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Neurodevelopmental status of HIV-exposed but uninfected children: A pilot study
P Springer, B Laughton, M Tomlinson, J Harvey, M Esser
South African Journal of Child Health , 2012,
Abstract: Introduction. HIV affects children both directly and indirectly, with evidence of increased infectious mortality and morbidity in the HIV-exposed but uninfected (HEU) infant. There is little published research on neurodevelopmental outcome of HEU infants in Africa. Following the introduction of successful prevention of mother-to-child transmission programmes, it has become important to determine whether differences exist between HEU infants and infants born to HIV-negative mothers in order to guide current management policies of this rapidly growing group of infants. Objectives. To compare the developmental outcome of infants exposed to HIV in utero who remained uninfected (HEU) with that of infants unexposed to HIV in utero (HUU). Methodology. This was a prospective, blinded, hospital-based study. Infants aged between 17 and 19 months were assessed on the Griffiths Mental Developmental Scales (GMDS). Birth history, previous hospitalisation, maternal and infant characteristics, antiretroviral exposure, anthropometric measurements and abnormal clinical findings were documented. Results. Of the original 55 infants enrolled at 2 weeks of age, 37 (17 HEU and 20 HUU) underwent neurological and developmental assessment. There were no significant differences between the groups with regard to the GMDS general quotient or other subscales, apart from the Personal/social subscale, where the HEU group performed significantly more poorly than the HUU participants (p=0.026). This difference is probably a result of cultural differences between the groups, as 76% of HEU and only 15% of HUU participants were of Xhosa origin. Discussion. There was no difference in neurodevelopmental outcome at 18 months between the HEU and HUU groups.
Low Birth Weight in Perinatally HIV-Exposed Uninfected Infants: Observations in Urban Settings in Cameroon  [PDF]
Casimir Ledoux Sofeu, Josiane Warszawski, Francis Ateba Ndongo, Ida Calixte Penda, Suzie Tetang Ndiang, Georgette Guemkam, Nicaise Makwet, Félicité Owona, Anfumbom Kfutwah, Patrice Tchendjou, Ga?tan Texier, Maurice Tchuente, Albert Faye, Mathurin Cyrille Tejiokem, The ANRS-PEDIACAM study group
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0093554
Abstract: Background The consequences of maternal HIV infection for fetal growth are controversial. Here, we estimated the frequency of small for gestational age and gender (SGAG) among neonates born to HIV-infected or uninfected mothers and assessed the contribution, if any, of maternal HIV to the risk of SGAG. Methods The data used were obtained from the ANRS-Pediacam cohort in Cameroon. Pairs of newborns, one to a HIV-infected mother and the other to an uninfected mother, were identified during the first week of life, and matched on gender and recruitment site from 2007–2010. SGAG was defined in line with international recommendations as a birth weight Z-score adjusted for gestational age at delivery and gender more than two standard deviations below the mean (?2SD). Considering the matched design, logistic regression modeling was adjusted on site and gender to explore the effect of perinatal HIV exposure on SGAG. Results Among the 4104 mother-infant pairs originally enrolled, no data on birth weight and/or gestational age were available for 108; also, 259 were twins and were excluded. Of the remaining 3737 mother-infant pairs, the frequency of SGAG was 5.3% (95%CI: 4.6–6.0), and was significantly higher among HIV-infected infants (22.4% vs. 6.3%; p<.001) and lower among HIV-unexposed uninfected infants (3.5% vs. 6.3%; p<.001) than among HIV-exposed uninfected infants. Similarly, SGAG was significantly more frequent among HIV-infected infants (aOR: 4.1; 2.0–8.1) and less frequent among HIV-unexposed uninfected infants (aOR: 0.5; 0.4–0.8) than among HIV-exposed uninfected infants. Primiparity (aOR: 1.9; 1.3–2.7) and the presence of any disease during pregnancy (aOR: 1.4; 1.0–2.0) were identified as other contributors to SGAG. Conclusion Maternal HIV infection was independently associated with SGAG for HIV-exposed uninfected infants. This provides further evidence of the need for adapted monitoring of pregnancy in HIV-infected women, especially if they are symptomatic, to minimize additional risk factors for SGAG.
