Category: Paediatrics

Categories : PaediatricsTags :

Postnatal Collapse is Rare but Can Have Deleterious Consequences

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Photo by Duda Oliveira

Sudden unexpected postnatal collapse during the first week of life is rare but can have deleterious consequences. A new study from Karolinska Institutet shows that the condition is more common than previously estimated and highlights measures that may reduce the risk.

Sudden unexpected postnatal collapse (SUPC) occurs when an apparently healthy newborn suddenly stops breathing and collapses during the first week of life. In a new study, published in the journal Acta Paediatrica, researchers investigated how common the condition is and when it occurs. 

The researchers analysed approximately 483 000 births at seven maternity units in Stockholm between 2002 and 2022 and identified 149 cases of SUPC. This corresponds to 31 cases per 100 000 live births. 

“It is important to remember that this is a very rare condition. According to our findings, it affects around 30 infants each year in Sweden, and two to four of these cases lead to death. Most cases occur during the infant’s first day of life,” says the study’s senior author, Eric Herlenius, paediatrician at Karolinska University Hospital and Professor of Paediatrics at the Department of Women’s and Children’s Health, Karolinska Institutet. 

The study found that 81 per cent of collapses occurred during the first 24 hours after birth, with half taking place within four hours of delivery. Seven per cent of affected infants died and 26 per cent sustained permanent neurological injuries. Two-thirds of the cases occurred while the infant was sharing a bed with a parent.

“Skin-to-skin contact is important for newborn infants, but parents need to ensure that the baby’s airways are always clear and visible. Adults should not fall asleep while holding their baby skin to skin, and infants should not sleep in the same bed as their parents during the first three months of life,” says Eric Herlenius

The researchers point out that SUPC still lacks a specific diagnostic code, making the condition difficult to monitor. According to the researchers, this may have contributed to an underestimation of its true incidence. 

Reviewed medical records

To identify cases, the researchers reviewed electronic medical records of infants born after at least 35 weeks of pregnancy. The records were searched for symptoms suggestive of collapse, such as episodes of apnoea, bluish skin discolouration, or sudden loss of muscle tone. Each suspected case was then assessed according to internationally established criteria for SUPC.

Since 2011, the researchers have also collected urine samples from affected infants and compared them with samples from healthy infants of the same age. They found higher levels of a prostaglandin E2 metabolite in infants who experienced SUPC during the first days of life, the same period during which most collapses occurred

“We believe that clearer guidelines for safe skin-to-skin care and safe sleep environments are needed and could help reduce the number of cases further,” says Eric Herlenius. 

At the same time, the researchers aim to improve understanding of the biological mechanisms underlying the condition, including the elevated levels of prostaglandin E2 metabolite observed in some affected infants. By studying the relationship between these levels and the brainstem’s control of breathing, the researchers hope to gain a better understanding of why some newborns develop SUPC and, in some cases, sudden unexpected death. 

Source: Karolinska Institutet

Categories : Metabolic Disorders PaediatricsTags :

Link Between Parents’ and Children’s Weight is Mostly Genetic, Study Finds

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An analysis of 86 000 Norwegian children found that the association between parental and childhood body weight is largely explained by shared genetics

AI image created with Gencraft

The association between parents’ body mass index (BMI) and their children’s childhood BMI may be primarily due to genetic inheritance rather than to any direct biological effect of parental weight during pregnancy, according to a new study published June 23rdin the open access journal PLOS Medicine by Tom Bond of the University of Bristol, UK, and colleagues from the University of Queensland, Australia and more.

Higher parental BMI is consistently associated with higher childhood BMI. It has been difficult for researchers to disentangle how much of this association is due to genetics and how much is due to biological effects of maternal weight during pregnancy. This may have implications for interventions that aim to control childhood BMI by targeting pre-conception parental weight.

In the new study, researchers analysed data from the Norwegian Mother, Father and Child Cohort Study, a prospective birth cohort of children born between 1999 and 2009. Data on 86 000 children, including their birth weight and BMI from six months to eight years of age, as well as appetite-related eating behaviours at age eight, was available in the dataset. The researchers looked at twin, sibling, and half-sibling relationships across multiple generations to directly quantify how much of the parent-child BMI association could be attributed to genetic confounding.

Maternal BMI was more strongly associated with offspring birth weight than paternal BMI, consistent with an effect of maternal body weight on birthweight through the environment inside the uterus. However, after birth the associations of maternal and paternal BMI with offspring BMI were broadly similar from age two to eight. Models showed that genetic effects explained an estimated 79% of the statistical association between a mother’s BMI and her child’s BMI at age 8, and 94% of the association for fathers. Higher parental BMI was also associated with obesity-related eating behaviours in children, including greater food responsiveness and emotional overeating, although the study was not able to conclusively determine how much of this was genetically driven.

