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Maternal Acetaminophen Use and Offspring's Neurodevelopmental Outcome: A Nationwide Birth Cohort Study.

Background Maternal acetaminophen use during pregnancy is common globally. However, its potential risks for neurodevelopmental disorders in offspring, including attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID), remain uncertain in Asian populations. Objective We examined the association between maternal acetaminophen use during pregnancy and diagnoses of neurodevelopmental disorders in offspring. Methods This nationwide birth cohort study included 217,602 children contributing 966,546 person-years using a nationwide administrative database from 2005 to 2022. We investigated the association between maternal acetaminophen use during pregnancy and offspring's neurodevelopmental outcomes using Cox proportional hazards models, with primary analyses based on 1:1 propensity score (PS) matching. The robustness of the primary findings was evaluated through alternative statistical approaches (adjusted model and inverse probability of treatment weighting [IPTW]), sibling comparison, probabilistic bias analyses for exposure misclassification, and negative exposure control methods. Results Of the 217,602 children, 85,853 (39.5%) were exposed to acetaminophen during pregnancy. PS-matched analyses (N = 42,123 children per comparator) yielded hazard ratios of 1.08 (95% CI 1.00, 1.16) for composite neurodevelopmental outcomes, 1.22 (95% CI 1.09, 1.36) for ADHD, 1.06 (95% CI 0.98, 1.15) for ASD, and 1.02 (95% CI 0.90, 1.19) for ID. Similar findings were observed in adjusted models and IPTW methods. Sibling comparisons (n = 23,593) showed point estimates in the opposite direction (e.g., HR of ADHD, 0.86 95% CI 0.52, 1.44). Probabilistic bias analysis for exposure misclassification suggested overestimation due to unrecorded over-the-counter acetaminophen use, with effect estimates shifting towards the null as misclassification increased. Negative exposure controls (e.g., NSAIDs and acetaminophen use after pregnancy) indicated potential positive bias in the observed associations. Conclusions Although PS-matched analyses indicated small increases in risk, sensitivity analyses suggested that unmeasured confounding, misclassification and other biases may partially explain these associations.

Okubo Y, Hayakawa I, Sugitate R et al.

Living with the aftermath: family experiences of managing concussion and sport-related head injury.

Introduction Sport-related head injury is increasingly recognised as a public health concern; however, research has predominantly focused on acute injury and individual recovery. Far less attention has been paid to how concussion and cumulative head injury are experienced and managed within families over time. In particular, the invisibility of concussion, the labour required of families to secure care, and the role of fragmented systems in shaping long-term harm remain underexplored. This study examines family experiences of living with and responding to the long-term consequences of sport-related head injury. Methods A qualitative study was conducted using in-depth interviews with family members of individuals who had experienced sport-related head injury (n = 10). Participants included parents, partners, spouses and adult children. Data were analysed using reflexive thematic analysis following Braun and Clarke's approach. Analysis was iterative, inductive, and interpretive, focusing on patterned meaning across cases rather than prevalence. Results Three interrelated themes were identified: (1) Struggling for recognition of an invisible injury, (2) Family advocacy as expected and exhausting labour, and (3) Fractured systems and preventing further harm. Families consistently described early identified recognition that something was wrong, which was repeatedly dismissed and/or minimised by medical, educational, and sporting institutions. The lack of recognition compelled parents and partners to assume prolonged advocacy roles, including care coordination, risk management, and crisis response, often in the absence of guidance or support. Health, education, and sport systems were experienced as siloed and reactive, with intervention frequently triggered only by crisis rather than functional impairment. Conclusions Family experiences of sport-related head injury are shaped by the interaction between invisible injury, unrecognised expertise, and fragmented systems. Long-term harm is socially and institutionally produced through delayed recognition and the routine transfer of responsibility onto families, highlighting the need to reconceptualise concussion as a condition with enduring family-wide consequences.

Daly E, Ryan L

Relationship of parental caregiving and child labour with developmental problems and mental health in children in low-to-middle-income countries using the socioecological resilience model.

Background The socioecological resilience (SER) model explains that individual, relational, and structural factors influence child development and mental health. Children in low-to middle-income countries (LMICs) are affected by multiple risk factors on different SER levels. This cross-sectional study aimed assess the influence of experience of child labour and poor caregiving practices on child development in LMICs using the SER model. Method Data regarding child development, caregiving practices, and child labour collected through Multiple Indicator Cluster Surveys (MICS) by UNICEF were analysed. Differences in prevalence of developmental delays, mental illness, child labour, and poor caregiving practices were compared across countries and across different sociodemographic index (SDI) levels. Multi-level modelling was used to determine factors associated with developmental difficulties, and anxiety, and depression symptoms in children. Results 251,681 children were included in the analysis. Significant variations in child labour engagement existed across low to upper-middle SDI countries. Prevalence of anxiety (30.8%), depression (40.8%) and socio-emotional difficulties (mean score = 0.115) were highest in low SDI countries. Poor physical caregiving, engagement in child labour, and low maternal education was significantly associated with higher socio-emotional difficulties, anxiety, and depression. Conclusion To address the complex interplay between extreme poverty and adverse child health outcomes across low SDI countries, a multifaceted approach aimed at alleviating poverty, improving access to education, strengthening social protection systems, and promoting effective caregiving practices are required.

