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Abstract Our group has developed an extra-uterine environment for newborn development (EXTEND) using an ovine model, that aims to mimic the womb to improve short and long-term health outcomes associated with prematurity. This study’s objective was to determine the histologic and transcriptomic consequences of EXTEND on the brain. Histology and RNA-sequencing was conducted on brain tissue from three cohorts of lambs: control pre-term (106–107 days), control late pre-term (127 days), and EXTEND lambs who were born pre-term and supported on EXTEND until late pre-term age (125–128 days). Bioinformatic analysis determined differential gene expression among the three cohorts and across four different brain tissue sections: basal ganglia, cerebellum, hippocampus, and motor cortex. There were no clinically relevant histological differences between the control late pre-term and EXTEND ovine brain tissues. RNA-sequencing demonstrated that there was greater differential gene expression between the control pre-term lambs and EXTEND lambs than between the control late pre-term lambs and EXTEND lambs (Supplemental Figs. 1 and 2). Our study demonstrates that the use of EXTEND to support pre-term lambs until they reach late pre-term gestational age results in brain tissue gene expression that more closely resembles that of the lambs who reached late pre-term gestation within their maternal sheep’s womb than that of the lambs who were born prematurely.

Abstract Prematurity-associated lung disease (PLD) is a long-term consequence of preterm-birth. Since the underlying mechanisms of PLD remain poorly characterised, we compared the urinary metabolome between recently described spirometry phenotypes of PLD. Preterm- and term-born children aged 7–12 years, from the Respiratory Health Outcomes in Neonates (RHiNO) cohort, underwent spirometry and urine collection. The urinary metabolome was analysed by gas chromatography time-of-flight mass spectrometry. Preterm-born children were classified into phenotypes of prematurity-associated obstructive lung disease (POLD, Forced expiratory volume in 1 s (FEV1)

Abstract Prematurity is associated with lower exercise capacity, which relies on the integrity of the cardiovascular, pulmonary, and skeletal muscle systems. Our animal model mimicking prematurity-associated conditions showed altered muscle composition and atrophy in adulthood. This study aimed to compare muscle composition and strength in adults born preterm versus full-term controls. This observational cohort study recruited 55 adults born preterm, ≤ 29 weeks’ of gestation and 53 full-term controls who underwent musculoskeletal ultrasound imaging to assess morphology of the rectus femoris at rest and during a maximal voluntary contraction. Maximal voluntary contraction of the hands and legs were measured by manual dynamometry. In adults born preterm, there was lower muscle strength (handgrip: − 4.8 kg, 95% CI − 9.1, − 0.6; knee extensor: − 44.6 N/m, 95% CI − 63.4, − 25.8) and smaller muscle area (− 130 mm2, 95% CI − 207, − 53), which was more pronounced with a history of bronchopulmonary dysplasia. Muscle stiffness was increased in the preterm versus term group (0.4 m/s, 95% CI 0.04, 0.7). Prematurity is associated with alterations in skeletal muscle composition, area, and function in adulthood. These findings highlight the necessity to implement preventive and/or curative approaches to improve muscle development and function following preterm birth to enhance overall health in this population.

Introduction: It is well recognized that hearing deficit is a severe consequence of prematurity. Premature infants have many concomitant risk factors, which influence the occurrence of hearing deficit. Hearing impairment if not detected within first 6 months of life has an important consequence for language acquisition, communication and cognitive, social and emotional development. To quantify audiometric contour and to detect high-frequency hearing loss, tone burst BERA is more beneficial for the preterm infants. Objectives: The aim of the present study was to detect the hearing impairment among the preterm infants. Methodology: The present study was carried out at the Department of Physiology, at R. G. Kar Medical College and Hospital on 40 preterm infants and 30 age- and sex-matched term infants from February 2020 to January 2021. BERA testing was performed with the machine Neuro-MEPNET (version 3), Neuro-soft, Russia. The responses were recorded, and statistical analysis was performed with SPSS software version 20. Result: Out of 40 preterm infants, 34 (85%) infants showed abnormality in Latency in one or both ears. The major abnormalities were absence of wave V or increase in wave V latency at 70 dB in both the ears. From our study, it was also found that there was statistically significant increase in the hearing threshold of both the ears of the preterm infants compared to term infants. Conclusion: We can infer from the present study that there is significant delayed maturation of auditory pathway in the form of BAEP abnormalities among the preterm infants.

Background: Retinopathy of prematurity (ROP) screening in Nigeria is at a nascent stage and at the moment there are no National guidelines for ROP screening in Nigeria. Thus it is desirable for screening programs to report findings amongst screened preterm infants in order to facilitate the development of national ROP screening criteria and guidelines. The aim of this report is to describe the frequency, severity and risk factors for retinopathy of prematurity (ROP) among preterm and very low-birth-weight babies screened within the first year of initiating an ROP screening program at a Nigerian tertiary facility. Methods: A cross-sectional study of infants born at less than 34 weeks gestational age; or with birth weight less than 1500g between May 2016 and May 2017. ROP screening examinations were performed by ophthalmologists with the use of an indirect ophthalmoscope, after pupillary dilation, in collaboration with the neonatology team. Information on gestational age at birth, birth weight, oxygen therapy and presence of other risk factors were recorded and analyzed. Results: A total of 74 infants were screened during the period. There were 36 (48.6%) males. Mean gestational age at birth was 29.6 (±2.35) weeks. Mean birth weight was 1.26 (±0.27) kg with a range of 800 to 1950g. ROP was detected in 9 (12.2%) infants. Two (22.2%) of these had Threshold ROP. There was no significant difference between the mean birth weight and mean gestational age of the infants who had ROP compared to those without ROP. The two infants with Threshold ROP were treated with intravitreal Bevazicumab and had regression of ROP. Conclusion: Retinopathy of prematurity was diagnosed in at risk infants in this facility. There is, therefore, a need to establish ROP screening programs in all neonatal units across the country. In addition, established programs need to evaluate their screening criteria with a view towards developing country-specific screening guidelines.

Background/Aim: Preterm birth is a major pregnancy complication that imposes tremendous long-term medical and financial burdens on affected children, families, and the healthcare system. The aim of this study was to find out the prevalence, risk factors, and outcome of preterm babies admitted to Bingham University Teaching Hospital's inborn Special Care Baby Unit. Methods: It was a retrospective study of the medical records of all preterm babies delivered in the hospital from January 2021 to June 2022. Results: A total of 1,160 live births occurred in the hospital during the study period out of which 196 (16.9%) were admitted. Of these, 100 (51.0%) were preterm's with gestational ages ranging from 24 to 36 weeks with a mean gestational age of 31.24 weeks (±2.78).Birth weight ranged from 650g to 2450g CC –BY 4.0 with a mean of 1530.22g (±414.11). There were 47 males and 53 females (M: F 0.89:1) and 63 (63.0%) were delivered via caesarean section. The duration of hospital stay ranged from 1 to 182days with a median of 9and IQRof 11 days. Preterm premature membrane rupture and preeclampsia were the two most frequent risk factors for prematurity. Jaundice was the most prevalent morbidity seen, closely followed by anaemia. The overall mortality rate was 20%. Conclusion: Prematurity continues to be a major contributor to infant morbidity and mortality in our hospital, thus there is a need to improve the quality of health care delivery in order to improve survival rate of these newborns.

Calcium, magnesium, phosphate and Vitamin D metabolism is intricately interwoven in human beings. For the foetus, the accretion of these nutrients occurs mainly in the third trimester. Hence, babies who are delivered preterm are at risk of suffering a deficiency of these micronutrients. Inadequate micronutrients can impair the infants' cellular functions, growth and development. Hence, this paper reviews the determinants of plasma levels of the micronutrients and how they are mobilised. It also reviews the evidence about the quantities of the nutrients available in breast milk and how much of them are available to the infant at optimal breastfeeding volumes. The possible implications on growth and the argument for or against supplementation of the nutrients in pregnant women and their preterm neonates who are exclusively breastfed are also discussed.

