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Reducing lamb mortality has production, economic and animal welfare benefits. The timing and causes of death and associated risk factors were investigated in a study conducted over 2 consecutive years (involving 1 103 and 1 038 ewes in 2017 and 2018, respectively) in three prolific (average litter size 1.91) indoor-lambing, lowland flocks (in Ireland) that consisted of a range of genotypes, managed in grass-based systems of production. Data were collected from all foetuses and lambs that died (between ∼120 days gestation and weaning at 14 weeks of age); 221 cases in 2017 and 241 cases in 2018. All cases were submitted to a Regional Veterinary Laboratory for necropsy examination using standardised protocols that were developed in advance of case submissions. The majority (60%) of lamb mortality occurred prior to or within 24 h of birth: 46% at or prior to birth and 14% within the first 24 h. Infection (32%) and dystocia (20%) accounted for over half of the mortality. Chlamydia abortus was detected more often in lambs from 2-year-old ewes lambing for the first time than in lambs from older ewes. Dystocia accounted for a statistically significant higher proportion of deaths among purebred lambs born to Texel ewes (49.4%, 95%CI (confidence interval) 36.0 – 62.9) compared to purebred lambs born to Belclare ewes (12.8, 95%CI 2.2 – 23.5). More lambs failed to yield a diagnosis of the cause of death when born to Belclare ewes (29.2%, 95%CI 17.8 – 40.6) than to Suffolk-X ewes (7.4%, 95%CI 0.1 – 14.8). About one−third of lamb mortality cases were adjudged to be preventable through more consideration of management factors during pregnancy, parturition and early postpartum. The use of good hygiene practices at lambing time and optimising lamb birth weight should reduce the level of preweaning lamb mortality in indoor lambing flocks.

Large diffusion-weighted brain MRI (dMRI) studies in neonates are crucial for developmental neuroscience. Our aim was to investigate the utility of ComBat, an empirical Bayes tool for multisite harmonization, in removing site effects from white matter (WM) dMRI measures in healthy infants born at 37 gestational weeks+ 0 days-42 weeks+ 6 days from the Theirworld Edinburgh Birth Cohort (n = 86) and Developing Human Connectome Project (n = 287). Skeletonized fractional anisotropy (FA), mean, axial and radial diffusivity (MD, AD, RD) maps were harmonized. Differences between voxel-wise metrics, skeleton means and histogram widths (5th-95th percentile) were assessed before and after harmonization, as well as variance associated with gestational age at birth and scan. Before harmonization, large cohort differences were observed. Harmonization removed all voxel-wise differences from MD maps and all metric means and histogram widths, however small voxel-wise differences (

Objective: Although family-centred care (FCC) is recommended in neonatal intensive care units (NICUs), barriers still exist. This study aimed to identify and understand and nurse-related factors contributing to the implementation of a father-friendly NICU (FF-NICU). Methods: Eleven pre- and post-implementation focus groups were conducted with 21 nurses. Data were analysed using meaning condensation. Results: Four pre-implementation themes emerged: 1) fathers' limited presence, 2) worries, vulnerability, and emotions, 3) types of fathers, and 4) involvement of fathers.Eight themes contributed to the implementation of FF-NICU: 1) Advantage for the infant/family, 2) Presence of fathers, 3) Less work for the nurses, 4) Daily work routines, 5) Taking something from the mother, 6) Different approaches, 7) Creativity and flexibility, and 8) Implementation process. Conclusion: Important for the implementation of FF-NICU were that the change was necessary, advantageous for the nurses, and beneficial for the families. Still, nurses needed to be flexible and creative in the care of the fathers/families. Innovation: This study focused on fathers - an underexposed target group. Examining key factors for those executing the intervention and discussing the findings using the theoretical framework of John P. Kotter's implementation strategy, we contribute to a better understanding of implementation processes.

Objectives: To analyse the clinical characteristics and risk factors for bloodstream infections (BSIs) caused by carbapenem-resistant Enterobacteriaceae (CRE) in neonates. Methods: This single-centre, retrospective study included all patients with BSIs admitted to a neonatal intensive care unit between 1 January 2015 and 30 April 2022. The clinical and microbiological data of patients were collected; predictors of 30-day mortality in patients with CRE BSIs were also identified in this study. Results: Among the 224 neonates with Enterobacteriaceae BSIs, 39.29% (88/224) of the patients developed CRE BSIs. The 30-day mortality rate reached up to 21.59% (19/88). The Quick Sequential Organ Failure Assessment score > 2 (odds ratio [OR] and 95% credibility interval [CI]: 3.852 [1.111–13.356], P < 0.05), prior to more than two kinds of antibiotics use (OR and 95% CI: 9.433 [1.562–56.973], P < 0.05), pneumonia (OR and 95% CI: 3.847 [1.133–13.061], P < 0.05), and caesarean section (OR and 95% CI: 2.678 [1.225–5.857], P < 0.05) were independent risk factors associated with CRE BSIs. Moreover, the risk factors for mortality in neonates with CRE BSIs were significantly associated with neonatal Sequential Organ Failure Assessment score > 6 (OR and 95% CI: 16.335 [1.446–184.517], P < 0.05). Conclusion: Prior to more than two kinds of antibiotics use, Quick Sequential Organ Failure Assessment score > 2, pneumonia and caesarean section were independent risk factors for CRE BSIs. The Neonatal Sequential Organ Failure Assessment score > 6 was a risk factor for mortality associated with CRE BSIs.

The lung macrophages play a crucial role in health and disease. Sexual dimorphism significantly impacts the phenotype and function of tissue-resident macrophages. The primary mechanisms responsible for sexually dimorphic outcomes in bronchopulmonary dysplasia (BPD) remain unidentified. We tested the hypothesis that biological sex plays a crucial role in the transcriptional state of alveolar macrophages, using neonatal murine hyperoxia-induced lung injury as a relevant model for human BPD. The effects of neonatal hyperoxia exposure (95 % FiO2, PND1-5: saccular stage) on the lung myeloid cells acutely after injury and during normoxic recovery were measured. Alveolar macrophages (AM) from room air- and hyperoxia exposed from male and female neonatal murine lungs were subjected to bulk-RNA Sequencing. AMs are significantly depleted in the hyperoxia-exposed lung acutely after injury, with subsequent recovery in both sexes. The transcriptome of the alveolar macrophages is impacted by neonatal hyperoxia exposure and by sex as a biological variable. Pathways related to DNA damage and interferon-signaling were positively enriched in female AMs. Metabolic pathways related to glucose and carbohydrate metabolism were positively enriched in the male AMs, while oxidative phosphorylation was negatively enriched. These pathways were shared with monocytes and airway macrophages from intubated male and female human premature neonates.

Background: To assess whether the number of extremely low birth weight (ELBW) infants treated annually in neonatal intensive care units (NICUs) in Taiwan affects the mortality and morbidity of this patient population. Methods: This retrospective cohort study included preterm infants with ELBW (≤1000 g). NICUs were divided into three subgroups according to the annual admissions of ELBW infants (low, ≤10; medium, 11–25; and high, >25). Perinatal characteristics, mortality, and short-term morbidities were compared between groups. Results: A total of 1945 ELBW infants from 17 NICUs were analyzed (low-volume, n = 263; medium-volume, n = 420; and high-volume, n = 1262). After risk adjustments, infants from NICUs with low patient volumes were at a higher risk of death. The risk-adjusted odds ratios (aOR) for mortality were 0.61 (95% CI, 0.43–0.86) in the high-volume NICUs and 0.65 (95% CI, 0.43–0.98) in medium-volume NICUs, compared with infants admitted to low-volume NICUs. Infants in medium-volume NICUs had the lowest incidence of prenatal steroid exposure (58.1%, P

Background: Very preterm infants are at risk for neurodevelopmental impairment because of postnatal morbidities. This study aims to (1) compare the outcomes of very-low-birth-weight (VLBW) infants in Singapore during two time periods over a decade; 2) compare performances among Singaporean neonatal intensive care units (NICUs); and 3) compare a Singapore national cohort with one from the Australian and New Zealand Neonatal Network (ANZNN). Methods: Singapore national data on VLBW infants born during two periods, 2007–2008 (SG2007, n = 286) and 2015–2017 (SG2017, n = 905) were extracted from patient medical records. The care practices and clinical outcomes among three Singapore NICUs were compared using SG2017 data. Third, using data from the ANZNN2017 annual report, infants with gestational age (GA) ≤29 weeks in SG2017 were compared with their Oceania counterparts. Results: SG2017 had 9.9% higher usage of antenatal steroids (p

Summary: Congenital cytomegalovirus (cCMV) infection carries a significant burden with a 0.64% global prevalence and a 17–20% chance of serious long-term effects in children. Since the last guidelines, our understanding, particularly regarding primary maternal infections, has improved. A cCMV guidelines group was convened under the patronage of the European Society of Clinical Virology in April 2023 to refine these insights. The quality and validity of selected studies were assessed for potential biases and the GRADE framework was employed to evaluate quality of evidence across key domains. The resulting recommendations address managing cCMV, spanning prevention to postnatal care. Emphasizing early and accurate maternal diagnosis through serological tests enhances risk management and prevention strategies, including using valaciclovir to prevent vertical transmission. The guidelines also strive to refine personalized postnatal care based on risk assessments, ensuring targeted interventions for affected families.

