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OBJECTIVE: To study the association between the Sarnat exam (SE) performed before and after therapeutic hypothermia (TH) and outcomes at 2 years in infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE). DESIGN: Secondary analysis of the High-dose Erythropoietin for Asphyxia and EncephaLopathy Trial. Adjusted ORs (aORs) for death or neurodevelopmental impairment (NDI) based on SE severity category and change in category were constructed, adjusting for sedation at time of exam. Absolute SE Score and its change were compared for association with risk for death or NDI using locally estimated scatterplot smoothing curves. SETTING: Randomised, double-blinded, placebo-controlled multicentre trial including 17 centres across the USA. PATIENTS: 479/500 enrolled neonates who had both a qualifying SE (qSE) before TH and a SE after rewarming (rSE). INTERVENTIONS: Standardised SE was used across sites before and after TH. All providers underwent standardised SE training. MAIN OUTCOME MEASURES: Primary outcome was defined as the composite outcome of death or any NDI at 22-36 months. RESULTS: Both qSE and rSE were associated with the primary outcome. Notably, an aOR for primary outcome of 6.2 (95% CI 3.1 to 12.6) and 50.3 (95% CI 13.3 to 190) was seen in those with moderate and severe encephalopathy on rSE, respectively. Persistent or worsened severity on rSE was associated with higher odds for primary outcome compared with those who improved, even when qSE was severe. CONCLUSION: Both rSE and change between qSE and rSE were strongly associated with the odds of death/NDI at 22-36 months in infants with moderate or severe HIE.

Background: Recent technological evolutions allow for the identification of hearing level (HL) in infants soon after birth. The goal of early hearing detection and intervention is to maximize linguistic and communication skills and literacy development for children who are deaf or hard of hearing. Infants whose HL has been confirmed before 6 months of age must be provided early intervention. Aims and Objectives: The aim of the study was to observe the changes in the otoacoustic emissions (OAE) and brainstem auditory evoked potential (BAEP) in infants with birth asphyxia (BA). Materials and Methods: The present study was a case– control study. A total of 50 cases of infants with BA and 50 normal-term infants were part of the study after obtaining informed consent as per the ICMR guidelines. A through clinical examination and otoscopy examination were done to rule out any conductive hearing loss. Then, OAE and BAEP were recorded to estimate the hearing loss and hearing threshold of infants. Results: BAEP waveform I, III, and V absolute latencies were significantly prolonged among BA infants than normal infants. The interpeak latency (IPL) of the right ear III-V was significantly increased in BA infants. However, III-V and I-V latencies though prolonged in BA infants, they are not statistically significant. No significant interaural difference was noted in absolute and IPLs of both BA and normal infants. No significant relationship existed between the mode of delivery and the degree of hearing loss in both ears. Significant association was observed between the degree of hearing loss and severity of BA (hypoxic-ischemic encephalopathy) in both ears. Conclusion: BAEP recording in BA infants is useful to identify the hearing impairment at the earliest. The implication of this research work will help in early detection of hearing impairment, so that speech and language developmental delay in the child can be prevented. [ABSTRACT FROM AUTHOR]

