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Interstitial lung diseases in children are a diverse group in terms of etiology and pathogenesis. With advances in genetic testing, mutations in surfactant protein have now been identified as the etiology for childhood interstitial lung disease of variable onset and severity, ranging from fatal acute respiratory distress syndrome (RDS) in neonates to chronic lung disease in adults. We presented an 11-month-old girl with surfactant protein C deficiency and secondary pulmonary hypertension, successfully treated with hydroxychloroquine, and provided a detailed discussion of the clinical and diagnostic approach and management. [ABSTRACT FROM AUTHOR]

The issues of vertical viral transmission from mother to fetus and the potential complications caused by SARS-CoV-2 coagulopathy are still unclear. There are few literature data about the vertical transmission of SARS-CoV-2 and health outcomes in neonates born to mothers with symptomatic or asymptomatic coronavirus disease, with the existing data based on small sample sizes. This case series study consists of two newborn children (one pre-term and one term) who were born to SARS-CoV-2-positive mothers and admitted to the neonatal intensive care unit a few hours after birth. One child had cyanotic changes that affected the entire left leg and the left forearm, with multiple livid changes on the front of the chest and abdomen, the right upper arm, right thigh, neck, and face, and one child had an altered umbilical cord. The first child was treated conservatively, and the second child was treated surgically. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Despite improvements in neonatal care, neonatal bacterial meningitis is still an emerging problem worldwide with high rates of mortality. The present study evaluates data on suspected- and culture-proven neonatal bacterial meningitis in the light of a single tertiary reference center experience in Turkey in comparison with the globe. STUDY DESIGN: In this retrospective cohort study newborns admitted to Hacettepe University Ihsan Dogramaci Children's Hospital Neonatal Intensive Care Unit during a 5-year-period between April 2014-May 2019 and who underwent atraumatic lumbar puncture were included. RESULTS: Two hundred sixty-four patients fulfilled the inclusion criteria. Most common symptoms in all patients raised suspicion in favor of NBM and resulted in lumbar puncture were fever (34.5%, n=91), respiratory distress (31.1%, n=82), lethargy (31.1%, n=82), and apnea (26.1%, n=69). The incidence of culture-proven NBM among suspected patients was 5.7% (n=15/264); while the incidence is 3.1 per 1000 (15/4574) at all Neonatal Intensive Care Unit admissions. Respiratory distress (60.0%, n=9/15) and apnea (40.0%, n=6/15) were the most common symptoms in patients with NBM; which may be due to the predominance of premature newborns in the NBM group. The most common microorganisms in CSF cultures were coagulase-negative Staphylococci with Methicillin-resistant Staphylococcus epidermidis being most common among all. CONCLUSIONS: The present study underlines high rates of culture-proven neonatal bacterial meningitis among suspected newborns despite improvements in modern health care, which raises attention to careful evaluation of these patients and early administration of properly-selected antibiotics. Our incidence rates are in keeping with studies from the developed world. [ABSTRACT FROM AUTHOR]

Background. Early diagnosis of hypoxic-ischaemic encephalopathy (HIE) is crucial in preventing neurodevelopmental disabilities and reducing morbidity and mortality. The study was to investigate the plasma metabolic signatures in the peripheral blood of HIE newborns and explore the potential diagnostic biomarkers. Method. In the present study, 24 newborns with HIE and 24 healthy controls were recruited. The plasma metabolites were measured by gas chromatography-mass spectrometry (GC-MS), and the raw data was standardized by the EigenMS method. Significantly differential metabolites were identified by multivariate statistics. Pathway enrichment was performed by bioinformatics analysis. Meanwhile, the diagnostic value of candidate biomarkers was evaluated. Result. The multivariate statistical models showed a robust capacity to distinguish the HIE cases from the controls. 52 metabolites were completely annotated. 331 significantly changed pathways were enriched based on seven databases, including 33 overlapped pathways. Most of them were related to amino acid metabolism, energy metabolism, neurotransmitter biosynthesis, pyrimidine metabolism, the regulation of HIF by oxygen, and GPCR downstream signaling. 14 candidate metabolites showed great diagnostic potential on HIE. Among them, alpha-ketoglutaric acid has the potential to assess the severity of HIE in particular. Conclusion. The blood plasma metabolic profile could comprehensively reflect the metabolic disorders of the whole body under hypoxia-ischaemic injury. Several candidate metabolites may serve as promising biomarkers for the early diagnosis of HIE. Further validation based on large clinical samples and the establishment of guidelines for the clinical application of mass spectrometry data standardization methods are imperative in the future. [ABSTRACT FROM AUTHOR]

Aim: The study aims to evaluate the effect of thyroid hormone levels on the development of transient tachypnea of the newborn (TTN) and neonatal outcomes in preterm and term infants during hospitalization. Methods: Eighty-seven newborns with gestational age ≥34 weeks admitted to neonatal intensive care unit (NICU) between January 2016 and December 2019 were enrolled in our retrospective study. The hospital database system and patient files were scanned for data collection. Infants were divided into three groups (late preterm, early term, and term). Maternal features and demographic characteristics, thyroid hormones, neonatal outcomes during hospitalization of newborns with TTN were recorded. Results: The mean fT4 level was 1.51±0.33 ng/dL and the median thyroid-stimulating hormone (TSH) level was 3.1 mIU/L. Among 87 infants, 21 were late-preterm, 41 were early-term, and 25 were term infants. There was no difference in the mode of delivery, gender, need, and duration of mechanical ventilation, and non-invasive ventilation or O2 therapy. The mean fT4 level was 1.35±0.29 ng/dL in late preterms 2.5±2.1 ng/dL in early terms and 1.56±0.25 ng/dL in term infants. Late preterms had a lower fT4 level than early term and term groups which was statistically significant but no difference was present between subgroups in TSH levels. Conclusion: Evaluation of thyroid function should be considered especially in preterm babies hospitalized to NICU because of respiratory distress for an individualized approach if treatment is needed. [ABSTRACT FROM AUTHOR]

Ischemic brain injury provokes complex, time-dependent downstream pathways that ultimately lead to cell death. We aimed to demonstrate the levels of a wide range of metabolites in brain lysates and their on-tissue distribution following neonatal stroke and cell therapies. Postnatal day 12 mice underwent middle cerebral artery occlusion (MCAO) and were administered 1 × 105 cells after 48 h. Metabolomic analysis of the injured hemisphere demonstrated that a variety of amino acids were significantly increased and that tricarboxylic acid cycle intermediates and some related amino acids, such as glutamate, were decreased. With the exception of the changes in citric acid, neither mesenchymal stem/stromal cells nor CD34+ cells ameliorated these changes. On-tissue visualization with matrix-assisted laser desorption/ionization-mass spectrometry (MALDI-MS) imaging revealed that the signal intensity of glutamate was significantly decreased in the infarct area, consistent with the metabolomic analysis, while its intensity was significantly increased in the peri-infarct area after MCAO. Although cell therapies did not ameliorate the changes in metabolites in the infarct area, mesenchymal stem cells ameliorated the increased levels of glutamate and carnitine in the peri-infarct area. MALDI-MS imaging showed the location-specific effect of cell therapies even in this subacute setting after MCAO. These methodologies may be useful for further investigation of possible treatments for ischemic brain injury. [ABSTRACT FROM AUTHOR]

