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Background: In the United States, patients with monochorionic diamniotic twins who undergo in utero fetoscopic laser photocoagulation (FLP) for twin-twin transfusion syndrome (TTTS) may travel great distances for care. After delivery, many parents cannot return to study sites for formal pediatric evaluation due to geographic location and cost. Objective: The aim of this study was to collect long-term pediatric outcomes in patients who underwent FLP for TTTS. Methods: We assessed the feasibility of using a web-based survey designed in REDCap (Research Electronic Data Capture; Vanderbilt University) to collect parent-reported outcomes in children treated for TTTS at a single center during 2011-2019. Patients with ≥1 neonatal survivor were invited via email to complete 5 possible questionnaires: the child status questionnaire (CSQ); fetal center questionnaire (FCQ); Ages & Stages Questionnaires, Third Edition (ASQ-3); Modified Checklist for Autism in Toddlers, Revised With Follow-Up (M-CHAT-R/F); and thank you questionnaire (TYQ). The R programming language (R Foundation for Statistical Computing) was used to automate survey distribution, scoring, and creation of customized reports. The survey was performed in 2019 and repeated after 12 months in the same study population in 2020. Results: A total of 389 patients in 26 different states and 2 international locations had an email address on file and received an invitation in 2019 to complete the survey (median pediatric age 48.9, IQR 1.0-93.6 months). Among surveyed mothers in 2019, the overall response rate was 37.3% (145/389), and the questionnaire completion rate was 98% (145/148), 87.8% (130/148), 71.1% (81/100), 86.4% (19/22), and 74.3% (110/148) for the CSQ, FCQ, ASQ-3, M-CHAT-R/F, and TYQ, respectively. In 2020, the overall response rate was 57.8% (56/97), and the questionnaire completion rate was 96.4% (54/56), 91.1% (51/56), 86.1% (31/36), 91.7% (11/12), and 80.4% (45/56) for the CSQ, FCQ, ASQ-3, M-CHAT-R/F, and TYQ, respectively. Conclusions: This is the first study to use both REDCap and computer automation to aid in the dissemination, collection, and reporting of surveys to collect long-term pediatric outcomes in the field of fetal medicine.

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The research and development of emerging technologies has potential long-term and societal impacts that pose governance challenges. This essay summarizes the development of research ethics in China over the past few decades, as well as the measures taken by the Chinese government to build its ethical governance system of science and technology after the occurrence of the CRISPR-babies incident. The essay then elaborates on the current problems of this system through the case study of ethical governance of brain-computer interface research, and explores how the transition from research ethics to translational bioethics, which encourages interdisciplinary collaboration and focuses on societal implications, may respond to the challenges of ethical governance of science and technology.

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Background: The European Foundation for the Care of Newborn Infants (EFCNI) has promoted the importance of parental involvement in the care of children. Objective: The study aimed to examine how the time required by parents to achieve autonomy in the care of their very low-birth weight newborn infants was modified during the implementation of a training program. Methods: This was an observational prospective study in the context of a quality improvement initiative. The Cuídame (meaning "Take Care of Me" in English) program was aimed at achieving parental autonomy. It was implemented over 2 periods: period 1, from September 1, 2020, to June 15, 2021; and period 2, from July 15, 2021, to May 31, 2022. The days required by parents to achieve autonomy in several areas of care were collected from the electronic health system. Results: A total of 54 and 43 families with newborn infants were recruited in periods 1 and 2, respectively. Less time was required to acheive autonomy in period 2 for participation in clinical rounds (median 10.5, IQR 5-20 vs 7, IQR 4-10.5 d; P<.001), feeding (median 53.5, IQR 34-68 vs 44.5, IQR 37-62 d; P=.049), and observation of neurobehavior (median 18, IQR 9-33 vs 11, IQR 7-16 d; P=.049). More time was required to achieve autonomy for kangaroo mother care (median 14, IQR 7-23 vs 21, IQR 10-31 d; P=.02), diaper change (median 9.5, IQR 4-20 vs 14.5, IQR 9-32 d; P=.04), and infection prevention (median 1, IQR 1-2 vs 6, IQR 3-12; P<.001). Conclusions: Parents required less time to achieve autonomy for participation in clinical rounds, feeding, and observation of neurobehavior during the implementation of the training program. Nevertheless, they required more time to achieve autonomy for kangaroo mother care, diaper change, and infection prevention.

