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When infants cannot directly breastfeed after birth, mothers are advised to initiate lactation through mechanical expression. Families are recommended to target an expression volume of at least 500–750 mL by Day 14 after birth, as this is considered a 'critical window' to establish milk supply. This is challenging for many mothers after a very preterm birth. This article explores the relationship of early milk quantity and later full breastmilk feeding as a 'gold standard' outcome, using statistical techniques designed for diagnostic tests. A cohort of 132 mothers of infants born at 23 + 0 to 31 + 6 weeks' gestational age submitted expressing logs on Day 4, 14 and 21 after birth and provided later feeding outcome. Using receiver operating characteristic (ROC) analysis, the following 24‐h milk quantities were identified as associated with high probability of full breastmilk at 36 weeks' post‐menstrual age (PMA): on Day 4, ≥250 g (specificity 88%; positive predictive value 88%) and on Day 21 ≥650 g (specificity 88%; positive predictive value 91%). The following values were identified as associated with low probability of full breastmilk at 36 weeks' PMA: on Day 4 <50 g (sensitivity 92%; negative predictive value 72%) and on Day 21 <250 g (sensitivity 90%; negative predictive value 70%). Participants exceeding the high thresholds had 3–4 times increased likelihood of full breastmilk, whereas those below the low thresholds had 3–5 times lower likelihood. These thresholds have potential as targets for families, to provide individualised prognostic information and to help clinicians target more intensive lactation support. Key messages: Mothers of very preterm infants who expressed at least 250 g at day four after birth had a high probability of providing later full breastmilk: 88% (95% CI: 72%–97%). This was similar for those who expressed at least 650 g at Day 21: 91% (95% CI: 77%–98%).Mothers of very preterm infants who expressed less than 50 g at day four after birth had a low probability of providing later full breastmilk: 28% (95% CI: 10%–53%). This was similar for those who expressed less than 250 g at Day 21: 30% (95% CI: 12%–54%).These thresholds may be useful for families to understand their lactation trajectories and for clinicians to target support. [ABSTRACT FROM AUTHOR]

Aim: This study aims to analyse the developmental data from public health nurses (PHNs) to identify early indicators of neurodevelopmental disorders (NDDs) in young children using Bayesian network (BN) analysis to determine factor combinations that improve diagnosis accuracy. Methods: The study cohort was 501 children who underwent health checkups at 18 and 36‐month. Data included demographics, pregnancy, delivery, neonatal factors, maternal interviews, and physical and neurological findings. Diagnoses were made by paediatricians and child psychiatrists using standardised tools. Predictive accuracy was assessed by the receiver operating characteristic (ROC) curve analysis. Results: We identified several infant/toddler factors significantly associated with NDD diagnoses. Predictive factors included meconium‐stained amniotic fluid, 1 min Apgar score, and early developmental milestones. ROC curve analysis showed varying predictive accuracies based on evaluation timing. The 10‐month checkup was valid for screening but less reliable for excluding low‐risk cases. The 18‐month evaluation accurately identified children at NDD risk. Conclusion: The study demonstrates the potential of using developmental records for early NDD detection, emphasising early monitoring and intervention for at‐risk children. These findings could guide future infant mental health initiatives in the community. [ABSTRACT FROM AUTHOR]

Objective Methods Results Significance Hypoxic–ischemic brain damage (HIBD) is a leading cause of neonatal mortality, resulting in brain injury and persistent seizures that can last into the late neonatal period and beyond. Effective treatments and interventions for infants affected by hypoxia–ischemia remain lacking. Clinical investigations have indicated an elevation of nuclear factor of activated T cells 5 (NFAT5) in whole blood from umbilical cords of severely affected HIBD infants with epilepsy. Experimental research has demonstrated that NFAT5 has ambivalent effects on neuroprotection and neurologic damage. However, the mechanistic role of NFAT5 in HIBD remains unclear. This investigation aims to further clarify the role of NFAT5 in epilepsy following HIBD insult.We created a neonatal HIBD mouse model through left common carotid artery occlusion. By specifically knocking down astrocytic NFAT5 and its downstream molecule, Nedd4‐2, using hippocampal delivery of adeno‐associated virus 5‐driven targeted shRNA, we investigated the role of astrocytic NFAT5 in epilepsy susceptibility in HIBD mice. This was assessed through electroencephalographic recordings, behavioral observations in vivo, and whole‐cell recordings of hippocampal neuronal activity. In vitro, we evaluated the effects of astrocytic NFAT5 alteration on Kir4.1 expression and IKir4.1 in both brain slices from HIBD mice and cultured astrocytes treated with oxygen–glucose deprivation/reoxygenation.Hypoxia–ischemia‐induced upregulation of hippocampal NFAT5 occurs in astrocytes rather than in neurons. This upregulation leads to increased expression of the ubiquitin ligase Nedd4‐2, resulting in excessive degradation of Kir4.1 in astrocytes. Consequently, astrocytic function in buffering extracellular K+ is impaired, causing depolarization of the resting potential and enhanced neuronal discharge. This disruption ultimately affects local neural network balance and increases susceptibility to epilepsy. In contrast, inhibiting or knocking down astrocytic NFAT5 almost completely reverses these effects.Our findings suggest that manipulating the NFAT5–Nedd4‐2–Kir4.1 axis in astrocytes could provide a potential therapeutic strategy for the epileptic complications of HIBD. [ABSTRACT FROM AUTHOR]

Objective Methods Results Significance Electroencephalographic seizures (ES) are common in neonates with hypoxic–ischemic encephalopathy (HIE), but identification with continuous electroencephalographic (EEG) monitoring (CEEG) is resource‐intensive. We aimed to develop an ES prediction model.Using a prospective observational study of 260 neonates with HIE undergoing CEEG, we identified clinical and EEG risk factors for ES, evaluated model performance with area under the receiver operating characteristic curve (AUROC), and calculated test characteristics emphasizing high sensitivity. We assessed ES incidence and timing in neonates subdivided by ES risk group (low, moderate, high) as determined by EEG risk factors.ES occurred in 32% (83/260) of neonates. Performing CEEG for only 24 h would fail to identify the 7% (17/260) of neonates with later onset ES (20% of all neonates experiencing ES). Identifying 90% or 95% of neonates with ES would require CEEG for 63 or 74 h, respectively. The optimal model included continuity and epileptiform discharges, both assessed in the initial 1 h of CEEG. It yielded an AUROC of .80, and at a cutoff that emphasized sensitivity, had sensitivity of 94%, specificity of 45%, positive predictive value of 44%, and negative predictive value of 95%. The model would avoid CEEG beyond 1 h in 32% (84/260) of neonates, but 6% (5/83) of neonates with ES would not have ES identified. ES incidence was significantly different (p < .01) across ES risk groups (6% low, 40% moderate, and 83% high). Only ~6 h of CEEG would identify all neonates with ES in the low‐risk group, whereas 75 and 63 h of CEEG would be required to identify 95% of neonates with ES in the moderate‐risk and high‐risk groups, respectively.Among neonates with HIE, a model employing two EEG variables from a 1‐h screening EEG and stratifying neonates into low‐, moderate‐, and high‐risk groups could enable evidence‐based strategies for targeted CEEG use. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To explore the association of maternal characteristics, oxygenation, and mechanical ventilatory parameters with fetal and neonatal outcomes.The present study was a multicenter, binational (Argentina/Colombia), prospective, cohort study, conducted in 21 intensive care units (ICUs) and including pregnant or postpartum patients with COVID‐19 pneumonia requiring advanced respiratory support and their fetuses/neonates. Advanced respiratory support was defined as high‐flow nasal cannula (HFNC), non‐invasive ventilation (NIV) or invasive mechanical ventilation (IMV).A total of 91 patients were admitted to 21 ICUs: 63 (69%) antepartum and 28 (31%) postpartum. Among those admitted antepartum (63), delivery was induced in 43 (68.3%), being the reasons mostly maternal (28/43; 65.1%). Of 71 births, 64 (90%) were preterm. A total of 14 fetal/neonatal losses (14/91;15.4%) occurred. The main differences between patients whose fetuses/neonates survived versus those who did not survive were in APACHE II (12 [7–15] vs. 16.5 [14–20]; P = 0.003), SOFA24 (4 [3–5] vs. 6.5 [5–8]; P = 0.001), gestational age at delivery (32.9 ± 3 vs. 27.6 ± 6.2; P = 0.014), acute respiratory distress syndrome (54 [70.1%] vs. 14 [100%]; P = 0.011), septic shock (26 [33.8%] vs. 9 [64.3%]; P = 0.031), IMV (55 [71.4%] vs. 14 [100%]; P = 0.019) and plateau pressure before delivery (23 [21–26] vs. 28 [27–30]; P = 0.019). The incidence of fetal/neonatal mortality among 47 pregnant patients requiring IMV with SpO2 < 95% versus SpO2 >95% before intubation was 12/35 (34.28%) versus 1/12 (8.33%), respectively; P = 0.163. The incidence of fetal/neonatal mortality among those with SpO2 <95% versus SpO2 >95% before delivery was 5/18 (27.77%) versus 8/29 (25.58%), respectively; P = 0.999.The vast majority of births were preterm. Among patients admitted antepartum, most deliveries were induced for maternal reasons. Fetal/neonatal losses were associated with gestational age at delivery, maternal severity of illness on admission and certain ventilatory parameters but not with maternal oxygenation, as is commonly the focus in these patients. [ABSTRACT FROM AUTHOR]

