Every year, approximately 13 million infants are born preterm (<37 weeks gestation). Preterm-born infants experience disproportionately high infection-related morbidity and mortality, reflecting the immaturity of their immune system, especially early in life. This review provides an up-to-date overview of the phenotype and function of the immune system in preterm infants compared with term infants, with an emphasis on adaptive immunity. At birth, both innate and adaptive immune cells of preterm infants show phenotypic and functional immaturity. In addition, antibody levels are reduced, and immunogenicity of some vaccine components is diminished, contributing to impaired pathogen clearance and suboptimal vaccine responses. During the first year of life, rapid maturation occurs and differences with term infants become less pronounced or disappear. This review provides readers with a framework for understanding the immunologic mechanisms underlying the increased infection risk in preterm-born infants. Recognizing the all-encompassing nature of immune immaturity in preterm infants is essential for the development of integrated strategies to further improve health outcomes.
Breast milk has long been recognized as the optimal source of nutrition for newborns, yet emerging research has revealed an additional dimension of its complexity: a diverse and dynamic microbial community. The breast milk microbiome constitutes one of the earliest and most consequential sources of microbial colonization in the infant gut, with direct relevance to neonatal immune development and long-term health. The core milk microbiome, dominated by Staphylococcus, Streptococcus, Lactobacillus, and Bifidobacterium, arrives principally via the entero-mammary pathway, maternal skin, and retrograde infant oral transfer, and is substantially modulated by maternal factors including diet, mode of delivery, antibiotic use, BMI, and lactation stage. Beyond live microorganisms, human milk oligosaccharides serve as critical prebiotics that selectively promote beneficial microbial taxa in the infant gut, while also exhibiting direct antimicrobial and immunomodulatory properties. Extracellular vesicles in breast milk carry bioactive payload, including proteins, microRNAs, and microbial components, that influence infant gut epithelial development and immune signaling, representing an underexplored frontier in milk biology. This review synthesizes current knowledge on the composition, origins, and functional significance of the breast milk microbiome. Based on a wide-ranging literature survey, the functional roles of the breast milk microbiome in colonization resistance, immune education, and metabolic programming in the developing infant are evaluated. Disruptions to this microbial community have been associated with conditions such as infant colic, atopic disease, and obesity. By mapping the available literature, we identify emerging research trends in the breast milk microbiome research and their translational implications for infant health optimization.
Human milk is a complex and dynamic biological fluid that provides essential nutrients and harbors a diverse, functional microbiota, playing a critical role in infant microbial colonization and early life development. The milk microbiota is derived from multiple maternal and environmental sources, including the maternal gut via the entero-mammary pathway, the mammary and skin microbiota, infant oral microbes through retrograde flow, and environmental exposures. Its composition is influenced by a range of factors, such as maternal metabolic and health status, diet, and antibiotic use, as well as delivery mode, lactation stage, infant characteristics, and geographic context. Human milk contributes to the establishment of oral, airway, and gut microbial communities by transferring key taxa such as Bifidobacterium and Lactobacillus, which are commonly detected in milk; however, direct evidence of specific strains establishing in the infant gut remains limited. Breastfeeding may partially compensate for microbiome deficits in cesarean-delivered, preterm, and antibiotic-exposed infants, supporting protection against infections, allergies, asthma, obesity, and other health outcomes. Translational strategies may help modulate the milk microbiota. These include maternal probiotic or prebiotic supplementation, dietary optimization, and approaches targeting microbiota or bioactive milk components. Such strategies offer feasible and cost-effective means to support healthy infant microbiome development. However, methodological constraints including low-biomass contamination, sequencing biases, and limited strain-level resolution remain significant challenges in accurately characterizing the human milk microbiota. Despite substantial advances, the relative contributions of distinct transmission routes, the persistence of maternal strains, and the efficacy of targeted maternal interventions remain incompletely understood. Addressing these gaps will be essential for refining strategies to promote healthy microbiome maturation and improve lifelong health outcomes.
