The Effects of Maternal Iron and Folate Supplementation on Pregnancy and Infant Outcomes in Africa: A Systematic Review.

BACKGROUND: Iron and folate deficiency are prevalent in pregnant women in Africa. However, limited research exists on the differential effect of oral iron-only, folate-only, or Iron Folic Acid (IFA) supplementation on adverse pregnancy and infant outcomes. This systematic review addresses this gap, focusing on studies conducted in Africa with limited healthcare access. Understanding these differential effects could lead to more targeted and potentially cost-effective interventions to improve maternal and child health in these settings. METHODS: A systematic review was conducted following PRISMA guidelines. The primary exposures were oral iron-only, folate-only, or IFA oral supplementation during pregnancy, while the outcomes were adverse pregnancy and infant outcomes. A qualitative synthesis guided by methods without meta-analysis was performed. RESULTS: Our qualitative synthesis analysed 10 articles reporting adverse pregnancy (adverse birth outcomes, stillbirths, and perinatal mortality) and infant outcomes (neonatal mortality). Consistently, iron-only supplementation demonstrated a reduction in perinatal death. However, evidence is insufficient to assess the relationship between iron-only and IFA supplementation with adverse birth outcomes, stillbirths, and neonatal mortality. CONCLUSION: Findings suggested that iron-only supplementation during pregnancy may reduce perinatal mortality in African women. However, evidence remains limited regarding the effectiveness of both iron-only and IFA supplementation in reducing stillbirths, and neonatal mortality. Moreover, additional primary studies are necessary to comprehend the effects of iron-only, folate-only, and IFA supplementation on pregnancy outcomes and infant health in the African region, considering rurality and income level as effect modifiers.

Infant, Neonatal, and Post-neonatal Mortality in Greece: A Nationwide Time-Trend Analysis.

INTRODUCTION: Infant mortality is a crucial perinatal measure and is also regarded as an important public health indicator. This study aimed to comprehensively present time trends in infant, neonatal, and post-neonatal mortality in Greece. METHODS: The annual infant mortality rate (IMR), the neonatal mortality rate (NMR), and the post-neonatal mortality rate (PNMR) were calculated based on official national data obtained from the Hellenic Statistical Authority, spanning 67 years from 1956 to 2022. The time trends of the mortality rates were evaluated using joinpoint regression analysis, and the annual percent changes (APC) and the overall average annual percent change (AAPC) were calculated with a 95% confidence interval (95% CI). RESULTS: The IMR exhibited accelerating declines over more than 50 years, with an APC of -1.9 (-2.8 to -1.0) from 1956 to 1968, -5.4 (-5.6 to -5.2) from 1968 to 1999, and -7.3 (-8.9 to -5.7) between 1999 and 2008. In 2008, IMR reached its all-time low of 2.7 per 1,000 live births, down 16.6-fold from its peak at 44.1 per 1,000 live births in 1957. This improving trend was reversed following the onset of the economic crisis in the country, leading to a 57% increase in IMR from 2008 to 2016, with an upward trend APC of 3.4 (1.2 to 5.5). In the recent period 2016-2022, there was an improvement with an APC of -3.7 (-6.2 to -1.1), resulting in an IMR of 3.1 per 1,000 live births in 2022. The decrease in IMR was estimated to have prevented 209,109 infant deaths in the country from 1958 to 2022. From 1956 to 2022, the IMR decreased with an AAPC of -3.9 (-4.3 to -3.4), while the PNMR saw a decline with an AAPC of -4.5 (-5.1 to -3.9) and the NMR with an AAPC of -3.2 (-3.7 to -2.6). CONCLUSION: Greece achieved an impressive decrease in infant mortality rates, but this progress was halted and completely reversed during the economic crisis. Although there have been some recent improvements after the country's economic recovery, the rates have yet to reach pre-crisis levels.

Factors affecting antenatal care attendance in Soweto, Johannesburg: The three-delay model.

