Infant

The trajectory of sleep in the first year of age is highly dynamic and correlates with developmental progress from the neonatal to the infantile period. During this critical period of brain growth, sleep facilitates neural maturation and memory consolidation. This review article examines the current evidence regarding the relationship between sleep and neurodevelopment in the first year of age. Over the first year, total sleep time decreases, nocturnal sleep consolidates with less nocturnal awakenings, and daytime sleep decreases. The dominant sleep state shifts from active sleep in neonates to non-rapid eye movement sleep at 12 months. Specific electroencephalogram (EEG) features include tracé alternant in neonates and sleep spindles and K complexes in infants. Characteristics of sleep spindles serve as biomarkers for neurodevelopmental outcomes. Adequate sleep duration is associated with enhanced white matter development. Healthy sleep parameters are linked to improved memory, language, executive function, sensorimotor skills, and overall cognitive development, whereas abnormal sleep during infancy is associated with cognitive, behavioral, and emotional disturbances. Developmental brain disorders and certain medical conditions are also associated with sleep disruption, indicating a bidirectional relationship. Sleep evolves rapidly in the first year of age, and adequate quantity and quality of sleep are critical for neurodevelopment. IMPACT: Sleep evolves significantly and rapidly during the first year, serving critical and active processes for neuromaturation. These sleep changes occur concurrently with major neurodevelopmental progress. Certain medical conditions, environmental exposures, and socioeconomic factors can disrupt sleep, potentially resulting in neurodevelopmental delay. Additionally, neurodevelopmental disorders are frequently associated with disruption in normal sleep architecture, suggesting a bidirectional relationship between sleep disruption and abnormal neurodevelopment. Future research should explore the neurodevelopmental consequences of medical and socioeconomic conditions that disrupt sleep. It is also essential to identify interventions to mitigate cognitive and behavioral disturbance arising from sleep disruption and to protect sleep health.

To develop and internally validate a model predicting neonatal mortality in infants with neonatal encephalopathy requiring therapeutic hypothermia (TH), using national data. Data from 385 infants treated with TH across 19 hospitals (2016-2021) were analysed. Multivariable logistic regression with backward stepwise selection was applied. Discrimination was assessed using the C-statistic, with internal validation by bootstrapping. The THERM (Therapeutic Hypothermia Early Risk Model for Mortality) tool was developed to calculate individualised mortality risk. Forty-six infants (11.9%) died within 28 days. Four predictors were retained: prelabour Caesarean section, adrenaline use, base excess ≤-22 mmol/L, and seizures during the first day of life. The model demonstrated excellent discrimination [optimism-adjusted C-statistic 0.885 (95% CI: 0.827-0.936)]. Four routinely collected variables predicted mortality in infants undergoing TH. The THERM tool provides a practical resource for clinicians, enabling personalised risk assessment and supporting parental counselling during the first day of life.

Preeclampsia is associated with increased long-term risks of cardiovascular disease, kidney disease, and stroke. International guidelines recommend structured follow-up care to prevent chronic disease, but limited research has explored women's knowledge of these risks, and their preferences regarding long-term follow-up care. This may impede how obstetric information is used for chronic disease prevention in practice. This qualitative study used purposive and snowball sampling to recruit women in Ireland diagnosed with preeclampsia at least one year prior. Semi-structured interviews were conducted online, exploring awareness of chronic disease risks and provision of follow-up care. Thematic analysis was performed using an inductive approach. Twelve women aged 28-64 years were interviewed, at median six years since preeclampsia diagnosis. Participants' antenatal and postnatal care experiences varied widely, but most described follow-up care after preeclampsia as being inconsistent or absent. Three key themes were generated: (1) Preeclampsia in the 'rear-view mirror'-women often viewed preeclampsia as an acute, resolved event, and had limited awareness of any long-term risks. However, they regarded chronic disease risk information as valuable and empowering; (2) Changing priorities as 'life takes over'- women often prioritised other family members' health needs above their own, particularly in the newborn phase. They favoured delaying discussions about chronic disease risks, ideally to 6-12 months after pregnancy, preferably provided through primary care; (3) Desire for proactive, 'blameless' follow-up care-women favoured systematic, non-judgmental follow-up programmes underpinned by clear communication between obstetric and primary care services, continuity of healthcare providers, and free access. Some described residual anxiety relating to their preeclampsia experience, and emphasised the importance of sensitive, person-centred follow-up care. Women affected by preeclampsia in Ireland typically have limited awareness of its links with long-term chronic disease risks, and frequently experience a lack of structured follow-up care. They expressed strong support for receiving personalised information about opportunities for secondary prevention, and advocated for systematic, proactive follow-up. Participants emphasised that future models of care should be pragmatic, person-centred, and include default enrolment for all women.