Aim: Skin‐to‐skin contact (SSC) immediately after birth may improve breastfeeding outcomes. This study explored the effect of the duration of SSC in the delivery room on breastfeeding quality and duration. Methods: In this prospective observational cohort study, mother–infant pairs practising SSC were categorised into two groups based on SSC duration (≤45 or >45 min). Outcomes included breastfeeding quality in the delivery room and at 24 h of age assessed by the Infant‐Breastfeeding Assessment Tool (IBFAT) score, and long‐term breastfeeding duration up to 6 months while accounting for potential confounding variables. Results: The study included 72 mother–infant pairs. SSC for more than 45 min was significantly correlated with longer immediate breastfeeding (65 vs. 19 min, p < 0.001) and higher breastfeeding quality scores immediately after birth (IBFAT score of 10 vs. 7, p < 0.001). Regarding the long‐term effect, infants in the extended SSC group were breastfed longer (5.2 vs. 3.7 months, p = 0.005) and had exclusive breastfeeding (4.7 vs. 2.7 months, p > 0.001). No significant confounding variables were identified. Conclusion: Extended SSC (>45 min) correlated with prolonged, higher‐quality breastfeeding after birth and longer successful breastfeeding. [ABSTRACT FROM AUTHOR]

Neonatal diabetes mellitus (NDM), defined as diabetes with an onset during the first 6 months of life, is a rare form of monogenic diabetes. The initial publications on this condition began appearing in the second half of the 1990s and quite surprisingly, the search for new NDM genes is still ongoing with great vigor. Between 2018 and early 2024, six brand new NDM‐genes have been discovered (CNOT1, FICD, ONECUT1, PDIA6, YIPF5, ZNF808) and three genes known to cause different diseases were identified as NDM‐genes (EIF2B1, NARS2, KCNMA1). In addition, NDM cases carrying mutations in three other genes known to give rise to diabetes during childhood have been also identified (AGPAT2, BSCL2, PIK3R1). As a consequence, the list of NDM genes now exceeds 40. This genetic heterogeneity translates into many different mechanism(s) of disease that are being investigated with state‐of‐the‐art methodologies, such as induced pluripotent stem cells (iPSC) and human embryonic stem cells (hESC) manipulated with the CRISPR technique of genome editing. This diversity in genetic causes and the pathophysiology of diabetes dictate the need for a variety of therapeutic approaches. The aim of this paper is to provide an overview on recent achievements in all aspects of this area of research. [ABSTRACT FROM AUTHOR]

The developmental trajectory of weight‐bearing locomotion and sensorimotor reflexes following a spinal cord injury, as well as the mechanisms for plasticity, remain unclear. In rats, the second postnatal week is a critical period for the development and recovery of spinal sensorimotor function. The purpose of the present study was to characterize developmental changes during this time frame to provide a basis for potential interventions and future research. Rats underwent a complete low‐thoracic (T8–T10) spinal cord transection surgery, or sham procedure, on postnatal day (P)1. Spontaneous locomotion and sensorimotor reflexes (surface righting, hindlimb placing, and crossed‐extensor reflex) were tested on P7, P14, or P21. Results show that spinal‐transected and sham rats exhibited the same amount of spontaneous locomotion, but the degree of relative weight bearing on the hindlimbs was different between groups and changed over time. Reflex findings showed that throughout the neonatal period, the isolated lumbar spinal cord can respond to sensory input and execute coordinated motor output following spinal cord transection. These insights contribute to understanding the developmental trajectory of spinal cord function after injury and provide a foundation for interventions to enhance recovery outcomes. [ABSTRACT FROM AUTHOR]

ABSTRACT Background/Objectives Methods Results Conclusions Miliaria pustulosa is a noninfectious, transient skin eruption of pustules overlying erythematous plaques secondary to obstruction of eccrine glands. There are very few case reports in the literature detailing miliaria pustulosa in neonates. When presenting in neonates, its similarity to life‐threatening infections may cause diagnostic confusion. By differentiating this condition from similar presentations, unnecessary treatments and tests in this population may be avoided.Retrospective review of the medical records of nine neonates presenting with a pustular eruption diagnosed as miliaria pustulosa. Patients were seen at a children's hospital in Chicago, IL, USA; cases were selected by investigator recall.In this case series, miliaria pustulosa presents in nine neonates as clusters of eruptive pustules with resolution or significant improvement noted after an average of 2.6 days (range 1–5 days). The average age was 4.6 days (range 1–10 days old) and the average gestational age was 34.7 weeks (range 26.3–40.1 weeks). All patients had pustular outbreaks in areas occluded by swaddling, clothes, or adhesive. Seven patients had geometric lesions that were underlying sites of intravenous (IV) site adhesive or electrocardiogram (EKG) leads.The consistent morphological features of this pustular eruption at sites of skin occlusion and the transient course in the setting of an otherwise well‐appearing infant are strongly suggestive of the diagnosis of miliaria pustulosa. It is important for clinicians to be familiar with this benign presentation and to differentiate it from other neonatal pustular eruptions to minimize invasive tests and treatments in this vulnerable population. [ABSTRACT FROM AUTHOR]

Objective: To identify current practices in the management of selective fetal growth restriction (sFGR) in monochorionic diamniotic (MCDA) twin pregnancies. Design: Cross‐sectional survey. Setting: International. Population: Clinicians involved in the management of MCDA twin pregnancies with sFGR. Methods: A structured, self‐administered survey. Main Outcome Measures: Clinical practices and attitudes to diagnostic criteria and management strategies. Results: Overall, 62.8% (113/180) of clinicians completed the survey; of which, 66.4% (75/113) of the respondents reported that they would use an estimated fetal weight (EFW) of <10th centile for the smaller twin and an inter‐twin EFW discordance of >25% for the diagnosis of sFGR. For early‐onset type I sFGR, 79.8% (75/94) of respondents expressed that expectant management would be their routine practice. On the other hand, for early‐onset type II and type III sFGR, 19.3% (17/88) and 35.7% (30/84) of respondents would manage these pregnancies expectantly, whereas 71.6% (63/88) and 57.1% (48/84) would refer these pregnancies to a fetal intervention centre or would offer fetal intervention for type II and type III cases, respectively. Moreover, 39.0% (16/41) of the respondents would consider fetoscopic laser surgery (FLS) for early‐onset type I sFGR, whereas 41.5% (17/41) would offer either FLS or selective feticide, and 12.2% (5/41) would exclusively offer selective feticide. For early‐onset type II and type III sFGR cases, 25.9% (21/81) and 31.4% (22/70) would exclusively offer FLS, respectively, whereas 33.3% (27/81) and 32.9% (23/70) would exclusively offer selective feticide. Conclusions: There is significant variation in clinician practices and attitudes towards the management of early‐onset sFGR in MCDA twin pregnancies, especially for type II and type III cases, highlighting the need for high‐level evidence to guide management. [ABSTRACT FROM AUTHOR]

Objective: To compare glucose measurements from capillary and venous blood samples using a point‐of‐care (POC) glucometer with a standard laboratory (colorimetric, glucose oxidase) assay (LABGLU) in a population of hospitalized, neonatal foals. Design: Multicenter, prospective, experimental study, conducted between March 2019 and June 2020. Setting: Four university teaching hospitals and 1 private referral hospital. Animals: Fifty‐four hospitalized neonatal (≤30 days of age) foals. Interventions: Simultaneous capillary (muzzle, POCMUZ) and venous (jugular, POCJUG) blood samples were obtained to determine POC glucose concentrations. Venous samples were also analyzed by LABGLU. Each foal was sampled at the time of enrollment or admission to the hospital and at 1 subsequent point during hospitalization. Indirect mean arterial pressure and hematocrit were concurrently recorded. Measurements and Main Results: Bland–Altman analysis showed a mean bias (95% limits of agreement) of −28.0 (−88.6 to 32.6) mg/dL for comparison of POCJUG with LABGLU, −8.2 (−94.3 to 78.0) mg/dL for POCMUZ and LABGLU, and 18.8 (−44.4 to 82.0) mg/dL for POCMUZ and POCJUG. A total of 63.5% of the POCJUG and 45.2% of the POCMUZ samples exceeded the reference value by ±15 mg/dL (for LABGLU samples <75 mg/dL) or ±15% (for LABGLU samples ≥75mg/dL). Concordance correlation coefficient (95% confidence interval [CI]) indicated a fair agreement between POCJUG and LABGLU (0.75, 95% CI: 0.66–0.82) and between POCMUZ and LABGLU (0.71, 95% CI: 0.58–0.80). Fifty percent (14/28) of hypoglycemic foals on the reference method were incorrectly classified as euglycemic by POCJUG, and 5 of 28 were incorrectly classified by POCMUZ. Conclusions: In the sampled population, the chosen POC glucometer lacked agreement with the standard laboratory measurement. Limits of agreement were wide for both POCJUG and POCMUZ. Inaccuracies in POC results could impact decision‐making in the clinical management of glycemic control in hospitalized neonatal foals and, importantly, increase the risk of hypoglycemic events being underdiagnosed in critical patients. [ABSTRACT FROM AUTHOR]

