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Thrombocytopenia is, after anemia, the most frequent hematological problem among sick neonates. In this population, thrombocytopenia has traditionally been defined as a platelet count 9 /L, and has been classified as mild (100–150 × 10 9 /L), moderate (50–99 × 10 9 /L), and severe ( 9 /L). However, large population-based studies have shown that platelet counts increase with advancing gestational age, and platelet counts between 100 and 150 × 10 9 /L are more frequent among otherwise healthy extremely preterm infants than among full term neonates or older children. This suggests that different definitions of thrombocytopenia and thrombocytosis should be applied to preterm infants. The diagnostic approach to a thrombocytopenic neonate is facilitated if the thrombocytopenia is categorized as “early onset” (within the first 72 hours of life, usually secondary to congenital or intrauterine abnormalities) or “late onset” (after 72 hours, usually due to acquired conditions). Importantly, infection/sepsis should always be considered near the top of the differential diagnosis, as any delay in diagnosis and treatment can have life-threatening consequences. While in vitro studies have clearly shown that neonatal platelets are hyporesponsive to most agonists, this platelet hyporeactivity is well compensated by factors in neonatal blood that increase clotting (i.e. high hematocrit, high VWF concentrations), resulting in adequate primary hemostasis. The risk of bleeding in thrombocytopenic neonates is poorly predicted by the platelet count; gestational age

A 3-month-old, full term female infant, adequate for gestational age, and exclusively breastfed, was admitted with a 10 day history of generalised scaling erythematous dermatitis, affecting the face (perinasal, nasolabial folds and periauricular), acral and intertriginous areas, with irritability and failure to thrive. Her mother had been treated with isoniazid since the third trimester because of family contact with tuberculosis. Based on a diagnosis of suspected impetiginised eczema, the infant was treated with flucloxacillin and prednisolone, and maternal isoniazid was suspended, with no improvement. Investigations found low serum zinc levels in the infant (33 μg/dL; normal range (NR) >60 μg/dL), normal plasma zinc levels in the mother (111.3 μg/dL; NR 68–120 μg/dL) and lower than the normal range of zinc levels in breast milk (270μg/L; NR 1000–2500 μg/L), suggesting acrodermatitis caused by zinc deficiency. Oral zinc supplementation (3 mg/kg/day) was started with a marked improvement in skin lesions, as well as good weight gain. At the age of 6 months, after food diversification, supplementation was suspended, without any recurrence of symptoms.

Background We aimed to evaluate the gastric volume and contents after an 8-h fasting period in full-term, non-laboring, pregnant women following a standardized meal. Methods In this prospective observational study, we included full-term pregnant women scheduled for elective cesarean delivery. The participants were instructed to fast after a standardized meal (apple juice, bread, and cheese). Participants were scanned in the semi-recumbent and right-lateral positions 8 h after the standardized meal. The primary outcome was the proportion of patients with gastric volume > 1.5 mL kg-1 calculated by two equations. Secondary outcomes included the antral cross-sectional area and gastric volume. Data are expressed as frequency (%, 95% confidence interval [CI]), mean ± standard deviation (95% CI of the mean), or median (quartiles) as appropriate. Results Forty-one women were available for the final analysis. For the primary outcome, one participant (2.4%, 95% CI of 0.06 to 12.8%) had gastric volume > 1.5 mL kg-1, and none had solids in the antrum. For the secondary outcomes, the mean (95% CI of the mean) of the antral cross-sectional area was 2.11 ± 0.72 (1.88 to 2.34) cm2 and 4.08 ± 1.80 (3.51 to 4.65) cm2 during the semi-recumbent and right-lateral position, respectively. The median (quartiles) gastric volume was 0.53 (0.32, 0.66) mL kg-1 and 0.33 (0.13, 0.52) mL kg-1 as estimated by Perlas et al. and Roukhomovsky et al. equations, respectively. Conclusion After 8-h fasting following a standardized meal, full-term pregnant non-laboring women are less likely to have a high residual gastric volume.

This study comprehensively examines clinical symptoms, laboratory findings, and placental pathology in 40 cases of singleton full-term SARS-CoV-2 negative neonates. Their mothers, previously healthy, with uncomplicated pregnancies, were infected peripartum and presented COVID-19 symptoms of various severity. Neonates had predominately diarrhea, the yet unreported absent sucking reflex, elevated COVID-19 inflammatory and ischemia/asphyxia markers as serum ferritin, interleukin-6 and cardiac troponin-T, while placentas demonstrated mild vascular and/or inflammatory lesions. We hypothesize that the above placental lesions may be associated with transient perinatal hypoxia resulting in absent sucking reflex, as well as with inflammatory cytokines transfer causing diarrhea.

BACKGROUND Maternal pre-pregnancy body mass index (BMI) is strongly associated with infant birthweight and the risk differs in pregnancies complicated by gestational diabetes (GDM). OBJECTIVES To examine the risk of large for gestational age (LGA) (≥97th percentile) singleton births at early term, full term and late term in relation to maternal pre-pregnancy BMI status mediated through GDM. METHODS We analysed data from the 2018 U.S. National Vital Statistics Natality File restricted to singleton term births (N = 3,229,783). In counterfactual models for causal inference, we estimated the total effect (TE), natural direct effect (NDE) and natural indirect effect (NIE) for the association of pre-pregnancy BMI with subcategories of LGA births at early, full and late term mediated through GDM, using log-binomial regression and adjusting for race/ethnicity, age, education, parity and infant sex. Proportion mediated was calculated on the risk difference scale and potential unmeasured confounders were assessed using the E-value. RESULTS Overall, 6.4% of women had GDM, and there were 3.6% LGA singleton term births. The highest prevalence of GDM was among pre-gestational overweight/obesity that also had the highest rates of LGA births at term. The TE estimates for the risk of LGA births were the strongest across women with higher pre-pregnancy BMI compared to women with normal pre-pregnancy BMI. The NDE estimates were higher than the NIE estimates for overweight/obese BMI status. The proportion mediated, which answers the causal question to what extent the total effect of the association between pre-pregnancy BMI and LGA births is accounted for through GDM, was the highest (up to 16%) for early term births. CONCLUSIONS Term singleton births make up the largest proportion in a cohort of newborns. While the percentage mediated through GDM was relatively small, health risks arising from pre-pregnancy overweight, and obesity can be substantial to both mothers and their offspring.

Background: In full term newborns, the Ductus arteriosus closes functionally within of birth, and it normally closes structurally between 2 to 8 weeks. Complete conclusion of the ductus in untimely babies may not happen until a half year old enough, and in exceptional cases may not happen until adulthood. Is medical term that afterwards birth, the ductus arteriosus fails to close, allowing oxygenated blood to travel back to the lungs from the left heart Changed Word Structural Changes Thesaurus via the pulmonary artery, which has a higher pressure. Increased laboured breathing and failure to gain weight at a normal rate are frequent later in the first year of life. A patent ductus arteriosus (PDA) can lead to pulmonary hypertension and right-sided heart failure if left untreated. Case Report Information: A 2 years 6 months old child brought by the parents in Aacharya Vinoba Bhave Rural Hospital on 22/12/2020. An patients parent’s verbalization, the child was apparently alright at 8 months of age. When he started having fever, cold and cough and decreased feed intake. Then they took the child to local doctor where 2D ECHO was done. Suggestive of patent ductus arteriosus. Patient is referred to Aacharya Vinoba Bhave hospital for further management. Conclusion: The patient was admitted in AVBRH with complaints of fever, cold and cough, decreased feed intake. Then the report mainly focused on surgical management and quality nursing care due to which patient was discharged without any further complication and satisfaction.

