Search Results (636)

The present work aimed to assess associations between food insecurity, WIC participation, diversity of dietary exposures, and diet quality in infancy. A secondary analysis was conducted of the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2), a national longitudinal study of WIC participation, feeding practices, and children’s health outcomes. Food security at 13 and 24 months, WIC participation at 13 and 24 months, diversity of dietary exposures between 5 and 13 months, and diet quality at 24 months were assessed in 1246 participants who had complete data on all variables of interest. Multivariable linear regression using weighted cases was used. Among families participating in WIC at 13 months, infants in families with low or very low food security had a greater diversity of dietary exposures (mean ± SE: 8.9 ± 0.3) compared to families with high or marginal food security (8.6 ± 0.2); the magnitude of this effect was small but significant (p = 0.03). In both food-insecure and -secure families, greater diversity of dietary exposures (b = 0.30, 95% CI 0.15, 0.44) and WIC participation at 24 months (b = 2.35, 95% CI 1.29, 3.40) were associated with higher diet quality at 24 months. Greater diversity of dietary exposures and participation in WIC may support improved diet quality during the first 2 years. Full article

Background: Eye tracking technology can be utilized to identify early markers of autism. Several neurodivergent features of social attention have been revealed by eye tracking studies in ASD toddlers. Our aim was to develop stimulus material that elicits highly distinctive gaze patterns in toddlers at low and high risk for autism as indicated by ADOS (i.e., scoring below and above the ADOS cut-off point). Additionally, we sought to identify the variables most effective in differentiating between these groups. Methods: In our research, we analyzed the data of 74 toddlers between 12 and 30 months. Children were divided into two groups based on their ADOS scores: the lower ADOS (lrADOS) group included those scoring below the ADOS cut-off point (n = 42; mean age = 22.5 ± 5.0 months), while the higher ADOS (hrADOS) group comprised children scoring above the cut-off (n = 32; mean age = 23.3 ± 4.8 months). We recorded eye gaze data during the presentation of dynamic social attention stimuli with a self-developed eye tracking device. We used two types of social attention stimuli: joint attention (ostensive) and preferential looking paradigm. We analyzed the area of interest based on the gaze–time ratio. To ensure sufficient robustness, we selected gaze retention interval (GRI) variables characterized by broader spatial and temporal parameters compared to traditional fixation-based measures. Results: As anticipated, we observed significant differences between the two groups across most variables. Typically, within the preferential paradigm, the distinct indicators of the social domain were higher on average in the lrADOS group compared to the hrADOS group, while the non-social domain exhibited the opposite trend. The results of correlations with ADOS scores indicated that the social ratio in the preferential paradigm exhibited the strongest negative correlation. Notably, there were higher effect sizes within the hrADOS group in comparison to the lrADOS group when correlation with ADOS scores was tested separately for each group. Conclusions: We developed stimulus materials and eye tracking variables that, thanks to their robustness, appear promising even when dealing with noisy eye tracking data typical of young children. In the preferential paradigm, beyond AOI ratio measures, GRI variables show promise in distinguishing between toddler groups with higher vs. lower ADOS scores. Furthermore, they may be related to severity based on their marked and significant correlations with ADOS scores. Especially when used in combination, these variables appear well-suited to capturing characteristics indicative of an elevated likelihood of autism. Full article

Introduction: To explore whether antenatal and preoperative factors predict disability-free survival of preterm newborns with biventricular complex congenital heart defects (CHD). Methods: Retrospective cohort study, using the prospectively designed database of Complex Pediatric Therapies Follow Up Program and a chart review of mother–newborn dyads, born under 37 weeks’ gestation with biventricular complex CHD, between 1997 and 2019, who had open heart surgery up to 6 weeks corrected age. Surviving children had neurodevelopmental assessments between 18 and 24 months corrected age. Bayley Scales of Infant Development, 2nd edition, and Bayley Scales of Infant and Toddler Development, 3rd edition, assessed cognitive, language, and motor skills; Adaptive Behavior Assessment System, 3rd edition, assessed adaptive skills. Univariate and multivariate analyses assessed predictors of mortality, disability (cerebral palsy, visual impairment, permanent hearing loss), and neurodevelopmental delay. Results: Of 84 preterm newborns (34.6 ± 2.1 weeks’ gestation, 2321 ± 609 g, 57% males), 8 (9.5%) died by 2 years of age; 69 (91%) survived without and 7 (9%) with disability. Chorioamnionitis was associated with death [Hazard ratio 7.92 (95% CI 1.3, 33.3), p = 0.025]; prolonged rupture of membranes was associated with disability [Odds Ratio 9.7 (95% CI 1.99, 46.9), p = 0.005]. Maternal diabetes, antenatal diagnosis of CCHD, birth head circumference, cardiopulmonary resuscitation, and chromosomal anomalies were associated with adverse neurodevelopment. Conclusions: Chorioamnionitis and prolonged rupture of membranes are associated with worse outcomes in preterm newborns with biventricular complex CHD up to 2 years of age. Adverse neurodevelopmental outcomes are associated with maternal diabetes and antenatal diagnosis of CCHD. Prospective studies are needed to confirm these results. Full article