Background: Nurse perceptions of developmental care practices have been researched globally for almost 30 years. Yet, there is a lack of research exploring this subject in the specialised setting of the surgical neonatal intensive care unit (sNICU). This research explores the effect of developmental care education programs on sNICU nurses’ perceptions of developmental care. Objective: To determine perceptions and attitudes towards developmental care in a specialty neonatal setting. Design: Cross-sectional study. Settings: Two surgical neonatal intensive care units in Australia. Participants: Registered nurses permanently employed at the study sites between May 2021 to April 2022. Methods: A modified electronic survey explored sNICU nurse perceptions of developmental care organised around three themes: effects of developmental care on parents and infants, application of developmental care, and unit practices. Associations between site, nurse characteristics, developmental care education and nurses’ perceptions were explored using logistic regression [odds ratios (OR) and 95 % confidence intervals (CI)]. Results: Of 295 sNICU nurses, 117 (40 %) participated in the survey. Seventy-five percent of respondents had attended a formal developmental care education program. High levels of agreement (>90 %) were reported regarding the benefits of developmental care for parents and infants. Exposure to developmental care education influenced perceptions of its application. Nurses without formal developmental care education were more likely to agree that it was consistently applied [OR:3.3, 95%CI:1.3–8.6], developmental care skills are valued [OR:2.7, 95%CI:1.1–6.8], and that their nursing peers offered support in its application ([OR:2.5, 95%CI:1.1–6.2]. Conclusions: The results from our research suggest sNICU nurses have a high level of awareness of developmental care and its positive impacts. Despite differences between the surveyed units' developmental care education programs, the value of developmental care in reducing stress for infants and supporting families was collectively recognised. Future research in this setting should focus on evaluating the application of developmental care in this setting.

Children who experienced moderate perinatal asphyxia (MPA) are at risk of developing long lasting subtle cognitive and behavioral deficits, including learning disabilities and emotional problems. The prefrontal cortex (PFC) regulates cognitive flexibility and emotional behavior. Neurons that release serotonin (5-HT) project to the PFC, and compounds modulating 5-HT activity influence emotion and cognition. Whether 5-HT dysregulations contribute to MPA-induced cognitive problems is unknown. We established a MPA mouse model, which displays recognition and spatial memory impairments and dysfunctional cognitive flexibility. We found that 5-HT expression levels, quantified by immunohistochemistry, and 5-HT release, quantified by in vivo microdialysis in awake mice, are reduced in PFC of adult MPA mice. MPA mice also show impaired body temperature regulation following injection of the 5-HT1A receptor agonist 8-OH-DPAT, suggesting the presence of deficits in 5-HT auto-receptor function on raphe neurons. Finally, chronic treatment of adult MPA mice with fluoxetine, an inhibitor of 5-HT reuptake transporter, or the 5-HT1A receptor agonist tandospirone rescues cognitive flexibility and memory impairments. All together, these data demonstrate that the development of 5-HT system function is vulnerable to moderate perinatal asphyxia. 5-HT hypofunction might in turn contribute to long-term cognitive impairment in adulthood, indicating a potential target for pharmacological therapies.

Neonatal jaundice due to hyperbilirubinemia is a common and mostly a harmless problem. However, there is a risk of acute bilirubin encephalopathy and kernicterus, which are rare but can cause permanent neurological damage. In 2022, the American Academy of Pediatrics (AAP) updated its clinical practice guideline for neonatal hyperbilirubinemia in newborns who are at least 35 weeks gestational age. The 2022 AAP guideline incorporates updated phototherapy and exchange transfusion nomograms that feature higher bilirubin thresholds than previous guidelines, and includes risk assessments for escalation-of-care, which is a new definition, universal bilirubin screening procedures, and neurotoxicity risk factors that no longer consider race as a risk factor. It is necessary to exercise caution and consult with local experts when adapting the updated guideline in low- and middle-income countries due to potential lack of resources for screening, follow-up, and treatment.

Aberrant neurodevelopment in Down syndrome (DS)—caused by triplication of human chromosome 21—is commonly attributed to gene dosage imbalance, linking overexpression of trisomic genes with disrupted developmental processes, with DYRK1A particularly implicated. We hypothesized that regional brain DYRK1A protein overexpression in trisomic mice varies over development in sex-specific patterns that may be distinct from Dyrk1a transcription, and reduction of Dyrk1a copy number from 3 to 2 in otherwise trisomic mice reduces DYRK1A, independent of other trisomic genes. DYRK1A overexpression varied with age, sex, and brain region, with peak overexpression on postnatal day (P) 6 in both sexes. Sex-dependent differences were also evident from P15-P24. Reducing Dyrk1a copy number confirmed that these differences depended on Dyrk1a gene dosage and not other trisomic genes. Trisomic Dyrk1a mRNA and protein expression were not highly correlated. Sex-specific patterns of DYRK1A overexpression during trisomic neurodevelopment may provide mechanistic targets for therapeutic intervention in DS.

Cryptosporidium parvum is a causative agent of cryptosporidiosis, an infectious gastroenteritis in neonatal ruminants, which can be fatal in severe cases. The aim of this study was to determine the prevalence of infections in dairy cattle/calves during the early stages of a calving season and the species/genotypes of the Cryptosporidium present. Faecal samples collected from pre- and post-partum dams (n = 224) as well as calves from age ∼1 day onwards (n = 312) were examined. Oocysts were concentrated, DNA extracted and tested by Cryptosporidium 18S rRNA gene PCR and sequencing, while genotypes of C. parvum were determined by gp60 and VNTR analysis. Results showed that 31.3% and 30.4% of pre- and post-partum dams tested positive for Cryptosporidium, respectively. In the adults, C. parvum (n = 52), C. bovis (n = 4) and C. andersoni (n = 19) were identified, while in the calves 248 out of 312 (79.5%) were PCR-positive for C. parvum. The proportion of positive calf samples was significantly higher (P

Background and purpose: Maternal and infant mortality are higher in low-income than in high-income countries due to weak health systems. The objective of this study was to improve access, utilization and quality of Maternal and Child Health care through a predesigned Enhanced Health Care System (EHC) that embodies the World Health Organization (WHO) pillars of the health system. Design and methodology: This study was conducted in two dispensaries in the Counties of Busia and Bungoma in Kenya as intervention sites and in four control clusters in Kakamega, Uasin Gishu, Trans Nzoia and Elgeyo Marakwet Counties. The study population was pregnant women and their children delivered over the study period in the intervention and control clusters.A quasi-experimental study design was used to conduct the study between 2015 and 2020 to compare the outcomes of the implementation of the EHC using the Find Link Treat and Retain (FLTR) strategy in one cluster, community owned initiatives in the other cluster and four control clusters at baseline and at the end of the study. A baseline survey was conducted in year one and an end line survey in the fifth year. Continuous data collection on maternal and childhood health indicators was done in all the six clusters and comparison made at the end of the study between the clusters. Results: We found a 26%, 10.3% and 0.8% increase in antenatal care (ANC) attendance in the intervention clusters of Obekai, Kabula and control clusters respectively. There was a 28.2%, 5.8% and 17.0% increase in attendance of 4+ ANC clinics of Obekai, Kabula and control clusters respectively. There was a 24% and 13% increase in Obekai and Kabula respectively in contraceptive use and a 2% decrease in contraceptive use in the control locations. There was a 38.2%, 25.6% and 34.7% increase in facility deliveries over the study period in Obekai, Kabula and control clusters respectively. There was a marked increase in immunization coverage in the intervention clusters of Obekai and Kabula compared to a significant decrease in control clusters for BCG, polio, pentavalent and measles. Conclusions and recommendations: In conclusion, use of the health systems approach in health care provision provides a holistic improvement in access and utilization of health services and in the improvement of health indicators.We do recommend that a systems approach be used in health services delivery to improve access, utilization and quality of health care provision at community and primary care levels.

