, using INTERGROWTH-21st standards to define LGA (>&#x2009;90th centile for gestational age and sex) and macrosomia (&#x2265;&#x2009;4000&#x2009;g, regardless of gestational age). We included LMIC population-based datasets with reliable gestational age and birthweight data, excluding studies with small sample sizes, high missing data, or implausible measurements. Prevalence estimates were stratified by region, study period and gestational age, and results were summarised as medians and interquartile ranges (IQR). Prevalence of LGA and macrosomia. Among 476&#x2009;939 live births, the median prevalence of LGA was 5.1% (IQR: 2.9%-9.6%) and was highest in Latin America and the Caribbean at 9.6% (4 studies, IQR: 2.7%-16.1%) and lowest in South Asia at 2.7% (13 studies, IQR: 2.3%-3.7%). Over time, the median LGA prevalence increased from 4.9% (12 studies; IQR: 4.1%-7.9%) during the period from 2000 to 2010 to 5.9% (33 studies, IQR: 2.7%-11.2%) from 2011 to 2021. Term LGA was more common at 3.2% (0.9-5.1) than preterm or post-term LGA. Among 313&#x2009;064 live births, the median prevalence of macrosomia was 1.3% (n&#x2009;=&#x2009;313&#x2009;064, IQR: 0.2%-2.4%), which was highest in Latin America and the Caribbean (4 studies, 3.1%, IQR: 0.7%-6.8%) and lowest in South Asia (8 studies, 0.1%, IQR: 0.0%-0.7%). The median prevalence remained stable over time: 1.1% (8 studies, IQR: 0.2%-3.1%) in older studies (2000-2010) and 1.3% (17 studies, IQR: 0.5%-2.4%) in more recent studies (2011-2021). Term macrosomia was more common at 1.2% (0.2-2.0) than preterm and post-term macrosomia. The overall prevalence of LGA and macrosomia was lower in these LMIC studies than is reported in high-income countries. The prevalence of large babies was highest in Latin America and the Caribbean.

The objective of this study was to estimate the association between gestational phthalate metabolite concentrations and mixtures and pediatric antibody response at 4-years of age to common childhood vaccines, while also exploring sexually dimorphic effects. This study utilized data from the Programming, Research, Obesity, and Social Stressors (PROGRESS) Study, an ongoing, longitudinal cohort of mother-child pairs residing in Mexico City. Fifteen phthalate metabolites were measured in spot urine samples collected from mothers during their second and third trimesters. Children have been regularly followed, with data collection on lifestyle, clinical, socio-economic, and demographic factors, and archived biologic specimen. IgG-specific antibody serum levels to measles, mumps, rubella, diphtheria, tetanus, and pertussis were quantified from children at the mean 4.7 years of age. Linear regression models, with log2 transformation of both the outcome and exposure variables, estimated the association between individual phthalate metabolites and antibody concentrations. Phthalate mixtures were analyzed using the Quantile G-Computational approach and Bayesian Kernel Machine regression. All analyses were also sex-stratified to investigate sexually dimorphic effects. The present analysis included 362 mother-child pairs. During the second trimester of pregnancy, a doubling increase of mono-2-ethyl-5-carboxypentyl terephthalate (MECPTP) concentrations was associated with a 6.98% decrease (95% CI: - 11.68%, - 2.04%) in diphtheria and a 2.57% decrease (95% CI: - 4.74%, - 0.35%) in mumps antibody levels, respectively. No statistically significant sex-differences were observed. Mixtures analyses did not reach statistical significance but observed similar associations with MECPTP. Concentrations of MECPTP, a replacement phthalate, were negatively associated with anti-diphtheria antibody levels in Hispanic children indicating a potential detrimental effect of newer alternative phthalates on pediatric health.