Zinc (Zn) is a vital trace element that plays a pivotal role in protein synthesis, cellular growth, and differentiation and is involved as a cofactor of metalloenzymes, performing a wide variety of metabolic, immune, and synthesis roles. Zn is required at all stages of an infant’s and child’s development, and severe Zn deficiency has been reported to lead to slower physical, cognitive, and sexual growth. Preterm neonates are at a higher risk of developing zinc deficiency for a variety of reasons, including low Zn intake from enteral feeds containing breast milk, relative malabsorption due to immaturity of the gastrointestinal tract with limited absorptive capacity, increased urinary loss of zinc, and increased demand during the early developmental stages. Moreover, premature infants are at risk of gastrointestinal diseases like necrotizing enterocolitis (NEC), which can limit absorption capacity and potentially lead to malabsorption. TPN is frequently used in preterm infants to provide them with sufficient nutrients and calories. However, it has its own complications, including cholestasis, especially if used for prolonged periods. In this case report, we are presenting the case of a male preterm infant who was delivered by caesarean section at 26 weeks’ gestation. The baby developed an intestinal perforation due to NEC, for which he underwent surgery for resection of the necrotic bowel and the creation of a high ileal stoma and was put on prolonged total parenteral nutrition (TPN), which led to the development of zinc deficiency.

Abstract Background Blood pressure is a vital hemodynamic marker during the neonatal period. However, normative values are often derived from small observational studies. Understanding the normative range would help to identify ideal thresholds for intervention to treat hypotension or hypertension. Therefore, the aim of this study was to assess observed blood pressure values in neonates who have not received any blood-pressure modifying treatments from birth to three months postnatal age and whether these vary according to birth weight, gestational age and postnatal age. Methods This was a systematic review. A literature search was conducted in MEDLINE, PubMed, Embase, Cochrane Library, and CINAHL from 1946 to 2017 on blood pressure in neonates from birth to 3 months of age (PROSPERO ID CRD42018092886). Unpublished data were included where appropriate. Results Of 3,587 non-duplicate publications identified, 30 were included (one unpublished study). Twelve studies contained data grouped by birth weight, while 23 contained data grouped by gestational age. Study and clinical heterogeneity precluded meta-analyses thus results are presented by subgroup. A consistent blood pressure rise was associated with increasing birth weight, gestational age, and postnatal age. In addition, blood pressure seemed to rise more rapidly in the most preterm and low birth weight neonates. Conclusion Despite blood pressure increasing with birth weight, gestational age, and postnatal age, there was marked blood pressure variability observed throughout. To better define hypotension and hypertension, future studies should develop consistent approaches for factors related to blood pressure variability, including the method and timing of measurement as well as statistical control of relevant patient characteristics.

Abstract Gestational diabetes is characterized by hyperglycaemia diagnosed during pregnancy. Gestational and pregestational diabetes can have deleterious effects during pregnancy and perinatally. The baby's weight is frequently above average and might reach macrosomia (≥ 4 kg), which can reduce pregnancy time causing preterm births, and increase foetal-pelvic disproportion which often requires delivery by caesarean section. Foetal-pelvic disproportion due to the baby’s weight can also cause foetal distress resulting in lower Apgar scores. To analyse the association between pregestational and gestational diabetes with maternal and foetal risk. We conducted a retrospective cohort study in women pregnant between 2012 and 2018 in the region of Lleida. Regression coefficients and 95% confidence intervals (CI) were used. The multivariate analysis showed statistically significant associations between pregestational diabetes and: prematurity (OR 2.4); caesarean section (OR 1.4); moderate (OR 1.3), high (OR 3.3) and very high (OR 1.7) risk pregnancies; and birth weight ≥ 4000 g (macrosomia) (OR 1.7). In getational diabetes the multivariate analysis show significant association with: caesarean section (OR 1.5); moderate (OR 1.7), high (OR 1.7) and very high (OR 1.8) risk pregnancies and lower 1-minuto Apgar score (OR 1.5). Pregestational and gestational diabetes increase: pregnancy risk, caesarean sections, prematurity, low Apgar scores, and macrosomia.

Early cardiac surgery in neonates and infants with congenital heart disease has been performed since the middle to late years of the twentieth century. To date, there are very few reports of successful congenital heart surgery using cardiopulmonary bypass (CPB) in premature babies less than 1000 g with serious congenital heart disease. Limited information is available in the literature describing perfusion techniques for this extremely fragile patient population. Miniaturization of the CPB circuit contributes to multiple factors that affect this population significantly. These factors include the reduction of patient-to-circuit ratios, volume of distribution of pharmacological agents, management of pressure gradients within the CPB system, and increased tactile control by the attending perfusionist. Careful management of the physiological environment of the patient is of utmost importance and can mitigate risks during CPB, including volume shifts into the interstitial space, electrolyte, and acid-base imbalance, and intracranial hemorrhage. We report perfusion techniques successfully utilized during the surgical repair of transposition of the great arteries for an 800 g, 28-week-old neonate. CPB techniques for the smallest and youngest patients may be executed safely when proper physical, chemical, and perfusion process adjustments are made and managed meticulously.

Introduction. Biliary atresia (BA) represents a progressive and obstructive fibrotic cholangiopathy, serving as a leading cause of liver failure and pediatric liver transplantation worldwide. Identifying risk factors associated with BA incidence is crucial for expediting diagnosis; however, limited research has been conducted in Indonesia. This study aims to investigate the characteristics and analyze the factors associated with the occurrence of BA. Methods. A retrospective observational analysis of medical records encompassing 523 cholestatic patients at the Pediatric Hepatology Outpatient Department and Pediatric Ward of “Dr. Soetomo” General Academic Hospital, Surabaya, from 2011 to 2022 was conducted. The data was segregated into BA and non-BA groups, and diagnostic chi-square tests were employed to determine interrelationships among variables. Subsequently, logistic regression analysis was performed to identify the most impactful variable. Results. Notably, age at first time visiting specialist (p = 0.003), gestational age (p

Introduction. Autoimmune diseases are a class of immunopathological conditions heterogeneous in clinical manifestations, characterized by immune disorders that cause the loss of the body's autoimmune tolerance and, as a result, abnormal reactivity of B-cells and T-cells, which leads to damage to own tissues. Today, about 10% of the population suffers from diseases of this class, which are clinically manifested in the form of more than 80 forms of autoimmune diseases. The aim of the study. Summarize current ideas about the therapeutic potential of conditioned media and exosomes of MSCs in the treatment of patients with autoimmune diseases based on data from open sources of information. Materials and methods. Publications were selected based on PubMed, Clinical Key Elsevier, Cochrane Library, eBook Business Collection and Google Scholar databases, which covered information on the use of conditioned media and MSC exosomes in the treatment of diseases of premature newborns using the Keywords: mesenchymal stem cells, conditioned media, secretion, autoimmune diseases. Results. The technical complexity and high costs associated with the production and regulatory approval procedures of MSC therapy create barriers to their clinical use. Studies have shown that the cell-free secretome of MSCs, which consists of a wide range of growth factors, cytokines, chemokines and extracellular vesicles, exhibits a pluripotent effect. Today, extracellular vesicles are classified according to their diameter into apoptotic bodies (>1000 nm), microvesicles (100–1000 nm) and exosomes (30–150 nm). Exosome activity can be easily manipulated by preconditioning MSCs, by simply adding cytokines or chemicals to the culture medium, by introducing gene modifications, or by using hypoxic culture conditions. A number of studies have demonstrated the comparable effectiveness of conditioned media and MSC exosomes in the treatment of patients with autoimmune diseases. Conclusions. Exosomes and conditioned media with MSCs have the potential to replace cell therapy or serve as a comparable clinical strategy to biological therapy in neonatology. MSC preconditioning will allow modulating the therapeutic effects of exosomes and will become the basis for establishing recommendations and standards for effective and safe cell-free therapy.

