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In this retrospective analysis, the Newborn Life Support (NLS) test scenario performance of participants of the Dutch Neonatal Advanced Life Support (NALS) course was assessed. Characteristics of participants and total amount of failures were collected. Failures were subdivided in (1) errors of omission; (2) errors of commission; and (3) unspecified if data was missing. Pearson's chi-squared test was used to assess differences between participant groups. In total, 23 out of 86 participants (27%) failed their NLS test scenario. Life support course instructors in general (20/21) passed their test scenario more often compared to other participants (43/65) (p = 0.008). In total 110 fail items were recorded; the most common errors being not assessing heart rate (error of omission) (n = 47) and inadequate performance of airway management (error of commission) (n = 24).Conclusion: A substantial part of NALS participants failed their NLS test scenario. Errors of omission could be reduced by the availability of a checklist/NLS algorithm. Life support course instructors possibly make less errors of commission due to retention of skills by teaching these skills at least twice a year. Therefore, our study suggests that neonatal basic life support skills should be retained by local assurance of training programmes. What is Known: • Retention of skills after life support courses decreases after three months. • Adherence to newborn life support guidelines is suboptimal. What is New: • NLS performance is suboptimal in participants for advanced neonatal life support. • Most common failures are not assessing heart rate and inadequate airway management.

This study investigated the relationship between three respiratory support approaches on lung volume recruitment during the first 2 h of postnatal life in preterm lambs. We estimated changes in lung aeration, measuring respiratory resistance and reactance by oscillometry at 5 Hz. We also measured intratracheal pressure in subsets of lambs. The first main finding is that sustained inflation (SI) applied noninvasively (Mask SI; n = 7) or invasively [endotracheal tube (ETT) SI; n = 6] led to similar rapid lung volume recruitment (∼6 min). In contrast, Mask continuous positive airway pressure (CPAP) without SI (n = 6) resuscitation took longer (∼30–45 min) to reach similar lung volume recruitment. The second main finding is that, in the first 15 min of postnatal life, the Mask CPAP without SI group closed their larynx during custom ventilator-driven expiration, leading to intratracheal positive end-expiratory pressure of ∼17 cmH2O (instead of 8 cmH2O provided by the ventilator). In contrast, the Mask SI group used the larynx to limit inspiratory pressure to ∼26 cmH2O (instead of 30 cmH2O provided by the ventilator). These different responses affected tidal volume, being larger in the Mask CPAP without SI group [8.4 mL/kg; 6.7–9.3 interquartile range (IQR)] compared to the Mask SI (5.0 mL/kg; 4.4–5.2 IQR) and ETT SI groups (3.3 mL/kg; 2.6–3.7 IQR). Distinct physiological responses suggest that spontaneous respiratory activity of the larynx of preterm lambs at birth can uncouple pressure applied by the ventilator to that applied to the lung, leading to unpredictable lung pressure and tidal volume delivery independently from the ventilator settings. NEW & NOTEWORTHY: We compared invasive and noninvasive resuscitation on lambs at birth, including or not sustained inflation (SI). Lung volume recruitment was faster in those receiving SI. During noninvasive resuscitation, larynx modulation reduced tracheal pressure from that applied to the mask in lambs receiving SI, while it led to increased auto-positive end-expiratory pressure and very large tidal volumes in lambs not receiving SI. Our results highlight the need for individualizing pressures and monitoring tidal volumes during resuscitation at birth. [ABSTRACT FROM AUTHOR]

Background: Adequate perinatal management is essential in caring for extremely preterm (EP) infants. We aimed to evaluate and compare the impact of different protocols on short-term outcomes. Methods: A retrospective study was conducted on EP infants in a Romanian perinatal tertiary center during 2008–2012 and 2018–2022. Results: Data on 270 EP infants (121 in period I, 149 in period II) were analyzed collectively and stratified into two subgroups by gestational age. Initial FiO2 administration (100% vs. 40%% p < 0.001), lung recruitment at birth (19.0% vs. 55.7% p < 0.001), early rescue surfactant administration (34.7% vs. 65.8%; p < 0.001), and the mechanical ventilation rate (98.3% vs. 58.4%; p < 0.001) were significantly improved during period II. Survival rates of EP infants significantly improved from 41.3% to 72.5%, particularly in the 26–28 weeks subgroup (63.8% to 83%). Compared to period I, the overall frequency of severe IVH decreased in period II from 30.6% to 14.1%; also, BPD rates were lower (36.6% vs. 23.4%; p = 0.045) in the 26–28 weeks subgroup. Despite improvements, there were no significant differences in the frequencies of NEC, sepsis, PVL, ROP, or PDA. Conclusions: Implementing evidence-based clinical guidelines can improve short-term outcomes. [ABSTRACT FROM AUTHOR]

