Caring for Twins During Infancy
The parents of twins could benefit from additional and specially developed advice from health professionals for considering and implementing adequate sleep and feeding practices that reduce parental fatigue and stress, as well as promote parent-twin relationships.
Summary
A Systematic Review Of The Literature On Sleeping And Feeding Practices Amongst Parents Of Twins
[Posted 8/Nov/2022]
AUDIENCE: Nursing
KEY FINDINGS: Caring for twins presents unique challenges that require specific choices to be made. The parents of twins could benefit from additional and specially developed advice from health professionals for considering and implementing adequate sleep and feeding practices that reduce parental fatigue and stress, as well as promote parent-twin relationships.
BACKGROUND: Purpose of this study is to better investigate how the parents of twins approach the care of their infants in terms of feeding and sleeping practices after birth by examining the sleeping and feeding behaviours of parents with twin babies.
DETAILS: Three electronic databases (PubMed, PsycINFO, and ScienceDirect) were searched, and studies published between 2006 and 2016 were included. The Preferred Reporting Item for Systematic Reviews and Meta-Analyses (Moher et al., 2015) was adopted. Key findings were extracted and synthesised. Fourteen studies were included (three focused on sleeping, seven focused on feeding, and four focused on sleeping but considered feeding to be a secondary issue).
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Copyright © Neonatal Nurses Association. Published by Elsevier Ltd. All rights reserved.
Source: Ionio, C., Macheroni, E., Landoni, M., et al. (2022). Caring for Twins During Infancy: A Systematic Review Of The Literature On Sleeping And Feeding Practices Amongst Parents Of Twins. J. Neonatal Nurs.. Published: October, 2022. DOI: 10.1016/j.jnn.2021.08.017.
Paternal Valproate Use During Spermatogenesis Not Linked to Neurodevelopmental Disorders in Offspring
A large Swedish-Norwegian cohort found no significant association between paternal valproate use during spermatogenesis and neurodevelopmental disorders in offspring compared with paternal lamotrigine or levetiracetam use. Findings were consistent across dose-response analyses and among fathers with epilepsy, supporting reassessment of paternal valproate restrictions.
Summary
A population-based cohort study in Sweden and Norway.
[Posted 17/Aug/2026]
AUDIENCE: Neurology, Psychiatry
KEY FINDINGS: In this large Nordic population-based cohort, paternal valproate monotherapy during spermatogenesis was not significantly associated with neurodevelopmental disorders in offspring compared with paternal lamotrigine or levetiracetam monotherapy. Findings were consistent across dose-response analyses and among fathers with epilepsy. The results do not support an increased neurodevelopmental risk from paternal valproate exposure, although limitations inherent to registry-based observational research remain.
BACKGROUND: Valproate is an effective antiseizure medication, but its established teratogenic effects with maternal exposure have led to regulatory restrictions for women of reproductive potential. Concerns about possible paternal effects on offspring neurodevelopment have also prompted precautionary recommendations for men. This study evaluated whether paternal valproate use during spermatogenesis was associated with neurodevelopmental disorders (NDDs) in offspring.
DETAILS: This population-based cohort study used nationwide Swedish and Norwegian health registries. It included singleton live births at >=22 completed gestational weeks between 1 January 2007 and 31 December 2020 in Sweden and between 1 January 2010 and 31 December 2018 in Norway. After exclusions, 4681 children in Sweden and 1572 children in Norway were included for analysis.
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The analysis compared children whose fathers received valproate monotherapy during spermatogenesis with children whose fathers received lamotrigine or levetiracetam monotherapy. Outcomes included NDDs, attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), intellectual disability (ID), and disorders of psychological development. Analyses were adjusted for relevant parental and child characteristics, including parental age, psychiatric diagnoses, psychotropic medication use, epilepsy diagnosis, and, in Sweden, parental education and maternal cohabitation/marital status.
The study specifically examined paternal antiseizure medication exposure during spermatogenesis, corresponding to the approximately 3 months before conception. Dose-response analyses and analyses restricted to fathers with epilepsy were also conducted.
Among the children included in the primary comparison, 2051 were born to fathers who used valproate monotherapy during spermatogenesis. No significant association was identified between paternal valproate exposure and NDDs compared with paternal lamotrigine or levetiracetam exposure. The findings remained consistent in dose-response analyses and when the analysis was restricted to fathers with epilepsy.
During follow-up in Sweden, 406 children were diagnosed with an NDD, including 287 with ADHD, 140 with ASD, 55 with ID, and 79 with disorders of psychological development. In Norway, 60 children were diagnosed with an NDD, including 35 with ADHD, 13 with ASD, 5 with ID, and 26 with disorders of psychological development.