Chlamydia trachomatis (C. trachomatis) screening and treatment in pregnancy allows the opportunity to reduce adverse pregnancy and neonatal outcomes worldwide. Although C. trachomatis infection is easily treated and cured with antibiotics, only some countries have routine pregnancy screening and treatment programs. We therefore evaluated whether just one maternal screening for C. trachomatis is enough to prevent adverse pregnancy and negative neonatal outcomes. Among the 4087 first-time gynecological–obstetric consultations granted at the National Institute of Perinatology in 2018, we selected the study population according to a case–cohort design. Antenatal C. trachomatis screening and treatment interventions were performed on 628 pregnant women using COBAS® TaqMan CT. C. trachomatis DNA was also detected in samples from 157 infants of these mothers. In the maternal cohort, incidence of C. trachomatis infection was 10.5%. The vertical transmission rate was 1.5% for the cohort of mothers who tested positive for C. trachomatis and received treatment, and 29.7% for those with a negative test. By evaluating symptomatic neonatal infection, the hazard rate of perinatal pneumonia was 3.6 times higher in C. trachomatis-positive babies than in C. trachomatis-negative babies. Despite the low rate of mother-to-child transmission in women positive for C. trachomatis, possible maternal infection that is not detected in pregnancy significantly increases the risk of neonatal infection with consequent perinatal pneumonia.

In South Africa, prematurity stands as one of the foremost causes of neonatal mortality. A significant proportion of these deaths occur because of respiratory distress syndrome of prematurity. The implementation of non-invasive respiratory support, such as continuous positive airway pressure (CPAP), has demonstrated both safety and efficacy in reducing mortality rates and decreasing the need for mechanical ventilation. Given the absence of blood gas analysers and limited radiological services in many district hospitals, the severity of respiratory distress is often assessed through observation of the infant’s work of breathing and the utilisation of bedside scoring systems. Based on the work of breathing, non-invasive therapy can be commenced timeously. While evidence supporting the use of high-flow nasal cannula as a primary treatment for respiratory distress syndrome remains limited, it may be considered as an alternative, provided that CPAP machines are available. The purpose of this article is to advocate the use of non-invasive therapy in low resource-limited settings and describe the indications, contraindications, complications, and application of CPAP therapy. This would benefit healthcare workers, especially in low-care settings and district hospitals.

Seven point five per cent of births in Portugal in 2021 were premature live births (INE, 2023). According to the medical journal of the American Academy of Neurology, being born prematurely (23-31 weeks) may increase five times the risk of being hospitalised for epilepsy in adulthood when compared to those who were born full-term (Crump et al., 2011). The present analysis aimed to determine research hotspots and prospective directions of the relation between prematurity and epilepsy research. Research about epilepsy related to prematurity was done in Web of Science (WoS) and PubMed database, considering the data between the first of January 2013 and the twentieth of June 2023. The descriptors used were: “(epilepsy OR convulsion OR seizure OR epileptic) AND (prematurity) AND (childhood OR children OR child OR infancy OR pediatric OR kids)”. The data extracted from Software R(V.4.3.0) in R format was analysed in the Bibliometrix program (http://www.bibliometrix.org (accessed 20/06/2023)), and the outcome was organised by sources, authors, affiliations, countries, keywords and the evolution of the research along time. One thousand and eighty-two articles were considered for analysis. Research growth since 2015, especially in 2022, was noticeable. USA, Israel and Australia are the countries with the largest number of publications, which was correlated with the affiliations with more research on the area (Tel Aviv University, Baylor College of Medicine and the University of Melbourne, from highest to lowest) and with the principal used keywords (humans, female, male and “infant, newborn”). The most relevant journal was Pediatric Neurology, and the most cited one was Pediatrics. Thomas Michael O’Shea (17 documents) and Francesco Pisani (16 documents) were the ones with the highest number of publications, and the most relevant affiliation was Columbia University Irving Medical Center (99 articles). The trend topics indicate microencephaly/genetics and “infant, newborn, diseases” as the most recently used. The country with the most citations was the USA (100 citations), and the one with the most collaborations. Portugal's collaborations mainly involved European countries but also with the USA, Egypt, Iran, and Israel. The USA is the country that publishes the most. Despite the large initial number, the most cited and relevant articles focus on a much smaller number. The most studied topics are currently microencephaly, genetics, infant, newborn and diseases. It would be important that future research focus on the relevance of these topics related to the incidence of cases in the population of the most influential countries.

Introduction Necrotizing enterocolitis (NEC) poses a significant threat to preterm infants, with nonspecific early manifestations complicating timely diagnosis. Therefore, this study aimed to develop a novel scoring system for early diagnosis of NEC, incorporating clinical and laboratory data with urinary caveolin-1 levels. Material and methods A single-center prospective cohort study was conducted at a tertiary hospital in East Java, Indonesia. NEC diagnosis was established by Bell’s criteria and proven gut dysbiosis. Urinary levels of claudin-2, caveolin-1, and epidermal growth factor (EGF) were assessed as potential indicators of tight junction disruption. The selected urine biomarker cutoff value was determined using symbolic classification analysis and combined with clinical and laboratory parameters from Bell’s criteria to create an NEC scoring system, validated with the Aiken index. Sensitivity and specificity analyses were performed. Results Thirty-four neonates, comprising NEC, preterm non-NEC, and term infants, were included. qPCR analysis highlighted elevated Klebsiella, Lactobacillus, Clostridium, and Bacteroides levels in NEC patients, indicating a gut dysbiosis trend. Among 3 biomarkers, caveolin-1 ≥ 17.81 ng/dl on day 3 demonstrated 72.86% negative predictive value and 87.50% positive predictive value. The combined scoring system which comprised abdominal cellulitis, distension, radiology, advanced resuscitation at birth, prematurity or low birthweight, platelet count, sepsis, orogastric retention, metabolic acidosis and caveolin-1 findings exhibited an AUC of 0.922 (95% CI: 0.81–1.00, p < 0.001), with ≥ 1.81 as the cutoff, offering 93% sensitivity and 94% specificity. Conclusions Urine caveolin-1 on day 3 signifies enterocyte tight junction damage and the acute phase of NEC in premature infants. The proposed scoring system demonstrates good performance in predicting NEC incidence in preterm infants.

Abstract Background Breast milk (BM) provides complete nutrition for infants for the first six months of life and is essential for the development of the newborn’s immature immune and digestive systems. While BM was conventionally believed to be sterile, recent advanced high throughput technologies have unveiled the presence of diverse microbial communities in BM. These insights into the BM microbiota have mainly originated from uncomplicated pregnancies, possibly not reflecting the circumstances of mothers with pregnancy complications like preterm birth (PTB). Methods In this article, we investigated the BM microbial communities in mothers with preterm deliveries (before 37 weeks of gestation). We compared these samples with BM samples from healthy term pregnancies across different lactation stages (colostrum, transitional and mature milk) using 16S rRNA gene sequencing. Results Our analysis revealed that the microbial communities became increasingly diverse and compositionally distinct as the BM matured. Specifically, mature BM samples were significantly enriched in Veillonella and lactobacillus (Kruskal Wallis; p

Abstract Background Infants born very and extremely premature (V/EPT) are at a significantly elevated risk for neurodevelopmental disorders and delays even in the absence of structural brain injuries. These risks may be due to earlier-than-typical exposure to the extrauterine environment, and its bright lights, loud noises, and exposures to painful procedures. Given the relative underdeveloped pain modulatory responses in these infants, frequent pain exposures may confer risk for later deficits. Methods Resting-state fMRI scans were collected at term equivalent age from 148 (45% male) infants born V/EPT and 99 infants (56% male) born at term age. Functional connectivity analyses were performed between functional regions correlating connectivity to the number of painful skin break procedures in the NICU, including heel lances, venipunctures, and IV placements. Subsequently, preterm infants returned at 18 months, for neurodevelopmental follow-up and completed assessments for autism risk and general neurodevelopment. Results We observed that V/EPT infants exhibit pronounced hyperconnectivity within the cerebellum and between the cerebellum and both limbic and paralimbic regions correlating with the number of skin break procedures. Moreover, skin breaks were strongly associated with autism risk, motor, and language scores at 18 months. Subsample analyses revealed that the same cerebellar connections strongly correlating with breaks at term age were associated with language dysfunction at 18 months. Conclusions These results have significant implications for the clinical care of preterm infants undergoing painful exposures during routine NICU care, which typically occurs without anesthesia. Repeated pain exposures appear to have an increasingly detrimental effect on brain development during a critical period, and effects continue to be seen even 18 months later.