Here, we present the case of a 2-month-old male infant with hyponatremic hypertensive syndrome resulting from stenosis of the right proximal and mid-renal arteries. The patient exhibited nephrotic-range proteinuria, low serum albumin, increased serum creatinine, and elevated renin and aldosterone levels. Doppler ultrasonography and computed tomography angiography revealed decreased vascular flow in the small right renal artery. Following a successful percutaneous balloon angioplasty, the patient experienced a decrease in blood pressure and normalization of serum electrolyte levels within a few days. However, it took 3 months for the proteinuria to resolve completely. This case is significant as it represents the first reported instance of a neonate presenting with clinical features resembling congenital nephrotic syndrome caused by renal artery stenosis that was successfully treated with percutaneous renal angioplasty. [ABSTRACT FROM AUTHOR]

Neonatal resuscitation training can change outcomes of neonatal mortality due to perinatal asphyxia. Recently, in 2021, the advanced NRP course material was changed, and for Basic NRP, a hybrid course was introduced in India. We assessed the instructor's feedback to improve the conduct of the IAP NNF NRP Program as well as get their perception of the effectiveness, usefulness, and pitfalls of the new hybrid Basic NRP course (offline + online). A cross-sectional survey was conducted amongst instructors across India with current status with IAP NRP FGM Office. The data were exported to a Microsoft Excel Spreadsheet. STATA 14.2 was used for descriptive [Frequency (percent) analysis. 827 basic and 221 advanced NRP instructors responded. Bag and mask ventilation was identified as the most important step in basic 468 (56.6%) and advanced 147 (66.5%) courses. In the basic NRP, almost two third (71.0%) participants believe that it is challenging to conduct a case scenario for bag and mask ventilation, whereas, in the advanced course, intubation 116 (52.5%) was considered the most difficult step to teach and medication 80(36.2%) followed by intubation 62(28.1%) are the most difficult steps to conduct case scenario. 725(87.7%) reported that it would be easy to explain them in an offline course after completion of an online course. Most of the instructors were satisfied with the course structure, material, overall quality of the workshop, and support from the IAP NRP office. Constructive suggestions were obtained from the instructors for improvement of the course. [ABSTRACT FROM AUTHOR]

Multimedia tutorials are more and more considered for online professional training as a valuable complement to traditional in presence training. Indeed, video and pictures can offer rich detail, show relevant context, and provide concrete visualisations of key concepts. An important aspect of achieving effective learning is to create an engaging experience for the learner. This can be obtained by increasing the level of interactivity required to the students, keeping them active and interested. However, there are different categories of interactive video, and what type of interactivity works best for online training needs to be systematically investigated. Moreover, the effort in developing such multimedia tutorials by instructional designers should be sustainable to enable large scale adoption. This calls for the development of appropriate methods and tools to support authors and teachers from the conception of an exercise to its deployment and evolution. These challenges have been addressed in the context of an industrial innovation project called ELEVATE (E-LEarning with Virtual interAcTive Experience). In order to collect empirical evidence on what type of interactive multimedia exercise could be effective in training, we performed an experiment to compare online training exercises based on linear videos with ones based on interactive videos having a graph-structure. Meanwhile, prototypes of the ELEVATE tool suite were being developed and validated in an iterative approach, by adding advanced features, such as those enabling the production of customisable exercises. In this paper, we present the design of the experiment and an execution with sixteen subjects, which provided useful results. The ELEVATE tool suite and the companion methodology are also described, together with the mechanisms it provides to develop customisable multimedia exercises. [ABSTRACT FROM AUTHOR]

Using a new analytic method ("unique non-overlapping region" (UNOR) analysis), we characterized the genotypes and phenotypes of a large cohort of individuals diagnosed with chromosome 9p deletion syndrome (9PMS) and defined critical genomic regions. We extracted phenotypic information from 48 individuals with 9PMS from medical records and used a guided interview with caregivers to clarify ambiguities. Using high-resolution whole-genome sequencing for breakpoint definition, we aligned deletions and drew virtual breakpoints to obtain UNORs associated with phenotypic characteristics. We next extracted genotype and phenotype data for 57 individuals identified from a systematic review of the 9PMS literature and analyzed these as above. Common phenotypic features included developmental delay/intellectual disability, dysmorphic features, hypotonia, genital defects in XY individuals, psychiatric diagnoses, chronic constipation, atopic disease, vision problems, autism spectrum disorder, gastroesophageal reflux disease, trigonocephaly, congenital heart disease, and neonatal hypoglycemia. Our approach confirmed previous literature reports of an association of FREM1 with trigonocephaly and suggested a possible modifier element for this phenotype. In conclusion, the UNOR approach delineated phenotypic characteristics for 9PMS and confirmed the critical role of FREM1 and a possible long-distance regulatory element in pathogenesis of trigonocephaly that will need to be replicated in future studies., (© 2024. The Author(s), under exclusive licence to European Society of Human Genetics.)