BackgroundThe composition of the infant gastrointestinal (GI) microbiome has been linked to adverse long-term health outcomes and neonatal sepsis. Several factors are known to impact the composition of the microbiome, including mode of delivery, gestational age, feeding method and exposure to antibiotics. The impact of intrapartum antibiotics (IPAs) on the infant microbiome requires further research.ObjectiveWe aimed to evaluate the impact of IPAs on the infant GI microbiome.MethodsWe searched Ovid MEDLINE and Embase Classic+Embase for articles in English reporting on the microbiome of infants exposed to IPAs from the date of inception to 3 January 2021. Primary outcomes included abundance and colonisation ofBifidobacteriumandLactobacillus, as well as alpha and beta diversity.Results30 papers were included in this review. In the first year of life, following exposure to IPAs, 30% (6/20) of infant cohorts displayed significantly reducedBifidobacterium, 89% (17/19) did not display any significant differences inLactobacilluscolonisation, 21% (7/34) displayed significantly reduced alpha diversity and 35% (12/34) displayed alterations in beta diversity. Results were further stratified by delivery, gestational age (preterm or full term) and feeding method.ConclusionsIPAs impact the composition of the infant GI microbiome, resulting in possible reductionsBifidobacteriumand alpha diversity, and possible alterations in beta diversity. Our findings may have implications for maternal and neonatal health, including interventions to prevent reductions in health-promoting bacteria (eg, probiotics) and IPA class selection.

Pregnancy complicated with juvenile granulosa cell tumor (JGCT) is very rare; thus, the experience on clinical diagnosis and management is limited. Two patients presented with abdominal pain, two were incidentally discovered, one by ultrasonography, and one during a caesarian section. One case received an emergency caesarian section because of tumor rupture at 38th week’s gestation, the rest were treated at full term and no abnormalities were detected in the newborns. Three cases received further staging surgery, two of which received postoperative adjuvant chemotherapy. No patient had recurrent disease after a follow-up period spanning from 13 to 57 months. In the absence of emergency, surgery can be delayed without affecting the fetus. More research is needed to determine the value of chemotherapy in FIGO stage I patients.

Because of chronic anemia, hypogonadotropic hypogonadism, and iron chelation, pregnancy in homozygous and heterozygous compound beta-thalassemia patients stays a challenge. Pregnancies of transfused beta-thalassemia women registered in the French National Registry, conducted between 1995 and 2015, are described. These pregnancies were compared with pregnancies in healthy women and to data previously published in the literature. Fifty-six pregnancies of 37 women were studied. There were 5 twin pregnancies. Assisted reproductive technologies (ART) were used in 9 pregnancies. Median term at delivery was 39 amenorrhea weeks, and median weight at birth was 2780 g. Cesarean section was performed in 53.6% of the pregnancies. There were 6 thromboembolic events, 6 serious infections, 6 pregnancy-induced hypertensions (PIH), 6 intrauterine growth retardations (IUGR), 5 severe hemorrhages, 4 gestational diabetes, 3 alloimmunizations, 2 heart diseases, and 1 pre-eclampsia. There were 5 infections and 4 osteoporosis in the first year of post-partum. ART and cesarean sections were more often used in the beta-thalassemia group, compared to control subjects. Thromboembolic events, PIH, hemorrhage at delivery, and IUGR were more frequent in the beta-thalassemia group. Time to delivery was not different, but infant weight at birth was significantly smaller in the beta-thalassemia group. In the post-partum period, global maternal complications were more frequent in the beta-thalassemia group. Pregnancy in transfused beta-thalassemia women is safe with rare obstetrical and fetal complications. Cesarean section remains often chosen, and infant weight at birth remains smaller than that in the general population, despite delivery at full term.

There are conflicting data on how delivery location impacts outcomes in neonates with ductal-dependent heart disease. Our goal was to evaluate the impact of delivery location on hospital length of stay and survival in infants with prenatally diagnosed hypoplastic left heart syndrome (HLHS) after stage 1 palliation (S1P). A multicenter cohort study was performed utilizing the National Pediatric Cardiology Quality Improvement Collaborative dataset for infants with prenatally diagnosed HLHS who underwent S1P from August 2016 to December 2018. Univariate comparisons of demographics, clinical, and outcome data were made and multivariable logistic regression was performed between groups stratified by distance from surgical center. A total of 790 patients from 33 centers were analyzed: 85% were born

Background: Vitamin D is a hormone that affects a wide range of functions within the body. Neonatal hypoxic ischemic encephalopathy (HIE) is a serious disease that may lead to permanent brain injury. Objective: The present study aimed to study vitamin D status in hypoxic ischemic in encephalopathy. Patients and methods: A case control study carried out in newborn intensive care unit (NICU) of Zagazig University Children Hospitals. Total number of cases that met the inclusion and exclusion criteria was 49 full term neonates with HIE divided according to Sarnat stages: stage I; 20 full term neonates, stage II; 15 full term neonates and stage III; 14 full term neonates. Cases were compared to 16 healthy controls. Results: There was a statistical significant increase in Apgar score 1, 5, 10 in control group compared to all cases groups. There were no statistical significant differences between the studied groups in relation to CBC results. There was a statistical significant difference between the different stages of HIE in CRP and pH.There was a statistical significant increase in frequency of hypoxic change in stage III compared to stage II and I. All stages of HIE showed statistical significant increase in frequency of vitamin D deficiency compared to control group. Stage III had statistical significant increase in frequency of vitamin D deficiency compared to stage I and II. Conclusion: Serum 25(OH) vitamin D insufficiency is present in the majority of term HIE neonates. 25 (OH) vitamin D was significantly deficient in stage III more than stage I and II.

Objectives Knowledge gaps exist in the use of biologics for pregnant patients with Crohn's disease (CD), especially the usage of ustekinumab (UST) and infliximab (IFX) infusion during the late gestation period. In this case series, we investigated perinatal and neonatal outcomes and pharmacokinetics of these biologics in pregnant CD patients. Methods Pregnant CD patients under treatment with IFX or UST during January 2017 to December 2019 were monitored. Growth and development of their babies were followed up to six months. Drug concentrations were measured in maternal peripheral and cord blood at delivery and infants' blood at six months of age. Results Four cases were kept IFX treatment until late gestation (median last dose: 31.2 weeks). One case received UST until 23 weeks of gestation. All cases were in clinical remission but moderately undernourished. Babies were delivered by cesarean section at full term without any complications or congenital abnormalities. No growth or developmental defects and no susceptibility to infections were observed by six months. However, two babies whose mothers received IFX after 30 weeks of gestation were detected IFX in their blood at six months of age (0.94 and 0.24 pg/ml). Concentrations of UST in maternal and cord blood were 267.7 and 756.5 ng/ml, respectively. UST was not detected in the infant at six months of age. Conclusions Administration of UST or IFX to pregnant patients with CD is safe, particularly IFX to be given in the late gestation period. Understanding of the pharmacokinetics of biologics in maternal-infant interactions may improve the management of pregnant CD patients.

