Category: Paediatrics

Categories : PaediatricsTags :

Flawed Advice on Drug Safety is Pushing Women to Stop Breastfeeding – New Study

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The evidence supporting the health benefits of breastfeeding is overwhelming, yet many women taking medicines are advised to stop, often unnecessarily.

Photo by Lucy Wolski on Unsplash

The evidence supporting the health benefits of breastfeeding is overwhelming, yet many women taking medicines are being advised to stop, often unnecessarily, according to a new study from the University of Bath.

The research, led by scientists in the Department of Life Sciences at Bath, reveals that concerns about drug safety during breastfeeding are a significant factor in the decision to stop, yet many medications prompting women to stop breastfeeding have either been found to cause no harm in limited studies, or the potential risks to the infant are considered minimal and outweighed by the benefits to the mother.

The new study, published today in the International Breastfeeding Journal, found that up to 18% of women who need a medication stopped breastfeeding due to that medication, rising to up to 58% among those with chronic illnesses.

These findings were supported by a Public Health England survey of 500 UK mothers, where 71% of respondents agreed with the statement, “It (breastfeeding) could prevent me from taking medication.”

The Bath study reviewed research from seven countries across Europe and the USA spanning the past two decades. It was inspired by the researcher’s personal experience as a breastfeeding mother and pharmacist, which led her to undertake a PhD at the University of Bath.

“I suspected the advice I was getting wasn’t right,” said Rachel Pilgrim. “I felt quite nervous challenging the doctor – even though, as a pharmacist, it’s usually part of my job to do that, it felt very different as a patient. But the experience made me think – what it is like for women who don’t feel able to speak up?”

Breastfeeding is widely recommended by health authorities the world over. In the UK, exclusive breastfeeding is advised for the first six months of life, with continued breastfeeding alongside solid foods until at least one year.

Yet, despite widespread promotion of breastfeeding, the UK continues to report some of the lowest breastfeeding rates in Europe. While nearly half of mothers (49%) are breastfeeding at 6-8 weeks after giving birth, only 1% breastfeed exclusively to six months, according to a 2010 UK survey.

International surveys have found that exclusive breastfeeding at six months is reported in 27.2% of infants in the USA, 38% in Canada, and 37.5% in Australia.

The evidence gap

The maternal use of medication during breastfeeding does require caution, as some drugs can pass into breastmilk and affect the baby. However, for many medications, the amount transferred is minimal and unlikely to cause harm.

One problem lies in the lack of clinical trial data, as breastfeeding women are typically excluded from pharmaceutical trials due to the ethical implications of exposing a baby to an untested drug. Information on the effects of a medicine during breastfeeding builds slowly once a new drug starts to be used.

However, key medicines information resources for clinicians, such as the British National Formulary (BNF), often advise against drug use during breastfeeding, not because the medicine is definitely unsafe, but because its effects are not known with certainty. This conservative stance can lead to overly cautious or even incorrect advice. The study found that even for common medications such as antidepressants and painkillers – where safety data is well-established – women are stopping breastfeeding.

“The BNF is the first place most professionals look, but it doesn’t always reflect the full picture,” said Ms Pilgrim.

“As a result, the advice given to women is often incorrect. And even when the safety data is more limited, women need to be given accurate, balanced information that considers both the risks of the medication and the benefits of continued breastfeeding.”

Real-world impact

An evaluation of the Drugs in Breastmilk Service, run by the UK-based Breastfeeding Network, has found that 21% of mothers who contacted the service had been advised to stop breastfeeding by a healthcare professional. In 98% of these cases, this advice was found to be incorrect, and the women could have safely continued breastfeeding.

Alarmingly, fewer than 6% of these women were referred to the service by a healthcare provider – most found it through social media or peer support groups.

This disconnect between available evidence and clinical practice is contributing to unnecessary breastfeeding cessation, says Ms Pilgrim.

Both Ms Pilgrim and Dr Matthew Jones – who co-authored and supervised the study – are sympathetic towards clinicians who err on the side of caution when prescribing to breastfeeding mothers.

Dr Jones, an academic and pharmacist in the Department of Life Sciences at Bath, said: “Double checking the ‘conservative’ advice found in the BNF is highly time consuming.

“In my previous job as an NHS medicines information specialist, I might spend two hours verifying the safety of a drug using more specialist resources. Most people don’t have that kind of time.”

