Pericardial cysts are rare, benign congenital cardiovascular malformations that account for approximately 7% of mediastinal masses. Epicardial cysts attached to the cardiac surface with intimate coronary artery involvement are even rarer and pose significant diagnostic and surgical challenges. This case highlights a giant pericardial cyst with intimate right coronary artery involvement in a 10-month-old infant, where subtotal resection was necessary to preserve coronary integrity. A 10-month-old male infant with a pericardial cyst initially detected at 27 weeks of gestation presented with progressive compression of right heart chambers. Imaging revealed a large multiloculated cystic mass (5.3 × 3.5 × 3.9 cm) compressing the right atrium and right ventricle, with associated pulmonary valve stenosis. Intraoperatively, the cyst was found on the epicardial surface with intimate involvement of the right coronary artery. Complete excision was not feasible due to the risk of coronary injury. The main cystic mass was excised with cavity obliteration, while the portion adjacent to the right coronary artery was intentionally preserved. Concurrent pulmonary valve commissurotomy and pulmonary artery augmentation were performed. Histopathology confirmed a mesothelial-lined pericardial cyst. The patient recovered uneventfully and was discharged. This case underscores the importance of comprehensive preoperative coronary artery assessment in pericardial cysts with atypical locations. When complete excision risks vital structure injury, subtotal resection with cavity obliteration represents a safe alternative strategy.

Pulmonary valve or main pulmonary artery infective endocarditis is rare in children and is associated with high morbidity and mortality. Fungal infective endocarditis, most commonly caused by Candida species, is particularly aggressive and often requires a combination of antifungal therapy and surgical intervention. We report two infants who developed Candida endocarditis following pulmonary artery banding.

In the first case, a female infant developed persistent candidemia after pulmonary artery banding, with echocardiography revealing a mobile mass at the pulmonary bifurcation and computed tomography angiography demonstrating a mycotic pseudoaneurysm. Blood cultures confirmed Candida albicans. She underwent debanding and main pulmonary artery reconstruction, later requiring pacemaker implantation, and recovered without relapse. In the second case, a female infant presented with fever and candidaemia after pulmonary artery banding. Echocardiography identified a distal main pulmonary artery vegetation, and cultures grew Candida parapsilosis. She received amphotericin B–based induction therapy followed by fluconazole step-down after surgical source control, achieving clinical cure at follow-up.

These cases highlight the diagnostic and therapeutic challenges of Candida endocarditis after right-sided palliation. Early multimodality imaging, species-directed antifungal therapy, and timely surgery are critical to optimise outcomes in this rare but life-threatening complication.

Effectiveness of nirsevimab against respiratory syncytial virus (RSV) hospitalization during the 2024/2025 season in Spain was estimated using a test-negative design (TND) and hospital-based respiratory infections surveillance data. Children born between 1 April 2024 and 31 March 2025 and hospitalized with severe respiratory infection between the start of the 2024 immunization campaign (regionally variable, between 16 September and 1 October 2024) and 31 March 2025 were systematically RT-PCR RSV-tested within 10 days of symptom onset and classified as cases if positive or controls if negative. Nirsevimab effectiveness ((1 − odds ratio) × 100) was estimated using logistic regression, adjusted for admission week, age, sex, high-risk factors, and regional RSV hospitalization rate. We included 199 cases (68.8% immunized) and 360 controls (86.4% immunized). Overall effectiveness was 65.5% (95% confidence interval: 45.2 to 78.3). Effectiveness was similar among infants born before and after the campaign start (63.6% vs. 70.4%, respectively). We found an unexpected early decrease in effectiveness with increasing time since immunization and age, albeit with wide confidence intervals for some groups. Strong age–period–cohort effects and potential sources of bias were identified, highlighting the need to further explore methodological challenges of implementing the TND in the dynamic population of newborns.

Superior vena cava obstruction following paediatric cardiac surgery is a rare yet serious complication. After arterial switch operations, four neonates diagnosed with acute superior vena cava thrombosis were treated using transcatheter interventions. The importance of early recognition and implementation of transcatheter intervention for a successful outcome is emphasised.

