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Aim: To assess the incidence and severity of nasal pressure injuries caused by nasal CPAP nasal masks and binasal prongs. Methods: Single NICU observational study among infants who required nCPAP, using the Nasal Injury Assessment Score Chart (NIASC). Results: In 90.7% (N = 118) skin injuries were observed. Eleven infants had no skin injury, 68 mild, 26 moderate and 13 severe. The severity of the injury was categorized into groups; group I (NIASC

Under a Creative Commons license: Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) Clinical practice is a moment of stress for nursing students with impact in academic outcomes. Neonatal Intensive Care Units (NICU) are a specific and multifaceted context that offer complex experiences to nursing students. A descriptive, cross-sectional, and observational study, with a qualitative approach was outlined that aimed to describe and categorize the experiences of nursing students in NICU. Semi structured interviews were used for data collection and content analysis for data analysis. Among eligible students (those that had performed clinical practice in NICU and agreed to participate) a purposive sample of 6 students was selected. Data analysis allowed the identification of five categories: clinical practice evolution, expectations about clinical practice, challenges faced in clinical practice, feelings for the babies and their parents, and comparing with the adult nursing clinical practice. The findings of this study indicate that nursing students experienced a wide range of feelings and experiences. info:eu-repo/semantics/acceptedVersion

Refereed/Peer-reviewed Lethal short-limb skeletal dysplasia Al-Gazali type (OMIM %601356), also called dysplastic cortical hyperostosis, Al-Gazali type, is an ultra-rare disorder previously reported in only three unrelated individuals. The genetic etiology for Al-Gazali skeletal dysplasia has up until now been unknown. Through international collaborative efforts involving seven clinical centers worldwide, a cohort of nine patients with clinical and radiographic features consistent with short-limb skeletal dysplasia Al-Gazali type was collected. The affected individuals presented with moderate intrauterine growth restriction, relative macrocephaly, hypertrichosis, large anterior fontanelle, short neck, short and stiff limbs with small hands and feet, severe brachydactyly, and generalized bone sclerosis with mild platyspondyly. Biallelic disease-causing variants in ADAMTSL2 were detected using massively parallel sequencing (MPS) and Sanger sequencing techniques. Six individuals were compound heterozygous and one individual was homozygous for pathogenic variants in ADAMTSL2. In one of the families, pathogenic variants were detected in parental samples only. Overall, this study sheds light on the genetic cause of Al-Gazali skeletal dysplasia and identifies it as a semi-lethal part of the spectrum of ADAMTSL2-related disorders. Furthermore, we highlight the importance of meticulous analysis of the pseudogene region of ADAMTSL2 where disease-causing variants might be located.

Background: Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second-stage caesarean section (SSCS) are the most commonly performed obstetric interventions, but the procedure chosen varies widely globally. Objectives: To compare maternal and perinatal morbidity, mortality and other adverse outcomes after VE versus SSCS. Search Strategy: A systematic search was conducted in PubMed, Cochrane and EMBASE. Studies were critically appraised using the Newcastle–Ottawa scale. Selection Criteria: All artictles including women in second stage of labour, giving birth by vacuum extraction or cesarean section and registering at least one perinatal or maternal outcome were selected. Data Collection and Analysis: The chi-square test, Fisher exact's test and binary logistic regression were used and various adverse outcome scores were calculated to evaluate maternal and perinatal outcomes. Main Results: Fifteen articles were included, providing the outcomes for a total of 20 051 births by SSCS and 32 823 births by VE. All five maternal deaths resulted from complications of anaesthesia during SSCS. In total, 133 perinatal deaths occurred in all studies combined: 92/20 051 (0.45%) in the SSCS group and 41/32 823 (0.12%) in the VE group. In studies with more than one perinatal death, both conducted in low-resource settings, more perinatal deaths occurred during the decision-to-birth interval in the SSCS group than in the VE group (5.5% vs 1.4%, OR 4.00, 95% CI 1.17–13.70; 11% vs 8.4%, OR 1.39, 95% CI 0.85–2.26). All other adverse maternal and perinatal outcomes showed no statistically significant differences. Conclusions: Vacuum extraction should be the recommended mode of birth, both in high-income countries and in low- and middle-income countries, to prevent unnecessary SSCS and to reduce perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available.

Background: Prolonged second stage of labour is an important cause of maternal and perinatal morbidity and mortality. Vacuum extraction (VE) and second-stage caesarean section (SSCS) are the most commonly performed obstetric interventions, but the procedure chosen varies widely globally. Objectives: To compare maternal and perinatal morbidity, mortality and other adverse outcomes after VE versus SSCS. Search Strategy: A systematic search was conducted in PubMed, Cochrane and EMBASE. Studies were critically appraised using the Newcastle–Ottawa scale. Selection Criteria: All artictles including women in second stage of labour, giving birth by vacuum extraction or cesarean section and registering at least one perinatal or maternal outcome were selected. Data Collection and Analysis: The chi-square test, Fisher exact's test and binary logistic regression were used and various adverse outcome scores were calculated to evaluate maternal and perinatal outcomes. Main Results: Fifteen articles were included, providing the outcomes for a total of 20 051 births by SSCS and 32 823 births by VE. All five maternal deaths resulted from complications of anaesthesia during SSCS. In total, 133 perinatal deaths occurred in all studies combined: 92/20 051 (0.45%) in the SSCS group and 41/32 823 (0.12%) in the VE group. In studies with more than one perinatal death, both conducted in low-resource settings, more perinatal deaths occurred during the decision-to-birth interval in the SSCS group than in the VE group (5.5% vs 1.4%, OR 4.00, 95% CI 1.17–13.70; 11% vs 8.4%, OR 1.39, 95% CI 0.85–2.26). All other adverse maternal and perinatal outcomes showed no statistically significant differences. Conclusions: Vacuum extraction should be the recommended mode of birth, both in high-income countries and in low- and middle-income countries, to prevent unnecessary SSCS and to reduce perinatal and maternal deaths when safe anaesthesia and surgery is not immediately available.

Cellulitis of neonates and infants younger than three months of age is rare and often atypical in presentation. Because of the potentially (and rapidly) lethal course of group B streptococcal sepsis, it is essential to avoid delay in diagnosis and treatment. We report the case of a neonate with group B streptococcal retroauricular cellulitis. Admitted for late bacterial neonatal infection with cutaneous location. The history of the disease dates back to one day before admission, with the appearance of a painful cervical swelling without other associated signs evolving in a context of fever of 39°. The clinical examination found a pink tonic reactive newborn in good hemodynamic and respiratory condition, febrile at 39.5°. With the presence of a painful and warm latero-cervical mass of hard consistency and the presence of associated bilateral latero-cervical adenopathies was noted. The oral cavity examination was unremarkable; Cellulitis in newborns and infants under 3 months of age is rare and has not been described in the literature except in a few clinical cases. In the case of any cellulitis of the face in a newborn or before the age of 3 months, late infection with group B streptococci (GBS) should be considered.

Objectives: to evaluate the evolution of extremely preterm and very preterm infants admitted to neonatal intensive care units, regarding the use of ventilatory support, morbidities, medication use, death, survival and viability. Methods: a non-concurrent cohort study, with 163 very premature and extreme newborns hospitalized in three neonatal intensive care units, during 2016 and 2017. A descriptive analysis of the data obtained from the medical records was performed. The outcomes studied were the use of ventilatory support, morbidities, medication use, death and causes of death. A survival curve was constructed and a viability limit was defined. Results: in the study, 28.2% were extreme and 71.8% were very premature. In this order of subgroups, the need for mechanical ventilation was higher for the extremes (65.2% and 41.0%) and the main diagnosis was early sepsis (78.6% and 82.6). Off-label (60.5% and 47.9%) and off-license (25.3% and 29.0%) medications were used. Most deaths (57.8%) occurred between the extremes, mainly due to septic shock. Survival was lower for the lowest gestational ages and the limit of viability was between 26 and 27 weeks. Conclusions: the main morbidities were from the respiratory system, with high use of off-label and unlicensed medications. Extremes had a greater demand for intensive care in addition to needing more drugs and progressing more to death. Resumo Objetivos: avaliar a evolução dos prematuros extremos e muito prematuros internados em unidades de terapia intensiva neonatais, quanto ao uso de suporte ventilatório e de medicamentos, óbito, sobrevida e viabilidade. Métodos: estudo de coorte não concorrente, com 163 recém-nascidos muito prematuros e extremos internados em três unidades de terapia intensiva neonatais, durante 2016 e 2017. Realizou-se análise descritiva dos dados obtidos dos prontuários. Os desfechos estudados foram o uso de suporte ventilatório, morbidades, uso de medicamentos, óbito e causas de óbito. Foi construída curva de sobrevivência e delimitado um limite de viabilidade. Resultados: no estudo, 28,2% eram extremos e 71,8% muito prematuros. Nessa ordem de subgrupos, a necessidade de ventilação mecânica foi maior para os extremos (65,2% e 41,0%) e o principal diagnóstico foi sepse precoce (78,6% e 82,6).Medicamentos off-label (60,5% e 47,9%) e sem-licença (25,3% e 29,0%) foramutilizados. A maioria dos óbitos (57,8%) ocorreu entre os extremos, principalmente por choque séptico. A sobrevivência foi menor para as menores idades gestacionais e o limite de viabilidade ficou entre 26 e 27 semanas. Conclusões: as principais morbidades foram do sistema respiratório, com alto uso de medicamentos off-label e sem licença. Extremos tiveram maior demanda de cuidados intensivos além de necessitarem de mais medicamentos e evoluírem mais ao óbito.

