Search Results (98)

Background/Objectives: Edwardsiella tarda is a rare Gram-negative pathogen that uncommonly infects humans. Neonatal infections are extremely rare but often severe, with a high incidence of central nervous system (CNS) complications. Case presentation: We report a term neonate born via spontaneous vaginal delivery who developed systemic signs of infection within 18 h of life. Blood and cerebrospinal fluid (CSF) cultures grew Edwardsiella tarda. CSF analysis revealed severe meningoencephalitis. Maternal stool culture was also positive for E. tarda, suggesting vertical transmission. Despite initial systemic antibiotic therapy with ampicillin, gentamicin, and ceftriaxone, neuroimaging revealed progressive multifocal brain abscesses. The infant underwent a series of neurosurgical procedures, including bilateral drainage of abscesses, Rickham reservoir placement and ventriculoperitoneal shunting. A revised antibiotic regimen, including systemic meropenem and trimethoprim-sulfamethoxazole plus intrathecal gentamicin, was administered. At six months, the infant showed mild motor delay with lower limb hypertonia and was under close neurosurgical and developmental follow-up. Methods: We conducted a literature review of 12 published neonatal E. tarda infections, including our case. Results: Most infected infants presented within 72 h of life and exhibited CNS involvement. Mortality was 25%, and 44% of survivors experienced long-term neurologic sequelae. Conclusions: Edwardsiella tarda infection in neonates is rare but potentially devastating. Early suspicion, culture confirmation, aggressive antibiotic therapy, and multidisciplinary care, including neurosurgical management, are essential for improving outcomes. Full article

Background and Objectives: Antiretroviral therapy used during pregnancy in HIV infected women effectively reduces vertical transmission, though concerns about potential adverse newborn outcomes persists. This study focused on prematurity and low birth weight in antiretroviral HIV-exposed children in two major Romanian centers, Bucharest and Constanța, in the context of free access to antiretroviral treatment for pregnant women in Romania since 2001. Materials and Methods: A retrospective observational study was performed including couples of HIV-infected women and their live singleton newborns from 2006 and 2012. Preterm delivery was defined as birth before week 37 and low birth weight was defined as birth weight less than 2500 g in full-term babies. Results: A total number of 352 children and 313 women were enrolled. Mean maternal age at delivery was 23.1 years. Mean newborn birth weight was 2726 g. In the children group, 191 (54.2%) were boys, and the rate of HIV transmission was 13.9%. The prematurity rate was 21.5% and low birth weight rate was 25.56%. Preterm birth was associated with high HIV RNA in the third trimester, HIV-positive final status in infants, and vaginal delivery. Low birth weight was associated with lack of antiretroviral treatment during pregnancy and HIV-positive status in infants. No association was found between prematurity and low birth weight in full-term newborns and exposure to any antiretroviral class, any specific antiviral drug, or with any number of maternal regimens, duration of antiretroviral treatment prior to conception, or maternal exposure during puberty. Conclusions: In our study, preterm birth was significantly associated with HIV vertical transmission in newborns and with exposure to high maternal viral replication during the last trimester of pregnancy. Low birth weight in full-term babies was significantly associated with lack of antiretroviral exposure in utero in our analysis. Full article

