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Background: Neonatal sepsis has been associated with poor neurodevelopmental outcome, however the evidence regarding the exact mechanism of the inflammation to the developing neonatal brain are inconclusive.Aims: To investigate association between cerebral oxygenation during neonatal sepsis and neurodevelopmental outcome.Study Design: Follow-up assessment of a previously described prospective case-control study.Subjects: A cohort of late preterm (34-37 weeks' gestation) and preterm (<34 weeks' gestation) infants with sepsis and healthy controls, evaluated at 18-24 months of corrected gestational age with Bayley-III Scales for Infant and Toddler Development (BSID-III).Outcome Measures: To evaluate the association between cerebral tissue oxygenation index (cTOI) and fractional tissue oxygen extraction (FTOE), measured with near-infrared spectroscopy, during sepsis and the composite cognitive and motor index scores.Results: Thirty-one infants with blood culture confirmed neonatal sepsis and thirty-five controls were recruited. The cerebral oxygenation was significantly lower in septic neonates, compared to controls (61 ± 7 compared to 72 ± 5; p < 0.001). Infants with sepsis had significantly lower cognitive and motor index scores and higher proportion of suboptimal cognitive (16% compared to 3%, p = 0.045) and motor (16% compared to none, p = 0.008) index score. The low mean cTOI and FTOE noted in septic infants were significantly associated with worse cognitive and motor composite index scores.Conclusions: Infants with lower cerebral oxygenation during neonatal sepsis are at increased risk of worse cognitive and motor scores in the neurodevelopmental assessment. [ABSTRACT FROM AUTHOR]

Objective Neonates with sepsis have increased risk of cerebral injury. Our aim was to evaluate cerebral oxygenation in septic neonates using near-infrared spectroscopy. Study Design A prospective study was designed enrolling neonates with sepsis, as defined by the International Consensus Conference of Pediatric Sepsis criteria and matched controls. Three cerebral half-hourly measurements were performed during the first, third, and seventh day of the episode and the values of tissue oxygenation index (TOI) and fractional tissue oxygen extraction (FTOE) were compared between the two groups. Result The study population consisted of 50 septic and 44 control neonates with similar characteristics. No differences on TOI and FTOE were recorded in the first and third day. However, on the seventh day, septic neonates had significantly decreased oxygenation (62.7 ± 7 vs. 71.4 ± 4.4%, p < 0.001) and increased oxygen extraction (0.35 ± 0.07 vs. 0.27 ± 0.05, p < 0.001), irrespectively of the severity of the infection. Conclusion Although septic neonates have normal cerebral oxygenation in the first and third day of the sepsis, they present decreased cerebral oxygenation in the seventh day independently of the infection severity. [ABSTRACT FROM AUTHOR]

To evaluate the consistency of the Hammersmith Infant Neurological Examination scores of very-low-birth-weight infants at 6 and 12 months of age and its correlation to cranial ultrasonography findings, we designed a prospective study between January 2005 and January 2008, in the tertiary Neonatal Unit of Aristotle University of Thessaloniki, Greece. All infants enrolled had a cranial ultrasonography performed at term. Preterm infants born at <32 weeks gestation with a birth weight <1500 g were eligible for the study. One hundred seventy-four infants were finally enrolled; out of those, 46 (26%) had an optimal score at 6 and 76 (44%) at 12 months of age. Mean global scores were 61 and 69 at 6 and 12 months, respectively. The Hammersmith Infant Neurological Examination score significantly increased between 6 and 12 months, equally in all ultrasonography groups. The presence of cystic periventricular leukomalacia was associated to lower scores and neurologic impairment. [ABSTRACT FROM PUBLISHER]