Aim: To investigate the knowledge level and clinical practice of neonatal intensive care unit nurses on the whole process of hypothermia prevention in preterm infants., Design: A polycentric descriptive cross-sectional study was conducted in 23 hospitals in Shandong province involving 254 neonatal intensive care unit nurses., Methods: An evidence-based knowledge and clinical practice questionnaire on hypothermia prevention in preterm infants and a general information questionnaire were used to collect data. SPSS and EXCEL 24.0 database were used for data statistics and analysis., Results: Nearly one-third of nurses were unclear about the definition of mild hypothermia and heat preservation measures during labour management and resuscitation. Knowledge about the correct rate of amniotic fluid evaporation was low. The higher the hospital level and nurses' education level, professional title, work experience, and position, the higher the knowledge level. The clinical practice of nurses differed in terms of body temperature assessment tools, measurement sites, and measurement frequency for premature infants., Conclusions: Nurses in neonatal intensive care units need to apply evidence-based knowledge and carry out practice interventions to ensure preterm infants' safe transition from the delivery room to the neonatal intensive care unit., Impact: There have been few studies evaluating neonatal nurses' knowledge and practices with regards to the preventing hypothermia of premature infants from delivery room to neonatal intensive care unit. The study identifies the deficiencies and problems in temperature management that can be attributed to the knowledge level of nurses. The findings will help improve the current curriculum, teaching strategies, and the nurses' knowledge levels, preventing premature hypothermia in infants., Reporting Method: This study adhered to the STROBE statement for observational studies and obtained approval (KYLL-2023LW045) from the ethics committee of The Second Hospital of Shandong University. The other 22 third- and second-level hospitals, as our alliance members, recognized our chairperson status within the alliance and were willing to join our academic activities. Mutual responsibility for ethical filing between alliance units., Public Contribution: 254 nurses were recruited from 23 tertiary and secondary public hospitals in Shandong province. No public or patient involvement. Members of the research group used the Questionnaire Star platform to prepare the electronic questionnaire, including obtaining informed consent, taking precautions for questionnaire completion, and using the aforementioned measurement tools. The project research team contacted the head nurses of 23 neonatal intensive care units in Shandong Province. After obtaining consent from the head nurses, they were asked to send the requirements and link of the electronic questionnaire to their WeChat management group. The nurses go through each question and make a choice which has two options of 'agree' or 'disagree.' Based on their answers, nurses were evaluated as having 'mastered' or 'not mastered' each item. Each 'mastered' item (correct answer) was given a score of 4; an item 'not mastered' (incorrect answer) was given a score of 0. The total score ranged from 0 to 100., (© 2024 John Wiley & Sons Ltd.)

About 10% of newborns require some degree of assistance to begin their breathing, and 1% necessitates extensive resuscitation. Sick neonates are exposed to a number of invasive life-saving procedures as part of their management, either for investigation or for treatment. In order to support the neonates with the maximum possible benefits and reduce iatrogenic morbidity, health-care providers performing these procedures must be familiar with their indications, measurements, and potential complications. Hence, the aim of this review is to summarise ten of the main neonatal intensive care procedures with highlighting of their indications, measurements, and complications. They include the umbilical venous and arterial catheterizations and the intraosseous line which represent the principal postnatal emergency vascular accesses; the peripherally inserted central catheter for long-term venous access; the endotracheal tube and laryngeal mask airway for airway control and ventilation; chest tube for drainage of air and fluid from the thorax; and the nasogastric/orogastric tube for enteral feeding. Furthermore, lumber puncture and heel stick were included in this review as very important and frequently performed diagnostic procedures in the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

Laryngeal mask airway (LMA) may be considered by health caregivers of level I–II hospitals for neonatal resuscitation and stabilization before and during interhospital care, but literature provides little information on this aspect. This study reviewed the use of LMA during stabilization and transport in a large series of neonates. This is a retrospective study evaluating the use of LMA in infants who underwent emergency transport by the Eastern Veneto Neonatal Emergency Transport Service between January 2003 and December 2021. All data were obtained from transport registry, transport forms, and hospital charts. In total, 64/3252 transferred neonates (2%) received positive pressure ventilation with an LMA, with increasing trend over time (p = 0.001). Most of these neonates were transferred after birth (97%), due to a respiratory or neurologic disease (95%). LMA was used before the transport (n = 60), during the transport (n = 1), or both (n = 3). No device-related adverse effects were recorded. Sixty-one neonates (95%) survived and were discharged/transferred from the receiving center. Conclusion: In a large series of transferred neonates, LMA use during stabilization and transport was rare but increasing over time, and showed some heterogeneity among referring centers. In our series, LMA was safe and lifesaving in "cannot intubate, cannot oxygenate" situations. Future prospective, multicenter research may provide detailed insights on LMA use in neonates needing postnatal transport. What is Known: • A supraglottic airway device may be used as an alternative to face mask and endotracheal tube during neonatal resuscitation. • The laryngeal mask may be considered by health caregivers of low-level hospitals with limited exposure on airway management, but literature provides little information on this aspect. What is New: • In a large series of transferred neonates, laryngeal mask use was rare but increasing over time, and showed some heterogeneity among referring centers. • The laryngeal mask was safe and lifesaving in "cannot intubate, cannot oxygenate" situations. [ABSTRACT FROM AUTHOR]

