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Nationwide studies investigating the association between daily mean temperature and Kawasaki disease are lacking. This study aimed to examine the association between ambient temperature and Kawasaki disease by utilizing daily data from nationwide administrative claims databases. The daily number of Kawasaki disease patients younger than 15 years old, who were hospitalized from 2011 to 2022, was extracted from the nationwide administrative claims database of hospitalizations in Japan. Daily mean temperature data and relative humidity data were obtained from the Japan Meteorological Agency. Since the exposure of interest includes heat, hospitalizations during the five warmest months (May through September) were used for analysis. A time-stratified case-crossover study with conditional quasi-Poisson regression analysis was used to estimate the relative risk (RR) of weather exposure for Kawasaki disease hospitalization with a lag of 0-5 days by prefecture. Relative humidity was included in the model simultaneously to control for its potential confounding effect. Random-effects meta-analysis was used to estimate pooled RRs. There was a total of 48,784 cases of Kawasaki disease hospitalization during the study period, of which 87.9% were under 5 years of age. Exposure to high daily mean temperatures was associated with an increased risk of hospitalization for Kawasaki disease. Specifically, exposure to extreme high daily mean temperatures (99th percentile high temperature) was associated with higher risk of hospitalization by 33% (RR 1.33, 95% confidence interval (CI):1.08, 1.65). Similar results were obtained from sensitivity analysis. Future research should elucidate the mechanisms by which high temperature is associated with hospitalization for Kawasaki disease., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: The association between temperature variability (TV) and elevated mortality risks is widely known. Yet, few studies investigated the distinct effects of intraday and interday temperature fluctuations considering age-specific, gender-specific, and cause-specific mortality stratified by four seasons., Objectives: We investigate the associations between total, intraday, and interday temperature variabilities and total, age-specific, gender-specific, cardiovascular, and respiratory mortality year-round and also stratified by four seasons., Methods: We collected district-level daily data for temperature and total, age-specific, gender-specific, cardiovascular, and respiratory mortality in South Korea from 2011 to 2021 (N = 3,113,425). TV indices (i.e., total TV, intraday TV, and interday TV) were computed as the standard deviations of daily minimum, maximum, and mean temperatures over a lag of one to seven days. The associations between TV and mortality were evaluated by a space-time-stratified case-crossover design with quasi-Poisson regression., Results: Mortality risks varied based on the type of TV index. The associations also differed depending on the mortality type and the season. Year-round associations showed interday TV was generally associated with elevated mortality risks (total mortality: 0.30% (95% CI: 0.07%, 0.52%), 65+ mortality: 0.32% (95% CI: 0.07%, 0.58%), female mortality: 0.49% (95% CI: 0.16%, 0.82%), CVD mortality: 0.47% (95% CI: 0.02%, 0.92%) on lag0-7) while intraday TV was not significantly associated with increased risk of mortality except for the male mortality, 0.68% (95% CI: 0.04%, 1.32%) on lag0-7. Season-stratified analysis revealed that TV-related mortality risks were high consistently in the spring season and generally in the summer season while the associations were generally negative in fall and insignificant in winter., Conclusion: This study provided evidence on the season-stratified, independent impacts of intraday and interday temperature variabilities on total, age-specific, gender-specific, and cause-specific mortality risks in South Korea drawing attention to the need of targeted policies to alleviate the impacts on human health., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Ho Kim reports financial support was provided by Korea Ministry of Environment. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Per- and polyfluoroalkyl substances (PFAS) have been detected in the blood of humans and animals worldwide. Exposure to some PFAS are associated with multiple adverse pregnancy outcomes. Existing literature has identified a strong association with PFAS exposure and metabolic dysfunction in humans, including modification of lipid metabolism. Using a subset of the Michigan Mother-Infant Pairs cohort (n = 95), this study investigated associations between first trimester plasma levels of PFAS and maternal lipids and metabolites in the first trimester (T1), at the time of delivery (T3), and in the infant cord blood (CB) using untargeted shotgun lipidomics and metabolomics. Identifying PFAS-induced alterations in the maternal lipid- or metabolome at specific timepoints may help elucidate windows of susceptibility to adverse pregnancy outcomes. Out of 9 PFAS measured, 7 were detected in at least 20% of samples and were used for further analyses. PFOS and PFHxS were measured at the highest concentrations with medians of 5.76 ng/mL and 3.33 ng/mL, respectively. PFOA, PFNA, and PFDA had lower measured values with medians of <1.2 ng/mL. PFHxS concentrations were positively associated with monounsaturated sphingomyelins (SMs) in T1 maternal plasma in adjusted models, determined by an adjusted p-value (q) < 0.1. PFHxS was positively associated with saturated and polyunsaturated SMs and inversely associated with saturated diacylglycerols in T1. Following metabolite-specific analysis, two mono-unsaturated diacylglycerols with carbon chain lengths of 32 and 35 were inversely associated with PFHxS in T1. In T3, only the association between PFHxS and SMs remained, but was attenuated. In addition, PFDA was associated with an increase in polyunsaturated plasmenyl-phosphatidylethanolamines in T3. No associations were identified between PFAS and infant cord blood lipids. Continued research into PFAS associated disruptions in lipid metabolism at sensitive stages of gestation may provide insight into the mechanisms that lead to adverse birth and pregnancy outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Residential relocation leads to environmental changes, besides being likely to be influenced by sociodemographic characteristics. The relationship between them is, however, still not well described. We aimed to investigate changes in patterns of urban, natural and physical environmental exposures due to relocation and related sociodemographic determinants in a population-based cohort study of children and adolescents. We included individuals between 0 and 17 years of age, registered in primary healthcare records in Catalonia, Spain from 2006 to 2018 and categorized them as non-movers and movers (first residential change). Hierarchical clustering identified groups of individuals based on their exposure to air pollution, green spaces and built environment. Low, medium and high environmental hazard exposure clusters were identified, which were used to identify changes in environmental exposure patterns due to relocation, namely same, worse, and better environment. Multinomial logistic regression determined whether sex, age, nationality and area-level deprivation influenced these changes. From 1,316,138 individuals, 221,058 were movers. Compared to non-movers, movers were more frequently with foreign nationality (12.1% vs. 21.3%, respectively) and more likely to live in the most deprived areas at baseline (19.2% vs. 24.4%). Younger children had higher risk of moving to better or worse environments. Individuals living in areas with the highest levels of deprivation were least likely to move within the same environments (i.e., either moving to better (Odds Ratio [95% Confidence Interval] 1.39[1.34-1.44]) or worse environment (1.56[1.49-1.63])). Compared to people from Spain, those from Africa moved to similar environments (OR of moving to a better environment 0.90 (0.87-0.94) with respect to move to the same environment, and OR of moving to a worse environment 0.82 (0.78-0.85)), those from America tended to move to other environments (1.17 (1.12-1.23) better and 1.09 (1.03-1.15) worse), while those from Asia and Europe moved to better environments (1.22 (1.12-1.33) and 1.20 (1.14-1.27) respectively). No associations were found for sex. Changes in patterns of environmental exposures due to residential mobility are complex and may be determined by age, deprivation and nationality., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Urban settlements have become the main living environment. Understanding the impact of urban exposures on human health has therefore become a growing area of research. Up-to-date knowledge about the influence of urban exposures on pregnant women's and children's health is especially relevant, as they are particularly vulnerable to certain external influences., Aim: This review aims to provide a synthesis of systematic reviews with meta-analyses reporting on an association between the urban environmental risk factors and health outcomes in pregnancy, infants, children and adolescents., Methods: We conducted an umbrella review, methodically analysing systematic reviews with meta-analyses, published between January 2016 and December 2022 in PubMed or Scopus. Adhering to the PRISMA checklist, we searched for free text using Medical Subject Headings (MeSH) terms related to air pollution, noise pollution, temperature, green space exposure, built and food environment, health outcomes, children (aged 0-18 years), pregnancy and systematic reviews with meta-analyses. We extracted key characteristics of each included study and assessed the quality of the included studies via the R-AMSTAR 2 tool., Results: Twenty-four studies met our inclusion criteria and identified 104 associations including 15 exposures and 60 health outcomes. The most frequently studied associations were related to air pollutants, followed by the built and food environment and noise. Birth outcomes (including low birth weight, pre-term birth or stillbirth) were the most commonly affected health outcomes, followed by respiratory outcomes such as asthma or respiratory infections. A total of 45 exposure-response function were reported to be statistically significant, including 10 exposures and 23 health effects., Conclusion: This umbrella review provides an overview of the evidence and availability of exposure response functions between selected urban exposures and child health outcomes. This helps to identify research gaps and to build the basis for health impact assessment., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: In utero exposure to environmental polycyclic aromatic hydrocarbon (PAH) is associated with neurodevelopmental impairments[1-8], prematurity[9-12] and low birthweight[9,13-15]. The gut microbiome serves as an intermediary between self and external environment; therefore, exploring the impact of PAH on microbiota may elucidate their role in disease. Here, we evaluated the effect of in utero PAH exposure on meconium microbiome., Methods: We evaluated 49 mother-child dyads within Fair Start Birth Cohort with full term delivery and adequate meconium sampling. Prenatal PAH was measured using personal active samplers worn for 48 h during third trimester. Post-processing, 35 samples with adequate biomass were evaluated for association between tertile of PAH exposure (high (H) vs low/medium (L/M)) and microbiome diversity., Results: No significant differences were observed in alpha diversity metrics, Chao1 and Shannon index, between exposure groups for total PAH. However, alpha