Cotrimoxazole Prophylaxis and Risk of Severe Anemia or Severe Neutropenia in HAART-Exposed, HIV-Uninfected Infants  [PDF]
Scott Dryden-Peterson, Oluwemimo Jayeoba, Michael D. Hughes, Haruna Jibril, Kenneth McIntosh, Taolo A. Modise, Aida Asmelash, Kathleen M. Powis, Max Essex, Roger L. Shapiro, Shahin Lockman
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0074171
Abstract: Background Prophylactic cotrimoxazole is recommended for infants born to HIV-infected mothers. However, cotrimoxazole may increase the risk of severe anemia or neutropenia. Methods We compared the proportion of HIV-exposed uninfected (HIV-EU) infants experiencing incident severe anemia (and separately, severe neutropenia) between a prospective cohort receiving prophylactic cotrimoxazole from 1 to 6 months vs. infants from two prior trials who did not receive cotrimoxazole. Infants were from rural and urban communities in southern Botswana. Results A total of 1705 HIV-EU infants were included. Among these 645 (37.8%) were fed with iron-supplemented formula from birth. Severe anemia developed in 87 (5.1%) infants, and severe neutropenia in 164 (9.6%) infants. In an analysis stratified by infant feeding method, there were no significant differences in the risk of severe anemia by prophylactic cotrimoxazole exposure–risk difference, ?0.69% (95% confidence interval [CI] ?2.1 to 0.76%). Findings were similar in multivariable analysis, adjusted odds ratio (aOR) 0.35 (95% CI 0.07 to 1.65). There were also no significant differences observed for severe neutropenia by cotrimoxazole exposure, risk difference 2.0% (95% CI ?1.3 to 5.2%) and aOR 0.80 (95% CI 0.33 to 1.93). Conclusions Severe anemia and severe neutropenia were infrequent among HIV-exposed uninfected infants receiving cotrimoxazole from 1–6 months of age. Concerns regarding hematologic toxicity should not limit the use of prophylactic cotrimoxazole in HIV-exposed uninfected infants. ClinicalTrials.gov Registration Numbers NCT01086878 (http://clinicaltrials.gov/show/NCT010868?78), NCT00197587 (http://clinicaltrials.gov/show/NCT001975?87), and NCT00270296 (http://clinicaltrials.gov/show/NCT002702?96).
Outcome of HIV-exposed uninfected children undergoing surgery
Jonathan S Karpelowsky, Alastair JW Millar, Nelleke van der Graaf, Guido van Bogerijen, Heather J Zar
BMC Pediatrics , 2011, DOI: 10.1186/1471-2431-11-69
Abstract: A prospective study of children less than 60 months of age undergoing general surgery at a paediatric referral hospital from July 2004 to July 2008 inclusive. Children underwent age-definitive HIV testing and were followed up post operatively for the development of complications, length of stay and mortality.Three hundred and eighty children were enrolled; 4 died and 11 were lost to follow up prior to HIV testing, thus 365 children were included. Of these, 38(10.4%) were HIVe, 245(67.1%) were HIVn and 82(22.5%) were HIVi children.The overall mortality was low, with 2(5.2%) deaths in the HIVe group, 0 in the HIVn group and 6(7.3%) in the HIVi group (p = 0.0003). HIVe had a longer stay than HIVn children (3 (2-7) vs. 2 (1-4) days p = 0.02). There was no significant difference in length of stay between the HIVe and HIVi groups. HIVe children had a higher rate of complications compared to HIVn children, (9 (23.7%) vs. 14(5.7%) (RR 3.8(2.1-7) p < 0.0001) but a similar rate of complications compared to HIVi children 34 (41.5%) (RR = 0.6 (0.3-1.1) p = 0.06).HIVe children have a higher risk of developing complications and mortality after surgery compared to HIVn children. However, the risk of complications is lower than that of HIVi children.HIV-exposed uninfected (HIVe) children are a rapidly growing population. Programs for the prevention of mother to child transmission (PMTCT) have reduced the transmission rate of perinatal HIV infection to approximately 2% to 5% [1-3]. Such programs have therefore effectively reduced the number of HIV infected (HIVi)children but identified an increasing population of HIVe children [4].HIVe children have been overlooked as a group of children who may be at an increased risk of illness compared to HIV-unexposed (HIVn) children. Recently, increased morbidity and mortality in HIVe children compared to HIVn children has been reported [4-10]. Many factors may account for this including innate deficiencies in immunity [11-13], feeding practice
Investigation on Thermophysical Properties of Thymic Cell Cultures Exposed to Electromagnetic Fields  [cached]
Federico Rossi,Andrea Nicolini
Environment and Pollution , 2012, DOI: 10.5539/ep.v2n1p11
Abstract: The paper deals with an investigation of the possible effects of RF electromagnetic fields towards the environment and human health. An experimental facility was designed and built and in vitro experiments were carried out on thymic cell cultures. They were exposed for three and six hours to 144 MHz RF electromagnetic fields. The effects were analysed in terms of the possible variation of their thermophysical properties (density, viscosity, specific heat). Results showed that the tested configuration does not induce alterations of the thermophysical properties of the tested cell cultures.