ObjectivesPerinatal death review programmes collect perinatal mortality data and identify modifiable factors in preventable perinatal deaths. Reviews may provide closure and answers to bereaved parents. Many parents remain uninvolved in the review process. This qualitative study aimed to explore the opinions of maternity staff regarding the existing review system, parent involvement in reviews and standardising the review system.MethodsThis study involved interviews with staff from three maternity units in different locations around Ireland. A topic guide was used to guide the discussion. We spoke with staff members from different backgrounds and managerial levels, including doctors, midwives, patient advocates, risk managers and pastoral care. Thematic analysis was conducted to analyze the results.Results32 interviews were conducted between May and December 2022. Three themes and six associated subthemes were generated relating to communication with parents regarding review and their involvement in this process. Participants felt that parents were not involved enough in the review process and that communication with parents about reviews needed improvement. A parent advocate was viewed as important for guidance and support for parents during the review process. Facilitators included an easy-to-use, electronic review form and providing education about the review process. Barriers included local resistance to changing the process and lack of time to complete reviews.ConclusionPerinatal death reviews are not standardised in Ireland. Communication with parents and parent involvement in reviews could be improved. Highlighted facilitators and barriers should be addressed prior to implementing any proposed changes to the review system.

Artificial intelligence has advanced significantly in recent years, thanks to innovations in the design and training of artificial neural networks (ANNs). Despite these advancements, we still understand relatively little about how elementary forms of ANNs learn, fail to learn, and generate false information without the intent to deceive, a phenomenon known as “confabulation.” To provide some foundational insight, in this paper, we analyze how confabulation occurs in reservoir computers (RCs): a dynamical system in the form of an ANN. RCs are particularly useful to study as they are known to confabulate in a well-defined way: when RCs are trained to reconstruct the dynamics of a given attractor, they sometimes construct an attractor that they were not trained to construct, a so-called “untrained attractor” (UA). This paper sheds light on the role played by UAs when reconstruction fails and their influence when modeling transitions between reconstructed attractors. Based on our results, we conclude that UAs are an intrinsic feature of learning systems whose state spaces are bounded and that this means of confabulation may be present in systems beyond RCs.

This study presents the in vitro and preliminary ex vivo development of a novel microneedle-based pH sensor for continuous intrapartum fetal monitoring. The objective was to evaluate the feasibility of using microneedle sensors to monitor fetal pH during labour and to develop a proof-of-principle microneedle pH sensor that meets clinical requirements such as high sensitivity to small pH changes (0.05 units) within a relevant range (6.50-7.45), minimal tissue disruption, and a compact design suitable for transcervical placement on the fetal scalp (<40 mm diameter). Platinum microneedles were passivated with ArCare medical adhesive and coated with iridium oxide via electrodeposition. Sensitivity was tested in phosphate buffered saline (PBS) and artificial interstitial fluid (ISF), using both external Ag/AgCl and internal platinum pseudo-reference electrodes. In PBS, the sensor exhibited linear responses in increments of 0.05 pH units over the clinically relevant range (6.5-7.45), with slopes of -60.49 mV/pH (R2 = 0.946, accuracy = 97.65%) and -63.2 mV/pH (R2 = 0.910, accuracy = 93.70%) in the external and internal configurations, respectively. In ISF, a slope of -25.5 mV/pH (R2 = 0.979) was obtained. Ex vivo testing on human skin confirmed successful microneedle penetration without visible iridium oxide transfer or tissue damage, as indicated by methylene blue staining. These findings support the potential for continuous minimally invasive fetal pH monitoring during labour, representing a significant step toward more objective and specific intrapartum assessment.

