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Perinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. Current tools and measurements mainly based on the analysis of clinical evaluation and laboratory and electrophysiological tests do not give consistent data allowing to predict the severity of hypoxic-ischemic encephalopathy (HIE) until a magnetic resonance imaging (MRI) score is performed. The aim of this work is to evaluate the usefulness of the new index, called Thermal Index (TI) in the assessment of the degree of brain damage in newborns in the course of therapeutic hypothermia (TH) due to PA. This was a prospective, observational, pilot study which did not require any changes in the applicable procedures. Analysis has been applied to six newborn babies treated with TH in Neonatal/Paediatric ICU in University Hospital in Opole in 2018 due to PA. They all met criteria for TH according to the current recommendations. Brain MRI was performed after the end of TH when the children were brought back to normal temperature, with the use of a 1.5 T scanner, using T1-, T2-weighted images, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR), susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI). The images were assessed using MRI score according to the scoring system proposed by Weeke et al. The Thermal Index assessing endogenous heat production was calculated according to the formula proposed in this paper. A high, statistically significant positive correlation was found between MRI scores and TI values (0.98; p = 0.0003) in the 1st hour of therapy. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. Further research is required to confirm the usefulness of the proposed method. [ABSTRACT FROM AUTHOR]

Two 3-oxo-Δ4 fetal bile acids, 3-oxachola-4,6-dien-24-oic acid (1) and 7α-hydroxy-3-oxochol-4-en-24-oic acid (2), occur normally in the human fetus but remain elevated in neonates and children with severe cholestatic liver disease due to an autosomal recessive inborn error of metabolism affecting Δ4-3-oxo-steroid 5β-reductase (AKR1D1). Relatively little is known about 1 and 2 in adult patients with liver disease. The chemical synthesis of 1 and 2 is therefore described and their quantitation in plasma by ultrarapid chromatography-triple quadrupole mass spectrometry. Plasma concentrations of 1 and 2 were investigated in 25 adult patients with varying degrees of liver cirrhosis with and without hepatocellular carcinoma (HCC). Highly statistically significant correlations (P < 0.0001) were found between severity of liver cirrhosis, determined by the Child–Pugh and MELD scores, with plasma 1 and 2 concentrations, both alone and combined. The presence of HCC did not influence these correlations. Plasma cholic, chenodeoxycholic, deoxycholic, lithocholic or ursodeoxycholic acids, free and as their glycine or taurine conjugates, did not correlate with Child–Pugh or MELD score when corrected for multiple comparisons. These findings demonstrate that plasma levels of fetal bile acids 3-oxachola-4,6-dien-24-oic acid and 7α-hydroxy-3-oxochol-4-en-24-oic acid and likely deteriorating AKR1D1 activity indicate the severity of liver cirrhosis measured by the Child–Pugh and MELD scores. [ABSTRACT FROM AUTHOR]

Congenital heart disease (CHD) is the most common congenital disorder diagnosed in newborns. Although lots of related studies have been published, yet the pathogenesis has not been fully elucidated. A growing body of evidence indicates perturbations of the gut microbiota may contribute in a significant way to the development of obesity and diabetes. Given that maternal obesity and diabetes are well-known risk factors for CHD, maternal gut microbiota may be considered as one of the environmental factors involved in the pathogenesis of CHD. The object of this study is to explore the association between maternal gut microbiota and risk of congenital heart disease (CHD) in offspring, as well as the possible mechanisms linking gut microbiota and disease risk. A case–control study was conducted in mothers of infants with CHD (n = 101) and mothers of infants without CHD (n = 95). By applying 16S rRNA gene sequencing and metabolic approaches to 196 stool and plasma samples, we determined microbiome and metabolome profiles in mothers of infants with CHD and controls, and their association with risk of CHD in offspring. The gut microbiome of mothers of infants with CHD was characterized with lower alpha-diversity and distinct overall microbial composition compared with mothers of infants without CHD. A distinct different metabolic profile was found between mothers of infants with CHD and controls. After controlling for the possible confounders, thirty-four bacterial genera and fifty-three plasma metabolites showed distinct abundances between the two groups. The results of the Spearman correlation analyses revealed a great number of significant correlations between the abundant bacterial genera and differentially expressed metabolites. In particular, the genus Bifidobacterium and Streptococcus showed comparable moderate positive correlations with a range of metabolites that involved in lipid metabolism pathway. Our findings suggest that perturbations of maternal gut microbiota and plasma metabolites may be associated with risk of CHD in offspring, and co-variation between microbiota and metabolites may play a part in the linkage between gut microbiota and risk of CHD in offspring. [ABSTRACT FROM AUTHOR]

Preterm birth remains the leading identifiable risk factor for cerebral palsy (CP), a devastating form of motor impairment due to developmental brain injury occurring around the time of birth. We performed genome wide methylation and whole transcriptome analyses to elucidate the early pathogenesis of CP in extremely low gestational age neonates (ELGANs). We evaluated peripheral blood cell specimens collected during a randomized trial of erythropoietin for neuroprotection in the ELGAN (PENUT Trial, NCT# 01378273). DNA methylation data were generated from 94 PENUT subjects (n = 47 CP vs. n = 47 Control) on day 1 and 14 of life. Gene expression data were generated from a subset of 56 subjects. Only one differentially methylated region was identified for the day 1 to 14 change between CP versus no CP, without evidence for differential gene expression of the associated gene RNA Pseudouridine Synthase Domain Containing 2. iPathwayGuide meta-analyses identified a relevant upregulation of JAK1 expression in the setting of decreased methylation that was observed in control subjects but not CP subjects. Evaluation of whole transcriptome data identified several top pathways of potential clinical relevance including thermogenesis, ferroptossis, ribosomal activity and other neurodegenerative conditions that differentiated CP from controls. [ABSTRACT FROM AUTHOR]

Before 2013, almost none of the cesarean section (CS) deliveries at our institution were performed with spinal anesthesia (SA), but after 2013 SA became the first-choice anesthesia for CS because it achieved better neonatal outcomes. However, the current rate of SA implementation at our institution was estimated to be approx. 60–70%, which is intermediate between these at other institutions in Japan or in other countries. This raises a question: What rate of SA use among CS cases achieves the best neonatal outcomes? To answer this question, we conducted this single-center case–control study with 1326 CS cases between 1994 and 2017 and compared the neonatal outcomes before to those after 2013. The logistic regression models were prepared to estimate the risk of birth asphyxia defined as a 5-min Apgar of < 7, associated with eight potential confounders, including the modified anesthetic protocol. The modified protocol was not a significant independent factor for neonatal asphyxia, indicating that our moderate SA priority protocol did not improve the neonatal outcomes even when compared to the outcomes at a 0% SA rate. A > 70% rate of SA implementation may be needed to provide better neonatal outcomes. [ABSTRACT FROM AUTHOR]

Background: Approximately 10% of fathers in the Cultural West (i.e., US, Europe, and Australia) experience depression. We broaden the cultural scope of paternal depression research by investigating the prevalence and predictors of depressive symptoms among Jamaican fathers.Methods: The present research draws upon structured interviews with 3425 fathers of newborn children participating in a Jamaican birth cohort study-JA Kids-and represents one of the largest sample sizes of any study on postnatal depression among fathers worldwide. This sample of fathers participated from July to September 2011, and represents approximately 30% of all men who became fathers during that time in Jamaica. Fathers answered questions about sociodemographic background, relationship status and quality, social support, health, expectations and views of a partner's pregnancy, and the ten-item Edinburgh Postnatal Depression Scale (EPDS).Results: Analyses reveal that 9.1% (95% CI 8.1-10.1) of these Jamaican fathers of newborns had EPDS scores of 10 or higher, indicative of possible depression. Results suggest that educational attainment was not related to EPDS scores, though higher indices of material wealth (e.g., refrigerator and vehicle) were weakly, negatively related to EDS scores. Paternal age was also weakly negatively predictive of EDS scores. Whereas relationship status was unrelated to depressive symptoms, relationship quality negatively predicted depressive symptoms. Several other measures of social support (lacking a close circle of friends, fewer family, or friends to help in times of trouble) were also associated with higher EPDS scores.Conclusions: We interpret these findings in light of existing work on paternal depression, including the importance of social context and support. [ABSTRACT FROM AUTHOR]