Актуальність. Новонароджені та діти перших місяців життя, особливо ті, які знаходяться на грудному вигодовуванні, природним чином схильні до дефіциту вітаміну К. Метою нашого дослідження було уточнення частоти виявлення дітей перших шести місяців життя української популяції, які знаходяться виключно на грудному вигодовуванні, із підвищеними концентраціями protein induced by vitamin K absence (PIVKA II) для вивчення сучасних умов формування дефіциту вітаміну К. Матеріали та методи. Об’єктом дослідження стали зразки донорської сироватки 180 дітей віком від 1 доби до 6 місяців, які народилися в строк із масою тіла від 2800 до 4200 г і оцінкою за шкалою Апгар 7–10 балів. Усі діти перебували на грудному вигодовуванні з моменту народження. Результати. Як показали наші спостереження, вітамін-К-дефіцитний стан відмічається в більше ніж 50 % новонароджених за даними виявлення позитивного тесту ELISA, що вказує на недостатній рівень карбоксильованого протромбіну (PIVKA II) у сироватці крові. Найбільше число позитивних за тестом PIVKA II немовлят відмічається в ранній неонатальний період, що свідчить про те, що гіповітаміноз формується внутрішньоутробно. Висновки. Забезпеченість вітамінами групи К, необхідними для синтезу цілого ряду незамінних протеїнів організму дитини, у більше ніж половини здорових народжених у строк новонароджених субпопуляції півдня України недостатня. Причинами цього явища є ідіопатичні внутрішньоутробні фактори, невиконання профілактичної ін’єкції вітаміну К після народження, виключно грудне вигодовування, дефіцитне за філо- та меноквінонами, а також порушення стану товстокишкового мікробіоценозу бактерій, що важливо для створення пулу ендогенних меноквінонів, які забезпечують подолання вітаміндефіцитного стану в ранньому дитинстві.

After pregnancy, Diastasis Recti is fairly frequent in women. It happens when the rectus abdominis muscles separate along the linea alba, causing the linea alba to expand. Diastasis recti is caused by a number of reasons. Multiple pregnancies and hormonal factors are the first and most apparent. Because of the elevated levels of relaxin, progesterone, and oestrogen during pregnancy, the linea alba weakens due to connective tissue softening. Diastasis recti should be treated as soon as possible in women. Dial calipers are used to assess diastasis recti in women who have just given birth. A dial caliper is a basic and quick measurement tool. The aim of the present study was to find out “Prevalence of Diastasis Recti in Primipara and Multipara Undergone Full Term Normal Delivery”. This study was carried out in Physiotherapy OPD, Ravi Nair Physiotherapy College and AVBRH, (Sawangi) Wardha. Diastasis recti was evaluated in full term normal delivery females. Diastasis recti was compared in primipara and multipara using dial calliper. The total number of full term normal delivery females in this study was 80 from the age group 22-37, of which 36 were primipara and 44 were multipara, and it showed that inter-rectal distance is greater in multipara while it was less in primipara.. From the present study we can conclude that there is presence of diastasis recti more in multipara than compared to primipara undergone full term normal delivery

According to the World Health Organization, 15 % of children under the age of five died of pneumonia worldwide in 2017. Objective: to create a mathematical model for determining the probability of developing congenital pneumonia in full-term newborns using the express method. A comprehensive examination was conducted in 116 full-term newborn infants, who were admitted to pediatric ward for newborn children and maternity physiological department of the State Institution “Republican Scientific Practical Center “Mother and Child” during the period from 2017 to 2019. A comparative analysis of 174 life history data, outcomes of previous pregnancies, complications of current pregnancy in mothers, clinical and routine laboratory methods used in newborns on day 1–2 of life was performed. Subsequently, the most significant factors associated with the development of congenital pneumonia in full-term newborns were determined. Based on binary logistic regression and receiver operating characteristic (ROC) analysis, a mathematical analysis of 387.4 million variable relationships was performed. The survey determined the most significant factors associated with the development of congenital pneumonia in full-term newborns: from the past obstetric-gynecologic and somatic history of the mother — a spontaneous abortion; complications of pregnancy — chronic intrauterine fetal hypoxia and chronic fetoplacental insufficiency; the results of clinical manifestations in the first days of life — the presence of respiratory failure. Based on the obtained data, a model was developed with a sensitivity of 90.6 %, specificity of 92.1 % and the area under the ROC curve = 0.930 ± 0.054, p < 0.001 (95% confidence interval 0.88–0.98). Threshold values were calculated using a predictive model: for spontaneous abortion — 0.836; for chronic intrauterine fetal hypoxia — 0.537; for chronic fetoplacental insufficiency — 0.533; the presence of respiratory failure — 0.939, which at threshold values of ≥ 0.53 of the ROC curve makes it possible to identify a group at high risk of developing congenital pneumonia among full-term newborns. The current mathematical model for determining the probability of developing congenital pneumonia in full-term newborns using the express method can be found on the website http://pneu.bsmu.by or https://www.bsmu.by (at the bottom of the page, there is Doctor/Pharmacist: Diagnosis of Congenital Pneumonia menu).

Background: The association between diabetes and pregnancy is a real public health problem due to the inherent maternal and fetal complications.Aims: To study the clinical and biological features of diabetic pregnancies.Methods: We conducted a retrospective descriptive study including pregnant diabetic women followed at the National Institute of Nutrition of Tunis.Results: We included 100 patients with a mean age of 32.87±5.3 years. In preconception, 63.6% of patients were overweight and had poorly balanced diabetes (HbA1c> 7%). The mean weight gain throughout the pregnancy was 8.62 ± 5.39 kg. Pregnancy was planned in 18% of cases.Significant improvement in HbA1c was observed in the second trimester. The average daily insulin dose increased from 0.68 u/kg/day in the first trimester to 0.87 u/kg/day in the third trimester (p

Despite the obstacles of limited education and employment opportunities—and the stress associated with immigration and pregnancy—Mexican immigrant women have low rates of preterm birth (PTB) compared to the US national average for all races and ethnicities. Stressors during pregnancy, and stressors associated with acculturation, may accelerate cellular aging manifested by shortened telomere length (TL) in pregnant women. Our objectives were to: (1) determine whether women with PTBs had shorter telomere lengths compared to women who had full term births; (2) assess the association of acculturation with TL and PTB. This prospective pilot study collected data from 100 self-identified Mexican-origin pregnant women. Survey data included self-administered sociodemographic and acculturation measures and was collected from participants via paper and pen, while biologic data was collected via a single blood draw during a regularly scheduled prenatal visit between 26 and 36 weeks gestation. PTB data was collected from the participant’s medical record after delivery. TL was significantly associated with PTB; the median TL of the women with PTB was less than the median TL for the full sample (p = 0.02). Based on regression analysis for PTB vs acculturation, we found no significant associations between acculturation and PTB or TL. This study provides important evidence of the association between shortened maternal TL and adverse birth outcomes. By linking social, clinical and biologic data, we can enhance our understanding of social determinants that may affect racial and ethnic disparities in preterm birth.

Introduction: The incidence of neonatal sepsis in India is 38 per 1000 live births. Many authors found an association between altered thyroid hormone levels and septic shock in neonates and it may be of prognostic importance in septic shock treatment. This study has been conducted to find the relationship between thyroid profile and septic shock in neonates and also to compare the thyroid profile in survivor and non-survivor groups of septic shock patients. Methods: This analytical prospective cohort study was conducted in the NICU of a tertiary care teaching institution in central India. Full-term neonates with late-onset sepsis were included in this study and estimation of thyroid hormones (TSH, T3, T4, fT3, and fT4) was performed. These neonates were divided into those with and without septic shock patients and levels of thyroid hormones were correlated between these patients to find significant relations. The Vasoactive-Inotropic Score (VIS) score was calculated. Results: A total of 195 full-term neonates were included in the study. The mean value of TSH, T3, T4, fT3, and fT4 among neonates with septic shock were 5.27 µg/ml, 80.01 ng/dl, 6.36 µg/dl, 1.40 pg/ml, and 1.40 µg/dl, respectively while the values were 5.29 µg/ml, 94.4 ng/dl, 7.25 µg/dl, 1.84 pg/ml, and 1.43 µg/dl, respectively in septic neonates without shock. This difference was statistically significant except for TSH (p>0.05). The mean value of TSH, T3, T4, fT3, and fT4 among septic shock survivors were 5.27 µg/ml, 80.01 ng/dl, 6.36 µg/dl, 1.40 pg/ml, and 1.40 µg/dl and in septic shock non-survivors were 2.40 µg/ml, 37.33 ng/dl, 3.86 µg/dl, 0.99 pg/ml, and 0.84 µg/dl, respectively (p