We examine the neuromotor outcomes of preterm infants with bronchopulmonary dysplasia. Two hundred and nineteen infants (gestational age, ≤32 weeks; birth weight, ≤1500 g) were studied. Neuromotor development was assessed using the Hammersmith Infant Neurological Examination. All potential risk factors associated with neuromotor scores (P < 0.015) were included in the generalized linear model (multiple linear regression) to determine if bronchopulmonary dysplasia had an independent relationship with neuromotor scores. Infants with severe bronchopulmonary dysplasia had lower global scores at ages 6 and 12 months. After adjustment for confounding factors, scores of infants with severe bronchopulmonary dysplasia were reduced by 13.2 units, whereas scores for those with periventricular leukomalacia were reduced by 11.1 units, at age 6 months. At age 12 months, scores for those with periventricular leukomalacia were reduced by 11.9 units. Duration of hospital stay reduced scores by 0.1 for each additional day increase in hospital. Bronchopulmonary dysplasia constitutes a major cause of poor neuromotor outcomes at age 6 months, but improvements in motor outcomes occur over time. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the neurological outcome of premature small for gestational age infants at the corrected age of 18 months by the Hammersmith Infant Neurological Examination. A prospective trial was conducted comparing 41 preterm infants being small for gestational age with 41 appropriate for gestational age infants. Birth weight was significantly lower in small for gestational age infants compared with appropriate for gestational age infants (1724.6 ± 433 versus 1221 ± 328 g). There were no significant differences regarding the median gestational age and Apgar scores. Median global scores differ significantly between both groups: 75 (47-78) versus 76 (72-78) for the small for gestational age and appropriate for gestational age infants, respectively. Both groups had optimal scores. In conclusion, although the small for gestational age group scored lower in the Hammersmith Infant Neurological Examination, median global score in both groups was within optimal range. [ABSTRACT FROM AUTHOR]

Objective Chorioamnionitis and fetal inflammatory response syndrome (FIRS) are significant risk factors for early onset sepsis (EOS). Recently, the use “Intrauterine Inflammation or Infection or both” or triple I has been proposed, classifying cases into an isolated maternal fever, suspected triple I, or confirmed chorioamnionitis. Evidence suggests that the association between suspected chorioamnionitis and confirmed histological chorioamnionitis (HCA) is not consistent, as well as the impact of HCA on the development of EOS. We aimed to evaluate the association between suspected chorioamnionitis and HCA, the impact of HCA on EOS, and the effect of antepartum antibiotic prophylaxis on EOS. Methods We retrospectively reviewed the medical records of all infants admitted to our institution, between 2017 and 2018, with a diagnosis of chorioamnionitis. We recorded the clinical evidence of chorioamnionitis, the histologic report of the placenta, the maternal and neonatal data, the neonatal inflammatory markers including C-reactive protein (CRP), and the incidence of EOS. The impact of antepartum antibiotic prophylaxis on the infants’ CRP and EOS was calculated, and the logistic regression model was performed to estimate the association of confirmed HCA with EOS, while controlling for FIRS stage, gestation age, birth weight, maternal fever, foul-smelling amniotic fluid, and prolonged rupture of membranes. Results During the study period, a total of 266 infants were identified; 81 (30%) infants had a confirmed HCA (HCA-present cases), and 185 (70%) infants were diagnosed with suspected triple I (HCA-absent cases). Antepartum antibiotics had been commenced in a significantly higher proportion in HCA-present cases (46%) in comparison to 14% of HCA-absent cases (p < .001). HCA-present infants were of significantly lower gestation (31.6 ± 4weeks versus 33.3 ± 4weeks, p = .004), and birth weight (1826 ± 840 g versus 2092 ± 849 g, p = .019), they had a significantly higher rate of clinical symptoms (31% versus 6%, p < .001), and a higher CRP at birth and 24 h (1.4 ± 1.5 mg/dL versus 0.3 ± 0.2 mg/dL, p < .001, and 2.1 ± 2.3 mg/dL versus 0.4 ± 0.6 mg/dL, p < .001, respectively). All HCA-present cases had evidence of FIRS; 43% were stage I, 25% stage II, and 32% were FIRS stage III. A significantly higher proportion of HCA-present infants were diagnosed with EOS (46% as compared to 6%, p < .001). The antepartum antibiotic administration was related to a significantly lower CRP at birth and 24 h only in HCA-present cases, albeit not with any reduction ιn EOS incidence. HCA was significantly associated with EOS (RR 3.18, 95% CI 2.81–5.18, p < .001). After adjusting for perinatal factors, the presence of HCA (OR 7.89, 95% CI 1.19-23.34, p = .032) and an advanced FIRS stage (OR 10.35, 95% CI 4.23–25.32, p < .001) were significantly associated with EOS. Conclusions Amongst infants with suspected chorioamnionitis, the diagnosis is partially supported by histological confirmation, and that is more prominent in pregnancies of a lower gestation. The presence of HCA and an advanced FIRS stage predispose to an increased risk of EOS after adjusting for other perinatal and neonatal factors. The antepartum prophylaxis against intra-amniotic infection was related to a significantly lower CRP in HCA-present cases. [ABSTRACT FROM AUTHOR]