Asphyxiated neonates often undergo therapeutic hypothermia (TH) to reduce morbidity and mortality. As perinatal asphyxia and TH impact neonatal physiology, this could also influence enzyme functionality. Therefore, this study aimed to unravel the impact of age, hypothermia and hypoxia on porcine hepatic cytochrome P450 (CYP) gene expression, protein abundance and activity. Hepatic CYP expression, protein abundance and activity were assessed in naive adult and neonatal Göttingen minipigs, alongside those from an (non‐survival) in vivo study, where four conditions—control (C), therapeutic hypothermia (TH), hypoxia (H), hypoxia and TH (H + TH)—were examined. Naive neonatal Göttingen minipigs exhibited 75% lower general CYP activity and different gene expression patterns than adults. In vitro hypothermia (33°C) decreased general CYP activity in adult liver microsomes by 36%. Gene expression was not different between TH and C while hypoxia up‐regulated several genes (i.e., CYP3A29 [expression ratio; ER = 5.1472] and CYP2C33 [ER = 3.2292] in the H group and CYP2C33 [ER = 2.4914] and CYP2C42 [ER = 4.0197] in the H + TH group). The medical treatment and the interventions over 24 h, along with hypoxia and TH, affected the protein abundance. These data on CYP expression, abundance and activity in young animals can be valuable in building physiologically‐based pharmacokinetic models for neonatal drug dose predictions. [ABSTRACT FROM AUTHOR]

Meconium, the first stool produced by neonates, has been used as an analyte for exogenous fetal exposures. However, few studies have investigated the relationship between meconium and androgen exposure in utero. Here, we examine the associations of testosterone and dehydroepiandrosterone (DHEA) across maternal antenatal salivary testosterone, cord blood, meconium, and infant salivary testosterone. A total of 47 women with singleton, uncomplicated pregnancies, and their infants were included in this study. Participants were recruited from an academic obstetric clinic. Maternal saliva was collected at 36‐weeks' gestation. Cord blood and meconium were collected at birth. Infant salivary testosterone was collected at 1 and 4 weeks of age. Multivariate model results showed that meconium testosterone was associated with neonatal testosterone at 1 (F = 5.62, p = 0.029) and 4 weeks (F = 4.28, p = 0.048) postnatal age; no sex differences were detected. This study suggests meconium is a valuable tool for evaluating endogenous androgen exposure and should be used in future studies to investigate the fetal hormonal milieu. [ABSTRACT FROM AUTHOR]

Introduction: The 400 000 residents of the Illawarra Shoalhaven Local Health District (ISLHD) experienced two distinct lockdowns aimed at mitigating the transmission of severe acute respiratory syndrome coronavirus 2 infection. Analysing effects of these lockdowns on maternal and neonatal outcomes presents a valuable opportunity to assess the impact of pandemic‐level restrictions on maternal and neonatal outcomes. Aim: Evaluate the impacts of restrictions from two lockdown periods on maternal, birthing, and neonatal outcomes within a regional local health district. Materials and Methods: The study included 22 166 women who gave birth within ISLHD between 2017 and 2022. Groups included for analysis: Control Group – mothers pregnant before the pandemic (conception before 3 April 2019); Exposure Group 1 – mothers pregnant during the first lockdown (conception date 22 January 2020 to 5 May 2020); and Exposure Group 2 – mothers pregnant during the second lockdown (conception date 30 April 2021 to 13 Sep 2021). Results: Odds of adverse birthing outcomes including non‐reassuring fetal status (odds ratio (OR) 1.34; 95% CI 1.14–1.56 and OR 1.20; 95% CI 1.03–1.40), and postpartum haemorrhage (OR 2.04; 95% CI 1.73–2.41 and OR 1.74; 95% CI 1.48–2.05) were substantially increased in Exposure Groups 1 and 2, respectively. Gestational diabetes, gestational hypertension, low birth weight and admission to neonatal intensive care rates improved. Conclusions: Pregnant women exposed to pandemic restrictions within ISLHD had decreased odds of adverse antenatal and neonatal outcomes, but increased odds of poor peripartum outcomes. [ABSTRACT FROM AUTHOR]

Bats inhabiting northern latitudes are faced with short reproductive seasons during which they must produce and rear pups before fattening up in time to survive the winter hibernation. Therefore, the timing of parturition has considerable impacts on future fitness prospects for the mother and pup. However, little is known about individual variation in breeding phenology and its consequences for postnatal development within bat populations. Here, we studied the phenology of breeding in Eptesicus nilssonii across 7 years using data collected by day‐to‐day monitoring of a breeding colony in Norway (60.1° N) for which the identity and age of each mother (N = 8) and pup (N = 28) were known. Using mixed‐effect models, we found that arrival at the colony was influenced by temperature conditions from mid‐April to mid‐May across all females, but that there were strong and consistent individual differences in arrival‐ and parturition time across years. Females generally arrived ~32.1 days before giving birth, but the gestation duration was reduced if females arrived late and prolonged if females left the colony when faced with cold weather conditions. Pups born later in the season were born smaller but had higher growth rates during the most rapid growth period (<10 days old). The within‐individual effects suggest that the higher growth rates could be due to mothers compensating (e.g. through increased food intake) for late parturition rather than by improved food availability. Date of parturition did not influence adult body size in pups. Pups became volant at the earliest only 13.1 days after birth and approached adult flight patterns during their first flight week. Our results suggest that E. nilssonii is highly adapted to a short breeding season by producing large, fast developing and early volant pups, despite the environmental pressures bats face at northern latitudes. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions The aim of this study was to describe the evolution of a regional neonatal service in Sierra Leone and changes in mortality and service use as it transitioned from a non‐specialist service to a dedicated special care baby unit (SCBU).This was a retrospective observational study. Anonymised data were taken from the ward admissions books at Bo Government Hospital, and trends in admissions and mortality within the neonatal service were examined for each stage of the department's evolution.Four phases of the service's development were identified between November 2015 and October 2019. Records of 2377 admissions and 333 deaths were identified. The average number of admissions per month and deaths per month varied by service development phase. There was a trend towards reduced death rates and increased numbers of admissions as the unit evolved into a dedicated neonatal unit with a reliable electricity supply.The development of an adequately sized SCBU with a reliable electricity supply and specially trained staff was associated with a reduction in the death rate and an increase in admissions. [ABSTRACT FROM AUTHOR]

Background/Aims: Congenital melanocytic nevi (CMN) are often unexpected discoveries at time of childbirth or adoption. Understanding how parents/guardians cope with these visible birthmarks can help clinicians better care for children and their families. Using qualitative methods, we sought to categorize early family responses to CMN and identify approaches to better engage with parents early in their child's life. Methods: Semi‐structured interviews were conducted within a broader study on shared decision making for families with children with CMN. Discussions included information on birth and early life experiences. Data was dual‐coded, inductively and deductively, and analyzed with the Parker and Endler framework exploring emotion‐, task‐, and avoidance‐oriented coping. Results: Fifteen parents of 13 children were interviewed. Parents described all three categories of coping. Emotions ranged from guilt, to neutrality, to positive responses seeing their child's CMN. Stress was lower in families with prior knowledge of CMN. Dermatology referral provided an opportunity for learning, but also triggered worry for some families. Conclusions: Parents process and react to the diagnosis of CMN with a range of emotions and coping styles. Dermatologists can utilize open‐ended questions to understand family emotions and provide families with tailored knowledge and resources. Early discussion of the diagnosis and family education are important support tools. [ABSTRACT FROM AUTHOR]

