搜索结果：Pediatrics in review

Hyperglycemia in pregnancy is associated with increased maternal and fetal morbidity and long-term health risks for both mother and child. For the first time our current guidelines integrate gestational diabetes mellitus (GDM) and preconception diabetes into joint guidelines. While the characteristics of individual diabetes subtypes are addressed separately, recommendations regarding lifestyle, glucose monitoring and pharmacotherapy apply to all forms of hyperglycemia during pregnancy. Women with diabetes diagnosed early in pregnancy are classified as pregnant women with overt diabetes, whereas GDM is usually identified by oral glucose tolerance testing (oGTT) between 24 and 28 weeks gestation, or earlier in high-risk patients. A novel aspect is the consideration of specific diagnostic criteria for early GDM. Key management strategies include nutritional counselling, regular self-monitoring of blood glucose and physical activity, with insulin as the treatment of choice if glycemic targets are not achieved. In women with preconception diabetes, pregnancy planning, preconception metabolic optimization and close interdisciplinary care are essential. Technical advances in continuous glucose monitoring, insulin pump therapy and automated insulin delivery (AID) systems are becoming increasingly more relevant in pregnancy. Postpartum, women with GDM should undergo an oGTT 4-12 weeks after delivery, with follow-up screening every 1-3 years if results are normal. All affected women should be informed about their elevated risk of type 2 diabetes and cardiovascular diseases. Breastfeeding is strongly recommended. Children of mothers with GDM or diabetes require long-term follow-up due to an increased risk of obesity and developmental disorders. Hyperglykämie in der Schwangerschaft ist mit erhöhter mütterlicher und fetaler Morbidität sowie langfristigen Risiken für Mutter und Kind assoziiert. Unsere aktuelle Leitlinie fasst erstmals Gestationsdiabetes (GDM) und präkonzeptionellen Diabetes in einer gemeinsamen Leitlinie zusammen. Während die Besonderheiten der einzelnen Diabetesformen getrennt dargestellt werden, gelten Empfehlungen zu Lebensstil, Glukosemonitoring und Pharmakotherapie für alle Formen der Hyperglykämie in der Schwangerschaft. Frauen mit in der Frühschwangerschaft diagnostiziertem Diabetes gelten als Schwangere mit manifestem Diabetes, während GDM üblicherweise zwischen der 24. und 28. Schwangerschaftswoche mittels oGTT diagnostiziert wird, bei Hochrisikopatientinnen auch früher. Eine Neuerung ist die Diskussion eigener Diagnosekriterien für einen frühen GDM. Zentrale Therapieelemente sind Ernährungsberatung, regelmäßige Blutzuckerselbstkontrollen und körperliche Aktivität; bei unzureichender Stoffwechselkontrolle ist Insulin die Therapie der Wahl. Bei präkonzeptionellem Diabetes sind Schwangerschaftsplanung, präkonzeptionelle Stoffwechseloptimierung sowie eine engmaschige Betreuung essenziell. Technische Fortschritte im kontinuierlichen Glukosemonitoring, in der Pumpentherapie und bei AID-Systemen gewinnen auch in der Schwangerschaft zunehmend an Bedeutung. Postpartal wird bei Frauen mit GDM ein oGTT nach 4 bis 12 Wochen empfohlen, bei Normalbefund mit Nachsorgeuntersuchungen alle 1 bis 3 Jahre. Alle Betroffenen sollen über ihr erhöhtes Risiko für Typ-2-Diabetes und kardiovaskuläre Erkrankungen aufgeklärt werden. Stillen wird ausdrücklich empfohlen. Kinder von Müttern mit GDM oder Diabetes sollten aufgrund eines erhöhten Risikos für Adipositas und Entwicklungsauffälligkeiten langfristig nachbetreut werden.

