Tonsillectomy by means of plasma-mediated ablation: prospective, randomized, blinded comparison with monopolar electrosurgery. Maternal Cognitions and Mother–Infant Interaction in Postnatal Depression and Generalized Anxiety Disorder The impact of postnatal and concurrent maternal depression on child behaviour during the early school years. Maternal antenatal anxiety and behavioural/emotional problems in children: a test of a programming hypothesis. Maternal sensitivity moderates the impact of prenatal anxiety disorder on infant responses to the still-face procedure. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Prenatal alcohol exposure and childhood behavior at age 6 to 7 years: I. dose-response effect. Is long-term pharmacist-managed anticoagulation service efficient? A pragmatic randomized controlled trial. Prenatal stress and its effects on the fetus and the child: possible underlying biological mechanisms. Antidepressant treatment for post-natal depression. Lower Pectoralis Muscle Area Is Associated with a Worse Overall Survival in Non–Small Cell Lung Cancer Maternal perinatal mental health and offspring academic achievement at age 16: the mediating role of childhood executive function Fifty-one prenatally diagnosed children and adolescents with sex chromosome abnormalities. Passive smoking and behavioural problems in children: results from the LISAplus prospective birth cohort study. Preventing postnatal maternal mental health problems using a psychoeducational intervention: the cost-effectiveness of What Were We Thinking Predictors of postnatal depression in an urban South African cohort. Dose-finding study of ibuprofen in patent ductus arteriosus using the continual reassessment method. Follow-up study of a randomized controlled trial of postnatal dexamethasone therapy in very low birth weight infants: effects on pulmonary outcomes at age 8 to 11 years. Is prenatal tobacco exposure a risk factor for early adolescent smoking? A follow-up study. Timing for the Introduction of Cycled Light for Extremely Preterm Infants: A Randomized Controlled Trial Attempting to prevent postnatal depression by targeting the mother-infant relationship: a randomised controlled trial. Associations between poor subjective prenatal sleep quality and postnatal depression and anxiety symptoms. Growth and development of preterm infants fed infant formulas containing docosahexaenoic acid and arachidonic acid.
OBJECTIVE To compare plasma-mediated ablation ( PMA ) with monopolar electrosurgery ( MES ) for pediatric tonsillectomy . DESIGN Prospect i ve , r and omized , blinded study . SETTING Academic children 's hospital . PARTICIPANTS Thirty-four children , aged 4 to 7 years . INTERVENTIONS Tonsillectomy by means of PMA ( n = 17 ) or MES ( n = 17 ) . OUTCOME MEASURES We measured surgical efficacy , estimated blood loss , and surgical time during tonsillectomy and morphine use , immediate postoperative pain , and recovery scores after tonsillectomy . Parents recorded recovery of normal diet and activity and their own return to work for 10 days after surgery . Histopathologic evaluation of excised tonsils was performed . We review ed medical records and attempted follow-up telephone contact . RESULTS With no significant difference in blood loss compared with MES , PMA was effective for tonsillectomy . Performance of PMA took longer ( 24 vs 16 minutes ; P = .002 ) . Results of histopathologic evaluation showed less thermal injury with PMA than with MES ( P = .03 ) . Morphine consumption , pain , and recovery scores were equivalent between groups . We found no significant difference in recovery of normal diet and activity or parental return to work .  Patients undergoing PMA  had a greater number of perioperative complications than those undergoing MES , including 2 patients in the PMA group ( compared with none in the MES group ) who required unplanned admission for postoperative airway obstruction . CONCLUSIONS Plasma-mediated ablation for pediatric tonsillectomy result ed in less histopathologic thermal injury than MES , but did not show a statistically faster recovery to normal activity and diet or parental return to work . In addition , PMA took longer to perform , and had more complications . Therefore , PMA should not replace MES for pediatric tonsillectomy . The reduced thermal injury with PMA supports investigation into other means of using plasma ablation to treat tonsillar hypertrophy Postnatal depression and anxiety have been shown to increase the risk of disturbances in mother – child interaction and child development . Research into mechanisms has focused on genetics and maternal behavior ; maternal cognitions have received little attention . Our aim was to experimentally determine if worry and rumination in mothers with generalized anxiety disorder ( GAD ) and major depressive disorder ( MDD ) , diagnosed in the postnatal 6 months , interfered with maternal responsiveness to their 10-month old infants . Mothers ( N = 253 : GAD n = 90 ; MDD n = 57 ; control n = 106 ) and their infants were r and omized to either a worry/rumination prime ( WRP ) or a neutral prime ( NP ) ; mother – infant interactions were assessed before and after priming . Type of priming was a significant predictor of maternal cognitions , with WRP result ing in more negative thoughts , higher thought recurrence and more self-focus relative to NP across the entire sample . Interaction effects between group and priming were significant for two parenting variables : Compared with controls , WRP had a more negative impact on maternal responsiveness to infant vocalization for GAD , and to a lesser extent for MDD ; WRP led to decreased maternal vocalization for GAD . Also , mothers with GAD used stronger control after the NP than WRP , as well as compared with other groups , and overall post-priming , their children exhibited lower emotional tone and more withdrawal . Across the entire sample , WRP was associated with increased child vocalization relative to NP . This study