scholarly journals In Utero and Postnatal Exposure to Antiretrovirals Among HIV-Exposed But Uninfected Children in the United States

2011 ◽  
Vol 25 (7) ◽  
pp. 385-394 ◽  
Author(s):  
Raymond Griner ◽  
Paige L. Williams ◽  
Jennifer S. Read ◽  
George R. Seage ◽  
Marilyn Crain ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
In Utero ◽  
Postnatal Exposure ◽  
Hiv Exposed

Cognitive and Behavioral Manifestations of Lead

2010 ◽  
Author(s):  
Hugh L. Evans
Keyword(s):  
United States ◽  
Blood Lead ◽  
The United States ◽  
Conduct Disorders ◽  
Lead Content ◽  
Blood Lead Levels ◽  
Toxic Exposure ◽  
Postnatal Exposure ◽  
Household Dust ◽  
Lead Levels

The link between exposure to lead and children’s cognitive problems was implied in the earliest medical reports of frank lead poisoning of young children in Australia in the 1800s (Lin-Fu 1992). Children with acute severe toxicity of lead (Pb) are now rarely seen in the United States. However, millions of children may have subclinical neurobehavioral disorders associated with chronic low-level exposure to lead, representing a major public health concern (Bellinger 2008a). Lead is a nonessential metal that is recognized as a source of toxic exposure, with the developing nervous system particularly vulnerable. Because of this, U.S. regulations limiting the lead content of gasoline and household paint have led to a gradual reduction of the average blood lead concentration of Americans over the last three decades. Average blood lead levels of children in the United States dropped an estimated 78% from 1976 to 1991 (Brody et al. 1994; Caldwell et al. 2009). Despite these reductions in exposure to lead, new advances in research techniques have documented harmful consequences associated with lower blood lead levels. This raises the possibility that there is no threshold for occurrence of lead-induced toxicity. Bellinger (2008a) refers to “the silent pandemic of neurodevelopmental disorders resulting from children’s continuing exposure to low levels of lead.” The developing brain may be more sensitive to exposure to lead than the adult. Since the pioneering work of Needleman and colleagues (1979), a large scientific literature has documented the deleterious effects of pre- and neonatal exposure to lead. Decrements in IQ scores have proven to be among the most sensitive and consistent consequences of a child’s exposure to lead, but other cognitive and behavioral changes have been described as well, including attention-deficit hyperactivity disorder (ADHD). Among the important current sources of children’s exposure to lead is household dust (Dixon et al. 2009) the lead content in old water pipes, batteries, and from contamination by numerous industrial processes. Pre and postnatal exposure to cigarette smoke is a cofactor with lead exposure in children’s conduct disorders (Braun et al. 2008). Diagnosis of lead-induced disorders involves the determination of exposure to lead and the atomic absorption assay of lead in whole blood.

scholarly journals 114. Birth Prevalence of Congenital Cytomegalovirus Infection and Language, Hearing, and Developmental Outcomes in a Cohort of HIV-Exposed, Uninfected Preschool Children

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S3-S3
Author(s):  
Murli Purswani ◽  
Tzy-Jyun Yao ◽  
Jonathan S Russell ◽  
Kathleen Malee ◽  
Stephen A Spector ◽  
...  
Keyword(s):  
United States ◽  
Cytomegalovirus Infection ◽  
Developmental Outcomes ◽  
The United States ◽  
Hiv Viral Load ◽  
Congenital Cytomegalovirus Infection ◽  
Congenital Cytomegalovirus ◽  
Birth Prevalence ◽  
Hiv Exposed ◽  
Exposed Uninfected

Abstract Background The prevalence of congenital cytomegalovirus infection (cCMV) at birth is 0.5%–1% in the United States. Most cCMV newborns are asymptomatic at birth with 10%–15% subsequently developing sequelae, such as hearing loss. Higher cCMV prevalence (2.5%–11.4%) is reported in infants born to HIV-infected women, associated with maternal immune suppression and lack of antiretroviral therapy (ART), with few studies addressing neurodevelopmental (ND) outcomes in their offspring. We report birth prevalence of cCMV in a cohort of HIV-exposed, uninfected infants (HEU) born to women on combination ART with well-controlled HIV and describe ND outcomes through age 5 years. Methods The Surveillance Monitoring for ART Toxicities (SMARTT) study is an ongoing NICHD-funded observational multi-centered cohort study (United States and Puerto Rico) of growth and development of HEU children that commenced in 2007. As of August 1, 2017, participants with stored blood pellets collected ≤3 weeks after birth and at least 1 ND assessment ≥1 year of age had pellets tested by DNA PCR to establish cCMV. Comparisons of ND outcomes (defined in figure) at ages 1, 2, and 5 by cCMV status were made using Wilcoxon and Fisher’s Exact tests. Results Of 895 children meeting study criteria (55% black; 32% white; 40% Latino), 8 had cCMV, yielding a birth prevalence of 0.89% (95% CI 0.39–1.75%). All were asymptomatic and similar to CMV-uninfected infants in gestational age and anthropometric measurements at birth. The last HIV viral load prior to delivery was undetectable in 88% of women. The last available CD4% was <20% in 3/8 mothers of cCMV newborns compared with 112/873 in those without (38% vs. 13%, P < 0.07). The mean duration of follow-up (± standard deviation) of children with cCMV was 7.2 years (1.6) and those without 5.9 (2.3) years (P < 0.11). ND assessments for language development (CDI at 1, A&S at 2, TOLD-P:3 at 5), cognition (Bayleys-III at 1), intelligence (WPPSI-III at 5), and hearing (PTA at 5) did not differ by cCMV status (figure). Conclusion Birth prevalence of cCMV in HEU children born within the last decade approaches national US prevalence. Preschool HEU children with asymptomatic cCMV at birth did not show poorer language, hearing, and developmental outcomes compared with CMV-uninfected HEU children. Disclosures All authors: No reported disclosures.

