Neonatal mortality remains high in Tanzania, where progress toward Sustainable Development Goal 3.2 is constrained by a severe shortage of trained workforce. To achieve the goal, Tanzania, with approximately two million annual births, aims to reduce neonatal mortality from 24 to fewer than 12 deaths per 1,000 live births by 2030. In 2020, only five neonatologists, including expatriates, were available nationwide. To fill this gap, the MSc Neonatology subspecialty program was established at Muhimbili University of Health and Allied Sciences in 2021. This study describes the processes and investment involved in establishing neonatal subspecialty training in Tanzania and examines short-term achievements. A retrospective review of documents related to the program's development, implementation, and evaluation was conducted. Curriculum development and implementation were funded by The Else Kröner-Fresenius-Stiftung through the German Society of Tropical Pediatrics and International Child Health. The curriculum was developed using Kern's six-step model, with input from national stakeholders and neonatology experts, and aligned with African neonatal subspecialty training standards. The program was accredited by the Tanzania Commission for Universities in April 2021, with the first cohort enrolling in October 2021. Program evaluation was conducted by an independent assessor using Organization for Economic Co-operation and Development/Development Assistance Committee (OECD/DAC) standards, drawing on quantitative and qualitative data from multiple stakeholders. By December 2024, eight fellows had enrolled in the program. Five had graduated, and two more completed their training in 2025. All graduates returned to their base hospitals, increasing the number of neonatologists by 50% and raising the total from five (40% local) to fourteen (92.9% local) across nine hospitals, expanding coverage to five of 31 regions. Fellows gained advanced clinical competencies, strengthened research skills, and contributed to mentorship and capacity building. Coinciding with program implementation, a 2.7% reduction in neonatal deaths was observed at MNH, although causality cannot be inferred. The program has strengthened Tanzania's neonatal workforce, clinical expertise, and research capacity. It has improved access to evidence-based newborn care and highlights the value of collaborative, in-country, context-specific training. Ongoing evaluation of neonatal outcomes is essential to assess long-term effectiveness and scalability in resource-limited settings.
Preterm birth is a major cause of neonatal respiratory morbidity and increases the risk of bronchopulmonary dysplasia (BPD). Tidal-breathing flow-volume loops (TBFVL) enable non-invasive early detection of respiratory abnormalities. While there is extensive data on TBFVL in preterm infants with BPD, data in those without BPD are limited. This prospective cohort study evaluates TBFVL and the impact of prematurity-related variables in preterm infants without BPD. Subjects were recruited from the Neonatology Unit of Buzzi Children's Hospital in Milan, Italy, from 1st February to 31st December 2025. TBFVLs were performed during natural sleep at term-equivalent postmenstrual age. Time-to-peak expiratory flow to total expiratory time (tPTEF/tE, measuring airway size), respiratory rate, tidal volume/kg and minute ventilation/kg were analysed, comparing them with reference values for term subjects and stratifying the sample by gestational age (GA) (≤32 vs >32 weeks). Several perinatal variables were collected, to identify potential associations with respiratory outcomes. 38 infants (mean GA 32.76 weeks) were included. The mean tPTEF/tE was significantly lower compared to a previously published cohort of healthy term infants (p<0.001). Infants born ≤32 weeks had significantly lower values than those born >32 weeks (p<0.001). Gestational age at birth was the only variable significantly associated with tPTEF/tE. Preterm infants, even without BPD, show greater signs of airway obstruction at term corrected age. GA at birth emerges as the main determinant of respiratory performance, suggesting a key role for intrauterine lung maturation. Longitudinal studies are needed to define its long-term clinical significance.