This systematic review aims to raise awareness of the concept of parental hope, which is distinct from the idea of agency &#x2013; acting on behalf of someone else. Parental hope is an important factor in end-of-life care, particularly in light of recent advances in perinatology, neonatology, and paediatric palliative care (PPC). Parenting involves autonomous agency &#x2013; acting and thinking on one's own behalf &#x2013; as well as making decisions for one's children. Consequently, parental permission, authority and decision-making are integral aspects of parental attitudes towards their children in PPC. To our knowledge, this is the first systematic review to focus specifically on the ethical implications of parental hope in PPC. A qualitative systematic review utilising Charmaz&#x2019;s initial and focused coding of constructing grounded theory. A systematic search was conducted across two databases: Web of Science and Embase. The research period was from 01/01/2014 to 20/02/2025. Two reviewers independently screened articles against the eligibility criteria and appraised them using CASP critical appraisal tools. Sixty studies met the inclusion criteria and were analysed using initial and focused coding, with the results presented in diagrams. The results were reported in the PRISMA protocol. Key findings included identifying parental hope in PPC as a valuable area of future ethical research, given the various dilemmas involved and the potential advantages for parents of developing their caregiving skills for their children. The results of the four themes (&#x2018;False and realistic versus unrealistic parental hope&#x2019;, &#x2018;Evolution of parental hope as a child&#x2019;s illness progresses&#x2019; with 17 sub-themes, &#x2018;Parental hope and decision-making in PPC&#x2019;, and &#x2018;Social and structural determinants of parental hope&#x2019;) were presented in four conceptual diagrams. The results reveal the preference of parents for honest encouragement over false hope. Furthermore, parents can use hope as a cognitive heuristic to influence their decision-making process. Parents also expect clinicians to understand their situation and help them manage their hopes while respecting parental authority. Ethical concerns include equitable access to support programmes and online groups that aid parental caregiving. We believe that the moral beliefs expressed by parents in our review could inform values and standards for parents as caregivers in PPC.

The global rise in atopic diseases, like atopic dermatitis and allergic rhinitis, may be linked to prenatal exposure to endocrine-disrupting chemicals like phthalates, with potential sex-specific effects. We analyzed 558 mother-child pairs from the PROGRESS birth cohort in Mexico City. Maternal urinary phthalate metabolites were measured during the 2nd and 3rd trimesters. Atopic dermatitis and allergic rhinitis symptoms were assessed at ages 4-6 and 6-8 years using the International Study of Asthma and Allergies in Childhood survey. Weighted Quantile Sum Regression (WQS) was used to assess sex-specific mixture associations. Individual sex-specific phthalate associations were examined using modified Poisson models with inclusion of product terms and stratification. Models were adjusted for maternal age, education, parity, pre-pregnancy body mass index, and prenatal tobacco exposure. We found that child sex modified associations between the 2nd trimester phthalate mixture and current atopic dermatitis symptoms at both 4-6 years (WQS*sex OR: 1.23, 95% CI: 1.00-1.60) and 6-8 years (WQS*sex OR: 1.46, 95% CI: 1.01-2.10). Among males, higher phthalate concentrations were positively associated with symptoms at both ages (OR: 1.10, 95% CI: 0.92, 1.32; OR: 1.16, 95% CI: 0.92, 1.46), while associations were negative in females (OR: 0.87, 95% CI: 0.73, 1.04; OR: 0.79, 95% CI: 0.62, 1.02). No sex-specific associations were found for 3rd trimester exposures. Individual metabolite analyses also showed effect modification by sex for 2nd trimester exposures. Prenatal exposure to phthalates is associated with atopic dermatitis symptoms in childhood in a sex-specific manner.