The authors caution that these findings do not support the idea that childhood obesity is inevitable for children of heavier parents. Children who inherit a genetic predisposition to higher BMI may still express those genes differently depending on their environment. The results also do not argue against the importance of maternal health in pregnancy, the authors say. Maternal obesity is well established to increase risk of adverse perinatal outcomes for both mother and child.

“Our results may have important public health implications, when considered alongside prior evidence,” they write. “Maternal BMI may be unlikely to have a large causal effect on child BMI beyond birth… and any causal effect of paternal BMI on offspring childhood BMI is likely to be similar to or smaller than that of maternal BMI. Consequently, reductions in the BMI of either parent before pregnancy may be unlikely to cause large reductions in childhood adiposity.”

Tom Bond states, “Obesity runs in families, but it is difficult to work out why this is. Our results suggest that the link between a mother’s or father’s body mass index (BMI) and their children’s BMI up to age 8 is mostly due to inherited genes. Expectant parents should be encouraged to maintain a healthy weight, but this may not be enough to ensure that their children also have a healthy weight.”

David Evans notes, “We were interested in examining whether obesity in mothers during pregnancy might also have adverse effects on the risk of obesity in their offspring when the children get older. We found that whilst maternal body mass index during pregnancy was likely to adversely affect offspring birthweight, it didn’t appear to have large effects on risk of offspring obesity in later life beyond that explained through the transmission of genes from mothers to their offspring.”

Alexandra Havdahl adds, “Our findings suggest that the link between parents’ and children’s body mass index is driven largely by shared genes rather than by the intrauterine environment or parenting behaviour.”

Provided by PLOS

Categories : PaediatricsTags :

Breast Milk, Best Sleep According to Japanese Study

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Japanese study of more than 82 000 children finds that breastfed infants are less likely to have short sleep at age one

Photo by William Fortunato on Pexels

In contrast to the misconception that breastfed babies sleep less as breastmilk is easily digested, a new study of 82 918 infants found that children who received breast milk during the first six months of life were less likely to experience short sleep duration at one year of age than those who were exclusively fed formula. Using data from the Japan Environment and Children’s Study, the researchers proposed biological mechanisms that may help explain this association.

The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life because of its many proven benefits, including protection against infections and support for healthy long-term development. However, perceptions that breastfed infants sleep less or require more frequent feeding than formula-fed infants remain common among parents and caregivers. Short sleep duration during infancy has also been linked to obesity, behavioural problems, and poorer cognitive performance later in life. Therefore, adequate sleep during this period is considered important for healthy physical and psychological development. Although infants are known to gradually develop longer and consolidated sleep periods, some caregivers choose formula feeding partly based on concerns about their child’s sleep.

To better understand the relationship between infant feeding and sleep, Ms. Yuri Nakagawa, a doctoral researcher at the University of Toyama, Japan, and colleagues analysed data from the nationwide Japan Environment and Children’s Study (JECS), one of the world’s largest birth cohort studies. The study examined 82 918 mother–infant pairs to investigate whether feeding practices during the first six months of life were associated with sleep duration at one year of age. The findings were published in the European Journal of Clinical Nutrition on March 31, 2026.

“WHO widely promotes breastfeeding, and most people are aware of the multiple health benefits it provides. Nevertheless, perceptions that breastfed infants sleep less, or that formula-fed infants sleep for longer periods, remain common. We wanted to provide solid evidence to bust this misconception,” says Ms Nakagawa, the study’s first author.

The mothers were given questionnaires at 6 months asking about the feeding practices they followed during the first six months for their babies. The children were then divided into four groups according to their feeding method. The first group consisted of infants fed exclusively with formula. The second group included infants who were breastfed for less than six months. The third group included infants who were breastfed throughout the six-month period while also receiving formula supplementation. The fourth group consisted of infants who were exclusively breastfed for six months. When the children reached one year of age, parents completed another questionnaire reporting their child’s sleep duration. Children sleeping less than 11 hours per day were considered to have insufficient sleep, based on the US National Sleep Foundation recommendations.