Quantitative nonlinear dynamics methods were used to study EEGs of newborns diagnosed with diseases accompanied by seizures and control EEGs of apparently healthy newborns. The control EEGs were found to have properties close to those of white noise. The EEGs of newborns with seizures had more pronounced regular properties. The obtained results may provide a basis for a technique for differentiating between newborns suspected for diseases accompanied by seizures and apparently healthy newborns. [ABSTRACT FROM AUTHOR]

Aim: Neonatal gastric perforation (NGP) is a rare, perplexing, life-threatening entity affecting neonates. We share our experience of operating upon cases of NGP s and highlight important points observed which may aid in further improving care of neonates, diagnosed with this entity. Materials and Methods: A retrospective analysis of all consecutive patients with NGP operated by the author, at various centers between January 2015 and December 2018, was carried out. We analyzed different variables for these and reached logical conclusions. Results: Between January 2015 and December 2018, we treated ten patients with gastric perforation. All the neonates were preterm, except one. Mean birth weight in our series was 1745 g (range 1300–2400 g). Deterioration in activity, worsening of sepsis, metabolic acidosis, increased ventilator requirements, and abdominal distension were prominent clinical features identified in all patients. All patients subsequently had massive pneumoperitoneum before surgery. Six patients had perforation along the greater curvature, two had perforation at the posterior wall, and two had near total gastric necrosis. We had four mortalities out of ten patients operated. Conclusion: NGP is associated with high mortality, especially in premature and low birth weight neonates. Severity of contributing factors in a premature predisposed neonate determines the severity of gastric necrosis, which in turn is an important prognostic factor. Certain preoperative signs can be useful and can aid in initiating preventive measures to curtail severity of the pathology. [ABSTRACT FROM AUTHOR]

The ATP-binding cassette transporter member A3 (ABCA3) is a lipid transporter with a critical function in pulmonary surfactant biogenesis. Biallelic loss-of-function mutations in ABCA3 result in severe surfactant deficiency leading to neonatal respiratory failure with death in the first year of life. Herein, we describe a newborn with severe respiratory distress at birth progressing to respiratory failure requiring transplant. This patient was found to have a maternally inherited frameshift loss-of-function ABCA3 mutation and a paternally inherited synonymous variant in ABCA3 predicted to create a cryptic splice site. Additional studies showed reduced ABCA3 expression in hyperplastic alveolar epithelial type II cells and lamellar body alterations characteristic of ABCA3 deficiency, leading to a diagnosis of autosomal recessive ABCA3-related pulmonary surfactant dysfunction. This case highlights the need for an integrated, comprehensive approach for the diagnosis of inherited diseases when in silico modeling is utilized in the interpretation of key novel genetic mutations. [ABSTRACT FROM AUTHOR]

Background Neonatal respiratory distress syndrome (NRDS) is commonly diagnosed by clinical sign and symptoms, blood gas analysis, and chest x-ray. In the past, lung ultrasound (LUS) was not standard for NRDS examination. Many studies show that ultrasound diagnostic tool for NRDS is accurate, reliable, low cost, easy to use, and safe because due to no ionizing radiation. Objective To determine the sensitivity and specificity of LUS in diagnosing NRDS. Methods This meta-analysis study was conducted LUS as a diagnostic tool for NRDS. Inclusion criteria were all studies from PubMed, Embase, and The Cochrane Library, without any limitation on published journals, as well as using keywords or search terms of ultrasound, neonatal, and respiratory distress syndrome. Statistical analysis was undertaken using MedCalc® version 18.2 software. Results Seven studies with a total of 580 patients met the inclusion criteria. Proportional meta-analysis obtained random effects models, with total sensitivity of LUS was 97.2% (95% CI for I2 74.24 to 92.88; P<0.0001) and specificity of LUS was 94.8% (95% CI for I2 88.60 to 98.03; P<0.00001). Conclusion Lung ultrasound should be considered as a diagnostic tool for NRDS because it is high in sensitivity and specificity, inexpensive, safe, as well as limited radiation exposure. [ABSTRACT FROM AUTHOR]

Background Neonatal sepsis is a severe disease with potentially serious impacts if not treated early. However, the symptoms and clinical signs are not specific. Several studies have been conducted to find early infection markers for detection of neonatal sepsis, but without satisfactory results. Mean platelet volume (MPV) is a new marker of infection that has good potential for diagnosing neonatal sepsis. Objective To assess the diagnostic value of MPV in early detection of neonatal sepsis. Methods This retrospective study with diagnostic testing was done with data collected from medical records of neonates with neonatal sepsis who were admitted to the Neonatology Department in Sanglah Hospital, Denpasar from December 2018 to March 2019. Mean platelet volume cut-off point was determined using a receiver-operating characteristic (ROC) curve. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MPV in neonatal sepsis were determined using a 2x2 table. Results Of 82 subjects, 55 subjects were male (67%). Positive blood culture results were found in 25 subjects (30%). Mean platelet volume with a cut-off point of 7.44 fL had 80% sensitivity, 84.2% specificity, 69% PPV, and 90.6% NPV. Conclusion Mean platelet volume with a cut-off point of 7.44 fL can be used to diagnose neonatal sepsis with a sensitivity of 80% and specificity of 84.2%. [ABSTRACT FROM AUTHOR]

Congenital hypogonadotrophic hypogonadism (CHH) is a rare but important etiology of pubertal failure and infertility, resulting from impaired gonadotrophin-releasing hormone secretion or action. Despite the availability of effective hormonal therapies, the majority of men with CHH experience unsatisfactory outcomes, including chronic psychosocial and reproductive sequelae. Early detection and timely interventions are crucial to address the gaps in medical care and improve the outlook for these patients. In this paper, we review the clinical implications of missing minipuberty in CHH and therapeutic strategies that can modify the course of disease, as well as explore a targeted approach to identifying affected male infants by integrating clinical and biochemical data in the early postnatal months. [ABSTRACT FROM AUTHOR]