Newborns are at relatively high risk for developing hypoglycaemia in the first 24 h after birth. Well-known risk factors are prematurity, small for gestational age (SGA) or large for gestational age (LGA), and maternal pre-existent or gestational diabetes mellitus. Prolonged hypoglycaemia is associated with poor neurodevelopmental outcomes; hence, prevention through proper monitoring and treatment is important. Given the ongoing debate concerning frequency and duration of screening for neonatal hypoglycaemia, therefore, we investigated the frequency and duration of glucose monitoring safe to discover neonatal hypoglycaemia in different risk groups. Data of newborns at risk for hypoglycaemia were retrospectively collected and analysed. Blood glucose concentrations were measured 1, 3, 6, 12, and 24 h after birth. Moderate hypoglycaemia was defined as a blood glucose concentration of < 2.2 mM and severe hypoglycaemia as a concentration of < 1.5 mM. Of 1570 newborns, 762 (48.5%) had at least one episode of hypoglycaemia in the first 24 h after birth; 30.6% of them had severe hypoglycaemia (all in the first 9 h after birth). Only three SGA and two LGA newborns had a first moderate asymptomatic hypoglycaemic episode beyond 12 h after birth. The incidence of hypoglycaemia increased with accumulation of multiple risk factors.Conclusion: Safety of limiting the monitoring to 12 h still has to be carefully evaluated in the presence of SGA or LGA newborns; however, our results suggest that 12 h is enough for late preterm newborns (> 34 weeks) and maternal diabetes. What is Known: • Newborns are at relatively high risk for developing hypoglycaemia and such hypoglycaemia is associated with adverse neurodevelopmental outcomes. • Proper glucose monitoring and prompt treatment in case of neonatal hypoglycaemia are necessary. What is New: • Glucose monitoring 12 h after birth is proficient for most newborns at risk. • Maternal diabetes leads to the highest risk of early neonatal hypoglycaemia and newborns with more than one risk factor are at increased risk of hypoglycaemia. [ABSTRACT FROM AUTHOR]

The aim of this study was to contribute further to existing randomized controlled trials and meta-analyses showing advantages in the outcome of less invasive surfactant administration (LISA)-treated infants and add new aspects concerning treatment and outcome data collected in the routine clinical setting. Four hundred seven very low birth weight infants who received surfactant via either LISA or intubation methods were enrolled in the observational cross-sectional multicenter study. To compare infants in terms of surfactant administration, we used an exact matching procedure (the same gestational age, severe perinatal depression (pH < 7.10), birth weight < 10th percentile, antenatal steroid treatment, and the same gender). To check for robustness, we performed repeated matching. LISA-treated infants required significantly less mechanical ventilation during hospital stay (p < 0.001) and days with supplemental oxygen (p = 0.03). Analgesics and sedatives were used less often during the stay (p < 0.001). Infants treated with LISA had significantly lower rates of bronchopulmonary dysplasia (p = 0.003). LISA failure infants were identified as more likely to be small for gestational age and more immature.Conclusion: Our study complements former results with advantages for LISA-treated infants in mechanical ventilation and bronchopulmonary dysplasia in the clinical routine.Trial Registration: DRKS00004589 What is Known: • According to existing literature, LISA-treated infants seem to have some favors in terms of treatment and outcome data. Observational studies in routine clinical setting are missing. What is New: • Data of 407 VLBW infants collected in routine clinical setting showed that LISA-treated infants needed less mechanical ventilation and fewer days with supplemental oxygen and less analgesics and sedatives. A reduced risk of BPD could be showed. SGA infants seem to have higher risks of LISA failure. [ABSTRACT FROM AUTHOR]

Limiting the number of days until achievement of full enteral feeding in extremely low birth weight neonates (ELBW; < 1000 g) might affect growth in the first years of life. This study compared the Z scores in growth over time of two cohorts of ELBW neonates that were comparable on maternal and neonatal characteristics and characteristics of hospitalization, but differed in enteral feeding strategy during neonatal admission. In the 2010-2014 cohort, full enteral feeding was achieved on average 16 days earlier than in the 2000-2005 cohort. In both cohorts, weight, height, and head circumference were recorded at birth and at the corrected ages of 9 and 24 months. A linear mixed model with repeated measures controlling for neonates small for gestational age showed no significant effect of different strategies in achievement of full enteral feeding on any anthropometric Z scores over time. Although full enteral feeding was achieved earlier in the 2010-2014 cohort, this was not associated with growth patterns during the first two years of life.Conclusion: The effect of a change in strategy to achieve full enteral feeding at an earlier stage in ELBW neonates was assessed. Early enteral feeding strategies do not necessarily improve growth during the first two years of life. What is Known: • Feeding strategies during neonatal stay may affect growth in the first years of life. • Strategies to achieve full enteral feeding earlier were implemented, but data on the impact on subsequent growth after discharge are limited. What is New: • Full enteral feeding was achieved earlier, but this was not associated with improved growth during the first 2 years of life after discharge. • Early enteral feeding strategies do not necessarily improve growth during the first 2 years of life. [ABSTRACT FROM AUTHOR]

The placenta is a complex organ that influences prenatal growth and development, and through fetal programming impacts postnatal health and well-being lifelong. Little information exists on placental pathology in the presence of congenital heart disease (CHD). Our objective is to characterize the placenta in CHD and investigate for distinctions based on type of malformation present. Placental pathology from singleton neonates prenatally diagnosed and delivered at > 37 weeks gestation was analyzed. Placental findings of absolute weight, placental weight-to-newborn birth weight ratio, chorangiosis, villus maturity, thrombosis, and infarction were recorded and analyzed based on four physiological categories of CHD: (1) single ventricle-aortic obstruction, (2) single ventricle-pulmonic obstruction, (3) two-ventricle anomalies, and (4) transposition of the great arteries (TGA). Associations between fetal Doppler assessments of middle cerebral/umbilical arterial flow and placental findings were investigated. A total of 120 cases of complex CHD were analyzed. Overall placental-to-birth weight ratios were < 10th percentile for 77% and < 3rd percentile for 49% with abnormalities of chorangiosis (18%), hypomature villi (15%), thrombosis (41%), and infarction (17%) common. There was no association between fetal Doppler flow measures and placental abnormalities. Newborns with TGA had the greatest degree of placental abnormality. Placentas of newborns with CHD are smaller than expected and manifest a number of vascular abnormalities, with TGA most prominent. Fetal Doppler does not correlate with these abnormalities. Studies investigating the relationship between placental abnormalities and postnatal outcomes may offer insight into the fetal origins of outcome variability in CHD. [ABSTRACT FROM AUTHOR]

Background: Sequence optimization in neonates might improve detection sensitivity of abnormalities for a variety of conditions. However this has been historically challenging because tissue properties such as the longitudinal relaxation time and proton density differ significantly between neonates and adults.Objective: To optimize the magnetization-prepared rapid gradient echo (MP-RAGE) sequence to enhance both signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) efficiencies.Materials and methods: We optimized neonatal MP-RAGE sequence through (1) reducing receive bandwidth to decrease noise, (2) shortening acquisition train length (acquisition number per repetition time or total number of read-out radiofrequency rephrasing pulses) using slice partial Fourier acquisition and (3) simulating the solution of Bloch’s equation under optimal receive bandwidth and acquisition train length. Using the optimized sequence parameters, we scanned 12 healthy full-term infants within 2 weeks of birth and four preterm infants at 40 weeks’ corrected age.Results: Compared with a previously published neonatal protocol, we were able to reduce the total scan time by reduce the total scan time by 60% and increase the average SNR efficiency by 160% (P<0.001) and the average CNR efficiency by 26% (P=0.029).Conclusion: Our in vivo neonatal brain imaging experiments confirmed that both SNR and CNR efficiencies significantly increased with our proposed protocol. Our proposed optimization methodology could be readily extended to other populations (e.g., older children, adults), as well as different organ systems, field strengths and MR sequences. [ABSTRACT FROM AUTHOR]