This document lists some challenges that researchers face when implementing transactive energy in weak power grids. These challenges often include high voltage fluctuations, limited generation, high line loadability, and unbalanced grids. The operation of transactive energy, as well as optimization techniques, are also considered, highlighting the performance and functionalities depending on power grid characteristics and market topology. Some of the most used optimization techniques for market clearing, considering the characteristics and topology, are presented as part of the research work.In addition, this paper compares different market topologies and highlights their advantages and challenges. Furthermore, this paper contains a brief description of the interoperability frameworks applied to a smart grid.As a result, it was determined that interoperability is necessary for the proper functioning of the grid. Moreover, all methods were found to be effective for their purpose from the user's point of view as each technique has different characteristics relevant to the user and the grid. It was concluded that it is convenient to combine the optimization techniques to consider different constraints in the market clearing. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to design and validate a new checklist and standardized scenario for assessing providers' performance during Newborn Life Support (NLS). Methods: We invited twelve experts in Neonatology to take part in a three-step Delphi process. They rated the importance of each item of a newly designed assessment tool to evaluate participants' performance during Newborn Life Support independently on a numeric rating scale from 1 to 5 (1 = lowest; 5 = highest) and were able to give additional comments. All items achieving a mean rating below four after the third round were deleted. For the reliability of the checklist, we calculated interrater reliability. Results: Using a standardized Delphi process, we revised the initial checklist according to the experts' ratings and comments. The final assessment tool includes 38 items covering all relevant steps during NLS. The mean expert rating of all items was 4.40. Interrater reliability showed substantial agreement between the two raters in the first draft (κ = 0.80) as well as in the final draft of the checklist (κ = 0.73). Conclusion: We designed a feasible assessment tool for evaluating performance during NLS. We proved the checklist to be valid and reasonable using a Delphi validation process and calculating interrater reliability. [ABSTRACT FROM AUTHOR]

Objective: The association between blood glucose level and cerebral oxygenation (cerebral regional oxygen saturation [crSO2] and cerebral fractional tissue oxygen extraction [FTOE]) in neonates has already been described. Aim of the present study was to investigate if acid-base and other metabolic parameters have an impact on cerebral oxygenation immediately after birth in preterm and term neonates. Study design: Post-hoc analyses of secondary outcome parameters of two prospective observational studies were performed. Preterm and term neonates born by caesarean section were included, in whom i) cerebral near-infrared spectroscopy (NIRS) measurements were performed during the first 15 minutes after birth and ii) a capillary blood gas analysis was performed between 10 and 20 minutes after birth. Vital signs were routinely monitored with pulse oximetry (arterial oxygen saturation [SpO2] and heart rate [HR]). Correlation analyses were performed to investigate potential associations between acid-base and metabolic parameters (lactate [LAC], pH-value [pH], base-excess [BE] and bicarbonate [HCO3]) from capillary blood and NIRS-derived crSO2 and FTOE at 15 minutes after birth. Results: One-hundred-fifty-seven neonates, 42 preterm neonates (median gestational age [IQR] 34.0 weeks [3.3], median birth weight 1845g [592]) and 115 term neonates (median gestational age [IQR] 38.9 weeks [1.0], median birth weight 3230g [570]) were included in the study. Median crSO2 [IQR] values at 15 minutes after birth were 82% [16] in preterm neonates and 83% [12] in term neonates. Median FTOE [IQR] values at 15 minutes after birth were 0.13 [0.15] in preterm neonates and 0.14 [0.14] in term neonates. In preterm neonates, higher LAC and lower pH and BE were associated with lower crSO2 and higher FTOE. In term neonates, higher HCO3 was associated with higher FTOE. Conclusion: There were significant associations between several acid-base and metabolic parameters and cerebral oxygenation in preterm neonates, while in term neonates only HCO3 correlated positively with FTOE. [ABSTRACT FROM AUTHOR]