Background & Objectives: Neonatal septicemia is responsible for 1.5 to 2.0 million deaths/year in the under developed countries of the world. Pakistan is number three among these countries and accounts for 7% of global neonatal deaths. The objective of the study was to determine the role of simple hematological parameter, immature to total neutrophil ratio (l/T ratio) in diagnosing early onset neonatal bacterial infection. Methods: A descriptive cross-sectional study was conducted in Neonatal Intensive Care Unit of Liaquat College of Medicine & Dentistry (LCMD) Hospital from January 2016 to January 2017. A total 85 neonates were admitted with clinical suspicion of presumed early onset sepsis or who had potential risk factors for sepsis like prematurity, prolonged rupture of membranes was carried out. After taking informed consent from parents of admitted neonates, data was collected in a structured questionnaire. Laboratory workup included White blood cell count, CRP, absolute neutrophil count, immature neutrophil count while blood C/S was kept as gold standard. Empirical antibiotics started after sample collection for workup. Manual differential count and immature neutrophil count of the peripheral blood smear was performed by a senior technician masked to clinical information. l/T ratio was calculated from WBC, neutrophils and immature neutrophil count by a simple formula. Results: Out of 85 neonates, 13 had positive blood cultures (15.29%). The mean white blood count was 18761.18 ± 8570.75 and mean l/T ratio was 0.1622 ± 0.0419.About 50% of proven sepsis cases had WBC higher than 26000 as compared to 50% of cases for negative diagnoses that had WBC <15500 . The mean l/T in positive CRP 0.204 ± 0.04 was non-significantly higher as compared to negative CRP 0.151 ± 0.034 (p =0.084). Point biserial correlation revealed that l/T ratio was significant strong correlation (r b= 0.721, p < 0.001) and overall l/T ratio was a good indicator of a positive and negative blood culture result. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of l/T ratio were 76.47%, 83.82%, 54.16% and 93.44% respectively. Similarly majority of neonates having high l/T ratio also depicts positive C-reactive protein (CRP) (NPV 91.23%). Therefore, both l/T and CRP showed a high negative predictive value (l/T = 93.44% and CRP = 91.23%) in this study. Conclusion: l/T ratio is a useful tool for early onset sepsis (EOS) with reasonable specificity but cannot be relied upon as sole indicator. Combination of normal immature to total neutrophil Ratio with negative CRP values in neonates with presumed sepsis is an indicator of non-infected neonate which comprised 78.8% of our study population. [ABSTRACT FROM AUTHOR]

Highlights • Heart rate asymmetry is significantly affected by stressful stimuli. • Standard descriptors of heart rate asymmetry could be used for detection of neonatal stress. • A newly introduced index of heart rate asymmetry shows promising diagnostic properties for neonatal stress. Abstract The autocorrelation of the heart rate variability is presented by various methods and models, but Poincaré plots remain valuable analytic tools. Heart rate asymmetry analysis (HRA) is used for the quantification of unevenly distributed points above and below the line of identity. The aim of this work is to implement HRA analysis in newborns, to use it as a marker for acute stress. Forty healthy term newborn infants were included in the study. The protocol included two baseline phases, and two stress phases (heel stimulation and heel stick blood sampling), during which the heart rate was measured. Additionally, to the standard HRA indices, a new index (SKG) related to the first differences of the RR interval time series is introduced. A ROC curve analysis was applied to test the diagnostic properties of the asymmetry indices. With AUC significantly different from 0.5, the results show that HRA indices may be used as clinical markers. With higher AUC values (0.906 and 0.785), accuracy (87.5% and 81.3%) and sensitivity (87.5% and 81.3%), the SKG index outperformed the traditional indices. This novel application of HRA shows potential benefit in stress assessment of newborns, and in nonverbal patients in general. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 9‑month‑old girl was referred from the Department of Pediatrics with asymptomatic, congenital skin folds affecting the distal parts of upper and lower extremities, progressively increasing with age; the child was born out of nonconsanguineous parentage, at term by normal vaginal delivery; and he birth weight was 2.7 kg and her growth and developmental milestones were delayed for age.

Hearing is one of the most important sense organs for man. Hearing loss is often associated with delayed speech and language development in young children. Early identification and intervention improves the chance a child gets to lesser delays in development and improving the overall quality of life. To find out the prevalence of hearing loss in neonates in the rural taluka of Maval, Pune, Maharashtra, India. Prospective Non Randomized Clinical Study. The study was carried out between April 2012 and April 2015. A total of 8192 babies were screened across various centers around the Maval area. The babies who had some high risk factors were 1683 in number and babies who had no high risk factors i.e. well babies were 6509. In our study, the overall prevalence of hearing loss in neonates in Maval taluka of Maharashtra was found to be 3.54 per 1000 live births, in normal born neonates (well babies) was 1.689 per 1000 births, in high risk babies was 10.69 per 1000 high risk births. The prevalence of low birth weight neonates, hyperbilirubinemia neonates and neonates with craniofacial abnormalities developing hearing impairment was found to be 5.9, 3.56 and 1.18 per 1000 high risk births respectively. India is the second most populated country in the world with nearly a fifth of the world’s population. There is a need for the universal neonatal screening for deafness for earlier detection of deafness and rehabilitation.Level of Evidence: Level IV. [ABSTRACT FROM AUTHOR]

Nonsteroidal anti-inflammatory drugs (NSAIDs) are used as tocolytics, which are medications that suppress uterine contractions for preterm birth prevention. Their effect on cerebral/systemic vascular beds poses the question of whether antenatal NSAID exposure is associated with neonatal hypertension. We performed a retrospective case-control study in a tertiary neonatal intensive care unit, including 40 hypertension cases (hospitalized neonates ≥ 35 weeks with systolic BP > 100 mm Hg on three consecutive days) compared to 134 controls matched by gestational age at delivery, plurality, and delivery date. Cases and controls were compared by antenatal NSAID exposure, other common tocolytics, and maternal/neonatal characteristics and complications. Multivariable logistic regression was used to estimate the odds of hypertension among those with prenatal exposure to NSAIDs versus those without exposure. Newborns with hypertension had a lower gestational age at delivery and increased incidence of neonatal complications, including respiratory distress syndrome, bronchopulmonary dysplasia, surfactant administration, longer duration of ventilation, and history of umbilical artery catheterization. Days of indomethacin exposure were positively associated with greater odds of neonatal hypertension (OR 1.17 [1.00 to 1.38], P = 0.055), even after adjustment for other factors associated with neonatal hypertension. Newborns with hypertension were less likely to have been exposed to calcium channel blockers as a tocolytic. The results of our study suggest an association between prenatal exposure to nonsteroidal anti-inflammatory drugs and neonatal hypertension. Furthermore, our data suggest that prenatal calcium channel blocker exposure may protect against the development of neonatal hypertension. Future multicenter studies are needed to understand the risks of tocolytics and subsequent consequences in preterm infants. [ABSTRACT FROM AUTHOR]

EEG signal contains some specific patterns that predict neuro-developmental impairments of a premature newborn. Extracting these patterns from a set of EEG records provides a dataset to be used in machine learning in order to implement an intelligent classification system that predict prognosis of the baby. In a previous work we proved that inter-burst intervals (IBI) found in the EEG records predicts abnormal outcomes of the premature. A bibliographic study on the amplitude of an EEG signal, with the annotations of the neuro-pediatricians, showed that low amplitudes in EEG signal are strongly correlated with an abnormal prognosis of the premature, similar to that of IBI. According to these hypotheses, we present in this paper, a segmentation methodology on the amplitude of bursts intervals of EEG signal into 3 segments: low, medium and high, in addition to the inter-burst intervals. We create a new algorithm that detects 6 important parameters in each interval of these 4 segments. After applying this new methodology, we obtain a new classified dataset that contains 24 parameters extracted from these 4 segments to obtain with gestational age of the preterm and the day of recording 26 input attributes and one output which is the class (normal, sick or risky). Finally we validate the pertinence of these attributes using artificial neural network. [ABSTRACT FROM AUTHOR]