All groups that received breastmilk showed lesser chance of insufficient sleep compared to exclusively formula-fed infants. While infants who received only formula for the first six months had a 12.2% chance of having short sleep, the risk in infants breastfed for less than 6 months was only 10.2%. When breastfed for the entire six months and supplemented with formula, the risk further fell to 9.7%. The least risk of insufficient sleep at age one was for babies exclusively breastfed for the first six months, at 8.8%. After adjusting for a wide range of maternal, infant, and environmental factors, infants who were exclusively breastfed for six months had a 23% lower likelihood of short sleep duration compared with those fed only formula. The findings also showed a graded association, with longer breastfeeding duration associated with a progressively lower likelihood of short sleep.

“This study provides reassurance against the common perception that breastfed babies sleep less because breast milk is digested more rapidly,” says Ms Nakagawa. “Our findings suggest that such concerns should not discourage parents from considering breastfeeding and its many well-established benefits,” she adds.

The researchers proposed several possible explanations. While the nutritional composition of formula remains relatively constant, that of breast milk adapts to the changing needs of the infant. To help establish and regulate the baby’s internal clock and sleep–wake cycle, melatonin – a hormone that promotes sleep onset and improves sleep quality—is secreted into breast milk at night. Because newborns produce only small amounts of their own melatonin, breast milk-derived melatonin may help support the development of healthy sleep rhythms. In addition, breast milk contains tryptophan, an amino acid used to produce melatonin. Interestingly, tryptophan concentrations in breast milk have also been found to be higher at night.

Furthermore, growing evidence supports the gut–brain axis, a communication network linking intestinal bacteria and brain function. Breastfeeding is known to positively influence the development of a healthy infant gut microbiome. Differences in gut microbiota between breastfed and formula-fed infants may also contribute to the development of healthy sleep–wake patterns and sleep quality.

Source: University of Toyama

Categories : PaediatricsTags :

Not All Children with Early Puberty Need the Same Level of Testing or Treatment

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Endocrine Society guideline addresses different subgroups of central precocious puberty

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Some subgroups of children with precocious puberty – such as older girls with slowly progressing puberty – may not need the same level of testing or treatment, according to a new Endocrine Society Clinical Practice Guideline.

“Children who start puberty earlier than usual should be carefully evaluated so they receive the right care at the right time – without unnecessary tests or treatment,” said the guideline’s writing group chair, Ana Claudia Latronico, MD, PhD, of the University of São Paulo. “The Endocrine Society’s guideline gives clinicians evidence-based suggestions to identify central precocious puberty, understand its causes and decide when and what treatment is appropriate.”

Central precocious puberty happens when a child’s brain activates puberty-related hormones too early – before age 8 years in girls and before age 9 years in boys. This early hormone signalling triggers physical changes such as breast development in girls, testicular enlargement in boys, rapid growth, and, in some cases, early menstruation.

Early puberty can affect a child’s adult height and is associated with long-term physical and emotional health risks, including psychosocial stress, heart disease, and some cancers later in life.

According to the guideline authors, puberty-pausing medication, which temporarily pauses the brain signals that start puberty, can be an effective treatment and has the potential to increase adult height as well as improve psychosocial and long-term health outcomes among children with early puberty.

“Some subgroups of children may not need the same level of testing or treatment. For example, older girls with slowly progressing precocious puberty often have normal adult height without intervention,” said the guideline’s writing group co-chair Stephanie Roberts, MD, of Boston Children’s Hospital in Boston, Mass. “We give clinicians suggestions that avoid unnecessary or invasive testing and treatment, such as sometimes initially using a period of observation by their health care provider, using simpler testing methods and individualising treatment when indicated.”

Suggestions from the guideline include:

  • Monitoring girls with early breast development with physical exams every 4-6 months before initiating diagnostic testing
  • Observing girls under 7 years old for 4-6 months to distinguish slowly vs. rapidly progressing puberty, since slow progression often results in normal adult height without treatment.
  • Using simple first-line testing with a basal luteinising hormone (LH) blood test rather than GnRH agonist stimulation testing.
  • Avoiding routine brain MRIs in older children (> 6 years in girls and > 7 years in boys) without neurological symptoms.
  • Not routinely doing genetic testing, especially for cases without a family history of early puberty.
  • Starting treatment with longer-acting puberty-delaying medications (rather than shorter-acting medications) whenever it is expected that longer-acting medications will be used for long-term therapy.
  • Not routinely using growth hormone therapy.
  • Not routinely doing frequent lab monitoring during treatment unless treatment failure is suspected.
  • Discontinuing therapy by early adolescence (about 10-11 years in girls, 11-12 years in boys).

The new guideline is available online.