Pneumatosis intestinalis (PI), defined by the presence of gas within the bowel wall, ranges in severity from a benign, incidental finding to a life-threatening condition. The true incidence in children is unclear, and standardized treatment protocols are lacking, resulting in variable management and potential for both over- and undertreatment. This review summarizes current knowledge on pediatric PI, including pathophysiology, clinical presentation, diagnostics, treatment strategies, and risk stratification. Development of PI is multifactorial, involving mechanical, bacterial, and biochemical mechanisms. Risk factors include necrotizing enterocolitis, immunosuppressive therapy, gastrointestinal dysmotility, developmental delay, and congenital anomalies. Clinical presentation ranges from asymptomatic cases discovered incidentally to severe disease with clinical symptoms and sepsis. PI can be identified on plain radiographs, ultrasonography, and cross-sectional imaging. Abnormal complete blood counts, elevated inflammatory markers, and metabolic acidosis are markers of severity. Treatment depends on the severity and underlying cause, with conservative management indicated for stable patients and surgical intervention required for those with signs of intestinal necrosis or perforation. Risk-stratification models are necessary to guide individualized management, minimizing prolonged bowel rest and antibiotic use while ensuring timely interventions for high-risk patients. Managing pediatric PI requires an understanding of its diverse presentations, diagnostic methods, and treatment options. Evidence-based risk-stratification protocols could minimize practice variability and optimize care, differentiating patients who are appropriate for conservative management from those who require escalation of care. This review serves as a guide for clinicians navigating the diagnostic and therapeutic challenges associated with PI in children.

The acronym "TORCH" was originally introduced in 1974 by Dr Nahmias to collectively describe the most common pathogens responsible for congenital and perinatal infections, including Toxoplasma gondii, others, rubella virus, cytomegalovirus (CMV), and herpes simplex virus. With advances in diagnostic capabilities and expanded epidemiologic surveillance, the list of recognized congenital pathogens has grown to include syphilis, varicella-zoster virus, Zika virus, HIV, parvovirus B19, and lymphocytic choriomeningitis virus. While the TORCH acronym continues to be widely used in clinical and educational settings, it no longer encompasses the full spectrum of pathogens implicated in perinatally acquired and in utero infections. A more nuanced and inclusive approach to the diagnosis and management of congenital infections is required. These vertically transmitted pathogens can disrupt fetal development, leading to outcomes ranging from subclinical disease to severe neurologic impairment, sensorineural hearing loss, or fetal demise. Epidemiologic trends vary globally: CMV is more prevalent in low-income countries, while congenital rubella is rare in regions with successful vaccination programs. The Zika virus outbreak underscored the need for early recognition of emerging threats to fetal health. Despite their potentially serious consequences, TORCH infections are frequently underdiagnosed due to nonspecific clinical presentations, diagnostic limitations, and inconsistencies in screening practices. Misinterpretation of serologic results and delays in diagnosis may lead to preventable complications. This review synthesizes current evidence on TORCH infections, emphasizing clinical manifestations, diagnostic strategies, therapeutic approaches, and long-term follow-up. A proposed multidisciplinary model aimed at improving perinatal screening and neonatal outcomes is offered.

Social-emotional development is an important part of early childhood development and appears to have a socioeconomic gradient. Going beyond conventional approaches, this study aimed to examine intersectional inequalities in social-emotional problems in three-year-old children in relation to their parents' income, education and place of birth and to consider the implications for public health. A cross-sectional design was used in this population-based study in Västerbotten County of Sweden with an effective sample of 8,823 children. Social-emotional problems were assessed using the parent/caregiver-report Ages and Stages Questionnaires: Social-Emotional (ASQ: SE) 36-month interval in Child Health Services over the years of 2014-2018 and linked to parents' sociodemographic characteristics obtained from national population registers. An analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach was combined with additive binomial regression, estimating risk differences for social-emotional problems across 27 intersectional categories. In the intersectional categories where multiple dimensions of social disadvantage overlapped, average risk differences generally increased. For instance, when comparing with the most advantaged category a risk difference as high as 25.4% (95% CI 13.7 to 37.0%) was found for the children whose parents' income was in the lowest tercile, only one parent had a higher educational level and whose parents were both born outside of Sweden. Discriminatory accuracy was estimated as moderate for the three included regression models, although it improved slightly for the model including dimensions of social disadvantage. The addition of intersectional categories provided no further significant improvement. The intersectional approach used in this study improves our understanding of complex social inequalities in social-emotional problems in preschool children in northern Sweden. Consistent with the concept of proportionate universalism, the results of this study indicate that universal public health policies are needed when addressing this issue in addition to policies targeting disadvantaged groups. Research that considers individual heterogeneity and discriminatory accuracy has the potential to advance our knowledge of health inequities and increase the effectiveness of public health policy.

