This case is a 4-month-old patient with Kawasaki disease who showed coronary artery lesions after a disease relapse. Following the guidelines from the Randomised Controlled Trial to Assess Immunoglobulin plus Steroid Efficacy, the patient initially saw an improvement in symptoms. However, a relapse occurred despite low levels of C-reactive protein, leading to significant coronary artery growth. Treatment with a third dose of intravenous immunoglobulin and cyclosporine led to a slow reduction in the size of the coronary artery abnormalities. This case highlights the difficulty in monitoring Kawasaki disease progression through clinical symptoms and C-reactive protein levels alone. We also emphasise the necessity of echocardiographic monitoring in patients receiving anti-inflammatory treatments, including steroids, because coronary artery problems can arise or continue without the usual signs of Kawasaki disease or increased C-reactive protein levels.

We report a case of dilated cardiomyopathy-like hypertensive cardiomyopathy (HTN-CM) with polycystic kidney disease without family history when a 3-month-old boy developed bacteraemia secondary to a urinary tract infection. He was later confirmed as having autosomal recessive inheritance due to the proven PKHD1 gene mutation. The treatment consisted mainly of antihypertensive and anti-heart failure therapies and he was discharged on the 131st day. To prevent the development of heart failure in patients with HTN-CM due to autosomal recessive polycystic kidney disease (ARPKD), it is important to improve the fetal diagnosis rate of ARPKD, detect hypertension early, and strictly control the blood pressure after birth.

The complementary feeding period (6-23 months of age) is when solid foods are introduced alongside breastmilk or infant formula and is the most significant dietary change a person will experience. The introduction of complementary foods is important to meet changing nutritional requirements(1). Despite the rising Asian population in New Zealand, and the importance of nutrition during the complementary feeding period, there is currently no research on Asian New Zealand (NZ) infants’ micronutrient intakes from complementary foods. Complementary foods are a more easily modifiable component of the diet than breastmilk or other infant milk intake. This study aimed to compare the dietary intake of micronutrients from complementary foods of Asian infants and non-Asian infants in NZ. This study reported a secondary analysis of the First Foods New Zealand cross-sectional study of infants (aged 7.0-9.9 months) in Dunedin and Auckland. 24-hour recall data were analysed using FoodFiles 10 software with the NZ food composition database FOODfiles 2018, and additional data for commercial complementary foods(2). The multiple source method was used to estimate usual dietary intake. Ethnicity was collected from the main questionnaire of the study, answered by the respondents (the infant’s parent/caregiver). Within the Asian NZ group, three Asian subgroups were identified – South East Asian, East Asian, and South Asian. The non-Asian group included all remaining participants of non-Asian ethnicities. Most nutrient reference values (NRV’s)(3) available for the 7-12 month age group are for total intake from complementary foods and infant milks, so the adequacy for the micronutrient intakes from complementary foods alone could not be determined. Vitamin A was the only micronutrient investigated in this analysis that had an NRV available from complementary foods only, allowing conclusions around adequacy to be made. The Asian NZ group (n = 99) had lower mean group intakes than the non-Asian group (n = 526) for vitamin A (274µg vs. 329µg), and vitamin B12 (0.49µg vs. 0.65µg), and similar intakes for vitamin C (27.8mg vs. 28.5mg), and zinc (1.7mg vs. 1.9mg). Mean group iron intakes were the same for both groups (3.0mg). The AI for vitamin A from complementary foods (244µg) was exceeded by the mean intakes for both groups, suggesting that Vitamin A intakes were adequate. The complementary feeding period is a critical time for obtaining nutrients essential for development and growth. The results from this study indicate that Asian NZ infants have lower intakes of two of the micronutrients of interest than the non-Asian infants in NZ. However, future research is needed with the inclusion of infant milk intake in these groups to understand the total intake of the micronutrients. Vitamin A intakes do appear to be adequate in NZ infants.