Rapid genomic sequencing (rGS) is being increasingly used in neonatal and paediatric intensive care units. While there is emerging evidence of clinical utility and cost-effectiveness, concerns have been raised regarding the impact of delivering genomic results in an acute care setting. To help investigate these concerns, we analysed survey data collected from caregivers whose children had received rGS through a national rapid genomic diagnosis program. The impact of rGS on families was assessed through the PedsQL2.0 Family Impact Module and the State-Trait Anxiety Inventory (STAI-6). Sixty-one parents/carers completed the survey during the study period (response rate 48%; 61/128). Mean parent and family functioning was reduced in this sample, reflecting the stressful conditions facing families with critically unwell children. We found caregivers whose children had received a diagnostic result through rGS reported a reduced family relationships score compared to caregivers of children who did not receive a diagnosis. These findings have implications for genetic counselling practice in this setting. ispartof: EUROPEAN JOURNAL OF HUMAN GENETICS vol:30 issue:9 pages:1036-1043 ispartof: location:England status: published

Place: France; This literature review focuses on the neonatal context. It provides an update of knowledge on the psychosocial consequences and communication needs expressed by parents. It highlights the obstacles to communication and proposes lines of thought for the development of new training systems to improve the communication practices of caregivers. OBJECTIVE: This review aims to assess and categorize the specific needs and expectations of families in terms of communication within the neonatal intensive care unit (NICU). METHODS: A bibliographic search was carried out on the Web of Sciences, PubMed and PsycArticles databases with the following keywords: "neonat* AND new* AND communication AND parent*". RESULTS: In total, 16 papers were selected showing that information and communication are particular needs for parents in NICUs. They are confronted with a stressful situation and have to deal with the fear and anticipation of the situation in a context of uncertainty. Parents are satisfied with the caregiver-parent relationship when the type of communication is adapted to the context and to their changing needs. Conversely, they feel excluded when they cannot be involved as they would like to be in the care or in the decision-making process. CONCLUSION: The development of new communication training methods and tools such as simulation would allow healthcare workers to acquire new communication skills focused on the needs of families.

The possibility to identify patients with spinal muscular atrophy through neonatal screenings has highlighted the need for clinical assessments that may systematically evaluate the possible presence of early neurological signs. The aim of this study was to use the Hammersmith Neonatal Neurological Examination (HNNE) and a module specifically designed for floppy infants to assess the possible variability of neurological findings in infants identified through neonatal screening. The infants included in this study were identified as part of a pilot study exploring neonatal screening in two Italian regions. A neurological examination was performed using the HNNE and an additional module developed for the assessment of floppy infants. Seventeen infants were identified through the screening. One patient had 1 SMN2 copy, 9 had 2 copies, 3 had 3, and 4 had more than 3 copies. Nine of the 17 infants (53%) had completely normal results on both scales, 3 had minimal signs, and the other 5 had more obvious clinical signs. The number of SMN2 copies was related to the presence of abnormal neurological signs (p = 0.036) but two SMN2 copies were associated with variable clinical signs as they were found in some infants with respectively normal examination or obvious severe early signs.Conclusions: Our results suggest that the combination of both scales increases the possibility to detect neonatal neurological signs and to define different early patterns of involvement also identifying paucisymptomatic patients. What is Known:• The use of new therapeutic options in presymptomatic SMA patients leads to a dramatic reduction of the onset and severity of the diesease.• The already existing tools commonly used in Type I SMA (HINE and CHOP-intend) may not be suitable to identify minor neurological signs in the neonatal period. What is New:• Combining the HNNE and the floppy infant module, we were able to identify early neurological signs in SMA infants identified through newborn screening and may help to predict the individual therapeutic outcome of these patients.• Iinfants with 2 SMN2 copies identified through the screening had a more variable neonatal examination compared to those with three or more copies, in agreement with similar findings in older infants.

ObjectiveIn response to the increasing focus on family-centred care, neonatal intensive care unit (NICU) environments have gradually shifted towards the single-room design. However, the assumed benefits of this emerging design remain a subject of debate. Our goal was to evaluate the impact of single-room versus open-bay care on the risk of neonatal morbidity and mortality in preterm neonates.DesignRetrospective cohort study.SettingLevel III NICU.PatientsNeonates born Main outcome measuresMortality and morbidities of a cohort of neonates admitted to a new, single-room unit (SRU) were compared with a historical cohort of neonates admitted to an open-bay unit (OBU). Group differences were evaluated and multivariable logistic regression analyses were performed.ResultsThree-hundred and fifty-six and 343 neonates were admitted to the SRU and OBU, respectively. No difference in neonatal morbidities and mortality were observed between cohorts (bronchopulmonary dysplasia: OR 1.08, 95% CI 0.73 to 1.58, p=0.44; retinopathy of the prematurity stage ≥2: OR 1.36, 95% CI 0.84 to 2.22, p=0.10; intraventricular haemorrhage: OR 0.89, 95% CI 0.59 to 1.34, p=0.86; mortality: OR 1.55, 95% CI 0.75 to 3.20, p=0.28). In adjusted regression models, single-room care was independently associated with a decreased risk of symptomatic patent ductus arteriosus (adjusted OR 0.54, 95% CI 0.31 to 0.95). No independent association between single-room care and any of the other investigated outcomes was observed.ConclusionsImplementation of single-rooms in our NICU did not lead to a significant reduction in neonatal morbidity and mortality outcomes.

Objective: to know the process of kangaroo care implementation and dissemination in the state of Santa Catarina. Method: this is socio-historical research with a qualitative approach, with data collection carried out from January to November 2019, through interviews with 12 oral sources. Analysis was carried out in the light of genealogical analysis proposed by Foucault, with the help of Atlas.ti Cloud®. Results: the process of kangaroo care implementation and dissemination in Santa Catarina happened from the breaking of resistance to the light of scientific knowledge, training and awareness that gradually captivated health professionals for the incorporation of new knowledge in neonatal care practice. Conclusion: kangaroo care implementation as a public health policy configured a paradigm shift in neonatal care in Santa Catarina. Although scientifically supported, it took years to materialize in the state and still faces resistance. RESUMEN Objetivo: conozca el proceso de implementación y difusión del método canguro en el estado de Santa Catarina. Método: se trata de una investigación sociohistórica con enfoque cualitativo, con recolección de datos realizada de enero a noviembre de 2019, a través de entrevistas con 12 fuentes orales. El análisis se realizó a la luz del análisis genealógico propuesto por Foucault, con la ayuda del software Atlas.ti Cloud®. Resultados: el proceso de implantación y difusión del método canguro, en Santa Catarina, pasó por el rompimiento de resistencias a la luz del conocimiento científico, la formación y la concientización que poco a poco contagió a los profesionales de la salud para la incorporación de nuevos conocimientos en la práctica del cuidado neonatal. Consideraciones finales: la implementación del método canguro, como política de salud pública, configuró un cambio de paradigma en la atención neonatal en Santa Catarina. Aunque científicamente respaldado, tardó años en materializarse en el estado y aún enfrenta resistencia. RESUMO Objetivo: conhecer o processo de implantação e disseminação do Método Canguru no estado de Santa Catarina. Método: pesquisa sócio histórica com abordagem qualitativa, com coleta de dados realizada de janeiro a novembro de 2019, por meio de entrevistas com 12 fontes orais. A análise foi realizada à luz da análise genealógica proposta por Foucault, com o auxílio do software Atlas.ti Cloud®. Resultados: o processo de implantação e disseminação do Método Canguru, em Santa Catarina, aconteceu a partir da quebra de resistências à luz do saber científico, capacitações e sensibilizações que contagiaram aos poucos os profissionais de saúde para a incorporação dos novos saberes na prática do Cuidado Neonatal. Considerações finais: a implantação do Método Canguru, enquanto política pública de saúde configurou uma mudança de paradigma no Cuidado Neonatal em Santa Catarina. Embora cientificamente respaldado, levou anos para se concretizar no estado e ainda enfrenta resistências.

The study of the placenta is of great importance, not only in the attempt to understand the etiopathogenesis of various maternal-fetal pathologies, but also in the attempt to understand whether it is possible to find the cause of pathological neonatal outcomes. On the other hand, abnormalities of blood vessel formation, such as angiodysplasias, have been poorly characterised in the literature, and there is a need for more studies investigating the potential impact on the fetus. In this paper, we retrospectively analysed 2063 placentas received at the Department of Pathology of the University of Bari ‘Aldo Moro’, among which we identified 70 placentas affected by angiodysplasia. On these placentas, we carried out histochemical staining with Masson’s Trichrome, orcein-alcian blue, and, subsequently, immunostaining with anti-CD31, CD34, and desmin and actin muscle smoothness antibodies. Finally, we performed a morphometric analysis on the allantochorionic and truncal vessels and correlated the results with neonatal outcomes. We studied the characteristics of the angiodysplasias in detail, dividing the patients into two classes (A and B) according to the morphology and histochemical characteristics of the affected vessels; statistical analysis reported a statistically significant association (p < 0.05) between the ratio of maximum thickness to maximum diameter (Tmax/Dmax) and neonatal outcome, with only 30% physiological outcome in the cohort of the placentas affected by angiodysplasia. These results shed light on a rather neglected aspect in the 2015 Amsterdam Classification, as well as in the literature, and provided strong evidence that placental angiodysplasia is predictive of an increased likelihood of the pathological fetal outcome, while other factors remain in the field. Studies with larger case series and guidelines with more attention to these aspects are mandated to further investigate the predictive potential of this pathology.

