Introduction: The identification of acute injury of the kidney relies on serum creatinine (SCr), a functional marker with poor temporal resolution as well as limited sensitivity and specificity for cellular injury. In contrast, urinary biomarkers of kidney injury have the potential to detect cellular stress and damage in real time. Methods: To detect the response of the kidney to injury, we have tested a lateral flow dipstick that measures a urinary protein called neutrophil gelatinase-associated lipocalin (NGAL). Analysis of urine was performed in a prospective cohort of 479 patients (final cohort N ¼ 426) entering an emergency department in New York City and subsequently admitted for inpatient care. Results: Colorimetric development had high interrater reliability (88% concordance rate) and correlated with traditional enzyme-linked immunosorbent assay (ELISA) measurements (r ¼ 0.732, P < .0001). Of the 14% of the cohort who met Acute Kidney Injury Network (AKIN) SCr criteria for acute kidney injury (AKI), 67% demonstrated transient (<2 days) and 33% demonstrated sustained (>2 days) elevation of SCr. Comparing the outcomes of patients with sustained versus transient or undetectable changes in SCr revealed that the urinary NGAL (uNGAL) dipstick had high specificity and negative predictive value (NPV) (high-vs. low-intermediate readings, sensitivity ¼ 0.55, specificity ¼ 0.91, positive predictive value ¼ 0.24, NPV ¼ 0.97, c 2 ¼ 20.39, P < 0.001). Conclusion: We show that the introduction of a bedside uNGAL dipstick permits accurate triage by identifying individuals who do not have tubular injury. In an era of shortening length of stay and rapid decisions based on isolated SCr measurements, real-time exclusion of kidney injury by a dipstick will be particularly useful to overcome the retrospective, insensitive, and nonspecific attributes of SCr.

Background: The postpartum hospital stay is a unique opportunity for clinicians to educate parents on the importance of promoting early child development. Pediatricians are well positioned to address both medical and developmental concerns during critical periods of development, yet very few parenting interventions are led by pediatricians. Aims: To assess the impact of a novel one-hour long pediatrician-led Newborn Class on maternal knowledge, confidence, and anxiety. Methods: We conducted a nonrandomized controlled trial to evaluate the effectiveness of the Newborn Class. First-time mothers who delivered a full-term singleton vaginally with no major complications and attended the class were recruited. Mothers who expressed a desire to attend the class but were discharged before a class was offered served as controls. Outcome measures: Maternal self-perceived anxiety and confidence were measured using standardized scales (State-Trait Anxiety Inventory for Adults and Karitane Parenting Confidence Scale). Knowledge on newborn care was assessed using a novel scale. Results: A total of 84 participants (intervention n=36, control n=48) were included in the study. Mothers who attended class showed significantly higher levels of knowledge compared to the control group as well as significantly higher parenting confidence levels. No change was observed in the overall level of anxiety. Conclusions: A short pediatrician-led parenting intervention can be an effective tool in improving maternal confidence and newborn care knowledge. Given the importance of the newborn period in establishing healthy developmental trajectories, this cost-and timeeffective intervention could be widely implemented to promote early strong mother-infant relationships that foster healthy development.

Importance: In 2021, the American Academy of Pediatrics published a policy statement seeking to create a paradigm shift away from a focus on childhood toxic stress and toward the emphasis on early relational health (ERH) as a buffer for childhood adversity and promoter of life-course resilience. A comprehensive appraisal of the efficacy of contemporary parent/caregiver-child interventions in — primarily — improving ERH, and — secondarily — enhancing child wellbeing and neurodevelopment is needed to guide widespread implementation and policy. Objective: Determine the effectiveness of contemporary early dyadic parent/caregiver-infant interventions on ERH, child socio-emotional functioning and development, and parent/caregiver mental health. Data Sources: PubMed, Medline, Cinhal, ERIC, and PsycInfo were searched on April 28, 2022. Additional sources: clinical trial registries (clinicaltrials.gov, ISRCTN Registry, EU Clinical Trials Register, Australian New Zealand Clinical Trials Registry), contacting authors of unpublished/ongoing studies, backward/forward reference-searching. Study Selection: Studies targeting parent/caregiver-infant dyads and evaluating effectiveness of a dyadic intervention were eligible. Study selection was performed in duplicate, using Covidence. Data Extraction and Synthesis: Cochrane methodological guidance presented per PRISMA guidelines. Data extraction and risk of bias assessment were completed in duplicate with consensuses by first author. Data were pooled using inverse-variance random effects models. Main Outcomes and Measures: The primary outcome domain was ERH. Secondary outcome domains were child socio-emotional functioning and development, and parent/caregiver mental health, and were only considered in studies where at least one ERH outcome was also measured. The association between dose of intervention and effect estimates was explored. Results: 93 studies (14,993 parent/caregiver-infant dyads) met inclusion criteria. Based on very low to moderate quality of evidence, we found significant non-dose-dependent intervention effects on several measures of ERH, including bonding, parent/caregiver sensitivity, attachment, and dyadic interactions, and a significant effect on parent/caregiver anxiety, but no significant effects on other child outcomes. Conclusion: Current evidence does not support the notion that promoting ERH through early dyadic interventions ensures optimal child development, despite effectively promoting ERH outcomes. Given the lack of an association with dose of intervention, the field is ripe for novel, innovative, cost-effective, potent ERH intervention strategies that effectively and equitably improve meaningful long-term child outcomes.

Background: The postpartum hospital stay is a unique opportunity for clinicians to educate parents on the importance of promoting early child development. Pediatricians are well positioned to address both medical and developmental concerns during critical periods of development, yet very few parenting interventions are led by pediatricians. Aims: To assess the impact of a novel one-hour long pediatrician-led Newborn Class on maternal knowledge, confidence, and anxiety. Methods: We conducted a nonrandomized controlled trial to evaluate the effectiveness of the Newborn Class. First-time mothers who delivered a full-term singleton vaginally with no major complications and attended the class were recruited. Mothers who expressed a desire to attend the class but were discharged before a class was offered served as controls. Outcome measures: Maternal self-perceived anxiety and confidence were measured using standardized scales (State-Trait Anxiety Inventory for Adults and Karitane Parenting Confidence Scale). Knowledge on newborn care was assessed using a novel scale. Results: A total of 84 participants (intervention n=36, control n=48) were included in the study. Mothers who attended class showed significantly higher levels of knowledge compared to the control group as well as significantly higher parenting confidence levels. No change was observed in the overall level of anxiety. Conclusions: A short pediatrician-led parenting intervention can be an effective tool in improving maternal confidence and newborn care knowledge. Given the importance of the newborn period in establishing healthy developmental trajectories, this cost- and time-effective intervention could be widely implemented to promote early strong mother-infant relationships that foster healthy development.