Source: Endocrine Society

Categories : PaediatricsTags :

Study Finds No Link Between Newborn Upper Lip Frenulum and Breastfeeding Difficulties

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A joint study by the University of Oulu and Oulu University Hospital in Finland suggests that a newborn’s upper lip frenulum is unlikely to be a major cause of breastfeeding difficulties.

The study, published in JAMA Network Open, followed 264 mother–infant pairs at Oulu University Hospital between 2023 and 2024. Researchers assessed the anatomy and mobility of the upper lip frenulum in healthy, full-term infants and compared the findings with mothers’ reported breastfeeding experiences.

Overall, 86% of mothers reported experiencing breastfeeding difficulties during the first days of breastfeeding. However, based on data collected in the six-month follow-up questionnaire, the researchers found no association between the anatomical characteristics of the upper lip frenulum and breastfeeding problems. The thickness of the frenulum, its attachment site, or other structural features did not increase the risk of breastfeeding difficulties.

Instead, previous breastfeeding experience appeared to be beneficial for breastfeeding. Breastfeeding problems were reported less frequently among mothers with experience of breastfeeding previous children.

According to the researchers, an upper lip frenulum that interferes with breastfeeding is a rare finding. Nevertheless, the number of lip-tie release procedures has increased in several countries in recent years, despite limited evidence supporting their benefits.

“Breastfeeding difficulties in newborns should always be assessed comprehensively,” said paediatrician and neonatologist Outi Aikio. “Based on our findings, we found no evidence to support upper lip frenulum surgery in healthy, full-term infants. Instead, I would emphasise the importance of high-quality breastfeeding support, particularly in the early weeks after birth, when breastfeeding challenges are common.”

Source: University of Oulo

Research article: Niemelä L, Lohi V, Aitamurto S, Lehtinen A, Aikio O. Upper Lip Frenulum Findings and Breastfeeding Problems in Healthy Newborns. JAMA Netw Open. 2026;9(5):e2613308.

Categories : Infection Control Neurology PaediatricsTags :

New Treatment Aims to Prevent Meningitis Without Antibiotics

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Meningitis is rare in newborns but often life-threatening and can cause serious and lasting damage, including developmental problems. Now, researchers from ETH Zurich and the University of Basel have developed an approach that seeks to prevent transmission to newborns. The research is published in Nature Communications.

Although meningitis is thankfully rare in newborns as a whole, it is more common in premature babies, affecting one in every 500 such infants in industrialised economies and likely more in developing countries. One of the leading pathogens responsible for these meningitis cases is the K1 form of the E. coli bacterium. In the adult intestine: in one in three healthy adults, E. coli K1 is part of the intestinal flora. As a silent cohabitant, the bacterium causes no problems in this environment. It is kept in check by other bacteria and a functioning immune system.

However, if the pathogen is carried by an expectant mother, it can be transmitted to the child during birth and enter its intestine. In premature babies whose immune systems are still weak, the pathogen can enter the bloodstream and migrate to the brain, where it causes severe inflammation.

First weaken the pathogen, then fight it

Researchers led by Emma Slack, Professor of Mucosal Immunology at ETH Zurich, and Médéric Diard, Professor of Infection Biology at the Biozentrum of the University of Basel, want to stop transmission from happening in the first place. Their idea is to eliminate the pathogen in pregnant women who carry it in their intestine – but that’s easier said than done.

A year ago, the two researchers from Zurich and Basel had already jointly developed a concept for eradicating other pathogens living in the intestine (as ETH News reported). Back then, they used a combination therapy with two components: an oral vaccination that weakens the pathogenic bacterium, followed by a dose of harmless microbes that compete with the weakened pathogen for food, starve it out, and ultimately supersede it. In experiments on mice, the researchers demonstrated that this approach can eliminate certain salmonellas and E. coli strains in the intestine.  

So tough that three components are needed

However, the K1 form of E. coli is a formidable opponent: unlike other E. coli bacteria, it is protected by a slippery outer layer. This prevents the antibodies generated by the oral vaccination from attacking the bacterium.

The team of researchers led by Slack and Diard therefore extended its previous two-pronged approach with a third component known as bacteriophages (or simply phages). These are viruses that specifically infect and kill bacteria.

However, the bacteria can make changes to themselves in order to evade the danger posed by these viruses. The phages attack the bacteria by docking to the protective layer, and the bacteria seek to prevent this by undergoing a sort of rapid evolution in which this layer is disposed of. Rapid in this case means that, since the bacteria are so numerous and multiply so quickly, they need fewer than 24 hours to adapt. 

“This is essentially a resistance mechanism that the bacteria deploy against the phages,” says Slack. “We use this mechanism to our advantage: the antibodies formed by the oral vaccination are effective against K1 bacteria that no longer have their protective coating.”