Aim: We investigated the influence of physiological-based cord clamping (PBCC) on cardiorespiratory stability in very low birth weight (VLBW) infants during the first 72 h of life., Methods: This retrospective study comprised VLBW infants born at <32 + 0 weeks of gestation and admitted to the neonatal intensive care unit of the Medical University of Graz, Austria, from December 2014 to April 2021. VLBW infants delivered with PBCC were matched by gestational age and birth weight to delayed cord clamping controls. The PBCC group was stabilised after birth with an intact cord. Routine monitoring parameters were compared between the groups., Results: We included 54 VLBW infants. The mean gestational ages of the PBCC group and controls were 27.4 ± 1.9 versus 27.4 ± 1.8 weeks (p = 0.87), and the mean birth weights were 912 ± 288 versus 915 ± 285 g (p = 0.96), respectively. The mean cord clamping time was 191 ± 78 s in the PBCC group. Heart rate was lower in the PBCC group during the first 3 days after birth, reaching significance by 10 h. Other monitoring parameters did not reveal any differences between the two groups., Conclusion: PBCC stabilised cardiorespiratory parameters in VLBW infants. The lower heart rate in the PBCC group suggested higher blood volume following intact cord resuscitation., (© 2024 The Authors. Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Background: Prematurity is associated with increased risk for morbidity and mortality. Aim of this study was to evaluate whether cerebral oxygenation during fetal-to-neonatal transition period was associated with long-term outcome in very preterm neonates. Methods: Preterm neonates ≤ 32 weeks of gestation and/or ≤ 1500 g with measurements of cerebral regional oxygen saturation (crSO2) and cerebral fractional tissue oxygen extraction (cFTOE) within the first 15 min after birth were analysed retrospectively. Arterial oxygen saturation (SpO2) and heart rate (HR) were measured with pulse oximetry. Long-term outcome was assessed at two years using "Bayley Scales of Infant Development" (BSID-II/III). Included preterm neonates were stratified into two groups: adverse outcome group (BSID-III ≤ 70 or testing not possible due to severe cognitive impairment or mortality) or favorable outcome group (BSID-III > 70). As the association between gestational age and long-term outcome is well known, correction for gestational age might disguise the potential association between crSO2 and neurodevelopmental impairment. Therefore, due to an explorative approach the two groups were compared without correction for gestational age. Results: Forty-two preterm neonates were included: adverse outcome group n = 13; favorable outcome group n = 29. Median(IQR) gestational age and birth weight were 24.8 weeks (24.2–29.8) and 760 g (670–1054) in adverse outcome group and 30.6 weeks (28.1–32.0) (p = 0.009*) and 1250 g (972–1390) (p = 0.001*) in the favorable outcome group, respectively. crSO2 was lower (significant in 10 out of 14 min) and cFTOE higher in adverse outcome group. There were no difference in SpO2, HR and fraction of inspired oxygen (FiO2), except for FiO2 in minute 11, with higher FiO2 in the adverse outcome group. Conclusion: Preterm neonates with adverse outcome had beside lower gestational age also a lower crSO2 during immediate fetal-to-neonatal transition when compared to preterm neonates with age appropriate outcome. Lower gestational age in the adverse outcome group would suggest beside lower crSO2 also lower SpO2 and HR in this group, which were however similar in both groups. [ABSTRACT FROM AUTHOR]

Chromosome 9p deletion syndrome is a rare autosomal dominant disorder presenting with a broad spectrum of clinical features, including congenital heart defects (CHDs). To date, studies focused on a deep characterization of cardiac phenotype and function associated with this condition are lacking. We conducted a multicentric prospective observational study on a cohort of 10 patients with a molecular diagnosis of 9p deletion syndrome, providing a complete cardiological assessment through conventional echocardiography and tissue Doppler imaging echo modality. As a result, we were able to demonstrate that patients with 9p deletion syndrome without major CHDs may display subclinical cardiac structural changes and left-ventricle systolic and diastolic dysfunction. Albeit needing validation in a larger cohort, our findings support the idea that a complete cardiac assessment should be performed in patients with 9p deletion syndrome and should be integrated in the context of a long-term follow-up. [ABSTRACT FROM AUTHOR]

Surfactant administered in the delivery suite might prevent or reduce the severity of subsequent respiratory distress syndrome. This review describes the evidence for surfactant delivery methods with relationship to their relevance in the delivery suite. The techniques include delivery using a thin catheter with the first breath, by the intubation-surfactant extubation procedure, less invasive surfactant administration (LISA) technique, using a laryngeal mask airway (LMA), or by nebulisation. There have been few randomised trials that have evaluated outcomes using these techniques in the delivery suite, and these were early trials. Currently, practitioners favour use of nasal continuous positive airway pressure with early rescue surfactant. Whether prophylactic surfactant given by the LISA technique or other techniques, such as via a LMA in the delivery suite, is more beneficial merits testing. This will require appropriately designed randomised trials with long-term outcomes. [ABSTRACT FROM AUTHOR]