BACKGROUND:  Antenatal care remains critical for identifying and managing complications contributing to maternal and infant mortality, yet attendance among women in South Africa persists as a challenge. AIM:  This study aimed to understand the challenges faced by women attending antenatal care in Soweto, Johannesburg, using the three-delay model. SETTING:  This study was conducted in Soweto, Johannesburg. METHODS:  An exploratory, descriptive and qualitative research design was used, and in-depth interviews were conducted with 10 pregnant women and four women who had recently given birth. RESULTS:  Findings indicate delays in seeking care due to factors such as pregnancy unawareness, waiting for visible signs, and fear of human immunodeficiency virus (HIV) testing. Challenges such as transportation difficulties, distance to clinics, and facility conditions further impeded the initiation of antenatal care. Late initiation often occurred to avoid long waits, inadequate facilities, language barriers and nurse mistreatment. CONCLUSION:  From this study, we learn that challenges such as unawareness of pregnancy, cultural notions of keeping pregnancy a secret, fear of HIV testing, long waiting lines, high cost of transportation fees, clinic demarcation, shortage of essential medicines, broken toilets and verbal abuse from nurses have delayed women from initiating antenatal care early in Soweto, Johannesburg.Contribution: Challenges of women with antenatal care attendance in South Africa must be addressed by implementing community-based health education interventions, institutionalising HIV psycho-social support services and improving quality of antenatal care services in public health facilities.

Infant and child mortality in Afghanistan: A scoping review.

Background and Aims: Since 1990, global child and infant mortality rates have typically stabilized or decreased due to improved healthcare, vaccination rollouts, and international funding. However, Afghanistan continues to face the highest child and infant mortality rates globally, with 43 deaths per 1000 live births. This study aims to examine the factors contributing to this high mortality rate and propose interventions to address the issue. Methods: A comprehensive literature search was conducted using databases such as Google Scholar and PubMed, focusing on articles published in English within the last 10 years (2013-2023). The search terms included "Child mortality," "Infant mortality," "SIDS," "COVID-19," and "Afghanistan." Original studies, systematic reviews, case studies, and reports meeting the inclusion criteria were selected for analysis. Additional sources from organizations such as UNICEF, the World Bank Group, WHO, and EMRO were also reviewed. Results: The study findings reveal significant challenges contributing to Afghanistan's high infant and child mortality rates. These challenges include birth defects, preterm birth, malnutrition, sudden infant death syndrome (SIDS), traumatic injuries, fatal infections, infanticide, and abuse. The ongoing conflict, insecurity, and humanitarian crises further exacerbate the situation, leading to increased child casualties. Despite efforts by international agencies like UNICEF to provide vaccines and maternal education, the infant mortality rate remains high. Conclusion: In conclusion, Afghanistan's child and infant mortality rates are of significant concern, and it is imperative that action be taken to reduce the incidence of child and infant mortality rates.

Association between risk of infant death and birth-weight z scores according to gestational age: A nationwide study using the Finnish Medical Birth Register.

OBJECTIVE: To investigate the association between infant mortality and birth weight using estimated fetal weight (EFW) versus birth-weight charts, by gestational age (GA). METHODS: This nationwide population-based study used data from the Finnish Medical Birth Register from 2006 to 2016 on non-malformed singleton live births at 24-41+6 weeks of gestation (N = 563 630). The outcome was death in the first year of life. Mortality risks by birth-weight z score, defined as a continuous variable using Marsál's EFW and Sankilampi's birth-weight charts, were assessed using generalized additive models by GA (24-27+6, 28-31+6, 32-36+6, 37-38+6, 39-41+6 weeks). We calculated z score thresholds associated with a two- and three-fold increased risk of infant death compared with newborns with a birth weight between 0 and 0.675 standard deviations. RESULTS: The z score thresholds (with corresponding centiles in parentheses) associated with a two-fold increase in infant mortality were: -3.43 (<0.1) at 24-27+6 weeks, -3.46 (<0.1) at 28-31+6 weeks, -1.29 (9.9) at 32-36+6 weeks, -1.18 (11.9) at 37-38+6 weeks, and - 1.34 (9.0) at 39-41+6 weeks according to the EFW chart. These values were - 2.43 (0.8), -2.62 (0.4), -1.34 (9.0), -1.37 (8.5), and - 1.43 (7.6) according to the birth-weight chart. CONCLUSION: The association between birth weight and infant mortality varies by GA whichever chart is used, suggesting that different thresholds for the screening of growth anomalies could be used across GA to identify high-risk newborns.