Most young animals protected

The project involved searching for effective strains of phages. Scientists generally find phages in places that are home to lots of bacteria: nutrient-rich bodies of water, the intestinal flora or, very often, waste water and waste water treatment plants. When it comes to the phages used in this study, the researchers from the Biozentrum in Basel found what they were looking for in waste water samples from the treatment plant of the Lucerne conurbation. From such a sample, their lab work successfully isolated several phages that are particularly effective at attacking the bacterium E. coli K1.

In experiments with pregnant mice, which the researchers had previously infected with pathogenic E. coli K1, they were able to demonstrate the effectiveness of their triple-pronged treatment. The researchers first gave the mice phages that forced the bacteria to cast off their protective shell. Second, they administered an oral vaccination that produced antibodies in the intestine in order to weaken the bacteria. Third, they gave them a harmless probiotic bacterium that could compete against the weakened bacteria and occupy their ecological niche in the intestine.

In a control experiment in which the researchers did not treat the mothers, E. coli K1 was transmitted to 83% of young animals at birth. By contrast, the triple-pronged treatment significantly reduced the level of E. coli K1 in the mothers’ intestines, such that the pathogen was only transmitted to 23% of the young animals. The remaining offspring were protected.

Works even when antibiotics fail

The researchers are now keen to continue with their approach in order to develop a treatment for humans. In a world in which effective antibiotics are becoming increasingly scarce, we need new therapeutic approaches, says Slack. “Bacteria such as E. coli K1 are difficult to tackle. Our approach is potentially the only one that can be used to fight this pathogen and others without antibiotics.”

Not only can E. coli K1 cause cases of meningitis in newborns, which today must be treated with antibiotics in a race against time. It is also one of the most frequent causes of cystitis and pyelitis – infections that can also lead to serious cases of sepsis. 

The ETH professor doesn’t perceive any major obstacles to developing an effective treatment for humans: “Oral vaccinations, probiotics and even phages are all already used in medicine,” she says. It will also be possible, she adds, to pack all three components into a single capsule that people can simply swallow.

Moreover, the scientists are planning projects in which they want to use the same approach to tackle bacteria other than E. coli K1, including multi-resistant pathogens, against which many antibiotics are no longer effective.

Source: ETH Zurich

Categories : PaediatricsTags :

Leucovorin Prescriptions in US for Children with Autism Surged After Public Attention

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National study found use of the drug rose sharply following major media coverage and later White House promotion, despite limited large-scale evidence for autism treatment

Leucovorin prescriptions for children with autism rose more than 2000% by late 2025. Courtesy of UC San Diego Health Sciences.

Researchers from the University of California San Diego found that prescriptions for leucovorin, a drug sometimes used off-label for autism spectrum disorder (ASD), rose sharply among children after widespread media attention and public statements from White House officials. The study, published May 18, 2026 in JAMA Network Open, analysed national electronic health record data and found prescribing rates increased more than 2000% compared with prior years.

“Families of children with autism are often searching for therapies that might improve communication and quality of life, especially when treatment options are limited,” said Joshua Rothman, MD, clinical assistant professor of pediatrics at the UC San Diego School of Medicine and first author of the study. “What this study shows is how quickly information shared through news coverage, social media and public figures can influence real-world prescribing patterns, even before large clinical trials establish whether a treatment is truly safe and effective for broad use.”

Leucovorin, also known as folinic acid, is a biologically active form of folic acid. Small clinical trials have suggested that some children with autism and folate-related deficiencies may experience improvements in verbal communication after taking the medication. However, researchers note that large-scale studies confirming the drug’s effectiveness and long-term safety for children with ASD have not yet been completed.

To better understand prescribing trends, the researchers analysed records from the Epic Cosmos database, which includes more than 300 million patient records from over 1800 hospitals and 41 500 clinics across all 50 states and Washington, D.C. The study focused on 838 801 children with autism who accounted for more than 11.9 million outpatient encounters between January 2023 and January 2026.

For roughly two years, leucovorin prescribing rates remained relatively stable, averaging about 34 prescriptions per 100 000 outpatient encounters among children with autism. Rates then began climbing steadily in early 2025 before surging later that year. By August 2025, prescribing rates had risen to 335 prescriptions per 100 000 encounters. In November 2025, rates climbed again to more than 835 prescriptions per 100,000 encounters.

The researchers observed that the initial rise in prescribing coincided with a February 2025 national television news segment featuring a family who reported dramatic language improvements in their child after treatment with leucovorin. Interest in the medication expanded further after White House officials publicly promoted leucovorin in September 2025 as part of broader autism-related initiatives.