In Mississippi, USA, infant hospitalization with congenital syphilis (CS) spiked by 1,000%, from 10 in 2016 to 110 in 2022. To determine the causes of this alarming development, we analyzed Mississippi hospital discharge data to evaluate trends, demographics, outcomes, and risk factors for infants diagnosed with CS hospitalized during 2016–2022. Of the 367 infants hospitalized with a CS diagnosis, 97.6% were newborn, 92.6% were covered by Medicaid, 71.1% were African American, and 58.0% were nonurban residents. Newborns with CS had higher odds of being affected by maternal illicit drug use, being born prematurely (

Abstract Background Premature birth and/or low birthweight have long-lasting effects on cognition. The purpose of the present systematic review is to examine whether the effects of prematurity and/or low birth weight on neurodevelopmental outcomes differ between males and females. Methods Web of Science, Scopus, and Ovid MEDLINE were searched for studies of humans born premature and/or of low birthweight, where neurodevelopmental phenotypes were measured at 1 year of age or older. Studies must have reported outcomes in such a way that it was possible to assess whether effects were greater in one sex than the other. Risk of bias was assessed using both the Newcastle–Ottawa scale and the National Institutes of Health Quality assessment tool for observational cohort and cross-sectional studies. Results Seventy-five studies were included for descriptive synthesis, although only 24 presented data in a way that could be extracted for meta-analyses. Meta-analyses found that severe and moderate prematurity/low birthweight impaired cognitive function, and severe prematurity/low birthweight also increased internalizing problem scores. Moderate, but not severe, prematurity/low birthweight significantly increased externalizing problem scores. In no case did effects of prematurity/low birthweight differ between males and females. Heterogeneity among studies was generally high and significant, although age at assessment was not a significant moderator of effect. Descriptive synthesis did not identify an obvious excess or deficiency of male-biased or female-biased effects for any trait category. Individual study quality was generally good, and we found no evidence of publication bias. Conclusions We found no evidence that the sexes differ in their susceptibility to the effects of severe or moderate prematurity/low birthweight on cognitive function, internalizing traits or externalizing traits. Result heterogeneity tended to be high, but this reflects that one sex is not consistently more affected than the other. Frequently stated generalizations that one sex is more susceptible to prenatal adversity should be re-evaluated.

Background: India shares a huge burden of the total number of global neonatal deaths. The neonatal mortality rate in Uttarakhand is higher in comparison to the national rate. Understanding the causes and contextual factors that contribute to neonatal deaths is critical for developing a health programme and policy. Therefore, this study was aimed to ascertain causes of neonatal deaths using verbal autopsy in Rishikesh, Uttarakhand. Material and Methods: A community-based cross-sectional study was conducted in Rishikesh, Uttarakhand from July 2018 to June 2019. The study participants were mothers or primary caregivers of deceased neonates. The verbal autopsy tool of the National Health Mission, Government of India was used to collect data. All neonatal deaths from July 2018 to June 2019 were included in this study. The cause of neonatal death was ascertained by two independent doctors. Results: A total of 23 neonatal deaths could be traced during July 2018 through June 2019 in Rishikesh. One death was excluded from the study. Sixty-eight percent (15/22) of neonatal deaths occurred in the first week of life. Major causes of neonatal deaths were perinatal asphyxia (7/22), congenital malformation (6/22), and prematurity (4/22). Most (9/22) of the delays were in making a decision to seek medical care for neonates. Conclusion: The major causes of neonatal deaths were perinatal asphyxia, congenital malformation, and prematurity. Most of the deaths occurred during the early neonatal period.

Abstract Background Diabetes has reached epidemic proportions in recent years with serious health ramifications. The aim of this study was to evaluate the strength and validity of associations between diabetes and anti-diabetic interventions and the risk of any type of gynaecological or obstetric conditions. Methods Design: Umbrella review of systematic reviews and meta-analyses. Data sources: PubMed, Medline, Embase, Cochrane Database of Systematic Reviews, manual screening of references. Eligibility criteria: Systematic reviews and meta-analyses of observational and interventional studies investigating the relationship between diabetes and anti-diabetic interventions with gynaecological or obstetric outcomes. Meta-analyses that did not include complete data from individual studies, such as relative risk, 95% confidence intervals, number of cases/controls, or total population were excluded. Data analysis: The evidence from meta-analyses of observational studies was graded as strong, highly suggestive, suggestive or weak according to criteria comprising the random effects estimate of meta-analyses and their largest study, the number of cases, 95% prediction intervals, I 2 heterogeneity index between studies, excess significance bias, small study effect and sensitivity analysis using credibility ceilings. Interventional meta-analyses of randomised controlled trials were assessed separately based on the statistical significance of reported associations, the risk of bias and quality of evidence (GRADE) of included meta-analyses. Results A total of 117 meta-analyses of observational cohort studies and 200 meta-analyses of randomised clinical trials that evaluated 317 outcomes were included. Strong or highly suggestive evidence only supported a positive association between gestational diabetes and caesarean section, large for gestational age babies, major congenital malformations and heart defects and an inverse relationship between metformin use and ovarian cancer incidence. Only a fifth of the randomised controlled trials investigating the effect of anti-diabetic interventions on women’s health reached statistical significance and highlighted metformin as a more effective agent than insulin on risk reduction of adverse obstetric outcomes in both gestational and pre-gestational diabetes. Conclusions Gestational diabetes appears to be strongly associated with a high risk of caesarean section and large for gestational age babies. Weaker associations were demonstrated between diabetes and anti-diabetic interventions with other obstetric and gynaecological outcomes. Trial registration Open Science Framework (OSF) (Registration https://doi.org/10.17605/OSF.IO/9G6AB ).

Abstract Background Congenital toxoplasmosis can be associated with serious clinical consequences from fetus to adulthood. Hence, early detection is required to minimize severe sequelae through appropriate therapy. We describe the first case of a congenital toxoplasmosis after maternal coinfection with Toxoplasma gondii and severe acute respiratory syndrome coronavirus 2 and the challenging serological diagnosis of the disease in this context. Case presentation A Caucasian boy was born at 27 weeks 2 days of gestation by cesarean section due to maternal COVID-19-related respiratory failure. Postpartum serological screening of the mother revealed a previously unrecognized active Toxoplasma gondii infection. The premature child initially tested negative for anti- Toxoplasma gondii immunoglobulin A and M antibodies 1, 2 and 4 weeks after birth, whereas immunoglobulin G antibodies were only weakly positive with no evidence of child-specific production. Neither neurological nor ophthalmological abnormalities were detected. Approximately 3 months after birth, serological testing indicated a congenital toxoplasmosis by presence of immunoglobulin A and M, in combination with a child-specific immunoglobulin G synthesis. Additionally, cerebrospinal fluid was tested positive for Toxoplasma gondii DNA. Although no clinical manifestations of congenital toxoplasmosis were detected, an antiparasitic therapy was initiated to minimize the risk of late sequelae. There were no hints for a transplacental transmission of severe acute respiratory syndrome coronavirus 2. Conclusion This case raises the awareness of possible coinfections with the risk of transplacental transmission in cases of maternal coronavirus disease 2019. The report emphasizes the need for screening vulnerable patients for toxoplasmosis in general and especially in the context of pregnancy. It becomes evident that prematurity can complicate the serological diagnosis of congenital toxoplasmosis due to a delayed antibody response. Repeated testing is recommended to carefully monitor children at risk and especially those with a history of preterm birth.