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BACKGROUND: Plagiocephaly is defined as an asymmetrical distortion of the skull, resulting in an oblique trapezoid or parallelogram head shape. Deformational plagiocephaly (DP) is caused by forces acting on one side of the back of the head, distorting normal skull symmetry. OBJECTIVE: The aims of this systematic review and meta-analysis were to critically assess the evidence for nonobstetric risk factors for DP and to make evidence-based recommendations for reducing the prevalence of DP. METHODS: The selection criterion was studies reporting risk factors for DP. Case reviews, case series, expert opinions, and systematic reviews were excluded. PubMed and Web of Science were searched from August 21, 2010, to August 21, 2022. Publication bias was assessed using funnel plots. Meta-analyses were presented using forest plots. RESULTS: A total of 19 studies (cohort studies: n=13, 68%; case-control studies: n=5, 26%; and cross-sectional studies: n=1, 5%) with a total of 14,808 participants were included. Of the 43 investigated potential nonobstetric factors, 16 (37%) were associated with DP. Of these 16 factors, 12 (75%) had odds ratios (ORs) with 95% CIs not crossing 1: insufficient vitamin D intake (OR 7.15, 95% CI 3.77-13.54), head position preference (OR 4.75, 95% CI 3.36-6.73), bottle-only feeding (OR 4.65, 95% CI 2.70-8.00), reduced tummy time (OR 3.51, 95% CI 1.71-7.21), sleeping position (OR 3.12, 95% CI 2.21-4.39), fewer motor milestones reached by the age of 6 months (OR 2.56, 95% CI 1.66-3.96), obesity (OR 2.45, 95% CI 1.02-5.90), maternal education level (OR 1.66, 95% CI 1.17-2.37), male sex (OR 1.51, 95% CI 1.07-2.12), formula feeding (OR 1.51, 95% CI 1.00-2.27), head circumference (OR 1.22, 95% CI 1.06-1.40), and mechanical ventilation (OR 1.10, 95% CI 1.00-1.14). No evidence of publication bias was detected. CONCLUSIONS: This study provides a comprehensive assessment of the nonobstetric factors associated with DP and presents 11 evidence-based recommendations for reducing its prevalence. The primary limitation is that only publication bias was assessed. TRIAL REGISTRATION: PROSPERO CRD42020204979; https://www.crd.york.ac.uk/prospero/display_record.php? ID=CRD42020204979.

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Introduction: Mothers with preterm babies at the NICU are at a high risk of acquiring psychological distress as a result of unexpected and upsetting experiences. While there is a strong emphasis on the infant's health, the mother's well-being, particularly her mental health, is sometimes disregarded. A qualitative exploratory descriptive design was used to explore maternal social support and resilience in caring for preterm newborns at the NICU in Municipal hospital in Ghana from May to July 2022. Methods: A qualitative exploratory method was used, and a purposive sampling technique was used to select 15 postnatal women who had their preterm babies on admission to the NICU until data saturation. Data was analysed using thematic content analysis. Results: The findings of the study showed that social support for their mothers as they care for their preterm infants contributed to their resilience. Three themes emerged from the analysis of the data: informational support, instrumental support and psychosocial support. Conclusion: There is a need for training in communication skills and counselling for healthcare professionals working in the NICU to be able to communicate effectively with mothers and also adopt a family-centered approach in the care of preterm infants. This will support mothers to strengthen their resilience when caring for their premature babies in the NICU. The role of instrumental support for mothers specifically financial and physical care support in building maternal resilience cannot be overemphasised.