Background: Recently, the International Liaison Committee on Resuscitation published a systematic review that concluded that routine suctioning of clear amniotic fluid in the delivery room might be associated with lower oxygen saturation (SpO2) and 10 min Apgar score. The aim of this study was to examine the effect of delivery room airway suctioning on the clinical appearance, including muscle tone and skin colour, of video-recorded term and preterm infants born through mainly clear amniotic fluid. Methods: This was a single-centre observational study using transcribed video recordings of neonatal stabilizations. All infants who received delivery room positive pressure ventilation (PPV) from August 2014 to November 2016 were included. The primary outcome was the effect of airway suctioning on muscle tone and skin colour (rated 0–2 according to the Apgar score), while the secondary outcome was the fraction of infants for whom airway suction preceded the initiation of PPV as a surrogate for "routine" airway suctioning. Results: Airway suctioning was performed in 159 out of 302 video recordings and stimulated a vigorous cry in 47 (29.6%) infants, resulting in improvements in muscle tone (p = 0.09) and skin colour (p < 0.001). In 43 (27.0%) infants, airway suctioning preceded the initiation of PPV. Conclusions: In this single-centre observational study, airway suctioning stimulated a vigorous cry with resulting improvements in muscle tone and skin colour. Airway suctioning was often performed prior to the initiation of PPV, indicating a practice of routine suctioning and guideline non-compliance. [ABSTRACT FROM AUTHOR]

Establishing immediate intravenous access to a newborn is challenging even for trained neonatologists in an emergency situation. Correct placement of umbilical catheter or an intraosseous needle needs consistent training. We evaluated the time required to correctly place an emergency umbilical button cannula (EUC) or an umbilical catheter (UC) using the standard intersection (S-EUC or S-UC, respectively) or lateral umbilical cord incision (L-EUC) by untrained medical personnel. Single-center cross-over pilot-study using a model with fresh umbilical cords. Video-based teaching of medical students before probands performed all three techniques after assignment to one of three cycles with different sequence, using a single umbilical cord divided in three pieces for each proband. Mean time required to establish L-EUC was 89.3 s, for S-EUC 82.2 s and for S-UC 115.1 s. Both application routes using the EUC were significantly faster than the UC technique. There was no significant difference between both application routes using EUC (p=0.54). Using an umbilical cannula is faster than an umbilical catheter, using a lateral incision of the umbilical vein is an appropriate alternative. [ABSTRACT FROM AUTHOR]

Objective: To conduct a systematic review and meta-analysis to compare the efficacy and safety of umbilical cord milking (UCM) versus delayed cord clamping (DCC) in term and late-preterm infants. Methods: MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, Clinical trial registries, and Gray literature were searched for randomized controlled trials (RCTs) comparing UCM with DCC in term and late-preterm infants for both short-term and long-term outcomes. Intact and cut UCM were compared separately with DCC using subgroup analysis. We used fixed effect model to pool the data. Random effects model was used when there was significant heterogeneity. Results: Nine studies (1632 infants) were included in the systematic review. Milking was performed on intact cord (i-UCM) in five studies (n = 829) and on cut cord (c-UCM) in four studies (n = 803). Cord milking significantly improved hemoglobin level at 48-72 h of life when compared to DCC (six studies, n = 924, mean difference 0.36 g/dL; 95% CI: 0.19-0.53). In addition, hemoglobin level at six to eight weeks of age was also significantly higher in the studies comparing i-UCM with DCC (two studies, n = 550: mean difference 0.16 g/dL; 95% CI: 0.06-0.27). There was no difference between the UCM group and DCC group for any other outcome. Only one study provided information on growth and hematological parameters at one year of age. Neurodevelopmental outcomes were not reported. None of the studies included non-vigorous infants. The grade of evidence was low to very low for all the outcomes studied. Conclusion: UCM is comparable to DCC in improving short-term hematological outcomes in term and late-preterm vigorous infants. Trials assessing the effect of UCM on important clinical and long-term outcomes among non-vigorous mature preterm infants are urgently required. [ABSTRACT FROM AUTHOR]

Aim: To describe the effectiveness of the Newborn Life Support (NLS) course in terms of attendees’ knowledge, perceived self-efficacy, and clinical applicability. Methods: We conducted an electronic survey of NLS course attendees (NLS + group). A control group (NLS–) was recruited via our regional perinatal network. The survey data were analyzed anonymously. Multiple linear regression analysis examined the following: NLS course, job tenure, maternity level, and profession. Results: The survey completion rate was 62% (200/323) for the NLS + group. Among participants, 84% had participated in neonatal resuscitation since their course. The scores for positive perceived experience for neonatal resuscitation (fluency, security, and quality of care delivered) were higher in the NLS + group than the NLS– group (p<.006). After adjustment, the independent factors associated with a higher positive perceived experience were the NLS course, work in tertiary level maternity ward, and job tenure >5 years. The multiple-choice questions (MCQs) score (n = 10) was 8.2 ± 1.3 (NLS+) vs. 6.7 ± 1.5 (NLS+) (p<.0001). NLS course, medical degree, and work in a tertiary level maternity ward were independently associated with higher knowledge scores. Conclusions: The NLS course was associated with a positive perceived experience regarding neonatal resuscitation. [ABSTRACT FROM AUTHOR]