Objective: To investigate the baseline thyroid function status and influencing factors in preterm infants. Methods: A cross-sectional study was conducted, enrolling 2 236 preterm infants with gestational ages of 28-<37 weeks admitted to the Department of Neonatology, Capital Center for Children's Health, Capital Medical University between September 2015 and September 2024, and 912 full-term infants hospitalized for jaundice during the same period. All neonates who enrolled to anaylized underwent first time thyroid function testing between 7-14 days of age. Clinical data, thyroid function levels, maternal pregnancy complications, birth-related and postnatal complications, and therapeutic medications were collected. Preterm infants were stratified by sex and gestational age weeks to describe thyroid function status for comparison with full-term infants. Preterm infants with thyroid function retesting between 37 and <40 weeks were further analyzed and compared thyroid hormone levels of full-term infants with gestational ages of 37-<38 weeks. Inter-group comparisons were performed using the Mann-Whitney U test, with multivariate linear regression analysis to identify influencing factors of thyroid function in preterm infants. Results: Among the 632 neonates who enrolled to anaylized, 354 cases (56.0%) were male and 278 cases (44.0%) were female; 365 cases (57.8%) were preterm infants and 267 cases (42.2%) were full-preterm infants. Female preterm infants exhibited higher serum T4 and T3 levels than males (both P<0.05).TSH was negatively associated with gestational age at birth (β=-0.18, P<0.001). In contrast, T4, FT4, T3, and FT3 were all positively associated with gestational age at birth (β=4.56, 0.39, 0.04, and 0.15, respectively; all P<0.001).In the thyroid function assay, a total of 127 preterm infants with corrected gestational ages ranging from 37 weeks to <40 weeks and 102 full-term infants were included. Comparative results between the two groups showed that the levels of T4, FT4, and T3 were all lower in the preterm infants than in the full-term group (all P<0.01), whereas no statistical difference was observed for TSH and FT3 (both P>0.05). Multivariate linear regression analysis indicated that TSH levels were positively correlated with gestational age and postnatal dopamine use (β=0.34 and 0.10, both P<0.05) and negatively correlated with the Apgar score at the first minute and the presence of patent ductus arteriosus (β=-0.16 and -0.12, both P<0.05). T3 levels were positively correlated with preterm gestational age and female sex (β=0.39 and 0.11, both P<0.05) and positively correlated with preterm gestational age and female sex (β=0.40 and 0.11, both P<0.05), but negatively correlated with the number of pregnancies and the presence of patent ductus arteriosus (β=-0.11 and -0.12, both P<0.05). FT3 levels were positively correlated with gestational age (β=0.34, P<0.05) and negatively correlated with the presence of patent ductus arteriosus (β=-0.11, P<0.05). FT4 levels were positively correlated with gestational age, postnatal neonatal respiratory distress syndrome, and pregnancy-induced hypertension (β=0.37, 0.15, 0.10; all P<0.05), but negatively correlated with the number of pregnancies (β=-0.12, P<0.05). Conclusions: The thyroid function of preterm infants differs from that of full-term infants, with lower birth gestational age being associated with a higher likelihood of transient hypothyroidism. Thyroid hormone levels in preterm infants corrected for gestational age at 37 weeks remain lower than those in full-term infants. In addition to gestational age, thyroid function in preterm infants is also influenced by gender, multiple pregnancies, Apgar score, patent ductus arteriosus, and use of dopamine medications. 目的： 探讨早产儿甲状腺功能及其影响因素。 方法： 横断面研究，纳入2015年9月至2024年9月在首都医科大学附属首都儿童医学中心住院的2 236例出生胎龄28~<37周早产儿，同时选取同期因黄疸住院的912例足月儿，于7~14日龄完成首次甲状腺功能检测的纳入数据分析。收集新生儿的临床资料、母妊娠期合并症、围生期情况和甲状腺激素水平。按照早产儿性别分组比较甲状腺激素水平，早产儿不同出生胎龄与足月儿组比较甲状腺激素水平。收集于校正胎龄37~<40周时复测甲状腺功能的早产儿甲状腺激素水平，与出生胎龄37~<38周的足月儿7~14日龄首次检测时的水平比较。组间比较采用或Mann-Whitney U检验方法，多元线性回归分析早产儿甲状腺功能的影响因素。 结果： 632名纳入分析的新生儿中男354例（56.0%）、女278例（44.0%），早产儿365例（57.8%）、足月儿267名（42.2%）。女性早产儿血清T4、T3水平均高于男性（均P<0.05）。血清TSH水平与出生胎龄负向关联（β=-0.18，P<0.001）；T4、FT4、T3及FT3水平与出生胎龄均正向关联（β=4.56、0.39、0.04、0.15，均P<0.001）。复测的127例早产儿的血清T4、FT4、T3 水平均低于102例足月儿的水平（均P<0.01），而 TSH 和 FT3差异无统计学意义（均P>0.05）。多元线性回归分析早产儿甲状腺功能影响因素，TSH水平与出生胎龄、使用多巴胺均正向关联（β=0.34、0.10，均P<0.05），与第1分钟Apgar评分、合并动脉导管未闭均负向关联（β=-0.16、-0.12，均P<0.05）；T3和T4水平与早产儿出生胎龄、女性均正向关联（β=0.39、0.11和0.40、0.11，均P<0.05）；T4水平与胎个数、合并动脉导管未闭均负向关联（β=-0.11、-0.12，均P<0.05）；FT3水平与出生胎龄正向关联（β=0.34，P<0.05），与合并动脉导管未闭负向关联（β=-0.11，P<0.05）；FT4水平与出生胎龄、新生儿呼吸窘迫综合征、母妊娠期高血压疾病均正向关联（β=0.37、0.15、0.10，均P<0.05），与胎个数负向关联（β=-0.12，P<0.05）。 结论： 早产儿甲状腺功能与足月儿不同，出生胎龄越小越容易表现为暂时性低甲状腺素血症。校正胎龄至37周时的早产儿甲状腺素水平仍低于足月儿。早产儿甲状腺功能除受出生胎龄影响外，还与性别、多胎、Apgar评分、动脉导管未闭、使用多巴胺药物等有关。.