Mendelian disorders are prevalent in neonatal and pediatric intensive care units and are a leading cause of morbidity and mortality in these settings. Current diagnostic pipelines that integrate phenotypic and genotypic data are expert-dependent and time-intensive. Artificial intelligence (AI) tools may help address these challenges. Dx29 is an open-source AI tool designed for use by clinicians. It analyzes the patient’s phenotype and genotype to generate a ranked differential diagnosis. We used Dx29 to retrospectively analyze 25 acutely ill infants who had been diagnosed with a Mendelian disorder, using a targeted panel of ~5000 genes. For each case, a trio (proband and both parents) file containing gene variant information was analyzed, alongside patient phenotype, which was provided to Dx29 by three approaches: (1) AI extraction from medical records, (2) AI extraction with manual review/editing, and (3) manual entry. We then identified the rank of the correct diagnosis in Dx29’s differential diagnosis. With these three approaches, Dx29 ranked the correct diagnosis in the top 10 in 92–96% of cases. These results suggest that non-expert use of Dx29’s automated phenotyping and subsequent data analysis may compare favorably to standard workflows utilized by bioinformatics experts to analyze genomic data and diagnose Mendelian diseases.

Introduction There is growing evidence that parental participation in the care of small and sick newborns benefits both babies and parents. While studies have investigated the roles that mothers play in newborn units in high income contexts (HIC), there is little exploration of how contextual factors interplay to influence the ways in which mothers participate in the care of their small and sick newborn babies in very resource constrained settings such as those found in many countries in sub-Saharan Africa. Methods Ethnographic methods (observations, informal conversations and formal interviews) were used to collect data during 627 h of fieldwork between March 2017 and August 2018 in the neonatal units of one government and one faith-based hospital in Kenya. Data were analysed using a modified grounded theory approach. Results There were marked differences between the hospitals in the participation by mothers in the care of their sick newborn babies. The timing and types of caring task that the mothers undertook were shaped by the structural, economic and social context of the hospitals. In the resource constrained government funded hospital, the immediate informal and unplanned delegation of care to mothers was routine. In the faith-based hospital mothers were initially separated from their babies and introduced to bathing and diaper change tasks slowly under the close supervision of nurses. In both hospitals appropriate breast-feeding support was lacking, and the needs of the mothers were largely ignored. Conclusion In highly resource constrained hospitals with low nurse to baby ratios, mothers are required to provide primary and some specialised care to their sick newborns with little information or support on how undertake the necessary tasks. In better resourced hospital settings, most caring tasks are initially performed by nurses leaving mothers feeling powerless and worried about their capacity to care for their babies after discharge. Interventions need to focus on how to better equip hospitals and nurses to support mothers in caring for their sick newborns, promoting family centred care.

This thesis comprises a series of studies initially focusing on the acid-base and glucose status of term and near-term infants at birth. It defines normal values and explores the influence on both short- and medium-term outcomes to elucidate prognosis and any interventions that might be warranted to improve this. The research then moves onto the oxygenation of preterm infants, firstly by examining the relationship between arterial partial pressure of oxygen (PaO2) and pulse oximeter oxygen saturations (SpO2), and then via case control studies examines the influence of oxygenation on important clinical outcomes (mortality and retinopathy of prematurity (ROP)). Acid-base status of term and near-term infants and likelihood of death and cerebral palsy The acid-base status of infants around birth can provide information about their past, current and future condition. Although umbilical cord blood pH less than 7.0 or base deficit equal to or greater than 12mmol/l is associated with increased risk of adverse outcome, there is uncertainty about the prognostic value of degree of acidosis as previous studies have used different variables, thresholds, outcomes, and populations. We aimed to describe the relationship between pH and base deficit around the time of birth, the immediate clinical condition of the infants after birth, the risk of neonatal encephalopathy, and the risk of death or survival with permanent disability at the age of 2 years. We conducted a retrospective review of routinely collected clinical data in all liveborn inborn infants of 35 weeks gestation or more delivered over an eight-year period at the Royal Infirmary of Edinburgh. Infants were included if their lowest recorded pH was less than 7 and/or highest base deficit equal to or greater than 12mmol/l on either umbilical cord blood and/or neonatal blood gas within one hour of birth. Two-year neurodevelopmental outcomes were collected from a targeted follow-up database. 56,574 infants were eligible. 507 infants (0.9%) met inclusion criteria. Poor condition at birth and all adverse outcomes increased with worsening acidosis. Combined outcome of death or cerebral palsy was 3%, 10% and 39% at lowest pH of 6.9-6.99, 6.8-6.89 and 10.7kPa, 80mmHg) at all SpO2 values below 98%. At SpO2 92-97% around 70% of specimens had PaO2 within between 6.7-10.7kPa (50-80mmHg) and high PO2 was less likely than low PO2. We concluded that an SpO2 target range of 90-95% permits many PaO2 values below 6.7kPa (50mmHg). High PaO2 readings are uncommon at SpO2 below 98%. We concluded that further studies examining an SpO2 target range of 92-97% may be beneficial as a higher range may confer additional survival advantage without significant hyperoxia, and this was incorporated into the recommendations for research as part of the NICE guideline NG124 Specialist neonatal respiratory care for babies born preterm. Achieved oxygen saturation profiles associated with risk of mortality in extremely preterm infants in the BOOST II UK trial In the Neonatal Oxygen Prospective Meta-analysis (NeOProM), mortality was higher in preterm infants randomised to target SpO2 85-89% than infants targeted to 91-95%. We aimed to describe the achieved SpO2 distribution of low SpO2 group infants in the BOOST II UK trial who died and compare it with that of surviving infants in both randomisation groups. A case control study using recorded SpO2 data was conducted. Infants randomised to the low SpO2 target who died were matched to a control survivor from each randomisation group. SpO2 values recorded from the day of birth until the time of death in the case infant were analysed. Data for control infants were analysed for the same duration of monitoring. The data demonstrated the achieved oxygen profiles of the groups differed significantly from the targeted range. The low SpO2 target group infants had SpO2 values above their intended range whether they lived or died (median SpO2 90% in low target group infants who died, 91% in low target group survivors and 93% in high target group survivors). Low target group infants who died spent less time with SpO2 > 92% than survivors in either control group (33% versus 40% versus 57% respectively) but did not spend more time with very low SpO2 (92%. We concluded that the oxygen profiles of surviving babies in the BOOST II UK trial were significantly higher than their intended targeted ranges and that clinicians should be cognisant of this before applying the recommended ranges using servo-control of inspired oxygen (FiO2). Future trials should investigate the risks and benefits of higher SpO2 targets than 90-95%. Achieved oxygen saturation profiles associated with risk of retinopathy of prematurity in extremely preterm infants in the BOOST II UK trial The pathophysiology of ROP is thought to involve initial hyperoxic arrest of vascular growth followed by hypoxia-induced hyperproliferation of the retinal vasculature. ROP risk increases with decreasing gestational age (GA), and an association between ROP and severity, time and variability of oxygen exposure is well established. A secondary analysis of the SUPPORT trial data demonstrated that infants with severe ROP spent more time at saturations of between 97–100% SpO2 compared to those without severe ROP. ROP proceeds in two phases (I: vasoconstrictive; II: vasoproliferative), during which similar oxygen saturations may have different effects. We aimed to describe the achieved SpO2 distribution of high SpO2 target group infants in the BOOST II UK trial who did not have ROP requiring laser treatment and compare it with that of high SpO2 target group infants who did require laser therapy for ROP. An exploratory cohort study analysis of BOOST II UK data was conducted, with index cases being surviving infants randomised to the higher SpO2 target range without ROP or with ROP that did not require laser treatment, matched by sex, gestation and birth weight to surviving infants in the higher SpO2 target range with ROP that required laser treatment. We demonstrated that infants targeted to an SpO2 range of 91-95% who developed ROP requiring laser therapy had a statistically significant increase in time at saturations greater than 98% than controls targeted to the same SpO2 target range. We concluded that a further study using a different dataset may elucidate whether an oxygen targeting strategy of between 92-97% could optimise survival and minimise ROP.