Cytomegalovirus (CMV) is the most common infectious cause of congenital malformations, often presenting with atypical clinical findings. Fetal damage is most severe following primary maternal infection during the first trimester of pregnancy, with the likelihood of transmission increasing with pregnancy advancement. CMV damage may continue to intensify during the early postnatal years. In this narrative review we summarized publications from the last 30 years addressing the epidemiology, diagnosis, prevention and treatment of CMV in pregnancy, with a special emphasis on embryonic and fetal damage. Substantial progress has been made in the diagnosis and treatment of CMV infection during pregnancy, warranting a reconsideration of current clinical approaches. Assessment of viral load enables prediction of fetal infection; its reduction by maternal treatment with valacyclovir may lower both the rate and severity of transmission. Confirmed fetal infection can be diagnosed by amniocentesis and viral DNA detection. Clinical manifestations in infants may be evident at birth (cCMV) or gradually emerge during the first years. The most common fetal damage is hearing loss alongside a variety of brain lesions resulting in significant neurological deficits, including intellectual impairment. Brain involvement is diagnosed by ultrasound or magnetic resonance imaging (MRI). Pharmacological treatment with ganciclovir or valganciclovir, if initiated early after birth, can slow the progression of hearing loss and may ameliorate other neurological and neurodevelopmental deficits. As of today, there is no approved CMV vaccine for prevention. The mRNA-1647’s vaccine, currently in phase 3 clinical trial, appears promising. These advances underscore the need for screening pregnant women in the first trimester and newborn infants of mothers suspected of having CMV infection. Neurodevelopmental follow up for several years, including hearing and visual assessment, is advised in all infants positive for CMV. Infants with clinical manifestations should be offered treatment as early as possible following diagnosis of cCMV. Full article

Gestational obesity, defined as obesity during pregnancy or a pre-pregnancy BMI ≥30, is a growing global health challenge with profound implications for both maternal and offspring health. This narrative review synthesizes current evidence on the mechanistic pathways by which maternal obesity affects pregnancy outcomes and intergenerational health trajectories. For mothers, gestational obesity increases the risk of gestational diabetes, hypertensive disorders, cesarean delivery, and postpartum weight retention. Offspring exposed to maternal obesity face higher risks of obesity, metabolic syndrome, cardiovascular disease, and neurodevelopmental disorders, many of which persist across the lifespan. The underlying mechanisms include metabolic dysregulation, insulin resistance, chronic inflammation, oxidative stress, and alterations in placental function. Epigenetic modifications, such as DNA methylation, histone changes, and non-coding RNA expression, play central roles in fetal programming, while maternal gut dysbiosis and alterations in breast milk microbiota further shape infant health outcomes. Importantly, maternal obesity not only influences pregnancy and early life but also perpetuates an intergenerational cycle of obesity and related comorbidities. Preventive strategies targeting preconception and prenatal health, combined with interventions to optimize lactation and maternal diet, may mitigate long-term risks. Future research should prioritize longitudinal and mechanistic studies to refine interventions aimed at disrupting the transmission of obesity-related disease across generations. Full article

Implementation of universal antiretroviral treatment (ART) in pregnancy has improved maternal health and reduced vertical transmission. However, women living with HIV (WLHIV) still experience worse perinatal outcomes. This retrospective study compared demographic, virological factors, ART regimens and perinatal outcomes in pregnant WLHIV between 2000–2010 (n = 318) and 2011–2021 (n = 140) at a tertiary center in Barcelona. Significant demographic shifts included changes in ethnic distribution, substance use, educational attainment, and maternal BMI. Significant progress in infection control was observed, with increased ART coverage up to 97%, improved viral suppression (80% to 91.3%, p = 0.002), and enhanced immunological status. ART regimens shifted significantly, with an increase in integrase strand transfer inhibitors (INSTI)-based regimens (0.7% to 39.2%, p < 0.001). Obstetric management evolved, with a rise in vaginal deliveries (24.8% to 44.3%, p < 0.001) and a decline in intrapartum zidovudine (93.7% to 54.7%, p < 0.001). Notably, preterm birth rates sharply declined, yet small-for-gestational-age (SGA) infants (26.4% vs. 20%, p = 0.323) and preeclampsia rates remained unchanged and higher than in the general population. All statistical analyses were performed in IBM SPSS statistics 23. In conclusion, although maternal and perinatal outcomes in pregnant WLHIV have improved over the past two decades, a high rate of adverse perinatal outcomes related to placental dysfunction (SGA, preeclampsia) persist. Our findings highlight the need for optimized prenatal care and further research to develop targeted interventions for WLHIV. Full article

