Search

The accurate identification and recognition of newborns hold significant importance in ensuring their safety and security within healthcare environments, particularly in hospitals and nurseries. This review article delves into the realm of biometric recognition techniques applied to newborns. The motivation behind this exploration lies in the pressing need for dependable methods that can prevent instances of mix-ups and mismatches, contributing to the overall welfare of infants and peace of mind for caregivers. The review encompasses an analysis of pertinent literature, focusing on authors, methodologies, databases, challenges faced, algorithms employed, performance metrics, and overarching observations. The authors examined a variety of biometric modalities, including footprint recognition based on minutiae features, handprints, facial recognition, and voice recognition. The study considers the distinct challenges associated with newborn biometrics, such as the limited availability of comprehensive databases containing diverse newborn biometric samples. The goal of this review paper is to conduct a thorough analysis of relevant research on biometric recognition of newborns, including the current state-of-the-art, potential challenges, and opportunities. [ABSTRACT FROM AUTHOR]

Skeletal age estimation using X-ray images is a widely employed clinical method for identifying anomalies in bone growth in infants and newborns. Pediatric bone abnormalities can arise from a spectrum of conditions, including wounds, infections, or tumors. Damage to the growth plate, stemming from factors like inadequate blood supply, separation from bone components, or minor misalignment, can impede bone development, distort joint structure, and potentially result in lasting joint injuries. Divergence between chronological and assessed ages can serve as an indicator of growth-related problems, as accurate bone age assessment mirrors the actual progression of growth. Skeletal age estimation plays a pivotal role in identifying endocrine disorders, genetic abnormalities, and growth irregularities. In our effort to address the challenge of bone age assessment, this study utilizes the Radiological Society of North America's Pediatric Bone Age Challenge dataset, comprising 12,600 radiological images of patients' left hands, along with their gender and bone age data. We propose a robust bone age evaluation system grounded in hand skeleton guidelines for the precise detection of hand bone maturation. The proposed approach for bone age assessment centers on a tailored convolutional neural network (CNN), which attains an accuracy rate of 97%. Moreover, this research analyzes growth rate prediction using six transfer learning models, offering valuable insights into the predictive capabilities of these models. This study not only contributes to advancing bone age estimation techniques but also underscores the potential of the proposed CNN-based approach in achieving highly accurate results, further enhancing diagnostic precision in pediatric medicine. [ABSTRACT FROM AUTHOR]

Background Aims Study Design Results Conclusions Relevance to Clinical Practice Premature birth is a traumatic and stressful situation for parents who are immediately separated from their infant because of the newborn's need for specialized care. The staff of these units are in charge of following the principles of family‐centred care and practices for neonates at risk of neurodevelopmental disorders, including providing training to the family during their hospital stay and after being discharged.The aim of this study is to explore the perceptions of parents of premature children at risk of neurodevelopmental disorders in regard to care, interventions and assistance provided during the first months of their child's life.A qualitative descriptive study was carried out through individual interviews. The data analysis was conducted through a thematic analysis. The methodology and results were reported following the standards for preparing qualitative research reports and recommendations.Twenty‐one parents of premature children were interviewed. From these interviews, three main themes emerged: (i) parents' perspectives on preterm birth risk communication, (ii) navigating parental support and early interventions in preterm birth and (iii) perceptions of preterm birth protective and challenging factors.The parents of premature children need to receive better communication about the care and interventions for their child, and it is necessary that health personnel are better trained in terms of management and administration of public resources. Strategies must be implemented that continuously guide parents on the follow‐up and care of their premature child not only during their first moments of life but also after being discharged from the hospital.This study highlights the need to improve care for parents with premature infants at risk, emphasizing the necessity for health care system reforms and support structures, allowing health care professionals to enhance attention and care. [ABSTRACT FROM AUTHOR]

Piperacillin is commonly used off‐label in neonates for the treatment of bacterial infections. This study aimed to assess a dried blood spots (DBS)‐based microsampling strategy for supporting population pharmacokinetics and treatment optimization of piperacillin in Chinese neonates. DBS samples from neonatal patients were collected at predefined intervals. Drug blood concentrations were quantified using a validated ultra‐high‐performance liquid chromatography‐tandem mass spectrometry method. A population pharmacokinetic model was developed using a nonlinear mixed‐effects modeling approach. The pharmacokinetic/pharmacodynamics (PK/PD) target was 75% of the time with the unbound drug plasma concentration above the minimum inhibitory concentration (fT>MIC), with a toxicity threshold of unbound drug plasma trough concentration above 64 mg/L. A total of 45 piperacillin samples from 24 neonates were collected. The pharmacokinetics of piperacillin was described using a one‐compartment model with postmenstrual age (PMA) as the most significant covariate on clearance. Simulations showed that dosing regimens achieving >90% PK/PD target attainment with <10% risk of possible toxicity were: PMA 33‐35 weeks (50 mg/kg q12h), 35‐37 weeks (50 mg/kg q8h), and 37‐41 weeks (50 mg/kg q6h). In conclusion, Using DBS sampling, we developed a population pharmacokinetic model of piperacillin in Chinese neonates, incorporating PMA to determine optimal dosing regimens. [ABSTRACT FROM AUTHOR]

Hypoxic-ischemic encephalopathy (HIE) is a diffuse brain tissue injury caused by acute ischemia and hypoxia, and it is most commonly found in newborn infants but can also occur in adults. Mesenchymal stem cell (MSC) therapies have showed improved outcomes for treating HIE-induced neuronal defects. However, many key issues associated with poor cell viability and tolerance of grafted MSCs after HIE remain to be resolved. Genetic engineering could endow MSCs with more robust regenerative capacities. Our research, along with that of other scientists, has found that the expression of intracellular erythropoietin (EPO) in human umbilical cord MSCs (hUC-MSCs) increases proportionally with the duration of hypoxia exposure. Furthermore, we observed that EPO, when introduced into the EPO gene-modified hUC-MSCs, can be secreted into the extracellular space. However, the underlying mechanisms that support the neuroprotective effects of EPO-MSCs remain unclear. EPO-MSCs, hUC-MSCs, and NC-MSCs were identified by flow cytometry, osteogenic, and adipogenic differentiation assays. The oxygen-glucose deprivation (OGD)-induced SH-SY5Y cell-line was established, and five groups were set up: control, 24-h ischemia-hypoxia, co-cultured with hUC-MSCs, NC-MSCs, and EPO-MSCs after hypoxia. LEGENDplex™ multi-factor flow cytometry was used to detect the secretion of inflammatory factors in cell supernatants and cerebrospinal fluid. Chromosome-targeted excision and tagging (CUT&Tag) sequencing was applied to detect genomic H3K4me2 modifications, and conjoint analysis with transcriptome sequencing (RNA-seq) was performed. Lentiviral vector infection was used to construct SH-SY5Y cells with stable knockdown of RE1-silencing transcription factor (REST), and flow cytometry was used to detect alterations in apoptosis. Finally, the molecular mechanism underlying the neuroprotective and anti-apoptotic effects of EPO-MSCs was investigated using RNA sequencing, qRT-PCR, and western blot assays. Our results suggest that EPO-MSCs are genetically engineered to secrete significantly more EPO. EPO-MSCs treatment has anti-apoptotic properties and offers neuronal protection during ischemic-hypoxic injury. Furthermore, RNA-seq results suggest that multiple inflammation-related genes were down-regulated after EPO-MSCs treatment. Application of RNA-seq and CUT&Tag combined analysis found that the expressions of REST were significantly up-regulated. Lentiviral vector infection to construct REST knockdown SH-SY5Y failed to rescue apoptosis after hypoxia and co-culture with EPO-MSCs, and SETD2-mediated H3K36me3 protein level expression was reduced. EPO-MSCs may promote neuronal survival by affecting H3K4me2 and thus activating the expression of REST and TET3. EPO-MSCs also upregulated the modification level of SETD2-mediated H3K36me3 and regulated the expression of inflammation-related genes such as PLCG2, as well as apoptosis genes BCL2A1. To investigate the neuroprotective effects of EPO-modified hUC-MSCs and the underlying epigenetic regulatory mechanisms, this study aims to provide a theoretical foundation for the potential application of EPO gene-modified hUC-MSCs in the treatment of HIE. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Conclusion The purpose of this study was to compare the effects of two caregiving models on full‐term healthy infants' wakefulness, rooting and sucking reflexes, initiation of breastfeeding, and physiological parameters when reunited with their mothers after a mother–infant separation of 130 min after elective cesarean birth.Ninety‐five mother–infant pairs participated in a randomized controlled trial, in which full‐term healthy infants were allocated to be either dressed in their mothers' arms (n = 56) or skin‐to‐skin with their mother (n = 39) when reunited with the mother within 130 min after cesarean birth. Data were collected by the Neonatal Behavioral Assessment Scale (NBAS) to assess the infants' wakefulness and prebreastfeeding behaviors. Physiological parameters were assessed at 15 min intervals, from 130 to 205 min after birth. Time to first breastfeed was measured in minutes from the reunion with the mother.The primary finding was that physiologic parameters did not differ but time for initiation of breastfeeding after the reunion with the mother was significantly faster in the skin‐to‐skin group compared to the infants in the mothers' arms group (p = 0.005). Over the full study period, a more relaxed state and drowsy were found in the skin‐to‐skin group compared to the infants in the mothers' arms group.Healthy full‐term infants born by elective cesarean, who were cared for by their mothers when reunited within 130 min of separation and cared for by their fathers during the mother–infant separation, initiated breastfeeding successfully and showed stable physiological patterns. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Conclusions Maternal preeclampsia is associated with both congenital heart defects and changes in left ventricular structure and function in the offspring. Whether preeclampsia and gestational hypertension also affect the offspring's cardiac conduction system is unknown.This study assesses whether infants exposed to maternal hypertensive disorders of pregnancy (HDPs) exhibit changes in their electrocardiogram (ECG) compared with infants unexposed to HDPs.This population‐based cohort study included newborns from the Copenhagen Baby Heart Study who had an ECG performed within 30 days of birth and had available obstetric information. ECG parameters of newborns exposed to maternal HDPs were compared with those of unexposed newborns using linear regression.Our study cohort included 11,826 newborns, including 441 exposed to maternal preeclampsia and 320 exposed to gestational hypertension. Infants exposed to preeclampsia had prolonged QRS durations (adjusted mean difference 0.6 ms, 95% confidence interval [CI] 0.04, 1.16) and lower maximum amplitudes of the R‐wave in V1 (adjusted mean difference, linear scale 0.95, 95% CI 0.90, 1.00), compared with unexposed infants. Exposure to maternal preeclampsia was not associated with changes in other ECG parameters. Exposure to gestational hypertension was associated with increased QT interval durations (QTc Bazett, adjusted mean difference 2.48 ms, 95% CI −0.23, 5.20; QTc Fridericia, adjusted mean difference 2.32 ms, 95% CI −0.19, 4.83).Our findings suggest that the newborn cardiac conduction system is affected by exposure to maternal preeclampsia. This could reflect the previously described thickening of the left ventricular myocardium in infants exposed to preeclampsia. [ABSTRACT FROM AUTHOR]

