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Early diagnosis and effective management of Primary immunodeficiency diseases (PIDs), particularly severe combined immunodeficiency (SCID), play a crucial role in minimizing associated morbidities and mortality. Newborn screening (NBS) serves as a valuable tool in facilitating these efforts. Timely detection and diagnosis are essential for swiftly implementing isolation measures and ensuring prompt referral for definitive treatment, such as allogeneic hematopoietic stem cell transplantation. The utilization of comprehensive protocols and screening assays, including T cell receptor excision circles (TREC) and kappa-deleting recombination excision circles (KREC), is essential in facilitating early diagnosis of SCID and other PIDs, but their successful application requires clinical expertise and proper implementation strategy. Unfortunately, a notable challenge arises from insufficient funding for the treatment of PIDs. To address these issues, a collaborative approach is imperative, involving advancements in technology, a well-functioning healthcare system, and active engagement from stakeholders. The integration of these elements is essential for overcoming the existing challenges in NBS for PIDs. By fostering synergy between technology providers, healthcare professionals, and governmental stakeholders, we can enhance the efficiency and effectiveness of early diagnosis and intervention, ultimately improving outcomes for individuals with PIDs. [ABSTRACT FROM AUTHOR]

Objective Design Setting Population Methods Main Outcome Measures Results Conclusions To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies.Cross‐sectional survey.International.Clinicians involved in the management of MCDA twin pregnancies with sFGR.A structured, self‐administered survey.Clinical practices and attitudes to diagnostic criteria and management strategies.Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter‐twin EFW discordance of >25% for the diagnosis of sFGR. For early‐onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early‐onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early‐onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early‐onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide.There is significant variation in clinician practices and attitudes towards the management of early‐onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high‐level evidence to guide management. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to explore the clinical effects of music therapy (MT) on premature infants in neonatal intensive care units (NICUs). Methods: A total of 78 premature infants in NICUs admitted from January 2021 to January 2022 in Wuhan Children's Hospital, Tongji Medical College, and Huazhong University of Science and Technology were selected as the reference group and received routine management. Wuhan Children's Hospital implemented MT from February 2022 to February 2023, and 74 premature infants in NICUs admitted during the same period were selected as the observation group. The corresponding management mode was implemented on the second day of NICU admission for premature infants. Amplitude-integrated electroencephalogram (aEEG) and neonatal behavioral neurological assessment (NBNA) were adopted to evaluate the brain function, specifically the neurological function of neonates, after the end of management. The degree of parent–child attachment was measured using the pictorial representation of attachment measure (PRAM) in a nonverbal (visual) manner. The temperature, pulse, respiratory rate (RR), the number and duration of crying, and incidence of complications were all compared between the two groups. Results: SPSS showed that no difference existed in the aEEG and NBNA scores between the two groups (P > 0.05). The distance of PRAM self-baby-distance was smaller in the observation group compared with the reference group (P < 0.05). Furthermore, there was no significant difference in temperature between the two groups (P > 0.05). The observation group had significantly lower pulse and RR values than the reference group (P < 0.05). Finally, no significant difference existed in the incidence of complications between the two groups (P > 0.05). Conclusion: MT has a certain application value for premature infants in NICUs and can thus be applied to newborns in other NICUs. However, further studies are required to completely verify the research results. [ABSTRACT FROM AUTHOR]

Objectives: Our aim is to estimate the long-term neurological sequelae and prognosis in term neonatal asphyxia treated with hypothermia via volumetric apparent diffusion coefficient (ADC) map histogram analysis (HA). Methods: Brain MRI studies of 83 term neonates with asphyxia who received whole-body hypothermia treatment and examined between postnatal (PN) fourth and sixth days were retrospectively re-evaluated by 2 radiologists. Volumetric HA was performed for the areas frequently affected in deep and superficial asphyxia (thalamus, lentiform nucleus, posterior limb of internal capsule, corpus callosum forceps major, and perirolandic cortex-subcortical white matter) on ADC map. The quantitative ADC values were obtained separately for each region. Qualitative-visual (conventional) MRI findings were also re-evaluated. Neonates were examined neurodevelopmentally according to the Revised Brunet-Lezine scale. The distinguishability of long-term neurodevelopmental outcomes was statistically investigated. Results: With HA, the adverse neurodevelopmental outcomes could only be distinguished from mild-moderated impairment and normal development at the thalamus with 10th percentile ADC (P = .02 and P = .03, respectively) and ADCmin (P = .03 and P = .04, respectively). Also with the conventional MRI findings, adverse outcome could be distinguished from mild-moderated impairment (P = .04) and normal development (P = .04) via cytotoxic oedema of the thalamus, corpus striatum, and diffuse cerebral cortical. Conclusion: The long-term adverse neurodevelopmental outcomes in newborns with asphyxia who received whole-body hypothermia treatment can be estimated similarly with volumetric ADC-HA and the conventional assessment of the ADC map. Advances in knowledge: This study compares early MRI ADC-HA with neurological sequelae in term newborns with asphyxia who received whole-body hypothermia treatment. We could not find any significant difference in predicting adverse neurological sequelae between the visual-qualitative evaluation of the ADC map and HA. [ABSTRACT FROM AUTHOR]

• Complications can be observed with umbilical venous catheterization (UVC), especially in a stressful context. To limit complications, reading a cognitive aid could improve the performances. • In a prospective simulation study, reading a cognitive aid for UVC placement in the delivery room during neonatal resuscitation improved prevention of air embolism and limited complications such as asepsis errors. Neonatal resuscitation may require urgent umbilical venous catheter (UVC) placement. Complications can be observed with umbilical venous catheterization, especially in a stressful context. Inspired by the aeronautic environment, medical routine checklists, also called "cognitive aids," secure the equipment and environment for the patients once they are admitted to the operating room. We hypothesized that reading a cognitive aid for UVC placement in the delivery room during neonatal resuscitation simulation scenarios can (a) improve the performance in reducing catheterization duration and (b) can limit complications. This was a prospective single-center randomized study. A total of 23 dyads for a simulation scenario were included: 12 in the control group and 11 in the cognitive aid group. In the cognitive aid group, the cognitive aid was read by the same facilitator for every scenario. No significant difference concerning the duration of the procedure was identified between the cognitive aid and control groups: 412 s [342; 420] vs. 374 s [338;402], respectively (p = 0.781). Nevertheless, there were significantly fewer deviations from hygiene guidelines and improved prevention of air embolism in the cognitive aid group compared with the control group. The UVC insertion time was similar between the control and cognitive aid groups. Moreover, cognitive aid can limit infectious complications or air embolism by allowing caregivers to follow UVC placement standards. [ABSTRACT FROM AUTHOR]

Summary: Maternal obesity and gestational diabetes mellitus (GDM) prevalence are increasing, with both conditions associated with adverse neonatal outcomes. This review aimed to determine the risk of adverse outcomes in women with obesity and GDM, compared with women with obesity alone. A systematic search identified 28 eligible articles. Meta‐analysis was conducted using a random effects model, to generate pooled estimates (odds ratios, OR, or mean difference, MD). Compared with normal‐weight controls, women with obesity had increased risks of large for gestational age (LGA, OR 1.98, 95% CI: 1.56, 2.52) and macrosomia (OR 2.93, 95% CI: 1.71, 5.03); the latter's risk almost double in women with obesity than GDM. Birth weight (MD 113 g, 95% CI: 69, 156) and shoulder dystocia (OR 1.23, 95% CI: 0.85, 1.78) risk was also higher. GDM significantly amplified neonatal risk in women with obesity, with a three‐ to four‐fold risk of LGA (OR 3.22, 95% CI: 2.17, 4.79) and macrosomia (OR 3.71, 95% CI: 2.76, 4.98), as well as higher birth weights (MD 176 g, 95% CI: 89, 263), preterm delivery (OR 1.49, 95% CI: 1.25, 1.77), and shoulder dystocia (OR 1.99, 95% CI: 1.31, 3.03), when compared with normal‐weight controls. Our findings demonstrate that maternal obesity increases serious neonatal adverse risk, magnified by the presence of GDM. Effective strategies are needed to safeguard against neonatal complications associated with maternal obesity, regardless of GDM status. [ABSTRACT FROM AUTHOR]

