Infant Boy Research Articles

Neonatal Circumcision in Boys With Posterior Urethral Valves

Source: Harper L, Blanc T, Peycelon M, et al. Circumcision and risk of febrile urinary tract infection in boys with posterior urethral valves: result of the CIRCUP randomized trial. Eur Urol. 2022;81(1):64-72; doi:10.1016/j.eururo.2021.08.024Investigators from multiple institutions in France conducted a randomized controlled trial to assess the effect of circumcision on the risk of febrile urinary tract infection (fUTI) in infant boys with posterior urethral valves (PUV). Participants were male neonates 1-28 days old with PUV diagnosed by voiding cystogram, who were enrolled between 2012 and 2017 at 13 pediatric urology centers. Study patients were randomized to circumcision and antibiotic prophylaxis (CATB), or antibiotic prophylaxis alone (ATB) treatment groups. Circumcision was performed at the time of valve resection under general anesthesia. Antibiotic prophylaxis consisted of cefaclor 10 mg/kg/day for 1 month, followed by cotrimoxazole (15 mg/kg/day) until participants were 2 years old. A technetium-99m dimercaptosuccinic acid (DMSA) scan was performed when patients were 1-2 months and 2 years of age to evaluate renal damage. Study children were followed for 2 years. The primary outcome was fUTI, defined as culture-proven infection (≥103 bacteria/mL in catheterized specimens and ≥104 bacteria/mL for urine specimens obtained by suprapubic aspiration) with pyuria, in the presence of fever (>38.5° C) and signs of inflammation (leukocytosis, elevated C-reactive protein, and/or procalcitonin). The risk of fUTI in the 2 treatment groups was assessed using Kaplan-Meier analysis, and Cox regression was used to compare the risks. Adherence to antibiotic prophylaxis was assessed throughout the 2-year follow-up period and compared between groups. Evidence of increased renal damage between the initial and follow-up DMSA scans was determined and compared in those with and without fUTI with a chi-square test.Data were analyzed on 91 boys, including 49 randomized to CATB and 42 to the ATB group; the mean age at enrollment was 4.3 ± 5.0 and 7.1 ± 6.7 days, respectively, and mean age at valve resection was 5.2 ± 5.4 and 9.4 ± 11.6 days, respectively. A total of 64 (70%) children completed the entire 2-year follow-up period (33 in the CATB group and 31 in the ATB group). Overall, the risk of fUTI was 20% in the ATB group and 3% in those randomized to circumcision (hazard ratio [HR], 10.3; 95% CI, 1.3, 82.5). Adherence to the antibiotic prophylaxis regimen declined in participants during the study period but was not significantly different between treatment groups. At the time of the initial DMSA scan, 63% of children had abnormalities identified, and deterioration on DMSA scans was noted on 18% at follow-up, including 33% of those with a history of fUTI and 16% without fUTI (P = 0.29).The authors conclude circumcision decreased the risk of fUTI in boys born with PUV.Dr Sanchez-Kazi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.The prevalence of fUTI is highest during the newborn period in boys with PUV.1 fUTI increases the risk of renal scarring, which can lead to chronic kidney disease. (See AAP Grand Rounds. 2019;42(5):53.)2 The current investigators evaluated whether circumcision reduces the risk of fUTI in boys with PUV. Although the results showed that CATB lowered the risk of fUTI, there was no difference between groups in the degree of kidney scarring as shown on the DMSA scans. Although it may be possible that this lack of significant change is explained by a lower number of participants, high attrition rate, variability in the radiographic interpretation of the DMSAs, short period of follow-up, or the inherent abnormal kidney parenchyma in boys with PUV due to possible dysplasia. However, the most likely explanation is that despite a substantial effect size (the rate of worsening DMSA scans was >2 times higher in those with fUTI than those without), there was insufficient power to detect a statistically significant difference in the outcomes.As stated in the accompanying editorial, circumcision reduced the occurrence of fUTI, but it did not decrease morbidity or mortality related to kidney scars.3 Steroid cream is currently used to manage phimosis in uncircumcised infants with fUTI.4 Will a retractable foreskin have the same advantage in infants with PUV?4 In boys with PUV however, neurogenic bladder and hydronephrosis are additional factors that significantly increase the probability of fUTI.1 In the most recent AAP Policy Statement on Circumcision in boys with a normal urinary tract, the committee left the decision-making to parents.5 The Canadian Urological Association also recommends early parental discussion of circumcision in the presence of an abnormal urinary tract including PUV, since the risk of fUTI is highest within the first 3 months of life.1,6 The results of the current study hopefully will contribute to more knowledgeable parental decision making.Neonatal circumcision in boys with posterior urethral valve decreases the risk of fUTI.