Clinical trials of hypothermia after pediatric cardiac arrest (CA) have not seen robust improvement in functional outcome, possibly because of the long delay in achieving target temperature. Previous work in infant piglets showed that high nasal airflow, which induces evaporative cooling in the nasal mucosa, reduced regional brain temperature uniformly in half the time needed to reduce body temperature. Here, we evaluated whether initiation of hypothermia with high transnasal airflow provides neuroprotection without adverse effects in the setting of asphyxic CA. Anesthetized piglets underwent sham-operated procedures (n = 7) or asphyxic CA with normothermic recovery (38.5°C; n = 9) or hypothermia initiated by surface cooling at 10 (n = 8) or 120 (n = 7) min or transnasal cooling initiated at 10 (n = 7) or 120 (n = 7) min after resuscitation. Hypothermia was sustained at 34°C with surface cooling until 20 h followed by 6 h of rewarming. At 4 days of recovery, significant neuronal loss occurred in putamen and sensorimotor cortex. Transnasal cooling initiated at 10 min significantly rescued the number of viable neurons in putamen, whereas levels in putamen in other hypothermic groups remained less than sham levels. In sensorimotor cortex, neuronal viability in the four hypothermic groups was not significantly different from the sham group. These results demonstrate that early initiation of high transnasal airflow in a pediatric CA model is effective in protecting vulnerable brain regions. Because of its simplicity, portability, and low cost, transnasal cooling potentially could be deployed in the field or emergency room for early initiation of brain cooling after pediatric CA. NEW & NOTEWORTHY: The onset of therapeutic hypothermia after cardiac resuscitation is often delayed, leading to incomplete neuroprotection. In an infant swine model of asphyxic cardiac arrest, initiation of high transnasal airflow to maximize nasal evaporative cooling produced hypothermia sufficient to provide neuroprotection that was not inferior to body surface cooling. Because of its simplicity and portability, this technique may be of use in the field or emergency room for rapid brain cooling in pediatric cardiac arrest victims. [ABSTRACT FROM AUTHOR]

To investigate the prevalence and associated outcomes of glucose abnormalities in infants with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia (TH). Glucose values were reviewed in all HIE infants. Pearson's correlation was used to assess the association of hypo- and hyperglycemic episodes with neonatal brain MRI and neurodevelopmental outcomes (NDO) at 12 & 24 months. Of 153 infants included, 31, 56 and 43 had episodes of hypo-, hyperglycemia and combined, respectively. Hyperglycemia and combined hypo/hyper had higher mortality (p = 0.035), seizures (p = 0.009), and longer hospitalization (p = 0.023). Hypo- and hyperglycemia were associated with parenchymal hemorrhages (p = 0.028 & p = 0.027, respectively). Hypoglycemia was associated with restricted diffusion (p = 0.014), while hyperglycemia was associated with cortical injuries (p = 0.045). Each hour of hyper- or hypoglycemia was associated with 5.2–5.8 times unfavorable outcomes (p < 0.001). Blood glucose aberrations were detrimental in HIE infants treated with TH. Optimizing glucose management is crucial in this setting. [ABSTRACT FROM AUTHOR]

Introduction: The prevalence of thyroid nodules and malignancies in the elderly is a growing concern. Thyroid nodules in this population have unique characteristics, requiring careful treatment strategies that balance risks and benefits. Oncocytic carcinoma of the thyroid (OCA) is a rare, aggressive subtype with diagnostic challenges. Methods: This case features an 84-year-old patient who presented with a neck mass and symptoms of asphyxia. Clinical evaluation, imaging studies, and biopsy were conducted to assess the nature of the thyroid lesion. Molecular testing, including genetic analysis, was performed to identify specific mutations associated with OCA and guide treatment decisions. Results: The patient was diagnosed with oncocytic carcinoma of the thyroid. The molecular testing revealed specific genetic mutations indicative of OCA, confirming the diagnosis. The presence of these mutations guided the treatment plan, emphasizing the importance of molecular diagnostics in managing thyroid malignancies, especially in the elderly. Discussion: This case illustrates the complexities of diagnosing and treating thyroid malignancies in the elderly. Biopsy and molecular testing provided diagnostic accuracy and informed treatment. Individualized approaches are essential for better outcomes, especially in aggressive subtypes, balancing the risks and benefits of intervention. [ABSTRACT FROM AUTHOR]