Background: Carbapenemase-producing Enterobacterales (CPE) are a group of Gram-negative bacteria causing global concern due to their resistance to carbapenems. In this report, we detail the learning points from a CPE outbreak in a tertiary neonatal unit (NU) in the UK. Methods: Routine surveillance screening (rectal swabs) of babies on the NU identified a potential cluster of CPE carriage. Samples were sent to a reference laboratory for confirmatory testing. Environmental screening and cot mapping were undertaken to determine movements of babies within the unit. Regular audits of cleaning standards, hand hygiene, and maternal hygiene when expressing breast milk were carried out. Results: The outbreak lasted 19 weeks. During the outbreak, there were 360 admissions, with 11 babies being colonised with the outbreak strain. Once the outbreak was declared, there were enhanced Infection Prevention and Control (IPC) precautions (including increased environmental and equipment cleaning frequency). CPE screening frequency was increased and cot capacity was reduced. Hand hygiene compliance improved from 92% at the start of the outbreak to 100% by its close. Cleaning standards remained compliant. Maternal hygiene standards varied from 78% to 100%, but no cross-infection links were identified. Environmental screening was negative. No route of cross-infection was identified. Notably, no babies developed invasive CPE infection. Conclusion: This is the first report of a CPE outbreak in a UK NU. Although no specific mode of cross-transmission was identified and the outbreak's end cannot be attributed to any single intervention, the bundle of interventions proved successful after a 5-month period. [ABSTRACT FROM AUTHOR]

Congenital tracheo-esophageal fistula/esophageal atresia (TEF/EA) with concomitant pulmonary agenesis is exceedingly rare and has a high mortality rate. While there are several reported cases of successful repair, all but one patient had right-sided pulmonary agenesis. In the case of left-sided pulmonary agenesis, the patient had incomplete agenesis and underwent repair through a left thoracotomy. We present the first successful repair of TEF/EA with complete left-sided pulmonary agenesis. This patient also underwent elective pre-operative veno-venous extracorporeal membrane oxygenation (ECMO) and subsequent repair of the TEF/EA. We discuss the management, anesthesia risks, and role of periprocedural ECMO in pediatric patients who are high anesthetic risk. [ABSTRACT FROM AUTHOR]

An accurate diagnosis of early-onset sepsis (EOS) is challenging because of subtle symptoms and the lack of a good diagnostic tool, resulting in considerable antibiotic overtreatment. A biomarker, discriminating between infected and non-infected newborns at an early stage of the disease, could improve EOS prediction. Numerous biomarkers have been tested, but have never been compared directly. We aimed to provide a comprehensive overview of early biomarkers and their diagnostic value in maternal samples, umbilical cord blood, and neonatal serum. PubMed-Medline, EMBASE, The Cochrane Library, and Web of Science were searched up to 1 March 2023, without restrictions on publication date, population, or language. Articles describing the diagnostic value of at least one biomarker in the detection of EOS in neonates, independent of gestational age, were included. The QUADAS-2 tool was used to assess study quality. Three independent researchers assessed the articles using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Meta-analysis was performed with all manuscripts describing diagnostic accuracy using a random-effects model. Of 2296 identified articles, 171 reports were included in the systematic review and 69 in the meta-analysis. Literature showed mixed and inconsistent evidence for most biomarkers and sample types, because of a lack of a uniform EOS case definition, small sample sizes, and large heterogeneity between studies. Interesting markers were procalcitonin (pooled sensitivity 79%, 95% CI 71–84%; specificity 91%, 95% CI 83–96%, n = 11) and interleukin (IL)-6 (pooled sensitivity 83%, 95% CI 71–90%; specificity 87%, 95% CI 78–93%, n = 8) in umbilical cord blood and presepsin (pooled sensitivity 82%, 95% CI 62–93%; specificity 86%, 95% CI 73–93%, n = 3) and serum amyloid A (pooled sensitivity 92%, 95% CI 75–98%; specificity 96%, 95% CI 78–99%, n = 4) in neonatal serum. Studies on the combination of biomarkers were scarce. A biomarker stand-alone test is currently not reliable for direct antibiotic stewardship in newborns, although several biomarkers show promising initial results. Further research into biomarker combinations could lead to an improved EOS diagnosis, reduce antibiotic overtreatment, and prevent associated health-related problems. [ABSTRACT FROM AUTHOR]

Background: Neonatal health assessment is crucial for detecting and intervening in various disorders. Traditional gene expression analysis methods often require invasive procedures during sample collection, which may not be feasible or ideal for preterm infants. In recent years, saliva has emerged as a promising noninvasive biofluid for assessing gene expression. Another trend that has been growing is the use of "omics" technologies such as transcriptomics in the analysis of gene expression. The costs for carrying out these analyses and the difficulty of analysis make the detection of candidate genes necessary. These genes act as biomarkers for the maturation stages of the oral feeding issue. Methodology: Salivary samples (n = 225) were prospectively collected from 45 preterm (<34 gestational age) infants from five predefined feeding stages and submitted to RT-qPCR. A better description of the targeted genes and results from RT-qPCR analyses were included. The six genes previously identified as predictive of feeding success were tested. The genes are AMPK, FOXP2, WNT3, NPHP4, NPY2R, and PLXNA1, along with two reference genes: GAPDH and 18S. RT-qPCR amplification enabled the analysis of the gene expression of AMPK, FOXP2, WNT3, NPHP4, NPY2R, and PLXNA1 in neonatal saliva. Expression results were correlated with the feeding status during sample collection. Conclusions: In summary, the genes AMPK, FOXP2, WNT3, NPHP4, NPY2R, and PLXNA1 play critical roles in regulating oral feeding and the development of premature infants. Understanding the influence of these genes can provide valuable insights for improving nutritional care and support the development of these vulnerable babies. Evidence suggests that saliva-based gene expression analysis in newborns holds great promise for early detection and monitoring of disease and understanding developmental processes. More research and standardization of protocols are needed to fully explore the potential of saliva as a noninvasive biomarker in neonatal care. [ABSTRACT FROM AUTHOR]

Most newborns are born vigorous and do not require resuscitation. However, the World Health Organization has estimated that 10% of all newborn infants need some intervention at birth and approximately 0.5% will require cardiopulmonary resuscitation. Frequently, the need for resuscitation may be anticipated based on maternal and obstetric history, but this is not always the case and therefore anyone involved in the delivery of newborn infants should be trained in resuscitation. [ABSTRACT FROM AUTHOR]

Trauma accounts for nearly half of all deaths of pregnant women. Pregnant women have distinct physiologic and anatomic characteristics which complicate their management following major trauma. This paper comprises a narrative review of the most recent literature informing the management of pregnant trauma patients. The incidence of trauma during pregnancy is 6–8%. The focus of clinical assessment must be on the mother, starting with the primary survey. During airway management, clinicians should consider early intubation if necessary and utilize gastric tubes to minimize the risk of aspiration. Pregnant women experience progesterone-mediated hyperventilation, and normal PaCO2 levels may portend imminent respiratory failure. Clinicians should utilize left lateral tilt in hypotensive pregnant women to displace the uterus off the inferior vena cava. Ultrasonography is an attractive imaging modality for pregnant women which is specific for ruling in intraabdominal hemorrhage but not sufficiently sensitive to exclude this diagnosis. Clinicians should not hesitate to order computed tomography imaging in unstable patients if there is diagnostic ambiguity. Cardiotocographic monitoring simultaneously assesses uterine contractions and fetal heart rate and should last at least 4 h for pregnant women following even minor abdominal trauma if their fetus has achieved viable gestational age (approximately 24 weeks). In the event of cardiac arrest, peri-mortem cesarean section may improve outcomes for the mother and fetus alike. Unique specific complications include uterine rupture and placental abruption, which require emergent resuscitation and obstetrics consultation for definitive management. Emergency clinicians should maintain a low threshold for transfer to a tertiary care center given correlations between even isolated and relatively minor traumatic injuries with adverse fetal and maternal outcomes. Trauma is a common cause of morbidity and mortality in pregnant women. Emergency clinicians must understand the evaluation and management of pregnant trauma patients. [ABSTRACT FROM AUTHOR]

