Search Results (292)

Background/Objectives: Urban green space has been increasingly recognized as a determinant of maternal and child health. This study investigated the association between prenatal exposure to different types of green space and the risk of congenital anomalies in South Korea. Methods: We analyzed data from the National Health Insurance Service (N = 142,422). Green space exposure was measured at the area level and categorized into grassland and forest; statistical analysis was performed using generalized estimating equations and generalized additive models to analyze the associations. Additionally, subgroup and sensitivity analyses were performed. Results: GEE analysis showed that a 10% increase in the proportion of grassland in a residential district was associated with a reduced risk of nervous system (adjusted odds ratio [aOR]: 0.77, 95% confidence interval [CI]: 0.63–0.94) and genitourinary system anomalies (aOR: 0.83, 95% CI: 0.71–0.97). The subgroup analysis results showed significance only for male infants, but the difference between the sexes was not significant. In the quartile-based analysis, we found a slightly significant p-value for trend for the effect of forests on digestive system anomalies, but the trend was toward increasing risk. In a sensitivity analysis with different exposure classifications, the overall and nervous system anomalies in built green space showed that the risk decreased as green space increased compared to that in the lowest quartile. Conclusions: Our results highlight the importance of spatial environmental factors during pregnancy and suggest that different types of green spaces differentially impact the offspring’s early health outcomes. This study suggests the need for built environment planning as part of preventive maternal and child health strategies. Full article

Background: Hypoxic–ischemic encephalopathy (HIE) is a leading cause of severe neurological impairments in childhood. Therapeutic hypothermia (TH) is both safe and effective in neonates born at ≥36 weeks gestation with moderate to severe HIE. We aimed to evaluate short-term outcomes—including brain injury detected on magnetic resonance imaging (MRI)—in infants born at 34–35 weeks of gestation drawing on our clinical experience with neonates under 36 weeks of gestational age (GA). Methods: In this retrospective cohort study, 20 preterm infants with a GA of 34 to 35 weeks and a matched cohort of 80 infants with a GA of ≥36 weeks who were diagnosed with moderate to severe HIE and underwent TH were included. Infants were matched in a 1:4 ratio based on the worst base deficit in blood gas and sex. Maternal and neonatal characteristics, brain MRI findings and short term outcomes were compared. Results: Infants with a GA of 34–35 weeks had a lower birth weight and a higher rate of caesarean delivery (both p < 0.001). Apgar scores, sex, intubation rate in delivery room, blood gas pH, base deficit and lactate were comparable between the groups. Compared to infants born at ≥36 weeks of GA, preterm neonates were more likely to receive inotropes, had a longer time to achieve full enteral feeding, and experienced a longer hospital stay. The mortality rate was 10% in the 34–35 weeks GA group. Neuroimaging revealed injury in 66.7% of infants born at 34–35 weeks of gestation and in 58.8% of those born at ≥36 weeks (p = 0.56). Injury was observed across multiple brain regions, with white matter being the most frequently affected in the 34–35 weeks GA group. Thalamic and cerebellar abnormal signal intensity or diffusion restriction, punctate white matter lesions, and diffusion restriction in the corpus callosum and optic radiations were more frequently detected in infants born at 34–35 weeks of gestation. Conclusions: Our study contributes to the growing body of literature suggesting that TH may be feasible and tolerated in late preterm infants. Larger randomized controlled trials focused on this vulnerable population are necessary to establish clear guidelines regarding the safety and efficacy of TH in late preterm infants. Full article