Helping midwives support families who require non-therapeutic infant male circumcision

In the UK, the majority of non-therapeutic infant male circumcisions for religious or cultural reasons are performed by private providers in community settings. There have been reports of unsafe practices by some unregulated private providers. The implementation of a voluntary quality assurance process in one region in northwest England has been associated with a decrease in paediatric surgical admissions of infant boys admitted following complications of circumcision in the community. Voluntary quality assurance is a feasible option to implement quality improvement for services outside clinical governance systems. The quality assurance process provides a valuable resource for midwives to signpost families to safely practising providers, potentially reducing the risk of harm to children resulting from families using unqualified providers and safeguarding infant boys from harm becuase of poor practice.

Blistering Lesions in a Newborn.

A 4-day-old infant boy presented with blisters on the skin. On day 2 of life, the patient developed bullae with breakdown of the skin on the bilateral heels and on the skin surrounding intravenous injection sites.

Characterization and Survival of Human Infant Testicular Cells After Direct Xenotransplantation.

BackgroundCryopreservation of prepubertal testicular tissue preserves spermatogonial stem cells (SSCs) that may be used to restore fertility in men at risk of infertility due to gonadotoxic treatments for either a malignant or non-malignant disease. Spermatogonial stem cell-based transplantation is a promising fertility restoration technique. Previously, we performed xenotransplantation of propagated SSCs from prepubertal testis and found human SSCs colonies within the recipient testes six weeks post-transplantation. In order to avoid the propagation step of SSCs in vitro that may cause genetic and epigenetic changes, we performed direct injection of single cell suspension in this study, which potentially may be safer and easier to be applied in future clinical applications.MethodsTestis biopsies were obtained from 11 infant boys (median age 1.3 years, range 0.5-3.5) with cryptorchidism. Following enzymatic digestion, dissociated single-cell suspensions were prelabeled with green fluorescent dye and directly transplanted into seminiferous tubules of busulfan-treated mice. Six to nine weeks post-transplantation, the presence of gonocytes and SSCs was determined by whole-mount immunofluorescence for a number of germ cell markers (MAGEA, GAGE, UCHL1, SALL4, UTF1, and LIN28), somatic cell markers (SOX9, CYP17A1).ResultsFollowing xenotransplantation human infant germ cells, consisting of gonocytes and SSCs, were shown to settle on the basal membrane of the recipient seminiferous tubules and form SSC colonies with expression of MAGEA, GAGE, UCHL1, SALL4, UTF1, and LIN28. The colonization efficiency was approximately 6%. No human Sertoli cells were detected in the recipient mouse testes.ConclusionXenotransplantation, without in vitro propagation, of testicular cell suspensions from infant boys with cryptorchidism resulted in colonization of mouse seminiferous tubules six to nine weeks post-transplantation. Spermatogonial stem cell-based transplantation could be a therapeutic treatment for infertility of prepubertal boys with cryptorchidism and boys diagnosed with cancer. However, more studies are required to investigate whether the low number of the transplanted SSC is sufficient to secure the presence of sperm in the ejaculate of those patients over time.

Prevalence and risk factors of discomfort in infants with severe bronchiolitis.

The aim of this study was to assess the prevalence of discomfort in infants with severe bronchiolitis supported by noninvasive ventilation and to identify its potential risk factors. A single-centre retrospective observational study. Discomfort was assessed using the EDIN (Echelle de Douleur et d'Inconfort du Nouveau-né) scale. Ninety-one infants (median age 34days [Interquartile IQR 19-55], 52 (57%) boys) were included in our study. Overall, no patient had a mean EDIN score higher than 8 on Days 1, 2 and 3. On Days 1 and 2, patients supported by bilevel positive airway pressure (BiPAP) had a higher EDIN score compared with other patients (3.3 [SD 2.5] versus 2.6 [SD 2.2] on Day 1 and 2.9 (SD 2.1) versus 2.3 (SD 2.2) on Day 2, both p<0.001). Patients with severe bronchiolitis and supported by any type of noninvasive ventilation had a low degree of discomfort during the first 3days of ICU stay. Patients requiring bilevel noninvasive ventilation appeared to have a higher degree of discomfort, while we found no correlation between the level of discomfort and the degree of respiratory distress.