This paper aims to describe the investigation and control of an outbreak of USA300 ST8 Panton–Valentine leucocidin (PVL)-positive meticillin-resistant Staphylococcus aureus (MRSA), confirmed by whole genome sequencing (WGS), within a maternity and neonatal setting in the UK. The identification of two linked PVL-MRSA cases led to an outbreak investigation. A lookback exercise conducted using the infection control surveillance database, typing of saved MRSA isolates, enhanced patient screening, and staff screening were used to identify further cases. Environmental screening was also performed. Genetic relatedness between isolates was assessed by WGS. During the outbreak, 18 cases were identified between 11th July 2021 and 22nd December 2022: 10 cases were infections and eight cases were colonizations. A healthcare worker (HCW) tested positive for colonization with the same strain, and environmental swabbing identified contaminated information technology equipment in the hospital. The outbreak was brought to an end by exclusion of the colonized HCW from work, and infection prevention and control measures. Since the end of the outbreak, cases of PVL-MRSA with similar molecular profiles have been found in the community. It is likely that the HCW played a role in the transmission of PVL-MRSA. Their exclusion from work and decolonization were key to preventing further cases. WGS was valuable in identifying and linking cases. The identification of community cases of PVL-MRSA with similar molecular profiles confirms transmission of the organism outside of healthcare settings. [ABSTRACT FROM AUTHOR]

Background: Bacterial infections are the leading cause of death in newborns. The growing resistance of bacteria to antibiotics is a major concern. In this study, we identified isolates from blood cultures in the neonatal intensive care unit (NICU) of a major referral hospital in Shiraz in southwest Iran and determined antibiotic resistance patterns. Methods: All newborns admitted to the NICU were evaluated in a four-year study. The blood samples were cultured using a BACTEC system. From May 2015 to March 2020, 5937 blood culture samples were analyzed. The antibacterial sensitivity test was conducted using the disk diffusion method, following the guidelines of Clinical & Laboratory Standards Institute (CLSI) 2018. Results: In this study, 507 isolates were obtained from 5937 specimens. The most commonly isolated gram-negative bacteria were Acinetobacter (8.7%), Escherichia coli (5.7%), Klebsiella (1.6%), Enterobacter (1.4%), and Pseudomonas (0.9%). Among the gram-positive bacteria, coagulase-positive staphylococci (51.1%), coagulase-negative staphylococci (15.4%), Staphylococcus epidermidis (10.2%), non-hemolytic streptococci (2.4%), alpha-hemolytic streptococci (1.4%), and Streptococcus pneumonia (1.3%) were the most frequently isolated bacteria. Of the 318 Staphylococcus aureus isolates, 88.5% were resistant to methicillin. Conclusion: Staphylococcus, with a high frequency in the NICU, can be an alarm for medical centers. Also, in dead infants, the most observed bacterial infection was Acinetobacter infection, which requires the serious attention of the hospital infection control unit. [ABSTRACT FROM AUTHOR]

A neurological condition known as autism spectrum disorder (ASD) first manifests before the age of 3. Numerous factors may have an impact on the development of autism; however, its precise causes are yet unknown. The research aims to identify certain risk factors that associate with children at a higher risk of developing autism. This study is a descriptive analysis of 80 children who were identified as being at risk for autism and meeting the requirements of the Modified Checklist for Autism in Toddlers at the community health center. A semistructured proforma was used to collect the baseline data from the mother and the child. Through the use of a thoughtfully created checklist, each child enrolled in the study had a thorough history completed, including the suspected prenatal, intranatal, neonatal, and infant risk factors with the help of their mothers. Descriptive statistics with frequency percentages were adopted for the demographic data of the participants. To find the association between possible risk factors and at-risk cases of ASD, an independent t -test was used. Fisher's exact test and Pearson's chi-squared test (p = 0.05, confidence interval = 95%) were used to find how the risks (odds ratios) of the factors studied affect the incidence of ASD. It was discovered that prenatal risk factors, such as pregnancy-related infections and medication use, were statistically significantly linked to an increased risk for autism. Significant intranatal risk factors for autism risk included a breech presentation, cesarean section, forced labor, and resuscitation at birth. Similar to this, the neonatal risk factors included maternal hemorrhage, Rh or ABO incompatibility, birth injuries, and feeding problems. Poor socioeconomic status and seizures were the baby risk variables, both of which were statistically significant and linked to an increased chance of autism. The results of the study support an array of perinatal, intranatal, neonatal, and infant risk factors linked to the likelihood of developing autism. [ABSTRACT FROM AUTHOR]

Background Modern advanced technologies in the neonatal intensive care unit (NICU) have created more noise sources of varying frequencies and intensities, increasing the risk of hearing loss in infants. This study aimed to determine the effect of earmuffs on neonatal behavior. Materials and Methods This study was conducted in the 13-bed level III-A NICU of a 1,000-bed tertiary care teaching hospital. Preexperimental, one-group pretest, posttest design was adopted in the study. Twenty-seven neonates were selected using nonprobability and purposive sampling techniques. The noise level was checked using a dosimeter (sound level meter SL-4030), the baseline variables were collected, and earmuffs were applied to the neonates for 2 hours in the morning and 2 hours in the evening for 3 consecutive days. An observational checklist was used to assess neonatal behavior. Results The mean age in days was 2.19 ± 0.96, the mean weight in kilograms was 2.92 ± 0.43, and the mean gestational week was 37.56 ± 1.50. The mean sound level in the NICU was 56.7 + 14, which was higher than the NICU's recommended noise level. The most noise-generating events and equipment found in NICU were human-made noise and ventilator bubbling sounds. There was a significant difference in the mean behavioral score among neonates using earmuffs, as the " p -value was < 0.05." However, there was no association between pretest neonatal behavior with baseline data (p > 0.05). Conclusion This study revealed that wearing earmuffs had a beneficial impact on enhancing newborn behavior. [ABSTRACT FROM AUTHOR]

Aim: The Prognostic Nutritional Index (PNI) is a novel inflammation biomarker that reflects the nutritional and inflammatory status of patients. While there are studies on its use in cancer, cardiovascular, and renal diseases, there are no studies on preterm neonatal late sepsis. This study aims to emphasize the value of PNI in neonatal sepsis. Materials and Methods: Newborns with a birth weight of less than 1500 grams and a gestational age of less than 32 weeks, along with healthy controls, were included in the study. The ability of PNI to predict sepsis, septic shock, and mortality was evaluated. Results: PNI was an independent and inversely related parameter to the presence and severity of neonatal sepsis. The cut-off value of PNI to predict the presence of sepsis was =49.5, with a sensitivity of 98.3% (95% CI: 91.1-100.0) and a specificity of 96% (95% CI: 86.3-99.5). The area under the curve (AUC) was 0.995 (95% CI: 0.957-1.000) (p<0.001). The optimum cut-off value of PNI to predict the presence of septic shock was =37.1, with a sensitivity of 92.3% (95% CI: 64.0-99.8) and a specificity of 77.3% (95% CI: 67.7-85.2). The AUC was 0.894 (95% CI: 0.821-0.945) (p<0.001). The optimum cut-off value of PNI to predict mortality was =37, with a sensitivity of 92.3% (95% CI: 64.0-99.8) and a specificity of 78.4% (95% CI: 68.8-86.1). The AUC was 0.899 (95% CI: 0.827-0.948) (p<0.001). Conclusion: PNI can be used as an independent dynamic biomarker to predict the presence and prognosis of neonatal sepsis. [ABSTRACT FROM AUTHOR]

