Background HIV-exposed uninfected (HEU) children experience increased mortality compared with their HIV-unexposed uninfected (HUU) peers. It is unclear whether HEU children are also at increased risk for undernutrition, a modifiable risk factor for mortality. Methods We conducted a cross-sectional, population-based survey of children under 5 years of age in five health districts in Botswana. Linear mixed-effects models were used to assess continuous outcomes while generalized estimating equations were used to estimate relative risks of stunting, wasting, and underweight between HEU (n=396) and HUU (n=1,109) children. Secondary analyses examined potential mediation by low birthweight. Results The association between maternal HIV-exposure and child stunting varied significantly by child age (p<0.01). HEU children <1 year and ≥2 years of age had 1.85 (95% CI: 1.03–3.31; p=0.04) and 1.41 (95% CI: 1.06–1.88; p=0.02) times the risk of stunting compared with HUU children after multivariate adjustment, respectively. During the period of 1–2 years of age, when breastfeeding cessation occurred among HUU children, HUU children had increased risk of stunting compared with HEU children who were predominantly formula fed (RR: 1.56; 95% CI: 1.05–2.32; p=0.03). A mediation analysis estimated 67% of the excess risk of stunting among HEU children ≥2 years was attributable to low birthweight (p=0.02). There was no difference in risk of wasting or underweight. Conclusion HEU children are at increased risk of stunting compared with their HUU peers; however, interventions to increase birthweight may significantly ameliorate this excess risk. Interventions to support optimal growth during weaning are needed for all breastfed children.

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Background: The management practices of Respiratory Distress Syndrome (RDS) in the newborn have changed over time. We examine the trends in the epidemiology, resource utilization, and outcomes (mortality and bronchopulmonary dysplasia [BPD]) of RDS in preterm neonates ≤34 weeks gestational age (GA) in the United States.Methods: In this retrospective serial cross-sectional study, we used ICD-9 codes to classify preterm infants GA ≤34 weeks between 2003 and 2014 from the National Inpatient Sample as having RDS or not. Trends in the prevalence of infants defined as RDS by ICD-9 code (ICD9-RDS), length of stay, BPD, and mortality were analyzed using Cochran-Armitage and Jonckheere-Terpstra tests and multivariable logistic regression.Results: Of 1 526 186 preterm live births with GA ≤34 weeks, 554 409 had ICD9-RDS (260 cases per 1000 live births) with the prevalence increasing from 170 to 361 (P trend < 0.001) and associated decrease in all-cause mortality (7.6% to 6.1%; P trend < 0.001) from 2003 to 2014. Increased utilization of non-invasive mechanical ventilation (NIMV) (69.5% to 74.3%; P trend < 0.001) was associated with decreased invasive mechanical ventilation (IMV) use >96 h (60.4 to 56.6%; P trend < 0.001). Exclusive NIMV use increased from 16.8% to 29.1% (P trend < 0.0001). BPD incidence decreased from 14% to 12.5% (P trend < 0.001). LOS increased from 32 days to 38 days (P trend < 0.001) and cost increased from $49,521 to $55,394 (P trend < 0.001).Conclusion: From 2003 to 2014, the assigned ICD9-RDS diagnosis, and utilization of NIMV increased and mortality among infants assigned the ICD9-RDS diagnosis decreased. With higher survival, hospital cost increased incrementally, indicating the importance of ongoing analysis of appropriate reimbursement for the care provided at tertiary centers for preterm infants. K E Y W O R D S bronchopulmonary dysplasia, epidemiology, invasive mechanical ventilation, national inpatient sample, non-invasive mechanical ventilation, respiratory distress syndrome Abbreviation: AHRQ, agency for healthcare research and quality; BPD, bronchopulmonary dysplasia; CI, confidence interval; HCUP, healthcare cost and utilization project; ICD-9-CM, International Classification of Diseases, Ninth edition, clinical modification; IMV, invasive positive pressure ventilation; NIMV, non-invasive mechanical ventilation; NIS, national inpatient sample; PN, preterm neonates; RDS, respiratory distress syndrome; TTN, transient tachypnea of the newborn.This study was presented in part as a poster abstract at the

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