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.
This study aims to assess the current status of enteral nutrition (EN) in preterm infants with a gestational age (GA) less than 34 weeks at a single neonatal intensive care unit (NICU) and to identify factors associated with delayed achievement of total enteral nutrition (TEN). A retrospective analysis was conducted on 137 preterm infants with GA less than 34 weeks admitted to the NICU of Jingzhou Hospital Affiliated to Yangtze University between December 2019 and June 2024. Infants were categorized into Group A (GA < 32 weeks) and Group B (GA ≥ 32 weeks). Each group was further divided into subgroups based on whether TEN was achieved within 21 days (Group A1) or not (Group A2), and within 14 days (Group B1) or not (Group B2), respectively. Differences in EN practices and clinical complications were compared using t-tests, rank sum tests, chi-squared tests, or Fisher's exact tests. The initiation of enteral feeding within 48 h and 24 h after birth occurred in 97.08% and 46.72% of cases, respectively. The mean time to achieve TEN was 42.50±22.06 days for infants with GA 26+0-27+6 weeks, 28.69±9.78 days for GA 28+0-31+6 weeks, and 17.27±0.70 days for GA 32+0-33+6 weeks. The median time to achieve TEN was 21 days in Group A and 14 days in Group B. Initial feeding volumes in Groups A1 (11.35 mL/kg·d) and B1 (15.05 mL/kg·d) were significantly higher than those in Groups A2 (6.09 mL/kg·d) and B2 (12.77 mL/kg·d), respectively. A more rapid advancement of feeding volume during the first one to 2 weeks after birth was also observed in Groups A1 and B1 (p < 0.05 or 0.01). The incidence of bronchopulmonary dysplasia (BPD) in Group A1 and feeding intolerance in Group B1 were lower compared to their respective control groups (p < 0.05). Preterm infants with GA less than 34 weeks showed a delay in the achievement of TEN. Higher initial feeding volumes and a faster rate of feeding advancement within the first 2 weeks after birth were associated with earlier achievement of TEN and a lower incidence of BPD.
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.
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.
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.
The aim of this study was to investigate the factors associated with the occurrence of screen-positive post-traumatic stress disorder (PTSD) symptoms in fathers of preterm infants in the neonatal intensive care unit (NICU) and the effects of the application of kangaroo care measures. This study comprised two components: a retrospective cross-sectional analysis to identify factors associated with PTSD in fathers of NICU preterm infants, and a prospective, quasi-experimental pre-post intervention study to evaluate the effects of kangaroo care. For the cross-sectional part, 251 fathers were included and grouped based on the Chinese version of the Perinatal Posttraumatic Stress Disorder Questionnaire (PPQ-C) scores (screen-positive group, n = 62; screen-negative group, n = 189). Univariate and multivariate logistic regression analyses were performed to identify independent risk factors, and a nomogram prediction model was constructed and internally validated using receiver operating characteristic (ROC) curves. For the intervention part, kangaroo care was implemented, and its effects were analyzed by comparing PTSD symptom rates, illness uncertainty, social support, and depressive symptom scores before and after the intervention. Significant differences were found in illness uncertainty, social support, depressed mood, infant birth weight, paternal occupation, and education level (p < 0.05). Logistic regression confirmed these as independent risk factors [odds ratio (OR) = 1.053, 0.893, 1.300, 2.564, 2.939, 2.389, p < 0.05]. The prediction model [area under the curve (AUC) = 0.872, 95% confidence interval (CI): 0.817-0.927] showed high accuracy. After kangaroo care, the rate of screen-positive PTSD symptoms, illness uncertainty, social support, and depressed mood improved significantly (p < 0.05). The risk of screening positive for PTSD symptoms and uncertainty of illness, social support, depressive symptoms, child birth weight, occupation, and education level are all independent risk factors. Screening high-risk groups using a nomogram prediction model and implementing kangaroo care interventions were associated with improvements in these psychological outcomes. These findings provide a preliminary theoretical and empirical basis for clinical efforts to mitigate paternal PTSD risk, though further controlled studies are needed to confirm causal efficacy.
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.
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.
Despite substantial national progress in reducing child mortality, disparities persist across sociodemographic groups in Bangladesh. A comprehensive understanding of how mortality rates vary by key risk factors is essential to guide equitable health interventions. This study analyzes trends in neonatal, infant, and under-5 mortality rates in Bangladesh from 1993 to 2022, focusing on the influence of socioeconomic, demographic, and maternal factors. Using data from nine rounds of the Bangladesh Demographic and Health Survey (1993-2022), we estimated mortality rates across categories of factors, such as maternal age, education, household wealth, fertility practices, and region. The findings show a substantial decline in all three mortality indicators over time, although some disparities remain. The neonatal mortality rate decreased across all groups, with the sharpest reduction among mothers under 20 years (from 67 to 23 per 1000 live births) and those with one child (from 44 to 10). Infant mortality rate (IMR) also declined significantly, particularly among wealthier, more educated, and rural mothers. Despite overall improvement, regional disparities persisted, with Khulna reporting the lowest IMR (40 in 2022). Under-5 mortality rate saw the largest decline among mothers having their first birth before age 20 (from 144 to 34 per 1000) and families with one child (from 98 to 17). Persistent relative risks of around twofold among the poorest households and children of less educated mothers indicate that mortality reductions have disproportionately benefited advantaged groups. These patterns call for prioritizing maternal education, poverty-targeted service delivery, and geographically focused interventions in high-risk regions, such as Sylhet and Rangpur, where excess risks remain consistently elevated.
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.
Acute pancreatitis (AP) is increasingly recognized in the pediatric population, although it remains uncommon in infants and young children. In this age group, diagnosis is often delayed because clinical manifestations, such as irritability, vomiting, and feeding intolerance, are nonspecific and may occur in the absence of classic abdominal pain. Most pediatric cases are mild and self‑limiting; however, severity can range from mild to severe depending on the presence and duration of organ dysfunction and the development of local or systemic complications at presentation.  A wide spectrum of etiologies has been described in pediatric AP, acute recurrent pancreatitis (ARP), and chronic pancreatitis (CP). However, vaccination is among the least frequently reported associations, with only isolated case reports in the literature. Establishing causality in such instances is challenging, and a thorough evaluation for more common etiologies remains essential. We report the case of a 12‑month‑old girl who developed AP three days after receiving the measles, mumps, and rubella (MMR) vaccine, which highlights the importance of maintaining a broad differential diagnosis.
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.
A growing body of research characterizes the stressful nature of early childhood teachers' work with children and families, although less is known about the experiences of infant/toddler (I/T) teachers. This qualitative study aimed to explore infant/toddler teachers' workplace stressors and workplace supports at the outset of the COVID-19 pandemic. Data were collected from interviews with 22 I/T teachers from a Midwestern state in the United States late spring and early summer 2020. Researchers conducted a thematic analysis of the interviews to develop and then finalize themes of teachers' stressors and supports during the pandemic. The findings revealed an emphasis on the relational work of I/T care and education. Specifically, the data reflected the deep affection and concern teachers feel for children and families, and the importance of teachers' relationships with children, colleagues, and administrators as contributors to teachers' wellbeing amidst stress. Findings complement the existing research on the effects of COVID-19 on I/T teachers by highlighting teachers' needs for personal and professional support and the professional satisfaction they get from their close relationships with children, and findings suggest the importance of the psychological rewards of ECE work to well-being.
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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.