Search Results (66)

Background and Objectives: Early identification and referral for intervention of former premature infants at risk of neurodevelopmental impairment is considered a standard of care. The main purpose of this review was to assess the optimal timing of the first visit in a neurodevelopmental follow-up programme in order to identify at-risk infants in a timely and reliable manner. Materials and Methods: We considered three possible moments for the first evaluation: before 37 weeks postmenstrual age, at Term Equivalent Age (TEA, also known as 40 weeks postmenstrual age) and at 3–5 months corrected age (CA). A structured scoping review, informed by PRISMA-ScR principles, was performed. We searched PubMed/MEDLINE, Web of Science Core Collection, and Scopus from database inception through March 2026, combined with a Wohlin-type snowballing strategy. Two assessment techniques were evaluated: the Amiel–Tison neurological examination of the newborn and infant, and the General Movements Assessment (GMA). We collected data on sensitivity, specificity, and positive and negative predictive values at each of the three moments, and reviewed whether early intervention was associated with improved prognosis. Results: Intervention initiated before 12 months of age was associated with improved cognitive and motor outcomes in infancy compared with standard care; an additional benefit was observed when intervention started before discharge, particularly for cognitive outcomes in infancy. Both examinations showed very good specificity and negative predictive value at all three evaluation moments, consistent with their shared optimality concept. Sensitivity and specificity increased with the infant’s age. At each moment, the examinations identified (i) a high-risk group clearly requiring early intervention, (ii) a “grey zone” with uncertain evolution requiring closer surveillance, and (iii) a normal group with a very low risk of adverse outcomes. Combining two examination techniques at the same visit consistently improved discriminative and predictive performance. Conclusions: Evaluation at TEA alone may be too early because some abnormal findings normalize by 3 months CA, yet also too late for the most severely affected infants, who may manifest abnormal signs before term. We propose a stratified approach, with repeated evaluations using both the Amiel–Tison examination and GMA at 35–37 weeks postmenstrual age, at TEA, and at 3–5 months CA, in order to progressively identify infants at risk and refer them to appropriate early intervention. This proposal requires validation through prospective, well-designed research. Full article

Background/Objectives: Adequate choline intake is critical across the peripartum period for optimal maternal-offspring health. Maternal depressive symptoms are associated with poor dietary quality, but the relationship between postpartum depression and choline intake in lactating mothers of preterm infants, a period of heightened intake requirements, has not been previously explored. Methods: Lactating mothers of hospitalized preterm infants (born ≤36 weeks gestational age) completed depression screening with the Edinburgh Postnatal Depression Scale (EPDS) and a dietary choline intake survey. Mann–Whitney U tests compared maternal choline intake based on EPDS screen status (low-risk or at-risk for depression). Multivariable linear regression assessed the relationship between maternal depressive symptoms and choline intake. Results: EPDS screens were at-risk in 18 (42%) of the 43 participants. Median choline intake across the cohort was <50% of recommended dietary intake (median [IQR] 221 [147, 308] mg), with lower intake in mothers with at-risk EPDS screens compared to low-risk screens (median [IQR] score: 156 [105, 218] mg vs. 298 [196, 357] mg, p < 0.01). In multivariable linear regression, EPDS score was negatively associated with maternal choline intake (β [95% CI] = −0.13 [−0.26, −0.01], p = 0.03). Conclusions: Dietary choline intake is low among lactating mothers of preterm infants, particularly those with postpartum depressive symptoms. Full article

Congenital heart disease (CHD) is the most common anatomical malformation occurring in live-born infants and an increasing cause of morbidity and mortality all over the world. Population-based observations have described associations between maternal cardiometabolic disorders and the risk of CHD in offspring. The present article is a narrative review. The aim of this study was to review the epidemiological evidence and clinical observations relating maternal obesity and diabetes mellitus to the risk of CHD in offspring, with particular attention paid to first trimester disturbances of fetal cardiac development and the influence of genetic, epigenetic and environmental factors. Studies have shown that maternal diabetes is a risk factor associated with nearly all subtypes of CHDs in offspring, while obesity and overweight are associated with increased risk for complex defects and outflow tract obstruction and decreased risk for ventricular septal defects. Diabetes and obesity share several phenotypes, which could be transmissible from mother to fetus via the placenta. This means that an increase in maternal glucose could be responsible for the prevalence of CHD in newborns of obese women. On the other hand, maternal diabetes may induce epigenetic modifications in the developing fetus. DNA methylation changes can impact gene expression patterns relevant to heart development. The abovementioned studies are heterogenous, express different opinions and are often difficult to compare. Therefore, the results from these meta-analyses must be interpreted with caution. Optimal diabetes control is responsible for the prevention of oxidative stress in diabetic pregnancies, and a deeper understanding of maternal risk factors holds the potential to improve both prenatal detection of CHDs by identifying at-risk pregnancies and primary prevention of diseases by improving preconception management. Full article

