Agricultural pesticide exposures in Ecuador and their spatial association with low birth weight: a combined cluster detection and Bayesian modelling approach.

Modifiable risk factors associated with diarrhoea and acute respiratory infection among children in high-burden low- and middle-income countries.

Neonatal sepsis is a leading cause of morbidity and mortality worldwide and is often complicated by myocardial dysfunction. While left ventricular (LV) impairment has been widely described, right ventricular (RV) dysfunction remains underrecognized. Tricuspid annular plane systolic excursion (TAPSE) is a simple, reproducible echocardiographic parameter to assess RV systolic function. This study aimed to evaluate the association between neonatal sepsis and ventricular dysfunction, focusing on right-sided heart failure indicated by reduced TAPSE. This study design is an observational-analytic with a cross-sectional design involved all infants aged 1-28 days that were admitted into NICU wards between May-June 2023. There were 53 infants included and were divided into two main groups: those with sepsis and those without. Each group was further stratified into two sub-groups based on birth weight: (1) sepsis with BW <1500 g, (2) sepsis with BW ≥ 1500 g, (3) no sepsis with BW < 1500 g, and (4) no sepsis with BW ≥ 1500 g. No significant differences were observed in LV systolic or diastolic parameters between septic and non-septic groups (Tei index p=0.69, EF p=0.65, FS p=0.77, MAPSE p=0.78). However, TAPSE was significantly lower in septic neonates (median 0.8 cm) compared to non-septic infants (median 0.9 cm, p=0.03), particularly among those with low birth weight. Neonatal sepsis is associated with RV systolic dysfunction, while LV function remains preserved. Reduced TAPSE may reflect early right-sided heart failure secondary to sepsis-induced pulmonary and myocardial injury, supporting TAPSE as a valuable tool for early detection and monitoring.

The role of public health interventions in modifying associations between prenatal exposures to ambient air pollution and extreme heat with child health outcomes: A systematic review.

Volatile organic compounds exposure and all health outcomes: An umbrella review and evidence map.

Association of prenatal exposure to criteria air pollutants and traffic-related air toxics with adverse birth outcomes: A population-based cohort study in California (1990-2021).

Adverse maternal and neonatal outcomes in extremely young mothers (≤ 17 years) versus women aged 20-35 years: a retrospective cohort study in Thailand.

Although VACTERL association is a recognized entity in patients with esophageal atresia (EA), its impact on surgical outcomes remains unclear. This study aimed to evaluate the influence of VACTERL association and chromosomal anomalies (VACTERL-CA) on the surgical outcomes of EA patients, offering novel insights into risk stratification. All patients enrolled in the European Pediatric Surgeons' Association (EUPSA) Esophageal Atresia Registry (EAR) between July 2014 and December 2017 were included. Patients were classified into two groups: those with VACTERL-CA and those without these anomalies (non-VACTERL). Groups were compared for demographics, associated malformations, surgical approach, complications, and outcomes. Among 372 patients, 22% (n = 82) were classified as VACTERL-CA. This group had significantly lower gestational age (35.9 weeks vs. 37.1 weeks, p = 0.004), birth weight (2,312 g vs. 2,663 g, p < 0.001), and APGAR scores at 5 and 10 minutes (p = 0.005). Surgical strategies, including rates of primary anastomosis (88% in both groups), did not differ. Anastomotic leak and stricture rates were similar; however, recurrent fistula was more common in VACTERL-CA (4.9% vs. 1.0%, p = 0.023). Overall mortality was higher in VACTERL-CA (14.6% vs. 5.2%, p = 0.003), largely due to associated anomalies such as cardiac or neurologic conditions, whereas EA-related mortality was more frequent in non-VACTERL (1% vs. 0%). Sepsis was also more frequent in VACTERL-CA (10.9% vs. 4.5%, p = 0.033). In multivariate analysis, low birth weight (adjusted odds ratios [aOR]: 0.95 per 100 g, p = 0.010) and cardiac malformations (aOR: 2.33, p = 0.002) were independently associated with VACTERL-CA. EA patients with VACTERL-CA represent a high-risk subgroup characterized by prematurity, major cardiac defects, and increased sepsis risk. These findings highlight the need for early cardiac screening, standardized infection-prevention bundles, and tailored multidisciplinary care to improve survival and reduce preventable complications.

Maternal and fetal outcomes of pregnancy-associated malignancy: A single-center retrospective cohort study.