Background: Hypertensive disorders are the most common medical problems encountered in pregnancy.Aim: This study aimed to assess the accuracy of neutrophil/lymphocyte ratio (NLR) in prediction of preeclampsia (PET) in low risk population.Materials and Methods: A prospective comparative cross-sectional study was designed to test the accuracy of neutrophil/lymphocyte ratio in prediction of preeclampsia in low risk population. The cases were divided into 2 groups; group I included 35 normotensive women at the first 48 hours after delivery with normal blood pressure throughout the pregnancy till full term delivery as a control group and group II included 35 preeclamptic pregnant women at the first 48 hours after delivery with blood pressure greater than or equal to 140 mm Hg systolic or greater than or equal to 90 mm Hg diastolic on two occasions at least 4 hours apart after 20 weeks of gestation in a woman with a previously normal blood pressure. A complete blood count was taken in three different occasions; the first one was taken just before labour then N/L ratio was calculated (Neutrophil/Lymphocyte ratio. The second one was taken in the first 48 hours after delivery then N/L ratio was calculated (Neutrophil/Lymphocyte ratio. Morover, the third one was taken at early pregnancy before 20th week of gestation from their files then N/L ratio was calculated (Neutrophil/Lymphocyte ratio.Conclusion: Neutrophil/Lymphocyte ratio cannot predict preeclampsia in low risk population

Objetivos: Evaluar causas/motivos que fragmentan el sueño relacionados con los cambios fisiológicos, en los diferentes trimestres de embarazo y compararlos con los de las mujeres no gestantes. Identificar algunos trastornos del sueño en las mujeres embarazadas (ME) y compararlos con los de las mujeres no embarazadas (MNE). Método: Se realizó un estudio transversal utilizándose un cuestionario específico para recopilar causas que fragmentan el sueño, también se utilizó el Cuestionario del sueño de Oviedo, la Escala de somnolencia de Epworth y otros relacionados. Se invitó a participar a ME y MNE. Los resultados se expresaron en medidas de frecuencia, porcentaje, desviaciones medias y estándar (DE). Las diferencias se consideraron significativas si p

Background Visual impairment is rare but has significant impact on the neurobehavioural development and quality of life of children. This paper presents the key findings from the Australian Childhood Vision Impairment Register, which commenced in 2008 to report on children diagnosed with permanent visual impairment. Subjects/methods Families consent to completing a data form related to their child and for contact with the child's ophthalmologist. Ophthalmologists complete and return a comprehensive data form on the child's primary and secondary ocular diagnoses, associated disabilities and health conditions, visual acuity and visual fields. Data is stored on a secure database and anonymised data is available to researchers and for planning purposes. Results Nine-hundred four children and their families provided informed consent for participation, with 57% males and 43% females. Most children spoke English in their home. Eighty-three percent of children were born full term, with a birth weight of >2500 g (81%). Children were commonly suspected to have visual impairment by a parent, with 68% of families receiving a diagnosis of visual impairment by their child's first birthday. The most common primary diagnoses were retinal dystrophy (17%), CVI (15%) and Albinism (11%). A secondary diagnosis of infantile nystagmus occurred in 33% of children. Additional disabilities and/or developmental delay were reported for 44% of children. Corrected binocular visual acuity was reported for 75% of children, with moderate visual impairment being most common. Conclusions These findings contribute to knowledge of rare diseases affecting the eye and visual pathway and represent Australian childhood visual impairment.

Introduction: Neonatal hypertension (HT) is an emerging challenge for neonatologists and pediatricians around the world. The prevalence of renal causes of neonatal hypertension due to congenital renal anomalies and malformations including obstructive uropathy and cystic kidney disease is not well estimated up till now. Early diagnosis of congenital renal anomalies is the corner stone of good prognosis and better outcome. Aim of the study: To determine the prevalence of neonatal renal hypertension in apparently healthy term neonates discharged in the first 48 h of life from two university hospitals. Methods: Two thousand apparently healthy appropriate for gestational age (AGA) term newborns had blood pressure (BP) measurements using the oscillometric technique All results of blood pressure were compared to estimated blood pressure values in percentile curves generated by Dionne et al. Results: There were 29 of 2000 (1.45%) screened newborns diagnosed as having systemic hypertension, our study showed that renal anomalies were the main causes of neonatal systemic hypertension. It represent (93.1 %) of total causes in our study, [with pelviureteric junction (PUJ) Obstruction (31%), polycystic kidney (24.1%), nephrocalcinosis (13.7 %), unilateral renal dysplasia (10.3%), renal hypoplasia (3.4%), unilateral multi cystic kidney (3.4%)].The remaining cases (6.9%) were due to aortic coarctation. No endocrinal cases was diagnosed in our study. Conclusion: This study showed that renal anomalies were the most common causes of neonatal systemic hypertension in apparently healthy term newborns. Beside that this study provided normative BP values for healthy full term AGA newborns in the first 48h of life. These values can be used in the evaluation of BP in newborns.

Introduction: Acute kidney injury (AKI) is a major contributor of neonatal mortality and morbidity. Understanding the different anatomy of the neonatal kidney could help physician understand pathology of AKI and consequently could treat it efficiently. Aim of the study: This one year duration prospective Cohort study involved twenty seven admitted neonates who had acute kidney injury (AKI). Methods: Laboratory and radiologic diagnosis of AKI, further AKIN and pRIFLE classification and follow up after one and three months. Results: AKI had an incidence of 1.35%, mainly in full-term (59%). Hypertension was presented in full-term (75%) and preterm (45.5%). Hematuria presented by 18.8% (full-term) and 27.3% (preterm). Proteinuria occurred in full-term (46.7%) and preterm (36.4%). Urinary tract infection was more among (45.5%) preterm than full term (25%). Oliguric AKI was found in full term (68.8%) and preterm (72.7%). Anuric AKI present in full-term (31.1%) and preterm (9.1%). Post renal AKI were present 18.8 %( full term) and 9.1 %( preterm). Perinatal asphyxia (18.8%) and sepsis (27.3%) were the most common risk factor. Both full-term (37.5%) and preterm (18.2%) needed peritoneal dialysis. Ultrasonography showed bilateral Grade 2 (50%) and 1(25%) nephropathy and bilateral back pressure (18%). pRIFLE was inversely correlate with age and urine output and positively correlated with hypertension at baseline. At one month; 43.8% full-term, 18.2 % preterm were found hypertensive, 18.8% fullterm had proteinuria, pRIFLE was inversely correlated with urine output and proteinuria and eCCL was significantly improved after one month in both preterm and full-term. At three month, chronic kidney disease was 12.5% and 9.1% in full-term and preterm respectively. Total recovery was higher in preterm neonates than in full-term ones. Conclusion: Sepsis and asphyxia are considered the most common causes of AKI. Limitation: A longer follow up is mandatory. Further follow up studies of AKI in preterm neonates are mandatory.