Background and Clinical Significance: Vitamin B12 deficiency in infancy is an uncommon but reversible cause of severe hematologic abnormalities and potential neurologic injury, particularly in exclusively breastfed infants whose vitamin B12 status depends on maternal stores. Because its clinical presentation may mimic bone marrow failure syndromes or hematologic malignancies, diagnosis can be challenging and delayed; Case Presentation: We report a case of early infantile pancytopenia ultimately attributed to profound vitamin B12 deficiency secondary to maternal celiac disease. Prompt recognition and treatment with cobalamin supplementation resulted in rapid hematologic recovery and a favorable clinical outcome; Conclusions: This case underscores the importance of considering vitamin B12 deficiency in the differential diagnosis of unexplained cytopenias in infants and highlights the critical role of maternal nutritional status in neonatal health. Improved awareness and targeted screening of at-risk mothers during pregnancy and lactation may prevent severe but readily treatable complications in affected infants. Full article

Retinopathy of Prematurity (ROP) affects preterm infants worldwide, involving abnormal development of retinal blood vessels associated with supplemental oxygen use in neonatal care. Although there have been strides in identifying at-risk infants, implementing early screening, updating disease criteria through the International Classification of Retinopathy of Prematurity (ICROP), and developing new therapies, ROP remains a leading cause of preventable blindness. As preterm birth survival rates rise, the incidence of ROP continues to increase and is projected to rise even in countries with abundant resources and well-established care programs. Improving ROP care requires global standardization of screening, diagnosis, and management to prevent missed diagnoses and minimize outcome variability. Intravitreal anti-vascular endothelial growth factor (VEGF) injections are changing the landscape of ROP management, but longitudinal research is needed to determine their long-term safety in preterm infants. Effective ROP management relies on teamwork across disciplines and open communication with parents. Given that parents are lifelong caregivers of a child who may be affected by ROP-related vision impairment, including them in the care team and encouraging psychosocial support is vital. Socioeconomic disparities and limited access to ROP-trained ophthalmologists exacerbate disease burden, underscoring the need for innovative solutions to improve access to care. This perspective emphasizes the importance of globally standardizing ROP prevention and care, noting that efforts are still incomplete, equitable access has not been realized, and the long-term role of anti-VEGF agents in ROP treatment remains unclear. Full article

Kidney development in the first 1000 days of life is vulnerable to numerous prenatal, perinatal, and congenital factors. This review aims to analyze the main determinants of early kidney development and to highlight the role of pediatricians in identifying at-risk infants and implementing preventive strategies to reduce the risk of chronic kidney disease (CKD). For at-risk newborns, early assessment of kidney size and function is essential for the timely detection of functional decline. Key risk factors include prenatal exposures, perinatal complications, genetic conditions, and postnatal factors. Early, tailored nephrological follow-up is crucial for preventing CKD and its complications. Determining optimal monitoring intervals through clinical, laboratory, and ultrasound evaluations enables risk stratification, ensuring closer surveillance for the most vulnerable infants during this critical window. This review integrates evidence from experimental, epidemiological, and clinical studies and highlights the importance of early-life interventions in shaping renal health across the lifespan. Full article

Objectives: The introduction of universal prophylaxis with Nirsevimab represents a major innovation in preventing respiratory syncytial virus (RSV) infections in newborns. In Sicily, Nirsevimab administration began on 1 November 2024, for all newborns under one year and at-risk infants during the 2024–2025 season. This study assessed the real-world impact of this strategy in reducing RSV-related hospitalizations. Methods: This retrospective cohort study examined newborns residing in Sicily from 2015 to May 2025, evaluating hospitalization incidence rates attributable to RSV during the first year of life. RSV hospitalizations were identified using ICD-9 codes (079.6, 466.11, 480.1) in any diagnostic position. Incidence rates in the 2024–2025 season (intervention period) were compared with preceding seasons. Results: During the study period, 4431 RSV hospitalization cases occurred (19.84 cases per 1000 person-years), peaking in 2023–2024 (53.47 cases per 1000 person-years). A statistically significant 40% reduction in RSV hospitalizations was observed during the 2024–2025 season (October–April) compared with the preceding season, with a relative reduction ranging between 33.4% and 54.8% across sensitivity models. Conclusions: These results confirm the significant impact of the universal prophylaxis program in real-world practice, consistent with other European programs. These findings support universal RSV prevention strategies and provide insights for optimizing regional and national health policies. Full article