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BACKGROUND: Birth asphyxia is a leading cause of neonatal deaths, but simple interventions may prevent it. The Helping Babies Breathe (HBB) course has significantly reduced neonatal mortality rates in lower and middle-income countries (LMICs) by training healthcare providers (i.e. midwives and nurses) on the essential skills of bag-and-mask ventilation and postnatal care. Although several studies have supported the efficacy of virtual learning in other medical education programs, there is still a lack of knowledge regarding a virtual approach to HBB. This study aims to compare the effectiveness of online versus in-person learning of the HBB course among medical and nursing students. METHODS: The study is a two-arm parallel randomized non-inferiority controlled trial, that includes medical and nursing students. Participants were randomly assigned to either online or in-person debriefing during the hands-on simulations of HBB. They attended a pre-recorded lecture before being assigned to one of three instructors for the simulation lab. Participants completed a seven-point anonymous Likert-based questionnaire and a standardized Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV) Short Form. The primary outcome was the Objective Structured Clinical Exam (OSCE) grade. The trial is listed on ClinicalTrials.gov with the registration number NCT05257499. RESULTS: 47 participants completed the study, with similar baseline characteristics in each arm (gender, age, and class). The participants in both arms reported high levels of satisfaction and confidence, with no significant difference between the two arms. The DASH score over 7 was also similar in the online arm (6.27±0.26) compared to the in-person arm (6.55±0.13) (p=0.07). The mean OSCE score in the online arm (45.8±5.2) was comparable to the mean OSCE score in the in-person arm (41.3±5.0) (p=0.22). Both online and in-person participants failed the OSCE. CONCLUSION: The survey responses conveyed that online simulation training is comparable to in-person simulation for the HBB course. Both online and in-person participants failed the OSCE most likely because they needed more training on HBB. This could be due to the fact that the material is too new to the students who needed more practice to pass the OSCE. Further research is needed to confirm these results and explore the long-term impact of online neonatal resuscitation training.

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Introduction Low birth weight (LBW) is a well-known contributing factor to neonatal health, emphasizing the importance of maternal health and socio-economic conditions. The birth weight of a newborn is a major public health problem, which is more common in low-middle-income countries (LMICs). Objective The objective of this study is to assess the association of different socio-economic and maternal factors with LBW babies in Lahore. Methods This case-control study was carried out at the Obstetrics and Gynecological Department in Mayo Hospital, Lahore, Pakistan from September 25, 2023 to December 31, 2023. A total of 186 mothers who delivered in the maternity ward, categorized into two groups (93 cases and 93 controls), were included and data was collected with the help of a self-administered structured tool. A chi-square test was used to identify maternal risk factors significant for LBW babies. The strength of association between maternal risk factors and LBW babies was presented using the odds ratio (OR) with the respective 95% confidence interval (CI). Results The study revealed that maternal anemia [OR: 3.378, 95% CI: 1.568, 7.275] and inadequate nutritional status [OR: 1.031, 95% CI: 0.014, 0.071] were more likely to cause delivery of LBW babies. Regarding socio-demographic factors, household income < 25000 [OR: 5.185, 95% CI: 2.770, 9.707] and illiterate mothers [OR: 3.325, 95% CI: 1.820, 6.074] were associated with increased likelihood of LBW babies. Maternal age < 20 had a strong association [OR: 10.920, 95% CI: 2.455,48.575] with delivery of LBW children.  Conclusion The study concludes that multiple risk factors including anemia, inadequate nutritional status, household income < 25000, illiterate mother, and maternal age < 20 are strongly associated with LBW babies. It is apparent that a multimodal strategy is necessary to reduce the risk of LBW babies.