diversity metrics were negatively associated with log benzo[a]anthracene (BaA) and log chrysene (Chry) with high exposure, but positively associated with log benzo[a]pyrene (BaP) with low/medium exposure. After adjustment for birthweight and sex, alpha diversity metrics were negatively associated with log BaA, BaP, Chry, Indeno (Zhang et al., 2021; Perera et al., 2018)pyrene (IcdP) and total PAH with high exposure. Conversely, with low/medium exposure, alpha diversity metrics positively correlated with log BaP and benzo[b]fluoranthane (BbF). No significant difference in beta diversity was observed across groups using UniFrac, weighted UniFrac, or Bray-Curtis methods. Differential expression analysis showed differentially abundant taxa between exposure groups., Conclusion: Bacterial taxa were detectable in 35/49 (71%) meconium samples. Altered alpha diversity metrics and differentially abundant taxa between groups suggest in utero PAH exposure may impede early colonization. Sample size is limited, but these findings provide supporting evidence for wider scale research. Research on long-term impact of prenatal PAH exposure on childhood health outcomes is ongoing. Differential effects of specific PAHs need further evaluation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: To assess the impact of low birth weight on early and late outcomes after staged palliation for single ventricle., Methods: Patients after stage 1 palliation for single ventricle in our institution were retrospectively included and divided into two weight groups: 2.5 kg or less (low birth weight) and more than 2.5 kg. The impact of low birth weight on mortality and on the progression to further palliation stages (bidirectional Glenn, stage 2, and total cavopulmonary connection, stage 3) was assessed., Results: A total of 452 patients were included. Patients with low birth weight (n = 37, 8 %) had more frequently associated prematurity and extracardiac anomalies. Early and inter-stage mortality after stage 1 was higher in patients with low birth weight, so that less of these patients reached the next palliation stage (57 % vs. 77 %, p = 0.01, and 38 % vs. 56 %, p = 0.05, for stage 2 and stage 3, respectively). After 5 years, overall survival was inferior in patients with low birth weight (48 % vs. 73 %, p < 0.001). Survival conditioned by stage 2 palliation was inferior in patients with low birth weight compared to the reference group (76 % vs. 89 % after 5 years, p = 0.04). Low birth weight was a risk factor for death in most patients' subgroups, inclusive those with restricted pulmonary blood flow after a systemic-to-pulmonary shunt procedure., Conclusions: During staged palliation of single-ventricle physiology, low birth weight has a detrimental impact on survival extending to beyond stage 2. This study calls for increased vigilance of these patients beyond the first interstage., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Wildfire-specific particulate matter with diameters ≤ 2.5 µm (PM 2.5 ) is the key component of wildfire smoke, with potentially higher toxicity than PM 2.5 from other sources. In this nationwide population-based cohort study, we included 22,163,195 births from Brazil during 20102019. Daily wildfire-specific PM 2.5 was estimated through the chemical transport model. Time-varying Cox proportional hazards models were used to characterize the exposure-time-response (E-T-R) relationship between weekly wildfire-specific PM 2.5 exposure and preterm birth (PTB) risks, followed by subgroup analyses. A 10 µg/m 3 increment in wildfire-specific PM 2.5 was associated with a hazard ratio of 1.047 (95 % confidence interval [CI]: 1.032-1.063) for PTB. Stronger associations between wildfire-specific PM 2.5 and PTB were observed during earlier pregnancy, among female infants, and pregnant women < 18 years old, in ethnic minorities, with a length of education ≥ 11 years, from low-income or high-temperature municipalities, and residing in North/Northeast regions. An estimated 1.47 % (95 % CI: 1.01 %1.94 %) of PTBs were attributable to wildfire-specific PM 2.5 in Brazil, increasing from 2010 to 2019. The PTBs attributable to wildfire-specific PM 2.5 surpassed those attributed to non-wildfire PM 2.5 (0.31 %, 95 % CI: 0.09 %0.57 %). Wildfire emerged as a critical source contributing to the PM 2.5 -linked PTBs. Prioritized fire management and emission control strategies are warranted for PTB prevention., Competing Interests: Declaration of Competing Interest All other authors declare they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background & Aims: Human milk is the optimal diet for very preterm infants (VPIs), but it requires nutrient fortification to support growth. Bovine colostrum (BC), rich in intact proteins and bioactive components, could serve as a novel fortifier with potential benefits to VPIs gut health. To evaluate a possible effect of feeding BC on intestinal metabolism, the gut microbiota, and their interaction, we studied the fecal metabolome of VPIs in the first month of life, as compared with a conventional fortifier (CF, based on infant formula ingredients)., Methods: Fecal samples were collected from VPIs recruited to the FortiColos trial (NCT03537365, BC, n = 107; CF, n = 112) before (FT0) and one (FT1) or two (FT2) weeks after start of fortification and analyzed using 1 H NMR spectroscopy. Abundances of metabolites were compared between BC versus CF groups. Further, temporal changes in metabolite levels after start of fortification, as well as correlations with specific gut bacterial genera were explored., Results: Infants in the BC group had higher levels of fecal acetoacetate, choline, methanol, uracil, creatine, creatinine, lysine and a lower leucine at both FT1 and FT2, relative to the CF group. Asparagine, tryptophan and phenylalanine levels were higher, and butyrate was lower in the BC group at FT1. At FT2, higher fecal succinate and lower isoleucine were found in the BC group. In addition, eight metabolites (asparagine, phenylalanine, tryptophan, lysine, creatinine, acetoacetate, methanol and uracil) had fortification-specific changes over time. Positive correlations were found between succinate and unclassified Enterobacteriaceae, butyrate and Clostridium, uracil and Staphylococcus, while negative correlation were found between uracil and unclassified Enterobacteriaceae members., Conclusion: Our study shows distinct fecal metabolome profiles in VPIs in the first weeks after fortification with BC versus CF. The fortification- and time-specific gut metabolite changes suggest that fortifiers influence luminal nutrient metabolism and microbiota activity in VPIs. Fortifier type for human milk affected gut health of VPIs via altered gut metabolite levels, interacting with microbiota in VPIs., Competing Interests: Conflict of interest The University of Copenhagen holds a patent on the use of colostrum for human infants (PCT/DK2013/050184). Biofiber Damino A/S is given options to license this patent. P.T.S. is listed as the sole inventor but has declined any share of potential revenue arising from commercial exploitation of such a patent. P.T.S. did not take part in any clinical work in the units involved in this study. Other authors declare no competing interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: The coronavirus pandemic has substantially influenced the transmission pattern of other respiratory viruses. However, screening and detecting other respiratory pathogens was unheeded during this time to combat the COVID-19 pandemic. High virulence and re assortment factors intensify the importance of influenza virus surveillance for effective disease management. Therefore, the present surveillance study was designed to determine the influenza positivity rate from 2008-24. This study will provide integral support in depicting a panoramic representation of two respiratory-pandemic periods, 2010-11 and 2019-2021, for influenza and COVID-19 pandemics, respectively., Methods: An inferential cross-sectional study was conducted from 2008 to 2024 by collecting influenza surveillance data from twelve sentinel sites in Pakistan. Clinical and demographic data was recorded at sample collection time. Specimens were collected through nasopharyngeal/throat swabs and stored in viral transport medium (VTM) at the sentinel site laboratory at 2-4 °C. Viral RNA was isolated from the samples using KingFisher TM Flex Purification System and MagMAX™ Viral/Pathogen Nucleic Acid Extraction Kit., Results: Within 16 years, 78118 samples were tested for influenza, of which 7999 (10.2 %) appeared positive. The positivity rate appeared very low in recent years, with only a 3.5 % positivity rate observed in 2020. Influenza A strain H1N1pdm09 seemed to be the prominent strain (n = 3407, 42.6 %), followed by influenza B (n = 2125, 26.6 %)., Conclusion: The positivity of influenza samples was 10.2 % and recorded in patients where typical clinical representation of influenza was absent. Fewer samples were reported during the coronavirus pandemic, which might be because influenza screening was hindered and overlooked to combat the SARS-CoV-2 virus, and the patient threshold was very high for COVID-19 virus screening., Competing Interests: Declaration of Competing Interest There is no conflict of interest between the author and any coauthor of this article., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To evaluate whether implementing a nutritional care bundle is associated with growth and morbidity in very preterm (VPT) infants., Study Design: This study compared 87 VPT infants (<32 gestational weeks) born 2018 (Before group) with 75 infants born 2020 (After group), treated at a single center in the Czech Republic. A nutritional care bundle was implemented during 2019., Results: Median gestational age (weeks) was 30.0 [IQR 27.6-31.1] for the Before group and 29.9 [IQR 27.9-30.6] for the After group. During postnatal days 1-14, parenteral fluid intake was significantly lower in the After group compared to the Before group and conversely for enteral fluid intake. Infants in the After group achieved full enteral feeds by postnatal day 14 (72.9 % vs. Before group 51.9 %). Weight z-scores decreased significantly less from birth to 36 weeks postmenstrual age in the After group (-0.8 [IQR -1.3 to -0.5]) compared to the Before group (-1.5 [IQR -2.0 to -1.2]). Head circumference z-scores decreased significantly less in the After group (-0.8±0.9) than the Before group (-1.6±1.1). Decreased rate of patent ductus arteriosus (PDA) requiring treatment was observed in the After group (P < 0.001)., Conclusions: Implementation of a nutritional care bundle in VPT infants was associated with improved postnatal growth and may reduce treatment-requiring PDA., Competing Interests: Declaration of competing interest The authors have no conflict of interest relevant to this article to disclose., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: The burden of cancer is expected to nearly double in sub-Saharan Africa over the next 20 years. In Gabon, the primary population-based cancer registry to be established is located in the Grand Libreville. This study presents cancer incidence rates covering the first 5-year period of registration in this region., Patients and Methods: 1,549 cancer cases were recorded among residents of the Grand Libreville between 2013 and 2017, 955 (61.6 %) women and 594 (38.3 %) males., Results: The age standardized incidence rates (ASR) for all sites were 73.3 per 10 5 in females and 47.7 per 10 5 in males, rather similar from those observed in neighbouring countries of central Africa. Breast (ASR 19.0 per 10 5 ) and cervical cancers (ASR 16.3 per 10 5 ) accounted for half of female cancers. Prostate (ASR 12.0 per 10 5 ), liver (ASR 5.1 per 10 5 ) and colorectal