The authors declare no conflicts of interest. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Chest X-Ray Interpretation in the EPICO Pediatric COVID-19 Study: Addressing MisconceptionsLuis Miguel Navarro‐Ramirez¹˒² | Pablo Vásquez‐Hoyos³˒⁴ | María Lucía Mesa‐Rubio⁵ | Melisa Naranjo Vanegas¹˒⁶ | Daniela Duarte-Montero¹˒⁷ | Claudia Burgos⁵ | Laura Melissa Mendez⁵ | María Margarita Rodriguez⁵ | Arianna Martinez⁵ | Paola Sanchez⁵ | Carolina Tovar⁵ | Gabriela Friedrich¹ | Gustavo Adolfo Triana‐Rodriguez⁸ | Mónica Royero‐Arias⁹ | Jessica Echeverry¹⁰ | Tamara Gamo¹⁰ | Luz Ángela Moreno⁴˒¹⁰ | Olga Lucía Baquero¹¹ | Luz Marina Mejía¹² | Sonia Restrepo‐Gualteros⁵ | Sergio Moreno‐Lopez¹ | Juan Gabriel Piñeros⁵ | Carlos Álvarez‐Moreno⁴˒¹³ | Alejandro Díaz‐Díaz¹⁴˒¹⁵ | Iván Felipe Gutierrez¹⁶ | Clara Galvis‐Diaz¹⁷ | José Manuel Nieto¹⁸ | Irati Gastesi¹⁹ | Cinta Moraleda¹⁹ | Alfredo Tagarro García¹⁹ | Andrea Ramirez Varela²⁰˒²¹˒²² | EPICO‐Colombia and EPICO‐AEP working groups¹ School of Medicine, Universidad de los Andes, Bogotá D.C., Colombia ² Craig Dalsimer Division of Adolescent Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA ³ Red Colaborativa Pediátrica de Latinoamérica (LARed Network), Montevideo, Uruguay ⁴ School of Medicine, Universidad Nacional de Colombia, Bogotá D.C., Colombia ⁵ Department of Pediatrics, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá D.C., Colombia ⁶ Medical Imaging & AI Group - Bioscience Center, Ayudas Diagnósticas Sura, Medellín, Antioquia, Colombia ⁷ PediAFe Research Group, Fundación Santa Fe de Bogotá, Universidad de los Andes, Bogotá D.C., Colombia ⁸ Department of Diagnostic Imaging, Fundación Santa Fe de Bogotá, Bogotá D.C., Colombia ⁹ Pediatric Radiology, Servicios de Salud San Vicente Fundación, Medellín, Antioquia, Colombia ¹⁰ HOMI, Fundación Hospital Infantil de la Misericordia, Bogotá D.C., Colombia ¹¹ Clínica Infantil Colsubsidio, Bogotá D.C., Colombia ¹² Instituto de Ortopedia Infantil Roosevelt, Bogotá D.C., Colombia ¹³ Clínica Universitaria Colombia, Clínica Colsanitas, Bogotá D.C., Colombia ¹⁴ Pediatric Infectious Diseases, Hospital Pablo Tobón Uribe, Medellín, Antioquia, Colombia ¹⁵ Pediatric Infectious Diseases, Hospital General de Medellín, Medellín, Antioquia, Colombia ¹⁶ Pediatric Infectious Diseases, Clínica Infantil Santa Maria del Lago, Clínica Colsanitas, Bogotá D.C., Colombia ¹⁷ Hospital Militar Central, Bogotá D.C., Colombia ¹⁸ Hospital Regional de la Orinoquía, Yopal, Casanare, Colombia ¹⁹ Fundación Investigación Biomédica Hospital Universitario 12 de Octubre (FIBH12O), Instituto de Investigación Hospital 12 de Octubre (imas12), Madrid, Spain ²⁰ Department of Epidemiology, School of Public Health, The University of Texas Health Science Center at Houston, Houston, Texas, USA ²¹ Department of Pediatrics, McGovern Medical School, University of Texas Health Sciences Center at Houston (UTHealth), Houston, Texas, USA ²² School of Public Health, Center for Health Equity, University of Texas Health Science Center at Houston, Houston, Texas, USACorresponding author: Luis Miguel Navarro-Ramirez | Lm.navarror@uniandes.edu.coAddress for reprint: Universidad de los Andes, School of Medicine, Carrera 7 # 116-05, Bogotá DC, Colombia.To the editor,We appreciate the opportunity to respond to the commentary by Daungsupawong and Wiwanitkit regarding our manuscript, “What to Look for in Chest X-Rays of Pediatric Patients With COVID-19: Insights From a Colombian Cohort” [1,2]. We thank the authors for their interest in our work and their thoughtful engagement. Several of the concerns raised in the commentary were, in fact, addressed in the original manuscript; nonetheless, we welcome the opportunity to clarify these points and provide additional context where needed.

