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The article describes a case of a newborn infant with a brown, reducible mass at the base of the umbilical cord, later identified as liver tissue. Born to a mother with late prenatal care, the infant underwent an exploratory laparotomy and was found to have normal abdominal imaging and echocardiogram results. After post-operative stability and successful feeding, the infant was discharged home on day nine of life.

The microbiome is a complex ecosystem comprising microbes, their genomes, and the surrounding environment. The microbiomeplays a critical role inearlyhumandevelopment, including maturation of the host immune system and gastrointestinal tract. Multiple factors, including diet, antibiotic use, and other environmental exposures, influence the establishment of the microbiome during infancy. Numerous studies have identified associations between the microbiome and neonatal diseases, including necrotizing enterocolitis, sepsis, and malnutrition. Furthermore, there is compelling evidence that perturbation of the microbiome in early life can have lasting developmental effects that increase an individual’s risk for immune and metabolic diseases in later life. Supplementation of the microbiome with probiotics reduces the riskofnecrotizingenterocolitisandsepsis inat-risk infants. This review focuses on the structure and function of the infant microbiome, the environmental and clinical factors that influence its assembly, and its impact on infant healthanddevelopment. [ABSTRACT FROM AUTHOR]

Neonatal hypoglycemia (NH) is broadly defined as a low plasma glucose concentration that elicits hypoglycemia-induced impaired brain function. To date, no universally accepted threshold (reference range) for plasma glucose levels in newborns has been published, as data consistently indicate that neurologic responses to hypoglycemia differ at various plasma glucose concentrations. Infants at risk for NH include infants of diabetic mothers, small or large for gestational age, and premature infants. Common manifestations include jitteriness, poor feeding, irritability, and encephalopathy. Neurodevelopmental morbidities associated with NH include cognitive and motor delays, cerebral palsy, vision and hearing impairment, and poor school performance. This article offers a timely discussion of the state of the science of NH and recommendations for neonatal providers focused on early identification and disease prevention. [ABSTRACT FROM AUTHOR]

Although a rare cause of neonatal seizures, inborn errors of metabolism (IEMs) remain an essential component of a comprehensive differential diagnosis for poorly controlled neonatal epilepsy. Diagnosing neonatal-onset metabolic conditions proves a difficult task for clinicians; however, routine state newborn screening panels now include many IEMs. Three in particular—pyridoxine-dependent epilepsy, maple syrup urine disease, and Zellweger spectrum disorders—are highly associated with neonatal epilepsy and neurocognitive injury yet are often misdiagnosed. As research surrounding biomarkers for these conditions is emerging and gene sequencing technologies are advancing, clinicians are beginning to better establish early identification strategies for these diseases. In this literature review, the authors aim to present clinicians with an innovative clinical guide highlighting IEMs associated with neonatal-onset seizures, with the goal of promoting quality care and safety. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate maternal Resolvin D1 levels in women with gestational diabetes mellitus (GDM) and investigate the association between perinatal outcomes. STUDY DESIGN: This case-control study included 88 singleton pregnancies, conducted from August 2023 to January 2024, at a tertiary care center. Participants were divided into two groups: 44 pregnant women diagnosed with GDM comprised the study group, and 44 healthy pregnant women served as the control group. Additionally, the GDM group was categorized based on management approach into 21 women managed with diet alone and 23 women requiring insulin therapy. Maternal plasma Resolvin D1 levels and maternal-neonatal outcomes were then compared between groups. The analysis involved determining the optimal Resolvin D1 cut-off levels for predicting composite adverse neonatal outcomes in GDM using receiver operating characteristic curve (ROC) analysis. RESULTS: The plasma Resolvin D1 level in pregnant women with GDM was significantly higher compared to the control group (337±74.1 vs. 297±56.7, p<0.001). Furthermore, maternal plasma Resolvin D1 levels were associated with composite adverse neonatal outcomes [presence of at least one of the following conditions: preterm birth (<37 weeks), low birth weight (LBW) (<2500 grams), neonatal hypoglycemia, hyperbilirubinemia, APGAR score at 5th minute <7, respiratory distress syndrome (RDS), and admission to the neonatal intensive care unit (NICU)], with a cut-off of >338.75, showing a sensitivity of 56.3%, a specificity of 79.2%, and an AUC of 0.675 (95% CI: 0.567-0.771, p=0.024). CONCLUSIONS: This study demonstrated that pregnancies affected by GDM exhibit elevated levels of Resolvin D1, which is associated with a higher incidence of composite adverse neonatal outcomes. [ABSTRACT FROM AUTHOR]

Understanding the intricate relationships between diseases is critical for both prevention and recovery. However, there is a lack of suitable methodologies for exploring the precedence relationships within multiple censored time-to-event data, resulting in decreased analytical accuracy. This study introduces the Censored Event Precedence Analysis (CEPA), which is a nonparametric Bayesian approach suitable for understanding the precedence relationships in censored multivariate events. CEPA aims to analyze the precedence relationships between events to predict subsequent occurrences effectively. We applied CEPA to neonatal data from the National Health Insurance Service, identifying the precedence relationships among the seven most commonly diagnosed diseases categorized by the International Classification of Diseases. This analysis revealed a typical diagnostic sequence, starting with respiratory diseases, followed by skin, infectious, digestive, ear, eye, and injury-related diseases. Furthermore, simulation studies were conducted to demonstrate CEPA suitability for censored multivariate datasets compared to traditional models. The performance accuracy reached 76% for uniform distribution and 65% for exponential distribution, showing superior performance in all four tested environments. Therefore, the statistical approach based on CEPA enhances our understanding of disease interrelationships beyond competitive methodologies. By identifying disease precedence with CEPA, we can preempt subsequent disease occurrences and propose a healthcare system based on these relationships. [ABSTRACT FROM AUTHOR]

Purpose: Group B Streptococcus (GBS) is the leading cause of invasive infections in newborns. The prevention of GBS neonatal disease relies on the administration of an intrapartum antibiotic prophylaxis to GBS-colonized women. In recent years, rapid intrapartum detection of GBS vaginal colonization using real-time nucleic acid amplification tests (NAATs) emerged as an alternative to antenatal culture screening methods. Methods: We compared the performances of two loop-mediated isothermal amplification (LAMP) tests, the Ampliflash® GBS and the PlusLife® GBS tests, to standard culture for GBS detection in vaginal specimens from pregnant women. The study was conducted from April to July 2023 in a French hospital of the Paris area. Results: A total of 303 samples were analyzed, including 85 culture-positive samples (28.1%). The Ampliflash® GBS test and the PlusLife® GBS tests gave a result for 100% and 96.3% tests, respectively. The performances of the tests were as follows: sensitivity 87.1% (95% confidence interval (CI) 78.3–92.6) and 98.7% (95% CI 93.0-99.8), specificity 99.1% (95% CI 96.7–99.8), and 91.9% (95% CI 87.3–95.0), respectively. False negative results of the Ampliflash® GBS test correlated with low-density GBS cultures. Time-to-results correlated with GBS culture density only for the PlusLife® GBS test (p < 0.001). Conclusion: Both techniques provide excellent analytical performances with high sensitivity and specificity together with a short turnaround time and results available in 10 to 35 min. Their potential to further reduce the burden of GBS neonatal disease compared with antenatal culture screening needs to be assessed in future clinical studies. [ABSTRACT FROM AUTHOR]