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Background: Extremely preterm infants often receive donor milk. Hindmilk, which is released more than 3 minutes after letdown, could be advantageous due to its elevated levels of fat and calorie density. Donor milk expression habits may influence milk composition but have not yet been investigated. This study aims to assess the practices of milk donors and the feasibility of hindmilk expression. Methods: Active milk donors in Québec were questioned using an online survey about their milk expression habits and whether hindmilk donation would be acceptable to them. Answers were analyzed using mixed methods. Results: Of 181 donors, 126 fully completed the questionnaire (70%); 57% reported expressing donated milk between breastfeeds; 15% reported simultaneously breastfeeding while expressing donated milk from the other breast; 12% reported breastfeeding their baby on each breast, then expressing donated milk (hindmilk). The majority (66%) would be willing to change their habits most or all the time to provide hindmilk for preterm infants. The main themes invoked by respondents in open-ended answers were altruism and gratitude for being able to help others. However, 15% commented on the complexity of milk expression or that adding further complexity might discourage them from donating. Conclusions: Expression practices are variable, which may lead to variability in donor milk composition. Most donors would agree to change their expression habits in favor of giving hindmilk to help the most fragile infants. More information is needed on how changing recommendations for milk expression might impact the supply and composition of donor milk.

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RATIONALE AND KEY POINTS: Respiratory auscultation involves listening to and interpreting sounds from within the chest. Undertaking respiratory auscultation effectively requires appropriate equipment, knowledge of physiology and pathophysiology and experience in listening to and interpreting breath sounds. Nurses undertaking this procedure must ensure they have the knowledge and skills to do so and work within the limits of their competence. This article provides a step-by-step guide that explains how to undertake respiratory auscultation with infants and children aged 0-16 years. • Respiratory auscultation is an essential procedure for informing differential diagnoses and assessing the trajectory of a child's illness and response to treatment. • In children with structurally normal, healthy lungs and a regular breathing pattern, the respiratory sound should be relatively quiet, with regular movement of air along the trachea and bronchioles, in and out of the lungs. • Any breath sounds heard in unexpected areas requires further investigation, while a complete absence of breath sounds must be treated as a clinical emergency and assistance from the medical team must be sought immediately. REFLECTIVE ACTIVITY: 'How to' articles can help to update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: • How this article might improve your practice when undertaking respiratory auscultation with infants and children. • How you could use this information to educate nursing students or your colleagues on the procedure for undertaking respiratory auscultation with infants and children.

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Catherine Chisholm BA MB ChB MD FRCP CBE (1879-1952) is celebrated as the first woman to qualify in medicine from Manchester University in 1904 and is remembered for founding the Manchester Babies Hospital in 1914 (later renamed in 1935 as the Duchess of York Hospital for Babies). She was indefatigable in her pursuit to improve the education and status of women doctors; the first woman member and president of the British Paediatric Society; first woman president of the Manchester Medical Society and was mainly responsible for establishing the Medical Women's Federation in 1917. Her career was a complex mixture of medical and social networks that linked her work as a children's physician to the Manchester Public Health Committee, Liberal politics and feminist groups. These networks played an important role in Dr Chisholm's successful career and are at the centre of this paper.

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The corporeal turn in developmental psychology has rekindled interest regarding how early motor development contributes to and enhances cognitive development across the first years of life. By highlighting embodied perceptual-motor engagement with the world, embodied cognitive learning emphasizes the importance of experience and perceptual-motor mechanisms in modulating the development of person-environment systems. The field currently calls for research that combines such conceptual frameworks with the complex everyday material and sociocultural landscapes that resource infants' developmental trajectories. We, therefore, aim to connect the conceptual refinement of bodily-anchored exploration to the contextual reality of everyday settings of early childhood education (ECE)-here situated in the Brazilian context-as relevant social and cultural suppliers and modulators of the developmental trajectories of babies. Secondarily, we ponder on the premises of national pedagogical curricula and their role in mediating the quality of experiences and systems of person-environment relations more closely. Cultural-historical psychology, in dialogue with the principles of Ecological Psychology, constitutes the theoretical framework that underpins the microgenetic analyses conducted. By analyzing episodes of exploratory actions of a focal baby situated in the ECE context, we seek to apprehend motor-perceptual indicators of embodied cognitive processing by considering the modes of appropriation entailed in episodes of embodied exploration. We reflect on pedagogical implications considering official national documents of early childhood education. This work contributes by providing complementary insights into the nature of infants' everyday sociocultural embodied experiences and their development in pedagogically oriented settings.