Characteristics of patients admitted to the intensive care unit during the 2019 measles epidemic in Samoa: A retrospective clinical case series.

Our report describes the characteristics of patients admitted to the intensive care unit of the National Hospital of Samoa during the 2019-2020 measles epidemic. The study design was a retrospective review of clinical records; the age range was 2 months to 51 years, with the majority of cases in the 2-23 month age group (71%). Vaccination status was unknown or unrecorded for 17 (24%). Of the 54 (75%) who were not fully vaccinated, 35 (65%) did not survive. Almost all (98%) presented with multiple complications on admission, mostly pneumonia (91%). The mortality rate was 61%, implying a low survival rate particularly among young infants and toddlers, even when optimal care was available and administered.

Planning, Implementation, and Evaluation of a Postpartum Nurse Home Visit Service to Improve Health Equity.

OBJECTIVE: To describe how a college of nursing and urban academic medical center partnered with the local health department to plan, implement, and evaluate a universal nurse home visit service to improve health equity in the postpartum period. DESIGN: Evidence-based practice. SETTING/LOCAL PROBLEM: Wide health disparity in rates of maternal and infant morbidity and mortality in Chicago, Illinois. PATIENTS: All patients who gave birth at the medical center and lived in Chicago. INTERVENTION/MEASUREMENTS: A nurse home visit was offered after birth to all eligible patients beginning in March 2020. We used data from a Web-based platform to determine key performance indicators for the program and examined patient demographics to determine equitable delivery of the service for all visits provided in 2022. RESULTS: There were 1,488 patients eligible for a home visit and 714 who received a home visit. The average contact rate was 76%, the scheduling rate was 63%, the completion rate for scheduled visits was 76%, and the population reach was 48%. Sixty-eight percent of families visited were from high-economic-hardship zip code areas of the city. Eighty-one percent of visits resulted in at least one referral to meet a family's need, and 98% of patients surveyed rated their visit as "very helpful." CONCLUSION: The successful implementation of this public-private partnership was due in part to an organizational culture that supports health equity initiatives, the inclusion of system-wide stakeholders, having a process in place to monitor outcomes, and hiring a diverse team of nurses who prioritize respectful patient-centered care.

Social Determinants of Health Among American Indians and Alaska Natives and Tribal Communities: Comparison with Other Major Racial and Ethnic Groups in the United States, 1990-2022.

Background and Objective: Limited research exists on health inequities between American Indians and Alaska Natives (AIANs), tribal communities, and other population groups in the United States. To address this gap in research, we conducted time-trend analyses of social determinants of health and disease outcomes for AIANs as a whole and specific tribal communities and compared them with those from the other major racial/ethnic groups. Methods: We used data from the 1990-2022 National Vital Statistics System, 2015-2022 American Community Survey, and the 2018-2020 Behavioral Risk Factor Surveillance System to examine socioeconomic, health, disability, disease, and mortality patterns for AIANs. Results: In 2021, life expectancy at birth was 70.6 years for AIANs, lower than that for Asian/Pacific Islanders (APIs) (84.1), Hispanics (78.8), and non-Hispanic Whites (76.3). All racial/ethnic groups experienced a decline in life expectancy between the pre-pandemic year of 2019 and the peak pandemic year of 2021. However, the impact of COVID-19 was the greatest for AIANs and Blacks whose life expectancy decreased by 6.3 and 5.8 years, respectively. The infant mortality rate for AIANs was 8.5 per 1,000 live births, 78% higher than the rate for non-Hispanic Whites. One in five AIANs assessed their physical and mental health as poor, at twice the rate of non-Hispanic Whites or the general population. COVID-19 was the leading cause of death among AIANs in 2021. Risks of mortality from alcohol-related problems, drug overdose, unintentional injuries, and homicide were higher among AIANs than the general population. AIANs had the highest overall disability, mental and ambulatory disability, health uninsurance, unemployment, and poverty rates, with differences in these indicators varying markedly across the AIAN tribes. Conclusion and Global Health Implications: AIANs remain a disadvantaged racial/ethnic group in the US in many health and socioeconomic indicators, with poverty rates in many Native American tribal groups and reservations exceeding 40%.