demonstrated that disturbances in maternal cognitions , in the context of postnatal anxiety and to a lesser degree depression , play a significant role in mother – child interaction BACKGROUND This prospect i ve study explores the ongoing impact of early and subsequent maternal depression on offspring behaviour in the early school years . METHODS Seventy five mothers recruited into a longitudinal study were assessed for symptoms of depression when their children were 4 , 12 and 15 months , 4 years and later when the children were 6 - 8 years of age . Mothers , fathers , and school teachers were asked to report on children 's internalising and externalising behaviour problems . RESULTS Exposure to maternal depression during the first postpartum year was related to mother reports of child internalising and externalising problems in the early school years . Although depression in the first year predicted later internalising problems , effects for externalising behaviour problems were mediated by concurrent depression . Relations between concurrent maternal depression and externalising problems were confirmed by teacher ratings . Interestingly , the severity of symptoms at four months was significantly correlated with behaviour problems seven years later . LIMITATIONS Attrition over successive study contacts and therefore limited statistical power is acknowledged . Findings may be a conservative estimate of associations between maternal depression and later child behaviour problems . Also , the high prevalence of depressive symptomatology in the population from which the sample was drawn may limit the generalisability of results . CONCLUSIONS Findings confirm the importance of early identification and treatment for mothers with postnatal depression , given the likelihood of ongoing depression and relations with later child behaviour problems . From a practical point , severity of early symptoms may be a reliable index of those mothers and children at greatest risk BACKGROUND Previous animal investigations link antenatal stress with a range of persistent behavioural abnormalities in the offspring . The current study examined if the effect was also found in humans through middle childhood . METHODS The current study is based on the Avon Longitudinal Study of Parents and Children ( ALSPAC ) , a prospect i ve , community-based study that has followed a cohort of women from pregnancy .  Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period . Children 's behavioural/emotional problems  were assessed by parent report at age 47 and 81 months . Information on obstetric and psychosocial factors was obtained at several points in pregnancy and the postnatal period . RESULTS Children whose mothers experienced high levels of anxiety in late pregnancy exhibited higher rates of behavioural/emotional problems at 81 months of age after controlling for obstetric risks , psychosocial disadvantage , and postnatal anxiety and depression ( for girls , OR = 1.91 , 95%CI = 1.26 - 2.89 ; for boys , OR = 2.16 , 95%CI = 1.41 - 3.30 ) . Furthermore , the effect at 81 months was comparable to what was previously obtained at 47 months , suggesting the kind of persistent effect proposed in the animal literature . CONCLUSIONS There is evidence that  antenatal stress/anxiety  has a programming effect on the fetus which lasts at least until middle childhood Animal studies have demonstrated the interactive effects of prenatal stress exposure and postnatal rearing style on offspring capacity to manage stress . However , little is known about how parenting quality impacts the association between maternal prenatal anxiety and stress reactivity in human infants . This prospect i ve study examined the impact of prenatal anxiety disorder and maternal caregiving sensitivity on infants ' responses to a st and ardised interactive stressor ( still-face procedure ) .  Eighty-four women completed a clinical interview during pregnancy to assess anxiety symptoms meeting DSM-IV diagnostic criteria . At infant age 7 months , maternal sensitivity to infant distress and infant negative affect were observed and coded during the still-face procedure .  Maternal postnatal ( concurrent ) anxiety and depression were also assessed at this time . Results indicated a negative association between maternal sensitivity to infant distress and infant negative affect responses to the still-face procedure . An unexpected finding was a positive association between parity and infant reactivity . The main effect for sensitivity was qualified by a significant interaction , p<.05 , suggesting that the impact of sensitivity was particularly marked among infants of women who experienced an anxiety disorder during pregnancy . This finding is consistent with a cumulative risk model suggesting that maternal prenatal anxiety and quality of maternal care act in concert to shape infant outcomes OBJECTIVE To examine the hypothesis that the effects of postnatal depression on children 's behavioral/emotional problems are explained by antenatal maternal mood . METHOD The current study investigated this hypothesis in the Avon Longitudinal Study of Parents and Children , a prospect i ve , community-based study that has followed a cohort of women since pregnancy ( n = 7,144 ) who delivered their baby between April 1 , 1991 , and December 31 , 1992 .  