To investigate the clinical efficacy and safety of inhaled budesonide and beclomethasone for the prevention and treatment of bronchopulmonary dysplasia (BPD) in very preterm infants. From October 2024 to November 2025, very preterm infants at high risk of BPD, aged >7 days and still requiring non-invasive respiratory support, who were admitted to the Neonatal Intensive Care Unit of Xuzhou Central Hospital, were selected and randomly divided into three groups. The control group received inhaled normal saline at a dose of 1 mL per administration, once every 12 h (q 12 h); the budesonide group received inhaled budesonide at a dose of 0.5 mg per administration, q 12 h; the beclomethasone group received inhaled beclomethasone at a dose of 0.4 mg per administration, q 12 h. Inhalation treatment was continued in all three groups until respiratory support was no longer needed. The total duration of respiratory support, the incidence and severity of BPD, the incidence of adverse outcomes, and inflammatory markers were compared among the three groups. Multivariate Logistic regression analysis was used to identify the independent risk factors and protective factors for BPD in very preterm infants. Finally, 37 cases were enrolled in the control group, 41 cases in the budesonide group, and 40 cases in the beclomethasone group. The total duration of respiratory support and length of hospital stay in the budesonide group (36.4 ± 14.9 d, 39.5 ± 10.1 d) and the beclomethasone group (35.6 ± 15.1 d, 39.8 ± 11.0 d) were shorter than those in the control group (43.5 ± 13.5 d, 50.4 ± 8.5 d), with statistically significant differences (P < 0.05). There were no statistically significant differences among the three groups in terms of the incidence of BPD, the incidence of mild and moderate-severe BPD, the mean values of fraction of inspired oxygen and oxygen saturation index within 48 h after initiation of treatment, the incidence of late-onset sepsis, stage Ⅱ-Ⅲ necrotizing enterocolitis, grade Ⅱ-Ⅳ intraventricular hemorrhage, the incidence of treatment-requiring retinopathy of prematurity at initial screening, the volume of packed red blood cell transfusion, hemodynamically significant patent ductus arteriosus at discharge, and hospitalization costs (P > 0.05). On the 14th day after treatment initiation, the levels of interleukin-8 were lower and the levels of interleukin-10 were higher in both the budesonide group and the beclomethasone group than those in the control group, with statistically significant differences (P < 0.05). There were no statistically significant differences in any of the indicators between the budesonide group and the beclomethasone group (P > 0.05). Younger gestational age and lower birth weight were identified as independent risk factors for BPD in very preterm infants, whereas inhaled budesonide or beclomethasone administration after the first week of life served as independent protective factors against BPD. Inhaled budesonide and beclomethasone after the first week of life can shorten the total duration of respiratory support in very preterm infants at high risk of BPD, aged > 7 days and still require non-invasive respiratory support, without increasing the incidence of adverse outcomes, demonstrating high safety. However, inhaled budesonide and beclomethasone do not show significant advantages in reducing the incidence and severity of BPD. https://www.chictr.org.cn/bin/project/edit?pid=248724, identifier ChiCTR2400091361.
Exclusive breastfeeding (EBF) provides essential nutrients and strengthens the immune system, significantly reducing the risk of infant hospitalization during the first six months of life. This study aims to evaluate the association between EBF and the risk of hospitalization during the first year of life in a cohort of 370 postpartum women. A prospective cohort study was conducted with postpartum women recruited from a maternity ward between August 2022 and 2023, with a one-year follow-up period. All postpartum women admitted during the same period who voluntarily agreed to participate in the study were included. The women were grouped by EBF and non-EBF status. Demographic and clinical variables and infant health outcomes were compared. The study included 370 dyads (postpartum women and their newborns), of which only three were lost to follow-up. Of the remaining 367 dyads, 163 maintained exclusive breastfeeding (EBF) and 204 did not. The non-EBF group had a higher hospitalization rate (35.5% vs. 22.7%; p < 0.001). Multivariate analysis showed that not practicing EBF doubled the risk of hospitalization (OR: 2.0; 95% CI: 1.4-2.8), regardless of other variables. Maintaining exclusive breastfeeding (EBF) is associated with a significant reduction in the risk of hospitalization during the first year of life, supporting its promotion as a public health strategy. Introducción: La lactancia materna exclusiva (LME) durante los primeros seis meses de vida aporta nutrientes esenciales, fortalece