Background and aims: High-risk neonates (HRNs) included neonates who were born with a weight of less than 1500 g at birth and/or gestational age between 24 and 37 weeks and needed longer intensive medical care. This study aimed to evaluate the prevalence of developmental disabilities among 5-year-old children that were HRNs in the neonatal period. Methods: In a historical cohort study, 120 five-year-old children were included and divided into two groups of 60 eligible children in the exposed and control groups. They were born as HRNs in 2016 and admitted to the neonatal intensive care units (NICUs). After stabilization of their general condition, the infants in the exposed group were discharged and received home care (HC) services, but the control group received long-time care in NICU and did not receive HC services. They were evaluated in terms of developmental domains including vision, hearing, fine motor skills, gross motor skills, communication, problem-solving, and personal and social affairs. The developmental screening was done using the Ages and Stages questionnaire (ASQ). Results: A total of 61 (50.83%) children were classified as suspected cases of developmental disabilities. There was no significant difference between the exposed and control children in the total frequency of developmental disability (P=0.1). A significant difference was seen only in the problem-solving domain between the exposed and control groups (P=0.043). Conclusion: There were no significant statistical differences in most dimensions of developmental disabilities (except for the problem-solving domain) between the exposed and control children.

Hamartomas are tumor-like lesions composed of tissue elements normally found at the site where they are located, but which grow in a disorganized manner. It generally occurs at birth or soon after but its exact mechanisms of development remain unknown. Although trauma and prematurity have been reported occasionally with the hamartomatous lesion. This article is to highlight a rare benign case of fibrous hamartoma of infancy located in the anterior abdominal wall in an eight-month female with a previous history of prematurity and low-birth weight.

Objectives: To determine the frequency and causal relationship of Pneumothorax in prematurely born neonates in a tertiary care hospital. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Paediatrics, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Aug 2017 to Jul 2019. Methodology: A total of 510 premature neonates fulfilling the inclusion criteria were enrolled in the study. In suspected cases,Pneumothorax was confirmed on a chest radiograph. Hemodynamically stable neonates were closely observed for spontaneous resolution, whereas unstable neonates were managed by needle thoracocentesis or thoracostomy with or without ventilator support. The outcome of the study was either death of the neonate or discharge from the NICU (Neonatal Intensive Care Unit). Results: Of 510 included premature neonates, 43(8.4%) developed Pneumothorax. Pneumothorax was more common in late pre-term (51.2%) and moderate pre-term (46.5%) infants. Underlying diseases causing Pneumothorax were respiratory distress syndrome (RDS) 21(48.8%), meconium aspiration syndrome (MAS) 8(18.6%), transient tachypnoea of the newborn (TTN) 5(11.6%), birth asphyxia syndrome (BAS) 6(14%) and Pneumonia 3(7%). 34(79.1%) patients required thoracostomy, whereas 7(16.3%) required only needle thoracocentesis. Spontaneous resolution occurred in only 2(4.7%) patients. Of 43 patients, 35(81.39%) were discharged, and 8 (18.60%) died. Conclusion: Pneumothorax is not an uncommon complication, especially in premature neonates. A high index of suspicion is required for early recognition and timely management of Pneumothorax, as delay is associated with significant mortality.

Introduction: Respiratory distress syndrome (RDS) is the most common cause of respiratory distress, morbidity, and mortality associated with premature delivery. Prolactin is present in very high concentrations in amniotic fluid, and prolactin receptors are present in lung preparations. Prolactin acts as a direct trigger of lecithin synthesis or in a “chain reaction” along the hypothalamic–pituitary–adrenal axis. Thus, prolactin seems to have a role in lung maturation along with many other factors through a complex mechanism. Aim: The aim of this study was to evaluate and compare the umbilical cord serum prolactin levels of preterm infants with and without RDS. Materials and Methods: This was a hospital-based comparative observational study carried out at neonatal units of the department of pediatric medicine in a tertiary care center from April 2019 to May 2020. Out of a total of 80 preterm infants, 40 developed RDS and other 40 served as controls. Umbilical cord blood prolactin levels in neonates were measured in both groups and compared. Chi-square test and an unpaired Student's t-test were used for statistical analysis. Probability was considered significant if

Introduction: Facility-Based Newborn Care program is one of the key initiatives launched by the Government of India under the National Rural Health Mission and RMNCH + A strategic program to improve the status of newborn health in the country. Under the program, efforts are being made to provide different levels of newborn care at the health facilities. Special newborn care unit (SNCU) is a neonatal unit in the vicinity of labor room which is to provide special care (all care except assisted ventilation and major surgery) for sick newborns. Aims and Objectives: We aimed to study the admission profile and treatment outcome of neonates admitted in SNCU. Materials and Methods: The present descriptive observational study with longitudinal design was conducted in the government-supported SNCU of District Hospital of Jalgaon district of Maharashtra which included all the neonates admitted in SNCUs from January 2013 to December 2019. The SNCU monthly report which is in a predefined format from the Ministry of Health and Family Welfare, Government of India, which includes data on admission information, reasons of admission, course of admission, and mortality reasons (if any) with treatment outcomes was used for data collection. The outcomes were classified into four groups, namely expired (died during the management), discharged (discharged after successful treatment), Left against medical advice (LAMA), and referred (referred to higher center for further management). Results: In the present study period (i.e., from January 2013 to December 2019), total 16,489 neonates were admitted to the SNCU. Out of them, 9895 (60.01%) were inborn. Majority (93.22%) of the deliveries were institutional deliveries. Meconium aspiration syndrome (MAS) (16.50%) was the most common indication for admission, followed by prematurity (12.68%), other low birth weight (LBW) (1000–2499 g) (11.96%), respiratory distress syndrome (RDS) (11.29%), and birth asphyxia (10.21%), respectively. 78.63% were discharged after successful management while 10.45% died during treatment. 3.97% were referred to higher center for further specialized management and 6.94% left the hospital against medical advice. Prematurity (25.70%) and RDS (25.48%) were the common causes of mortality. Birth asphyxia (15.12%), sepsis (7.73%), MAS (7.67%), and extremely LBW (7.62%) were other important conditions leading to the death of newborns. Conclusion: Thus, we conclude that the admission rate for inborn was higher as compared to outborn. MAS was observed to be the most common indication for admission, followed by prematurity, other LBW (1000–2499 g), RDS, and birth asphyxia, respectively. The discharge rate was 78.63% after successful management while the mortality rate was 10.45%. Prematurity, RDS, and birth asphyxia were the common causes of mortality.

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.

The main aim of the study was to identify factors associated with preterm birth. The study was conducted for a period of 6 months from September 2019 to February 2020 in 1607 women at SVS Medical College and Hospital, and Sushrutha Hospital, Mahabubnagar and it eventually selected 80 pregnant women for the final experiment. Those pregnant women who had pre-eclampsia, intrahepatic cholestasis during pregnancy, placenta previa or chorioamnionitis were more likely to experience pre-term birth. A patient interview was conducted in a detailed manner and all the necessary information regarding the mother and the infant were collected to carry out the study. Among 80 patients, collected the highest number of 39 cases i.e. 49% in between the age group of 17-23 years and the least number of cases therefore 19 i.e. 24% in between the age group of 35-45 years. We studied that maternal variable such as social status and educational status also impacts deliveries. Alcoholics had the highest number of very pre-term deliveries i.e., 36.25%. And among undergraduates, moderate preterm deliveries were a predominant number, i.e. 38.75%. Among the cases collected, 22.5% of women who have previous abortions had the highest number of preterm births with 31 cases and 5% of women with thyroid had the least number of pre-term births. 41% of preemie births were observed in the gestational gap of < 18 months, while 24% were recorded in > 30 months. In between two types of deliveries, 69% of preemie births were observed in the cesarean section and normal delivery includes 31%. The results of our study reveal that there is a need to assess the causes and complications among pregnant women who are at risk of delivering a premature baby. We have concluded that counseling the patients about their risk factors is necessary, and the patients should be told that harmful social habits will have a huge impact on their baby, before or after the delivery.

