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Objectives: To compare blood pressures (BP) between neonates with culture-proven sepsis and clinical sepsis in the first 120 h of sepsis onset and to examine association between BP and in-hospital mortality. Methods: In this cohort study, consecutively enrolled neonates with 'culture-proven' sepsis [growth in blood/ cerebrospinal fluid (CSF) within 48 h] and clinical sepsis (sepsis workup negative, cultures sterile) were analyzed. Their BP was recorded every 3-hourly for initial 120 h and averaged in 20 time-epochs of 6 h each (0–6 h to 115–120 h). BP Z-scores were compared between neonates with culture-proven vs. clinical sepsis and survivors vs. non-survivors. Results: Two hundred twenty eight neonates (102—culture-proven and 126—clinical sepsis) were enrolled. Both groups had comparable BP Z-scores except significantly lower diastolic BP (DBP) and mean BP (MBP) in 0–6 and 13–18 time-epochs in culture-proven sepsis group. Fifty-four neonates (24%) died during their hospital stay. BP Z-scores in the initial 54 h of sepsis were independently associated with mortality [systolic BP (SBP) Z-scores in first 54 h, DBP Z-scores in first 24 h, and MBP Z-scores in first 24 h] after adjusting for gestational age, birth weight, cesarean delivery, and 5-min Apgar score. On receiver operating characteristic curves, SBP Z-scores showed better discriminative ability than DBP and MBP to identify non-survivors. Conclusions: Neonates with culture-proven and clinical sepsis had comparable BP Z-scores except low DBP and MBP in the initial few hours in culture-proven sepsis. BP in initial 54 h of sepsis was significantly associated with in-hospital mortality. SBP discriminated non-survivors better than DBP and MBP. [ABSTRACT FROM AUTHOR]

High‐flow nasal cannula (HFNC) oxygen therapy, which is important in noninvasive respiratory support, is increasingly being used in critically ill neonates with respiratory failure because it is comfortable, easy to setup, and has a low incidence of nasal trauma. The advantages, indications, and risks of HFNC have been the focus of research in recent years, resulting in the development of the application. Based on current evidence, we developed guidelines for HFNC in neonates using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). The guidelines were formulated after extensive consultations with neonatologists, respiratory therapists, nurse specialists, and evidence‐based medicine experts. We have proposed 24 recommendations for 9 key questions. The guidelines aim to be a source of evidence and reference of HFNC oxygen therapy in clinical practice, and so that more neonates and their families will benefit from HFNC. [ABSTRACT FROM AUTHOR]

Objective To summarize the outcomes of robotic-assisted surgical system for congenital intestinal malrotation (CIM). Methods From August 2020 to June 2021, 15 CIM neonates underwent robotic-assisted surgery. The relevant clinical data、Surgery-related data, postoperative recovery were collected retrospectively. By analyzing the preoperative, intraoperative and prognosis of the children, The robotic-assisted surgical system for congenital intestinal malrotation was summarized. Results Of the 15 children, 13 were male and 2 female; gestational age 36+ 2 to 40+ 4 weeks; 2 premature infants, 13 term infants; 7 caesarean section, 8 vaginal delivery; operation age (11.7±5.9) d; weight (3 065±377) g; Preoperative ultrasound test showed that 7 cases with volvulus 720, 5 cases with volvulus 540, 3 cases with volvulus 360; 12 cases with biliary vomiting, 3 cases with non-biliary vomiting; 4 cases with combined atrial septal defect, 2 cases with complicated patent artery duct, 2 cases with combined ventricular septal defect and the remaining 7 cases without cardiac malformation. All of them underwent robotic-assisted procedures without any conversion into open surgery. The average operative duration was (57±8) min, the average system installation time (14±3) min, the average intra-abdominal pressure (IAP)(5.6±0.3)mmHg and the average end-tidal carbon dioxide (38.4±4.3) mmHg. The intra-operative bleeding volume was from 1 to 3 ml, the average mechanical ventilation time (5.2±1.8) hours, the average Initial oral feeding time (3.1±1.2) days, the average sufficient feeding time (7.2±1.8) days and the average hospitalization time (12.1±2.7) days. One child was re-operated due to an obstruction of focal intestinal adhesion. Another case was hospitalized for 27 days and it was significantly longer than other children due to abnormal intestinal motility. The remainders recovered well with no postoperative complications such as vomiting, abdominal distension or incision infection. During postoperative follow-ups, all of them were well fed with satisfactory surgical incision healing and normal growth and development. Conclusion Robot-assisted surgery is both safe and feasible for neonatal CIM and offers excellent outcomes. [ABSTRACT FROM AUTHOR]

Purpose In most neonatal intensive care units, echocardiography is performed at the bedside. The lack of closure of interatrial communications (IACs) in the oval fossa can affect mortality and morbidity. This study aimed to establish the rate of spontaneous closure of IACs diagnosed in the neonatal period and predict the need for subsequent evaluation according to various factors, including defect size and shape. Methods The study group comprised 1,242 newborns admitted between March 2017 and December 2020. We judged the closure of the IACs and evaluated the risk factors of each. Patients were classified into the absence or presence of IACs. The morphology of the IACs was classified into atrial septal defects, patent foramen ovale, and multiple holes. Results A total of 317 patients (131 female, 186 male) were enrolled in the study, and the average defect size was 3.0±1.0 mm. An overall spontaneous closure rate of 89.9% was observed during an average follow-up interval of 5.1±1.1 months. When multiple Cox regression analyses were performed to analyze the risk factors for spontaneous closure, initial defect size was a significant factor. The optimal cut-off value for predicting spontaneous closure of the IAC was 3.05 mm, and the area under the receiver operating characteristic curve was 0.625 (95% confidence interval, 0.520 to 0.729). Preterm infants had a larger defect size corrected for birth weight and a higher closure rate than term infants. Conclusion Other than large defect size, no factors delayed spontaneous closure. When defects in the oval fossa measure ≤3 mm, most patients experience spontaneous closure by 7 months of age.

Abstract Congenital knee dislocation (CKD) is a rare malformation characterized by hyperextension deformity of the knee with anterior tibia displacement, present at birth. Rarely reported, CKD might occur as an isolated deformity or commonly associated with musculoskeletal abnormalities, with the most common ones being developmental dysplasia of the hip (DDH) and clubfoot. The etiology is unknown, but CKD has been associated with certain intrinsic and extrinsic factors. Treatment with conservative methods at an early stage is most likely to yield successful results. We report here a rare case of successful spontaneous reduction of CKD in an infant within 24 hours of life.

Purpose We aimed to characterize invasive group B streptococcal infection (IGBSI) in young infants hospitalized through the emergency department. Methods We analyzed medical records of infants younger than 90 days with IGBSI, defined as group B streptococcus bacteremia or meningitis, who visited the emergency department from January 2009 through December 2021. Their clinical features were compared as per 2 criteria, neonates and meningitis. For the comparisons, we defined 2 composite outcomes, “clinically important abnormality (any of the followings: temperature > 38.5℃, leukocytes < 5,000/mm3 or > 15,000/mm3, absolute neutrophils > 4,000/mm3 or C-reactive protein > 2.0 mg/dL)”and “poor outcomes (any of the followings: intensive care unit, transfer, seizure or complications).”Percentages are rounded to the first decimal places. Results A total of 35 infants, of whom 15 (43%) were neonates and 17 (49%) were boys, had IGBSIs, including 23 infants (66%) with isolated bacteremia, 11 (31%) with bacteremia with meningitis, and 1 (3%) with isolated meningitis. Ill appearances were noted in 27 infants (77%) who encompassed all with meningitis. The other 8 infants (23%) looking well had 1 or more components of the clinically important abnormality. The neonates showed a higher frequency of vaginal delivery (87% vs. 35%; P = 0.002) and a lower frequency of a temperature > 38.5℃, compared to their counterparts (47% vs. 80%; P = 0.040). The infants with meningitis had a longer median time required to visit (5.0 vs. 2.0 hours; P = 0.011), and higher frequencies of ill appearance (100% vs. 65%; P = 0.032), leukocytes < 5,000/mm3 (67% vs. 13%; P = 0.002), and the poor outcomes (75% vs. 0%; P < 0.001). Conclusion Young infants with ill-looking appearance or abnormality in any of the fever or inflammatory markers may have IGBSIs, particularly meningitis.