el sistema inmunológico y se asocia a una disminución del riesgo de hospitalización infantil. El objetivo es evaluar la asociación LME y el riesgo de hospitalización durante el primer año de vida en una cohorte de 370 puérperas. Materiales y métodos: Estudio de cohorte prospectivo que reclutó mujeres puérperas entre agosto de 2022 y 2023 en un servicio de maternidad con un seguimiento de 1 año. Se incluyeron sistemáticamente todas las mujeres puérperas que presentaron internación conjunta que aceptaron participar voluntariamente en el estudio. Estas fueron agrupadas por LME y no LME. Se compararon variables demográficas, clínicas y resultados de salud infantil. Resultados: En el estudio se reclutaron 370 diadas (mujeres puérperas y recién nacidos) de las cuales solo 3 se perdieron en el seguimiento. De los 367 restantes, 163 mantuvieron LME y 204 no LME. El grupo de no LME presentó una mayor tasa de hospitalización (35.5 % vs. 22.7 %; p < 0.001). El análisis multivariado mostró que no realizar LME duplicó el riesgo de hospitalización (OR: 2.0; IC 95 %: 1.4‐2.8), independientemente de otras variables. Conclusión: El mantenimiento de LME se asocia a una disminución del riesgo de hospitalización durante el primer año de vida, respaldando su promoción como estrategia de salud pública.
Late-onset sepsis (LOS) remains a leading cause of morbidity and mortality in preterm infants, with decreasing incidence in high-income countries but persistent challenges in low- and middle-income countries. This study aimed to evaluate the epidemiology, microbiological profile, and short-term outcomes of LOS in very low birth weight (VLBW) preterm infants in Brazil. A multicenter cohort study across 18 level 3 neonatal units of the Brazilian Network on Neonatal Research included 13,439 VLBW infants (400-1499 g birth weight, 22-36 weeks gestation) admitted between 2010 and 2020, excluding those with major malformations, congenital infections or death before 72 hours. Main outcomes included incidence of proven and clinical LOS, in-hospital mortality, and associated short-term morbidities. The cohort had a mean gestational age of 29 ± 3 weeks and birth weight of 1079 ± 275 g. The incidence of proven LOS was 24.6%, and clinical LOS was 19.2%. Gram-positive bacteria predominated (64.1%, with 49.4% coagulase-negative staphylococci), followed by Gram-negative bacteria (27.2%) and fungi (8.8%). Over the decade, fungal infections decreased, while Gram-negative bacterial infections and proven LOS incidence increased. In-hospital mortality was 24.8%, showing no reduction. LOS was associated with an increased risk of death and severe morbidities. This comprehensive 10-year cohort in Brazil reveals a concerning epidemiological shift, characterized by a significant increase in Gram-negative infections and a persistent, high LOS incidence and mortality among VLBW infants. These findings, particularly the lack of improvement in prognosis, underscore the urgent need for targeted and effective preventive and control interventions tailored for resource-limited settings.
Chylothorax is a medical condition characterised by the abnormal accumulation of lymphatic fluid in the pleural cavity. In its congenital form, chylothorax develops as a result of an idiopathic abnormality in the thoracic duct. Congenital chylothorax (CCT) is the leading cause of pleural effusion in infants, a condition where excess fluid builds up in the space between the lungs and the chest wall. This scoping review includes a wide range of published studies from 1980 to January 2024, obtained from multiple reputable databases, including Google Scholar, PubMed, Springer and BioMed Central. Effective management strategies are crucial for improving outcomes in infants with CCT. Timely drainage of pleural fluid is essential to alleviate respiratory distress and prevent further complications. Appropriate nutritional care is also critical, as it helps in supporting the neonate's overall health and recovery. Early intervention and continuous monitoring can significantly improve the likelihood of a positive outcome. What the study adds. Congenital chylothorax (CCT) is a serious but rare condition in newborns. CCT is characterised by the accumulation of lymphatic fluid in the pleural space with subsequent respiratory distress. This scoping review of recent literature describes current concepts in the aetiology, diagnosis and treatment of CCT in newborns, emphasising the importance of timely diagnosis and a multidisciplinary strategy. The review integrates available evidence on CCT, emerging diagnostic strategies such as lymphangiography and lymphoscintigraphy, and treatments such as video-assisted thoracoscopic surgery, to provide clinicians with practice-informed choice.Implications of the findings. Early management and tailored intervention can improve results in infants with CCT. Improvements in morbidity and mortality have demonstrated the importance of new management strategies.
