Breast milk (BM) is considered as a reference for infant nutrition. The role of bioactive components, such as cytokines, hormones, growth factors (GFs) and fatty acids (FAs) is poorly known, but they might be implicated in immune response development. The aim of this study was to identify the lipid profile and the spectrum of cytokines and neuronal GF in BM samples and analyse the influence of gestational age and lactation time on these components. This study used a longitudinal prospective method for the characterization of cytokines, FAs and GFs global profiles in 120 BM samples from 40 healthy mothers (20 preterm and 20 term) collected as colostrum, transitional and mature milk. The cytokines were analysed by protein array (Ray Bio® Human Cytokine Array G6. Ray Biotech, Inc. Norcross, GA, USA) and the FAs were analysed by gas chromatography. The FA profile was similar between the term and the preterm BM samples. Omega-3-α-linoleic and docosahexaenoic acid (DHA) and omega-6-linoleic acid were the most abundant in the term and preterm samples during lactation. Omega-3 ETA and omega-3 EPA we observed exclusively in the preterm samples. The cytokine profile showed a different trend based on gestational age. A significantly higher expression of neurotrophic factors was found in the mature preterm milk samples as compared to the mature term samples. Our study is the first to identify the influence and interactions of perinatal factors on cytokine, GFs and FAs in human milk.

Extrahepatic portal vein obstruction, although rare in children, is a significant cause of portal hypertension (PHT) leading to life-threatening gastrointestinal bleeding in the pediatric age group. PHT may also lead to other complications such as hyperesplenism, cholangyopathy, ascites, and even hepatopulmonary syndrome and portopulmonary hypertension that may require organ transplantation. Herein we report the case of an asymptomatic 11-month-old infant wherein a hepatomegaly and cavernous transformation of the portal vein was detected by liver ultrasound. Neither signs of thrombosis in arteriovenous system, nor affectation of biliary tract were identified in the magnetic resonance imaging study. A significant enlargement of the caudate lobe of the liver was reported. No risk factors were detected. The differential diagnosis performed was extensive. Inherited thrombophilia and storage disorders were especially considered. Liver biopsy was normal. Upper gastrointestinal esophagogastroduodenoscopy detected two small varicose cords on the distal third of the esophagus. Finding a cavernous transformation of the portal vein with evidence of collateral circulation in such an early age is a challenging condition for professionals, since PHT may lead to severe complications during childhood and can compromise growth and development. Evidence-based guidelines for the management of PHT in adults have been published. However, follow-up and treatment of pediatric patients have not yet been standardized. Moreover, management of PHT in infants faces particular difficulties such as technical restrictions that could hinder their treatment.

CASE: A 14-year-old girl is taken to the pediatric emergency department (ED) by her parents because of sudden complex hallucinations. She shows moderate intellectual disability without a peculiar phenotype already evaluated by neuropediatrics (normal comparative genomic hybridization array and brain magnetic resonance imaging) and most likely related to affective deprivation at the orphanage. Adopted at 20 months from China, her parents reported that on arrival she had scars, allegedly from being tied to a chair for a long time, and that although she was able to stand, she could not walk. At 22 months, she had experienced several episodes of loss of consciousness with rigidity that were attributed to sobbing spasms. Her family history is unknown. She is up to date on all her vaccinations and had menarche a year ago. Adaptation to her new family was complicated at first, but thanks to their dedication, she established a strong family bond and managed to settle into an ordinary school with curriculum adaptation. She is good friends with her classmate and has not shown any behavioral problems. Her clinical history started 48 hours before the current visit when she told her parents that at school that day a classmate had hit her on the neck (an unfortunate incident later confirmed to be without malicious intent). From then on, she became increasingly agitated and unable to sleep, and so she was assessed the next day. On her first visit to the ED, she was distressed and presented with referred cervicalgia, showing lateralization of the neck suggestive of muscle contracture. Analgesia and diazepam were administered with good response in behavior and neck posture. Within hours of the first visit, she started having visual and auditory hallucinations. She complained of individuals threatening to harm her: “a man wearing a patch who wanted to gouge out her eye” and “a girl with a gun who wanted to shoot her.” She stared and pointed fearfully toward where she could supposedly see them. Despite a further dose of diazepam, she stayed awake and soliloquized overnight, apparently responding to these individuals and expressing great fear of them (anxiously begging them “not to harm her,” claiming to see “blood falling from her ear”) and also displaying delirious interpretations (on meeting 2 men wearing gowns, she asked them for help). Aside from these, she displayed marked food refusal, was afebrile, and had no other symptoms. She had not taken any medication recently, had no access to drugs, and had not suffered any head trauma.

The diaper rash is a common medical query in pediatric offices. Most of the time it is due to a contact dermatitis or mild infection that only requires local care for its resolution. The appearance of more severe lesions, such as ulcers, and the resistance to conventional therapy should make us suspect the existence of an underlying disease.