Sepsis represents a critical medical condition stemming from an imbalanced host immune response to infections, which is linked to a significant burden of disease. Despite substantial efforts in laboratory and clinical research, sepsis remains a prominent contributor to mortality worldwide. Nanotechnology presents innovative opportunities for the advancement of sepsis diagnosis and treatment. Due to their unique properties, including diversity, ease of synthesis, biocompatibility, high specificity, and excellent pharmacological efficacy, peptides hold great potential as part of nanotechnology approaches against sepsis. Herein, we present a comprehensive and up-to-date review of the applications of peptides in nanosystems for combating sepsis, with the potential to expedite diagnosis and enhance management outcomes. Firstly, sepsis pathophysiology, antisepsis drug targets, current modalities in management and diagnosis with their limitations, and the potential of peptides to advance the diagnosis and management of sepsis have been adequately addressed. The applications have been organized into diagnostic or managing applications, with the last one being further sub-organized into nano-delivered bioactive peptides with antimicrobial or anti-inflammatory activity, peptides as targeting moieties on the surface of nanosystems against sepsis, and peptides as nanocarriers for antisepsis agents. The studies have been grouped thematically and discussed, emphasizing the constructed nanosystem, physicochemical properties, and peptide-imparted enhancement in diagnostic and therapeutic efficacy. The strengths, limitations, and research gaps in each section have been elaborated. Finally, current challenges and potential future paths to enhance the use of peptides in nanosystems for combating sepsis have been deliberately spotlighted. This review reaffirms peptides' potential as promising biomaterials within nanotechnology strategies aimed at improving sepsis diagnosis and management. Highlights: • Due to their unique characteristics, Peptides hold significant promise as part of nanotechnology approaches for diagnosing and treating sepsis, a current leading global killer. • Various diagnostic nanotools utilizing peptides as pathogen recognition moieties can improve the pathogen capturing efficiency for sepsis diagnosis. • Nano-delivery can overcome the limitations of bioactive peptides and enhance their antibacterial and anti-inflammatory efficacy in sepsis management. • Peptides offer significant capabilities as targeting moieties and nanocarriers to augment the effectiveness of antisepsis agents. • Future research identified can potentiate the applications of peptides for the diagnosis and treatment of sepsis. [ABSTRACT FROM AUTHOR]

The article offers information on neonatal meningitis, a rare but serious disease affecting newborns, with acute inflammation of the brain tissue. Topics include the categorization of neonatal meningitis into early and late onset, common pathogens like Group B Streptococcus and Escherichia coli, and risk factors such as prematurity and maternal colonization.

Premature newborns face significant risks of reduced bone mineral content ensuing osteopenia which are more likely to occur in high‑risk newborns, particularly preterms who are on corticosteroids or diuretics for an extended period or have neuromuscular issues. The methodology prescribed by Arksey and O’Malley was followed. Database searches using PubMed, Scopus, and PEDro were performed for original research published in English between 2011 and 2022. Nine studies have shown that there are few papers on the role of physical therapy in preventing osteopenia of prematurity among newborns. The ability of a newborn to perform functionally is improved by early identification and exercise exposure. This scoping review aims to identify relevant and reliable studies that discuss the use of physical therapy to treat preterm newborns as this will decrease the chances of future complications among children. [ABSTRACT FROM AUTHOR]

Background: The study of thyroid status and its influence on neonatal and postneonatal development of newborns from mothers with endemic goiter (EG) is one of the topical areas of modern endocrinology. Objective: The study of thyroid hormone levels in newborns born to women with endemic goiter. Materials and Methods: The design of the study is based on a randomized controlled method, taking into account the requirements of CONSORT, with distribution into mutually comparable study groups. A study was carried out on 68 newborns born to women with EG. Methods included the collection of history and study of thyroid hormone levels in neonates and women in labor. Results: In newborns born from women with EG, thyroid‑stimulating hormone (TSH) in cord blood averaged 15.6 ± 0.87 mIU/l, which is 22.38% higher compared to the control group (P = 0.038). The difference between free triiodothyronine (T3) and thyroxine (T4) in newborns from mothers with EG in comparison to the control group was below 8.57% and 4.29%, respectively. In the 1st month of life, a lag in weight gain was noted by an average of 9.57% concerning practically healthy newborns. Conclusions: In newborns from women with EG, there was a decrease in T4 – 4.29% and T3 – 8.57%, against the background of an increase in the level of TSH to 22.38% in the cord blood relative to children from the control group. These fluctuations may persist in the 1st month of life and manifest as a delay in weight gain. [ABSTRACT FROM AUTHOR]

There is an emerging view that remittances improve health outcomes in developing countries, though less is known about the conditions under which they may be effective. This study investigates whether and how the impact of remittances on child mortality depends on the level of mortality itself. Using a sample of 134 developing countries over the period 1990 to 2018, we estimate unconditional quantile treatment effects with an endogenous treatment variable, on aggregate child mortality and the three leading cause-specific child mortality rates: mortality from neonatal disorders, lower respiratory infections, and diarrheal diseases. We find that the impact of remittances differs systematically across the mortality distribution and across mortality indicators. Remittances appear less effective at reducing child mortality at the lowest and highest mortality rates than at the average. [ABSTRACT FROM AUTHOR]

Objectives Jaundice occurs in 60% of full-term and 80% of pre-term newborns. This study compared the effect of phototherapy with and without phenobarbital on icteric newborns. Materials & Methods This study is a randomized clinical trial conducted from July until March 2018 at Imam Reza Hospital, Mashhad University of Medical Science, Iran. Full-term and near-term neonates with more than 2000 grams who were hospitalized in the mentioned period for jaundice were entered into the study. The newborns were divided into two groups using block randomization. Data were analyzed by SPSS version 19. Results The average gestational age was 36.4 weeks (SD 2.39) in the intervention group and 36.9 weeks (SD 2.16) in the control group, with no significant difference between them. The mean hospital stay for the intervention group was 72 hours (SD 1.66), compared to 55 hours (SD 1.88) for the control group. At discharge, the serum bilirubin level in the intervention group was 11.53 mg/dL (SD 0.77), while it was 10.80 mg/dL (SD 1.09) in the control group, a statistically significant difference. Conclusion According to this study, phototherapy with phenobarbital is not more effective than phototherapy alone in neonatal hyperbilirubinemia. [ABSTRACT FROM AUTHOR]

Copyright of Enfermería Neonatal is the property of Fundacion para la Salud Materno Infantil (FUNDASAMIN) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective of the study was to assess the relationship between the nurses' training and neonatal pain management. The term "neonatal period" refers to the period from birth to the first 28 days of a person's life. Pain management for newborns can help avoid both short- and long-term issues that may arise from untreated pain. A quiz-experimental study design was implemented in the Pediatrics Ward of the Jinnah Hospital, Lahore. A sample of 50 nurses was chosen by using purposive sampling with twenty-five nurses placed in the research group and twenty-five nurses in the control group. A structured research questionnaire was used to collect data. The SPSS version 26.0 was used to analyze the data. There were significant statistical changes between the pre-and post-application periods for the educational program on newborn pain management. The nurses' training program proved instrumental in improving neonatal pain management. It is also suggested that there is a need to more focus on the training of nurses. [ABSTRACT FROM AUTHOR]

Rationale: Two molecular phenotypes of sepsis and acute respiratory distress syndrome, termed hyperinflammatory and hypoinflammatory, have been consistently identified by latent class analysis in numerous cohorts, with widely divergent clinical outcomes and differential responses to some treatments; however, the key biological differences between these phenotypes remain poorly understood. Objectives: We used host and microbe metagenomic sequencing data from blood to deepen our understanding of biological differences between latent class analysis–derived phenotypes and to assess concordance between the latent class analysis–derived phenotypes and phenotypes reported by other investigative groups (e.g., Sepsis Response Signature [SRS1–2], molecular diagnosis and risk stratification of sepsis [MARS1–4], reactive and uninflamed). Methods: We analyzed data from 113 patients with hypoinflammatory sepsis and 76 patients with hyperinflammatory sepsis enrolled in a two-hospital prospective cohort study. Molecular phenotypes had been previously assigned using latent class analysis. Measurements and Main Results: The hyperinflammatory and hypoinflammatory phenotypes of sepsis had distinct gene expression signatures, with 5,755 genes (31%) differentially expressed. The hyperinflammatory phenotype was associated with elevated expression of innate immune response genes, whereas the hypoinflammatory phenotype was associated with elevated expression of adaptive immune response genes and, notably, T cell response genes. Plasma metagenomic analysis identified differences in prevalence of bacteremia, bacterial DNA abundance, and composition between the phenotypes, with an increased presence and abundance of Enterobacteriaceae in the hyperinflammatory phenotype. Significant overlap was observed between these phenotypes and previously identified transcriptional subtypes of acute respiratory distress syndrome (reactive and uninflamed) and sepsis (SRS1–2). Analysis of data from the VANISH trial indicated that corticosteroids might have a detrimental effect in patients with the hypoinflammatory phenotype. Conclusions: The hyperinflammatory and hypoinflammatory phenotypes have distinct transcriptional and metagenomic features that could be leveraged for precision treatment strategies. [ABSTRACT FROM AUTHOR]