Diagnosing and treating newborn seizures accurately and promptly is crucial for providing the best possible care for these patients. For the purpose of intelligently identifying newborn seizures, this work introduced a unique method that uses spectral and spatial graph neural networks (SSGNNs) optimized with the Aquila algorithm. Using electroencephalogram (EEG) recordings, the suggested methodology takes advantage of the complex spatial and spectral characteristics of infant brain activity. Spatial and spectral GNNs were used to extract significant spatiotemporal patterns suggestive of seizure episodes by organizing the brain activity data as a graph, with nodes representing various brain regions and edges signifying functional relationships. By combining spectral and spatial data, the depiction of newborn brain dynamics was improved and made it possible to distinguish between seizure and non-seizure phases with greater accuracy. Moreover, the introduction of the Aquila algorithm improved the GNNs’ performance in seizure identification tasks by streamlining the training process. A large dataset of EEG recordings from newborns with and without seizures was used to assess the effectiveness of the suggested method. Higher accuracy, sensitivity, and specificity in seizure detection were achieved in the experimental results, which showed greater performance when compared to conventional methods. This work offered an automated, data-driven method for identifying newborn seizures, which is a major development in the treatment of newborns. By combining spectral and spatial GNNs and optimizing the results using the Aquila method, it is possible to enhance seizure detection accuracy and potentially prevent neurological consequences in affected children by intervening early. This method has the potential to completely change the way neonatal care is provided by giving medical professionals a strong tool for accurate and prompt seizure monitoring in neonatal intensive care units (NICU). [ABSTRACT FROM AUTHOR]

The goal of this investigation was to identify the association between Syndecan-1 (S1) serum levels in preterm newborns exposed to chorioamnionitis (CA) in utero and the potential of S1 as a biomarker of early-onset neonatal sepsis. A cohort of preterm newborns born <33 weeks gestational age was recruited. Within 48 hours of birth, 0.5 mL of blood was drawn to obtain S1 levels, measured via ELISA. Placentas were examined and classified as having (1) no CA, (2) CA without umbilical cord involvement, or (3) CA with inflammation of the umbilical cord (funisitis). S1 levels were compared between preterm newborns without exposure to CA verus newborns with exposure to CA (including with and without funisitis). Preterm newborns exposed to CA were found to have significantly elevated S1 levels compared to those unexposed. Although S1 levels could not differentiate fetal exposure to CA from exposure to CA with funisitis, the combined CA groups had significantly higher S1 levels compared to those not exposed to CA. S1 level has the potential to become a clinically useful biomarker that could assist in the management of mothers and preterm newborns with CA and funisitis. Furthermore, S1 level could aid in the diagnosis and treatment of early-onset neonatal sepsis. [ABSTRACT FROM AUTHOR]

Background Aims Study Design Results Conclusion Relevance to Clinical Practice Very and extremely preterm infants (VEPIs) experience sensory deprivation in the neonatal intensive care unit (NICU). While various sensory‐supported interventions might improve immediate physiological response, their impact on long‐term development remains unclear. Additionally, these interventions may pose challenges in the NICU environment due to complex treatments and monitoring requirements.This review aimed to understand the current evidence on sensory‐supported interventions in the NICU, identify the components of these interventions and determine their effects on the VEPIs.A systematic search across nine electronic databases (PubMed, EBSCO, EMBASE, Web of Science, Scopus, Cochrane, Cochrane trial, IEEE Xplore DL and ACM DL) was conducted in December 2020 and updated in September 2022. The search gathers information on sensory‐supported interventions for VEPIs in the NICU.The search yielded 23 systematic reviews and 22 interventional studies, categorized into auditory (19), tactile/kinesthetic (5), positional/movement support (7), visual (1) and multisensory (13) interventions. While unimodal and multimodal interventions showed short‐term benefits, their long‐term effects on VEPIs are indeterminate. Translating these findings into clinical practice remains a challenge due to identified gaps.Our reviews indicate that sensory‐supported interventions have a transient impact, with intervention studies reporting positive effects. Future research should develop and test comprehensive, continuous multisensory interventions tailored for the early NICU stage.Multimodal sensory interventions show promise for VEPIs, but long‐term effects need further study. Standardizing protocols for NICU integration and parental involvement is crucial. Ongoing research and collaboration are essential for optimizing interventions and personalized care. [ABSTRACT FROM AUTHOR]

Background: Epigenetic scores (EpiScores), reflecting DNA methylation (DNAm)-based surrogates for complex traits, have been developed for multiple circulating proteins. EpiScores for pro-inflammatory proteins, such as C-reactive protein (DNAm CRP), are associated with brain health and cognition in adults and with inflammatory comorbidities of preterm birth in neonates. Social disadvantage can become embedded in child development through inflammation, and deprivation is overrepresented in preterm infants. We tested the hypotheses that preterm birth and socioeconomic status (SES) are associated with alterations in a set of EpiScores enriched for inflammation-associated proteins. Results: In total, 104 protein EpiScores were derived from saliva samples of 332 neonates born at gestational age (GA) 22.14 to 42.14 weeks. Saliva sampling was between 36.57 and 47.14 weeks. Forty-three (41%) EpiScores were associated with low GA at birth (standardised estimates |0.14 to 0.88|, Bonferroni-adjusted p-value < 8.3 × 10−3). These included EpiScores for chemokines, growth factors, proteins involved in neurogenesis and vascular development, cell membrane proteins and receptors, and other immune proteins. Three EpiScores were associated with SES, or the interaction between birth GA and SES: afamin, intercellular adhesion molecule 5, and hepatocyte growth factor-like protein (standardised estimates |0.06 to 0.13|, Bonferroni-adjusted p-value < 8.3 × 10−3). In a preterm subgroup (n = 217, median [range] GA 29.29 weeks [22.14 to 33.0 weeks]), SES–EpiScore associations did not remain statistically significant after adjustment for sepsis, bronchopulmonary dysplasia, necrotising enterocolitis, and histological chorioamnionitis. Conclusions: Low birth GA is substantially associated with a set of EpiScores. The set was enriched for inflammatory proteins, providing new insights into immune dysregulation in preterm infants. SES had fewer associations with EpiScores; these tended to have small effect sizes and were not statistically significant after adjusting for inflammatory comorbidities. This suggests that inflammation is unlikely to be the primary axis through which SES becomes embedded in the development of preterm infants in the neonatal period. [ABSTRACT FROM AUTHOR]

Background: Phytobacter diazotrophicus (P. diazotrophicus) is an opportunistic pathogen that causes nosocomial outbreaks and sepsis. However, there are no reports of P. diazotrophicus isolated from human blood in China. Case presentation: A 27-day-old female infant was admitted to our hospital with fever and high bilirubin levels. The clinical features included jaundice, abnormal coagulation, cholestasis, fever, convulsions, weak muscle tension, sucking weakness, ascites, abnormal tyrosine metabolism, cerebral oedema, abnormal liver function, clavicle fracture, and haemolytic anaemia. The strain isolated from the patient's blood was identified as P. diazotrophicus by whole-genome sequencing (WGS). Galactosemia type 1 (GALAC1) was diagnosed using whole-exome sequencing (WES). Based on drug sensitivity results, 10 days of anti-infective treatment with meropenem combined with lactose-free milk powder improved symptoms. Conclusion: P. diazotrophicus was successfully identified in a patient with neonatal sepsis combined with galactosemia. Galactosemia may be an important factor in neonatal sepsis. This case further expands our understanding of the clinical characteristics of GALAC1. [ABSTRACT FROM AUTHOR]