Objective: To describe clinical features and early neurological outcomes in neonatal Chikungunya.Methods: Clinical, pathological and radiological details of neonates with acute encephalitic features and typical rash, later diagnosed as Chikungunya, are presented. Neurodevelopmental evaluation and imaging was done at discharge/three months.Results: Abnormal neurological examination with fever was typical presentation in all 13 babies with/without seizures/peri-oral rashes; 12 had persistent neurological abnormalities at discharge. A follow-up at three months revealed continued neurodevelopmental deficits. Neuroimaging abnormalities were seen in eight out of ten cases.Conclusions: Perinatal Chikungunya should be considered in neonates presenting within first week with fever, encephalopathy and perioral rashes with/without seizures with history of maternal Chikungunya within last week before delivery. [ABSTRACT FROM AUTHOR]

Background: Van Den Ende-Gupta Syndrome (VDEGS) is an extremely rare autosomal recessive syndrome with less than 20 reported families (approximately 40 patients) in the worldwide literature. Case presentation: We have assessed one consanguineous Saudi family with typical features of VDEGS. Two siblings were affected with almost identical features; including blepharophimosis, arachnodactyly, flexion contractures of the elbows, camptodactyly, slender ribs, hooked lateral clavicular ends, and bilateral radial head dislocations. Both patients had several unusual features; including joint laxity, flat feet, recurrent patellar dislocations, and bilateral short distal ulnae. Full sequencing of SCARF2 revealed a homozygous mutation c.773G > A (p. Cys258Tyr) in both affected children. The parents (both with no abnormalities) were heterozygous for the same mutation. Conclusion: Joint laxity, recurrent patellar dislocations, and short distal ulnae should be included as part of the clinical spectrum of VDEGS. [ABSTRACT FROM AUTHOR]

Objective: to analyze the anxiety level of the mothers of newborns with congenital malformations who were diagnosed in prenatal and postnatal care. Methods: a cross-sectional study with 115 mothers of 117 newborns with congenital malformation admitted to three neonatal units. A questionnaire containing maternal and neonatal variables was used, as well as the Trait-State Anxiety Inventory. Data were analyzed by Student's t-test and Kolmogorov-Sminorv test. The anxiety level was categorized as low (percentile <25), moderate (25-75) and high (> 75), with a significance level of 5%. Results: most mothers had moderate levels of anxiety. Regarding the diagnosis of the malformation, 57% received the news in the prenatal and 43% in the postnatal period. The anxiety level of those who received the prenatal diagnosis was lower than those who received in the postnatal period, evaluated by the Trait Anxiety Inventory (p = 0.026). Conclusion: mothers of newborns with malformations presented moderate anxiety, and this was higher when the diagnosis was given in the postnatal period. The use of the Trait-State Anxiety Inventory can provide guidance to other studies and to clinical practice. [ABSTRACT FROM AUTHOR]

Although congenital diaphragmatic hernia (CDH) primarily presents in either the prenatal or neonatal period, late presentation has a reported incidence of 2.5–25%. This case report describes an 8-month-old-male who presented to the emergency department with dehydration and a 24-h history of bilious emesis. Work-up led to the diagnosis of a left-sided Bochdalek CDH. He subsequently underwent laparoscopic diaphragmatic hernia repair with reduction of near-total length of incarcerated bowel. The patient had an uneventful recovery. Babies born with CDH are typically unstable at birth, and even with repair, the mortality rate remains high. However, in the case of delayed CDH diagnosis where there are no perinatal issues, surgical repair has very high success rates, provided that there are no complications regarding the delay. If there is not a high index of suspicion based on the patient's history and exam, delayed diagnosis and intervention with late CDH presentations can lead to complications which could otherwise be minimized. The purpose of this case report is to raise awareness and contribute to the growing knowledge about delayed CDH presentation among physicians and surgeons to facilitate early diagnosis and care of a morbid yet manageable condition. [ABSTRACT FROM AUTHOR]

Background & objective: Perinatal asphyxia affects all organs of the body and brain is the most affected organ. The study was undertaken to find out the status of serum magnesium and calcium level and their significant association among asphyxiated term newborns with moderate to severe HIE. Material & methods: The Cross sectional study was done in the Department of Neonatology, Dhaka Medical College Hospital during January 2012 to July 2012. A total of 102 asphyxiated term neonates were enrolled, who has H/O perinatal asphyxia and had Apgar score of 6 or <6 at 5 minutes. Clinical grading of HIE into moderate and severe was done according to modified Sarnat and Sarnat scoring system .Under aseptic precautions with standard protocol, estimation of serum magnesium and calcium level in venous blood was done at 48 hours and 7th day of birth . Among the study population, 17 patients had died during follow up and 4 patients were absconded. Finally 81 patients were evaluated by both blood samples though initial 102 cases were evaluated by their first sample. 50 normal healthy infants were also evaluated for serum magnesium and calcium at their 48 hours of birth. Chi-square test was used to assess statistical significance, Pearson correlation coefficient test was done to find out correlation between serum magnesium and calcium status and APGAR score & t test was done to assess the comparison between the values of serum magnesium and calcium found on two occasions. Results: Of 102 cases majority (58%) were male. Most of the cases (65.68%) were moderate HIE. Mean serum magnesium was 1.36(0.9-2.8) mg/dl and 1.16(.88-2.6) mg/dl among HIE II and HIE III respectively (p<0.05). Mean serum calcium of HIE II and HIE III were 7.14(5.1-9.6) mg/dl and 6.58(5.3-9.0) mg/dl respectively (p<0.05). There is positive correlation with individual APGAR score with serum magnesium (r=0.229, p=0.02) and serum calcium (r=0.231, p=0.019) level. Hypocalcaemia was found 35.82% and 57.14% among HIE II And HIE III cases respectively (p<0.01). Hypomagnesaemia was found 28.36% and 45.71% among HIE II and HIE III (p<0.05). Conclusion: Hypomagnesaemia and hypocalcaemia are significantly associated with the degree of severity of HIE. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effectiveness of critical congenital heart disease (CCHD) screening program for early diagnosis of cardiac anomalies in newborn infants. Methods: This is a hospital-based prospective cross-sectional study conducted in the Pediatric and Neonatology Department, King Fahad Hospital at Albaha, Saudi Arabia, between February 2016 and February 2017. Results: We screened 2961 (95.4%) of 3103 patients in a nursery unit; 142 (4.6%) patients were not screened. The test was positive in 114 (3.9%) patients and negative in 2847 (96.1%). There were 94 (3.2%) false positives and 20 (0.7%) true positives. Critical cardiac defects were diagnosed in 7 (0.2%) patients of all screened infants, and severe pulmonary hypertension was diagnosed in 13 (0.4%) patients. True negative results were found in 2841(96%) patients, and no cardiac defect was diagnosed, whereas false negative results were seen in 6 (0.2%) patients diagnosed with ventricular septal defect. The sensitivity was 77%, and the specificity was very high at 97%, with a positive predictive value of 18%, and a negative predictive value of 99.8% (95% confidence interval 13.78-19.18, p=0.0001). Conclusion: Pulse oximetry was found to be easy, safe, sensitive, and highly specific for diagnosis of CCHD. [ABSTRACT FROM AUTHOR]