Background: Understanding the origin and natural organization of early infant vocalizations is important for predicting communication and language abilities in later years. The very frequent production of speech-like vocalizations (hereafter “protophones”), occurring largely independently of interaction, is part of this developmental process. Objectives: This study aims to investigate the gap durations (time intervals) between protophones, comparing typically developing (TD) infants and infants later diagnosed with autism spectrum disorder (ASD) in a naturalistic setting where endogenous protophones occur frequently. Additionally, we explore potential age-related variations and sex differences in gap durations. Methods: We analyzed ~1500 five min recording segments from longitudinal all-day home recordings of 147 infants (103 TD infants and 44 autistic infants) during their first year of life. The data included over 90,000 infant protophones. Human coding was employed to ensure maximally accurate timing data. This method included the human judgment of gap durations specified based on time-domain and spectrographic displays. Results and Conclusions: Short gap durations occurred between protophones produced by infants, with a mode between 301 and 400 ms, roughly the length of an infant syllable, across all diagnoses, sex, and age groups. However, we found significant differences in the gap duration distributions between ASD and TD groups when infant-directed speech (IDS) was relatively frequent, as well as across age groups and sexes. The Generalized Linear Modeling (GLM) results confirmed these findings and revealed longer gap durations associated with higher IDS, female sex, older age, and TD diagnosis. Age-related differences and sex differences were highly significant for both diagnosis groups. Full article

Background: Very preterm infants are at increased risk of impairment. The objective was to explore the effect of immediate parent–infant skin-to-skin contact at very preterm birth on cognition, motor, social, and language development during the two first years. Methods: The Immediate Parent-Infant Skin-To-Skin Study (IPISTOSS) was a clinical trial with inclusions between April 2018 to June 2021, in three Scandinavian neonatal intensive care units. Infants were randomised at gestational age 28 + 0 to 32 + 6 weeks plus days, to immediate and continuous skin-to-skin contact at birth or conventional care, during the first six hours of life. Results: At three months, 42 infants underwent a General Movement Assessment. At four and 12 months, 69 and 62 infants, respectively, were assessed with the Alberta Motor Infant Scale. At 24 months, language and cognition were tested in 62 infants with the Bayley Scales of Infant and Toddler Development, third edition. Parents completed the Modified Checklist for Autism in Toddlers for 57 infants. There were no significant differences in motor development, cognition, or autism spectrum disorders. A significant difference in language scores in favour of immediate skin-to-skin contact, was found, when adjusted for fathers’ education, mothers’ education, and infants’ sex, Beta (95% CI): 32.00 (7.57, 56.43) p = 0.01, 11.51 (8.94, 55.06) p = 0.007, and 32.00 (7.85, 56.15) p = 0.01, respectively. Conclusions: Skin-to-skin contact immediately at birth did not enhance cognition, motor, or social development during the first two years of life but may have been important for language skills. Our findings support the World Health Organisation guidelines recommending iSSC for preterm born infants in all settings. Full article

Background/Objectives: Developmental dysplasia of the hip (DDH) affects 1–3% of newborns and requires early detection for optimal outcomes. DDH involves abnormal acetabular–femoral congruence between the acetabulum and femoral head, resulting from either shallow acetabular development or delayed femoral ossification of the femoral head. We evaluated the ossification nucleus of the femoral head (ONFH) to determine prevalence, radiographic timing, and associations with perinatal factors. Methods: We analyzed 100 pelvic radiographs of infants between 90 and 150 days of age. Participants were selected by convenience sampling, based on inclusion criteria. We identified the presence of ONFH and measured biometric parameters, morphology, and anatomical location. Sociodemographic and perinatal data were collected from the participating infants. Results: The prevalence of ONFH was 33%, and the mean age at visualization was 104 days. The presence of ONFH was correlated with birth weight (p = 0.011), discharge weight (p = 0.005), and weight at 1 month (p = 0.034). In our study, female sex (p = 0.004) was associated with a 4.966-fold higher odds of ONFH prevalence compared to males. Conclusions: This study provides relevant evidence regarding the prevalence, morphology, and characteristics of ONFH. Few studies report this information on ONFH in different populations. The optimal timing for radiographic visualization of ONFH in infants remains undefined, but the appearance of the ONFH was concentrated around 104 days of life. The novel association between weight and ONFH provides new insights into DDH. This provides new insights for DDH screening. This association warrants further research for the early detection of DDH. Full article