Normal ECG values in newborns, infants, and children have been collected and published. ECG in the adolescent, however, remains, to be collected and studied. The present study was designed and carried out to establish the normal ECG standards in male and female adolescents. A total of 898 school children and adolescents screened and examined as healthy were divided by age and sex into 6-9, 9-13, and 13-18 years age-groups. A 12 lead conventional ECG was recorded in 10 mm/mV and 25 mm/s, utilizing an automated Fukuda Denshi FCP-4301, MS-DOS/IBM-AT ECG machine. Lead V3R was not taken. Analog-to-digital conversion was performed by Fukuda signal acquisition module at a sampling rate of 500 Hz. The data on 69 ECG parameters were analyzed for the mean, standard deviation, 2nd to 98th percentiles, 95% confidence intervals, and sex difference. Normal values on 69 ECG parameters, sex-specific heart rate, P-QRS-T interval, duration, axis, wave amplitude, and calculated R/S amplitude ratio and ventricular activation time by age-group and sex were established. Male and female difference was noted in 49 (71.0%) parameters, of which 3 (6.1%) began in 6-9 years age-group, 30 (61.2%) began in 9-13 years age-group, and 16 (32.7%) in 13-18 years age-group. No sex difference occurred in 20 (29.0%) parameters. Normal male and female ECG standards on 69 ECG parameters in the adolescent were established. ECG sex difference began to appear the earliest at ages 6-9 years, and it occurred mostly at ages 9-13 years and 13-18 years, reflecting the anatomical and physiological consequences of puberty. [ABSTRACT FROM AUTHOR]

We examine birth order differences in health of newborns and follow the children throughout childhood using high-quality administrative data on individuals born in Denmark between 1981 and 2010. Family fixed effects models show a positive and robust effect of birth order on health at birth; firstborn children are less healthy at birth. During earlier pregnancies, women are more likely to smoke, receive more prenatal care, and are more likely to suffer a medical pregnancy complication, suggesting worse maternal health. We further show that the health disadvantage of firstborns persists in the first years of life, disappears by age seven, and becomes a health advantage in adolescence. In contrast, later-born children are throughout childhood more likely to suffer an injury. The results on health in adolescence are consistent with previous evidence of a firstborn advantage in education and with the hypothesis that postnatal investments differ between first- and later-born children. [ABSTRACT FROM AUTHOR]

Historically, newborns, and especially premature newborns, were thought to Bfeel nothing.^ However, over the past decades, a growing body of evidence has shown that newborns are aware of their environment, but the extent and the onset of some sensory capacities remain largely unknown. The goal of this review is to update our current knowledge concerning newborns' perceptual world and how ready they are to cope with an entirely different sensory environment following birth. We aim to establish not only how and when each sensory ability arises during the pre-/postbirth period but also discuss how senses are studied. We conclude that although many studies converge to show that newborns are clearly sentient beings,much is still unknown. Further, we identify a series of internal and external factors that could explain discrepancies between studies, and we propose perspectives for future studies. Finally, through examples from animal studies, we illustrate the importance of this detailed knowledge to pursue the enhancement of newborns' daily living conditions. Indeed, this is a prerequisite for assessing the effects of the physical environment and routine procedures on newborns' welfare. [ABSTRACT FROM AUTHOR]

Purpose: Due to the fact that the internal carotid artery (ICA) is responsible for nourishing two thirds of the brain volume, our aim was to inspect the morphofunctional consequences of the bilateral lack of this artery. Methods: In order to examine this condition, we referred to both the library archive of our Faculty of Medicine and electronic databases of anatomical and clinical reports that included the following keywords: 'absence,' 'aplasia,' or 'agenesis' in combination with 'internal carotid artery,' 'common carotid artery,' or only 'carotid artery.' Result: We found 60 recorded cases of the bilateral ICA absence in the subjects of newborn status to the eighth decade of life, which had been discovered in 20 countries. The following ten parameters were described: the embryological base, terminology, history, incidence, general data, differential diagnosis, collateral circulation, the associated vascular aplasia and/or other variants, pathophysiology, and the importance in praxis. Conclusion: This review noted all the cases of the bilateral ICA aplasia published for the past 104 years. Although there were 11.6% of cases of the associated cerebral aneurysms and 1-4 cases of 16 other diseases, approximately one quarter of the cases was without any pathology. [ABSTRACT FROM AUTHOR]

Neonatal inflammatory bowel disease (IBD) is a subclass of very early onset IBD that includes children younger than 1 month. It is characterized by more colonic involvement and monogenetic etiology, resistance to classical anti-inflammatory/immunomodulatory treatments and associated with colitis in first-degree family members. Herein we report a 3 month-old girl who was admitted with bloody diarrhea since 10 days of age. Her symptoms persist despite diet elimination. She was diagnosed with neonatal ulcerative colitis (UC) based on clinical, laboratory and histopathological examination. But, she was unresponsive to the immunosuppressive therapy. On the follow-up, she was hospitalized for the high fever two times. Genetic analysis revealed homozygote M694 V mutation. Bloody diarrhea and other clinical findings were improved after colchicine therapy. Neonatal UC associated with Familial Mediterranean fever is an extremely rare condition and to the best of our knowledge our case is the first case in literature. Early diagnosis autoinflammatory disease may prevent complications related to unnecessary immunosuppressive drug usage and the risk of development of amyloidosis associated with autoinflammatory disorders. [ABSTRACT FROM AUTHOR]

The incidence of congenital stridor is on rise due to improved neonate and infant survival rate. The gold standard investigation for evaluation of stridor is rigid laryngotracheobronchoscopy, but this is invasive and requires general anesthesia. Flexible fibreoptic laryngoscopy, a relatively simple and less invasive procedure can be done under topical anaesthesia for evaluation of stridor. In this study, we have presented our experience of flexible laryngoscopy in children with congenital stridor, their results and management. Laryngomalacia was the commonest cause of stridor accounting for 80% of cases. 15% (6) patients required tracheostomy for relieving airway obstruction and 22.5% (9) patients required a definitive surgical procedure for correcting the cause. Flexible laryngoscopy is safe and gives a comprehensive analysis of airway including its dynamic functions. We also recommend flexible laryngoscopy as a frontline investigation for evaluation of stridor. [ABSTRACT FROM AUTHOR]

The aims of this study are to examine how frequently near-term and term small-for-gestational-age (SGA) infants were investigated in our clinical practice, whether being born less than the third centile for weight increased the yield of positive investigations, and whether there were additional characteristics in infants with positive investigations. This retrospective cohort study was compiled using a database of a large maternity network, using the search near term and term gestational age (greater than or equal to 35 weeks) over a span of 4 years. SGA babies were further filtered into less than the tenth centile and third centile. Out of a population of 30,461 infants in the study period, 3437 (11.3%) SGA infants were identified. Four hundred fifteen SGA infants (12.1%) underwent screening investigations, of which 49 infants (11.8%) yielded a positive investigation. 27.2% of karyotypes, 12.8% of cranial ultrasounds and 0.4% of urine CMV tests showed positive results in < 10th centile group. Being born less than the third centile for weight did not increase the yield of positive investigations. Most infants with positive investigations had an additional maternal or neonatal characteristic or risk factor present.Conclusion: SGA babies without additional maternal or neonatal characteristics have a poor yield on neonatal screening investigations. Additional characteristics may be considered while deciding whether a SGA infant needs screening investigation. What is Known: • Small-for-gestational-age (SGA) infants have an increased risk of short- and long-term complications. • Whilst the causes for SGA are multifactorial, there has been a tendency to undertake screening investigations like Toxoplasma, Others, Rubella, Cytomegalovirus, Herpes group of viruses (TORCH) screening and cranial ultrasounds in the neonatal period. What is New: • Comprehensive study investigating the rates of screening in near-term and term SGA population. • The yield of screening tests for near-term and term SGA infants without additional antenatal and postnatal characteristics is low. [ABSTRACT FROM AUTHOR]