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

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Summary: Maternal obesity and gestational diabetes mellitus (GDM) prevalence are increasing, with both conditions associated with adverse neonatal outcomes. This review aimed to determine the risk of adverse outcomes in women with obesity and GDM, compared with women with obesity alone. A systematic search identified 28 eligible articles. Meta‐analysis was conducted using a random effects model, to generate pooled estimates (odds ratios, OR, or mean difference, MD). Compared with normal‐weight controls, women with obesity had increased risks of large for gestational age (LGA, OR 1.98, 95% CI: 1.56, 2.52) and macrosomia (OR 2.93, 95% CI: 1.71, 5.03); the latter's risk almost double in women with obesity than GDM. Birth weight (MD 113 g, 95% CI: 69, 156) and shoulder dystocia (OR 1.23, 95% CI: 0.85, 1.78) risk was also higher. GDM significantly amplified neonatal risk in women with obesity, with a three‐ to four‐fold risk of LGA (OR 3.22, 95% CI: 2.17, 4.79) and macrosomia (OR 3.71, 95% CI: 2.76, 4.98), as well as higher birth weights (MD 176 g, 95% CI: 89, 263), preterm delivery (OR 1.49, 95% CI: 1.25, 1.77), and shoulder dystocia (OR 1.99, 95% CI: 1.31, 3.03), when compared with normal‐weight controls. Our findings demonstrate that maternal obesity increases serious neonatal adverse risk, magnified by the presence of GDM. Effective strategies are needed to safeguard against neonatal complications associated with maternal obesity, regardless of GDM status. [ABSTRACT FROM AUTHOR]

Background Aims Study Design Results Conclusion Relevance to Clinical Practice Very and extremely preterm infants (VEPIs) experience sensory deprivation in the neonatal intensive care unit (NICU). While various sensory‐supported interventions might improve immediate physiological response, their impact on long‐term development remains unclear. Additionally, these interventions may pose challenges in the NICU environment due to complex treatments and monitoring requirements.This review aimed to understand the current evidence on sensory‐supported interventions in the NICU, identify the components of these interventions and determine their effects on the VEPIs.A systematic search across nine electronic databases (PubMed, EBSCO, EMBASE, Web of Science, Scopus, Cochrane, Cochrane trial, IEEE Xplore DL and ACM DL) was conducted in December 2020 and updated in September 2022. The search gathers information on sensory‐supported interventions for VEPIs in the NICU.The search yielded 23 systematic reviews and 22 interventional studies, categorized into auditory (19), tactile/kinesthetic (5), positional/movement support (7), visual (1) and multisensory (13) interventions. While unimodal and multimodal interventions showed short‐term benefits, their long‐term effects on VEPIs are indeterminate. Translating these findings into clinical practice remains a challenge due to identified gaps.Our reviews indicate that sensory‐supported interventions have a transient impact, with intervention studies reporting positive effects. Future research should develop and test comprehensive, continuous multisensory interventions tailored for the early NICU stage.Multimodal sensory interventions show promise for VEPIs, but long‐term effects need further study. Standardizing protocols for NICU integration and parental involvement is crucial. Ongoing research and collaboration are essential for optimizing interventions and personalized care. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the definition and causes of neonatal bradycardias. Methods: This retrospective study included 135 term‐born newborns referred for 24‐hour Holter monitoring due to bradycardia. Bradycardia was defined as either a heart rate below 80 beats per minute (standard definition) or a heart rate below our recently published age‐specific reference values for neonatal heart rate. Results: The mean (SD) age was 6.1 (1.3) days. With standard definition, 107 newborns (79%) had bradycardia, whereas only 20 (15%) had a minimum heart rate lower than the age‐specific reference. Younger newborns had lower heart rates. Each day increased the minimum, mean and maximum heart rate by 1.8 (95% CI: 1.0, 2.6), 4.2 (95% CI: 3.0, 5.3) and 2.1 beats per minute (95% CI: 0.3, 3.8), respectively. Male sex and maternal levothyroxine medication were negatively associated with the mean and maximum heart rate. None of the newborns had a cardiac cause for low heart rate. Conclusion: Among term newborns with bradycardias, younger age, male sex and maternal levothyroxine medication were associated with a lower heart rate on Holter monitoring. Given the age‐related increase in heart rate, the 80 beats per minute limit as a universal threshold for abnormal heart rate in newborns appears inappropriate. [ABSTRACT FROM AUTHOR]

Background: Fasting before elective anesthesia care is a standardized practice worldwide. The aim is to decrease the risk of aspiration leading to pulmonary complications such as aspiration pneumonitis during anesthesia care. There are different guidelines for elective preoperative fasting in children. However, there is insufficient literature measuring gastric emptying time after breast milk or formula milk feeding in infants. Objective: This study used gastric ultrasound to determine the gastric emptying time for breast milk and formula milk in children below 6 months of age. We also compared the calculated gastric volumes among breast‐fed and formula milk‐fed based on Schmitz's and Spencer's formula. Materials and methods: This prospective observational study was conducted at a tertiary care center in India between November (2017–2019). A total of 52 infants less than 6 months of age were recruited. The study population was divided into two groups (breast‐fed and formula milk‐fed) of 26 patients each. Ultrasound was used to measure the antral cross‐sectional area of the stomach and to calculate the gastric volume using the two classical formulas (Schmitz and Spencer's). Gastric emptying was reported when the bull's eye appearance of the gastric antrum was seen or when the antral cross‐sectional area was less than 3.07 cm2. Results: The number of breast‐fed children whose antral cross‐sectional was greater than 3.07 cm2 (cut‐off value for aspiration risk) beyond 1 h was 14/26 (53.84%) while none (0) children went beyond 3 h. The number of formula‐fed children whose antral cross‐sectional was greater than 3.07 cm2 beyond 1 h was 17/26 (65.38%) while one child (3.84%) went beyond 3 h. Using Schmitz's formula, mean (SD) gastric emptying times were 0.35 ± 0.68 h (95% CI 0.35 ± 0.185, range 0.165–0.535) for breast‐fed patients and 0.35 ± 0.69 h (95% CI 0.35 ± 0.188, range 0.162–0.538) for formula‐fed patients, and were thus neither clinically nor statistically different (p =.73) Using Spencer's formula, the mean gastric emptying times were 0.12 ± 0.33 h (95% CI 0.12 ± 0.09, range 0.03–0.21) for breast‐fed patients and 0.04 ± 0.20 h (95% CI 0.04 ± 0.05, range −0.01 to 0.09) for formula‐fed patients, and were also neither clinically nor statistically different p =.13. Conclusion: In our series, the gastric emptying times in breast‐fed and formula‐fed infants less than 6 months old were similar. Our results support the fasting guidelines of the European Society of Anaesthesiology and Intensive Care 2022, that is, 3 h for breastfeeding and 4 h for formula milk feeding. In addition, this shows that the Schmitz's and Spencer's formulae used to calculate the gastric volume based on ultrasound measurement of the antral cross‐sectional area are not comparable in infants less than 6 months. [ABSTRACT FROM AUTHOR]

Introduction: Intrahepatic cholestasis of pregnancy (ICP) is a problem with an increasing incidence and negative maternal, fetal, and neonatal consequences. This problem is becoming increasingly important. This systematic review and meta‐analysis aimed to determine the incidence of ICP and its adverse maternal, fetal, and neonatal adverse outcomes based on primary research studies. Methods: This systematic review and meta‐analysis used Preferred Reporting Items for Systematic Reviews and Meta‐Analyses reporting guidelines and was conducted between June and September 2023 using the following keywords: obstetric cholestasis OR intrahepatic cholestasis AND pregnancy OR pregnant OR prenatal OR antenatal OR perinatal OR maternal OR fetal OR neonatal. Quality assessment of the studies was performed using the Critical Appraisal Checklists developed by the JBI Institute. Data were synthesized using meta‐analysis methods. Results: The analysis included 10 studies published between 2013 and 2023. The meta‐analysis showed that the incidence of ICP was 1.7% (odds ratio [OR], 0.021; 95% CI, 0.012‐0.027), whereas maternal, fetal, and neonatal adverse outcomes included cesarean birth (OR, 2.938; 95% CI, 1.467‐5.881), preterm birth or preterm prelabor rupture of membranes (OR, 4.241; 95% CI, 1.996‐9.009), hypertensive disorders of pregnancy (OR, 3.715; 95% CI, 1.545‐8.929), maternal infection (OR, 3.301; 95% CI, 2.917‐3.737), neonatal intensive care unit admission (OR, 2.715; 95% CI, 1.458‐5.056), birth weight less than or equal to 2500 g (OR, 2.518; 95% CI, 1.296‐4.892), and small for gestational age (OR, 1.915; 95% CI, 1.424‐2.573). Discussion: This systematic review and meta‐analysis revealed that ICP has a high incidence and several maternal, fetal, and neonatal adverse outcomes. Therefore, midwives and other health professionals must be aware of these outcomes and provide appropriate care to pregnant individuals with ICP. [ABSTRACT FROM AUTHOR]