Self-report measures of maternal anxiety and depression were assessed at repeated intervals in pregnancy and the postnatal period . Children 's behavioral/emotional problems were assessed by parent report at age 4 years . RESULTS After controlling for smoking , alcohol use , birth weight for gestational age , maternal age , child sex , and socioeconomic status , postnatal depression  at 8 weeks ( OR = 2.27 [ 1.55 - 3.31 ] ) and 8 months ( OR = 1.68 [ 1.12 - 2.54 ] ) was associated with children 's behavioral/emotional problems . Subsequent analyses that included antenatal maternal mood indicated that antenatal anxiety in late pregnancy and not antenatal depression was also independently associated with behavioral/emotional problems at age 4 ( OR = 1.72 [ 1.14 - 2.59 ] ) ; 8 week postnatal depression remained a significant predictor after antenatal maternal mood was statistically controlled for ( OR = 1.56 [ 1.04 - 2.32 ] ) . CONCLUSIONS  Antenatal anxiety and postnatal depression  represent separate risks for behavioral/emotional problems in children and act in an additive manner OBJECTIVE Moderate to heavy levels of prenatal alcohol exposure have been associated with alterations in child behavior , but limited data are available on adverse effects after low levels of exposure . The objective of this study was to evaluate the dose-response effect of prenatal alcohol exposure for adverse child behavior outcomes at 6 to 7 years of age . METHODS Beginning in 1986 , women attending the urban university-based maternity clinic were routinely screened at their first prenatal visit for alcohol and drug use by trained research assistants from the Fetal Alcohol Research Center . All women reporting alcohol consumption at conception of at least 0.5 oz absolute alcohol/day and a 5 % r and om sample of lower level drinkers and abstainers were invited to participate to be able to identify the associations between alcohol intake and child development . Maternal alcohol , cigarette , and illicit drug use were prospect ively assessed during pregnancy and postnatally . The independent variable in this study , prenatal alcohol exposure , was computed as the average absolute alcohol intake ( oz ) per day across pregnancy . At each prenatal visit , mothers were interviewed about alcohol use during the previous 2 weeks . Quantities and types of alcohol consumed were converted to fluid ounces of absolute alcohol and averaged across visits to generate a summary measure of alcohol exposure throughout pregnancy . Alcohol was initially used as a dichotomous variable comparing children with no prenatal alcohol exposure to children with any exposure . To evaluate the effects of different levels of exposure , the average absolute alcohol intake was relatively arbitrarily categorized into no , low ( > 0 but < 0.3 fl oz of absolute alcohol/day ) , and moderate/heavy ( > /=0.3 fl oz of absolute alcohol/day ) for the purpose of this study . Six years later , 665 families were contacted . Ninety-four percent agreed to testing . Exclusions included children who missed multiple test appointments , had major congenital malformations ( other than fetal alcohol syndrome ) , possessed an IQ > 2 st and ard deviations from the sample mean , or had incomplete data . The Achenbach Child Behavior Checklist ( CBCL ) was used to assess child behavior . The CBCL is a parent question naire applicable to children ages 4 to 16 years . It is widely used in the clinical assessment of children 's behavior problems and has been extensively used in research . Eight syndrome scales are further grouped into Externalizing or undercontrolled ( Aggressive and Delinquent ) behavior and Internalizing or overcontrolled ( Anxious/Depressed , Somatic Complaints , and Withdrawn ) behaviors . Three syndromes ( Social , Thought , and Attention Problems ) fit neither group . Higher scores are associated with more problem behaviors . Research assistants who were trained and blinded to exposure status independently interviewed the child and caretaker . Data were collected on a broad range of control variables known to influence childhood behavior and /or to be associated with prenatal alcohol exposure . These included perinatal factors of maternal age , education , cigarette , cocaine , and other substances of abuse and the gestational age of the baby . Postnatal factors studied included maternal psychopathology , continuing alcohol and drug use , family structure , socioeconomic status , children 's whole blood lead level , and exposure to violence . Data were collected only from black women as there was inadequate representation of other racial groups . STATISTICAL ANALYSES Statistical analyses were performed using the SPSS statistical package . Frequency distribution , cross-tabulation , odds ratio , and chi(2 ) tests were used for analyzing categorical data . Continuous data were analyzed using t tests , analyses of variance ( ANOVAs ) with posthoc tests , and regression analysis . RESULTS Testing was available for 501 parent-children dyads . Almost one fourth of the women denied alcohol use during pregnancy . Low levels of alcohol use were reported in 63.8 % and moderate/heavy use in 13 % of pregnancies . Increasing prenatal alcohol exposure was associated with lower birth weight and gestational age , higher lead levels , higher maternal age , and lower education level , prenatal exposure to cocaine and smoking , custody changes , lower socioeconomic status , and paternal drinking and drug use at the time of pregnancy . Children with any prenatal alcohol exposure were more likely to have higher CBCL scores on Externalizing ( Aggressive and Delinquent ) and Internalizing ( Anxious/Depressed and Withdrawn ) syndrome scales and the Total Problem Score . The odds ratio of scoring in the clinical range for Delinquent behavior was 3.2 ( 1.3 - 7.6 ) in children with any prenatal exposure to alcohol compared with nonexposed controls . The threshold dose was evaluated with the 3 prenatal alcohol exposure groups . One-way ANOVA revealed a significant between group difference for Externalizing ( Aggressive and Delinquent ) and the Total Problem Score . ( ABSTRACT TRUNCATED BACKGROUND Some pharmacist-managed anticoagulation services ( PMAS ) provide initial follow-up to patients on oral anticoagulant , who are transferred to their physician once they are stabilized . This may be as effective as and less expensive than long-term PMAS follow-up . METHODS Once PMAS patients were stabilized and ready for discharge , they were r and omized to be transferred to their physician or stay with the PMAS . Quality of international normalized ratio ( INR ) control , incidence of complications , health-related quality of life , use of health care services , and direct incremental cost of PMAS follow-up were evaluated . RESULTS One hundred thirty-eight physicians and 250 patients participated . Patients were initially followed at the PMAS for a mean of 11.3 weeks and afterwards were followed by their physician ( n = 122 ) or by the PMAS pharmacists ( n = 128 ) for a mean of 14.9 and 14.5 weeks , respectively . Pharmacist-managed anticoagulation services ' and physician 's patients were within the exact target range 77.3 % and 76.7 % of the time ( 95 % CI of the difference -4.9 % to 6.0 % ) and within the extended range 93.0 % and 91.6 % of the time ( 95 % CI -2.1 % to 4.7 % ) , respectively . Pharmacist-managed anticoagulation services patients have seen their family physician less often ( 95 % CI -3.1 to -0.1 visit per year ) . Number of INR tests , incidence of complications , and health-related quality of life were similar in both groups . The incremental cost of PMAS follow-up was estimated at CAN$123.80 per patient year . CONCLUSION Once PMAS patients are well stabilized , maintaining a PMAS follow-up or transferring them to their physician is associated with excellent INR control . However , long-term PMAS follow-up may be more expensive Many prospect i ve studies have shown that if a mother is depressed , anxious or stressed while pregnant , this increases the risk for her child having a wide range of adverse outcomes including emotional problems , symptoms of attention deficit hyperactivity disorder ( ADHD ) or impaired cognitive development . Although genetics and postnatal care clearly affect these outcomes , evidence for a prenatal causal component also is substantial . Prenatal anxiety/depression may contribute 10 - 15 % of the attributable load for emotional/behavioural outcomes .The mechanisms underlying these changes are just starting to be explored . One possible mediating factor is increased exposure of the fetus to cortisol , as has been shown in animal studies . However , the human hypothalamic-pituitary-adrenal ( HPA ) axis which makes cortisol functions differently in human pregnancy from in most animals . The maternal HPA axis becomes gradually less responsive to stress as pregnancy progresses . And there is only a weak , if any , association between a mother 's  prenatal mood and her cortisol level , especially later in pregnancy . Cytokines are alternative possible mediators . An additional explanation is that stress or anxiety causes increased transfer of maternal cortisol across the placenta to the fetus . The placenta plays a crucial role in moderating fetal exposure to maternal factors and presumably in preparing the fetus for the environment in which it is going to find itself . There is some evidence in both rat models and in humans that prenatal stress can reduce placental 11β-HSD2 , the enzyme which metabolises cortisol to inactive cortisone . The level of cortisol in the amniotic fluid , surrounding the baby in the womb , has been shown to be inversely correlated with infant cognitive development . However , several other biological systems are likely to be involved . Serotonin is another possible mediator of prenatal stress induced programming effects on offspring neurocognitive and behavioural development . The role of epigenetic changes in mediating alterations in offspring outcome following prenatal stress is likely to be important and starting to be explored BACKGROUND : Postnatal depression is a common disorder , which can have profound short and long term effects on maternal morbidity , the new infant and the family as a whole . Social factors appear to be particularly important in the aetiology and prognosis of postnatal depression and treatment is often largely social support and psychological interventions . It is not known whether antidepressants are an effective and safe choice for treatment of this disorder . OBJECTIVES : To evaluate the effectiveness of different antidepressant drugs  and compare their effectiveness with other forms of treatment . To assess any adverse effects of antidepressants in the mother or the nursing baby . SEARCH STRATEGY : The registers of clinical trials maintained and up date d by the Cochrane Depression , Anxiety and Neurosis Group and the Cochrane Pregnancy and Childbirth Group were search ed . Other data bases ( outlined below ) were also search ed and contacts were made with pharmaceutical companies and experts in the field . SELECTION CRITERIA : All trials were considered in which women with depression in the first six months postpartum were r and omised to receive antidepressants alone or in combination with another treatment , or to receive any other treatment including placebo . DATA COLLECTION AND ANALYSIS : Data was extracted independently from the trial reports by the review ers . Missing information was requested from investigators wherever possible . Data was sought to allow an " intention to treat " analysis . MAIN RESULTS : Only one trial could be included in this review , leaving most of the objectives of the review unfulfilled . Appleby et al ( 1997 ) reported that Fluoxetine was significantly more effective than placebo and , after an initial session of counselling , as effective as a full course of cognitive-behavioural counselling in the treatment of postnatal depression . There was no interaction between medication and counselling . REVIEW ER 'S CONCLUSIONS : Women with postnatal depression can be effectively treated with fluoxetine , which is as effective as a course of cognitive-behavioural counselling in the short-term . However , more trials with a longer follow-up period are needed to compare different antidepressants in the treatment of postnatal depression , and to compare antidepressant treatment with psychosocial interventions .  