ABSTRACT Introduction: Giant omphalocele (GO) is a complex condition for which many surgical treatments have been developed; however, no consensus on its treatment has been reached. The benefits and efficacy of botulinum toxin A (BTA) in the repair of large abdominal wall defects in adults has been proven, and its reported use in children has recently grown. The goal of this study is to describe a novel technique for primary repair of GO using BTA during the neonatal period and report our initial experience. Methods: patients were followed from August 2020 to July 2022. BTA was applied to the lateral abdominal wall in the first days of life followed by surgical repair of the abdominal defect. Results: while awaiting surgery, patients had minimal manipulation, without requiring mechanical ventilation, were on full enteral feeding, and in contact with their parents. The midline was approximated without tension and without the need for additional techniques or the use of a prosthesis. Patients were discharged with repaired defects. Conclusion: this approach represents a middle ground between staged and the nonoperative delayed repairs. It does not require aggressive interventions early in life, allowing maintenance of mother-child bonding and discharge of the patient with a repaired defect without the need for additional techniques or the use of a prosthesis. We believe that this technique should be considered as a new possible asset when managing this complex condition.

The sex ratio of live births (males/total [M/T]) approximates 0.515. Many factors reduce M/T, and these include stress. Antenatal sexing is used for female foeticide in the setting of male offspring preference. Regional differences and latitude gradients in M/T also occur. This study analysed M/T in the US by Census Regions. This was an ecological study. Live births by sex, Census region, state and mother's race were obtained from CDC Wonder (2007–2020). There were 55,453,437 births (M/T 0.5116, 95% confidence interval: 0.5115–0.5118). M/T was Black/African American < Indian/Alaska Native American < White < Asian (P <<0.0001). M/T was significantly lowest in South and highest in West. The South had the lowest proportion of Asian/Pacific Islander births (3.9%) and the highest proportion of Black/African American (21.9%). West has the highest proportion of Asian/Pacific Islander (11.2%) and the lowest proportion of Black/African American births (5.3%). In Asian/Pacific Islander births, M/T significantly rose to third order and fell to sixth order births, unlike the other races that showed a decline from the first order. Asian M/T may be elevated because of male offspring preference and selective female foeticide. M/T may be depressed in Black and American Indian/Alaskan births due to chronic stress, as race remains the most important factor associated with wealth inequality in the United States. The lower M/T of these two races when compared with White equates to a constant loss of 4.13 and 2.55/1000 male births. The higher Asian M implies a chronic loss of 3.78 females per 1000 births. Both have public health implications. [Display omitted] [ABSTRACT FROM AUTHOR]

Little is known about changes in portal, splenic, and hepatic vein flow patterns in children undergoing congenital heart surgery. This study aimed to determine the characteristics of portal, splenic, and hepatic vein flow patterns using ultrasonography in children undergoing cardiac surgery. Single-center, prospective observational study. Tertiary children's hospital, operating room. Children undergoing cardiac surgery. The authors obtained ultrasound data from the heart, inferior vena cava, portal, splenic, and hepatic veins before and after surgeries. In the biventricular group, which included children with atrial and ventricular septal defects and pulmonary stenosis (n = 246), the portal pulsatility index decreased from 38.7% to 25.6% (p < 0.001) after surgery. The preoperative portal pulsatility index was significantly higher in patients with pulmonary hypertension (43.3% v 27.4%; p < 0.001). In the single-ventricle group (n = 77), maximum portal vein flow velocities of Fontan patients were significantly lower (13.5 cm/s) compared with that of patients with modified Blalock-Taussig shunt (19.7 cm/s; p = 0.035) or bidirectional cavopulmonary shunt (23.1 cm/s; p < 0.001). The cardiac index was inversely correlated with the portal pulsatility index in the bidirectional cavopulmonary shunt and Fontan circulation. (β = -5.693, r2 = 0.473; p = 0.001) The portal pulsatility index was correlated with splenic venous pulsatility and hepatic venous atrial reverse flow velocity in biventricular and single-ventricle groups. The characteristics of venous Doppler patterns in the portal, splenic, and hepatic veins differed according to congenital heart disease. Further studies are required to determine the association between splanchnic venous Doppler findings and clinical outcomes in this population. [ABSTRACT FROM AUTHOR]

Objective: to evaluate clinical follow-up after hospital discharge of preterm newborns discharged from NICU located in the city of Pelotas. Method: quantitative, longitudinal and prospective study, held from October 2022 to March 2023. A questionnaire on sociodemographic and health conditions was applied during the intra-hospital period. After discharge, follow-up occurred through telephone calls to family members, at intervals of 30, 60 and 90 days, respectively. The outcome was associated with the maternal and health characteristics of PTNB using chi-square, considering p< 0.05. Results: eighty-seven children who were discharged from neonatal intensive care units were followed-up. A total of 60.9% of the children had their first consultation in the outpatient follow-up clinics. After consultation in the follow-up clinic with a pediatrician, 13.2%, were referred to other specialized professionals. For those treated in other health units, no subsequent referral was identified (p<0.001). Conclusion: clinical follow-up of premature babies occurs in a fragmented manner and does not follow the standard discharge flow, which can delay interventions and end up damaging growth and development. [ABSTRACT FROM AUTHOR]

The Korean Neonatal Network (KNN), which is celebrating its 10th anniversary, currently has more than 100 staff and researchers from >70 neonatal intensive care units nationwide in Korea. More than 85% to 90% of the population of very low birth weight infants in Korea are registered yearly, and more than half are followed up for up to 3 years at the KNN. A total of >19,000 cases have been accumulated through a strict data quality management process of the KNN. Based on this, >100 research projects have been proposed, >70 peer-reviewed papers have been published in leading international journals, and the cornerstone of the quality improvement project has been launched. In addition, we recently expanded the number of subjects for registration to very premature infants

Introduction. During the development and spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, a new inflammatory response syndrome arose in newborns, defined as the multisystem inflammatory syndrome (MIS) in neonates (MIS-N). Case report. A term infant girl with a fever diagnosed with SARS-CoV-2 infection was admitted to the hospital. In laboratory findings, the values of lactate dehydrogenase, ferritin, interleukin-6, and D-dimer were elevated. Upon admission, dual parenteral antibiotic therapy (ceftazidime, vancomycin), and one day later, low molecular weight heparin (LMWH) therapy, was commenced. After five days of hospitalization and febrility, with negative results of microbiological analyses and further deterioration of laboratory findings, intravenous immuno-globulin (IVIg) was administered at a dose of 2 g/kg for one day and methylprednisolone at a dose of 1 mg/kg/day for four days, after which the reduction of corticosteroid therapy was continued with prednisone. One day after IVIg dministration, the newborn became afebrile, with the gradual normalization of laboratory findings. The newborn was discharged after 16 days of hospitalization. Ten days after discharge, prednisone therapy was discontinued. Two weeks after discharge, the administration of heparin was discontinued. Seven days later, the D-dimer value increased significantly, and the anticoagulant therapy was reinstated. After one month, the D-dimer value completely normalized, and the LMWH therapy was discontinued. Conclusion. After the applied therapy for MIS in children, there was a cessation of febrility and gradual normalization of values of the laboratory parameters. This confirms that the new-born, in this case, probably had MIS-N. The prolonged elevated D-dimer value was most probably a consequence of the MIS.