According to the available data, the breastfeeding rate at hospital discharge is suboptimal in Italy. The present study aims to evaluate the effectiveness of the Hospital Policy on Breastfeeding (HPB) Project launched by the Italian scientific societies specialising in perinatal care to promote breastfeeding in maternity hospitals (MHs). The HPB project was designed as an open before-after study to increase the rate of exclusive breastfeeding at hospital discharge in a population of healthy term infants with a normal birth weight following a bundle intervention. The primary outcome was the breastfeeding rate at hospital discharge. The secondary outcomes were data on the elements of the bundle intervention: 1) establishment of a local hospital breastfeeding working group, 2) adoption of a breastfeeding policy, 3) breastfeeding training for perinatal care professionals, 4) enhanced implementation of skin-to-skin contact practice at childbirth and mother-baby rooming-in, and 5) development and/or improvement of breastfeeding-related protocols. Of the 104 hospitals that were initially enrolled in a two-years study between February 2023 and January 2025, 97 completed it. The exclusive breastfeeding rate and the fully breastfeeding rate of healthy term newborns with a normal birth weight at hospital discharge increased from 67.3% to 71.0% (p < 0.001), and from 69.3% to 71.3% (p < 0.001), respectively over a four-month period. Moreover, all secondary outcomes improved. Specifically: 1) more MHs set up a multidisciplinary breastfeeding working group, developed breastfeeding policy and prepared the breastfeeding-related protocols, 2) the proportion of perinatal healthcare workers trained in breastfeeding increased from 55.9% up to 71.7% (p < 0.001), and 3) the proportion of newborns who experienced skin-to-skin contact in the delivery room after vaginal delivery increased from 76.9% to 89.4% (p < 0.001), as did the proportion of newborns who experienced rooming-in, from 83.9% to 85.4% (p < 0.05), as measured over a one-month period. The HPB Project successfully promoted exclusive breastfeeding at hospital discharge, as well as skin-to-skin contact and rooming-in practices, among healthy term infants with a normal birth weight, in a large sample of Italian MHs.
Pulmonary overcirculation secondary to a hemodynamically significant patent ductus arteriosus (hsPDA) increases endothelial shear stress, triggering the release of endogenous nitric oxide (NO). Since NO rapidly oxidizes hemoglobin to methemoglobin (MetHb), we hypothesized that preterm infants with hsPDA would exhibit elevated serum MetHb levels. This study aimed to investigate the association between peak MetHb levels and hsPDA requiring treatment. This retrospective cohort study included preterm infants (< 34 weeks' gestation) admitted to a tertiary NICU. Infants were stratified into two groups: those requiring pharmacological or surgical treatment for hsPDA (hsPDA group, n = 30) and those not requiring treatment (Control group, n = 96). MetHb levels were obtained from routine daily arterial blood gas analyses performed during the first 7 postnatal days. The primary outcome was the comparison of peak MetHb levels between groups. Infants in the hsPDA group were significantly more immature (26.8 vs. 30.1 weeks; p < 0.001). While baseline (Day 1) MetHb levels were comparable, the hsPDA group exhibited significantly higher Peak MetHb levels during the first week compared to controls (3.58% ± 0.25 vs. 3.32% ± 0.35; p = 0.004). This elevation was most pronounced on postnatal days 3 and 4. In a refined multivariate logistic regression model adjusted for gestational age, invasive ventilation duration, and early erythrocyte transfusion, elevated Peak MetHb remained independently associated with hsPDA (Adjusted Odds Ratio: 1.76; 95% CI: 1.08-2.88; p = 0.024). A Peak MetHb cutoff of > 3.4% demonstrated significant predictive value (AUC = 0.74). Synchronized analysis at physical ductal closure confirmed a significant drop in MetHb levels (p < 0.001), indicating dynamic reversibility. Severe hsPDA is associated with a significant, transient elevation in serum methemoglobin levels during the first week of life. While this observational data cannot establish causality, the 'oxidative spike' may reflect the systemic spillover of endothelium-derived nitric oxide released in response to pulmonary overcirculation. With further prospective validation, monitoring MetHb trends could serve as an accessible adjunctive marker to aid in evaluating the hemodynamic burden of a patent ductus arteriosus.