cancers (ASR of 5.0 per 10 5 ) accounted for 41.1 % of male cancers., Conclusion: Breast and prostate cancers ranked first in females and males, respectively, even if the incidences appear much lower in comparison with other regional cancer registries rates, implying they may be underestimated. Cancers of the digestive organs were markedly more frequent in men than women, especially for liver, colorectal (and anus) and the mouth and pharynx. The incidence rates of these latter cancers are relatively similar to those of other registries of the central African region. These results may be of importance for implementing more adapted strategies in the battle against cancer., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Stress exposure, operationalized as a count of painful or skin-breaking breaking procedures, is an important concept for inclusion in studies of preterm infants. The Neonatal Infant Stressor Scale (NISS) was developed to also account for nonpainful and environmental stressors; however, validity of this measure is unknown., Aims: The purpose of this review was to define the breadth of use of the NISS in neonatal research studies and determine its predictive and concurrent validity., Methods: Using the methods for integrative review, a systematic search of the literature was conducted using PubMed, CINAHL, PsycINFO, and Embase with keywords "NISS" OR "Neonatal Infant Stressor Scale". Study findings were narratively synthesized., Results: Twenty-nine articles were retained for the review and included two cross-sectional studies describing development or adaptation of the measure, two protocols for empirical studies, and 25 empirical studies of preterm infants. Modifications to the original NISS were common and included addition or exclusion of specific stressors and use of unweighted scores. Although findings were inconsistent across studies, limited data support the predictive validity of the NISS, as higher NISS scores have been associated with abnormal brain development and cognitive, motor, and behavioral deficits. Two studies found concurrent associations between NISS scores and cortisol., Conclusion: The NISS may be a useful tool to quantify stressors experienced by preterm infants; however, there are only limited data to support its predictive or concurrent validity. The NISS may be particularly useful as a method to bring awareness to the infant's stress burden in clinical practice. Additional research is needed to validate inclusion of specific stressors in the NISS., Competing Interests: Declaration of competing interest Thao Griffith reports financial support was provided by National Institute of Nursing Research. Marliese Nist reports a relationship with National Association of Neonatal Nurses that includes: travel reimbursement. Marliese Nist reports a relationship with National Institute of Child Health and Human Development that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Infants with birth brachial plexus injury (BPBI) may have various comorbidities such as fractures, torticollis, plagiocephaly, central nervous system disorders. In infants with BPBI, it is important to identify fractures, which are common among comorbidities, objectively assess pain, and investigate factors that may be associated with pain., Aim: The aim of this study is to determine the pain level, comorbidities, and motor function in infants with BPBI and to examine the relationship between these parameters. The second aim is to determine the cut-off value of the pain score that may be a sign of fracture in patients with BPBI, in order to suspect and predict a fracture in the shoulder region and to request additional examinations., Subjects and Measurements: 59 infants with BPBI aged 15-90 days were included in the study. Comorbidities, active joint movements, and total upper extremity function assessed with the Active Movement Scale and pain scores measured with the FLACC Pain Scale were retrospectively analyzed. In addition, pain, comorbidities and motor function were investigated according to types of Narakas, which indicates the degree of nerve injury., Results: Of the 59 participants, 18 (30.5 %) had at least one comorbidity and 12 (20.3 %) had fractures. The number of comorbidities (p = 0.41), the number of fractures (p = 0.84), and the level of pain (p = 0.71) did not differ by types of Narakas. There was a moderate negative correlation between pain level and upper extremity motor function in upper trunk injuries (p < 0.5, -0.67 < r < -0.46). There was a difference in pain level measured by palpation (p < 0.01) and passive joint movement (p < 0.01) in infants with and without comorbidities. To suspect a fracture in the shoulder region and to request further evaluation, the cut-off value of the Flacc pain level, which may predict a fracture, was 3.5 points for palpation and passive shoulder abduction and 4.5 points for passive external rotation., Conclusion: This is the first study in the BPBI to measure pain in infants using a quantifiable and widely used assessment. Pain level was ranked from high to low as infants with fractures, infants with comorbidities other than fractures and infants without comorbidities. Increased pain adversely affects motor function and pain above the cut-off values is a predictor of fracture., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The global prevalence of α-thalassemia necessitates effective newborn screening strategies due to its severe clinical consequences. Traditional methods such as liquid chromatography (LC), capillary electrophoresis (CE), and isoelectric focusing (IEF) face limitations, including low separation efficiency, poor sensitivity for detecting Hb Bart's, and time-intensive operations, particularly with dried blood spots (DBS). These limitations hinder timely and accurate screening. This study addresses the need for a more efficient, sensitive, and rapid method for detecting Hb Bart's in newborns., Results: We enhanced IEF separation and sensitivity by designing a microfluidic IEF (mIEF) system with shortened columns and employing a coelution sample loading technique using oil-sealed blood spots for rapid sample pretreatment. Our experiments demonstrated significant improvements: the total analysis time was reduced from 1110 min (IPG IEF) and 46 min (LC) per batch to 36 min per batch. For individual samples, the focusing time decreased from 6 min (previous mIEF) to 3 min, with the microcolumn length shortened by 50 %, from 30 mm to 15 mm. The developed method showed excellent consistency with clinical Bart's detection and PCR diagnosis, achieving 100 % sensitivity and 98 % specificity for α-thalassemia screening., Significance and Novelty: Our novel mIEF method provides an efficient, sensitive, and rapid tool for screening newborns for α-thalassemia. This advancement addresses the limitations of traditional techniques, improving early diagnosis and intervention strategies and ultimately enhancing health outcomes for at-risk newborns., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: The unique physiological changes during pregnancy present challenges in understanding the full scope and effects of COVID-19 on pregnant women, adding complexity to their medical management. Given the significant changes in the immune, circulatory, respiratory, and hormonal systems during the progression of the pregnancy, and the specific factors with higher risk of COVID-19, like metabolic, vascular, and endothelial factors, typically also associated with maternal and neonatal unfavorable outcomes, the full understanding of how COVID-19 affects pregnant women is not clarified yet., Methods: In this study, anonymous data from medical records of pregnant women with lab-confirmed COVID-19 in Astana, Kazakhstan from May 1, 2021, to July 14, 2021, were collected retrospectively. A multivariate regression model was built to identify factors associated with the risk of ICU admission. Cluster analysis was performed to identify distinct groups among women admitted to the ICU based on their blood parameters, coagulation profiles, and oxygenation saturation levels., Results: 10.7 % of pregnant women were admitted to ICU. Among them, 4.36 % were in the 2nd trimester and 13.58 % in the 3rd trimester. No women in the 1st trimester were admitted to ICU. A multivariate regression model demonstrates that gestational diabetes, leukocytes, CRP, and saturation were the factors significantly associated with a higher risk of ICU admission. Three clusters of pregnant women were segmented, and preterm birth was frequent in clusters 1 (serious systemic conditions affecting multiple organs) and 3 (women with hypertension and preeclampsia), whereas cluster 2 represents women who can also be characterized as suffering from infections with a possible autoimmune component. Neutrophil to lymphocyte ratio was frequent in clusters 1 and 3., Conclusion: In this study, multivariable analysis identified factors with a risk of ICU admission, and clustering analysis helped to identify groups of COVID-19-infected pregnant women admitted to ICU with similar risk profiles. Differences in clusters can help to explain discrepancies in COVID-19 outcomes and suggest biochemical and molecular mechanisms involved in COVID-19 and outline a more personalized approach to understanding, diagnosing, and treating women., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Cardiac autonomic regulation and early neurodevelopment are linked, but research has focused largely on specific domains, such as attention and memory, neglecting broad neurodevelopmental outcomes. The use of diverse study populations and methodologies further hinders interpretation, highlighting the need for more consistent, integrative research in this area. Therefore, the aim of this study was to clarify how cardiac autonomic regulation (as quantified by heart rate indices) is associated with global neurodevelopment in infancy through a systematic literature review., Method: A systematic literature search was carried out in the Scopus, PubMed, Web of Science, and ProQuest databases for studies published between January 1980 and December 2022. The search terms were a combination of words that included elements from three categories: 1) cardiac vagal regulation, 2) neurodevelopment indicators, and 3) population (neonate/infant)., Results: Five studies involving 933 infants (48 % of whom were girls) and baseline evaluations from birth to 26 weeks of age were included. The findings were mixed: while some studies identified positive associations between parasympathetic activity and neurodevelopmental outcomes, others reported nonsignificant or inconsistent associations. The variability in study designs, measurement methods, and population characteristics likely contributed to these discrepancies. However, respiratory sinus arrhythmia (RSA) was the most commonly used indicator, and the highest percentage of studies reported significant associations between neurodevelopment and autonomous functioning (RSA = 83 %, heart rate variability = 69 %), particularly when controlling for factors such as age and birthweight., Conclusions: Although autonomic regulation during the first years of life appears to be associated with neurodevelopment, the evidence is not entirely consistent across all heart rate indices or developmental domains. Further research is needed to better understand these relationships, particularly in light of the methodological differences and potential confounding factors. Recognizing individual differences in autonomic nervous system regulation could provide valuable insights into neurodevelopmental trajectories., Competing Interests: Declaration of competing interest No potential conflict of interest was reported by the author(s)., (Copyright © 2024. Published by Elsevier B.V.)