Background: Unsafe sleep environments are the primary modifiable risk factor for sudden unexpected infant death (SUID). Despite this knowledge, products that deviate from the American Academy of Pediatrics (AAP) safe sleep recommendations continue to be commonplace, such as inclined sleepers. Analyses to estimate risk among these products are lacking, perpetuating their presence in the marketplace. We present a method of comparing risk of SUID in an inclined sleeper to an AAP-recommended sleep environment. Methods: A case-control analysis using publicly available and previously published survey data was conducted for SUID events occurring between January 1, 2018 and April 12, 2019 (the date of the first inclined sleeper recall). SUID deaths were categorized as occurring in an AAP-recommended sleep environments or in an inclined sleeper. Exposure Odds Ratios (OR) are reported as the risk of SUID among infants using inclined sleepers relative to an AAP-recommended sleep environment. Results: During the study period, 4,900,573 births and 4,363 SUID deaths occurred in the US. Control characteristics were similar between previous night users of an AAP-recommended sleep environment (24%) and inclined sleepers (3.8%). Inclined sleepers were associated with a 5-fold (OR: 5.1; 95% CI: 3.2, 7.9) increased risk of SUID among infants < 12 months compared to infants in an AAP-recommended sleep environment. This risk was greatest among infants ≥ 4 months (RR: 10.4; 95% CI: 5.1, 21.5). Conclusions: This novel analysis fills a longstanding gap in risk assessments of inclined infant sleep products. More timely risk analyses may improve the safety of the marketplace. [ABSTRACT FROM AUTHOR]

Objective: To determine the effectiveness of phase-change-material mattress (PCM) during transportation of newborns with hypoxic ischemic encephalopathy (HIE). Study design: Randomized controlled trial of newborns with HIE from June 2016 to December 2019. Patients were randomized to transport with PCM or without PCM (control) when transferred to a cooling center in northern Vietnam. Primary outcome measure was mortality rate, secondary outcomes including temperature control and adverse effects. Result: Fifty-Two patients in PCM-group and 61 in control group. Median rectal temperature upon arrival was 34.5 °C (IQR 33.5–34.8) in PCM-group and 35.1 °C (IQR 34.5–35.9) in control group (p = 0.023). Median time from birth to reach target temperature was 5.0 ± 1.4 h and 5.5 ± 1.2 h in the respective groups (p = 0.065). 81% of those transported with PCM versus 62% of infants transported without (p = 0.049) had reached target temperature within the 6-h timeframe. There was no record of overcooling (< 32 °C) in any of the groups. The was no difference in mortality rate between the two groups (33% and 34% respectively (p > 0.05)). Conclusion: Phase-change-material can be used as a safe and effective cooling method during transportation of newborns with HIE in low-resource settings. Trial registration: The study was retro-prospectively registered in Clinical Trials (04/05/2022, NCT05361473). [ABSTRACT FROM AUTHOR]

Research Summary: Following high‐profile police killings, many U.S. cities banned officers from using chokeholds and other neck restraints. The evidence for such bans, however, is limited. To test whether use‐of‐force policies prohibiting neck restraints are related to fewer police killings, we use three modeling approaches to analyze 2183 U.S. cities between 2009 and 2021. Police killings were lower in places that adopted neck‐restraint bans and the bans were associated with less crime and fewer assaults on officers, net of controls. Because officer labor unions can affect use‐of‐force policies and the frequency of police killings, we also analyzed them, finding unionization increased the likelihood a city had a neck‐restraint ban and had a null or negative association with police killings. Policy Implications: Adopting a neck‐restraint ban is likely an effective way to reduce deaths due to police use of force with minimal collateral consequences. The bans operate through a diffuse discouragement of many types of lethal force or as a part of an array of use‐of‐force policies. Their direct relationship to asphyxiation deaths remains unclear. Officer unionization is unlikely to change the frequency of police killings, except through its association with stricter use‐of‐force policies. [ABSTRACT FROM AUTHOR]