Enteroviruses (EVs) cause broad clinical manifestations, particularly in children. Certain serotypes have been implicated in respiratory infections; however, epidemiological studies analyzing EV circulation based on clinical respiratory specimens are limited in Korea. This retrospective study evaluates EV detection patterns in respiratory specimens to demonstrate their clinical and epidemiological significance as respiratory pathogens in Korea. Respiratory samples collected from outpatient and hospitalized patients with respiratory symptoms at Dankook University Hospital between 2018 and 2024 were analyzed. EV detection patterns were analyzed by year, season, sex, and age. EVs were detected in 303/6292 respiratory specimens. The highest and lowest positivity rates were in 2018 (8.2%) and 2020 (1.6%), likely due to non-pharmaceutical interventions during the COVID-19 pandemic. The highest positivity rates were in summer and autumn, and in children aged 2–11 years and infants aged 0–1 years. EV positivity did not differ significantly between sexes. Significant differences were identified across years, seasons, and age groups. EVs can be detected in respiratory specimens from symptomatic patients and exhibit a marked seasonal distribution and elevated positivity rates in pediatric populations. Hence, EVs may act as atypical respiratory pathogens, underscoring the need for integrated public health surveillance and seasonal prevention strategies. Full article

Background/Objectives: Iron stores accrued in utero are critical for fetal and infant neurodevelopment. Low neonatal hemoglobin (Hb) may indicate inadequate iron capture and storage. Prior studies differ on whether and under what conditions maternal anemia predicts neonatal Hb; whether sex differences are present is unknown. Methods: Maternal and neonatal Hb and sociodemographic and health characteristics were abstracted from electronic medical records for biorepository participants at a tertiary academic medical center. Maternal anemia was defined as Hb < 11 g/dL in trimesters T1 and T3 and Hb < 10.5 g/dL in T2. Adjusted linear regression models were used to estimate associations of maternal anemia with neonatal Hb. Sex differences were evaluated with product terms and stratification. Results: In 228 participants with maternal Hb measured, the prevalence of prenatal (pre-delivery) and delivery anemia was 54% and 44%, respectively. Maternal race and ethnicity but no other sociodemographic characteristics were associated with maternal anemia. Neonatal hematology was available for 114 newborns < 7 days old (50%; 52% male). The median (IQR) neonatal Hb was 16.7 g/dL (14.9, 18.0) and did not differ by sex, but it was lower among infants of mothers with vs. without delivery anemia (15.9 vs. 17.1, p = 0.032) and those identifying as Black vs. Hispanic or other (16.0, 17.9, 17.0, respectively; p = 0.003). Independent associations of maternal anemia and race and ethnicity with neonatal Hb were stronger in males and attenuated to null in females. Conclusions: Maternal anemia was highly prevalent and associated sex-specifically with neonatal Hb independent of maternal race and ethnicity. Future studies to replicate these findings with a more comprehensive panel of iron biomarkers are needed. Functional consequences of greater susceptibility to risk factors for low neonatal Hb in male infants need to be further investigated. Full article

Background/Objectives: Respiratory syncytial virus (RSV) is a leading cause of respiratory infections across all age groups, with the greatest burden observed in young children and older adults. The COVID-19 pandemic significantly disrupted RSV circulation, resulting in an immunity gap and altered transmission dynamics. This study aimed to assess the seroprevalence of anti-RSV IgG antibodies in the Polish population during the 2023/2024 epidemic season. To our knowledge, this is the first study to characterize RSV seroprevalence at the population level in Poland. Methods: A total of 700 serum samples from individuals across different age groups were analyzed using a commercial assay to detect anti-RSV IgG antibodies. Seroprevalence and antibody levels, expressed as the index of positivity (IP), were examined by age and sex. Results: The overall seroprevalence of anti-RSV IgG antibodies was 91.4%. Antibody positivity increased markedly from 35.5% in infants aged 0–1 years to over 90% in children aged 4–5 years, reaching nearly universal levels in older age groups, including 99.1% in adults aged ≥60 years. Median IP values also rose with age, peaking in individuals aged ≥60 years. No significant differences in seroprevalence were observed between sexes, though older men showed slightly higher median IP values, potentially reflecting greater cumulative RSV exposure. Conclusions: This study provides key insights into the post-pandemic landscape of RSV immunity in Poland. The high seroprevalence across most age groups underscores widespread prior exposure, while the lower rates in infants highlight a continued vulnerability. These findings support the development and implementation of targeted immunization strategies, particularly for infants and older adults. Full article