Background and Objectives: Spontaneous massive foetomaternal haemorrhage (SM‐FMH) is a rare yet critical condition that poses substantial risk to foetal health and survival. Existing data indicate that many cases may be undiagnosed. The current study aimed to investigate and validate the utility of identifying mixed field red blood cell (RBC) agglutination during maternal blood typing as a diagnostic aid for SM‐FMH. Materials and Methods: Retrospective analysis of medical records from neonates born at our tertiary, university‐affiliated medical centre between 2016 and 2023 was performed. Diagnosis of SM‐FMH was based on neonates born with severe anaemia (haematocrit [HCT] <15%) within the first 24 h post‐delivery with positive maternal Kleihauer–Betke (KB) test. Maternal ABO/Rhesus D (RhD) blood typing results were scrutinized with the primary objective of assessing the ability to identify dual RBC populations in cases clinically diagnosed with SM‐FMH. Results: Among 29,192 neonates studied, a mere 0.02% (5 cases) exhibited severe SM‐FMH. Notably, a mixed field RBC agglutination was discerned in 80% (4/5) of these cases. Conclusion: This study underscores the significance of detecting mixed field RBC agglutination during antepartum maternal ABO/RhD blood typing as a potential indicator for SM‐FMH. Increased awareness among blood bank technology specialists and obstetricians regarding these laboratory findings could prove instrumental in saving foetal lives. [ABSTRACT FROM AUTHOR]

With technological advancement, neonatal intensive care units (NICUs) have become noisier than ever. Studies have shown the detrimental effects of increasing noise in NICU on growing pre-term and sick neonates. The present study aimed primarily to compare the amount of noise in NICUs of private and government hospitals. The secondary aim was to compare the strategies adopted by these hospitals to control the detrimental effects of noise on newborns. A detailed noise survey was conducted in the NICUs of two private and two government hospitals in the Jodhpur district, India. The noise survey was performed for a duration of 48 h using "Sound Ear 3-300" noise meters. The analyses were measured in Leq (equivalent continuous sound level) A-weighted decibels (dBA). The extracted data analysis revealed that the noise measured was in the range of 61.62–82.32 dBA in four NICUs of the district. The results also revealed a statistically significant difference between the NICU noise of private and government hospitals. The levels of alarming sounds differed between the hospitals with a general trend of lesser alarming sounds in private hospitals. The major differences in strategies adopted were that both private hospitals had a protocol to purposely reduce levels of alarming sounds when heard, and purposely limited the number of staff present in certain areas of the NICU, which were correlated with reduced sound compared to the government hospitals. Strategies like these require no additional cost to make drastic changes in the average noise measured. [ABSTRACT FROM AUTHOR]

Nasal septal abscess in a newborn is a rare condition. This case report describes a case of nontraumatic, nasal septal abscess in a newborn baby with no evidence of sinusitis or other localized trauma/ infections. A 15-day-old newborn was admitted to a tertiary care hospital with a history of nasal blockage and swelling of the nasal septum. Physical examination revealed a fusiform swelling involving the nasal septum. The patient underwent Diagnostic Nasal Endoscopy with Incision and Drainage followed by 48-hour nasal packing. Neonates being obligate nasal breathers, after drainage, due to the bilateral nasal packs, the otolaryngology and paediatric team had to find a way to make the neonate breathe and swallow simultaneously. The neonate showed gradual improvement following nasal pack removal and had a normal nasal airway on follow-up at 14 days and one-month post-drainage. Even though the septal abscess in neonates is a rare entity however, it can significantly compromise the nasal airway in an obligatory nasal breather, and with limited space for intervention also poses a challenge in managing the condition. [ABSTRACT FROM AUTHOR]

Efforts to implement and evaluate genome sequencing (GS) as a screening tool for newborns and infants are expanding worldwide. The first iteration of the BabySeq Project (2015–2019), a randomized controlled trial of newborn sequencing, produced novel evidence on medical, behavioral, and economic outcomes. The second iteration of BabySeq, which began participant recruitment in January 2023, examines GS outcomes in a larger, more diverse cohort of more than 500 infants up to one year of age recruited from pediatric clinics at several sites across the United States. The trial aims for families who self-identify as Black/African American or Hispanic/Latino to make up more than 50% of final enrollment, and key aspects of the trial design were co-developed with a community advisory board. All enrolled families receive genetic counseling and a family history report. Half of enrolled infants are randomized to receive GS with comprehensive interpretation of pathogenic and likely pathogenic variants in more than 4,300 genes associated with childhood-onset and actionable adult-onset conditions, as well as larger-scale chromosomal copy number variants classified as pathogenic or likely pathogenic. GS result reports include variants associated with disease (Mendelian disease risks) and carrier status of autosomal-recessive and X-linked disorders. Investigators evaluate the utility and impacts of implementing a GS screening program in a diverse cohort of infants using medical record review and longitudinal parent surveys. In this perspective, we describe the rationale for the second iteration of the BabySeq Project, the outcomes being assessed, and the key decisions collaboratively made by the study team and community advisory board. [Display omitted] This perspective describes the design of the second iteration of the BabySeq Project, a randomized controlled trial of genome sequencing early in life that is generating evidence on medical, psychosocial, and economic outcomes in the United States. [ABSTRACT FROM AUTHOR]