The burden of newborn infectious disease has long been recognized as the highest across the entire human life span. The precise underlying cause is unfortunately still far from clear. A substantial body of data derived mostly from in vitro experimentation indicates 'lower' host immune responses in early vs. adult life and is briefly summarized within this review. However, emerging data derived mostly from in vivo experimentation reveal that the newborn host also exhibits an exuberant immune and inflammatory response following infection when compared to the adult. In this context, it is important to emphasize that 'infection' does not equate 'infectious disease,' as for many infections it is the host response to the infection that causes disease. This simple insight readily arranges existing evidence into cause-effect relationships that explain much of the increase in clinical suffering from infection in early life. We here briefly summarize the evidence in support of this paradigm and highlight the important implications it has for efforts to ameliorate the suffering and dying from infection in early life. [ABSTRACT FROM AUTHOR]

Immunisation of the newborn represents a key global strategy in overcoming morbidity and mortality due to infection in early life. Potential limitations, however, include poor immunogenicity, safety concerns and the development of tolerogenicity or hypo-responsiveness to either the same antigen and/or concomitant antigens administered at birth or in the subsequent months. Furthermore, the neonatal immunological milieu is polarised towards Th2-type immunity with dampening of Th1-type responses and impaired humoral immunity, resulting in qualitatively and quantitatively poorer antibody responses compared to older infants. Innate immunity also shows functional deficiency in antigen-presenting cells: the expression and signalling of Toll-like receptors undergo maturational changes associated with distinct functional responses. Nevertheless, the effectiveness of BCG, hepatitis B and oral polio vaccines, the only immunisations currently in use in the neonatal period, is proof of concept that vaccines can be successfully administered to the newborn via different routes of delivery to induce a range of protective mechanisms for three different diseases. In this review paper, we discuss the rationale for and challenges to neonatal immunisation, summarising progress made in the field, including lessons learnt from newborn vaccines in the pipeline. Furthermore, we explore important maternal, infant and environmental co-factors that may impede the success of current and future neonatal immunisation strategies. A variety of approaches have been proposed to overcome the inherent regulatory constraints of the newborn innate and adaptive immune system, including alternative routes of delivery, novel vaccine configurations, improved innate receptor agonists and optimised antigen-adjuvant combinations. Crucially, a dual strategy may be employed whereby immunisation at birth is used to prime the immune system in order to improve immunogenicity to subsequent homologous or heterologous boosters in later infancy. Similarly, potent non-specific immunomodulatory effects may be elicited when challenged with unrelated antigens, with the potential to reduce the overall risk of infection and allergic disease in early life. [ABSTRACT FROM AUTHOR]

Up to now, little has been known about the prevalence and clinical relevance of colonisation of asymptomatic pregnant women with methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA) or extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. In this two-centre cross-sectional study, we evaluated the performance and importance of screening at different times and different locations for colonisation in pregnant women and newborns. Between October 2013 and December 2015, four samples were collected from pregnant women, two from newborns at birth and three from 3-day-old newborns. Samples were screened on culturing media and were confirmed with molecular methods. MSSA was used as a surrogate for MRSA, as the two share most microbiologic characteristics and colonisation patterns. Of 763 pregnant women, 14.5% (111) were colonised with MSSA, 0.4% (3) with MRSA and 2.6% (20) with ESBL-producing E. coli. Of 658 newborns, 0.9% (10) were colonised with MSSA at birth and 13.1% (70) at 3 days old, 0.5% (3) were colonised with MRSA and 2.6% (17) with ESBL-producing E. coli. Nasal sampling identified 91.0% of MSSA-colonised pregnant women and 60.0% of newborns. In newborns, nasal and umbilical sampling at 3 days after birth discovered 84.0% of colonised cases. For ESBL-producing E. coli, the perianal region was positive in all colonised pregnant women and in 88.2% of colonised newborns. Combining nasal and perianal swabs is optimal when screening for antibiotic-resistant bacteria in pregnant women. Nasal, perianal and umbilical sample collection from 3-day-old newborns significantly increased the sensitivity compared to screening immediately after birth. [ABSTRACT FROM AUTHOR]

Regionalization of pediatric cardiac surgical care varies between and within states. In most geographic regions, at least some neonates with critical heart disease are transferred from their birth hospital to a different hospital for surgery. The impact of neonatal transfer for surgery, particularly over a considerable distance (>10 miles), has been largely unexplored. We sought to examine the impact of transferring neonates for cardiac surgery. We queried the New York State Cardiac Surgery database (2005-2014) from a single institution to identify neonates born within the cardiac surgery center and those transferred for surgery. Outcomes were compared between groups, with subgroup analysis of neonates with single ventricle anatomy. 113 surgical neonates were born at the cardiac surgery center, and 268 were transferred to the cardiac surgery center. Median transfer distance was 91 (IQR 73, 94) miles. Age at operation and the need for preoperative ventilation were significantly lower in neonates born at the cardiac surgery center. In addition, single ventricle anatomy was more prevalent among those born at the cardiac surgery center (48.7 vs. 31.3%; p = 0.001). However, postoperative outcomes were the same-30-day survival was similar across groups (birth: 89% vs. transfer: 90%; p = 0.7), and for those with single ventricle palliation (birth: 81% vs. transfer: 81%; p = 0.9). Within our regionalized network, we found no difference in 30-day survival between neonates either born or transferred to a cardiac surgery center, which supports the use of a regionalized network of hospitals to the care of children with congenital heart disease. [ABSTRACT FROM AUTHOR]

Cardiac rhabdomyoma (CR) is the most common cardiac tumor in newborns. Approximately 75% of cases are associated with tuberous sclerosis complex. Although these tumors usually spontaneously regress after 2 years of age, they can be life-threatening when they obstruct major cardiac inflow or outflow pathways. Everolimus is an inhibitor of the mammalian target of rapamycin, reducing its production of the proteins harmartin and tuberin. Everolimus has demonstrated a remarkable suppression effect in children with tuberous sclerosis complex at doses of 4.7-5.6 mg/M/day and serum trough levels of 5-15 ng/mL. Since 2012, five case reports of neonates with CR have also reported the tumor-regressing effect of everolimus. However, the optimal dosage for neonates is still unknown. Over the past 2 years, we have deliberately used a low dose everolimus regimen (0.3-0.67 mg/M/day) in three neonates with large CRs, in an effort to maintain serum trough levels at 3-7 ng/mL. In all three cases, the tumors regressed smoothly within 2 months. Regarding the drug's side effect of predisposing patients to infection, we observed that adenovirus pneumonia occurred in one case at 3 months of age, and chicken pox occurred in another case at 9 months of age; both recovered smoothly. Our three cases of neonatal CR demonstrate that a low-dose everolimus regimen is an effective treatment for tumor regression. [ABSTRACT FROM AUTHOR]

Objective: To compare the physical growth outcomes, morbidity profile and mortality at an age of 12 months among late preterm (34 to 36) neonates to term (37 to 41) neonates. Study design: Prospective cohort study. Setting: A tertiary care center of Northern India during 2014-2015. Participants: 200 apparently healthy late preterms and term infants, followed up to 12 months of age. Main outcome measures: Physical growth parameters, morbidity profile and mortality. Results: At mean age of 12 months, mean (SD) weight, length and head circumference of late preterms were 7.4 (0.8) kg, 69.2 (2.5) cm and 43.0 (1.1) cm, respectively; which were significantly lower than that of the full term infants [8.7 (1.6) kg, 72.2 (3.1) cm and 44.2 (1.1) cm] ( P < 0.001). On univariate analysis, late preterm group was associated with higher odds (95% CI) of being underweight [5.6 (3.4, 5.5)], stunted [3.5 (2.1, 5.8)] and wasted [3.6 (1.9, 6.9)]. On multivariate analysis, only adjusted odds of late preterms becoming underweight by one year was significant [OR 4.1; 95% CI (1.6, 10.4)]. Feeding difficulties, jaundice and re-hospitalization rates were significantly higher in the late preterm group. The median (IQR) episodes per baby for late preterms as compared to terms for diarrhea [1.84 (0,3) vs 1.14 (0,2) ( P <0.001)], and fever [1.33 (0,2) vs. 0.95 (0,2) ( P = 0.01)] were higher. Conclusion: Healthy late preterms are at significantly higher risk of being underweight in the first year of life, in addition to having significantly higher morbidity. [ABSTRACT FROM AUTHOR]