Background: Playing Tetris is a relatively new concept when considering how to treat or prevent post-traumatic stress symptoms (PTSS). Benefits have been identified regarding how playing the game can influence traumatic memory processing and storage. However, the concept is under-explored and can potentially help populations who are at risk of and are known to experience post-traumatic stress, such as parents of preterm infants in the Neonatal Unit. The aim of the review was to establish if preterm parents playing Tetris was a feasible option to potentially minimise PTSS. Method: A scoping review was conducted using PRISMA-ScR guidance. Databases searched were Cinahl, Medline and PsychInfo, over a 20 year period (2003-2023). Titles and abstracts were screened before analysis of full-text articles. A variety of clinical and experimental studies were examined, with differing trauma exposure experienced by participants. Results: Thirteen articles were reviewed and four common themes identified. These were memory consolidation, playing Tetris and its effect on intrusive memories (IMs), the effect on the brain and the acceptability as a technique to minimize PTSS in clinical trials. Conclusion: Tetris, in theory, is a first-aid intervention and has the potential to minimise the impact of trauma. Based on the findings of the review, Tetris has been effective in other clinical areas and deemed acceptable by participants. Therefore, Tetris is worthy of consideration for use in the population of preterm parents. [ABSTRACT FROM AUTHOR]

AbstractThis scoping review aimed to synthesize the analytical techniques used and methodological limitations encountered when undertaking secondary research using residual neonatal dried blood spot (DBS) samples. Studies that used residual neonatal DBS samples for secondary research (i.e. research not related to newborn screening for inherited genetic and metabolic disorders) were identified from six electronic databases: Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Medline, PubMed and Scopus. Inclusion was restricted to studies published from 1973 and written in or translated into English that reported the storage, extraction and testing of neonatal DBS samples. Sixty-seven studies were eligible for inclusion. Included studies were predominantly methodological in nature and measured various analytes, including nucleic acids, proteins, metabolites, environmental pollutants, markers of prenatal substance use and medications. Neonatal DBS samples were stored over a range of temperatures (ambient temperature, cold storage or frozen) and durations (two weeks to 40.5 years), both of which impacted the recovery of some analytes, particularly amino acids, antibodies and environmental pollutants. The size of DBS sample used and potential contamination were also cited as methodological limitations. Residual neonatal DBS samples retained by newborn screening programs are a promising resource for secondary research purposes, with many studies reporting the successful measurement of analytes even from neonatal DBS samples stored for long periods of time in suboptimal temperatures and conditions. [ABSTRACT FROM AUTHOR]

Neonatal pulmonary hemorrhage is a late manifestation of various diseases. Premature delivery and low body weight are frequently observed as high-risk factors, characterized by acute onset, rapid progression, and high mortality rates. Pulmonary hemorrhage caused by cytomegalovirus infection in newborns with normal immune function is a rare occurrence. This case report focuses on a term neonate with normal birth weight who presented solely with nasal obstruction shortly after birth. However, 4 days after birth, the newborn experienced a sudden onset of blood gushing from both the mouth and nasal cavity. The patient was diagnosed with gastrointestinal bleeding, neonatal pneumonia and neonatal lung consolidation. And he was discharged after ten days of symptomatic treatment. However, upon returning home, the patient experienced a sudden onset of bleeding from the mouth and nose, leading to his untimely demise. Subsequent autopsy revealed the presence of pulmonary hemorrhage in newborn, which presented as interstitial pneumonia. The cause of pulmonary hemorrhage is cytomegalovirus infection. This case emphasizes the importance of pediatricians enhancing their skills in differentiating pulmonary hemorrhage, especially from cytomegalovirus pneumonia. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal jaundice is a significant problem that occurs in 80% of premature infants and 30-60% of term infants in the first week of life. About 6-10% of these cases develop severe hyperbilirubinemia in need of treatment (bilirubin level above 90% of age per hour ), and 5-36% of healthy full-term neonates who are discharged from the hospital are readmitted due to moderate to severe hyperbilirubin. Treatments for jaundice include phototherapy and blood exchange transfusions. Percutaneous phototherapy by photoisomerization reduces blood bilirubin. However, it is expensive, and due to the necessity of hospitalization and the eyes being covered, it disrupts the relationship between the mother and the child. Furthermore, the power of phototherapy to reduce bilirubin levels above 20 is not so high. Methods: The infants at the neonatal intensive care units (NICUs) of Imam Reza (AS) and Samen Al-Aimeh hospitals, Mashhad, Iran, were selected for this study after receiving approval from the Research Council of Mashhad University of Medical Sciences, informing the infants' parents, and obtaining their informed consent. Phenobarbital complications were explained to the parents of infants weighing more than 2.5 kg before admission, and adjustments were made based on gestational age. Infants were randomly assigned to either the phenobarbital (case) or the placebo (control) group. Routine laboratory tests for jaundice were performed for all infants. After that, phototherapy and medications were administered. Bilirubin levels were checked every 6, 12, 24, and 48 h after medication, and at discharge. The collected data were analyzed using SPSS software (version 16). The results are considered with 80% power, a 95% confidence interval, and a 5% significance level. Results: This study was performed on 80 jaundiced infants who were referred to Imam Reza (AS) and Samen Al-Aimeh hospitals, Mashhad, Iran, for treatment and were transferred to the NICU. According to the results, 45% of infants in the study group and 52.2% of the total number of them were male, but the difference was not significantly significant (P>0.05). There was also no significant difference in infants' gestational age, weight, or the age of hospitalization. The mean and standard deviation of bilirubin levels before and after the intervention were not significantly different between the two groups after 6, 12, 24, and 48 h and at discharge time. Despite the significant difference, the length of hospital stay could not be studied due to the absence of exact hospitalization and discharge hours, as well as measurement errors. Conclusion: This double-blind clinical trial study aimed to determine the effect of a single dose of 20 mg/kg of phenobarbital on healthy full-term infants who were breastfed and had symptomatic bilirubin levels in need of phototherapy. Overall, 80 full-term neonates with nonhemolytic hyperbilirubinemia were studied in two groups. The treatment in the case group included phototherapy and phenobarbital, while the control group only received phototherapy. The inclusion and exclusion criteria were considered for each infant, and the study was started after parents' informed consent was obtained. Phototherapy with 20 mg/kg phenobarbital was prescribed for the case group, while phototherapy alone was performed for the control group. After that, the bilirubin levels of both groups were checked every 6, 12, 24, and 48 h, and at the time of discharge. Decreased bilirubin was observed every 6, 12, 24, and 48 h, as well as at the time of discharge in the case group. In neonates with jaundice, phototherapy with a single dose of phenobarbital (20 mg) did not reduce bilirubin levels or the length of hospital stay. [ABSTRACT FROM AUTHOR]

In September 2023, 58 psychological professionals from across the UK and Republic of Ireland convened for an 'Unconference' event in Birmingham to strengthen their developing community of practice in paediatric and neonatal critical care settings. This article describes the origins, purpose, format, content and evaluation of the Unconference, providing a map for groups to follow when organising such events in the future including helpful routes to take and pitfalls to avoid. [ABSTRACT FROM AUTHOR]

