Stressful encounters within the neonatal or early infant period are harmful both acutely and longitudinally. Prior research on stress exposure in hospitalised infants excludes infants with CHD, limiting our understanding of stress exposure in this uniquely vulnerable population. This study aimed to identify and describe sources of stress, stress cues, stress responses, and clinical implications in neonates and infants undergoing cardiac surgery. Conducted at tertiary cardiac centres, 17 expert clinicians in nursing, anaesthesia, surgery, and intensive care medicine were included. Participants represented two care areas (cardiac intensive care unit, operating room) and three phases of care (preoperative, operative, postoperative). Using individual semi-structured interviews informed by Selye’s General Adaptation Syndrome, clinicians were asked about their perceptions of sources of infant stress within each phase of care and signs or cues of overwhelming stress or of stress tolerance. Utilising semantic content analysis, responses were analysed thematically and by frequency. Seven themes were identified involving sources of infant stress (Clinical Environment, Operative Stress, Disrupted Bonding, Cardiac Physiology), and clinician recognition and response to infant stress (Cognitive Integration, Infant Protection, Balance of Care). Perceived sources of infant stress were identified and together describe infant stress burden related to cardiac surgery. This study highlights the concept of infant stress specific to cardiac surgical intervention and offers a foundation to recognise and address infant stress as part of comprehensive cardiac care. The results may inform future research evaluating stress exposure and determining whether stress reduction strategies can improve outcomes in this high-risk population.

Se is an important micronutrient that plays a key role in brain development. Only a few studies have explored the associations between prenatal maternal Se concentration and motor development in early infancy. We have previously described that 36 % of pregnant Nepalese women had Se concentration below the cut-off of 71·1 µg/l in early pregnancy. In the current cohort study, we aimed to describe the association between maternal plasma Se concentration and infant motor development measured at 8–12 weeks of age. From a cohort of 800 Nepalese mother–infant pairs, we included 711 dyads with available data on maternal Se concentration and motor development scores. Maternal Se concentration was measured in plasma samples collected within 15 weeks of gestation using inductively coupled plasma MS. Motor development was measured by the Test of Infant Motor Performance (TIMP). We examined the association between Se concentration and the TIMP scores in regression models adjusted for age of the mother and socioeconomic status. There was no association between maternal Se concentration and the TIMP scores (coefficient for the total TIMP score: −0·035 (95 % CI: −0·105, 0·036). In conclusion, even though a considerable proportion of the women had Se concentration below the cut-off of 71·1 µg/l, there was no association between maternal Se concentration and early motor development in their infants. Our findings do not support Se supplementation during pregnancy to enhance early infant motor development. However, Se may still be essential for other aspects of maternal and infant health.

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.