Background/Aim. Congenital heart defect (CHD) is the most common type of birth defect and one of the leading causes of infant mortality. It can be isolated or occur as a part of multiple different syndromes. The reported worldwide incidence of isolated CHD is between 70 and 120 per 10,000 live births. The aim of the study was to estimate the incidence of nonsyndromic C HD in the Republic of Srpska (RS), Bosnia and Herzegovina and compare it with other countries. Methods. The fetuses, live-born and stillborn infants with CHD during 2015 and 2016 in the RS, were analyzed using data from a cross-sectional study. Results. The total incidence of CHD was 163.95 per 10,000 total births, and the incidence of live-born with CHD was 136.64 per 10,000. The diagnosis was established prenatally in 8.09% of cases. The most common type of anomaly was ventricular septal defect (45.63%), followed by an atrial septal defect (31.40%), patent ductus arteriosus (7.44%), and pulmonary valve stenosis (5.18%). A significant difference in the incidence of CHD between regions and different maternal age groups was found. Conclusion. The incidence of CHD in the RS found in this study is higher than in other studies, with marked heterogeneity between different regions. This study provides baseline data for future monitoring of the risk factor changes and the implementation of primary preventive measures.

Introduction. Empyema thoracis, defined as the accumulation of pus in the pleural space, is rare in the neonatal population. Limited data are reported in the medical literature, and still, no treatment guidelines are available for this age. Case report. We present a term 12-day-old neonate (born healthy) who developed sepsis caused by methicillin-resistant Staphylococcus aureus (MRSA) and pneumonia associated with advanced-stage empyema. The child was admitted to our hospital with a few-hours history of difficulty breathing and lethargy. On admission, the child was cyanotic with desaturation and in severe respiratory distress; therefore, the child was intubated, and mechanical ventilation was started. Imaging tests were performed in an emergency, hence chest computed tomography (CT) scan was done without contrast. Suspected congenital pulmonary airway malformation with trapped air collections, significant mediastinal shift on CT scan, and deterioration of the patient’s condition indicated urgent surgery. Intraoperatively, the diagnosis of stage II empyema was established, and decortication of thickened parietal and visceral pleura was performed. Afterward, the baby showed quick and progressive clinical improvement. Conclusion. The diagnosis and management of empyema in neonates may be challenging, especially in the case of unremarkable history, fulminant progression of the disease, and incomplete imaging tests.

Purpose North Korean refugee women struggle with the double burden of adaptation and parenting as mothers in a new environment. This study aimed to identify the knowledge, confidence, and educational needs regarding newborn care among North Korean refugees, and to determine differences between these variables according to participants' characteristics. Methods Data were collected from September to October 2022, and 150 North Korean refugee women recruited using convenience sampling participated in the study. Descriptive statistics, the t-test, analysis of variance, and Pearson correlation analysis were used for data analysis. Results The mean scores were as follows: parenting knowledge, 14.97 out of 25; infection prevention knowledge and confidence, 20.09 out of 33 and 51.37 out of 80, respectively; and educational needs, 245.86 out of 310. Significant differences were observed in newborn care, knowledge, and confidence according to maternal age, educational level, family structure, and pregnancy history. Significant positive correlations were observed between the participants' newborn care knowledge, confidence, and educational needs. Conclusion Personalized educational programs should be implemented to enhance North Korean refugee women's confidence in newborn care, focusing on areas with low knowledge levels and high educational needs and enabling women to achieve healthy pregnancy and childbirth, and to parent well.

Background Timely and accurate pain assessment is essential for safe and effective management of pain in neonates. Scholars at home and abroad have developed more than 40 pain assessment scales for different neonatal groups and types of pain. However, the reliability and stability of the outcomes vary significantly. In addition, existing single studies or systematic reviews (SRs) can only provide unsystematic evidence of a particular scale or specific psychometric properties, which is not conducive to clinical decision-making. Objective To overview the SRs of psychometric properties of neonatal pain assessment scales, providing clinical practitioners and researchers with evidence for the best pain assessment scale. Methods Databases including CNKI, SinoMed, Wanfang DATA, VIP, PubMed, Embase, Cochrane Library, Web of Science and CINAHL were searched for SRs about psychometric properties of neonatal pain assessment scales. By screening the references of the included SRs, their associated studies were found. Two researchers independently performed literature screening, and data extraction, then assessed the methodological quality using the JBI systematic review critical appraisal tool, risk of bias using the ROBIS, the reporting quality using the PRISMA statement, and the evidence quality using CERQual. Results A total of seven SRs were included. According to the JBI and ROBIS tools, four SRs were of high quality and had a low risk of bias, while three were of relatively low quality and had an increased risk of bias. With the PRISMA checklist, 5 SRs were fairly complete with over 60% of report completion rate (RCR) , 1 SR had certain reporting deficiencies with 45.95% of RCR, and 1 SR had serious information missing with 10.81% of RCR. The results of CERQual showed that there were 22 pieces of evidence in total, including two pieces of high quality (9.09%) , eight pieces of moderate quality (36.36%) , nine pieces of low quality (40.91%) , and three pieces of critically low quality (13.64%) . A synthesis of evidence showed that there were 25 scales with good internal consistency, inter-rater reliability, construct validity, and interpretability. Those scales could be used to measure acute pain, persistent pain, postoperative pain, or mechanically ventilated pain in preterm and/or term infants. Conclusion No single pain assessment scale is available to assess all types of pain in neonates. It is recommended that the selection of validated scales for periodic dynamic pain assessment in neonates should be based on clinical situations such as age and pain type. More high-quality, well-designed studies are needed to examine the reliability and stability of the existing scales for measuring different kinds of pain in neonates in China and to explore the feasibility of expanding their applications.

Purpose We aimed to survey current status of preparedness for neonatal resuscitation in delivery rooms in Korea. Methods We analyzed data regarding preparedness for the resuscitation in terms of personnel, equipment, and education using a questionnaire, which was developed by the Korean Association of Cardiopulmonary Resuscitation. From August 2020 through January 2021, the questionnaires were sent to hospitals affiliated with the Korean Association of Maternity Hospitals or the Korean Neonatal Network (KNN) operated by the Korean Society of Neonatology. As per the affiliated society, the hospitals were grouped as the maternity hospitals or the KNN hospitals. The questionnaires were delivered in 3 steps: mailout, electronic mail, and phone calls. Results Response rate was 21.3% (115 of 541) and 65.3% (49 of 75) in the maternity and KNN hospitals, respectively. The maternity hospitals showed a higher mean number of delivery and fewer pediatricians. In the KNN hospitals, pediatricians played a leading role during the resuscitation, but in the maternity hospitals, their role as a leader was less conspicuous. The KNN hospitals were better equipped with masks of variable sizes, oxygen blender, T-piece resuscitator, and electrocardiographic monitor (all Ps < 0.001). In the maternity hospitals, the preparedness of oxygen blender or T-piece resuscitator was positively associated with the number of pediatricians (P = 0.005). Although bag-mask ventilation was mostly feasible in both groups, endotracheal intubation was less feasible in the maternity hospitals (P = 0.007). The annual participation in resuscitation training for providers was higher in the KNN hospitals (P < 0.001). In the maternity hospitals, the annual participation was positively associated with the numbers of deliveries, obstetricians, and pediatricians. Conclusion This preliminary survey indicates the need for further improvement in preparing in personnel, equipment, and education, particularly in maternity hospitals.