Fragile X syndrome is characterized by the diminished expression of the fragile X messenger ribonucleoprotein (FMRP), a ubiquitously expressed RNA binding protein with numerous functions in cells. Our prior work found significant differences in physiological and behavioral outcomes as a function of FMRP levels and in response to diet in mice. Here, we assess protein biomarker levels as a function of FMRP levels, sex and matched casein and soy protein isolate-based purified ingredient diets in Fmr1^KO and littermate mice. Brain regions (cortex, hippocampus, and hypothalamus) and blood plasma were analyzed by RayBiotech’s Quantibody^® Mouse Cytokine Antibody Array 640 to quantitate the expression of 640 proteins. The main findings were the identification of numerous proteins that were differentially expressed in response to diet, sex and/or genotype. Of note, prolactin (PRL) levels in blood plasma were significantly elevated in Fmr1^KO female mice as a function of genotype and sex selectively with the AIN-93G/casein diet. Also, using a moderately stringent significance cutoff, growth differentiation factor 9 (GDF-9) in plasma from mice fed AIN-93G/soy was the only protein studied by Quantibody arrays that was differentially expressed between WT and Fmr1^KO male mice. When comparing the results from a pelleted infant formula study with AIN-93G-based diets, insulin-like growth factor binding protein 5 (IGFBP5) in plasma was the only protein differentially expressed as a function of soy in the diet. There was no overlap in statistically significant results when comparing tissue analyzed by mass spectrometry versus Quantibody arrays from mice maintained on AIN-93G-based diets. In conclusion, gene–diet interactions affect protein expression in Fmr1^KO and littermate mice and need to be considered in study design. Full article

Background and Objectives: Air pollutants have been shown to affect hypertensive disorders and placental hypoxia due to vasoconstriction, inflammation, and oxidative stress. The objective of this study was to evaluate whether high levels of maternal exposure to heavy metals during the second trimester of pregnancy are associated with an increased risk of preeclampsia and eclampsia, using national health insurance claim data from South Korea. Methods: Data on mothers and their newborns from 2016 to 2020, provided by the National Health Insurance Service, were used (n = 1,274,671). Exposure data for ambient air pollutants (PM2.5, CO, SO₂, NO₂, and O₃) and heavy metals (Pb, Cd, Cr, Cu, Mn, Fe, Ni, and As) during the second trimester of pregnancy were retrieved from the Korea Environment Corporation. Atmospheric condition data based on the mother’s registration area were matched. A logistic regression model was adjusted for maternal age, infant sex, season of conception, and household income. Results: In total, 16,920 cases of preeclampsia and 592 cases of eclampsia were identified. In the multivariate model, copper exposure remained significantly associated with an increased risk of preeclampsia (odds ratio: 1.011; 95% confidence interval: 1.001–1.023), and higher ozone exposure during pregnancy was associated with an elevated risk of eclampsia. Conclusions: Increased copper exposure during the second trimester of pregnancy was associated with a high incidence of preeclampsia. Full article