BackgroundLung recruitment maneuvers (LRM) during high-frequency oscillatory ventilation (HFOV) lack bedside standardized monitoring.AimTo evaluate the efficacy and safety of FiO2-guided LRM in preterm infants with moderate-to-severe respiratory-distress syndrome (RDS) using integrated functional echocardiography (FE) and lung ultrasound (LUS). Also, we hypothesized that a standardized LUS score can accurately guide successful recruitment.MethodsThis a prospective, single-arm, protocol-driven cohort study that was conducted at a tertiary NICU (Alexandria University), and 70 preterm infants (GA 32-37 weeks) requiring HFOV within 24 h of life were included. Integrated LUS and FE were performed at three phases: pre-initiation, maintenance pressure (opening), and pre-weaning. Lung aeration was quantified using a standardized 12-zone LUS protocol (0-3 points per zone) based on international consensus. Hemodynamics were assessed via tricuspid regurgitation (TR) gradient, superior vena cava (SVC) flow, and right ventricular myocardial performance index (RV-MPI).ResultsLRM led to significant improvements in oxygenation and lung aeration. Mean LUS scores decreased significantly from 23.13 ± 1.33 (pre-initiation) to 19.94 ± 1.67 (maintenance) and 3.70 ± 2.49 (pre-weaning) (p < 0.001). FE demonstrated a significant reduction in TR gradient (p < 0.001), while SVC flow and RV-MPI remained stable, indicating preserved myocardial function. Pre-weaning LUS scores were significantly associated with weaning success from HFOV.ConclusionsFiO2-guided LRM is effective and safe in late-preterm infants with RDS. Integrated bedside imaging confirms that recruitment improves lung aeration without compromising hemodynamics. A standardized LUS score is a reliable tool for identifying optimal lung opening and guiding the weaning process.
Women's autonomy in infant feeding decisions is a fundamental element in maternal mental health, which is often disrupted by external factors like societal expectations, cultural norms, and institutional policies. The informed decisions made by the mothers in feeding their infants are often not made in a private environment, and they are not refrained from judgments and coercion. This qualitative study analysed 11 mothers' narratives of their infant feeding experiences through semi-structured, in-depth interviews. The participants gave individual informed consent for the interview, and the sessions were recorded with the participants' consent. The collected narratives were summarised using thematic analysis, and the recorded interviews were transcribed into English. The thematic analysis revealed key themes like (1) Pregnancy Expectation vs. Postpartum Reality, (2) External Criticism from Family and Peers, (3) Emotional and Physiological Burden of Breastfeeding, and (4) Structural Barriers and Workplace Expectations. The findings of the study highlight the interplay of external factors that influence the mother's feeding practices and decisions, which exacerbate maternal mental health. The findings reveal a crucial contrast between maternal reality and expectations, which are shaped by cultural beliefs and societal norms. The study supports the need to address these realistic challenges, which demand a supportive community, empathetic healthcare practices and structural reforms that will uplift women's autonomy and maternal mental health.
Blood purification techniques are rarely used in low-weight pediatric patients because extracorporeal circuits and devices designed for adults may expose neonates and infants to significant adverse events. Recently, hemoadsorption cartridges with low priming volumes (Jafron®) have become available. We report a descriptive case series of four pediatric patients treated with hemoadsorption using HA60 cartridges, including two neonates (2.8 kg and 3.5 kg) and two infants (7 kg and 10 kg). All patients were admitted to the PICU with septic shock and received standard therapy, including broad-spectrum antibiotics and vasoactive agents. Two of the four patients required extracorporeal membrane oxygenation (ECMO) because of severe respiratory and circulatory failure. In all patients, continuous renal replacement therapy (CRRT) was initiated for acute kidney injury and/or fluid overload, and HA60 hemoadsorption was added. Clinical and laboratory parameters, together with vasoactive drug requirements, were recorded from the initiation of hemoadsorption until the end of treatment. Three of the four patients survived. Our findings are limited to describing the feasibility and safety of HA60 hemoadsorption in neonates and small infants with septic shock, as well as the logistical aspects associated with the use of these novel extracorporeal technologies, rather than demonstrating clinical efficacy. No major adverse events were observed. Within this perspective, the fatal outcome observed in Case 1 was considered unrelated to the hemoadsorption procedure itself. Given the descriptive nature of the study and the presence of multiple concomitant therapies, no conclusions regarding efficacy can be drawn. Larger studies are needed to confirm these preliminary observations.