For ASD, the pooled adjusted hazard ratio was 1.29 (95% CI 0.89 to 1.85). The study authors noted that point estimates were slightly above 1.0 in some analyses but did not reach statistical significance.
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Source: Razaz, N., Soderling, J., Tomson, T., et al. Risk of Neurodevelopmental Disorders Associated With Paternal Use of Valproate During Spermatogenesis. Journal of Neurology, Neurosurgery & Psychiatry. 2026; 97-8: 671-679. Published: August, 2026. DOI: 10.1136/jnnp-2025-337441.
Hepatic Venous Pressure Gradient Predicts Anticoagulation Response and Prognosis in PA-HSOS
In 76 patients with PA-HSOS, HVPG independently predicted nonresponse to initial anticoagulation. An HVPG cutoff of 20.165 mmHg yielded an AUC of 0.741, increasing to 0.881 when combined with serum total bilirubin, heart rate, and blood urea nitrogen. Higher HVPG was associated with poorer survival and greater sinusoidal injury.
KEY FINDINGS: In patients with PA-HSOS, HVPG may help identify individuals at increased risk of nonresponse to initial anticoagulation and poorer survival. An HVPG threshold of 20.165 mmHg demonstrated moderate predictive performance, while a model incorporating HVPG, serum total bilirubin, heart rate, and blood urea nitrogen showed improved discrimination. The prognostic and disease-severity associations of HVPG were stronger when measurement was performed within 1 month of disease onset. These findings suggest that early HVPG assessment may support risk stratification and treatment planning, although the results require validation in larger prospective studies.
BACKGROUND: Pyrrolizidine alkaloid-induced hepatic sinusoidal obstruction syndrome (PA-HSOS) is a drug-induced liver injury characterized by rapidly progressive portal hypertension. Although hepatic venous pressure gradient (HVPG) is an established measure of sinusoidal portal hypertension, its utility in assessing disease severity, predicting response to anticoagulation, and determining prognosis in PA-HSOS remains uncertain. This retrospective study evaluated the clinical value of HVPG in patients with PA-HSOS.
DETAILS: This single-center retrospective study included 76 patients diagnosed with PA-HSOS according to the Nanjing criteria who underwent HVPG measurement between January 2016 and April 2020. All patients received anticoagulation-transjugular intrahepatic portosystemic shunt (TIPS) stepwise treatment. The investigators assessed the association of HVPG with nonresponse to initial anticoagulation, prognostic survival, Drum Tower Severity Scoring (DTSS), and histopathological findings.
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Among the 76 patients, 33 responded to initial anticoagulation, whereas 43 did not respond and subsequently underwent TIPS. The median follow-up duration was 35.42 (0.53-54.47) months. HVPG was evaluated using multivariable logistic regression and receiver operating characteristic analysis. A subgroup analysis was performed after excluding patients with disease onset more than 1 month before assessment.
HVPG was independently associated with nonresponse to initial anticoagulation (95% CI: 1.006-1.413, P=0.043). An HVPG cutoff of 20.165 mmHg predicted nonresponse with a sensitivity of 0.744, specificity of 0.697, and AUC of 0.741 (95% CI: 0.626-0.857, P<0.001). Combining HVPG >20.165 mmHg with serum total bilirubin, heart rate, and blood urea nitrogen increased the AUC to 0.881 (95% CI: 0.804-0.958, P<0.001).
Patients with HVPG >20.165 mmHg had significantly poorer survival than those with HVPG <=20.165 mmHg (P=0.022, χ2=5.285). Overall mortality was 13.16% (10/76), with 9 deaths among 42 patients in the high-HVPG group and 1 death among 34 patients in the low-HVPG group.
HVPG was positively correlated with the area of sinusoidal bleeding (P=0.008, R=0.343). After excluding patients with disease onset of more than 1 month, the predictive performance of HVPG improved, with an AUC of 0.789 (95% CI: 0.654-0.924, P=0.001). In this subgroup, HVPG also showed significant linear relationships with DTSS (P0.001, R=0.522) and sinusoidal bleeding area (P=0.001, R=0.499).
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Source: Cai, Z., Li, R., Zhang, H., et al. The Value of Hepatic Venous Pressure Gradient in Patients With Pyrrolidine Alkaloid-Induced Hepatic Sinusoidal Obstruction Syndrome. Journal of Gastrointestinal Surgery. 2026; 30(8)): 102376. Published: August, 2026. DOI: 10.1016/j.gassur.2026.102376.
Once-Weekly Oral Islatravir-Lenacapavir Maintains HIV-1 Viral Suppression at 48 Weeks
In 607 adults with virologically suppressed HIV-1, once-weekly oral ISL/LEN was noninferior to once-daily B/F/TAF at week 48. HIV-1 RNA levels of 50 copies/mL or higher occurred in 0% versus 0.3% of participants, respectively. Virologic suppression, CD4+ T-cell changes, and safety outcomes were comparable between the groups.
