BACKGROUND & AIMS: BACKGROUND:As the global under-five mortality rate declines, an increasing percentage is attributable to early neonatal mortality. A quarter of early neonatal deaths are due to perinatal asphyxia. However, neonatal resuscitation (NR) simulation training in low-resource settings, where the majority of neonatal deaths occur, has achieved variable success. In Bihar, India, the poorest region in South Asia, there is tremendous need for a new approach to reducing neonatal morality. METHODS:This analysis aims to assess the impact of a novel in-situ simulation training program, developed by PRONTO International and implemented in collaboration with CARE India, on NR skills of nurses in Bihar. Skills were evaluated by clinical complexity of the simulated scenario, which ranged from level 1, requiring NR without a maternal complication, to level 3, requiring simultaneous management of neonatal and maternal complications. A total of 658 nurses at 80 facilities received training 1 week per month for 8 months. Simulations were video-recorded and coded for pre-defined clinical skills using Studiocode™. RESULTS:A total of 298 NR simulations were analyzed. As simulation complexity increased, the percentage of simulations in which nurses completed key steps of NR did not change, even with only 1-2 providers in the simulation. This suggests that with PRONTO training, nurses were able to maintain key skills despite higher clinical demands. As simulation complexity increased from level 1 to 3, time to completion of key NR steps decreased non-significantly. Median time to infant drying decreased by 7.5 s (p = 0.12), time to placing the infant on the warmer decreased by 21.7 s (p = 0.27), and time to the initiation of positive pressure ventilation decreased by 20.8 s (p = 0.12). Nevertheless, there remains a need for improvement in absolute time elapsed between delivery and completion of key NR tasks. CONCLUSIONS:PRONTO simulation training enabled nurses in Bihar to maintain core NR skills in simulation despite demands for higher-level triage and management. Although further evaluation of the PRONTO methodology is necessary to understand the full scope of its impact, this analysis highlights the importance of conducting and evaluating simulation training in low-resource settings based on simultaneous care of the mother-infant dyad.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:In a randomized controlled trial (RCT) with 8402 stable low birthweight (LBW) infants, majority being late preterm or term small for gestational age, community-initiated KMC (ciKMC) showed a significant improvement in survival. However, the effect of ciKMC on neurodevelopment is unclear. This is important to elucidate as children born with low birth weight are at high risk of neurodevelopmental deficits. In the first 552 stable LBW infants enrolled in the above trial, we evaluated the effect of ciKMC on neurodevelopmental outcomes during infancy. METHOD:This RCT was conducted among 552 stable LBW infants, majorly late preterm or term small for gestational age infants without any problems at birth and weighing 1500-2250 g at birth. The intervention comprised of promotion of skin-to-skin contact and exclusive breastfeeding by trained intervention delivery team through home visits. The intervention group mother-infant-dyads were supported to practice ciKMC till day 28 after birth or until the baby wriggled-out. All infants in the intervention and control groups received Home Based Post Natal Care (HBPNC) visits by government health workers. Cognitive, language, motor and socio-emotional outcomes were assessed at infant-ages 6- and 12-months using Bayley Scale of Infant Development (BSID-III). Other outcomes measured were infant temperament, maternal depression, maternal sense of competence, mother-infant bonding and home-environment. We performed post-hoc equivalence testing using two one-sided tests of equivalence (TOST) to provide evidence that ciKMC does not do harm in terms of neurodevelopment. RESULTS:In the intervention arm, the median (IQR) time to initiate ciKMC was 48 (48 to 72) hours after birth. The mean (SD) duration of skin-to-skin-contact was 27.9 (3.9) days with a mean (SD) of 8.7 (3.5) hours per day. We did not find significant effect of ciKMC on any of the child developmental outcomes during infancy. The TOST analysis demonstrated that composite scores for cognitive, language and motor domains at 12 months among the study arms were statistically equivalent. CONCLUSION:Our study was unable to capture any effect of ciKMC on neurodevelopment during infancy in this sample of stable late preterm or term small for gestational age infants. Long term follow-up may provide meaningful insights. TRIAL REGISTRATION:The trial is registered at clinicaltrials.gov NCT02631343 dated February 17, 2016; Retrospectively registered.