Background/Objectives: Social Media Use has become an integral part of contemporary motherhood, with potential effects on maternal mental health and breastfeeding behaviors. This study aimed to examine the relationship between problematic social media use, anxiety levels, infant feeding attitudes, and feeding intentions among social media-native mothers. Methods: A mixed-methods design was used with 222 mothers. Quantitative data were collected using the Trait Anxiety Inventory (STAI-T), Social Media Disorders Scale (SMDS-9), Iowa Infant Feeding Attitude Scale (IOWA), and Newborn Feeding Intention Scale (IFI). Qualitative data were obtained through semi-structured interviews. Quantitative analyses explored associations between problematic social media use, anxiety, and feeding-related outcomes, while qualitative data were analyzed thematically. Results: SMDS-9 scores were generally low; only 2.7% of participants reported low feeding intention. No significant association was found between problematic social media use and breastfeeding intention or attitudes. Mothers with strong breastfeeding intentions demonstrated significantly more positive attitudes toward nursing than those with lower intentions. Higher problematic social media use was observed among high school graduates and those from high-income groups. Qualitative analysis identified two main themes of Negative Impacts and Positive Impacts, as well as five sub-themes of comparison and inadequacy, information overload, breastfeeding mistakes, anxiety, and social support. Conclusions: Problematic social media use did not directly affect breastfeeding intentions or attitudes; however, high school-educated and high-income mothers were more likely to report higher usage. Incorporating social media literacy into prenatal education and adapting tools for assessing postpartum anxiety to include indicators for problematic social media use, particularly for these at-risk groups, may support early detection, reduce stress, and promote positive breastfeeding practices. Full article

Background/Objectives: Childhood stunting remains a critical public health issue in low- and middle-income countries. Despite Malaysia’s economic growth, there is limited large-scale evidence on the determinants of stunting among children from infancy to primary school age. This cross-sectional study, part of South East Asian Nutrition Surveys II (SEANUTS II), aimed to determine sociodemographic and environmental risk factors for stunting among 2989 children aged 0.5–12 years. Methods: Children were recruited from four regions in Peninsular Malaysia (Central, East Coast, 2022–2030Northern, Southern). Standing height or recumbent length was measured, and stunting was classified based on WHO criteria (height-for-age Z-score below −2 standard deviations). Parents reported information on socioeconomic status, sanitation facilities, and hygiene practices. Multivariate binary logistic regression was used to determine the determinants of stunting. Results: Stunting prevalence was 8.9%, with infants (aOR = 2.92, 95%CI:1.14–7.52) and young children (aOR = 2.92, 95%CI:1.80–4.76) having higher odds than school-aged children. Key biological predictors included low birth weight (aOR = 2.41; 95%CI:1.40–4.13) and maternal height <150 cm (aOR = 2.24; 95%CI:1.36–3.70). Chinese (aOR = 0.56; 95%CI:0.35–0.88) and Indian children (aOR = 0.16; 95%CI:0.05–0.52) had a lower risk of stunting compared to Malays. Conclusions: This study highlights the ongoing challenge of childhood stunting in Malaysia, with age, birth weight, ethnicity, and maternal height identified as key determinants. These findings call for early identification of at-risk households and targeted support, especially through education and financial aid to foster healthy child growth. Full article