KEY FINDINGS: Once-weekly oral ISL/LEN was noninferior to once-daily B/F/TAF for maintaining virologic suppression through week 48 in adults with previously suppressed HIV-1. No participants receiving ISL/LEN had HIV-1 RNA levels of 50 copies/mL or higher, and virologic suppression rates remained high in both treatment groups. CD4+ T-cell changes and safety outcomes were broadly comparable. The once-weekly oral regimen may provide a less frequent treatment option for patients who prefer oral therapy but may benefit from reduced dosing frequency.
BACKGROUND: Daily single-tablet antiretroviral regimens have substantially improved HIV-1 management; however, maintaining long-term adherence remains challenging for some patients. Less frequent oral treatment schedules may provide an alternative to daily therapy while avoiding the need for injectable regimens. This phase 3 trial evaluated the efficacy and safety of once-weekly oral islatravir-lenacapavir (ISL/LEN) in adults with virologically suppressed HIV-1.
DETAILS: This phase 3, double-blind, randomized, active-controlled, noninferiority trial was conducted in 12 countries. Adults with HIV-1 viral suppression for at least 6 months while receiving once-daily bictegravir-emtricitabine-tenofovir alafenamide (B/F/TAF) were randomly assigned in a 1:1 ratio to switch to once-weekly oral ISL/LEN (2 mg/300 mg) or continue once-daily B/F/TAF for 96 weeks. The primary endpoint was the proportion of participants with HIV-1 RNA levels of 50 copies/mL or higher at week 48, assessed using the FDA-defined snapshot algorithm. The prespecified noninferiority margin was 4 percentage points. A total of 607 participants underwent randomization, including 304 assigned to ISL/LEN and 303 assigned to B/F/TAF. At week 48, no participants in the ISL/LEN group and 1 participant (0.3%) in the B/F/TAF group had HIV-1 RNA levels of 50 copies/mL or higher (difference, -0.3 percentage points; 95.002% CI, -1.4 to 0.8), meeting the criterion for noninferiority. HIV-1 RNA levels below 50 copies/mL were observed in 284 participants (93.4%) receiving ISL/LEN and 280 participants (92.4%) receiving B/F/TAF (difference, 1.0 percentage point; 95% CI, -3.2 to 5.2). The mean change in CD4+ T-cell count was -10 cells/µL with ISL/LEN and -18 cells/µL with B/F/TAF, with a least-squares mean difference of 12 cells/µL (95% CI, -16 to 39). Treatment discontinuation due to adverse events occurred in 6 participants (2.0%) receiving ISL/LEN and 5 participants (1.7%) receiving B/F/TAF; serious adverse events occurred in 16 participants (5.3%) and 14 participants (4.6%), respectively.
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Obesity, Rather Than High Body Surface Area Alone, Predicts Clinically Significant Asparaginase Toxicity During Induction Therapy for Acute Lymphoblastic Leukemia
Among 4,925 children and young adults with ALL, obesity—not high BSA alone—was the strongest predictor of clinically significant asparaginase toxicity. Patients with obesity and high BSA had the highest risk of hepatic toxicity and thromboembolism, whereas induction toxicities were not associated with increased end-of-induction MRD positivity.
KEY FINDINGS: This large multicenter analysis demonstrates that obesity-not elevated BSA alone-is the principal patient-related risk factor for clinically significant asparaginase toxicity during induction therapy for ALL. The greatest excess risk occurred in patients with both obesity and high BSA, particularly for hepatic toxicity and thromboembolic events, while pancreatitis risk was unaffected. Older age independently increased toxicity risk, especially hyperbilirubinemia. Notably, induction-phase AAT did not compromise early treatment response, as measured by EOI MRD. These findings suggest that obesity should be prioritized when identifying patients for enhanced toxicity surveillance and future preventive strategies, whereas high BSA in the absence of obesity does not appear to justify dose modification based solely on body size.
BACKGROUND: Asparaginase remains a cornerstone of induction therapy for acute lymphoblastic leukemia (ALL), but treatment-limiting toxicities frequently interrupt therapy and may compromise long-term outcomes. Previous studies have produced conflicting evidence regarding whether older age, obesity, or high body surface area (BSA) independently increase the risk of asparaginase-associated toxicities (AAT). This large Children’s Oncology Group analysis evaluated the relative contributions of these risk factors and examined whether induction-phase AAT affected early treatment response measured by end-of-induction (EOI) minimal residual disease (MRD).