Neonatal respiratory disorders pose significant challenges in clinical settings, often requiring rapid and accurate diagnostic solutions for effective management. Lung ultrasound (LUS) has emerged as a promising tool to evaluate respiratory conditions in neonates. This evaluation is mainly based on the interpretation of visual patterns (horizontal artifacts, vertical artifacts, and consolidations). Automated interpretation of these patterns can assist clinicians in their evaluations. However, developing AI-based solutions for this purpose is challenging, primarily due to the lack of annotated data and inherent subjectivity in expert interpretations. This study aims to propose an automated solution for the reliable interpretation of patterns in LUS videos of newborns. We employed two distinct strategies. The first strategy is a frame-to-video-level approach that computes frame-level predictions from deep learning (DL) models trained from scratch (F2V-TS) along with fine-tuning pre-trained models (F2V-FT) followed by aggregation of those predictions for video-level evaluation. The second strategy is a direct video classification approach (DV) for evaluating LUS data. To evaluate our methods, we used LUS data from 34 neonatal patients comprising of 70 exams with annotations provided by three expert human operators (3HOs). Results show that within the frame-to-video-level approach, F2V-FT achieved the best performance with an accuracy of 77% showing moderate agreement with the 3HOs. while the direct video classification approach resulted in an accuracy of 72%, showing substantial agreement with the 3HOs, our proposed study lays down the foundation for reliable AI-based solutions for newborn LUS data evaluation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Cancer is projected to become the primary cause of death in the 21st century. Although childhood cancer is relatively rare, it remains a significant contributor to mortality among children. This study examines the geographical distribution of childhood cancer incidence in Iranian provinces using data from the National Cancer Registry between 2014 and 2018., Materials and Methods: This registry-based study analyzed data from 14,711 children under 20 diagnosed with common childhood cancers, sourced from the Iranian National Population-based Cancer Registry for the period 2014-2018. The age-standardized incidence rates (ASR) were calculated using direct standardization methods and reported per 1 million person-years. Spatial autocorrelation measures, including global and local indices such as Moran's I and Getis-Ord's G, were employed to identify high-risk and low-risk areas, assess overall spatial dependence, and pinpoint specific clusters and hotspots of incidence rates., Results: ASR for childhood cancer in Iran was 119.56 per 1 million individuals aged 0-19 years. Boys had a higher ASR (129.98) than girls (107.68). Childhood cancer cases increased from 2765 in 2014 to 3354 in 2018, with leukemia as the most common type, followed by brain and nervous system, lymphoma, bone, and connective and soft tissue cancers. Spatial analysis identified high-risk clusters in central Iran (Isfahan, Yazd, Tehran) and low-risk clusters in the northeast (Kermanshah, West and East Azerbaijan, Kurdistan)., Conclusion: This study highlights high childhood cancer incidence in Iran, particularly among boys and in central regions, with elevated leukemia rates. These findings call for targeted prevention strategies and further research to address geographic and gender disparities and to improve care programs., Competing Interests: Declaration of Competing Interest Authors have no conflicts of interests to declare., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Neonatal care needs more robust guidance on pharmacotherapy, (formulation, dosage regimen, safety and efficacy information). This requires structured advocacy. We therefore discuss advocacy related to improving information about medicines including current practices, clinical trials, the current setting, and trial preparedness. This steps can improve neonatal drug development by generating evidence, particularly if a programmatic approach (identify dosing, eligibility criteria, and outcomes) to evidence generation is followed. Trial design should be guided by the intended use of the medicine and the benefits/risks that the study participant is exposed to. Regulatory trials (explanatory, controlled environment, internal validity, endpoints reflect clinically important outcomes, strong causal evidence) are sometimes necessary. However, some research questions are best addressed with informative trials. In either case, trial design can be supported by real world data and evidence, extrapolation from other subpopulations, or physiologically-based pharmacokinetic modeling. Data management, safety reporting, and management of drugs should be specified and proportionate. Trial design and conduct also necessitate awareness of Good Clinical Practice specific to neonates. Relevant aspects include protocol and trial design, research skills and interactions with Ethics Committees or Institutional Research Boards, capacities and competences needed within the research team, and aspects related to consent and recruitment., Competing Interests: Declaration of competing interest The research activities of A. Smits are supported by a Senior Clinical Investigatorship of the Research Foundation Flanders (FWO) (18E2H24N)., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Optimal oxygenation requires the delivery of oxygen to meet tissue metabolic demands while minimizing hypoxic pulmonary vasoconstriction and oxygen toxicity. Oxygen saturation by pulse oximetry (SpO 2 ) is a continuous, non-invasive method for monitoring oxygenation. The optimal SpO 2 target varies during pregnancy and neonatal period. Maternal SpO 2 should ideally be ≥95 % to ensure adequate fetal oxygenation. Term neonates can be resuscitated with an initial oxygen concentration of 21 %, while moderately preterm infants require 21-30 %. Extremely preterm infants may need higher FiO 2 , followed by titration to desired SpO 2 targets. During the NICU course, extremely preterm infants managed with an 85-89 % SpO 2 target compared to 90-94 % are associated with a reduced incidence of severe retinopathy of prematurity (ROP) requiring treatment, but with higher mortality. During the later stages of ROP progression, studies suggest that higher SpO 2 targets may help limit progression. A target SpO 2 of 90-95 % is generally reasonable for term infants with respiratory disease or pulmonary hypertension, with few exceptions such as severe acidosis, therapeutic hypothermia, and possibly dark skin pigmentation, where 93-98 % may be preferred. Infants with cyanotic heart disease and single-ventricle physiology have lower SpO 2 targets to avoid pulmonary over-circulation. In low- and middle-income countries (LMICs), the scarcity of oxygen blenders and continuous monitoring may pose a challenge, increasing the risks of both hypoxia and hyperoxia, which can lead to mortality and ROP, respectively. Strategies to mitigate hyperoxia among preterm infants in LMICs are urgently needed to reduce the incidence of ROP., Competing Interests: Declaration of competing interest All authors have no conflicts of interest to disclose. University of California, Davis has intellectual property rights related to inventions resulting from congenital heart disease screening by pulse oximetry and a provisional patent has been submitted by the university., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Risk prediction scores are used to guide clinical decision-making. Our primary objective was to externally validate two patient-specific risk scores for 30-day in-hospital mortality using the Multicenter Perioperative Outcomes Group (MPOG) registry: the Pediatric Risk Assessment (PRAm) score and the intrinsic surgical risk score. The secondary objective was to recalibrate these scores., Methods: Data from 56 US and Dutch hospitals with paediatric caseloads were included. The primary outcome was 30-day mortality. To assess model discrimination, the area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve (AUC-PR) were calculated. Model calibration was assessed by plotting the observed and predicted probabilities. Decision analytic curves were fit., Results: The 30-day mortality was 0.14% (822/606 488). The AUROC for the PRAm upon external validation was 0.856 (95% confidence interval 0.844-0.869), and the AUC-PR was 0.008. Upon recalibration, the AUROC was 0.873 (0.861-0.886), and the AUC-PR was 0.031. The AUROC for the external validation of the intrinsic surgical risk score was 0.925 (0.914-0.936) and AUC-PR was 0.085. Upon recalibration, the AUROC was 0.925 (0.915-0.936), and the AUC-PR was 0.094. Calibration metrics for both scores were favourable because of the large cluster of cases with low probabilities of mortality. Decision curve analyses showed limited benefit to using either score., Conclusions: The intrinsic surgical risk score performed better than the PRAm, but both resulted in large numbers of false positives. Both scores exhibited decreased performance compared with the original studies. ASA physical status scores in sicker patients drove the superior performance of the intrinsic surgical risk score, suggesting the use of a risk score does not improve prediction., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: Paediatric trauma is a leading cause of death, with correlations between trauma outcomes and geographical locations. Certain rural regions of Norway face a higher risk of trauma-related fatalities compared to the nationwide population. Among adults, the risk of both fatal and non-fatal injuries rises with increased rurality. The study aimed to investigate whether there is an increased risk of fatal and non-fatal injuries for children in rural areas across the entire country, as well as any changes over two decades., Materials and Methods: We conducted a retrospective cohort study of fatal and non-fatal paediatric injuries by accessing two national registries for all trauma-related patients under the age of 18. All cases were stratified into six groups according to level of centrality based on a national index used as a proxy for rurality. For inter-group comparison, urban-rural disparities were evaluated using Pearson`s Chi-square test, linear regression, and relative risk (RR)., Result: 1,059 paediatric deaths were included in the study period from 2002 to 2021. The mortality rate increased linearly with increased rurality (r = 0.985, p < .001). The overall mortality risk was 2.4 times higher in the most rural group compared to the most urban (RR = 2.37, 95 %CI 1.78 - 3.14, p < .001). Most deaths occurred pre-hospital (73 %), the total number of fatalities was highest in the age group 16 to 17 (42 %), and transport-related injury (32 %) was the most common cause of death. The relative risk of non-fatal injury was significantly higher for all centrality groups compared to most urban, and the highest rate was seen in sub-rural areas (RR = 1.39, 95 %CI 1.37 - 1.42, p < .001)., Conclusion: The mortality rate increased linearly across all levels of centrality, and the relative risk was 2.4 times higher in the most rural population compared to the most urban population. To effectively target primary prevention and enhance trauma care for paediatric patients in rural areas, a deeper epidemiological understanding and more comprehensive studies are essential., Competing Interests: Declaration of competing interest All authors state that they have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. The HBCD study has faced several ethical and legal challenges due to its goal of enrolling pregnant people (including those with substance use disorder) and their newborns. Challenges not fully anticipated at the outset emerged from the rapidly changing legal landscape around reproductive rights in the United States. By embedding scholars in bioethics and law within research teams and engaging them in conversation with each other and other study personnel, we were able to address many challenges proactively and respond promptly to unanticipated challenges. In this paper, we highlight several important ethical and legal challenges that arose from the first phase of funding through the beginning of participant enrollment. We explain the methods used to address these challenges, the ethical and legal tradeoffs that arose, and the resolution of challenges through the design of the study. Based on this experience, we provide recommendations for research teams, sponsors, and reviewers to address legal risks and promote the ethical