Objective This study systematically analyzed coronavirus disease 2019 (COVID-19) and vaccination details during pregnancy by using the national health insurance claims data. Methods Population-based retrospective cohort data of 12,399,065 women aged 15–49 years were obtained from the Korea National Health Insurance Service claims database between 2019 and 2021. Univariate analysis was performed to compare the obstetric outcomes of pregnant women (ICD-10 O00–O94) and their newborns (ICD-10 P00–P96) with and without COVID-19. Univariate analysis was also performed to compare the age and obstetric outcomes of pregnant women receiving different types of vaccines. Results The percentage of pregnant women with COVID-19 during pregnancy was 0.11%. Some obstetric outcomes of pregnant women with COVID-19, including the rates of preterm birth or cesarean delivery, were significantly better than those of pregnant women without COVID-19. The rate of miscarriage was higher in pregnant women with COVID-19 than without COVID-19. However, the outcomes of newborns of women with and without COVID-19 were not significantly different. Regarding vaccination type, obstetric outcomes of pregnant women appeared to be worse with the viral vector vaccine than with the mRNA vaccine. Conclusion To the best of our knowledge, this is the first study to systematically analyze COVID-19 and vaccination details during pregnancy using the national health insurance claims data in Korea. The obstetric outcomes in pregnant women with and without COVID-19 and their newborns were similar.

Abstract Background End-of-life decisions with potential life-shortening effect in neonates and infants are common. We aimed to evaluate how often and in what manner neonatologists consult with parents and other healthcare providers in these cases, and whether consultation is dependent on the type of end-of-life decision made. Methods Based on all deaths under the age of one that occurred between September 2016 and December 2017 in Flanders, Belgium, a nationwide mortality follow-back survey was performed. The survey asked about different types of end-of-life decisions, and whether and why parents and/or other healthcare providers had or had not been consulted. Results Response rate was 83% of the total population. End-of-life decisions in neonates and infants were consulted both with parents (92%) and other healthcare providers (90%), and agreement was reached between parents and healthcare providers in most cases (96%). When medication with an explicit life-shortening intent was administered parents were always consulted prior to the decision; however when medication without explicit life-shortening intention was administered parents were not consulted in 25% of the cases. Conclusions Shared decision-making between parents and physicians in case of neonatal or infant end-of-life decision-making is the norm in daily practice. All cases without parental consultation concerned non-treatment decisions or comfort medication without explicit life-shortening intention where physicians deemed the medical situation clear and unambiguous. However, we recommend to at least inform parents of medical options, and to explore other possibilities to engage parents in reaching a shared decision. Physicians consult other healthcare providers before making an end-of-life decision in most cases.

Objective: To determine the prevalence of 3 -methylcrotonyl -CoA carboxylase deficiency (MCCD) in neonates in Shijiazhuang City, and to test the mutations of the related genes. Methods：185 683 neonates born in Shijiazhuang City were screened for MCCD by tandem mass spectrometry from January 2014 to December 2021, and the gene mutations of MCCC1 and MCCC2 were analyzed in those screened positive neonates. The growth and development of positive neonates were followed up. Results：Two children were diagnosed, with a prevalence of 1.08/100 000. Among them, one case was MCCD2 type with a complex heterozygous variation, which were c.592C>T and c.1144_1147delAAAAinsTTTT. The mutation of c.592C>T was a pathogenic variation while the c.1144_1147delAAAAinsTTTT was an unreported mutation, so its pathogenicity was classified as a suspected pathogenicity. The results of tandem mass spectrometry screening showed that the level of serum C5OH in the child with gene mutaion was increased. The initial screening level of C5OH was 12.26 μmol/L (normal value range is 0.07-0.61 μmol/L). The growth and development was normal during 1 year and 3 months of following up. The another child with the maternal MCCD 1 type was also tested. The primary screening level of C5OH increased to 6.28 μmol/L, and reduced to 0.75 μmol/L within the normal range after 6 months. The MCCC1 heterozygous variation was c.1679_1680insA, which was an unreported gene mutation, and the pathogenicity is classified as suspected pathogenicity. The development of this child was normal during 4 years and 3 months of following up. Conclusions：The prevalence of MCCD in neonates in Shijiazhuang area is 1.08/100 000. Three gene variation sites were found, two of which were unreported gene variations. These results enrich the variation spectrum of MCCC1 and MCCC2 genes, and provid a basis for genetic counseling. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective: Clinically validate the Neonatal Skin Condition Score - Portuguese version with Portuguese newborns, verifying if the risk of skin injury in this population is influenced by their condition. Method: Observational, cross-sectional and methodological study, conducted from 2018 to 2021. The Neonatal Skin Risk Assessment Scale - Portuguese version and Neonatal Skin Condition Score were used in data collection. Of the latter, content validation and sensitivity of the items were improved. MANOVA was used to evaluate whether the effect of independent variables (intrinsic and extrinsic factors) on dependent variables (score of both scales) was statistically significant. Non-random sampling (n=167). Results: The items showed good sensitivity. MANOVA revealed that the factors had a significant effect on the scores of the two scales. Conclusion: The comparison of the scales shows clinical validity, revealing that better skin condition corresponds to a lower risk of injury, and the two scales can be applied concomitantly.

Objective To investigate the clinical features of neonates with enterovirus encephalitis, and to prevent the outbreak of enterovirus infection by improving the early identification of this disease. Methods A total of 12 neonates with enterovirus encephalitis who were admitted to our hospital from June 2019 to June 2022 were enrolled and analyzed in terms of clinical features and laboratory examination. The key points of treatment were summarized, and their prognosis was assessed. ResultsAmong the 12 neonates, 7 were preterm infants, with the clinical manifestations of nonspecific sepsis-like symptoms and normal or mildly elevated inflammatory markers. All neonates tested positive for enterovirus nucleic acid in cerebrospinal fluid. All neonates were given standard isolation, intravenous injection of human immunoglobulin, and symptomatic supportive treatment and achieved a good prognosis after treatment. Conclusion Neonates with enterovirus encephalitis often have atypical clinical manifestations and thus require early identification and targeted strategies for the prevention and control of infection.

Purpose Atrial flutter is an uncommon arrhythmia in the neonatal period. This study aimed to describe the cause and clinical course of atrial flutter in neonates. Methods The medical records of 14 patients diagnosed with atrial flutter at Ulsan University Hospital Neonatal Intensive Care Unit (NICU) between March 2008 and August 2020 were reviewed retrospectively. Results All 14 cases occurred on the first day of birth. Of these, two were term infants, and 12 were preterm infants. Causes of atrial flutter included three cases of the umbilical venous catheter misplacement, one with a diabetic mother, and one ivolving atrial flutter after an intravenous aminophylline injection. Thirteen patients had structurally normal hearts with no congenital heart diseases. The patient, born to a diabetic mother, had an atrial septal defect and ventricular hypertrophy. Adenosine was administered first to differentiate it from paroxysmal supraventricular tachycardia. Synchronized cardioversion was attempted in 11 patients, while one received it after an esmolol injection that failed to convert to sinus rhythm. One patient had a recurrence after the intrusion of a peripherally inserted central catheter; however, atrial flutter disappeared after repositioning it. No patient had a recurrence after discharge. Conclusion Neonatal atrial flutter is a rare tachyarrhythmia with the risk factors often unknown; however, it could occur in structural heart disease, mispositioning of the umbilical venous catheter, and if the mother has diabetes. During umbilical venous catheterization, clinicians should be cautious and ensure appropriate monitoring of infants in the NICU as it may cause complications.