A dramatic interpretation of the fragilities of the FGM narrative: a reply to ‘The prosecution of Dawoodi Bohra women’ by Richard Shweder

Inspired by Richard Shweder’s paper, What about ‘Female Genital Mutilation?’ And Why Understanding Culture Matters in the First Place (MIT Press, 2000), I wrote the play Human Rites seeking to challenge audiences’ assumptions about the practice of circumcision among women, known colloquially as ‘female genital mutilation’ (FGM). Throughout the development of Human Rites, which involved research and extensive interaction with Shweder and Fuambai Sia Ahmadu (both of whom served as bases for characters in the play), I experienced anticipated and unanticipated pushback on the controversial perspectives voiced in the play, as well as the appropriateness of a Caucasian man authoring a play about black and brown women’s bodies. The two productions of Human Rites went on to generate highly engaged dialogue among audiences, as they grappled with their own, mostly unexamined pre-conceptions about FGM, the disparity in moral attitudes toward male and female circumcision, and the inherent moral authority Westerners often hold with regard to ‘primitive’ practices in other countries and cultures. Shweder’s subsequent paper ‘The prosecution of Dawoodi Bohra women: some reasonable doubts,’ has inspired a kind of sequel to Human Rites, that will interrogate the widely accepted practice of circumcision among infant boys in Western Jewish and Christian communities.

Case report of recurrent bleeding in an infant with isolated prolonged prothrombin time due to congenital factor VII deficiency---a riddle solved

ABSTRACTFactor VII deficiency is a rare bleeding disorder showing an autosomal recessive pattern of inheritance. Data from our country on this particular entity is lacking. Especially the specific mutations associated with this disease are not well documented. The disease can have a wide spectrum of presentation from asymptomatic to catastrophic central nervous system or gastrointestinal system bleed. It can often present early in the neonatal period or be detected quite later in life. The genotype and phenotype correlation is also not well understood. Here, we report a case of recurrent bleeding in an infant boy who was otherwise absolutely well. His investigations had revealed isolated prolonged prothrombin time which remained uncorrected despite administration of injection vit K. Specific assay for factor VII level revealed that its value less than 1%. Sequencing of the F7 gene revealed our patient to be homozygous for mutation of promoter consensus sequence of F7 gene (-94C > T).

Hemophilia: The Past, the Present, and the Future.

Hemophilia: The Past, the Present, and the Future.

Intraventricular Septation in the Context of Dilated Cardiomyopathy Associated With TTN Mutation

A 6-month-old infant boy presented with symptomatic heart failure. Dilated cardiomyopathy was found in association with a mutation in TTN. Structural heart disease included novel septation of the left ventricle with a fenestrated membrane resulting from aberrant congenital mitral valve apparatus formation. (Level of Difficulty: Advanced.)