Background: Exchange transfusion (ET) is an effective treatment for acute bilirubin encephalopathy and extreme neonatal hyperbilirubinemia (ENH). It can reduce mortality and morbidity. This study aimed to investigate the trends and risk factors of ENH requiring ET in hospitalized neonates in Iran. Methods: A retrospective analysis of medical records of neonates who underwent ET due to ENH was conducted from 2011 to 2021, in Shiraz, Iran. Clinical records were used to gather demographic and laboratory data. The quantitative data were expressed as mean±SD, and qualitative data was presented as frequency and percentage. P<0.05 was considered statistically significant. Results: During the study, 377 ETs were performed for 329 patients. The annual rate of ET decreased by 71.2% during the study period. The most common risk factor of ENH was glucose-6-phosphate dehydrogenase (G6PD) deficiency (35%), followed by prematurity (13.06%), ABO hemolytic disease (7.6%), sepsis (6.4%), Rh hemolytic disease (6.08%), and minor blood group incompatibility (3.34%). In 28.52% of the cases, the cause of ENH was not identified. 17 (5.1%) neonates had acute bilirubin encephalopathy, of whom 6 (35.29%) had G6PD deficiency, 6 (35.29%) had ABO incompatibility, and 2 (11.76%) had Rh incompatibility. Conclusion: Although the rate of ET occurrence has decreased, it seems necessary to consider different risk factors and appropriate guidelines for early identification and management of neonates at risk of ENH should be developed. The findings of the study highlighted the important risk factors of ENH in southern Iran, allowing for the development of appropriate prevention strategies. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate hematological and cardiac changes after early (ECC) versus delayed cord clamping (DCC) in preterm infants at 24–34 weeks of gestation. Methods: Ninety-six healthy pregnant women were assigned randomly to the ECC (< 10 s postpartum, n = 49) or DCC (45–60 s postpartum, n = 47). Primary endpoint was evaluation of neonatal hemoglobin, hematocrit and bilirrubin levels within the first 7 days after birth. A postpartum blood test was performed in the mother and a neonatal echocardiography in the first week of life. Results: We found differences in hematological parameters during the first week of life. On admission, the DCC group had higher hemoglobin levels than the ECC group (18.7 ± 3.0 vs. 16.8 ± 2.4, p < 0.0014) and higher hematocrit values (53.9 ± 8.0 vs. 48.8 ± 6.4, p < 0.0011). Around day 7 of life, hemoglobin levels were also higher in the DCC group compared with the ECC group (16.4 ± 3.8 vs 13.9 ± 2.5, p < 0.005), as was the hematocrit (49.3 ± 12.7 vs 41.2 ± 8.4, p < 0.0087). The need of transfusion was lower in the DCC compared to the ECC (8.5% vs 24.5%; OR: 0.29, 95% CI: 0.09–0.97, p < 0.036). The need for phototherapy was also higher in the DCC (80.9% vs 63.3%; OR: 0.23, 95% CI: 0.06–0.84, p < 0.026). No differences in cardiac parameters or maternal blood tests. Conclusion: DCC improved neonatal hematological parameters. No changes in cardiac function were found and maternal blood loss did not increase to require transfusion. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To understand the importance of recognising postnatal depression in fathers • To identify fathers’ barriers to, and motivators for, seeking support for postnatal depression • To consider how healthcare services could better support fathers experiencing postnatal depression. Background: Many men tend to avoid seeking support for mental health issues and little is known about help-seeking among fathers who experience postnatal depression. Aim: To explore fathers’ help-seeking for postnatal depression, including barriers and motivators, and their experiences of informal support from partners and formal support from healthcare professionals. Method: Data were obtained through individual semi-structured interviews with eight fathers who self-identified as having experienced postnatal depression. Data were analysed using interpretative phenomenological analysis. Findings: Five themes emerged from the data analysis: not recognising postnatal depression; fatherhood expectations restricting postnatal depression disclosure; disappointment at the medicalised response to help-seeking; health visitors as a feared profession which excludes fathers; needing communication, validation and a safe space to talk. Conclusion: Some fathers need professional support for their mental health after the birth of their child. Nurses and health visitors should routinely ask fathers about their mental well-being, validate their feelings and encourage them to discuss their mental health issues with a healthcare professional. [ABSTRACT FROM AUTHOR]

Aim: To develop a nurse‐led model of analgesia to manage post‐operative pain in the surgical neonate. Design: A four‐round e‐Delphi study was conducted from March to December 2022. Methods: An e‐Delphi method was used seeking a consensus of 70% or greater. Fifty‐one experts were invited to join the panel. Members consisted of multi‐disciplinary healthcare professionals who work in areas associated with neonatal care. In round 1, 49 statements relative to neonatal pain assessment and management were distributed to the panel. Panel members were asked to rate their level of agreeance on a Likert scale from 1 to 5 (1 = strongly disagree to 5 = strongly agree). Ratings equal to or greater than 4 represented agreement, 3 indicated uncertainty and 2 or less disagreement with the proposed statement. An opportunity for free‐text responses after each statement was provided. This iterative process continued for three rounds. In the fourth and final round, the completed model of neonatal nurse‐controlled analgesia was presented along with a further opportunity to provide feedback on the final version. Results: Four rounds of statements and voting were required to reach consensus on a model of neonatal nurse‐controlled analgesia. The model consists of criteria for use, over‐arching guidelines and three separate pathways based on an individual baby's pain assessment scores, need for pain relieving interventions and time‐lapsed post‐surgical procedure. Conclusion: A comprehensive model of neonatal nurse‐controlled analgesia, applicable to the Australasian context, was developed in collaboration with a group of neonatal experts. Impact: This study provides a multi‐modal family‐integrated model to manage neonatal post‐operative pain. By providing nurses with increased autonomy to assess and manage acute pain, this model has the potential to not only provide a more responsive and individualized approach to alleviate discomfort, but highlights the integral role of parent partnerships in the neonatal intensive care. Reporting Method: This study was reported in line with the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies. Patient or Public Contribution: No patient or public contribution was utilized for this study. [ABSTRACT FROM AUTHOR]

For neonatal pups, parenteral anaesthesia is said to be not reliable as low doses induce no anaesthesia whereas high doses render high mortality rates. In this work we have adapted parenteral anaesthesia procedures approved for pups >7 days of age, to anaesthetize neonatal animals (postnatal days 3–4; P3–P4) for keeping them immobile for a long period. In our first experiment we analysed the behaviour of P3–P4 mouse pups for 70 min after intraperitoneal administration of low (37.5/3.75 mg/kg) or high (50/5) doses of a ketamine/xylazine anaesthetic mixture, both in the low range as compared with dosages employed in adults. Pups became immobile in ≈7 min and remained immobile for ≈45 min, irrespective of the age and dose of anaesthesia, younger pups (P3) being apparently more sensitive to the dosage. In the second experiment, we studied the response of P3 pups to mildly nociceptive stimulations, performed with a 4.0 g von Frey filament applied to the dorsal aspect of their paws. These stimuli elicited reaction in 100% of the cases in non-anaesthetized pups. The results indicate that the high dose significantly reduced responses as compared with the low dose of anaesthesia. With the low dose, <40% of the pups were unresponsive to nociceptive stimulation, whereas the high dose resulted in 50–60% of the animals not responding. Mortality was low irrespective of age or dose, suggesting that doses can be further increased if needed for invasive experimental procedures. [ABSTRACT FROM AUTHOR]

Background: Targeted neonatal echocardiography (TNE) and hemodynamic consultation have typically been performed by physicians. The Stollery Children's Hospital neonatal intensive care unit (NICU) expanded their TNE training program to include neonatal nurse practitioners (NNPs), the first in North America. Purpose: This study examines the thoughts and perceptions of clinicians about the incorporation of NNPs providing TNE and hemodynamic consultation and investigates key facilitators and challenges for consideration when planning future training, expansion of service in Edmonton, or beyond. Methods: In this descriptive study using qualitative methodology, purposive sampling was used to invite NICU clinicians to participate. Using a semistructured topic guide, a focus group and 2 individual interviews were conducted. Results: Participants were supportive of NNPs. Advantages included increased access to service, acquisition and retention of skills, provision of patient-centered care, and leveraged interpersonal relationships in the decision-making process. Key aspects of program expansion included climate and culture of the NICU, presence of adequate patient volume, and resources to support training. Implications for Practice and Research: Support across disciplines and the collaborative working nature of the NICU are key factors in the success of the program's development and implementation. Benefits of having NNPs on the TNE team were clearly expressed. Benefits to the health system included rapid access to hemodynamic information allowing for care based on specific pathophysiology and additional local capacity to perform TNE and reducing demand on other trained providers. Additional research could consider parental views of NNPs performing TNE and hemodynamic consultation as well as the accuracy of diagnosis between the NNPs and physician group. [ABSTRACT FROM AUTHOR]