ABSTRACT A male infant presented with progressive jaundice immediately after birth. Fecal acholia and choluria associated with extensive bullous skin lesions in his trunk, abdomen, and upper and lower limbs developed during phototherapy. Several diagnostic hypotheses were presented, including neonatal porphyria, hemochromatosis, Alagille syndrome, and neonatal lupus. A 24-hour urine sample for the dosage of urinary porphyrins was collected, showing high results (1823.6µg in 100mL). At 50 days of life, fluorescence spectroscopy using a Wood’s lamp revealed simultaneous bright red fluorescence of urine-stained diapers and sample blood. A definitive diagnosis of congenital erythropoietic porphyria was made following identification of a mutation of the uroporphyrinogen synthetases III gene on genetic testing. The patient was subsequently maintained in a low light environment since then, resulting in improvement of the lesions. Congenital erythropoietic porphyria is a disease of the group of porphyrias that presents shortly after birth with blistering occurring in regions exposed to the sun or other ultraviolet light. Atrophic scars, mutilated fingers, and bright red fluorescence of the urine and teeth may also be observed. There is no specific treatment, and prophylaxis comprising a total avoidance of sunlight is generally recommended. A high degree of suspicion is required for diagnosis. An early diagnosis can lead to less damage. Here, we present the case of a newborn with congenital erythropoietic porphyria diagnosed after presenting with bullous lesions secondary to phototherapy.

ABSTRACT We report the long-term outcomes of a case of prenatal gastroschisis repair using a fully percutaneous fetoscopic approach with partial carbon dioxide insufflation. Surgery was performed as an experimental procedure before the scheduled elective birth. The fetal intestines were successfully returned to the abdominal cavity without any fetal or maternal complications. Ultrasonography performed 24 hours later revealed bowel peristalsis and no signs of fetal distress. After 48 hours, partial extrusion of the small bowel was observed, and the fetus was delivered. Gastroschisis repair was immediately performed upon delivery using the EXIT-like procedure as per our institutional protocol. The newborn did not require assisted mechanical ventilation, was discharged at 14 days of age and was then exclusively breastfed. At 3-year follow-up, the patient had no associated gastroschisis-related complications. This is the first case of prenatal repair of gastroschisis, which provides baseline knowledge for future researchers on the potential hurdles and management of prenatal repair.

ABSTRACT Purpose: to analyze the linguistic development of extremely premature children at birth, through the Initial Speech and Language Acquisition Scale, and to verify the knowledge of these children's parents about language. Methods: the study included 21 parents of extremely premature children at birth. A booklet on the development of children's language and a questionnaire was prepared for the study, in order to investigate the efficiency of guidance to parents. Initially, the children were assessed using the Initial Speech and Language Acquisition Scale, and then, the parents received oral guidance on how to stimulate their children's language. Therefore, the questionnaire was applied to verify the impact of the guidelines on their knowledge. The data obtained through the scale were related to the answers obtained through the questionnaire applied to the parents, through descriptive percentages and Mann-Whitney test, with p

Aplasia cutis congenita (ACC) is a rare congenital condition characterised by the absence of skin, with or without the absence of underlying structures. Can appear as an isolated lesion or associated with other congenital malformations. The approach can be conservative or surgical. We report a case of a full-term male newborn with two adjacent ulcerated lesions with well-demarcated limits in the upper occipital region (20 and 4-5 mm diameter). Other alterations that could be associated with aplasia cutis were identified at examination, so the patient was referred to several consultations, and other system involvement was excluded. Re-evaluation at the first month of life revealed complete healing and conservative treatment was kept. After identification of ACC should be excluded other associated congenital malformations. Particularly if large skin defects or bone involvement is detected (higher risk of complications and mortality).