The transition to a low-carbon society will completely change the structure of energy systems from a standalone hierarchical centralised vision to cooperative and distributed Multi-Energy Systems. The analysis of these complex systems requires the collaboration of researchers from different disciplines in the energy, ICT, social, economic, and political sectors. Combining such disparate disciplines into a single tool for modeling and analyzing such a complex environment as a Multi-Energy System requires tremendous effort. Researchers have overcome this effort by using co-simulation techniques that give the possibility of integrating existing domain-specific simulators in a single environment. Co-simulation frameworks, such as Mosaik and HELICS, have been developed to ease such integration. In this context, an additional challenge is the different temporal and spatial scales that are involved in the real world and that must be addressed during co-simulation. In particular, the huge number of heterogeneous actors populating the system makes it difficult to represent the system as a whole. In this paper, we propose a comparison of the scalability performance of two major co-simulation frameworks (i.e. HELICS and Mosaik) and a particular implementation of a well-known multi-agent systems library (i.e. AIOMAS). After describing a generic co-simulation framework infrastructure and its related challenges in managing a distributed co-simulation environment, the three selected frameworks are introduced and compared with each other to highlight their principal structure. Then, the scalability problem of co-simulation frameworks is introduced presenting four benchmark configurations to test their ability to scale in terms of a number of running instances. To carry out this comparison, a simplified multi-model energy scenario was used as a common testing environment. This work helps to understand which of the three frameworks and four configurations to select depending on the scenario to analyse. Experimental results show that a Multi-processing configuration of HELICS reaches the best performance in terms of KPIs defined to assess the scalability among the co-simulation frameworks. [ABSTRACT FROM AUTHOR]

Background: The term "bacterial translocation" (BT) refers to the migration of bacteria or their products from the gastrointestinal tract to tissues located outside it, and may occur after intestinal ischemia-reperfusion injury. The term "endotoxin" is synonymous, and is used interchangeably with the term lipopolysaccharide (LPS). LPS, a component of Gram-negative gut bacteria, is a potent microbial virulence factor, that can trigger production of pro-inflammatory mediators, causing localized and systemic inflammation. The aim of this study is to investigate if neonatal asphyxia provokes BT and an increased concentration of LPS in an animal model of asphyxia in piglets. Methods: Twenty-one (21) newborn male Landrace/Large White piglets, 1–4 days old, were randomly allocated into three groups, Control (A), Asphyxia (B) and Asphyxia-Cardiopulmonary Resuscitation (CPR) (C). All animals were instrumented, anesthetized and underwent hemodynamic monitoring. In Group A, the animals were euthanized. In Group B, the endotracheal tube was occluded to cause asphyxia leading to cardiopulmonary arrest. In Group C, the animals were resuscitated after asphyxia and further monitored for 30′. Bacterial translocation was assessed by the measurement of endotoxin in blood from the portal vein and the aorta, and also by the measurement of endotoxin in mesenteric lymph nodes (MLNs) at euthanasia. The results are given as median (IQR) with LPS concentration in EU/mL. Results: BT was observed in all groups with minimum LPS concentration in the MLN and maximum concentration in the portal vein. LPS levels in the MLNs were higher in the Group B: 6.38 EU/mL (2.69–9.34) compared to the other groups (Group A: 2.1 EU/mL (1.08–2.52), Group C: 1.66 EU/mL (1.51–2.48), p = 0.012). The aorta to MLNs LPS difference (%) was lower in Group B: 0.13% (0.04–1.17), compared to Group A: 5.08% (2.2–10.7), and Group C: 3.42% (1.5–5.1)) (p = 0.042). The same was detected for portal to MLNs LPS difference (%) which was lower in Group B: 0.94% (0.5–3) compared to Group A: 4.9% (4–15), and Group C: 3.85% (1.5–5.1)) (p = 0.044). Conclusions: Neonatal asphyxia can provoke ΒΤ and increased LPS concentration in blood and tissue located outside the gastrointestinal system. [ABSTRACT FROM AUTHOR]

Myotonic dystrophy (DM) is a highly variable, multisystemic disorder that clinically affects one in 8000 individuals. While research has predominantly focused on the symptoms and pathological mechanisms affecting striated muscle and brain, DM patient surveys have identified a high prevalence for gastrointestinal (GI) symptoms amongst affected individuals. Clinical studies have identified chronic and progressive dysfunction of the esophagus, stomach, liver and gallbladder, small and large intestine, and rectum and anal sphincters. Despite the high incidence of GI dysmotility in DM, little is known regarding the pathological mechanisms leading to GI dysfunction. In this review, we summarize results from clinical and molecular analyses of GI dysfunction in both genetic forms of DM, DM type 1 (DM1) and DM type 2 (DM2). Based on current knowledge of DM primary pathological mechanisms in other affected tissues and GI tissue studies, we suggest that misregulation of alternative splicing in smooth muscle resulting from the dysregulation of RNA binding proteins muscleblind-like and CUGBP-elav-like is likely to contribute to GI dysfunction in DM. We propose that a combinatorial approach using clinical and molecular analysis of DM GI tissues and model organisms that recapitulate DM GI manifestations will provide important insight into defects impacting DM GI motility. [ABSTRACT FROM AUTHOR]