To determine whether obstetric outcomes differ between women with endometriosis and those without, where all women undergo first-trimester screening for endometriosis. A prospective observational cohort study. The Early Pregnancy Unit at University College London Hospital, United Kingdom. Women with a live pregnancy progressing beyond 12 weeks' gestation and concurrent endometriosis (n = 110) or no endometriosis (n = 393). All women underwent a pelvic ultrasound examination in early pregnancy to examine for the presence of endometriosis and uterine abnormalities. The primary outcome of interest was preterm birth, defined as delivery before 37 completed weeks' gestation. Secondary outcomes included late miscarriage, antepartum hemorrhage, placental site disorders, gestational diabetes, hypertensive disorders of pregnancy, neonates small for gestational age, mode of delivery, intrapartum sepsis, postpartum hemorrhage, and admission to the neonatal unit. Women with a diagnosis of endometriosis did not have statistically significantly higher odds of preterm delivery (adjusted odds ratio [aOR] 1.85 [95% confidence interval {CI} 0.50–6.90]), but they did have higher odds of postpartum hemorrhage during cesarean section (aOR 3.64 [95% CI 2.07–6.35]) and admission of their newborn infant to the neonatal unit (aOR 3.24 [95% CI 1.08−9.73]). Women with persistent or recurrent deep endometriosis after surgery also had higher odds of placental site disorders (aOR 8.65 [95% CI 1.17–63.71]) and intrapartum sepsis (aOR 3.47 [95% CI 1.02–11.75]). We observed that women with endometriosis do not have higher odds of preterm delivery, irrespective of their disease subtype. However, they do have higher odds of postpartum hemorrhage during the cesarean section and newborn admission to the neonatal unit. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies have established a history of shoulder dystocia as an important risk factor for shoulder dystocia, but studies on shoulder dystocia by severity are scarce. It is unknown if shoulder dystocia tends to be passed on between generations. We aimed to assess the recurrence risk of shoulder dystocia by severity in the same woman and between generations on both the maternal and paternal side. We also assessed the likelihood of a second delivery and planned cesarean section after shoulder dystocia. Material and methods: This was a population‐based cohort study, using data from the Medical Birth Registry of Norway. To study recurrence in the same mother, we identified 1 091 067 pairs of first and second, second and third, and third and fourth births in the same mother. To study intergenerational recurrence, we identified an individual both as a newborn and as a mother or father in 824 323 mother‐offspring pairs and 614 663 father‐offspring pairs. We used Bayesian log‐binomial multilevel regression to calculate relative risks (RR) with 95% credible intervals. Results: In subsequent deliveries in the same woman the unadjusted RR of recurrence was 7.05 (95% credible interval 6.39–7.79) and 2.99 (2.71–3.31) after adjusting for possible confounders, including current birthweight. The RRs were higher with severe shoulder dystocia as exposure or outcome. With severe shoulder dystocia as both exposure and outcome, unadjusted and adjusted RR was 20.42 (14.25–29.26) and 6.29 (4.41–8.99), respectively. Women with severe and mild shoulder dystocia and those without had subsequent delivery rates of 71.1, 68.9 and 69.0%, respectively. However, the rates of planned cesarean section in subsequent deliveries for those without shoulder dystocia, mild and severe were 1.3, 5.2 and 16.0%, respectively. On the maternal side the unadjusted inter‐generational RR of recurrence was 2.82 (2.25–3.54) and 1.41 (1.05–1.90) on the paternal side. Corresponding adjusted RRs were 1.90 (1.51–2.40) and 1.19 (0.88–1.61), respectively. Conclusions: We found a strong recurrence risk of shoulder dystocia, especially severe, in subsequent deliveries in the same woman. The inter‐generational recurrence risk was higher on the maternal than paternal side. Women with a history of shoulder dystocia had more often planned cesarean section. [ABSTRACT FROM AUTHOR]

Introduction: Respiratory syncytial virus (RSV) leads to significant morbidity in newborn infants in the United Kingdom (UK). Nirsevimab, a long-acting monoclonal antibody, received approval from the European Medicines Agency and has been licensed by the Medicines and Healthcare products Regulatory Agency for preventing RSV lower respiratory tract disease (LRTD) in neonates and infants during their first RSV season. The objective of this study was to assess the potential impact of nirsevimab on RSV-associated LRTDs, related costs, and loss of quality-adjusted life years (QALYs) in infants experiencing their first RSV season. Methods: The impact of administering nirsevimab across all infant populations compared to palivizumab in the high-risk palivizumab-eligible population was assessed via a static decision-analytic model specified for a UK birth cohort experiencing their first RSV season. The RSV-related health events of interest included primary care (PC), accident and emergency (A&E) visits, hospitalizations [including hospitalizations alone and those resulting in intensive care unit (ICU) admissions], recurrent wheezing in infants who were previously hospitalized, and all-cause LRTD hospitalizations. Results: Under the current standard of practice (SoP), RSV was estimated to result in 329,425 RSV LRTDs annually, including 24,381 hospitalizations and ICU admissions, representing £117.8 million (2024 GBP) in costs. Comparatively, universal immunization of all infants with nirsevimab could avoid 198,886 RSV LRTDs, including 16,657 hospitalizations and ICU admissions, resulting in savings of £77.2 million in RSV treatment costs. Considering the impact on all-cause LRTD of a universal immunization strategy, nirsevimab could be valued between £243 and £274, assuming willingness-to-pay (WTP) thresholds of £20,000 and £30,000 per QALY saved, respectively. Conclusions: This analysis demonstrated that the health and economic burden of RSV would be substantially reduced in all infants experiencing their first RSV season in the UK (including term, preterm, and palivizumab-eligible infants) as a result of a universal immunization strategy with nirsevimab. [ABSTRACT FROM AUTHOR]

Fidgety movements provide early information about a potential development of cerebral palsy in preterm neonates. The aim was to assess differences in the combined outcome of mortality and fidgety movements defined as normal or pathological in very preterm neonates according to the group allocation in the randomised-controlled multicentre COSGOD III trial. Preterm neonates of two centres participating in the COSGOD III trial, whose fidgety movements were assessed as normal or pathological at six to 20 weeks of corrected age, were analysed. In the COSGOD III trial cerebral oxygen saturation (crSO2) was measured by near-infrared spectroscopy (NIRS) during postnatal transition and guided resuscitation in preterm neonates randomised to the NIRS-group, whereby medical support was according routine, as it was also in the control group. Fidgety movements were classified in normal or abnormal/absent at six to 20 weeks of corrected age. Mortality and fidgety movements of preterm neonates allocated to the NIRS-group were compared to the control-group. Normal outcome was defined as survival with normal fidgety movements. One-hundred-seventy-one preterm neonates were included (NIRS-group n = 82; control-group n = 89) with a median gestational age of 29.4 (27.4–30.4) and 28.7 (26.7–31.0) weeks in the NIRS-group and the control-group, respectively. There were no differences in the combined outcome between the two groups: 90.2% of the neonates in the NIRS-group and 89.9% in the control-group survived with normal outcome (relative risk [95% CI]; 0.96 [0.31–2.62]). Conclusions: In the present cohort of preterm neonates, monitoring of crSO2 and dedicated interventions in addition to routine care during transition period after birth did not show an impact on mortality and fidgety movements defined as normal or pathological at six to 20 weeks corrected age. What is Known • Fidgety movements display early spontaneous motoric pattern and may provide early information about a potential development of cerebral palsy in preterm neonates. What is New • This retrospective observational study of the randomised-controlled multicentre COSGOD III trial is the first study investigating the potential influence of cerebral oxygenation guided resuscitation during postnatal transition period on combined outcome of mortality and fidgety movements up to 20 weeks of corrected age in very preterm neonates. • This study adds to the growing interest of assessing cerebral oxygenation, that monitoring of cerebral oxygen saturation and dedicated interventions during postnatal transition period according to the COSGOD III trial has no significant influence on mortality and fidgety movements defined as normal or pathological in very preterm neonates. [ABSTRACT FROM AUTHOR]