Effective clinical communication is a core component of patient-centered care. Immersive learning technologies, including virtual patients, virtual reality, and augmented reality, are increasingly used to train clinical communication skills in undergraduate health professions education. However, the existing evidence is fragmented and methodologically heterogeneous. This umbrella review synthesizes review-level evidence on immersive technologies and virtual patients for developing clinical communication skills in undergraduate health professions education and explores barriers to curricular integration and key research gaps. An umbrella review of systematic reviews (with or without meta-analysis) was conducted following PRISMA guidelines. Searches were performed in PubMed, ScienceDirect, CINAHL, and Cochrane Library. Eligible reviews examined immersive technologies (e.g., VR, AR, MR, XR, virtual patients) targeting clinical communication skills in undergraduate learners. Methodological quality was assessed using AMSTAR-2. No pooled meta-analysis was feasible because of substantial heterogeneity in interventions, comparison conditions, and outcome measures. Nine systematic reviews were included. All were rated as critically low in methodological quality, which limits confidence in the conclusions that can be drawn. Across reviews, immersive technologies were reported as potentially beneficial for short-term communication performance, learner engagement, and perceived confidence, particularly in comparison with no intervention or some traditional teaching formats. However, evidence regarding long-term retention, empathy development, non-verbal communication, and transfer to clinical practice remained inconsistent. Substantial heterogeneity in intervention design, outcome measures, and feedback structures limited comparability across reviews.
To evaluate the long-term associations between pediatric obstructive sleep apnea (OSA) and multiple domains of child health and to examine potential differences according to surgical treatment. We conducted a retrospective cohort to assess children aged 2-18 years with newly diagnosed OSA confirmed by polysomnography (PSG) who were followed for up to 10 years. Three cohorts were constructed: non-surgically treated OSA, surgically treated OSA who underwent adenotonsillectomy, and age-matched healthy controls. Outcomes included growth failure, delayed developmental milestones, obesity, precocious puberty, and attention-deficit/hyperactivity disorder (ADHD). Propensity score matching and Cox proportional hazards models were used to estimate long-term risks. Children with non-surgically treated OSA demonstrated higher risks of growth failure (HR: 1.97, P < 0.001), delayed developmental milestones (HR: 2.48, P < 0.001), obesity (HR: 1.51, P < 0.001), precocious puberty (HR: 1.59, P < 0.001), and ADHD (HR: 1.66, P < 0.001). These risks emerged early after diagnosis and persisted during follow-up. Younger children showed greater susceptibility to growth and developmental outcomes, whereas obesity became more evident at older ages. ADHD remained elevated across childhood and adolescence. Adenotonsillectomy was associated with lower risks of growth failure, delayed developmental milestones, and ADHD, whereas associations with obesity and precocious puberty were not evident. Pediatric OSA is associated with sustained adverse outcomes across multiple domains of child health. Adenotonsillectomy may be associated with reduced risk of growth, developmental and neurobehavioral consequences. Early recognition and evaluation of pediatric OSA may therefore be important for improving long-term child health.
