Facilitating coordination between medical and educational systems to improve access to pediatric therapies for preschool children with developmental delays and disabilities.

INTRODUCTION: A large portion of preschool-age children with developmental delays and disabilities (PCw/DD) do not receive recommended therapeutic services, including legally mandated school-based therapies. This study examines the feasibility of a community-clinical linkage using virtual patient navigation and a medical-educational care plan called Preschool and Me (PreM) to connect clinical settings serving historically marginalized communities with early childhood special education (ECSE) services. METHOD: Parents of PCw/DD attending an urban pediatric clinic from January to March 2022 were enrolled to receive PreM which included navigation support for ECSE, overcoming barriers accessing ECSE, and health care provider communication. Families completed measures of demographics and indicators of feasibility at baseline and 4-month follow-up. RESULTS: Of the 34 families referred, 30 were eligible and enrolled. Most parents identified as mothers (97%). Most participant children (70% male, 60% Black, 30% Hispanic) were enrolled in public health insurance (93%) and were not receiving any clinic-based therapies (93%). Parents overwhelmingly found PreM acceptable with the majority stating it would be a strong reason to continue care at the clinic. Among families who received PreM, 26 (96%) completed an individualized education plan (IEP) evaluation (96%). Of these, 24 (92%) children were eligible for an IEP. Nineteen children enrolled in an ECSE program; two families awaited school assignments and three families did not consent to the assigned school placement due to neighborhood safety concerns. DISCUSSION: Our findings suggest PreM was feasible, acceptable, and demonstrated promise in supporting families to navigate the ECSE process. Future studies examining effectiveness are warranted. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Use of non-steroidal anti-inflammatory drugs in pregnancy and oligohydramnios: a review.

OBJECTIVE: The aim of this review is to evaluate the relationship between the use of non-steroidal anti-inflammatory drugs (NSAIDs) during last trimesters of the pregnancy and the reduction of amniotic fluid. METHODS: Electronic databases were searched (PubMed, Medline, and Scopus). Selection criteria included studies reporting the relationship between oligohydramnios and use of NSAID during pregnancy. We analyzed the median age of women, weeks of pregnancy at the beginning of the drug administration, kind of medication, period of exposure and dosage, deepest vertical pocket (DVP), and amniotic fluid index (AFI). RESULTS: Of the 68 records identified, we analyzed 29 studies investigating the administration of NSAIDs, including 11 studies examined the administration of the Indomethacin, four articles have focused on the use of Nimesulide, and only two manuscripts considered the use of Diclofenac. We found a strict correlation between the development of oligohydramnios and the use of NSAIDs. The oligohydramnios is reversible, and the normal amount of amniotic fluid is restored after the interruption of the treatment. CONCLUSIONS: The use of NSAIDs should be considered when maternal benefits outweigh the potential fetal risk, at the lowest effective dose for shortest duration. Beyond 48 h of NSAIDs treatment, we consider ultrasound monitoring of amniotic fluid, and we suggest stopping therapy if a decline AFI is present.

Creating Connections: A Feasibility Study of a Technology-Based Intervention to Support Mothers of Newborns during Pediatric Well-Visits.

Objective: Intervention in the earliest period of parenthood can make a strong, positive impact on parenting, yet engaging parents of newborns in parenting interventions can be difficult. Technological adaptation of important interventions can improve early engagement. This study reports the initial feasibility of the Creating Connections intervention, a technology-based intervention developed to support mothers of newborns, and feasibility of evaluating the intervention through a randomized clinical trial in pediatric primary care. The intervention includes: 1) a brief tablet-based intervention delivered during a newborn well-child pediatric check-up, and 2) tailored text messages delivered thereafter to boost intervention content. Intervention content includes empirically-supported aspects of parenting behaviors known to positively influence children's social-emotional development. Methods: Project recruitment took place in an ambulatory care pediatric clinic in a large Midwestern city. Mothers received information about infant soothing, book sharing, or both. Results: One hundred and three parents learned about the program and 72 participated. Mothers were primarily Black/African American with incomes at or below $30,000. Only 50% of mothers that received text messages through the program completed follow-up, but these mothers gave overall positive ratings of text messages. Conclusions: Program engagement and ratings of parents support feasibility, but retention rates need improvement. Based on barriers and successes of this investigation, lessons learned about feasibility and acceptability are discussed.

Pregnancy and post-partum outcomes of obese women after bariatric surgery: A case-control study.

INTRODUCTION: Bariatric surgery (BS) is known to reduce several obesity-related complications during pregnancy, but there is concern that it may increase the risk of maternal-fetal morbidity because of the malabsorption. This study aimed to investigate the impact of restrictive BS on several pregnancy outcomes in comparison with different grades of obesity. MATERIALS AND METHODS: A single-center retrospective case-control study. All primiparous singleton pregnant women who underwent BS between the previous 1-5 years or with body mass index (BMI) ≥ 30 kg/m2 delivering in our center were included. Obstetric and perinatal outcomes were analyzed and compared between the two groups. RESULTS: Overall, 90 women were included: 30 underwent BS and 60 were obese. The mean pre-pregnancy BMI was 31.0 ± 4.2 kg/m2 in the BS group and 38.1 ± 4.3 kg/m2 in the control group (p < 0.001). The obese group experienced higher rate of fetal macrosomia (25% vs 6.7%; p = 0.049), gestational hypertension (23.3% vs 3.3%; p = 0.04), preeclampsia (23.3% vs 0%; p = 0.04), gestational diabetes (33.3% vs 6.7%; p = 0.01), and cesarean section (68.3% vs 20%; p < 0.0001). The BS group showed higher frequency of small for gestational age (SGA) (46.7% vs 18.3%; p = 0.006), late preterm delivery (PTD) (33.3% vs 10%; p = 0.009), cholestasis (13.3% vs 1.7%; p = 0.049). Breastfeeding ≥ 6 months was higher among BS mothers (36.7% vs 11.7%; p = 0.007). CONCLUSIONS: Our findings support the positive impact of BS on several obstetric outcomes, at the expense of a higher frequency of SGA and PTD. BS mothers more frequently achieved the recommended goal of breastfeeding for 6 months compared to obese women.