conduct of studies with pregnant people and caregivers. We highlight the importance of collaboration with bioethics and legal scholars in studies involving complex and evolving legal risks, as well as the necessity of designing robust approaches to informed consent and maintaining participant trust while navigating ethical challenges in research., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests. Jenny Kingsley reports financial support was provided by National Institutes of Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This study estimated the effect of changing trends in drug- and firearm-related mortality on life expectancy in the U.S. over the last two decades., Study Design: Retrospective cross-sectional study., Methods: We used national vital registration data from CDC WONDER, stratified by sex, to estimate the mortality rate due to accidental and intentional poisoning (ICD Codes X40-X49, X60-X69, Y10-Y19 and X85), and firearm deaths (ICD codes W32-W34, X72-X74, X93-X95, Y22-Y24) for the period 2000-2020. We applied standard life table methods to all cause mortality rates with and without these mortality causes to estimate the life expectancy at each age over this period., Results: In 2020, mortality due to drugs and firearms combined reduced male life expectancy by1.67 years compared to 0.67 years in 2000, and without the effect of these two causes of death, male life expectancy in 2019 would have been 78.02 years. For women, drugs and firearm-related mortality reduced life expectancy by 0.20 years in 2000 and 0.63 years in 2020, and female life expectancy would have been 82.25 years in 2019 without the retarding effect of these two preventable causes., Conclusions: Drug- and firearm-related deaths have increased so rapidly, especially among younger populations, that life expectancy at birth is significantly reduced by these causes of death. Without urgent action to tackle these preventable causes of death, US life expectancy will continue to stagnate and may even decline, even without the effect of COVID-19., (Copyright © 2024 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Purpose: This study aims to provide a broad overview of the epidemiology of cancer of the paranasal sinuses (PSC) in Germany. The data include information on incidence, staging, clinicopathological features and survival from one of the largest cancer registries in Europe., Methods: Population-based data on PSC diagnosed from January 1st, 2009 until December 31st, 2019 were retrieved from the German Centre for Cancer Registry Data (ZfKD). Age standardized incidence was calculated and relative survival estimates were computed by sex, histological subtype, age group and T-, N-, and M-Stage., Results: In total, 3975 cases were included in this study. The age-adjusted incidence rate (ASR) for PSC was 0.3/100,000 which remained stable during the observation period. The most frequent tumor localization was the maxillary sinus (41.9 %) and the most common histological subtype was keratinizing squamous cell carcinoma (kSCC) (44.3 %). All subtypes were predominantly found in the maxillary sinus except for adenocarcinoma and neuroendocrine carcinomas (SNEC), which were most frequently located in the ethmoidal sinus. The majority of the patients with a known T stage was diagnosed in tumor stage T4 (60.8 %). The overall 5-year relative survival (RS) for all patients with PSC was 52 %. RS dropped from 93 % for T1 stage tumors to 39 % for T4 tumors. RS was 58 % for N0 and 31 % for N+ cases, 54 % for M0 and 27 % for M1 cases., Conclusion: Age-adjusted incidence for PSC is low and has been stable for the observed 11-year period. RS decreases continuously with increasing T-, N- and M-stage., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To analyze the impact of injury mortality changes on life expectancy (LE) in Tianjin in 2021 compared with 2003 by age, gender, urban-rural, and cause-specific differences., Methods: The abridged life table and Arriaga's decomposition method were applied to analyze the cause of death surveillance data of Tianjin residents in 2003 and 2021, calculating the age-specific and subcategory-specific contribution of injury to the increase of LE., Results: From 2003 to 2021, the injury mortality rate dropped from 30.33 to 21.57 per 100,000 in Tianjin. Over this period, LE varied from 77.70 to 82.03 years, with an increase of 4.33 years. The reduction in injury mortality contributed 0.3111 years (7.18 %) to the growth of LE. The positive impact on LE was notably observed in the age group of 1-49 years, contributing 0.4348 years (10.04 %) cumulatively. The major injuries that contributed significantly to the increase of LE were transport accidents excluding motor vehicles (0.2558 years, 5.91 %), accidental poisoning (0.0845 years, 1.95 %), motor vehicle traffic accidents (0.0474 years, 1.09 %), and drowning (0.0359 years, 0.83 %). However, the rise in intentional self-harm mortality rate from ages 10-24 and increased mortality rates due to other accidents and adverse effects, motor vehicle traffic accidents, and falls from ages 50+ had negative impacts on LE., Conclusion: During 2003-2021, the decline in injury mortality rates among children and young to middle-aged individuals in Tianjin played a crucial role in the increase of LE. It is essential to enhance primary prevention efforts, particularly focusing on key populations, to reduce the negative impact on LE growth from intentional self-harm, other accidents and adverse effects, motor vehicle traffic accidents, and falls., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: Understanding the burden of influenza-associated acute respiratory infection (ARI) and severe ARI (SARI) is crucial for public health decision-making. A population-based study with multiple data sources was conducted to estimate the burden of influenza-associated ARI in Wanzhou District, Chongqing, southern China., Study Design: Population-based surveillance study., Methods: Active surveillance of ARI was conducted in different levels of health facilities in the Wanzhou District between October 2021 and March 2022. Nasal or throat swabs were collected and tested for influenza viruses in hospital-based surveillance. A health utilisation survey was used to estimate health-seeking behaviour, and all electronic medical records were collected. An epidemiological model was used to estimate the disease burden., Results: There were an estimated 52,960 influenza-associated ARI (95 % confidence interval [CI]: 39,213-84,891), including 2,529 SARI cases (95 % CI: 1,385-21,712) during winter 2021/22 in the Wanzhou District. The incidence rate for all influenza-associated ARI and SARI was 3,385/100,000 and 162/100,000, respectively. A higher incidence rate of influenza-associated ARI was observed among individuals aged <50 years, while a higher influenza-associated SARI rate was observed in those aged ≥50 years., Conclusions: Using an epidemiological model with data from multiple sources, this study documented a substantial burden of influenza-associated ARI in the Wanzhou District, highlighting the need for influenza vaccination and providing a possible foundation for public health decision-making., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Degloving soft tissue injuries (DSTIs) of the extremities, which are often underestimated in terms of their severity, present significant challenges to reconstructive surgeons. We propose a comprehensive management protocol to standardize the reconstructive approach, aiming for successful treatment of these devastating injuries., Methods: We retrospectively analyzed data from consecutive patients with extremity DSTIs over a 12-year period. Patients were categorized into three age groups (0-17, 18-65, and >65 years) to highlight the different treatment options based on age. Various surgical techniques were employed depending on the injury pattern. Treatment strategies for each patient were individualized based on age, underlying conditions, and injury type. Wound healing, complications, and functional outcomes were recorded., Results: Of the hospitalized patients, 20 were lost to follow-up, and 105 were included in the analysis. The mean age at the time of injury was 40 ± 44.9 years, with a mean follow-up of 30.1 ± 12.7 months. Furthermore, 19 % of patients were aged 0-17 years, 61 % were aged 18-65 years, and 20 % were aged >65 years. Treatment plans were personalized based on injury characteristics, with numerous patients being treated with a combination of multiple surgical techniques. Older patients had significantly longer wound healing times and delayed return to activities of daily living compared to the other age groups. Overall, patients were generally satisfied with their outcomes. The total complication rate was 46.7 %, with 79.5 % being categorized as major complications. Each complication was addressed with a tailored treatment plan., Conclusion: The management of DSTIs should be individualized, taking into account the specific characteristics of each injury. Age and medical fitness play crucial roles in determining both the surgical approach and prognosis. An accurate initial evaluation and thorough debridement are essential for optimal outcomes., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Timely diagnosis of vertical Trypanosoma cruzi infections involves microscopy-based detection of circulating parasites from peripheral blood, which lacks sensitivity and is operator dependent. Consequently, most children born to T. cruzi-infected mothers are required to undergo serological testing after 9 months, which risks loss to follow-up. Alternatively, the loop-mediated isothermal amplification (LAMP) test for T. cruzi DNA offers high analytical and clinical performance and is easy to use in low-complexity laboratories. Recently, we optimized this technique using an ultrarapid DNA extraction method combined with the LAMP in dried blood spots (DBSs) on Flinders Technology Associates cards. The procedure has been implemented in 10 public maternities across Paraguay, Bolivia, and Argentina, involving the training of 14 technicians. Operators' performance was evaluated using a standardized DBS testing panel for harmonization, including negative controls and DBS samples artificially contaminated with T. cruzi at 50 and 20 cells/mL. There was strong agreement (ĸ = 0.924) for controls and 50 cells/mL samples, and good agreement (ĸ = 0.718) across all testing panels, even at the detection limit of the test. A prospective study collected 306 DBSs from 222 newborns at birth and/or 2 months, detecting T. cruzi microscopically in four cases. LAMP identified eight positive cases and perfectly aligned with real-time PCR (ĸ = 1), demonstrating higher sensitivity than microscopic observation for early detection of infection in infants., (Copyright © 2024 Association for Molecular Pathology and American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.)