Overall, China has made substantial progress in improving child survival over the past few decades, but a detailed understanding of child mortality trend at local level is limited. This study aimed to present a comprehensive analysis of under-5, infant, and neonatal mortality rates and its trend in Xicheng district of Beijing, China. We used the surveillance data of under-5 children reported by Preventive Health Department of Xicheng District Community Health Service Center from 1991 to 2022. The data was collected based on the Child Death Reporting Card of the Beijing Under-5 Mortality Rate Surveillance Network. Data check was performed by each community health service center and related medical institutions. We extracted data included maternal age, date of death, date of birth, gender, census register, classification of any causes of death, and utilization of healthcare services before death and doubly input it in the Excel 2016 program. Categorization of the causes of death was adapted by the International Categorization of Diseases (ICD-10). Mortality rates and distribution of the leading causes of death were analyzed with descriptive statistics and the Pearson’s Chi-square test using SAS 14.0 software. The Chi-square trend test was used to explore the trends in mortality. Interrupted time series analysis (ITSA) was conducted to assess the impact of the two-child policy on mortality using STATA statistical packages. From 1991 to 2022, totally, there were 166,061 live births and 793 (4.78 ‰) under-5 deaths. The mortality rates of under-5 children, infants and neonates in Xicheng district decreased from 14.75 ‰, 11.25 ‰ and 8.00 ‰ to 1.03 ‰, 0.83 ‰ and 0.41 ‰ respectively. All mortality rates showed an overall significant decline trend (χ2 trend for neonatal = -15.8136, P trend for neonatal

Recovery from lung injury during the neonatal period requires the orchestration of many biological pathways. The modulation of such pathways can drive the developing lung towards proper repair or persistent maldevelopment that can lead to a disease phenotype. Sex as a biological variable can regulate these pathways differently in the male and female lung exposed to neonatal hyperoxia. In this study, we assessed the contribution of cellular diversity in the male and female neonatal lung following injury. Our objective was to investigate sex and cell-type specific transcriptional changes that drive repair or persistent injury in the neonatal lung and delineate the alterations in the immune-endothelial cell communication networks using single cell RNA sequencing (sc-RNAseq) in a murine model of hyperoxic injury. We generated transcriptional profiles of >55,000 cells isolated from the lungs of postnatal day 1 (PND 1; pre-exposure), PND 7, and PND 21neonatal male and female C57BL/6 mice exposed to 95 % FiO2 between PND 1–5 (saccular stage of lung development). We show the presence of sex-based differences in the transcriptional states of lung endothelial and immune cells at PND 1 and PND 21. Furthermore, we demonstrate that biological sex significantly influences the response to injury, with a greater number of differentially expressed genes showing sex-specific patterns than those shared between male and female lungs. Pseudotime trajectory analysis highlighted genes needed for lung development that were altered by hyperoxia. Finally, we show intercellular communication between endothelial and immune cells at saccular and alveolar stages of lung development with sex-based biases in the crosstalk and identify novel ligand-receptor pairs. Our findings provide valuable insights into the cell diversity, transcriptional state, developmental trajectory, and cell-cell communication underlying neonatal lung injury, with implications for understanding lung development and possible therapeutic interventions while highlighting the crucial role of sex as a biological variable.

Life threatening burns of non-accidental origin in neonates are extremely rare. Their management represents a great challenge, particularly since necrosectomy of deep burns and grafting at this young age are technically very demanding. Thus, a strategic surgical master plan is mandatory to achieve rapid and definitive autologous coverage and avoidance of undue risks and iatrogenic burden for the fragile neonatal patient. We present the case of a four day-old neonate who sustained non-accidental deep burns involving 40 % of its total body surface area (TBSA) and the successful application of a laboratory grown, autologous dermo-epidermal skin analogue, termed Zurich Skin (also named denovoSkin), within a clinical trial sub-study. Due to COVID-19 pandemic restrictions, a telemedicine-based approach was installed and a total of 260 cm2 Zurich Skin were transplanted, video assisted, on a wound bed previously prepared with a dermal substitute, thereby covering 20 % TBSA. Take of Zurich Skin was excellent on the chest, good to moderate on the abdomen, and poor on other small areas, where we observed a prolonged healing. After maturation, Zurich Skin showed a close to natural skin coverage without need for further reconstructive surgery. This unique case delivers the proof of concept that Zurich Skin can be successfully applied in early life and even under most adverse medical and paramedical circumstances, provided a carefully crafted masterplan properly addressing the key issues can be executed by joint forces of committed partner institutions.

Resumen: Introducción: En Chile los casos reportados de COVID-19 a nivel nacional al tercer año de pandemia (3 de noviembre del 2022) son de 4.769.638 y 61.725 fallecidos (1,3%), con el 93% de la población con esquema completo de vacunación (17.686.528). Objetivo: El objetivo de este estudio es una comunicación breve sobre el impacto de la pandemia de SARS-CoV-2 en la mortalidad materna, perinatal y prematuridad en Chile. Método: Se utilizó la base de datos nacional del Departamento de Informática del Ministerio de Salud de Chile (DEIS), y la información reportada desde sitio web oficial de OMS. Se incluyeron todos los nacidos, muertes generales y fetales desde enero 1990 a septiembre del 2022. Se realiza una comparación entre los indicadores básicos maternos y perinatales de los últimos 30 años y los de los años de la pandemia. Resultados: Desde marzo 2020 a septiembre 2022, fallecieron más de 61.000 personas en Chile con diagnóstico asociado al COVID-19, el 17% de la mortalidad general para el período (364.000 fallecidos). Se observó una aceleración en la tendencia histórica hacia la disminución de la razón nacimientos/defunciones generales de 1,9 pre-pandemia a 1,4 al tercer año de pandemia. La razón de mortalidad materna en el año 2020 fue de 28,1 × 100.000 nacidos vivos y aumentó en comparación al año 2019 pre-pandemia (19,1) o a la línea simple de tendencia histórica proyectada para el 2020 (18) en un 56%. La prematuridad bajo 37 semanas de gestación, se incrementó de 8,5% (2019) a 9,5% para los años 2021 y 2022. La mortalidad neonatal de los primeros 28 días se mantuvo estable en 9 × 1.000 nacidos vivos durante los 3 años de pandemia y la mortalidad fetal (>21 semanas) tuvo un leve incremento a 4,7 × 1.000 nacidos vivos (año 2020) en relación a 3,4 del año 2019. Conclusiones: En Chile ocurrió un aumento de aproximadamente un 56% de la mortalidad materna el primer año de pandemia de SARS-CoV-2, el segundo año se observa un aumento significativo de la prematuridad tardía y un leve incremento de la mortalidad fetal. Estos hallazgos han sido reportados en las revisiones y últimas actualizaciones del año 2022. Abstract: Introduction: At the third year of the pandemic in Chile, the reported cases of COVID-19 reached 4,769,638 and 61,725 deaths (1.4%), with 93% of the population with a complete vaccination schedule (17,686,528). Aim: The purpose of this study is a brief communication on the impact of the SARS-CoV-2 pandemic on maternal, perinatal and prematurity mortality in Chile. Method: The national database of the Informatics Department of the Ministry of Health of Chile (DEIS), and the information reported from the official WHO website were used. All births, general and fetal deaths from January 1990 to September 2022 were included. A comparison is made between the basic maternal and perinatal indicators of the last 30 years and those of the years of the pandemic. Results: From March 2020 to September 2022, approximately 61,000 people died in Chile with a diagnosis associated with COVID-19, 17% of the general mortality for the period (approx. 364.000 deaths). An acceleration in the historical trend towards a decrease in the overall birth/death ratio was observed from 1.9 pre-pandemic to 1.4 during the third year of the pandemic. Maternal Mortality Ratio in 2020 (28.1 × 100,000) increased compared to 2019 pre-pandemic (19.1) or the simple historical trend line projected for 2020 (18.0) by 56%. Prematurity under 37 weeks of gestation increased from 8.5% (2019) to 9.5% for the years 2021 and 2022. Neonatal mortality in the first 28 days remained stable at 9 per thousand births during the 3 years of the pandemic and fetal mortality (>21 weeks) had a slight increase to 4.7 per thousand (year 2020) in relation to 3.4 in 2019. Conclusions: In Chile, an increase of approximately 56% in maternal mortality occurred in the first year of the SARS-CoV-2 pandemic. In the second year, a significant increase in late prematurity and a slight increase in fetal mortality were observed. These findings have been reported in the reviews and latest updates of the year 2022.

Background: Understanding the impact of SARS-CoV-2 infection on pregnancy outcomes and of pregnancy on COVID-19 outcomes is critical for ensuring proper prenatal and antenatal care. No similar studies have been published in Saudi Arabia. Methods: We performed a prospective cohort study of pregnant women with confirmed SARS-CoV-2 infection who presented at King Faisal Specialist Hospital and Research Center (KFSHRC) in Riyadh, Kingdom of Saudi Arabia. COVID-19 staging was performed, pregnancy-related complications were assessed, and neonatal infection was evaluated. Results: We enrolled 81 patients (mean age 31.75 years, SD 5.25) of which there were 17 cases in the first trimester, 20 in the second trimester, and 34 in the third trimester. The distribution of COVID-19 severity was 40 patients with Stage A, 36 with Stage B, 4 with Stage C, and 1 with Stage D. Complications were pregnancy loss in 2 patients (one in each first and second trimester) and 1 fetal death after 20 weeks of pregnancy, 7 patients with fetal growth restriction, and 8 with pre-term delivery. Conclusions: We did not observe an unusual frequency of pregnancy-related complications due to SARS-CoV-2 infection in this high-risk obstetric population and there was no evidence of vertical transmission in newborns from women who delivered while positive for the virus.