MP44-12 STENTLESS ROBOTIC PYELOPLASTY: LESS OPERATIVE TIME AND NO INCREASE IN COMPLICATIONS

You have accessJournal of UrologyPediatric Urology II (MP44)1 Sep 2021MP44-12 STENTLESS ROBOTIC PYELOPLASTY: LESS OPERATIVE TIME AND NO INCREASE IN COMPLICATIONS Campbell Grant, William DeFoor, Michael Daugherty, Andrew Strine, Pramod Reddy, and Paul Noh Campbell GrantCampbell Grant More articles by this author , William DeFoorWilliam DeFoor More articles by this author , Michael DaughertyMichael Daugherty More articles by this author , Andrew StrineAndrew Strine More articles by this author , Pramod ReddyPramod Reddy More articles by this author , and Paul NohPaul Noh More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002065.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Children undergoing robotic pyeloplasty (RP) for ureteropelvic junction obstruction often have internal double J ureteral stents placed at the time of surgery to facilitate drainage and prevent complications. However, placement of a stent typically requires a second anesthetic for removal. Previous studies have shown that stentless pyeloplasties are a feasible option, but none have compared outcomes to stented patients. The goal of this study is to assess overall complication rates between stented and stentless pyeloplasties at a single institution. METHODS: A prospective cohort study was performed of all robotic pyeloplasties performed by four surgeons in our institution from 2015 to 2020. A historical cohort of stented pyeloplasties from 2009 to 2020 was used as a control group. Categorical variables were analyzed using a chi-square test and continuous variables were compared using a two-sided t-test. RESULTS: A total of 310 patients underwent RP and met inclusion criteria. 114 patients in the study group underwent pyeloplasty without a ureteral stent and 196 control patients had a stent placed at the time of surgery. Stentless patients were younger (median: 19 vs. 75 months, p<0.001) and weighed less (11 vs. 23 kg, p<0.001) than stented patients. The average operative time for stentless patients (192 minutes) was less than stented patients (211 minutes, p=0.002). The overall complication rate in the stentless group (7%) was comparable to the stented group (10%), although there was a higher incidence of Clavien level 3/4 complications in the stentless group (5.3% vs. 2%). One infant boy with worsening hydronephrosis developed urosepsis requiring a PICU admission 4 weeks post-operatively and underwent urgent stent placement. There was one confirmed urinary leak and two suspected urinary leaks due to abdominal distension and ileus that were treated with a ureteral stent. One concomitant unrecognized ureterovesical junction obstruction required a percutaneous nephrostomy. CONCLUSIONS: Stentless robotic pyeloplasty appears to be comparable to stented pyeloplasties from a safety and clinical outcomes standpoint with the benefits of a shorter operative time and the avoidance of a second procedure. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e797-e797 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Campbell Grant More articles by this author William DeFoor More articles by this author Michael Daugherty More articles by this author Andrew Strine More articles by this author Pramod Reddy More articles by this author Paul Noh More articles by this author Expand All Advertisement Loading ...

Novel Pathogenic DNAH5 Variants in Primary Ciliary Dyskinesia: Association with Visceral Heterotaxia and Neonatal Cholestasis.

The dynein axonemal heavy chain 5 gene codes for a subunit of axonemal dynein necessary for ciliary motor function. Though research has elucidated the consequences of some variants in this gene, it is still unclear whether many variants in the DNAH5 locus are benign or pathogenic due to the rarity of primary ciliary dyskinesia (PCD, of which Kartagener's syndrome is a subset). Here, we introduce the case of an infant boy presenting with the classical findings of PCD along with visceral heterotaxia and neonatal cholestasis. Genetic testing indicated that the patient is a compound heterozygote with a pathogenic c.8498G > A (known as pathogenic) on the maternally derived allele and two variants of uncertain significance, c.1206T > A and c.7800T > G, on the paternally derived allele. As PCD is autosomal recessive, we conclude that one, or both, of these paternally derived variants are pathogenic. To our knowledge, this is the first time that the clinical implications of c.1206T > A (p.Asn402Lys) and c.7800T > G (p.Ile2600Met) are documented. Furthermore, we use this case as an example to recommend clinicians to assess for PCD and laterality defects when presented with severe infantile cholestasis. While the association of cholestasis with PCD is relatively uncommon, PCD is a risk factor for increased prevalence of biliary atresia and infections, both of which are known causes of cholestasis in early infancy.

O-189 Male fertility restoration by direct transplantation of human infant testicular cells into infertile recipient mouse testis