Multiple pregnancies sustain the high pace of extreme prematurity. Little evidence is available about triplet gestation given the evolution in their management during the last decades. The aim of the study was to compare the neonatal outcomes of triplets with those of matched singletons in a cohort study. An observational retrospective cohort study of triplets and matched singletons born between 2004 and 2017 matched by gestational age was conducted. Additionally, the investigation performed in regard to data from the overall Greek population of interest. The primary outcome was mortality or severe neonatal morbidity based on pregnancy type. A total of 237 triplets of 24–36 weeks' gestation and 482 matched singletons were included. No differences in the primary outcome between triplets and singletons were found. Rates of severe neonatal morbidities did not differ significantly between triplets and singletons. A threshold of 1000 gr for birthweight and 28 weeks' gestation for gestational age determined survival on triplets [OR: 0.08 (95% CI: 0.02–0.40, p=0.0020) and OR: 0.13 (95% CI: 0.03–0.57, p=0.0020) for gestational age and birthweight respectively]. In Greece stillbirths in triplets was 8 times higher than that of singletons (OR: 8.5, 95% CI: 6.9–10.5). From 3,375 triplets, 94 were stillborn, whereas in singletons, 4,659 out of 1,388,273. In our center 5 times more triplets than the expected average in Greece were delivered with no significant difference in stillbirths' rates. No significant differences were identified in mortality or major neonatal morbidities between triplets and matched singletons highlighting the significance of prematurity and birthweight for these outcomes. [ABSTRACT FROM AUTHOR]

Maternal diet before and during pregnancy plays an important role for the developing fetus. Any eating disorder in this period can cause transient or/and permanent negative effects on the mother and her offspring. [ABSTRACT FROM AUTHOR]

Objective: To examine cerebral oxygenation and perfusion in small for gestational age (SGA) compared with appropriate for gestational age (AGA) neonates during the first postnatal week, and to investigate any association with neurodevelopmental outcomes at 24–36 months of age. Methods: A prospective matched case-control study was conducted evaluating cerebral oxygenation and perfusion, using near-infrared spectroscopy (NIRS), between SGA and AGA neonates, during the first postnatal week. A neurodevelopmental assessment with Bayley-III was performed at 24–36 months of age. Results: Forty-eight SGA and 48 AGA neonates of similar gestation (32.8 ± 2.1 vs. 32.5 ± 1.9) were enrolled. On the first postnatal day, the cerebral oxygenation was equal between SGA and AGA neonates (71 ± 7% vs. 72 ± 8%); however, in the subgroup analysis, males had higher oxygenation compared to female SGA neonates (73 ± 7% vs. 69 ± 7%, P = 0.04). Cerebral perfusion was significantly higher in SGA neonates on the first postnatal day (1.4 ± 0.6 vs. 1.1 ± 0.5, P = 0.04), but this difference was diminished on subsequent measurements. There were no significant differences between the SGA and AGA infants regarding the composite cognitive, communication and motor index scores. The length of mechanical ventilation and late-onset sepsis were significant risk factors affecting the cognitive and communication composite index scores, respectively. Conclusion: Cerebral oxygenation was equal between SGA and AGA neonates, while cerebral perfusion was transiently increased in SGA neonates during the first postnatal day. There was no significant association of cerebral oxygenation and perfusion with neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Hearing impairment affects 2% to 4% of NICU graduates and is associated with several risk indicators. OBJECTIVE: Our goal was to investigate the prevalence of hearing impairment in newborns hospitalized in an NICU and its association with risk indicators. METHODS: Subjects consisted of 422 post-NICU infants who fulfilled 34 weeks of gestational age and were examined between March 2005 and December 2006. The following parameters were evaluated: perinatal asphyxia, craniofacial deformities, furosemide and aminoglycoside therapy (duration of administration), meningitis, duration of mechanical ventilation, and nursing duration in an incubator. Screening was performed with the last-generation automated auditory brainstem response (AABR) equipment, ALGO 3 (Natus Medical Inc, San Carlos, CA). RESULTS: Results were considered normal when the newborn showed response to a 35-dBNA signal bilaterally. Newborns with hearing impairment were referred for early intervention. Multivariate analysis with logistic regression was used to identify the independent risk factors for hearing disturbances. The prevalence of AABR impairment was 2.84% (12 of 422 newborns); the impairment was unilateral in 7 of the infants and bilateral in 5 of them. These 12 infants were examined with conventional ABR with the following results: 6 of them showed normal responses, and in the other 6 infants the pathologic result was confirmed. Multivariate analysis revealed a statistically significant association between hearing loss and craniofacial deformities, meningitis, and duration of mechanical ventilation (P < .001, P = .001, and P = .038, respectively). CONCLUSIONS: Although the study sample was limited, the hearing-loss rate that we found was in accordance with that reported in the literature. The prevalence of hearing impairment found when using AABR is high. The only risk factors directly associated with hearing impairment proved to be craniofacial deformities, meningitis, and duration of mechanical ventilation. [ABSTRACT FROM AUTHOR]