背景与目标：

BACKGROUND & AIMS: :This article provides a synthesis of clinical trial data with an aim to deduce the timing of mother-to-child transmission of HIV-1. Because transmission of the infection to the infant through breastfeeding is one of the main challenges in fighting paediatric HIV/AIDS in the developing world, we present separate estimates for the timing of HIV transmission for non-breastfeeding and breastfeeding populations. Our estimates predict that, for non-breastfeeding populations, 50% of HIV infections are transmitted to the infant at the very end of pregnancy, near to the time of labour. For breastfeeding populations, the postnatal period accounts for most of the HIV infections transmitted to the infant. We discuss the potential benefit of exclusive breastfeeding for the first 6 months of life as a policy to decrease the magnitude of HIV transmission. Furthermore, we present the hypothesis, based on recent research findings of viral latency, that the time when a fetus initially encounters the virus might not be when infection is established. We discuss the implications of this hypothesis and how it could lead to new interventions for the prevention of mother-to-child HIV transmission.

背景与目标： : 本文提供了临床试验数据的综合，旨在推断HIV-1母婴传播的时间。由于通过母乳喂养向婴儿传播感染是发展中国家抗击儿科艾滋病毒/艾滋病的主要挑战之一，因此我们对非母乳喂养和母乳喂养人群的艾滋病毒传播时间提出了单独的估计。我们的估计预测，对于非母乳喂养的人群，50% 的艾滋病毒感染会在怀孕结束时 (接近分娩时) 传播给婴儿。对于母乳喂养的人群，产后时期占传播给婴儿的大部分艾滋病毒感染。我们讨论了在出生后的头6个月内进行纯母乳喂养的潜在好处，以减少HIV传播的幅度。此外，我们根据最近对病毒潜伏期的研究发现提出了假设，即胎儿最初遇到病毒的时间可能不是确定感染的时间。我们讨论了该假设的含义，以及它如何导致预防母婴HIV传播的新干预措施。