Lin K, M KAH, Thapa S et al.

Psychological challenges of distance parenting among young working mothers.

Motherhood plays a vital role in shaping a woman's identity and her ability to provide essential nurturing to her child. However, in the twenty-first century, social workers have observed an increase in mothers practising distance parenting due to labour migration, which poses a significant threat to the establishment and maintenance of mother-child relationships. This article explores the psychological challenges faced by young mothers practising distance parenting in Geelhoupark Rustenburg, North-West province, South Africa. This study employed a qualitative research approach and an exploratory case study design. A total of 12 participants from Geelhoutpark were selected using a purposive-sampling technique. Interviews were conducted using Microsoft Teams, guided by a structured interview schedule. The data was thematically analysed. The study found that young working mothers often experience feelings of guilt and failure as they believe that society placed high demands on them. Due to the society's expectations and personal-level emotional reactions to the absence of their children, young working mothers felt emotionally distressed, sad, as well as self-doubting their motherhood capabilities. The study concludes that young working mothers face significant psychological challenges, which are often worsened by societal expectations. Future studies can further examine both the psychological and social challenges experienced by young mothers practising distance parenting.

Modise TV, Tladi-Mapefane OA, Matlakala FK

Home-Based Parenting Strategies and Challenges of Primary Parental Caregivers of Children With Medical Complexity in Japan: A Qualitative Study.

Background In Japan, the number of children with medical complexity (CMC) is increasing. In response, the Act on Support for Children Requiring Constant Medical Care and Their Families mandated prefectural support centre establishment and promoted coordination across health, welfare and education sectors. In addition to services comparable to those in the United States (e.g., public school options and respite care), Japan strengthened publicly funded home-visit physician, nursing, and personal helper and after-school services to support parents. However, it remains unclear how parents adapt to this evolving system. This study aimed to qualitatively examine the strategies and challenges of primary parental caregivers of CMC in Japan to generate insights that can support family-centred services and clinical care practice. Methods We conducted a qualitative study guided by the Consolidated Criteria for Reporting Qualitative Research and included 13 primary parental caregivers. The inclusion criterion was ≥ 1 year as the principal at-home caregiver of CMC (< 18 years). Results Interviews were transcribed verbatim and inductively coded by two experienced researchers to achieve thematic saturation. Caregivers were predominantly mothers (11 mothers [female] and 2 fathers [male]). The median [interquartile range] ages of the parents and children were 47.0 [35.0-50.0] and 10.0 [7.0-13.0] years, respectively. Eight themes were identified. The challenge subthemes highlighted insufficient paediatric-trained home-visit nursing services, weak support for interagency coordination and transition-to-adult care support and inadequate respite care as priority areas for healthcare professionals. Conclusions Parents effectively leveraged supportive policies; however, deficiencies remain in paediatric-trained home-visit nursing services, interagency coordination, transition-to-adult care support and respite care. These challenges mirror international reports indicating global and implementation-level gaps. Additionally, reflecting on the unique context of Japan, caregiving was predominantly mother-centred, and practical strategies for disaster preparedness were identified. Family-centred care should prioritize workforce expansion, stronger cross-sector coordination and practical respite solutions at the point of care.

Yamaguchi M, Suzuki Y

Impact of Access to Pasteurised Donor Human Milk on Rates of Necrotising Enterocolitis in Neonatal Units in Australia: A Cohort Study.