Thrombocytopenia is common in preterm neonates and can be associated with hemorrhage. Most platelet transfusions are prophylactic. Previously, higher platelet-count thresholds were recommended for neonates, but this recommendation has been questioned in recent studies. In the PlaNeT2 trial, mortality and serious bleeding were more frequent in neonates with the highest platelet-count threshold than in others. Following this trial, we changed our platelet transfusion practice by lowering the platelet-count threshold for prophylactic transfusion from 50,000 to 25,000/mm3. We conducted a before–after retrospective cohort study to quantify the frequency of platelet transfusions and assess the new protocol by analyzing death and serious hemorrhage events. This retrospective monocentric study included neonates born before 37 weeks of gestation with platelet count < 150,000/mm3 during the 2 years preceding the new platelet transfusion protocol (high prophylactic transfusion threshold, 50,000/mm3) and during the 2 years after the new platelet transfusion protocol (low prophylactic transfusion threshold, 25,000/mm3). The primary outcome was the proportion of neonates receiving at least one platelet transfusion in both groups. We also compared the proportion of deaths and severe hemorrhage events. A total of 707 neonates with thrombocytopenia were identified. In the high-threshold group, 99/360 (27.5%) received at least one platelet transfusion as compared with 56/347 (16.1%) in the low-threshold group (p < 0.001). The groups did not differ in proportion of deaths or severe hemorrhage events. Conclusions: A reduced platelet-count threshold for transfusion allowed for a significant reduction in the number of platelet transfusions without increasing severe hemorrhage events. What is Known: • A recent randomized trial suggested that restrictive platelet-count thresholds for platelet transfusion could be beneficial for preterm neonates. What is New: • On lowering the platelet-count threshold for transfusion from 50,000 to 25,000/mm3, the number of transfusions significantly decreased without increasing severe hemorrhage events in a neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

The aim of this study was to perform a retrospective data analysis of established peripheral artery catheters (pAC) in extremely preterm infants. The primary outcome was the pAC life span and its correlation to gestational age, birth weight, localizations, and pAC removal. Retrospective data analysis of electronic patient records of all extremely preterm infants (born less than 28 weeks gestation) admitted to the neonatal intensive care unit in Graz (Austria) between January 2014 and December 2020. A total of 196 preterm infants with a median (IQR) gestational age of 25.7 (24.6–26.6) weeks and a birth weight of 730 (614–898) g were included. In 155 (79%) of these preterm infants, 286 pAC and six umbilical artery catheters were inserted successfully. The first pAC was inserted 2.5 (1.4–7.4) h after birth, and the median pAC life span was 57.5 (22.–107.2) h. Gestational age, birth weight, and catheter localization did not correlate with the pAC life span. The pAC localizations were the radial artery (63%), tibial posterior artery (21%), ulnar artery (6%), dorsal artery of the foot (6%), others (1%), and not documented (3%). Adverse reactions including temporarily impaired peripheral perfusion, local inflammation, extravasation, or bleeding were reported in 13% of all pAC, but none of these resulted in long-term sequelae. A median (IQR) of 9 (5–18) arterial blood samples were drawn via pAC, resulting in a notable reduction of pain stimuli. Conclusion: The use of pAC in extremely preterm infants is feasible and safe. Neither gestational age, birth weight nor localization did affect the life span of pAC. No long-term sequelae were observed, and pain events were reduced by using pAC for blood drawing. What is Known: • Peripheral artery catheters can be used for continuous blood pressure measurement and blood draw even in extremely preterm infants. • (Severe) adverse reactions such as bleeding, necrosis, or amputation occur between 1 and 4%. • What is New: • The median peripheral arty catheter life span is 58 h and is not affected by gestational age, birth weight, nor localization. • A median of nine blood samples can be taken per each single pAC and, therefore, prevent pain events in extremely preterm infants. [ABSTRACT FROM AUTHOR]

• Different growth standards lead to significantly different rates of SGA and severe SGA diagnoses. • Choosing a growth standard suited to the local population is crucial for accurate diagnosis. • Overdiagnosis and underdiagnosis of SGA can both have negative consequences. Small for gestational age (SGA) neonates are known to be at an elevated risk for neonatal morbidity. Despite this, there is a growing array of proposed size standards for identifying SGA fetuses. Given the inherent differences in design, acquisition methods, and the characteristics of the populations they represent, the generalizability of these standards to diverse populations remains uncertain. This study aimed to assess variations in rates of SGA and severe SGA using six distinct size standards: Hadlock, Fetal Medicine Foundation (FMF), World Health Organization (WHO), Intergrowth-21 (IG-21), and two locally derived population-based size standards. The objective was to examine the differences in SGA and severe SGA rates among these size standards. A retrospective cohort study was conducted, encompassing all singleton deliveries in two tertiary referral hospital campuses with an annual birth count exceeding 10,000, from January 2019 to July 2022. SGA and severe SGA were defined as birthweights below the 10th or 3rd percentile, respectively, based on each growth standard. The study design included details on the setting, subjects (singleton deliveries), and the chosen size standards. Comparative analyses were performed to assess variations in SGA and severe SGA rates among these size standards. Our study analyzed 32,912 singleton deliveries. We found that the choice of growth standard significantly impacted the rates of both SGA and severe SGA infants. Notably, the WHO criteria identified 5,548 (16.9 %) fetuses as SGA, compared to only 1,716 (5.2 %) using the INTERGROWTH-21 standard (p < 0.001). Similarly, for severe SGA, the FMF charts classified 2098 (6.37 %) infants, significantly higher than the 320 (1 %) identified by Dolberg's local population-based charts (p < 0.001). Our study demonstrates a significant variety of SGA and severe SGA rates using different size standards. Therefore, the decision on the size standards in use is critical given the significant influence on clinical management. There are significant variations in SGA and Severe SGA rates depending on the chosen size standard. [ABSTRACT FROM AUTHOR]

Objective Ocular hemorrhages (OHs) may cause visual disturbances and incidence vary from 18 to 39% in newborns. Precipitated/instrumental delivery and perinatal asphyxia were predefined risk factors. Acidosis can interfere with coagulation and disrupt the pressure of ocular capillaries and put infants with moderate acidosis with or without hypoxic–ischemic encephalopathy at risk for OH. We aimed to evaluate the OH in neonates with fetal acidosis. Study Design Neonates >34 weeks are included if pH < 7.10 and BE < −12 mmol/L within the first hour. Ophthalmologic examinations for retinal (RH), vitreous, and anterior chamber (hyphema) hemorrhage were done within the third day. RH was staged according to Egge's classification. Follow-up of the patients was continued until the age of 2. Clinical characteristics of newborns were analyzed. Results Sixty-two neonates (38 ± 2.3 weeks, 2,971 ± 612 g) were included. pH = 6.91 ± 0.16, BE = − 17.2 ± 5.3 mmol/L. OH was found in 22 (36.7%) neonates (hyphema n = 2, vitreous n = 2, RH n = 21). Thirty-eight eyes with RH were staged (Stage 3: n = 15 [39.5%]; Stage 2: n =11 [28.9%]; Stage 1: n = 12 [31.6%]). Vaginal delivery (OR: 4.9, 95% CI [1.4–17.8]) and advanced resuscitation at the delivery room (OR: 8.8; 95% CI [1.9–41.7]) were found to increase the risk of RH. Conclusion Approximately one-third of neonates with moderate to severe acidosis exhibited RH when examined on the third day. Contrary to previous studies that reported mild RH in otherwise healthy neonates, our findings revealed that neonates with moderate to severe acidosis predominantly presented with Stage 3 RH. While the higher incidence of RH in vaginally delivered infants is consistent with previous studies, the identification of advanced resuscitation as a risk factor is a new addition to the literature. The findings in our study highlight the importance of retinal examination in neonates with acidosis in the presence of intubation during resuscitation. Key Points One-third of neonates with moderate to severe acidosis exhibited RH. Stage 3 RH was identified as the most prevalent. Advanced resuscitation was identified as an independent risk factor for RH. [ABSTRACT FROM AUTHOR]