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Background: Parental health literacy is important to children's health and development, especially in the first 3 years. However, few studies have explored effective intervention strategies to improve parental literacy. Objective: This study aimed to determine the effects of a WeChat official account (WOA)-based intervention on parental health literacy of primary caregivers of children aged 0-3 years. Methods: This cluster randomized controlled trial enrolled 1332 caregiver-child dyads from all 13 community health centers (CHCs) in Minhang District, Shanghai, China, between April 2020 and April 2021. Participants in intervention CHCs received purposefully designed videos via a WOA, which automatically recorded the times of watching for each participant, supplemented with reading materials from other trusted web-based sources. The contents of the videos were constructed in accordance with the comprehensive parental health literacy model of WHO (World Health Organization)/Europe (WHO/Europe). Participants in control CHCs received printed materials similar to the intervention group. All the participants were followed up for 9 months. Both groups could access routine child health services as usual during follow-up. The primary outcome was parental health literacy measured by a validated instrument, the Chinese Parental Health Literacy Questionnaire (CPHLQ) of children aged 0-3 years. Secondary outcomes included parenting behaviors and children's health outcomes. We used the generalized linear mixed model (GLMM) for data analyses and performed different subgroup analyses. The ß coefficient, risk ratio (RR), and their 95% CI were used to assess the intervention's effect. Results: After the 9-month intervention, 69.4% (518/746) of caregivers had watched at least 1 video. Participants in the intervention group had higher CPHLQ total scores (ß=2.51, 95% CI 0.12-4.91) and higher psychological scores (ß=1.63, 95% CI 0.16-3.10) than those in the control group. The intervention group also reported a higher rate of exclusive breastfeeding (EBF) at 6 months (38.9% vs 23.44%; RR 1.90, 95% CI 1.07-3.38) and a higher awareness rate of vitamin D supplementation for infants younger than 6 months (76.7% vs 70.5%; RR 1.39, 95% CI 1.06-1.82). No significant effects were detected for the physical score on the CPHLQ, breastfeeding rate, routine checkup rate, and children's health outcomes. Furthermore, despite slight subgroup differences in the intervention's effects on the total CPHLQ score and EBF rate, no interaction effect was observed between these subgroup factors and intervention factors. Conclusions: Using a WHO literacy model-based health intervention through a WOA has the potential of improving parental health literacy and EBF rates at 6 months. However, innovative strategies and evidence-based content are required to engage more participants and achieve better intervention outcomes.

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BACKGROUND: Pandemics, such as COVID-19, have the potential to adversely affect children's development due to a variety of negative factors at the level of children, families, and services. In this study the effect of the pandemic on the cognitive, language and motor development of premature babies who are among the most vulnerable group, were evaluated. METHODS: The study included 236 premature infants who were followed at Hacettepe University Department of Developmental Pediatrics. The Bayley-Third Edition Developmental Assessment (Bayley III) was used to evaluate the neurodevelopment of 152 premature infants from the pre-pandemic group and 84 from the post-pandemic group at the corrected age of 18-24 months. The perinatal and sociodemographic risks were also evaluated. RESULTS: No difference in Bayley III scores (cognitive, language, and motor) was found between the pre- and post-pandemic groups. Furthermore, the multivariate covariance analysis displayed that regardless of the pandemic, infants with higher maternal education consistently scored higher in the cognitive, language, and motor domains; and the motor area scores of infants with moderate perinatal risk were also significantly higher than infants with high perinatal risk. CONCLUSIONS: It is crucial to monitor the development of vulnerable children who encounter developmental risks, such as premature babies. Fortunately, no significant effect was encountered during the COVID-19 pandemic. However, this does not underweigh the need for close supervision in extraordinary circumstances. Additionally, it should be noted that severe postnatal comorbidities, perinatal risks, and social factors, such as maternal education level, interact to influence the neurodevelopmental outcomes of preterm infants.