Study co-supervisor Dr Sarah Chapman from King’s College London, added: “We know breastfeeding women frequently choose not to take safe, beneficial medications because of misinformation and worries about effects on their baby; this study shows women also stop breastfeeding unnecessarily.”

Plans to improve safety awareness

Ms Pilgrim will build on her study through a three-phase PhD research project due to start in September and funded by Pharmacy Research UK.

As part of this work, she will develop a resource to make it easier for people to access specialist advice on breastfeeding. This will either be aimed at healthcare professionals or at women themselves.

Her goal is to improve communication between healthcare professionals and women, raise awareness that most drugs are safe to take when breastfeeding and ultimately support more women to continue feeding their babies while taking essential medications.

Source: University of Bath

Categories : PaediatricsTags :

How Much Infants Cry is Mostly Down to Genetics

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Photo by William Fortunato

How much an infant cries is largely steered by their genetics and there is probably not much that parents can do about it. This has been shown in a new Swedish twin study from Uppsala University and Karolinska Institutet in which researchers investigated how genetics and environment influence infants’ crying duration, sleep quality and ability to settle during the first months of life.

The study, which was recently published in JCPP Advances, is based on questionnaire responses from parents of 1000 twins spread across Sweden. The parents were asked questions about their children’s sleep, crying and ability to settle when the twins were two months old and then again at five months old. The researchers were interested in finding out how genetics and environment influence these behaviours during the first months of life – something that no study has done before.

The clearest results were seen when the researchers analysed how long the children cried per day.

“What we found was that crying is largely genetically determined. At the age of two months, the children’s genetics explain about 50 per cent of how much they cry. At five months of age, genetics explain up to 70% of the variation. For parents, it may be a comfort to know that their child’s crying is largely explained by genetics, and that they themselves have limited options to influence how much their child cries,” says Charlotte Viktorsson, postdoctoral fellow in psychology and lead author of the study.

The parents who participated in the study were asked how long their children cried, how often they woke up at night, and how long it took until they settled. There was large individual variation between the children. For example, some children could wake up a total of up to 10 times per night. The figures below show averages.

2 months:
Crying duration (per 24 hours): about 72 minutes
Wakeups: 2.2 times per night
Time until settled: about 20 minutes

5 months:
Crying duration (per 24 hours): about 47 minutes
Wakeups: 2.1 times per night
Time until settled: about 14 minutes

The remaining percentage that cannot be explained by genetics was explained by what the researchers call ‘unique environment’ – factors in the children’s environment or life situation that are unique to each child and cannot be identified precisely from the questionnaire responses.

Charlotte Viktorsson is the lead author of the study that investigated how genetics and environment influence infants’ crying, sleep, and ability to settle during the first months of life. Photo: Mikael Wallerstedt

Twin studies reveal the importance of genetics

The participants were recruited by letter, which was sent to families with twins aged 1–2 months. These families were identified from the population register. To be able to capture how much of a behaviour is genetically determined, the researchers compared identical (monozygotic) twins with fraternal (dizygotic) twins. The advantage of studying twins is that they share important factors such as home environment, family situation, and socio-economic status. If identical twins become more similar to each other than fraternal twins in terms of a certain trait, such as how much they cry, it is seen as an expression of the importance of genetics for that trait.

The environment plays a role in infants’ time until settled

Using the same method, the researchers also analysed the number of times the children woke up at night. Here, genetics played less of a role. The number of awakenings during the night was mainly influenced by environmental factors, which can include sleep routines and the environment in which the child sleeps

In the questionnaire, the parents were also asked to state how long it took from the child being put to bed until they were asleep.

“How rapidly the infant settles was primarily due to the environment at 2 months of age, but by 5 months, their genetics had gained some significance. This reflects the rapid development that occurs in infants, and may indicate that parents’ efforts in getting their child to settle may have the greatest impact in the first months,” says Charlotte Viktorsson, who led the study.

However, it is difficult to draw conclusions about which interventions are effective based on this type of observational study.

“Although we cannot see which specific environmental factors influence the number of awakenings during the night, or how long it takes until the child settles, this study points out a direction for future studies with a focus on sleep routines,” she says.