Objective To investigate the clinical utility of ultrasound parameters in diagnosing neonatal annular pancreas. Methods A total of 56 neonates with descending duodenal obstruction underwent saline-contrast ultrasound examination. Ultrasonic parameters, including dilated duodenum diameter (DDD), dilated duodenum thickness (DDT), and stenosis duodenum diameter (SDD), were measured. The cases were categorized into three groups: annular pancreas (group A, n = 28), descending duodenal atresia (group B, n = 3), and descending duodenal septum (group C, n = 25). One-way ANOVA was employed to compare statistical differences among the three ultrasonic parameters across the groups, followed by LSD-t test for pairwise comparisons between two groups showing significant differences. Receiver operating characteristics analysis was conducted to calculate the area under the curve and determine the cut-off value if there were statistically significant differences observed. Results In group A, group B, group C, the diameters of DDD were measured as(23.2 ± 2.4)mm, (25 ± 1.0)mm, (19.4 ± 2.6) mm, respectively. When comparing these three groups, there was a statistically significant difference between group A or group B and group C in terms of DDD diameter measurements (t = 5.7, P < 0.05; t = 3.793, P < 0.05). However, no statistically significant difference was observed between group A and group B for DDD diameter measurements (t = 1.232, P > 0.05). The corresponding values for DDT were measured as (3.0 ± 0.6)mm, (3.2 ± 0.4) mm, and (2.4 ± 0.3) mm, respectively. When comparing these three groups, the results showed a statistically significant difference between either Group A or Group B compared to Group C in terms of DDT measurement (t = 4.695, P < 0.05; t = 2.778, P < 0.05). However, no statistically significant difference was found between Group A and Group B regard- ing the measurement of DDT (t = 0.666, P > 0.05). The SDD measurements in the three groups were (1.9 ± 0.3) mm, (3.6 ± 0.8)mm, (5.5 ± 0.7)mm, respectively. Statistical analysis using LSD-t test revealed significant differences between the three groups (t = 5.521, P < 0.05; t = 6.142, P < 0.05; t = 25.828, P < 0.05).The sensitivity, specificity, positive predictive value, and negative predictive value for detecting annular pancreas at a cutoff of 2.3 mm were determined to be 96.4%, 100%, 100%, and 96.6%, respectively, with an area under the receiver operating characteristic curve of 0.999. Conclusion SDD could be employed for the diagnosis of neonatal annular pancreas. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion The aim of this study is to describe circumstances, management and short‐term outcomes of neonatal head trauma, and adherence to the Paediatric Emergency Care Applied Research Network (PECARN) head trauma prediction rule for children under 2 years.Multicentre retrospective cohort study of neonates (<29 days) with head trauma across 25 emergency departments (ED) from January 2017 to June 2021.A total of 492 neonates (median age 17 days, range 0–28 days) with non‐trivial head trauma were enrolled. Falls were the most common injury mechanism (375/492, 76.2%). Imaging was performed in 150/492 (30.5%) neonates.Clinically important traumatic brain injury (ciTBI), defined as death, neurosurgery, prolonged intubation, or extended hospitalisation from injury, occurred in 7/492 (1.4%) cases. Notably, 286/492 (58.1%) neonates were managed by short‐term observation (<48 h), and 126/492 (25.6%) were admitted.Among high‐risk neonates per PECARN criteria, 17/21 (80.9%) did not undergo recommended head CT scans but were observed within ED short observation units or underwent alternative imaging, with no ciTBI diagnoses among those discharged without CT.Severe neonatal head injuries are rare, and most neonatal head injuries have a favourable outcome, making observation a suitable approach, while remaining vigilant for signs of non‐accidental injuries. [ABSTRACT FROM AUTHOR]

Chagas disease, also known as American trypanosomiasis, is caused by a protozoan blood-borne pathogen called Trypanosoma cruzi. The World Health Organization (WHO) has classified Chagas as one of 21 neglected tropical diseases present in the world and estimates that 6-7 million people are currently infected with Chagas. Congenital transmission of Chagas disease contributes to a significant amount of new infections, especially in endemic areas where 22.5% of new infections are due to congenital transmission. In this paper, we investigate congenital transmission's impact on Chagas disease dynamics through a mathematical model. Specifically, we examine how treating a proportion of infants born to infected individuals impacts the progression and spread of Chagas disease. The influence of newborn therapy on the dynamics of the model is thoroughly investigated, both theoretically and numerically. The results illustrate the importance of treating a high proportion of newborns to reduce the number of infected cases of the disease. The findings show that the therapy given to newborns is necessary but not sufficient to curb the transmission of Chagas disease, and a comprehensive approach that includes vector and vertical transmission control strategies is essential for eradicating Chagas disease. We also observed that if vector transmission can be controlled, then at least 55% of the newborns need to be treated to eliminate the disease. [ABSTRACT FROM AUTHOR]

There is no objective criteria to wean CPAP in preterm neonates. We aimed to assess the accuracy of ‘saturation trends’ to predict successful CPAP discontinuation.We included very preterm neonates who required CPAP. Index tests were ‘saturation trends’. Outcome was successful CPAP discontinuation, defined as baby stable in room air for 72 h.We had 120 neonates with mean±SD gestation 28.6±1.8 weeks. 96 (80%) neonates had successful discontinuation and 24 (20%) failed. Neonates with successful discontinuation had significantly greater ‘saturation trends’ during 24 h before discontinuing CPAP compared to those who failed [64.3 (48.1–83.7) vs. 47.3 (23.0–65.0), p = 0.001]. Saturations > 95% while on CPAP with 21% FiO2 for > 60% time had 63% sensitivity and 70% specificity to predict successful CPAP discontinuation.‘Saturation trends’ is a readily available objective parameter that can be used to guide weaning CPAP in preterm neonates. [ABSTRACT FROM AUTHOR]

Early onset epilepsies occur in newborns and infants, and to date, genetic aberrations and variants have been identified in approximately one quarter of all patients. With technological sequencing advances and ongoing research, the genetic diagnostic yield for specific seizure disorders and epilepsies is expected to increase. Genetic variants associated with epilepsy include chromosomal abnormalities and rearrangements of various sizes as well as single gene variants. Among these variants, a distinction can be made between germline and somatic, with the latter being increasingly identified in epilepsies with focal cortical malformations in recent years. The identification of the underlying genetic mechanisms of epilepsy syndromes not only revolutionizes the diagnostic schemes but also leads to a better understanding of the diseases and their interrelationships, ultimately providing new opportunities for therapeutic targeting. At the XVI Workshop on Neurobiology of Epilepsy (WONOEP 2022, Talloires, France, July 2022), various etiologies, research models, and mechanisms of genetic early onset epilepsies were presented and discussed. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Infantile hemangiomas (IHs), the most prevalent vascular tumors in infancy, are generally understood to be absent at birth, appearing in the initial weeks of life during their proliferative stage. While the classic presentation is recognizable, the precursor lesion of IHs may be misinterpreted as other entities, including vascular malformations.A retrospective, single‐center study was conducted, examining neonates with photographed IH precursor lesions on day of life (DOL) 1 and matured classical IHs. The study spanned from 2017 to 2023.The case series is comprised of nine neonates all exhibiting precursor lesions on DOL 1. A comparative display of photographs featuring precursor lesions and classic IH is presented. Further tabulated information for each case includes IH locations, subsequent treatment modalities, and further diagnostic workup if necessary.Improving recognition of precursor lesions increases diagnostic accuracy, decreasing unnecessary workup. This, in turn, allows dermatologists to confidently employ close follow‐up management strategies. Additionally, in cases of extensive involvement, recognition of the precursor lesion allows for expedited investigation for syndromes such as PHACE (posterior fossa malformations, hemangioma, arterial anomalies, coarctation of the aorta/cardiac defects, and eye abnormalities) and LUMBAR (lower body IH, urogential anomalies, ulceration, myelopathy, bony deformities, anorectal malformations, arterial anomalies, and renal anomalies). [ABSTRACT FROM AUTHOR]

Clinical parameters along with echocardiographic markers are used to interrogate the haemodynamics in persistent pulmonary hypertension of the newborn (PPHN). The aim of this study was to compare different echocardiographic markers in recent cohort of newborn infants with and without PPHN.In this retrospective study, common echocardiographic markers were examined in infants>34 weeks’ gestation with PPHN (cases) and without PPHN (controls). Infants with congenital heart disease were excluded. Binary regression testing was used to evaluate echocardiographic markers predicting PPHN and death. In addition, diagnostic accuracy testing of echocardiographic markers using ROC was also performed. Intra-observer reliability for echocardiographic markers was examined using coefficient of variation (CoV) and intraclass correlation.Fifty-two infants were studied; 22 (42 %) infants with PPHN had significantly higher oxygen requirement, oxygenation index and ventilation days when compared with controls. Echocardiographic markers such as TR Vmax, S/D TR, PAAT, TAPSE and eccentricity index (EI) were significantly different between cases and controls. Receiver operator characteristics analysis of echocardiographic markers revealed TR Vmax 0.96 (0.9–1.0), S/D TR 0.95 (0.87–1.0) and end systolic EI 0.94 (0.87–1.0). These markers were found to predict death in this cohort of infants. CoV and Intra-observer reliability was good for various echocardiographic markers.Among the various echocardiographic markers studied, TR Vmax when present along with S/D TR and end systolic EI had good intra-observer reliability and were diagnostic of PPHN and predicted death in this cohort. Future trials could use these markers in studies examining PPHN. [ABSTRACT FROM AUTHOR]