In this study we aimed to investigate the levels of selected heavy metals and trace elements (Hg, Pb, Cd, As, Mn, Se, and Cu) in three different biomatrices—maternal urine (Mu), neonatal urine (Nu), and cord blood—of preterm newborns born at less than 35 weeks’ gestation who were staying in the NICU and their mothers, and the relationships of these elements with maternal and neonatal characteristics. Cord Pb, As, and Hg were significantly lower than in Mu, whereas Se and Cu were higher (p < 0.001). All elements were excreted more in Mu than in Nu (p < 0.001). Nu levels of Cd, Mn, Se, and Cu were lower, while As and Hg were higher than in cord blood. Nu metal excretion increased significantly over time (p < 0.001). Positive correlations were found between MuCu and NuCu (r_s = 0.35) and between maternal Se and maternal age (r_s = 0.41). NuHg, MuMn, and cord Mn showed negative correlations with penile length, and NuHg was also negatively correlated with anogenital distance. The first and second NuPb levels were positively correlated with birth weight percentile. The findings suggest transplacental transmission and ongoing exposure to heavy metals and trace elements in preterm infants, highlighting the importance of prenatal environmental exposure awareness for healthcare providers. Full article

HIV mother-to-child transmission (MTCT) continues to pose a significant public health challenge, especially in regions with limited resources, although the worldwide distribution of antiretroviral therapy (ART) has drastically lowered the risk of vertical transmission to even below 1% in some regions. There are still uncertainties regarding the safety of some ART regimens during pregnancy and their longer-term effects on infants who are perinatally exposed to HIV but remain uninfected. This review explores current evidence regarding the interplay between maternal HIV infection, ART during pregnancy, and both maternal and pediatric outcomes. Particular attention is given to the risk/benefit ratio surrounding different drug classes, with integrase inhibitors seeming promising choices in MTCT due to their rapid viral suppression and favorable safety profiles. Meanwhile, regimens containing protease inhibitors or nucleoside reverse transcriptase inhibitors have been linked to some adverse outcomes such as low birth weight, growth restriction, and potential mitochondrial or metabolic disturbances. Although ART remains central in preventing MTCT, a deeper understanding of its effects on fetal development and postnatal health is needed, and it should be thoroughly monitored through future research and longitudinal surveillance. Full article

Background/Objectives: Parental mental representations play a crucial role in shaping early parent–child relationships, particularly during the perinatal period. These internal models influence caregiving behaviors, emotional attunement, and the intergenerational transmission of attachment. The present systematic review aims to address this gap by examining the nature of both maternal and paternal mental representations in the perinatal period (involving pregnancy and the first postnatal time), with a particular emphasis on reflective functioning, and by outlining the variables that are influenced by these representations. Methods: Following PRISMA guidelines, eligible peer-reviewed studies were identified through a comprehensive literature search of major scientific databases (Scopus, Web of Science, PsychArticle/PsycInfo). Qualitative assessment and detailed description were carried out. Results: In total, 28 studies were selected and analyzed. Findings reveal that while representations tend to organize around shared psychological domains—such as expectations regarding the child, parental identity, and the anticipated relationship—there is significant heterogeneity in how these are conceptualized and measured across studies. Risk factors such as maternal depression, low social support, and adverse life experiences were consistently linked to disengaged or distorted representations, whereas balanced representations were associated with greater RF, emotional availability, and protective relational contexts. Conclusions: Overall, the review highlights the clinical relevance of assessing parental mental representations and RF during the perinatal period, suggesting that early, targeted interventions may enhance parental sensitivity and promote secure parent–infant bonds. Future research should adopt integrated theoretical models, include diverse family configurations, and evaluate the efficacy of preventive programs that support reflective and adaptive representations. Full article