Background: Second-stage caesarean sections, of which there are around 34,000 per year in the UK, have greater maternal and perinatal morbidity than those in the first stage. The fetal head is often deeply impacted in the maternal pelvis, and extraction can be difficult. Numerous techniques are reported, but the superiority of one over another is contentious and there is no national guidance. Objective To determine the feasibility of a randomised trial of different techniques for managing an impacted fetal head during emergency caesarean. Design A scoping study with five work packages: (1) national surveys to determine current practice and acceptability of research in this area, and a qualitative study to determine acceptability to women who have experienced a second-stage caesarean; (2) a national prospective observational study to determine incidence and rate of complications; (3) a Delphi survey and consensus meeting on choice of techniques and outcomes for a trial; (4) the design of a trial; and (5) a national survey and qualitative study to determine acceptability of the proposed trial. Setting Secondary care. Participants Health-care professionals, pregnant women, women who have had a second-stage caesarean, and parents. Results Most (244/279, 87%) health-care professionals believe that a trial in this area would help guide their practice, and 90% (252/279) would be willing to participate in such a trial. Thirty-eight per cent (98/259) of parents reported that they would take part. Women varied in which technique they thought was most acceptable. Our observational study found that impacted head is common (occurring in 16% of second-stage caesareans) and leads to both maternal (41%) and neonatal (3.5%) complications. It is most often treated by an assistant pushing the head up vaginally. We designed a randomised clinical trial comparing the fetal pillow with the vaginal push technique. The vast majority of health-care professionals, 83% of midwives and 88% of obstetricians, would be willing to participate in the trial proposed, and 37% of parents reported that they would take part. Our qualitative study found that most participants thought the trial would be feasible and acceptable. Limitations Our survey is subject to the limitation that, although responses refer to contemporaneous real cases, they are self-reported by the surgeon and collected after the event. Willingness to participate in a hypothetical trial may not translate into recruitment to a real trial. Conclusions We proposed a trial to compare a new device, the fetal pillow, with a long-established procedure, the vaginal push technique. Such a trial would be widely supported by health-care professionals. We recommend that it be powered to test an effect on important short term maternal and baby outcomes which would require 754 participants per group. Despite the well-known difference between intent and action, this would be feasible within the UK. Future work We recommend a randomised controlled trial of two techniques for managing an impacted fetal head with an in-built internal pilot phase and alongside economic and qualitative substudies. Study registration This study is registered as Research Registry 4942. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 6. See the NIHR Journals Library website for further project information. Plain language summary: One-quarter of UK pregnant women have a caesarean section. Most of these procedures are straightforward, but in a small number of cases unexpected complications can make the birth difficult. One complication, an impacted fetal head, may happen when caesarean sections are done in the second ‘pushing’ stage of labour. If the baby’s head is low and wedged in the woman’s pelvis, lifting it can be difficult, which can result in damage to the mother’s womb and vagina, and to her baby. Occasionally, babies die. There are different techniques doctors and midwives can use to make these births easier, but there is uncertainty around which is best. To plan a trial to test these techniques, we needed to know how often impacted head happens, what techniques are used to manage it and whether or not research is acceptable to parents and health-care professionals. We surveyed doctors and midwives to find out which techniques they use and what training they need. We surveyed parents and pregnant women and interviewed women who had experienced a second-stage caesarean. We collected information from UK hospitals to find out how common this is and the impact on women and babies. We found out the following: Around 7% of caesareans take place in second stage, and impacted fetal head occurs in 16% of these births. One-third of women would consent to take part in a trial, if the complication happened to them. Nearly all midwives and doctors thought that this research was important and would be willing to take part. Using all of the information we collected, we designed a clinical trial. We wanted to compare two techniques for managing an impacted fetal head. The first is the vaginal push technique, where the doctor or midwife puts their hand into the mother’s vagina to push her baby’s head up, and the second is the fetal pillow, a device inserted into the mother’s vagina before the operation starts to dislodge the baby’s head upwards. Scientific summary: Background Emergency caesarean section (CS) performed in the second stage of labour, which occurs in 34,000 births per annum in the UK, has greater perinatal and maternal morbidity than CS performed in the first stage. Second-stage CS may be complicated by the fetal head being deeply impacted in the maternal pelvis, which occurs in 1.5% of all emergency CSs. Complications include longer delivery times, uterine tears, injury to the baby and even, albeit rarely, death. Numerous techniques to assist in delivery of an impacted fetal head (IFH) are reported. The superiority of one technique over another is contentious. At present, there is no national guidance on what techniques to employ. Research questions What are the current practice, level of experience and training requirements for managing an IFH during emergency CS among UK obstetricians, obstetric anaesthetists and midwives? What are the views of pregnant women and their partners on research in this area? How acceptable is a randomised trial in this area to women who have experienced a second-stage caesarean birth, and what are their views on the different proposed techniques for managing an IFH? What is the incidence of IFH and maternal and neonatal complications arising from IFH in the UK? What techniques and outcomes do health-care professionals and parents think should be included in a randomised trial in IFH? What should the design be for a randomised trial in IFH? How acceptable is the randomised trial we have designed to health-care professionals, women who have experienced a second-stage caesarean birth and pregnant women? Methods We undertook a national survey of obstetricians, trainee obstetricians, obstetric anaesthetists and midwives to determine current practice, level of experience and training requirements for managing IFH during emergency CS. We also undertook a national survey of parents to determine their views on this topic. Individual face-to-face interviews with women who have experienced a second-stage CS were carried out to determine the acceptability of a randomised trial in this area and their views on the different proposed techniques for managing IFH. A national, prospective UK Obstetric Surveillance System (UKOSS) surveillance study was undertaken to determine the incidence and consequences of IFH in the UK. Based on the findings of previous work packages, we conducted a Delphi survey followed by a virtual consensus meeting of experts and important stakeholders to decide which techniques should be tested in any trial and which outcomes should be included. A randomised trial of different techniques for managing IFH during emergency CS was designed. We undertook a national survey of lead obstetricians, pregnant women and midwives to determine the feasibility and acceptability of the randomised trial designed. Three sets of individual telephone or video interviews were carried out with lead obstetricians/senior obstetric trainees, women who have experienced a second-stage CS and primiparous women to determine the acceptability and feasibility of the planned trial. Results The majority (89%) of health-care professionals stated that a clinical trial in this area would help to guide their clinical practice, and 87% would be willing to participate in such a trial. In addition, 37% of parents reported that they would be either likely or very likely to take part, or neutral. Women varied in which technique they thought was most acceptable, and their trust in medical expertise and prioritising the safety of the baby were important moderators of acceptability. Our national prospective observational study found that impacted head is common, occurring in 16% of second-stage caesarean births in the UK, and leads to both maternal and neonatal complications. Overall, 230 (41%) women and 20 babies (3.5%) experienced complications. Thirteen babies (2%) died or sustained severe injury. Seven suffered bony fracture, two brachial plexus injury and one facial palsy. Three had moderate or severe hypoxic ischaemic encephalopathy, and seven were cooled. Four babies died: one prior to the caesarean, one with multiple abnormalities and two as a direct result of complications caused by IFH. IFH is currently most often treated by an assistant pushing the head up vaginally during the CS. Data from earlier work packages were used throughout the project, culminating in the design of a randomised clinical trial. Our proposed trial would compare a new device, the fetal pillow, with a procedure used for many years, the vaginal push technique, for preventing IFH. Most doctors and midwives believed that such a trial would be important and were willing to recruit participants to one. About one in three women said that they would be willing to join such a trial. The only interventions that were more popular with patients were tocolysis and the head-down technique. Both of these are adjunct techniques used by all obstetricians and, therefore, are not suitable for evaluation in a trial. The required sample size of such a trial depends on whether it is powered to show a difference in severe maternal morbidity (control event rate 2.3%, 4698 participants per group), a difference in fetal short-term morbidity (control event rate 13.7%, 754 participants per group) or only a difference in less severe maternal events, including haemorrhage over 1000 ml (control event rate 27%, 322 participants per group). We believe that it is not feasible to conduct the trial powered on severe maternal morbidity. However, parents and doctors believe that a trial to test the effect of different procedures on meaningful baby outcomes is important. We therefore recommend that the required sample size would be 754 per group. The vast majority of midwives (83%) and obstetricians (88%) would be willing to participate in the clinical trial proposed. In addition, 37% of parents reported that they would be either likely or very likely to take part, or neutral. Our qualitative study found that most participants thought that the trial would be feasible and acceptable. Conclusions We recommend that a randomised trial with an internal pilot phase comparing a new device, the fetal pillow, with a procedure used for many years, the vaginal push technique, for managing IFH be conducted. This trial is widely supported by health-care professionals. We recommend that the definitive trial be powered to test an effect on important short-term maternal and baby outcomes, which would require 754 participants per group. A sufficient number of women would be willing to be join such a trial to make it likely to be feasible in the UK. Study registration This study is registered as Research Registry 4942. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 27, No. 6. See the NIHR Journals Library website for further project information.

A male infant presented with progressive jaundice immediately after birth. Fecal acholia and choluria associated with extensive bullous skin lesions in his trunk, abdomen, and upper and lower limbs developed during phototherapy. Several diagnostic hypotheses were presented, including neonatal porphyria, hemochromatosis, Alagille syndrome, and neonatal lupus. A 24-hour urine sample for the dosage of urinary porphyrins was collected, showing high results (1823.6µg in 100mL). At 50 days of life, fluorescence spectroscopy using a Wood's lamp revealed simultaneous bright red fluorescence of urine-stained diapers and sample blood. A definitive diagnosis of congenital erythropoietic porphyria was made following identification of a mutation of the uroporphyrinogen synthetases III gene on genetic testing. The patient was subsequently maintained in a low light environment since then, resulting in improvement of the lesions. Congenital erythropoietic porphyria is a disease of the group of porphyrias that presents shortly after birth with blistering occurring in regions exposed to the sun or other ultraviolet light. Atrophic scars, mutilated fingers, and bright red fluorescence of the urine and teeth may also be observed. There is no specific treatment, and prophylaxis comprising a total avoidance of sunlight is generally recommended. A high degree of suspicion is required for diagnosis. An early diagnosis can lead to less damage. Here, we present the case of a newborn with congenital erythropoietic porphyria diagnosed after presenting with bullous lesions secondary to phototherapy. [ABSTRACT FROM AUTHOR]

We report the long-term outcomes of a case of prenatal gastroschisis repair using a fully percutaneous fetoscopic approach with partial carbon dioxide insufflation. Surgery was performed as an experimental procedure before the scheduled elective birth. The fetal intestines were successfully returned to the abdominal cavity without any fetal or maternal complications. Ultrasonography performed 24 hours later revealed bowel peristalsis and no signs of fetal distress. After 48 hours, partial extrusion of the small bowel was observed, and the fetus was delivered. Gastroschisis repair was immediately performed upon delivery using the EXIT-like procedure as per our institutional protocol. The newborn did not require assisted mechanical ventilation, was discharged at 14 days of age and was then exclusively breastfed. At 3-year follow-up, the patient had no associated gastroschisis-related complications. This is the first case of prenatal repair of gastroschisis, which provides baseline knowledge for future researchers on the potential hurdles and management of prenatal repair. [ABSTRACT FROM AUTHOR]