Klebsiella pneumoniae is the leading cause of sepsis among neonates in low- and middle-income countries (LMICs) in Africa and Asia, contributing substantially to the overall burden of antimicrobial resistant (AMR) infections and mortality among neonates globally. Pathogen sequencing has been used to investigate case clusters and confirm nosocomial transmission in a small number of neonatal units. Here we utilise pathogen sequence data to estimate the fraction of K. pneumoniae neonatal sepsis attributable to nosocomial transmission in African and South Asian countries. We estimated the proportion of invasive K. pneumoniae disease involved in nosocomial transmission clusters in a given neonatal unit, using single-linkage clustering based on pairwise temporal and genetic distances estimated from bacterial whole-genome sequences aggregated from 10 contributing studies. Analysing 1,523 K. pneumoniae isolates from 27 units in 13 countries in Africa and South Asia between 2013 and 2023, we inferred 156 nosocomial transmission clusters, ranging from 2 to 188 neonates each (83 of the clusters comprised ≥3 cases). Overall, we estimated that 1,035 neonatal infections (68.0%) were part of nosocomial transmission clusters. Excluding the first infection in each cluster as a potential index case, we estimate at least 879 (57.7%) infections were acquired via nosocomial transmission. Sensitivity analyses showed that results were robust to the choice of genetic distance estimation methods and thresholds used to define clusters, and cluster estimates were stable over temporal distance thresholds ranging from 2 to 8 weeks. Isolates were mostly extended-spectrum beta-lactamase (ESBL) producers (90.9%) and included 172 multi-locus sequence types (STs). Fourteen STs, including several globally recognised multidrug-resistant lineages, were associated with transmission clusters at multiple units, and these were collectively responsible for two-thirds of all infections. Carriage of carbapenemase genes (adjusted odds ratio, aOR = 2.08 [95% confidence interval, CI: 1.04, 4.14]; p = 0.04) and ESBL genes (aOR = 2.48 [95% CI: 1.26, 4.90]; p = 0.006) were significantly positively associated with transmission in a logistic regression model with site as a covariate. Limitations of this study include the lack of sufficient clinical data to allow high-resolution investigation of transmission dynamics and lack of facility-level data to investigate contributors to the observed differences in transmission burden across sites. Nosocomial transmission contributes to a substantial proportion of K. pneumoniae sepsis in neonatal care units in Africa and South Asia. Reducing transmission within these settings through improved infection prevention and control and other measures could substantially reduce the neonatal sepsis burden. A high burden of transmission clusters is associated with the same drug-resistant lineages that are recognised as high-risk clones associated with hospital outbreaks in high-income countries, indicating global connectivity of the AMR pathogen population.
To investigate a unique, multicultural population to allow us to examine the association of ethnicity, socioeconomic status (SES) and spoken language at home on performance using developmental assessment tools. Analysis of a prospective cohort study. Hamad Maternity Hospital, Doha, Qatar. 271 participants included infants born at Hamad Maternity Hospital between September 2016 and September 2017 (Q-Prem cohort). At 24 months (corrected for gestational age), children were assessed with both the language-based Bayley Scales of Infant and Toddler Development III (Bayley-III) and Babyscreen, a non-verbal tablet-based cognitive assessment tool. Bayley-III cognitive, motor, and language composite scores and Babyscreen scores were the main outcome measures. Median Bayley-III scores in all groups were lower than expected norms (cognitive composite 95 (IQR: 90 to 105), motor 91 (IQR: 85 to 97), language 89 (IQR: 79 to 94)). In contrast, Babyscreen scores were similar to published norms for term infants: mean 13 (IQR: 11 to 15). Children whose main reported language at home was not English had decreased odds for a satisfactory score of >90 for the Bayley-III cognitive and motor composite scores (OR 0.20 (95% CI 0.03 to 0.77) and OR 0.23 (95% CI 0.04 to 0.79) respectively). In contrast, reported language at home had no impact on Babyscreen performance. Higher SES was associated with a mild increase in odds of a satisfactory result on Bayley-III language assessment (OR 1.07 (95% CI 1.01 to 1.13)) but had no effect on Babyscreen. Maternal ethnicity had no significant effect. Performance on developmental assessment may be affected by the language spoken at home rather than true cognitive ability. SES contributed to a lesser extent and maternal ethnicity had no effect. These results highlight the need for non-language-based assessment tools in multicultural cohorts to better compare true cognitive ability.
ObjectiveTo evaluate the association between admission blood gas parameters, particularly pH and base excess (BE), and serial amplitude-integrated electroencephalography (aEEG) background patterns, and to determine whether these early metabolic markers are associated with MRI-defined brain injury severity in neonates with hypoxic-ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH).MethodsThis retrospective study included 80 neonates (gestational age ≥35 weeks) with moderate-to-severe HIE treated with TH. Admission pH and BE values were recorded. Serial aEEG monitoring was performed at 6, 24, 48, and 72 h of life, and background patterns were classified according to Hellström-Westas criteria. aEEG recordings were independently interpreted by two reviewers blinded to the clinical and MRI data. Brain MRI was performed in 74 neonates at a median postnatal age of 5 days and was evaluated by a blinded pediatric neuroradiologist.ResultsAdmission BE was significantly associated with aEEG background patterns at all evaluated time points (6 h: p = 0.001; 24 h: p = 0.003; 48 h: p = 0.034; 72 h: p = 0.005). Infants with more severely depressed aEEG patterns had more negative admission BE values. In contrast, neither admission pH nor BE was significantly associated with MRI-defined brain injury severity. Overall mortality was 7.5%.ConclusionAdmission metabolic derangement, particularly BE, is associated with early electrocortical depression on serial aEEG but not with MRI-defined structural brain injury severity in neonates with HIE treated with TH. These findings support a dissociation between early metabolic acidosis and established structural brain injury and underscore the importance of multimodal prognostic assessment in early clinical decision-making.