Justification: Hearing impairment is one of the most critical sensory impairments with significant social and psychological consequences. Evidence-based, standardized national guidelines are needed for professionals to screen for hearing impairment during the neonatal period. Process: The meeting on formulation of national consensus guidelines on developmental disorders was organized by Indian Academy of Pediatrics in Mumbai, on 18 and 19 December, 2015. The invited experts included Pediatricians, Developmental Pediatricians, Pediatric Neurologists and Clinical Psychologists. The participants framed guidelines after extensive discussions. Objective: To provide guidelines on newborn hearing screening in India. Recommendations: The first screening should be conducted before the neonate's discharge from the hospital-if it 'fails', then it should be repeated after four weeks, or at first immunization visit. If it 'fails' again, then Auditory Brainstem Response (ABR) audiometry should be conducted. All babies admitted to intensive care unit should be screened via ABR. All babies with abnormal ABR should undergo detailed evaluation, hearing aid fitting and auditory rehabilitation, before six months of age. The goal is to screen newborn babies before one month of age, diagnose hearing loss before three months of age and start intervention before six months of age. [ABSTRACT FROM AUTHOR]

The objective of the study was to estimate the proportion of patients who receive an electroencephalogram (EEG) among five common indications for EEG monitoring in the intensive care unit: traumatic brain injury (TBI), extracorporeal membrane oxygenation (ECMO), cardiac arrest, cardiac surgery and hypoxic-ischemic encephalopathy (HIE). We performed a retrospective cross-sectional descriptive study utilizing the Kids' Inpatient Database (KID) for the years 2010-2012. The KID is the largest pediatric inpatient database in the USA and it is based on discharge reports created by hospitals for billing purposes. We evaluated the use of electroencephalogram (EEG) or video-electroencephalogram in critically ill children who were mechanically ventilated. The KID database had a population of approximately 6,000,000 pediatric admissions. Among 22,127 admissions of critically ill children who had mechanical ventilation, 1504 (6.8%) admissions had ECMO, 9201 (41.6%) TBI, 4068 (18.4%) HIE, 2774 (12.5%) cardiac arrest, and 4580 (20.7%) cardiac surgery. All five conditions had a higher proportion of males, with the highest (69.8%) in the TBI group. The mortality rates ranged from 7.02 to 39.9% (lowest in cardiac surgery and highest in ECMO). The estimated use of EEG was 1.6% in cardiac surgery, 4.1% in TBI, 7.2% in ECMO, 8.2% in cardiac arrest, and 12.1% in HIE, with an overall use of 5.8%. Among common indications for EEG monitoring in critically ill children and neonates, the estimated proportion of patients actually having an EEG is low. [ABSTRACT FROM AUTHOR]

Purpose: The use of general anesthesia in young children has come under increasing scrutiny due to its potential long-term neurotoxic effects. Meanwhile, regional anesthesia for surgical procedures in neonates has many advantages, including preservation of respiratory status and faster return to feeding. We describe the successful use of 3% 2-chloroprocaine administered via continuous caudal infusion as the sole anesthetic agent during elective surgical procedures in infants.Methods: A retrospective chart review of all patients who underwent elective surgical procedures under continuous caudal regional anesthetic at a single institution was performed. Thirty patients (27 males, three females) were identified: 28 patients underwent inguinal hernia repairs. Caudal anesthesia was established via continuous infusion of 3% 2-chloroprocaine through an indwelling catheter.Results: Successful analgesia by regional block alone was achieved in all patients for the duration of each surgical procedure without need for rescue anesthesia. Mean operative time was 49 min. Patients were able to return to feeding immediately after surgery and were ready for discharge home within that day.Conclusion: Continuous caudal infusion of chloroprocaine is a safe and effective way to maintain adequate analgesia for elective surgeries in infants. This successful regional approach obviates the use of general anesthetic which reduces post-operative recovery time and avoids concerns for neurotoxicity. [ABSTRACT FROM AUTHOR]

Domperidone has been used as a galactagogue; however, solid evidence from an adequate sized randomized clinical trial is missing. Optimal dosage, start of treatment, length of treatment and scope of patients who can benefit also remain unknown. Although milk obtained after domperidone administration has not been shown to have untoward effects on newborns, no sufficiently large randomized clinical trial has been done to establish safety. Domperidone has repeatedly been shown to produce sudden cardiac death, starting at 30 mg/day. Because of this known cardiac effect, the use of domperidone to increase breast milk production may not be justified. [ABSTRACT FROM AUTHOR]

The current study examines the association between early father involvement and infant neurodevelopment, and whether neonatal medical risk moderates this association. Data from approximately 6000 fathers and their children were obtained from the Early Childhood Longitudinal Study: Birth Cohort (ECLS-B). Hierarchical regression was employed to analyze the data. The findings reveal that the association between early father involvement and infant neurodevelopment is contingent on both the timing of involvement (i.e., prenatal/perinatal or infancy) and offspring medical status at birth. The neurodevelopment of medically at-risk neonates was enhanced when fathers were involved during the gestational period and at the time of their birth. This relationship was not detected, however, in the case of infants who did not experience medical risks as neonates. Neonatal medical risk appears to be an important moderating factor in the link between father involvement during pregnancy and childbirth and infant neurodevelopment. Practitioners should continue to make efforts to involve fathers during gestation and childbirth. The findings of the present study suggest that doing so may protect against neurodevelopmental delays in neonates with medical risks. [ABSTRACT FROM AUTHOR]

In a continuation of a prospective longitudinal cohort study in a healthy population on the course of skull shape from birth to 24 months, at 5 years of age, 248 children participated in a follow-up assessment using plagiocephalometry (ODDI-oblique diameter difference index, CPI-cranio proportional index). Data from the original study sampled at birth, 7 weeks, 6, 12, and 24 months were used in two linear mixed models.Main Findings: (1) if deformational plagiocephaly (ODDI <104%) and/or positional preference at 7 weeks of age are absent, normal skull shape can be predicted at 5 years of age; (2) if positional preference occurs, ODDI is the highest at 7 weeks and decreases to a stable lowest value at 2 and 5 years of age; and (3) regarding brachycephaly, all children showed the highest CPI at 6 months of age with a gradual decrease over time.Conclusion: The course of skull deformation is favourable in most of the children in The Netherlands; at 5 years of age, brachycephaly is within the normal range for all children, whereas the severity of plagiocephaly is within the normal range in 80%, within the mild range in 19%, and within the moderate/severe range in 1%. Medical consumption may be reduced by providing early tailored counselling. What is Known: • Skull deformation prevalence increased after recommendations against Sudden Infant Death Syndrome, little is known about the longitudinal course. • Paediatric physical therapy intervention between 2 and 6 months of age reduces deformational plagiocephaly at 6 and 12 months of age. What is New: • The course of skull deformation is favourable in most of the children in The Netherlands; at 5 years of age, deformational brachycephaly is within the normal range for all children, whereas the severity of deformational plagiocephaly is within the normal range in 80%, within the mild range in 19%, and within the moderate to severe range in only 1%. • Paediatric physical therapy intervention does not influence the long-term outcome; it only influences the earlier decrease of the severity of deformational plagiocephaly. [ABSTRACT FROM AUTHOR]