This is an area that has been neglected despite the large public health impact described above Background : Muscle wasting is a component of the diagnosis of cancer cachexia and has been associated with poor prognosis . However , recommended tools to measure sarcopenia are limited by poor sensitivity or the need to perform additional scans . We hypothesized that pectoralis muscle area ( PMA ) measured objective ly on chest CT scan may be associated with overall survival ( OS ) in non – small cell lung cancer ( NSCLC ) . Methods : We evaluated 252 cases from a prospect ively enrolling lung cancer cohort . Eligible cases had CT scans performed prior to the initiation of surgery , radiation , or chemotherapy .  PMA was measured in a semi-automated fashion while blinded to characteristics of the tumor , lung , and patient outcomes . Results : Men had a significantly greater PMA than women ( 37.59 vs. 26.19 cm2 , P < 0.0001 ) . In univariate analysis , PMA was associated with age and body mass index ( BMI ) . A Cox proportional hazards model was constructed to account for confounders associated with survival . Lower pectoralis area ( per cm2 ) at diagnosis was associated with an increased hazard of death of 2 % ( HRadj , 0.98 ; confidence interval , 0.96–0.99 ; P = 0.044 ) while adjusting for age , sex , smoking , chronic bronchitis , emphysema , histology , stage , chemotherapy , radiation , surgery , BMI , and ECOG performance status . Conclusions : Lower PMA measured from chest CT scans obtained at the time of diagnosis of NSCLC is associated with a worse OS . Impact : PMA may be a valuable CT biomarker for sarcopenia-associated lung cancer survival . Cancer Epidemiol Biomarkers Prev ; 26(1 ) ; 38–43 . © 2016 AACR . See all the articles in this CEBP Focus section , “ The Obesity Paradox in Cancer : Evidence and New Directions . Background Elucidating risk pathways for under‐achieving at school can inform strategies to reduce the number of adolescents leaving school without passing grade s in core subjects . Maternal depression can compromise the quality of parental care and is associated with multiple negative child outcomes . However , only a few small studies have investigated the association between perinatal maternal depression and poor academic achievement in adolescence . The pathways to explain the risks are also unclear . Method Prospect i ve observational data from 5,801 parents and adolescents taking part in a large UK population cohort ( Avon‐Longitudinal‐ Study ‐of‐Parents‐ and ‐Children ) were used to test associations between  maternal and paternal depression and anxiety  in the perinatal period , executive function ( EF ) at age 8 , and academic achievement at the end of compulsory school at age 16 . Results Adolescents of postnatally depressed mothers were 1.5 times ( 1.19 , 1.94 , p = .001 ) as likely as adolescents of nondepressed mothers to fail to achieve a ‘ pass ’ grade in math ; antenatal anxiety was also an independent predictor of poor math . Disruption in different components of EF explained small but significant proportions of these associations : attentional control explained 16 % ( 4 % , 27 % , p < .001 ) of the association with postnatal depression , and working memory explained 17 % ( 13 % , 30 % , p = .003 ) of the association with antenatal anxiety . A similar pattern was seen for language grade s , but associations were confounded by maternal education . There was no evidence that paternal factors were independently associated with impaired child EF or adolescent exams . Conclusion Maternal postnatal depression and antenatal anxiety are risk factors for adolescents underachieving in math . Preventing , identifying , and treating maternal mental health in the perinatal period could , therefore , potentially increase adolescents ’ academic achievement . Different aspects of EF partially mediated these associations . Further work is needed , but if these pathways are causal , improving EF could reduce underachievement in math Children with sex chromosome abnormalities ( SCA ) are known to be at risk for developmental delays . These risks were identified 2 decades ago by seven international research groups who prospect ively followed children ascertained after birth . Subsequently , some of these investigators suggested the course of prenatally identified children with SCA may be different from children in earlier studies . The first such evidence was published by Robinson et al. [ 1992 : Am J Med Genet 44:365 - 368 ] , who compared 20 prenatally diagnosed children to the original postnatally diagnosed cohort . The following report presents an up date and expansion of that research and includes 51 children and adolescents prenatally diagnosed with SCA , now 7 - 18 years of age . Results confirm that this cohort of prenatally diagnosed children has a milder developmental course than children ascertained postnatally . The study provides new information to health professionals counseling families faced with prenatal diagnosis of SCA OBJECTIVE To analyse the association between pre- and postnatal exposure to tobacco smoke and child behavioural problems  and to further investigate the influence of trimester-specific exposure to maternal smoking and the impact of paternal smoking at home on the same outcome . METHODS Data of 3097 German children recruited at birth for a population -based , prospect i ve study were used . Detailed information on children 's tobacco smoke exposure was collected by self-administered question naires at each follow-up . Behavioural outcomes were measured by the Strengths and Difficulties Question naire applied at 10-year follow-up . RESULTS Children exposed to environmental tobacco smoke at home showed increased risks of hyperactivity/inattention problems . Only smoking during the entire pregnancy increased the risk for conduct and hyperactivity/inattention problems ( proportional odds ratio (pOR)=1.58 , 95 % confidence interval (CI)=1.06 - 2.37 and pOR=1.67 , CI=1.03 - 2.72 ) . Pre- and postnatal exposure to paternal smoking was associated with hyperactivity/inattention problems in children of non-smoking mothers ( pOR=1.97 , CI=1.06 - 3.65 ) . Effect estimates were adjusted