The researchers have followed the twins up to 36 months of age, allowing them to see how sleep and crying change as the children get older. The current study is thus the first in order based on this data.

Source: Uppsala University

Categories : Paediatrics VaccinesTags :

Can African Countries Meet 2030 Childhood Immunisation Goals?

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Researchers analysed 1 million records from national health surveys in 38 African countries and found progress in childhood immunisation coverage – but many countries, including South Africa, may still fall short of global targets

Maps of childhood immunisation coverage in African countries at regional level for 2020.

Image credit: Nguyen PT et al., 2025, PLOS Medicine, CC-BY 4.0

In the last two decades, childhood immunisation coverage improved significantly across most African countries. However, at least 12 countries, including South Africa, are unlikely to achieve global targets for full immunisation by 2030, according to a new study published July 29th in the open-access journal PLOS Medicine by Phuong The Nguyen of Hitotsubashi University, Japan, and colleagues.

Vaccines are one of the most effective ways to protect children from deadly diseases, yet immunisation coverage is still suboptimal in many African countries. Monitoring and progress in childhood immunisations at the national and local level is essential for refining health programmes and achieving global targets in these countries.

In the new study, researchers used childhood immunisation data contained in approximately 1 million records from 104 nationally representative Demographic and Health Surveys (DHS) conducted in 38 African countries between 2000 and 2019. Using modelling techniques, they estimated immunisation coverage trends through 2030 and assessed disparities across geographic regions and between socioeconomic groups.

The data showed overall improvements in immunisation coverage between 2000 and 2019. It forecast that, if current trends continue, most countries are projected to meet or exceed targets for achieving 80% or 90% coverage of vaccines against tuberculosis, measles, polio, diphtheria, pertussis (whooping cough), and tetanus. However, 12 of 38 countries are not on track to meet full immunisation goals, including high-development nations like South Africa, Egypt, and Congo Brazzaville. The study also pinpointed significant socioeconomic inequalities in coverage, with gaps in coverage of up to 58% between wealth quintiles. While these disparities were present across all countries, most are projected to shrink by 2030 –except in Nigeria and Angola, where inequalities are expected to persist or grow.

“These achievements are likely the result of sustained progress driven by decades of national and sub-national initiatives along with international support aimed at prioritising immunisation,” the authors say. “However, progress towards full immunisation coverage remains slow in 12 African countries examined. In most African nations, challenges related to vaccine affordability, accessibility, and availability remain major obstacles, driven by weak primary healthcare systems and limited resources.”

The authors add, “This study shows that while childhood immunisation coverage has improved in Africa, progress is uneven. Many countries and regions remain off track to meet global targets by 2030.”

The authors conclude, “Conducting this study reinforced how critical reliable sub-national data is for identifying communities being left behind. We hope the findings will help inform more equitable and targeted immunisation strategies.”

Provided by PLOS

Categories : Allergies PaediatricsTags :

Eliminating the Risk of Anaphylaxis from Children’s Peanut Allergy Desensitisation

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Photo by Corleto on Unsplash

Oral immunotherapy helps many children with peanut allergy – but for some, it can also trigger severe allergic reactions. In the journal Allergy, a team led by Young-Ae Lee explains what might be behind these differences and how treatment could become more personalised.

Peanut allergy is one of the most common – and most dangerous – food allergies. Tiny amounts of the protein-rich legumes can be enough to cause allergic reactions like itching and swelling, or even life-threatening anaphylaxis. For a long time, the only solution was to avoid peanuts as vigilantly as possible. Since many foods may contain traces of peanuts, that’s still a major challenge, especially for parents of affected children. Emergency medication must always be close at hand.

Recently, oral desensitisation has become available for children with peanut allergies. “Some children respond well to this treatment, but others don’t benefit at all,” says Professor Young-Ae Lee, Group Leader of the Molecular Genetics of Allergic Diseases lab at the Max Delbrück Center. “In some cases, the therapy – based on gradually increasing doses of peanut allergens – can even trigger anaphylactic reactions.”

A team led by Lee and Professor Kirsten Beyer, Head of the Pediatric Allergy Clinical Research Center at Charité – Universitätsmedizin Berlin, has now investigated why children respond so differently to the therapy and how to make it safer and more effective. Their study, published in “Allergy,” was led by first author Dr Aleix Arnau-Soler, a scientist in Lee’s lab. “We looked for molecular changes in the immune systems of children undergoing oral immunotherapy ¬– and we found them,” explains Arnau-Soler.