BACKGROUND & AIMS: BACKGROUND:Nutrition and environmental factors are essential for the education of the neonatal immune system. Epidemiological evidence has shown that malnutrition and allergic diseases that occur during early childhood share similar protective and risk factors. This paper describes the protocol of the Mother and Infant Cohort Study (MICOS), which aims to determine the contribution of early nutrition to the development of malnutrition and allergic diseases in infants' first year of life. METHODS:MICOS is a prospective cohort study conducted at selected government health clinics in two states, namely Selangor and Wilayah Persekutuan Kuala Lumpur, Malaysia. Women in their third trimester of pregnancy are recruited into the study and their infants will be followed-up at 3, 6, and 12 months of age. Information on prenatal factors including socio-demographic characteristics, obstetric history, pre-pregnancy body mass index, gestational weight gain, smoking, family history of allergic diseases, maternal dietary intake and sunlight exposure during pregnancy are obtained through face-to-face interviews. Postnatal factors including dietary intake, sun exposure, and anthropometric measurements of the mothers, as well as feeding practices, dietary intake, anthropometric measurements, and development of allergic diseases of the infants are assessed at each follow-up. Blood samples are collected from the mothers in the third trimester to determine 25-hydroxyvitamin D levels as well as from the infants at age 12 months to determine atopic sensitisation. DISCUSSION:The concept of developmental origins of health and disease (DOHaD) which emphasises on the role of early life environments in shaping future health and disease susceptibility in adulthood has gained a huge interest in recent years. The DOHaD paradigm has influenced many fields of research including malnutrition and allergic diseases. While findings from the developed countries remain controversial, such studies are scarce in developing countries including Malaysia. The present study will determine the cause and effect relationship between early nutrition and the development of malnutrition and allergic diseases in infants' first year of life.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:To determine the percentage of infected children for whom nevirapine (NVP) was used to prevent peripartum mother-to-child transmission (MTCT) of HIV in Yaoundé, Cameroon. DESIGN:The study was a prospective Public Health Pilot Program covering a 3-year period (January 2000-December 2002). METHODS:Counseled and consenting HIV-1-positive pregnant women were given a single dose of NVP at the onset of labor. Babies were given 2 mg/kg NVP syrup within the first 72 hours of life. NVP-treated children were regularly followed up and examined for HIV-1 infection at 6-8 weeks and 5-6 months through plasma viral load (VL) quantification with the bDNA system. RESULTS:One hundred twenty-three children were diagnosed with perinatal HIV-1 infection at 6-8 weeks and 5-6 months. Thirteen children (10.6% [13/123]; 95% confidence interval, 5.1-16) were infected and presented with high VLs, in general >500,000 copies/mL. Two children had intermediate VLs (between 50 and 3500 copies/mL) at both time points. One hundred seven children (87%) were considered not infected at 6-8 weeks of age. CONCLUSIONS:Our results indicate that the HIV-1 MTCT rate 6-8 weeks after NVP administration was not >13% (16/123), thus demonstrating the effectiveness of NVP for lowering the risk of HIV-1 MTCT in real-life settings.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:to explore the maternal and neonatal effects of fentanyl administered subcutaneously to women during labour. DESIGN:two methods were used: (1) A retrospective audit of the birth register and maternal and neonatal records for the period from January 2000 to December 2007. (2) A pilot study was also conducted on a convenience sample of women between July 2008 and October 2008. SETTING:this study was conducted within a maternity unit at a rural South Australian hospital where approximately 350 babies are birthed each year. PARTICIPANTS:audit participants included women who had uncomplicated pregnancies and birthed at term (37-42 weeks gestation). Women in the experimental group consisted of those who had utilised only subcutaneous fentanyl for pain relief (n=75), or nitrous oxide and oxygen prior to being administered subcutaneous fentanyl (n=196). Stratified random selection based on parity and age was used to determine the control group, which consisted of women who used no pharmacological pain relief (n=196). The pilot study involved a convenience sample of women (n=10) assessed to have an uncomplicated pregnancy and labour occurring at term (≥37 weeks gestation). MEASUREMENTS:audit variables examined included the women's age, parity, labour duration, mode of birth (spontaneous or assisted), analgesia used, total dosage, time administered prior to birth, time of birth, neonatal Apgar scores, time to establish breathing, naloxone use, days spent in hospital post-birth and breast-feeding outcomes upon discharge. The pilot study explored maternal effects assessed pre- and 30 minutes post-administration of subcutaneously administered fentanyl by observing pain scores, vital signs, sedation levels, nausea/vomiting scores and anti-emetic use. To assess possible adverse effects in the neonate Apgar scores, time to establish respiration, naloxone use, transfer to neonatal nursery and breast-feeding outcomes upon discharge were recorded. FINDINGS:women in the experimental groups were more likely to be induced, experienced a longer duration of labour and had an increased likelihood of an assisted vaginal birth. The average total dose of fentanyl administered was 250 μg. Neonatal outcomes were comparable between groups when examining Apgar scores <7 at 1 and 5 minutes and time to establish breathing. There was, however, a significant difference with naloxone administration between the groups. There was no significant difference between groups in hospital stay or breast-feeding on discharge. The pilot study identified a clinically significant reduction in pain scores for 78% of women following the administration of subcutaneous fentanyl, with the average pain score decreasing from 8.4 (±1.4) to 7.2 (±1.1) (paired t-test, p=0.017). Vital signs were not affected, no anti-emetics were required and all women remained alert with no sedation noted. KEY CONCLUSIONS:the audit identified fentanyl use was associated with a longer length of labour, but this may be explained by more women in the experimental groups requiring induction of labour than those in the control group. However, length of hospital stay, breast-feeding rates and neonatal outcomes were comparable amongst the three groups. Results of the pilot study are consistent with those of the audit in relation to the effects on mother and neonate. In addition, the pilot study begins to provide evidence that fentanyl is efficacious in providing pain relief. IMPLICATIONS FOR PRACTICE:results of this study are the first to explore the effects of fentanyl administered subcutaneously to women during labour. This method of analgesia offers women an additional choice of pain relief during childbirth and may be particularly beneficial in remote and rural settings where resources are often limited and access to specialist services difficult. Further research, however, is required to be able to generalise the outcomes and provide further data to support the clinical effectiveness of this route of administration of fentanyl.

