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ObjectiveTo determine the feasibility of adapting Family Integrated Care to a neonatal hospital unit in a low-income country.DesignSingle-centre, pre/post-pilot study of an adapted Family Integrated Care programme in Uganda (UFICare).SettingSpecial Care Nursery at a Ugandan hospital.PatientsSingleton, inborn neonates with birth weight ≥2 kg.InterventionsAs part of UFICare, mothers weighed their infant daily, assessed for severe illness (‘danger signs’) twice daily and tracked feeds.Main outcome measuresFeasibility outcomes included maternal proficiency and completion of monitoring tasks. Secondary outcomes included maternal stress, discharge readiness and post-discharge healthcare seeking.ResultsFifty-three mother–infant dyads and 51 mother–infant dyads were included in the baseline and intervention groups, respectively. Most mothers were proficient in the tasks 2–4 days after training (weigh 43 of 51; assess danger signs 49 of 51; track feeds 49 of 51). Mothers documented their danger sign assessments 82% (IQR 71–100) of the expected times and documented feeds 83% (IQR 71–100) of hospital days. In the baseline group, nurses weighed babies 29% (IQR 18–50) of hospitalised days, while UFICare mothers weighed their babies 71% (IQR 57–80) of hospitalised days (p<0.001). UFICare mothers had higher Readiness for Discharge scores compared with the baseline group (baseline 6.8; UFICare 7.9; p<0.001). There was no difference in maternal stress scores or post-discharge healthcare seeking.ConclusionsUgandan mothers can collaborate in the medical care of their hospitalised infant. By performing tasks identified as important for infant care, mothers felt more prepared to care for their infant at discharge.

Background The gut microbiota is recognized as a regulator of brain development and behavioral outcomes during childhood. Nonetheless, associations between the gut microbiota and behavior are often inconsistent among studies in humans, perhaps because many host-microbe relationships vary widely between individuals. This study aims to stratify children based on their gut microbiota composition (i.e., clusters) and to identify novel gut microbiome cluster-specific associations between the stool metabolomic pathways and child behavioral outcomes. Methods Stool samples were collected from a community sample of 248 typically developing children (3–5 years). The gut microbiota was analyzed using 16S sequencing while LC-MS/MS was used for untargeted metabolomics. Parent-reported behavioral outcomes (i.e., Adaptive Skills, Internalizing, Externalizing, Behavioral Symptoms, Developmental Social Disorders) were assessed using the Behavior Assessment System for Children (BASC-2). Children were grouped based on their gut microbiota composition using the Dirichlet multinomial method, after which differences in the metabolome and behavioral outcomes were investigated. Results Four different gut microbiota clusters were identified, where the cluster enriched in both Bacteroides and Bifidobacterium (Ba2) had the most distinct stool metabolome. The cluster characterized by high Bifidobacterium abundance (Bif), as well as cluster Ba2, were associated with lower Adaptive Skill scores and its subcomponent Social Skills. Cluster Ba2 also had significantly lower stool histidine to urocanate turnover, which in turn was associated with lower Social Skill scores in a cluster-dependent manner. Finally, cluster Ba2 had increased levels of compounds involved in Galactose metabolism (i.e., stachyose, raffinose, alpha-D-glucose), where alpha-D-glucose was associated with the Adaptive Skill subcomponent Daily Living scores (i.e., ability to perform basic everyday tasks) in a cluster-dependent manner. Conclusions These data show novel associations between the gut microbiota, its metabolites, and behavioral outcomes in typically developing preschool-aged children. Our results support the concept that cluster-based groupings could be used to develop more personalized interventions to support child behavioral outcomes. BZUULjYHP9-uSx-sQtCLaZ Video Abstract

The Third Edition of this highly popular pocket guide presents the state-of-the-art approaches to pain management that are currently taught and practiced at the Massachusetts General Hospital. This edition has new chapters on chronic back pain, pain control in children with chronic and terminal disease, and diagnostic and therapeutic procedures, plus new illustrations of procedures and techniques. All chapters include the latest evidence-based information and coverage of fibromyalgia, psychosomatic complaints, headaches, and opioid cautions has been expanded. Tables and chapter-opening outlines enable readers to find information quickly. A drug appendix and seven other practical appendices are included.