IntroductionLimited evidence exists on the association between mode of birth and long-term depression and/or severe anxiety in mothers. We aimed to examine the association between mode of birth and depression and/or severe anxiety by 14 years postpartum.MethodsWe used data from the Millennium Cohort Study. Data on mode of birth were collected when mothers were 9 months postpartum, and categorized as spontaneous vaginal birth (VB), assisted VB, induced VB, emergency cesarean section (CS), planned CS, and CS after induction. Depression/severe anxiety were collected as one variable and self reported by mothers at 9 months, 3, 5, 7, 11, and 14 years postpartum based on a doctor diagnosis. The primary outcome measure was a diagnosis of depression/severe anxiety up to 14 years postpartum. We used multivariable logistic regression models to estimate crude and adjusted odds ratios (OR) for the association between mode of birth and depression/severe anxiety by 14 years postpartum.ResultsThere were 10,507 singleton mothers included in our analyses. Fully adjusted odds ratio (aOR)for the association between mode of birth and depression/severe anxiety by 14 years postpartum was induced VB, (aOR, 1.13 [95% CI], 1.01–2.28), assisted VB (aOR, 1.03 [95% CI], 0.89–1.19), Emergency CS, (aOR, 1.08 [95% CI], 0.92–1.27), planned CS (aOR, 1.09 [95% CI], 0.93–1.27), and CS after induction (aOR, 1.08 [95% CI], 0.91–1.28). Fully adjusted models did not report any significant association between mode of birth and depression/severe anxiety at other postpartum time points.ConclusionsThe present findings provide support for association between induction of labor and the risk of long-term depression/severe anxiety by 14 years postpartum. The findings provide no evidence to support association between other modes of birth and maternal depression/anxiety.

Fetal pulse oximetry may improve intrapartum fetal evaluation by providing a non-invasive measurement of fetal oxygen saturation (FSpo2). To assess the association between abnormal intrapartum FSpo2 and perinatal and long-term neurodevelopmental outcomes, and to evaluate if the addition of the measurement of FSpo2 to established forms of fetal monitoring, such as fetal heart rate monitoring, affects birth, perinatal, and long-term neurodevelopmental outcomes. We conducted a comprehensive search of PubMed, EMBASE, CINAHL, The Cochrane Library, Web of Science, ClinicalTrials.gov, and WHO ICTRP from database inception through February 2024, with no restrictions on date, geographic region, country income level, or language. Studies involving women in labor with a cephalic baby were included. Two interventions were reviewed: (1) low FSpo2 (<30%), and (2) the use of fetal pulse oximetry during labor. Independent reviewers screened studies, extracted data, and assessed quality using the Risk of Bias tool and the Newcastle-Ottawa Scale. The approach evaluated evidence certainty. A random-effects meta-analysis followed PRISMA and MOOSE guidelines. Forty-seven studies with 13 071 mother-infant pairs were included. FSpo2 <30% was associated with umbilical artery pH <7.15 (odds ratio [OR] 7.86, 95% confidence interval [CI] 3.29-18.75, I2 = 71%, P < 0.001), 5-min Apgar score less than 7 (OR 16.63, 95% CI 5.64-49.01, I2 = 30%, P < 0.001) and NICU admission (OR 5.89, 95% CI 1.73-20.01, I2 = 0%, P < 0.005). FSpo2 monitoring combined with fetal heart rate monitoring was associated with lower odds of cesarean section for non-reassuring fetal status (OR 0.59, 95% CI 0.40-0.86, I2 = 71%, P = 0.006) without impacting 5-min Apgar scores <7 (OR 0.66, 95% CI 0.37-1.17, I2 = 0%, P = 0.160) or neonatal intensive care unit admissions (OR 0.98, 95% CI 0.82-1.18, I2 = 0%, P = 0.840). FSpo2 monitoring combined with fetal heart rate monitoring may reduce unnecessary cesarean sections for suspected fetal distress without affecting short-term neonatal outcomes. The association between FSpo2 <30% and adverse perinatal outcomes supports its potential as a valuable adjunct in intrapartum monitoring.