Objective To assess the relationship between prenatal methamphetamine exposure (PME) and behavior problems at age 7.5 years, and the extent to which early adversity mediated this relationship. Study design The multicenter, longitudinal IDEAL study enrolled 412 mother-infant pairs at 4 sites. Methamphetamine-exposed participants (n= 204) were identified by self-report and/or gas chromatography/mass spectrometry confirmation of amphetamine and metabolites in infant meconium. Matched participants (n = 208) denied methamphetamine use and had a negative meconium screen. At the 7.5 year follow-up, 290 children with complete Child Behavior Checklist (CBCL) data and an early adversity index score were available for analysis (n=146 exposed). Results PME was significantly associated with an increased early adversity index score (P<0.001) and with increased externalizing, rule-breaking behavior, and aggressive behavior (P<0.05). Early adversity was also associated with higher externalizing behavior scores. Early adversity significantly mediated the relationship between PME and behavioral problems. After adjusting the mediation model for sex, prenatal tobacco, alcohol, and marijuana exposures, and study site, the association of PME with early adversity remained significant. Conclusion Though PME is associated with behavioral problems, early adversity may be a strong determinant of behavioral outcome for children exposed to methamphetamine in utero. Early adversity significantly mediated the relationship between PME and behavioral problems.

Objectives: Though Nasal Continuous Positive Airway Pressure (NCPAP) is commonly used for non-invasive neonatal respiratory support, the optimal method of weaning NCPAP is not established. In this prospective, two-center randomized control trial we hypothesize that gradually increasing spontaneous breathing time off NCPAP increases successful weaning from NCPAP in infants born <31 weeks gestational age. Methods and Study Design:Infants were randomized to one of the two NCPAP weaning protocols, a sprinting, i.e., gradually increasing spontaneous breathing time off CPAP, protocol vs. a non-sprinting (weaning pressure down) protocol.Results: Eighty-six infants were enrolled in one of the two study groups. Thirty-one infants (77%) in the sprinting group and 30 (75%) in the non-sprinting group were successfully weaned off NCPAP at the first attempt (p > 0.05). It took 1.3 (1-1.75) (median (IQR)) attempts & 7 (7-7) days to wean NCPAP off in the sprinting group vs. 1.3 (1-1.75) attempts & 7 (7-10) days in the non-sprinting group (p > 0.05). Additionally, no differences in the secondary outcomes of bronchopulmonary dysplasia, severe retinopathy of prematurity (≥ stage 3), periventricular leukomalacia, and length of stay were noted between the two groups. Conclusion:Weaning NCPAP via sprinting or non-sprinting protocol is comparable, not only for successful weaning, but also for the occurrence of common neonatal morbidities that impact the long-term outcome in premature infants. (ClinicalTrials.gov number, NCT02819050)