Objective: The aim of this study was to investigate the effects of prenatal heavy metal (arsenic, cadmium, manganese) exposure on infant neurodevelopment through a systematic review and meta-analysis, elucidating the toxicological mechanisms and dose–response relationships for consideration in environmental risk assessment. Methods: Following the PRISMA guidelines, systematic searches were conducted in PubMed, Embase, and other databases, ultimately resulting in 17 observational studies involving 6907 participants. Results: Arsenic (As): A 50% increase in arsenic exposure was associated with a reduction of 0.51 points in the Mental Development Index (MDI; 95% CI: −1.43 to 0.4) and 0.15 points in the Psychomotor Development Index (PDI; 95% CI: −0.96 to 0.65). However, these results did not achieve statistical significance (p > 0.05). Cadmium (Cd): Prenatal cadmium exposure significantly decreased the Full-Scale Intelligence Quotient (FSIQ) in children aged 5–9 years. A 50% increase in cadmium exposure resulted in a 0.44-point drop in the FSIQ (95% CI: −0.67 to −0.21, p < 0.05), with stable effects (I² = 0%). Manganese (Mn): Manganese exposure showed a negative association with the MDI (β = −0.11) and PDI (β = −0.18). However, a high degree of heterogeneity was observed (I² = 20.89–73.35%), and some studies suggested potential risks even at low exposure levels. Sensitivity analyses indicated that the heterogeneity in the arsenic and manganese results mainly stemmed from individual study differences (e.g., sample characteristics), whereas the cadmium effects were consistent. Conclusions: Prenatal heavy metal exposure (notably cadmium) adversely impacts neurodevelopment, even at low doses. Future research should prioritize critical exposure windows, mixed effects, and sex-specific vulnerabilities. Strengthening environmental monitoring and prenatal guidelines is crucial to mitigate developmental risks. Full article

Background: Respiratory syncytial virus (RSV) poses a significant health burden in children, being the major cause of lower respiratory tract infection (LRTI), including bronchiolitis. During the 2023–2024 RSV season, Spain introduced nirsevimab, a monoclonal antibody for universal RSV prophylaxis in infants. This study reviews the safety of nirsevimab through post-marketing surveillance. Material and Methods: A descriptive pharmacovigilance study was made based on spontaneous reporting data of suspected adverse events (SAEs) from the Spanish Pharmacovigilance System for Medicinal Products for Human Use (SEFV-H) and industry reports. SAEs reported between September 2023 and May 2024 were extracted from the Spanish Pharmacovigilance Adverse Reactions Data (FEDRA) database. Cases were analysed by sex, age, severity, and SAEs classification using the Preferred Terms (PT) level of the Medical Dictionary for Regulatory Activities (MedDRA). Reporting rates were estimated based on immunization coverage and birth data. Results: Sixty-seven cases reported 141 SAEs, yielding an overall rate of 23.1 cases per 100,000 doses. Common events included rash (8.51%), drug ineffectiveness (7.09%), and pyrexia (7.09%). Serious events constituted 53.70% of reports, including two fatalities (3.00%). No new safety signals or unexpected risks, such as antibody-dependent enhancement (ADE), were identified. Discussion: SAEs reported peaked early in the campaign, reflecting heightened reporting in new immunization programs. The safety profile aligns with clinical trial findings and regulatory expectations, confirming nirsevimab’s benefit–risk balance. Continued pharmacovigilance is critical for maintaining public trust in RSV prophylaxis. Nirsevimab demonstrated a favorable safety profile during Spain’s initial universal RSV immunization campaign in infants, supporting its continued use in reducing RSV-related morbidity. Full article

Mini-puberty refers to the transient activation of the hypothalamic–pituitary–gonadal (HPG) axis during early infancy, lasting up to six months in boys and 12–24 months in girls. This phase represents the second activation of the HPG axis, following its initial activation during the second half of fetal life. At birth, the removal of the suppressive effect of placental estrogens on the HPG axis prompts a rise in both gonadotropins and sex steroid hormones, resulting in distinct clinical and laboratory markers of mini-puberty. While the clinical significance of mini-puberty remains partially understood, emerging evidence underscores its essential role in several aspects of human growth and development. In boys, testosterone influences penile growth, increases Sertoli cell numbers in the testes, and lays the foundation for future spermatogenesis. In girls, the increase in estradiol levels promotes follicular maturation and stimulates breast and uterine growth. Beyond the gonadal effects, mini-puberty appears to impact body composition, affecting body weight and promoting accelerated growth. Additionally, it may affect early psychosomatic and neural maturation, playing a role in several key aspects of the infantile brain. This narrative review examines recent findings on the physiology of the activation of the HPG axis before and after birth along with its significance in various aspects of human growth and development. In addition, mini-puberty-unique features in specific groups, such as preterm and small-for-gestational-age infants, are presented. Full article