Background/Objectives: Although there is a critical need for timely, accurate recognition of infants with hypoxic ischemic encephalopathy (HIE) eligible for therapeutic hypothermia (TH), there is little published literature that comprehensively validates strategies to achieve this. For the Mater Mothers’ Hospital, a screening protocol combining use of umbilical cord gases according to obstetric criteria and other evidence of depression at birth with a decision aid (the HIE Trigger Tool (TT)) for at-risk infants was developed. We audited whether the protocol supported appropriate clinical decisions. Methods: Obstetric records were searched from 1 January 2016 to 31 July 2022 for eligible infants. Neonatal records were examined to assess usage, determine outcomes (diagnosis of HIE or other neurological conditions, use of TH, mortality and neurodevelopmental outcomes) and detect any additional HIE cases. Results: Of 64,055 live births ≥35 weeks, 35.4% had cord gases taken. Of 580 eligible infants, the TT was applied to 498 (86.3%), 155 of whom screened positive for HIE (any severity). Of 76 infants with moderate or severe encephalopathy, 69 received TH. The other seven had contraindications to TH (n = 2), late presentations without any depression at birth (>6 h, n = 3) or other causes of their encephalopathy (n = 2). The TT (which per instructions was commenced by one hour of age) was used to identify 61 of the infants with moderate/severe encephalopathy, while 15 were diagnosed before it was applied. No infants who screened negative using the TT presented later with seizures or any other signs of moderate or severe HIE. Conclusions: The protocol including cord gases and the HIE TT is an effective method of screening for acute HIE needing TH. Full article

Background: Currently, there is a lack of data regarding the reliability of different anthropometric, instrumental, and biochemical indexes in detecting metabolic syndrome (MetS) in pediatric patients with Prader–Willi syndrome (PWS). Therefore, this study aimed to compare the accuracy of different indices to identify the simplest and most accurate predictor of MetS in this at-risk population. Methods: We conducted a multicenter study involving 124 children and adolescents with PWS (61 males and 63 females), aged 13.6 ± 3.7 years. For each participant, we assessed all components of MetS, defined according to either the Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study or the International Diabetes Federation (IDF) criteria, based on age. The following indexes were calculated: Body Mass Index (BMI), BMI standard deviation score (BMI-SDS), tri-ponderal mass index, body mass fat index, fat mass index, fat-free mass index, body shape index, visceral adiposity index, waist-to-height ratio, cardiometabolic index, total cholesterol/high-density lipoprotein cholesterol (HDL-C) ratio, and triglycerides/HDL-C (TG/HDL-C) ratio. Results: MetS was identified in 24 subjects (9 females and 15 males), representing 19.4% of the sample. When comparing the receiver operating characteristic (ROC) curves, the TG/HDL-C ratio and cardiometabolic index demonstrated significantly better performance than the other indices in detecting MetS, with no difference between the two. As a result, we focused on the TG/HDL-C ratio since it is the simplest measure, requiring no additional anthropometric data compared to the cardiometabolic index. Additionally, applying age- and gender-specific thresholds can further improve its accuracy. Conclusions: The TG/HDL-C ratio, which requires only two standard biochemical markers, provides the same accuracy as more complex indexes in detecting MetS in children and adolescents with PWS, making it the optimal predictor for MetS in this population. Full article

Background/Objectives: Cerebral palsy (CP), often caused by early brain injury such as perinatal stroke or hemorrhage, is the most common lifelong motor disability. Early identification of at-risk infants and timely access to rehabilitation interventions are essential for improving long-term outcomes. The General Movements Assessment (GMA), performed in the first months of life, has high sensitivity and specificity to predict CP; however, the neurological correlates of general movements remain unclear. This analysis aimed to investigate the relationship between white matter integrity and general movements in infants with perinatal brain injury using advanced neuroimaging techniques. Methods: Diffusion-weighted MRI data were analyzed in 17 infants, 12 with perinatal brain injury and 5 typically developing infants. Tractography was used to identify the corticospinal tract, a key motor pathway often affected by perinatal brain injury, and tract-based spatial statistics (TBSS) were used to examine broader white matter networks. Diffusion parameters from the diffusion tensor imaging (DTI) and neurite orientation dispersion and density imaging (NODDI) models were compared between infants with and without typical general movements. Results: Corticospinal tract integrity did not differ between groups when averaged across hemispheres. However, infants with asymmetric general movements exhibited greater corticospinal tract asymmetries. A subset of infants with atypical general movement trajectories at <6 weeks and 3–5 months of age showed reduced corticospinal tract integrity compared to those with typical general movements. TBSS revealed significant differences in white matter integrity between infants with typical and atypical general movements in several white matter pathways, including the corpus callosum, the right posterior corona radiata, bilateral posterior thalamic radiations, the left fornix/stria terminalis, and bilateral tapetum. Conclusions: These findings support and expand upon previous research suggesting that white matter integrity across multiple brain regions plays a role in the formation of general movements. Corticospinal integrity alone was not strongly associated with general movements; interhemispheric and cortical-subcortical connectivity appear critical. These findings underscore the need for further research in larger, diverse populations to refine early biomarkers of neurodevelopmental impairment and guide targeted interventions. Full article