The impact of a reproductive health voucher in Uganda using a quasi-experimental matching design.

This study assesses the impact of a voucher project that targeted vulnerable and poor pregnant women in Uganda. Highly subsidised vouchers gave access to a package of safe delivery services consisting of four antenatal visits, safe delivery, one postnatal visit, the treatment and management of selected pregnancy-related medical conditions and complications, and emergency transport. Vouchers were sold during the project's operational period from 2016 to 2019. This study covers 8 out of 25 project-benefiting districts in Uganda and a total of 1,881 pregnancies, including both beneficiary and non-beneficiary mothers. Using a matching design, the results show a positive effect on the survival of new-born babies. The difference in the survival rate between the control group and the treatment group is 5.4% points, indicating that the voucher project reduced infant mortality by more than 65 per cent.

Timing of infant mortality in French Guiana: The persistence of high post neonatal mortality.

BACKGROUND: Infant mortality in French Guiana, a French overseas territory, is 2.7 times greater than in mainland France. Given the importance of better understanding infant mortality we aimed to describe the early & late neonatal, and postneonatal mortality in French Guiana between 2007 and 2022. METHODS: We used data from the Institut National de la Statistique et des Etudes Economiques to describe trends and performed survival analysis. RESULTS: Overall, there were 1 073 deaths before one year of age, of which 297 (27.7 %) occurred on the first day of life. The overall proportion of early neonatal deaths was 47.1 %, late neonatal deaths was 17.3 %, and post-neonatal deaths was 35.6 %. The overall incidences were 4.6 per 1,000 for early neonatal mortality, 1.4 per 1,000 for late neonatal mortality, and 3.1 per 1,000 for post neonatal mortality. The incidence for infant mortality for French Guiana residents was thus 9.1 per 1,000. CONCLUSIONS: We show that post neonatal deaths in French Guiana are proportionally greater than in mainland France and they do not seem to decline, as they did in France. The relative proportions of post-neonatal mortality can thus help to identify important areas for action to correct excess infant mortality. Although poor pregnancy follow-up remains a problem we show that follow-up of infants is also a pressing problem that warrants increased efforts.

Infant mortality and social causality: Lessons from the history of Britain's public health movement, c. 1834-1914.

What are the historical conditions under which a sociologically informed understanding of health inequality can emerge in the public sphere? We seek to address this question through the lens of a strategically chosen historical puzzle-the stubborn persistence of and salient variation in high infant mortality rates across British industrial towns at the dawn of the previous century-as analysed by Arthur Newsholme, the Medical Officer of the Local Government Board. In doing so, we retrace the historical processes through which the evolving public health movement gradually helped crystallise a scientific understanding of the social causes of excess mortality. We map the dominant ideology of the public sphere at the time, chart the shifting roles of the state, and retrace the historical origins and emergence of 'public health' as a distinctive category of state policy and public discourse. We situate the public health movement in this historical configuration and identify the cracks in the existing ideological and administrative edifice through which this movement was able to articulate a novel approach to population health-one that spotlights the political economy of social inequality. We relate this historical sequence to the rise of industrial capitalism, the social fractures that it spawned, and the organised counter-movements that it necessitated.

Trends in maternal and child health in China and its urban and rural areas from 1991 to 2020: a joinpoint regression model.