Objective: Neonatal presentation of Ebstein anomaly (EA) represents the most severe form of this condition. Despite significant advances, operative mortality remains high and management decisions represent a formidable challenge. We used a strategy aimed to match anatomy and physiology with type and time of intervention to increase survival. Methods: We performed a review of all patients with fetal or neonatal diagnosis of EA managed at a single center between 2007 and 2020. Results: Among 18 patients with EA, 8 underwent neonatal intervention. The most common indication included cyanosis and heart failure (8/8), end organ dysfunction (6/8), and maldistribution of cardiac output (6/8). Only 2/8 had antegrade pulmonary blood flow. Associated conditions included pulmonary regurgitation in 4/8, atrial tachyarrhythmia in 4, and a ventricular septal defect in 3. Three patients underwent initial stabilization with main pulmonary artery occlusion including bilateral pulmonary artery banding in 2. Five patients underwent biventricular repair with conversion to right ventricle exclusion in 2 cases. Three others underwent the Starnes procedure as initially planned. The median age at surgery was 10 days (range, 1-30) and median weight 2.6 kg (range, 1.9-4.0). The median duration of mechanical ventilation and intensive care unit stay were 9 days (range, 5-34) and 30 days (range, 15-100), respectively. Operative mortality was 1/8. At a median follow-up of 130 months (range, 5-146), there were no late deaths, and all survivors remain in functional class I and free of valvular reintervention. Conclusions: Symptomatic neonates with EA can be effectively managed with good outcomes. Preoperative stabilization and choice of management pathway on the basis of anatomy and physiology can help reduce morbidity and mortality.

Summary: Background: Magnetic Resonance (MR) imaging is key for investigation of suspected newborn brain abnormalities. Access is limited in low-resource settings and challenging in infants needing intensive care. Portable ultralow field (ULF) MRI is showing promise in bedside adult brain imaging. Use in infants and children has been limited as brain-tissue composition differences necessitate sequence modification. The aim of this study was to develop neonatal-specific ULF structural sequences and test these across a range of gestational maturities and pathologies to inform future validation studies. Methods: Prospective cohort study within a UK neonatal specialist referral centre. Infants undergoing 3T MRI were recruited for paired ULF (64mT) portable MRI by convenience sampling from the neonatal unit and post-natal ward. Key inclusion criteria: 1) Infants with risk or suspicion of brain abnormality, or 2) preterm and term infants without suspicion of major genetic, chromosomal or neurological abnormality. Exclusions: presence of contra-indication for MR scanning. ULF sequence parameters were optimised for neonatal brain-tissues by iterative and explorative design. Neuroanatomic and pathologic features were compared by unblinded review, informing optimisation of subsequent sequence generations in a step-wise manner. Main outcome: visual identification of healthy and abnormal brain tissues/structures. ULF MR spectroscopy, diffusion, susceptibility weighted imaging, arteriography, and venography require pre-clinical technical development and have not been tested. Findings: Between September 23, 2021 and October 25, 2022, 102 paired scans were acquired in 87 infants; 1.17 paired scans per infant. Median age 9 days, median postmenstrual age 40+2 weeks (range: 31+3–53+4). Infants had a range of intensive care requirements. No adverse events observed. Optimised ULF sequences can visualise key neuroanatomy and brain abnormalities. In finalised neonatal sequences: T2w imaging distinguished grey and white matter (7/7 infants), ventricles (7/7), pituitary tissue (5/7), corpus callosum (7/7) and optic nerves (7/7). Signal congruence was seen within the posterior limb of the internal capsule in 10/11 infants on finalised T1w scans. In addition, brain abnormalities visualised on ULF optimised sequences have similar MR signal patterns to 3T imaging, including injury secondary to infarction (6/6 infants on T2w scans), hypoxia-ischaemia (abnormal signal in basal ganglia, thalami and white matter 2/2 infants on T2w scans, cortical highlighting 1/1 infant on T1w scan), and congenital malformations: polymicrogyria 3/3, absent corpus callosum 2/2, and vermian hypoplasia 3/3 infants on T2w scans. Sequences are susceptible to motion corruption, noise, and ULF artefact. Non-identified pathologies were small or subtle. Interpretation: On unblinded review, optimised portable MR can provide sufficient contrast, signal, and resolution for neuroanatomical identification and detection of a range of clinically important abnormalities. Blinded validation studies are now warranted. Funding: The Bill and Melinda Gates Foundation, the MRC, the Wellcome/EPSRC Centre for Medical Engineering, the MRC Centre for Neurodevelopmental Disorders, and the National Institute for Health Research (NIHR) Biomedical Research Centres based at Guy’s and St Thomas’ and South London & Maudsley NHS Foundation Trusts and King's College London.

Objective: Necrotizing enterocolitis (NEC) continues to have high surgical mortality despite progressive regionalization to children's hospitals. It is unclear whether outcomes for patients with NEC undergoing surgery vary depending on volume of these children's hospitals. This study aimed to examine the relationship between operative outcomes and a hospital's overall NEC patient volume, as well as operative volume for NEC across children's hospitals. Methods: A retrospective, cross sectional analysis was performed using the Pediatric Health Information System (PHIS). NEC patients were identified using ICD-10 codes from 2016-2021. Two hospital volume metrics were used: annual volume of NEC patients treated in the NICU, and annual volume of NEC patients undergoing surgery. Primary outcome was mortality and secondary outcome was complication. Regression models were estimated to determine the association between each volume metric and patient outcomes. Results: A total of 1780 children who had surgery for NEC from 47 tertiary children's hospitals were included. Overall mortality rate was 23.3%. Median overall and surgical NEC patient volume per hospital were 53 [IQR 41-65] and 11 [IQR 7-16], respectively. A chi-squared test comparing mortality to volume metrics for total NEC volume, and surgical NEC volume showed no significant associations (p=0.07, p=0.74). Simple logistic regression demonstrated total NEC patient volume to have best fit with mortality outcome. Conclusion: No statistically significant association was found between the two volume metrics and discharge mortality. This lack of association suggests that the volume in these tertiary children's hospitals may be higher than the threshold for optimized outcomes. Level of Evidence: III

A Enterocolite Necrosante (EN) é uma doença gastrointestinal multifatorial enquadrada como sepse tardia e pode acometer os neonatos. É considerada uma causa relevante de morbimortalidade em prematuros, estando presente de forma significativa nas internações em Unidade de Terapia Intensiva Neonatal (UTIN). Essa patologia tem como fatores de risco a Idade Gestacional (IG), que é inversamente proporcional à incidência, o baixo peso ao nascer, alterações locais e sistêmicas de fluxo sanguíneo, tipo e progressão de dieta, entre outros. Assim, é necessário compreender as características dos casos ocorridos, especialmente em surtos, para que sejam tomadas as devidas providências de prevenção e controle. Isso posto, relatamos a ocorrência de um surto de EN na UTIN no Hospital das Clínicas da Universidade Federal de Pernambuco. Trata-se de estudo descritivo, quantitativo e retrospectivo, cujos dados foram obtidos da Comissão de Controle de Infecções relacionadas à Assistência (CCIRAS) do Hospital e da UTIN. Foram notificados, entre dezembro de 2022 e junho de 2023, nove casos de EN, dos quais sete foram prematuros de IG variando entre 27,4 e 36,7 semanas e peso ao nascer entre 615 e 4050g. Ademais, quatro dos pacientes são gemelares, cuja IG varia entre 27,4 e 30 semanas, e predominantemente classificados com extremo baixo peso ao nascer. O desfecho de óbito ocorreu em cinco prematuros com idade gestacional igual ou menor a 30 semanas, de extremo baixo peso ao nascer ou muito baixo peso ao nascer, sendo apenas um deles relacionado a outras causas diferentes da EN. Dentre os óbitos, também foi notado o quadro de sepse ou infecção pré-diagnóstico de EN em 80% dos casos. A prematuridade com baixa IG e baixo peso ao nascer se revelaram como os fatores de risco preponderantes associados aos quadros de EN, especialmente naqueles associados a sepse. Outros fatores, como uso de fórmula artificial ou cirurgia abdominal não se mostraram tão importantes para um desfecho negativo nos casos analisados. A gemelaridade, apesar de não ser um fator de risco, está relacionada ao parto prematuro, o que pode indicar a relação com o alto número de casos de EN em gêmeos. A análise dos dados e o diagrama de Ishikawa sobre o surto possibilitaram um plano de ação para prevenção de novos casos, intervenção via visitas técnicas e educação permanente para os profissionais da UTIN, objetivando prevenir a sepse neonatal anterior à EN, intervindo no principal fator de risco prevenível.

