Previous observational studies and randomized trials have reported an association between the use of epidural analgesia for pain relief in labor and intrapartum maternal fever. Studies have also reported an increase in adverse neonatal outcomes with intrapartum maternal fever.

Among low-risk women receiving epidural analgesia, intrapartum maternal temperature >99.5°F was associated with adverse neonatal outcomes, with the rate of adverse outcomes increasing directly with maximum maternal temperature. Without temperature elevation, epidural use was not associated with adverse neonatal outcomes. (Read the full article)

Pulmonary hypertension is associated with bronchopulmonary dysplasia in extremely low birth weight infants and contributes to morbidity and mortality.

Pulmonary hypertension affects at least 1 in 6 extremely low birth weight infants and persists to discharge in most survivors. Routine screening of these infants with echocardiography at 4 weeks of age identifies only one-third of those affected. (Read the full article)

Although China has the largest birth population in the world and a number of multicenter studies of neonatal respiratory failure are reported, there is a paucity of data regarding outcome measurement of very premature neonates requiring respiratory care and surfactant therapy.

This study is the largest survey, to date, in a Chinese network of 55 NICUs that presents the incidence, morbidity, and mortality rates, with risk factors of neonatal respiratory failure, with special emphasis on surfactant-treated very immature infants. (Read the full article)

Atherosclerotic cardiovascular diseases have roots in childhood. Modification of dietary fat intake influences serum lipid and lipoprotein concentrations. Reduction of saturated fat intake is recommended to promote cardiovascular health.

Dietary counseling had a beneficial effect on saturated fat intake from ages 7 months to 19 years. The counseling reduced serum low-density lipoprotein cholesterol concentrations in both genders. It also decreased computationally estimated concentrations of intermediate-density lipoprotein cholesterol, very low-density lipoprotein–triglycerides and apolipoprotein B in boys. (Read the full article)

Delayed umbilical cord clamping in premature infants has been associated with decreased rates of intraventricular hemorrhage; however, the mechanisms that explain this finding have not been described.

Premature infants with delayed umbilical cord clamping have improved superior vena cava blood flow over the first days of life. This may provide one of the mechanism(s) by which this technique reduces the incidence in intraventricular hemorrhage in this at-risk population. (Read the full article)

There is evidence of an impaired respiratory regulation in SIDS, in which serotonergic and noradrenergic neurons are involved. Monoamine oxidase A is the enzyme that degrades both neurotransmitters, and genetic variation of this gene might contribute to SIDS.

Alleles with weak effect on the monoamine oxidase A gene activity (*2/*3) appear to be associated with sudden infant death syndrome in boys. This association is strongest in infants who died at the age with the highest SIDS prevalence. (Read the full article)

Infantile colic affects almost 10% of all infants and is characterized by crying and fussing in an otherwise healthy and well-fed infant. Prenatal exposure to tobacco smoking is a risk factor, but it is unclear whether nicotine causes the association.

Infants exposed to nicotine replacement therapy during pregnancy had elevated infantile colic risk of the same magnitude as infants exposed to tobacco smoking. Intrauterine exposure to nicotine may play a causal role in the pathogenesis of infantile colic. (Read the full article)

The demographics of trials that use antenatal consent may not be representative of the populations that they are intended to study.

This study analyzes the difference in clinical outcomes between the enrolled and eligible but not enrolled populations of a trial that required antenatal consent. (Read the full article)

Approximately 1.1% to 5.9% of febrile infants aged <90 days have bacteremia, but the incidence of bacteremia in this age is unknown. Escherichia coli, group B Streptococcus, and Staphylococcus aureus are the leading causes of bacteremia.

Bacteremia occurs in 2.2% of infants who have a blood culture drawn. The incidence rate of true bacteremia was 0.57 in 1000 full-term births. The most common pathogens were Escherichia coli (56%), group B Streptococcus (21%), and Staphylococcus aureus (8%). (Read the full article)

Breastfeeding and oral sucrose have shown an analgesic effect in premature newborn infants for minor painful procedures. Studies suggest that the analgesic properties of breast milk are superior to oral sucrose in term neonates.

For premature infants from 32 to 37 weeks, there is no significant difference in analgesic effect between breast milk and oral sucrose. Breast milk is a safe and natural method for pain relief in late preterm infants. (Read the full article)

Numerous late preterm infants undergo repetitive heel lancing procedures during their first hours of life to evaluate glycemic control. Heel lances are painful and 25% glucose solution is effective on reducing procedural neonatal pain scores and crying behavior.