Studies characterising the immunoglobulin (Ig)-bound microbiota apply varying methodologies, making comparisons difficult. This scoping review synthesised evidence on Ig-microbiota binding patterns in maternal and infant contexts, identified recurrent Ig-bound and -unbound bacteria across studies, and highlighted knowledge gaps for further study. Nine articles investigating Ig-microbiota binding patterns in stool or breastmilk samples in mothers or infants were included. Ig-microbiota associations were influenced by sample type, Ig-subclass, genetics, and diet. The most important antibody was IgA, with partial functional redundancy with IgM, while IgG appeared more selective for pathobionts. Ig-bound taxa in early life included important commensals and pathobionts, with high levels of individuality. Ig-microbiota associations shifted with microbiome maturation, environmental and host factors, resembling adults at around 2 years of age. Transfer of Ig-bound Bifidobacterium through breastmilk may contribute to vertical transmission from mother to infant. Ig-microbiota associations also differed between health and disease states, beyond the overall microbiota. Results were limited by study numbers and a lack of methodological consistency. We propose the standardised term "Ig-Seq" in referring to the technique to study Ig-microbiota binding patterns, and suggest standardisation of laboratory protocols, bioinformatic pipelines, and statistical analyses to improve consistency in Ig-Seq.
Prehospital recognition of upper versus lower airway disease in infants or young children is critical as management strategies differ. A minimal amount is known regarding how well these distinctions are made in the field and whether they are associated with changes in care. We describe patient characteristics, emergency medical services (EMS) clinician impressions, assessments, and prehospital treatments for patients under 3 years old who were diagnosed in the emergency department (ED) with upper airway disease (croup) or lower airway disease (acute bronchitis, bronchiolitis, or asthma). This retrospective analysis of prehospital electronic patient care records used linked hospital outcome data from the 2019-2020 ESO Data Collaborative, a national database of de-identified records from more than 1,200 agencies. We included 9-1-1 responses for patients older than 24 h and younger than 3 years of age who were diagnosed in the ED with croup, acute bronchitis, bronchiolitis, or asthma using ICD-10 codes. We describe patient and encounter characteristics, EMS clinician impressions, vital sign assessment, and prehospital treatments stratified by upper versus lower airway conditions. Of 1,352 records analyzed, 346 (25.6%) patients were diagnosed with an upper airway condition. Patients with upper airway diagnoses tended to be older, male, and more likely to be discharged home from the ED. "Acute respiratory distress" was the most common emergency medical services (EMS) primary impression in both upper (60.4%) and lower airway groups (50.0%). End-tidal CO2 (EtCO2) was recorded for 8% of patients, while SpO2 was recorded for 92%. The most common treatments for patients diagnosed with upper airway disease were oxygen (33.2%), albuterol (28.3%), and nebulized epinephrine (23.1%). For patients with lower airway diagnoses, the most common treatments were oxygen (39.6%), albuterol (32.6%), and ipratropium (11.9%). EMS clinicians documented similar primary impressions and administered many of the same treatments across both upper and lower airway groups, demonstrating minimal differentiation in prehospital management of young children. Therefore, EMS impressions and treatments did not consistently align with the underlying etiology diagnosed at the ED. Addressing these gaps through protocol revisions, system-wide improvements, and targeted education may help strengthen the quality and safety of prehospital pediatric respiratory care.