scholarly journals Third Trimester Vitamin D Status Is Associated With Birth Outcomes and Linear Growth of HIV-Exposed Uninfected Infants in the United States

2019 ◽  
Vol 81 (3) ◽  
pp. 336-344 ◽  
Author(s):  
Christopher R. Sudfeld ◽  
Denise L. Jacobson ◽  
Noé M. Rueda ◽  
Daniela Neri ◽  
Armando J. Mendez ◽  
...  
Keyword(s):  
United States ◽  
Vitamin D ◽  
Birth Outcomes ◽  
Linear Growth ◽  
The United States ◽  
Vitamin D Status ◽  
Third Trimester ◽  
Hiv Exposed ◽  
Exposed Uninfected

scholarly journals In utero exposure to threat of evictions and preterm birth: Evidence from the United States

2020 ◽  
Vol 55 (S2) ◽  
pp. 823-832
Author(s):  
Aayush Khadka ◽  
Günther Fink ◽  
Ashley Gromis ◽  
Margaret McConnell
Keyword(s):  
United States ◽  
Preterm Birth ◽  
The United States ◽  
In Utero ◽  
In Utero Exposure

scholarly journals Cardiac effects in perinatally HIV-infected and HIV-exposed but uninfected children and adolescents: a view from the United States of America

2013 ◽  
Vol 16 (1) ◽  
pp. 18597 ◽  
Author(s):  
Steven E Lipshultz ◽  
Tracie L Miller ◽  
James D Wilkinson ◽  
Gwendolyn B Scott ◽  
Gabriel Somarriba ◽  
...  
Keyword(s):  
United States ◽  
Children And Adolescents ◽  
United States Of America ◽  
The United States ◽  
Cardiac Effects ◽  
Hiv Exposed

scholarly journals Rates of Hospitalization and Infection-Related Hospitalization Among Human Immunodeficiency Virus (HIV)–Exposed Uninfected Children Compared to HIV-Unexposed Uninfected Children in the United States, 2007–2016

2019 ◽  
Vol 71 (2) ◽  
pp. 332-339
Author(s):  
Sarah M Labuda ◽  
Yanling Huo ◽  
Deborah Kacanek ◽  
Kunjal Patel ◽  
Krista Huybrechts ◽  
...  
Keyword(s):  
United States ◽  
Human Immunodeficiency Virus ◽  
Poisson Regression ◽  
The United States ◽  
Hiv Disease ◽  
Significant Difference ◽  
Immunodeficiency Virus ◽  
Maternal Hiv ◽  
Hiv Exposed ◽  
Exposed Uninfected

Abstract Background Studies from multiple countries have suggested impaired immunity in perinatally human immunodeficiency virus (HIV)–exposed uninfected children (HEU), with elevated rates of all-cause hospitalization and infections. We estimated and compared the incidence of all-cause hospitalization and infection-related hospitalization in the first 2 years of life among HEU and HIV-unexposed uninfected children (HUU) in the United States. Among HEU, we evaluated associations of maternal HIV disease–related factors during pregnancy with risk of child hospitalization. Methods HEU data from subjects enrolled in the Surveillance Monitoring for Antiretroviral Therapy Toxicities Study (SMARTT) cohort who were born during 2006–2017 were analyzed. HUU comparison data were obtained from the Medicaid Analytic Extract database, restricted to states participating in SMARTT. We compared rates of first hospitalization, total hospitalizations, first infection-related hospitalization, total infection-related hospitalizations, and mortality between HEU and HUU using Poisson regression. Among HEU, multivariable Poisson regression models were fitted to evaluate associations of maternal HIV factors with risk of hospitalization. Results A total of 2404 HEU and 3 605 864 HUU were included in the analysis. HEU children had approximately 2 times greater rates of first hospitalization, total hospitalizations, first infection-related hospitalization, and total infection-related hospitalizations compared with HUUs. There was no significant difference in mortality. Maternal HIV disease factors were not associated with the risk of child infection or hospitalization. Conclusions Compared with HUU, HEU children in the United States have higher rates of hospitalization and infection-related hospitalization in the first 2 years of life, consistent with studies in other countries. Closer monitoring of HEU infants for infection and further elucidation of immune mechanisms is needed.