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Background: The implementation of surfactant for respiratory syndrome approbates the therapy as a revolutionary method in intensive neonatal therapy and respiratory resuscitation. It is important to investigate the costs of this treatment. Objective: The aim of the study is to analyze the data by the application of the surfactant Curosurf to preterm babies with respiratory complications and describe the treatment costs, healthcare resource utilization and evaluate economic benefits of surfactant use in the treatment of neonates with respiratory distress syndrome (RDS) and hyaline-membrane disease (HDM). Methods: A retrospective survey was performed covering 167 babies based on respiratory complications due to preterm birth and the necessity to apply a surfactant therapy. A documentary method was implemented and for each patient, an individual research protocol was filled out - a questionnaire created specifically for the purposes of the study. Results and discussion: An analysis of the data from the application of CUROSURF was made and the obtained therapeutic results were compared to expenditures for the therapy, short-term therapeutic effect, benefits and consequences of the therapy of preterm newborns with respiratory complications. The application of CUROSURF to babies with RDS resulted in the realization of net savings due to the elimination of the necessity of conducting several diagnostic and therapeutic procedures as well as their duration reduction of hospital stay, thus defining its health-economic benefits. Conclusions: The models of evaluation of cost effectiveness reveal that the medicinal product is expensive but effective from the aspect of short-term therapeutic results.

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Studying percutaneous penetration of various cosmetic ingredients through intact and compromised skin can provide insight on quantitative exposure assessment for baby products intended for diapered skin. We developed an in vitro model (tape-stripped human skin) designed to achieve the Trans-Epidermal Water Loss values measured in babies with various degrees of diaper dermatitis. Six reference compounds showed the impact of physicochemical properties on absorption through this "diaper rash" skin model. Under simulated diaper conditions, dermal absorption of cosmetic ingredients (phenoxyethanol, sodium benzoate, benzyl alcohol, disodium EDTA, and propylene glycol) was different, but <100%. Additionally, the effect of diaper rash on dermal absorption of well-absorbed ingredients (phenoxyethanol, sodium benzoate, and benzyl alcohol) was limited (enhancement of 1.1-1.3), while the enhancement for moderately absorbed compounds (disodium EDTA and propylene glycol) was 1.8-3.3. Absorption via skin with "diaper rash" is specific to individual ingredients and exposure conditions, so a fixed uncertainty factor is not appropriate for safety assessment. The data support that the default 100% dermal absorption commonly used in first-tier risk assessments for diapered skin is conservative. This diaper rash skin model provides a practical tool of estimating absorption of various ingredients in baby products intended for diapered skin.

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AIM: To investigate the impact of ongoing workshop training of the "Helping Babies Breathe" program on the durability of midwives' knowledge and skills. BACKGROUND: Implementing the Helping Babies Breathe (HBB) program is crucial as a simple protocol for neonatal resuscitation in low-resource healthcare settings to decrease the rate of asphyxia and perinatal mortality by the initial healthcare providers. In addition to training in this program, it is also essential to guarantee the retention of the acquired knowledge and skills. DESIGN: A quasi-experimental clinical trial study with a single-group, pre-test-and-post-test design. METHODS: This study was conducted throughout the year 2022, with a sample size of 61 midwives selected through a census sampling from those working in the delivery and operating rooms of X Hospital in x City. The midwives participated in 3-hour workshops. This study was performed in two stages: intervention and follow-up. The evaluation Instruments included the HBB educational package, which consisted of a questionnaire and 3 Objective Structured Clinical Exams. During the intervention phase, the HBB program training was conducted through a series of workshops held at four different time points over a span of six months. In the follow-up stage, the learners were not provided with any further training. The evaluation was done immediately after the initial training workshop of the HBB program, at the end of the final workshop in the sixth month and at the end of the follow-up period. RESULTS: The mean knowledge score of the baseline, at six months and at twelve months after the initial workshop were documented as (17 SD1.2), (17.79 SD 0.4) and (17.73 SD 0.5), respectively. There was a statistically significant difference in the mean knowledge scores between the baseline and the six and twelve months (P<0.05), but no statistically significant difference was observed between six and twelve months (P>0.05). The mean skill scores showed a significant improvement and were maintained after six months compared with the initial assessment (P<0.05); however, there was a significant decrease in skill score twelve months later, in comparison to both the initial assessment and the first six months (P<0.05). CONCLUSIONS: Healthcare workers can maintain their knowledge and skills by participating in ongoing training workshops. However, without continuous training, their skills may diminish. Therefore, it is essential to implement training programs that emphasize regular practice and repetition to ensure knowledge and skills retention. REGISTRATION NUMBER: The present research was a part of the research work with the ethics ID IR.IRSHUMS.REC.1400.019.