Anti-hypotensive treatment, which includes dopamine, dobutamine, epinephrine, norepinephrine, milrinone, vasopressin, terlipressin, levosimendan, and glucocorticoids, is a long-established intervention in neonates with arterial hypotension (AH). However, there are still gaps in knowledge and issues that need clarification. The main questions and challenges that neonatologists face relate to the reference ranges of arterial blood pressure in presumably healthy neonates in relation to gestational and postnatal age; the arterial blood pressure level that potentially affects perfusion of critical organs; the incorporation of targeted echocardiography and near-infrared spectroscopy for assessing heart function and cerebral perfusion in clinical practice; the indication, timing, and choice of medication for each individual patient; the limited randomized clinical trials in neonates with sometimes conflicting results; and the sparse data regarding the potential effect of early hypotension or anti-hypotensive medications on long-term neurodevelopment. In this review, after a short review of AH definitions used in neonates and existing data on pathophysiology of AH, we discuss currently available data on pharmacokinetic and hemodynamic effects, as well as the effectiveness and safety of anti-hypotensive medications in neonates. In addition, data on the comparisons between anti-hypotensive medications and current suggestions for the main indications of each medication are discussed. [ABSTRACT FROM AUTHOR]

Abstract Objectives: to assess the prevalence and epidemiological factors associated with group B Streptococcus (GBS) colonization in pregnant women in Porto Velho City, Rondônia. Methods: GBS was identified and isolated by genotypic and microbiological methods from rectovaginal samples of pregnant women between 35 and 37 weeks of gestation. Epidemiological data were collected using questionnaires and their correlation with colonization was assessed. The antimicrobial susceptibility profile was determined by disk diffusion method. Results: a total of 22.5% (102/453) pregnant women were colonized with GBS. A higher level of colonization was observed at the vaginal tract (17.6%), compared to the rectal area. We did not find any sociodemographic or obstetric factors associated with an increased risk of GBS colonization. All strains were susceptible to antibiotics penicillin, ampicillin, cefazolin, and ceftriaxone. In contrast, the rates of resistance to tetracycline (74.1%), erythromycin (14.1%), and clindamycin (3.5%) were observed. Conclusion: the prevalence of GBS as well as the absence of predictors of colonization demonstrated the need for universal screening for GBS in all pregnant women in the region. In addition, we showed that the first-line antibiotics recommended for prophylaxis are still good options for the prevention of neonatal GBS disease in the region.

Endothelial colony-forming cells (ECFCs) are progenitors of endothelial cells with significant proliferative and angiogenic ability. ECFCs are a promising treatment option for various diseases, such as ischemic heart disease and peripheral artery disease. However, some barriers hinder the clinical application of ECFC therapeutics. One of the current obstacles is that ECFCs are dysfunctional due to the underlying disease states. ECFCs exhibit dysfunctional phenotypes in pathologic states, which include but are not limited to the following: premature neonates and pregnancy-related diseases, diabetes mellitus, cancers, haematological system diseases, hypoxia, pulmonary arterial hypertension, coronary artery diseases, and other vascular diseases. Besides, ECFCs are heterogeneous among donors, tissue sources, and within cell subpopulations. Therefore, it is important to elucidate the underlying mechanisms of ECFC dysfunction and characterize their heterogeneity to enable clinical application. In this review, we summarize the current and potential application of transcriptomic analysis in the field of ECFC biology. Transcriptomic analysis is a powerful tool for exploring the key molecules and pathways involved in health and disease and can be used to characterize ECFC heterogeneity. [ABSTRACT FROM AUTHOR]

Background/Aims: Vaginal birth following a previous caesarean section is considered a safe option for subsequent births following personal planning and counselling. The aim of this study was to compare neonatal outcomes for both elective caesarean and vaginal birth after a previous caesarean section to aid decision making for women/pregnant people. Methods: This quantitative study used retrospective data from low-risk pregnant people/women at term with one previous caesarean section (n=392). Logistic regression was used to determine the impact of mode of birth on neonatal outcomes. Further descriptive analyses were carried out to explore the results and reasons for admission to neonatal unit. Results: Apgar scores were higher in the vaginal birth group compared to the elective repeat caesarean group. There were no differences in neonatal unit admissions by mode of birth. Conclusions: There is minimal difference in neonatal outcomes, regardless of intention for either vaginal birth following a previous caesarean section or elective repeat caesarean. To fully investigate the factors that impacted Apgar scores and neonatal unit admissions for these groups, a much larger sample is needed. [ABSTRACT FROM AUTHOR]

Introduction: The brain-sparing (BS) phenomenon is considered an adaptive mechanism of the fetus, which is activated to protect the fetal brain in adverse conditions. The current challenge is, therefore, to identify vulnerable fetuses at risk of hypoxic complications, particularly within an apparently low-risk cohort before the onset of labor. The cerebroplacental ratio (CPR) is emerging as an important predictor of adverse pregnancy outcomes, and this has implications for assessment of the well-being of SGA and AGA fetuses close to term. Materials and methods: It was a hospital-based prospective observational study. After obtaining informed consent from the patient, she was subjected to detailed history-taking and examination and underwent antenatal USG with color Doppler for CPR calculation. Observations and results: The mean age of females enrolled in the study was 25.95 ± 3.50 years. About 63.5% patients had normal vaginal delivery, 35.0% had cesarean delivery, and 1.5% had instrumental delivery for intrapartum fetal compromise. Patients were divided into groups on the basis of Doppler findings, i.e., CPR ≤1.08 (n = 50) and CPR >1.08 (n = 150), adverse outcomes were significantly higher in groups with CPR ≤1.08 than in groups with CPR >1.08. CPR ≤1.08 was found to be 56.25% sensitive and 95.83% specific in predicting the poor outcome. Conclusion: With the high specificity and positive predictive value of CPR, it is likely that those having normal CPR will have very less chance of adverse perinatal outcomes and, therefore, their delivery can be conducted at a peripheral center, and those with low CPR should be timely referred to a higher center where there are facilities for extensive fetal monitoring during the intrapartum period with availability of the neonatal unit (NNU). [ABSTRACT FROM AUTHOR]

Background: Management of neural tube defects (NTDs) is challenging and the outcome is demanding. Aims: To analyze the outcomes in operated cases of NTDs closed using various types of flaps. Materials and Methods: The data between June 2017 and May 2023 were analyzed. The mode of presentation, timing of intervention, type of flap, neurological status after closure, status of the wound, presence of hydrocephalous, flap blackening, flap necrosis, features of sepsis, and the outcome were recorded and analyzed. Covered NTD; closure done using primary closure or 'Z' Plasty (everywhere); incomplete data; lost to follow-up; and not giving consent were excluded from the study. Results: Out of 92 cases, 35 were operated using the rhomboid flap, 33 using dufourmentel modification of limberg flap, and 24 using keystone island flap. The mean age at presentation was 4 days (range: 0--28 days). The mean duration of surgery after presentation was 2 days (range: 1--3 days). Mean operating time was 1.15 h (range: 0.45--3.15 h). A ventriculoperitoneal shunt was required in 62 cases at various stages. The preoperative and the postoperative power were nearly the same in all. Wound infection was seen in 2, 3, and 1 cases in each group. Blackening of the flap was seen in 3, 2, and 1 cases in three groups. Cerebrospinal fluid (CSF) leak was seen in 2, 2, and 0 cases. Wound dehiscence was present in one case in each group and sepsis was present in 2, 3, and 2, respectively. Conclusion: The management of open NTD requires adequate planning. CSF shunting and flap closure are often required. [ABSTRACT FROM AUTHOR]