Growth in VLBW infants fed predominantly fortified maternal and donor human milk diets: a retrospective cohort study
Tarah T Colaizy, Susan Carlson, Audrey F Saftlas, Frank H Morriss Jr
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-124
Abstract: Retrospective cohort study.171 infants with median gestational age 27 weeks (IQR 25.4, 28.9) and median birthweight 899 g (IQR 724, 1064) were included. 97% of infants received human milk, 51% received > 75% of all enteral intake as human milk. 16% of infants were small-for-gestational age (SGA, < 10th percentile) at birth, and 34% of infants were SGA at discharge. Infants fed >75% human milk had a greater negative change in weight z-score from birth to discharge compared to infants receiving < 75% (?0.6 vs, -0.4, p = 0.03). Protein and caloric supplementation beyond standard human milk fortifier was related to human milk intake (p = 0.04). Among infants receiving > 75% human milk, there was no significant difference in change in weight z-score by milk type (donor ?0.84, maternal ?0.56, mixed ?0.45, p = 0.54). Infants receiving >75% donor milk had higher rates of SGA status at discharge than those fed maternal or mixed milk (56% vs. 35% (maternal), 21% (mixed), p = 0.08).VLBW infants can grow appropriately when fed predominantly fortified human milk. However, VLBW infants fed >75% human milk are at greater risk of poor growth than those fed less human milk. This risk may be highest in those fed predominantly donor human milk.Maternal milk diets have been associated with advantages for extremely low birthweight (ELBW) infants. ELBW infants fed maternal milk have lower rates of necrotizing enterocolitis (NEC) [1-3], the combined outcome of NEC or death [4], late onset sepsis [2,5,6], and have superior neurodevelopmental outcomes compared with those fed preterm formulas [7,8].However, maternal milk diets have also been associated with inferior in-hospital growth when compared with preterm formula. Studies performed prior to the current practice of human milk fortification demonstrated poorer growth in maternal–milk-fed infants compared with those fed formula [9], although neurodevelopmental advantages were associated with human milk intake [7,10]. Results of subsequent
Feasibility and safety of setting up a donor breastmilk bank in a neonatal prem unit in a resource limited setting: An observational, longitudinal cohort study
Irene Coutsoudis, Miriam Adhikari, Nadia Nair, Anna Coutsoudis
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-356
Abstract: Low birth weight infants < 1800 g and under 32 weeks gestational age were followed up in the NPU over a 3 week period; feeding data and morbidity data was collected in order to determine if there were any adverse events associated with donor breastmilk. Samples of pasteurized breastmilk were cultured to check for any bacterial contamination.191 infants met the inclusion criteria of whom 96 received their mother's own breastmilk. Of the 95 infants who were potentially eligible to receive donor milk, only 40 did in fact receive donor milk. There was no evidence of bacterial contamination in the samples analyzed, and no evidence of adverse events from feeding with donor breastmilk.It is feasible to supply donor breastmilk to infants in an NPU in a resource limited setting, however staff needs to be sensitized to the importance of donor breastmilk to improve uptake rates. Secondly we showed that it is possible to supply donor breastmilk according to established guidelines with no adverse events therefore making it possible to prevent NEC and other side effects often associated with formula feeding of premature infants.The particular benefits of human breastmilk for preterm and term infants have been well described in medical literature [1]. Human milk provides important nutritional components, digestive enzymes, immunological factors, growth factors, and hormones that make it a clinical standard of care for preterm (including very low-birth-weight) and term infants [2]. The beneficial effects of human milk (fresh and pasteurized) on rates of pediatric infection such as necrotizing enterocolitis (NEC) and sepsis have also been clearly demonstrated [3-5]. Donor breastmilk has been encouraged as the milk of choice when a mother's own breastmilk is not available due to illness/infections, medications, or other social reasons [6]. Using human milk is of particular importance for preterm infants of HIV infected mothers as early introduction of formula feeds could be the sourc
Global health policies that support the use of banked donor human milk: a human rights issue
Lois DW Arnold
International Breastfeeding Journal , 2006, DOI: 10.1186/1746-4358-1-26