Objectives: In Japan, population-based epidemiological data on respiratory syncytial virus (RSV) infections are limited. To elucidate the epidemiology of RSV before the introduction of new prophylactic drugs, we conducted a population-based study during and after the SARS-CoV-2 pandemic., Methods: This study was performed in four hospitals in Chiba City and three hospitals in Ichihara City. Clinical information and residual samples from RSV rapid antigen tests of infants under one year old were collected. Samples from patients with lower respiratory tract infections (LRTI) were analyzed using the FilmArray Respiratory 2.1 panels., Results: A total of 1200 infants underwent the RSV rapid antigen test, with 497 diagnosed with LRTI. Although five samples could not be stored, 252 out of 492 (51.2%) were positive for RSV. Among the RSV PCR-positive infants, 63 (25.0%) had underlying diseases, compared to 100 out of 240 (41.7%) RSV PCR-negative infants (P < 0.05). In Chiba City, the annual incidence of hospitalization per 1000 children was 12.7 in 2021, 4.4 in 2022, and 9.2 in 2023., Conclusions: During and after the SARS-CoV-2 pandemic, most hospitalized infants with RSV-LRTI did not have underlying diseases. Widespread use of prophylaxis in infants without underlying disease is desirable., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. The acquisition of multimodal magnetic resonance-based brain development data is central to the study's core protocol. However, application of Magnetic Resonance Imaging (MRI) methods in this population is complicated by technical challenges and difficulties of imaging in early life. Overcoming these challenges requires an innovative and harmonized approach, combining age-appropriate acquisition protocols together with specialized pediatric neuroimaging strategies. The HBCD MRI Working Group aimed to establish a core acquisition protocol for all 27 HBCD Study recruitment sites to measure brain structure, function, microstructure, and metabolites. Acquisition parameters of individual modalities have been matched across MRI scanner platforms for harmonized acquisitions and state-of-the-art technologies are employed to enable faster and motion-robust imaging. Here, we provide an overview of the HBCD MRI protocol, including decisions of individual modalities and preliminary data. The result will be an unparalleled resource for examining early neurodevelopment which enables the larger scientific community to assess normative trajectories from birth through childhood and to examine the genetic, biological, and environmental factors that help shape the developing brain., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Tobias Kober and Tom Hilbert are employees of Siemens Healthineers International AG, Switzerland. Yulin Chang is an employee of Siemens Medical Solutions USA Inc. Dan Rettmann and Ralph Noeske are employed by GE HealthCare. Guillaume Gilbert, Yansong Zhao, Sandeep Ganji, and Maarten Versluis are employed by Philips Healthcare. Carina Lucena, Lucky Heisler-Roman, and Dhruman Goradia are employed by PrimeNeuro Inc. Under a license agreement between Philips and the Johns Hopkins University, Dr. van Zijl and the University are entitled to fees related to an imaging device used in the study discussed for publication. Dr. van Zijl also is a paid lecturer for Philips and receives research support from Philips. This arrangement has been reviewed and approved by the Johns Hopkins University in accordance with its conflict of interest policies. Damien Fair is a patent holder on the Framwise Integrated Real-Time Motion Monitoring (FIRMM) software. He is also a co-founder of Turing Medical Technologies, Inc. The nature of this financial interest and the design of the study have been reviewed by two committees at the University of Minnesota. They have put in place a plan to help ensure that this research is not affected by the financial interest. All other authors report no biomedical financial interests or potential conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Prenatal listening experience reportedly modulates how humans process speech at birth, but little is known about how speech perception develops throughout the perinatal period. The present experiment assessed the neural event-related potentials (ERP) and mismatch responses (MMR) to native vowels in 99 neonates born between 32 and 42 weeks of gestation. The vowels elicited reliable ERPs in newborns whose gestational age at time of experiment was at least 36 weeks and 1 day (36 + 1). The ERPs reflected spectral distinctions between vowel onsets from age 36 weeks + 6 days and durational distinctions at vowel offsets from age 37 weeks + 6 days. Starting at age 40 + 4, there was evidence of neural discrimination of vowel length, indexed by a negative MMR response. The present findings extend our understanding of the earliest stages of speech perception development in that they pinpoint the ages at which the cortex reliably responds to the phonetic characteristics of individual speech sounds and discriminates a native phoneme contrast. The age at which the brain reliably differentiates vowel onsets coincides with what is considered term age in many countries (37 weeks + 0 days of gestational age). Future studies should investigate to what extent the perinatal maturation of the cortical responses to speech sounds is modulated by the ambient language., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The HEALthy Brain and Child Development (HBCD) Study, a multi-site prospective longitudinal cohort study, will examine human brain, cognitive, behavioral, social, and emotional development beginning prenatally and planned through early childhood. The longitudinal collection of biological samples from over 7000 birthing parents and their children within the HBCD study enables research on pre- and postnatal exposures (e.g., substance use, toxicants, nutrition), and biological processes (e.g., genetics, epigenetic signatures, proteins, metabolites) on neurobehavioral developmental outcomes. The following biosamples are collected from the birthing parent: 1) blood (i.e., whole blood, serum, plasma, buffy coat, and dried blood spots) during pregnancy, 2) nail clippings during pregnancy and one month postpartum, 3) urine during pregnancy, and 4) saliva during pregnancy and at in-person postnatal assessments. The following samples are collected from the child at in-person study assessments: 1) saliva, 2) stool, and 3) urine. Additionally, placenta tissue, cord blood, and cord tissue are collected by a subset of HBCD sites. Here, we describe the rationale for the collection of these biospecimens, their current and potential future uses, the collection protocol, and collection success rates during piloting. This information will assist research teams in the planning of future studies utilizing this collection of biological samples., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Drs. Elinor L Sullivan, Ryan Bogdan, Ludmila Bakhireva, Pat Levitt, Julie M. Croff, Moriah Thomason(,) Jamie Lo(,) Leigh-Anne Cioffredi, Andrea G. Edlow, Brittany R. Howell, Barbara H Chaiyachati, Namasivayam Ambalavanan(,) and Jenae M. Neiderhiser report financial support provided by National Institutes of Health that includes funding grants. In addition, the Children's Hospital of Philadelphia has received payment for the expert testimony of Dr. Chaiyachati when subpoenaed for cases of suspected child abuse. Andrea G. Edlow serves as a consultant for Mirvie, Inc. outside of this work and receives research funding and consultant funding from Merck Pharmaceuticals outside of this work. Julie M. Croff reports financial support provided by Bill & Melinda Gates Foundation and reports a relationship with Oklahoma State University Center for Health Sciences that includes: funding grants, speaking and lecture fees, and travel reimbursement. Joseph Jones is employed by United States Drug Testing Laboratories, a national commercial reference laboratory, that is in the business of selling some of the services mentioned in this manuscript. This relationship did not influence the design or composition of this manuscript. Leigh MacIntyre discloses the following financial interests that may be considered as potential competing interests: She is the CEO and founder of Lasso Informatics, and has an equity stake and receives a salary from the company. Lasso Informatics is involved in the HBCD Study and provides project management and data services. During the course of this research, Lasso Informatics received a professional services contract from HBCD, providing financial compensation for Lasso Informatics’ contribution to the study. This contract was awarded in 2024 and pertains to the work reported in this manuscript. Leigh MacIntyre declares that these financial interests have been disclosed fully and believe they do not compromise the integrity of the research presented in this manuscript. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Purpose: Impacted fetal head (IFH) can be defined as the deep engagement of the fetal head in the maternal pelvis at the time of cesarean delivery that leads to its difficult or impossible extraction with standard surgical maneuvers. In this narrative review, we aimed to ascertain its incidence, risk factors, management and complications from the perspective of the anesthesiologist as a multidisciplinary team member., Methods: Databases were searched from inception to 24 January 2023 for keywords and subject headings associated with IFH and cesarean delivery., Results: IFH has an incidence of 2.9-71.8 % in emergency cesarean section. Maternal risk factors are advanced cervical dilatation, second stage of labor and oxytocin augmentation. Anesthetic and obstetric risk factors include epidural analgesia and trial of instrumental delivery and junior obstetrician, respectively. Neonatal risk factors are fetal malposition, caput and molding. Current evidence indicates a lack of confidence in the management of IFH across the multidisciplinary team. Simple interventions in IFH include lowering the height or placing the operating table in the Trendelenburg position, providing a step for the obstetrician and administering pharmacological tocolysis. Maternal complications are postpartum hemorrhage and bladder injury while neonatal complications include hypoxic brain injury, skull fracture and death. Surgical complications are reviewed to remind the anesthesiologist to anticipate and prepare for potential problems and manage complications in a timely manner., Conclusion: The anesthesiologist has a fundamental role in the facilitation of delivery in IFH. We have proposed an evidence based management algorithm which may be referred to in this emergency situation., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Childhood cancer has few established risk factors and environmental influences are underexplored. This ecologic study investigated the association between domestic radon exposure and childhood cancer risk in a large sample of United States (U.S.) counties., Methods: Monthly ZIP code-level basement radon estimates from a geographic machine learning model were aggregated annually to counties, analyzed as continuous and dichotomized (cut point: 74 Bq/cubic meter (Bq/m 3 ) or 2.0 picocuries/L (pCi/L)) versions, and lagged by one year. Annual county-level counts of sex- and site-specific (all, leukemia, brain and central nervous system [CNS], and other sites) incident cancer diagnoses among those 0-19 years from 2001 to 2018 were obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program database. Sex- and site-specific counts were modeled as zero-inflated Poisson distributions in a Bayesian spatiotemporal framework and sequentially adjusted for random and fixed confounder effects., Results: In 727 counties across 14 states, the average population aged 0-19 years was 41,599 people at baseline. Results from fully adjusted spatiotemporal statistical models indicated 1.05 (95% credible interval, CrI: 1.00, 1.09) times higher relative risks (RRs) of leukemia among both sexes and a RR of 1.06 (95%CrI: 1.00, 1.12) in males from a 50 Bq/m 3 (1.35 pCi/L) increase in radon concentration the year prior. For radon exposures ≥74 Bq/m 3 (2.00 pCi/L) the year prior, RRs were 1.08 (95%CrI: 1.02, 1.15) for both sexes and 1.12 (95%CrI: 1.04, 1.22) for females. No associations were found with other cancer sites or sexes from prior year radon exposures., Conclusions: County-level childhood leukemia risk in both sexes were associated with average radon levels below U.S. Environmental Protection Agency guidelines recommending mitigation (148 Bq/m 3 or 4.00 pCi/L). These findings warrant further investigation using population-based and individual-level study designs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier B.V.)

