Background: The evaluation of metabolic syndrome (MetS) is critical among children and adolescents as it can predict cardiovascular disease in adulthood. The TG/HDL-C ratio has the best predictive accuracy among the different lipid ratios. This study aims to evaluate the prevalence and factors associated with a high TG/HDL-C ratio and the predictive accuracy for pediatric MetS. Methods: This is a cross-sectional study of adolescents aged 9–21 to determine the prevalence of and associations between an elevated TG/HDL-C ratio and MetS. A ROC curve analysis was performed to determine the predictive accuracy of TG/HDL-C with MetS. Results: Of the 604 subjects, 29.8% had elevated TG/HDL-C, MetS was identified in 28.2%, and 54.5% were obese. Among patients with MetS, those with obesity were more likely to have an elevated TG/HDL-C ratio compared to those with a normal BMI (64% vs. 14%, p < 0.05). Gender, obesity, ethnicity, and METS are significantly associated with a high TG/HDL-C ratio. TG/HDL-C has a good discriminatory ability to distinguish patients with MetS from those without (AUC 0.65, p < 0.05). Conclusions: The TG/HDL-C ratio was able to distinguish between children and adolescents with MetS. Hence, the TG/HDL-C ratio may be used in the rapid risk assessment of pediatric MetS, especially in those with obesity.

Objective This study aimed to assess the association between neonatal antibiotic exposure and the risk of childhood obesity. Study Design This retrospective cohort study enrolled neonates born between 2011 and 2015 and followed up until 5 years. The incidence of obesity at 5 years old, and other characteristics were compared between the antibiotic-exposed and unexposed groups. Chi-square test was conducted on categorical variables and Student's t-test for normally distributed continuous variable. Significant variables (p < 0.05) in bivariate analysis were modelled in a stepwise multivariate logistic regression analysis to ascertain independent predictors of obesity at 5 years. Results Of the 1,447 subjects, 749 (51.8%) received ampicillin and gentamicin, and 333 (23%) were obese. Neonates exposed to antibiotics were more likely to be obese compared with those unexposed (26 vs. 20%, p = 0.01). In the adjusted model, this association persisted (adjusted odds ratio: 1.37, p = 0.02). Conclusion Neonatal antibiotic exposure is associated with early childhood obesity and may play a significant role in the weight trajectories of these children. Hence, antibiotic stewardship in this period cannot be overemphasized. Key Points

Background: There are limited data on prescription patterns in adolescents and adults with Fontan circulation. Methods: We conducted a retrospective analysis of patients 13 years of age and older enrolled between 2022 and 2024 in the Fontan Outcomes Network (now SV‐ONE [Single Ventricle Outcomes Network]) who had undergone Fontan operation without subsequent Fontan takedown or heart transplantation. Demographics, clinical variables, and medications prescribed were assessed. Logistic regression was used to identify factors associated with prescribed cardiac medications. Results: There were 639 patients (age range 13–67 years, 55.6% male, 81.1% White race, 46.8% dominant left ventricle) enrolled at 16 centers. The most frequently prescribed medication classes were antiplatelets (75.6%) and renin‐angiotensin system inhibitors (55.9%). Direct oral anticoagulant prescription (15.0%) exceeded that of warfarin (11.6%). SGLT2 (sodium glucose cotransporter 2) inhibitors were prescribed to 6.3% of patients, and angiotensin receptor/neprilysin inhibitors were prescribed to 2.2%. Moderate or severely decreased systolic ventricular function was most strongly associated with prescription of digoxin (odds ratio [OR], 4.2 [95% CI, 2.1–8.3]). Protein losing enteropathy was most strongly associated with prescription of diuretics (OR, 22.9 [95% CI, 8.1–64.9]), mineralocorticoid receptor agonists (OR, 5.3 [95% CI, 2.4–11.8]), and pulmonary vasodilators (OR, 5.2 [95% CI, 2.5–10.8]). Conclusions: In a multicenter cohort of adolescents and adults with Fontan circulation, medications indicated for biventricular heart failure with reduced ejection fraction are often used despite an absence of supportive evidence in this distinct circulation. Future prospective analysis may provide further insight into shifting prescribing patterns and response to therapy.

Cardiac rhabdomyomas are the most common benign paediatric cardiac tumours. Arrhythmias and cardiac conduction abnormalities have both been described with these tumours and resolved with reduction in size of the tumours. Here, we present a case of a child who was prenatally diagnosed with multiple cardiac rhabdomyomas and cardiac arrhythmias and found to have ventricular pre-excitation after birth, in whom the tumours regressed, and pre-excitation resolved with 12 weeks of sirolimus and propranolol therapy. However, 8 weeks after cessation of sirolimus and propranolol therapy, tumour size increased, and manifest ventricular pre-excitation recurred and progressed to ventricular tachycardia. Subsequent follow-up after restarting sirolimus and propranolol therapy showed a significant reduction in tumour burden and resolution of pre-excitation. Conclusions: This finding underscores the need for risk stratification among patients with cardiac rhabdomyomas to identify those that need more prolonged medical treatment or closer monitoring.