This noninferiority randomized controlled trial demonstrated that compared with breast milk, 25% glucose provided lower pain scores and reduced duration of cry. Further research is necessary to clarify breast milk’s mechanisms and efficacy on neonatal pain relief. (Read the full article)

Preterm infants are at increased risk of behavioral problems, which has been associated with maternal distress. Paternal psychological well-being is less studied. Parents’ concerns may affect their perceptions or attitudes and have negative effects on the behavior of the child.

Parents report more behavior problems in VLBW children at age 3 if they themselves have had symptoms of depression, parenting stress, or weak sense of coherence. Also, the paternal psychological well-being contributes to the behavioral development of a preterm child. (Read the full article)

Inhaled nitric oxide for premature infants has been evaluated in multiple studies; however, these trials differed in treatment initiation, duration of therapy, and inclusion criteria. Furthermore, these trials reached differing conclusions regarding the benefit of inhaled nitric oxide.

We used a large sample of infants from children’s hospitals and found that the use of inhaled nitric oxide in premature infants was variable even when controlling for demographic characteristics and disease. (Read the full article)

There is a perception among clinicians that methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and/or meningitis result in a greater burden of disease than invasive infections attributed to methicillin-susceptible Staphylococcus aureus (MSSA) among very low birth weight (VLBW) infants.

VLBW infants with MRSA and MSSA bacteremia and/or meningitis have equivalent morbidity and mortality. These findings suggest that allocation of resources for prevention and treatment of both MRSA and MSSA infections among VLBW infants should be comparable. (Read the full article)

Postpartum vitamin A supplementation is a strategy to combat vitamin A deficiency and seems to reduce maternal/infant morbidity and mortality. However, controversies exist regarding which dose has a greater efficacy, 200 000 IU (WHO protocol) or 400 000 IU (IVACG protocol).

In this study, postpartum maternal supplementation with 400 000 IU of vitamin A did not provide any additional beneficial effect in reducing infant morbidity compared with the standard dose of 200 000 IU. (Read the full article)

Infantile hypertrophic pyloric stenosis incidence varies over different regions and time periods. Recently, a decline was reported in the United States, Sweden (concurrent with a decline in sudden infant death syndrome), Scotland, and Denmark. The etiology remains unclear; therefore, epidemiologic data are valuable.

A decline in the incidence of infantile hypertrophic pyloric stenosis in Germany from 2000 to 2008 was noted but with wide regional variations. The regional distribution of infantile hypertrophic pyloric stenosis was different from that of sudden infant death syndrome. (Read the full article)

The survival of extremely low birth weight infants in resource-limited situations is dismal due to limited neonatal intensive care facilities. Nasal continuous positive airway pressure resulted in an increased survival of these infants, but many still require back-up ventilation.

Nasal continuous positive airway pressure and intubation, surfactant, and extubation practiced in a neonatal high care ward with limited resources and limited back-up ventilatory facilities can improve the survival of extremely low birth weight infants. (Read the full article)

Prone sleep, bed-sharing, maternal smoking during pregnancy, and prematurity increase the risk of sudden infant death syndrome. The sudden infant death syndrome rate initially declined dramatically after the initiation of the US Back-to-Sleep campaign in 1994, but subsequently plateaued.

The risk profile has changed since the Back-to-Sleep campaign; the prevalence of simultaneous risks has remained consistent. Intrinsic and extrinsic risks provide unification into 1 underlying triple-risk model and insights into potential underlying mechanisms. (Read the full article)

Fetus and infants until 3 months of age are unable to metabolize caffeine, which crosses the placenta and in adults has a somnolytic effect. Little is known about the effect of caffeine consumption by pregnant or nursing mothers over infant sleeping.

In this setting where caffeine is largely consumed in pregnancy and by nursing mothers, heavy consumption (≥300 mg/day) did not increase the number of nighttime awakenings by their 3-month-old infants. (Read the full article)

Although developmental care in NICUs reduces the stress experienced by preterm infants, the actual level of developmental care may vary and little is known about how the level of developmental care relates to preterm infants’ neurobehavioral performance.