Gut immune cells play a key role

For their study, the researchers analyzed blood samples from 38 children, with an average age of seven, who were undergoing oral desensitization for peanut allergy at Charité. The team measured levels of immunoglobulins, which are allergy-related antibodies, and cytokines, which are inflammatory messengers, before and after therapy. 

Our results open the door to personalised approaches to treating peanut allergy – which affects three per cent of all children in industrialised countries – more effectively and safely in the future.

Young-Ae LeeHead of the “Molecular Genetics of Chronic Inflammation and Allergic Disease” lab

They also assessed how much peanut protein each child could tolerate before and after treatment – essentially, how successful the desensitization was. To delve deeper, they used modern omics technologies to identify which genes in the children’s immune cells were activated when they were exposed to peanut proteins in the lab.

“Children who responded well to the therapy already had a less reactive immune system before treatment began. Their blood showed lower levels of immunoglobulins and cytokines,” explains Arnau-Soler. These findings could help identify in advance which children are most likely to benefit from desensitization – and those who are at higher risk of side effects.

The team also found consistent differences in gene expression and DNA methylation patterns between children who responded well and those who didn’t. Methylation plays a key role in regulating gene activity. “These differences were particularly pronounced in certain immune cells that are rarely found in the blood, but more common in the gut, where they perform important functions,” says Arnau-Soler. These included both specialized T cells, part of the adaptive immune system, and cells involved in the body’s innate defenses.

New biomarkers pave the way for personalized therapy

“Our results open the door to personalized approaches to treating peanut allergy – which affects three percent of all children in industrialized countries – more effectively and safely in the future,” says Lee. “We now have potential biomarkers to find out how well a child will respond to the therapy and what risks are associated with it in each individual case, even before the therapy begins.” It may soon be possible to tailor the length of treatment and the amount of peanut allergen given to each child’s unique immune profile.

The team is currently working to validate their findings in a follow-up study. They also plan to further investigate the gut-associated immune cells found in blood. “At the same time, we’re developing a predictive model so that in the future we can use a simple blood test to better tailor oral desensitization to the individual child,” adds Arnau-Soler. That could make peanut allergy far less frightening for families.

Source: Max Delbrück Center for Molecular Medicine

Categories : Diet and Nutrition PaediatricsTags :

Consuming Certain Sweeteners May Increase Risk of Early Puberty

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Photo by Amit Lahav on Unsplash

Consuming certain sweeteners commonly found in foods and beverages may increase the risk of early puberty in children, particularly among those who are genetically predisposed, according to a study being presented Sunday at ENDO 2025, the Endocrine Society’s annual meeting in San Francisco, Calif. 

The researchers found that consuming aspartame, sucralose, glycyrrhizin and added sugars was significantly associated with a higher risk of early puberty, especially in children with certain genetic traits. The more of these sweeteners the teens consumed, the higher their risk of central precocious puberty.

“This study is one of the first to connect modern dietary habits – specifically sweetener intake – with both genetic factors and early puberty development in a large, real-world cohort,” said Yang-Ching Chen, MD, PhD, of Taipei Municipal Wan Fang Hospital and Taipei Medical University in Taipei, Taiwan. “It also highlights gender differences in how sweeteners affect boys and girls, adding an important layer to our understanding of individualised health risks.” 

A type of early puberty known as central precocious puberty is increasingly common. It can lead to emotional distress, shorter adult height, and increased risk of future metabolic and reproductive disorders.

Chen’s previous research found that certain sweeteners can directly influence hormones and gut bacteria linked to early puberty. For example, one artificial sweetener, acesulfame potassium or AceK, was shown to trigger the release of puberty-related hormones by activating “sweet taste” pathways in brain cells and increasing stress-related molecules. Another sweetener, glycyrrhizin (found in liquorice) was found to change the balance of gut bacteria and reduce the activity of genes involved in triggering puberty. 

“This suggests that what children eat and drink, especially products with sweeteners, may have a surprising and powerful impact on their development,” Chen said.