Antenatal hypoxia-ischaemia (HI) in preterm fetal sheep can trigger delayed evolution of severe, cystic white matter injury (WMI), in a similar timecourse to WMI in preterm infants. We therefore examined how severe hypoxia-ischaemia affects recovery of electroencephalographic (EEG) activity. Chronically instrumented preterm fetal sheep (0.7 gestation) received 25 min of complete umbilical cord occlusion (UCO, n = 9) or sham occlusion (controls, n = 9), and recovered for 21 days. HI was associated with a shift to lower frequency EEG activity for the first 5 days with persisting loss of EEG power in the delta and theta bands, and initial loss of power in the alpha and beta bands in the first 14 days of recovery. In the final 3 days of recovery, there was a marked rhythmic shift towards higher frequency EEG activity after UCO. The UCO group spent less time in high-voltage sleep, and in the early evening (7:02 pm ± 47 min) abruptly stopped cycling between sleep states, with a shift to a high frequency state for 2 h 48 min ± 40 min, with tonic electromyographic activity. These findings demonstrate persisting EEG and sleep state dysmaturation after severe hypoxia-ischaemia. Loss of fetal or neonatal sleep state cycling in the early evening may be a useful biomarker for evolving cystic WMI. [ABSTRACT FROM AUTHOR]

Survivors of intimate partner violence (IPV) often experience violent blows to the head, face, and neck and/or strangulation that result in brain injury (BI). Researchers reviewed the de-identified forensic nursing examination records of 205 women. More than 88% of women were subjected to multiple mechanisms of injury with in excess of 60% experiencing strangulation. About 31% disclosed various symptoms consistent with BI. Women experiencing strangulation were 2.24 times more likely to report BI-related symptoms compared to those who reported no strangulation. In conclusion, women experiencing IPV are prone to BI suggesting early screening and appropriate management are warranted. [ABSTRACT FROM AUTHOR]

In recent years, reports of health problems associated with nitrous oxide consumption have significantly increased. In Germany, nitrous oxide (N2O) is easily available in cartridges without legal restrictions. The main reason for its popularity in the party scene are the euphoric, psychedelic effects of the gas. In addition to severe and sometimes irreversible health problems associated with long-term use of nitrous oxide, e.g., anemia and nerve damage, life-threatening or fatal consequences of acute nitrous oxide consumption can also occur: accidents under the influence of nitrous oxide, pneumothorax, pneumopericardium and shock due to an explosive increase in airway pressure when inhaled directly from the cartridge. But the most common cause of severe complications is asphyxia as the gas is usually inhaled pure from large balloons and without oxygen. The resulting hypoxia during use may be perpetuated by the diffusion hypoxia that occurs during the reoxygenation period. Nitrous oxide as a cause in accidental or intoxication events is usually not detectable but can only be identified as a trigger based on the patient's history or the circumstances. Acute medical treatment is symptomatic. [ABSTRACT FROM AUTHOR]

Background: Oliguria is a sign of impaired kidney function and has been shown to be an early predictor of adverse prognoses in patients with acute kidney injury. The relationship between urine output (UOP) and early lactate levels in neonates with perinatal asphyxia (PA) has not been extensively explored. This study aimed to investigate the link between oliguria during the first 24 h of life and early lactate levels in neonates with PA. Methods: The medical records of 293 term neonates with asphyxia from 9216 hospitalized newborns were retrospectively analyzed, including 127 cases designated as the oliguria group and 166 cases as controls. Peripheral arterial blood gas after PA and UOP within 24 h after birth were analyzed. Logistic regression analyses and receiver operating characteristic curve analysis were conducted. Results: Oliguria occurred in 43.34% of neonates with PA. The median UOP of the oliguria and control groups were 0.65 and 1.46 mL/kg/h, respectively. Elevated lactate levels after PA are an independent risk factor for oliguria in the following 24 h (p = 0.01; OR: 1.19; 95%CI: 1.04–1.35) and show a moderate discriminatory power for oliguria (AUC = 0.62). Using a cut off value of 8.15 mmol/L, the positive and negative predictive values and the specificity were 59.34%, 63.86%, and 78.30%, respectively. Conclusion: Neonates with elevated lactate levels after PA face a risk of oliguria in the following 24 h. Based on early elevated lactate levels after resuscitation, especially ≥ 8.15 mmol/L, meticulously monitoring UOP will allow this vulnerable population to receive early, tailored fluid management and medical intervention. [ABSTRACT FROM AUTHOR]