Aim: To evaluate the effects of a hands-off recorder/time coach versus an additional hands-on healthcare provider on Neonatal Resuscitation Program (NRP) algorithm compliance and team member workload in neonatal resuscitations. Methods: Two interventions were studied using a 2 × 2 factorial design: an additional hands-on team member and the presence of a designated, hands-off recorder/time coach. The recorder/time coach documented interventions and delivered pre-specified prompts at defined points during the resuscitation. The primary outcome was cumulative time error. Secondary outcomes were time to first dose of IV epinephrine, overall team performance as assessed by the Neonatal Resuscitation Performance Evaluation (NRPE) score, and workload assessed by the NASA Task Load Index (NASA TLX). Results: 64 teams were studied. Teams with a recorder had a significantly lower cumulative time error compared to teams without a recorder (p

Resumen: Introducción y objetivo: : La isquemia arterial es una complicación infrecuente durante la canalización de una arteria; sin embargo, puede ocurrir durante su realización para la monitorización de un paciente neonatal. Este documento trata de reunir las principales recomendaciones acerca del mejor manejo de la isquemia arterial y así poder ser de utilidad en la práctica clínica médica. Casos clínicos: Se describen los casos de dos recién nacidos pretérmino que desarrollaron resultados adversos tras la canalización arterial, siendo preciso una intervención quirúrgica. En uno de ellos fue necesario la amputación del miembro inferior; en el otro, la realización de una fasciotomía. Conclusión: En este documento se resumen los datos más recientes publicados en relación con el tratamiento médico y quirúrgico de la isquemia arterial, así como del control del dolor asociado. El manejo de esta patología continúa siendo un reto debido a la escasa literatura existente de esta complicación en la población neonatal. Abstract: Introduction and objective: Arterial ischemia is an uncommon complication of arterial cannulation. Nonetheless, this condition may occur in neonatal population. This paper seeks to gather the main recommendations with regards to arterial ischemia management so as to be useful for physicians in their clinical practice. Case reports: The cases of two preterm newborns who developed adverse outcomes requiring surgical intervention derived from femoral arterial cannulation are presented. One patient required lower limb amputation; the other one, a fasciotomy. Conclusion: We summarize the most recent published data, concerning both medical and surgical ischemia treatment and associated pain control. Arterial ischemia management remains a challenge to physicians as there is limited data available about the best management of arterial ischemia in the neonatal population.

ABSTRACT: Objectives: Vancomycin-resistant enterococcus (VRE) is an emerging drug-resistant organism responsible for increasing nosocomial infections. Few data are available on the epidemiology of VRE colonization or infection in neonates, and is of recent interest. This study analyzes the prevalence of neonatal VRE colonization in a neonatal intensive care unit (NICU), and describes risk factors and molecular phenotypes associated with VRE colonization. Methods: We performed a prospective epidemiological study on neonates admitted to an NICU. We compared neonates with VRE isolates detected in rectal swab cultures to those without. Association of VRE colonization with risk factors was tested by using univariate and multivariate methods. Results: During a period of 18 months, amongst 180 neonates enrolled in the study, 76 (42.2%) were colonized by VRE. VRE isolates were resistant to amikacin in 68%, gentamicin in 26%, and ampicillin in 17.1% of cases. Molecular analysis showed the vanA gene in all isolates. Two VRE-positive patients developed infection during the observation time. No deaths occurred during this period. Prematurity (P = 0.023), low birth weight (P = 0.019), history of admission in other hospitals (P = 0.00), and antibiotic therapy for more than seven days (P = 0.01) were identified as risk factors for VRE colonization. Conclusion: Newborn susceptibility to early colonization with VRE in NICUs is increased in preterm and low birth weight newborns. All VRE colonization in the NICU was related to the acquisition of the vanA gene. Adherence to infection control policies and antimicrobial stewardship strategies are of the highest importance.

Objectives: The aim of our study is to describe the various anesthetic techniques and intraoperative management used during transcatheter closure of hemodynamically significant PDAs in VLBW premature infants weighing less than 1.5 kg and their potential impact on postoperative outcomes using a retrospective chart review. Design: A retrospective electronic medical chart review was performed in infants who underwent Transcatheter Patent Ductus Arteriosus (TC-PDA) closure at an academic institution between January 1, 2008 and October 4th 2019. Only premature patients with isolated PDA weighing less than 1500 g at the time of the procedure were included in the study. Setting: Single Institutional Hospital. Participants: Premature patients with isolated PDA weighing less than 1500 g at the time of the procedure. Interventions: None. Measurements and main results: Interprocedurally, there was no evidence of device embolization or clinically significant vascular obstruction on follow-up echocardiography, and inotropic or vasoactive infusions were not required. All patients survived and were discharged from the hospital after a mean of 86.4 ± 48.49 days (median 74, range 40–180) following initial admission to the NICU. At 7 post-operative days, freedom from ventilatory support reached 70% in all patients. Incidences of device embolization or clinically significant vascular obstruction were not noted on follow-up echocardiography. Conclusions: Though our preliminary findings show promising outcomes following TC-PDA closure relative to traditional surgical approaches, further investigations with higher patient volume are needed to validate these promising observations.

Aim: Advanced life support courses have a clear educational impact; however, it is important to determine whether participation of one or more members of the resuscitation team in an accredited advanced life support course improves in-hospital cardiac arrest patient survival outcomes. Methods: We searched EMBASE.com, Medline, Cochrane and CINAHL from inception to 1 November 2022. Included studies were randomised or non-randomised interventional studies assessing the impact of attendance at accredited life support courses on patient outcomes. Accredited life support courses were classified into 3 contexts: Advanced Life Support (ALS), Neonatal Resuscitation Training (NRT), and Helping Babies Breathe (HBB). Existing systematic reviews were identified for each of the contexts and an adolopment process was pursued. Appropriate risk of bias assessment tools were used across all outcomes. When meta-analysis was appropriate a random-effects model was used to produce a summary of effect sizes for each outcome. Results: Of 2714 citations screened, 19 studies (1 ALS; 7 NRT; 11 HBB) were eligible for inclusion. Three systematic reviews which satisfied AMSTAR-2 criteria for methodological quality, included 16 of the studies we identified in our search. Among adult patients all outcomes including return of spontaneous circulation, survival to discharge and survival to 30 days were consistently better with accredited ALS training. Among neonatal patients there were reductions in stillbirths and early neonatal mortality. Conclusion: These results support the recommendation that accredited advanced life support courses, specifically Advanced Life Support, Neonatal Resuscitation Training, and Helping Babies Breathe improve patient outcomes.

Background: Sustainable Development Goals −3 (SDG – 3) were to ensure healthy live and promote well-being by reducing global maternal and neonatal deaths. These were to be implemented through the concept of continuum of care in maternal health program framework to improve health outcomes. There is a paucity of published evidences; as such, this review is designed to assess the effectiveness of the concept of continuum of care in maternal and neonatal health services on the reduction of maternal and neonatal mortality. Methods: A search was conducted using the key words; maternal and neonatal, health services, continuum of care, maternal and neonatal mortality. Search focused on PubMed, Cochrane, MEDLINE and Google Scholar. Extractions of articles were done based on predetermine criteria. Data were compiled, and screened, entered and analysis was done using STATA 13 and Rev. Man. software. Effects of the intervention package were determined and the result was interpreted in random effect RR with 95%CI. The publication bias was determined by using funnel plot, Egger and Bagger test, heterogeneity, and sensitivity test. Results: A total of 4685 articles were retrieved of these 20 articles reviewed. Articles on 631,975 live births (LBs) were analyzed. Results showed the distribution as follows; 23,126 newborns died within 28 days resulting [NMR = 35/1000LBs among the intervention group whereas NMR = 39/1000LBs among the control group]. The pooled effect of the intervention was significantly reduced neonatal mortality (RR = 0.84; 95%CI: 0.77–0.91). Similarly, 1268 women died during the pregnancy period up to 42 days after childbirth that resulted [MMR = 330/100,000LBs among the intervention group whereas MMR = 460/100,000LBs among the control group]. The pooled effect of the intervention was not a statistically significant association with maternal mortality (RR = 0.64; 95%CI: 0.41–1.00). Conclusion: Adoption of continuum of care concepts in maternal health services reduced maternal and neonatal mortality. We recommend strengthening and effective implementation of a continuum of care in maternal health services to improve maternal and neonatal health care outcomes.