“Families of children with autism are often searching for therapies that might improve communication and quality of life, especially when treatment options are limited. What this study shows is how quickly information shared through news coverage, social media and public figures can influence real-world prescribing patterns, even before large clinical trials establish whether a treatment is truly safe and effective for broad use.”

— Joshua Rothman, MD, clinical assistant professor of paediatrics at the UC San Diego School of Medicine and first author of the study

“The timing was striking,” Rothman said. “The increases began after a widely viewed media story and accelerated again after federal officials publicly discussed the medication. It highlights how rapidly clinical practice can shift when a treatment captures public attention.”

The study does not determine whether leucovorin improves symptoms of autism, nor does it evaluate patient outcomes after treatment. Researchers also cautioned that prescriptions recorded in the database could not always be linked to a confirmed medical indication.

Still, the authors say the rapid increase in use raises important questions for clinicians, policymakers and families. In March 2026, the US Food and Drug Administration approved leucovorin for cerebral folate transport deficiency, an ultra-rare genetic neurological disease associated with specific genetic changes, but the drug was not approved for autism spectrum disorder.

Researchers say the findings underscore the need for continued monitoring of prescribing trends and for larger randomised clinical trials evaluating whether leucovorin is beneficial for specific groups of children with autism.

“We now have a real-world example of how public attention can accelerate adoption of a therapy before the evidence fully catches up,” Rothman said. “The next step is making sure we generate the rigorous data needed to help families and clinicians make informed decisions.”

Read the full study: Rates of Leucovorin Prescriptions for Children With Autism

Source: University of California – San Diego

Categories : PaediatricsTags :

New Study Finds Many Neonatal Deaths in SA Are Preventable

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New post-portem study reveals over 80% of infection-related neonatal deaths in South Africa are preventable.

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A groundbreaking study published in The Lancet Infectious Diseases Journal has identified that the vast majority of neonatal (newborn infant in the first 28 days of life) deaths caused by infections in South Africa and other low-and-middle-income countries could be prevented through improved clinical care and targeted medical interventions. The research, conducted by the Child Health and Mortality Prevention Surveillance (CHAMPS) network, utilised innovative post-mortem techniques that enables accurate identification of causes of death in low-resource settings. To provide the most granular look to date at what is killing newborns in these regions, more than 2600 neonatal deaths were analysed using minimally invasive tissue sampling (MITS).

The study, titled “Post-mortem characterisation of pathogen-specific causes of infection-related deaths in African and south Asian neonates: a prospective, observational, multicentre study which included a major surveillance site in Soweto, South Africa”, has revealed that infections are involved in 44% of neonatal deaths across multiple sites in Africa and South Asia, underscoring an urgent need to strengthen infection prevention, diagnosis, and treatment strategies. Crucially, an expert panel determined that over 80% of these infection-related deaths were preventable under current or improved facility-based conditions.

Key Findings for South Africa:

  • Dominant Hospital Pathogens: In South Africa, Acinetobacter baumannii was the overwhelming driver of hospital-acquired infections, contributing to 74.3% of presumed hospital-acquired neonatal deaths.
  • Community-Acquired Threats: Group B Streptococcus (GBS) was identified as the leading cause of community-acquired neonatal deaths in South Africa, accounting for 30.6% of such cases, followed by Escherichia coli at 24.7%.
  • Emerging Fungal Risks: South Africa was the only site to report specific life-threatening fungal infections, including Candidozyma auris and Nakaseomyces glabratus, in the causal pathway to death.
  • Preventability: The modifiable factors identified to reduce these deaths include improvements in infection prevention and control (50.8%), clinical care (50.7%), and antenatal and obstetric care (42.2%).

The findings reveal that current empirical antibiotic treatments may be insufficient, particularly in high-burden settings where antimicrobial resistance is rising. The study also shows that infections often occur alongside other conditions such as prematurity and birth complications, indicating that neonatal deaths are driven by multiple, interconnected factors.

 “These findings indicate an urgent need to review empirical antibiotic treatment for neonatal infections,” said Prof Shabir A. Madhi, Director of the South African Medical Research Council Vaccines and Infectious Diseases Analytics Research (Wits VIDA) Unit and lead author of the study. “The high prevalence of multidrug-resistant pathogens like K. pneumoniae and A. baumannii suggests our current standard protocols may no longer be sufficient. Alarmingly, some of these bacteria are resistant to all classes of antibiotics currently available.”