Neonatal disorders, particularly those resulting from prematurity, pose a major challenge in health care and have a significant impact on infant mortality and long-term child health. The limitations of current therapeutic strategies emphasize the need for innovative treatments. New cell-free technologies utilizing extracellular vesicles (EVs) offer a compelling opportunity for neonatal therapy by harnessing the inherent regenerative capabilities of EVs. These nanoscale particles, secreted by a variety of organisms including animals, bacteria, fungi and plants, contain a repertoire of bioactive molecules with therapeutic potential. This review aims to provide a comprehensive assessment of the therapeutic effects of EVs and mechanistic insights into EVs from stem cells, biological fluids and non-animal sources, with a focus on common neonatal conditions such as hypoxic–ischemic encephalopathy, respiratory distress syndrome, bronchopulmonary dysplasia and necrotizing enterocolitis. This review summarizes evidence for the therapeutic potential of EVs, analyzes evidence of their mechanisms of action and discusses the challenges associated with the implementation of EV-based therapies in neonatal clinical practice. [ABSTRACT FROM AUTHOR]

Introduction Sepsis and septic shock represent severe pathological states, characterized by the systemic response to infection, which can lead to organ dysfunction and high mortality. Early diagnosis and rapid intervention are crucial for improving survival chances. However, the diagnosis of sepsis is complex due to its nonspecific symptoms and the variability of patient responses to infections. Methods The objective of this research was to analyze the implications of using artificial intelligence (AI) in the diagnosis of sepsis and septic shock. The research method applied in the analysis of the implications of using artificial intelligence (AI) in the diagnosis of sepsis and septic shock is the literature review. Results Among the benefits of using AI in the diagnosis of sepsis, it is noted that artificial intelligence can rapidly analyze large volumes of clinical data to identify early signs of sepsis, sometimes even before symptoms become evident to medical staff. AI models can use predictive algorithms to assess the risk of sepsis in patients, allowing for early interventions that can save lives. AI can contribute to the development of personalized treatment plans, adapting to the specific needs of each patient based on their medical history and response to treatment. The use of patient data to train AI models raises concerns regarding data privacy and security. Conclusions Artificial intelligence has the potential to revolutionize the diagnosis and treatment of sepsis, offering powerful tools for early identification and management of this critical condition. However, to realize this potential, close collaboration between researchers, clinicians, and technology developers is necessary, as well as addressing ethical and implementation challenges. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sudden unexpected postnatal collapse (SUPC) of healthy newborns is a catastrophic event caused by cardiorespiratory collapse in a healthy newborn. The most common cause of SUPC is poor positioning of the newborn during skin-to-skin contact or breastfeeding when the newborn is not being observed by a health professional, attentive parent, or caretaker. Maternal/newborn health care professionals need to know about the essential information, definitions, incidence, risk factors, clinical presentation, outcomes, and prevention and management strategies to minimize the occurrence and impact of SUPC. A sample SUPC hospital policy is included in the manuscript. [ABSTRACT FROM AUTHOR]

Background: Neonates have an increased risk of vitamin D insufficiency due to the inadequate supplementation of mothers and infants after birth. Insufficiency of vitamin D is frequently detected in critically ill patients and is associated with disease severity and mortality. There is yet to be a consensus on the appropriate regimen of vitamin D3 supplementation in high-risk infants. Aim: The main objectives of this study were to determine the prevalence of vitamin D insufficiency in neonates with severe comorbidities and to evaluate whether high-dose vitamin D3 oral administration leads to normal plasmatic concentrations without side effects. Methods: The current study was a randomized, prospective trial of 150 patients admitted to the Neonatal Intensive Care Unit (NICU) at Maria Sklodowska Curie Emergency Children's Hospital in Bucharest. Patients were divided into three subgroups based on the chronological order of their admission date. Each subgroup received a different pharmaceutical product of vitamin D3. We administered a dosage of 10,000 IU/kg of vitamin D3 orally in three steps, as follows: at admission, one week after admission, and one month from the first administration, targeting a serum 25-hydroxyvitamin D concentration of at least 40 ng/mL. Results: Most neonates (68%) achieved an optimum vitamin D level after one month, even though only 15% of patients had an optimum concentration at admission. After the first high dose of vitamin D3, there was a 27% increase in the mean vitamin D plasmatic level compared to admission levels. However, after one month, the concentrations decreased in all subgroups due to the gap of three weeks between the last two administrations. Conclusions: An intermittent, weekly high-dose vitamin D3 oral administration leads to a steadier increase and normalization of vitamin D concentration in most critically ill neonates. However, high-dose vitamin D3 administered orally after three weeks decreases vitamin D levels in this high-risk population. [ABSTRACT FROM AUTHOR]

This narrative review explores the evolution and implications of robotic-assisted surgery in pediatric and neonatal cases, focusing on its advantages, drawbacks, and the specific diseases amenable to this innovative technology. Following PRISMA guidelines, 56 relevant articles from the past five years were selected, emphasizing advancements in precision, reduced trauma, and expedited recovery times for pediatric patients. Despite challenges like cost and training, ongoing research shapes pediatric robotic-assisted surgery, promising improved outcomes. The technology's benefits include enhanced precision, minimized scarring, and faster recovery, addressing the challenges in delicate pediatric procedures. Challenges encompass cost, training, and instrument design, but ongoing refinements aim to overcome these. This review underscores psychological and musculoskeletal considerations for patients and surgeons. While acknowledging limitations and preferred pathologies, this review outlines the transformative potential of robotic-assisted surgery in reshaping pediatric surgical care. This comprehensive assessment concludes that, despite challenges, ongoing advancements promise a future of enhanced precision and tailored care in pediatric surgery. [ABSTRACT FROM AUTHOR]

Background and Objectives: According to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3), sepsis is defined as "life-threatening organ dysfunction caused by a dysregulated host response to infection". The increased presence of free radicals causes an increase in oxidative stress. Vitamin C is an essential water-soluble vitamin with antioxidant activity and immunoregulatory effects that plays a potential role in the treatment of bacterial infections. Our aim was to evaluate the effectiveness of adding vitamin C to the conventional treatment of sepsis to decrease its mortality rate. Materials and Methods: In a prospective cohort study, we included patients with a diagnosis of sepsis and a SOFA score ≥ 9 who were evaluated in an Intensive Care Unit at a secondary-care hospital. According to the intensive care specialist, they were treated using two different strategies: Group 1—patients with sepsis treated with conventional treatment without vitamin C; Group 2—patients with sepsis with the addition of vitamin C to conventional treatment. Results: We included 34 patients with sepsis. The incidence of mortality was 38%, and 47% of patients used vitamin C as an adjuvant to the basic treatment of sepsis. In the basal analyses, patients treated with use of vitamin C compared to patients treated without vitamin C required less use of glucocorticoids (75% vs. 100%, p = 0.039). At follow-up, patients treated without vitamin C had higher mortality than patients treated with vitamin C as an adjuvant for the treatment of sepsis (55.6% vs. 18.8%, p = 0.03). We observed that the use of vitamin C was a protective factor for mortality in patients with sepsis (RR: 0.54, 95% CI: 0.31–0.96, p = 0.03). Conclusions: The use of vitamin C as an adjuvant to treatment decreases the risk of mortality by 46% in patients with sepsis and SOFA ≥ 9 compared to patients treated without vitamin C as an adjuvant to sepsis. [ABSTRACT FROM AUTHOR]

The role of a prosthodontist in the management of facial cleft patients is the restoration of feeding, respiration, facial harmony, dental harmony and phonation. This case report presents the fabrication of an appliance for a pediatric patient with congenital median facial cleft who had sleep apnea due to the absence of nasal septum, which is a rare condition, with a unique method that fulfilled the patient's needs and improved quality of life. The patient also had median cleft lip and premaxilla along with hypertelorism. [ABSTRACT FROM AUTHOR]