Porod in rojstvo otroka je občutljivo in ranljivo obdobje za žensko, novorojenčka in celotno družino. Rojstvo prvega otroka pomeni vzpostavitev družinskega sistema, v katerem se na sistemski, interpersonalni in intrapsihični ravni odzrcalijo koncepti in mehanizmi, s katerimi se ukvarja relacijska družinska terapija. Ta zmore z njimi poiskati pot razrešitve bolečih psihičnih vsebin in privesti do razbremenitve sistema. Ob prehodu v starševstvo prihajajo boleča afektivna občutja posebej do izraza, vendar je navadno v središču pozornosti zunanjega sveta rojstvo otroka, in ne počutje njegovih staršev ter vzdušje v družini. Središče raziskovalnega polja v doktorskem delu pa je prav ženska, ki s porodom kot točko prehoda stopi v svet nežnega, sočutnega in čustveno kompetentnega materinstva ali pa se v vrtincu različnih dejavnikov tveganja znajde v globini porodne travme, ki se kaže na različne načine disfunkcionalnega čutenja, odzivanja in vedenja. Porodni proces lahko pusti nezadovoljive občutke, ki pa kmalu izzvenijo, a se zgodi, da porod sproži tudi potlačene in nezavedne vsebine preteklosti, ki se ob intenzivni fizični in psihični preizkušnji poroda aktivirajo in vodijo v disfunkcionalne odnose. Doktorsko disertacijo z naslovom Doživljanje materinstva in podporni model terapevtske obravnave na prehodu v starševstvo pri ženskah z izkušnjo rojstva otroka s carskim rezom sestavljata teoretični in empirični del. V doktorskem delu je prikazan in kritično ovrednoten praktični preizkus celostne zdravstveno-terapevtske obravnave s PMTO. Iz celotne doktorske disertacije izhaja ugotovitev, da gre za inovativno obravnavo žensk in novorojenčkov po porodu, saj zajema dognanja in strategije več strokovnih področij oz. metod: zdravstvene obravnave, babištva, NBO ter relacijska družinska terapija. Dokazana je njena učinkovitost v primeru mater, ki so rodile s carskim rezom, in hkrati nakazana možnost za uporabo tudi pri drugih načinih poroda in prehoda v starševstvo. Njena uporaba v klinični in terapevtski praksi je prispevek h krepitvi duševnega zdravja nosečnic, porodnic in otročnic, njihovih novorojenih otrok ter družin. The birth of a child is a delicate and vulnerable time for the woman, the newborn and the whole family. The birth of the first child creates a family system in which the concepts and mechanisms that Relational Family Therapy deals with are reflected at the systemic, interpersonal, and intrapsychic levels. This therapy is used to help family members find a way to resolve painful psychological content and liberate the system. Painful affective emotions are especially pronounced during the transition to parenthood, but the attention of the outside world is usually focused on the birth of the child rather than on the well-being of the parents and the family atmosphere. The focus of the research field of this dissertation is the woman who enters the world of tender, compassionate, and emotionally competent motherhood with childbirth as a transition point or who finds herself in the depths of birth trauma in a vortex of various risk factors that manifests itself in various types of dysfunctional feelings, reactions, and behaviours. The birth process usually leaves unsatisfactory feelings and experiences that are temporary in nature, but it also happens that birth triggers repressed and unconscious contents of the past that are activated by the intense physical and psychological ordeal of birth and lead to dysfunctional relationships. The dissertation, entitled »Experience of Motherhood and a Supportive Therapeutic Model in the Transition Period to Parenthood in Women with the Experience of Giving Birth by Caesarean Section« consists of a theoretical and an empirical section. The dissertation presents and critically evaluates a practical test of integrated medical-therapeutic treatment with PMTO. The dissertation concludes that it is an innovative approach to the treatment of postpartum women and newborns because it integrates the knowledge and strategies of several professional fields or methods: Midwifery, NBO, and Relational Family Therapy. It has been shown to be effective with mothers who have delivered by caesarean section, but also demonstrates the possibility of using it with other delivery methods and in the transition to parenthood. Its use in clinical and therapeutic practice contributes to the mental health of pregnant and postnatal women, their newborn children, and families.

Neonatal drug information (DI) is essential for safe and effective pharmacotherapy in (pre)term neonates. Such information is usually absent from drug labels, making formularies a crucial part of the neonatal clinician’s toolbox. Several formularies exist worldwide, but they have never been fully mapped or compared for content, structure and workflow. The objective of this review was to identify neonatal formularies, explore (dis)similarities, and raise awareness of their existence. Neonatal formularies were identified through self-acquaintance, experts and structured search. A questionnaire was sent to all identified formularies to provide details on formulary function. An original extraction tool was employed to collect DI from the formularies on the 10 most commonly used drugs in pre(term) neonates. Eight different neonatal formularies were identified worldwide (Europe, USA, Australia-New Zealand, Middle East). Six responded to the questionnaire and were compared for structure and content. Each formulary has its own workflow, monograph template and style, and update routine. Focus on certain aspects of DI also varies, as well as the type of initiative and funding. Clinicians should be aware of the various formularies available and their differences in characteristics and content to use them properly for the benefit of their patients.

Background Family-centered rounds is recognized as a best practice for hospitalized children, but it has only been possible for children whose families can physically be at the bedside during hospital rounds. The use of telehealth to bring a family member virtually to the child’s bedside during hospital rounds is a promising solution. We aim to evaluate the impact of virtual family-centered hospital rounds in the neonatal intensive care unit on parental and neonatal outcomes. Methods This two-arm cluster randomized controlled trial will randomize families of hospitalized infants to have the option to use telehealth for virtual hospital rounds (intervention) or usual care (control). The intervention-arm families will also have the option to participate in hospital rounds in-person or to not participate in hospital rounds. All eligible infants who are admitted to this single-site neonatal intensive care unit during the study period will be included. Eligibility requires that there be an English-proficient adult parent or guardian. We will measure participant-level outcome data to test the impact on family-centered rounds attendance, parent experience, family-centered care, parent activation, parent health-related quality of life, length of stay, breastmilk feeding, and neonatal growth. Additionally, we will conduct a mixed methods implementation evaluation using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Discussion The findings from this trial will increase our understanding about virtual family-centered hospital rounds in the neonatal intensive care unit. The mixed methods implementation evaluation will enhance our understanding about the contextual factors that influence the implementation and rigorous evaluation of our intervention. Trial registration ClinicalTrials.gov Identifier: NCT05762835. Status: Not yet recruiting. First posted: March 10, 2023; last update posted: March 10, 2023.

Congenital portosystemic fistula (CPF) is a congenital malformation defined by one or more communications between a hepatic portal venous system and a systemic venous cava. Other terminologies exist in the literature, in particular for extrahepatic communications, such as "Abernethy malformation". It may be associated with other malformations or syndromes. Because of this non-physiological vascular communication, PFC can lead to the development of extrahepatic complications: hepatic encephalopathy and pulmonary vascular diseases (hepato-pulmonary syndrome or pulmonary hypertension). It can also lead to hepatic complications with the appearance of benign or malignant tumors and biological and metabolic disorders. We report the case of a newborn with a portosystemic hepatic fistula discovered during neonatal jaundice with cutaneous angiomatosis.

A ventilação de alta frequência (VAF) é uma estratégia de proteção pulmonar que pode ser utilizada desde pacientes neonatais a adultos com lesão pulmonar aguda. Embora a evidência estatística que apoia a VAF seja particularmente baixa, benefícios potenciais para sua aplicação em muitas manifestações clínicas ainda permanecem. Todos os pacientes com lesão pulmonar induzida por ventilação ou com risco de desenvolver lesões ou Síndrome do Desconforto Respiratório Agudo seriam candidatos adequados para a VAF, especialmente aqueles que falharam na ventilação mecânica convencional. Esta narrativa tem como objetivo fornecer uma revisão da VAF quanto às suas indicações, contra indicações, perigos, objetivos clínicos, mecanismos de ação e controles para otimização da ventilação e oxigenação na nossa população neonatal e pediátrica.

RESUMO: Objetivo: apresentar um algoritmo de indicação de acessos venosos para recém-nascidos em Unidade de Terapia Intensiva Neonatal. Desenvolvimento: estudo descritivo realizado na Unidade de Terapia Intensiva Neonatal no sul do Brasil, no período de 2017 a 2020 em duas etapas de idealização: desenho do algoritmo; e a adequação baseada na aplicação conforme observações realizadas pelos enfermeiros envolvidos. O algoritmo desenvolvido contemplou a previsão de acesso venoso para pacientes com indicação de cirurgia abdominal e outras cirurgias, prematuros estratificados em idade gestacional superior e inferior a 30 semanas, cardiopatias com dependência ou não de canal arterial e hipoglicemia neonatal persistente. De acordo com a rede venosa, número de terapias prescritas, jejum, antibioticoterapia e drogas vasoativas, há indicação inicial de um tipo de cateter que pode ser seguido de outro de acordo com a necessidade. Conclusão: a participação do enfermeiro na indicação de acesso venoso integra as práticas interprofissionais e incrementa a assistência neonatal. ABSTRACT Objective: to present an algorithm for the indication of venous accesses for newborns in Neonatal Intensive Care Unit. Development: descriptive study conducted in a Neonatal Intensive Care Unit in southern Brazil, in the period from 2017 to 2020 in two stages of idealization: design of the algorithm; and the adequacy based on the application according to observations made by the nurses involved. The developed algorithm contemplated the prediction of venous access for patients with indication for abdominal and other surgeries, premature infants stratified in gestational age higher and lower than 30 weeks, heart diseases with dependence or not on arterial channel and persistent neonatal hypoglycemia. According to the venous network, number of prescribed therapies, fasting, antibiotic therapy and vasoactive drugs, there is an initial indication for one type of catheter that may be followed by another according to need. Conclusion: the participation of nurses in the indication of venous access integrates interprofessional practices and increases neonatal care. RESUMEN Objetivo: presentar un algoritmo para la indicación de accesos venosos para recién nacidos en la Unidad de Cuidados Intensivos Neonatales. Desarrollo: estudio descriptivo realizado en una Unidad de Cuidados Intensivos Neonatales en el sur de Brasil, en el período de 2017 a 2020 en dos etapas de idealización: diseño del algoritmo; y la adecuación basada en la aplicación de acuerdo con las observaciones realizadas por las enfermeras involucradas. El algoritmo desarrollado contemplaba la predicción de acceso venoso para pacientes con indicación de cirugías abdominales y de otro tipo, prematuros estratificados en edad gestacional superior e inferior a 30 semanas, cardiopatías con dependencia o no de canal arterial e hipoglucemia neonatal persistente. En función de la red venosa, el número de terapias prescritas, el ayuno, la antibioticoterapia y los fármacos vasoactivos, existe una indicación inicial para un tipo de catéter que puede ir seguida de otra según las necesidades. Conclusión: la participación del enfermero en la indicación de acceso venoso integra las prácticas interprofesionales e incrementa la asistencia neonatal.