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BACKGROUND: The use of artificial intelligence (AI) for pain assessment has the potential to address historical challenges in infant pain assessment. There is a dearth of information on the perceived benefits and barriers to the implementation of AI for neonatal pain monitoring in the neonatal intensive care unit (NICU) from the perspective of health care professionals (HCPs) and parents. This qualitative analysis provides novel data obtained from 2 large tertiary care hospitals in Canada and the United Kingdom. OBJECTIVE: The aim of the study is to explore the perspectives of HCPs and parents regarding the use of AI for pain assessment in the NICU. METHODS: In total, 20 HCPs and 20 parents of preterm infants were recruited and consented to participate from February 2020 to October 2022 in interviews asking about AI use for pain assessment in the NICU, potential benefits of the technology, and potential barriers to use. RESULTS: The 40 participants included 20 HCPs (17 women and 3 men) with an average of 19.4 (SD 10.69) years of experience in the NICU and 20 parents (mean age 34.4, SD 5.42 years) of preterm infants who were on average 43 (SD 30.34) days old. Six themes from the perspective of HCPs were identified: regular use of technology in the NICU, concerns with regard to AI integration, the potential to improve patient care, requirements for implementation, AI as a tool for pain assessment, and ethical considerations. Seven parent themes included the potential for improved care, increased parental distress, support for parents regarding AI, the impact on parent engagement, the importance of human care, requirements for integration, and the desire for choice in its use. A consistent theme was the importance of AI as a tool to inform clinical decision-making and not replace it. CONCLUSIONS: HCPs and parents expressed generally positive sentiments about the potential use of AI for pain assessment in the NICU, with HCPs highlighting important ethical considerations. This study identifies critical methodological and ethical perspectives from key stakeholders that should be noted by any team considering the creation and implementation of AI for pain monitoring in the NICU.

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Introduction: Hyponatremia is one of the most prevalent water-electrolyte disturbances encountered in clinical practice in pediatrics and can arise from various conditions. However, there are limited reports on hyponatremia in hospitalized infants. The objective of this study was to provide an overview of the incidence, etiologies, and clinical characteristics of hyponatremia in hospitalized babies (from birth to 3 years old) at a tertiary hospital. Method: Computer records of all hospitalized babies (from birth to 3 years old) with hyponatremia were extracted from the First Affiliated Hospital of Guangxi Medical University's clinical databases. Results: 801 patients from 39,019 hospital admissions were found to have hyponatremia and the overall prevalence of this condition was 2.05% in babies. Patients with hyponatremia due to aldosterone signaling abnormalities, neurological disorders, and liver diseases exhibited more severe outcomes than those with other etiologies. Conclusions: Various conditions can result in hyponatremia in hospitalized babies. Aldosterone signaling abnormalities were not that uncommon and it could lead to severe hyponatremia in babies.