Horses are a precocious species that must accomplish several milestones that are critical to survival in the immediate post-birth period for their survival. One essential milestone is the successful transition from the intrauterine unconsciousness to an extrauterine state of consciousness or awareness. This transition involves a complex withdrawal of consciousness inhibitors and an increase in neuroactivating factors that support awareness. This process involves neuroactive hormones as well as inputs related to factors such as cold, visual, olfactory, and auditory stimuli. One factor not previously considered in this birth transition is a yet unreported direct neural reflex response to labor-induced physical compression of the fetus in the birth canal (squeezing). Neonatal maladjustment syndrome (NMS) is a disorder of the newborn foal characterized by altered behavior, low affinity for the mare, poor awareness of the environment, failure to bond to the mother, abnormal sucking, and other neurologically-based abnormalities. This syndrome has been associated with altered events during birth, and was believed to be caused exclusively by hypoxia and ischemia. However, recent findings revealed an association of the NMS syndrome with the persistence of high concentrations of in utero neuromodulating hormones (neurosteroids) in the postnatal period. Anecdotal evidence demonstrated that a novel physical compression (squeeze) method that applies 20 min of sustained pressure to the thorax of some neonatal foals with this syndrome might rapidly hasten recovery. This survey provides information about outcomes and time frames to recovery comparing neonatal foals that were given this squeeze treatment to foals treated with routine medical therapy alone. Results revealed that the squeeze procedure, when applied for 20 min, resulted in a faster full recovery of some foals diagnosed with NMS. The adjunctive use of a non-invasive squeeze method may improve animal welfare by hastening recovery and foal-mare interactions that minimize health problems. This would also avoid or reduce costs arising from hospitalization associated with veterinary and nursing care that sometimes leads owners to elect for euthanasia. [ABSTRACT FROM AUTHOR]

Transient abnormal myelopoiesis (TAM) also known as transient myeloproliferative disorder (TMD), a unique transient neonatal preleukaemic disorder characterized by clonal proliferation of megakaryoblasts, has been usually described to be associated with Down syndrome neonates. However, there are case reports of it occurring in neonates without Down phenotype, who are either mosaic for trisomy 21 or have trisomy 21 restricted to leukemic clone. This case report presents a case of TAM in a phenotypically normal neonate who presented in respiratory distress with features of tumour lysis syndrome (TLS) immediately after birth who was treated symptomatically and had spontaneous remission within three months. [ABSTRACT FROM AUTHOR]

Background: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is commonly detected during mass screening for neonatal disease. We developed a method to measure reduced glutathione (GSH) and glutathione disulfide (GSSG) using tandem mass spectrometry (MS/MS) for detecting G6PD deficiency.Methods: The concentration of GSH and the GSH/GSSG ratio in newborn dry-blood-spot (DBS) screening and in blood plus sodium citrate for test confirmation were examined by MS/MS using labeled glycine as an internal standard.Results: G6PD-deficient newborns had a lower GSH content (242.9 ± 15.9 μmol/L)and GSH/GSSG ratio (14.9 ± 7.2) than neonatal controls (370.0 ± 53.2 μmol/L and 46.7 ± 19.6, respectively). Although the results showed a significance of P < 0.001 for DBS samples plus sodium citrate that were examined the first day after preparation, there were no significant differences in the mean GSH concentration and GSH/GSSG ratio between the G6PD deficiency-positive and negative groups when examined three days after sample preparation.Conclusion: The concentration of GSH and the ratio of GSH/GSSG in blood measured using MS/MS on the first day of sample preparation are consistent with G6PD activity and are helpful for diagnosing G6PD deficiency. [ABSTRACT FROM AUTHOR]

Background: Yearly, nearly all the estimated worldwide 2.7 million neonatal deaths occur in low- and middle-income countries. Infections, including those affecting the umbilical cord (omphalitis), are a significant factor in approximately a third of these deaths. In fact, the odds of all-cause mortality are 46% higher among neonates with omphalitis than in those without. Five large randomized controlled trials in Asia and Sub-Saharan Africa (SSA) have examined the effect of multiple cord stump applications with 4% chlorhexidine (CHX) for at least 7 days on the risk of omphalitis and neonatal death. These studies, all community-based, show that multiple CHX applications reduced the risk of omphalitis. Of these trials, only one study from South Asia (the Bangladeshi study) and none from Africa examined the effect of a single application of CHX as soon as possible after birth. In this Bangladeshi trial, CHX led to a reduction in the risk of mild-moderate omphalitis and neonatal death. It is important, in an African setting, to explore the effect of a single application among health-facility births. A single application is programmatically much simpler to implement than daily applications for 7 days. Therefore, our study compares umbilical cord cleansing with a single application of 4% CHX at birth with dry cord care among Ugandan babies born in health facilities, on the risk of omphalitis and severe neonatal illness.Methods: The CHX study is a facility-based, individually randomized controlled trial that will be conducted among 4760 newborns in Uganda. The primary outcomes are severe illness and omphalitis during the neonatal period. Analysis will be by intention-to-treat.Discussion: This study will provide novel evidence, from a Sub-Saharan African setting, of the effect of umbilical cord cleansing with a single application of 4% CHX at birth and identify modifiable risk factors for omphalitis.Trial Registration: ClinicalTrials.gov, identifier: NCT02606565 . Registered on 12 November 2015. [ABSTRACT FROM AUTHOR]

Introduction. Zonulin (ZO), a new diagnostic biomarker of intestinal permeability, was tested in newborns presenting symptoms of infection and/or inflammation of the gut or being at risk of intestinal pathology. Material and Methods. Serum ZO was assessed in 81 newborns diagnosed with sepsis, necrotizing enterocolitis (NEC), rotavirus infection, and gastroschisis, also in extremely low gestational age babies, and in controls (healthy newborns). ZO concentration was compared to C-reactive protein (CRP) and procalcitonin (PCT) values, leucocyte and platelet count, basic demographic data, and the value of the Neonatal Therapeutic Intervention Scoring System (NTISS). Results. Median values of ZO were markedly higher in groups with rotavirus infection and gastroschisis (36.0 (1-3Q: 26.0–43.2) and 20.3 (1-3Q: 17.7–28.2) ng/ml, resp.) versus controls (3.5 (1-3Q: 2.7–4.8) ng/ml). Its concentration in the NEC group was twice as high as in controls but did not reach statistical significance. ZO levels were not related to NTISS, CRP, and PCT. Conclusions. Zonulin is a promising biomarker of intestinal condition, markedly elevated in rotavirus infections. Its role in defining the severity of necrotizing enterocolitis and the risk for perforation is not well described and needs further evaluation. An increase in zonulin may not be parallel to the release of inflammatory markers, and low CRP should not exclude an injury to neonatal intestine. [ABSTRACT FROM AUTHOR]

