Paediatric and perinatal epidemiology最新文献

Background: Early-onset neonatal infections are among the most common neonatal diseases. However, the long-term outcomes of the infections are not well understood.

Objective: To study the association between early-onset neonatal infection and attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

Methods: A nationwide register-based cohort study was conducted, including near-term and term children born between 1997 and 2013 with follow-up until 2021. An early-onset infection was defined as an invasive bacterial infection occurring within the first week of life, including both physician-assigned diagnoses and positive bacterial cultures. ADHD and ASD were defined by diagnoses or prescriptions of relevant medication. Associations between sepsis and the neurodevelopmental disorders were investigated using multivariable Cox regression to estimate adjusted hazard ratios (HR), whereas associations with meningitis were examined using person-time incidence rate ratios (IRR). Sibling-matched analyses were also conducted for associations with sepsis.

Results: A total of 981,869 children were included, with 8154 defined as having sepsis and 152 defined as having meningitis. Among these, only 257 children had culture-positive sepsis, whereas 32 had culture-positive meningitis. The incidence rate of ADHD and ASD for children with sepsis was 4.5 per 1000 and 3.3 per 1000 person-years, respectively. Sepsis was associated with an increased adjusted likelihood of both ADHD (HR 1.28, 95% CI 1.17, 1.39) and ASD (HR 1.43, 95% CI 1.30, 1.58). However, sibling-matched analyses especially attenuated the association with ADHD (HR 1.12, 95% CI 0.93, 1.34). Point estimates suggested that children with meningitis also had an increased likelihood of both ADHD (IRR 1.77, 95% CI 0.88, 3.17) and ASD (IRR 2.05, 95% CI 0.89, 4.04).

Conclusions: Early-onset sepsis was associated with an increased likelihood of ASD, whereas the majority of the association with ADHD could be explained by unmeasured shared familial confounding.

Background: While individual socioeconomic attributes have been widely studied in relation to child growth, the associations with broader, area-level socio-demographic characteristics of residential areas have not been thoroughly assessed.

Objectives: To examine the associations between area-level socio-demographic features of small residential areas and child growth trajectories.

Methods: We conducted a population-based retrospective cohort study, including all children born in Israel from 2004 to 2018, who underwent postnatal follow-up in the Mother and Child Health Clinics (MCHC) of the Ministry of Health. The MCHC network covers a significant proportion of the Israeli paediatric population, providing vaccination and developmental assessments to children up to 6 years old. Socio-demographic scoring was retrieved from the Israel Bureau of Statistics' geographical unit grading system, established for 990 rural areas and 1629 micro-geographical areas in 81 cities, using various population measurements. Height-for-age (HAZ) and weight-for-age (WAZ) z-scores were calculated using data from MCHC visits at birth and specific intervals.

Results: A total of 1,485,198 children were included (51.3% male). The mean birthweight and length were 3210 ± 52.2 g (z = -0.22) and 49.4 ± 3.33 cm (z = -0.06), respectively. Children resided in low (47%), intermediate (24.4%) and high (28.5%) socioeconomic areas. Throughout follow-up, children from low SES areas had consistently lower HAZ and WAZ scores across all birthweight groups, particularly among those with normal and high birthweight. In linear mixed-effects models, birth HAZ and WAZ scores were higher in high vs. low SES areas (β = 0.3 and β = 0.1, respectively), with non-linear growth trajectories characterised by early advantages in higher SES groups, a plateau in mid-childhood and renewed growth acceleration later in childhood.

Conclusions: The study provides evidence of impaired child growth in lower socio-demographic areas. This underscores the importance of identifying areas based on global attributes to identify regions predisposed to child growth impairment, particularly in developed nations.

Background: There is limited data on the extent of psychotropic medication exposure through breast milk in infants. This information is essential for identifying research gaps and informing clinical practice.

Objectives: To examine the prevalence and trend of psychotropic medication exposure among exclusively breastfed infants.

Methods: A population-based descriptive study among exclusively breastfed infants during 2012-2022, using Danish nationwide registers. Psychotropic prescriptions (Anatomical Therapeutic Chemical Classification System codes N05-N06) filled by mothers during the recorded breastfeeding period were identified in the Prescription Registry. We calculated the prevalence of potential exposure to any psychotropic medication (expressed per 1000 infants), categorised by drug class and stratified by maternal demographic and clinical factors.

Results: Among 446,573 exclusively breastfed infants, 7882 (17.6 per 1000 infants, 95% confidence interval [CI] 17.2, 18.1) were exposed to at least one, and 699 (1.6 per 1000 infants, 95% CI 1.5, 1.7) to two different psychotropic medications via breastfeeding. The most frequent exposure was antidepressants, with a prevalence of 15.0 per 1000 infants (95% CI 14.6, 15.4), primarily sertraline. This was followed by hypnotics and sedatives, at 1.3 per 1000 infants (95% CI 1.2, 1.4), predominantly zopiclone, and antipsychotics, at 1.1 per 1000 infants (95% CI 1.0, 1.2), mainly quetiapine. Psychotropic medication exposure in exclusively breastfed infants increased 1.39-fold, from 15.7 per 1000 infants (95% CI 14.5, 17.1) in 2012 to 21.8 per 1000 infants (95% CI 20.3, 23.4) in 2022. This increase was observed for all drug classes except anxiolytics. The prevalence of psychotropic medication exposure varied by maternal demographic and clinical factors.

Conclusions: Approximately 2% of exclusively breastfed infants are potentially exposed to psychotropic medications through breast milk in Denmark. The prevalence has shown an upward trend over time, especially for psychostimulants.

Background: Increases in maternal age, obesity and other factors have led to an increase in hypertension, diabetes, and other chronic diseases among pregnant women. However, the impact of chronic diseases on maternal mortality has not been adequately studied.

Objectives: To quantify the contribution of maternal mortality associated with chronic disease to maternal mortality in the United States in 1999-2002 and 2018-2022.

Methods: The study was based on maternal deaths in the United States in 1999-2002 and 2018-2022, with data obtained from the mortality and live birth files of the National Center for Health Statistics. Maternal deaths and maternal deaths associated with chronic disease were identified based on the presence of pregnancy-related causes and chronic diseases among the multiple causes of death. Maternal mortality ratios (MMR) and ratios of MMRs and their 95% confidence intervals (CI) were estimated to assess period change. Temporal changes in MMRs were adjusted for maternal age using direct standardisation.

Results: Although overall MMRs were stable, direct obstetrical deaths decreased by 14% (95% CI 9, 23) from 1999-2002 to 2018-2022. Maternal deaths associated with chronic disease increased by 28% (95% CI 17, 40) from 5.41 in 1999-2002 to 6.92 per 100,000 live births in 2018-2022. The temporal increases in chronic disease-related maternal deaths were attenuated but not abolished following adjustment for maternal age (age-adjusted increase 16%, 95% CI 10, 23). MMRs associated with chronic disease increased in all age groups, especially among women aged < 20 and 30-39 years (57% and 17% increase, respectively). Non-Hispanic Black women had the highest MMRs associated with chronic disease (15.8 per 100,000 live births in 2018-2022), while age-adjusted MMRs increased among non-Hispanic White women (45% increase, 95% CI 33, 59).

Conclusions: A substantial fraction of maternal deaths in the United States is associated with chronic disease, although patterns vary by race/ethnicity.