Pregnant women are exposed to various contaminants through foods, with environmental toxicants and aflatoxin (AF) being among the major food contaminants. Therefore, this review was conducted for a better perspective on the AF exposure during pregnancy or infancy, highlighting how exposure through the mother (via placenta and breast milk) and directly through infant foods ultimately affects infant health. The literature suggests that AF exposure during pregnancy may lead to maternal anaemia, premature delivery, pregnancy loss or decreased number of live births. AF crosses through the placenta and also passes through breast milk. AF exposure during pregnancy may also lead to deleterious effects on the fetus or infants such as reduced fetal growth, low birth weight, impairment of linear or long bone growth and developmental delay such as small head circumference and reduced brain size, stillbirth or fetal death. It may also have an adverse effect on some organs and organ systems, causing aberrations such as neonatal jaundice and disrupting hormone synthesis. In the Indian context, there are limited clinical studies to assess the health effects of AF exposure during pregnancy. For the first time, we have made an attempt to estimate the AF exposure by calculating the AF estimated daily intake using the empirical formulae based on several reported studies. However, more research needs to be undertaken to understand the AF exposure outcomes during pregnancy. The data presented in this review warrant more clinical studies in India on maternal AF exposure to elucidate the birth outcomes and associated infant health outcomes.

This cross-sectional study evaluated the nutritional composition and labelling of commercial foods in Canada targeted to infants up to 18 months of age. Front-of-package labelling requirements were assessed based on daily values identified by Health Canada for saturated fatty acids, sugars, and sodium for children aged one year and older. Infant commercial food products were identified from online and in-person records of retailers across Canada. A total of 1,010 products were identified. Products aimed at older infants (12–18 months) contained significantly more calories, macronutrients, sugars, saturated fat, and trans fat compared to those targeted at younger infants (<12 months). In addition, 40% of products for children aged 12–18 months required a ‘high in sugar’ front-of-package label, while less required a ‘high in saturated fats’ (13%) and ‘high in sodium’ (5%) label. Organic products had higher added sugar and fibre, while they were lower in calories, total fat, saturated fat, and protein. Plant-based products, including vegetarian/vegan products, contained fewer calories, fat, saturated fat, trans fat, and protein, but more fibre. Gluten-containing products had more calories, macronutrients, sugar, fibre, and saturated fat. Non-GMO labelled products had more calories, carbohydrates, and sugar, but less saturated fat. Significant differences were observed for vitamins and minerals across food categories (p < 0.05). Our findings offer valuable guidance for parents, caregivers, and healthcare professionals on infant nutrition, highlighting the importance of selecting foods that align with infants’ specific dietary needs.

This study examines how infant temperament, particularly fear, influences physiological improvements in infants following maternal postpartum depression (PPD) treatment. Forty infants of birthing parents with major depressive disorder and 40 healthy controls were recruited. Parents with PPD participated in a nine-week cognitive-behavioral therapy intervention. Infant emotion regulation was assessed using high-frequency heart-rate variability (HF-HRV) and frontal alpha asymmetry (FAA) at baseline (T1), immediately post-treatment (T2), and three months later (T3). Birthing parents also reported on their infant’s temperamental fear using the Infant Behavior Questionnaire-Revised Short-Form at these times. A significant increase in HF-HRV was observed immediately after treatment in the PPD group which persisted at T3. While no Group × Visit × Fear interaction emerged from repeated measure models, follow-up regression analyses within the PPD group revealed that higher baseline fear was associated with smaller increases in HF-HRV from T1 to T2 or T3. Although FAA shifted leftward over time, fear did not significantly predict FAA changes. No associations between fear and physiology were observed in the control group. The study suggests that infant fear may reduce the physiological benefits of maternal PPD treatment for infants, underscoring the importance of considering infant characteristics when assessing the impact of maternal PPD interventions.