Parvovirus B19 (B19V) re-emerged across Europe in 2024, raising concerns about vertical transmission and neonatal morbidity. We undertook a prospective, single-centre cohort study to characterise the early clinical course of congenitally infected neonates born between April and December 2024. Seventy-one pregnancies with serologically or PCR-confirmed maternal infection were enrolled; seven neonates met laboratory criteria for congenital B19V infection and were followed with serial clinical, biochemical and imaging assessments through the first year of life. Troponin I and CK-MB were measured on days 1, 3, 7 and 15; electrocardiogram (ECG) and echocardiography were repeated in parallel, and cranial ultrasound (US), ophthalmologic and audiologic screening were scheduled prospectively. Mean troponin rose from 50.7 ng L⁻¹ on day 1 to a peak of 120.7 ng L⁻¹ on day 7 (p < 0.01), normalising by one month, while echocardiograms remained structurally normal, and only one transient arrhythmia was recorded. CK-MB exceeded the reference range in 29% of infants but showed no clinical sequelae. Multiple periventricular hyperechogenicities were identified in 8/70 neonates (11%), and moderate anaemia (Hb ≤ 9.8 g/dL) occurred in 2 cases. Serum PCR detected high-level viraemia (>10⁸ genome equivalents mL⁻¹) in 40% of those tested; saliva and urine were consistently negative. No instances of myocarditis or hydrops were observed. Our findings indicate that congenital B19V infection during the current outbreak is marked by transient biochemical myocardial stress and subtle neurosonographic changes rather than overt cardiac disease, supporting an outpatient-focused follow-up strategy incorporating serial biomarkers and targeted neuroimaging. Full article

The composition of the gut and/or tumor microbiome has been intricately involved in the onset of carcinogenesis, tumor progression, therapy response, and patient outcomes in diverse solid cancers. The microbiome type, composition, and their metabolome have been functionally implicated in the multifarious cellular processes, transformation, proliferation, tumor immune evasion, cellular migration, etc. Despite such compelling evidence on the role of microbiome interactions in cancer, the realization of their role in neuroblastoma (NB), the deadly extracranial tumor in infants is few and fragmentary. This review comprehends the composition, diversity, and significance of microbiota in human health. Further, this review discusses the microbiota composition, their mode of action, and their signaling flow through and cellular processes in diverse cancers including NB. Precisely, this study for the first time has realized the functional relevance and clinical significance of the gut and tumor microbiome for NB. Interestingly, large cohort clinical and preclinical in vivo models of NB realized the following: gut microbiota predicts the risk for NB; postnatal (and or not maternal transmission) microbiome rearrangements; gut microbial effect on NB pathogenesis; tumor-altering gut microbial composition; microbial composition predicts treatment outcomes in NB; prebiotic remedies for stabilizing NB-associated microbial rearrangements; microbial composition in tumor-infiltrating microbiota predicts NB outcomes. Full article

Background: Despite decades of high childhood vaccination coverage, pertussis has re-emerged in the Autonomous Province of Vojvodina (AP Vojvodina), Serbia. We aimed to describe the temporal, seasonal, and age-specific patterns of pertussis in AP Vojvodina and to analyze trends by vaccination status in order to highlight changes in epidemiology and potential gaps in vaccine-induced protection. Methods: We retrospectively analyzed 2796 pertussis cases reported between January 1997 and December 2024, examining temporal, seasonal, and age-specific trends, stratifying by vaccination status across four consecutive periods (1997–2003, 2004–2010, 2011–2017, and 2018–2024). Results: Throughout the 28-year period, after low and sporadic cases in the pre-2012 period, a dramatic rise was observed in 2014, 2017, and 2018, culminating in the highest annual number of reported cases in 2024 (1011 cases). Throughout this period, primary vaccination coverage with the DTwP/DTaP three-dose series ranged between 91% and 98%, while first booster coverage gradually declined from 98% in the early 2000s to 83% in 2024. Regarding seasonality, a sharp increase in cases began in 2012, peaking in November 2023 (>350 cases) and early 2024 (312 in January, 268 in February), with a seasonal shift from summer peaks in the 2011–2017 period to higher incidence rates during colder months more recently. Adolescents aged 10–14 years had the highest cumulative incidence (1149.4/100,000), followed by infants under 12 months (978.5/100,000), despite the latter representing fewer absolute cases. The proportion of pertussis in fully vaccinated individuals rose from 6.3% (1997–2003) to 49.7% (2018–2024). Conclusions: These findings suggest that booster immunization in adolescence and routine maternal vaccination during pregnancy could reduce transmission, particularly to infants. Enhanced surveillance and updated immunization policies are critical to mitigating future pertussis outbreaks. Full article