The degree of increase in haematocrit and equilibration time following packed red blood cell (PRBC) transfusion in neonates is not well studied. We evaluated change in haematocrit 15 min, 6 h and 24 h after PRBC transfusion in neonates and factors predicting this change. Among neonates receiving PRBC transfusion, we recorded pre-transfusion haematocrit and a priori identified putative variables affecting change in haematocrit following transfusion. The factors affecting change in haematocrit were analyzed by multiple linear regression analysis. Eighty-one neonates received 119 PRBC transfusions (mean volume 16 ± 4 mL/kg). Haematocrit increased from 26 ± 5 to 41 ± 5% at 15 min after PRBC transfusion (p = 0.001) and remained stable till 6 h (41 ± 5%, p = 0.11). It decreased to 40 ± 5%, at 24 h post transfusion (p < 0.001). On linear regression analysis, baseline haematocrit of the baby, donor blood haematocrit and volume of PRBC transfusion were independent determinants of increase in haematocrit.Conclusion: After 16 mL/kg PRBC transfusion in neonates, haematocrit increased by 15% at 15 min post transfusion. The equilibration in haematocrit values was achieved by 15 min after transfusion. Baseline haematocrit of neonate, donor blood haematocrit and transfusion volume independently determine the rise in haematocrit. What is Known: • Rise in haematocrit following PRBC transfusion in neonates has been studied in a small number of stable infants. • Determinants of efficacy of PRBC transfusion have not been well studied in newborns. What is New: • Each milliliter/kilogramme of PRBC transfusion increases the neonate's haematocrit by approximately 1%. • Baseline haematocrit, donor blood haematocrit and transfusion volume per kilogramme body weight independently determine the rise in haematocrit. [ABSTRACT FROM AUTHOR]

Newborn screening for congenital adrenal hyperplasia (CAH) is performed by measuring the concentration of 17α-hydroxyprogesterone (17-OHP) in dried blood spots. Unfortunately, the level of 17-OHP varies due to multiple factors, and therefore, the false positive rate for the test is a challenge. We analyzed screening data from 2007 to 2015 to determine the effect of seasonal changes and manufacturer kit lot changes on 17-OHP values and on numbers of infants referred. Data from screening 2.2 million infants over a 9-year period indicates that in the NYS during the colder months, daily mean 17-OHP values are higher, more retests are performed, and more infants are referred even though fewer infants are born. The practice of using fixed cutoffs for referring infants for CAH leads to more false positive results in colder months. In addition, there was an overall 10% increase in the daily mean 17-OHP values from the 2 years before and after a manufacturer kit lot change that occurred in November 2013, suggestive of a functional change in the kit at that time.Conclusion: Newborn screening programs should be cognizant of seasonal temperature variations and (un)anticipated manufacturer kit changes because they may affect 17-OHP values and CAH referral rates. What is Known: • Newborn screening for congenital adrenal hyperplasia is generally performed by measuring 17α-hydroxyprogesterone (17-OHP) levels in dried blood spots. • 17-OHP concentrations are affected by gestational age/weight of infant when specimen is collected, specimen collection time after birth, as well as race and sex of infant. What is New: • Seasonal temperature variations and unanticipated manufacturer kit changes affect 17-OHP levels and consequently referral rates in programs that use fixed cutoffs. • Daily mean 17-OHP is generally higher when the ambient temperature is lower. [ABSTRACT FROM AUTHOR]

Our aim was to assess the utility of serum thyroxine and thyroid stimulating hormone performed at 10-14 days of life in diagnosing congenital hypothyroidism (CH) in babies born to mothers with hypothyroidism. This was a retrospective study of all babies born in a tertiary referral centre for neonatology over a 12-month period. Infants who had thyroid function testing (TFT) checked at 10-14 days of life because of maternal hypothyroidism during the period of study were included. The results of the newborn bloodspot and day 10-14 TFT were recorded along with whether or not patients were subsequently treated. Of the 319 patients included in the study, only two patients were found to have CH and in both cases the newborn blood spot had been abnormal.Conclusion: No extra cases of CH were detected from the thyroid test at 10-14 days and this practice should be discontinued due to the robust nature of existing newborn screening programmes. What is Known: • Congenital hypothyroidism(CH) is the commonest preventable cause of childhood intellectual impairment. • Family history of hypothyroidism has been implicated as a risk factor for CH. • CH has formed part of newborn screening since the 1970s. What is New: • There is no research recommending thyroid function testing at 10-14 days of life to detect CH in neonates born to mothers with hypothyroidism. • Thyroid function testing at 10-14 days of life does not improve diagnostic yield for CH in babies born to mothers with hypothyroidism. • Newborn blood spot remains the mainstay for accurate and timely diagnosis of CH. [ABSTRACT FROM AUTHOR]

There is sufficient evidence that diabetes during pregnancy is associated with a higher risk of neurodevelopmental anomalies including learning deficits, behavioral problems and motor dysfunctions in the offspring. Synaptophysin (SYP) is an integral membrane protein of synaptic vesicles and is considered as a marker for synaptogenesis and synaptic density. This study aimed to examine the effects of maternal diabetes in pregnancy on the expression and localization of SYP in the developing rat cerebellum. Wistar female rats were maintained diabetic from a week before pregnancy through parturition and male offspring was euthanized at postnatal day (P) 0, 7, and 14. The results revealed a significant down-regulation in the mRNA expression of SYP in the offspring born to diabetic animals at both P7 and P14 ( P < 0.05 each). One week after birth, there was a significant reduction in the localization of SYP expression in the external granular (EGL) and in the molecular (ML) layers of neonates born to diabetic animals ( P < 0.05 each). We also found a marked decrease in the expression of SYP in all of the cerebellar cortical layers of STZ-D group pups at P14 ( P < 0.05 each). Moreover, our results revealed no significant changes in either expression or localization of SYP in insulin-treated group pups when compared with the controls ( P ≥ 0.05 each). The present study demonstrated that maternal diabetes has adverse effects on the synaptogenesis in the offspring's cerebellum. Furthermore, the rigid maternal blood glucose control in the most cases normalized these negative impacts. [ABSTRACT FROM AUTHOR]

Objective: To compare supplemental intravenous fluids with no supplementation in asymptomatic polycythemic late preterm and term neonates. Methods: 55 infants with venous haematocrit of 65-75 were randomly allocated to receive either 25 mL/kg IV normal saline over 6-8 hours or routine fluids. They were followed up for 48 hours. Results: There was no significant difference between fluid supplementation and control groups regarding need for partial exchange transfusion [6/27 (22.2%) vs 8/28 (28.6%); P=0.59]. Conclusions: We did not find any evidence of clinical benefit with IV fluid supplementation in late preterm and term neonates with asymptomatic polycythemia (PCV 65-75). [ABSTRACT FROM AUTHOR]

Purpose: A cephalocele is a congenital anomaly involving the herniation of intracranial tissue from a skull defect. The sac containing the central nervous system (CNS) with the ventricle system is called the encephalocystocele. An atretic cephalocele is thought to be an abortive form of cephalocele, and the essential nature is still controversial. Case report: Here, we report the case of a newborn boy with an occipital cephalocele containing a small cystic component which was composed of ependymal cells and the immature CNS tissue. A newborn boy was admitted to our hospital because of an occipital mass, which was about 2.5 cm in diameter, located at the posterior midline, and covered with alopetic skin without CSF leakage. He had a cleft palate. Magnetic resonance imaging (MRI) clearly showed an occipital cephalocele with a tiny cystic component connecting to the subarachnoid space. MRI also showed mild hydrocephalus, hypoplasia of the corpus callosum and tentorium cerebelli, dropping down of the bilateral occipital lobes and vermicular agenesis. We performed the extirpation of the subscalp module under general anesthesia and histologically examined the resected mass. On immunohistopathological examination, most part of the subscalp module was fibrous tissue with numerous vessels and meningeal origin cells. In a small part of the innermost layer, we found a small island consisting of CNS tissue and a tiny cyst lined with a single layer of ependymal cells. Conclusion: Based on radiological and immunohistopathological findings, we speculate that the cystic component at the base of the nodule seems to correspond to neural crest remnants but not to true herniation of the brain and cerebral ventricles. [ABSTRACT FROM AUTHOR]