Advances in cancer detection and treatment have resulted in a growing population of survivors. Many face long-term physical, psychological, and financial challenges that are unevenly distributed across socioeconomic, racial, and demographic groups. Clinical guidelines should provide recommendations to guide survivorship care and ensure equity. To provide an overview of recommendations from existing guidelines addressing follow-up care after cancer. International and German clinical guidelines were identified through a systematic search of MEDLINE, TRIP, GuidelineCentral, NICE, G-I-N and SIGN, complemented by manual searches of relevant registries (AWMF, Onkopedia, ESMO, IGHG). Guidelines were included if they contained at least one recommendation on follow-up or survivorship care. Screening was performed independently by two reviewers. Recommendations were coded using a predefined framework and synthesized using tables and interactive evidence-maps. 198 guidelines comprising 2270 recommendations were included. The most frequently represented categories were cross-sectional guidelines (i.e., not limited to a specific cancer type) (n = 36), followed by gastrointestinal tumors (n = 15) and myeloid proliferations (n = 14); most targeted adults (n = 150). Of all recommendations, 39% were evidence-based. Frequently addressed topics included previous treatment (n = 342), long-term survivorship (>5 years) (n = 705), screening for adverse events (n = 263), timing of follow-up (n = 338), and counselling and education (n = 234). The extent to which recommendations explicitly addressed equity-related factors varied considerably: age was frequently considered (n = 160), whereas socioeconomic status (n = 18), race/ethnicity (n = 5), and religion/culture (n = 6) were rarely addressed. Survivorship care was addressed heterogeneously across guidelines, with long-term and equity aspects underrepresented. More consistent, evidence-based and equity-oriented guideline development is needed.

To evaluate the association between high Anti-Müllerian Hormone (AMH) levels and key outcomes of In Vitro Fertilization (IVF)/Intracytoplasmic Sperm Injection (ICSI) in women with Polycystic Ovary Syndrome (PCOS). A systematic search was performed in MEDLINE (via PubMed), Web of Science, and Scopus, on September 17, 2024. We included observational studies in PCOS patients stratified by AMH levels that reported any of the IVF/ICSI outcomes of interest, namely: live birth rate, clinical pregnancy rate, miscarriage rate, oocytes retrieved, MII oocytes and fertilization rate. Two reviewers independently extracted data and assessed risk of bias using the National Heart, Lung, and Blood Institute Study Quality Assessment Tool. Discrepancies were resolved by consensus. Data were pooled using meta-analysis when appropriate. Sensitivity analyses were conducted using a leave-one-out approach. Thirteen studies met the inclusion criteria. Ten were rated as low risk of bias, two as unclear, and one as high risk, indicating overall fair to strong methodological quality. Women with high AMH levels had a lower live birth rate (odds ratio [OR]: 0.85; 95%CI: 0.71-1.02), which became significant after leave-one-out analysis (OR: 0.80; 95%CI: 0.64-0.99). Clinical pregnancy rates were 2% lower in women with elevated AMH levels (OR: 0.98; 95%CI: 0.82-1.17). Miscarriage rates showed a non-significant 25% increase in women with high AMH levels (OR: 1.25; 95%CI: 0.88-1.76). High AMH levels were associated with more retrieved oocytes in the overall meta-analysis (mean difference: 3.52; 95%CI: 1.70-5.33), with consistent findings in sensitivity analyses. There was no significant difference in fertilization rate between the two groups. While high AMH levels indicate greater ovarian reserve, they negatively influence reproductive outcomes in PCOS patients. These findings highlight the need for individualized ART strategies and further research to clarify underlying mechanisms.PROSPERO: CRD42024596056.