Neonatal diabetes (ND) is a rare subtype of diabetes occurring in the first 6 months of life. High incidence has been reported among populations with high rates of consanguineous marriage. However, there is paucity of reported data from sub-Saharan African countries. We report the incidence, genotype, and phenotype of ND in a large cohort from Sudan and compare these findings to regional and international data. All infants with onset of diabetes in the first 6 months of life, attending one of the only two tertiary pediatric diabetes centers in Sudan, Gaafar Ibn Auf Pediatric Tertiary Hospital and Sudan Childhood Diabetes Center, during the period of January 2006 to December 2022 were included. Medical records were reviewed for demographic and clinical information. Genetic testing was performed for 48 patients by the Exeter Genomics laboratory in the UK and for one patient by the University of Cambridge, Metabolic Research Laboratories, UK. The estimated incidence was 4.8 per 100,000 live births. Forty-nine ND patients from 45 unrelated families were identified, and a genetic diagnosis was confirmed in 37 patients (75.5%) from 33 unrelated families. Consanguinity was reported in 34 families (75.6%). The commonest genetic cause for permanent neonatal diabetes was EIF2AK3 recessive variants causing Wolcott–Rallison syndrome (18.92%). Pathogenic variants in two recently identified genes, ZNF808 and NARS2, were found in three patients each (8.11%). Activating variants in KCNJ11 and ABCC8 were identified in four (10.81%) and two (5.41%) patients, respectively. Apart from hyperglycemia, the commonest clinical presentations included dehydration, failure to thrive, and diabetic ketoacidosis. ND in Sudan has a different pattern of etiologies compared to Western and Asian populations yet similar to some Arab countries with EIF2AK3 mutations being the commonest cause. Pathogenic variants in recently identified genes reflect the impact of genome sequencing on increasing the rate of genetic diagnosis. [ABSTRACT FROM AUTHOR]

Background: Maternal sepsis is the third leading cause of maternal death in the world. Women in resource-limited countries shoulder most of the burdens related to sepsis. Despite the growing risk associated with maternal sepsis, there are limited studies that have tried to assess the impact of maternal sepsis in resource-limited countries. The current study determined the outcomes of maternal sepsis and factors associated with having poor maternal outcomes. Methods: A facility-based retrospective cross-sectional study design was employed to assess the clinical presentation, maternal outcomes, and factors associated with maternal sepsis. The study was conducted in Ayder Comprehensive Specialized Hospital, Tigray, Ethiopia, from January 1, 2017, to December 31, 2021. Sociodemographic characteristics, clinical characteristics and outcomes of women with maternal sepsis were analyzed using a descriptive statistic. The association between dependent and independent variables was determined using multivariate logistic regression. Results: Among 27,350 live births, 298 mothers developed sepsis, giving a rate of 109 maternal sepsis for every 10,000 live births. There were 22 maternal deaths, giving rise to a case fatality rate of 7.4% and a maternal mortality ratio of 75 per 100,000 live births. Admission to the intensive care unit and use of mechanical ventilator were observed in 23.5% and 14.1% of the study participants, respectively. A fourth (24.2%) of the mothers were complicated with septic shock. Overall, 24.2% of women with maternal sepsis had severe maternal outcomes (SMO). Prolonged hospital stay, having parity of two and above, having the lung as the focus of infection, switchof antibiotics, and developing septic shock were significantly associated with SMO. Conclusions: This study revealed that maternal sepsis continues to cause significant morbidity and mortality in resource-limited settings; with a significant number of women experiencing death, intensive care unit admission, and intubation attributable to sepsis. The unavailability of recommended diagnostic modalities and management options has led to the grave outcomes observed in this study. To ward off the effects of infection during pregnancy, labor and postpartum period and to prevent progression to sepsis and septic shock in low-income countries, we recommend that concerted and meticulous efforts should be applied to build the diagnostic capacity of health facilities, to have effective infection prevention and control practice, and to avail recommended diagnostic and management options. [ABSTRACT FROM AUTHOR]

Background: Infective Endocarditis (IE) and Sepsis are two closely related infectious diseases, yet their shared pathogenic mechanisms at the transcriptional level remain unclear. This research gap poses a barrier to the development of refined therapeutic strategies and drug innovation. Methods: This study employed a collaborative approach using both microarray data and single-cell RNA sequencing (scRNA-seq) data to identify biomarkers for IE and Sepsis. It also offered an in-depth analysis of the roles and regulatory patterns of immune cells in these diseases. Results: We successfully identified four key biomarkers correlated with IE and Sepsis, namely CD177, IRAK3, RNASE2, and S100A12. Further investigation revealed the central role of Th1 cells, B cells, T cells, and IL-10, among other immune cells and cytokines, in the pathogenesis of these conditions. Notably, the small molecule drug Matrine exhibited potential therapeutic effects by targeting IL-10. Additionally, we discovered two Sepsis subgroups with distinct inflammatory responses and therapeutic strategies, where CD177 demonstrated significant classification value. The reliability of CD177 as a biomarker was further validated through qRT-PCR experiments. Conclusion: This research not only paves the way for early diagnosis and treatment of IE and Sepsis but also underscores the importance of identifying shared pathogenic mechanisms and novel therapeutic targets at the transcriptional level. Despite limitations in data volume and experimental validation, these preliminary findings add new perspectives to our understanding of these complex diseases. [ABSTRACT FROM AUTHOR]

Aldosterone synthase deficiency (ASD) is a rare autosomal recessive disorder involving isolated aldosterone deficiency without any compromise of other adrenal hormones. This condition manifests mainly in the neonatal period and in infants as a salt wasting syndrome with vomiting and failure to thrive. Due to its potentially life-threatening effects, ASD requires a careful and early diagnosis based on appropriate hormonal investigations in order to initiate adequate management: rehydration as well as salt and fludrocortisone supplementation. Genetic analysis of the CYP11B2 gene will confirm ASD in most cases. We report the case of a newborn with a typical clinical presentation associated with some uncommon phenotypic features (hyperhidrosis, liver injury). Furthermore, our patient carries a new CYP11B2 splicing variant to be added to the approximately 60 pathogenic or likely pathogenic variants already reported. [ABSTRACT FROM AUTHOR]

The role of parents in decision-making concerning their child's end-of-life care is not clearly defined. Their participation is encouraged by ethical reflection, in particular by the CCNE (French National Ethics Advisory Committee), but laws are limited to imposing a duty to provide information to doctors. Decisions are taken at the end of a collegial meeting (CM) intended to better inform the child's referring physician (RP) who is in charge of the final decision following the French law. The aim of this study was to describe the support provided to bereaved families after they had been invited to attend a CM concerning their child, if they so wished. Additional aims were to determine the differences resulting from their acceptance or their refusal to participate as regards their perception of their child's history and as regards their grieving process. We conducted a retrospective study of all CMs held between November 2016 and May 2021, drawing a distinction between proposals made or not made to parents and their decision to accept or refuse. In total, 49 CMs concerning 46 children were held during the study period. The proposal was not made to the parents in three cases; the parents chose to be present in 28 cases. The psychological follow-up (15/28 parents attending, 10/16 parents absent) illustrated that their presence enabled them to reflect on their child's death after having listened to and understood the reasons why it happened. They did not dispute the team's approach or decisions taken. It is possible to include parents in CMs if they so wish. It would appear more beneficial than merely providing them with the information required. Studies must be carried out to ensure potential long-term benefit. [ABSTRACT FROM AUTHOR]

Background: High-frequency ventilation (HFV) is frequently used in critically ill preterm neonates. We aimed to determine the incidence of acute kidney injury (AKI) in neonates less than 29 weeks gestation who received HFV in the first week of life and to determine if the rates of AKI differed in those who received other forms of respiratory support. Methods: This retrospective cohort study of 24 international, level III/IV neonatal intensive care units (NICUs) included neonates less than 29 weeks gestation from the AWAKEN study database. Exclusion criteria included the following: no intravenous fluids ≥ 48 h, admission ≥ 14 days of life, congenital heart disease requiring surgical repair at < 7 days of life, lethal chromosomal anomaly, death within 48 h, severe congenital kidney abnormalities, inability to determine AKI status, insufficient data on ventilation, and when the diagnosis of early AKI was unable to be made. Subjects were grouped into three groups based on ventilation modes (CPAP/no ventilation, conventional ventilation, and HFV). Results: The incidence of AKI was highest in the CPAP/no ventilation group, followed by HFV, followed by conventional ventilation (CPAP/no ventilation 48.5% vs. HFV 42.6% vs. conventional ventilation 28.4% (p = 0.009). An increased risk for AKI was found for those on HFV compared to CPAP/no ventilation (HR = 2.65; 95% CI:1.22–5.73). Conclusions: HFV is associated with AKI in the first week of life. Neonates on HFV should be screened for AKI. The reasons for this association are not clear. Further studies should evaluate the relationship between ventilator strategies and AKI in premature neonates. [ABSTRACT FROM AUTHOR]