Objective To compare the clinical efficacy, safety and efficacy of thoracoscopy versus traditional open surgery for congenital diaphragmatic hernia (CDH). Methods From June 2013 to June 2020, a total of 37 CDH children with admitted were selected as research objects and divided into two groups of endoscopic (n=24) and open (n=13) according to surgical approaches.Major outcomes included recurrence rate, length of hospital stay, operation duration, postoperative mechanical ventilation time, postoperative lactation time and target feeding time.Secondary outcomes included incision infection, intraoperative blood loss and hernia diameter. Results General profiles and hernia characteristics were similar in two groups.Length of hospital stay[(13.46±2.41) vs.(18.77±2.89) days], postoperative mechanical ventilation time[(3.81±0.80) vs.(5.98±1.06) days], postoperative open milking time[(4.35±1.03) vs.(7.46±1.45) days]and time to reach target feeding[(8.33±1.74) vs.(13.38±2.22) days].The differences were statistically significant (P < 0.001);Recurrence rate[(4.2%, 1/24) vs.(7.7%, 1/13) days]was not statistically significant (P=1.000);One child died in open group and there was no mortality in thoracoscopic group. Conclusion Thoracoscopic CDH repair offers the advantages of shorter operative duration, minimal trauma, cosmetic incision, faster postoperative recovery and lower recurrence rate.It is a safe and effective surgical option for CDH. [ABSTRACT FROM AUTHOR]

Objective To explore the intraoperative risk factors associated with neonatal hypoglycemia. Methods From August 2019 to July 2020, a total of 229 neonatal surgical children were recruited. Based upon the level of neonatal intraoperative blood glucose, individuals below 2.2 mmol/L were assigned into hypoglycemia group (n=19) and those above or equal to 2.2 mmol/L into non-hypoglycemic group (n=210). The relevant clinical data of two groups were compared with regards to preoperative profiles (including age, body weight, corrected gestational age, postnatal Apgar score, gestational diabetes mellitus, pregnancy-induced hypertension, neonatal bilirubin concentration, albumin concentration, anemia, hypoproteinemia and parenteral nutrition) and intraoperative findings (including ASA grade, operative duration, operation approach, intraoperative blood glucose, intraoperative blood transfusion volume, infusion volume, blood loss volume, urine volume, dosing of vasoactive drugs and body temperature). Results The corrected gestational age of hypoglycemic and non-hypoglycemic groups was[35(34, 38) vs. 38(35, 39) week], body weight[(2.15±0.68) vs. (2.81±0.74) kg], 1 min Apgar score[9(8, 10) vs. 10(10, 10)], incidence of hypoproteinemia[36.84%(7/19) vs. 11.90%(25/210)], ASA grade[3(2, 3) vs. 2(2, 2)], intraoperative blood transfusion volume[42.11%(8/19) vs. 19.52%(41/210)]. The above results showed significant sinter-group tatistical differences (P < 0.05). No significant inter-group difference existed in preoperative blood glucose level or operative duration (P>0.05). The results of multivariate analysis indicated that high ASA grade and low corrected gestational age were independent risk factors for neonatal hypoglycemia (P=0.026 and P=0.006). Conclusion Occurrence of intraoperative hypoglycemia in neonates is associated with high ASA grade and low corrected gestational age. [ABSTRACT FROM AUTHOR]

Objective To construct a nomogram model for predicting the mortality risk of postoperative in children with complex congenital heart disease (CCHD) and validate its predictive potence. Methods From January 2018 to December 2019, a retrospective review was conducted for 354 CCHD children undergoing cardiopulmonary bypass (CPB) thoracotomy. And independent risk factors for postoperative mortality were screened by univariate and multivariate Logistic regression analyses and constructing a nomogram prediction model. Results The independent postoperative mortality risk factors for CCHD children were as follows: inotropic score increased(IS, OR=1.113, 95%CI: 1.055-1.175), white blood cell increased(WBC, OR=1.140, 95%CI: 1.044-1.245), hemoglobin decreased(HB, OR=0.973, 95%CI: 0.949-0.998), albumin decreased(ALB, OR=0.907, 95%CI: 0.838-0.983) and cardiopulmonary resuscitation-preoperative (CPR-pre, OR=36.656, 95%CI: 5.187-259.037). A nomogram prediction model was constructed with the above risk factors as input variables and output variable was total score. The higher total scores, the greater of mortality and vice versa. This model verification showed that C-index and area under curve (AUC) were 0.898 and 0.899 respectively. And calibration curve was close to ideal, indicating decent prediction and discriminant validity. Also the optimal cut-off value was 36. Conclusion IS, WBC, HB, ALB and CPR-pre are independent postoperative mortality risk factors for CCHD children. The nomogram model constructed on the basis of five risk factors offers excellent predictive accuracy. Individuals with a total score ≥36 should raise a high alert and more aggressive intervention is required for a better prognosis. [ABSTRACT FROM AUTHOR]

Objective: To analyze the profile of the compounded cardiovascular medicines prescribed in neonatology in Brazil. Data source: An integrative bibliographic review was carried out, including studies published in the last 20 years. The used descriptors were: Intensive Care Neonatal, Off-Label Use, Pharmaceutical Preparations, in the databases Virtual Health Library (VHL), PubMed, and Scientific Electronic Library Online (SciELO). Review articles and guidelines were excluded. The quality of the evidence was analyzed, and 10 articles were selected to integrate the study. Data synthesis: The profile of routine prescription in the neonatal unit was evaluated. The main cardiovascular medications prescribed as compounding formulation were: Spironolactone, Captopril, Furosemide, Hydrochlorothiazide, Propranolol, Amiodarone, Nifedipine, Carvedilol, Digoxin, Enalapril, Epinephrine, and Hydralazine. The drugs were obtained from adaptations of dosage forms, through the transformation of capsules or tablets into liquid formulations, as a solution, suspension, or syrup, as well as in the form of solutions prepared from active pharmaceutical ingredients. The compounding of medications made drug therapy possible in neonatology, considering that such medications do not have registration of the oral liquid dosage form in the country, despite being part of the List of Essential Medicines for Children of the Word Health Organization. Conclusions: It was possible to analyze the profile of compounded cardiovascular medicines prescribed in neonatology in Brazil. The results showed the need for the development of medications suitable for the neonatal population, and the standardization of operational procedures for preparing extemporaneous formulations in neonatology to increase drug safety. [ABSTRACT FROM AUTHOR]

Objective: To analyze the main causes and trends in preventable early and late neonatal mortality according to Brazilian regions. Methods: This is an ecological time series study carried out with records of neonatal deaths from 2000 to 2018 through the Mortality Information System. To classify the avoidable causes, the Unified Health System List of Preventable Causes of Death by Interventions (Lista de Causas de Mortes Evitáveis por Intervenções do Sistema Único de Saúde) was used. From mortality rates of early and late neonatal components, joinpoint regressions of the main causes were performed using the Annual Percentage Change and Average Annual Percentage Change. Results: The highest avoidable mortality rates were found in the early neonatal phase. The South had the lowest avoidable mortality rates. The main causes according to groups on the list were tetanus of newborns, respiratory distress syndrome, birth asphyxia, bacterial septicemia, pneumonia and sudden death syndrome. The reduction in early neonatal mortality was higher from 2000 to 2004 (4.19% per year, p<0.001) and lower between 2012 and 2018 (1.80% per year, p<0.001). Considering late neonatal mortality, there was an average annual reduction of 2.02% (p<0.001). The Northeast had more than one turning point in the trend of mortality due to respiratory distress and asphyxia at birth and stability due to septicemia. In the South, a downward trend was identified for all the preventable causes studied. Conclusion: There was a lower reduction in early neonatal mortality and inequalities in the trend of preventable neonatal mortality according to causes and regions of residence. [ABSTRACT FROM AUTHOR]