Neuropathic pain is a significant point of distress in pediatric oncology patients. While oral pain medications such as acetaminophen, nonsteroid inflammatory drugs, gabapentinoids, and/or opioids are commonly prescribed, they can have adverse effects, may interfere with cancer treatment, and increase patient's pill burden. In adult oncology, topical analgesia with combination ointments such as amitriptyline-ketamine-lidocaine (AKL) have shown some efficacy for neuropathic pain relief, however, no significant data for safety or efficacy of topical analgesia exists in pediatric oncology. To assess the effects of a compounded AKL cream on neuropathic pain symptoms in a cohort of pediatric oncology patients. Through a retrospective chart review of children and young adults with cancer who were treated with topical AKL cream over a span of five years, we evaluated pain scores at baseline compared to the 10 days following AKL cream administration. We utilized a mixed effects model to study the association between pain scores and study day and age. Changes from baseline were assessed using contrasts with Dunnett-adjusted P-values. Of the 53 patients included, all used AKL cream at least once. Pain scores were significantly lower on study days 3-5 and 7-10 than at baseline. Opioid showed a nonstatistically significant decrease over time. Independently, pain scores increased linearly by 0.19 for each additional year of age. Lower pain scores were achieved in patients using topical AKL cream over the study period. Topical cream can serve as a potential therapeutic adjuvant for cancer-related neuropathic pain in pediatric patients.

Social determinants of health (SDOH) influence access to nutrition, healthcare, and living conditions and may contribute to pediatric anemia. Anemia in children is particularly concerning because delayed identification can lead to developmental and long-term health consequences. Despite their potential impact, SDOH are not explicitly recognized as risk factors in current AAP anemia screening guidelines. Identifying whether SDOH predict anemia risk may facilitate earlier detection and treatment. To determine whether specific SDOH domains predict an increased risk of anemia in pediatric patients in primary care settings. Pediatric patients (<18&#x2009;years) presenting for routine or acute primary care visits and their caregivers were recruited. Caregivers completed a validated SDOH screener, and tcHgb measurements were obtained. A retrospective chart review provided demographic and clinical data. Associations between tcHgb and numeric variables were assessed using Spearman correlations; categorical variables were analyzed with Kruskal-Wallis or Wilcoxon rank sum tests. Regression analysis evaluated tcHgb as the outcome with SDOH risk as the predictor, adjusting for age, sex, race, and insurance type. Analyses were conducted using SAS v9.4. Among 248 families, 186 children (75%) had at least one identified social need. The most common were financial strain (31.85%), food insecurity (25.00%), cognitive disabilities (21.77%), language and literacy barriers (21.05%), and mental health concerns (18.11%). Mean (SD) tcHgb was 12.7 (1.2) g/dL, with a median of 2.0 [0.5, 3.0] positive SDOH domains when present. TcHgb was not associated with age, BMI, or sex but differed by insurance type. Each additional SDOH concern was associated with a 0.29&#x2009;g/dL decrease in tcHgb (p&#x2009;<&#x2009;.0001). SDOH risk factors are significantly associated with lower hemoglobin levels in pediatric patients, with cumulative social needs conferring increased anemia risk. Incorporating SDOH screening into pediatric primary care may improve early identification and outcomes for children at risk of anemia.

Procollagen type 1&#xa0;N-terminal propeptide (P1NP) is a vital biomarker for evaluating bone formation, reflecting osteoblast activity and offering meaningful insights into bone health. Elevated P1NP levels may signal heightened bone turnover, as observed in conditions like osteoporosis. Conversely, decreased P1NP levels could serve as a prognostic indicator for fracture risk stratification in the elderly population. This study aimed to establish P1NP levels to enhance diagnostic and therapeutic methods in evaluating bone health. A systematic literature search were performed across multiple databases until April 15, 2023, focusing on articles that measured serum P1NP levels in healthy individuals aged 50 and older. After removing duplicates, two reviewers evaluated titles and abstracts of potentially relevant studies. Data were extracted on authors, publication year, sample size, laboratory kits used, participants' fasting status, sex, and serum P1NP levels using a pre-designed data sheet. The risk of bias was assessed with the Newcastle Ottawa checklist, and pooled mean P1NP levels were estimated using Stata software, with statistical heterogeneity analysed through Cochran's Q test and the I2 statistic. Out of 11,011 studies identified, 49 met the inclusion criteria after screening and removing 4,227 duplicates. The pooled P1NP levels were 39.6 ng/mL for males and 48.5 ng/mL for females, with a combined level of 46.5 ng/mL. Under fasting conditions, P1NP levels were 40.0 ng/mL for males and 49.7 ng/mL for females. Funnel plot analysis suggested publication bias, but the overall quality of the studies was assessed as generally strong. The current study points out the necessity for the determination of sex-specific values for P1NP, highlighting elevated P1NP levels in women to be associated with a higher risk of osteoporosis. The online version contains supplementary material available at 10.1007/s40200-026-01945-0.