Abstract: Donor milk banking thrives in countries such as Brazil, where there has been a concerted effort at the Health Ministry level to incorporate milk banks into health policy [1]. Its prime mover, Dr. Joao Aprigio Guerra de Almeida, has been honored with the prestigious WHO Sasekawa prize for making an important contribution to his country's overall health by establishing a network of donor human milk banks [2,3]. In countries where donor milk banking is protected, promoted, and supported as an extension of national breastfeeding policies, milk banking is considered a reasonable and effective part of health care delivery for infants and children.Premature infants who are fed infant formula have a higher risk of developing necrotizing enterocolitis (NEC) than when they are fed human milk, either mother's own milk or banked donor milk [4-6]. In this regard, donor milk banking could be considered preventive "medicine" in the premature population; by reducing the incidence of NEC and optimizing central nervous system development, the premature infant has a better start in life than he would have if fed premature infant formula. The argument has been made [7] that these infants become more productive members of society as adults if their health and neurological potential are maximized through optimal nutrition and appropriate health care from the start. This argument is made despite a general lack of published research on the efficacy of banked human milk because in many parts of the world there is a general belief that human milk in any form is superior to manufactured infant formulas. This is contrary to the pervading philosophy among many health care providers, especially in the US, that infant formula and human milk are equivalent.If donor milk banking has been incorporated into national public health policy and regulation, (such as France [8,9], Germany [10,11], and the Scandinavian countries [12]) and/or in other countries with socialized medicine, such as Canada and Gr
Effects of antiretroviral agents during pregnancy on liver enzymes and amylase in HIV-exposed, uninfected newborn infants
El Beitune, Patrícia;Duarte, Geraldo;Campbell, Oona;Quintana, Silvana Maria;Rodrigues, Laura C.;
Brazilian Journal of Infectious Diseases , 2007, DOI: 10.1590/S1413-86702007000300003
Abstract: this study assessed the effect of antiretroviral drugs administered to pregnant women on amylase and liver enzymes of the neonate. a prospective study was conducted on 52 neonates divided into three groups: infants born to hiv-infected mothers taking zidovudine (zdv group, n = 18), infants born to mothers taking zidovudine + lamivudine + nelfinavir (tt group, n = 22) and infants born to normal women (control group, n = 12). umbilical cord blood from the newborn infant was used to determine liver transaminases and amylase. data were analyzed statistically by nonparametric tests, with the level of significance set at p<0.05. the median levels for tt group newborns were 33.3 u/l for oxaloacetic transaminase, 21.5 u/l for pyruvic transaminase, 1.9 mg/dl for total bilirubin, 153 mg/dl for alkaline phosphatase, and 9.6 u/l for amylase. these results did not differ from those obtained for control newborns or newborns exposed to zdv alone. no association was observed between the use of antiretroviral drugs during pregnancy and adverse effects on neonatal amylase and hepatic parameters at birth.
Antiretroviral therapy during pregnancy and early neonatal life: consequences for HIV-exposed, uninfected children
El Beitune, Patrícia;Duarte, Geraldo;Quintana, Silvana Maria;Figueiró-Filho, Ernesto A.;Marcolin, Alessandra Cristina;Abduch, Renata;
Brazilian Journal of Infectious Diseases , 2004, DOI: 10.1590/S1413-86702004000200004
Abstract: women have emerged as the fastest growing human immunodeficiency virus (hiv) infected population worldwide, mainly because of the increasing occurrence of heterosexual transmission. most infected women are of reproductive age and one of the greatest concerns for both women and their physicians is that more than 1,600 infants become infected with hiv each day. almost all infections are a result of mother-to-child transmission of hiv. with the advent of combination antiretroviral therapies, transmission rates lower than 2% have been achieved in clinical studies. antiretroviral compounds differ from most other new pharmaceutical agents in that they have become widely prescribed in pregnancy in the absence of proof of safety. we reviewed antiretroviral agents used in pregnant women infected with human immunodeficiency virus, mother-to-child transmission, and their consequences for infants.
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