Introduction: Preterm birth (PTB) is a worldwide cause of infant mortality and morbidity. Prenatal exposure to endocrine disrupting chemicals (EDCs) especially bisphenol A (BPA) is questioned as a potential risk factor for PTB. Lower gestational vitamin D levels are associated with various maternal and fetal complications. Aim of the Work: This study aimed to evaluate the gestational exposure to BPA and the potential association between urinary BPA and serum vitamin D levels in a sample of Egyptian women having spontaneous PTB. Subjects and Methods: This study was conducted on 106 reproductive aged females divided into Group I with full term delivery (37-42 weeks gestational age) as “control group” and Group II with spontaneous preterm contractions (24 - ˂37 weeks gestational age) that ended with preterm delivery as “PTB group”. Results: The median level of urinary uncorrected and specific gravity (SG)-corrected BPA was found to be higher in PTB group with high statistically significant difference between both studied groups (P

A Caucasian male infant born full term via normal spontaneous vaginal delivery was given vitamin K after birth, circumcised on day of life (DOL) 1, and discharged from the nursery on DOL 2. At the time of circumcision, oozing from the surgical site was noted and initially resolved with silver nitrate. Over the next two days, he presented to local emergency rooms multiple times for recurrent bleeding, eventually developing hemorrhagic shock resulting in admission to the neonatal intensive care unit. After extensive work up, he was ultimately diagnosed with severe congenital factor XIII deficiency. Congenital factor XIII deficiency is a rare bleeding disorder characterized by normal prothrombin time (PT) and activated partial thromboplastin time (aPTT) coagulation labs on routine screening, and has a high risk of complications, such as spontaneous intracranial hemorrhage. Although uncommon, when caring for a child with bleeding, physicians must have a high index of suspicion to make this diagnosis in order to initiate proper treatment and start prophylaxis given the risk of morbidity and mortality in untreated patients.

Respiratory syncytial virus (RSV) is the leading cause of hospitalizations in infants worldwide. Palivizumab, a humanized monoclonal antibody against the RSV F protein, is the only licensed agent for prevention of severe RSV infection in high-risk infants. Palivizumab is administered intramuscularly, every month during the RSV season, usually 5 doses are required. In recent years, the resolution of the structure of the RSV F protein, with identification of potent neutralizing epitopes, and new technologies for production of monoclonal antibodies (mAbs) have facilitated the development of new alternative strategies for the prevention of RSV infections. One promising approach is a new generation of mAbs directed to new neutralizing epitopes and with prolonged half life. These enhanced mAbs are expected to provide adequate protection during the complete RSV season with a single intramuscular (IM) dose. The long-term goal of this approach is to provide passive immunization for the prevention of RSV lower respiratory tract infection to all infants (preterm and full term) in the first months of life before their initial exposure to RSV.

Newborn infants with respiratory difficulties frequently require nasal respiratory support such as nasal continuous positive airway pressure (nCPAP) or high-flow nasal cannulae (HFNC). Oral feeding of these infants under nasal respiratory support remains controversial out of fear of aspiration and cardiorespiratory events. The main objective of this study was to evaluate the safety of oral feeding under different types of nasal respiratory support in newborn lambs without or with tachypnea. Eight lambs aged 4-5 days were instrumented to record sucking, swallowing, respiration, ECG, oxygen saturation, and arterial blood gases. Each lamb was given two bottles of 30 mL of milk with a pause of 30 s under videofluoroscopy in four conditions [no respiratory support, nCPAP 6 cmH2O, HFNC 7 L/min, HFNCCPAP (= HFNC 7 L/min + CPAP 6 cmH2O)] administered in random order. The study was conducted in random order over 2 days, with or without standardized tachypnea induced by thoracic compression with a blood pressure cuff. Generalized linear mixed models were used to compare the four nasal respiratory supports in terms of safety (cardiorespiratory events and aspiration), sucking-swallowing-breathing coordination, and efficacy of oral feeding. Results reveal that no nasal respiratory support impaired the safety of oral feeding. Most of the few laryngeal penetrations we observed occurred with HFNCCPAP. Nasal CPAP modified sucking-swallowing-breathing coordination, whereas the efficiency of oral feeding decreased under HFNCCPAP. Results were similar with or without tachypnea. In conclusion, oral feeding under nasal respiratory support is generally safe in a term lamb, even with tachypnea.NEW & NOTEWORTHY The practice of orally feeding newborns suffering from respiratory problems while on nCPAP or HFNC remains controversial for fear of triggering cardiorespiratory events or aspiration pneumonia, or aggravating chronic lung disease. The present results show that bottle-feeding is generally safe in full-term lambs under nasal respiratory support, both without and with tachypnea.

Recently, the active management of the third stage of labor hasbecome a routine practice. In this study we compared two different ecobolics which were oxytocin and methyl ergometrinethrough intra-umbilical route. The method: the trial divided theincluded pregnant full term (>37 weeks) women in two groupsrandomly; one for 0.2 mg methyl ergometrine and the second 10units oxytocin. The outcomes were on the short term; estimatedblood loss (EBL), the need to add another ecobolic, vomiting,blood pressure changes and the duration of the third stage, andthe long-term outcomes were hemoglobin levels and the needfor surgical or medical uterine evacuation. The results: the meanblood loss was 155± 50.45ml and 167± 45.76 in the methyl ergometrine and the oxytocin groups respectively. Three cases inthe oxytocin group (3%) required additional methyl ergometrinewhile in the ergometrine group only one case was given an additional oxytocin (1%). No vomiting was reported in both groupsand there were trivial changes in blood pressure. In the oxytocin group, the third stage duration was average 3.03± 1.02 minin comparison to 2.98± 1.54min in the ergometrine group. Neither did those cases who were injected methyl ergometrine havesignificant changes in the hemoglobin levels nor did they needuterine evacuation. However, only one case in the oxytocin siderequired blood transfusion due to uterine atony. Conclusion: intra-umbilical methyl ergometrine should be considered as an effective safe ecobolic in the third stage of labor.

Pregnancy and giving a birth are natural processes experienced by productive ages women; in this case the mothers will undergo several changes, either physically or psychologically. After giving a birth, some adjustments are required by mothers. Some of them are able to adjust themselves and some of them are not. Events, Reviews those Unable to adjust Themselves undergo a psychological disturbance the so-called "Maternity Blues". The mother's milk clogging is one of the problems during the period of parturition. This matter can not be neglected, because the best food for the babies is the Mother's Milk. This is a cross-sectional research. The researcher performed a research on mothers having postpartum on the 2nd day till the 10th day, the for the undergoing and non-undergoing the Maternity Blues. The samples consist of 36 mothers of having postpartum with the inclusion criteria, among others: the mother with postpartum on the 2nd till the 10th day, understanding the English language, having the history of depression, having the Apgar Score of more than 7, the baby is full term (having enough month in its mother's womb). Instruments used in this research are the Maternity Blues Scale, functioning to detect Whether a mother Suffering from Maternity Blues or not, and the other instrument to know the existence of the Mother's Milk clogging is the Six-Point engorgement Sale. The Data are analysed by using the Man Witney Test. Based on the hypothetical testing, it is Obtained that the value of p = 0.930 bigger than 0:05. Thus, it is concluded that H a is rejected, meaning that there is no difference in the events of the Mother's Milk on mothers undergoing clogging and non-undergoing the Maternity Blues. The research output indicates that there is no difference in the events of the Mother's Milk on mothers undergoing clogging and non-undergoing the Maternity Blues, in the which both of them similarly experience the Mother's Milk clogging.

Introduction Children born prematurely often score lower on standardized tests of language in early childhood. Less is known about longer term outcomes. This investigation considered language outcomes in pre-adolescent children born very preterm/very low birthweight, as assessed by both standardized test scores and language sample measures, and explored attention abilities as a possible moderating factor. Method The present investigation provided a longitudinal follow-up to Mahurin Smith et al. (2014) by examining the language outcomes of 84 children at the 11-year time point (39 with a history of prematurity and 45 born at full term) and a total of 82 at the 12-year time point (37 with a history of prematurity, 45 born at full term). Assessments included subtests of the Clinical Evaluation of Language Fundamentals– Fourth Edition, productive language measures taken from narrative tasks, and parent and examiner ratings of attention. Results Gestational age significantly predicted standardized language scores at age 11 years, but this effect was no longer statistically significant at age 12 years. When parent ratings of attention were considered as additional variables, gestational age was no longer a significant predictor. Gestational age did not serve as a significant predictor for the productive language measures at either time point. Discussion Results indicate that catch-up growth in language may take place in pre-adolescence for many children born prematurely. Clinical implications focus on the need to utilize multiple forms of language assessment and to directly consider the potential role of attention on standard test results.