DETAILS: This retrospective analysis included 4,925 patients aged 1-30 years enrolled in the Children’s Oncology Group trials AALL0232 and AALL0434. All patients received a single induction dose of pegaspargase 2500 IU/m² without dose capping. Investigators assessed grade >=3 hyperbilirubinemia, grade >=4 alanine aminotransferase (ALT) elevation, grade >=2 thromboembolism, and grade >=3 acute pancreatitis. Multivariable analyses evaluated the independent effects of age, obesity, and BSA, while EOI MRD positivity (>=0.01%) was analyzed to determine whether AAT adversely influenced early leukemia response. Among 4,925 patients, 290 (6%) experienced at least one clinically significant AAT during induction. Toxicity rates increased with advancing age and obesity. After adjustment for confounding variables, obesity independently increased the likelihood of AAT (OR 2.5; 95% CI 1.88-3.24), whereas high BSA alone was not an independent predictor. Patients with both obesity and high BSA had the greatest risk of overall AAT (OR 3.3; 95% CI 2.22-4.77), while high BSA without obesity was not associated with increased risk (OR 1.4; 95% CI 0.94-2.04). Older patients (>=10 years) demonstrated more than a twofold increase in AAT risk compared with younger children.
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Obesity combined with high BSA significantly increased the risk of hyperbilirubinemia (OR 3.5; 95% CI 2.2-5.7), severe ALT elevation (OR 3.3; 95% CI 1.7-6.6), and thromboembolism (OR 3.1; 95% CI 1.5-6.5). Acute pancreatitis showed no significant association with obesity or BSA. Importantly, development of AAT did not increase the likelihood of EOI MRD positivity (36.6% vs 33.5%; Ps= .318), suggesting that induction toxicities did not adversely affect early disease response.
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Source: Orgel, E., Maese, L. D., Devidas, M., et al. Toxicity From Asparaginase During Acute Lymphoblastic Leukemia Induction: A Report From the Children's Oncology Group. Blood Advances. 2026; 10(14):4923-4930. Published: July 28, 2026. DOI: 10.1182/bloodadvances.2026019870
Suicide Risk Peaks During the First Year After Dementia Diagnosis in Older Adults
Among 2,667,987 older adults with newly diagnosed dementia, suicide risk during the first year was significantly higher than in the general population (SMR 1.53), peaking within 90 days of diagnosis. Adults aged 65–74 years, patients with frontotemporal dementia, and those with mental illness, substance use disorders, or chronic pain had the greatest risk.
KEY FINDINGS: Older adults experience a significantly elevated risk of suicide during the first year after receiving a dementia diagnosis, particularly within the first 90 days. Individuals aged 65-74 years and those diagnosed with frontotemporal dementia represent the highest-risk groups. Coexisting mental illness, substance use disorders, chronic pain, rural residence, and recent mental health service utilization further increase suicide risk. These findings support routine suicide risk assessment, early psychiatric evaluation when appropriate, caregiver support, and discussions regarding restriction of access to lethal means immediately after a dementia diagnosis.
BACKGROUND: A new diagnosis of Alzheimer's disease or related dementias (ADRD) can be psychologically distressing and may increase vulnerability to suicidal behavior. Previous studies have reported inconsistent findings regarding suicide risk after dementia diagnosis. This nationwide U.S. cohort study evaluated suicide mortality and non-fatal suicidal events during the first year following a new ADRD diagnosis and identified patient characteristics associated with increased risk.
DETAILS: This retrospective cohort study included 2,667,987 Medicare fee-for-service beneficiaries aged >=65 years with newly diagnosed ADRD identified between 2012 and 2015. Patients were followed for up to 12 months after the initial dementia diagnosis or until death. Suicide deaths were identified through linkage with the National Death Index, while non-fatal suicidal events were captured using hospital claims. Standardized mortality ratios (SMRs) compared suicide risk with that of the general U.S. older adult population. Adjusted hazard ratios (AHRs) were calculated after controlling for age, sex, and race/ethnicity. During the first year after diagnosis, 705 suicide deaths occurred, corresponding to a suicide rate of 26.42 per 100,000 person-years, with an overall SMR of 1.53 (95% CI 1.42-1.65) compared with the general older adult population. The highest relative risk was observed among adults aged 65-74 years (SMR 3.40; 95% CI 2.94-3.86), and approximately half of all suicides occurred within the first 90 days after diagnosis. Patients with frontotemporal dementia had the highest suicide rate (124.63 per 100,000 person-years) and a significantly increased risk of suicide compared with unspecified dementia (AHR 2.91; 95% CI 1.67-5.05). Rural residence, recent mental health disorders, substance use disorders, chronic pain, and recent mental health-related healthcare utilization were independently associated with higher suicide risk. Non-fatal suicidal events were more frequent among patients with vascular dementia, personality disorders, bipolar disorder, anxiety disorders, substance use disorders, and chronic pain.
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