Approximately 10% of infants at birth require some assistance to breathe and 1% require vigorous resuscitation. As such, midwives need appropriate education and training on newborn life support (NLS) techniques. We conducted a survey on Italian territory about the correlation between obstetric education and the management of the neonatal resuscitation in the delivery room. The study was led through a web survey based on 23 questions, given anonymously online through the Google Drive platform. 272 women aged from 19 to 59 years answered the questions (83% midwives and 17% midwifery students). 93% of them attended an NLS course before graduation, while only 57% have repeated it afterwards once or more times. The midwives working in hospitals with neonatal intensive care units (NICUs) experienced more involvement within the emergency neonatal resuscitation team than the others working in other kind of hospitals (hospital with NICU 79%, hospital without NICU 57%, private hospital 48%; p <.001). Moreover, the midwives' years of experience at work are much more related to the prompt execution of primary resuscitation maneuvers (more than 10 years of experience 74%, 5–10 years 48%, less than 5 years 30%; p <.001). Power analysis showed an adequate sample size of the study population. In spite of NLS techniques are taught to near all midwives, only working in hospitals within a NICU and longer work experience are directly related with greater involvement of a midwife in the neonatal resuscitation team. [ABSTRACT FROM AUTHOR]

Smart grid (SG) has been designed as a response to the limitations of traditional power grids caused by growing power supply demands. SG is considered a critical infrastructure in which dependability plays a crucial role and manifestation of failures can lead to severe consequences. Architecture-wise, SGs can be decomposed in several layers comprising variety of physical, software, communication and business components, each representing a potential point of failure determined by their underlying faults. In this paper, we present a systematic literature review surveying 30 different faults and failures which can occur in the SG infrastructure. The discovered faults and failures are investigated to extract details about their causes, impacts, detection techniques and counter-measures. Based on the collected information, the faults and failures are classified and mapped to Smart Grid Reference Architecture Model (SGAM), providing a useful frame of reference for practitioners and researchers dealing with hardware and software dependability in this complex domain. [ABSTRACT FROM AUTHOR]

Noninvasive respiratory support during postnatal transition may be challenging. Thus, we aimed to analyze frequency and effects of maneuvers to improve noninvasive respiratory support in neonates immediately after birth. We included neonates born between September 2009 and January 2015 who were video recorded as part of prospective observational studies and required noninvasive respiratory support during the first 15 min after birth. Maneuvers to improve respiratory support were assessed by video analysis. Vital parameter measurement using pulse oximetry and near-infrared spectroscopy was supplemented by respiratory function monitoring. One-hundred forty-three of 653 eligible neonates (21.9%) required respiratory support. Video recordings were analyzed in 76 preterm and 58 term neonates, showing airway maneuvers in 105 of them (78.4%). Repositioning of the face mask was the most common maneuver (56.9%). We observed a median of three maneuvers (0–22) in preterm and a median of two maneuvers (0–13) in term neonates (p =.01). Regional cerebral tissue oxygen saturation was significantly higher during the 60 s after the first airway maneuver. Maneuvers to improve respiratory support are commonly required during neonatal resuscitation, with a higher incidence in preterm neonates. The first airway maneuver was associated with an improvement of cerebral tissue oxygenation. [ABSTRACT FROM AUTHOR]

Respiratory complications are among the most common problems addressed in neonatology in the first hours after birth, whereas the risk of any cancer in the neonatal period is 28 per million. Sarcomas, malignant mesenchymal neoplasms, account for about 8% of all neoplasms in the neonatal period. We report on a male neonate born at 36 + 4/7 weeks of gestation, diagnosed with retropharyngeal synovial carcinoma. Ineffective respiratory movements and generalized cyanosis were the first symptoms to be noted. On the ultrasound examination of the neck, a tumor of the retropharyngeal space was exposed, then visualized by an MRI of the head and neck. The biopsy analysis revealed the diagnosis of an extremely rare tumor in a neonate. The location of its growth was atypical, contributing to a diagnostic challenge. The neoplasm was treated solely with chemotherapy concordantly with the CWS protocol, individually customized for our patient. Preterm birth, as in our case, 36 + 4/7 weeks of gestation, may imply a possible need for resuscitation or support in the transition period. Aggressive high-grade tumors of the head and neck region are locally invasive and prone to metastasize. However, prognosis in infants is hard to estimate, therefore both individualized treatment and multidisciplinary care should be tailored to the needs of the patient. [ABSTRACT FROM AUTHOR]