Pediatric Reports

Background/Objectives: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social interaction and communication, as well as by repetitive behaviors, with a rising global prevalence. Concurrently, the use of Assisted Reproductive Technologies (ART) has increased among couples experiencing infertility. This study aimed to compare the frequency of ART-conceived children between those diagnosed with ASD and those with other neurodevelopmental disorders (nASD), and to examine differences in prenatal, perinatal and medical histories of ART- and spontaneously (non-ART)-conceived children within an ASD group. Methods: We retrospectively analyzed data from 507 children with a neurodevelopmental disorders (NDDs) diagnosis, classified into ASD (n = 234) and nASD (n = 273) groups. Subsequent analyses focused on the ASD group, further divided into an ART and non-ART group according to the conception mode. Results: ART-conceived children were more frequent in the ASD group than in the nASD group. Moreover, within ASD, ART was significantly associated with potential risk factors such as twin pregnancy, cesarean delivery, low birth weight and parental age. Logistic Binary Regression confirmed these results, suggesting that ART co-occurs with a cluster of perinatal and familial risk factors. Conclusions: Our results indicate that ART is not an independent causal exposure; however, given the retrospective design and the absence of a general population control group, causal inference cannot be drawn. The observed association with ASD appears to be mediated by perinatal and parental variables. These findings underscore the importance of improving obstetric management and care, and ensuring early developmental monitoring for ART-conceived children.

Background: Persistent pulmonary hypertension of the newborn (PPHN) remains a life-threatening condition resulting from failure of postnatal circulatory adaptation. Inhaled nitric oxide (iNO) is the standard first-line therapy; however, limited access or inadequate response highlight the need for alternative treatments. Milrinone, a selective phosphodiesterase-3 inhibitor with nitric oxide-independent vasodilatory and inotropic properties, has been proposed as one such option. Methods: In this study we present a case series of three neonates with PPHN—term (41 weeks), late preterm (35 weeks), and extremely preterm (23 weeks)—treated with intravenous milrinone in a neonatal unit without immediate access to iNO. A narrative literature review was also conducted, focusing on clinical outcomes, safety, and therapeutic applicability. Results: Milrinone was initiated within the first 24 h of life. In the term and late-preterm infants, oxygenation and echocardiographic parameters improved within 48 h, with normalization of shunt direction and successful extubation by days 4–10. Transient systemic hypotension occurred in both cases and required dose adjustment or vasoactive support. In the extremely preterm neonate, only temporary hemodynamic improvement was achieved, followed by severe intraventricular hemorrhage and coagulopathy, possibly exacerbated by vasodilatory and antiplatelet effects of milrinone. Conclusions: Milrinone may serve as a feasible adjunct or bridging therapy for PPHN when iNO is unavailable. However, its use requires careful hemodynamic and neurological monitoring, particularly in very preterm infants. Further studies are needed to confirm safety and define optimal dosing across gestational ages.

Background/Objective: Accurate determination and documentation of causes of death in children are essential for generating reliable mortality statistics and guiding public health strategies. Previous studies have reported frequent inaccuracies in pediatric death certificates (DCs), including the use of vague terms, omissions of relevant conditions, and variability across physician specialties. This study evaluated the accuracy of pediatric DCs in Shiga Prefecture, Japan; identified common errors in these DCs; and examined changes in the underlying causes of pediatric death before and after the COVID-19 pandemic. Methods: We performed a population-based retrospective review of 391 DCs for individuals under 18 years issued between 2015 and 2023. Two pediatricians and two forensic pathologists independently reviewed each DC, assessed accuracy, and classified errors using predefined criteria. Error rates were compared by physician specialty. Underlying causes of death were reassessed into ten categories, and their distributions were compared between 2015–2019 and 2020–2023. Results: Overall, 30.9% of DCs contained errors. The error rates differed by physician specialty: obstetricians had the highest error rate (92.9%), whereas forensic physicians had the lowest (8.4%). The most common error type was the use of non-specific mechanisms such as “cardiac arrest” or “respiratory failure”, rather than the actual causes of death. Congenital anomalies were often listed under other significant conditions contributing to death and not as an underlying cause of death. After the onset of the COVID-19 pandemic, deaths from acute diseases declined from 16.8% to 4.0%, while deaths from congenital disorders increased from 12.6% to 24.3%. Conclusions: Pediatric DCs often contain errors, particularly those completed by obstetricians. Misclassifying mechanisms as causes of death and underreporting congenital anomalies remain the main challenges. Strengthening physician education and introducing systematic review processes are essential to improve accuracy, clarify regional mortality trends, and guide effective public health interventions.