Objective: To analyze the stress-related factors of parents of newborns hospitalized in a Neonatal Intensive Care Unit. Methods: This is a cross-sectional study developed with 204 parents present in a Neonatal Intensive Care Unit in the state of Rio Grande do Sul. For data collection, we used an instrument to characterize participants and the Brazilian version of the Parental Stress Scale: Neonatal Intensive Care Unit. Data were analyzed using the Mann-Whitney and Kruskal-Wallis tests. Results: The sociodemographic variables that were associated with higher levels of stress were sex, previous experience with neonatal unit, education and religion. And the clinical variables of newborns were hospitalization unit, respiratory and intravenous therapies and previous surgical procedure. Conclusion: Female participants, who had no previous experience with a neonatal unit, with higher education and religion, had higher levels of stress, as well as those who had their children hospitalized in the high-risk unit, with respiratory support, use of two intravenous devices and with previous history of surgical procedure. [ABSTRACT FROM AUTHOR]

Objective: To construct and validate an educational video about bathing newborns in a bucket. Methods: This is applied and methodological research, of technological production, developed in three phases: pre-production, production and post-production from December 2020 to February 2022. In pre-production, the script and storyboard were elaborated and staff recruitment and resources. In production, content validity and script and storyboarding appearance and recording of scenes and in post-production, scene editing and video composition. The validity process of the script, storyboard and edited video was carried out with PhD nurses, social communication professionals and the nursing team. The items objective, content, relevance, environment, verbal language, inclusion of topics, functionality, usability, efficiency, audiovisual technique, environment and procedure were assessed by a Likert scale and the agreement among judges analyzed from the Content Validity Index and Cronbach's alpha above 0.80. Results: The educational video on how and why to bathe in a bucket was entitled "Good practices: bathing newborns in a bucket" and organized into three scenes: before bathing, during bathing, after bathing; lasting seven minutes and 48 seconds. Conclusion: The video was developed and validated by nursing and social communication experts and may contribute to the actions developed in the field of neonatology as an adequate health education tool carried out by nurses for families who wish to adopt this type of bath. [ABSTRACT FROM AUTHOR]

Objective: To analyze the impact of nurse-mediated case management on prematurity, low birth weight, and neonatal mortality. Methods: A pragmatic, quasi-experimental, single-arm, clinical trial, conducted in a city in the south of Brazil, with implementation of the nurse-mediated case management model as an intervention during ten months, in a sample of 91 pregnant women. The intervention consisted of nursing and multi-professional appointments, educational actions, home visits, and a telephone call. The data of the intervention group were compared to the data of births from 2016 to 2018 in the city, with calculation of the relative risk, the absolute risk reduction and the number needed to treat. Results: Premature births accounted for 4.4% (95% CI 0.18%; 8.61%). Case management effectiveness in prematurity was 62%; for every 14 pregnant women in the intervention group, one premature birth was avoided. An absolute risk reduction of 7.3% was identified compared to previous city numbers. Newborns with low birth weight (<2500g) (p =0.975) were 8.9% of the total of neonates born, and neonatal mortality in the intervention group was not identified (p =0,850). Conclusion: Nurse-mediated case management during pregnancy proved to be a strategy for prevention of prematurity and demonstrated the magnitude in neonatal mortality. However, regarding the birth weight, this model had no effectiveness. The regular presence of nurses is fundamental to improve the care during pregnancy. Brazilian Registry of Clinical Trials - ReBEC: RBR-1073gcfm [ABSTRACT FROM AUTHOR]

Objective: To summarize the scientific evidence on anatomical landmarks on radiography used to evaluate the distal tip of the peripherally inserted central catheter in newborns. Methods: This is an integrative literature review performed between 2017 and 2021 in Web of Science, National Library of Medicine (PubMed/MEDLINE) and Scopus databases. Results: Thirteen out of 263 documents found in the databases met the eligibility criteria and were selected for analysis. Of these, 12 were observational studies and one was experimental. As for the country of origin, only one study was published in Brazil, five in China, two in the United States of America; and Italy, Germany, Canada, Iran and India with one study each. The evidence found demonstrated the existence of seven anatomical landmarks used in radiography to visualize the tip of the percutaneous catheter in newborns, and the vertebral body as the predominant guiding reference. Conclusion: For catheters inserted in the upper limbs, the anatomical landmarks closer to the cavo-atrial junction are the fifth and seventh thoracic vertebrae, or two vertebral bodies below the level of the carina. For the lower limbs, the catheter tip should be positioned between the ninth and tenth thoracic vertebrae or above the fourth lumbar vertebra. [ABSTRACT FROM AUTHOR]

Objective: To identify the associations of factors of a social nature with prematurity. Methos: This is a cross-sectional study with a correlational method, carried out from a database of a medium-sized municipality in the countryside of São Paulo, containing information on all newborns from January 2018 to July 2020, aimed at the identification of social and biological risks after birth. Results: The analysis included 4,480 newborns, of which 78.9% were classified as usual-risk babies and 21.1% as at-risk babies. Among the risk factors of a social nature for newborns analyzed in the present study, there was a higher prevalence of newborns whose head of household had no income, had mothers under 16 years of age, a dead sibling aged less than 5 years and mothers who did not undergo prenatal care, with the last two having association with prematurity. Conclusion: Factors of a social nature were associated with prematurity. This study made it possible to improve the newborn surveillance database, facilitating the elaboration and planning of health care. [ABSTRACT FROM AUTHOR]

Copyright of Minas Gerais Medical Journal / Revista Médica de Minas Gerais is the property of Associacao Medica de Minas Gerais 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.)

Objective: This study aims to determine the predictors for intrapartum fever and for poor maternal and neonatal outcomes in parturients with intrapartum fever, and to evaluate the pathogens involved and their resistance to antibiotics. Methods: Medical records of patients with intrapartum fever and singleton delivery at term in Tuen Mun Hospital, Hong Kong between 1 July 2020 and 31 June 2021 were retrieved. Each patient was matched with a consecutive healthy control by parity and gestational age. The case and control groups were compared in terms of composite adverse maternal and neonatal outcomes. Multivariate analyses were used to determine predictors for intrapartum fever and for poor maternal and neonatal composite outcomes. Pathogens isolated from maternal, placental, and neonatal specimens were evaluated, as was their resistance to antibiotics. Results: The incidence of intrapartum fever was 4.4% (164/3729). In multivariate analysis, predictors for intrapartum fever were hypertensive disease (adjusted odds ratio [aOR]=7.42, p=0.015), epidural analgesia (aOR=6.22, p<0.001), and duration of ruptured membranes (aOR=1.07, p=0.044). Epidural analgesia was a predictor for composite adverse maternal outcome (aOR=2.65, p=0.007), whereas maternal temperature of =39°C was a predictor for composite adverse neonatal outcome (aOR=5.15, p=0.036). Positive bacterial culture was not associated with poor neonatal outcomes. Higher degrees of maternal temperature were associated with higher composite maternal and neonatal morbidity. 89 (54.3%) of febrile patients had positive culture results. Enterococcus was the most common grampositive organism (48.1%) and Escherichia coli was the most common gram-negative bacteria (65.2%). Conclusion: Intrapartum fever is associated with poor maternal and neonatal outcomes. Obstetricians should avoid long duration of labour and high maternal temperature. The choice of antibiotics for intrapartum fever/chorioamnionitis should be carefully selected, with consideration of efficacy, possible adverse effects, and antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Copyright of Revista Facultad de Medicina de la Universidad Nacional de Colombia is the property of Universidad Nacional de Colombia 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.)