Nearly half of all deaths in children under five occur in the neonatal period, with the highest burden in Africa and South Asia. Importantly, local data further underscores the urgency of action. Within the Soweto and Thembelihle surveillance population, the neonatal mortality rate is estimated at 16.0 deaths per 1000 live births, significantly higher than both South Africa’s national estimate of 10 per 1000 and the Sustainable Development Goal (SDG) 2030 target of 12 per 1000 live births.

These findings highlight persistent inequalities in maternal and child health outcomes, even within urban settings, and reinforce the need for targeted, evidence-based interventions.

The MITS technique used at Wits VIDA uses needle biopsies rather than full autopsies to collect biological specimens. This method proved far more effective than traditional antemortem diagnostics, which failed to identify a pathogen in up to 73% of suspected sepsis cases in South Africa.

The study provides one of the most comprehensive, pathogen-specific analyses of neonatal deaths to date and ultimately, the study highlights a powerful opportunity. That most infection-related neonatal deaths are preventable. The CHAMPS consortium concludes that prioritising new maternal vaccines and strengthening hospital infection control are essential steps to reducing the high burden of neonatal mortality.

CHAMPS South Africa consistently shares its granular research findings with the National Department of Health (NDoH) through various channels to ensure this detailed evidence assists in developing targeted strategies to prevent neonatal infections. These data, which provide a precise look at the pathogens responsible for mortality, are intended to help the NDoH refine empirical antibiotic protocols and strengthen hospital infection control measures. Beyond policy-level engagement, CHAMPS collaborates with local communities to raise awareness regarding prevention strategies, specifically emphasizing the importance of early antenatal care booking and consistent attendance. By focusing on these modifiable factors, the initiative seeks to improve obstetric care and reduce the number of babies born “too soon or too small,” addressing the preterm birth complications that frequently underlie neonatal deaths.

 About CHAMPS: The Child Health and Mortality Prevention Surveillance (CHAMPS) network is a global collaboration funded by The Gates Foundation. It aims to provide accurate data on the causes of childhood death to inform policy and save lives in high-mortality regions.

Link to the study in The Lancet Infectious Diseases Journal.

Source: Wits University

Categories : Neurology PaediatricsTags :

What Factors are Involved in the Co-occurrence of Autism in Children with Epilepsy?

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Children with epilepsy have a higher risk of also having autism spectrum disorder (ASD). A new study in Developmental Medicine & Child Neurology examined factors associated with the co-occurrence of autism and epilepsy in a large population-based group.

For the study, investigators at the Mayo Clinic compared the prevalence of autism spectrum disorder in children with and without epilepsy based on medical records, and they evaluated associated factors including sex, age at autism identification, and intellectual disability. The study included 30 490 children in the Olmsted County, Minnesota birth cohort, of whom 257 (0.84%) had epilepsy diagnosed before 19 years of age.

Autism prevalence was significantly higher among children with epilepsy as compared with children without across all three research and clinical definitions assessed (21.4% versus 3.2% using broad research criteria, 14.0% versus 1.6% using stricter research criteria, and 7.9% versus 0.7% for clinical diagnosis).

Children with epilepsy and autism were more likely to have intellectual disability (56.5% versus 15.4%), were more often female (38.2% versus 25.8%), and were identified with autism at a younger age (7.4 versus 8.7 years) compared with those without autism.

“These observations highlight clinically relevant differences within this group and underscore the importance of early recognition of developmental concerns,” said lead author Mariya Saify. MBBS.

Senior author Elaine C. Wirrell, MD added that although children with epilepsy are at an elevated risk of autism, recognition can be delayed. “Our findings emphasise the importance of screening for autism in this population to support earlier diagnosis and timely intervention, both of which are key to improving long-term outcomes.”

Source: Wiley

Categories : Environmental Effects PaediatricsTags :

Eczema and Asthma in Children: How Household Fuels are Harming Health in Poor South African Homes

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Mandla Bhuda, University of South Africa; Janine Wichmann, University of Pretoria, and Joyce Shirinde, University of Pretoria

In many households in Mabopane and Soshanguve – townships on the northern outskirts of South Africa’s City of Tshwane that are marked by high poverty, unemployment and informal economic activity – evenings follow a familiar pattern.

When electricity cuts occur or power becomes unaffordable, families turn to gas stoves, paraffin heaters, or wood and coal fires to cook meals and keep warm. These energy sources contribute to air pollution, but the most harmful exposure often happens indoors, where children spend much of their time. These choices, though often unavoidable, put young children’s health at risk.

Children are particularly vulnerable to air pollution. Their lungs are still developing, their airways are narrower, and they breathe faster than adults.