Background: Late preterm births account for a large portion of preterm births, yet the optimal method of nutrition and enteral feeding in this population remains unclear and often involves intravenous (IV) fluids. Purpose: To develop and implement a late preterm feeding protocol in order to decrease the necessity of IV access, decrease the use of starter parenteral nutrition (PN), and reduce the pain endured by an infant in the neonatal intensive care unit. Methods: The Plan-Do-Study-Act quality improvement model was utilized as a framework for the implementation of this quality improvement project. A literature review was conducted and subsequently, a feeding protocol was developed and included the more judicious use of starter PN. This protocol was implemented, evaluated, and adopted. A second Plan-Do-Study-Act cycle was completed with the addition of an auto-text reminder incorporated into admission notes in the electronic medical record. Results: The implementation of the protocol significantly reduced placement of IV access and the use of starter (PN) in late preterm infants without considerable differences in balancing measures. The percentage of infants who received peripheral IV access declined considerably from 70% to 42% (P = .0017) subsequently, less pain endured by the infants. There was a decrease in the initiation of starter PN from 55% to 7% (P < .00001). Implications for Practice and Research: Administering enteral feedings on admission to stable, late preterm infants, reduced the need for peripheral IV access and thus decreased pain from this procedure. More research needs to be done to determine the optimal amount of feedings to administer in the first 24 hours of life for the late preterm infant as well as the best method for supplementation if necessary. [ABSTRACT FROM AUTHOR]

Background: The Chandler Regional Medical Center (CRMC) neonatal intensive care unit (NICU) began a phased implementation of Eat-Sleep-Console (ESC) for the management of those at risk for neonatal opioid withdrawal syndrome (NOWS). Purpose: The purpose of this initiative is to track short-term outcomes as well as the program's effect on nursing workflow and job performance rating/satisfaction. Methods: A retrospective review of the ESC implementation process at CRMC from the years 2018-2020. The study consisted of 3 epochs: (1) traditional pharmacologic management; (2) parent-led ESC management; and (3) parent/nurse-led ESC management. Length of stay (LOS), treatment pathway assignment, and proportion of infants treated with pharmacologic agents were compared between epochs. In addition, a survey of NICU nursing staff was distributed to measure nurses' perceptions and attitudes towards the ESC program and the management of infants with NOWS. Results: The proportion of infants treated via ESC increased (0%, 53%, and 100%), with an associated decrease in LOS (18.4, 10.5, and 9.3 days) during each epoch of the study period. Thirty-seven nurses completed the survey, with 94% of nurses reporting being comfortable caring for ESC patients and 89% feeling supported in their ESC nursing assignments, with only 11% stating that caring for ESC patients significantly alters their other nursing care processes. Implications for Practice and Research: Implementation of an ESC treatment program for infants with NOWS significantly decreased LOS and the proportion of infants treated pharmacologically. This phased implementation process was not associated with self-reported negative nursing perceptions of the program and its treatment goals/outcomes. [ABSTRACT FROM AUTHOR]

Background: Despite proven benefit, pediatric subspecialists often have not been offered formal serious illness communication skills training. We sought to: 1) develop and evaluate the impact of a communication skills course, based on the VitalTalk framework, on Neonatal Intensive Care Unit (NICU) clinicians; 2) evaluate provider comfort with key serious illness communication skills and frequency of use of those skills, before and after "NeoTalk" and; 3) explore differences and similarities between adult and pediatric serious illness communication skills courses. Methods: We developed a NICU specific communication skills course and surveyed course participants to evaluate comfort with key communication skills before and after course participation, and frequency of use of key skills before and 2 months after our course. Wilcoxon signed rank tests and Kruskal-Wallis tests were performed to compare participant responses across time points. Results: 34 providers completed NeoTalk training. Complete pre- and post-course data was available for 29 participants. Participants reported increased comfort with skills including 'sharing difficult news' (P =.018), and 'responding to emotion' (P =.002). Participants did not report increased frequency in using target skills 2 months after training. Conclusions: A multi-disciplinary cohort of NICU providers endorsed increased confidence in key communication skills but not increased skill application 2-months post-course completion. While a single course can successfully teach skills, additional exposure may be necessary to build new communication habits. Our experience developing NeoTalk helped elucidate some of the ways in which conversations about seriously ill infants may be different from conversations about seriously ill adults. [ABSTRACT FROM AUTHOR]

Objective: Abnormal localization of the placenta with complete or partial closure of the cervix is called placenta previa. Placenta previa occurs in approximately 0.3-0.5% of pregnancies. In this study, we aimed to determine the risk factors and adverse fetal outcomes by comparing the neonatal outcomes of patients who underwent cesarean section for placenta previa with those of patients who underwent cesarean section for other indications. Method: Patients with singleton pregnancies diagnosed with placenta previa were retrospectively analyzed. Placenta previa, risk factors, and adverse neonatal outcomes were estimated using multivariate logistic regression models. Results: A total of 61,110 deliveries were analyzed, and 632 deliveries (288 patients, 344 controls) were included in the study. The prevalence of placenta previa was 0.47%. Advanced maternal age [odds ratio (OR)=3.03], multigravida (≥5) (OR=2.31), previous abortion (OR=1.58) and curettage (OR=2.32) were significant risk factors for placenta previa. However, these patients had an increased risk of 1st minute Apgar score <7 (OR=1.59) and neonatal intensive care unit (NICU) admission (OR=2.15). At the same time, the risk of Apgar score <7 at 1 min (OR=5.59) and 5 min (OR=3.94) and NICU admission (OR=28.47) increased in infants of patients with placenta previa <34 weeks. Newborns in the >37 weeks gestational age group with placenta previa were more likely to have a lower birth weight (OR=4.21) and an Apgar score <7 at 5 min (OR=1.89). Conclusion: Pregnancies with a diagnosis of placenta previa were associated with an increased risk of serious fetal outcomes compared with cesarean deliveries for all other indications, regardless of delivery timing. [ABSTRACT FROM AUTHOR]

The effects of preterm birth, neonatal morbidities and environmental influences on infant sleep development is an important yet under-researched topic, with little known about normative sleep for infants born sick or preterm. The aim of this prospective, observational longitudinal study was to evaluate maternal perceptions and degree of bother with infant sleep behaviours and feeding outcomes across the first 9 months after discharge for sick/preterm infants cared for in the neonatal intensive care unit (NICU) and for healthy term-born infants. This paper reports outcomes for the sick/preterm cohort (I = 94) that were recruited from two NICUs in Perth, Western Australia. Total bother scores were on average 20.2% higher at 9 months than at two weeks post-discharge (p < 0.001). Increased night waking frequency, evening settling duration and crying duration were all positively associated with total bother scores. Maternal confidence scores were negatively associated with maternal bother scores; with each unit increase in confidence, maternal bother decreased by 8.5% (p < 0.001). Covariates such as birth gestation, breastfeeding status and multiple births were not associated with maternal bother. Families may benefit from additional support when experiencing increased night waking frequency and crying and settling durations in the first 9 months after discharge from NICU. [ABSTRACT FROM AUTHOR]