Early-life gut microbiota development is critical for orchestrating mucosal barrier function and immune priming, as disruptions in this process can increase susceptibility to life-threatening diseases such as necrotizing enterocolitis (NEC) and sepsis. This longitudinal multi-omics study of 186 preterm infants (<32 weeks of gestation or <1500 g birth weight) explores the impact of early-life exposures in the neonatal intensive care units (NICUs) on gut microbiota, metabolism, and immune responses. We analyzed 1153 stool samples using quantitative microbial profiling, untargeted metabolomics, and fecal S100A8/A9 (calprotectin) levels. Antibiotic exposure suppressed anaerobic colonization and microbial diversity in a cumulative exposure-dependent manner, with breastmilk feeding partially mitigating these effects. The stool metabolome correlated with microbial colonization, showing antibiotic-driven disruptions in polyamine metabolism linked to anaerobe abundance. Host calprotectin levels followed a biphasic pattern, correlating with microbial diversity and polyamine metabolites. Mediation analysis identified anaerobe suppression and polyamine depletion as key drivers of antibiotic-associated reductions in calprotectin. This study reveals that NICU interventions, particularly antibiotics, reprogram the preterm gut ecosystem and immune response, with anaerobes and polyamines being key mediators linking microbial ecology to immune maturation during early life.
Choline was first declared to be an essential nutrient in 1998. Current research on choline intake has been sufficient for the Food and Nutrition Board of the National Academies of Science, Engineering & Medicine to establish a loose guideline, but more investigation into healthy choline intakes is necessary to clarify guidelines. Choline is intimately involved in human metabolism, as an essential precursor for cell membrane components such as phosphatidylcholine and sphingomyelin, lipoprotein and fatty acid trafficking, and the neurotransmitter acetylcholine. It plays an essential role in histone, RNA, and DNA methylation, creatine synthesis, and more. Choline-related pathologies have already been implicated in multiple severe developmental diseases, such as schizophrenia, Down syndrome, and neural tube defects, and age-related diseases such as Alzheimer's. Choline supplementation has been shown to alleviate the symptoms of neurodevelopmental diseases, such as Fetal Alcohol Spectrum Disorder and neonatal hyperbilirubinemia. The choline intake by most adults is estimated to be less than the current recommendations. Choline supplementation, particularly for vulnerable populations such as pregnant women, preterm infants, and cystic fibrosis patients, requires further investigation to establish adequate recommendations and to fully elucidate the consequences of malnutrition. Outcomes of choline deficiency and supplementation, such as neurodevelopment, should be measured. IMPACT: What this article adds to the existing literature An up-to-date summary of the metabolism of choline A review of the role of choline in normal and abnormal neurodevelopment A concise description of sources of choline.
We have investigated postoperative dynamic changes in endothelial glycocalyx (EG) degradation markers in infants who have undergone cardiopulmonary bypass (CPB) for congenital heart disease (CHD) surgery, and related the observations to the development of pediatric acute respiratory distress syndrome (PARDS). Single-center prospective, case-control study, June to December 2024. Twenty-bed to a pediatric cardiac ICU (CICU) in a tertiary hospital in China. Overall, 45 infants (age range 121-351 d) undergoing nonemergency CPB for CHD were recruited; 15 with PARDS and 30 matched non-PARDS cases. None. PARDS patients in comparison with non-PARDS patients had higher glycocalyx degradation markers at CICU admission (T 1 ): syndecan-1, 199.2 ± 22.1 vs. 118.6 ± 6.2 ng/mL ( p < 0.05); heparan sulfate (HS), 105.7 ± 11.9 vs. 79.1 ± 6.8 ng/mL ( p < 0.05); and hyaluronic acid (HA), 53.6 ± 10.5 vs. 40.4 ± 4.7 ng/mL ( p < 0.05). Biomarkers were highest at T 1 , fell at postoperative day 1 (T 2 ), and returned to baseline by day 5 (T 3 ) in both groups, with levels consistency higher in PARDS infants. The PARDS group also had longer median duration of mechanical ventilation (48 vs. 24 hr, p < 0.001), CICU stay (7.0 vs. 4.0 d), and hospital stay (18.5 vs. 12.0 d), with T 1 biomarker levels correlated with duration of mechanical ventilation (r = 0.52-0.68) and CICU length of stay (r = 0.61-0.71; all p < 0.05). In CHD infants admitted to the CICU after surgery involving CPB, PARDS cases exhibit an associated EG injury. Monitoring of the peak levels of degradation markers (syndecan-1, HS, and HA) at admission to the CICU may help identify those at most risk of PARDS.
