Background: Preterm infants may inadvertently be exposed to lead from the packed red blood cell (pRBC) transfusions with almost no or very limited data available. The aim of the study was to quantify this exposure in preterm infants ≤30 wk gestational age (GA). Methods: Prospective cohort study, infants ≤30 wk GA were eligible, infants < 23 wk GA and known chromosomal diseases were excluded. Blood lead levels (BLLs) were obtained at birth, before and after each transfusion, and at discharge. BLLs were also obtained from the donor pRBC aliquot transfused. A linear mixed model analysis was done. results: Of 75 infants, 34 received a total of 126 pRBC transfusions. Each infant had an average of 3.7 transfusions. 92% of lead levels in the transfused aliquot were ≤ 5 mcg/dl, 6.8% were between 6-8 mcg/dl and 1 had a level of 56 mcg/ dl. Average total lead load was 1.3 mcg/dl. For each 1 mcg/dl increase in transfused pRBC lead level, infant's post-transfusion BLL increased by 0.20 mcg/dl (95% CI: 0.07 mcg/dl, 0.33 mcg/ dl; P = 0.002), adjusting for GA and birth weight. There was no significant increase in discharge BLLs, which were similar for both transfused and nontransfused infants. conclusion: Post-transfusion infant BLLs correlate significantly with the transfused pRBCs lead level.

Palliative care and hospice services were identified by providers as important components in the management of chronic illnesses in western Kenya. Further provider education as well as increased access to pain medications including opioids is necessary to improve the care of patients in western Kenya.

Key Points Last menstrual period should be considered a vital sign and abnormalities should be investigated.Clinicians should educate girls and their caregivers about what to expect from the first menstrual period and the variation in cycles thereafter.Amenorrhea is defined as the absence of menses and can be primary or secondary.Functional hypothalamic amenorrhea is associated with stress, weight change, chronic illness, physical activity, and eating disorders. Prolonged amenorrhea can lead to low bone density caused by inadequate estrogen production.