Dietary fat is a major energy source and an essential nutrient that supports healthy growth and development in young children(1). Despite the important role of dietary fat in early childhood, our understanding of fat intake trends during this period is limited, particularly among Australian children. Insufficient evidence has led to the establishment of an Adequate Intake (AI) for infants aged 0-12 months in Australia, while no recommendation is available for children ages 1-5 years. This study aimed to comprehensively describe fat intake and major food sources in young Australian children. The data of children at ages 9 months (n = 393), 18 months (n = 284), 3.5 years (n = 244), and 5 years (n = 240) from the Melbourne InFANT Program were used(2). At each time point, child dietary intake data were collected via three 24-hour recalls. Food measurement booklets were utilised to estimate food portions. Food groups and nutrient intakes per day were calculated using the 2007 AUSNUT Food Composition Database. Daily energy (kJ/d) and fat (g/d) intake, the contribution of fat to total energy intake, and key food sources of fat intake were calculated. Descriptive statistics (mean and SD) were used to summarise all data. The mean daily energy intake increased from 3490 kJ/d at 9 months to 5889 kJ/d at 5 years. The mean (SD) fat intake (g/d) was 33.7 (8.0) (Australian AI is 30 g/d) at 9 months, 37.5 (9.5) at 18 months, 44.6 (13.4) at 3.5 years, and 49.0 (15.1) at 5 years. The WHO/FAO recommends that total fat intakes should constitute a minimum of 35% of energy (%E) for children aged 6-24 months, gradually reducing to a range of 25% to 35 %E for children aged 2 to 5 years(3). Notably, 40% of children at 9 months, 76% at 18 months, 14% at 3.5 years, and 12% at 5 years had fat intakes below the WHO/FAO recommendations. In contrast, 24% of children at 3.5 years and 28% at 5 years exceeded the recommendation. At 9 months, the primary source of fat was formula/breastmilk, while at later ages, the major sources were milk/milk products, cakes/cookies, and breads/cereals. The proportion of fat from discretionary foods, such as cakes/cookies, processed meats, butter, oil or fat spreads, increased with age. The percentage of total fat from fish, nuts, and seeds was low, contributing <4 %E at all time points. The study highlights a significant proportion of children exceeding or falling below fat intake recommendations. Moreover, the results suggest low consumption of healthy fat sources such as fish, nuts, and seeds. The study findings will contribute to the refinement of fat recommendations in young Australian children and contribute to interventions that aims to improve fat intakes.

The prevalence of food allergies in New Zealand infants is unknown; however, it is thought to be similar to Australia, where the prevalence is over 10% of 1-year-olds(1). Current New Zealand recommendations for reducing the risk of food allergies are to: offer all infants major food allergens (age appropriate texture) at the start of complementary feeding (around 6 months); ensure major allergens are given to all infants before 1 year; once a major allergen is tolerated, maintain tolerance by regularly (approximately twice a week) offering the allergen food; and continue breastfeeding while introducing complementary foods(2). To our knowledge, there is no research investigating whether parents follow these recommendations. Therefore, this study aimed to explore parental offering of major food allergens to infants during complementary feeding and parental-reported food allergies. The cross-sectional study included 625 parent-infant dyads from the multi-centred (Auckland and Dunedin) First Foods New Zealand study. Infants were 7-10 months of age and participants were recruited in 2020-2022. This secondary analysis included the use of a study questionnaire and 24-hour diet recall data. The questionnaire included determining whether the infant was currently breastfed, whether major food allergens were offered to the infant, whether parents intended to avoid any foods during the first year of life, whether the infant had any known food allergies, and if so, how they were diagnosed. For assessing consumers of major food allergens, 24-hour diet recall data was used (2 days per infant). The questionnaire was used to determine that all major food allergens were offered to 17% of infants aged 9-10 months. On the diet recall days, dairy (94.4%) and wheat (91.2%) were the most common major food allergens consumed. Breastfed infants (n = 414) were more likely to consume sesame than non-breastfed infants (n = 211) (48.8% vs 33.7%, p≤0.001). Overall, 12.6% of infants had a parental-reported food allergy, with egg allergy being the most common (45.6% of the parents who reported a food allergy). A symptomatic response after exposure was the most common diagnostic tool. In conclusion, only 17% of infants were offered all major food allergens by 9-10 months of age. More guidance may be required to ensure current recommendations are followed and that all major food allergens are introduced by 1 year of age. These results provide critical insight into parents’ current practices, which is essential in determining whether more targeted advice regarding allergy prevention and diagnosis is required.

Refractory chylothorax, a postoperative complication of CHD, is difficult to manage and sometimes fatal. Herein, we report the case of a 10-month-old infant with 22-mosaic trisomy and a coarctation complex, who developed refractory chylothorax after cardiac repairs and was successfully treated with midodrine, an oral alpha-1-adrenoreceptor agonist. Midodrine may be used as adjunctive therapy for postoperative refractory chylothorax.

Using both online and offline measures, this study investigates how maternal education and work status (stay-at-home, part-time, full-time) are jointly associated with infants’ word learning ability and vocabulary size. One hundred 24-month-old infants completed a lab-based mutual exclusivity task, which assesses infants’ novel word learning ability. Caregivers reported infants’ productive vocabulary size using the MCDIs. There was no evidence for an association between infants’ productive vocabulary size and maternal education, maternal work status, or their interaction. However, infants’ novel word learning ability was significantly related to both maternal factors and their interaction. The positive association between maternal education and word learning performance was attenuated for infants of part-time and full-time working mothers compared to infants with at home mothers. These findings suggest that using real-time measures with high task demand may better capture developmental differences in infants and expand our understanding of maternal factors contributing to early language development.