背景与目标：

BACKGROUND & AIMS: :This article is for women who ask whether it is possible to combine motherhood with academia and still be successful and happy. It is also for those working with, bosses of, or married to such women, giving them a better feel for the challenges mothers in academia face, and the strategies that can be used to survive and thrive in both of these worlds.

背景与目标： : 本文是针对那些询问是否有可能将母性与学术界结合起来并仍然成功和幸福的女性。这也是为那些与这些女性一起工作、与之结婚或与之结婚的人准备的，让她们更好地感受到学术界母亲面临的挑战，以及可以用来在这两个世界生存和茁壮成长的策略。

BACKGROUND & AIMS: SUMMARY OBJECTIVES:To determine factors associated with pregnant women being HIV positive, barriers to the uptake of single-dose nevirapine (sdNVP) for prevention of mother-to-child transmission (PMTCT) and feasibility and effectiveness of reporting HIV-exposed infants born in facilities with no PMTCT services so as to receive NVP. METHODS:From 2002 to 2007, a sdNVP PMTCT service was implemented in 53 rural villages of south-west Uganda. Twenty-five of them were HIV-surveillance study villages. The proportions of mothers testing positive and mother and newborns receiving and ingesting sdNVP and associated factors were determined. RESULTS:Women with incomplete primary or no education, aged 25-34 years or not living with their partners were at increased risk of being HIV infected. Seventy-seven percentage of pregnant women with HIV (PWH) received therapy. Of the 63 PWH who received therapy and had surviving live births, only 39 (62%) reported births and received newborn prophylaxis within 72 h. Women were more likely to collect and ingest NVP if they were from study villages, preferred home administration of newborn NVP or presented at a more advanced stage of pregnancy. Newborns were more likely to be reported and receive NVP if mothers were aged 25-34 years, on antiretroviral therapy (ART) or came from study villages. CONCLUSIONS:The uptake of PMTCT services was unacceptably low. Asking PWH with less advanced pregnancies to return to collect NVP leads to missed opportunities especially if PWH are less educated. Birth reporting enabled the programme to provide NVP to some infants who otherwise would have missed. Antenatal, delivery and PMTCT services should be integrated.

背景与目标：

BACKGROUND & AIMS: :A recent study has found that carrying - not just holding - by human mothers has a specific calming effect on crying infants, inducing a coordinated physiological response that includes a reduction in heart rate. A similar response in mice has opened the door to elucidating the underlying neural mechanisms.

背景与目标： : 最近的一项研究发现，人类母亲携带 (不仅仅是抱着) 对哭泣的婴儿具有特定的镇静作用，从而引起协调的生理反应，包括心率降低。小鼠的类似反应为阐明潜在的神经机制打开了大门。

BACKGROUND & AIMS: :The aim of this study is to show the central role of the concept of the dead mother in the psychic process of anorexia nervosa, and the dead mother's transformation into the living mother by means of the use of the therapist in a successful psychoanalytic psychotherapy process. This psychoanalytic psychotherapy approach to anorexia nervosa is especially useful when patients are young, because even though they are often unstable and not yet mature, they are at the same time open to positive psychic changes in their personality structure--as the clinical case shows. The resurrection of the internal dead mother into the internal living mother, by means of the object usage of the therapist in the described therapy process, brought about the anorectic patient's recovery from a "dead swan" to a young "living swan."

背景与目标： : 这项研究的目的是展示死去的母亲的概念在神经性厌食症的心理过程中的核心作用，以及通过成功的心理分析心理治疗过程中使用治疗师将死去的母亲转变为活着的母亲。这种对神经性厌食症的精神分析心理治疗方法在患者年轻时特别有用，因为即使他们通常不稳定且尚未成熟，但他们同时对人格结构的积极心理变化持开放态度-如临床病例所示。通过治疗师在所描述的治疗过程中的对象使用，内部死去的母亲复活为内部活着的母亲，使厌食症患者从 “死天鹅” 恢复为年轻的 “活天鹅”。”