Neonatal sepsis is considered critical for a significant increase in neonatal morbidity and mortality among hospitalized neonates. Neonatal sepsis, in most cases, coexists with coagulopathy, which can prove to be life-threatening. Complex molecular and cellular systems are involved in the cross-talk between inflammation and hemostasis during sepsis. Disturbances in the regulating systems of the vascular endothelium, and platelet–endothelial and platelet–neutrophil interactions play a pivotal role in both inflammation and coagulation. This complex process is poorly understood in neonates. In addition to the developmental maturation of hemostasis and the immune response in neonatal sepsis, a cellular model of hemostasis during sepsis should be taken into account. This review focused on the molecular and cellular mechanisms underlying inflammation and hemostasis during neonatal sepsis, taking the developmental immune response and developmental hemostasis into account in order to provide future diagnostic approaches to be applied in everyday clinical settings. Regarding the diagnostic modalities, we briefly provide the limitations of the currently used conventional coagulation assays, focusing on viscoelastic tests and platelet flow cytometry. [ABSTRACT FROM AUTHOR]

Abstract: Background: The pathogenetic profile of premature Small for Gestational Age (SGA) neonates is strongly related to their haemostatic equilibrium, which is inadequately understood. Objective: To evaluate coagulation and fibrinolysis in premature SGA neonates before intervening with Vitamin K administration. Study design: We performed a comparison of coagulation, natural inhibitors and fibrinolysis between SGA and Appropriate for Gestational Age (AGA) infants born prematurely [gestational age (G.A.) <37weeks]. Study population consisted of 139 preterm newborns, 68 of whom were SGA (25 males and 43 females), while 71 were AGA (37 males and 34 females) that consisted the control group. Blood samples were obtained within 30minutes following birth and before the administration of vitamin K. Investigation included: PT, INR, APTT, fibrinogen, coagulation factors II, V, VII, VIII, IX, X, XI, XII, vWillebrand factor, protein C and free protein S, antithrombin (AT), APCR, tPA and PAI-1. The independent t-test and the Mann-Whitney U test were used to compare the differences between the values of haemostatic parameters. Results: Premature SGA infants presented significantly lower levels of fibrinogen (p <0.029) and higher levels of VIIIc factor, APCR, tPA and PAI-1 (p <0.041, 0.017, 0.021 and 0.019 respectively). The two groups had similar demographic characteristics (except from birth weight), without significant differences in the values of other haemostatic parameters. Conclusions: Despite the statistically significant differentiation in the levels of fibrinogen, VIIIc factor, APCR, tPA and PAI-1, the rest of haemostatic parameters have similar values between SGA and AGA preterms. [Copyright &y& Elsevier]

Abstract: Background: Small for Gestational Age (SGA) neonates often appear with haemostatic alterations, principally due to hepatic dysfunction that results from chronic intrauterine hypoxia. Polycythaemia and thrombocytopenia are common findings in this neonatal population. Study design: We performed a comparison of coagulation, natural inhibitors and fibrinolysis between SGA and Appropriate for Gestational Age (AGA) infants born full term [gestational age (G.A.) >37 weeks]. Study population consisted of 188 healthy newborns, 90 of whom were SGA (62 females and 28 males), while the rest were the control group (44 females and 54 males). Blood samples were obtained within 30 minutes following birth and before the administration of vitamin K. Investigation included: PT, INR, APTT, fibrinogen, coagulation factors II, V, VII, VIII, IX, X, XI, XII, vWillebrand factor, protein C and free protein S, antithrombin (AT), APCR, tPA and PAI-1. The independent t-test was used to compare the differences between the values of haemostatic parameters. Results: Statistical analysis revealed a significant prolongation in PT, INR, elevated levels of tPA (p <0.015, 0.01 and 0.002 respectively) and a decrease in the values of XII and free protein S (p <0.045 and 0.007 respectively) in SGA full term neonates. The two groups had similar demographic characteristics (except birth weight), without significant differences in the values of other haemostatic parameters. Conclusions: Despite of statistically significant differences in PT, INR, values of tPA, XII and free protein S, levels of haemostatic factors range within laboratory references for healthy full term newborns. These findings were not accompanied with clinical manifestations of altered haemostasis. [Copyright &y& Elsevier]