Investigation and control of a meticillin-resistant Staphylococcus aureus (MRSA) outbreak in a Level 2 neonatal unit in England: findings from a cohort study.

Restrictive immigration policies limit maternity care access and exacerbate poverty and isolation among migrant women. In the UK, many migrant women face No Recourse to Public Funds (NRPF), restricting welfare access and making them liable for maternity care charges. Population-level evidence on perinatal outcomes remains limited. To examine perinatal outcomes among migrant women with NRPF compared with UK-born women, migrants with recourse to public funds, and migrants with unknown visa status in an ethnically diverse urban UK population. We conducted a retrospective analysis of linked maternity and neonatal electronic health records (eLIXIR -Born In South London) from 2018 to 2023, including 44,634 pregnancies. Multivariable regression estimated adjusted risk ratios (aRR) controlling for sociodemographic and clinical characteristics. Migrant women with NRPF had higher risks of adverse maternal outcomes (emergency caesarean aRR 1.74, 95% CI 1.55-1.95; severe maternal morbidity 1.49, 1.33-1.67). Their infants were more likely to have low Apgar scores (1.53, 1.07-2.16) and less likely to receive skin-to-skin contact (0.92, 0.88-0.97). Infants of women with NRPF did not show higher risk of neonatal death (1.44, 0.85-2.29), whereas infants of women with unknown visa status had the highest risks of preterm birth (1.24, 1.13-1.35), low birthweight (1.28, 1.17-1.39), and neonatal death (2.27, 1.81-2.86). Migrant women with NRPF and infants of women with unknown visa status face disproportionate risks of adverse outcomes. Addressing these inequities requires inclusive maternity care, accurate migration data collection, and reconsideration of NRPF and charging policies.

Chronic hypertensive disorders in pregnancy are associated with adverse maternal and perinatal outcomes. Hemodynamic-guided management has been proposed to optimize antihypertensive therapy. This study evaluates outcomes before and after the introduction of the USCOM® device - a non-invasive hemodynamic monitor - into clinical practice for tailoring antihypertensive treatment. A retrospective, monocentric descriptive study was conducted at the AOU Policlinic of Modena. USCOM® was implemented in March 2022. The control group included 22 pregnant individuals with chronic hypertensive disorder (HD) from 2021, while the USCOM group included 46 individuals from 2023 who received USCOM® hemodynamic monitoring to tailor antihypertensive therapy. Patients with missing delivery data or gestational hypertension were excluded. Maternal and neonatal outcomes were collected retrospectively from electronic medical records and analyzed using SPSS v.28. Continuous variables were presented as means with standard deviations, and categorical variables as counts and percentages. No significant differences in maternal characteristics were observed between groups. The USCOM group showed a significantly lower incidence of low-birthweight (<2500 g) newborns (6.5% vs. 36.4%; P=0.004) and longer gestational age (38.9 vs. 37.4 weeks; P=0.049). Although not statistically significant, trends indicated fewer extremely preterm births (<34 weeks; P=0.096) and lower Neonatal Intensive Care Unit (NICU) admissions (P=0.096). Multivariate analysis confirmed USCOM® evaluation as the only significant factor reducing the risk of low birth weight (adjusted odds ratio [aOR] 0.118, P=0.004), adjusted for parity, ethnicity, and prepregnancy Body Mass Index (BMI). While larger studies are needed to confirm these findings, the implementation of USCOM® in routine clinical practice may contribute to improved neonatal outcomes in pregnancies complicated by chronic hypertensive disorders.

A case report of Coffin-Siris syndrome and autism spectrum disorder in an extremely low birth weight infant with de novo ARID1B nonsense variant: The role of genetic analysis

Neonatal Sepsis from 2014-2024: The Resurgence of Gram-Negative Rods.