Abstract Study question Is colonization of human gonocytes and spermatogonial stem cells (SSCs) directly transplanted to seminiferous tubules of busulfan sterilised mice testis during an 8-week period feasible? Summary answer Gonocytes and SSCs from infant boys can settle on the basal membrane and form germline stem cell colonies in the seminiferous tubules of recipient mice. What is known already The neonatal or immature animal provides higher populations of gonocytes and/or SSCs than adults, and the number of transplanted donor SSCs directly affects the colonization rate of the recipient testes. Along with SSC transplantation restoring the recipient’s spermatogenesis, donor gonocyte was also reported to be capable of establishing spermatogenesis in rodents. Study design, size, duration Transplantation of human testicular cells including gonocytes and SSCs into seminiferous tubules of infertile recipient mice. We included 10 infant testis biopsies from which single-cell suspension was transplanted individually into the seminiferous tubules of 10 immunodeficient mice. The immunodeficient mouse testes were injected with busulfan to deplete germ cells. Four weeks later, we did the xenotransplantation. Then after eight weeks, we collected all mouse testes to do further analysis. Participants/materials, setting, methods Testis biopsies were obtained from cryptorchid boys undergoing orchidopexy. After enzymatic digestion of the testis biopsies, dissociated single-cell suspensions were pre-labeled with a green fluorescent dye. Then the single-cell suspensions were transplanted into seminiferous tubules of the infertile recipient mice. Eight weeks later, the presence of gonocytes and SSCs was determined by immunohistochemistry and whole-mount immunofluorescence. Main results and the role of chance Without in vitro propagation, naturally enriched human germline stem cells settled on the basal membrane of seminiferous tubules and survived in the mouse testes at least for two months demonstrating that human gonocytes and SSCs were capable of colonizing the recipient mouse seminiferous tubules. Limitations, reasons for caution The study samples were from infant boys with undescended testes that were more likely to contain gonocytes. It was not possible to determine which germ-cell type at transplantation resulted in the detected gonocytes and SSC colonies after xenotransplantation. Transplantation of gonocytes may include the potential risk of stem cell-related malignancy. Wider implications of the findings Without in vitro propagation, male germline stem cell-based transplantation could provide a relatively safe therapeutic treatment for prepubertal boys with cryptorchidism and boys diagnosed with cancer. This method could also facilitate clinical translation. Trial registration number not applicable

Pelizaeus-Merzbacher Disease as a Rare Cause of Stridor in an Infant with Severe Reflux and Hypotonia

Stridor is high-pitched, noisy breathing that occurs as a result of a narrowed airflow. It is considered as a respiratory emergency in which if left untreated, may lead to death. The most common cause of stridor in paediatric is laryngomalacia (LM). Nevertheless, other causes of persistent stridor in infant have to be ruled out, in the case of failed surgical therapy. Here, we report a rare case of a three-month-old infant boy with persistent stridor since birth who had undergone aryepiglottoplasty for LM at day ten of life and was referred back to the hospital due to worsening of stridor with signs of respiratory distress and subsequently he was diagnosed with Pelizaeus-Merzbacher Disease (PMD). This is the first report to discuss on PMD as a rare differential diagnosis of stridor.

Reproductive Hormone Concentrations and Associated Anatomical Responses: Does Soy Formula Affect Minipuberty in Boys?

Soy formula feeding is common in infancy and is a source of high exposure to phytoestrogens, documented to influence vaginal cytology in female infants. Its influence on minipuberty in males has not been established. To assess the association between infant feeding practice and longitudinally measured reproductive hormones and hormone-responsive tissues in infant boys. The Infant Feeding and Early Development study was a prospective cohort of maternal-infant dyads requiring exclusive soy formula, cow milk formula, or breast milk feeding during study follow-up. In the 147 infant boy participants, serum testosterone, luteinizing hormone, stretched penile length, anogenital distance, and testis volume were longitudinally assessed from birth to 28 weeks. We examined feeding-group differences in age trajectories for these outcomes using mixed-effects regression splines. Median serum testosterone was at pubertal levels at 2 weeks (176 ng/dL [quartiles: 124, 232]) and remained in this range until 12 weeks in all feeding groups. We did not observe differences in trajectories of hormone concentrations or anatomical measures between boys fed soy formula (n = 55) and boys fed cow milk formula (n = 54). Compared with breastfed boys (n = 38), soy formula-fed boys had a more rapid increase in penile length (P = .004) and slower initial lengthening of anogenital distance (P = .03), but no differences in hormone trajectories. Reproductive hormone concentrations and anatomical responses followed similar trajectories in soy and cow milk formula-fed infant boys. Our findings suggest that these measures of early male reproductive development do not respond to phytoestrogen exposure during infancy.