Sedation and anesthesia are often required in order to facilitate collection of high-quality imaging studies free of significant motion artifact for infants and neonates. Provision of safe sedation and anesthesia requires good communication between the ordering provider, radiologist, and anesthesiologist, careful pre-procedural evaluation of the patient, and availability of appropriate and sufficient equipment, drugs, personnel, and facilities. There are many additional factors to be considered for provision of safe sedation or anesthesia for infants and neonates—it is ideal to involve a fellowship-trained pediatric anesthesiologist in the planning and carry-out of these plans. In this review, we discuss some of the basic definitions of sedation and anesthesia, requirements for safe sedation and anesthesia, and many of the germane risks and additional considerations that factor into the delivery of a safe sedation or anesthesia plan for the imaging of an infant or neonate. [ABSTRACT FROM AUTHOR]

Every 15 minutes in the US, an infant exposed to opioids is born. Approximately 50% of these newborns will develop Neonatal Opioid Withdrawal Syndrome (NOWS) within 5 days of birth. It is not known which infants will develop NOWS, therefore, the current hospital standard-of-care dictates a 96-hour observational hold. Understanding which infants will develop NOWS soon after birth could reduce hospital stays for infants who do not develop NOWS and decrease burdens on hospitals and clinicians. We propose noninvasive clinical indicators of NOWS, including newborn neurobehavior, autonomic biomarkers, prenatal substance exposures, and socioeconomic environments. The goals of this protocol are to use these indicators shortly after birth to differentiate newborns who will be diagnosed with NOWS from those who will have mild/no withdrawal, to determine if the indicators predict development at 6 and 18 months of age, and to increase NOWS diagnostic sensitivity for earlier, more accurate diagnoses. [ABSTRACT FROM AUTHOR]

Background: Group B Streptococcus (GBS) infection remains a leading cause of newborn morbidity and mortality. The study aimed to determine the adherence rate to the universal screening policy a decade after its introduction. Secondly, whether the timing of antibiotics given in GBS carriers reduces the incidence of neonatal sepsis. Methods: Delivery records at Hong Kong Baptist Hospital in 2022 were examined to retrieve antenatal and intrapartum details regarding maternal GBS carrier status, previous maternal GBS carrier status, antibiotic treatment, timing of treatment, neonatal condition at birth and whether the neonate had sepsis. Univariate statistics was used to assess the relationship between maternal GBS carrier and neonatal sepsis overall. Incidence of neonatal sepsis was stratified according to mode of delivery and timing of antibiotic. Results: The adherence rate to the universal GBS screening policy was 97%. The risk of neonatal sepsis was 5.45 (95% CI 3.05 to 9.75) times higher in women who were GBS screened positive when compared to non-GBS carriers (p < 0.001). Amongst term neonates from GBS carriers delivered by Caesarean section, the risk of neonatal sepsis significantly decreased by 70% after antenatal antibiotic treatment (p = 0.041) whereas in term neonates delivered vaginally, the risk of neonatal sepsis decreased by 71% (p = 0.022) if intrapartum antibiotic prophylaxis was given 4 or more hours. Conclusion: Giving antenatal antibiotic treatment before Caesarean section or intrapartum antibiotic prophylaxis for 4 or more hours before vaginal delivery may decrease the risk of neonatal sepsis in term neonates delivered from GBS carriers. [ABSTRACT FROM AUTHOR]

To explore whether rs2073244 at PAX9 increased susceptibility for full-term low birth weight infants and whether indoors passive smoking exposure has a combined effect with rs2073244 on newborn low birth weight (LBW), a 1:2 paired case–control study of LBW newborns was conducted at Xiamen University Affiliated Women and Children’s Hospital from March 2010 to October 2013. The rate of indoor passive smoking exposure in the LBW group was higher than it in the NBW group (p = 0.019). GG of PAX9 rs2073244 decreased the risk of LBW [OR = 0.38, 95% CI: (0.15-0.98)] and smaller HC [OR = 0.44, 95% CI:(0.20-0.98)]. The relative excess risk for LBW contributed by the additive interaction between the rs2073244 risk genotypes AG/AA and mother pregnancy passive smoking exposure was 10.679 (95%CI 1.728–65.975). Our study suggested that the AG/AA genotype of PAX9 rs2073244 might be a risk factor for LBW of full-term newborns, especially in maternal passive smoking. [ABSTRACT FROM AUTHOR]

Two cases of neonatal splenic hemorrhage with acute cardiorespiratory failure are described in this report. The first case involves a full-term neonate who was found unresponsive without any witnesses and could not be successfully resuscitated. A postmortem diagnosis revealed a splenic hemorrhage. Second case is an extremely premature neonate who experienced a witnessed cardiovascular collapse on the 14th day of life. Rapid cardiovascular support was administered, resulting in a positive outcome. While splenic hemorrhage is commonly associated with traumatic events, these cases highlight the need of considering spontaneous splenic hemorrhages as a potential cause of acute neonatal compromise, even in the absence of birth-related trauma (e.g., asphyxia, prolonged labor, clavicle fractures, brachial plexus injuries). This report emphasizes the importance of including splenic hemorrhage timely in the differential diagnosis of neonatal cardiorespiratory instability, especially in the absence of more common diagnoses, and discusses the challenges associated with its recognition and treatment. [ABSTRACT FROM AUTHOR]

Vancomycin has a narrow therapeutic window and a high inter‐individual pharmacokinetic variability, especially in neonates with fast maturational and pathophysiological changes, that needs individualized dosing. Physiologically based pharmacokinetic (PBPK) model and population pharmacokinetic (PopPK) model are both useful tools in model‐informed precision dosing, while the former is under research in application of vancomycin in neonates. This study aimed to develop a PBPK model of vancomycin in adult and pediatric population, and compared it with published PopPK model (priori or Bayesian method) in predicting vancomycin concentration in 230 neonatal patients (postmenstrual age, PMA, 25–45 weeks). The developed PBPK model showed a good fit between predictions and observations. PBPK model and PopPK model are complementary in different clinical scenarios of vancomycin application. The physiological‐change description of PBPK model showed a superior advantage in initial dosing optimization. As for subsequent dose optimization, PopPK Bayesian forecasting performed better than the PBPK estimation in neonates. However, initial precision dosing tools for early neonates (with PMA < 36 weeks) still need further exploitation. [ABSTRACT FROM AUTHOR]

In contrast to neonates and lower organisms, the adult mammalian heart lacks any capacity to regenerate following injury. The vast majority of our understanding of cardiac regeneration is based on research in young animals. Research in aged individuals is rare. This is unfortunate as aging induces many changes in the heart. The first part of this review covers the main technologies being pursued in the cardiac regeneration field and how they are impacted by the aging processes. The second part of the review covers the significant amount of agingrelated research that could be used to aid cardiac regeneration. Finally, a perspective is provided to suggest how cardiac regenerative technologies can be improved by addressing agingrelated effects. [ABSTRACT FROM AUTHOR]

Polydactyly is a common congenital anomaly characterized by the presence of extra digits on the hands and/or feet, potentially involving all four limbs simultaneously. The terminology used to describe polydactyly involving all four limbs varies in the literature, with terms such as "tetrapolydactyly," "polydactyly 24," and "hexadactyly of all limbs" being used interchangeably. We encountered a case of tetrapolydactyly in a female neonate with postaxial polydactyly involving all four limbs. Our patient had an extra digit on the ulnar side with a bony component on the left hand and a similar extra digit without a bony articulation at the base of the right hand. The right foot showed postaxial polydactyly, and the left foot exhibited both preaxial polysyndactyly and postaxial polydactyly. A review of the literature shows that this combination of anomalies is extremely rare. A family history is present in approximately 30% of cases, asymmetric patterns are rarer than symmetric patterns, and heptadactyly is particularly uncommon. This report summarizes the information on tetrapolydactyly in the literature and discusses the clinical implications as well as management strategies. [ABSTRACT FROM AUTHOR]