Aim: Review changes in neonatal ventilation practice within our regional transport service, Embrace, identifying interventions with greatest impact on improved rates of normocapnia during transfer. Methods: Using internal transport databases and UK Neonatal Transport Group data submissions, we tracked local and national rates of ventilation and normocapnia. We correlated this with internal changes in practice, including introduction of new equipment, staffing changes, educational interventions and quality improvement projects. Results: Data demonstrated improvement in normocapnia rates benchmarked against national figures, which was not explained by changes in ventilation methods or rates, or by changes in availability of post‐transfer gases. Greatest improvement was identified following introduction of transcutaneous CO2 monitoring and ventilators enabling volume‐guided ventilation strategies. Additionally, although less quantifiable, educational and quality improvement interventions, and case review mechanisms were felt to be influential. Conclusion: Volume guided ventilation and transcutaneous CO2 monitoring have had a positive influence on the maintenance of normocapnia during transfer at Embrace Transport Service, although introduction of new equipment still presents challenges which must be overcome. Recognising the significant impact of these technologies allows for ongoing financial, time and educational investment to emphasise their importance and ensure appropriate awareness of limitations and troubleshooting options, maximising their positive impact. [ABSTRACT FROM AUTHOR]

Although sucrose is widely administered to hospitalized infants for single painful procedures, total sucrose volume during the entire neonatal intensive care unit (NICU) stay and associated adverse events are unknown. In a longitudinal observation study, we aimed to quantify and contextualize sucrose administration during the NICU stay. Specifically, we investigated the frequency, nature, and severity of painful procedures; proportion of procedures where neonates received sucrose; total volume of sucrose administered for painful procedures; and incidence and type of adverse events. Neonates <32 weeks gestational age at birth and <10 days of life were recruited from four Canadian tertiary NICUs. Daily chart reviews of documented painful procedures, sucrose administration, and any associated adverse events were undertaken. One hundred sixty‐eight neonates underwent a total of 9093 skin‐breaking procedures (mean 54.1 [±65.2] procedures/neonate or 1.1 [±0.9] procedures/day/neonate) during an average NICU stay of 45.9 (±31.4) days. Pain severity was recorded for 5399/9093 (59.4%) of the painful procedures; the majority (5051 [93.5%]) were heel lances of moderate pain intensity. Sucrose was administered for 7839/9093 (86.2%) of painful procedures. The total average sucrose volume was 5.5 (±5.4) mL/neonate or 0.11 (±0.08) mL/neonate/day. Infants experienced an average of 7.9 (±12.7) minor adverse events associated with pain and/or sucrose administration that resolved without intervention. The total number of painful procedures, sucrose volume, and incidence of adverse events throughout the NICU stay were described addressing an important knowledge gap in neonatal pain. These data provide a baseline for examining the association between total sucrose volume during NICU stay and research on longer‐term behavioral and neurodevelopmental outcomes. [ABSTRACT FROM AUTHOR]

Aim: Repeated exposure to ketamine during the neonatal period in mice leads to cognitive impairments in adulthood. These impairments are likely caused by synaptic plasticity and excitability damage. We investigated the precise role of brain‐derived neurotrophic factor (BDNF) in the cognitive impairments induced by repeated ketamine exposure during the neonatal period. Methods: We evaluated the cognitive function of mice using the Morris water maze test and novel object recognition test. Western blotting and immunofluorescence were used to detect the protein levels of BDNF. Western blotting, Golgi‐Cox staining, transmission electron microscopy, and long‐term potentiation (LTP) recordings were used to assess synaptic plasticity in the hippocampus. The excitability of neurons was evaluated using c‐Fos. In the intervention experiment, pAdeno‐CaMKIIα‐BDNF‐mNeuronGreen was injected into the hippocampal CA1 region of mice to increase the level of BDNF. The excitability of neurons was enhanced using a chemogenetic approach. Results: Our findings suggest that cognitive impairments in mice repeatedly exposed to ketamine during the neonatal period are associated with downregulated BDNF protein level, synaptic plasticity damage, and decreased excitability of glutamatergic neurons in the hippocampal CA1 region. Furthermore, the specific upregulation of BDNF in glutamatergic neurons of the hippocampal CA1 region and the enhancement of excitability can improve impaired synaptic plasticity and cognitive function in mice. Conclusion: BDNF downregulation mediates synaptic plasticity and excitability damage, leading to cognitive impairments in adulthood following repeated ketamine exposure during the neonatal period. [ABSTRACT FROM AUTHOR]

The prevalence of undocumented medical treatments among children is a significant issue, as well as many EU countries lack access to newly developed children‐friendly medicines. Consequently, there is a pressing need for supplementary resources that can facilitate informed decision‐making regarding children's medication. We therefore aim to describe the process of establishing a children's Drug and Therapeutics Committee (cDTC), as well as the preparing and implementation of recommendations for children in the capital region of Denmark. Following the guidelines outlined by the World Health Organization, we established a cDTC, and recommendations for paediatric medication practice were constructed from assessments of medication use patterns among children in the capital region between 2019 and 2021. The recommendations were meticulously crafted based on evaluation of the current marketing authorization landscape and existing best available evidence. In 2019, the capital region established the first cDTC supported by expert councils and an editorial board. A total of 2429 purchase item numbers covering 1 222 846 defined daily doses and 592 088 purchased packages covering 10 200 000 defined daily doses were identified in the secondary and primary sectors, respectively. Three comprehensive lists covering recommendations for newborns and children were published between 2021 and 2020 totaling 331 recommended pharmaceutical products. The recommendations primarily intended for use in the secondary healthcare sector were implemented through the revision of 38 paediatric‐ and six neonatal product ranges throughout capital region. In conclusion, recommendation lists for children governed by a cDTC provide a rational auxiliary tool that can be immediately implemented in the clinic. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of empiric antibiotic protocols for peripartum bacteremia at a quaternary institution by describing incidence, microbial epidemiology, clinical source of infection, susceptibility patterns, and maternal and neonatal outcomes. Methods: Retrospective chart review of peripartum patients with positive blood cultures between 2010 and 2018. Results: The incidence of peripartum bacteremia was 0.3%. The most cultured organisms were Escherichia coli (51, 26.7%), Streptococcus spp. (52, 27.2%), and anaerobic spp. (35, 18.3%). Of the E. coli cases, 54.9% (28), 19.6% (10), and 19.6% (10) were resistant to ampicillin, first‐ and third‐generation cephalosporins, respectively. Clinical sources of infection included intra‐amniotic infection/endometritis (115, 67.6%), upper and/or lower urinary tract infection (23, 13.5%), and soft tissue infection (8, 4.7%). Appropriate empiric antibiotics were prescribed in 137 (83.0%) cases. There were 7 ICU admissions (4.2%), 18 pregnancy losses (9.9%), 9 neonatal deaths (5.5%), and 6 cases of neonatal bacteremia (3.7%). Conclusion: Peripartum bacteremia remains uncommon but associated with maternal morbidity and neonatal morbidity and mortality. Current empiric antimicrobial protocols at our site remain appropriate, but continuous monitoring of antimicrobial resistance patterns is critical given the presence of pathogens resistant to first‐line antibiotics. Synopsis: Peripartum bacteremia was most associated with Escherichia coli, and while resistance to first‐line empiric antimicrobials is a concern, current antibiotic protocols remain appropriate. [ABSTRACT FROM AUTHOR]

Objective: The main aim of this study was to investigate the perinatal outcomes of dichorionic twin pregnancies complicated by selective fetal growth restriction (sFGR). Design: Retrospective cohort study. Setting: Tertiary reference centre. Population: Dichorionic twin pregnancies complicated by sFGR between 2000 and 2019 in St George's University Hospital. Methods: Regression analyses were performed using generalised linear models and mixed‐effects generalised linear models where appropriate to account for pregnancy level dependency in variables. Time to event analyses were performed with mixed‐effects Cox regression models. Main outcome measures: Stillbirth, neonatal death or neonatal unit admission with morbidity in one or both twins. Results: A total of 102 (of 2431 dichorionic twin pregnancies) pregnancies complicated by sFGR were included in the study. The Cochrane–Armitage test revealed a significant trend for increased adverse perinatal outcome rates with more severe forms of umbilical artery flow impedance, i.e. reversed, absent, positive with resistant flow and positive flow without resistance. A multivariable model including maternal and conception characteristics had poor predictive accuracy for stillbirth (area under the curve: 0.68, 95% confidence interval [CI] 0.55–0.81) and composite adverse perinatal outcomes (area under the curve: 0.58, 95% CI 0.47–0.70). When umbilical artery Doppler parameters were added to the models, the area under the curve values improved to 0.95 (95% CI 0.89–0.99) and 0.83 (95% CI 0.73–0.92) for stillbirth and composite adverse perinatal outcomes, respectively. Conclusion: In dichorionic twin pregnancies complicated by sFGR, the umbilical artery Z‐scores were associated with both intrauterine death and adverse perinatal outcomes. Linked article: This article is commented on by Laura Sarno, pp. 201 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471-0528.17600 [ABSTRACT FROM AUTHOR]