Intimate partner violence (IPV) is a public health crisis across the globe, and one particular act of IPV, non-fatal strangulation, warrants serious attention. Non-fatal strangulation is a risk factor for intimate partner homicide (IPH) and can create long-term negative mental and physical health consequences. In this meta-analysis, we sought to examine factors associated with non-fatal strangulation victimization among women to help inform education and assessment efforts. Using database searches and Boolean search terms, a total of 16 studies met the inclusion criteria. A total of 16 factors that were found in at least two unique studies were examined. The strongest associated factors included physical IPV victimization, physical injury, IPH, and sexual IPV victimization. Other significant associated factors included lower education, anxiety symptoms, perceived risk of harm, post-traumatic stress symptoms, depressive symptoms, stalking victimization, and identifying as a Black woman. Experiencing childhood trauma, the length of the relationship, age, substance use, and identifying as Hispanic were not significantly related to strangulation victimization by an intimate partner. Education and assessment implications are discussed. [ABSTRACT FROM AUTHOR]

Background & Objective: We aimed to compare the correlation between nucleated red blood cell (NRBC) and creatine kinase (CK) levels with hypoxic-ischemic encephalopathy (HIE) in asphyxiated newborns. Materials & Methods: This case-control study included 30 asphyxiated (case) and 30 healthy neonates (control) born at Al-Zahra Hospital in Rasht, Iran. We collected the cord blood samples for CK level and NRBC at birth. The clinical stage of Sarnat indicated the severity of HIE. Data were analyzed in the two groups using IBM SPSS Statistics for Windows, version 22. Results: The case group had a higher NRBC count (P=0.001). The CK level was significantly different between the two groups and was higher in the case group than in the control group (P= 0.002). Results demonstrated a significant association between NRBC count and the occurrence of HIE in neonates with asphyxia (P = 0.021). Besides, a positive correlation was found between HIE and CK levels in the case group (r = 0.7, P=0.001). Conclusion: According to our results, NRBC count and umbilical cord CK level measurement are valuable predictors of asphyxia and HIE in neonates. In addition, measuring these parameters may help clinicians for faster diagnosis and better management. [ABSTRACT FROM AUTHOR]

The diagnosis of death by drowning remains a difficult task for forensic experts at the time of postmortem examination. The presence of putrefaction and postmortem artefacts cover essential signs of drowning found on external and internal examination of dead body. This study involved gross examination of middle ear cavity for presence of haemorrhage to establish a diagnosis of antemortem drowning. It was planned considering the lack of research on this subject in the North Indian population. This study was conducted in the Department of Forensic Medicine and Toxicology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab and included drowning deaths brought for autopsy. This study helped assessing the reliability of incidence of middle ear hemorrhage to affirm the diagnosis of antemortem drowning in the absence of other external and internal signs suggestive of drowning. [ABSTRACT FROM AUTHOR]

Background. Aspiration of food or liquids can result in suffocation, evolving in coughing, difficulty breathing and forced exhalation. Asphyxia occurs when the aspirated material occludes the upper airways, either in the proximal or distal tract, resulting in the inability to breathe. The risk of asphyxiation death, is increased if a person makes sudden movements while eating, walks or runs while eating, or even becomes distracted or frightened. It is higher in individuals with neurological diseases, intellectual disability (ID), cognitive impairment, psychiatric pathologies or their pharmacological treatments and people carrying additional physiological impairments, which can cause oral dysfunction and dysphagia. Protective mechanisms may sometimes lack or fail to expel food fragments stuck in the airways, which completely obstruct them. Case series. The authors present some peculiar cases of subjects who died from food bolus choking, namely a case of mozzarella-cheese clogging in a young subject (25 years old) undergoing rehabilitation treatment following a stroke; a 38-year-old man with middle-grade mental retardation died from first airway food bolus (mush of bread) clogging; a 26-year-old subject with epilepsy died from tripe clogging in the course of a seizure; a 38-year-old subject in psychiatric treatment for depressive disorder who died from clogging with octopus tentacles. Conclusion. Food bolus clogging asphyctic deaths generally occur in subjects with psychic/neurological pathologies, resulting in altered deglutition mechanisms or lack of protective reflexes. Foodstuff, especially if large or viscous, obstruct the proximal or distal airways, leading to acute respiratory failure and death. Autopsy is diriment in ascertain the cause of death. [ABSTRACT FROM AUTHOR]