Synthesize data on whether existing behavioral interventions can improve health equity among youth with type 1 diabetes. While existing behavioral interventions demonstrated efficacy in improving health and/or psychosocial outcomes, evidence that these same interventions may improve health equity were lacking. Most interventions were evaluated using predominantly White and affluent samples and some studies did not report on racial, ethnic, or sociodemographic characteristics of their sample. Only a few interventions have been adapted for youth from minoritized backgrounds. Recent multisystemic and technology/mHealth interventions recruited samples that were sociodemographically representative of youth experiencing disparities, suggesting that these interventions could improve health and/or psychosocial outcomes for these sociodemographic groups. However, no studies conducted subgroup analyses to examine whether the effect of the intervention might vary as a function of sociodemographic characteristics. The prevalence and persistence of disparities in psychosocial and glycemic outcomes among youth with T1D underscore the urgent need for effective, evidence-based behavioral interventions for populations in most need of this care. There is a critical need for research that prioritizes recruitment of samples that represent youth most impacted by health disparities. Additionally, existing interventions can be adapted for youth from minoritized backgrounds. Future research would benefit from leveraging existing intervention development/adaptation frameworks and engaging community partners through the research process.

Lafora disease is a rare, autosomal recessive neurodegenerative disorder characterized by the progressive accumulation of abnormal, insoluble, and hyperphosphorylated forms of glycogen, known as Lafora bodies, in the brain and other tissues. The disease typically manifests during early adolescence with myoclonus, seizures, and rapidly progressive cognitive decline, ultimately leading to severe neurological deterioration and death within a decade of onset. Mutations in the EPM2A or EPM2B genes, which encode the proteins laforin and malin-key regulators of glycogen metabolism-are the underlying cause of Lafora disease. Current research focuses on understanding the molecular mechanisms of the disease and exploring potential therapeutic approaches, including gene therapy, antisense oligonucleotides, enzyme-based therapies, and pharmacological interventions aimed at mitigating glycogen accumulation and alleviating disease symptoms. Multiple mouse models have been generated to advance our understanding of disease pathogenesis and facilitate treatment development. These include models deficient in Epm2a or Epm2b gene expression, the Epm2a-/- and Epm2b-/- mouse models, and a knock-in mouse model harboring the most frequent mutation in the Epm2a gene, the R240X mutation. Recently, we developed two new knock-in mouse models with Epm2b gene mutations. In this work, we describe the generation and characterization of these malin knock-in mice and compare their phenotype with Epm2b-/- mice. These new models exhibit distinct neurological alterations, including motor and cognitive impairments, epileptic-like activity and altered synaptic plasticity. Based on these results, they can serve as valuable models for studying specific aspects of Lafora disease, providing more suitable tools for future research.

Maternal obesity is increasingly recognized as an important modulator of early-life microbial and metabolic environments. This study investigates the association between maternal body mass index (BMI) and the microbiota and metabolite profiles of colostrum and neonatal feces in a Mexican mother&#x2013;infant cohort. Milk and fecal samples were collected from dyads of obese and normal-weight mothers. Bacterial microbiota composition was characterized by sequencing the 16&#xa0;S rRNA gene (V3 region) using Ion Torrent technology, and metabolomic profiling was performed using Fourier transform ion cyclotron resonance (FT-ICR) mass spectrometry. The results provide evidence consistent with vertical microbial and metabolic transmission, with Firmicutes and Patescibacteria predominating in Colostrum. Neonates born to obese mothers exhibited reduced relative abundances of Lactobacillus in neonatal fecal samples, alongside increased levels of Lactobacillus and Staphylococcus in both colostrum and mother&#xb4;s feces. Overall microbial diversity across maternal stool, colostrum, and neonatal stool samples was not significantly associated with maternal BMI; however, distinct metabolite signatures linked to maternal obesity, like oligopeptides, glycoside-related compounds, Phosphatidic Acid (PA) Derivatives, bioactive molecules such as enkephalinamide derivatives, were observed. These findings highlight the role of breastfeeding as a key interface in shaping the neonatal gut microbiota and metabolome and suggest potential pathways linking maternal metabolic status with early-life microbial and metabolic programming. This study advances understanding of maternal&#x2013;infant microbial ecology and supports further investigation into the long-term health implications of maternal obesity.