The long-term trends in maternal and child health (MCH) in China and the national-level factors that may be associated with these changes have been poorly explored. This study aimed to assess trends in MCH indicators nationally and separately in urban and rural areas and the impact of public policies over a 30‒year period. An ecological study was conducted using data on neonatal mortality rate (NMR), infant mortality rate (IMR), under-five mortality rate (U5MR), and maternal mortality ratio (MMR) nationally and separately in urban and rural areas in China from 1991 to 2020. Joinpoint regression models were used to estimate the annual percentage changes (APC), average annual percentage changes (AAPC) with 95% confidence intervals (CIs), and mortality differences between urban and rural areas. From 1991 to 2020, maternal and child mortalities in China gradually declined (national AAPC [95% CI]: NMRs - 7.7% [- 8.6%, - 6.8%], IMRs - 7.5% [- 8.4%, - 6.6%], U5MRs - 7.5% [- 8.5%, - 6.5%], MMRs - 5.0% [- 5.7%, - 4.4%]). However, the rate of decline nationally in child mortality slowed after 2005, and in maternal mortality after 2013. For all indicators, the decline in mortality was greater in rural areas than in urban areas. The AAPCs in rate differences between rural and urban areas were - 8.5% for NMRs, - 8.6% for IMRs, - 7.7% for U5MRs, and - 9.6% for MMRs. The AAPCs in rate ratios (rural vs. urban) were - 1.2 for NMRs, - 2.1 for IMRs, - 1.7 for U5MRs, and - 1.9 for MMRs. After 2010, urban‒rural disparity in MMR did not diminish and in NMR, IMR, and U5MR, it gradually narrowed but persisted. MCH indicators have declined at the national level as well as separately in urban and rural areas but may have reached a plateau. Urban‒rural disparities in MCH indicators have narrowed but still exist. Regular analyses of temporal trends in MCH are necessary to assess the effectiveness of measures for timely adjustments.

Mediation Analysis of Racial Disparity for Infant Mortality Using Bayesian Estimation of Potential Outcomes.

Background/Objectives: While the overall rate of infant mortality in the United States has been decreasing over decades, the racial disparity, defined as the difference between races, has increased. Even though a person's race cannot change, it may be possible to identify factors that mediate or cause this racial disparity. Evaluating the factors that mediate or cause racial disparity is imperative because current clinical recommendations could be based on preventative modalities that are more effective for white women and their children. Methods: A Bayesian approach modeled the data from the full United States National Natality Database for the years 2016 to 2018. The binomial rate parameters for each combination of race and mediators provided the potential outcomes. Estimating the mediation outcomes, including total effect, controlled direct effect, mediated effect, and proportion mediated used common counterfactual definitions for these probabilities. Results: Maternal smoking, low birthweight, and teenage maternity interacted in causing racial disparity for infant mortality. The proportion of racial disparity attributable to low birthweight was approximately 0.73, with only small variations attributable to maternal smoking and teenage maternity. Conclusions: The novel approach facilitated modeling of multiple mediators. Low birthweight caused racial disparity for infant mortality. The model can be extended to evaluate additional mediational factors with the objective of identifying the preventable causes.

Does oral iron and folate supplementation during pregnancy protect against adverse birth outcomes and reduced neonatal and infant mortality in Africa: A protocol for a systematic review and meta-analysis?

BACKGROUND: Globally, one-third of pregnant women are at risk of iron deficiency, particularly in the African region. While recent findings show that iron and folate supplementation can lower the risk of adverse birth outcomes and childhood mortality, our understanding of its impact in Africa remains incomplete due to insufficient evidence. This protocol outlines the systematic review steps to investigate the impact of oral iron and folate supplementation during pregnancy on adverse birth outcomes, neonatal mortality and infant mortality in Africa. METHODS AND ANALYSIS: MEDLINE, PsycINFO, Embase, Scopus, CINAHL, Web of Science, and Cochrane databases were searched for published articles. Google Scholar and Advanced Google Search were used for gray literature and nonindexed articles. Oral iron and/or folate supplementation during pregnancy is the primary exposure. The review will focus on adverse birth outcomes, neonatal mortality and infant mortality. Both Cochrane Effective Practice and Organization of Care and Newcastle-Ottawa Scale risk of bias assessment tools will be used. Meta-analysis will be conducted if design and data analysis methodologies permit. This systematic review and meta-analysis will provide up-to-date evidence about iron and folate supplementation's role in adverse birth outcomes, neonatal mortality and infant mortality in the African region. ETHICS AND DISSEMINATION: This review will provide insights that help policymakers, program planners, researchers, and public health practitioners interested in working in the region. PROSPERO REGISTRATION NUMBER: CRD42023452588.

Determinants of Neonatal, Infant and Child Mortalities in Iran: A Systematic Review.