In 2021, exposure to air pollution was linked to more than 700 000 deaths of children under five years old globally.

They are exposed by inhaling polluted air, swallowing contaminated dust or food, and through skin contact. Household fuel combustion releases tiny particles and harmful gases that irritate the lungs and airways. These pollutants can also damage the skin, triggering immune responses that worsen allergic conditions such as eczema and asthma.

As public health specialists, we examined the association between household air pollution and eczema and severe asthma symptoms among children aged seven years and younger in Mabopane and Soshanguve. We found that the use of polluting household fuels and gas was associated with an increased likelihood of eczema, followed by severe asthma symptoms.

Eczema and its impact

Eczema, or atopic dermatitis, is a chronic skin condition that causes itching, redness and inflammation.

It can significantly affect a child’s life by disrupting sleep and increasing the risk of skin infections. It also raises the likelihood of developing asthma, hay fever, or food allergies later. Visible rashes can equally affect confidence, social interactions and participation in school or play. Exposure to cigarette smoke inside the home further increases the risk of developing or worsening eczema, especially when mothers or female caregivers smoke.

Severe asthma and its impact

Asthma is a long-term condition affecting the lungs and airways, making breathing difficult. Symptoms include wheezing, coughing, chest tightness and shortness of breath. Global asthma prevalence ranges from 9.1% to 9.5% for children.

Severe asthma refers to frequent, hard-to-control, and sometimes life-threatening symptoms. Children with severe asthma may struggle to speak during attacks and are far more likely to need emergency care or hospitalisation. Young children are particularly vulnerable because their lungs, skin barrier and immune systems are still developing. Exposure to indoor air pollution during these early years increases the risk of long-term health problems.

Our study

To understand how household environments affect children’s health, we studied preschool-aged children in Mabopane and Soshanguve, in South Africa’s largely urban Gauteng province, between January 2022 and March 2023.

We randomly selected 42 preschools and collected health and household information from caregivers of 1840 children, including details on eczema, asthma symptoms, household fuel use, and exposure to cigarette smoke inside the home.

What we found

About one in eight children had experienced eczema at some point, and a similar proportion were currently experiencing symptoms. We also found that children from households using electricity for cooking and with no tobacco smoke exposure were less likely to have eczema than those who were exposed.

Children living in homes using open fires – such as paraffin, wood, or coal – for cooking or heating were more likely to have eczema. Exposure to cigarette smoke inside the home further increased this risk, particularly when mothers or female caregivers smoked.

Severe asthma symptoms were also common, affecting about one in six children. The use of gas for cooking or heating was strongly linked to severe asthma symptoms, even though gas is often viewed as a cleaner alternative during power cuts. Poor ventilation can increase indoor pollution, making these energy sources harmful to children.

The use of combined building materials in homes increased the likelihood of having eczema and corrugated iron significantly increased the likelihood of developing its symptoms. The frequency of trucks passing near the preschool children’s residences on weekdays was found to be associated with eczema and current symptoms. There was a significant association observed when trucks passed the children’s residences almost all day on weekdays. Children who walked to preschool had an increased risk of severe asthma symptoms compared with those using other modes of transport.

Why this matters

Although nearly 89% of residents in the study area have access to electricity, many households cannot rely on it consistently. Rising electricity costs and scheduled power cuts force families to use alternative fuels. These coping strategies, while understandable, increase children’s exposure to indoor air pollution during the most vulnerable stage of their development.

Eczema and severe asthma are not just medical issues but also social and environmental ones.

Our study confirmed that children in poorer communities face higher health risks due to their living environments, not just genetics. Susceptible groups, such as children, should be prioritised to reduce the adverse health effects of both outdoor and indoor air pollution.

What needs to change

Protecting children’s health requires more than asking parents to make better choices, as many families do not have safe, affordable alternatives.

Public health education on the dangers of cigarette smoke is crucial. Education campaigns, smoking cessation support and community-level interventions can help reduce children’s exposure to environmental tobacco smoke.

Stronger action on indoor and household air pollution is urgently needed. Evidence from this study can support the South African government in fast-tracking regulations and enforcing ambient air quality laws. It can also help in promoting safer household energy options.

Cleaner air inside homes is not a luxury. For South Africa’s children, it is a public health necessity.

Mandla Bhuda, Senior Lecturer: Public Health, University of South Africa; Janine Wichmann, Professor, University of Pretoria, and Joyce Shirinde, Associate Professor, University of Pretoria

This article is republished from The Conversation under a Creative Commons license. Read the original article.