for study centre , sex , parental educational level , mother 's age at birth , having a single parent and time spent in front of a screen . CONCLUSIONS Not only maternal smoking during pregnancy but also paternal smoking at home should be considered as a risk for hyperactivity/inattention problems in children Objectives Postnatal maternal mental health problems , including depression and anxiety , entail a significant burden globally , and finding cost-effective preventive solutions is a public policy priority . This paper presents a cost-effectiveness analysis of the intervention , What Were We Thinking ( WWWT ) , for the prevention of postnatal maternal mental health problems . Design The economic evaluation , including cost-effectiveness and cost-utility analyses , was conducted alongside a cluster-r and omised trial . Setting 48 Maternal and Child Health Centres in Victoria , Australia . Participants Participants were English-speaking first-time mothers attending participating Maternal and Child Health Centres . Full data were collected for 175 participants in the control arm and 184 in the intervention arm .  Intervention WWWT is a psychoeducational intervention targeted at the partner relationship , management of infant behaviour and parental fatigue . Outcome measures The evaluation considered public sector plus participant out-of-pocket costs , while outcomes were expressed in the 30-day prevalence of depression , anxiety and adjustment disorders , and quality -adjusted life years ( QALYs ) . Incremental costs and outcomes were estimated using regression analyses to account for relevant sociodemographic , prognostic and clinical characteristics . Results The intervention was estimated to cost $ A118.16 per participant . The analysis showed no statistically significant difference between the intervention and control groups in costs or outcomes . The incremental cost-effectiveness ratios were $ A36 451 per QALY gained and $ A152 per percentage-point reduction in 30-day prevalence of depression , anxiety and adjustment disorders . The estimate lies under the unofficial cost-effectiveness threshold of $ A55 000 per QALY ; however , there was considerable uncertainty surrounding the results , with a 55 % probability that WWWT would be considered cost-effective at that threshold . Conclusions The results suggest that , although WWWT shows promise as a preventive intervention for postnatal maternal mental health problems , further research is required to reduce the uncertainty over its cost-effectiveness as there were no statistically significant differences in costs or outcomes . Trial registration number ACTRN12613000506796 ; results BACKGROUND Postnatal depression can have a significant impact on both maternal and child health . There have been very few studies undertaken in the developing world to identify women at risk of postnatal depression .  The present study aim ed to investigate risk factors for the occurrence of postnatal depression in urban South African women . METHOD A large prospect i ve population cohort study identified antenatal risk factors for postnatal depression in Soweto , Johannesburg , South Africa . One thous and and thirty-five women were interviewed in the antenatal period and subsequently completed the Pitt Depression Question naire in the postnatal period . RESULTS 170/1035 ( 16.4 % ) women were probable cases of postnatal depression . The strongest independent predictors of postnatal depression were exposure to extreme societal stressors ( witnessing a violent crime/danger of being killed ) ( adjusted Odds Ratio 2.468 ( 95 % Confidence Interval 1.509 , 4.037 ) ) and reporting difficulties with their partner ( adjusted OR 1.645 ( 1.088 , 2.488 ) ) . LIMITATIONS There was some loss of the sample during follow-up ( 35.1 % ) , which was to be expected given the turbulent nature of the study setting . The measures were question naires administered by interview . CONCLUSION Postnatal depression is common in women in developing world setting s , such as this part of Southern Africa . Although some of the risk factors for postnatal depression were similar to those identified in studies in developed nations , some important differences exist , most notably antenatal exposure to extreme societal stressors . This study shows that it is possible to identify women at risk during pregnancy in a developing world setting OBJECTIVE Intravenous ibuprofen ( IBU ) has been found to be as effective as indomethacin for the treatment of patent ductus arteriosus ( PDA ) in preterm infants and has been associated with fewer adverse effects in comparative phase III studies . The dose regimen used ( 10 - 5 - 5 mg/kg/day ) was based on limited pharmacokinetic data and no phase II study was available to determine the optimal dose of IBU for this indication . The present study was design ed to determine the minimum effective dose regimen ( MEDR ) of IBU ( one course ) required to close ductus arteriosus in preterm infants . METHOD A double-blind dose-finding study was conducted using the continual re assessment method , a Bayesian sequential design . Two distinct target closure rates were initially chosen according to postmenstrual age ( PMA ) at birth : 80 % in infants with a PMA of 27 - 29 weeks , and 50 % in infants with a PMA < 27 weeks . Forty neonates ( 20 in each PMA group ) with PDA were treated between days 3 and 5 of life . Four different dose regimens were tested : loading doses of 5 , 10 , 15 or 20 mg/kg , followed by two doses ( 1/2 loading dose ) at 24-h intervals . Efficacy was evaluated by echocardiography 24 h after the third infusion . RESULTS In infants with a PMA of 27 - 29 weeks , the estimated MEDR was 10 - 5 - 5 mg/kg with a final estimated probability of success of 77 % ( 95 % credibility interval : 56 - 92 % ) . The 15 - 7.5 - 7.5 mg/kg dose regimen had a better estimated probability of success ( 88 % , 95 % credibility interval : 68 - 97 % ) , but result ed in more minor renal adverse effects . In contrast , in infants with a PMA < 27 weeks , the estimated MEDR was 20 - 10 - 10 mg/kg with an estimated probability of success of 54.8 % ( 95 % credibility interval : 22 - 84 % ) , whereas the conventional dose regimen result ed in a low estimated probability of success ( 30.6 % , 95 % credibility interval : 13 - 56 % ) . In these infants , compared with those with a PMA of 27 - 29 weeks , minor renal adverse effects were more frequent from the 10 - 5 - 5 mg/kg/day dose regimen and did not appear to be clearly dose related . CONCLUSION This study confirms that the currently recommended dose regimen ( 10 - 5 - 5 mg/kg ) of IBU is associated with a high closure rate ( 80 % ) and few adverse effects in premature infants with a PMA of 27 - 29 weeks . The failure rate was much higher below 27 weeks . A higher dose regimen ( 20 - 10 - 10 mg/kg ) might achieve a higher closure rate . However , tolerability and safety of this dose regimen should be assessed in a larger population before considering the use of these doses for ductus arteriosus closure OBJECTIVE To determine whether postnatal dexamethasone ( DEX ) exposure affects pulmonary outcomes at school age in children born with very low birth weight ( VLBW ) . STUDY DESIGN Follow-up study of 68 VLBW children who participated in a r and omized controlled trial of postnatal DEX .  Pulmonary function was assessed by spirometry . Current asthma status was obtained from a parent . RESULTS Sixty-eight percent of the placebo group had below-normal forced expiratory volume in 1 second ( FEV1 ) , compared with 40 % of the DEX group ( chi2 = 4.84 ; P = .03 ) , with trends for lower forced vital capacity ( FVC ) and FEV1 values in the placebo group . Fifty percent of the placebo group and 34 % of DEX group had below normal FEV1/FVC ( chi2 = 1.59 ; P = .21 ) . Parent-reported prevalence of asthma did not differ between groups . Logistic regression analysis suggested that the positive effects of DEX on pulmonary function at follow-up were mediated in part by shortened exposure to mechanical ventilation . CONCLUSIONS Postnatal DEX exposure was associated with higher expiratory flow with no adverse effects on pulmonary outcomes at school age . The prevalences of asthma and impaired pulmonary function underscore the influence of neonatal illness on health at school age , and stress the importance of repeated follow-up examinations of these children Recent reports indicate a relation between prenatal tobacco exposure ( PTE ) and  offspring smoking .  Many of these reports have been retrospective or have not included important variables such as other prenatal substance exposures , maternal and child psycho-social characteristics , mother 's current smoking , and friends ' smoking . No prior study has examined the timing of PTE . In this prospect i ve study of a birth cohort of 567 14-year-olds , we examined the relation between trimester-specific PTE , offspring smoking , and other correlates of adolescent smoking .  Average age of the adolescents was 14.8 years ( range : 13.9 - 16.6 years ) , 51 % were female , 54 % were African-American . Data on maternal tobacco and other substance use were collected both prenatally and postnatally , 51 % of the mothers were prenatal smokers and 53 % smoked when their children were 14 years . PTE in the third trimester significantly predicted offspring smoking ( ever/never , smoking level , age of onset ) when demographic and other prenatal substances were included in the analyses . PTE remained a significant predictor of the level of adolescent smoking when maternal and child psychological characteristics were added to the model . When more proximal measures of the child 's smoking were included in the model , including mother 's current smoking and friends ' smoking , PTE was no longer significant . Significant predictors of adolescent smoking at age 14 were female gender , Caucasian race , child externalizing behavior , maternal anxiety , and child depressive symptoms . Although direct effects of PTE on offspring smoking behavior have previously been reported from this study and by others , by early-adolescence , this association is not significant after controlling for the more proximal covariates of adolescent smoking such as mother 's current smoking and peer smoking Day-night cycled light improves health outcomes in preterm infants , yet the best time to institute cycled light is unclear . The hypothesis of this study was that extremely preterm infants receiving early cycled light  would have better health and developmental outcomes than infants receiving  late cycled light .  Infants born at ≤28 weeks gestation were r and omly assigned to early cycled light ( ECL ) starting at 28 weeks postmenstrual age [ PMA ] or late cycled light ( LCL ) , starting at 36 weeks PMA . Daylight was 200 - 600 lux and night was 5 - 30 lux . Primary outcomes were weight over time and length of hospitalization . Secondary outcomes were hospital costs , sleep development , and neurodevelopment at 9 , 18 , and 24 months corrected age . Of 121 infants r and omized , 118 were included in analysis . Weight gain in the two groups did not differ significantly but increased across time in both groups . In PMA weeks 36 - 44 , the mean weight gain was 193.8 grams in the ECL group compared to 176.3 grams in the LCL group . Effect sizes for weight were Cohen d = 0.26 and 0.36 for 36 and 44 weeks PMA . Infants in the ECL group went home an average of 5.5 days earlier than the LCL group , but this difference was not statistically significant . There were no group differences on neurodevelopmental outcomes . Although statistically non-significant , clinical ly important differences of improved weight gain and decreased hospital stay were observed with ECL . The small observed effect sizes on weight during hospitalization should be considered in future cycled light research with extremely preterm infants . © 2017 Wiley Periodicals , AIM The purpose of the study was to investigate whether an intervention