Background: Over 5 million stillbirths and neonatal deaths occur annually. Limited and imprecise information on the cause of these deaths hampers progress in achieving global health targets. Complete diagnostic autopsies (CDAs)-the gold standard for cause of death determination-are difficult to perform in most high-burden settings. Therefore, validation of simpler and more feasible methods is needed.Methods and Findings: In this observational study, the validity of a minimally invasive autopsy (MIA) method in determining the cause of death was assessed in 18 stillbirths and 41 neonatal deaths by comparing the results of the MIA with those of the CDA. Concordance between the categories of diseases obtained by the 2 methods was assessed by the Kappa statistic, and the sensitivity, specificity, positive, and negative predictive values of the MIA diagnoses were calculated. A cause of death was identified in 16/18 (89%) and 15/18 (83%) stillborn babies in the CDA and the MIA, respectively. Fetal growth restriction accounted for 39%, infectious diseases for 22%, intrapartum hypoxia for 17%, and intrauterine hypoxia for 11% of stillborn babies. Overall, the MIA showed in this group a substantial concordance with the CDA (Kappa = 0.78, 95% CI [0.56-0.99]). A cause of death was identified in all (100%) and 35/41 (85%) neonatal deaths in the CDA and the MIA, respectively. In this group, the majority of deaths were due to infectious diseases (66%). The overall concordance of the MIA with the CDA in neonates was moderate (Kappa = 0.40, 95% CI [0.18-0.63]). A high percentage of accuracy was observed for the MIA in all the diagnostic categories in both stillbirths and neonates (>75%). The main limitation of this study is that some degree of subjective interpretation is inherent to cause-of-death attribution in both the MIA and the CDA; this is especially so in stillbirths and in relation to fetal growth restriction.Conclusions: The MIA could be a useful tool for cause-of-death determination in stillbirths and neonatal deaths. These findings may help to accelerate progress towards meeting global health targets by obtaining more accurate information on the causes of death in these age groups, which is essential in guiding the design of new interventions and increasing the effectiveness of those already implemented. [ABSTRACT FROM AUTHOR]

Background: As the number of deaths among children younger than 5 years of age continues to decline globally through programs to address the health of older infants, neonatal mortality is becoming an increasingly large proportion of under-5 deaths. Lack of access to safe delivery care, emergency obstetric care and postnatal care continue to be challenges for reducing neonatal mortality. This article reviews the available evidence regarding the effectiveness of community-based primary health care (CBPHC) and common components of programs aiming to improve health during the first 28 days of life.Methods: A database comprising evidence of the effectiveness of projects, programs and field research studies (referred to collectively as projects) in improving maternal, neonatal and child health through CBPHC has been assembled and described elsewhere in this series. From this larger database (N = 548), a subset was created from assessments specifically relating to newborn health (N = 93). Assessments were excluded if the primary project beneficiaries were more than 28 days of age, or if the assessment did not identify one of the following outcomes related to neonatal health: changes in knowledge about newborn illness, care seeking for newborn illness, utilization of postnatal care, nutritional status of neonates, neonatal morbidity, or neonatal mortality. Descriptive analyses were conducted based on study type and outcome variables. An equity assessment was also conducted on the articles included in the neonatal subset.Results: There is strong evidence that CBPHC can be effective in improving neonatal health, and we present information about the common characteristics shared by effective programs. For projects that reported on health outcomes, twice as many reported an improvement in neonatal health as did those that reported no effect; only one study demonstrated a negative effect. Of those with the strongest experimental study design, almost three-quarters reported beneficial neonatal health outcomes. Many of the neonatal projects assessed in our database utilized community health workers (CHWs), home visits, and participatory women's groups. Several of the interventions used in these projects focused on health education (recognition of danger signs), and promotion of and support for exclusive breastfeeding (sometimes, but not always, including early breastfeeding). Almost all of the assessments that included a measurable equity component showed that CBPHC produced neonatal health benefits that favored the poorest segment of the project population. However, the studies were quite biased in geographic scope, with more than half conducted in South Asia, and many were pilot studies, rather than projects at scale.Conclusions: CBPHC can be effectively employed to improve neonatal health in high-mortality, resource-constrained settings. CBPHC is especially important for education and support for pregnant and postpartum mothers and for establishing community-facility linkages to facilitate referrals for obstetrical emergencies; however, the latter will only produce better health outcomes if facilities offer timely, high-quality care. Further research on this topic is needed in Africa and Latin America, as well as in urban and peri-urban areas. Additionally, more assessments are needed of integrated packages of neonatal interventions and of programs at scale. [ABSTRACT FROM AUTHOR]

Respiratory distress (RD) is the commonest reason for admission in Neonatology intensive care units (NICU) and it is caused by respiratory and non-respiratory illnesses. The goal of the study is to find out most important causes of RD in preterm babies with 32 or more weeks of gestation, and to compare the etiology factors for RD in those preterm and in full term babies. Retrospective study in the NICU, Clinical Hospital Osijek, during the year 2016 was done. Almost 20% of admitted in NICU have RD, 34% of preterm babies of or older than 32 weeks, and 12% of terms babies. Among newborns with RD 61% were boys, and 39% girls. Among all live born 4% of boys and 2, 6% of girls had RD. Mother's illnesses as a cause of RD were found in 23, 2% and illnesses of the child in the other 60, 1%. Complications during delivery caused RD in the last 4% of newborns (some neonates have had more than one reason for RD). In 18, 9% of newborns the etiological factor was not found, and RD is probably genetically caused. The proportion of unknown causes is higher in preterm babies (22%). RD in term babies is mainly caused by illnesses of the child himself, and in pre-term by mother's illnesses. [ABSTRACT FROM AUTHOR]

A 34-year-old woman at 25 weeks 3 days was diagnosed with preterm labor and underwent an emergency cesarean section. The neonate did not cry or show any activity. The heart rate was 80 beats/min and the oxygen saturation on pulse oximetry (SpO2) was 77%. Immediately, positive pressure ventilation was delivered by T piece resuscitator, and then anesthesiologist performed endotracheal intubation. The neonate demonstrated severe cyanosis and the SpO2 dropped to 30%. Ventilation was not successful even after intubation, and we found neck crepitus, chest wall distension, and severe cyanosis on physical examination. We suspected tension pneumothorax and performed needle thoracentesis. The neonate was stabilized and transferred to the neonatal intensive care unit for further treatment, but expired on the 10th day of life. We report a case of pulmonary air leak developing tension pneumothorax, pneumomediastinum, subcutaneous emphysema in an extremely-low-birth-weight preterm infant immediately after birth. [ABSTRACT FROM AUTHOR]