INTRODUCTION: The incidence of neonatal sepsis in developing countries is still high, reaching 170 out of 1000 births. An increased premature birth rate has become the leading cause of death in children under five years old. Studies examining the correlation between prematurity and neonatal sepsis onset have not been widely reported. Therefore, we assessed the correlation between gestational age and the onset of sepsis in neonatal patients. METHODS: Hospital-based cross-sectional study was performed on all neonates diagnosed with neonatal sepsis in the NICU of a tertiary referral hospital in East Java between 1 January 2019 – 31 December 2019. Logistic regression was used to analyze the obtained data. P-value 0.05). CONCLUSION: Although preterm birth is often reported as one of the most important risk factors of neonatal sepsis, prematurity does not appear to be an independent risk factor of neonatal sepsis onset.

Introduction: High neonatal mortality rates may be attributed to the lack of early recognition of severe illness, early and safe referral, and proper care. Therefore, there is a need to develop a simple, cost-effective scoring system that can be quickly applied to newborns referred from peripheral to tertiary care settings in resource-constrained areas. The Extended Sick Neonate Score (ESNS) is one such scoring system used to assess the severity of illness in critically ill neonates and predict their outcomes. Aim: To evaluate the effectiveness of the Extended Sick Newborn Score in predicting outcomes for neonates admitted to the Neonatal Intensive Care Unit (NICU) of a tertiary care centre. Materials and Methods: This prospective cohort study included 122 outborn neonates admitted to the NICU of SDM College of Medical Sciences and Hospital in Dharwad, Karnataka, India, from June 2021 to June 2022. All the required parameters for scoring, such as respiratory effort, heart rate, mean blood pressure, axillary temperature, capillary filling time, random blood sugar, SpO2, Moro reflex, and modified Downe’s score, were assessed and documented in a predesigned proforma. The ESNS was calculated upon admission to predict the outcomes. Statistical analysis included ANOVA test and independent t-test, using SPSS version 17.0 and MS Excel. Results: The study evaluated a total of 122 neonates, including 78 males and 44 females. Of these, 99 were term neonates and 23 were preterm neonates. The mean age for term neonates was 8.5 days ±8.6, and for preterm neonates, it was 4.1 days ±4.3. Term neonates with an ESNS Score ≤11 exhibited higher mortality, while preterm neonates with an ESNS score ≤12 showed higher mortality. The sensitivity and specificity of the ESNS score in predicting death were 78.57% and 99.07%, respectively. The ESNS score at admission was significantly lower in non-survivors compared to survivors, and it demonstrated a positive correlation with the outcome. Conclusion: This study found a significant correlation between the ESNS score at admission and in-hospital mortality. The use of the ESNS score is an acceptable method for risk stratification and prognosis of newborns in the NICU.

Magnesium sulfate (MagSul) is used clinically to prevent eclamptic seizures during pregnancy and as a tocolytic for preterm labor. More recently, it has been implicated as offering neural protection in utero for at-risk infants. However, evidence is mixed. Some studies found that MagSul reduced the incidence of cerebral palsy (CP) but did not improve other measures of neurologic function. Others did not find any improvement in outcomes. Inconsistencies in the literature may reflect the fact that sex effects are largely ignored, despite evidence that MagSul shows sex effects in animal models of neonatal brain injury. The current study used retrospective infant data to assess differences in developmental outcomes as a function of sex and MagSul treatment. We found that on 18-month neurodevelopmental cognitive and language measures, preterm males treated with MagSul (n = 209) had significantly worse scores than their untreated counterparts (n = 135; p < 0.05). Female preterm infants treated with MagSul (n = 220), on the other hand, showed a cognitive benefit relative to untreated females (n = 123; p < 0.05). No significant effects of MagSul were seen among females on language (p > 0.05). These results have tremendous implications for risk–benefit considerations in the ongoing use of MagSul and may explain why benefits have been hard to identify in clinical trials when sex is not considered.

Introduction. The human papilloma virus (HPV) is a virus usually transmitted through mucocutaneous contact directly with the infected organs, resulting in a sexually transmitted infection that exposes particularly young women to a high risk of developing neoplasia of cervical, anogenital, respectively oropharyngeal origin if the virus persists for more than 1-2 years. Our study aimed to detect the correlation between HPV infection and spontaneous preterm labor. Materials and methods. We conducted an observational comparative case-control study in the Department of Neonatology/Obstetrics and Gynaecology of Elias Emergency University Hospital on women diagnosed with HPV infection to assess the risk of preterm labour associated with this infection. Results. The overall group of patients was divided into two groups (confirmed and unconfirmed (or negative) with HPV infection). We observed that, among positive patients, there was a higher incidence of patients infected with a single HPV strain (n=36), followed by patients infected with 2 strains (n=7). Our study revealed the fact that only 4 cases (22.2%) had a history of preterm birth, as opposed to 77.8% (14 cases) who had no associated preterm birth history in the case of HPV genotype 16 positive patients. The data obtained showed no statistical significance (p=0.977). Conclusions. Preterm birth remains one of the leading causes of perinatal mortality and lifetime morbidity worldwide. HPV is a frequently diagnosed viral infection, but clinical studies have observed mixed results regarding the association of HPV 16 and the risk of preterm birth.

Introduction. Coarctation of the aorta (CoA) occurs in 6-8% of patients with congenital heart disease, with an incidence of 4/10,000 live births. It can be present with various clinical pictures, in an age range between newborn and adolescence. Infants with birth weights ≤ 2 kg with CoA have increased risk of severe intraventricular hemorrhage (IVH) compared to their birth weight-matched cohorts. Case presentation. We present a case of a premature, male newborn, with low birth weight, who at the age of 3 weeks developed signs and symptoms of cardiogenic shock. Clinical examination, echocardiography and angio-CT confirmed the diagnosis of a severe CoA, without any flow through the ductus arteriosus. Treatment with prostaglandin E1 was initiated, to promote ductal patency. The systolic blood pressures were above 99 percentile for his gestational age in the upper extremities, with a noninvasive pressure gradient around 86 mmHg between the arm and leg. Transfontanellar ultrasonography evaluation revealed a grade II/III bilateral IVH, in resorption, with cystic transformation. At the age of 6 weeks definitive surgical repair was performed. Postoperatively, at the 3 month follow-up, the clinical suspicion of recoarctation of the aorta arose, confirmed by echocardiography and angio-CT, with arterial hypertension and gradient around 37 mmHg between the arm and leg. Prosthetic patch aortoplasty was performed. The postoperative evolution was marked by the persistence of arterial hypertension, the infant requiring continued treatment with angiotensin-converting enzyme inhibitor. Conclusions. Premature neonates with low birth weight have always constituted a medical management challenge, with short and long term implications. A strong point in solving such cases is a multidisciplinary medical for assessment, management and outcomes.