The phenomenon of complex suicide is well-known and defined as the use of more than one suicidal method to cause death. It accounts for 1.5 to 05 % of all suicidal deaths. In complex suicides, planned and unplanned acts are differentiated. In unplanned suicides, one or more methods are used consecutively after the previous method failed and did not result in death. The present case report discusses the unplanned suicide of a young, extremely obese, 18-year-old boy. The boy was found in an unconscious state at his home in the bathroom, in sitting position on the floor with his neck suspended to the shower head with a rope with multiple cut marks over his body. During the autopsy, external examination revealed a ligature mark around neck and multiple superficial incised injuries over his face, neck and both wrists. Detailed autopsy examination confirmed the cause of death as asphyxia due to suicidal hanging with multiple incised injuries over the body. It is of utmost importance for the forensic investigator to have in-depth knowledge about different unusual suicidal methods. This will prevent unnecessary criminal investigation and help in the concrete establishment of the manner and cause of death. [ABSTRACT FROM AUTHOR]

BackgroundHypoxic-ischemic brain injury/encephalopathy affects about 1.15 million neonates per year, 96% of whom are born in low- and middle-income countries. Therapeutic hypothermia is not effective in this setting, possibly because injury occurs significantly before birth. Here, we studied the pharmacokinetics, safety, and efficacy of perinatal azithromycin administration in near-term lambs following global ischemic injury to support earlier treatment approaches.MethodsEwes and their lambs of both sexes (n=34, 141-143 days) were randomly assigned to receive azithromycin or placebo before delivery as well as postnatally. Lambs were subjected to severe global hypoxia-ischemia utilizing an acute umbilical cord occlusion model. Outcomes were assessed over a 6-day period.ResultsWhile maternal azithromycin exhibited relatively low placental transfer, azithromycin-treated lambs recovered spontaneous circulation faster following the initiation of cardiopulmonary resuscitation and were extubated sooner. Additionally, peri- and postnatal azithromycin administration was well tolerated, demonstrating a 77-hour plasma elimination half-life, as well as significant accumulation in the brain and other tissues. Azithromycin administration resulted in a systemic immunomodulatory effect, demonstrated by reductions in proinflammatory IL-6 (interleukin-6) levels. Treated lambs exhibited a trend toward improved neurodevelopmental outcomes while histological analysis revealed that azithromycin supported white matter preservation and attenuated inflammation in the cingulate and parasagittal cortex.ConclusionsPerinatal azithromycin administration enhances neonatal resuscitation, attenuates neuroinflammation, and supports limited improvement of select histological outcomes in an ovine model of hypoxic-ischemic brain injury/encephalopathy.

Originally approved by the U.S. Food and Drug Administration (FDA) for its antihistamine properties, clemastine can also promote white matter integrity and has shown promise in the treatment of demyelinating diseases such as multiple sclerosis. Here, we conducted an in-depth analysis of the feasibility, safety, and neuroprotective efficacy of clemastine administration in near-term lambs (n = 25, 141-143 days) following a global ischemic insult induced via an umbilical cord occlusion (UCO) model. Lambs were randomly assigned to receive clemastine or placebo postnatally, and outcomes were assessed over a six-day period. Clemastine administration was well tolerated. While treated lambs demonstrated improvements in inflammatory scores, their neurodevelopmental outcomes were unchanged.