Sn-2 palmitate is a unique lipid found in breast milk that enhances the absorption of palmitic acid (PA) and prevents the soaping of PA in the gut. Feeding formulas with high sn-2 palmitate levels influences infant growth and neurodevelopment; however, few studies have evaluated the long-term effects on these outcomes. In this study, we evaluated the association between feeding formula and exposure to different levels of sn-2 palmitate in infancy and growth or neurodevelopment in infants after 6 months. This study was conducted as a follow-up of 1-month-old infants included in a previous study. Infant formulas commercially available in Japan were classified as either high sn-2 formula (PA sn-2 ratio ≥ 50%) or low sn-2 formula (< 50%). The associations between the feeding volume of high/low sn-2 formula at 1 and 6 months of age and anthropometric z-scores or neurodevelopment (Ages & Stages Questionnaires, third edition; ASQ-3) scores at 9 and 18 months were evaluated. Multiple regression analysis of anthropometric z-scores showed no significant association with feeding with either the low or high sn-2 formulas. Multiple regression analysis of the ASQ-3 scores showed that the communication score at 18 months was negatively associated with feeding with the low sn-2 formula at 1 month, with no association observed for the high sn-2 formula. Compared with the formula with low sn-2 palmitate, feeding formulas with high sn-2 palmitate at 1 month had a lower association with reduced neurodevelopment at 18 months.
Term macrosomic newborns (≥ 4000 g) born between 37 and 42 weeks of gestation face greater risks of early neonatal morbidity and mortality than term infants with appropriate birth weights. Our study aimed to evaluate these outcomes specifically in term macrosomic newborns. From January 2022 to June 2023, we included singleton live-born infants with a birth weight ≥ 2500 g who were delivered at 37-42 weeks of gestation. The study group consisted of newborns with a birth weight ≥ 4000 g, while the control group was comprised of newborns with a birth weight of 2500-3999 g. Clinical and demographic data were prospectively collected from patient records and stored in an electronic database. Our study revealed a macrosomia frequency of 4.09% (43/1052). We identified a statistically significant positive correlation between maternal prepregnancy weight and neonatal birth weight (p < 0.05). Systolic and diastolic blood pressures were notably higher in the study group during the initial 15 min after birth (p < 0.05). Blood glucose levels decreased significantly in the study group during the first hour after birth (p < 0.01). History of lack of prenatal follow-up (66.6%) and cephalopelvic disproportion were significantly more prevalent in the macrosomic group (p < 0.05). No significant disparities concerning other morbidities were observed between the groups (p > 0.05). No mortality was documented in our study. We found that maternal prepregnancy weight demonstrated a statistically significant positive correlation with neonatal birth weight. Additionally, we noted a decrease in blood sugar levels during the first hour of life as birth weight increased, with significantly lower levels in the macrosomic group than in the control group. Furthermore, noninvasive arterial systolic/diastolic blood pressures measured within the first 15 min after birth in the delivery room were significantly higher in the macrosomic group than in the control group.
Background: Pediatric clinical autopsy plays an important role; however, interpretation of autopsy findings is often challenging. Genome-wide postmortem testing has emerged as a promising approach, yet its utility in clinical autopsy remains uncertain. Methods: This retrospective, single-center study included systematic analysis of all pediatric clinical autopsies performed between 2020 and 2025, following institutional introduction of postmortem genomic testing using whole-exome sequencing. Results: Among 61 autopsies, postmortem genomic testing was performed in 27 cases, revealing primary findings in 8 (30%), including 6 (22%) identified by whole-exome sequencing. Among cases with primary findings, genomic findings confirmed the diagnosis in 5 cases and facilitated interpretation of autopsy findings in the remaining 3 cases. Conclusion: This study provides the first autopsy-based evaluation of postmortem genomic testing, demonstrating improved diagnostic precision and facilitating family counseling. These findings highlight the value of integrating postmortem genomic testing into pediatric autopsy practice.