Maternal diabetes and obesity are established risk factors for adverse offspring health. Emerging evidence suggests that these fetal programming effects vary by sex, yet it remains unclear whether these factors independently or interactively influence early brain development. This prospective study included 1,965 infants from six international cohorts. Infant MRI was used to derive subcortical volumes (thalamus, amygdala, hippocampus, pallidum, putamen, caudate). ComBat harmonization was applied. Multiple linear regression tested main and interaction effects of maternal obesity, maternal diabetes, and sex, controlling for covariates with false discovery rate (FDR) corrections. Of the sample, 46% were female (N&#x2009;=&#x2009;909), 9% were exposed to maternal diabetes (N&#x2009;=&#x2009;172), 22% to maternal obesity (N&#x2009;=&#x2009;386), and 3% to both (N&#x2009;=&#x2009;61). MRI scans were performed at 25.9&#x2009;&#xb1;&#x2009;18.8&#xa0;days. Maternal diabetes was associated with smaller thalamic volume (standardized &#x3b2;&#x2009;=&#x2009;-0.09, 95%CI -0.16 to -0.01, FDR P&#x2009;=&#x2009;0.020), but this association was attenuated after adjusting for maternal obesity. Maternal obesity was associated with smaller hippocampal (standardized &#x3b2;&#x2009;=&#x2009;-0.13, 95%CI -0.21 to -0.05, FDR P&#x2009;=&#x2009;0.009) and thalamic volumes (standardized &#x3b2;&#x2009;=&#x2009;-0.09, 95%CI -0.14 to -0.03, FDR P&#x2009;=&#x2009;0.007). Sex-specific associations were observed. In females, maternal obesity was associated with smaller hippocampal (standardized &#x3b2;&#x2009;=&#x2009;-0.24, 95%CI -0.36 to -0.13, FDR P&#x2009;<&#x2009;0.001) and amygdala volumes (standardized &#x3b2;&#x2009;=&#x2009;-0.18, 95% CI&#x2009;=&#x2009;-0.30 to -0.06, FDR P&#x2009;=&#x2009;0.016). A three-way interaction (diabetes x obesity x sex) was observed for thalamus volume (standardized &#x3b2;&#x2009;=&#x2009;-0.50, 95%CI -0.81 to -0.18, FDR P&#x2009;=&#x2009;0.017). In males, combined exposure had lower thalamic volume compared to those with one or neither exposure (all Ps&#x2009;<&#x2009;0.05). In females, maternal obesity (standardized &#x3b2;&#x2009;=&#x2009;-0.12, 95%CI -0.20 to -0.04, FDR P&#x2009;=&#x2009;0.015) and diabetes (standardized &#x3b2;&#x2009;=&#x2009;-0.16, 95%CI -0.30 to -0.02, FDR P&#x2009;=&#x2009;0.042) showed independent associations with thalamic volume, without a significant interaction (standardized &#x3b2;&#x2009;=&#x2009;0.23, 95%CI -0.01 to 0.46, FDR P&#x2009;=&#x2009;0.092). Maternal obesity shows stronger associations with infant subcortical volumes than maternal diabetes. It is associated with smaller hippocampal and amygdala volumes in females, while combined exposure to maternal diabetes and obesity is associated with smaller thalamic volumes in males. These findings highlight the role of maternal metabolic health and infant sex in early neurodevelopment.