Background and aim In 2018, a pasteurised donor human milk (PDHM) service was established within Australia's national blood service, Lifeblood, and subsequently expanded to a national service. Before 2018, five milk banks operated in Australia, but most infants admitted to Australian neonatal intensive care units (NICUs) still did not have access to PDHM. This study aimed to compare infant outcomes before and after Australian NICUs had access to an assured supply of PDHM from Lifeblood. Methods Cohort study utilising Australian and New Zealand Neonatal Network data for infants born < 32 weeks' gestation admitted to 15 NICUs across Australia over a 3-year period (2018-2020; n = 4395 infants). The primary study factor was NICU access to an assured supply of PDHM from Lifeblood. Neonatal outcomes were compared in periods with "PDHM available" versus "PDHM not available". The primary outcome was the proportion of infants born < 28 weeks' gestation who developed NEC. Secondary outcomes included duration of parenteral nutrition, retinopathy of prematurity, infection, death, length of stay, weight at discharge, and breast milk feeding at discharge. Results After adjusting for confounding risks, NEC relative risk was 38% lower for infants born < 28 weeks' (aRR 0.62, 95% CI 0.46-0.83) when Lifeblood PDHM was available. Weight at discharge (2828.8 vs. 2939.56 g, p = 0.001) was lower when PDHM was available. Breast milk feeding at discharge, infections and death were not associated with PDHM availability. Conclusions Reliable access to PDHM was associated with reduced risk of NEC for infants born < 28 weeks' gestation in Australian NICUs.

Klein LD, Lui K, Chughtai AA et al.

Blood transfusion

Unlabelled This guideline covers assessing for, and managing, blood transfusions in adults, young people and children aged 1 year and over. It covers the general principles of blood transfusion, but does not make recommendations relating to specific conditions. This guideline does not cover blood transfusions, or use of tranexamic acid for surgery, during pregnancy and labour. For more information on what the guideline does and does not cover, see the section on inclusions and exclusions. Some people have religious beliefs that do not allow the transfusion of blood. Specific issues relating to these people have been addressed when reviewing the evidence and writing the recommendations. For guidance on blood transfusions and anticoagulant reversal for people with acute upper gastrointestinal bleeding, see the section on resuscitation and initial management in NICE's guideline on acute upper gastrointestinal bleeding in over 16s. Who is it for? Healthcare professionals who assess for and manage blood transfusions and their alternatives. Commissioners and providers of transfusion services. People aged 1 year and over who may need a blood transfusion, their families and carers.

Neonatal Outcomes Following Preterm Birth Between 28 and 36 Weeks' Gestation in Vietnam: A Cohort Study.

Background Preterm birth leads to adverse neonatal outcomes. Data on neonatal outcomes in middle-income settings like Vietnam are lacking. Aims Describe preterm neonatal outcomes in Vietnam. Materials and methods Retrospective cohort study including all live singleton births at 28-36 weeks' gestation in Vietnam from June 2019 to June 2020. Outcomes included neonatal morbidity and mortality and were examined by labour onset and gestational age groups. Logistic regression was used to estimate the odds of neonatal morbidity and mortality following planned birth (labour induction and prelabour caesarean) relative to spontaneous birth. Results Among 5374 live singleton preterm births, 663 (12.4%) occurred between 28 and 31 weeks, 824 (15.3%) between 32 and 33 weeks and 3887 (72.3%) between 34 and 36 weeks; 2765 (51.5%) births followed spontaneous labour and 2616 (48.5%) were planned births. Mortality rates decreased with increasing gestational age. More than 90% of neonates born at 28-33 weeks had morbidity, with the rate of morbidity decreasing from 34 weeks. The odds of mortality were no different following labour induction (aOR 1.22, 95% CI, 0.72-2.09) or prelabour caesarean (aOR 1.04, 95% CI, 0.63-1.73) compared with spontaneous labour. The odds of morbidity were higher among pregnancies following labour induction (aOR 1.53, 95% CI, 1.31-1.80) and prelabour caesarean section (aOR 2.14, 95% CI, 1.84-2.50) than spontaneous labour. Among planned preterm births < 35 weeks, antenatal corticosteroids were associated with higher morbidity (90.7% vs. 74.3%, p < 0.001) and lower mortality rates (2.5% vs. 5.1%, p = 0.022). Conclusions Preterm neonates born before 34 weeks are at particularly high likelihood of morbidity and mortality, with planned preterm birth associated with a higher rate of morbidity.

Tran QTT, Seeho SK, Nippita TA et al.

Love, Labour, and Wages: Should Society Pay Parents?

While everyone, parents and non-parents alike, benefit from children, parents alone incur the cost of bearing and raising them. Johan Bester argues that, since society tasks parents with the labourious and financially burdensome task of raising children, and children are a social good, society has an obligation to help ease the burden of parenting by offering direct financial compensation to parents. While I agree that society should do much more to support parents, I am not convinced that the support should include direct financial payment to parents. After setting out Bester's arguments for this position and distinguishing it from a similar argument in political science, I offer a series of concerns: parenting is unlike socially beneficial employment-type work; Bester's argument may extend in problematic directions; financial incentives may harm the parent-child relationship; and there are other ways to promote parenting. Despite being critical, the purpose of this paper is to invite further discussion among bioethicists on how society can support parents in the important task of parenting.

Bobier C