The transition from breastmilk to solid foods (weaning) is a critical stage in infant development and plays a decisive role in the maturation of the complex microbial community inhabiting the human colon. Diet is a major factor shaping the colonic microbiota, which ferments nutrients reaching the colon unabsorbed by the host to produce a variety of microbial metabolites influencing host physiology(1). Therefore, making adequate dietary choices during weaning can positively modulate the colonic microbiota, ultimately contributing to health in infancy and later life(2). However, our understanding of how complementary foods impact the colonic microbiota of weaning infants is limited. To address this knowledge gap, we employed a metagenome-scale modelling approach to simulate the impact of complementary foods, either combined with breastmilk or with breastmilk and other foods, on the production of organic acids by colonic microbes of weaning infants(3). Complementary foods and combinations of foods with the greatest impact on the in silico microbial production of organic acids were identified. These foods and food combinations were further tested in vitro, individually or in combination with infant formula. Fifty-three food samples were digested using a protocol adapted from INFOGEST to mimic infant digestion and then fermented with faecal inoculum from 6 New Zealand infants (5-11 months old). After 24h of fermentation, the production of organic acids was measured by gas chromatography. Differences in organic acid production between samples were determined using the Tukey Honestly Significant Difference test to account for multiple comparisons. The microbial composition was characterised by amplicon sequencing of the V3-V4 regions of the 16S bacterial gene. Taxonomy was assigned using the DADA2 pipeline and the SILVA database (version 138.1). Bioinformatic and statistical analyses were conducted using the R packages phyloseq and ANCOM-BC2, with the Holm-Bonferroni adjustment to account for false discovery rates in differential abundance testing. Blackcurrant and raspberries increased the production of acetate and propionate (Tukey’s test, p<0.05) and the relative abundance of the genus Parabacteroides (Dunnett’s test, adjusted p<0.05) compared to other foods. Raspberries also increased the abundance of the genus Eubacterium (Dunnett’s test, adjusted p<0.05). When combined with infant formula, black beans stood out for increasing the production of butyrate (Tukey’s test, p<0.05) and the relative abundance of the genus Clostridium (Dunnett’s test, adjusted p<0.05). In conclusion, this study provides new evidence on how complementary foods, both individually or in combination with other dietary compounds, influence the colonic microbiota of weaning infants in vitro. Insights generated by this research can help design future clinical trials, ultimately enhancing our understanding of the relationship between human nutrition and colonic microbiota composition and function in post-weaning life.

Poor iron status is one of the most prevalent problems facing infants worldwide, in both developing and developed countries(1). A complex interplay of both dietary and non-dietary factors affects iron intake, absorption, and requirements, and subsequently iron status(2). We aimed to describe iron status in an ethnically diverse cohort of urban-dwelling infants. Data were collected from 364 infants aged 7.0 to 10.0 months living in two main urban centres in New Zealand (Auckland and Dunedin) between July 2020 and February 2022. Participants were grouped by total ethnicity, with any participants who did not identify as either Māori or Pacific categorised into a single ‘others’ group. Haemoglobin, plasma ferritin, soluble transferrin receptor (sTfR), C-Reactive protein, and alpha-1-acid-glycoprotein were obtained from a non-fasting venous blood sample. Inflammation was adjusted for using the Biomarkers Reflecting Inflammation and Nutritional Determinants of Anaemia (BRINDA) method(3). Body iron concentration (mg/kg body weight) was calculated using the ratio of sTfR and ferritin. A total of 96.3% of Pacific infants were iron sufficient, defined as body iron ≥0 mg/kg body weight and haemoglobin (Hb) ≥105 g/L, compared to 82.3% of Māori and 76.0% of ‘other’ (i.e. neither Māori nor Pacific) infants. ‘Other’ infants had the highest prevalence of iron deficiency overall, with 2.8% categorised with iron-deficiency anaemia (IDA) (body iron <0 mg/kg, haemoglobin <105 g/L), 11.8% with early ‘functional’ iron deficiency (body iron <0 mg/kg, haemoglobin ≥105 g/L), and 9.4% with iron depletion (ferritin <15 µg/L, in the absence of early ‘functional’ iron deficiency and iron deficiency anaemia). For Māori infants, 3.2% and 6.5% had IDA and early ‘functional’ iron deficiency respectively, and 8.1% were iron depleted. One (3.7%) Pacific infant was iron depleted, and the remainder were iron sufficient. Plasma ferritin and body iron concentration were, on average, higher in Pacific compared to non-Pacific infants. These findings give an up-to-date and robust understanding of the iron status of infants by ethnicity, highlighting an unexpected finding that infants who are neither Māori nor Pacific may be at higher risk of poor iron status in NZ.

Breastfeeding is the recommended way to feed infants. However, a safe and nutritious substitute for human milk is needed for infants when breastfeeding is not possible. As infants are a vulnerable population group, infant formula products are regulated by prescriptive provisions for composition and labelling. Any changes to the composition of these products must be established as safe prior to being permitted. As our knowledge of human milk expands, infant formula ingredients are developed to better replicate it. Food Standards Australia New Zealand (FSANZ) has assessed the addition of ingredients for the addition to infant formula products including human identical milk oligosaccharides (HiMOs) isolated using precision fermentation methodology. These ingredients are considered to be nutritive substances as their addition to food is intended to achieve specific nutritional purposes. In accordance with the Ministerial Policy Guidelines, FSANZ must assess both the safety and the health effect of nutritive substances for their use in infant formula. FSANZ risk assessments are undertaken by a multidisciplinary team covering toxicological and nutritional considerations using the best available scientific evidence. FSANZ assessments of the health effects concluded that the use of HiMOs in infant formula products would have a beneficial outcome for infants and align with the equivalent role of these substances in human milk(1,2). The weight of evidence supports health effects through an increase in the abundance of Bifidobacterium spp. in the infant gut microbiota, anti-pathogenic effects, inflammatory suppression and facilitation of appropriate immune responses and antigenic memory. FSANZ safety and technical assessments concluded that there are no public health and safety concerns associated with adding HiMOs to infant formula products(1, 2). The permitted levels are comparable to levels in human milk and are chemically and structurally identical to the naturally occurring forms. Food Standards Australia New Zealand, Canberra, 2606, Australia Based on the available evidence and intended purpose, a number of HiMOs have been permitted for use in infant formula products including 2′- fucosyllactose, lacto-N-neotetraose, difucosyllactose, lacto-N-tetraose, 3'-sialyllactose sodium salt, 6'-sialyllactose sodium salt. Evidence continues to emerge on the beneficial effects of HiMOs on infant health.