Abstract: Background: Clinical and experimental researches have linked smoking to disturbances of coagulation and fibrinolysis. Several potential mechanisms are incriminated involving inflammation, fibrinogen synthesis and clotting factors. Based on the fact that the majority of tobacco components cross the placental barrier, the objective of our current study is to investigate the influence of smoking during pregnancy on neonatal haemostasis. Study design: The study was based on a comparative evaluation of coagulation and fibronolysis between healthy full term infants of women who smoked during pregnancy and a control group. Subjects consisted of 39 newborns of smoking and 43 newborns of nonsmoking mothers. Blood samples were obtained shortly after birth and before the administration of vitamin K. Investigation included: PT, INR, aPTT, fibrinogen, coagulation factors II, V, VII, VIII, IX, X, XI, XII, vWillebrand (vWF), protein C and S, APCr, anti-thrombin (AT), t-PA and PAI-1. The independent t- test was used to compare the differences between the values of coagulation and fibrinolytic parameters at the p<0.05 level. Results: We discovered a statistically significant decrease in factor II and protein S levels and an elevation in t-PA and factor VIII concentrations in newborns of smoking mothers, without clinical manifestations of altered haemostasis. There were no significant differentiations in other coagulation or fibrinolytic parameters. Conclusion: The alteration in factor II, protein S, t-PA and factor VIII in neonates exposed in utero to tobacco smoke is not accompanied by loss in the balance between coagulation and fibrinolytic pathways. [Copyright &y& Elsevier]

Background: Adequate nutrition is essential for optimal neurodevelopment to preterm infants. Our aim was to evaluate the impact of caloric deprivation on Bayley-III scales performance at 18-24 months of corrected age, in a cohort of preterm infants.Methods: We prospectively enrolled infants with gestational age <30 weeks and birth weight <1500 g. Apart from a whole cohort analysis, we performed a subgroup analysis between infants received inadequate calories (<85 Kcal/kg/day) during the first two weeks of age, compared to a standard nutrition group. All infants underwent a Bayley-III assessment at 18-24 months of corrected age.Results: From the 63 preterm infants analysed, 25% had caloric deprivation compared to 75% with adequate nutrition. Caloric deprived infants were of lower gestational age and birth weight, and received a lower amount of enteral feeding during the first 14 days of age. There were no differences between the two groups regarding the common neonatal co-morbidities. Caloric deprived infants had significantly lower composite index scores at 18-24 months of corrected age. Caloric deprivation, late onset sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia were significant risk factors of neurodevelopmental impairment.Conclusions: Several neonatal factors affect the neurodevelopmental outcome of preterm infants, and nutrition may pose an important role. [ABSTRACT FROM AUTHOR]

Introduction: Drug-induced immune thrombocytopenia is considered extremely rare, as a cause of neonatal thrombocytopenia (PLT 0.000/μL). Diagnosis of drug-induced immune thrombocytopenia is considered as definite when all four George criteria are met: 1. Drug administration preceded thrombocytopenia. Recovery was complete and sustained after drug discontinuation 2. Other drugs administered prior to thrombocytopenia were continued or reintroduced after discontinuation of the suspected drug 3. Other etiologies of thrombocytopenia excluded 4. Re-exposure to the drug resulted in recurrent thrombocytopenia Objectives: We describe an interesting case of early onset, severe ampicilline-induced immune thrombocytopenia, in newborn twins. Material - Method: Monochorionic- diamniotic female twin neonates (A) and (B) (GA: 36 weeks) Results: Twins were born after an uncomplicated pregnancy via cesarean section (due to previous one). Perinatal history was unremarkable. Administration of empirical treatment with ampicillin and amikasin intravenously. On 2nd day of life (DOL), they exhibited severe thrombocytopenia (table 1), without hemorrhagic diathesis. Coagulation tests of (A) twin were prolonged (day 3). Laboratory screening for infection (CRP, blood culture), TORCH, perinatal asphyxia, necrotizing enterocolitis, neonatal alloimmune thrombocytopenia and disseminated intravascular coagulation, was negative. Drug-induced immune thrombocytopenia is an allergic reaction type II and in our case was related to ampicillin. Antibiotics were discontinued at 2nd DOL. Platelet transfusions were administered in both twins and fresh frozen plasma in (A) twin. On 5th DOL, platelet count was normal as well as coagulation tests of (A) twin, and no recurrence of thrombocytopenia was observed. Conclusions: Drug-induced neonatal immune thrombocytopenia is acute and severe. Clinical suspicion is important for diagnosis, which is probable in our case. [ABSTRACT FROM AUTHOR]