The study demonstrates the relationship between variations in developmental care in NICUs and the neurobehavior of preterm infants. Infants from NICUs with high-quality developmental care compared with infants from units with low quality of care evidenced a better neurobehavioral profile. (Read the full article)

Preterm, growth-restricted infants are at high risk of necrotizing enterocolitis (NEC). NEC occurs most frequently in infants who have received enteral feeds. It is common practice to delay introduction of enteral feeds in these infants.

Early introduction of enteral feeds results in earlier achievement of full enteral feeding. Early feeding is not associated with a higher risk of NEC. Delayed feeding is associated with a higher risk of cholestasis. (Read the full article)

Pain during routine infant immunization causes parental anxiety. Oral sucrose solutions are effective pain-reduction strategies. Few studies have measured a combined strategy of a physical intervention along with sucrose to decrease the infant’s pain response.

We demonstrate that a physical, nonpharmacological intervention called the 5 S’s (swaddling, side/stomach position, shushing, swinging, and sucking) provides significant pain reduction with or without sucrose during routine 2- and 4-month vaccinations. (Read the full article)

Information on infant safety after exposure to maternal antiretroviral regimens during pregnancy in international clinical trials is lacking. As antiretroviral drugs are released to populations in resource-limited settings through clinical trials, it becomes critical to collect pediatric outcome data.

The study demonstrates the feasibility of reporting infant outcomes following adult antiretroviral trials in developing countries, provides HIV-free infant survival and prospective growth data in association with maternal parameters, and details morbidity, mortality, and genetic defects following maternal antiretroviral exposure. (Read the full article)

Twin studies provide a natural experiment that can determine the extent of genetic and environmental influences on sleep behavior. Previous studies have indicated that genes contribute moderately to sleep.

In the largest pediatric study to date, we demonstrate that the shared environment strongly influences sleep behavior in infants, with no gender differences in the results. This research provides strong impetus to future work identifying the key modifiable environmental drivers. (Read the full article)

Infants weighing 501 to 1500 g are at high risk for mortality and for neonatal morbidities associated with both short- and long-term adverse consequences.

Mortality and major neonatal morbidity in survivors decreased for infants 501 to 1500 g between 2000 and 2009. However, in 2009, a high proportion of these infants still either died or survived after experiencing ≥1 major neonatal morbidity. (Read the full article)

Neonatal follow-up programs are designed in part to identify developmental delays among high-risk infants after NICU hospitalization and make referrals to state-funded early intervention. Early intervention has been shown to benefit children with developmental delays.

Many high-risk infants demonstrating developmental delays at neonatal follow-up programs are not referred to early intervention. Subspecialty clinics share responsibility with the medical home in referring children from birth through three years with developmental problems to early intervention services. (Read the full article)

Although soy protein–based infant formula is known to support physical growth equal to that of infants fed cow's milk–based formula, data are lacking on developmental status of infants fed soy formula compared with breast milk or milk formula.

Infants fed soy protein–based formula scored within normal limits on standardized developmental testing and did not differ from infants fed cow’s milk–based formula. Breastfed infants have a slight advantage on cognitive development compared with formula-fed infants. (Read the full article)

Although morbidity-free survival for preterm infants has remained constant in US NICUs when assessed collectively, morbidity-free survival differs among centers. Center-specific practices before, at, or after delivery might affect outcomes of the most premature infants.

Our findings suggest that the approach taken to infants at the limits of viability is associated with outcomes of more-mature infants. Identifying centers with higher survival and lower morbidity might lead to identification of key practices to improve morbidity-free survival. (Read the full article)

Preterm children born between 29 and 36 gestational weeks are at higher risk of developmental delay. The Ages and Stages Questionnaires (ASQ) have been recommended as a developmental screening tool.

At 12 months’ corrected age (CA), the ASQ was insufficient in identifying delays on both mental and psychomotor scales of the Bayley Scales of Infant Development but was accurate in detecting mental delay at CA of 24 months. (Read the full article)

Previous studies show beneficial effects of cycled lighting in neonatal care on infant day–night activity, sleep behavior, and postnatal growth. The American Academy of Pediatrics and the American College of Obstetricians and Gynecologists recommend neonatal care under cycled lighting conditions.