Kaposiform hemangioendothelioma (KHE) is a rare, aggressive vascular tumor predominantly seen in children. It can infiltrate the deeper soft tissues and is clinically marked by erythematous to violet plaques, sometimes associated with the Kasabach-Merritt phenomenon. A male neonate presented with a substantial mass on the dorsum of his left hand. Surgical excision on the 8th day after birth identified the tumor as KHE, without evidence of Kasabach-Merritt syndrome. Two additional operations were performed over the following year to address contractures and restore finger function. At a 6-month follow-up, the patient showed no significant functional impairment. KHE poses unique clinical challenges due to its aggressive nature. This case highlights the need for prompt surgical intervention, given the tumor's size and location. Managing KHE requires a rapid diagnosis and intervention, particularly in functionally critical areas, to ensure optimal outcomes. [ABSTRACT FROM AUTHOR]

Background: The timing of cord clamping has become a focal point for neonatal caregivers due to the promising outcomes associated with delayed cord clamping, which is a simple and cost-effective method to enhance the survival and well-being of preterm infants. While initially the rationale behind delaying clamping was to facilitate increased placental transfusion, research has unveiled additional hemodynamic benefits. Summary: Experimental studies have demonstrated improved circulatory transition when clamping is postponed until the lungs are adequately aerated. This suggests that infants requiring assistance during the transition phase may benefit from stabilization while still attached to the cord. The Aeration, Breathing, and then Clamping (ABC) project aimed to translate these experimental findings into clinical practice. Key Message: In this review, we will discuss the insights gained and lessons learned from the project's implementation. [ABSTRACT FROM AUTHOR]

Background: Newborn resuscitation algorithms have since the turn of the century been more evidence-based. In this review, we discuss the development of American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR)'s algorithm for newborn resuscitation from 1992–2024. We have also aimed to identify the remaining gaps in non-evidenced practice. Summary: Of the 22 procedures reviewed in the 2020 ILCOR recommendations, the evidence was either low, very low, or non-existing. The strength of recommendation is weak or non-existing for most topics discussed. Several knowledge gaps are also summarized. The special challenge for low- and middle-income countries (LMIC) is discussed. Key Messages: Newborn resuscitation is still not evidence-based, although great progress has been achieved the recent years. We have identified several knowledge gaps which should be prioritized in future research. The challenge of obtaining evidence-based knowledge from LMIC should be focused on in future research. [ABSTRACT FROM AUTHOR]

Walking in the footsteps of our ancestors can provide important ancestral precedents that can support Indigenous wāhine (women) in Aotearoa in working through the challenges we might face today and into the future. At the end of 2020, a group of seven Raukawa wāhine re-walked the journey of their ancestress Māhinaarangi. She walked, whilst heavily pregnant, from the lands of her people on the East Coast of Aotearoa to those of her husband, Tūrongo, in the central North Island. Her hīkoi (walk) offers significant conceptual and physical maps that speak to mātauranga (knowledge) and traditions about childbirth and mothering; the relationships between tribes and between people and the land; intimate knowledge of diverse environments; and endurance and courage to move through space to new lands, all done with a newborn baby. Māhinaarangi was a cartographer in her own right—mapping her story, history, language, tradition, ceremony, knowledge, and therefore herself and her descendants into the land upon which her footsteps fell. Through re-walking her journey, we both take something of that place with us and leave something of ourselves there and thus are involved in (re)storying and (re)storing ancestral places with our own footsteps. Retracing the journeys of our ancestors does more than memorialise their feats; rather, in placing our footprints along their pathways, we reclaim and remake place in uniquely Indigenous and Māori ways. [ABSTRACT FROM AUTHOR]

Background: Newborn screening (NBS) for primary carnitine deficiency (PCD) has poor performance. This study aimed to evaluate the feasibility of incorporating next‐generation sequencing (NGS) as a second‐tier PCD test. Methods: Between March and December 2020, 60,070 newborns were screened for inherited metabolic disorders. Newborns with free carnitine (C0) levels below 8.5 μmol/L were selected for second‐tier genetic testing. Results: In total, 130 (0.22%) newborns with low C0 levels underwent second‐tier genetic testing, 87 (66.92%) had positive genetic testing results, and 30 (23.08%) carried pathogenic variants of the SLC22A5 gene. Six newborns were diagnosed with PCD. The incidence of PCD was approximately 1 in 1:10,012 newborns. The PPV reached 20% after combining with second‐tier NGS. Of the eight variants identified in patients with PCD, the three most common variants were c.760C>T (p.Arg254*), c.51C>G (p.Phe17Leu), and c.1400C>G (p.Ser467Cys). The C0 levels of patients with PCD were significantly lower than those of PCD carriers (p = 0.0026) and PCD‐negative individuals (p = 0.0005). Conclusions: Our results showed that the PPV reached 20% after combining with second‐tier NGS. The MS/MS‐based NBS and second‐tier NGS combination can effectively reduce the false‐positive rate and detect PCD in patients. [ABSTRACT FROM AUTHOR]

Sepsis is a leading cause of death in preterm neonates. The increased susceptibility to sepsis is due to prolonged hospitalization, the need for invasive procedures, and immaturity of innate and adaptive immunity. Chlorhexidine gluconate is a popular topical disinfectant that was not recommended for use in preterm neonates until 2012. Thus, there are few studies assessing the role of chlorhexidine gluconate in antisepsis for preterm neonates. A better understanding of the safety and efficacy of chlorhexidine gluconate as an antiseptic agent for preterm neonates is the first step in establishing best practice guidelines for this population. [ABSTRACT FROM AUTHOR]

There is limited information available on pressure‐related neonatal nasal injuries. We present three neonates born with erythema and purpura of the nasal tip that subsequently ulcerated, then evolved into a thick eschar. Each healed well with conservative management but left behind significant scarring. The sharp demarcation and location of the lesions were suggestive of hypoxic tissue damage akin to halo scalp ring alopecia. Further investigation is necessary to elucidate the etiology and optimal management of this condition. [ABSTRACT FROM AUTHOR]

Background: This study aims to explore the association between variations in the Surfactant Protein-B (SFTPB) gene and the risk of neonatal respiratory distress syndrome (NRDS). Methods: A comprehensive literature search was conducted across PubMed, Scopus, EMBASE, and CNKI databases up to February 10, 2024, to identify pertinent studies. Results: A total of seventeen studies examining the +1580 C/T polymorphism (2,058 cases and 2,596 controls) and five studies investigating the −18 A/C polymorphism (680 cases and 739 controls) were included in the analysis. The pooled data indicated that the +1580 C/T polymorphism confers a protective effect against NRDS in various populations and ethnic groups. Conversely, the −18 A/C polymorphism did not demonstrate a significant association either globally or among Asian neonates. Conclusions: The +1580 C/T variant appears to be protective against NRDS, whereas the −18 A/C polymorphism shows minimal impact on the disease's progression. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Early detection of occult spinal dysraphism, such as diastematomyelia with tethered cord, is vital to prevent neurological damage. Though rarely diagnosed in the neonatal period, cutaneous stigmata can aid early identification. Utilizing neonatal ultrasound enables timely management and multidisciplinary intervention. [ABSTRACT FROM AUTHOR]

Background: It is important that blood glucose concentrations be accurately and conveniently measured in infants. However, especially in the early neonatal period, point-of-care testing devices used for adults may not accurately measure blood glucose concentrations in neonates. Methods: In Study 1, the accuracy of neonatal whole-blood glucose measurements was evaluated for the existing glucose analyser Glutest Mint® (hereinafter MINT1; Sanwa Kagaku Kenkyusho, Nagoya, Japan) by comparing the data with reference blood glucose concentrations. In Study 2, we used MINT2, which was modified based on the findings from Study 1, to measure whole-blood glucose concentrations in newborns, and the accuracy of the measurements was compared with that of MINT1. Results: Blood glucose concentrations were measured in 100 infants each in Study 1 and 2. In Study 1, the whole-blood glucose concentrations measured using MINT1 were found to be significantly lower than the reference blood glucose concentrations in early neonates. The results of Study 1 suggested that characteristics of erythrocyte membranes in early neonates affected the measurements. Therefore, we conducted Study 2 using MINT2, which was modified to be less susceptible. MINT2 was found to accurately measure whole-blood glucose concentrations in the early neonatal period. Conclusion: The study showed that the point-of-care testing device could be improved to allow for accurate whole-blood glucose measurements in the early neonatal period. [ABSTRACT FROM AUTHOR]