During 2022, AIDS claimed a life every minute and about 9.2 million HIV-infected people were not on treatment. In addition, a person living with HIV is estimated to be 20–30 times more susceptible to developing active tuberculosis. Every year, 130,000 infants are newly infected, with vertical transmission being the main cause of pediatric HIV infection. Thus, the development of an effective, safe, and accessible vaccine for neonates and/or adults is an urgent need to prevent or control HIV infection or progression to AIDS. An effective HIV vaccine should induce long-lasting mucosal immunity, broadly neutralizing antibodies, innate immunity, and robust stimulation of CD4+ and CD8+ T-cell responses. Recombinant BCG is a promising live-attenuated bacterial vaccine vector because of its capacity to stimulate T-cell immunity. As a slow-growing microorganism, it provides prolonged low-level antigenic exposure upon infecting macrophages and APCs, potentially stimulating both effector and memory T-cell responses. BCG is considered safe and is currently administered to 80% of infants in countries where it is part of the national immunization program. Additionally, BCG offers several benefits as a live vaccine vehicle since it is cost-effective, easy to mass-produce, and heat stable. It is also well-suited for newborns, as maternal antibodies do not interfere with its efficacy. Furthermore, BCG has a strong safety profile, having been administered to over three billion people as a TB vaccine. In this review, we provide an extensive summary of the literature relating to immunogenicity studies in animal models performed since 2011. Moreover, we provide a comprehensive analysis of the key factors influencing the design of recombinant BCG as a live vaccine vehicle: (i) expression vectors; (ii) selection of HIV immunogen; (iii) promoters to regulate gene expression; (iv) BCG strain and BCG codon optimization; (v) genetic plasmid stability; (vi) influence of preexisting immunity, route, and dose immunization; and (vii) safety profile. Full article

The discovery that the Oropouche virus (OROV) can be transmitted vertically from an infected pregnant mother to the fetus, resulting in fetal and placental OROV infection, miscarriage, stillbirth, and congenital malformations including microcephaly, has emphasized its public health significance. Because of the importance of breastfeeding in those areas affected by the Oropouche fever outbreak, public health agencies have continued to encourage nursing among mothers who have had OROV infection or who reside or travel in endemic regions. However, the basis for this recommendation has not been stated. At the present time, there have been no reports of the OROV being transmitted from mothers having had Oropouche fever during pregnancy to their infants through breast milk. To further evaluate the potential risk of OROV transmission through breastfeeding, we have examined the peer-reviewed literature to determine if related Orthobunyavirus species infecting humans and animals are transmissible via breast milk. Bibliographic search engines, including PubMed, Scopus, and Google Scholar, were extensively reviewed using keywords, MeSH terms, and other sources cited in the articles examined. Studies investigating Orthobunyavirus species that infect humans and animals, including reassortant strains of OROV and viruses within the Simbu serogroup, were reviewed. We found that there have been no reported events of vertical transmission of any Orthobunyavirus through breast milk. Based on these results, we believe that the advantages of breastfeeding following maternal OROV infection outweigh any negligible risk for vertical transmission. Full article