Polydactyly is a common congenital limb anomaly characterized by supernumerary digits, most frequently involving the hands or feet. Foot polydactyly is traditionally classified into preaxial, postaxial, and central types, with postaxial forms being the most common and central forms the rarest. Heptadactyly, defined as the presence of seven digits in a single limb, represents an exceptionally rare and severe expression within this spectrum, most often described as central duplication. Isolated unilateral heptadactyly of the foot with combined preaxial and postaxial duplication is exceedingly rare, with very few cases reported in the literature. We report the case of a 9-month-old female infant who presented with a congenital deformity of the right foot noted at birth. Clinical examination revealed unilateral heptadactyly with seven well-formed toes involving both preaxial and postaxial duplication, resulting in medial and lateral widening of the forefoot. The contralateral foot, upper limbs, and systemic examination were normal, and there was no family history of congenital anomalies. Radiographic evaluation confirmed complete duplication of the medial and lateral rays without central ray involvement, tarsal abnormalities, or syndactyly, consistent with isolated mixed-pattern preaxial-postaxial heptadactyly. Given concerns regarding footwear and future gait function, elective surgical correction was performed at 9 months of age. The procedure involved excision of the most medial and lateral supernumerary rays with meticulous preservation of neurovascular structures and reconstruction of soft tissues to restore a narrowed, stable, plantigrade foot. No internal fixation or ligament reconstruction was required due to preserved postoperative stability. The postoperative course was uneventful, with satisfactory wound healing, improved cosmetic appearance, and symmetric early functional use of the limb. This case highlights an exceptionally rare presentation of isolated unilateral heptadactyly with combined preaxial and postaxial duplication. It expands the phenotypic spectrum of foot polydactyly and emphasizes the importance of detailed clinical and radiological assessment for accurate classification and surgical planning. Early individualized surgical management can achieve favorable functional and cosmetic outcomes, while long-term follow-up remains essential to monitor gait development and detect late deformities.
Pediatric low-grade gliomas (PLGGs) are generally slow-growing tumors associated with favorable long-term outcomes. However, their occurrence in early infancy is rare, particularly when arising in the posterior fossa with extensive dissemination and hydrocephalus. Advances in molecular profiling have identified specific genetic subtypes, including FGFR1-mutated gliomas, which may demonstrate more aggressive clinical behavior than suggested by histology alone. We report a four-month-old female who presented with signs of increased intracranial pressure and sunsetting eyes. Imaging revealed a heterogeneously enhancing exophytic medullary mass with a large cystic component causing tetraventricular hydrocephalus. Following ventriculoperitoneal shunt placement and surgical decompression, histology confirmed a low-grade glioneuronal tumor with low proliferative activity. Molecular analysis identified an FGFR1 mutation and 18q13 deletion, and methylation profiling classified the tumor within the MYB(L1)-family subtype B. Despite benign histologic features, the tumor progressed with cervical cord extension and diffuse spinal leptomeningeal metastases. Targeted therapy with trametinib achieved partial radiologic response before further progression. The patient remains clinically stable under ongoing therapy and multidisciplinary care. This case underscores the critical role of molecular diagnostics in risk stratification and treatment selection, particularly in infants with atypically aggressive PLGG.
Type II choledochal cysts (CCs), a rare form of congenital biliary dilation characterized as a true diverticulum along the extrahepatic duct, comprise less than 2% of all cases. The coexistence of CC, annular pancreas (AP), and duodenal stenosis (DS) has been scarcely reported. We present the case of a 45-day-old female with a rare combination of congenital upper gastrointestinal anomalies discovered intraoperatively after imaging identified malrotation with concern for possible volvulus. The patient underwent exploratory laparotomy revealing a Type II CC, partial AP, and DS. Management included cyst excision, diamond-shaped duodenoduodenostomy, and Ladd procedure, after which the patient's recovery was uneventful. This case highlights the importance of maintaining a broad differential in infants with upper gastrointestinal tract obstruction and aims to improve awareness of these associated congenital pathologies.