Valproic acid (VPA) is a known drug for treating epilepsy and mood disorders; however, it is not recommended for pregnant women because of its possible teratogenicity. VPA affects neurotransmission and gene expression through epigenetic mechanisms by acting as a histone deacetylase inhibitor and has been used to establish animal models of autism spectrum disorder (ASD). However, studies on the long-term effects of early exposure to VPA on glucocorticoid and neurosteroid synthesis in the brain are lacking. Therefore, this study aimed to investigate the long-term changes in metabolic alterations and gene expression regulation according to sex, using metabolic steroid profiling data from cerebral cortex samples of rats four weeks after VPA exposure (400 mg/kg). In neonatal VPA-exposed models, estradiol levels decreased, and cytochrome P450 19A1 gene (Cyp19a1) expression was reduced in the prepubertal male cortex. Progesterone and allopregnanolone levels decreased, and 3β-hydroxysteroid dehydrogenase 1 gene (Hsd3b1) expression was also downregulated in the prepubertal female cortex. Furthermore, cortisol levels increased, and mRNA expression of the nuclear receptor subfamily 3 group C member 1 gene (Nr3c1) was downregulated in the cortices of both sexes. Unlike the neonatal VPA-exposed models, although a decrease in progestin and estradiol levels was observed in females and males, respectively, no differences were observed in cortisol levels in the cortex tissues of 8-week-old adult rats administered VPA for four weeks. These results indicate that early environmental chemical exposure induces long-term neurosteroid metabolic effects in the brain, with differences according to sex.

ObjectiveTo describe the genomic analysis and epidemiologic response related to a slow and prolonged methicillin-resistant Staphylococcus aureus (MRSA) outbreak.DesignProspective observational study.SettingNeonatal intensive care unit (NICU).MethodsWe conducted an epidemiologic investigation of a NICU MRSA outbreak involving serial baby and staff screening to identify opportunities for decolonization. Whole-genome sequencing was performed on MRSA isolates.ResultsA NICU with excellent hand hygiene compliance and longstanding minimal healthcare-associated infections experienced an MRSA outbreak involving 15 babies and 6 healthcare personnel (HCP). In total, 12 cases occurred slowly over a 1-year period (mean, 30.7 days apart) followed by 3 additional cases 7 months later. Multiple progressive infection prevention interventions were implemented, including contact precautions and cohorting of MRSA-positive babies, hand hygiene observers, enhanced environmental cleaning, screening of babies and staff, and decolonization of carriers. Only decolonization of HCP found to be persistent carriers of MRSA was successful in stopping transmission and ending the outbreak. Genomic analyses identified bidirectional transmission between babies and HCP during the outbreak.ConclusionsIn comparison to fast outbreaks, outbreaks that are "slow and sustained" may be more common to units with strong existing infection prevention practices such that a series of breaches have to align to result in a case. We identified a slow outbreak that persisted among staff and babies and was only stopped by identifying and decolonizing persistent MRSA carriage among staff. A repeated decolonization regimen was successful in allowing previously persistent carriers to safely continue work duties.

Introduction: Understanding the course of stress during the neonatal intensive care unit stay may provide targets for interventions. Our aim was to describe the course of stress in preterm infants during the first 28 days of life, the influence of gestational age, and associations with clinical characteristics. Methods: In a single centre prospective cohort study, we included infants with a gestational age Results: We included 45 infants, with a median gestational age of 27 weeks. The mean daily NISS score was 66.5 (SD 8.7), with highest scores in the first 7 days of life. Scores decreased the slowest for the lowest gestational ages, in particular for nursing scores, rather than skin-breaking, monitoring and imaging, and medical morbidity-related scores. Adjusted for gestational age, infants with lower Apgar scores, sepsis, intraventricular haemorrhages, and on mechanical ventilation had significantly higher cumulative NISS scores at 7, 14, and 28 days. Conclusion: NISS scores varied greatly within infants and over time, with the highest mean scores in the first week after birth. The course of declining NISS scores in the first 28 days depended on gestational age at birth.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected over 200 million people worldwide and has likely exposed millions of neonates to SARS-CoV-2 in utero. A large body of literature has examined the possibility of vertical transmission from pregnant women infected with SARS-CoV-2 to their neonates. In this chapter, we review mechanisms of—and evidence for—vertical transmission of SARS-CoV-2, including transplacental, through other biospecimens and breastfeeding, and discuss neonatal outcomes following in utero exposure. Based on the available literature, we conclude vertical transmission of SARS-CoV-2 is rare, and exposed neonates generally show favorable health outcomes.

Background: Corona Virus Disease 2019 (COVID-19) in pregnant women has important impacts on perinatal and neonatal outcomes. However, there are a limited number of studies investigating the effect of the pandemic period on newborns. With this study, we aimed to determine the impact of the 2020 COVID-19 outbreak on prenatal care, obstetric outcomes, neonatal mortality and morbidity. Methods: The retrospective results of patients hospitalized to the Tertiary Neonatal Intensive Care Unit between 1 March and 30 May 2020, the first peak period of the pandemic in our country, were compared with the data of the same period of the previous year. Results: A total of 307 cases were included in our study. The mean gestational weeks of the neonates hospitalized in the Neonatal Intensive Care Unit during the COVID-19 period were higher than those in the control group (p: 0.003). During the pandemic period, an increase was found in the frequency of pregnant women presenting to obstetric emergency services in emergencies requiring acute intervention (p: 0.01). Compared to the control group, there was an increase in the number of infants with small for gestational age (SGA) diagnosis, 5th-minute Apgar score of 0.05). Conclusions: During the COVID-19 pandemic, it was shown that pregnant women disrupted their regular antenatal care, and more pregnant women were admitted to the obstetric emergency department with emergencies requiring acute intervention. This led to an increase in the number of cases diagnosed with SGA and hypoxic-ischemic encephalopathy in newborns. Our results will be useful for better management of current and future pandemic periods.

BACKGROUND: Lung Ultrasound (LUS)-guided Lung Recruitment Maneuver (LRM) has been shown to possibly reduce ventilator-induced lung injury in preterm infants. However, to avoid potential hemodynamic and pulmonary side effects, the indication to perform the maneuver needs to be supported by early signs of lung recruitability. Recently, a new LUS pattern (S-pattern), obtained during the reopening of collapsed parenchyma, has been described. This study aims to evaluate if this novel LUS pattern is associated with a higher clinical impact of the LUS-guided LRMs. METHODS: All the LUS-guided rescue LRMs performed on infants with oxygen saturation/fraction of inspired oxygen (S/F) ratio below 200, were included in this cohort study. The primary outcome was to determine if the presence of the S-pattern is associated with the success of LUS-guided recruitment, in terms of the difference between the final and initial S/F ratio (Delta S/F). RESULTS: We reported twenty-two LUS-guided recruitments, performed in nine patients with a median gestational age of 34 weeks, interquartile range (IQR) 28–35 weeks. The S-pattern could be obtained in 14 recruitments (64%) and appeared early during the procedure, after a median of 2 cmH2O (IQR 1–3) pressure increase. The presence of the S-pattern was significantly associated with the effectiveness of the maneuver as opposed to the cases in which the S-pattern could not be obtained (Delta S/F 110 +/- 47 vs 44 +/- 39, p = 0.01). CONCLUSIONS: Our results suggest that the presence of the S-pattern may be an early sign of lung recruitability, predicting LUS-guided recruitment appropriateness and efficacy.