Study on infant and young children complementary feeding in poor rural regions in China

To analyze complementary feeding status and issues among 6-23 month infants and young children(IYC) in poor rural regions in China to figure out actions further IYC nutrition in China. Using 2018 monitoring data from Project of Children Nutrition Improvement in Poor Rural Regions, 6-23 months infants were sampled with the method of a combination of provincial stratification, multi-stage stratified cluster, PPS and random equidistant. Complementary feeding practices were collected by 24 hours diet recall method and and parental knowledge on IYC feeding was collected by KAP questionnaire. Complementary diet was analyzed according to the World Health Organization& apos; s definition of infant and young child feeding indicators. Logistic regression model was used to analyze the influencing factors of minimum acceptable diet(MAD). A total of 40 910 infants(boys 21 153, girls 19 757) completed the survey. The proportion of infants 6-8 months of age who receive solid, semi-solid foods was 83.8%, the percentage of IYC who get minimum dietary diversity(MDD), minimum meal frequency(MMF), and MAD was 67.8%, 71.4% and 39.7%, respectively. The age of months, mother& apos; s educational level and parent& apos; s nutrition and feeding knowledge had significant impact on the outcome of MAD. The OR for month& apos; s age were 1.990 and 1.905(P& lt; 0.001), OR for mother education level was 1. 545(P& lt; 0.001) and OR for parent knowledge were 1.114 and 1.346(P& lt; 0.001). Complementary feeding practices were poor in terms of the proportion of infants 6-8 months of age who introduced complementary foods, MDD, MMF and MAD in poor region of China.

Infant’s Negative Emotionality as a Potential Moderator Between Teacher’s Emotion-Related Socialization Behaviors and Infant’s Emotional Intelligence

Objectives This study aimed to identify the role of teachers’ emotion-related socialization behaviors in the development of an infant’s emotional intelligence and the moderating role of their negative emotionality on it. Methods Data were collected from 198 two-year-old infants (boys = 88, girls = 110) and their child care teachers. Descriptive statistics were computed, and Pearson's correlation and PROCESS macro (model 1) was used for data analysis. Results The study found that the relationship between teachers’ emotion-related socialization behaviors and infants’ emotional intelligence could be deteriorated by the infants’ emotionality. More specifically, their low levels of emotionality showed a significant moderating effect on the relationship between the teachers’ minimization or punitive reactions and the infants’ emotional intelligence. Conclusion These results indicate that infants’ negative emotionality and the teachers’ response to it could hamper the development of infants’ emotional intelligence, and provide a basis for relevant education and programs for preventive interventions. Keywords: infant’s emotional intelligence, negative emotionality, teacher’s emotion-related socialization behaviors, differential susceptibility model

THE LOST OEDIPAL STAGE OF HUMBERT HUMBERT IN NOBOKO'S LOLITA

This paper analyses the lost oedipal stage of Humbert in Vladimir Nabokov’s Lolita. It aims to discover the main character’s motivation behind his sexual disorder and the inner conflicts of his psyche, in response to Humbert not experiencing the oedipal stage in his early years. The oedipal stage is a crucial development stage of a human being, and Humbert’s inexperience causes him to be unable to express his desires as an infant boy towards his mother resulting in his psyche developing abnormally. Humbert is considered a hebephiliac for his sexual attraction towards young girls due to the loss of maternal figure at the age of three. Thus, psychoanalysis theory by Sigmund Freud is used in order to analyse the impact of Humbert’s lost oedipal stage to his adult psyche by applying the tripartite theory. The data are collected using qualitative descriptive method, represented in direct quotes from the book. The paper reveals that Humbert’s lost oedipal stage holds a vital role in developing his sexuality in adult life. He only received a strong affection and love when he was thirteen, from Annabel that aged no older than fourteen. He has been holding on to the moment, in which he was able to express his desires as his id, and is unable to let it go even after Annabel’s decease, as his id was not fully fulfilled. This causes him a traumatic experience, leading to his sexual disorder which is developed further once he met Dolores Haze as Lolita.