Objective: To determine adverse effects of Human Milk Fortifier on Preterm neonates in a Neonatal Intensive Care Unit. Study Design: Descriptive study. Setting: Indus Hospital NICU in Karachi. Period: Mar 2022 to September 2023. Methods: Aimed to investigate the adverse effects of HMF on 139 preterm neonates. The study excluded infants with congenital anomalies. Adverse effects, including Necrotizing Enterocolitis (NEC), metabolic acidosis, feeding intolerance, and other complications, were monitored. Results: The findings revealed that feeding intolerance was the most common adverse effect of HMF. Mild metabolic acidosis and NEC were also observed. These results are consistent with previous studies and may be attributed to the high osmolality of feeds following fortification with HMF. Despite the well-established role of HMF in promoting weight gain in preterm infants, the study underscores the importance of closely monitoring its use. Conclusion: Careful consideration of the potential risks and benefits of HMF is essential before prescribing it to preterm neonates. Future research with larger sample sizes and controlled designs is needed to validate these findings and explore strategies to mitigate the adverse effects of HMF in NICU settings. [ABSTRACT FROM AUTHOR]

Mechanisms resulting from the physiological immaturity of the digestive system in children delivered before 32 weeks of gestation and, in particular, different interactions between the microbiome and the body have not been fully elucidated yet. Next-generation sequencing methods demonstrated the presence of bacterial DNA in the placenta and amniotic fluid, which may reflect bacterial populations that initiate intestinal colonization in utero. Numerous studies confirmed the hypothesis stating that intestinal bacteria played an important role in the pathogenesis of necrotizing enterocolitis (NEC) early- and late-onset neonatal sepsis (EONS and LONS). The model and scale of disorders within the intestinal microbiome are the subject of active research in premature infants. Neonatal meconium was primarily used as an indicator defining the environment in utero, as it is formed before birth. Metagenomic results and previous data from microbiological bacterial cultures showed a correlation between the time from birth to sample collection and the detection of bacteria in the neonatal meconium. Therefore, it may be determined that the colonization of the newborn's intestines is influenced by numerous factors, which may be divided into prenatal, perinatal, and postnatal, with particular emphasis put on the mode of delivery and contact with the parent immediately after birth. Background: The aim of this review was to collect available data on the intrauterine shaping of the fetal microbiota. Methods: On 13 March 2024, the available literature in the PubMed National Library of Medicine search engine was reviewed using the following selected keywords: "placental microbiome", "intestinal bacteria in newborns and premature infants", and "intrauterine microbiota". Results: After reviewing the available articles and abstracts and an in-depth analysis of their content, over 100 articles were selected for detailed elaboration. We focused on the origin of microorganisms shaping the microbiota of newborns. We also described the types of bacteria that made up the intrauterine microbiota and the intestinal microbiota of newborns. Conclusions: The data presented in the review on the microbiome of both term newborns and those with a body weight below 1200 g indicate a possible intrauterine colonization of the fetus depending on the duration of pregnancy. The colonization occurs both via the vaginal and intestinal route (hematogenous route). However, there are differences in the demonstrated representatives of various types of bacteria, phyla Firmicutes and Actinobacteria in particular, taking account of the distribution in their abundance in the individual groups of pregnancy duration. Simultaneously, the distribution of the phyla Actinobacteria and Proteobacteria is consistent. Considering the duration of pregnancy, it may also be concluded that the bacterial flora of vaginal origin dominates in preterm newborns, while the flora of intestinal origin dominates in term newborns. This might explain the role of bacterial and infectious factors in inducing premature birth with the rupture of fetal membranes. [ABSTRACT FROM AUTHOR]

Introduction: Hyaline Membrane Disease (HMD) is a major cause of respiratory distress in preterm neonates due to a deficiency in pulmonary surfactant. Continuous Positive Airway Pressure (CPAP) serves as an effective non-invasive respiratory support that can reduce the necessity for invasive ventilation. This study evaluated the efficacy and outcomes of nasal CPAP in preterm neonates with HMD. Materials & Methods: After receiving IEC approval, a 12-month retrospective and prospective observational study was conducted. The study involved 50 intramural neonates, aged 28-36 weeks gestation, admitted to the NICU at IMCHRC with clinical and radiological signs of HMD. These neonates were treated with nasal CPAP and categorized into two groups: CPAP success (weaned off CPAP) and CPAP failure (required mechanical ventilation). Statistical analyses compared outcomes between these groups. Results: Among 227 preterm deliveries, 62 inborn neonates were diagnosed with HMD, and 50 received CPAP within 0-6 hours of birth. CPAP was successful in 82% of cases, while the remaining 18% required advanced ventilation. The mean CPAP duration was 37.5 ± 15.40 hours for the success group and 9.2 ± 1.56 hours for the failure group. CPAP effectiveness was 100% for mild, 93.10% for moderate, and 46.67% for severe HMD. Furthermore, 90% of those needing ventilation were under 32 weeks gestation. Conclusion: In developing countries, where prematurity and limited antenatal steroid use increase HMD risk, early nasal CPAP effectively treats mild to moderate HMD but is less effective for severe cases. It offers a safe, cost-effective alternative to invasive ventilation, reducing mechanical ventilation requirements, hospital stays, complications, and mortality. [ABSTRACT FROM AUTHOR]

Background: In the majority of neonates from developing nations, the birth and development of neonates is done in rural backgrounds. However, the literature data is scarce concerning the assessment of the burden of morbidities in rural children at Indian healthcare centers. Aim: The present study aimed to assess the incidence of various morbidities in the neonates of rural areas along with associated case fatalities in rural neonates that are home-cared for. The study also assessed neonates with indications for health care and the subjects that received the healthcare. Methods: The study assessed neonates by trained female village healthcare workers at birth and in the neonatal period of 0 to 28 days through 8 visits at home. The data was checked by a physician expert in the field and to assess morbidities, a computer program was used. The data gathered was statistically assessed. Results: Among 508 live births, 95% of births were at home and a total of 75% (n=381) neonates were assessed. The agreement in the observations of physicians and healthcare workers was 92%. High-risk morbidities were seen in 48.03% (n=183) neonates with a case fatality of >10%. Inadequate weight of <300 grams and low-risk morbidities were seen in 17.9% and 72.2% of subjects respectively. Clinical features of sepsis were seen in 17% of subjects. 54% of subjects needed healthcare and 19 neonates died among these 20 with only 2% getting medical attention. The rate of neonatal mortality was 52.4/1000 live births. Conclusions: The present study concludes that nearly half of neonates in rural areas develop 10 times more neonatal morbidity rates and require healthcare. However, these neonates practically do not receive healthcare facilities. This gap in care needs urgent home-based neonatal care development to decrease neonatal mortality and morbidity. [ABSTRACT FROM AUTHOR]

This document contains abstracts from the Journal of Neonatal - Perinatal Medicine, covering a range of topics related to neonatal encephalopathy (NE) and its associated complications. The studies explore the efficacy of AI-based seizure-detection algorithms, the feasibility of EEG recordings in emergency transport, the validation of neonatal encephalopathy scores using neurophysiology measures, and the use of an automated seizure detection algorithm for neonatal EEG. Additionally, the document discusses the development and achievements of the HRB Neonatal Encephalopathy PhD Training Network (HRB NEPTuNE) research program, which aims to improve understanding, diagnosis, and management of NE. The text also includes studies on somatosensory evoked potentials (SEPs), red reflex assessment, catecholamine therapy, and neonatal ventriculitis. [Extracted from the article]

This document is a collection of abstracts from the 15th International Newborn Brain Conference. The abstracts cover a range of topics related to newborn brain health and development. One study focuses on perinatal hypoxic-ischemic brain damage and the activation of the caspase pathway. Another examines the yield of genetic testing in cases of posterior fossa anomalies. A third investigates the association between nighttime births and neonatal asphyxia or hypoxic ischemic encephalopathy. The fourth explores the incidence of multi-organ dysfunction in neonates with hypoxic ischemic encephalopathy. The fifth focuses on prenatal MRI brain findings associated with epilepsy. The final abstract examines the associations between cerebral metabolism/hemodynamic parameters and neurodevelopmental outcomes. The document also includes two medical cases, one involving infants with hypoxic-ischemic encephalopathy and genetic or congenital anomalies, and the other involving a patient with a rare metabolic disorder. These cases highlight the importance of genetic testing in diagnosing and managing congenital diseases. [Extracted from the article]