Background: Mutations in the GLI-similar 3 (GLIS3) gene encoding the transcription factor GLIS3 are a rare cause of neonatal diabetes and congenital hypothyroidism with 12 reported patients to date. Additional features, previously described, include congenital glaucoma, hepatic fibrosis, polycystic kidneys, developmental delay, facial dysmorphism, osteopenia, sensorineural deafness, choanal atresia, craniosynostosis and pancreatic exocrine insufficiency. Case presentation: We report a new case for consanguineous parents with homozygous novel mutation in GLIS3 gene who presented with neonatal diabetes mellitus, severe resistant congenital hypothyroidism, cholestatic liver disease, bilateral congenital glaucoma and facial dysmorphism. There were associated abnormalities in the external genitalia in form of bifid scrotum, bilateral undescended testicles, microphallus and scrotal hypospadias which might be a coincidental finding. Conclusions: We suggest that infants with neonatal diabetes associated with dysmorphism should be screened for GLIS3 gene mutations. [ABSTRACT FROM AUTHOR]

Background: Ralstonia genus are gram negative bacillus and includes four bacteria namely Ralstonia picketti, Ralstonia Solanacearum, Ralstonia insidiosa and Ralstonia mannitolilytica. These are opportunistic pathogens and cause infections in immunocompromised host. The sources of infection are usually contaminated solutions and water. The majority of the reported cases are caused by R. picketti. It is very rare cause of neonatal sepsis with less than twenty cases reported in literature till date. Case presentation: A late preterm male infant, Indian race was admitted to the neonatal intensive care unit for respiratory distress developing soon after birth. The infant was managed with respiratory support and gradually infant improved and diagnosis of transient tachypnea of newborn was made. At age of 84 h of postnatal life, the infant developed features of neonatal sepsis and investigations were suggestive of sepsis. The infant was started on intravenous antibiotic, multiple vasopressors and steroids. The blood culture showed growth of multi-drug resistant R. picketti. The antibiotics were changed as per sensitivity pattern and infant was discharged in good condition and was accepting breast feeding at the time of discharge. There was also no other case of R. picketti in the nursery during the same time period. Conclusion: Ralstonia picketti is an uncommon cause of neonatal sepsis and usually source of infection are contaminated solutions and medical products. The management involves early detection, treatment with appropriate antibiotics and doing surveillance culture to identify the possible source of infection. [ABSTRACT FROM AUTHOR]

Objective: To validate the quantification of T-cell receptor excision circles (TRECs) and kappa-deleting recombination excision circles (KRECs) by real-time polymerase chain reaction (qRT-PCR) for newborn screening of primary immunodeficiencies with defects in T and/or B cells in Brazil. Methods: Blood samples from newborns and controls were collected on filter paper. DNA was extracted and TRECs, and KRECs were quantified by a duplex real-time PCR. The cutoff values were determined by receiver operating characteristic curve analysis using SPSS software (IBM®, Armonk, NY, USA). Results: Around 6,881 samples from newborns were collected and TRECs and KRECs were quantified. The TRECs values ranged between 1 and 1,006 TRECs/μL, with mean and median of 160 and 139 TRECs/μL, respectively. Three samples from patients with severe combined immunodeficiency (SCID) showed TRECs below 4/μL and a patient with DiGeorge syndrome showed undetectable TRECs. KRECs values ranged from 10 to 1,097 KRECs/μL, with mean and median of 130 and 108 KRECs/μL. Four patients with agammaglobulinemia had results below 4 KRECs/μL. The cutoff values were 15 TRECs/μL and 14 KRECs/μL and were established according to the receiver operating characteristic curve analysis, with 100% sensitivity for SCID and agammaglobulinemia detection, respectively. Conclusions: Quantification of TRECs and KRECs was able to diagnose children with T- and/or B-cell lymphopenia in our study, which validated the technique in Brazil and enabled us to implement the newborn screening program for SCID and agammaglobulinemia. [ABSTRACT FROM AUTHOR]

Congenital Zika virus infection can cause microcephaly and severe brain abnormalities (1). Congenital Zika syndrome comprises a spectrum of clinical features (2); however, as is the case with most newly recognized teratogens, the earliest documented clinical presentation is expected to be the most severe. Initial descriptions of the effects of in utero Zika virus infection centered prominently on the finding of congenital microcephaly (3). To assess the possibility of clinical presentations that do not include congenital microcephaly, a retrospective assessment of 13 infants from the Brazilian states of Pernambuco and Ceará with normal head size at birth and laboratory evidence of congenital Zika virus infection was conducted. All infants had brain abnormalities on neuroimaging consistent with congenital Zika syndrome, including decreased brain volume, ventriculomegaly, subcortical calcifications, and cortical malformations. The earliest evaluation occurred on the second day of life. Among all infants, head growth was documented to have decelerated as early as 5 months of age, and 11 infants had microcephaly. These findings provide evidence that among infants with prenatal exposure to Zika virus, the absence of microcephaly at birth does not exclude congenital Zika virus infection or the presence of Zika-related brain and other abnormalities. These findings support the recommendation for comprehensive medical and developmental follow-up of infants exposed to Zika virus prenatally. Early neuroimaging might identify brain abnormalities related to congenital Zika infection even among infants with a normal head circumference (4). [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to determine the occurrence and antimicrobial profile of AmpC β-lactamase producing bacteria. Methods: The study was conducted at The Children s Hospital and The Institute of Child Health Lahore, Pakistan, during September 2011 to June 2012. A total number of 1,914 blood samples of suspected neonatal septicemia were processed. Isolates were identified using Gram s staining, API 20E and API 20NE tests. Gram negative isolates were screened for AmpC β-lactamase production against ceftazidime, cefotaxime and cefoxitin resistance and confirmed by inhibitor based method. Results: Total number of 54 (8.49%) Gram positive and 582 (91.5%) Gram negative bacteria were identified. Among Gram negative isolates 141 (22%) were AmpC producers and found to be 100% resistant to co-amoxiclav, cefoxitin, ceftazidime, cefotaxime, cefuroxime, cefixime, ceftriaxone, cefpodoxime, gentamicin, amikacin and aztreonam. Less resistance was observed against cefepime (30.4%), sulbactamcefoperazone (24.8%), piperacillin-tazobactam (10.6%), ciprofloxacin (20.5%) and meropenem (2.1%). All the isolates were found sensitive to imipenem. The patients harbored AmpC β-lactamases were on various interventions in which intravenous line was noted among (51.1%), naso-gastric tube (37.6%), ambu bag (8.5%), endotracheal tube (3.5%), ventilator (2.1%) and surgery (0.7%). Conclusion: Extensive use of invasive procedures and third generation cephalosporins should be restricted to avoid the emergence of AmpC beta-lactamases in neonates. [ABSTRACT FROM AUTHOR]