The new findings come from the Taiwan Pubertal Longitudinal Study (TPLS), begun in 2018. The study included data from 1407 teens. Central precocious puberty was diagnosed in 481 teens. The researchers assessed teens’ sweetener intake through validated questionnaires and testing of urine samples. Genetic predisposition was quantified using polygenic risk scores derived from 19 genes related to central precocious puberty. Early puberty was diagnosed based on medical exams, hormone levels and scans. 

Sucralose consumption was linked to a higher risk of central precocious puberty in boys and consumption of glycyrrhizin, sucralose and added sugars was associated with a higher risk of central precocious puberty in girls.

“The findings are directly relevant to families, paediatricians and public health authorities,” Chen said. “They suggest that screening for genetic risk and moderating sweetener intake could help prevent early puberty and its long-term health consequences. This could lead to new dietary guidelines or risk assessment tools for children, supporting healthier development.”

Source: The Endocrine Society

Categories : Immune System PaediatricsTags :

Prenatal Exposure to PFAS ‘Forever Chemicals’ Shapes Baby Immunity

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PFAS lurks in numerous consumer products – from nonstick cookware and food packaging to stain-resistant fabrics and personal care items. Photo by Cooker King on Unsplash

New research reveals that tiny amounts of per- and polyfluoroalkyl substances (PFAS; widely known as “forever chemicals”) cross the placenta and breast milk to alter infants’ developing immune systems, potentially leaving lasting imprints on their ability to fight disease.

University of Rochester Medical Center (URMC) researchers tracked 200 local healthy mother–baby pairs, measuring common PFAS compounds in maternal blood during pregnancy and then profiling infants’ key T‑cell populations at birth, six months, and one year. By age 12 months, babies whose mothers had higher prenatal PFAS exposure exhibited significantly fewer T follicular helper (Tfh) cells – vital coaches that help B cells produce strong, long‑lasting antibodies – and disproportionately more Th2, Th1, and regulatory T cells (Tregs), each linked to allergies, autoimmunity, or immune suppression when out of balance.

“This is the first study to identify changes in specific immune cells that are in the process of developing at the time of PFAS exposure,” said Kristin Scheible, MD, an associate professor of Pediatrics and Microbiology & Immunology at URMC and lead author of the study, which appears in the journal Environmental Health Perspectives. “Identification of these particular cells and pathways opens up the potential for early monitoring or mitigation strategies for the effects of PFAS exposure, in order to prevent lifelong diseases.”

Implications for vaccines, allergies, and autoimmunity

Tfh cell depletion helps explain previous findings that higher PFAS levels in children correlate with weaker vaccine responses to tetanus, measles, and other routine immunisations. Conversely, the uptick in Th2 and Treg cells can predispose to allergic inflammation or dampened defences, while excess Th1 activity raises concerns about future autoimmune conditions such as juvenile arthritis or type 1 diabetes.

“The cells impacted by PFAS exposure play important roles in fighting infections and establishing long-term memory to vaccines,” said Darline Castro Meléndez, PhD, a researcher in Scheible’s lab and first author of the study. “An imbalance at a time when the immune system is learning how and when to respond can lead to a higher risk of recurrent infections with more severe symptoms that could carry on through their lifetime.”

Minimising PFAS exposure

Although Rochester’s drinking water meets current safety standards, PFAS lurks in numerous consumer products – from nonstick cookware and food packaging to stain-resistant fabrics and personal care items. The study’s mothers had relatively low PFAS blood levels compared to other regions, yet the immune shifts were pronounced even in this small sample.

While not all environmental exposures can be avoided, families can reduce PFAS contact during critical windows of foetal and infant immune development. “Use water filters, minimise cooking in damaged nonstick pans, switch to alternatives like stainless steel or cast iron, and store food in glass or ceramic containers,” said Scheible. “Small steps can help lower the cumulative burden of exposure.”

The team plans a longer follow-up to determine whether these early T‑cell imbalances persist into toddlerhood and whether they translate into more infections, allergies, or autoimmune diseases. Measuring PFAS in infants directly and unravelling the molecular underpinnings of these immune disruptions are key objectives for future research.

Source: University of Rochester

Categories : Paediatrics Surgeries & ProceduresTags :

Researchers Use Fitbits to Predict Children’s Surgery Complications

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Photo by Natanael Melchor on Unsplash

Although postoperative complications, such as infections, can pose significant health risks to children after undergoing surgical procedures, timely detection following hospital discharge can prove challenging.

