Background: Exclusive breastfeeding (EBF) provides health benefits, yet its continuation remains limited. Maternal endocrine disorders, including gestational hypothyroidism, may impair lactogenesis through hormonal dysregulation; however, evidence regarding the association between gestational hypothyroidism and breastfeeding outcomes remains limited. Objective: To investigate the association between maternal gestational hypothyroidism and breastfeeding outcomes in term infants, with a focus on EBF at the end of the first month and formula-free breast milk feeding at 6 months. Methods: This retrospective matched case–control study compared term infants of mothers with gestational hypothyroidism treated with levothyroxine ( n = 103) and matched controls ( n = 103). Feeding data were obtained from medical records and 6-month telephone follow-up, and factors associated with early formula supplementation were analyzed using multivariable logistic regression. Results: EBF rates were significantly lower in the case group at 1 month (58.3% versus 81.6%, p < 0.001). Formula supplementation within the first postnatal day was more frequent in the case group than in controls (46.6% versus 21.4%; χ ² = 14.63, p < 0.001). At 6 months, formula feeding—either alone or combined with breastfeeding and/or complementary foods—was significantly more frequent in the case group (45.6% versus 25.2%, p = 0.003). Among infants who ever received formula ( n = 84), formula was initiated during the first postnatal month more frequently in the case group (82.7% versus 59.4%, p = 0.018), with earlier mean age at formula initiation (1.4 ± 0.97 versus 2.3 ± 1.51 months, p = 0.003). Multivariable logistic regression showed that higher maternal gravidity was independently associated with early formula supplementation (odds ratio = 3.16; 95% confidence interval: 1.09–9.10; p = 0.033). Conclusions: Gestational hypothyroidism was associated with lower EBF rates at 1 month and increased early formula supplementation. These findings underscore the need for targeted lactation support and careful postpartum follow-up in mothers with gestational hypothyroidism.

Introduction: Biopsy-related hemorrhage in neonates is rare but may rapidly become life-threatening when refractory to conventional hemostatic interventions. This case is unique in reporting the first successful use of topical Ankaferd Blood Stopper® (ABS) as a salvage hemostatic agent in a neonate with infantile undifferentiated round-cell sarcoma within the differential spectrum of BCOR-altered sarcomas, an exceptionally rare malignancy, following life-threatening, refractory post-biopsy hemorrhage. Patient concerns and clinical findings: A term female neonate presented with a rapidly enlarging left facial mass with proptosis and restricted eye movements. Intraoral incisional biopsy was performed to obtain histopathological diagnosis. Within 72–74 h post-biopsy, active hemorrhage persisted despite multiple conventional hemostatic measures, including local compression, topical epinephrine, intravenous tranexamic acid, vitamin K, and fresh frozen plasma (FFP). The neonate developed hemorrhagic shock with hemodynamic instability (heart rate >170 bpm, blood pressure 45/25 mmHg, oxygen saturation <88%) and required packed red blood cell (PRBC) transfusion. Baseline coagulation parameters were within normal neonatal reference ranges; comprehensive coagulopathy screening excluded an underlying bleeding disorder. Diagnosis, intervention, and outcomes: Histopathological examination was most consistent with infantile undifferentiated round-cell sarcoma within the differential spectrum of BCOR-altered sarcomas. Topical ABS was applied as a salvage intervention at 72–74 h post-biopsy. Hemostasis was achieved within minutes and was reproducible across three applications, with a total administered volume of no more than 6 mL and no local or systemic adverse effects. The neonate subsequently underwent urgent surgical debulking/resection and adjuvant therapy. At six-month follow-up, the patient remains alive without evidence of disease recurrence. Conclusion: Topical ABS may represent an effective and potentially lifesaving option for managing severe, refractory hemorrhage in neonates when conventional therapies fail. Its coagulation-independent mechanism may be particularly advantageous in this vulnerable population. This case highlights the importance of considering ABS in life-threatening neonatal hemorrhagic emergencies and underscores the need for prospective studies to establish standardized neonatal protocols.

Background/Objectives: Serum vitamin B12 testing is frequently ordered in pediatric outpatient practice, either routinely or incidentally as part of broad laboratory panels or in response to symptoms and nutritional concerns; however, how the yield of low serum vitamin B12 results varies across age groups and testing indications remains poorly defined. The primary focus was age-related variation in low serum vitamin B12 results, with recorded testing indications examined as a secondary question and symptom-specific analyses considered exploratory. Methods: This single-center retrospective study analyzed testing episodes from children aged 0–18 years attending general pediatric outpatient clinics in 2025. Outcomes were <200 pg/mL (primary) and <300 pg/mL (secondary). Two blinded physicians classified testing indications. Cluster-robust regression evaluated age, sex, and indication; 18 symptom indicators were evaluated in age- and sex-adjusted models with Benjamini–Hochberg correction. Results: Of 34,744 episodes, 34,721 were valid; 5.8% were <200 pg/mL and 27.5% were <300 pg/mL. Low-result yield (<200 pg/mL) showed a bimodal age pattern: 7.9% at ages 0–2 years, 2.3% at 3–5 years, and 10.6% at 15–18 years. The number of tests per low result ranged from 9.4 at ages 15–18 years to 42.8 at ages 3–5 years. Routine or incidental testing comprised 63.9% of episodes; crude yield by indication ranged from 4.9% to 7.3%. Compared with 6–11 years, adjusted odds were higher at 0–2 years (aOR 2.81, 95% CI 2.44–3.24) and 15–18 years (aOR 3.92, 95% CI 3.42–4.51). No indication independently predicted the primary outcome; no symptom remained significant for that outcome after false discovery rate correction. Conclusions: The yield of low serum vitamin B12 results was strongly age-dependent and bimodal, with higher-yield periods during the first two years of life and adolescence. Broad retrospectively recorded testing indications were not independently associated with results < 200 pg/mL after adjustment for age and sex. These findings support age-informed assessment alongside clinician-directed testing.

Diaphragmatic eventration is a rare congenital anomaly characterized by the replacement of diaphragmatic muscle with fibroelastic tissue, leading to diaphragm elevation and functional impairment. While it can occur in isolation, it is sometimes associated with congenital syndromes, including septo-optic dysplasia (SOD). This report presents a case of diaphragmatic eventration in a neonate with Fryns syndrome presenting with cleft palate and SOD, highlighting diagnostic challenges. A late preterm female neonate, born via cesarean at 36 weeks gestation, presented with respiratory distress and required intubation and surfactant therapy. Physical examination revealed features suggestive of Fryns syndrome, including coarse facies, microphthalmia, and cleft palate. Imaging studies, including chest X-ray and thoracic ultrasound, raised suspicion of diaphragmatic hernia, but subsequent MRI confirmed diaphragmatic eventration. Additional cranial imaging identified agenesis of the corpus callosum, colpocephaly, and optic nerve hypoplasia, leading to the diagnosis of SOD. Diaphragmatic eventration, though rare, can present in neonates with other congenital anomalies, making diagnosis challenging. In this case, the overlapping symptoms with cleft palate and SOD complicated the clinical picture. Early imaging, including MRI, is crucial for accurate diagnosis and timely management. Multidisciplinary follow-up is essential for optimal patient care.