Relevance: The growth of neuropsychiatric diseases caused by perinatal pathology indicates the need to study the biochemical markers of brain damage in the newborn for the timely prevention of adverse consequences. Serotonin in early ontogenesis provides intensive development of neuronal structures and cortical networks involved in the mechanisms of formation of cyclic sleep organization a fine criterion of morphofunctional development of the brain. aim: The aim of the work is to study the content of serotonin in healthy full-term newborns in comparison with the quantitative and qualitative characteristics of the electropoligraphic sleep pattern. Material and methods: 84 healthy newborns were examined, which, depending on the gestational age, were divided into 3 groups: I 37 weeks (20 people), II 38 weeks (24 people), III 39-40 weeks (40 people). The content of serotonin in platelet-rich plasma of blood from the umbilical cord vein and in platelet suspension prepared from venous blood taken from mothers and children on the first day of life and again on day 5 was determined by high-performance liquid chromatography with electrochemical detection. A quantitative and qualitative analysis of the sleep electropoligram was performed 7-12 hours after birth. Results: The content of serotonin in platelet-rich plasma in umbilical cord blood in children does not depend on the method of birth, is 2 times lower than in the venous blood of mothers (0.379 0.116 microns/l, versus 0.756 0.200 microns/l, but there is a high correlation between the indicators (r = 0.8, p 0.05). At the gestational age of 39-40 weeks, the level of serotonin in platelet-rich plasma and in venous blood platelets is significantly higher than in those born at 37 weeks. In the latter, the increase in the content of serotonin in platelets continues after birth (at day 1, 0.539 0.149 nM/109 Tr, and on day 5 0.846 0.094 nM/109 Tr; p 0.05), whereas the indicators for those born at 39-40 weeks of pregnancy. They do not change (0.797 0.190 nM/109 Tr and 0.749 0.142 nM/109 Tr, respectively). A significant increase in the content of serotonin in the platelet-rich plasma and in the platelets of the child in the period from 37 to 39 weeks, both during intrauterine development and in the first days of life, correlates with an increase in the representation of the orthodox phase in the sleep cycle. Conclusion: The general pattern of changes in serotonin content and cyclic sleep organization in the early neonatal period in healthy newborns, depending on gestational age, indicates the possibility of using the obtained standard values of serotonin as a biochemical marker of functional brain development.

Background: Induction of labor has increased dramatically over the past two decades. Indications for induction of labor are either maternal (preeclampsia, pregnancy-induced hypertension) or fetal (post-term dates, growth retardation, ruptured membranes, diabetes). Objective: The purpose of this study was evaluation of the beneficial effect of isosorbide mononitrate and misoprostol for cervical ripening in induction of labor. Patients and Methods: A randomized clinical trial was carried out on 120 full-term pregnant women who were admitted for induction of labor in Zagazig University Hospitals in the period of July 2017 to March 2018. Patients were divided into two groups: Group A included 60 full term pregnant females who received 25 μg misoprostol (Vagiprost tablet) and placebo tablet in the posterior vaginal fornix. Group B included 60 full-term pregnant females who received vaginal 25 μg misoprostol (Vagiprost tablet) plus 40 mg isosorbide mononitrate (Effox tablet) in the posterior vaginal fornix. Results: There was little difference between the effectiveness of vaginal 25 mg misoprostol vaginal inserts and 40 mg isosorbide mononitrate vaginal inserts in induction of labor. The safety profiles of both drugs were similar, but isosorbide mononitrate administration is considered a low-risk method of labour induction for pregnant women at full term. Conclusions: The combination of misoprostol and isosorbide mononitrate may be more safe and effective for induction of cervical ripening in full-term pregnancy in comparison to misoprostol alone.

Objective of the Study: To test the efficacy of the cerebroplacental ratio [CPR] in the prediction of early labor fetal distress and adverse neonatal outcomes in full-term [FT] low risk pregnancy. Patients and Methods:One hundred fifty pregnant women met the inclusion and exclusion criteria were subjected for the estimation of umbilical artery [UA] and middle cerebral artery [MCA] pulsatility indices [PI]]. CPR is calculated by dividing MCAPI by UAPI. All of these measures have been converted to multiple medians [MOMs]. The findings of CPR MOM were Correlated with the following; traces of cardiotocography; cesarean section [CS] for fetal distress; 5 min APGAR scoring; cord PH; and NICU admission. The ROC curve was used to test CPRMOM's predictive performance of adverse perinatal outcomes. Results:Out of 150 patients, 18 [12%] showed abnormal CPR MOM There was negative significant correlation between CPRMOM and both of emergency CS, [r=-0.293, p

OBJECTIVE: Early identification of neonates at risk of neurological impairment is particularly important for the bedside clinician. Clinical value of S100b and neuron-specific enolase in neonates h...

Objectives For women with Swyer Syndrome, a 46,XY gonadal dysgenesis, full term pregnancies are possible after oocyte donation. According to literature, mode of delivery is almost always by Caesarean section for various reasons. Medical indications are multiple pregnancies and related complications, preeclampsia, an androgynous shaped pelvis and failed induction of labor. Elective Caesarean sections were performed based on maternal request and medical recommendation. Methods Following careful examination and shared decision making, we planned a spontaneous delivery with a patient with Swyer syndrome and tested the different hypotheses regarding anatomical and functional features according to literature. In addition, deliveries of women with Swyer Syndrome were analyzed in a German multicenter case series. Results A total of seven women with Swyer syndrome with a total of 10 pregnancies were identified, who later gave birth to twelve live-born children. Seven out of 10 births were performed by elective and non-elective Caesarean section, three births took place vaginally. Conclusions In summary, the risk of Caesarean section delivery has increased, but spontaneous delivery can be attempted in the event of inconspicuous findings.

One strategy for improving detection of fetal growth restriction (FGR) is developing biosensors identifying placental dysfunction as a leading pathogenesis for FGR. The aim of this pilot study was to investigate the performance of a biosensor specified to detect placental dysfunction by means of maternal arterial turbulence acoustics in a low-resource setting. A cohort of 147 singleton pregnant women were prospectively followed with double-blinded biosensor tests, sonographic estimation of fetal weight (EFW) and Doppler flow at 26–28, 32–34 and 37–39 weeks of pregnancy. Full term live births with recorded birth weights (BWs) and without major congenital malformations were included. Outcomes were defined as (A) a solitary biometric measure (BW &lt, 3rd centile) and as (B) a biometric measure and contributory functional measure (BW &lt, 10th centile and antenatally detected umbilical artery pulsatility index &gt, 95th centile). Data from 118 women and 262 antenatal examinations were included. Mean length of pregnancy was 40 weeks (SD ± 8 days), mean BW was 3008 g (SD ± 410 g). Outcome (A) was identified in seven (6%) pregnancies, whereas outcome (B) was identified in one (0.8%) pregnancy. The biosensor tested positive in five (4%) pregnancies. The predictive performance for outcome (A) was sensitivity = 0.29, specificity = 0.97, p = 0.02, positive predictive value (PPV) was 0.40 and negative predictive value (NPV) was 0.96. The predictive performance was higher for outcome (B) with sensitivity = 1.00, specificity = 0.97, p = 0.04, PPV = 0.20 and NPV = 1.00. Conclusively, these pilot-study results show future potential for biosensors as screening modality for FGR in a low-resource setting.