Effect of prenatal phthalate exposure on the association of maternal hormone levels during early pregnancy and reproductive markers in infants at the age of 3 months

Phthalates belong to the endocrine-disrupting chemicals, altering the hormonal balance in humans during pregnancy with further effects on the reproductive system. This study aimed to investigate the associations between maternal hormone levels during early pregnancy (≤15th week of pregnancy) and reproductive markers in infant boys (n = 37; 61.67 %; average age 3.51 ± 0.73 months) and girls (n = 23; 38.33 %; average age 3.30 ± 0.33 months) concerning prenatal exposure to phthalates. We used high-performance liquid chromatography, tandem mass spectrometry (HPLC-MS/MS), and electro-chemiluminescence immunoassay to quantify urinary concentrations of phthalates and serum concentrations of hormones, respectively. In Mother-Infant Study Cohort (PRENATAL), we observed positive and negative correlations between infants' reproductive markers and phthalate metabolites (p ≤ 0.05). Next, we noticed associations between the penile length and maternal testosterone (β = 0.464) and estradiol levels (β = −0.365) with increasing significance after adjustment to maternal mono-n-butyl phthalate (MnBP) and monobenzyl phthalate (MBzP) (p ≤ 0.05). We observed a positive association (β = 0.337) between penile width and maternal testosterone with increasing significance after adjustment to maternal mono-iso-butyl phthalate (MiBP) (p ≤ 0.05). In a group of girls, we reported a negative association between ACD/AFD ratio and maternal follicle-stimulating hormone (FSH) and estradiol levels with increasing significance after adjustment to maternal monoethyl phthalate (MEP), MnBP, and mono(hydroxy-iso-butyl) phthalate (OH-MiBP). Our results highlight that prenatal phthalate exposure may modulate the effects of maternal hormone levels during early pregnancy on infants' reproductive markers.

Endovascular Treatment of Intracranial Pial Arteriovenous Fistula in Paediatric Patient

Pial arteriovenous fistula (AVFs) are a rare, although clinically significant, vascular anomaly affecting the pediatric population, consisting of a high-flow connection between one or more pial arteries and the venous. In children, the clinical presentation varies according to age, can present with high output cardiac failure, macrocrania, neurodevelopmental delay, seizures, venous infarctions due to venous stenosis or hemorrhage secondary to venous thrombosis. The treatment, is a multimodal approach, most commonly endovascular, is effective in the obliteration of AVF. A case is presented of a previously healthy infant boy with neurological deficit arising from pAVF of the middle and posterior cerebral artery. The pAVF was successfully treated with endovascular occlusion.

Retractable foreskin reduces urinary tract infections in infant boys with vesicoureteral reflux

Uncircumcised males are at higher risk of urinary tract infection (UTI) in the first year of life and circumcision is recommended as an option for males with vesicoureteral reflux (VUR). Uncircumcised males treated successfully with topical corticosteroid cream have decreased risk of UTI but the role of preputial management has not been explored previously in males with VUR. We hypothesized that among uncircumcised boys with VUR, those with retractable foreskin would be at reduced risk of UTI compared to those with non-retractable foreskin. Males less than one year of age with primary VUR were prospectively enrolled. Patients with concomitant urologic diagnoses or less than one month of follow-up were excluded. Phimosis severity was graded on a 0-5 scale. Primary outcome was UTI during follow-up. Patients were divided into three groups for analysis: circumcised, low grade phimosis (grades 0-3) and high grade phimosis (grades 4-5). Multivariable Cox proportional hazards regression was used to estimate UTI risk adjusting for risk factors. One-hundred and five boys (24 circumcised and 81 uncircumcised) with VUR were included. Median age at enrollment was 4.4 months (IQR 2.2-6.6) and median follow-up was 1.1 years (IQR 0.53-2.9). Males with phimosis grades 4-5 had a higher UTI rate (29%) compared to phimosis grade 0-3 (4%). Based on Kaplan-Meier curves, boys with initial phimosis grades 4-5 were significantly more likely to develop a UTI than boys who were circumcised or had phimosis grades 0-3 (p=0.005). On multivariable analysis, boys with phimosis grades 4-5 were significantly more likely to develop UTI when compared to boys with grades 0-3 phimosis (HR=8.4, 95% CI: 1.1-64, p=0.04). Males with a retractable prepuce had a lower UTI risk compared to males with non-retractable prepuce (high grade phimosis) and this remained significant on multivariable analysis. This is concordant with prior studies demonstrating that a retractable prepuce is associated with decreased UTI risk. Limitations of our study include using phimosis grade at time of study enrollment and heterogenous prophylactic antibiotic use in our population. Retractable foreskin reduces UTI risk in uncircumcised boys less than one year of age with VUR. Medical phimosis treatment to achieve a retractable prepuce offers an alternative and less invasive modality to reduce UTI risk in males with VUR.