Niger is afflicted with high rates of poverty, high fertility rates, frequent environmental crises, and climate change. Recurrent droughts and floods have led to chronic food insecurity linked to poor maternal and neonatal nutrition outcomes in vulnerable regions. We analyzed maternal and neonatal nutrition trends and subnational variability between 2000 and 2021 with a focus on the implementation of policies and programs surrounding two acute climate shocks in 2005 and 2010. We used four sources of data: (a) national household surveys for maternal and newborn nutritional indicators allowing computation of trends and differences at national and regional levels; (b) document review of food security reports; (c) 30 key informant interviews and; (d) one focus group discussion. Many food security policies and nutrition programs were enacted from 2000 to 2020. Gains in maternal and neonatal nutrition indicators were more significant in targeted vulnerable regions of Maradi, Zinder, Tahoua and Tillabéri, from 2006 to 2021. However, poor access to financial resources for policy execution and suboptimal implementation of plans have hindered progress. In response to the chronic climate crisis over the last 20 years, the Nigerien government and program implementers have demonstrated their commitment to reducing food insecurity and enhancing resilience to climate shocks by adopting a deliberate multisectoral effort. However, there is more that can be achieved with a continued focus on vulnerable regions to build resilience, targeting high risk populations, and investing in infrastructure to improve health systems, food systems, agriculture systems, education systems, and social protection. Key messages: Niger is ranked as the most vulnerable country in the world for exposure and sensitivity to the negative effects of disasters and climate change. Acute environmental shocks in 2005 and 2010 elevated government and development partner responses to the 'food security crises'.Multisectoral policy and program investments in vulnerable regions played a meaningful role in improving food security and subsequently maternal and neonatal nutrition but progress is slow or stagnant.The Nigerien government, program implementers, and donors should prioritize investments in infrastructure and shock resilience to improve health systems, food systems, agriculture systems, education systems, and social protection, particularly in high risk populations. [ABSTRACT FROM AUTHOR]

Objective: To investigate associations between maternal testosterone status and offspring birth anthropometrics. Design: Population‐based prospective cohort study. Setting: University Hospital. Population: 1486 mother–child dyads from Odense Child Cohort. Methods: Maternal blood samples were collected at gestational weeks 27–30 and free testosterone (FT) levels were calculated using the Vermeulen equation from total testosterone (TT) analysed by mass spectrometry and sex hormone binding globulin. Associations between FT or TT levels and birth anthropometrics were analysed with multiple linear regression models according to offspring sex with adjustment for maternal age, parity, smoking and educational level. Analyses were repeated with polycystic ovary syndrome as exposure for offspring birth anthropometrics. Main outcome measures: Offspring birth weight (BW), birth length, abdominal and head circumferences. Results: Maternal mean (SD) age was 30.2 (4.5) years and pre‐pregnancy body mass index was 23.5 (5.3) kg/m2. In boys (n = 787), higher FT was associated with lower birth weight (adjusted doubling constant = −65.53, P = 0.010), shorter birth length (adjusted doubling constant = −0.43, P < 0.001), and lower abdominal circumference (adjusted doubling constant = −0.39, P < 0.001); Higher TT was associated with lower abdominal circumference (adjusted doubling constant = −0.25, P = 0.028). In girls, no associations were found between maternal FT or TT and offspring anthropometrics. Conclusions: Higher maternal free testosterone exposure was linked to reduced birth weight, length and abdominal circumference in boys, whereas girls were not susceptible to maternal testosterone exposure. [ABSTRACT FROM AUTHOR]

Background: Admission of a baby for neonatal care represents a deeply traumatic time for parents. Webcam technology facilitating live‐streaming of the baby when the parents are unable to be physically present has been introduced to support bonding and parental engagement in care. Aim: This systematic review explores the impact and experiences of webcam technology upon parents of babies in the neonatal unit and neonatal health care professionals. Study Design: A systematic search of Embase, Medline and Scopus was conducted using the keywords 'video technology', 'newborn' and 'neonatal intensive care.' Studies written in English and exploring live‐stream technology were included. Thematic analysis per group (parents and health care professionals) was undertaken to identify similarities between themes across published studies. Results: Ten studies were included. Six studies explored the impact of webcam technology on parents only, two on both parents and health care professionals and two on health care professionals only. Thematic analysis per group identified three themes for parents, including parental well‐being, parent‐infant bonding and quality of care. Two themes were identified for neonatal health care professionals, including quality of care and feasibility of webcam technology. Conclusions: Webcam technology has many documented benefits for parental well‐being. However, new technology requires adequate staff training, support and plans for ongoing maintenance. Further research is required to explore the long‐term impacts on breast‐milk production and infant neurological development. Relevance to Clinical Practice: The use of webcam technology in neonatal units can potentially improve the mental health and well‐being of the parents and promote bonding between the infant, their parents and wider family members. Specialist roles to support advancing technology in the neonatal unit may allow parents and professionals to integrate webcams into practice and enhance care. [ABSTRACT FROM AUTHOR]

Objectives: First, to determine the incremental yield of whole‐genome sequencing (WGS) over quantitative fluorescence polymerase chain reaction (QF‐PCR)/chromosomal microarray analysis (CMA) with and without exome sequencing (ES) in fetuses, neonates and infants with a congenital anomaly that was or could have been detected on prenatal ultrasound. Second, to evaluate the turnaround time (TAT) and quantity of DNA required for testing using these pathways. Methods: This review was registered prospectively in December 2022. Ovid MEDLINE, EMBASE, MEDLINE (Web of Science), The Cochrane Library and ClinicalTrials.gov databases were searched electronically (January 2010 to December 2022). Inclusion criteria were cohort studies including three or more fetuses, neonates or infants with (i) one or more congenital anomalies; (ii) an anomaly which was or would have been detectable on prenatal ultrasound; and (iii) negative QF‐PCR and CMA. In instances in which the CMA result was unavailable, all cases of causative pathogenic copy number variants > 50 kb were excluded, as these would have been detectable on standard prenatal CMA. Pooled incremental yield was determined using a random‐effects model and heterogeneity was assessed using Higgins' I2 test. Subanalyses were performed based on pre‐ or postnatal cohorts, cases with multisystem anomalies and those meeting the NHS England prenatal ES inclusion criteria. Results: A total of 18 studies incorporating 902 eligible cases were included, of which eight (44.4%) studies focused on prenatal cohorts, incorporating 755 cases, and the remaining studies focused on fetuses undergoing postmortem testing or neonates/infants with congenital structural anomalies, constituting the postnatal cohort. The incremental yield of WGS over QF‐PCR/CMA was 26% (95% CI, 18–36%) (I2 = 86%), 16% (95% CI, 9–24%) (I2 = 85%) and 39% (95% CI, 27–51%) (I2 = 53%) for all, prenatal and postnatal cases, respectively. The incremental yield increased in cases in which sequencing was performed in line with the NHS England prenatal ES criteria (32% (95% CI, 22–42%); I2 = 70%) and in those with multisystem anomalies (30% (95% CI, 19–43%); I2 = 65%). The incremental yield of WGS for variants of uncertain significance (VUS) was 18% (95% CI, 7–33%) (I2 = 74%). The incremental yield of WGS over QF‐PCR/CMA and ES was 1% (95% CI, 0–4%) (I2 = 47%). The pooled median TAT of WGS was 18 (range, 1–912) days, and the quantity of DNA required was 100 ± 0 ng for WGS and 350 ± 50 ng for QF‐PCR/CMA and ES (P = 0.03). Conclusion: While WGS in cases with congenital anomaly holds great promise, its incremental yield over ES is yet to be demonstrated. However, the laboratory pathway for WGS requires less DNA with a potentially faster TAT compared with sequential QF‐PCR/CMA and ES. There was a relatively high rate of VUS using WGS. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Objectives: Transcerebellar diameter (TCD) has been utilized prenatally as a tool to estimate gestational age (GA) when fetal growth aberrations are suspected. Traditionally, first trimester ultrasound (1TUS) has been the gold standard of dating a pregnancy in spontaneous pregnancies. We sought to determine if neonatal TCD measurement was as accurate as 1TUS in the estimation of postconceptual gestational age (PCGA). Methods: A retrospective cohort from a registry of high‐quality transmastoid views of consecutive patients from July 2019 to November 2020, delivered from 24 to 34 weeks GA, and with a 1TUS were included. The reference PCGA was the sum of the GA at delivery by 1TUS and day of life. The PCGA by TCD was calculated from Chang et al for GA by TCD. Reference and experimental values were compared by correlation, agreement within 7 days, and Bland–Altman analysis. Results: Of the 154 individual patients in the registry of high‐quality transmastoid views during the study period, 62 met inclusion and exclusion criteria. PCGA by 1TUS and TCD were highly correlated (r = 0.86, P <.001; κ = 47% agreement within 7 days of PCGA). The bias of PCGA by TCD was 4.6 days earlier than the PCGA by 1TUS (95% confidence interval of agreement: −29.2, 20). Conclusions: PCGA estimation by neonatal transmastoid TCD was highly correlated with that of 1TUS. It generally underestimates GA by 4.6 days. This relationship warrants further investigation to determine if this method of estimating PCGA in undated gestations is generalizable. [ABSTRACT FROM AUTHOR]