Healthcare professionals, especially nurses, play a central role in supporting parents during their stay in neonatal intensive care units (NICUs). Fathers often have their own support needs; however, studies have shown that these needs are rarely met to the same degree as those of the mothers. We developed a “father-friendly NICU” with the aim of providing good-quality care to the entire family. To evaluate the impact of this concept, we adopted a quasi-experimental design; using the Nurse Parent Support Tool (NPST), we investigated the differences in the fathers’ (n = 497) and mothers’ (n = 562) perception of the nursing support received on admission and discharge between before and after the intervention. In the historical control and intervention groups, the fathers’ median NPST scores at admission were 4.3 (range, 1.9–5.0) and 4.0 (range, 2.5–4.8), respectively (p < 0.0001); at discharge, these scores were 4.3 (range, 1.6–5.0) and 4.4 (range, 2.3–5.0), respectively (difference not significant). In the historical control and intervention groups, the mothers median NPST scores at admission were 4.5 (range, 1.9–5.0) and 4.1 (range, 1.0–4.8), respectively (p < 0.001); at discharge, these scores were 4.4 (range, 2.7–5.0) and 4.4 (range, 2.6–5), respectively (difference not significant). The parental perception of support did not increase after the intervention; however, the parents reported a high level of staff support both before and after the intervention. Further studies should focus on parental support needs during the different phases of hospitalization (i.e., admission, stabilization, and discharge).

Neonatal diarrhea is one of the most severe diseases in human beings and pigs, leading to high mortality and growth faltering. Gut microbiome-related studies mostly focus on the relationship between bacteria and neonatal diarrhea onset, and no research study has investigated the role of the gut virome in neonatal diarrhea. Here, using metagenomic sequencing, we characterized the fecal viral community of diarrheal and healthy neonatal piglets. We found that the viral community of diarrheal piglets showed higher individual heterogeneity and elevated abundance of Myoviridae. By predicting the bacterial host of the identified viral genomes, phages infecting Proteobacteria, especially E. coli, were the dominant taxa in neonatal diarrheal piglets. Consistent with this, the antibiotic resistance gene of E. coli origin was also enriched in neonatal diarrheal piglets. Finally, we established a random forest model to accurately discriminate between neonatal diarrheal piglets and healthy controls and identified genus E. coli- and genus listeria-infecting bacteriophages, including psa and C5 viruses, as key biomarkers. In conclusion, we provide the first glance of viral community and function characteristics in diarrheal and healthy neonatal piglets. These findings expand our understanding of the relationship among phages, bacteria and diarrhea, and may facilitate the development of therapeutics for the prevention and treatment of neonatal diarrhea.

Objective: To assess prevalence and factors associated with hypothermia in preterm infants admitted to a neonatal intensive care unit. Methods: It is a cross-sectional retrospective study, with 154 premature newborns admitted between 2017 and 2019 in a neonatal intensive care unit. Logistic regression was used to evaluate the association to hypothermia. Results: There was a predominance of males (55.8%), coming from the operating room (55.8%), gestational age > 32 weeks (71.4%), weight > 1500g (59.1%), Apgar in the 1st minute of life less than seven (51.9%) and in the 5th minute of life greater than or equal to seven (94.2%). The prevalence of hypothermia at admission was 68.2%. It was found that the lower the weight, the greater the chances of hypothermia, being three times higher in low weight (OR 3.480), five times higher in very low weight (OR5.845) and up to 47 times higher in extremely low weight (OR47.211). Conclusion: Hypothermia was 68.2% and it was associated with lower birth weight. RESUMEN Objetivo: Evaluar prevalencia y factores asociados a la hipotermia entre los recién nacidos prematuros ingresados en una unidad de cuidados intensivos neonatales. Métodos: Estudio transversal retrospectivo, con 154 recién nacidos prematuros ingresados entre 2017 y 2019 en una unidad de cuidados intensivos neonatales. Se utilizó la regresión logística para evaluar la asociación a la hipotermia. Resultados: Hubo un predominio de varones (55,8%), procedentes del centro quirúrgico (55,8%), edad gestacional > 32 semanas (71,4%), peso > 1500g (59,1%), puntuación de Apgar en el primer minuto de vida inferior a siete (51,9%) y en el quinto minuto superior o igual a siete (94,2%). La prevalencia de hipotermia al ingreso fue del 68,2%. Se comprobó que cuanto menor es el peso, mayores son las posibilidades de hipotermia, tres veces más para el peso bajo (R.O. 3,480), cinco veces más para el peso muy bajo (R.O.5,845) y hasta 47 veces más para el peso extremadamente bajo (R.O.47,211). Conclusión: La hipotermia fue del 68,2% y se asoció a un menor peso al nacer. RESUMO Objetivo: Avaliar prevalência de hipotermia e fatores associados entre recém-nascidos prematuros admitidos em uma unidade de terapia intensiva neonatal. Métodos: Estudo transversal retrospectivo, com 154 recém-nascidos prematuros admitidos entre 2017 e 2019 em uma unidade de terapia intensiva neonatal. Utilizou-se regressão logística para avaliar associação à hipotermia. Resultados: Houve predomínio do sexo masculino (55,8%), procedência de centro cirúrgico (55,8%), idade gestacional > 32 semanas (71,4%), peso > 1.500g (59,1%), Apgar no 1º minuto de vida menor que sete (51,9%) e no 5º maior ou igual a sete (94,2%). A prevalência de hipotermia à admissão foi de 68,2%. Verificou-se que quanto menor o peso, maiores as chances de hipotermia, sendo três vezes maior no baixo peso (O.R. 3,480), cinco vezes maior no muito baixo peso (O.R. 5,845) e 47 vezes maior no extremo baixo peso (O.R. 47,211). Conclusão: A hipotermia foi de 68,2% e esteve associada ao menor peso ao nascer.

Background Next-generation sequencing (NGS) based population screening holds great promise for disease prevention and earlier diagnosis, but the costs associated with screening millions of humans remain prohibitive. New methods for population genetic testing that lower the costs of NGS without compromising diagnostic power are needed. Methods We developed double batched sequencing where DNA samples are batch-sequenced twice — directly pinpointing individuals with rare variants. We sequenced batches of at-birth blood spot DNA using a commercial 113-gene panel in an explorative (n = 100) and a validation (n = 100) cohort of children who went on to develop pediatric cancers. All results were benchmarked against individual whole genome sequencing data. Results We demonstrated fully replicable detection of cancer-causing germline variants, with positive and negative predictive values of 100% (95% CI, 0.91–1.00 and 95% CI, 0.98–1.00, respectively). Pathogenic and clinically actionable variants were detected in RB1, TP53, BRCA2, APC, and 19 other genes. Analyses of larger batches indicated that our approach is highly scalable, yielding more than 95% cost reduction or less than 3 cents per gene screened for rare disease-causing mutations. We also show that double batched sequencing could cost-effectively prevent childhood cancer deaths through broad genomic testing. Conclusions Our ultracheap genetic diagnostic method, which uses existing sequencing hardware and standard newborn blood spots, should readily open up opportunities for population-wide risk stratification using genetic screening across many fields of clinical genetics and genomics.

Objective Expected Ɣ-Glutamyl transferase (GGT) enzyme levels vary by age group; elevated GGT levels are interpreted following age-appropriate values. GGT levels are routinely utilized in neonatal intensive care units (NICU) to eliminate obstructive liver disorders or oxidative liver damage. However, it might be challenging to interpret because typical GGT values have not been established for infants. Therefore, the purpose of our study was to analyze the association between serum GGT levels and gestational age and determine if gestational age, gender, and mode of delivery influence serum GGT levels. Method Liver function tests were performed on 200 patients admitted to the neonatal intensive care unit at Amasya Sabuncuoğlu Şerefeddin Training and Research Hospital between January 2021 and December 2022, including GGT levels, weeks of gestation, birth weights, genders, and mode of delivery (cesarean or normal birth). They were classified as preterm, late preterm, or term newborns based on their gestational week. The study includes GGT levels recorded in the first seven days of specific patients and two GGT values measured between 8 and 28 days. The GGT readings of the neonates tested after the 28th day were excluded from the research. Result 95 (47.5%) of these infants were female, while 105 (52.5%) were male. There were 32 preterm infants (16%), 73 term infants (36.5%), and 95 late preterm infants (34-37 weeks of gestation). 180 (90%) of the patients were delivered through C/S (Cesarean section), whereas 20 (10%) were born via spontaneous vaginal birth (NSVY). The mean GGT (GGT1) value for preterm infants between 1-7 days was 156±58; GGT (GGT2) value for 7-28 days was 132±48; the GGT1 value for the late preterm group was 124.9 74, GGT 2 mean value was 122 38, term baby GGT1 mean value was 150 83, GGT2 mean value was 119±29. There was no statistically significant difference between the groups (P=0.189, P=0.184). Serum GGT1 and GGT2 levels were substantially higher in male babies (146±116, 133±121) than in female newborns (135±80, 114±64) (P Conclusion Variations in serum GGT levels depend on age, gender, and measuring procedure. In published investigations, GGT levels of preterm infants were examined, but the gestational week was not mentioned. In our investigation, GGT levels in preterm and full-term infants were shown to be much greater than in prior studies and book chapters.