Background: Children mortality is considered as one of the main indicators of population development and health, while most of the children's deaths are preventable. This study systematically reviewed the determinants of children mortality in Iran. Methods: This systematic review was conducted to summarize all the factors associated with children mortality in three age groups; Neonate (0-28 d), Infant (28 d-1 yr old) and children (<5 yr old), based on the PRISMA guideline. Many of the electronic international and national databases, in addition to hand searching of reference of selected articles, grey literature, formal and informal reports and government documents were screened to identify potential records up to Jan 2022. We included all studies that identified determinants of child mortality in any province of Iran or the whole country, without any restriction. Results: Overall, 32 studies were included, published between 2000 and 2022, of which 23 were cross-sectional and 15 published in Farsi language. The associations between several risk factors (n=69) and the child mortality were examined. Among the identified factors, 'birth weight', 'mother's literacy', 'socioeconomic status', 'delivery type', 'gestational age', 'pregnancy interval', 'immaturity', 'type of nutrition', and 'stillbirth' were the most important mentioned determinants of child mortality in Iran. Conclusion: Appropriate interventions and policies should be developed and implemented in Iran, addressing the main identified associated factors, resulting from this review study, with the aim of minimizing preventable child deaths, based on their age categories.

Maternal BCG scars and mortality risk for male and female newborns: observational study from Guinea-Bissau.

BACKGROUND: Maternal priming with Bacille Calmette-Guérin (BCG) has been associated with reduced mortality in male offspring. We investigated this association in a cohort of healthy BCG-vaccinated neonates. METHODS: Observational study within a randomized controlled trial comparing different BCG strains conducted in Guinea-Bissau from 2017-2020. As part of trial inclusion procedures, on the day of discharge from the maternity ward, maternal BCG scar status was evaluated by visual inspection, followed by offspring BCG and polio vaccination. Through mortality data collected at telephone interviews at six weeks and six months of age, we assessed all-cause mortality risk in Cox Proportional Hazards models adjusted for maternal schooling and BCG strain, providing adjusted Mortality Rate Ratios (aMRRs). RESULTS: 64% (11,070/17,275) of mothers had a BCG scar, which for females and overall was not associated with neither admission risk, admission severity nor all-cause mortality. By six months of age, the mortality rate (MR) was 4.1 (200 deaths/4,919 person-years) for the maternal BCG scar cohort and 5.2 (139 deaths/2,661 person-years) for no maternal scar, aMRR=0.86 (0.69-1.06). In males, six-month MRs were 4.3 (109/2,531) for maternal BCG scar vs 6.3 (87/1,376) for no scar, the maternal scar/no scar aMRR being 0.74 (0.56-0.99). In females, six-month MRs were 3.8 (91/2,388) vs 4.0 (52(1,286), the aMRR being 1.04 (0.74-1.47), p for interaction with sex=0.16. CONCLUSION: While we cannot rule out an association in females, being born to a mother with a BCG scar reduced the risk of death during early infancy for BCG-vaccinated males, reproducing findings from previous studies.

Infant mortality in Ghana: investing in health care infrastructure and systems.

Child and infant mortality is a global problem. Almost half of deaths of children under age 5 years occur in the neonatal period, the first 28 days of life, with 2.4 million neonatal deaths globally in 2020. Sub-Saharan Africa has disproportionately high numbers of neonatal deaths. Ghana's neonatal mortality rate is 22.8 per 1000 live births and remains behind targets set by the United Nations Sustainable Development Goals. Quality antenatal care, postnatal monitoring, breastfeeding support, and postnatal family planning are important in preventing neonatal deaths. While Ghana has made progress in making care more financially accessible, it has not been matched with the improvements in the critical infrastructure required to ensure quality health care. The improvements have also not eliminated out-of-pocket costs for care, which have hindered progress in decreasing infant mortality. Policymakers should consider investments in health care infrastructure, including expanding public-private partnerships. Policies that improve workforce development programs, transportation infrastructure, and health insurance systems improvements are needed.

Increases in drug-related infant mortality in the United States.