Objective: To describe initial experience with use of the Glidescope Go videolaryngoscope by an Australian neonatal pre‐hospital and retrieval service. Methods: We conducted a 31‐month retrospective review of an airway registry for neonates intubated by MedSTAR Kids clinicians. Results: Twenty‐two patients were intubated using the Glidescope Go, compared with 50 using direct laryngoscopy. First‐pass success was 17/22 (77.3%) with the Glidescope Go and 38/50 (76%) with direct laryngoscopy. Complications occurred in 7/22 (32%) and 8/50 (16%), respectively. Conclusions: On initial review of this practice change, videolaryngoscopy allows neonatal tracheal intubation with a comparable success rate to direct laryngoscopy in a pre‐hospital and retrieval setting. [ABSTRACT FROM AUTHOR]

Background: Premature infants are inevitably exposed to painful events, including repetitive procedures, inflammation, or mixed stimulation that may induce long‐term behavioral outcomes. Here, we set up three neonatal painful models to investigate their long‐term effect on somatosensation and cognition. Methods: Three types of neonatal pain models in rat were set up. Rat pups were randomly assigned to four groups. The needling pain (NP) group received repetitive needle pricks on the paws from the day of birth (PD0) to postnatal day 7 (PD7) to mimic the diagnostic and therapeutic procedures. The inflammatory pain (IP) group received the injection of carrageenan into the left hindpaw at PD3 to induce IP in peripheral tissues. The mixed pain group received a combination of the NP and IP (NIP). The control (CON) group was untreated. We performed behavioral and biochemical testing of juvenile rats (PD21–PD26). Results: The NIP group showed a longer hypersensitivity than the NP group, when given a secondary inflammatory stimulation. NP led to insensitivity to anxiety‐causing stimuli and impairment of fear memory both aggravated by NIP. NP reduced the expression of synapse‐related molecules (GluN1/PSD95/GFAP) in the medial prefrontal cortex, and NIP exacerbated this decrease. The corticosterone secretion in the NIP group increased after the behavioral task, compared with those in other three groups. Conclusion: A combination of NP with inflammation occurring in the neonatal period might aggravate the adverse effects of each on somatosensory and cognitive development of rats, the mechanism of which might be associated with the increase of corticosterone secretion and the dysregulation of synaptic molecules. [ABSTRACT FROM AUTHOR]

Aim: Blood component transfusion is a common intervention in the neonatal intensive care unit (NICU). Parents consent on their babies' behalf. This study aimed to explore parents' understandings and experiences of consenting and the subsequent blood transfusion. Methods: A "low inference" qualitative descriptive semi‐structured interview approach was utilised. Grounded theory was employed. Parents described their memories of babies' transfusions, their responses to the consent process and assessed the written information they were given. Results: A purposive sample of 17 parents whose babies required blood transfusion in the NICU participated. Parents talked about their initial fears of transfusion, later replaced by confidence in the process and results of transfusion and trust in the healthcare professional team. The main themes elicited by the interviews were parents' expectations and outcomes of transfusion, parents' prior and current opinions of transfusion, parents trust in healthcare professionals and how parents would like to receive information about transfusions in the NICU. Conclusion: Parents in our study trust information from the healthcare professionals caring for their baby and would like more specific information about how blood transfusion will impact their baby, in a variety of means. Parents felt that blood transfusions were beneficial for their babies. [ABSTRACT FROM AUTHOR]

Background: Intensive care settings have high rates of medication administration errors. Medications are often administered by nurses and midwives using a specified process (the '5 rights'). Understanding where medication errors occur, the contributing factors and how best practice is delivered may assist in developing interventions to improve medication safety. Aims: To identify medication administration errors and context specific barriers and enablers for best practice in an adult and a neonatal intensive care unit. Secondary aims were to identify intervention functions (through the Behaviour Change Wheel). Study Design: A dual methods exploratory descriptive study was conducted (May to June 2021) in a mixed 56‐bedded adult intensive care unit and a 6‐bedded neonatal intensive care unit in Sydney, Australia. Incident monitoring data were examined. Direct semi‐covert observational medication administration audits using the 5 rights (n = 39) were conducted. Brief interviews with patients, parents and nurses were conducted. Data were mapped to the Behaviour Change Wheel. Results: No medication administration incidents were recorded. Audits (n = 3) for the neonatal intensive care unit revealed no areas for improvement. Adult intensive care unit nurses (n = 36) performed checks for the right medication 35 times (97%) and patient identity 25 times (69%). Sixteen administrations (44%) were interrupted. Four themes were synthesized from the interview data: Trust in the nursing profession; Availability of policies and procedures; Adherence to the '5 rights' and departmental culture; and Adequate staffing. The interventional functions most likely to bring about behaviour change were environmental restructuring, enablement, restrictions, education, persuasion and modelling. Conclusions: This study reveals insights about the medication administration practices of nurses in intensive care. Although there were areas for improvement there was widespread awareness among nurses regarding their responsibilities to safely administer medications. Interview data indicated high levels of trust among patients and parents in the nurses. Relevance to clinical practice: This novel study indicated that nurses in intensive care are aware of their responsibilities to safely administer medications. Mapping of contextual data to the Behaviour Change Wheel resulted in the identification of Intervention functions most likely to change medication administration practices in the adult intensive care setting that is environmental restructuring, enablement, restrictions, education, persuasion and modelling. [ABSTRACT FROM AUTHOR]

Alzheimer's disease (AD) is a debilitating neurodegenerative disorder, characterized by memory deficit and dementia. AD is considered a multifactorial disorder where multiple processes like amyloid‐beta and tau accumulation, axonal degeneration, synaptic plasticity, and autophagic processes plays an important role. In this study, the spatial proteomic differences in the neonatal 5xFAD brain tissue were investigated using MALDI‐MSI coupled to LC‐MS/MS, and the statistically significantly altered proteins were associated with AD. Thirty‐five differentially expressed proteins (DEPs) between the brain tissues of neonatal 5xFAD and their littermate mice were detected via MALDI‐MSI technique. Among the 35 proteins identified, 26 of them were directly associated with AD. Our results indicated a remarkable resemblance in the protein expression profiles of neonatal 5xFAD brain when compared to AD patient specimens or AD mouse models. These findings showed that the molecular alterations in the AD brain existed even at birth and that some proteins are neurodegenerative presages in neonatal AD brain. Highlights: Spatial proteomic alterations in the 5xFAD mouse brain compared to the littermate.26 out of 35 differentially expressed proteins associated with Alzheimer's disease (AD).Molecular alterations and neurodegenerative presages in neonatal AD brain.Alterations in the synaptic function an early and common neurobiological thread. [ABSTRACT FROM AUTHOR]

Objective: Seizures are common in critically ill children and neonates, and these patients would benefit from intravenous (IV) antiseizure medications with few adverse effects. We aimed to assess the safety profile of IV lacosamide (LCM) among children and neonates. Methods: This retrospective multicenter cohort study examined the safety of IV LCM use in 686 children and 28 neonates who received care between January 2009 and February 2020. Results: Adverse events (AEs) were attributed to LCM in only 1.5% (10 of 686) of children, including rash (n = 3,.4%), somnolence (n = 2,.3%), and bradycardia, prolonged QT interval, pancreatitis, vomiting, and nystagmus (n = 1,.1% each). There were no AEs attributed to LCM in the neonates. Across all 714 pediatric patients, treatment‐emergent AEs occurring in >1% of patients included rash, bradycardia, somnolence, tachycardia, vomiting, feeling agitated, cardiac arrest, tachyarrhythmia, low blood pressure, hypertension, decreased appetite, diarrhea, delirium, and gait disturbance. There were no reports of PR interval prolongation or severe cutaneous adverse reactions. When comparing children who received a recommended versus a higher than recommended initial dose of IV LCM, there was a twofold increase in the risk of rash in the higher dose cohort (adjusted incidence rate ratio = 2.11, 95% confidence interval = 1.02–4.38). Significance: This large observational study provides novel evidence demonstrating the tolerability of IV LCM in children and neonates. [ABSTRACT FROM AUTHOR]