Provision of mother's milk for very premature infants (&#x2264;32 weeks' gestation) is a critical, modifiable factor that improves outcomes in this highly vulnerable population. Despite this, however, longstanding lactation disparities persist. Mothers who are non-Hispanic Black, non-English speaking, have lower income, lower educational attainment, or public insurance are less likely to provide mother's milk, and these inequities have remained largely unchanged over decades. For mothers of very preterm infants, sustaining lactation presents unique challenges. Mothers are typically dependent on breast pumps to express milk every 3-4 h due to infant physiologic immaturity and prolonged hospitalization. They must do so while navigating the physical separation from their infant, transportation barriers, and financial strain from a NICU admission. Although NICUs commonly provide hospital-grade pumps and specialized lactation support in the hospital, mothers may face multi-level barriers to lactation, including limited access to equipment at home, difficulty visiting the NICU, and inadequate social or resource support. These barriers often intersect to contribute to disparate lactation outcomes, as racially and ethnically minoritized mothers are disproportionately affected by adverse social drivers of health. Addressing inequities in lactation requires multilevel, evidence-based interventions. In this report, we structure barriers and proposed interventions within a socio-ecological framework.

The H9N2 subtype avian influenza virus, as a mutant strain of low-pathogenic avian influenza (LPAI), has augmented its transmission ability and pathogenicity via genetic evolution. At present, it has incurred the most substantial economic losses to the global poultry industry, particularly in Asia where it is extensively prevalent. To tackle this challenge, it is essential to devise effective prevention and control strategies for the H9N2 subtype. Among these strategies, vaccine development and highly sensitive diagnostic techniques are the primary countermeasures. Although more than twenty different vaccines and diagnostic kits for various types of avian influenza are currently available on the market, existing detection methods lack sufficient specificity for avian influenza virus subtypes. Precise subtype differentiation still depends on polymerase chain reaction (PCR)-based methods, which necessitate specialized equipment and are rarely accessible in on-site settings such as poultry farms. Our laboratory has developed specific single-domain antibodies (VNAR) derived from sharks against the H9N2 subtype of the avian influenza virus. The recombinant anti-H9N2 VNAR demonstrates high specificity for hemagglutinin (HA) binding activity and can specifically recognize, bind to, and neutralize the H9N2 subtype avian influenza virus on the surface of Madin-Darby canine kidney (MDCK) cells. Owing to their low molecular weight, excellent stability, and enhanced tissue penetration, these specific VNAR molecules possess extremely high application potential, rendering them innovative candidate drugs for the diagnosis and prevention of H9N2 infections.

SCD is a prevalent genetic disorder marked by chronic complications that impact quality of life and survival. Affecting approximately 100&#x2009;000 individuals in the United States and millions globally, SCD results from a mutation in the &#x3b2;-globin gene, leading to sickle-shaped red blood cells and subsequent vaso-occlusive episodes, hemolysis, and multiorgan damage. Despite advancements such as newborn screening and disease-modifying therapies, individuals with SCD continue to face significant long-term challenges. This review focuses on the major long-term complications of SCD, including chronic pain, mental health diagnoses, neurological deficits, infection, alloimmunization, cardiopulmonary complications, and reproductive health concerns. Pain, often a hallmark of SCD, significantly affects quality of life and requires an individualized approach to management. Depression and anxiety are prevalent and impact both psychosocial well-being and disease outcomes. Neurological complications, including stroke and cognitive deficits, pose substantial risks and require ongoing monitoring. Reproductive health concerns, such as fertility and pregnancy complications, demand careful management. Alloimmunization, a potential consequence of transfusion exposure transfusion exposure, complicates future transfusion therapy and increases the risk of delayed hemolytic transfusion reactions. Cardiopulmonary complications, including pulmonary hypertension and restrictive lung disease secondary to recurrent acute chest syndrome, are associated with increased morbidity and warrant early recognition and monitoring. This review aims to bridge the knowledge gap for general pediatricians by providing comprehensive insights into these long-term complications and offering strategies for effective management. Understanding these aspects is essential for improving patient outcomes and ensuring that pediatricians can provide informed, empathetic, and proactive care for children with SCD.

