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Necrotizing enterocolitis (NEC) is a critical gastrointestinal emergency with substantial morbidity and mortality risks, especially for very low-birth-weight (VLBW) infants, and unclear multifactorial pathophysiology. Whether common treatments for VLBW infants increase the NEC risk remains controversial. Indomethacin (utilized for patent ductus arteriosus) offers benefits but is concerning because of its vasoconstrictive impact on NEC susceptibility. Similarly, corticosteroids used to treat bronchopulmonary dysplasia may increase vulnerability to NEC by compromising immunity and altering the mesenteric blood flow. Histamine-2 receptor blockers (used to treat gastric bleeding) may inadvertently promote NEC by affecting bacterial colonization and translocation. Doxapram (used to treat apnea) poses a risk of gastrointestinal disturbance via gastric acid hypersecretion and circulatory changes. Glycerin enemas aid meconium evacuation but disrupt microbial equilibrium and trigger stress-related effects associated with the NEC risk. Prolonged antibiotic use may unintentionally increase the NEC risk. Blood transfusions for anemia can promote NEC via interactions between the immune response and ischemia–reperfusion injury. Probiotics for NEC prevention are associated with concerns regarding sepsis and bacteremia. Amid conflicting evidence, this review unveils NEC risk factors related to treatments for VLBW infants, offers a comprehensive overview of the current research, and guides personalized management strategies, thereby elucidating this clinical dilemma. [ABSTRACT FROM AUTHOR]

Background: Hypoglycemia is a significant problem for all neonates and requires minimally invasive and reliable monitoring. The primary objective of this study was to verify the safety and accuracy of the continuous glucose monitoring (CGM) of full‐term neonates using Freestyle Libre, a flash glucose monitoring (FGM) device. Methods: The study was conducted on 20 neonates. Shortly after birth, we placed the FGM sensor on the outside of the neonates' thighs. We scanned the CGM values at 60, 120, 180, and 360 min after birth and simultaneously obtained blood glucose values with plantar capillaries by heel puncture. The neonates wore the sensors for up to 6 h and then they were removed. Results: Of the 75 data points to be measured, 65 points (86.7%) were obtained by scan. There was no change in the sensor attachment site in 12 of 18 completed cases in this study but we observed slight induration in four cases (22.2%) and slight redness in one case (5.5%) at the sensor puncture site. A moderate correlation was observed between the CGM and blood glucose values. The CGM values tended to be low at 120, 180, and 360 min after birth, and tended to be high only at 60 min after birth. Conclusions: The CGM device was safe to wear on the neonate and the CGM data correlated well with blood glucose levels. There was dissociation between CGM data and blood glucose levels in the acute period soon after birth when the blood glucose levels changed rapidly. [ABSTRACT FROM AUTHOR]

Background: Thyroid hormones (THs) play a critical role in normal maturation of the developing brain in the fetus and infant. Continuing advances in neonatal medicine have contributed to an increased survival of extremely premature infants with neonatal morbidities. In these infants, thyroid system immaturities, as well as morbidity-related thyroid dysfunction, contribute to transient hypothyroxinemia of prematurity (THOP), which is characterized by very low total and free thyroxine and normal or low thyroid-stimulating hormone (TSH) levels. Review: Undoubtedly, low levels of THs with elevated TSH are associated with poor neurodevelopmental outcome. However, continuing debate exists regarding whether THOP is harmful to the developing brain. Moreover, no clear effects of TH treatment on neurodevelopmental outcome in preterm infants with THOP have been demonstrated. THs could have unpredictable effects if given unnecessarily. Conclusion: The current recommendation is to treat THOP with TH only if THOP is accompanied with TSH elevation. [ABSTRACT FROM AUTHOR]