This study found that cycled lighting during neonatal care reduces infant’s fussing and crying behavior at 5 and 11 weeks’ corrected age and improves growth during neonatal period. These findings support the introduction of cycled lighting in neonatal care practice. (Read the full article)

Death or neurodevelopmental impairment in extremely premature neonates can be predicted at birth by considering gender, antenatal steroids, multiple birth, birth weight, and gestational age.

Prediction of death or neurodevelopmental impairment in extremely premature infants is improved by using information available later during the clinical course. The importance of birth weight declines, whereas that of respiratory illness severity increases with advancing postnatal age. (Read the full article)

Male circumcision reduces risk of HIV acquisition in men by 60% and is associated with other health benefits. Compared with adult circumcision, infant male circumcision is safer, less expensive, and represents a cost-saving intervention for HIV prevention in many settings.

IMC is little known in East Africa and is not routinely practiced. This is the first study to assess acceptability and uptake of IMC in East Africa among parents who were actually offered the procedure. (Read the full article)

Febrile infants in the first 90 days may have life-threatening serious bacterial infection. Well-appearing febrile infants with serious bacterial infections cannot be distinguished from those without by examination alone. Variation in care resulting in both undertreatment and overtreatment is common.

The systemwide implementation of an evidence-based care process model for the care of febrile infants in Intermountain Healthcare was associated with increased delivery of evidence-based care, improved infant outcomes, and lower costs. This model adopted nationally can improve value. (Read the full article)

There is no literature on the concentrations of vitamin B₆ vitamers in cerebrospinal fluid of preterm and term newborn infants. This knowledge, however, is highly important, because vitamin B₆ plays a pivotal role in brain development and functioning.

In cerebrospinal fluid of newborn infants, B₆ vitamer concentrations are strongly dependent on postmenstrual age, indicating that vitamin B₆ homeostasis in brain differs between preterm and term newborns. This has implications for the evaluation of epilepsy and vitamin B₆ deficiency. (Read the full article)

Preterm infants from 33 gestational weeks can detect specific shape features (prism and cylinder) by touch (without visual control), and remember them; however, nothing is known about such abilities earlier in development.

The preterm infant, even when very immature (from 28 gestational weeks), is endowed with tactile sensory abilities: the exploration and memorization of an object by touch, the discrimination of a novel object, and the recognition of a familiar object after interference. (Read the full article)

Data suggest that delivery at high-volume, high-technology hospitals reduces neonatal mortality. No study has examined other complications or compared the effects in multiple states by using a study design to control for unmeasured differences in case mix.

The survival benefit to delivering at a high-level NICU between 1995 and 2005 is larger than previously reported and varies between states. The survival benefits affect both extremely and moderately preterm infants. Complication rates were similar between hospital types. (Read the full article)

Sudden infant death syndrome remains the major cause of postneonatal death in developed countries. Although infant-parent bed-sharing following antenatal smoking or maternal consumption of alcohol on the bed-sharing night increases the risk of death, the mechanism is not known.

Bed-sharing infants experienced more oxygen desaturations and episodes of carbon dioxide rebreathing than cot-sleeping infants but showed appropriate behavioral and physiologic responses. A deficit in these responses in vulnerable infants could link to increased risk of sudden infant death syndrome. (Read the full article)

Infantile hemangiomas have a period of rapid growth in early infancy. Most hemangioma growth is completed by 5 months of age, but the majority of patients are not seen by a specialist until after the growth phase is complete.

The most rapid hemangioma growth is between 1 and 2 months of life, much earlier than previously believed. Patients with high-risk hemangiomas should be followed closely, and treatment initiation should be considered before or during the most rapid growth phase. (Read the full article)

Food insecurity has been linked to childhood obesity in a number of studies. Few studies have explored potential pathways through which food insecurity is related to child weight, especially in low-income families with young infants.

We found that food insecurity was related to maternal controlling feeding styles and concerns about the infants’ future weight. Early obesity prevention should aim to decrease food insecurity and to reduce controlling feeding styles in families who remain food insecure. (Read the full article)

Childhood obesity occurs in 20% of children before they enter kindergarten. Treatment is difficult, making prevention desirable, but little is known about effective methods using anticipatory guidance to prevent obesity in pediatric primary care.

This study provides a comparison of 2 approaches versus usual care using anticipatory guidance to improve infant feeding during the first year of life, and demonstrates positive specific feeding behavior differences at 1 year in the intervention groups. (Read the full article)

Cholestasis predisposes to the development of fat-soluble vitamin (FSV) deficiency. D-α tocopheryl polyethylene glycol-1000 succinate and coadministered FSVs are absorbed in spite of cholestasis.