Although the diagnosis of sepsis requires the identification of the three components of infection, a systemic inflammation response, and organ dysfunction, there is currently no consensus on gold-standard criteria. There are however suggested tools and tests, which have been proposed in international guidelines, including those produced by the Surviving Sepsis Campaign. Biomarkers play an important role in these tools and tests, and numerous heterogeneous studies have been performed to evaluate their respective clinical utility. Our review of the current practice shows that no biomarkers of infection, systemic inflammation response, organ dysfunction and sepsis are currently specifically recommended, which is probably due to the lack of standardization of studies. We therefore propose to define a framework for conducting clinically relevant translational biomarker research and seek to establish ideal criteria that can be applied to an infection, systemic inflammation response, organ dysfunction and sepsis biomarkers, which can enable early screening of sepsis, diagnosis of sepsis at the time of clinical suspicion and monitoring of sepsis treatment efficacy. [ABSTRACT FROM AUTHOR]

Aims: Bespoke glycaemic control strategies following antenatal corticosteroids for women with diabetes in pregnancy (DIP) may mitigate hyperglycaemia. This study aims to identify predictive factors for the glycaemic response to betamethasone in a large cohort of women with DIP. Methods: Evaluation of a prospective cohort study of 347 consecutive DIP pregnancies receiving two doses of 11.4 mg betamethasone 24 h apart between 2017 and 2021 and treated with the Pregnancy‐IVI intravenous insulin protocol. Regression modelling identified factors associated with maternal glycaemic time‐in‐range (TIR) and maternal insulin requirements following betamethasone. Factors associated with neonatal hypoglycaemia (glucose <2.6 mmol/L) in infants born within 48 h of betamethasone administration (n = 144) were investigated. Results: The mean maternal age was 31.9 ± 5.8 years, with gestational age at betamethasone of 33.5 ± 3.4 weeks. Gestational diabetes was present in 81% (12% type 1; 7% type 2). Pre‐admission subcutaneous insulin was prescribed for 63%. On‐infusion maternal glucose TIR (4.0–7.8 mmol/L) was 83% [IQR 77%–90%] and mean on‐IVI glucose was 6.6 ± 0.5 mmol/L. Maternal hypoglycaemia (<3.8 mmol/L) was uncommon (0.47 h/100 on‐IVI woman hours). Maternal glucose TIR was negatively associated with indicators of insulin resistance (type 2 diabetes, polycystic ovary syndrome), late‐pregnancy complications (pre‐eclampsia, chorioamnionitis) and the 1‐h OGTT result. Intravenous insulin requirements were associated with type of diabetes, pre‐eclampsia and intrauterine infection, the 1‐h OGTT result and the timing of betamethasone administration. Neonatal hypoglycaemia was associated with pre‐existing diabetes but not with measures of glycaemic control. Conclusion: An intravenous infusion protocol effectively controls maternal glucose after betamethasone. A risk‐factor‐based approach may allow individualisation of therapy. [ABSTRACT FROM AUTHOR]

Background and Aims: Neonatal diseases are a significant threat to global public health, affecting the homeostasis and well‐being of patients and reflecting the status of, and challenges to, regional, national, and global healthcare systems. This study sought to investigate how the disease spectrum observed among neonatal inpatients changed after the onset of the coronavirus disease 2019 (COVID‐19) pandemic. Methods: The present hospital‐based retrospective study analyzed the demographic and clinical characteristics of 19,943 hospitalized newborns from January 2018 to December 2022 using data derived from pediatric department registers. Results: According to the International Classification of Diseases 11th Revision (ICD‐11) classification criteria, the two most common neonatal disorders during this study period were "Certain conditions originating in the perinatal period" and "Disease of the respiratory system." Following the start of the COVID‐19 pandemic (2020 onwards), the number of neonatal patients declined markedly (5742 per year vs. 2820 per year), and the incidence of "Disease of the respiratory system" was significantly lower than in 2018–2019 (25.72% vs. 17.46%). Conclusion: The study offers detailed insights into the shifts in neonatal disease patterns at the Seventh Medical Center of the PLA General Hospital following the onset of the COVID‐19 pandemic, providing a foundation for future research and policymaking efforts. Key messages: The disease spectrum observed among neonatal inpatients has changed markedly after the onset of the coronavirus disease 2019 (COVID‐19) pandemic. The study also analyzed changes in the disease spectrum among neonatal inpatients before and after lifting COVID‐19 lockdown measures. The epidemiological characterization of neonatal diseases can enhance understanding of their pathophysiological basis and aid in identifying disease‐related risk factors among professionals. These findings offer a valuable foundation for formulating health policies. [ABSTRACT FROM AUTHOR]

Rural dwellers explore Bryophyllumpinnatum and Rauvolfiavomitoria for treating neonatal infections. The antibacterial activities of medicinal plant biofractions were evaluated against multidrug-resistant Group B Streptococcus (GBS) strains causing neonatal sepsis. Pulverized plant leaves were extracted with different solvents for primary extraction and subjected to column chromatography and phytochemical analysis. A broth microdilution assay to determine the minimal inhibitory concentration (MIC) and minimal bactericidal concentration (MBC) was performed against multidrug-resistant GBS strains. Duplex polymerase chain reaction (PCR) was employed to detect ermB and tetO-resistant genes in 10 different GBS strains that were resistant to both erythromycin and tetracycline. The data obtained was analyzed using Spearman rank correlation and ANOVA. The results obtained from this study showed that the selected plants have concentration-dependent activity against GBS. The ethanol biofraction of R. vomitoria was the most active, with an MIC value between 12.5 mg/mL and 50 mg/mL and an MBC value between 25 mg/mL and 50 mg/mL. It was followed by the methanol biofraction of B. pinnatum, which had an MIC value between 50 mg/mL and 100 mg/mL on 32 of the 35 strains that were studied. The N-hexane and aqueous biofractions were the least active. Also, ermB and tetO genes were present in all 10 GBS strains. These findings indicate that B. pinnatum and R. vomitoria could serve as potential alternatives for treating neonatal sepsis caused by GBS. This study examined the assertion of the effectiveness of medicinal herbs in treating newborn sepsis. [ABSTRACT FROM AUTHOR]

Sepsis is a disease caused by multiple microbial infections resulting in multiple organ failure. Schistosoma japonicum secreted cystatin (Sj-Cys) is a strong immunomodulator that stimulates M2 macrophages and alleviates inflammatory damage caused by sepsis. To determine whether the therapeutic effect of Sj-Cys on sepsis can be conveyed by the exosomes released by Sj-Cys-stimulated macrophages, RAW264.7 macrophages were stimulated with rSj-Cys in vitro, the exosomes were obtained from the cell culture supernatant by ultracentrifugation. Sepsis was induced in BALB/c mice by cecal ligation and puncture (CLP). The septic mice were treated with exosomes derived from Sj-Cys-treated macrophages. The treatment effect of exosomes on sepsis was assessed by examining the survival rate of mice up to 72 hr and measuring serum levels of inflammatory cytokines, liver/kidney damage biomarkers, and observing pathological changes in tissue sections. The tissue levels of M1, M2 macrophage surface markers, and TRL2/MyD88 were measured to explore possible mechanisms. Results. Exosomes derived from Sj-Cys-treated macrophages exhibited significant therapeutic effect on CLP-induced sepsis in mice with prolonged survival rate and less damage of critical organs by downregulating the proinflammatory factors TNF-α and IL-6 and upregulating the anti-inflammatory factor TGF-β. The therapeutic effect of exosomes is associated with macrophage polarization from M1 to M2 in the infected tissues via downregulating TRL2/MyD88 inflammatory pathway. Conclusions. Exosomes derived from Sj-Cys-treated macrophages attenuated sepsis in mice through promoting macrophage polarization from M1 to M2 and reducing inflammatory responses, possibly via downregulating TLR2/MyD88 inflammatory signaling pathway. This offers new approaches for immunotherapy of sepsis. [ABSTRACT FROM AUTHOR]