Background: Having an infant in the Neonatal Intensive Care Unit (NICU) can disrupt parent well-being, the transition to parenthood, and the typical trajectories of infant and child health. For lesbian, gay, bisexual, transgender, queer, or other sexual and gender minority identity (LGBTQ+) parents, this stress may be compounded by health disparities and fear of stigma and discrimination; however, research is lacking about LGBTQ+ parents of infants in the NICU. Objectives: The purpose of this integrative review was to better understand the experiences of LGBTQ+ parents of NICU infants, with a focus on experiences of stigma and discrimination, sources of strength and resilience, and provision of family-centered care. Method: We searched EBSCOHost, ProQuest, Web of Science, and Google Scholar between 30 May 2023 and 18 September 2023 for empirical studies published in English in peer-reviewed scholarly journals in which LGBTQ+ parents shared their experiences with having infants admitted to the NICU. Results: We identified six articles that met inclusion criteria, all of which were qualitative studies that included 12–14 LGBTQ+ parents of NICU infants. Conclusions: LGBTQ+ parents in all studies reported instances of perceived stigma and discrimination while their infants were in the NICU, whereas parents in two studies mentioned strength and resilience, and parents in three studies described elements of family-centered care. There is a need for rigorous research on family-centered NICU care that includes questions about sources of strength and resilience in addition to challenges. We propose that future researchers use community engaged methods to center perspectives of LGBTQ+ parents. [ABSTRACT FROM AUTHOR]

Outcomes of neonatal encephalopathy (NE) have improved since the widespread implementation of therapeutic hypothermia (TH) in high-resource settings. While TH for NE in term and near-term infants has proven beneficial, 30-50% of infants with moderate-to-severe NE treated with TH still suffer death or significant impairments. There is therefore a critical need to find additional pharmacological and non-pharmacological interventions that improve the outcomes for these children. There are many potential candidates; however, it is unclear whether these interventions have additional benefits when used with TH. Although primary and delayed (secondary) brain injury starting in the latent phase after HI are major contributors to neurodisability, the very late evolving effects of tertiary brain injury likely require different interventions targeting neurorestoration. Clinical trials of seizure management and neuroprotection bundles are needed, in addition to current trials combining erythropoietin, stem cells, and melatonin with TH. IMPACT: The widespread use of therapeutic hypothermia (TH) in the treatment of neonatal encephalopathy (NE) has reduced the associated morbidity and mortality. However, 30-50% of infants with moderate-to-severe NE treated with TH still suffer death or significant impairments. This review details the pathophysiology of NE along with the evidence for the use of TH and other beneficial neuroprotective strategies used in term infants. We also discuss treatment strategies undergoing evaluation at present as potential adjuvant treatments to TH in NE.

BackgroundMaternal high fat diet (mHFD) exposure expands IL-17 producing group 3 innate lymphoid cells (IL17+ve ILC3) in the small intestine of neonatal murine offspring and increases their susceptibility to intestinal inflammation. How mHFD modulates innate immunity in the fetal offspring remains unclear.MethodsDams were exposed to 60% high fat diet or maintained on regular diet (RD) prior to and during mating. Amniotic fluid (AF) was collected during mid-pregnancy and metabolites examined by global non-targeted mass spectrometry in conventional wild-type (WT) and germ-free pregnant dams. Offspring were delivered by C-section or vaginally and fecal contents examined for major bacterial phyla and small intestinal lamina propria cells (LP) by flow cytometry. Susceptibility to intestinal inflammation was determined using a lipopolysaccharide and platelet-activating factor model (LPS/PAF) in WT, germ-free and MyD88 deficient offspring. Neonatal germ-free pups were exposed to HFD or RD AF by gavage and LP examined by flow cytometry.ResultsWe identified differentially produced metabolites in mHFD AF when compared to RD AF in conventionally raised mice, with no difference seen in germ-free mice. C-section delivery maintained the mHFD phenotype of expansion of IL17+ve ILC3 and increased susceptibility to inflammation in neonatal offspring. In addition, mHFD offspring had expansion of IL17+ve ILC3 at birth and 2 weeks of life, which was not seen in germ-free and MyD88 KO mice exposed to mHFD. Germ-free and MyD88 KO mice were protected from mHFD induced LPS/PAF injury and IL17+ve ILC3 expansion, demonstrating that the maternal microbiome and MyD88 are prenatally necessary for the expansion of IL17+ve ILC3 in mHFD offspring. Furthermore, introduction of mHFD AF to neonatal germ-free pups by gavage was sufficient to expand IL17+ve ILC3 in the small intestine.ConclusionOur findings indicate that mHFD interacts with the maternal microbiome to modify AF metabolites and signal via MyD88 to expand IL17+ve ILC3 in murine neonatal offspring.

This research presents a comprehensive review of studies on neonatal encephalopathy conducted between 2005 and 2024, utilizing knowledge graph analysis through CiteSpace and VOSviewer software. A search of the Web of Science core database identified 893 articles, with the United States emerging as a prominent contributor in terms of publication volume. Key co-occurrence keywords identified include “Hypoxic-ischemic encephalopathy”, “Neonatal encephalopathy”, and “Therapeutic hypothermia”. Notable contributors, such as Seetha Shankaran and Floris Groenendaal, have significantly advanced research in this area. Leading institutions in this field include the University of Washington, while the journal Pediatrics is recognized as a leading publication in the domain of neonatal encephalopathy. These findings provide a solid foundation for guiding future research endeavors.

Abstract Bats inhabiting northern latitudes are faced with short reproductive seasons during which they must produce and rear pups before fattening up in time to survive the winter hibernation. Therefore, the timing of parturition has considerable impacts on future fitness prospects for the mother and pup. However, little is known about individual variation in breeding phenology and its consequences for postnatal development within bat populations. Here, we studied the phenology of breeding in Eptesicus nilssonii across 7 years using data collected by day‐to‐day monitoring of a breeding colony in Norway (60.1° N) for which the identity and age of each mother (N = 8) and pup (N = 28) were known. Using mixed‐effect models, we found that arrival at the colony was influenced by temperature conditions from mid‐April to mid‐May across all females, but that there were strong and consistent individual differences in arrival‐ and parturition time across years. Females generally arrived ~32.1 days before giving birth, but the gestation duration was reduced if females arrived late and prolonged if females left the colony when faced with cold weather conditions. Pups born later in the season were born smaller but had higher growth rates during the most rapid growth period (

A reliable referral system is the key to handling emergency cases, for this reason, it is necessary to conduct an in-depth study of the description of the referral system that is in force and implemented in North Lampung, considering that most maternal deaths are caused by cases that require fast and integrated treatment. The aim of the research is to provide an overview of the readiness of the maternal neonatal referral system in terms of four aspects: i) infrastructure, ii) human resources readiness, iii) community readiness, and iv) policy readiness. The research is using qualitative analysis. Data collection uses in-depth interviews, documentation studies, observations, and Focus Group Discussions (FGDs). The Maternal Mortality Rate (MMR) is impacted by the quality of maternal and neonatal services, including handling pregnancy complications. The percentage of rural North Lampung who gained coverage for focusing on pregnancy issues throughout 2021 was a miserable 52.66%. Rural North Lampung's pregnancy-related issues procedures do not adhere to the operational guidelines for maternal-neonatal referral procedures. The fundamental reference, Educate Basic Emergency Neonatal Obstetric (BEmONC), is no longer in operation, as is Comprehensive Emergency Neonatal Obstetric Services (CEmONC). The readiness of all stakeholders for the neonatal and maternal referral system needs to be improved, including the readiness of infrastructure, human resources, and family-community readiness, and needs to be supported by regional government policies.

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

The article discusses the imprecision of point-of-care testing (POCT) for capillary blood glucose measurements in neonates and its impact on managing hypoglycemia. Topics include the variability of glucose readings, factors influencing accuracy, and practical recommendations for pediatricians when interpreting POCT results.