Infants with biliary atresia with total bilirubin >2 mg/dL are at risk for fat-soluble vitamin (FSV) deficiency. A multivitamin preparation containing d-α tocopheryl polyethylene glycol-1000 succinate alone is not effective in treating biochemical FSV insufficiency in cholestatic infants. (Read the full article)

Birth defects are associated with preterm birth and are a major contributor to infant mortality. There are persistent black-white differences in overall infant mortality and infant mortality attributable to birth defects.

Among infants delivered at 37 to 44 weeks, blacks and Hispanics had significantly higher neonatal and postneonatal mortality attributable to birth defects than whites. Among infants delivered at 20 to 33 or 34 to 36 weeks, neonatal mortality attributable to birth defects was significantly lower among blacks. (Read the full article)

Previous studies suggest that abnormal findings on conventional EEG during the neonatal period are associated with death or severe brain injury in preterm infants. However, large cohort studies on preterm EEG for predicting later neurodevelopmental outcome remain scarce.

This study demonstrates precise prognostic values of conventional EEG for predicting neurodevelopmental outcome in the current perinatal care setting. Additionally, its prognostic values are independent of severe injury on neuroimaging and clinical risk factors. (Read the full article)

Declining dietary omega 3 polyunsaturated fatty acids has been associated with rising allergy prevalence and fish oil is therefore of interest in allergy prevention. Supplementation during pregnancy, but not after the age of 6 months, has achieved some allergy reductions.

We assessed the effect of fish oil supplementation from birth to 6 months, which has not been investigated previously. Our results, together with previous findings, will likely help define a "window of opportunity" for allergy intervention using fish oil supplements. (Read the full article)

Mortality of very low birth weight infants varies widely between regions and countries; however, the variation in morbidities after adjusting for confounders has not been adequately studied.

Composite outcome of mortality or short-term morbidity for very low birth weight infants was lower in Japan than in Canada. However, marked variations in mortality and individual morbidity exist, revealing areas for improvement in each country. (Read the full article)

Behavioral techniques effectively reduce infant sleep problems and associated maternal depression in the short- to medium-term (4–16 months’ postintervention). Despite their effectiveness, theoretical concerns persist about long-term harm on children’s emotional development, stress regulation, mental health, and the child-parent relationship.

Behavioral sleep techniques did not cause long-lasting harms or benefits to child, child-parent, or maternal outcomes. Parents and health professionals can feel comfortable about using these techniques to reduce the population burden of infant sleep problems and maternal depression. (Read the full article)

Current human milk fortifiers fail to provide the higher protein intake that is now recommended for feeding human milk–fed infants. There is a desire to avoid the use of powdered products when feeding these infants.

A new ultraconcentrated liquid human milk fortifier that provides more protein than current powdered fortifiers is safe and supports better growth in human milk–fed infants than a powdered fortifier. (Read the full article)

The Apgar score is a convenient method to rapidly assess the clinical status of the newborn infant. Recent literature suggests Apgar scores vary widely in preterm infants.

The Apgar signs for respiratory effort, grimace, and muscle tone demonstrated considerable disagreement in preterm infants ≤28 weeks’ gestation. Disagreement exists despite the level of respiratory intervention, continuous positive airway pressure, or intubation, and is likely independent of gestational age. (Read the full article)

Most studies on corticoid treatment of respiratory syncytial virus (RSV) respiratory diseases have revealed no beneficial effect. The mechanism by which RSV respiratory-infected patients are insensitive to the antiinflammatory effect of corticosteroids is unknown.

This study helps to understand how a respiratory syncytial viral infection may alter the normal antiinflammatory response to cortisol and the insensitivity to glucocorticoid treatment. The increase expression of β glucocorticoid receptor could be a marker of disease severity. (Read the full article)

Despite numerous preventive strategies including prophylaxis with 400 IU/day of vitamin D in recent years, the deficiency of vitamin D in infants is still a global health problem.

This study reveals that the risk of vitamin D deficiency is high in exclusively breastfed infants, especially in winter, despite vitamin D supplementation. Therefore, it is suggested that an adjustment of vitamin D dosage for seasonal variation might be necessary. (Read the full article)