Background: Extracorporeal membrane oxygenation (ECMO) has been widely used in severe neonatal diseases for approximately 50 years, while few studies have concentrated on the long-term follow-up of its neuropsychological development. Objective: To assess the long-term neuropsychological complications in children who underwent ECMO in infancy. Methods: The PubMed, Web of Science, Cochrane, and EMBASE databases were searched for retrieving studies published in the recent 10 years (until June 10, 2022). All studies were eligible that concentrated on the long-term follow-up of neuropsychological complications in neonates undergoing ECMO. Excluding animal studies, neonates with congenital craniocerebral dysplasia and studies with data from the same center performed at different times. Statistical analysis was performed using RevMan 5.3 and Stata/SE 12.0 software. A random-effects model was used to report results. The sensitivity analysis was utilized to identify sources of heterogeneity. Results: The meta-analysis of 10 studies that enrolled 1199 patients was conducted, showing the pooled morbidity of intelligence (pooled morbidity: 20.3%, 95% CI: 0.16-0.25, I2: 9.5%, P=0.33), motor activity (pooled morbidity: 10.3%, 95%CI: 0.07-0.14, I2: 43.5%, P=0.15), learning (pooled morbidity: 9.0%, 95%CI: -0.03-0.21, I2: 63.2%, P=0.10), hearing (pooled morbidity: 15.7%, 95%CI: 0.02-0.29, I2: 94.2%, P=0.00), vision (pooled morbidity: 18.5%, 95%CI: 0.12-0.25, I2: 0%, P=0.46), cognition (pooled morbidity: 26.3%, 95%CI: 0.19-0.34, I2: 0%, P=0.32), attention (pooled morbidity: 7.4%, 95%CI: 0.02-0.13, I2: 38.9%, P=0.20), speed in attention (pooled morbidity: 69.9%, 95%CI: 0.62-0.78), and accuracy in attention (pooled morbidity: 39.0%, 95%CI: 0.30-0.48) in neonates undergoing ECMO. The results of the Begg's test and sensitivity analysis indicated that the heterogeneity was originated from factors other than sample size. Conclusion: This systematic review and meta-analysis showed that neonates undergoing ECMO were associated with various neuropsychological complications. Additional randomized controlled trials (RCTs) with a larger sample size and a higher quality are needed. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to identify a panel of biomarkers for distinguishing early stage sepsis patients from non-infected trauma patients. Background: Accurate differentiation between trauma-induced sterile inflammation and real infective sepsis poses a complex life-threatening medical challenge because of their common symptoms albeit diverging clinical implications, namely different therapies. The timely and accurate identification of sepsis in trauma patients is therefore vital to ensure prompt and tailored medical interventions (provision of adequate antimicrobial agents and if possible eradication of infective foci) that can ultimately lead to improved therapeutic management and patient outcome. The adequate withholding of antimicrobials in trauma patients without sepsis is also important in aspects of both patient and environmental perspective. Methods: In this proof-of-concept study, we employed advanced technologies, including Matrix-Assisted Laser Desorption/Ionization (MALDI) and multiplex antibody arrays (MAA) to identify a panel of biomarkers distinguishing actual sepsis from trauma-induced sterile inflammation. Results: By comparing patient groups (controls, infected and non-infected trauma and septic shock patients undermechanical ventilation) at different time points, we uncovered distinct protein patterns associated with early trauma-induced sterile inflammation on the one hand and sepsis on the other hand. SYT13 and IL1F10 emerged as potential early sepsis biomarkers, while reduced levels of A2M were indicative of both trauma-induced inflammation and sepsis conditions. Additionally, higher levels of TREM1 were associated at a later stage in trauma patients. Furthermore, enrichment analyses revealed differences in the inflammatory response between trauma-induced inflammation and sepsis, with proteins related to complement and coagulation cascades being elevated whereas proteins relevant to focal adhesion were diminished in sepsis. Conclusions: Our findings, therefore, suggest that a combination of biomarkers is needed for the development of novel diagnostic approaches deciphering trauma-induced sterile inflammation from actual infective sepsis. [ABSTRACT FROM AUTHOR]

Backgrounds: In children with sepsis, circulatory shock and multi-organ failure remain major contributors to mortality. Prolonged capillary refill time (PCRT) is a clinical tool associated with disease severity and tissue hypoperfusion. Microcirculation assessment with videomicroscopy represents a promising candidate for assessing and improving hemodynamic management strategies in children with sepsis. Particularly when there is loss of coherence between the macro and microcirculation (hemodynamic incoherence). We sought to evaluate the association between PCRT and microcirculation changes in sepsis. Methods: This was a prospective cohort study in children hospitalized with sepsis. Microcirculation was measured using sublingual video microscopy (capillary density and flow and perfused boundary region [PBR]—a parameter inversely proportional to vascular endothelial glycocalyx thickness), phalangeal tissue perfusion, and endothelial activation and glycocalyx injury biomarkers. The primary outcome was the association between PCRT and microcirculation changes. Results: A total of 132 children with sepsis were included, with a median age of two years (IQR 0.6–12.2). PCRT was associated with increased glycocalyx degradation (PBR 2.21 vs. 2.08 microns; aOR 2.65, 95% CI 1.09–6.34; p = 0.02) and fewer 4–6 micron capillaries recruited (p = 0.03), with no changes in the percentage of capillary blood volume (p = 0.13). Patients with hemodynamic incoherence had more PBR abnormalities (78.4% vs. 60.8%; aOR 2.58, 95% CI 1.06–6.29; p = 0.03) and the persistence of these abnormalities after six hours was associated with higher mortality (16.5% vs. 6.1%; p < 0.01). Children with an elevated arterio-venous CO2 difference (DCO2) had an abnormal PBR (aOR 1.13, 95% CI 1.01–1.26; p = 0.03) and a lower density of small capillaries (p < 0.05). Prolonged capillary refill time predicted an abnormal PBR (AUROC 0.81, 95% CI 0.64–0.98; p = 0.03) and relative percentage of blood in the capillaries (AUROC 0.82, 95% CI 0.58–1.00; p = 0.03) on admission. A normal CRT at 24 h predicted a shorter hospital stay (aOR 0.96, 95% CI 0.94–0.99; p < 0.05). Conclusions: We found an association between PCRT and microcirculation changes in children with sepsis. These patients had fewer small capillaries recruited and more endothelial glycocalyx degradation. This leads to nonperfused capillaries, affecting oxygen delivery to the tissues. These disorders were associated with hemodynamic incoherence and worse clinical outcomes when the CRT continued to be abnormal 24 h after admission. [ABSTRACT FROM AUTHOR]