Children with Down syndrome (DS) show considerable variability in social-communication and cognitive profiles, and a subset meet criteria for co-occurring autism. In the present study, we examined the associations between developmental domains and autistic trait severity in toddlers with DS. Participants included 38 toddlers (M = 4.19 years, SD = 0.99) who completed a home-based assessment, including measures of language, fine motor, and visual reception skills. Caregivers also completed standardized questionnaires on communication and executive functioning. Multiple regression analyses tested the degree of association between these developmental domains and autistic traits. Fewer words produced fewer gestures, and more impaired fine motor and visual reception scores were significantly associated with higher autism trait severity, whereas executive function domains were not significantly associated. Preliminary findings indicate that variability in language and nonverbal developmental skills contributes to the expression of autism traits in DS, underscoring the need for early, multidomain assessment approaches to support accurate identification and tailored intervention. Full article

Background/Objectives: Primary steroid-resistant nephrotic syndrome (SRNS) in children is an ominous diagnosis due to limited therapeutic options and poor prognosis. The younger the child, the greater the probability of a genetic etiology which is typically resistant to immunosuppressive therapy. International guidelines recommend genetic testing and a search for rare infectious causes in the youngest age group. When no identifiable etiology is found, an immunologic cause of SRNS is suspected, with few therapeutic options available, which lately have included anti-CD20 therapy for children > 7 years of age. This is the first report on the successful use of obinutuzumab in a very young child with primary SRNS. Methods: Two consecutive doses of obinutuzumab, a humanized anti-CD20 antibody (300 mg/m² BSA), were administered two weeks apart to a 24-month-old boy with severe, complicated SRNS which had been refractory to cyclosporin A and rituximab and in whom previous genetic testing and a search for multiple infectious causes had been negative. Results: Complete remission of severe nephrotic syndrome was achieved 2 months after the last infusion with, to date, sustained resolution of proteinuria and normal serum albumin levels without further use of IMS drugs and no severe adverse effects noted. Conclusions: Obinutuzumab may be a rescue option for severe, multidrug-resistant ISN, even in young children, when no other therapeutic options are available. Full article

Background/Objectives: Autism Spectrum Disorder (ASD) is a multifaceted neuropsychiatric condition characterized by early behavioral irregularities that often precede formal diagnosis. Timely and precise detection remains a major clinical challenge due to the complexity of behavioral manifestations and the limited accessibility of diagnostic resources. Methods: In this study, we present an explainable machine learning framework for the early diagnosis of ASD using behavioral biomarkers derived from toddler screening data. The framework integrates unsupervised learning (DBSCAN and K-means clustering) to identify latent behavioral patterns, followed by predictive modeling using logistic regression (LR), random forest (RF), and support vector machine (SVM). To ensure transparency and clinical interpretability, a SHAP (SHapley Additive exPlanations) analysis is employed to quantify the contribution of each behavioral feature to the model’s predictions. Results: Experimental evaluations reveal that the RF model achieves the highest accuracy (98.85%), followed by SVM (97.70%) and LR (90.53%). The explainability results highlight meaningful and clinically relevant behavioral indicators associated with ASD risk. Conclusions: The proposed framework not only enhances diagnostic accuracy but also promotes interpretable AI for real-world integration into neuropsychiatric assessment pipelines. Full article