A new study from Northwestern University, along with other institutions, is the first to use consumer wearables to quickly and precisely predict postoperative complications in children and shows potential for facilitating faster treatment and care. The study appears in Science Advances.

“Today, consumer wearables are ubiquitous, with many of us relying on them to count our steps, measure our sleep and more,” said senior author Arun Jayaraman, professor at Northwestern University Feinberg School of Medicine and a scientist at Shirley Ryan AbilityLab. “Our study is the first to take this widely available technology and train the algorithm using new metrics that are more sensitive in detecting complications. Our results suggest great promise for better patient outcomes and have broad implications for paediatric health monitoring across various care settings.”

How the study worked

As part of the study, commercially available Fitbit devices were given to 103 children for 21 days immediately after appendectomy, the most common surgery in children, which results in complications up to 38% of the time. Rather than just using the metrics automatically captured by the Fitbit to identify signs of complications (eg, low activity, high heart rate, etc.), Shirley Ryan AbilityLab scientists trained the algorithm using new metrics related to the circadian rhythms of a child’s activity and heart rate patterns. 

In the process, they found such metrics were more sensitive to picking up complications than the traditional metrics. In fact, in analysing the data, scientists were able to retrospectively predict postoperative complications up to three days before formal diagnosis with 91% sensitivity and 74% specificity. 

“Historically, we have been reliant upon subjective reporting from children – who often have greater difficulty articulating their symptoms – and their caregivers following hospital discharge. As a result, complications are not always caught right away,” said study author Dr Fizan Abdullah, who at the time of the study was an attending physician of paediatric surgery at Ann & Robert H. Lurie Children’s Hospital of Chicago and a professor at Feinberg. “By using widely available wearables, coupled with this novel algorithm, we have an opportunity to change the paradigm of postoperative monitoring and care – and improve outcomes for kids in the process.”

What’s next?

This research is part of a four-year National Institutes of Health-funded project. As a next step, scientists plan to transition this approach into a real-time (vs retrospective) system that analyses data automatically and sends alerts to children’s clinical teams. 

“This study reinforces wearables’ potential to complement clinical care for better patient recoveries,” said Hassan M.K. Ghomrawi, vice chair of research and innovation in the department of orthopaedic surgery at University of Alabama at Birmingham. “Our team is eager to enter the next phase of research exploration.”

Source: Northwestern University

Categories : Neurodegenerative Diseases PaediatricsTags :

Why Do Newborns Have Elevated Levels of an Alzheimer’s Biomarker?

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Photo by Pedro Kümmel on Unsplash

What do the brains of newborns and patients with Alzheimer’s disease have in common? Researchers from the University of Gothenburg, led by first author Fernando Gonzalez-Ortiz and senior author Professor Kaj Blennow, recently reported that both newborns and Alzheimer’s patients have elevated blood levels of a protein called phosphorylated tau, specifically a form called p-tau217.

While this protein has been largely used as a diagnostic test for Alzheimer’s disease, with an increase in p-tau217 blood levels proposed to be driven by another process, namely aggregation of b-amyloid protein into amyloid plaques. Newborns (for natural reasons) do not have this type of pathological change, so interestingly, in newborns increased plasma p-tau217 seems to reflect a completely different – and entirely healthy – mechanism.

In a large international study that involved Sweden, Spain and Australia, researchers analyzed blood samples from over 400 individuals, including healthy newborns, premature infants, young adults, elderly adults, and people diagnosed with Alzheimer’s disease. They found that newborn babies had the highest levels of p-tau217 – even higher than those found in people with Alzheimer’s. These levels were particularly elevated in premature babies and started to decrease over the first few months of life, eventually settling to adult levels.

First time in the blood of newborns

Previous research, largely based on animal models, had hinted at the role of phosphorylated tau in early brain development. This is the first time scientists have directly measured p-tau217 concentrations in the blood of human newborns, opening the door to a much clearer understanding of its developmental role.

But here’s where it gets fascinating, while in Alzheimer’s disease p-tau217 is associated with tau aggregation into harmful clumps called tangles, believed to cause the breakdown of brain cells and subsequent cognitive decline. In contrast, in newborns this surge in tau appears to support healthy brain development, helping neurons grow and to form new connections with other neurons, thereby shaping the structure of the young brain.