Neonatal obstetric brachial plexus palsy is common in newborns with fetal macrosomia, especially those who are delivered vaginally with shoulder dystocia or breech delivery. The anatomical structure of brachial plexus in newborns is thin, and it is neither collinear nor coplanar in space; The location, the type and degree of neonatal brachial plexus injury need to be comprehensively judged by clinical history, neurological and imaging examination. Conventional MR imaging is not sufficient to diagnose brachial plexus injury. In this case report, we describe the clinical and imaging data of a newborn with brachial plexus injury diagnosed by the fat-suppressed T2-weighted sequence and MR myelography and confirmed by surgery. In addition, we review the related literature in an attempt to provide a better understanding of the principles and characteristics of neonatal brachial plexus injury diagnosed by magnetic resonance neurography.

Background: Sepsis is a life-threatening condition that requires aggressive and rapid intervention. However, data on the association between antibiotic administration timing in neonatal sepsis and neonatal outcomes is limited, particularly in the gulf area. Objective: This study aimed to evaluate the association between the timing of antibiotic administration and the outcome of neonatal sepsis. Design and setting: This retrospective comparative study was conducted through data collection from medical records of patients with neonatal sepsis. The patients were categorized into two groups based on the time interval between antibiotic prescription and drug administration: non-delayed group consisted of patients who received antibiotics within 3 h and the delayed group consisted of those who received antibiotics after 3 h. Results: A total of 237 neonates diagnosed with sepsis were included, of which 9.3% had necrotizing enterocolitis, 35% had bronchopulmonary dysplasia, and 6.3% had maternal chorioamnionitis. Additionally, 18.6% of the neonates’ mothers were prescribed with antibiotics during labor, and 5.5% had maternal fever. Staphylococcus epidermidis was the most commonly isolated strain (24.1%). Of the total neonates, 87.3% received antibiotics within the first 3 h from the prescription. Survival rate was significantly higher and the risk of complications such as necrotizing enterocolitis, and bronchopulmonary dysplasia was significantly lower in the non-delayed group. Moreover, the length of hospital stay was significantly shorter in the non-delayed group. Conclusion: Early antibiotic administration in patients with neonatal sepsis can improve the survival rate and reduce the incidence of complications.

Introduction: In 2017, a worldwide survey was conducted on compliance with the practices promoted by Neo-BFHI (Baby-friendly Hospital Initiative expansion to neonatal wards). Objective: To present the results of the Spanish wards that participated in the global survey and compare them with those obtained internationally. Material and methods: Cross-sectional study through a survey on compliance with the Neo-BFHI (“Three basic principles”, “Ten steps adapted to neonatal wards” and “the compliance with the International Code of Marketing of Breast-milk Substitutes” and subsequent relevant World Health Assembly resolutions). Compliance was calculated as the mean in each indicator and a final mean score for each neonatal unit. For the partial and final scores for each country and at the international level, the median was used. All scores ranged between 0 and 100. Results: The response rate in Spain was 90%. The range of the national mean for neonatal wards were from 37 to 99, with no differences in the final score according to the level of care. The global score for Spain (72) is below the international median (77) and this also occurs in 8 of 14 items. The neonatal wards from BFHI designated hospitals, obtained a significantly higher mean global score, and in 9 of 14 items than the non-accredited ones. Conclusions: Both international and national results indicate an improvement in breast feeding practices in neonatal units. The benefits of the BFHI accreditation of maternity reach neonatal wards. Spain has several key points below the international score. Resumen: Introducción: En 2017 se realizó una encuesta a nivel mundial sobre el cumplimiento de las prácticas que promueve la Neo-IHAN (Iniciativa para la Humanización de la Asistencia al Nacimiento y la Lactancia en las unidades neonatales). Objetivo: Presentar los resultados de las unidades españolas que participaron en la encuesta mundial y compararlos con los obtenidos internacionalmente. Material y métodos: Estudio transversal mediante una encuesta sobre el cumplimiento de los requisitos de la Neo-IHAN (“Tres principios básicos”, “Diez pasos adaptados a unidades neonatales” y “el Cumplimiento del Código Internacional de Comercialización de Sucedáneos de Leche Materna”). El cumplimiento se calculó como la media en cada indicador y una puntuación media final para cada unidad neonatal. Para las puntuaciones parciales y finales de cada país y a nivel internacional se utilizó la mediana. Las puntuaciones van de 0 a 100. Resultados: La tasa de respuesta en España fue del 90% de las unidades de nivel 2 y 3. El rango de la media para las unidades neonatales fue de 37 a 99, sin diferencias según el nivel asistencial. La puntuación global de España (72) está por debajo de la mediana internacional (77) así como en 8 de los 14 requisitos de la Neo-IHAN. Las unidades neonatales de hospitales con maternidades acreditadas IHAN, obtuvieron una puntuación media final significativamente mayor así como en 9 de los 14 requisitos frente a las no acreditadas. Conclusiones: Los resultados tanto internacionales como nacionales indican una mejora de las prácticas de la lactancia materna en las unidades neonatales. Los beneficios de la acreditación IHAN de las maternidades alcanzan a las unidades neonatales. España tiene varios puntos clave por debajo de la puntuación internacional.

Summary: Background: Early-onset colorectal cancer has risen worldwide, leaving more women with colorectal cancer at reproductive ages. We aimed to investigate the risk of adverse pregnancy and neonatal outcomes among women with early-onset colorectal cancer. Methods: We conducted a nationwide, matched case–control study of maternal/pregnancy outcomes including pre-eclampsia and Cesarean delivery (C-section) as well as neonatal outcomes including preterm birth among 207 births in women with early-onset colorectal cancer (ages 18–49) and 1019 births in women without colorectal cancer in Sweden (1992–2019). Early-onset colorectal cancer cases were identified through the Cancer Register, and outcome data were retrieved through linkage to Medical Birth Register and National Patient Register. Using conditional logistic regression, we estimated multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Findings: Between Jan 1, 1992, and Dec 31, 2019, women with early-onset colorectal cancer who gave birth had increased odds of pre-eclampsia (7.2% vs 3.2%; OR = 2.52, 95%CI = 1.25–5.08), any C-section (24.6% vs 19.4%; OR = 1.43, 95%CI = 1.00–2.06), particularly emergency C-section (17.4% vs 10.5%; OR = 1.79, 95%CI = 1.17–2.75), after adjustment for maternal education level, country of birth, body mass index and smoking in early pregnancy, and comorbidities. Maternal history of early-onset colorectal cancer was also associated with offspring preterm birth (12.1% vs 5.2%; OR = 2.31, 95%CI = 1.34–3.99), delineated as spontaneous (OR = 1.06, 95%CI = 0.47–2.39) or medically-indicated preterm birth (OR = 4.48, 95%CI = 2.05–9.79). There was no increased risk of congenital malformation or small for gestational age birth. Interpretation: In this population-based study, maternal history of early-onset colorectal cancer was associated with risk of both adverse pregnancy (pre-eclampsia, C-section) and neonatal outcomes (preterm birth). Funding: US National Institutes of Health, Swedish Society of Medicine, Swedish Cancer Foundation.

Objectives: The acoustic frequencies present in an incubator are within the hearing range of a newborn; this requires adapting the environment so that the noise inside the incubator is more compatible with that range and facilitates proper hearing development. The objective of this study is to make a comparison, in thirds of an octave (frequency analysis), of the noise present in the NICU room and the interior space of the incubator, analyzing the ambient acoustic quality perceived by the newborn. Methods: The experiment carried out in this work consisted of two series of measurements of noise levels in the NICU of the “Puerta del Mar” University Hospital (Cádiz, Spain) and two selected incubators in the room. A third-octave frequency band analysis was performed within the audible field (20 Hz/20 kHz). Data were recorded at 1 s intervals for more than 24 h (3600 registers de 1 s.) Results and conclusions: One may wonder if noise levels inside incubators affect newborns. Based on existing references, the answer is probably “yes”, since the frequencies present inside an incubator are within the audible range of a newborn. According to the consulted bibliography, the audible range of neonates is between 400 Hz and 4 kHz. In this work, the acoustic measurements carried out in the NICU made it possible to evaluate the noise levels in the room and inside the incubators. According to the results, the indicator used LAeq, 1 h, should be complemented with a study in 1/3 octave bands (frequency analysis) to determine the acoustic quality and hearing protection of neonates.

Tablet manipulation (modification) is a practice where the licensed tablet product is customized into reduced fractions of doses or changed into dispersions using solvents because of suitable dose for paediatrics and neonates are frequently unavailable. As a result, unlicensed dosage form frequently used after manipulation, outside what is approved by drug regulatory authorities. Objective: To assess the practice of off-label tablet manipulation in pediatric and neonatal wards at selected public hospitals in Ethiopia. Methods: A prospective, direct observational approach was used to investigate the frequency, nature and appropriateness of tablet manipulations in neonatal and pediatrics patients of two public hospitals of Ethiopia from April 12, to June 30, 2021. Results: During the study period a total of 303 tablet manipulations were observed. Two hundred nine (69%) of tablets were dispensed to pediatric patients to be taken after split into lower strengths. The remaining nighty four (31%) tablets were manipulated into dispersion using 0.9% normal saline as a main solvent. Interestingly, 48 (15.8%) of tablet manipulations into dispersions involved practically insoluble drugs whose manipulation may probably affect their bioavailability. In 12.5% (12/94) dispersion manipulations, large undissolved fractions were observed during administration through naso-gastric tubes. The most commonly manipulated tablets were drugs for central nervous system (n = 135, 44.6%) followed by cardiovascular drugs (n = 85, 28%). Conclusions: and recommendations: The study revealed the off-label use of tablets for pediatrics age groups is very common in Ethiopia. Evidence-based guidelines for tablet manipulations should be practiced to improve the safety of paediatric drug use. As for policy implication, this study concurs with previous scientific recommendations that manufacturers introduce a wide range of dosage forms to reduce the need for manipulations.