which focused on enhancing the quality of the mother-infant relationship would prevent the development of postnatal depression ( PND ) and the associated impairments in parenting and adverse effects on child development . BACKGROUND Recent meta-analyses indicate modest preventive effects of psychological treatments for women vulnerable to the development of PND . However , given the strong evidence for an impact of PND on the quality of the mother-infant relationship and child development , it is notable that there are limited data on the impact of preventive interventions on these outcomes . This is clearly a question that requires research attention . Accordingly , a r and omised controlled trial ( RCT ) was conducted of such a preventive intervention . METHODS A large sample of pregnant women was screened to identify those at risk of PND . In an RCT 91 were r and omly assigned to receive the index intervention from research health visitors , and 99 were assigned to a control group who received normal care .  In an adjacent area 76 women at risk of PND received the index intervention  from trained National Health Service ( NHS ) health visitors . The index intervention involved 11 home visits , two antenatally and nine postnatally . They were supportive in nature , with specific measures to enhance maternal sensitivity to infant communicative signals , including items from the Neonatal Behavioral Assessment Scale . Independent assessment s were made at 8 weeks , 18 weeks , and 12 and 18 months postpartum . Assessment s were made of maternal mood , maternal sensitivity in mother-infant engagement , and infant behaviour problems , attachment and cognition . FINDINGS The RCT revealed that the index intervention had no impact on maternal mood , the quality of the maternal parenting behaviours , or infant outcome , although there were suggestions , on some self-report measures , that those with a lower level of antenatal risk experienced benefit . This was also the case for the intervention delivered by trained NHS health visitors . The findings indicate that the approach investigated to preventing PND and its associated problems can not be recommended BACKGROUND Symptoms of depression and anxiety are common during pregnancy and the postnatal period . A risk factor for mood disorders is poor sleep quality . In this study we investigate the effects of poor subjective prenatal sleep quality on postnatal depressive and anxiety symptoms , independent of prenatal depression or anxiety , amongst pregnant women in the general population . METHODS We analysed data from a subset of women taking part in a prospect i ve cohort study , Growing Up in Singapore towards Healthy Outcomes . The participants completed the  Edinburgh Postnatal Depression Scale and State-Trait Anxiety Inventory between 26 and 28 weeks of pregnancy ( Time 1 ) and at 3 months postpartum ( Time 2 ) , and the Pittsburgh Sleep Quality Index at Time 1 . Logistic regression analyses were used to investigate the associations between subjective prenatal sleep quality and postnatal depressive and anxiety symptoms , while adjusting for prenatal depressive/anxiety symptoms and education . RESULTS Although borderline-high depressive/anxiety symptoms were the strongest predictors of postnatal depressive/anxiety , independent of this , poor subjective sleep quality during pregnancy was also associated with borderline-high postnatal depressive symptoms , but not with postnatal anxiety . LIMITATIONS Sleep quality and prenatal/postnatal mood were derived from self-reported question naires , which may be more susceptible to bias . CONCLUSION Although treatment of symptoms of prenatal depression and anxiety will be the most important for reducing postnatal depression and anxiety , in addition to that , future studies may explore treatments improving prenatal sleep quality , particularly for women with antenatal depressive symptoms OBJECTIVES To evaluate safety and benefits of feeding preterm infants formulas containing docosahexaenoic acid ( DHA ) and arachidonic acid ( ARA )  until 92 weeks postmenstrual age ( PMA ) , with follow-up to 118 weeks PMA . STUDY DESIGN This double-blinded study of 361 preterm infants r and omized across three formula groups : ( 1 ) control , no supplementation ; ( 2 ) algal-DHA ( DHA from algal oil , ARA from fungal oil ) ; and ( 3 ) fish-DHA ( DHA from fish oil , ARA from fungal oil ) . Term infants breast-fed > or = 4 months ( n = 105 ) were a reference group . Outcomes included growth , tolerance , adverse events , and Bayley development scores . RESULTS Weight of the algal-DHA group was significantly greater than the control group from 66 to 118 weeks PMA and the fish-DHA group at 118 weeks PMA but did not differ from term infants at 118 weeks PMA . The algal-DHA group was significantly longer than the control group at 48 , 79 , and 92 weeks PMA and the fish-DHA group at 57 , 79 , and 92 weeks PMA but did not differ from term infants from 79 to 118 weeks PMA . Supplemented groups had higher Bayley mental and psychomotor development scores at 118 weeks PMA than did the control group . Supplementation did not increase morbidity or adverse events . CONCLUSIONS Feeding formulas with DHA and ARA from algal and fungal oils result ed in enhanced growth . Both supplemented formulas provided better developmental outcomes than unsupplemented formulas
The strongest evidence for an adverse effect of PMA exposure is in somatic and psychological outcomes ; the evidence for an effect of PMA on child development is inconclusive .
Several decades of research have focused on the impact of exposure to postnatal depression on children , while anxiety has been largely overlooked .
Estimates of the prevalence of postnatal maternal anxiety ( PMA ) range from 3 % to 43 % , suggesting PMA may be an important risk factor for adverse outcomes in children .
This review summarizes what is known about the effects of  PMA exposure on children and makes recommendations for future research .