Objectives: The hospital organizational model can have an impact on people’s health. A critical lesson can be drawn from the pandemic. The possible negative sequelae of the practice of separation of maternal–infant dyads adopted during an infant’s first SARS-CoV-2 pandemic infection on infants have not been considered. Our purpose was to investigate the short- and long-term effects on neonates born to SARS-CoV-2 infected mothers of two different mother–infant dyad management strategies after birth (Separation vs. Rooming-In). Methods: This prospective cohort study enrolled 60 pregnant women who tested positive for SARS-CoV-2 infection and their newborns. We identified two cohorts of study based on mother–infant dyad management after delivery: Cohort A (Separation) and Cohort B (Rooming-In). Inclusion criteria were neonates born from mothers infected with SARS-CoV-2 during the pregnancy undergoing or not undergoing separation. Main Outcome: Rate of exclusive breastfeeding at 6 months of age was the primary outcome. The rate of mother–infant transmission of SARS-CoV-2 infection, growth, incidence of acute infections and neurodevelopment up to 12 months of life were also evaluated. Results: In total, 60 mother–infant dyads (maternal age 30.6 vs. 33.8 years, p = 0.335; gestational age 39.0 vs. 38.9 weeks, p = 0.451) were enrolled at delivery, and 53 dyads completed the study at the 6-month follow-up. Baseline clinical characteristics were similar between the two cohorts. At 6-month follow-up, the rate of breastfeeding was significantly decreased in Cohort A compared with Cohort B (4% vs. 46%, p < 0.001). The rate of SARS-CoV-2 infection was similar between the two cohorts of the study. Weight gain at 6 months of life was significantly higher in Cohort A compared to Cohort B (8129 g, 95% CI, 7562 to 8695; vs. 7393 g, 95% CI, 6912 to 7874; p = 0.005). No differences were detected in terms of rate of acute neonatal infections and neurodevelopment outcomes. Conclusions: The separation practice led to a reduction in the rate of breastfeeding after discharge and to a consequently increased implementation of formula milk, which might justify the alarming increased weight gain of newborns who did not undergo the Rooming-In practice. Given the potential of recurrent outbreaks of other viral pandemics, our results suggest more caution early in life towards the disruption of consolidated procedures that may have long-term consequences. However, the COVID-19 pandemic offered a unique context to observe the effects of temporary mother–infant separation; clinicians should be reassured that the temporary separation practice did not affect neurodevelopment and be aware that it could be considered an option, at least if Rooming-In cannot be carried out due to severe reasons such as lack of staff or adequate space. Full article

Vitamin B12 (cobalamin) plays a crucial role in neurodevelopment, particularly during pregnancy and early childhood. It is essential for DNA synthesis, red blood cell formation, and nervous system function. Maternal B12 levels are particularly important, as they influence fetal brain development. Inadequate maternal intake during pregnancy may lead to altered neurodevelopmental trajectories and increase the risk of ASD. Postnatally, insufficient dietary cobalamin in infants and young children could further contribute to cognitive and behavioral impairments. One potential mechanism linking low B12 levels to ASD involves its role in the gut microbiota balance. Dysbiosis, commonly observed in individuals with ASD, is associated with increased gut permeability, low-grade inflammation, and disruptions in the gut–brain axis, all of which may contribute to ASD symptoms. Additionally, B12 is essential for neurotransmitter metabolism, particularly in the synthesis of serotonin and dopamine, which regulate mood, cognition, and behavior. Cobalamin also plays a key role in neuronal myelination, which ensures efficient signal transmission in the nervous system. Disruptions in these processes could underlie some of the cognitive and behavioral features associated with ASD. Despite growing evidence, the link between B12 and ASD remains inconclusive due to inconsistent findings across studies. Research suggests that B12 levels may serve as a potential biomarker for disease progression and treatment response. However, many studies rely on single-time-point measurements, failing to account for individual variability, genetic predispositions, dietary intake, and environmental factors, all of which can influence B12 levels and ASD risk. Further longitudinal studies are needed to clarify this relationship. Full article