Background/Objectives: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) improves the health of nutritionally at-risk populations. However, engagement challenges, such as missed appointments and unredeemed food benefits, may limit program efficacy. Barriers to engagement are heightened among American Indian populations, who often experience disproportionately high levels of participation-related challenges. This study assessed whether newly developed health communication theory-based text messages incorporating persuasive language and different message framing (i.e., gain-framed and loss-framed) improved WIC appointment attendance and food benefit redemption rates, above and beyond standard information-based reminders. Methods: The sample included participants served by the Inter Tribal Council of Arizona WIC between the months of September 2022 and February 2023 who (a) had an appointment during the intervention period (n = 7584) or (b) were eligible to receive a reminder text about unused food benefits during the intervention period (n = 2177). A three-phase intervention design was used, with each phase lasting six weeks. During the baseline phase, participants received standard information-based text messages, while during the two intervention phases, participants received newly developed messages using (1) gain-framed and (2) loss-framed persuasive language. Difference-in-difference regression analyses compared whether differences in outcomes (i.e., appointment attendance and monthly food benefit redemption rates) between participants who received reminder messages and those who did not differed over intervention phases. Results: Receipt of both gain-framed and loss-framed theory-based messages was associated with higher appointment attendance, when compared to receipt of standard information-based messages during baseline (p = 0.003 and p = 0.01, respectively). Neither the gain-framed nor loss-framed messages were associated with higher food benefit redemption rates than standard messages. Conclusions: Results indicated that persuasive communication theory-based text reminders may be an effective, low-cost strategy to boost WIC appointment attendance among American Indians. Full article

Background: Respiratory syncytial virus (RSV) infections usually cause mild, cold-like symptoms in most people, but are a leading infectious disease causing infant death and hospitalization and can result in increased morbidity and mortality in older adults and at-risk individuals. Pfizer has developed Abrysvo^®, an unadjuvanted bivalent recombinant protein subunit vaccine containing prefusion-stabilized fusion (F) proteins representing RSV A and RSV B subgroups (RSVpreF). It is the only RSV vaccine approved for both maternal immunization to protect infants and active immunization of older adults (≥60 years) and 18–59-year-old individuals with high-risk conditions for prevention of RSV disease. Methods: Nonclinical safety studies, including a repeat-dose toxicity (RDT) study in rats and a combined developmental and reproductive toxicity (DART) study in rabbits, were conducted to support early clinical development. Study designs and parameters evaluated in these studies were consistent with principles and practices as outlined in relevant regulatory guidelines. RSVpreF bivalent vaccine, with or without Al(OH)₃, was administered intramuscularly (IM) at 2× the human dose to animals in both studies. Results: Locally tolerated, reversible, inflammatory responses at the injection sites and the draining lymph nodes were observed as typical findings following vaccination. No effect of RSVpreF, with or without Al(OH)₃, was observed on female fertility or on embryo–fetal or postnatal survival, growth, or development in the DART study. In both studies, robust immune responses to both RSV A and B antigens were observed, especially with the Al(OH)₃ formulation. Conclusions: RSVpreF was well-tolerated both locally and systemically without any adverse effects on reproductive and developmental endpoints. Full article

Background/Objectives: Hemolysis has been associated with acute kidney injury (AKI) in infants and neonates after surgery involving cardiopulmonary bypass (CPB). Erythrocyte hemolysis and subsequent end-organ injury have been shown to be a complex process involving the liberation of multiple molecules that mediate the loss of nitric oxide and oxidative damage. This study assesses the association of multiple products of erythrocyte hemolysis with the evolution of AKI in neonates and infants undergoing CPB surgery. Methods: Blood and urine samples were collected at multiple time points before and after CPB and stored within an institutional biorepository. Twenty-one patients with AKI were matched with twenty-one non-Aki patients based on demographic and case complexity data. Results: Samples were analyzed for cell-free hemoglobin, heme, non-transferrin-bound iron, haptoglobin, hemopexin, and nitrite/nitrate. NGAL and KIM-1 were measured to index AKI. Cell-free hemoglobin was higher, haptoglobin was lower, and haptoglobin:hemoglobin ratio was lower in AKI compared to non-AKI patients. Conclusions: AKI in neonates and infants after CPB is associated with a pre and postoperative decrease in serum haptoglobin. These results confirm the need for future studies to prevent injury from hemolysis during CPB and potentially identify at-risk patients with decreased haptoglobin levels before surgery if delay is an option. Full article