The Simulator of the Human Intestinal Microbial Ecosystem (SHIME) system was provided with baby feed for one week to stabilise the microbial community, followed by a 10-day period with baby feed and another 10-day period with adult feed. The study was conducted using sterilised and standardised feed formulations, which model dietary conditions in vitro. Following the transition from baby to adult feed, a significant reduction in the proportion of butyrate in comparison to total SCFA was found after transitioning to adult feed in both the transverse colon and distal colon bioreactors. Our findings suggest that abrupt early-life dietary changes from simple to complex carbohydrates as well as the exclusion of bovine milk proteins can transiently lower the ability of the microbiota to produce butyrate. The lack of additional microbial input leads to a delay or impairment of the adaptation to the modified feed composition. However, given the short treatment duration and sterilised feed composition, these findings should be interpreted within the limitations of this in vitro model. A reduction in butyrate concentration following the transition to adult feed may reflect a temporary shift in microbial metabolic activity rather than a long-term impact on energy extraction efficiency in vivo.

This study aimed to assess the impact of hypertensive disorders of pregnancy on infant neurodevelopment by comparing 6-month and 2-year psychomotor development outcomes of infants exposed to gestational hypertension (GH) or preeclampsia (PE) versus normotensive pregnancy (NTP). Participating infants were children of women enrolled in the Postpartum Physiology, Psychology and Paediatric (P4) cohort study who had NTPs, GH or PE. 6-month and 2-year Ages and Stages Questionnaires (ASQ-3) scores were categorised as passes or fails according to domain-specific values. For the 2-year Bayley Scales of Infant and Toddler Development (BSID-III) assessment, scores > 2 standard deviations below the mean in a domain were defined as developmental delay. Infants (n = 369, male = 190) exposed to PE (n = 75) versus GH (n = 20) and NTP (n = 274) were more likely to be born small for gestational age and premature. After adjustment, at 2 years, prematurity status was significantly associated with failing any domain of the ASQ-3 (p = 0.015), and maternal tertiary education with increased cognitive scores on the BSID-III (p = 0.013). However, PE and GH exposure were not associated with clinically significant risks of delayed infant neurodevelopment in this study. Larger, multicentre studies are required to further clarify early childhood neurodevelopmental outcomes following hypertensive pregnancies.

Se is particularly necessary in infants because of their rapid physical growth period in addition to being indispensable for neurodevelopment. Severe deficiency can lead to cardiomyopathy, hypothyroidism and faltering growth. However, Se can be toxic at high doses. In the paediatric age group, plasma/serum and erythrocyte Se levels seem to increase with age, except in the first year of life. Understanding the variability in Se status during this period can help to identify infants at risk of deficiency and develop strategies for controlling and preventing its consequences. This review aimed to identify the extent and characteristics of the variability of Se status during the first year of life. A search was conducted across five databases to find articles published until 30 July 2024, with no limitations on the language or date of publication. Articles were screened, data were extracted independently by two reviewers, and any disagreement was resolved by a third reviewer. A total of 22 studies comprising 1288 participants were included in this review, 21 of which assessed plasma/serum Se and 12 assessed erythrocyte Se. In the first 4 months of age, serum/plasma Se decreased, remained stable or increased depending on feeding, with an increase in supplemented formula-fed infants and breastfed infants of supplemented mothers. Erythrocyte Se levels showed a declining trend, except in infants fed supplemented formula or breastfed by supplemented mothers. Variability of serum/plasma and erythrocyte Se levels in the first year was associated with maternal Se intake/supplementation and the Se content of the infant’s diet.