Hemimyeloschisis is a very rare congenital malformation of the spine which is characterized by a split cord malformation associated with complete exposureof the one hemicord to the exterior. We report a case of hemimyeloschisis on the right hemicord in a patient with hydrocephalus. The patient was a female neonate with myeloschisis, skin defect, and hypertrichosis visible at birth in the upper lumbar region. There was also skin defect around the myeloschisis. Computed tomography (CT) revealed a bony septum at the L2 level as well as the myeloschisis on the right hemicord, which enabled us to make a precise preoperative diagnosis of this rare malformation. There was also mild hydrocephalus in cranial CT scan. Closure of the myeloschisis and removal of the septum were successfully performed associated with the closure of the skin in one stage surgery to prevent subsequent infection and neurological deterioration. Ventriculoperitoneal shunt insertion was performed for hydrocephalus. The presence of combined split cord malformation and myeloschisis is consistent with the hypothesis of an ontogenic basis of development. This combination also emphasizes the importance of early imaging for diagnosis in this complex malformation. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to describe some radiological features in the newborns with microcephaly caused by Zika virus infection during pregnancy. Methods: We radiologically analyzed 13 cases of newborns with microcephaly born to mothers who were infected by the Zika virus in the early stage of pregnancy. Results: The most frequently observed radiological findings were microcephaly and decreased brain parenchymal volume associated with lissencephaly, ventriculomegaly secondary to the lack of brain tissue (not hypertensive), and coarse and anarchic calcifications mainly involving the subcortical cortical transition, and the basal ganglia. Conclusions: Although it cannot be concluded that there is a definitive pathognomonic radiographic pattern of microcephaly caused by Zika virus, gross calcifications and anarchic distribution involving the subcortical cortical transition and the basal ganglia, in association with lissencephaly and in the absence of hypertensive ventriculomegaly, are characteristic of this type of infection. [ABSTRACT FROM AUTHOR]

Unlabelled: The harmful effects of smoking during pregnancy are well known, but we lack prevalence data concerning this subject in Austria. The aim ofz the present study was to determine the prevalence and any changes in the prevalence of smoking during pregnancy in the last few years. The investigation was conducted at a perinatal center in Vienna, Austria. Further aims of the study were to evaluate maternal characteristics associated with smoking and demonstrate the harmful effects of smoking on neonatal outcome in this population. Once inquired, self-reported smoking during pregnancy, maternal age, and neonatal data from 2007 to 2012 were evaluated retrospectively. Of birth records, 11,142 were analyzed. From 2007 to 2012, the prevalence of smoking declined significantly from 19.1 to 15.6 %. The overall prevalence was 18.1 % and was highest (43.7 %) among young women (<20 years). The risk of small for gestational age (SGA) was significantly higher among newborns of smoking mothers.Conclusion: The prevalence of smoking among pregnant women has declined in Austria in the last few years but is still quite high. Prevention programs should focus on young women, who are at highest risk in this regard.What Is Known: • Smoking during pregnancy is known to exert harmful effects What is New: • Paucity of epidemiological data regarding this subject in Austria • Significant decline of self-reported smoking during pregnancy from 2007 to 2012 in Vienna. [ABSTRACT FROM AUTHOR]

Unlabelled: Neonates administered ethanol-containing medicines are potentially at risk of dose-dependent injury through exposure to ethanol and its metabolite, acetaldehyde. Here, we determine blood ethanol and acetaldehyde concentrations in 49 preterm infants (median birth weight = 1190 g) dosed with iron or furosemide, medicines that contain different amounts of ethanol, and in 11 control group infants (median birth weight = 1920 g) who were not on any medications. Median ethanol concentrations in neonates administered iron or furosemide were 0.33 (range = 0-4.92) mg/L, 0.39 (range = 0-72.77) mg/L and in control group infants were 0.15 (range = 0.03-5.4) mg/L. Median acetaldehyde concentrations in neonates administered iron or furosemide were 0.16 (range = 0-8.89) mg/L, 0.21 (range = 0-2.43) mg/L and in control group infants were 0.01 (range = 0-0.14) mg/L. There was no discernible relationship between blood ethanol or acetaldehyde concentrations and time after medication dose.Conclusion: Although infants dosed with iron or furosemide had low blood ethanol concentrations, blood acetaldehyde concentrations were consistent with moderate alcohol exposure. The data suggest the need to account for the effects of acetaldehyde in the benefit-risk analysis of administering ethanol-containing medicines to neonates.What Is Known: • Neonates are commonly treated with ethanol-containing medicines, such as iron and furosemide. • However, there is no data on whether this leads to appreciable increases in blood concentrations of ethanol or its metabolite, acetaldehyde. What is New: • In this study, we find low blood ethanol concentrations in neonates administered iron and/or furosemide but markedly elevated blood acetaldehyde concentrations in some infants receiving these medicines. • Our data suggest that ethanol in drugs may cause elevation of blood acetaldehyde, a potentially toxic metabolite. [ABSTRACT FROM AUTHOR]

Remifentanil is a synthetic opioid derivative that was introduced into clinical practice in the United States in 1996. The unique modification of its chemical structure to include a methyl-ester ring allows its hydrolysis by non-specific plasma and tissue esterases. This molecular configuration results in its rapid metabolism thereby providing a rapid onset, easy titration by continuous infusion, and a short context-sensitive half-life with rapid elimination. These principles are stable and consistent across all age groups regardless of the infusion characteristics. Owing to these pharmacokinetic characteristics, it is an effective agent in the neonatal population allowing the provision of intense analgesia and anesthesia with a rapid recovery profile in various clinical scenarios. Here, we review the pharmacokinetics of remifentanil in neonates, discuss its clinical applications including intraoperative administration for anesthetic care, unique applications for procedural sedation including endotracheal intubation, and its potential use for sedation in the Intensive Care Unit setting during mechanical ventilation. [ABSTRACT FROM AUTHOR]

In this study, the authors report the results of a three-stage newborn hearing screening (NHS) program for well babies at the Gazi University Hospital (GUH) in Ankara between 2003 and 2013. GUH-NHS was performed by automated transient evoked otoacoustic emission (a-TEOAE) at the first and second steps and by automated brainstem audiometry (a-ABR) at the third step. The data were analysed to assess not only rate of congenital permanent hearing loss (CPHL), but also the effectiveness of the program during the years. A total of 18,470 well babies were tested. The data showed that coverage ratio for the GUH-born babies was increased and more outside-born babies (OBB) were admitted by time (means 84.31 and 11.28 %, respectively). Mean CPHL was found to be 0.26 %. Mean referral rate was decreased to 0.81 % by a-ABR from 2.16 % by a-TEOAE. Mean of missed cases in any stage of GUH-NHS was 4.88 %. It was seen that neither CPHL nor referral rate, but only ratio of missed ones presented increase in parallel to increment in OBB. This paper first presents that clinically acceptable screening procedures developed in GUH by time, and secondly higher rate of CPHL in Turkey than in the Western countries, and benefits of third stage screening by a-ABR because it prevented referral of 251 children (1.29 %) to the clinical tests. We think that this number is reasonably important regarding not only economical point of view, but also waiting lists in the audiology departments in a developing country, in which audiological service is still limited. [ABSTRACT FROM AUTHOR]

Antibiotics are invaluable in the management of neonatal infections. However, overuse or misuse of antibiotics in neonates has been associated with adverse outcomes, including increased risk for future infection, necrotizing enterocolitis, and mortality. Strategies to optimize the use of antibiotics in the neonatal intensive care unit include practicing effective infection prevention, improving the diagnostic evaluation and empiric therapy for suspected infections, timely adjustment of therapy as additional information becomes available, and treating proven infections with an effective, narrow-spectrum agent for the minimum effective duration. Antibiotic stewardship programs provide support for these strategies but require the participation and input of neonatologists as stakeholders to be most effective. [ABSTRACT FROM AUTHOR]

Purpose: We aimed to determine whether the outcome of general surgery neonates, cared for within our unit, was influenced by socio-economic status as measured by a selection of social variables [primary caregiver's education level, primary caregiver's age, and living standards measure (LSM)] and to determine the rate for each of the three levels of the outcome measure (i.e., good outcome, poor outcome, and deceased).Methods: A consecutive sampling strategy was used, including all subjects in our neonatal data base with major surgical diagnoses operated on between 1 July 2010 and 31 August 2011. The primary caregiver of each patient was questioned with respect to the variables and these results were analysed along with clinical information from patient records. Multinomial logistic regression was used to answer both objectives.Results: The final multinomial logistic model is highly significant and includes only LSM as a predictor variable. As LSM increases by one level, the risk of experiencing a poor outcome decreases by 82 % as compared to those patients experiencing a good outcome. As LSM increases by one level, the risk of neonatal death also decreases by 88 % as compared to those patients experiencing a good outcome.Conclusion: This study shows that the probability of a neonate having a good outcome increases with increasing LSM. [ABSTRACT FROM AUTHOR]