Neonatal hypoxia causes cytotoxic neuronal swelling by the entry of ions and water. Multiple water pathways have been implicated in neurons because these cells lack water channels, and their membrane has a low water permeability. NKCC1 and KCC2 are cation-chloride cotransporters (CCCs) involved in water movement in various cell types. However, the role of CCCs in water movement in neonatal neurons during hypoxia is unknown. We studied the effects of modulating CCCs pharmacologically on neuronal swelling in the neocortex (layer IV/V) of neonatal mice (post-natal day 8–13) during prolonged and brief hypoxia. We used acute brain slices from Clomeleon mice which express a ratiometric fluorophore sensitive to Cl− and exposed them to oxygen-glucose deprivation (OGD) while imaging neuronal size and [Cl−]i by multiphoton microscopy. Neurons were identified using a convolutional neural network algorithm, and changes in the somatic area and [Cl−]i were evaluated using a linear mixed model for repeated measures. We found that (1) neuronal swelling and Cl− accumulation began after OGD, worsened during 20 min of OGD, or returned to baseline during reoxygenation if the exposure to OGD was brief (10 min). (2) Neuronal swelling did not occur when the extracellular Cl− concentration was low. (3) Enhancing KCC2 activity did not alter OGD-induced neuronal swelling but prevented Cl− accumulation; (4) blocking KCC2 led to an increase in Cl− accumulation during prolonged OGD and aggravated neuronal swelling during reoxygenation; (5) blocking NKCC1 reduced neuronal swelling during early but not prolonged OGD and aggravated Cl− accumulation during prolonged OGD; and (6) treatment with the “broad” CCC blocker furosemide reduced both swelling and Cl− accumulation during prolonged and brief OGD, whereas simultaneous NKCC1 and KCC2 inhibition using specific pharmacological blockers aggravated neuronal swelling during prolonged OGD. We conclude that CCCs, and other non-CCCs, contribute to water movement in neocortical neurons during OGD in the neonatal period.

Large congenital diaphragmatic hernia (CDH) defects that cannot be closed primarily often require reinforced repair. Synthetic patch is a widely used method of prosthetic patch closure. Infections associated with synthetic patch repair are poorly understood. This case series reviews ten patients cared for at the Children's Hospital of Philadelphia from 1996 to 2022 who underwent neonatal CDH repair with a synthetic patch and were subsequently diagnosed with suspected or confirmed patch infection, and proposes definitions for suspected and confirmed CDH patch infection to inform both current clinical care as well as future research on outcomes after CDH repair.

Objectives: A child's critical illness and admission to intensive care can have significant short- and long-term impacts for the parents and hospitalized child. While experiences of parents have been explored, the impact on siblings remains unclear. The aim was to systematically review and synthesize qualitative research exploring the experiences of siblings when a child is critically ill, from the perspectives of siblings and relevant key stakeholders., Methods: Comprehensive searches were performed across six databases and three sources of grey literature on October 30, 2023 and September 23, 2024. Original qualitative research focusing on sibling experiences during a child's critical illness were included. Two independent reviewers screened studies, with conflicts resolved by a third reviewer. Data extraction and quality assessment were carried out by one reviewer and verified by a second reviewer using Covidence. Thematic synthesis was used to synthesize extracted data, ensuring the rigor of the findings., Findings: Of 1,552 studies screened, 24 met inclusion criteria. Seven mixed methods and 17 qualitative studies were included. Experiences of siblings were categorized into eight themes and included elements such as visiting the ICU, being separated, changing roles, looking to the future, and getting support. Sibling experiences could be positively or negatively influenced by parents, healthcare professionals, hospital policies and environment., Conclusions: This study provides a novel insight into the underrepresented sibling experience in critical care research. Siblings experience significant multi-faceted impacts when a child is critically ill. This review underscores the necessity for further research on siblings' perspectives in critical care, to aid development of appropriate supports and interventions for siblings and families during a child's critical illness., Implications for Clinical Practice: Understanding siblings' experiences can enhance holistic family-centered care. Findings from this review demonstrate the need for more supportive practices for siblings in intensive care, through development of inclusive, family-centered care policies and guidelines., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: In utero exposure to environmental polycyclic aromatic hydrocarbon (PAH) is associated with neurodevelopmental impairments[1-8], prematurity[9-12] and low birthweight[9,13-15]. The gut microbiome serves as an intermediary between self and external environment; therefore, exploring the impact of PAH on microbiota may elucidate their role in disease. Here, we evaluated the effect of in utero PAH exposure on meconium microbiome., Methods: We evaluated 49 mother-child dyads within Fair Start Birth Cohort with full term delivery and adequate meconium sampling. Prenatal PAH was measured using personal active samplers worn for 48 h during third trimester. Post-processing, 35 samples with adequate biomass were evaluated for association between tertile of PAH exposure (high (H) vs low/medium (L/M)) and microbiome diversity., Results: No significant differences were observed in alpha diversity metrics, Chao1 and Shannon index, between exposure groups for total PAH. However, alpha diversity metrics were negatively associated with log benzo[a]anthracene (BaA) and log chrysene (Chry) with high exposure, but positively associated with log benzo[a]pyrene (BaP) with low/medium exposure. After adjustment for birthweight and sex, alpha diversity metrics were negatively associated with log BaA, BaP, Chry, Indeno (Zhang et al., 2021; Perera et al., 2018)pyrene (IcdP) and total PAH with high exposure. Conversely, with low/medium exposure, alpha diversity metrics positively correlated with log BaP and benzo[b]fluoranthane (BbF). No significant difference in beta diversity was observed across groups using UniFrac, weighted UniFrac, or Bray-Curtis methods. Differential expression analysis showed differentially abundant taxa between exposure groups., Conclusion: Bacterial taxa were detectable in 35/49 (71%) meconium samples. Altered alpha diversity metrics and differentially abundant taxa between groups suggest in utero PAH exposure may impede early colonization. Sample size is limited, but these findings provide supporting evidence for wider scale research. Research on long-term impact of prenatal PAH exposure on childhood health outcomes is ongoing. Differential effects of specific PAHs need further evaluation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Corona Virus Disease 2019 (COVID-19) in pregnant women has important impacts on perinatal and neonatal outcomes. However, there are a limited number of studies investigating the effect of the pandemic period on newborns. With this study, we aimed to determine the impact of the 2020 COVID-19 outbreak on prenatal care, obstetric outcomes, neonatal mortality and morbidity. Methods: The retrospective results of patients hospitalized to the Tertiary Neonatal Intensive Care Unit between 1 March and 30 May 2020, the first peak period of the pandemic in our country, were compared with the data of the same period of the previous year. Results: A total of 307 cases were included in our study. The mean gestational weeks of the neonates hospitalized in the Neonatal Intensive Care Unit during the COVID-19 period were higher than those in the control group (p: 0.003). During the pandemic period, an increase was found in the frequency of pregnant women presenting to obstetric emergency services in emergencies requiring acute intervention (p: 0.01). Compared to the control group, there was an increase in the number of infants with small for gestational age (SGA) diagnosis, 5th-minute Apgar score of 0.05). Conclusions: During the COVID-19 pandemic, it was shown that pregnant women disrupted their regular antenatal care, and more pregnant women were admitted to the obstetric emergency department with emergencies requiring acute intervention. This led to an increase in the number of cases diagnosed with SGA and hypoxic-ischemic encephalopathy in newborns. Our results will be useful for better management of current and future pandemic periods.