Site-Level fine-tuning with progressive layer freezing: Towards robust prediction of bronchopulmonary dysplasia from day-1 chest radiographs in extremely preterm infants

Maternal undernutrition and micronutrient deficiencies remain pervasive, contributing to adverse pregnancy outcomes and long-term health risks for mothers and offspring. Multiple micronutrient supplementation (MMS) during pregnancy has demonstrated benefits, including reduced risks of low birth weight, small-for-gestational-age births, and neonatal mortality, when compared with standard iron-folic acid supplementation. Current MMS strategies, however, often follow a standard MMS, overlooking variations in nutritional status, health profiles, and context. Advances in artificial intelligence (AI), particularly deep learning and natural language processing, provide opportunities to strengthen maternal nutrition programs by integrating diverse data sources. Rather than promising fully individualized recommendations, AI could help stratify women by risk of insufficiencies or deficiencies, highlight groups most likely to benefit from additional support, and inform the design of more responsive supplementation strategies during preconception and pregnancy. We outline a conceptual model in which multimodal health data-including electronic health records (EHRs), wearable sensor outputs, nutrition and fertility app logs, genomic markers, and sociodemographic information-are aggregated and analyzed by AI systems to inform personalized MMS plans. The framework introduces the concept of a "nutritional digital twin," a virtual profile of the patient's nutritional and metabolic state. This digital twin can simulate micronutrient needs and predict maternal-fetal outcomes under different supplementation scenarios, enabling clinicians to test scenario-based options (e.g. standard MMS ± targeted add-ons) for individuals. We describe how deep learning models can identify complex patterns (e.g. diet-genome interactions or behavioral trends) while natural language processing (NLP) algorithms extract clinically relevant insights from unstructured data (such as medical notes or patient queries). In addition, we discuss the role of digital maternal health tools, such as mobile apps and wearable trackers, in supplying real-time data to the AI models and in engaging women to improve adherence to supplementation regimens. Harnessing AI for MMS could transform maternal nutrition care in both high- and low-resource settings. In high-income contexts, rich data (comprehensive EHRs, genetic tests, continuous monitoring devices) could feed advanced predictive models to support risk-stratified care with protocolized supplementation options, under clinical oversight. In low- and middle-income countries, where maternal undernutrition and micronutrient gaps are most prevalent, AI-driven approaches can help stratify risk groups and optimize limited resources. Ubiquitous mobile phone access and digital health tools in many such settings provide avenues for data collection and intervention delivery. We highlight examples where machine learning on population data revealed "hidden hunger" patterns and key predictors of low supplement uptake (e.g. low education, minimal antenatal visits)-insights that policymakers can use to target nutrition programs. A nutritional digital twin could further allow scenario-testing (e.g. predicting the impact of adding a vitamin D supplement for a specific patient) before clinical decisions are made. To realize this vision, the key concerns are ethics, credibility, and fairness. Ethical frameworks must guide development so that sensitive reproductive health data are protected and clinician oversight remains central. The credibility of AI-generated recommendations depends on transparency about the assumptions used to translate nutritional and health data into supplement type and dose, and on prospective validation against maternal and neonatal outcomes. This requires a continuous feedback loop in which recommendations are tested in real-world settings and recalibrated using outcomes data, ensuring that the system learns from observed benefits and harms, rather than relying solely on theoretical modeling. Fairness demands that training data sets represent diverse populations and that solutions are tailored to local contexts to reduce bias and avoid widening disparities. Critically, the approach must be fed by data streams that extend beyond initial demographics and clinical baselines to include biomarkers, adherence patterns, and pregnancy outcomes, so that the models can be refined and dosing rules adjusted over time. If these safeguards are embedded, AI-enhanced personalized MMS can move beyond proof of concept towards a credible, equitable, and empirically grounded contribution to global maternal health. AI-driven personalized nutrition support represents a frontier in obstetric care. By combining clinical knowledge with data-driven intelligence, we can move beyond generalized prenatal supplements towards precision maternal nutrition. The integration of deep learning models and digital health innovations into antenatal care pathways has the potential to better nourish pregnancies, save lives, and ensure healthier futures for mothers and children worldwide.

Schizophrenia and autism share neurobiological mechanisms and overlapping clinical features, often resulting in the emergence of autistic traits in early stages of psychosis. The PANSS Autism Severity Score (PAUSS) provides a rapid measure of autistic features within the standard PANSS assessment. We aimed to determine the prevalence of autistic features in first-episode psychosis (FEP), characterise their clinical, cognitive, and functional profile, and examine their impact on 2-year outcomes. A total of 328 FEP patients were included from the PEPs multicentre cohort, followed for 2 years. Autistic features were rated using PAUSS (cut-off ≥ 30), yielding autistic (n = 38) and non-autistic (n = 290) groups. Sociodemographic, clinical, cognitive, and functional variables were analysed. Longitudinal analyses examined symptomatic remission rates and trajectories of psychopathology and functioning using logistic regression and mixed-model ANOVA. The autistic group represented 11.6% of the sample. At baseline, they exhibited lower birth weight, greater medication side effects, higher general psychopathology and depressive severity, and poorer global functioning. Cognitively, they showed significant deficits in working memory, social cognition, and cognitive reserve compared to the non-autistic group. Over 2 years, this group was 3.6 times less likely to achieve symptomatic remission and consistently exhibited higher symptom severity and lower functioning across all follow-ups. Autistic features in FEP identify a subgroup with a possible distinct profile of neurodevelopmental markers, greater cognitive and functional impairments, and poorer clinical outcomes. Early identification may guide more personalised interventions, although further research is needed to refine PAUSS specificity and develop targeted, tailored treatments.