A pregnancy complicated with rheumatologic diseases can have various influences on the fetus and/or neonate. Maternal systemic lupus erythematosus (SLE) may cause preterm and/or small for gestational age (SGA) delivery and neonatal lupus (NL). Some neonates with NL have congenital heart block (CHB) with increased morbidity and mortality, even requiring pacemakers. Antiphospholipid syndrome may occur with SLE and affect fetal and/or neonatal outcomes. Pregnancy involving primary Sjögren's syndrome (pSS) tends to result in preterm delivery and low birthweight infants. Moreover, CHB is the most challenging complication for neonates delivered by women with pSS. Pregnant women with rheumatoid arthritis (RA) are at an increased risk for delivering a preterm or SGA neonate. In addition, RA drugs may have adverse effects on the fetus and breast-fed neonate. With dermatomyositis/polymyositis, pregnancies are at increased risk for spontaneous abortion, perinatal death, and preterm delivery. At present, overall neonatal survival rates are good for pregnancies involving systemic sclerosis, despite an increased frequency of premature and SGA neonates. In conclusion, maternal rheumatological diseases require careful monitoring to ensure the best possible management for fetal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Fetal adrenal gland size is known to have a positive correlation with both gestational age and estimated body weight. In contrast, some clinical observations suggest that maturation of the adrenal stress response occurs after 30 weeks of gestation. In this study, adrenal gland size at birth in extremely preterm to term neonates was investigated using ultrasonography to evaluate the adrenal developmental pattern and the impact of prematurity and perinatal factors.Methods: The area of the right adrenal gland was measured in the first 3 h of life in 350 neonates and corrected for birth weight (BW) to determine the corrected adrenal area index (cAI). The neonates were subdivided into three groups: group 1 (before 30 weeks of gestation), group 2 (30 to 36 weeks), and group 3 (after 37 weeks). Differences in the cAI among the 3 groups were compared to estimate the impact of perinatal factors.Results: The adrenal gland size was measurable in all neonates with gestational age ranging from 23 to 41 weeks. Right adrenal gland area was highly correlated with BW (r = 0.75, p < 0.01). cAI showed a significant negative correlation with gestational age in group 1 (r = - 0.67, p < 0.01), whereas it showed no correlation with gestational age in both groups 2 and 3. As for the impact of perinatal parameters on cAI, only gestational age in group 1 and only fetal distress in group 2 were correlated with cAI. In group 3, perinatal parameters such as fetal distress and low Apgar score were correlated with cAI.Conclusions: The present study demonstrated that the developmental pattern of fetal adrenal gland was different before and after 30 weeks of gestation, suggesting that the magnitude of adrenal stress response might mature after 30 weeks of gestation. [ABSTRACT FROM AUTHOR]

Background: Isolated congenital asplenia (ICA) is a rare and life-threatening condition that predisposes patients to severe bacterial infections. Most of the reported cases are familial and the mode of inheritance is usually autosomal dominant. Here, we report a case of sporadic isolated asplenia and review the literature while focusing on sporadic cases.Case Presentation: We report the case of an 11-month-old female infant who developed fulminant pneumococcal meningitis. The pneumococcal vaccine-unimmunized patient was hospitalized with fever, irritability, and purpura, and was diagnosed as having meningitis, septic shock, and disseminated intravascular coagulation. Streptococcus pneumoniae was isolated from both cerebrospinal fluid and blood. She was successfully treated with prompt antibiotic therapy. During hospitalization, abdominal ultrasonography and computed tomography findings, scintigraphy results, and Howell-Jolly body-containing red blood cells indicated the presence of asplenia without any visceroarterial anomalies. Moreover, the findings of peripheral blood smears and spleen ultrasonographic examinations of her parents were normal.Conclusions: Majority of sporadic ICA cases were detected only after the onset of overwhelming infection and had a high mortality. In cases of severe invasive pneumococcal disease, a systematic search for Howell-Jolly bodies on blood smears and the presence of asplenia on abdominal imaging are essential for detecting ICA even in the absence of any family history. After the diagnosis of ICA, patient and parent education, vaccinations, antibiotic prophylaxis, and prompt empiric treatment of febrile episode should be provided. [ABSTRACT FROM AUTHOR]