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The breastfeeding coverage rate (that is, the number of mothers reached by breastfeeding programs) in several regions in Indonesia, including Banten and West Java, is still below the actual rate of breastfeeding nationwide. The breastfeeding coverage rate is influenced by mothers' condition after childbirth, particularly among mothers who have had a caesarean section. Support from partners, family, and close friends also has a large influence on the continuation of exclusive breastfeeding. This study aims to identify the effectiveness of a culturally based intervention and its effect on mothers' perceptions of breast milk adequacy and the weight of newborns after caesarean section. This study used a quasi-experimental design involving 116 respondents who were grouped into control and intervention groups. Pre- and postintervention measurements were taken using the Perceived Insufficient Milk scale (r=0.976) and calibrated baby weight scales. Paired t tests were used for the analysis. There was a significant increase in perception of breast milk adequacy and newborn weight in the intervention group compared to the control group. The intervention also increased the odds of perceiving breastfeeding as "very sufficient" by 2.53 times (odds ratio 2.53, 95% CI 1.36-4.73) after controlling for culturally held myths regarding breast milk insufficiency and family support. This model could be applied as an alternative intervention by health care personnel, especially nurses, to support postpartum mothers who have undergone a cesarean section.
Herein, we report a rare case of a 1 year old female who was diagnosed with congenital lumbar hernia along with vertebral, ribs, and abdominal wall anomalies suggestive of lumbo-costovertebral syndrome. It was also associated with musculoskeletal, genital, ocular, and cardiovascular defects. The patient presented with a palpable swelling in the lumbar region, which was initially suspected to be a simple hernia. Other apparent ocular and musculoskeletal findings revealed complex systemic anomalies that necessitated further investigation. Imaging studies, including ultrasonography and computed tomography, confirmed the presence of a left lumbar hernia and highlighted the associated abnormalities. The management strategy involved surgical repair of the hernia with the placement of a biological mesh over the defect. This case highlights the importance of considering multisystem involvement in children with congenital lumbar hernias and the need for a multidisciplinary approach to improve the diagnosis and outcomes.
Subglottic stenosis (SGS) is a congenital or acquired condition and is the most common site of airway narrowing in children. The pathogenesis of SGS includes subglottic mucosal pressure necrosis, leading to mucosal ulceration, perichondritis and mature scar formation. Acquired SGS accounts for 90% of laryngotracheal stenosis in children. To describe the associated disease factors, management and outcomes of infants with acquired SGS in a middle-income country. A retrospective, descriptive study was performed between January 2018 and August 2022, including all infants aged ≤1 year who had bronchoscopically confirmed SGS. Data regarding demographics, intubation and invasive ventilation, various disease parameters, findings at bronchoscopy and short-term outcomes were collected. Descriptive statistical analysis was performed. Ethical approval was provided by Stellenbosch University. During the research period, 44 infants were diagnosed with acquired SGS, of whom 29 were included in the study. Most infants were born at term and underwent diagnostic bronchoscopy at a mean chronological age of <2 months. All infants were intubated and ventilated at birth, for a variety of diagnoses. Bronchoscopy showed grade 2 or worse stenosis in the majority, and most infants were managed successfully with balloon dilatation. An inappropriately sized endotracheal tube was used in 52% of infants, one-third of infants required multiple invasive ventilation periods, and one-third experienced unexpected extubation episodes. In a resource-limited setting, SGS often develops as a result of preventable causes, with the majority of children being successfully treated with endoscopic procedures. What the study adds. The characteristics and management of subglottic stenosis (SGS) in infants aged ≤1 year are described in this retrospective study done at Tygerberg Hospital, South Africa. This is the first report of acquired SGS in infants aged ≤1 year from a resource limited setting. Potential preventable risk factors were identified, specifically looking at the tertiary referral setting. The most common factor was use of an endotracheal tube (ETT) of the incorrect size. A few possible novel associations were also identified, that require further investigation. Balloon dilatation was noted to be an effective treatment option, and is feasible for use in resource-limited settings.Implications of the findings. The findings of this study highlight the importance of having correct intubation practices in place to reduce the risk of acquired SGS. Training, supervision and correct documentation of airway management will contribute to a reduction in intubation attempts and unplanned extubations, and improve knowledge on the correct size of ETT to be used. The findings also support the effectiveness of balloon dilatation as a treatment option in a resource-limited setting.