OBJECTIVES: We explored temporal trends in drug-related infant deaths in the United States (U.S.) from 2018 to 2022. METHODS: We used data from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (WONDER). A total of 295 drug-involved infant deaths were identified from 2018 to 2022 (provisional mortality data for year 2022) based on the underlying cause of death. RESULTS: In the U.S. from 2018 to 2022, there was a significant 2.2-fold increase in drug-involved infant mortality. The observed increases were higher in non-Hispanic White and Black infants. The findings show that drug-involved infant deaths were more likely to occur in the postneonatal period, defined as ages 28-364 days (81.4 %) compared to the neonatal period. The most prevalent underlying causes of death included assault (homicide) by drugs, medicaments and biological substances (35.6 %) followed by poisoning due to exposure to narcotics and psychodysleptics (hallucinogens) (15.6 %). The most common multiple causes of drug-involved infant deaths were psychostimulants with abuse potential of synthetic narcotics. CONCLUSIONS: Drug-related infant mortality has increased significantly from 2018 to 2022. These increases are particularly evident among White and Black infants and occurred predominantly in the postneonatal period. These findings require more research but also indicate the need to address drug-involved infant deaths as preventable clinical and public health issues. Effective strategies to reduce drug-involved infant deaths will require preventing and treating maternal substance use disorders, enhancing prenatal care access, and addressing broader social and behavioral risk factors among vulnerable maternal and infant populations.

Pumps: A Possible Tool to Promote More Equitable Lactation Outcomes.

Pregnant individuals and infants in the US are experiencing rising morbidity and mortality rates. Breastfeeding is a cost-effective intervention associated with a lower risk of health conditions driving dyadic morbidity and mortality, including cardiometabolic disease and sudden infant death. Pregnant individuals and infants from racial/ethnic subgroups facing the highest risk of mortality also have the lowest breastfeeding rates, likely reflective of generational socioeconomic marginalization and its impact on health outcomes. Promoting breastfeeding among groups with the lowest rates could improve the health of dyads with the greatest health risk and facilitate more equitable, person-centered lactation outcomes. Multiple barriers to lactation initiation and duration exist for families who have been socioeconomically marginalized by health and public systems. These include the lack of paid parental leave, increased access to subsidized human milk substitutes, and reduced access to professional and lay breastfeeding expertise. Breast pumps have the potential to mitigate these barriers, making breastfeeding more accessible to all interested dyads. In 2012, The Patient Protection and Affordable Care Act (ACA) greatly expanded access to pumps through the preventative services mandate, with a single pump now available to most US families. Despite their near ubiquitous use among lactating individuals, little research has been conducted on how and when to use pumps appropriately to optimize breastfeeding outcomes. There is a timely and critical need for policy, scholarship, and education around pump use given their widespread provision and potential to promote equity for those families facing the greatest barriers to achieving their personal breastfeeding goals.

Biochemical Abnormalities Associated With Sudden Infant Death Syndrome: A Case Report.

Sudden infant death is a complex event characterized by biochemical features that are difficult to understand in general settings. Herein, we present a case report of a three-month-old infant who succumbed to sudden infant death syndrome (SIDS), focusing on the biochemical abnormalities identified through post-mortem analysis. The infant, previously healthy and meeting developmental milestones, was found lifeless in the crib during sleep. An autopsy revealed no anatomical abnormalities or signs of external trauma, consistent with SIDS diagnosis. Biochemical analysis of SIDS continued after post-mortem samples revealed dysregulation in neurotransmitter pathways, particularly serotonin, within the brain stem. These findings suggest a potential disruption in serotonin signaling, which may contribute to the vulnerability of infants to sudden death during sleep. Furthermore, metabolic profiling revealed deficiencies in enzymes involved in mitochondrial energy metabolism, particularly those related to fatty acid oxidation. These metabolic disturbances may compromise cellular function and contribute to the pathogenesis of SIDS. Environmental factors were also explored, with analysis revealing elevated levels of nicotine metabolites in post-mortem samples, suggesting maternal smoking exposure during pregnancy. Nicotine and its derivatives have known effects on neurotransmitter systems, potentially exacerbating underlying biochemical vulnerabilities in susceptible infants. This case report underscores the complex interplay of biochemical factors in the pathogenesis of SIDS and highlights the importance of multidisciplinary approaches in unraveling its mysteries. Further research is warranted to elucidate the precise mechanisms underlying these biochemical abnormalities and to develop targeted interventions aimed at reducing the incidence of SIDS and safeguarding infant health.