SUMMARY: Purpose: Many studies have maintained that nursing support is necessary and essential for mothers of preterm infants; however, the perceived nursing support for mothers of preterm infants has not been sufficiently measured. This study aimed to develop a perceived nursing support scale for mothers of preterm infants (PNSS-MP). Methods: The preliminary items of the PNSS-MP were developed through a literature review and in-depth interviews with mothers of preterm infants. Content and face validities were assessed by experts and mothers of preterm infants. A pilot study was conducted to confirm the feasibility and comprehension of the scale. To validate the PNSS-MP, 223 mothers of preterm infants were surveyed. Exploratory factor analyses were performed to confirm construct validity. Convergent and discriminant validities were analyzed using a multitrait-multimethod (MTMM) matrix. Reliability was tested by calculating Cronbach’s α and performing split-half testing. Results: The PNSS-MP consisted of 27 items and was categorized into five factors, explaining 65.3% of the total variance. The factors were named: “baby care support” (7 items), “mental care support” (6 items), “maternal role support” (6 items), “introducing resources support” (4 items), and “information delivery support” (4 items). The overall reliability of the scale was .95. Conclusion: The PNSS-MP adequately reflected the neonatal intensive care unit (NICU) in South Korea. Additionally, the PNSS-MP proved relatively valid and reliable; therefore, it can be used to measure nursing support in the NICU.

Bacille Calmette Guérin (BCG) is a live-attenuated vaccine for protection against Mycobacterium tuberculosis. Despite high disease protection in infancy and early childhood, it generates poor long-term protection against pulmonary tuberculosis. We hypothesized that the unique immune profile that includes elevated interleukin (IL)-27, contributes to insufficient protection from routine neonatal BCG administration. Using a novel method to obtain neonatal progenitors, we showed that neonatal bone marrow-derived dendritic cells (BMDCs) increase production of IL-27 following BCG stimulation. To study the effect of IL-27 on BMDCs, we utilized mice deficient for IL-27 receptor-α (KO). We observed greater BCG clearance and elevated IL-12 production in the neonatal KO BMDCs compared to WT. BMDCs from KO neonates in turn stimulated more interferon-γ production from CD4+ T cells isolated from BCG-vaccinated mice than WT counterparts. To further confirm the importance of these findings, C57BL/6 mice were vaccinated as neonates in line with the approach to human vaccination in high TB burden regions. IL-27 levels progressively increased through 5 weeks and were significantly elevated in mice vaccinated with BCG compared to controls. The impact of IL-27 production on clearance of BCG was significant as KO mice cleared BCG from peripheral tissues that persisted in WT mice 5 weeks post-vaccination. These results are the first to highlight the suppressive role of IL-27 on DCs in the neonatal period and the impact on neonatal immune responses to BCG.

Background: Maternal, fetal and neonatal mortality are higher in low-income compared to high-income countries due to weak health systems including poor access and utilization of health services. Despite enormous recent improvements in maternal, neonatal and under five children health indicators, more rapid progress is needed to meet the targets including the Sustainable Development Goal 3(SDG). In Kenya these indicators are still high and comprehensive systems are needed to attain these goals. Objective: To facilitate innovative partnerships in health care provision and to assess trends in access, utilization and quality of Maternal and Child Health care through the health systems approach using community owned initiatives including use of community owned resourse persons (CORPs), establishment of Community Based Organisations (CBOs) and Income Generating Activities(IGAs). Study site: This was implemented in Kabula location, Bungoma County, Kenya between January 2016 and April 2019. Study population: Pregnant women, newborns and under-five children living in Kabula location identified by Community Owned Resource Persons (CORPs). Methods: A prospective study to show trends in maternal, neonatal and infant outcomes through the implementation of community owned initiatives. Findings: General, under five and antenatal clinic attendance increased four fold in 2016,2017 and 2018. There was a 76% full immunization coverage with 97% BCG and 84% Polio coverage respectively among children studied. There was an 87% facility delivery rate among the pregnant women enrolled in the study. Conclusions: Trends in Maternal and under-five health indicators in Kabula showed improvements over the study period following the implementation of the community owned initiatives and community participation. Recommendations: The community owned initiatives as implemented in this study is useful in primary care and universal health coverage programs in health care delivery systems in LMICs.

Resumen: La historia de los inicios en Chile de la implementación nacional de las unidades de cuidados intensivos neonatales, y por ende de los inicios de la neonatología moderna en Chile, es de visionarios motivados exclusivamente por el profundo deseo de mejorar la sobrevida y calidad de vida de pequeños que nacían, muy a su pesar, antes de tiempo. Es una historia que, como muchas otras del desarrollo de la medicina, vale la pena relatar no solo por los logros que alcanzó, sino que también por el proceso de gestación y desarrollo en sí. Recordaremos para ello primero la historia de los orígenes y desarrollo del cuidado de los recién nacidos en el mundo, su avance gradual en el siglo XIX y principios del siglo XX, su consolidación a partir de la década de los 60, y finalmente su impulso en Chile con especial mención de la gestación del programa nacional de cuidados intensivos de prematuros en la década de los 80. Summary: The story of the onset of nationwide implementation of neonatal intensive care units in Chile, and therefore the beginnings of modern neonatology in Chile, is a story of visionaries motivated exclusively by a deep desire to improve the survival rate and quality of life of the little ones who were born, much to their regret, before their time. It is a story that, like many others of advances in medicine, is worth telling not only for the achievements acomplished but also for the gestation and development process itself. We’ll begin this story by recalling the history of the origins and development of newborn care in the world, its gradual growth in the 19th and early 20th centuries, its consolidation from the 1960s onward and finally its development in Chile, with special focus on the gestation of the national program of intensive care for premature infants in the 1980s.

الملخص: يهدف هذا التقرير إلى تنبيه الأطباء حول النزيف المتأخر داخل المخ باعتباره مظهر نادر لمرض المكورات العقدية من المجموعة ب لدى حديثي الولادة، وتسليط الضوء على الحاجة إلى إرشادات علاجية فاعلة. نقدم هنا حالة مرض نزيف متأخر داخل المخ ناتج عن مرض المكورات العقدية من المجموعة ب لدى طفلة حديثة ولادة تبلغ من العمر ١٧ يوما، وكانت الحالة معقدة مع نزيف ثنائي تحت العنكبوتية أكده التصوير بالرنين المغناطيسي، من خلال مراجعة الملف الطبي. تأخرت الأعراض لهذه المريضة مع أعراض الحمى والخمول والتشنجات والتأكيد الميكروبيولوجي للمكورات العقدية في مزرعة الدم، إضافة إلى وجود نزيف ثنائي تحت العنكبوتية ونقص التروية الدماغي المنتشر الذي أكده التصوير بالرنين المغناطيسي للدماغ، يشير إلى حدوث مضاعفات شديدة، مع عدد قليل جدا من الحالات المبلغ عنها من نزيف داخل المخ. وقد أظهرت المتابعة على المدى القصير تأخرا ملحوظا في النمو.يعد الفحص المبكر لعدوى المكورات العقدية من المجموعة ب بين النساء الحوامل أمرا مهما لمنع الحالات الشديدة من مرض النزيف المتأخر داخل المخ الناتج عن مرض المكورات العقدية من المجموعة ب. وهناك حاجة إلى مزيد من الأدلة لدعم الصلة الوثيقة بين مرض النزيف المتأخر داخل المخ الناتج عن مرض المكورات العقدية من المجموعة ب والنزيف داخل المخ. Abstract: This report aims to alert clinicians to the possibility of intracerebral haemorrhage as a rare manifestation of late-onset neonatal group B streptococcal (LOGBS) disease. This case also highlights the need for effective treatment guidelines for LOGBS disease. We report a case of LOGBS disease in a 17-day-old full-term female neonate, complicated by bilateral subarachnoid haemorrhage confirmed on magnetic resonance imaging (MRI). The patient presented with fever, lethargy, and convulsions. Microbiological examination confirmed the presence of Streptococcus agalactiae in the blood culture. Brain MRI showed bilateral subarachnoid haemorrhage and diffuse cerebral ischaemia, suggesting a severe complication of LOGBS disease. Short-term follow-up of the patient showed marked developmental delay. Early screening for group B streptococcus infection in pregnant women is essential to prevent severe cases of LOGBS disease. Very few cases of intracerebral haemorrhage in LOGBS disease have been reported. Further evidence is required to support a pertinent link between LOGBS disease and intracerebral haemorrhage.

Background: Improving the early identification of HIV-1-infected newborns with birth testing is critical to comprehensive early infant diagnosis and care for newborns living with HIV-1. Automated RNA quantification systems are valuable diagnostic tools, but the volume of plasma that viral load platforms require makes their widespread use for young children difficult. Method: Seventy-nine plasma samples with different viral load ranges were evaluated in parallel with the use of 1x PBS, pH 7.4, to supplement the required volume at dilutions factors from 1:2 to 1:50. Viral load quantification assays were evaluated using ABBOTT Molecular platforms, USA. Results: Using 1x PBS, at 1:10 dilution (70 µL plasma in 630 µL 1x PBS), a sensitivity of 100% and 100% specificity were obtained for detecting a viremia above 400 copies/mL (Kappa of 0.96, p

Severe granulomatous chronic villitis with focal remnants of Toxoplasma was confirmed by immunohistochemistry and DNA-based methods in the placenta from a child that died four days after birth. The immunocompetent mother was seronegative for Toxoplasma at delivery and 10 months later. Placental infection may happen without maternal systemic infection.