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INTRODUCTION: Neonatal mortality is an issue that affects both the developed and developing world. It is very important in the neonatal intensive care unit (NICU) to do the assessment of the severity of neonatal illness, which in turn helps in estimating and preventing mortality in the NICU by improving healthcare control and by rational use of resources. This research was carried out to evaluate how effectively the Clinical Risk Index for Babies (CRIB) II score can predict mortality rates among newborns treated in our NICU.  Methodology: This prospective observational study spanned one year, commencing in October 2021 and concluding in September 2022, within the confines of our NICU. The CRIB II score calculation was performed for included newborns, and the outcomes of the newborns were compared. A receiver operating characteristic (ROC) curve was obtained to ascertain the optimal CRIB II cut-off score for predicting mortality. RESULTS: Within the designated research timeframe, 292 neonates were admitted to the NICU. Forty-four newborns were enrolled in the study. Preterm neonates who died had higher CRIB II scores than those who survived, and their median (IQR) was 6 (1-12) vs. 9.5 (5-14) (p=0.0003). The estimate for the area under the curve was 0.83 (95% CI 0.68-0.92), and the odds ratio of 2.56 suggests neonates with a higher CRIB II score have higher chances of mortality. CONCLUSION: The CRIB II score is very good at predicting mortality in preterm newborns.

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Background: Mental, emotional, and behavioral disorders are chronic pediatric conditions, and their prevalence has been on the rise over recent decades. Affected children have long-term health sequelae and a decline in health-related quality of life. Due to the lack of a validated database for pharmacoepidemiological research on selected mental, emotional, and behavioral disorders, there is uncertainty in their reported prevalence in the literature. objectives: We aimed to evaluate the accuracy of coding related to pediatric mental, emotional, and behavioral disorders in a large integrated health care system's electronic health records (EHRs) and compare the coding quality before and after the implementation of the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) coding as well as before and after the COVID-19 pandemic. Methods: Medical records of 1200 member children aged 2-17 years with at least 1 clinical visit before the COVID-19 pandemic (January 1, 2012, to December 31, 2014, the ICD-9-CM coding period; and January 1, 2017, to December 31, 2019, the ICD-10-CM coding period) and after the COVID-19 pandemic (January 1, 2021, to December 31, 2022) were selected with stratified random sampling from EHRs for chart review. Two trained research associates reviewed the EHRs for all potential cases of autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD), major depression disorder (MDD), anxiety disorder (AD), and disruptive behavior disorders (DBD) in children during the study period. Children were considered cases only if there was a mention of any one of the conditions (yes for diagnosis) in the electronic chart during the corresponding time period. The validity of diagnosis codes was evaluated by directly comparing them with the gold standard of chart abstraction using sensitivity, specificity, positive predictive value, negative predictive value, the summary statistics of the F-score, and Youden J statistic. κ statistic for interrater reliability among the 2 abstractors was calculated. Results: The overall agreement between the identification of mental, behavioral, and emotional conditions using diagnosis codes compared to medical record abstraction was strong and similar across the ICD-9-CM and ICD-10-CM coding periods as well as during the prepandemic and pandemic time periods. The performance of AD coding, while strong, was relatively lower compared to the other conditions. The weighted sensitivity, specificity, positive predictive value, and negative predictive value for each of the 5 conditions were as follows: 100%, 100%, 99.2%, and 100%, respectively, for ASD; 100%, 99.9%, 99.2%, and 100%, respectively, for ADHD; 100%, 100%, 100%, and 100%, respectively for DBD; 87.7%, 100%, 100%, and 99.2%, respectively, for AD; and 100%, 100%, 99.2%, and 100%, respectively, for MDD. The F-score and Youden J statistic ranged between 87.7% and 100%. The overall agreement between abstractors was almost perfect (κ=95%). Conclusions: Diagnostic codes are quite reliable for identifying selected childhood mental, behavioral, and emotional conditions. The findings remained similar during the pandemic and after the implementation of the ICD-10-CM coding in the EHR system.

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