The purpose of this study was to examine the transfer rate of SARS-CoV-2 IgG antibodies in pregnancy and newborns. Two Danish labor wards screened all women for SARS-CoV-2 by PCR upon arrival. Women (n = 99) with a SARS-CoV-2 PCR–positive nasopharyngeal (NP) swab or with a household member with a positive swab at labor or any time during pregnancy, or COVID-19 symptoms upon admission (November 2020 through August 2021), were included. Mother and infant were tested by NP swabs at delivery, and maternal and infant (umbilical cord) venous blood samples were collected. We obtained clinical information including previous PCR test results from the medical records. SARS-Cov-2 IgM and quantified IgG antibodies were measured by enzyme-linked immunosorbent assay and transfer ratios of IgG. We detected IgG antibodies in 73 women and 65 cord blood sera and found a strong correlation between SARS-CoV-2 IgG concentrations in maternal and umbilical cord sera (r = 0.9; p 1.0 in 51 out of 73 (69%) infants and > 1.5 in 26 (35%). We found that transfer was proportional to time from a positive SARS-CoV-2 PCR NP swab to delivery (r = 0.5; p

New bronchopulmonary dysplasia (BPD) is a neonatal disease that is theorized to begin in utero and manifests as reduced alveolarization due to inflammation of the lung. Risk factors for new BPD in human infants include intrauterine growth restriction (IUGR), premature birth (PTB) and formula feeding. Using a mouse model, our group recently reported that a paternal history of 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) exposure increased his offspring’s risk of IUGR, PTB, and new BPD. Additionally, formula supplementation of these neonates worsened the severity of pulmonary disease. In a separate study, we reported that a paternal preconception fish oil diet prevented TCDD-driven IUGR and PTB. Not surprisingly, eliminating these two major risk factors for new BPD also significantly reduced development of neonatal lung disease. However, this prior study did not examine the potential mechanism for fish oil’s protective effect. Herein, we sought to determine whether a paternal preconception fish oil diet attenuated toxicant-associated lung inflammation, which is an important contributor to the pathogenesis of new BPD. Compared to offspring of standard diet TCDD-exposed males, offspring of TCDD-exposed males provided a fish oil diet prior to conception exhibited a significant reduction in pulmonary expression of multiple pro-inflammatory mediators (Tlr4, Cxcr2, Il-1 alpha). Additionally, neonatal lungs of pups born to fish oil treated fathers exhibited minimal hemorrhaging or edema. Currently, prevention of BPD is largely focused on maternal strategies to improve health (e.g., smoking cessation) or reduce risk of PTB (e.g., progesterone supplementation). Our studies in mice support a role for also targeting paternal factors to improve pregnancy outcomes and child health.

Objective: Neonatal Sepsis (NS) is a term used to define any systemic bacterial infection in the first month of life. NS continues to be a major factor for morbidity and mortality in newly born babies both in developed and developing countries. The selection of tests for early diagnosis of sepsis and the acceleration of the initiation of the treatment process are of critical importance in reducing morbidity and mortality. This study aimed at determining the significance of Neutrophil/Lymphocyte Ratio (NLR) and its relationship with mortality in preterm or full-term babies born with sepsis. Method: The study retrospectively included inpatient preterm and full-term babies with late-onset NS who were treated between January 2012 and January 2014 at the Neonatal Intensive Care Unit (NICU) of Zekai Tahir Gynaecology Training and Research Hospital. Those who did not have any clinical conditions or laboratory findings indicating sepsis such as jaundice were included in the control group. The variables studied in the groups were maternal age, maternal clinical diseases, maternal infections, and prepartum and postpartum problems during treatment. Results: The NLR values of the groups were compared with respect to infection. The patient group was found to have higher Neutrophil (p=0,005), NLO (p0.05). Conclusion: As a result of the analyses performed in our study, it was determined that NLR is important in the early diagnosis of neonatal late onset sepsis. However, it was found that NLR had no effect on predicting mortality.

This scoping review will provide a clear definition of prolonged pain and contribute to the operationalization of the updated findings for the clinical practice in neonatal prolonged pain management. This protocol describes the methodology for a scoping review that aims to determine the scope, extent and nature of the available literature on prolonged pain in premature neonates hospitalized in the NICU. This scoping review will follow the PRISMA-ScR guidelines.

Sepsis represents a common cause of morbidity in the Neonatal Intensive Care Unit (NICU). Our objective was to assess the value of clinical and laboratory parameters in predicting septicemia (positive blood culture) in NICU infants. In the first part of the present study (derivation cohort) we retrospectively reviewed the clinical files of 120 neonates with symptoms of suspected sepsis and identified clinical and laboratory parameters associated with proven sepsis on the day the blood culture was taken, as well as 24 h and 48 h earlier. These parameters were combined into a sepsis prediction score (SPS). Subsequently (validation study), we prospectively validated the performance of the SPS in a cohort of 145 neonates. The identified parameters were: temperature instability, platelet count < 150,000/mm3, feeding volume decrease > 20%, changes in blood glucose > 50%, CRP > 1 mg/dL, circulatory and respiratory deterioration. In the retrospective cohort, on the day the blood culture was obtained, a SPS ≥ 3 could predict sepsis with 82.54% sensitivity, 85.96% specificity, 5.88 PLR (Positive Likelihood Ratio), 0.20 NLR (Negative Likelihood Ratio), 86.67% PPV (Positive Predictive Value), 81.67% NPV (Negative Predictive Value) and 84.17% accuracy. In the prospective cohort, on the day the blood culture was obtained, a SPS ≥ 3 could predict sepsis with 76.60% sensitivity, 72.55% specificity, 2.79 PLR, 0.32 NLR, 83.72% PPV, 62.71% NPV and 75.17% accuracy. We concluded that this combination of clinical and laboratory parameters may assist in the prediction of septicemia in NICUs.

Objective Assess mortality and neurodevelopmental outcomes at 2 years of corrected age in children who participated in the PlaNeT-2/MATISSE (Platelets for Neonatal Transfusion - 2/Management of Thrombocytopenia in Special Subgroup) study, which reported that a higher platelet transfusion threshold was associated with significantly increased mortality or major bleeding compared to a lower one. Design Randomised clinical trial, enrolling from June 2011 to August 2017. Follow-up was complete by January 2020. Caregivers were not blinded; however, outcome assessors were blinded to treatment group. Setting 43 level II/III/IV neonatal intensive care units (NICUs) across UK, Netherlands and Ireland. Patients 660 infants born at less than 34 weeks’ gestation with platelet counts less than 50×109/L. Interventions Infants were randomised to undergo a platelet transfusion at platelet count thresholds of 50×109/L (higher threshold group) or 25×109/L (lower threshold group). Main outcomes measures Our prespecified long-term follow-up outcome was a composite of death or neurodevelopmental impairment (developmental delay, cerebral palsy, seizure disorder, profound hearing or vision loss) at 2 years of corrected age. Results Follow-up data were available for 601 of 653 (92%) eligible participants. Of the 296 infants assigned to the higher threshold group, 147 (50%) died or survived with neurodevelopmental impairment, as compared with 120 (39%) of 305 infants assigned to the lower threshold group (OR 1.54, 95% CI 1.09 to 2.17, p=0.017). Conclusions Infants randomised to a higher platelet transfusion threshold of 50×109/L compared with 25×109/L had a higher rate of death or significant neurodevelopmental impairment at a corrected age of 2 years. This further supports evidence of harm caused by high prophylactic platelet transfusion thresholds in preterm infants. Trial registration number NCT87736839.

Neonatal drug information (DI) is essential for safe and effective pharmacotherapy in (pre)term neonates. Such information is usually absent from drug labels, making formularies a crucial part of the neonatal clinician's toolbox. Several formularies exist worldwide, but they have never been fully mapped or compared for content, structure and workflow. The objective of this review was to identify neonatal formularies, explore (dis)similarities, and raise awareness of their existence. Neonatal formularies were identified through self-acquaintance, experts and structured search. A questionnaire was sent to all identified formularies to provide details on formulary function. An original extraction tool was employed to collect DI from the formularies on the 10 most commonly used drugs in pre(term) neonates. Eight different neonatal formularies were identified worldwide (Europe, USA, Australia-New Zealand, Middle East). Six responded to the questionnaire and were compared for structure and content. Each formulary has its own workflow, monograph template and style, and update routine. Focus on certain aspects of DI also varies, as well as the type of initiative and funding. Clinicians should be aware of the various formularies available and their differences in characteristics and content to use them properly for the benefit of their patients. ispartof: Children (Basel) vol:10 issue:5 pages:848- ispartof: location:Switzerland status: Published online

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The aim of this review is to map the existing research about nurses' knowledge and practices on non-pharmacological pain management in neonatology.

Objective: The objective was to conduct a systematic review describing the competencies required from nurses working in neonatal intensive care settings. Design: Systematic review. Data sources: A total of eight databases, including PubMed, Scopus, CINAHL, MEDLINE, Mednar, Web of Science, ProQuest and Medic, were screened for relevant literature during February and September 2022. Review methods: The systematic review process followed Joanna Briggs Institute guidelines. The inclusion criteria were: 1) (P = population) registered nurses; 2) (C = concept) the competence; 3) (C = context) nursing in neonatal intensive care units; and 4) cross-sectional study as study method. A critical appraisal tool for cross-sectional studies from Joanna Briggs Institute was used by two independent reviewers. After data extraction, thematic analysis was performed. Results: The database searches yielded a total of 8887 studies and after two independent evaluations, a total of 50 eligible studies were identified comprising of 7536 registered nurses working in neonatal intensive care units across 19 countries. The studies described four main competence themes: 1) neonatal care interventions; 2) caring for a dying infant; 3) family-centered care; and 4) neonatal intensive care interventions. Conclusion: Previous research has focused on evaluating specific competencies that are necessary in the neonatal intensive care setting. There is a need for research concerning the overall competence of nurses working in neonatal intensive care units. There was a lot of variety within the quality of the eligible studies and within the used instruments. Protocol registration: This systematic review was registered in Prospero (PROSPERO 2022 CRD42022308028).