The study also revealed that in both healthy and premature babies, p-tau217 levels were closely linked to how early they were born. The earlier the birth, the higher the levels of this protein, suggesting a role in supporting rapid brain growth under challenging developmental conditions.

Potential roadmap for new treatments 

What’s perhaps most compelling about these findings, published in the journal Brain Communications, is the hint that our brains may once have had built-in protection against the damaging effects of tau, so that newborns can tolerate, and even benefit from, high levels of phosphorylated tau without triggering the kinds of damage seen in Alzheimer’s.

“We believe that understanding how this natural protection works – and why we lose it as we age – could offer a roadmap for new treatments. If we can learn how the newborn brain keeps tau in check, we might one day mimic those processes to slow or stop Alzheimer’s in its tracks”, says Fernando Gonzalez-Ortiz.

So while an increase of p-tau217 is a danger signal in older brains, in newborns it might be a vital part of building one. The same molecule, two dramatically different roles – one building the brain, the other marking its decline.

Plasma p-tau217 has recently received FDA approval for use in diagnosing Alzheimer’s disease, making it an increasingly important tool in clinical settings. The authors emphasise

Source: the need to also understand the mechanism for the increase in p-tau217, especially for interpreting it as an outcome in clinical and epidemiological research and in drug development. This study indicate that amyloid plaques may not be the main driver of increases in p-tau217.

Source: University of Gothenburg

Categories : PaediatricsTags :

Why Caffeine Might Hold the Key to Preventing Sudden Infant Death Syndrome

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After decades of stalled national progress in reducing the rate of Sudden Unexpected Infant Death (SUID), a category of infant mortality that includes sudden infant death syndrome (SIDS), researchers at Rutgers Health have proposed an unexpected solution: Caffeine might protect babies by preventing dangerous drops in oxygen that may trigger deaths.

The hypothesis, published in the Journal of Perinatology, comes as the number of SUID cases has plateaued in the US at about 3500 deaths a year for 25 years or one death for every 1000 live births. Despite an initial decline in the 1990s with the introduction of widespread education campaigns promoting back to sleep and other safe infant sleep recommendations by the American Academy of Pediatrics, SIDS, even on its own, remains the leading cause of death in infants between 1 and 12 months old.

“We’ve been concerned about why the rates haven’t changed,” said Thomas Hegyi, a neonatologist at Rutgers Robert Wood Johnson Medical School who led the research. “So, we wanted to explore new ways of approaching the challenge.”

That approach led Hegyi and Ostfeld to a striking realisation: Virtually all known risk factors for SIDS and other sleep-related infant deaths, from stomach sleeping to maternal smoking to bed-sharing to preterm birth, have one thing in common. They are all associated with intermittent hypoxia, brief episodes where oxygen levels drop below 80%.

“I wondered, what can counter intermittent hypoxia?” Hegyi said. “Caffeine.”

The connection isn’t entirely theoretical. Neonatologists already use caffeine to treat apnoea in premature infants, where it works as a respiratory stimulant. The drug has an excellent safety profile in babies, with minimal side effects even at high doses.

What makes caffeine particularly intriguing as a proposed preventive measure is how differently infants process it. While adults metabolise caffeine in about four hours, the half-life in newborns can be as long as 100 hours. Caffeine remains in an infant’s system for weeks, not hours.

This unique metabolism might explain a long-standing puzzle: why SIDS peaks between two and four months of age. As infants mature, they begin metabolising caffeine more quickly. The researchers suggest caffeine consumed during pregnancy or passed through breast milk might provide early protection that wanes as metabolism speeds up.

The theory also could explain why breastfeeding appears to protect against SIDS.

“We hypothesize that the protection afforded by breast milk is, in part, due to caffeine,” wrote the researchers, noting caffeine readily passes from mothers to infants through breast milk.

Barbara Ostfeld, a professor at Rutgers Robert Wood Johnson Medical School, the programme director of the SIDS Center of New Jersey and co-author of the paper, said if the theory proves true, any efforts to give infants caffeine would complement, not replace, existing risk reduction strategies.

“The idea isn’t that caffeine will replace risk-reduction behaviours,” Ostfeld said. “A baby dying from accidental suffocation, one component of SUID, is not likely to have benefited from caffeine but would have from such safe sleep practices as the elimination of pillows and other loose bedding from the infant’s sleep environment.”