Aflatoxin M1 (AFM1), a hydroxylated metabolite of aflatoxin B1, is a persistent food safety hazard in the dairy production chain. This study investigated AFM1 occurrence in fermented dairy products collected from the Croatian market in spring 2025 and assessed associated dietary exposure risks. A total of 81 samples were analyzed using ultra-high performance liquid chromatography tandem mass spectrometry (UHPLC-MS/MS) following immunoaffinity column clean-up. AFM1 was detected in 48.1% of samples, with a mean concentration of 0.015 µg/kg. Products with thermophilic and probiotic bacterial cultures showed the lowest incidence rates, at 33.3% and 40.0%, respectively. Significantly higher AFM1 occurrence was found in Croatian samples than in imported ones (p < 0.05). Exposure assessment, based on estimated daily intake (EDI), hazard index (HI), and margin of exposure (MOE), identified toddlers and children as the most at-risk groups, with EDI ranging from 0.21 to 0.93 ng/kg bw/day, depending on AFM1 concentration. HI exceeded 1 even at mean AFM1 levels, while MOE fell below the safety threshold of 10,000 in worst-case scenarios, indicating potential health concerns. These findings underscore the need for continuous monitoring and targeted risk mitigation strategies for vulnerable populations, and support expanding regulatory limits to include processed dairy products. Full article

Background/Objectives: Early detection and timely treatment of amblyopia require reliable visual acuity testing in toddlers; however, conventional Landolt ring charts often show poor testability in 2–3-year-old children. Therefore, we aimed to verify the practicality of a new Child-Friendly Minimum-Separable (CFMS) chart for 2–3-year-old children by comparing cooperation rates with the standard Landolt ring visual acuity chart. Methods: A prospective pilot study was conducted on 20 children aged 2 years (30.6 ± 3.2 months) and 20 children aged 3 years (41.8 ± 3.9 months). Right-eye visual acuity was tested in random order using the Landolt ring (four options, 3/5 considered correct) and the CFMS chart (two options, 3/3 considered correct). Test cooperation rates and visual acuity were analyzed. Results: In the 2-year-olds, the cooperation rate was 15% and 75% for the Landolt ring and CFMS chart, respectively (p = 0.0005). Twelve children refused to cooperate with the Landolt ring but cooperated with the CFMS chart; the reverse did not occur. In the 3-year-olds, the cooperation rate was 60% and 90% for the Landolt ring and CFMS chart, respectively (p = 0.031); six children cooperated only with the CFMS chart. The odds ratio for cooperation per additional month of age was 1.34 (95% confidence interval [CI]: 1.12–1.59; p = 0.001) and 1.24 (95% CI: 1.03–1.50; p = 0.026) for the Landolt ring and CFMS chart, respectively. Conclusions: Compared to the Landolt ring, the CFMS chart significantly improves cooperation rates for visual acuity testing in 2−3-year-old children, especially among 2-year-olds. Full article

Background: Early detection of autism spectrum disorder (ASD) is essential, as the first two years of life represent a critical window of neuroplasticity during which timely interventions can improve developmental outcomes. Traditional diagnostic methods, such as ADOS and ADI-R, rely on caregiver reports and structured observations, limiting ecological validity and accessibility. Eye-tracking (ET) offers a non-invasive, scalable approach to assess early atypical gaze patterns. Objectives: This systematic review and meta-analysis synthesized evidence on the diagnostic accuracy of ET for early ASD detection and its potential as an adjunctive screening tool. Methods: A comprehensive search of PubMed, Scopus, Web of Science, Medline, and the Cochrane Library identified studies published between January 2015 and July 2025. Eligible studies evaluated ET in infants and toddlers (≤36 months) for early ASD identification, following PRISMA guidelines. Results: Out of 513 records, 57 studies were included. Most studies reported reduced fixation on social stimuli, atypical gaze following, and preference for geometric over social images in infants later diagnosed with ASD. Pooled effect sizes indicated a moderate-to-large difference between ASD and typically developing groups in social fixation time (Hedges’ g ≈ 0.65, 95% CI: 0.48–0.82, I² = 58%). Studies integrating machine learning algorithms (n = 14) achieved improved sensitivity (up to 89%) and specificity (up to 86%) compared with conventional gaze metrics. Conclusions: Overall, ET shows strong potential as an early adjunctive screening method for ASD. Nonetheless, methodological heterogeneity and lack of standardized protocols currently limit clinical translation, underscoring the need for multi-center validation and task standardization. Full article