Introduction: Congenital Anomalies (CA) are a significant cause of neonatal mortality both in developed and developing nations. Congenital abnormalities can have different patterns, prevalence rates, and risk factors across time and across different geographic regions. Aim: To find out the incidence of CA occurring among institutional live births and to study the associated maternal and perinatal risk factors in Northeast region of India. Materials and Methods: This retrospective observational study was carried out in the Neonatal Intensive Care Unit (NICU) at a Tertiary Care Hospital, Guwahati, Assam, India. The duration of the study was from January 2019 to December 2019. All newborns with CA during this period were included. Maternal and labour ward records were obtained. Data of maternal and antenatal factors such as age, parity, history of consanguinity, family history of congenital abnormality and mode of delivery were collected. The data were analysed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) version 26.0 (IBM SPSS Statistics for Windows, Armonk, NY, USA). Proportion was calculated and the association was tested with Chi-square test and Fisher’s-exact test. p

Introduction: Respiratory Distress Syndrome (RDS) is one of the most common conditions leading to significant morbidity and mortality. Early diagnosis with a non-invasive imaging tool such as ultrasound, with no radiation hazard will be beneficial for timely intervention in neonates. Aim: To evaluate the utility of Lung Ultrasound (LUS) in diagnosing RDS in neonates and to compare it with chest X-ray (CXR). Materials and Methods: A cross-sectional study was conducted at a tertiary care hospital in Department of Pediatrics, AJ Institute of Medical Sciences, Mangalore, Karnataka, India, from June 2017 to December 2018. Forty neonates (preterm and term) admitted to Neonatal Intensive Care Unit (NICU) with symptoms of respiratory distress within six hours of life and fulfilling clinical criteria of RDS were included in the study. CXR and LUS were performed and interpreted by the same radiologist. The disease was graded as mild and severe by LUS based on the indices like B (Beam like comet-tail pattern) lines, alveolar consolidation, air bronchogram and white lung and it was compared with CXR in terms of sensitivity and specificity to diagnose RDS. Data were statistically analysed using Kendall’s tau-b test. Results: Eighteen (45%) neonates were 34 weeks of gestation. Twenty-six (65%) were males and 14 (35%) were females. Mean gestational age of the study cohort was 32±2 weeks. Mean birth weight in the study group was 1.7±0.5 kg. 14 out of the 40 neonates (65%) received steroids prior to delivery. LUS detected signs of RDS in all the 40 cases (100% sensitivity). Sixteen out of 40 (40%) neonates were graded as mild RDS and 24 out of 40 neonates (60%) as severe RDS. The sensitivity to detect severe cases was 100% when compared to CXR but specificity to detect mild cases was found to be 59%. The Positive Predictability Value (PPV) was found to be 54% and the Negative Predictable Value (NPV) was found to be 100%. Conclusion: LUS can be used as a reliable, bed side screening tool for the early diagnosis of RDS in NICU without side-effects of radiation.

Background: The Gerbode defect is an extremely rare type of congenital cardiac anomaly characterized by direct communication between the left ventricle (LV) and right atrium (RA), leading to a left-to-right shunt. It can be either congenital or acquired, and its clinical manifestations can range from completely asymptomatic presentation to heart failure. Transthoracic echocardiography is the preferred technique for its diagnosis, although the gold standard is transesophageal ultrasound. Surgery is often elective, but conservative treatment is possible in asymptomatic cases. Case presentation: A Caucasian female was born after 30 weeks of gestation, with a history of intrauterine growth restriction and suspected fetal cardiopathy. In response to her prematurity, she required non-invasive respiratory support and surfactant replacement. Echocardiography showed a persistent left superior vena cava in the coronary sinus, an atrial septal defect with a left-to-right shunt, and indirect signs of pulmonary hypertension. During her fourth day of life, the infant still showed respiratory distress and was difficult to wean from respiratory support. A second echocardiogram offered a hemodynamic explanation with the presence of a communication between the LV and RA, known as the Gerbode defect. The consequent pulmonary overflow required aggressive diuretic therapy for an extended period, which conferred clinical stability despite occasional signs of respiratory fatigue and feeding difficulties. When the child was 2 months old, she underwent palliative cardiac surgery with a pulmonary artery bandage, which was followed by corrective surgical intervention at 8 months of corrected age. Conclusions: To our knowledge, this is the first case of the Gerbode defect associated with a persistent left superior vena cava in the coronary sinus, described in a premature newborn. The complexity of the case is remarkable because several comorbidities were linked to the pulmonary immaturity of the patient.

Abstract Prematurity and low birth weight are of concern in neonatal health. In this work, geospatial analysis was performed to identify the existence of statistically significant clusters of prematurity and low birth weight using Moran’s I. Data was obtained from March of Dimes and the National Center for Health Statistics for the years 2015 to 2019. Analysis demonstrated the presence of hotspot (High-High) and coldspot (Low-Low) geographic clusters of these variables in regions across the United States. Additionally, factorial ANOVA was performed, and revealed the significance of demographic variables of interest. Given the strong relationship between these two variables, regions that are hotspots for one variable, but not the other, are of particular interest for further study.

Impaired fertility is an important public health concern, especially in patients with immune-mediated rheumatic condiHydroxychloroquine (HCQ) is an antimalarial drug containing a 4-aminoquinoline radical, with immunomodulatory, antioxidant, anti-inflammatory and vascular protective effects, which is widely used in the treatment of various rheumatological conditions and is also compatible with pregnancy. It is well known that hydroxychloroquine crosses the placental barrier and hence it can protect against adverse perinatal outcomes, such as congenital heart block in fetusesof anti-SSA/Ro positive mothers. When it is administered at daily doses inferior or equal to 400 mg, HCQ is not associated with augmented risk of perinatal morbidity and it has also been found to prevent disease flares among pregnant women with systemic lupus erythematosus (SLE) or rheumatoid arthritis (RA), improving maternal outcomes and being protective toward fetal health as well. However, the concerns about its safety in pregnancy are still present because studies on the risks of perinatal defects associated with HCQ administration arise sparse and have controversial results. The purpose of the current article is to make a review of the medical literature concerning the safety of HCQ in pregnancy. For this purpose, scientific research in online medical publications such as Elsevier, PubMed, and The Lancet, was conducted.

Low birth weight causing mortality, morbidity, and lifelong disability is an important public health problem. Infants with very low birth have long hospital lengths of stay. The study aims to determine the factors affecting the length of stay of very low birth weight ( [Med-Science 2022; 11(1.000): 354-60]

Worldwide, three-quarters of a million babies are born extremely preterm (

Objective: It remains unclear if changes in neonatal care have resulted in better outcomes for extremely preterm infants (EPTs). This study was to evaluate neonatal mortality and morbidity in EPTs. Material and Methods: A retrospective cohort study of EPTs at a gestational age (GA) ≤28 weeks, who were admitted to the neonatal intensive care unit between January 2004 and December 2018. The study was divided into 2 periods, from 2004-2010 and 2011-2018. The likelihood ratio test in Multiple Cox regression models were used to determine adjusted hazard ratios (aHR) for differences in mortality among the two periods. Results: A total of 188 EPTs were enrolled. The overall median (interquartile range), GA and birth weight of the enrolled infants were 26 (25, 27) weeks and 780 (667, 875) g, respectively. The mortality rate was 66/188 (35.1%). The mortality rate between 2004-2010 and 2011-2018 decreased from 44.6% to 32.8%, but was not statistically significant (p-value=0.170). Multiple Cox regression analysis of mortality rate demonstrated statistical significance with infants of 23-24 and 25-26 weeks GA VS 27-28 weeks GA [aHR 3.85, 95% confidence interval (CI) (1.95, 7.58), p-value

Background: Worldwide COVID-19 infection has played havoc. The number of COVID-positive pregnant cases in this study was not far behind the National average. The present study was conducted to evaluate the outcome of COVID-19 infection in pregnant women during their antenatal, intrapartum, and postnatal periods. Methodology: The study design was a prospective cohort study. The total number of COVID-19 pregnant patients admitted to this tertiary care hospital from March 2020 to June 2021 was 106 cases at various trimesters. This hospital caters to serving personnel, ex-servicemen, and dependents of the Indian Armed Forces. The community being studied were only the dependents and the serving female personnel. Proper history, presenting complaints, period of gestation, obstetric and systemic examination findings, the severity of symptoms, home isolation or hospital stay, and treatment were all recorded in the form of the questionnaire. Finally, the antenatal, intrapartum, postnatal, and neonatal outcomes of these COVID-positive pregnant patients were compiled and studied. Results: The prevalence of COVID-positive pregnant women in the community being studied was 9.9%. About 43.39% of the cases were diagnosed in the third trimester. Ninety-three percent of the patients in the present study were asymptomatic or with very mild symptoms. The mode of delivery in the present study was mostly by cesarean section (69.56%). Conclusion: In the present study, pregnancy-associated complications were within the range of 2.8%–3% and only two newborns were COVID positive.