The researchers plan to test their hypothesis by comparing caffeine levels in infants who died of SIDS with those who died from other causes, such as trauma or disease.

The research represents a fundamental shift in approaching SIDS prevention. While current strategies focus on eliminating environmental risks, this would be the first potential pharmaceutical intervention.

“For over 30 years, we’ve been educating New Jersey’s parents about adopting safe infant sleep practices.  These efforts have contributed to our state rates being the second lowest in the US.  Still, for various reasons, these proven recommendations are not universally adopted,” Ostfeld said. “This new hypothesis offers a way not just to address important risk factors but potentially intervene.”

Crucially, the researchers said this is hypothesis-generating research meant to inspire further study, not a recommendation for parents to give their babies caffeine. Any intervention would require extensive testing for safety and efficacy.

Still, in a field where progress has stagnated for decades, the possibility of a new approach offers hope.

As Hegyi put it, the goal is “to stimulate new thinking about a problem that has remained unchanged for 25 years.”

Source: Rutgers University

Categories : Cardiovascular Disease Implants and Prostheses PaediatricsTags :

Heart Valve Which ‘Grows’ with Young Children Undergoing Preclinical Testing

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The Iris Valve, a transcatheter, growth-accommodating pulmonary valve designed for very young children, was developed at UC Irvine and is currently progressing toward FDA clinical approval. Arash Kheradvar

Researchers at the University of California, Irvine have successfully performed preclinical laboratory testing of a replacement heart valve intended for toddlers and young children with congenital cardiac defects, a key step toward obtaining approval for human use. The results of their study were published recently in the Journal of the American Heart Association.

The management of patients with congenital heart disease who require surgical pulmonary valve replacement typically occurs between the ages of 2 and 10. To be eligible for a minimally invasive transcatheter pulmonary valve procedure, patients currently must weigh at least 20.4kg. For children to receive minimally invasive treatment, they must be large enough so that their veins can accommodate the size of a crimped replacement valve. The Iris Valve designed and developed by the UC Irvine team can be implanted in children weighing as little as 7.7 to 10kg and gradually expanded to an adult diameter as they grow.

Research and development of the Iris Valve has been supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Heart, Lung, and Blood Institute; and the National Science Foundation.

This funding has enabled benchtop fracture testing, which demonstrated the valve’s ability to be crimped down to a 3mm diameter for transcatheter delivery and subsequently enlarged to 20mm without damage, as well as six-month animal studies that confirmed successful device integration within the pulmonary valve annulus, showing valve integrity and a favourable tissue response.

“We are pleased to see the Iris Valve performing as we expected in laboratory bench tests and as implants in Yucatan mini pigs, a crucial measure of the device’s feasibility,” said lead author Arash Kheradvar, UC Irvine professor of biomedical engineering. “This work represents the result of longstanding collaboration between our team at UC Irvine and Dr Michael Recto at Children’s Hospital of Orange County built over several years of joint research and development.”

Congenital heart defects affect about 1% of children born in the United States and Europe, with over 1 million cases in the US alone. These conditions often necessitate surgical interventions early in life, with additional procedures required to address a leaky pulmonary valve and prevent right ventricular failure as children grow.

The Iris Valve can be implanted via a minimally invasive catheter through the patient’s femoral vein. The Kheradvar group employed origami folding techniques to compress the device into a 12-French transcatheter system, reducing its diameter to no more than 3mm. Over time, the valve can be balloon-expanded up to its full 20mm diameter.

This implantation method, along with the ability to begin treatment earlier in very young patients, helps mitigate the risk of complications from delayed care and reduces the need for multiple surgeries in this vulnerable population.

“Once the Iris Valve comes to fruition, it will save hundreds of children at least one operation – if not two – throughout the course of their lives,” said Recto, an interventional paediatric cardiologist at CHOC who’s also a clinical professor of paediatrics at UC Irvine. “It will save them from having to undergo surgical pulmonary valve placement, as the Iris Valve is delivered via a small catheter in the vein and can be serially dilated to an adult diameter and also facilitate the future placement of larger transcatheter pulmonary valves – with sizes greater than 20 millimetres, like the Melody, Harmony and Sapien devices – if needed.”

Source: University of California, Irvine