Objectives: This paper illustrates the use of the National Cancer Institute (NCI) Markov Chain Monte Carlo (MCMC) method for usual intake (UI) analyses of 5-year-old children’s diets by comparing results from the MCMC method with results from other estimation methods. Methods: This study involves secondary analysis of data from the Infant and Toddler Feeding Practices Study-2 (ITFPS-2), a nationally representative prospective cohort study that followed children from around birth through age 9. Dietary data analyzed were collected between April 2018 and August 2019. All study participants in the longitudinal cohort (n = 1030) had 1 day of dietary recall data, and 122 participants had 2 days of recall. We compare differences in intake distributions for sodium, added sugars, whole grains, energy, and Healthy Eating Index (HEI) scores using the NCI UI methods, as well as single-day and two-day methods. We use regression analysis to assess associations by intake estimation method. Results: Across the methods examined, means for daily consumed nutrients differed by less than 2 percentage points and mean HEI component scores differed by less than half a point. However, for episodically consumed whole grains, the NCI UI methods yielded mean intake estimates that differed by 37%, with the univariate method indicating higher mean intake than the MCMC method. Conclusions: For the daily consumed nutrients examined, the NCI MCMC method is a useful alternative to the univariate method. However, for episodically consumed whole grains, the NCI UI methods yield notably different mean estimates. For episodically consumed dietary constituents, abandoning the NCI univariate method may exacerbate differences between recommended and estimated population mean intake levels for young children. Full article

Infant formulas are specialized foods designed for babies and toddlers who cannot be exclusively breastfed. However, acrylamide (AA) may form during the thermal processing involved in their production. Although chromatographic techniques offer high sensitivity and detection capability for AA analysis, their application remains limited due to the complexity of diverse food matrices, high operating costs, time requirements, and environmental concerns. A new validated liquid chromatography–mass spectrometry (LC-MS) protocol for AA detection in infant formula was developed using sequential hydration, acetonitrile (ACN) precipitation, and dual-sorbent clean-up, which minimized matrix effects and ensured clarity and high reproducibility. The validated method demonstrated excellent linearity (R² = 0.9985, solvent-based; 0.9903, matrix-based), a pronounced matrix effect (−67%), satisfactory sensitivity (limit of detection, LOD: 10 µg/kg; limit of quantification, LOQ: 20 µg/kg), and consistent recovery (82–99%) with less than 15% variation. AA analysis was performed on 31 infant formula samples. The highest individual AA level (268.2 µg/kg) was detected in an amino acid-based formula intended for infants under one year of age while the highest mean concentration was found in cereal-based samples (188.1 ± 100.8 µg/kg), followed by goat’s milk-based (52.7 ± 25.67), plant-based (48.8 ± 31.68), and cow’s milk-based (27.5 ± 29.62) formulas (p < 0.001). The wide variability in AA concentrations among infant formulas can be attributed to differences in formulation, ingredient composition, manufacturing processes, and analytical methodologies. These findings highlight the need for continuous monitoring of AA levels in infant foods to ensure their safety. Full article

Background/Objectives: The COVID-19 pandemic substantially altered children’s daily experiences, limiting social interactions, which are critical for language development. This study aims to explore how the pandemic influenced receptive and expressive language abilities in children under six years, focusing on the impact of exposure duration and differences with the pandemic period. Methods: This retrospective cross-sectional study reviewed 189 children assessed for language delay at our outpatient clinic between 2018 and 2021. Only children evaluated using the Sequenced Language Scale for Infants or the Preschool Receptive-Expressive Language Scale were included. Participants were categorized by assessment period: pre-COVID (2018–2019), acute-COVID (2020), and chronic-COVID (2021), and by age (toddlers vs. preschoolers). Linear regression assessed the relationship between pandemic exposure duration and language scores; non-parametric tests compared groups. Results: During the acute-COVID period, longer exposure was associated with lower receptive and expressive percentile scores. In preschoolers, receptive scores were significantly lower in the chronic-COVID group than in the pre-COVID group, while expressive scores were lower in the chronic-COVID group than in the acute-COVID group. Conclusions: Prolonged exposure to the pandemic environment was associated with measurable delays in both receptive and expressive language development, especially in preschoolers. The results suggest that pandemic restrictions can hinder children’s language acquisition, indicating the need to strengthen early screening and provide timely interventions to support their developmental recovery. Full article