Short-chain acyl-CoA dehydrogenase deficiency (SCADD) is a rare autosomal recessive mitochondrial disorder of fatty acid β-oxidation, and is associated with mutations in the acyl-CoA dehydrogenase (ACADS) gene. Recent advances in spectrometric screening for inborn errors of metabolism have helped detect several metabolic disorders, including SCADD, without symptoms in the neonate period. This allows immediate initiation of treatment and monitoring, so they remain largely symptomless metabolic disease. Here, we report a 15-month-old asymptomatic male, who was diagnosed with SCADD by newborn screening. Spectrometric screening for inborn errors of metabolism 72 hours after birth revealed an elevated butyrylcarnitine (C4) concentration of 2.25 μmol/L (normal, <0.99 μmol/ L). Urinary excretion of ethylmalonic acid was also elevated, as detected by urine organic acid analysis. To confirm the diagnosis of SCADD, direct sequencing analysis of 10 coding exons and the exon-intron boundaries of the ACADS gene were performed. Subsequent sequence analysis revealed compound heterozygous missense mutations c.164C>T (p.Pro55Leu) and c.1031A>G (p.Glu344Gly) on exons 2 and 9, respectively. The patient is now growing up, unretarded by symptoms such as seizure and developmental delay. [ABSTRACT FROM AUTHOR]

Background: Conducting clinical trials with pre-term or sick infants is important if care for this population is to be underpinned by sound evidence. Yet, approaching the parents of these infants at such a difficult time raises challenges to obtaining valid informed consent for such research. In this study, we asked, What light does the analytical literature cast on an ethically defensible approach to obtaining informed consent in perinatal clinical trials?Methods: In a systematic search, we identified 30 studies. We began our analysis by applying philosophical frameworks, which were then refined as concepts emerged from the analytical studies, to present a coherent picture of a broad literature.Results: Between them, the studies addressed four themes. The first three were the ethical basis for parental informed consent for neonatal and/or perinatal research, the validity of parental consent in this context, and the range of possible options in methods for gaining consent. The last was the issue of risk and the possibility of a double-standard or asymmetry in the current approaches to the requirement for consent for research and consent for clinical treatment.Conclusions: In addressing these issues, the analysed studies showed that, whilst there are a variety of possible defences for seeking parental 'consent' to neonatal and/or perinatal clinical trials, these are all consistent with the strongly and widely held view that it is important that parents do give (or decline) consent for such research. So far as the method of obtaining consent is concerned, none of the existing consent processes reviewed by the research is satisfactory, and there are philosophical reasons for supposing that at least some parents will fail to give valid consent in a neonatal context. Furthermore, in giving parental 'consent' in a perinatal context, parents are authorising infant participation, not giving 'proxy consent'. Finally, there are reasons for giving weight to both parental 'consent' and the infant's best interests in both research and clinical treatment. However, there are also reasons to treat these factors differently in the two contexts, and this may be partly due to the differing relevance of risk in each case. A significant gap is the lack of any detailed discussion of a process of emergency and/or urgent 'assent', in which parents assent or refuse their baby's participation as best they can during the emergency and later give full consent to continuing participation and follow-up. [ABSTRACT FROM AUTHOR]

Introduction: A variety of lesions which may be transient, physiological, or pathological may be present during the neonatal period. However, most of these conditions are benign and self-limiting. Objective: To study the hospital-based incidence and clinical pattern of dermatoses during the early neonatal period. Methods: A hospital-based, cross-sectional study was conducted in a government hospital. A total of 1260 consecutive live babies delivered over a period of 1 year at the Department of Obstetrics and Gynecology were examined up to 7 days of extrauterine life. Results: Among 1260 newborns, 1242 (98.5%) had cutaneous lesions. Among them, 700 (55.5%) were males and 560 (44.4%) were females. Of these, 1119 (88.1%) weighed >2.5 kg, whereas 141 (11.9%) weighed <2.50 kg. 1176 (93.3) were born at term, 66 (5.3%) were preterm, and 18 (1.4%) were postterm. History of consanguinity was present in 211 (16.7%) cases. 817 (64.8%) newborns were delivered by normal vaginal route and 443 (35.1%) by cesarean section. Majority, i.e., 764 (60.6%) mothers were in the age group of 21-25 years, 318 (25.23%) below 20 years, 162 between 26 and 30 years (12.86%), and 16 (1.26) were more than 30 years. Mongolian spot, milia, sebaceous hyperplasia, erythema toxicum, and physiological scaling were the common physiological and transient dermatoses seen. A few pathological conditions such as Waardenburg syndrome and bathing trunk nevus were seen. Conclusion: The hospital-based incidence of neonatal dermatoses was 98.5% with no sexual predilection. Although common, most of the skin lesions in newborn are self-limiting requiring no treatment. Correct diagnosis and counseling the parents may relieve the anxiety and mental trauma. [ABSTRACT FROM AUTHOR]

Copyright of Jornal de Pediatria is the property of Sociedade Brasileira de Pediatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Jornal de Pediatria is the property of Sociedade Brasileira de Pediatria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Widespread use of fetal ultrasonography is accompanied by more frequent detection of antenatal hydronephrosis. Therefore, sonographic evaluation of neonates with a history of antenatal hydronephrosis is becoming more widespread. As an initial postnatal non-invasive imaging modality, ultrasonography is used to screen for persistence of hydronephrosis, determine the level and severity of obstruction, and contribute to appropriate diagnosis and treatment. This review aims to provide a practical overview of the sonographic evaluation of neonatal hydronephrosis and to describe the sonographic findings of conditions associated with hydronephrosis in the newborn. [ABSTRACT FROM AUTHOR]

Purpose: To determine the incidence of intraretinal hemorrhage in newborns at the Hospital de San José, Bogotá, Colombia from September 2009 to September 2010. Design: Cohort study. Methodology: Live newborns were examined at the San José Hospital for a year (September 2009 to 2010), analyzing neonatal and maternal factors associated with the presence of intraretinal hemorrhages. A simple random cluster sampling was used, excluding newborns with a compromised general status, as well as those whose parents or legal guardians did not sign the informed consent form. Patients with the presence of intraretinal hemorrhages were examined every 2 weeks until resolution was observed. Results: A total of 190 newborns were examined, finding an incidence of intraretinal hemorrhages of 22.6% (95% CI 16.6 to 28.6). Most of the mothers were nulliparous (55.8%) and deliveries were eutocic (65.1%). From newborns with hemorrhages, 81.3% were born at term, and hemorrhages in most patients (93.0%) were resolved by the second week of monitoring. Associations between hemorrhages and cesarean section (RR 0.42, CI 0.22 to 0.79) and episiotomy (RR 1.73, CI 1.02 to 2.94) were observed. Conclusions: Newborns who presented intraretinal hemorrhages were children of nulliparous mothers on whom episiotomy was performed, and some with eutocic and instrumented Intraretinal hemorrhages in newborns: Incidence and associated factors deliveries. The first two variables had statistical significance for the development of intraretinal hemorrhages. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal diabetes is a rare and surprising diagnosis, with many complications and difficult management by the medical team. Objectives: Management of the diabetes mellitus new-born in our maternity. Matherial and methods: Analysis of one of the rare cases of diagnosed neonatal diabetes. Conclusions: Given the rarity of such cases, this event can guide the medical care team consisting of obstetricians, neonatologist and diabetes doctor to effective collaboration by protocol management of new-born with diabetes mellitus suspicion. [ABSTRACT FROM AUTHOR]