Background: Nuchal cords are very common, with prev-alence rates ranging from 18% to 25%. Color Doppler sonog-raphy is a noninvasive method that can be used for nuchalcord diagnosis.Aim of Study: In this study, we investigated the diagnosticaccuracy of color Doppler ultrasound (US) in the detectionof nuchal cord among full term pregnant women.Material and Methods: We conducted a prospective studyon 250 full term pregnant women, who were examined bytwo-dimensional US and color Doppler US to detect nuchalcord presence. Only women with cephalic presentation andsonographicaly detected nuchal cord were included.Results: The mean age of studied group was 26.86±5.53years and the mean parity was 1.59±1.21. The mean gestational age was 38.24±1.218 weeks and the estimated fetal weight was 3.236±0.378Kg. Overall, the two-dimensional US detected 64% of the nuchal cord loops; while the color Doppler US detected 100% of the loops. Besides, the frequency of loops of cord around the neck detected after delivery was 94%; which was one loop in 83% of the cases. Accuracy of 2D US in detecting cord around the neck was 61.2%, while that of color Doppler is 94%.Conclusions: In conclusion, the accuracy of detecting thenuchal cord is more with color Doppler US than two-dimensional US.

Objective To investigate the clinical features and outcome of recurrent endometrial cancer (EC) or atypical endometrial hyperplasia (AEH) patients who underwent hysterectomy after fertility-sparing therapy. Methods Clinical data was retrospectively collected for 15 recurrent endometrial cancer or atypical endometrial hyperplasia patients who underwent hysterectomy in six hospitals from 2003 to 2019. According to the indicators of hysterectomy, patients were divided into four groups: 7 patients who underwent direct hyesterectomy after the first relapse, 4 due to re-treatment failure, 1 after full term live birth, and 3 because of multiple recurrence. Clinical coexisting conditions, regimen and outcome of fertility-sparing therapy, pre- and post-operative pathological results, and prognosis were analyzed. Results (1) Fertility-spraring treatment was given to a total of 15 eligible patients, including 6 with EC and 9 with AEH. Median time interval from remission to recurrence was 12 months (range 3–92). Oral progestin-based medicine was the main fertility-sparing therapy in both primary treatment and re-treatment after recurrence. Six (6/8) patients received progestin combined with gonadotrophin releasing hormone agonist or metformin in three re-treatment groups. (2) Nine patients underwent hysterectomy and 6 staging surgery. Three patients had pathological upgrade after surgery. Five (5/10) EC patients had superficial myometrial invasion in postoperative pathology. All patients showed no evidence of disease in the median follow-up of 17 months (range 3–118). (3) Among seven patients who failed to re-treatment and had multiple recurrence, six were overweight/obesity and six had insulin resistance. Two of these patients had synchronous ovarian cancer in the postoperative pathology. Conclusion For the patients with recurrent EC or AEH after primary fertility-sparing therapy, overweight/obesity and insulin resistance might be the risk factors for re-treatment failure. Hysterectomy is recommended when patients had re-treatment failure or multiple recurrence; and generally the prognosis is favorable.

Background: Nuchal cord is a defined as a full twist ofumbilical cord around fetal neck for at least one round. Whilemost nuchal cords have no adverse clinical consequences,emerging reports have demonstrated significant associationsbetween the presence of nuchal cord and maternal/fetal out-comes, which appears to be correlated with the tightness andnumber of cords around the neck.Aim of Study: In this study, we investigated the associationbetween nuchal cord detection during labor and perinataloutcome among full term pregnant women.Material and Methods: We conducted a prospective studyon 250 full term pregnant women, who were examined bytwo-dimensional US and color Doppler US to detect nuchalcord presence. Only women with cephalic presentation andsonographicaly detected nuchal cord were included. Thestudy's outcomes included mode of delivery, APGAR scoringat 1 and 5min, need for admission in neonatal Intensive careunit (NICU), and blood gases of the newborn.Results: The mean age of studied group was 26.86±5.53years and the mean parity was 1.59±1.21. Overall, 83% ofthe women had one loop.Conclusions: In conclusion, the presence of two or morenuchal loops may affect the mode of delivery and earlyneonatal outcome.

History A 6-year-old male child, born at full term via vaginal delivery, presented with a history of ataxia and delayed motor development. There was no family history of neurodegenerative disease. On examination, there was slight dysarthria, dysmetria on a finger-to-nose test, slowing of fast repetitive movements, and increased deep tendon reflexes and clonus in the lower limbs. Electromyography revealed axonal neuropathy, which was predominantly sensory. On arrival at our institution, unenhanced MRI of the brain was performed, and selected images are presented.

Term and preterm neonates have very few circulating Tfh-like cells (cTfh), and no circulating Tfr-like cells. Neonatal cTfh are CXCR5lo PD-1lo CD45RAhi , suggestive of a naive, possibly recently activated phenotype. CXCL13 is high at birth, but decreases rapidly in the first weeks of life. Overall, signs of GC activity in human neonates are weak, even in those born prematurely or after sepsis. Term and preterm neonates have very few circulating Tfh-like cells (cTfh), and no circulating Tfr-like cells. Neonatal cTfh are CXCR5(lo)PD-1(lo)CD45RA(hi), suggestive of a naive, possibly recently activated phenotype. CXCL13 is high at birth, but decreases rapidly in the first weeks of life. Overall, signs of GC activity in human neonates are weak, even in those born prematurely or after sepsis. (dagger)

Background Paramyotonia congenita is a rare autosomal dominant myopathy which presents with periodic weakness due to cold and exercise. It is caused by mutations of the SCN4 gene which encodes the sodium channel in skeletal muscles. Case presentation We report a full term obstetric patient with both paramyotonia congenita and terminal filum lipoma who presents for induction of labour followed by an emergency caesarean section performed under epidural anesthesia. Her recovery is subsequently complicated by a 3-day history of postpartum paraparesis attributed to hypokalemic periodic paralysis. Conclusion We describe the perioperative anesthesia considerations and challenges in this case with a review of the current literature. This case report highlights the importance of early proactive and collaborative multidisciplinary approach, maintaining normal temperature and electrolytes with a heightened vigilance for muscle-related perioperative complications.

Melike Aslan, Şeyda Yavuzkir Obstetrics and Gynecology Department, Fırat University Medicine Faculty Hospital, Elazığ, TurkeyCorrespondence: Melike AslanDepartment of Obstetrics and Gynecology, Fırat University Medicine Faculty Hospital, Elazığ, TurkeyEmail mlkbaspinar@hotmail.comBackground: Caesarean scar pregnancy (CSP) is associated with various serious pregnancy complications. This study presents the outcomes of patients treated with suction curettage and Foley balloon as the first-line treatment for CSP as well as their future outcomes in terms of successful pregnancy.Methods: Of the 44 patients diagnosed with CSP between January 2015 and April 2019, 42 who provided consent for the termination of pregnancy and who simultaneously underwent the transabdominal ultrasound-guided suction curettage + Foley balloon treatment were included in the study. These patients were then contacted and interviewed to collect data concerning their post-treatment number of pregnancies, number of miscarriages, number of live or dead births, mode of delivery, delivery time as well as whether any abnormal placental invasion or uterine ruptures developed.Results: Transabdominal ultrasound-guided suction curettage + Foley balloon was simultaneously performed as the first-line treatment in 42 patients with CSP. In two of these cases, wherein post-treatment level of β-hCG reached a plateau, single-dose systemic methotrexate was administered. Emergency surgical intervention, hysterectomy, massive blood transfusion and additional systemic methotrexate administration were not required. Twenty-six of 42 patients could be contacted. 18/26 were trying to conceive. 6/18 patients had secondary infertility, and 12/18 patients managed to conceive. 8/12 had caesarean delivery at full term. 1/12 was 16-week pregnant, 1/12 had tubal ectopic pregnancy and 2/12 had first-trimester abortus.Conclusion: When administered as the first-line treatment for CSP, the suction curettage + Foley balloon treatment is a highly successful, cheap and easily performed minimally invasive method that requires only a short hospital stay, making it comfortable for patients. Compared with other uterine-sparing methods, it does not harm fertility and has positive effects on patients’ future fertility outcomes.Keywords: caesarean scar ectopics, first-line management, suction curettage, Foley balloon, pregnancy outcomes