Background: Congenital cytomegalovirus (CMV) infection is the leading cause of hearing loss and neurocognitive delay among children. Affected infants may be asymptomatic at birth and even pass their universal hearing screen. Early identification of CMV-infected infants will allow earlier detection, evaluation and management. The prevalence of congenital CMV infection in the developed world varies geographically from 0.6% to 0.7% of all deliveries and certain regions are at higher risk. The prevalence of congenital CMV is unknown for our region. Aim: The purpose of this study was to determine the prevalence of CMV infection among the neonatal population at an urban, tertiary hospital in northeast Florida which serves a large population of patients with low socioeconomic status to assess if universal screening program for congenital asymptomatic CMV infection can be determined. Methods: The study was submitted and approved by our Institutional Review Board. We tested the urine for CMV infection in 100 asymptomatic newborns (>32 weeks gestational age and >1,750 g weight at the time of delivery) delivered between June 2016 and July 2017. Results: Urine CMV was tested on 100 infants. One infant had a positive urine NAAT for CMV, making the prevalence of congenital CMV infection among asymptomatic newborns in our hospitals' population 1%. Conclusion: CMV prevalence in our setting of an urban, tertiary hospital is relatively consistent with the national average of all congenital CMV infections. A policy of universal screening for congenital CMV may be necessary. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a life-threatening condition caused by an excessive inflammatory response to an infection, associated with high mortality. However, the regulatory mechanism of sepsis remains unclear. Results: In this study, bioinformatics analysis revealed the novel key biomarkers associated with sepsis and potential regulators. Three public datasets (GSE28750, GSE57065 and GSE95233) were employed to recognize the differentially expressed genes (DEGs). Taking the intersection of DEGs from these three datasets, GO and KEGG pathway enrichment analysis revealed 537 shared DEGs and their biological functions and pathways. These genes were mainly enriched in T cell activation, differentiation, lymphocyte differentiation, mononuclear cell differentiation, and regulation of T cell activation based on GO analysis. Further, pathway enrichment analysis revealed that these DEGs were significantly enriched in Th1, Th2 and Th17 cell differentiation. Additionally, five hub immune-related genes (CD3E, HLA-DRA, IL2RB, ITK and LAT) were identified from the protein–protein interaction network, and sepsis patients with higher expression of hub genes had a better prognosis. Besides, 14 drugs targeting these five hub related genes were revealed on the basis of the DrugBank database, which proved advantageous for treating immune-related diseases. Conclusions: These results strengthen the new understanding of sepsis development and provide a fresh perspective into discriminating the candidate biomarkers for predicting sepsis as well as identifying new drugs for treating sepsis. [ABSTRACT FROM AUTHOR]

Background: Sepsis is one of the main causes of morbidity and mortality in the intensive care units (ICUs). It is difficult to differentiate it accurately and timely from other confusing conditions. So, it is of utmost importance to evaluate new biomarkers with a differentiation ability between sepsis and nonsepsis conditions. Soluble urokinase-type plasminogen activator receptor (suPAR) is a stable biomarker of inflammation. The aim of the study is to evaluate the value of suPAR in the diagnosis of septic ICU patients and to compare it (if present) with that of Creactive protein (CRP) and procalcitonin (PCT). Methods: A case-control study was conducted at Zagazig University Hospitals from December 2017 to October 2019. A total of 90 subjects were enrolled in the study. Based on Systemic Inflammatory Response Syndrome (SIRS) criteria, they were divided into 2 groups: (i)Group A: 60 septic ICU admitted patients;(ii)Group B: 30 non-septic ICU admitted patients as control group. Single determination of level of serum suPAR was measured by enzyme-linked immunosorbent assay (ELISA) for all the participants. Results: Septic ICU patients had statistically significant higher serum suPAR, CRP and PCT levels than non-septic patients. suPAR had a sensitivity of 72%, specificity of 70% and AUC of 0.7 in sepsis diagnosis. Conclusion: Serum suPAR is a fair diagnostic test for septic ICU patients at cut-off 3.983 ng/ml but does not surpass that of PCT or CRP. [ABSTRACT FROM AUTHOR]

Background: Sepsis-associated acute kidney injury (S-AKI) is a critical illness and is often associated with high morbidity and mortality rates. The soluble urokinase-type plasminogen activator receptor (suPAR) is an important immune mediator and is involved in kidney injury. However, its diagnostic value in S-AKI patients remains unclear. Therefore, we assessed the early predictive value of suPAR for S-AKI patients. Methods: We prospectively enrolled adult patients, immediately after fulfilling the sepsis-3 criteria. Plasma suPAR levels at 0-, 12-, 24-, and 48-h post-sepsis diagnosis were measured. S-AKI development was the primary outcome. S-AKI risk factors were analyzed using logistic regression, and the value of plasma suPAR for early S-AKI diagnosis was assessed using receiver operating characteristic (ROC) curves. Results: Of 179 sepsis patients, 63 (35.2%) developed AKI during hospitalization. At 12-, 24-, and 48-h post-sepsis diagnosis, plasma suPAR levels were significantly higher in patients with S-AKI than in patients without S-AKI (p < 0.05). The plasma suPAR had the highest area under the ROC curve of 0.700 (95% confidence interval (CI), 0.621–0.779) at 24-h post-sepsis diagnosis, at which the best discrimination ability for S-AKI was achieved with suPAR of ≥6.31ng/mL (sensitivity 61.9% and specificity 71.6%). Logistic regression analysis showed that suPAR at 24-h post-sepsis diagnosis remained an independent S-AKI risk factor after adjusting for mechanical ventilation, blood urea nitrogen, and pH. Conclusions: The findings suggest that plasma suPAR may be a potential biomarker for early S-AKI diagnosis. [ABSTRACT FROM AUTHOR]

Simple Summary: Congenital tumors are an uncommon finding on prenatal ultrasound and in the first 3 months of life, and they are (almost) always subjected to magnetic resonance imaging. Although they are usually easy to recognize as pathological masses, differential diagnosis is not easy and includes both benign and malignant conditions. Teratomas are the most frequent group of inborn neoplasms, followed by cardiac rhabdomyomas. In this paper, the authors show a series of cases in order to provide tips to identify the more common masses and to keep in mind that the most unusual tumor may occur as congenital and that no diagnosis should be rejected a priori. The article is intended to raise awareness and draw attention to this little-known group of cancers and facilitate the diagnostic process. Congenital tumors are rare and, owing to this rarity, there is limited information on many of them. A total of 839 fetal and postnatal MRI studies performed in the first 3 months of life were retrospectively reviewed. They were performed with the use of 1.5 T scanners. Seventy-six tumors were diagnosed based on fetal MRI between 20 and 37 gestational weeks, and 27 were found after birth, from 1 day of age to 3 months of life. Teratomas were the most common tumors in our dataset, mainly in the sacrococcygeal region (SCT), followed by cardiac rhabdomyomas and subependymal giant cell astrocytomas (SEGA) associated with TSC, and neuroblastomas. The group of less common tumors consisted of infantile fibrosarcomas, malignant rhabdoid tumors, mesoblastic nephromas and Wilms tumor, craniopharyngiomas, brain stem gliomas, desmoplastic infantile astrocytoma, choroid plexus carcinoma, glioblastoma, hemangiopericytoma, rhabdomyosarcoma, melanoma, mesenchymal hamartomas of the chest wall and the liver, and juvenile xanthogranuloma, with special consideration of blue rubber bleb nevus syndrome. MRI plays a significant role in further and better characterization of congenital tumors, leading to a correct diagnosis in many cases, which is crucial for pregnancy and neonatal management and psychological preparation of the parents. No diagnosis is impossible and can be absolutely excluded. [ABSTRACT FROM AUTHOR]

Background: Infection is a challenge in intensive care units (ICUs), causing high mortality and morbidity. Early diagnosis and prediction is useful in improving management strategies of Adult patients. This study aimed at assessing the accuracy of presepsin for diagnosis of sepsis among adults. Methods: This study was conducted on ninety-six patents within ICUs of Internal Medicine hospital Zagazig University from December 2019 and May 2020. All patients were assessed physically with quick SOFA score, laboratory investigations including serum presepsin level. Results: Age of patients ranged from 19 to 60 years with median 56.5 years and male represented 54.2%. Positive blood culture was found in 75% of patients; out of them, 66.7%, 22.2% and 11.1% had infection, sepsis and septic shock respectively. About 57% and 24% had pneumonia and urinary tract infection respectively. Median C reactive protein (CRP) and procalcitonin were 62.5% and 1.7% respectively. Presepsin significantly positively correlated with procalcitonin and C reactive protein(p<0.05). It significantly negatively correlated with platelet count(p<0.05). There is significant association between serum presepsin and disease severity, with highest level in septic shock followed by sepsis(p<0.05). The best cutoff of serum presepsin in diagnosis of infection was =1.95 mg/mL with sensitivity 80% and specificity 71% while at cutoff =2.4 mg/mL, it can predict sepsis, sensitivity 78.3% and specificity 69%.Presepsincutoff =7.9 mg/mL can predict septic shock with sensitivity 90% and specificity 92%. Conclusions: Presepsin is a promising marker for diagnosis of infection and sepsis with capability for differentiating between sepsis severity groups. [ABSTRACT FROM AUTHOR]