Background: Interpretation of coagulation testing in neonates currently relies on reference intervals (RIs) defined from older patient cohorts. Direct RI studies are difficult, but indirect estimation may allow us to infer normative neonatal distributions from routinely collected clinical data., Objective: Assess the utility of indirect reference interval methods in estimating coagulation reference intervals in critically ill neonates., Methods: We analyzed first-in-life coagulation testing results from all patients admitted to a level IV neonatal intensive care unit between January 1, 2018, and January 1, 2024. Results obtained after transfusion of any blood product were excluded. Indirect RIs were estimated across gestational age groups using refineR and compared with currently reported intervals for patients less than 1 year of age., Results: Prothrombin times (PTs) and international normalized ratios (INRs) were available for 1128 neonates, while activated partial thromboplastin times (APTTs) were available for 790 neonates. The indirect RI was 10 to 25 seconds in preterm, 10 to 22 seconds in term, and 10 to 24 seconds in all neonates for PT; 0.7 to 2.1 in preterm, 0.8 to 1.8 in term, and 0.8 to 1.9 in all neonates for INR; and 25 to 68 seconds in preterm, 25 to 58 seconds in term, and 25 to 62 seconds in all neonates for APTT. Compared with our current intervals, the indirect RIs would flag 58% fewer PT, 43% fewer INR, and 17% fewer APTT results as abnormal., Conclusion: Indirectly estimated RIs in neonates admitted to intensive care show substantial divergence from current, first-year-of-life RIs, leading to an abundance of abnormal flags. The associations between these flags and provider behavior, transfusion practice, or clinical outcomes are areas of future exploration., Competing Interests: Declaration of competing interests The authors have no competing interests to disclose., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: In this longitudinal study on Danes born 1980-2000, the objectives were to identify and describe trajectories of childhood poverty and explore their association with trajectories of contacts with the healthcare system., Methods: Children born in Denmark from 1980-2000 were linked to national registers. Parental disposable income information was obtained for each year of the child's life from 0-16 years. Group-based trajectory modeling was used to identify trajectories of childhood poverty. The outcome was trajectories of contacts with the healthcare system identified with group-based multi-trajectory modeling. The associations between childhood poverty trajectories and trajectories of contacts with the healthcare system were estimated using multinomial logistic regression., Results: Four distinct groups of childhood poverty trajectories were identified. The largest group (87 %) had very low probability of childhood poverty, and the smallest group (2 %) had high probability of persistent poverty throughout childhood. Two groups experienced either early (5 %) or late (6 %) poverty in childhood. Early and late childhood poverty were associated with higher odds of being in the psychiatric use group in both sexes, and with higher odds of being in the low use and high use groups in women. Persistent poverty was associated with higher odds of being in the low use group and lower odds of being in the high use group and the psychiatric use group in both sexes., Conclusion: In conclusion, childhood poverty is associated with healthcare contacts in adolescence and early adulthood in Denmark., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction/background: The repeated or lengthy use of general anesthesia (GA) in children under three years old is cautioned against due to potential neurodevelopment effects. Spinal anesthesia (SA) has emerged as a safe and effective alternative for routine pediatric urologic procedures. In this study, we describe the use of SA in the urgent surgical treatment of neonatal testicular torsion., Objective: We aim to evaluate the safety and efficacy of SA for urgent scrotal exploration in neonates., Study Design: We retrospectively collected data on neonates younger than 30 days old undergoing SA for the indication of testicular torsion from May 2018 to June 2022. We recorded patient demographics, adjuvant medications use, and time points for start/stop of spinal injection, procedure, and operating room utilization., Results: Six neonates, with an average age of 1.9 days of life and average weight of 3.4 kg, underwent scrotal exploration for testicular torsion using SA. Four patients (67%) required orchiectomy of the nonviable torsed testicle, and all patients underwent orchiopexy of the unaffected testicle. Mean total operative time was 45.3 (SD 11.7) minutes, including Gomco circumcision in five patients. One patient received preoperative intranasal dexmedetomidine for sedation. Mean time for SA administration was 6.3 (SD 5.5) minutes, with a mean total time in the operating room of 77.3 (SD 9.8) minutes. There were no perioperative or postoperative complications., Discussion: We describe a single institution experience of surgical management of neonatal torsion under SA. In this case series, SA was safely utilized for all neonates involved without the need for conversion to GA or intravenous (IV) sedation., Conclusion: The use of SA is safe and efficacious for urgent scrotal exploration for testicular torsion in neonates, even those under 48 h of age. More widespread utilization requires collaboration between pediatric urologists and experienced pediatric anesthesiologists trained in SA., Competing Interests: Conflicts of interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Introduction: Zinner Syndrome (ZS) is a rare congenital disorder characterized by seminal vesicle cysts (SVC) and ipsilateral upper urinary tract abnormalities, mainly due to developmental anomalies of the mesonephric duct. This series highlights our institutional experience with pediatric ZS, with a review of the current literature offering insights into its etiopathogenesis in early childhood., Material and Methods: A retrospective case review of pediatric ZS diagnosed at our institution from 2019 to 2023, alongside a comprehensive literature review., Results: Four pediatric ZS cases were identified, a neonate, an infant and two older (pre-pubertal) children, presenting with recurrent epididymo-orchitis and/or UTIs. The two older children had duplex systems, both undergoing curative upper moiety heminephrectomy; the infant underwent nephroureterectomy and the neonate is under observation, asymptomatic for past 18 months., Discussion: When Zinner identified the link between unilateral renal agenesis and ipsilateral SVC in 1914, the condition's embryological basis was attributed to incorrect ureteric bud migration from the mesonephric duct, failing to stimulate the metanephros, leading to renal agenesis/dysplasia and this disruption was hypothesized to obstruct seminal vesicle drainage, causing cyst formation. Another theory suggests anomalous development of the distal mesonephric duct leading to ejaculatory duct atresia/stenosis which results in cystic enlargement of the seminal vesicles which, in turn, leads to aberrant ureteral budding, resulting in renal malformations. It is our belief that the SVCs, that are typically problematic in adolescence/adulthood due to secretion accumulation, sometimes manifest in childhood due to urinary reflux into the seminal vesicles, leading to epididymo-orchitis or UTIs. This contrasts with adult pathogenesis, where ejaculatory duct obstruction predominates. Hence, treatment leans towards a conservative approach for asymptomatic cases, with surgery reserved for symptomatic children. The scope of this case series is limited by the rare nature of ZS in prepubertal children (41 published cases in English literature), preventing a comprehensive understanding of its untreated natural history and restricting the formulation of generalized recommendations., Conclusion: The variability in presentation of ZS in children necessitates a tailored approach. Unlike adults, where ejaculatory duct obstruction is the common cause, pediatric ZS symptoms mainly stem from urethra-cystic reflux, leading to recurrent infections., Competing Interests: Conflict of interest None to declare., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: Per- and polyfluoroalkyl substances (PFAS) is perceived as an emerging environmental endocrine disruptor, which have been linked to children neurodevelopment. However, the potential mechanisms are not clear. Brain-derived neurotrophic factor (BDNF) is a vital protein in neurodevelopment, and the associations between PFAS exposure and BDNF require exploration., Objective: We aimed to explore the relationships between PFAS exposure and the levels of BDNF in cord serum., Methods: A total of 1,189 mother-infant dyads from the Sheyang Mini Birth Cohort Study (SMBCS) were enrolled. The levels of 12 PFAS and BDNF were measured in cord serum. We utilized generalized linear models (GLMs), quantile-based g-computation (QGC) models, and Bayesian Kernel Machine Regression (BKMR) models to explore the relationships between single and mixed PFAS exposure and BDNF concentration. Additionally, the potential sex differences were explored by sex-stratified analysis., Results: Median concentrations of the included 10 PFAS ranged from 0.04 to 3.97 μg/L. In the single chemical models, four PFAS congeners, namely perfluorononanoic acid (PFNA), perfluorooctane sulfonic acid (PFOS), perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA), were negatively associated with BDNF levels in cord serum among females only (β: -0.116 to -0.062, p < 0.05). In the BKMR models of total mother-infant dyads and female fetuses, the significant negative relationships between PFAS mixtures and BDNF were observed, and PFUnDA was identified as an important contributor (Posterior inclusion probability, PIP = 0.8584 for the total subjects; PIP = 0.8488 for the females). PFOS was another important driver based on the mixture approaches., Conclusions: We found that PFNA, PFOS, PFDA, and PFUnDA were associated with decreased BDNF concentration in the females, although the causal inference might be limited. PFAS mixtures were also negatively linked with BDNF levels in the total mother-infant pairs and female fetuses. The adverse effect of PFAS exposure on fetal BDNF levels might be sex-specific., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Zhijun Zhou reports financial support was provided by National Natural Science Foundation of China. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Since the Management of Myelomeningocele Study (MOMS) publication in 2011 we have designed a prospective protocol for surveillance of neurogenic bladder according to the Leal da Cruz categorization system (J Urol, 2015) that guides us on treatment. Our institution was the precursor of in-utero myelomeningocele (MMC) in Latin America, so our database was biased mostly for patients that underwent fetal surgery for MMC closure. We have demonstrated that in-utero MMC closure does not improve bladder function in opposition to the data from the urological branch of the MOMS study (10), but our control group was based on a historical cohort, before the onset of in-utero MMC repair in our division (15) Since 2018, we have identified an increasing number of referrals of postnatal operated MMC patients to our group just for urological follow up. We decided then to start this prospective protocol for all neurogenic patients and provide a contemporary database to record differences in early bladder function, presence of hydronephrosis and vesicoureteral reflux, treatment, initial outcome and indication of surgery among three mains groups (in-utero MMC repair, post-natal repair and miscellaneous other cases of neurogenic bladder). We want to present preliminary data of this cohort in the period of time 2018 to 2023 (5 years). There was not an exclusion criteria, all patients with neuropathic bladder were included in this study., Materials and Methods: We evaluated our database of all neurogenic bladder (NB) patients aged <1 year who started urological treatment in our institution from 2018. We evaluated diagnosis, age at first visit, clinical data, prevalence of hydronephrosis and (vesicoureteral reflux) VUR, bladder pattern according to the Leal da Cruz categorization system (1), treatment, time of follow-up, number of clinical visits and (urodynamic evaluation) UE performed, final bladder status and surgeries performed., Results: We identified 43 were aged <1 year with a mean age of 4.5 months (median 3.5) at first urological appointment. Diagnosis was myelomeningocele in 33 patients and miscellaneous in 10. From the MMC group, 24 were operated in-utero and 9 post-natal. The initial bladder pattern in the whole group showed 23 (53.5%) high risk, 11 normal (25.6%), 5 underactive bladder (11.6%) and 4 incontinent (9.3%). Mean follow-up was 24 months, mean age at last UE (cases with minimum of 2): 37 months, mean UE per patient: 2. At present, 28 patients perform clean intermittent catheterization (CIC), 23 with anticholinergics and 15 are only under surveillance. VUR was seen in 11/43 cases: 25.6%. Urological surgery has been performed in 4 patients: bladder augmentation in 3 and vesicostomy in 1. Bladder categorization for high-risk and normal patterns were respectively 62.5% and 25% for in utero and 44.4% and 22.2% for postnatal repair and detailed statistical analysis did not present statistical significance of in utero and postnatal groups., Conclusion: Our study can conclude in a contemporary prospective study the findings of elevated incidence of high-risk patterns irrespectively of in-utero or post-natal repair (62.5% and 44.4%). We acknowledge that even though this is not new information and besides the still limited follow up, this cohort is one of the very few that follow and compare in one single institution with comparable UE for in-utero and post-natal MMC repair population, having also a miscellaneous group of NB as a pictorial report of also a similar initial distribution of bladder patterns. We plan to report in the future in a larger cohort the continuation of this study., (Copyright © 2024. Published by Elsevier Ltd.)