Objective: We aimed to understand the mortality risks of vulnerable newborns (defined as preterm and/or born weighing smaller or larger compared to a standard population), in low-and middle-income countries (LMICs). Design: Descriptive multi-country, secondary analysis of individual-level study data of babies born since 2000. Setting: Sixteen subnational, population-based studies from nine LMICs in sub-Saharan Africa, Southern and Eastern Asia, and Latin America. Population: Live birth neonates. Methods: We categorically defined five vulnerable newborn types based on size (large-or appropriate-or small-for-gestational age [LGA, AGA, SGA]), and term (T) and preterm (PT): T + LGA, T + SGA, PT + LGA, PT + AGA, and PT + SGA, with T + AGA (reference). A 10-type definition included low birthweight (LBW) and non-LBW, and a four-type definition collapsed AGA/LGA into one category. We performed imputation for missing birthweights in 13 of the studies. Main Outcome Measures: Median and interquartile ranges by study for the prevalence, mortality rates and relative mortality risks for the four, six and ten type classification. Results: There were 238 143 live births with known neonatal status. Four of the six types had higher mortality risk: T + SGA (median relative risk [RR] 2.8, interquartile range [IQR] 2.0–3.2), PT + LGA (median RR 7.3, IQR 2.3–10.4), PT + AGA (median RR 6.0, IQR 4.4–13.2) and PT + SGA (median RR 10.4, IQR 8.6–13.9). T + SGA, PT + LGA and PT + AGA babies who were LBW, had higher risk compared with non-LBW babies. Conclusions: Small and/or preterm babies in LIMCs have a considerably increased mortality risk compared with babies born at term and larger. This classification system may advance the understanding of the social determinants and biomedical risk factors along with improved treatment that is critical for newborn health.

Objective: This study aimed to investigate whether neonatal intensive care units (NICUs) in Brazilian hospitals use a protocol for weaning from noninvasive ventilation (NIV), how this ventilatory support is withdrawn, and whether there is consensus among the methods used by the institutions. Methods: A cross-sectional survey was conducted from December 2020 to February 2021, based on responses to an electronic questionnaire, filled out by physical therapists working in NICU in Brazilian hospitals about the routine of physical therapy and the use of NIV and its weaning. Results: A total of 93 answers to the electronic questionnaire met the study criteria: 52.7% were from public health institutions, with an average of 15 NICU beds (15.2±15.9), 85% of the physical therapists worked exclusively in the NICU, 34.4% of the NICU had 24-h physical therapy care, 66.7% of the units use the continuous positive airway pressure (CPAP) as ventilatory mode, and 72% the nasal prong as NIV interface; 90% of the NICU physical therapists answered that their NICU had no NIV weaning protocol, with various methods of weaning reported, the most cited being pressure weaning. Conclusions: Most Brazilian NICUs have no NIV weaning protocol. The most used method among institutions, with or without a protocol, is pressure weaning. Although most of the participating physical therapists work exclusively in NICU, many hospitals do not have the recommended workload, which can be one of the negative factors in the organization of protocols and in the progress of ventilatory weaning. RESUMO Objetivo Investigar se as unidades de terapia intensiva neonatal (UTIN) dos hospitais brasileiros utilizam protocolo para desmame de ventilação não invasiva (VNI), de que forma é realizada a retirada desse suporte ventilatório e se há consenso entre os métodos utilizados pelas instituições. Métodos Foi realizado um estudo de corte transversal de dezembro de 2020 a fevereiro de 2021, com base nas respostas a um questionário eletrônico, preenchidas por fisioterapeutas que trabalham em UTIN de hospitais brasileiros sobre a rotina da fisioterapia, o uso de VNI e seu desmame. Resultados Preencheram os critérios do estudo 93 respostas ao questionário eletrônico: 52,7% foram de instituições públicas de saúde, com média de 15 leitos de UTIN (15,2 ±15,9); 85% dos fisioterapeutas trabalhavam exclusivamente na UTIN, 34,4% das UTIN possuíam atendimento fisioterapêutico 24 horas por dia; 66,7% das unidades utilizam o Continuous Positive Airway Pressure (CPAP) como modo ventilatório e 72% a pronga nasal como interface de VNI; 90,3% dos fisioterapeutas responderam que suas UTIN não possuíam protocolo de desmame de VNI, com métodos de desmame relatados variados, sendo mais citado o desmame de pressão. Conclusões A maior parte das UTIN brasileiras não possui protocolo de desmame de VNI; o método mais utilizado entre as instituições que possuem ou não protocolo é o desmame de pressão. Apesar de a maioria dos voluntários trabalhar exclusivamente em UTIN, muitos hospitais não possuem a carga horária recomendada, o que pode ser um dos fatores negativos na organização dos protocolos e no andamento do desmame ventilatório.

The peripheral immune system plays a critical role in neuroinflammation of the central nervous system after an insult. Hypoxic-ischemic encephalopathy (HIE) induces a strong neuroinflammatory response in neonates, which is often associated with exacerbated outcomes. In adult models of ischemic stroke, neutrophils infiltrate injured brain tissue immediately after an ischemic insult and aggravate inflammation via various mechanisms, including neutrophil extracellular trap (NETs) formation. In this study, we used a neonatal model of experimental hypoxic-ischemic (HI) brain injury and demonstrated that circulating neutrophils were rapidly activated in neonatal blood. We observed an increased infiltration of neutrophils in the brain after exposure to HI. After treatment with either normothermia (NT) or therapeutic hypothermia (TH), we observed a significantly enhanced expression level of the NETosis marker Citrullinated H3 (Cit-H3), which was significantly more pronounced in animals treated with TH than in those treated with NT. NETs and NLR family pyrin domain containing 3 (NLRP-3) inflammasome assembly are closely linked in adult models of ischemic brain injury. In this study, we observed an increase in the activation of the NLRP-3 inflammasome at the time points analyzed, particularly immediately after TH, when we observed a significant increase in NETs structures in the brain. Together, these results suggest the important pathological functions of early arriving neutrophils and NETosis following neonatal HI, particularly after TH treatment, which is a promising starting point for the development of potential new therapeutic targets for neonatal HIE.

The milk fat globule membrane (MFGM) appears to play an important role in infant neurocognitive development; however, its mechanism(s) of action remains unclear. This study aimed to investigate the role of a dietary MFGM supplement on the lipid profiles of different neonatal brain regions. Ten-day-old male piglets (4–5 kg) were fed unsupplemented infant formula (control, n = 7) or an infant formula supplemented with low (4%) or high (8%) levels of MFGM (n = 8 each) daily for 21 days. Piglets were then euthanized, and brain tissues were sectioned. Untargeted liquid chromatography-mass spectrometry lipidomics was performed on the cerebellum, hippocampus, prefrontal cortex, and the rest of the brain. The analyses identified 271 and 171 lipids using positive and negative ionization modes, respectively, spanning 16 different lipid classes. MFGM consumption did not significantly alter the lipidome in most brain regions, regardless of dose, compared to the control infant formula. However, 16 triacylglyceride species were increased in the hippocampus (t-test, p-value < 0.05) of the high-supplemented piglets. Most lipids (262 (96.7%) and 160 (93.6%), respectively) differed significantly between different brain regions (ANOVA, false discovery rate corrected p-value < 0.05) independent of diet. Thus, this study highlighted that dietary MFGM altered lipid abundance in the hippocampus and detected large differences in lipid profiles between neonatal piglet brain regions.

Background Increased survival rates for children with understudied conditions, such as those with congenital anomalies requiring early major surgery, or other severe conditions such as Human Parechovirus type 3 (HPeV-3), have resulted in neonatal intensive care units needing to help families to identify and manage children’s longer-term disability and poor neurodevelopmental outcomes. Undiagnosed and untreated disability following neonatal surgery and HPeV-3 infection exists. With no formal longer term follow-up services routinely in place, families are unsure where to seek support and what they can do to assist their children. Methods Two longitudinal follow-up studies with multiple timepoint and statistical analyses were undertaken to complete this thesis: 1) 1, 3 and 8 and 9 year follow-ups were conducted for children who survived either cardiac or non-cardiac surgery (DAISy study); 2) 3 and 8 year follow-ups were conducted for survivors of HPeV-3 infection (ELPIN Study). Results Children who had cardiac surgery, non-cardiac surgery and HPeV-3 had poorer motor outcomes, with higher rates of motor impairment and higher risk of Developmental Coordination Disorder (DCD), when compared to healthy controls and the reported population prevalence respectively. Boys had poorer outcomes at 8 years in both the surgical and HPeV-3 infection populations. Conclusion In Australia, current routine long-term follow-up clinics at 8 years are non-existent for the HPeV-3 infection populations and are only short term for the surgical populations. This impacts the ability to identify DCD, motor impairments and other long-term sequelae, and therefore the ability to engage in early intervention to maximise neurodevelopmental outcomes. Children who require early surgery and who are admitted with HPeV-3 infection should be considered high-risk populations for longer-term neurodevelopmental sequelae, and their development should be systematically followed up until at least 8 years of age.