Background: Recent technological evolutions allow for the identification of hearing level (HL) in infants soon after birth. The goal of early hearing detection and intervention is to maximize linguistic and communication skills and literacy development for children who are deaf or hard of hearing. Infants whose HL has been confirmed before 6 months of age must be provided early intervention. Aims and Objectives: The aim of the study was to observe the changes in the otoacoustic emissions (OAE) and brainstem auditory evoked potential (BAEP) in infants with birth asphyxia (BA). Materials and Methods: The present study was a case–control study. A total of 50 cases of infants with BA and 50 normal-term infants were part of the study after obtaining informed consent as per the ICMR guidelines. A through clinical examination and otoscopy examination were done to rule out any conductive hearing loss. Then, OAE and BAEP were recorded to estimate the hearing loss and hearing threshold of infants. Results: BAEP waveform I, III, and V absolute latencies were significantly prolonged among BA infants than normal infants. The interpeak latency (IPL) of the right ear III-V was significantly increased in BA infants. However, III-V and I-V latencies though prolonged in BA infants, they are not statistically significant. No significant interaural difference was noted in absolute and IPLs of both BA and normal infants. No significant relationship existed between the mode of delivery and the degree of hearing loss in both ears. Significant association was observed between the degree of hearing loss and severity of BA (hypoxic-ischemic encephalopathy) in both ears. Conclusion: BAEP recording in BA infants is useful to identify the hearing impairment at the earliest. The implication of this research work will help in early detection of hearing impairment, so that speech and language developmental delay in the child can be prevented.

Abstract Background Unsafe sleep environments are the primary modifiable risk factor for sudden unexpected infant death (SUID). Despite this knowledge, products that deviate from the American Academy of Pediatrics (AAP) safe sleep recommendations continue to be commonplace, such as inclined sleepers. Analyses to estimate risk among these products are lacking, perpetuating their presence in the marketplace. We present a method of comparing risk of SUID in an inclined sleeper to an AAP-recommended sleep environment. Methods A case-control analysis using publicly available and previously published survey data was conducted for SUID events occurring between January 1, 2018 and April 12, 2019 (the date of the first inclined sleeper recall). SUID deaths were categorized as occurring in an AAP-recommended sleep environments or in an inclined sleeper. Exposure Odds Ratios (OR) are reported as the risk of SUID among infants using inclined sleepers relative to an AAP-recommended sleep environment. Results During the study period, 4,900,573 births and 4,363 SUID deaths occurred in the US. Control characteristics were similar between previous night users of an AAP-recommended sleep environment (24%) and inclined sleepers (3.8%). Inclined sleepers were associated with a 5-fold (OR: 5.1; 95% CI: 3.2, 7.9) increased risk of SUID among infants

Abstract Objective To determine the effectiveness of phase-change-material mattress (PCM) during transportation of newborns with hypoxic ischemic encephalopathy (HIE). Study design Randomized controlled trial of newborns with HIE from June 2016 to December 2019. Patients were randomized to transport with PCM or without PCM (control) when transferred to a cooling center in northern Vietnam. Primary outcome measure was mortality rate, secondary outcomes including temperature control and adverse effects. Result Fifty-Two patients in PCM-group and 61 in control group. Median rectal temperature upon arrival was 34.5 °C (IQR 33.5–34.8) in PCM-group and 35.1 °C (IQR 34.5–35.9) in control group (p = 0.023). Median time from birth to reach target temperature was 5.0 ± 1.4 h and 5.5 ± 1.2 h in the respective groups (p = 0.065). 81% of those transported with PCM versus 62% of infants transported without (p = 0.049) had reached target temperature within the 6-h timeframe. There was no record of overcooling ( 0.05)). Conclusion Phase-change-material can be used as a safe and effective cooling method during transportation of newborns with HIE in low-resource settings. Trial registration The study was retro-prospectively registered in Clinical Trials (04/05/2022, NCT05361473).