Bronchopulmonary dysplasia (BPD) remains a significant source of morbidity and mortality among preterm infants, especially those born before 28&#xa0;weeks gestation. Although the survival of preterm infants has improved, the incidence of BPD remains high among extremely low birth weight infants. The pathogenesis of BPD involves inflammation and oxidative stress, leading to impaired alveolarization and dysregulated development of the pulmonary vasculature. Mechanical ventilation, oxygen toxicity, inflammation, and nutritional deficiencies, as well as genetic susceptibility, can increase the risk for and/or severity of BPD. Infants with moderate to severe BPD require prolonged respiratory support and are at risk for respiratory tract infections, pulmonary hypertension, growth failure, and neurodevelopmental impairment. Diagnosis and classification of BPD are based on assessment of an infant's oxygen needs and respiratory support requirement at 36&#xa0;weeks postmenstrual age. Management of BPD emphasizes minimizing exposure to mechanical ventilation and oxygen toxicity, use of caffeine, and optimizing nutrition. The use of pharmacologic therapies, such as corticosteroids, diuretics, and beta-agonists, is limited to select patients given an uncertain risk-benefit profile. After discharge, infants with BPD require multidisciplinary follow-up to monitor respiratory health and manage supplemental oxygen, to monitor and support growth and feeding, and to assess neurodevelopment and coordinate early intervention services. These infants face high risks of rehospitalization, infections, pulmonary hypertension, and systemic hypertension. Although many children experience a gradual improvement, long-term follow-up should include a multidisciplinary and family-centered approach including pulmonologists, dietitians, gastroenterologists, therapists (speech-occupational and physical), and case management.

BACKGROUND: Immunising children saves 2&#x2013;3&#xa0;million lives every year, making it one of the most effective public health interventions. India&#x2019;s childhood immunisation rates are steadily improving, but there are still significant differences between states. Tamil Nadu consistently has one of the highest rates of child immunisation, while Nagaland is below the national average. If we figure out the socioeconomic factors that contribute to this difference, we can guide context-specific strategies to improve coverage. OBJECTIVE: To compare the level and socioeconomic and geographic determinants of full immunisation coverage among children aged 12&#x2013;23 months in Tamil Nadu and Nagaland using data from the fifth National Family Health Survey (NFHS-5, 2019-21). METHODS: A survey-weighted cross-sectional analysis was performed on 1851 children (Tamil Nadu: 1291; Nagaland: 560). To be fully immunised, a child had to receive BCG, three doses of DPT, three doses of OPV, and one dose of MCV. Weighted bivariate chi-square tests and multivariable logistic regression models were used to assess associations between full Immunisation and socioeconomic, demographic, and geographic characteristics. We performed sensitivity analysis by restricting to only children who possessed vaccination cards, to assess the robustness of our findings. RESULTS: Immunisation coverage was higher in Tamil Nadu (89.2%) than in Nagaland (57.9%). In bivariate analysis, maternal education was significantly associated with full Immunisation in both states, while wealth, residence, distance to health facility, and birth order were additionally significant in Nagaland, and residence and religion in Tamil Nadu.In multivariable analysis, maternal education remained the most consistent predictor in Nagaland (AOR=2.61; p=0.003) and Tamil Nadu (AOR=2.32; p=0.029). In Nagaland, distance to health facility was also significant (p=0.034), whereas in Tamil Nadu, urban residence (AOR=1.83; p=0.008) and religion (AOR=4.00; p=0.003) were associated with Immunisation status. Other variables were not significant after adjustment. CONCLUSION: The main factors for the differences in immunisation coverage between states are gaps in maternal education and access to healthcare. To increase vaccination coverage in states with lower coverage, it is crucial to enhance women's education, extend outreach to rural populations, and address socioeconomic barriers.

Relative Energy Deficiency in Sport (RED-S), driven by problematic low energy availability (LEA), is common in adolescent athletes of all genders and sports and is associated with negative effects across multiple organ systems. In recent years, best practices for the screening, clinical evaluation, and management of RED-S health consequences have evolved for both female and male athletes. LEA significantly affects physiological systems and sports performance and increases the likelihood of missed training due to illness. LEA has also been associated with higher bone resorption and reduced bone formation, increasing the risk for bone stress injury. Recent evidence suggests that low carbohydrate availability, even in the absence of LEA, can independently impair bone health, iron metabolism, and immune function. Recent updates have been made to guidelines for bone mineral density (BMD) screening and management of low BMD, as well as athlete risk stratification and return-to-play decision-making. Early identification of RED-S and management of young athletes is essential for improving short- and long-term health outcomes. Caring for young athletes with RED-S should involve a comprehensive, individualized, multidisciplinary approach. Further research is needed to improve RED-S screening methods and treatment of low BMD, particularly among adolescent male athletes.