BACKGROUND & AIMS: :Vertical transmission, or mother-to-child transmission (MTCT), is the main mode of HIV-1 acquisition in infants and children. The presence of passively transferred maternal antibodies to HIV-1 has not protected infants front HIV-1 infection and there is no clear understanding about the role of antibodies in preventing MTCT. Immune factors, such as leukemia inhibitory factor, CC chemokines, Lewis X component and secretory leukocyte protease inhibitor, appear to be involved in the protection of HIV-exposed, uninfected infants. The mainstay of reducing HIV transmission risk in infants remains the use of antiretroviral therapy. Future strategies to augment the role of antiretrovirals in preventing MTCT, or to target the prevention of transmission through breastfeeding, may include the use of vaccination and/or passive immunization with neutralizing monoclonal antibodies.

背景与目标： : 垂直传播或母婴传播 (MTCT) 是婴儿和儿童HIV-1获取的主要方式。被动转移至HIV-1的母体抗体的存在并未保护婴儿HIV-1前感染，并且对抗体在预防MTCT中的作用也没有明确的了解。免疫因子，例如白血病抑制因子，CC趋化因子，Lewis X成分和分泌性白细胞蛋白酶抑制剂，似乎参与了对暴露于HIV的未感染婴儿的保护。降低婴儿艾滋病毒传播风险的主要手段仍然是使用抗逆转录病毒疗法。增强抗逆转录病毒药物在预防MTCT中的作用或针对通过母乳喂养预防传播的未来策略可能包括使用疫苗接种和/或使用中和单克隆抗体进行被动预防接种。

BACKGROUND & AIMS: : Background: Florida's Healthy Start Program is a statewide prenatal screening program that aims to identify pregnant women at risk of adverse birth outcomes. However, the effectiveness of this legislatively mandated prenatal risk screening tool in predicting poor birth outcomes is unknown. This study aimed to evaluate associations between risk factors self-reported on this screening tool and adverse birth outcomes. Materials and Methods: A 1-year retrospective birth cohort at a large academic referral center was created. Risk factors reported on the tool by mothers who had a preterm or low-birthweight (LBW) infant were compared with those reported by mothers who delivered full-term non-LBW infants in bivariate and multivariate analyses. All data were extracted from maternal or infant electronic health records. Results: The Mother/Infant Dyad Screening cohort consisted of 528 dyads. We identified two items on the screening tool that significantly associated with adverse birth outcomes, but which do not currently contribute to the total risk score used to identify women for referral to preventive social services. These items were feeling alone and thinking it was not a good time to be pregnant. Conclusions: Comprehensive prenatal risk screening is an underutilized strategy in medicine. Florida's mandatory self-reported, prenatal survey can identify women at risk for poor neonatal outcomes. A more nuanced understanding how women are interpreting survey items and a re-evaluation of scoring practices may allow the tool to better serve as a model for other programs seeking to identify pregnant women at risk of poor birth outcomes.

背景与目标：

BACKGROUND & AIMS: PURPOSE OF REVIEW:A general anaesthetic is usually given for an emergency caesarean section (Category 1), where there is imminent threat to the mother or foetus. There are many risks in performing a general anaesthetic. The aim of this review is to highlight the effects and risks to the mother and foetus of each step of a general anaesthetic. RECENT FINDINGS:Anaesthetic techniques are changing, and the traditional mantra of using a general anaesthetic for an emergency caesarean sections is being challenged. There are also multiple potential risks of a general anaesthetic that are being better defined. This ranges from awareness during surgery, through to foetal and maternal risks of complications. SUMMARY:This review will outline the different stages of a general anaesthetic and highlight the risks. This summary will allow a better understanding of anaesthetic risks. This will allow obstetricians to have a more informed conversation with an anaesthetist as to form of anaesthetic required (general anaesthetic versus spinal or epidural top-up). The review will also allow obstetricians to give more informed consent to mothers and be aware of the postoperative risks.