This study elucidates the effects of additional supplementation of vitamins A and K2 on skeletal development and growth in preterm infants. This study was a single-center, single-blind, randomized controlled trial. Eighty-six preterm infants were randomized into the control group (who received vitamin D 400 IU/day and K1 20 μg/day) and intervention group (who additionally received vitamin A 1500 IU/day and K2 (MK-7) 50 μg/day for 12 months). Bone mineral density (BMD), height standard deviation score (HtSDS), serum vitamin levels, and adverse events were assessed. After 12 months, the intervention group had higher lumbar spine and femur BMD, greater HtSDS, and higher serum vitamin A, D, K1, K2, and 25-OH-D levels, with statistically significant differences (all P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between groups (P > 0.05). Supplementing vitamins A and K2 alongside routine vitamin D/K1 was associated with significant improvements in skeletal maturity, bone mineral density, and micronutrient status in preterm infants, without affecting safety.
Mild encephalopathy with a reversible splenial lesion (MERS) is a clinico-radiological syndrome characterized by acute encephalopathy and a transient lesion in the splenium of the corpus callosum on magnetic resonance imaging (MRI). We report a case of a six-year-old girl who presented with behavioral disturbance and altered mental status after one week of a viral prodrome in the setting of household SARS-CoV-2 exposure. Cerebrospinal fluid analysis was unremarkable, and SARS-CoV-2 serology showed positive immunoglobulin G (IgG) and negative immunoglobulin M (IgM). Brain MRI demonstrated a focal splenial lesion with bilateral cerebellar involvement of the dentate nuclei, consistent with MERS type II. The patient initially received ceftriaxone and acyclovir for suspected encephalitis. Neurological deterioration with dysphagia led to treatment with intravenous methylprednisolone followed by intravenous immunoglobulin. Follow-up MRI at one month showed complete lesion resolution, and complete neurological recovery was achieved by three months. This case highlights the importance of recognizing this reversible clinico-radiological pattern in children with acute encephalopathy to facilitate diagnosis, guide management, and avoid unnecessary investigations.
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Long peripheral catheters (LPCs) are increasingly used as alternatives to short peripheral catheters (SPCs) in neonatal intensive care units, but their effectiveness for short-term infusion therapy in late preterm and term neonates remains uncertain. This study compared the risk of failure between LPCs and SPCs while accounting for intentional device changes as competing events. We conducted a single-center retrospective cohort study between November 2019 and October 2020, including neonates with gestational age ≥34 weeks and birth weight ≥1,500 g who received either a LPC or a SPC as the first venous access device. The primary outcome was infusion failure, defined as premature discontinuation of the index device due to occlusion or extravasation requiring reinsertion or unplanned removal before completion of therapy. Intentional change to another catheter for therapeutic reasons was treated as a competing event. Subdistribution hazard ratios were estimated using Fine-Gray competing-risks regression, and incidence rate ratios per 1,000 device-days were calculated using Poisson regression; cause-specific Cox models were used as complementary analyses. Of 197 eligible neonates, 66 received LPCs and 131 received SPCs. Median gestational age (37 weeks in both groups) and birth weight (2,750 g vs 2,760 g) were similar. Median dwell time was 3 days in both groups. Excluding intentional changes, failure occurred in 12/58 LPCs (21%) and 48/108 SPCs (44%). The incidence of failure was 62 versus 146 events per 1,000 device-days in the LPC and SPC groups. In the Fine-Gray model, LPC use was associated with a lower subdistribution hazard of failure than SPC use (subdistribution hazard ratios: 0.46, 95% confidence interval: 0.23-0.89). Cause-specific Cox models showed a similar association (adjusted hazard ratio: 0.42, 95% confidence interval: 0.22-0.83). In late preterm and term neonates requiring short-term peripheral infusion therapy, LPCs were associated with a significantly lower risk of failure and lower failure incidence per device-day than SPCs, even when intentional device changes were considered as competing events. LPCs as a more reliable option for completing short-term planned peripheral infusion therapy in selected neonatal populations, with the caveat that thrombotic complications were not assessed and warrant evaluation in future studies.