Two distinct defense strategies, disease resistance (DR) and disease tolerance (DT), enable a host to survive infectious diseases. Newborns, constrained by limited energy reserves, predominantly rely on DT to cope with infection. However, this approach may fail when pathogen levels surpass a critical threshold, prompting a shift to DR that can lead to dysregulated immune responses and sepsis. The mechanisms governing the interplay between DR and DT in newborns remain poorly understood. Here, we compare metabolic traits and defense strategies between survivors and non-survivors in Staphylococcus epidermidis (S. epidermidis)-infected preterm piglets, mimicking infection in preterm infants. Compared to non-survivors, survivors displayed elevated DR during the initial phase of infection, followed by stronger DT in later stages. In contrast, non-survivors showed clear signs of respiratory and metabolic acidosis and hyperglycemia, together with exaggerated inflammation and organ dysfunctions. Hepatic transcriptomics revealed a strong association between the DT phenotype and heightened oxidative phosphorylation in survivors, coupled with suppressed glycolysis and immune signaling. Plasma metabolomics confirmed the findings of metabolic regulations associated with DT phenotype in survivors. Our study suggests a significant association between the initial DR and subsequent DT, which collectively contributes to improved infection survival. The regulation of metabolic processes that optimize the timing and balance between DR and DT holds significant potential for developing novel therapeutic strategies for neonatal infection., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Cancer, the second most common cause of death worldwide, is projected to cause 17 million deaths by 2045. Epidemiological studies on cancer play a vital role in understanding cancer burden impact and formulating control plans. This study aimed to analyse the changes in cancer mortality rates within Luxembourg from 1998 to 2021 by sex and age., Methods: Data on cancer-related deaths were extracted from Luxembourg's National Registry of Death Causes (1998-2021), and the corresponding population data were analysed. Age-standardized mortality rates (ASRs) per 100,000 individuals were calculated and adjusted to the European standard population. To identify significant changes in cancer mortality over time, the Average Annual Percentage Changes (AAPC) method was used., Results: We identified 23,750 cancer-related deaths, resulting in an ASR of 152.86 per 100,000 people per year. Lung cancer was the most common cancer-related case of death in men and in both sexes combined. In women, breast cancer was the most common cancer death. Significant decreases in the ASR over time were observed for both sexes. Sex-specific cancers, such as prostate (AAPC: -2.7) and breast (AAPC: -1.0) cancers, also exhibited significant decreasing trends in mortality. In the evaluation by life stage, stability or significant decreases were observed for women, men and both sexes, however significant increases were observed in late adulthood women in laryngeal and lung cancer (AAPC: 3.9 and 1.8, respectively). The trend patterns observed during 1998-2021 were largely consistent with those seen when excluding the COVID-19 pandemic year of 2020., Conclusion: Our study provides a comprehensive analysis of mortality trends by cancer type in Luxembourg, contributing to the understanding of cancer epidemiology and informing healthcare policy and planning. This highlights the importance of targeted public health interventions as such early detection and screening programs and continued advancements in cancer treatment., Competing Interests: Declaration of Competing Interest The authors have no competing interests to declare., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To use the prevalence of prenatal/infancy interglobular dentine (IGD) as a proxy for suboptimal vitamin D status and explore its link to mortality, biological sex, cultural behaviours and environmental factors during the end of the pre-industrial/ beginning of the industrial period., Materials: 50 skeletons from the St. Antoine cemetery (1799-1854), Montreal, Quebec with a well-preserved first mandibular molar., Methods: Thin sections were prepared for histological examination of IGD in crown dentine., Results: IGD prevalence was 74 % (37/50) and not significantly correlated statistically to sex and age-at-death. Most IGD occurred at birth and up to 3 years-old, six individuals were affected in utero, 54 % of the sample (27/50) presented longstanding IGD and six individuals displayed multiple IGD episodes., Conclusions: Prenatal IGD episodes revealed suboptimal maternal vitamin D levels, which, alongside a high frequency of IGD episodes around birth/from birth until a certain age, suggest cultural influences. Multiple and longstanding IGD episodes might also reflect suboptimal seasonal vitamin D attainment., Significance: This study provides in-depth data on IGD within a relatively large archaeological North American sample, proving relevant to epidemiological studies on suboptimal vitamin status in 19th century Montreal., Limitations: The total number of IGD episodes is underestimated due to methodological biases; first-generation migrants in this study could not be identified and excluded from the sample., Suggestions for Further Research: Use of a larger sample with a wider age-at-death range; further research on infants and children to investigate links between growth and lesion formation and visibility., Competing Interests: Declaration of Competing Interest None, (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The outcomes of single-ventricle palliation in unbalanced atrioventricular canal defect with coarctation of aorta (uAVC+CoA) have not been well studied. Systemic ventricle outflow tract obstruction has a propensity to develop in these patients after aortic arch repair with pulmonary artery banding (arch-PAB), which may adversely affect survival and Fontan candidacy., Methods: A retrospective review was performed of patients who underwent single-ventricle palliation for uAVC+CoA from 2000 to 2022. Patients were divided into 2 groups based on initial palliation: (1) arch-PAB and (2) Norwood procedure. Demographic and clinical characteristics were analyzed and compared along with survival data., Results: Stage 1 palliation for uAVC+CoA was performed in 41 patients. Arch-PAB was performed in 14 infants and Norwood in 27 infants. Arch-PAB patients had more chromosomal abnormalities (28.6 vs 7.4%, P < .009) and less severe systemic ventricle outflow tract obstruction on baseline echocardiogram (0.0 vs 70.4%, P < .001). Survival to stage 3 palliation was lower for the arch-PAB group (28.6% vs 66.6%, P = .02). Arch-PAB remained a significant risk factor for mortality (hazard ratio, 2.93; 95% CI, 1.05-8.53; P = .04) after adjusting for chromosomal abnormalities and atrioventricular valve regurgitation. After arch-PAB, systemic ventricle outflow tract obstruction was diagnosed in 13 of 14 patients. Echocardiography underestimated the degree of outflow tract obstruction in 10 of 13 arch-PAB patients., Conclusions: Arch-PAB has worse outcomes than Norwood for uAVC+CoA. Systemic ventricle outflow tract obstruction develops in almost all patients after arch-PAB. Outflow tract obstruction is underestimated by the echocardiogram and requires a high index of suspicion, along with advanced imaging, to ensure timely diagnosis and management., Competing Interests: Disclosures Fawwaz R. Shaw is a member of The Annals of Thoracic Surgery Editorial Board. The other authors have no conflicts of interest to disclose., (Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Background: Anti-TNF are usually maintained during pregnancy in patients with inflammatory bowel disease (IBD) but safety is still a concern for them., Aims: To provide data on management of anti-TNF agents during pregnancy, safety of live vaccines (BCG-MMR-rotavirus) and breastfeeding in newborns and dedicated information delivered to IBD women., Methods: We performed an observational study in 25 centers from 2016 to 2018. We administered questionnaires to women with IBD receiving anti-TNF during pregnancy with newborn follow-up ≥ one year., Results: Of 153 patients, 52 % maintained anti-TNF during the third trimester. Anti-TNF was shortly resumed in 79 % (58/73) after delivery. The rate of breastfeeding was 44 % (68/153) without any complication; 38 % of the mothers denied to breastfeed based on physician's advice. 26 % (34/129) of the newborns received live vaccines before 6 months-old (BCG:30 %; MMR:63 %; Rotavirus:8 %) and only 3 complications occurred (local BCGitis=1, fever=2). Information concerning anti-TNF during pregnancy/post-partum was delivered to 92 % of the patients, mainly by a gastroenterologist (97 %) who discussed with the obstetrician or the paediatrician in only 48 % and 25 %., Conclusion: In IBD patients, maintaining anti-TNF during pregnancy and breastfeeding is safe. Accidental live vaccines before 6 months did not lead to significant adverse events. The communication about these questions remains to improve., Competing Interests: Declaration of competing interest Romain Altwegg received board or lectures fees from Abbvie, Janssen, Pfizer, Takeda. Vered Abitbol received lecture fees from Biogen Amgen Sandoz Mylan Pfizer Takeda Janssen, Gilead, Tillots. Laurent Peyrin-Biroulet received consulting fees from Merck, Abbvie, Janssen, Genentech. Ferring, Norgine, Tillots, Vifor, Shire, Therakos, Pharmacosmos, Pilège, BMS, UCB-Pharma. Hospira, Celltrion, Takeda, Biogaran, Boerhinger-Ingelheim, Lilly, Pfizer, and HAC-Pharma. This author also received lecture fees from Merck, Abbvie, Takeda, Janssen Cilag, Ferring. Norgine, Tillots, Vifor, Therakos, HAC-Pharma, and Mitsubishi. No conflicts of interest are claimed by the remaining authors., (Copyright © 2024. Published by Elsevier Ltd.)

Introduction/background: Requests for circumcision revision are common in our American pediatric urology clinic. As parents are the surrogate decision maker for their child, there are several influences that can impact a parent's decision for or against circumcision., Objective: We sought to assess parents' regret regarding their child's circumcision status and to correlate regret to factors that might have affected the original decision., Study Design: From March 2023 to January 2024, we surveyed parents who brought their male child to our office for any reason, independent of circumcision status. The questionnaire was two-fold: a validated Decisional Regret Scale (DRS) (0-100 where higher scores = higher regret) and our questions regarding their decision-making process and outcome. Regret scores served as a function of each of the independent decision making and outcome variables., Results: Overall, decisional regret scores from both uncircumcised and circumcised parent groups were positively skewed with a median 0, mean 22, and ranged from 0 to 75. For those circumcised (n = 91), the median regret score was 0 (IQR 0-25). For those uncircumcised (n = 28), median regret score was 0 (IQR 0-24). Overall, 55% of both groups reported no regret (DRS = 0), 24% had low-mild regret (DRS 5-25), and 21% yielded moderate-strong regret (DRS 30-100). Parents who felt they made an informed decision or were counseled by any physician had lower regret scores. Parents who presented for issues related to their child's uncircumcised or circumcised penis (DRS score 37.5 and 25 respectively) had higher regret scores., Discussion: We found that a large portion of parents expressed no regret regarding their decision to have or not have their child circumcised (55%). There also was no difference in median regret scores between parent groups. However, a significant portion of parents did express moderate-strong regret (21%) and several influential factors were correlated with regret scores. These factors included informed decision making, physician counseling, appearance satisfaction, and problems related to their child's circumcised or uncircumcised penis. These factors are supported by other literature using the DRS and population studies. The limitations of our study included the limited recruitment of participants and potential time dependent bias of responses., Conclusion: One in five parents of both circumcised and uncircumcised boys expressed moderate to strong regret regarding their decision about neonatal circumcision in our pediatric urology clinic. Our data suggests that ensuring parents have sufficient counseling prior to a decision regarding neonatal circumcision is important., Competing Interests: Conflict of interest None., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Objective: To calculate the prevalence of physical restraint (PR) use in Spanish PICUs and (2) to analyze the correlation between the prevalence of PR use and the sociodemographic, clinical variables of the patients and the PICU structural and organizational variables., Methods: We conducted a multicenter prevalence study from January 2022 to January 2023 in Spanish PICUs. The method of data collection was by direct observation, review of the patient's medical history, and asking the professionals involved in the patient's care. Three weekly 24-hour prevalence observations (morning, afternoon, and night) were conducted for 6 months., Results: A total of 336 patients were included in the study, obtaining an overall crude prevalence of PR use of 16 % (95 %CI: 15 %-17.7 %). Pediatric patients with respiratory pathology received the highest number of hours of PR, with significant differences observed when comparing respiratory cases with post-surgical cases. Statistical significance was also observed when comparing the mean scores of hours of PR according to admission diagnosis (p = 0.01), with respiratory patients being the ones who were restrained the longest (24 h [20-24]) and infectious patients the least (15 h [14-20]). Patients who receive PR upon admission remain in this situation for more hours (24 h [15-24] and in the PICUs that specifically recorded PR application, fewer hours of PR occurred (20 h [4-24])., Conclusions: The use of PR is still present in the PICUs analyzed, with a crude prevalence of 16%. Factors such as the reason for admission, the use of respiratory support, and the reason for application of PR were linked to the hours of use of PR., Implications for Clinical Practice: Knowing the prevalence of PR use will make professionals aware that it is still necessary to implement policies that avoid its use to prevent the side effects they have in pediatric patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)