Introduction: Life-threatening haemorrhage in neonates is related to high mortality rates. Use of Prothrombin complex concentrate (PCC) in such cases could be significantly valuable because of the low levels of vitamin K-dependent coagulation proteins in neonates and their consumption in case of DIC status. Administration of PCC results in a faster and more effective discontinuation of bleeding, providing time to stabilize the neonate without the risks of fluid overloading and bloodstream infections. Objective:Proposal of an alternative therapeutic approach to intractable bleeding in neonates resistant to conventional haemostatic therapy and compared the clinical outcome of newborns treated with PCC for intractable bleeding or severe coagulation disturbances according to time administrated. Subjects/methods:Data of 39 neonates treated successfully with PCC were retrospectively analyzed. Each patient received a median of 2.1 doses of 25/U of PCC in slow iv push with 12 hrs time-interval. Blood samples for evaluation of coagulation parameters (PT,aPTT,INR) were obtained 1/hr following infusion of each PCC dose. Results:The population consisted of 39 neonates, 14 of them survived (group/A) and 25 died (group/B). There was no difference in BW, GA and bleeding cause or/and site between the 2 groups. In the neonates who survived PCC had been administered earlier in the disease process (within 24 hours of beginning of bleeding) compared to those who died (p=0.048). We observed a statistically significant decrease in PT (from 39.5±41 to 18.7±4.41 prior and after to PCC respectively, p=0.001) and in INR (from 3.67±4.01 to 1.61±0.52 prior and after to PCC respectively, p=0.002). There were no clinical signs of thrombosis or any other adverse effect due to PCC treatment. Conclusion: PCC was safe and efficacious in neonates with intractable bleeding and/or severe coagulation disturbances and PCC was more effective in early intervention as rescue therapy, without any adverse events in all neonates [ABSTRACT FROM AUTHOR]

Introduction: Necrotizing enterocolitis (NEC) is one of the most common surgical emergencies in very low birth weight infants (VLBWI) [birth weight(BW)<1,500g]. Objective: The aim of this study was to determine the incidence of NEC in VLBWI and compare the risk factors for outcomes in VLBWI with surgical NEC (sNEC). Subjects/methods: We have performed a retrospective review of VLBWI with NEC who underwent a surgical procedure between January 2009 to June 2017. Data collected include: mode of conception, gestational hypertension, placenta abruption, chorioamnionitis, preterm/premature/rupture/of/membranes (PPROM), uterus contractions (UC), tocolysis, mode of delivery, gestational age(GA), BW, perinatal asphyxia, gender, intrauterine growth retardation, respiratory distress syndrome, intraventricular hemorrhage, patent ductus arteriosus, enteral feeding, age at perforation, interval time between the offspring of NEC and the operation and laboratory findings (PLT, PT, INR, aPTT). Data above were analyzed regarding their possible relationship with mortality. Results: During study period 4,618 neonates were admitted to our hospital and 639 (13.8%) of them were VLBWI. Among these 639, twenty-eight(4.4%) have NEC. Of the 28 infants with NEC, 21 (75%) were operated on. Following treatment, 14 patients (groupA) recovered and were discharged, while 7 patients (groupB) died (mortality 33.3%). All deceased neonates were male. The median age of NEC onset (p=0.167), the GA [groupA:29.12.6w vs groupB:27.21.8w, (p=0.108)] and the BW [groupA:1037313g vs groupB:835250g, (p=0.086)] were not different between the two groups. From the above factors only male gender(p=0.018) and PROM(p=0.025) were associated with mortality as well as the presence of UC was associated with a lower incidence of mortality(p=0.024). No difference was noticed between the rest of the factors. Conclusions: In our NICU the incidence of sNEC in VLBWI was low and the survival rate was high and similar to that of other multicenter studies. However, sNEC remains a major cause of morbidity and mortality. [ABSTRACT FROM AUTHOR]

Abstract: We describe a case of an acquired subglottic cyst presented with persistent stridor and voice hoarsening in a baby diagnosed with Williams–Beuren syndrome that was born premature and required intubation during neonatal period. We also comment on whether this is a coincidence or there can be an association between impaired elastogenesis, a feature of patients with the syndrome and the formation of a subglottic cyst. [Copyright &y& Elsevier]