Postpartum haemorrhage is the leading cause of maternal mortality and morbidity worldwide. Tranexamic acid (TXA) has been shown to reduce blood loss and blood product transfusion requirements. Despite clinical evidence, further studies are needed to better define the pharmacokinetic and pharmacodynamic characteristics of TXA in pregnant women. The objective of our prospective observational ex-vivo study was to define the effective TXA concentration required to inhibit 95% (EC95) of tissue-type plasminogen activator (t-PA)-induced fibrinolysis in full-term pregnant women. Hyperfibrinolysis was induced by adding supraphysiologic concentration of t-PA to blood samples obtained from 30 full-term pregnant women and 10 healthy nonpregnant female volunteers. Increasing TXA concentrations (0--40 μg/ml) were then spiked into the blood samples and inhibition of fibrinolysis was assessed using the lysis index at 30 min of the ROTEM measured on EXTEM and NATEM tests. Effective TXA concentrations required to achieve EC95 were extrapolated using nonlinear regression. EC95 were compared between groups using an extra sum-of-squares F test. EC95 in pregnant women was 14.7 μg/ml (95% CI 12.4--17.5 μg/ml) on EXTEM and 11.2 μg/ml (95% CI 8.3--15.1 μg/ml) on NATEM tests. These values were significantly higher than those obtained in volunteers: 8.7 μg/ml (95% CI 5.5--13.9 μg/ml) and 6.8 μg/ml (95% CI 5.3--8.8 μg/ml), respectively (both P < 0.001). Our results suggest a higher fibrinolytic potential in pregnant women compared with nonpregnant women.

Aim: To examine the differences in return to work time after childbirth; the differences in income; and the differences in out of pocket health-care costs between mothers who had a preterm birth and mothers who delivered a full term baby in Australia. Methods: Using administrative data, the length of time and ‘risk’ of returning to employment for mothers whose child was born premature relative to those whose child was born full term was reported. Multivariate linear regression models were constructed to assess the difference in maternal income and the differences in mean out-of-pocket costs between mothers who had a preterm birth and mothers who had a full term birth. Results: The mean length of time for mothers of babies born full term to return to work was 1.9 years and for mothers of preterm babies it was 2.8 years. Mothers of preterm babies had a significantly lower median income ah at 0–1, 2–3 and 4–5 years postpartum compared to mothers of full term babies. The adjusted mean out of pocket costs for health care paid by mothers who had a preterm birth was $1298 for those whose child was aged 32–36 weeks; and $2491 for those whose child was aged

OBJECTIVE To compare risks of maternal and perinatal outcomes by completed week of gestation from 39 weeks in low-risk nulliparous patients undergoing expectant management. METHODS We conducted a secondary analysis of a multicenter randomized trial of elective induction of labor at 39 weeks of gestation compared with expectant management in low-risk nulliparous patients. Participants with nonanomalous neonates, who were randomized to and underwent expectant management and attained 39 0/7 weeks of gestation, were included. Delivery gestation was categorized by completed week: 39 0/7-39 6/7 (39 weeks), 40 0/7-40 6/7 (40 weeks), and 41 0/7-42 2/7 (41-42 weeks) (none delivered after 42 2/7). The coprimary outcomes were cesarean delivery and a perinatal composite (death, respiratory support, 5-minute Apgar score 3 or less, hypoxic ischemic encephalopathy, seizure, sepsis, meconium aspiration syndrome, birth trauma, intracranial or subgaleal hemorrhage, or hypotension requiring vasopressor support). Other outcomes included a maternal composite (blood transfusion, surgical intervention for postpartum hemorrhage, or intensive care unit admission), hypertensive disorders of pregnancy, peripartum infection, and neonatal intermediate or intensive care unit admission. For multivariable analysis, P

IntroductionMonitoring of renal function in acute kidney injury in the pediatric population is complicated by the lack of age-related reference values of new biomarkers. Urinary netrin-1 is a new marker to demonstrate early kidney damage. Netrin-1 has a molecular mass of 72 kDa. It is therefore unlikely that it is filtered by the glomerulus under normal conditions. However, netrin-1 is highly induced after acute and chronic kidney injury and excreted in urine in humans. The aim of the study was to determine the normal concentrations of urinary netrin-1 in healthy full-term newborns.Material and methodsThe study included 88 healthy full-term neonates (51 boys and 37 girls) born from normal, uncomplicated pregnancies. The concentration of netrin-1 was determined in urine obtained on the first or second day of life with a commercially available ELISA kit.ResultsThe urinary concentration of netrin-1 in newborns was independent of gender and time of urine collection. We found a negative correlation between both the urinary netrin-1 concentration and urinary netrin-1 concentration after normalization for urinary creatinine and the birth weight.ConclusionsThis is the first study showing the urinary netrin-1 concentration in healthy full-term newborns. Future investigation is needed to confirm its potential role as a marker of kidney function in this age group.

Background Postpartum depression (PPD) is a frequent mental disorder after delivery. In China, most parturients give birth with the assistance of labor analgesia (LA) or by cesarean section (CS); however, it is still unclear whether these two approaches reveal different effects on PPD. Methods One hundred and ninety-eight patients with single pregnancy at full term were allocated to receive either group LA or group CS. Maternal and neonatal variables in the perinatal period were recorded. Multivariate logistical regression analysis was conducted to evaluate the associated factors of PPD. Results The incidence of PPD in group LA was lower than in group CS. Besides, eight factors were found to be potential predictors of PPD. Multivariate logistic model showed that LA was a protective factor against PPD. However, high family income and Edinburgh postnatal depression scale (EPDS) scores at 3 days postpartum were associated with an increased risk of PPD. Conclusion LA could reduce the incidence of PPD in women with single pregnancy at full term. Family income and EPDS scores in the early postpartum period were also related with PPD. Large sample size studies are needed to verify the impact of LA on the psychological states of postpartum women.

Our objective is to report one rare case of dual gender chimerism involving abnormal male trisomy 18 and normal female karyotype. The baby was born full term with birth weight of 1.8 kg, not vigorous with light meconium stained liquor and Apgar score of 51, 85 and 910. Parents are 40 years old and mother is G6P5 + 1. The baby had clinical features of Edwards syndrome, and a blood sample was sent to Human Genome Centre, Universiti Sains Malaysia, Malaysia for cytogenetic analysis. Conventional cytogenetic analysis results showed two distinct sex discordant genetic cell lines XY and XX in 90:10 ratio. The male genetic cell line XY also showed trisomy 18 (47,XY, + 18) consistent with clinical diagnosis of male Edwards syndrome, whereas the second genetic cell line showed normal 46,XX female. The present case was reported as dual gender chimera with chi 47,XY, + 18/46,XX karyotype pattern. To the best of available knowledge, dual gender chimerism with abnormal male trisomy 18 and normal female karyotype has not been reported so far, and this case is reported for its rarity and as the first report.