The effects of maternal postpartum depression (PPD) on offspring emotion regulation (ER) are particularly deleterious as difficulties with ER predict an increased risk of psychopathology. This study examined the impact of maternal participation in a public health nurse (PHN)-delivered group cognitive behavioral therapy (CBT) intervention on infant ER. Mothers/birthing parents were ≥ 18 years old with an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10, and infants were < 12 months. Between 2017 and 2020, 141 mother–infant dyads were randomized to experimental or control groups. Infant ER was measured at baseline (T1) and nine weeks later (T2) using two neurophysiological measures (frontal alpha asymmetry (FAA) and high-frequency heart rate variability (HF-HRV)), and informant-report of infant temperament. Mothers were a mean of 30.8 years old (SD = 4.7), 92.3% were married/ common-law, and infants were a mean of 5.4 months old (SD = 2.9) and 52.1% were male. A statistically significant group-by-time interaction was found to predict change in HF-HRV between T1 and T2 (F(1,68.3) = 4.04, p = .04), but no significant interaction predicted change in FAA or temperament. Results suggest that PHN-delivered group CBT for PPD may lead to adaptive changes in a neurophysiological marker of infant ER, highlighting the importance of early maternal intervention.

Fe-deficiency anaemia is a major public health concern in children under 5 years of age. TMPRSS6 gene, encoding matriptase-2 protein, is implicated in Fe homoeostasis and has been associated with anaemia and Fe status in various populations. The aim of this cross-sectional study was to investigate the associations between the single nucleotide polymorphism (SNP) TMPRSS6 rs855791 and biomarkers of anaemia and Fe deficiency in Brazilian children attending day care centres. A total of 163 children aged 6–42 months were evaluated. Socio-economic, demographic, biochemical, haematological, immunological and genotype data were collected. Multiple logistic and linear regressions with hierarchical selection were used to assess the effects of independent variables on categorised outcomes and blood marker concentrations. Minor allele (T) frequency of rs855791 was 0·399. Each copy of the T allele was associated with a 4·49-fold increased risk of developing anaemia (P = 0·005) and a 4·23-fold increased risk of Fe deficiency assessed by serum soluble transferrin receptor (sTfR) (P < 0·001). The dose of the T allele was associated with an increase of 0·18 mg/l in sTfR concentrations and reductions of 1·41 fl and 0·52 pg in mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH), respectively. In conclusion, the T allele of SNP TMPRSS6 rs855791 was significantly associated with anaemia and Fe deficiency assessed by sTfR in Brazilian children attending day care centres. The effect was dose dependent, with each copy of the T allele being associated with lower MCV and MCH and higher concentrations of sTfR.

Premature birth, bronchopulmonary dysplasia or restrictive nutrition in the first weeks of postnatal life may have repercussions on lung development and affect long-term lung function outcomes. This prospective observational study is based on a cohort of 313 very low birth weight (VLBW) neonates, born between 1 January 2008 and 1 December 2016. The daily intake of calories, protein, fat and carbohydrates during the first week of life and evidence of inadequate weight gain (Δwt) until week 36 of gestational age (GA) were recorded. FEV1, FEF25–75 %, forced vital capacity (FVC) and the FEV1/FVC ratio were determined. The relations between these parameters were determined by regression analysis. Spirometric parameters were obtained for 141 children with a mean age of 9 years (95 % CI 7, 11); 69 of them (48·9 %) had presented wheezing episodes on more than three occasions. In addition, 60 (42·5 %) had a history of bronchopulmonary dysplasia. Of these, n 40 (66·6 %) had a history of wheezing. Significant association between protein/energy intake in the first week of life and the lung function parameters analysed was observed. Poor Δwt to GA week 36 was significantly associated with decreased mean pulmonary flow. Inadequate protein/energy intake in the first week of life of VLBW newborns and poor Δwt to week 36 of GA is associated with a significant worsening of lung function parameters.

Massive vertical vein aneurysm in a supracardiac total anomalous pulmonary venous connection is rare. Herein, vertical vein aneurysm with total anomalous pulmonary venous connection and additional pathological findings are reported in a young child.

The inflammatory myofibroblastic tumour, although very rare, must be considered in the differential diagnosis of intracardiac masses in children as it has systemic implications. We present a case of an infant whose diagnosis was suspected on clinical basis and echocardiogram, but the anatomopathological analysis with immunohistochemical study was essential for the conclusion of the histological type and orientation of the clinical follow-up.

We performed coronary artery bypass grafting with the internal thoracic artery in three infants. Grafts were patent in all cases. One patient was lost due to chronic heart failure. Coronary artery bypass grafting can be performed even in infancy, and early surgical intervention may be necessary when myocardial ischaemia is recognised.

Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, “Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease,” includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.