Neonatal abstinence syndrome (NAS) due to maternal opioid use affects both term and preterm infants; however, the relationship between gestational age and clinical symptomatology is still poorly understood. In this study, we compared the clinical features and outcomes of NAS in infants admitted to a neonatal intensive care unit (NICU) based on gestational age groups: preterm (32–36 6/7 weeks) and term (37 weeks or older). A retrospective data analysis was conducted using the medical records of infants with a diagnosis of NAS admitted to a regional perinatal center between 2014 and 2020. A modified Finnegan scoring system was used based on three different symptom categories, including Central Nervous System (CNS), Gastrointestinal (GI) and Other. In total, 166 infants with a diagnosis of NAS were included, with 52 (31%) who were preterm and 114 (69%) who were term. The highest NAS score was significantly lower for the preterm group than for the term group. Preterm infants were less likely to require first-line pharmacotherapy with morphine (52% versus 75%) and to experience GI symptoms during their hospitalization. Newer NAS assessment modalities, such as eat, sleep, console (ESC), may overcome the existing challenges of traditional scoring systems, but will require validation in preterm infants.

Abstract Introduction According to the World Health Organization, 11% of all children are born prematurely, representing 15 million births annually. An extensive analysis on preterm birth, from extreme to late prematurity and associated deaths, has not been published. The authors characterize premature births in Portugal, between 2010 and 2018, according to gestational age, geographic distribution, month, multiple gestations, comorbidities, and outcomes. Methods A sequential, cross‐sectional, observational epidemiologic study was conducted, and data were collected from the Hospital Morbidity Database, an anonymous administrative database containing information on all hospitalizations in National Health Service hospitals in Portugal, and coded according to the ICD‐9‐CM (International Classification of Diseases), until 2016, and ICD‐10 subsequently. Data from the National Institute of Statistics was utilized to compare the Portuguese population. Data were analyzed using R software. Results In this 9‐year study, 51.316 births were preterm, representing an overall prematurity rate of 7.7%. Under 29 weeks, birth rates varied between 5.5% and 7.6%, while births between 33 and 36 weeks varied between 76.9% and 81.0%. Urban districts presented the highest preterm rates. Multiple births were 8× more likely preterm and accounted for 37%–42% of all preterm births. Preterm birth rates slightly increased in February, July, August, and October. Overall, respiratory distress syndrome (RDS), sepsis, and intraventricular hemorrhage were the most common morbidities. Preterm mortality rates varied significantly with gestational age. Conclusion In Portugal, 1 in 13 babies was born prematurely. Prematurity was more common in predominantly urban districts, a surprise finding that warrants further studies. Seasonal preterm variation rates also require further analysis and modelling to factor in heat waves and low temperatures. A decrease in the case rate of RDS and sepsis was observed. Compared with previously published results, preterm mortality per gestational age decreased; however, further improvements are attainable in comparison with other countries.

Resumen: A pesar de las mejoras en el cuidado neonatal en las últimas décadas, los recién nacidos extremadamente prematuros continúan en alto riesgo de mortalidad y morbilidad, incluyendo discapacidad en el neurodesarrollo. El objetivo de este artículo es revisar la literatura en búsqueda de datos y recomendaciones respecto a este tema de tanta importancia en nuestra práctica clínica neonatal habitual. El establecimiento de un límite de la viabilidad sigue siendo un tema complejo y controvertido, que se debe basar en múltiples factores, no solo en la edad gestacional, y que varía ampliamente en función del entorno y las circunstancias concretas de nacimiento del bebé. La incertidumbre sobre el curso de los bebés extremadamente prematuros hace difícil establecer un pronóstico preciso. En el difícil proceso de toma de decisiones de este contexto, existe acuerdo a nivel internacional acerca de la elaboración de recomendaciones y guías para la asistencia perinatal de estos pacientes, así como la elaboración de registros nacionales de datos y la formación del personal a su cargo. Es una obligación del sistema sanitario poner a disposición de estos recién nacidos el mayor nivel asistencial posible. La participación de las familias, junto con una información bien fundamentada y honesta por parte del personal sanitario, es actualmente el modelo preferido en la toma de decisiones Summary: Despite improvements in neonatal care in recent decades, extremely preterm infants continue to be at high risk for mortality and morbidity, including neurodevelopmental disability. The aim of this article is to review the literature in search of data and recommendations regarding this issue of such importance in our routine neonatal clinical practice. The establishment of a limit of viability remains a complex and controversial issue, which must be based on multiple factors, besides gestational age, and which varies widely depending on the environment and the specific circumstances of the baby's birth. The uncertainty about the course of extremely premature babies makes it difficult to establish an accurate prognosis. In this difficult decision-making context, there is international agreement on the creation of recommendations and guidelines for the perinatal care of these patients, as well as the preparation of national data registries and the training of the health care providers. It is an obligation of the health care system to provide these newborns with the highest available level of care. Family participation, along with well-founded and honest information from healthcare personnel, is currently the preferred model for decision-making.

Resumen: La respuesta inflamatoria, frecuentemente asociada al parto prematuro extremo, tiene un rol relevante en el pronóstico, ya que la inmadurez propia del sistema inmune en estas condiciones impide la apropiada modulación de estos procesos, promoviendo una inflamación persistente en el tiempo con los consiguientes daños en el corto, mediano y largo plazo. Objetivo: revisar los mecanismos inmunológicos en el prematuro extremo, los efectos en los sistemas de mayor relevancia y nuevas perspectivas terapéuticas. Summary: Inflammatory response, frequently associated with extreme preterm birth, has a relevant role in outcome, since immaturity of immune system, in such conditions, does not allow an appropriate modulation of these processes leading to sustained inflammation, to secondary damage and thus promoting short-medium- and long-term sequelae. Objective: to review immunological mechanisms involved in extreme prematurity, their effects on the most relevant systems and new therapeutical approaches.

Background: Retinopathy of prematurity (ROP) is the leading cause of blindness among prematurely born children. The incidence of any stage of ROP in children born before the 31st gestational week in Europe and the USA is between 10-45%. The purpose of this study was to show characteristics of ROP between 2015 and 2019 at the Neonatal Intensive Care Unit of the University Medical Centre Ljubljana (NICU-Lj), which is the larger of the two tertiary referral centres in Slovenia and in which more than two thirds of Slovenian very low birth weight children are treated. Methods: All prematurely born children screened for ROP at NICU-Lj between 2015 and 2019 were included in the study. The following parameters were recorded: number of children screened, total number of exams, number of exams per child, number of children with ROP, ROP stages, number of children who needed ROP treatment and number of treatments per child treated. Results: Between 2015 and 2019, 82-130 prematurely born children fulfilled ROP screening criteria each year. A total of 1,412 exams were performed over the period of five years (range: 239-386 per year). Every child had one or more ROP screening exams (range: 1-10). Extremely preterm children born before the 27th week of gestation had more exams (average: 5 exams/child) compared to other prematurely born children (average: 1.5 exams/child). The number of prematurely born children with any stage of ROP ranged from 17 to 30 per year. ROP of any stage was present in 18.75% (2015), in 17.7% (2016), in 23% (2017), in 29.3% (2018), and in 24.1% (2019). More than 70% of all babies with ROP were born before the 27th gestational week. The most mature baby with ROP was born with 29 6/7 weeks of gestational age. Every year, 15-35% of babies with ROP received laser treatment. Conclusions: ROP is an important disease in prematurely born children. During the period 2015-2019, the incidence of any stage of ROP and of serious ROP requiring treatment was comparable. The screening and treatment of ROP requires intense cooperation between paediatric ophthalmologists and neonatologists in order to prevent blindness in prematurely born children.