背景与目标：

BACKGROUND & AIMS: :Vitellogenin (Vtg), a yolk nutrient protein that is synthesized in the livers of female animals, and subsequently carried into the ovary, contributes to vitellogenesis in oviparous animals. Thus, Vtg levels are elevated during oogenesis. In contrast, Vtg proteins have been genetically lost in viviparous mammals, thus the yolk protein is not involved in their oogenesis and embryonic development. In this study, we identified Vtg protein in the livers of females during the gestation of the viviparous teleost, Xenotoca eiseni Although vitellogenesis is arrested during gestation, biochemical assays revealed that Vtg protein was present in ovarian tissues and lumen fluid. The Vtg protein was also detected in the trophotaeniae of the intraovarian embryo. Immunoelectron microscopy revealed that Vtg protein is absorbed into intracellular vesicles in the epithelial cells of the trophotaeniae. Furthermore, extraneous Vtg protein injected into the abdominal cavity of a pregnant female was subsequently detected in the trophotaeniae of the intraovarian embryo. Our data suggest that the yolk protein is one of the matrotrophic factors supplied from the mother to the intraovarian embryo during gestation in X. eiseni.

背景与目标： 卵黄蛋白原 (Vtg) 是一种卵黄营养蛋白，在雌性动物的肝脏中合成，随后被带入卵巢，有助于卵生动物的卵黄发生。因此，卵子发生过程中Vtg水平升高。相反，Vtg蛋白在胎生哺乳动物中已在遗传上丢失，因此卵黄蛋白不参与其卵子发生和胚胎发育。在这项研究中，我们在胎生硬骨鱼的妊娠过程中鉴定了雌性肝脏中的Vtg蛋白，Xenotoca eiseni尽管在妊娠过程中阻止了卵黄发生，但生化分析表明Vtg蛋白存在于卵巢组织和腔液中。在卵巢内胚胎的滋养细胞中也检测到Vtg蛋白。免疫电子显微镜显示，Vtg蛋白被吸收到滋养细胞上皮细胞的胞内囊泡中。此外，随后在卵巢内胚胎的滋养细胞中检测到注入怀孕女性腹腔的多余Vtg蛋白。我们的数据表明，卵黄蛋白是在X. eiseni妊娠期间从母亲向卵巢内胚胎提供的基质营养因子之一。

BACKGROUND & AIMS: :Parent-offspring recognition is crucial for offspring survival. At long distances, this recognition is mainly based on vocalizations. Because of maturation-related changes to the structure of vocalizations, parents have to learn successive call versions produced by their offspring throughout ontogeny in order to maintain recognition. However, because of the difficulties involved in following the same individuals over years, it is not clear how long this vocal memory persists. Here, we investigated long-term vocal recognition in goats. We tested responses of mothers to their kids' calls 7-13 months after weaning. We then compared mothers' responses to calls of their previous kids with their responses to the same calls at five weeks postpartum. Subjects tended to respond more to their own kids at five weeks postpartum than 11-17 months later, but displayed stronger responses to their previous kids than to familiar kids from other females. Acoustic analyses showed that it is unlikely that mothers were responding to their previous kids simply because they confounded them with the new kids they were currently nursing. Therefore, our results provide evidence for strong, long-term vocal memory capacity in goats. The persistence of offspring vocal recognition beyond weaning could have important roles in kin social relationships and inbreeding avoidance.

背景与目标： : 父母-后代的识别对于后代的生存至关重要。在长距离下，这种识别主要基于发声。由于发声结构与成熟相关的变化，父母必须在整个个体发育过程中学习其后代产生的连续通话版本，以保持认可。但是，由于多年来跟踪同一个人所涉及的困难，因此尚不清楚这种声音记忆会持续多长时间。在这里，我们调查了山羊的长期声音识别。我们测试了断奶后7-13个月母亲对孩子的电话的反应。然后，我们将母亲对以前孩子的电话的反应与产后五周对相同电话的反应进行了比较。与11-17个月后相比，受试者在产后五周对自己的孩子的反应更多，但对以前的孩子的反应比对其他女性熟悉的孩子的反应更强。声学分析表明，母亲们不太可能对以前的孩子做出反应，仅仅是因为他们将他们与目前正在护理的新孩子混淆了。因此，我们的结果为山羊具有强大的长期声音记忆能力提供了证据。断奶后后代声音识别的持续存在可能在亲属社会关系和避免近亲繁殖中起重要作用。