Acute leukemia is the most common type of cancer in children; however, the etiology is poorly understood. The objective of this review was to summarize the current evidence of the role of perinatal factors in the development of acute leukemia. All epidemiological studies published up to October 2023 that evaluated perinatal risk factors for childhood acute leukemia were identified using a multi-tiered approach in two electronic databases (PubMed and Web of Science), without restriction on publication year or language. A total of 85 studies (13 prospective cohort studies, 62 case-control studies, and 10 pooled analyses) were included. We combined the published risk estimates in a meta-analysis, using the Generic Inverse Variance method. An increased risk of acute leukemia and the lymphoblastic subtype (ALL) was associated with high birth weight (>4000&#x2009;g) (odds ratio [OR]&#x2009;=&#x2009;1.35; 95% confidence interval [95% CI] 1.20-1.53 and OR&#x2009;=&#x2009;1.21; 95% CI 1.08-1.34, respectively), maternal history of abortion (OR&#x2009;=&#x2009;1.27; 95% CI 1.12-1.43 and OR&#x2009;=&#x2009;1.24; 95% CI 1.08-1.43, respectively), and maternal diabetes (OR&#x2009;=&#x2009;1.30; 95% CI 1.14-1.48 and OR&#x2009;=&#x2009;1.32; 95% CI 1.16-1.50, respectively). In addition, an increased risk for ALL was also associated with maternal hypertension (OR&#x2009;=&#x2009;1.21; 95% CI 1.06-1.38) and cesarean section (OR&#x2009;=&#x2009;1.10; 95% CI 1.05-1.16). Our review suggests a potential role for perinatal factors in the development of acute leukemia in children. These findings indicate potential avenues for developing cost-effective prevention strategies applicable at the population level, while the mechanism of action is investigated.

Objective: Breastfeeding, depending on its duration, has been suggested to benefit children's cognitive development. We aimed to examine this issue by using the Japan Environment and Children's Study, a nationwide prospective birth cohort study. Methods: We evaluated the relationship between feeding methods and cognitive development in 2- and 4-year-old children. We classified the children based on the following feeding method during the first 6 months postpartum: (1) exclusive breastfeeding group, solely breastfeeding; (2) partial breastfeeding group, solely breastfeeding for &#x2264;5 months and combination of breastfeeding/formula for the rest of months; (3) formula-fed group, solely formula feeding for &#x2265;4 months; and (4) others. Cognitive development was assessed by trained testers using the Kyoto Scale of Psychological Development 2001. Results: Data on 1,329 boys and 1,398 girls were analyzed. Multiple regression analysis was performed using the exclusive breastfeeding group as the reference. Boys of age 2 years in the formula-fed group had significantly lower developmental quotients (DQs) in the language-social developmental (L-S) area (partial regression coefficient [B]: -4.624, p = 0.01), whereas no significant difference was observed in those of age 4 years. Girls of age 2 and 4 years in the formula-fed group had significantly lower L-S area DQ (B: -3.637, p = 0.03 and B: -3.414, p = 0.03, respectively). In the partial breastfeeding group, no significant differences in the L-S area DQ were observed in 2- and 4-year-old boys and girls. Conclusions: Exclusive breastfeeding for the first 6 months postpartum may be more beneficial for verbal cognitive development in 4-year-old girls than solely formula feeding for &#x2265;4 months. Furthermore, breastfeeding combined with formula for the first 6 months postpartum may not have a disadvantage on cognitive development in boys and girls of age &#x2265; 2 years, when compared with that observed with exclusive breastfeeding during the first 6 months postpartum.

The COVID-19 pandemic that started in 2020 led to a significant reduction of many respiratory tract infections, including respiratory syncytial virus (RSV) infection. With the cooperation of all 16 pediatric inpatient facilities in Fukushima Prefecture, we actively investigated the total numbers of RSV hospitalizations and severe lower respiratory tract infections (LRTIs) requiring respiratory support during a 10-year period from 2014 to 2023. In addition, the number of sentinel RSV reports was obtained. We compared the disease burden of RSV infection between the period of 2014 and 2019 (defined as pre-pandemic) and that of 2021 to 2023 (defined as post-pandemic). The annual number of sentinel RSV reports per 10,000 children aged <5&#x2009;years after the pandemic increased to 611 from 445 compared to the pre-pandemic period. In contrast, the number of RSV-related hospitalizations decreased from 175 to 104, and the number of severe RSV-related LRTI cases decreased from 59 to 43. Analysis of sentinel reports and hospitalization numbers by age group showed a higher hospitalization rate in children aged <1&#x2009;year compared to those aged &#x2265;1&#x2009;year. The age distribution of sentinel RSV reports was higher post-pandemic than pre-pandemic. Although the number of sentinel RSV reports increased after the pandemic, the number of RSV cases requiring hospitalization decreased compared to before the pandemic due mainly to an increase in the age of the infected children. This indicates the importance of preventing initial infection in children aged <1&#x2009;year.