Purpose: Different timing and approaches to screening for developmental dysplasia of the hip (DDH) are used in the orthopaedic community. Thus ultrasonographic screening programs and reports based on clinical examinations produced differing incidence rates of DDH. Furthermore different risk factors and a change of incidence of DDH in the last decades were discussed. The purpose of this study was the evaluation of incidence and risk factors of the very early DDH in a modern cohort based on a universal ultrasound screening program.Methods: We analysed the results of the screening program performed at our institution: 5,356 consecutive hips of newborns were screened ultrasonographically and clinically according to the system published by R. Graf within the first two postnatal weeks [1]. A set of risk factors was analysed by univariate and multiple linear regression models.Results: Sonographic signs of developmental dysplasia of the hip were found in 0.24 % of the newborns. A significant negative influence of the risk factors birth weight, family history of DDH and female gender on the α-angle was found. Early or pre-term delivery showed a protective potential for DDH.Conclusions: Our data show a very low incidence of DDH in the first two postnatal weeks. Despite the significance of the risk factors analysed, it has to be considered that these factors only showed low impact on the risk of early DDH. In conclusion we favour universal ultrasound screening for DDH at the age of six to eight weeks. [ABSTRACT FROM AUTHOR]

Even early life in utero cannot provide a safe place for newborns. The first acquaintance with chemicals takes place in utero and/or with mother's milk after delivery. Besides legislations and bans to persistent organic pollutants (POPs), these chemicals are still affecting the general population especially the children as they are one of the populations most susceptible to chemicals, and also the health problems may arise in the future. Our objective is to collect the first data in newborns in Turkey to determine baseline levels of POPs in the general population and estimate the potential cancer risk related to exposure. Twenty-nine organochlorine pesticides (OCPs) and 18 polychlorinated biphenyl (PCB) congeners in blood samples of newborn boys (0-1 month old) who were born in İstanbul, Turkey, in 2010-2012 were evaluated with high-resolution gas chromatography-high-resolution mass spectrometry (HRGC/HRMS). Results for analyzed chlorinated compounds are as follows: hexachlorocyclohexane (ΣHCH) 1828 ± 3650 pg/g lipid, dichlorodiphenyltrichloroethane (ΣDDT) 10,000 ± 15,398 pg/g lipid, and ΣPCB 1068 ± 1823 pg/g lipid. 4,4′-DDT, 4,4′-dichlorodiphenyldichloroethylene (4,4′-DDE), hexachlorobenzene, and PCB 138 and 153 are the major contaminants. New POPs as lindane 61 ± 268 pg/g lipid, pentachlorobenzene 13 ± 74 pg/g lipid, and endosulfan 29 ± 106 pg/g lipid are also detected in blood. Estimated total risk for lifetime PCB exposure is less than 1 × 10, an acceptable risk. Blood concentration levels will be important base data in the assessment of health concerns of newborns as well as for studies about how endocrine disruptors affect humans. [ABSTRACT FROM AUTHOR]

Introduction: Chiari 1 malformation is a rare craniovertebral junction malformation accounting up to 1 case in every 1000 newborns per year. It is characterized by herniation of cerebellar tonsils below the foramen magnum sometimes with syringomyelia. Usually, patients have a long history of slowly progressive neurological symptoms. Uncommonly, Chiari 1 malformation could present with a sudden onset, also after trauma. Few cases are reported about young children. Methods: The authors report a case of a 6-month child with symptoms at onset after a mild trauma. The pertinent literature is reviewed. Conclusions: Symptoms of Chiari 1 malformation are usually slowly progressive. Few cases have been reported of the sudden onset of symptoms, some of these after trauma. In young children, the clinical setting could be insidious and potentially lethal. A sudden onset of Chiari 1 malformation must be considered as a consequence of trauma, usually after performing a brain MRI. Management of these cases is still controversial, and surgery may be indicated in managing symptoms; however, it seems to not affect clinical outcome. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to assess the characteristics of posterior fossa (PF) abnormalities in a cohort of high-risk term neonates, as well as the diagnostic performance of cranial ultrasound (CUS) with additional mastoid fontanelle (MF) views for the detection of these abnormalities, with magnetic resonance imaging (MRI) being the reference standard. Methods: In this retrospective study, 113 term neonates with CUS and subsequent MRI were included. Sensitivity, specificity, and predictive values of routine CUS and CUS with MF views were calculated. Results: Posterior fossa abnormalities were diagnosed on CUS in 46 of 113 infants. MRI confirmed these findings in 43 and showed additional abnormalities in 32 infants. The sensitivity and specificity of anterior fontanelle views for major PF abnormalities as seen on MRI were 16 % and 99 %. Adding MF views increased the sensitivity of US to 82 %. The sensitivity and specificity of MF views for the detection of any (major or minor) PF abnormality were 57 % and 95 %. Especially acute hypoxic-ischemic injury and small subdural and punctate cerebellar haemorrhage remained undetected by CUS. Conclusions: PF abnormalities are frequent in high-risk term infants. MF-CUS enables early diagnosis of major PF abnormalities. We therefore advocate to perform MF-CUS in high-risk term neonates. Key Points: • Posterior fossa abnormalities are a frequent finding in high-risk term infants. • Adding mastoid fontanelle views improves ultrasound detection of clinically relevant abnormalities. • Hypoxic-ischemic injury and small posterior fossa haemorrhages are better detected with MRI. • Cranial ultrasound examination should include mastoid fontanelle views in high-risk term neonates. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to characterize the maternal and neonatal morbidities of women with placenta previa. Study design: This retrospective group study used the Consortium on Safe Labor electronic database, including 12 clinical centers, and 19 hospitals. Patients with placenta previa noted at the time of delivery were included. Maternal and neonatal variables were compared to a control group of women undergoing cesarean delivery with no previa. Logistic regression and general linear regression were used for the analysis, with p < 0.05 significance. Results: There were 19,069 patients in the study: 452 in the placenta previa group and 18,617 in the control group. Neonates born to mothers with placenta previa had lower gestational ages and birth weights. In univariate analysis only, these neonates were at increased risk of lower 5 min Apgar scores, neonatal intensive care unit admission, anemia, respiratory distress syndrome, mechanical ventilation, and intraventricular hemorrhage. There was no association of placenta previa with small for gestational age infants, congenital anomalies or death. As previously shown, women with placenta previa have significantly more maternal morbidities. Conclusion: Increased maternal morbidity was noted; however, only those neonatal morbidities associated with preterm delivery occurred in the placenta previa group. [ABSTRACT FROM AUTHOR]

Purpose: To review and compare the foetal outcomes and mode of delivery in patients with nuchal cord for single loop, double loops, and multiple loops. Methods: A retrospective study of 4,404 singleton term pregnancies which underwent spontaneous labour was conducted. The patients were classified into five groups: without nuchal cord, nuchal cord of any turns, nuchal cord for 1 turn, nuchal cord for 2 turns and nuchal cord for 3 turns or above. The perinatal outcomes and mode of delivery were then compared. Results: Nuchal cord of any turns was not shown to be associated with intrauterine death, neonatal death, Apgar score <7 at 1 and 5 min. Only nuchal cord for three turns or more were associated with higher incidence of meconium-stained liquor, neonatal unit admission, suspected foetal distress during labour and emergency caesarean section. Conclusions: Only nuchal cord for 3 turns or more was associated with higher incidence of suspected foetal distress. However, the Apgar scores were not affected. Therefore, nuchal cord of any turns was not associated with adverse foetal outcomes. Prenatal ultrasound scan for nuchal cord is, therefore, unnecessary and there should be no differences in management of nuchal cord of any turns. [ABSTRACT FROM AUTHOR]