Ankyrin Repeat Domain 11 (ANKRD11) gene mutations are associated with KBG syndrome, a developmental disability that affects multiple organ systems. The function of ANKRD11 in human growth and development is not clear, but gene knockout or mutation are lethal in mice embryos and/or pups. In addition, it plays a vital role in chromatin regulation and transcription. Individuals with KBG syndrome are often misdiagnosed or remain undiagnosed until later in life. This is largely due to KBG syndrome's varying and nonspecific phenotypes as well as a lack of accessible genetic testing and prenatal screening. This study documents perinatal outcomes for individuals with KBG syndrome. We obtained data from 42 individuals through videoconferences, medical records, and emails. 45.2% of our cohort was born by C‐section, 33.3% had a congenital heart defect, 23.8% were born prematurely, 23.8% were admitted to the NICU, 14.3% were small for gestational age, and 14.3% of the families had a history of miscarriage. These rates were higher in our cohort compared to the overall population, including non‐Hispanic and Hispanic populations. Other reports included feeding difficulties (21.4%), neonatal jaundice (14.3%), decreased fetal movement (7.1%), and pleural effusions in utero (4.7%). Comprehensive perinatal studies about KBG syndrome and updated documentation of its phenotypes are important in ensuring prompt diagnosis and can facilitate correct management. [ABSTRACT FROM AUTHOR]

Heterozygous pathogenic variants in PPP2R5D gene are associated with PPP2R5D‐related neurodevelopmental disorder, a rare autosomal dominant condition, characterized by neurodevelopmental impairment in childhood, macrocephaly/megalencephaly, hypotonia, epilepsy, and dysmorphic features. Up‐to‐date, only approximately 100 cases have been published in the literature and the full phenotypic and genotypic spectrum have not yet been fully described. PPP2R5D gene encodes the B56δ subunit of the PP2A enzyme complex. We describe a neonatal form of PPP2R5D‐related disorder with early infantile death, caused by a novel in‐frame deletion causing loss of 8 amino acids and insertion of serine at position 201 (p.Phe194_Pro201delinsSer) of the B56δ subunit. This deletion is predicted to disrupt a critical acidic loop of amino acids important for binding other subunits of the PP2A enzyme complex, and harbors many of the residues previously reported to cause a mild–moderate form of this condition. This report describes a neonatal lethal presentation of the PPP2R5D‐related neurodevelopmental disorder and provides additional evidence that disruption of the acidic loop is an important pathomechanism underlying PPP2R5D‐related disorder. [ABSTRACT FROM AUTHOR]

Spondylocostal dysostosis (SCD), a condition characterized by multiple segmentation defects of the vertebrae and rib malformations, is caused by bi‐allelic variants in one of the genes involved in the Notch signaling pathway that tunes the "segmentation clock" of somitogenesis: DLL3, HES7, LFNG, MESP2, RIPPLY2, and TBX6. To date, seven individuals with LFNG variants have been reported in the literature. In this study we describe two newborns and one fetus with SCD, who were found by trio‐based exome sequencing (trio‐ES) to carry homozygous (c.822‐5C>T) or compound heterozygous (c.[863dup];[1063G>A]) and (c.[521G>T];[890T>G]) variants in LFNG. Notably, the c.822‐5C>T change, affecting the polypyrimidine tract of intron 5, is the first non‐coding variant reported in LFNG. This study further refines the clinical and molecular features of spondylocostal dysostosis 3 and adds to the numerous investigations supporting the usefulness of trio‐ES approach in prenatal and neonatal settings. [ABSTRACT FROM AUTHOR]

Introduction: Peripheral blood stem cell collection (PBSCC) is well‐documented in adults and pediatric patients with larger total blood volume (TBV). However, very little data are available for the successful PBSCC of pediatric patients weighing less than 10 kg. Here, we highlight our institutional approach to PBSCC in this smaller‐sized patient population. Methods: Our protocol, including blood prime, was reviewed for PBSCC for bone marrow transplantation (BMT) in 18 children weighing 4.5‐9.9 kg who safely underwent 37 PBSCC procedures at a single institution, Children's Hospital Colorado, between September 2016 and February 2022. Results: We attained the individualized collection goals in all 18 patients with an average yield of 17.03 million CD34+ cells/kg of patient body weight (range: 0.84‐67.45 million/kg). The average collection efficiency of the procedures was 41.5% (range: 23.0%‐71.5%). We performed all 37 procedures safely and without complication. The estimated average TBV was 587 mL (range: 351‐765 mL), the average blood volume processed was 596 mL (range: 351‐756 mL), and the average TBVs processed was 2.5 (range: 1‐4). Conclusion: PBSCC in patients ranging from 4.5 to 9.9 kg is safe and effective for collecting peripheral blood stem cells for BMT. [ABSTRACT FROM AUTHOR]

Tuberous sclerosis complex (TSC) is a rare genetic disease with neurocutaneous manifestations, often presenting initially to the dermatology clinic. We report a cohort of neonates who presented with a novel finding of white epidermal nevus and were eventually diagnosed with TSC. White epidermal nevus may be yet another dermatological finding that may aid in the early diagnosis of TSC. [ABSTRACT FROM AUTHOR]

A 3‐week‐old baby with hydrops fetalis, acute respiratory failure, and shock of unknown etiology developed a diffuse, pustular rash with worsening inflammatory markers and respiratory status despite antimicrobials. Whole exome sequencing revealed a de novo, frameshift mutation in the SAM9DL gene, leading to the diagnosis of SAMD9L‐associated autoinflammatory disease. [ABSTRACT FROM AUTHOR]

This article discusses a case of a 2-week-old girl who presented with faint, pink-red patches on her abdomen. The examination revealed bilateral, symmetric, blanchable erythematous telangiectasias that formed a butterfly-shaped pattern over the lower abdomen. The diagnosis was determined to be transient abdominal telangiectasia of the newborn (TATN), which is a transient phenomenon that typically resolves on its own. The article also mentions other conditions that should be considered in the differential diagnosis and emphasizes that further testing and workup are unnecessary in the absence of abdominal distension. [Extracted from the article]

Background: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is caused by antibodies against human platelet antigens (HPA). However, in many cases that meet clinical criteria for the condition, maternal sera do not have HPA antibodies. In studies examining whether human leukocyte antigen (HLA) antibodies cause FNAIT, the results are limited and inconclusive. This study sought to examine whether clinically suspected FNAIT cases with absent maternal HPA antibodies had different HLA antibody strength and specificity compared to controls. Study Design and Methods: A retrospective case–control study assessed class I HLA antibody strength and specificity in cases submitted for testing to Versiti, Wisconsin. There were 813 cases that met initial screening criteria, but written consent could only be obtained for 50. After review of medical records and expert panel review, 31 cases with clinical criteria of FNAIT and maternal HLA but not HPA antibodies were included. Each case was matched for maternal age, gestational age at delivery, parity, and race/ethnicity to two controls from unaffected pregnancies that had maternal serum HLA antibodies. Results: FNAIT cases were found to have both significantly higher HLA antibody strength, measured by mean fluorescence index (MFI), and broader HLA antibody specificity at antigen epitope level, compared to matched controls (p <.001). p‐values remained significant after controlling for parity and gestational age at delivery. Discussion: Additional studies are needed to further examine whether the strong HLA antibodies identified in HPA‐antibody‐negative cases directly cause neonatal thrombocytopenia and whether prenatal treatment may be warranted in select cases to prevent recurrence. [ABSTRACT FROM AUTHOR]

Histopathologic findings in neonatal lupus erythematosus (NLE) are usually congruent with those of subacute cutaneous lupus erythematosus. However, neutrophilic dermatosis‐type histopathologic features are being increasingly recognized in the literature including rare cases with variant histiocytoid morphology. We report the case of a 7‐week‐old male presenting with figurate erythema. His mother was found to have elevated anti‐nuclear antibodies and was positive for anti‐SSA/Ro, anti‐SSB/La antibodies and Ro52 autoantibodies. The infant had a similar serological profile. Skin biopsy showed a histiocytoid interstitial infiltrate with mild lichenoid features, sparse neutrophils and mild leukocytoclasis. The histiocytoid infiltrate showed prominent CD68, CD163, and myeloperoxidase expression. Isolated clusters of CD123+ histiocytes were also present. This case highlights the rare finding of non‐bullous neutrophilic dermatosis with histiocytoid change in neonatal lupus. In neonates presenting with figurate erythemas with morphological histiocytic change on biopsy, NLE should be considered as a differential diagnosis and investigated for accordingly. [ABSTRACT FROM AUTHOR]