Outcomes in pregnant women diagnosed with preeclampsia with and without fetal growth restriction at high altitude: A cross-sectional study.

In this nationwide study from Germany, transcatheter PDA closure was performed in approximately one-third of preterm infants, whereas surgical closure remained the predominant approach, particularly in smaller and more immature infants. The high incidence of adverse events following both methods-TCPC and surgical closure-warrants close ongoing surveillance. Substantial off-label use of paracetamol reflects evolving medical practice. • PDA in PIs remains a common clinical challenge, with a wide range of treatment strategies across NICUs. • New transcatheter PDA closure (TCPC) devices have recently been approved for use in preterm infants weighing > 700g, expanding interventional options in this vulnerable population. • Surgical PDA closure seems to be still the preferred PDA treatment option in Germany especially in more immature infants. • Overall safety demonstrated no meaningful difference between TCPC and surgical PDA closure.

To compare the clinical manifestations and associated characteristics of congenital tuberculosis (CTB) and non-congenital tuberculosis (NCTB) in infants, thereby improving early recognition and enabling precision treatment. A retrospective analysis was conducted of 72 tuberculosis cases in infants aged ≤ 1 year admitted to Kunming Children's Hospital between 2014 and 2024. Given the inherent difficulty in distinguishing congenital from early postnatal acquisition in retrospective studies, patients were classified into a CTB group (n = 23) and an NCTB group (n = 49) using modified Cantwell-based criteria. Differences in perinatal factors, clinical symptoms, laboratory and imaging findings, microbiological/immunological test results, treatment strategies, and outcomes were compared between groups. The CTB group had a significantly earlier onset of disease (17 days vs. 173 days) and a higher prevalence of prematurity (56.5% vs. 14.3%), cesarean delivery (43.5% vs. 18.4%), and low birth weight (2.33kg vs. 3.00kg). No statistically significant differences were observed between groups in fever or cough. However, cyanosis (17.4% vs. 0%), dyspnea (73.9% vs. 40.8%), and jaundice (13.0% vs. 0%) were more frequent in the CTB group. Imaging findings revealed that CTB was more strongly associated with miliary patterns (65.2% vs. 32.7%), pleural effusion (52.2% vs. 20.4%), and hepatosplenic abnormalities (hepatosplenomegaly and nodular hypodense lesions). The CTB group exhibited a more pronounced inflammatory response, with higher WBC/NEU/CRP levels, lower albumin, and elevated bilirubin and urea. Serum IgM and IgA levels were significantly reduced in CTB. The TB-DNA positivity rate was higher in the CTB group (68.2% vs. 41.7%), whereas the IGRA positivity rate was lower (55.0% vs. 89.7%). Compared with NCTB, CTB was associated with substantially higher rates of mechanical ventilation (52.2% vs. 6.1%), ICU admission (56.5% vs. 30.6%), and longer hospitalization (27 days vs. 12 days), as well as a higher incidence of drug-induced liver injury (65.2% vs. 26.5%). No statistically significant differences were found between groups in mortality or treatment discontinuation. CTB presents earlier in infancy and is characterized by greater dissemination and disease severity, frequently complicated by respiratory-circulatory failure and hepatosplenic involvement. Molecular testing (TB-DNA) is more likely to be positive, whereas immunologic assays (IGRA) are more likely to be negative. However, given the retrospective design and the inherent difficulty in definitively distinguishing congenital from early postnatal infection, these findings should be considered hypothesis-generating. Enhanced screening of high-risk neonates in the perinatal period, combined with molecular diagnostics and multisystem imaging assessment, may facilitate early identification, guide clinical management, and support vigilant monitoring of liver function. Not applicable.