Background and Clinical Significanc: Congenital duodenal diaphragm (CDD) is a rare congenital condition causing partial or complete obstruction of the duodenum, most frequently located in the second part of the duodenum. It is a rare but important cause of intestinal obstruction in infants and young children. Clinically, it often presents with persistent vomiting and failure to thrive. Diagnosis can be made through abdominal X-ray showing the characteristic “double bubble” sign, upper gastrointestinal (GI) series, or gastroscopy. Case Presentation: A 17-month-old female infant with known psychomotor retardation was admitted for evaluation of inadequate weight gain and intermittent postprandial vomiting, both present since birth. Laboratory investigations, including metabolic and electrolyte panels, were within normal limits. Given the persistent clinical symptoms, an upper gastrointestinal series was performed to assess for possible anatomical abnormalities. Imaging revealed a significant delay in the passage of contrast into the second portion of the duodenum, with marked prestenotic dilatation. Subsequent gastroscopy identified a duodenal diaphragm nearly occluding the duodenal lumen at the same site, impeding the passage of the endoscope. Associated findings included gastritis and the presence of food debris in the stomach and proximal duodenum, indicating impaired gastric emptying. The patient underwent successful surgical management via duodenotomy with resection of the septum. Postoperative recovery was uneventful. Conclusions: In infants or young children with persistent postprandial vomiting and inadequate weight gain, anatomical causes such as duodenal diaphragm/web should be considered in the differential diagnosis. Once identified, treatment should be initiated promptly, either endoscopically or surgically, depending on the severity and anatomical characteristics of the obstruction. Full article

Background/Objectives: Magnesium sulfate (MgSO₄) has historically been used in obstetrics as a tocolytic and to prevent eclamptic seizures. MgSO₄ has also been investigated as a potential neonatal neuroprotectant for infants born preterm. However, randomized controlled trials of prenatal MgSO₄ have shown mixed results, with single-center observational studies also suggesting differential effects by sex. We sought to evaluate sex-dependent associations between prenatal MgSO₄ exposure and standardized neurodevelopmental outcomes in a large, multi-center cohort of extremely preterm neonates (24–0/7 to 27–6/7 weeks’ gestation) from the Preterm Erythropoietin Neuroprotection Trial (PENUT). Methods: The relationship between maternal MgSO₄ exposure and neurodevelopmental outcomes assessed at 2 years using the Bayley Scales of Infant and Toddler Development Index, 3rd edition was examined by sex in n = 666 infants (n = 328 female, n = 338 male). To account for confounding by indication, we performed both matching and inverse probability weighting using 17 maternal predictors of MgSO₄ exposure. Results: In both unadjusted and adjusted (weighted and matched) analyses, no relationship between MgSO₄ exposure and neurodevelopmental outcomes was seen, either overall or by sex. Conclusions: This study reaffirms the safety of MgSO₄, but appropriate clinical trials of MgSO₄ in extremely preterm infants are still required to better understand any effects on neurodevelopmental outcomes. Full article

Per- and polyfluoroalkyl substances (PFASs) are persistent and bioaccumulative contaminants frequently detected in animal-derived foods, raising concerns for consumer health. In 2020, the European Food Safety Authority (EFSA) established a group tolerable weekly intake (TWI) of 4.4 ng/kg bw per week for four PFAS (PFOA, PFNA, PFOS, PFHxS) based on immunotoxicity, prompting the European Commission to set maximum levels in food. However, many other PFAS are present in the diet, and their cumulative risk is poorly characterized. This study applied the Relative Potency Factor (RPF) approach, using hepatic toxicity as the reference endpoint. The RPF approach addresses a key challenge in assessing human dietary exposure to PFAS by enabling cumulative risk assessment for complex mixtures found in food, moving beyond single-compound evaluations. Occurrence data from EFSA’s 2020 opinion were combined with European consumption data for fish, meat, eggs, and milk across four population groups (toddlers, adolescents, adults, elderly). Exposure estimates, expressed in PFOA equivalents, were compared with the group TWI. Results showed toddlers as the most vulnerable, with cumulative exposure approaching or exceeding TWI through fish, meat, and eggs, while milk contributed less. PFOS and PFOA were the main contributors across all food categories, with PFNA and PFDA also relevant, especially in younger populations. The findings highlight the added value of the RPF approach for cumulative PFAS risk assessment and emphasize the need for updated monitoring, refinement of potency factors for under-studied PFAS, and continued regulatory measures to protect high-risk consumers. Full article