scholarly journals Reduction in Newborns With Discharge Coding of In Utero Alcohol Effects in the United States, 1993 to 2002

2006 ◽  
Vol 160 (12) ◽  
pp. 1224 ◽  
Author(s):  
James M. Robbins ◽  
T. M. Bird ◽  
John M. Tilford ◽  
J. Alex Reading ◽  
Mario A. Cleves ◽  
...  
Keyword(s):  
United States ◽  
The United States ◽  
In Utero ◽  
Alcohol Effects

scholarly journals Hematologic Findings in Children Exposed to A-Bomb Radiation In Utero in Hiroshima

Blood ◽  
1961 ◽  
Vol 17 (6) ◽  
pp. 728-737
Author(s):  
TSUGISO TAKAMURA ◽  
SHOICHI UEDA
Keyword(s):  
United States ◽  
Iron Deficiency ◽  
Atomic Bomb ◽  
The United States ◽  
In Utero ◽  
Predisposing Factors ◽  
Normal Children

Abstract 1. Hematologic findings in in utero atomic bomb irradiated and nonirradiated children of Hiroshima between the years 1950 to 1957 have been compared, and no changes peculiar to the irradiated group were found. 2. Despite several predisposing factors in Japan toward the development of iron deficiency in children, overt anemia was rare and distribution of hemoglobin levels was only slightly lower than those reported in American and European children. 3. Leukocyte levels, irrespective of age of the children, were found to be progressively falling in the children of Hiroshima, whether or not exposure to irradiation had occurred. Thus, by 1957 the values were distinctly lower than those reported for normal children in Japan and the United States. No cause for this change was apparent.

Prevention of Lead Poisoning in Children—An Issue for Both Developing and Industrialized Countries

PEDIATRICS ◽  
1988 ◽  
Vol 82 (3) ◽  
pp. 524-525
Author(s):  
ROBERT GUTHRIE
Keyword(s):  
United States ◽  
Lead Concentration ◽  
Blood Lead ◽  
The United States ◽  
Blood Levels ◽  
Industrialized Countries ◽  
Postnatal Exposure ◽  
Human Species ◽  
Low Levels ◽  
Poisoning In Children

To the Editor.— This is in response to two articles1,2 concerning lead exposure in fetuses and children. Recent evidence has begun to document the threat to the human species of prenatal, as well as postnatal, exposure to low levels of blood lead concentration. Studies in Australia3 and the United States4-6 have described the problem for industrialized countries, and reports from England7,8 and the United States and Kuwait9 have produced evidence for developing countries. What is particularly disturbing is that the blood levels of prenatal as well as postnatal exposure that have produced permanent deficits in the CNS of children are not much greater than the blood levels found in most of us living in modern, industrialized society.

Immunologic and Virologic Factors Associated with Hospitalization in HIV-Exposed, Uninfected Infants in the United States

2021 ◽  
Author(s):  
Christiana Smith ◽  
Yanling Huo ◽  
Kunjal Patel ◽  
Kirk Fetters ◽  
Shannon Hegemann ◽  
...  
Keyword(s):  
United States ◽  
Regression Models ◽  
The United States ◽  
Pediatric Hiv ◽  
First Year ◽  
Virus Family ◽  
Vaccine Antigens ◽  
Hiv Exposed ◽  
First Year Of Life ◽  
Exposed Uninfected

Abstract Background HIV-exposed, uninfected (HEU) infants experience higher rates of morbidity and mortality than HIV-unexposed uninfected (HUU) infants. Few studies have examined whether particular infections and/or immune responses are associated with hospitalization among HEU infants born in the United States. Methods We evaluated a subset of HEU infants enrolled in the International Maternal Pediatric Adolescent AIDS Clinical Trials Group P1025 and/or Pediatric HIV/AIDS Cohort Study Surveillance Monitoring for ART Toxicities studies. We determined seroconversion to 6 respiratory viruses and measured antibody concentrations to 9 vaccine antigens using quantitative ELISA or electrochemiluminesence. Multivariable modified Poisson regression models were fit to evaluate the associations of seroconversion to each respiratory virus/family and antibody concentrations to vaccine antigens with the risk of hospitalization in the first year of life. Antibody concentrations to vaccine antigens were compared between HEU infants and HUU infants from a single site using multivariable linear regression models. Results Among 556 HEU infants, seroconversion to respiratory syncytial virus (RSV) and parainfluenza were associated with hospitalization [adjusted risk ratio: 1.95 (95% CI 1.21-3.15); 2.30 (1.42-3.73), respectively]. Antibody concentrations to tetanus toxoid, pertussis, and pneumococcal vaccine antigens were higher among 525 HEU compared with 100 HUU infants. No associations were observed between antibody concentrations to any vaccine and hospitalization among HEU infants. Conclusions RSV and parainfluenza contribute to hospitalization among HEU infants in the first year of life. HEU infants demonstrate robust antibody responses to vaccine antigens; therefore, humoral immune defects likely do not explain the increased susceptibility to infection observed in this population.

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