Background: Cow-milk-induced allergic proctocolitis (CMIAP) is a non-IgE-mediated food hypersensitivity that often resolves spontaneously but may predispose infants to IgE-mediated allergies and eosinophilic gastrointestinal disorders. Understanding its pathophysiology is crucial for microbiota-based interventions. Methods: We enrolled 32 exclusively breastfed infants—16 with confirmed cases of CMIAP and 16 age-matched healthy controls. The cohorts were sex-balanced (8 F/8 M), term-born (gestational age ± SD: 40 ± 1.2 vs. 39 ± 1.3 weeks), vaginally delivered, and sampled at a mean age of 2.0 ± 0.44 months (range 1.5–3.0) vs. 2.4 ± 0.66 months (range 1.5–3.5). Faecal samples underwent 16S rRNA gene sequencing on the Illumina NovaSeq platform, with diversity and differential abundance analyses. Results: The maternal dairy intake was similar (total dairy: 250 ± 80 vs. 240 ± 75 mL/day; yoghurt: 2.3 ± 1.0 vs. 2.5 ± 1.2 days/week; p = 0.72). Bray–Curtis dissimilarity assessments revealed distinct microbiota in infants with CMIAP. Infants with CMIAP had a lower abundance of Bifidobacterium (log₂FC−2.27; q = 0.022; ANCOM-BC), Collinsella (−29.35; padj < 0.0001; DESeq2), and Limosilactobacillus (−8.01; padj = 0.0285; DESeq2; q < 0.0001; ANCOM-BC) compared with controls. In contrast, Hungatella (+24.99; padj < 0.0001; DESeq2), Veillonella (+4.73; padj = 0.0221; DESeq2), Citrobacter (+10.44; padj = 0.0124; DESeq2), and Ruminococcus gnavus (+2.69; q < 0.0001; ANCOM–BC) were more abundant in the CMIAP group. Conclusions: Infants with CMIAP exhibit gut dysbiosis, which is characterised by the depletion of beneficial commensals and the enrichment of potential pathogens, independent of maternal dairy intake. Further studies should establish whether these microbiota alterations are causal or consequential in CMIAP. Full article

Background: Neonatal birth-related intracranial subdural hemorrhages (SDHs) represent a form of bleeding inside the skull that occurs in newborns. This condition includes the extravasation of blood both in the encephalic parenchyma and in the extra-axial spaces. Recent studies have shown that SDH and particularly post-traumatic birth-related hemorrhages represent a frequent occurrence, but they are often asymptomatic. The gold standard for the diagnosis and follow-up of patients with SDH is multiparametric Magnetic Resonance Imaging. The aim of this study is to describe our experience by reporting several cases of SDH with different distribution and Central Nervous System involvement by the MRI of this pathology in infants up to 30 days of age. Methods: We analyzed the age and sex of the patients included in this study, the localization of SDH in different CNS areas, and their frequency using distribution plots and pie charts. Results: About the analysis of the SDH locations in the 32 patients, the most common location was the cerebellum (31/32, 96.9%), followed by parietal and occipital lobes (19/32, 59.4%; 18/32, 56.2%, respectively), falx cerebri (11/32, 34.4%), tentorium cerebelli (10/32, 31.2%), temporal lobes (6/32, 18.7%), and finally cervical and dorsal spine in the same patients (4/32, 12.5%). According to SDH locations, the patients were divided into supratentorial, infratentorial, both, and Spinal Canal. Conclusions: Our study confirmed the literature data regarding the neonatal birth-related SDH high frequency, but also allowed us to focus our attention on the rarest spinal SDH localizations with the same benign evolution. Full article