Introduction: In all Neonatal Resuscitation Program (NRP) scenarios, Heart Rate (HR) counting is essential to assess the response to resuscitation. Undue delay in initiating Positive Pressure Ventilation (PPV) due to the time taken in HR counting may increase the risk of hypoxic injury and infant mortality. Aim: To observe whether omitting the HR counting step in the First Golden Minute (FGM) and early initiation of PPV affects outcomes. Materials and Methods: The present Randomised Controlled Trial (RCT) was conducted in the Special Newborn Care Unit (SNCU), GSVM Medical College, Kanpur, Uttar Pradesh, India, from September 2020 to March 2022. A total of 67 newborns were included, with 34 in the control group (group 1) and 33 in the intervention group (group 2). In the control group, neonatal resuscitation was performed according to Facility-based Newborn Care (FBNC) guidelines, while in the intervention group, only the HR counting step was omitted from the FGM. Both groups of newborns were assessed for outcomes including normal baby, baby developing Hypoxic Ischaemic Encephalopathy (HIE) stage I, II and III, and death. Data was compiled and analysed using percentages for categorical variables. Continuous variables were analysed using mean and standard deviation of Z score and Student’s t-test. A p-value less than 0.05 was considered statistically significant. Results: The mean gestational age was 38.3±5.8 weeks in group 1 and 37.9±6.1 weeks in group 2. Gender distribution was almost equal, with 19 (56%) female newborns in group 1 and 17 (52%) female newborns in group 2. The mean total time from birth to the end of PPV (in seconds) was significantly lower in group 2 (63.47±7.09) compared to group 1 (78.18±8.36), with a p-value of

Introduction: Resource limitation in developing countries may preclude access to cardiac troponin- T assay thereby necessitating reliance on clinical judgment for identification of hypoxic myocardial cellular injury. Objectives: cardiac troponin–T levels. Conclusion: Clinicians working in resource–limited health facilities should have a high index of suspicion for myocardial cellular injury when these signs are e To relate selected clinical signs with elevated serum cardiac troponin-T in asphyxiated term neonates. Methods: Asphyxia was identified by low umbilical arterial blood pH ≤ 7.20 and low five minute Apgar score ≤ 6 while controls were term, non–asphyxiated neonates. All babies were examined for heart rate, heart rhythm irregularities, peripheral pulse volume, respiratory rate, pallor, cyanosis, heart murmur and sensorium. Results: Thirty term, asphyxiated neonates and their matched controls were studied. Central cyanosis, reduced pulse volume, pallor, depressed sensorium; tachycardia and tachypnea were all associated with increased odds ratios for abnormallicited.

Background: Most deliveries in the developing world take place outside the hospital with poor assistance for the newborn. This puts the babies at risk of severe intrapartum events such as perinatal asphyxia. Most newborn babies admitted in tertiary centres with severe asphyxia are referred. Objectives: To determine the socio-demographic and clinical correlates of the perinatal outcome of neonates referred to a Nigerian tertiary facility on account of severe perinatal asphyxia. Methods: A prospective cross- sectional study was conducted at the Children’s Emergency Room and Neonatal Ward among newborn babies referred with severe asphyxia. Socio-demographic and clinical parameters were recorded and statistically analysed. Results: A total of 72 mother infant pairs were studied. Half of the babies were admitted after 24 hours of birth and 75.0% of the families belonged to the lower socio-economic classes. Only 62.5% of mothers received antenatal care at orthodox health facilities. Most of the deliveries took place at private hospitals (29; 40.3%) and Traditional Birth Homes (18; 25.0%). HypoxicIschaemic encephalopathy (HIE) was diagnosed among 57 (79.2%) babies with 46 (80.7%) and 11 (19.3%) classified as Stages II and III HIE respectively. There were 15 (20.8%) early neonatal deaths giving a perinatal mortality rate of 208.3/1000 admissions. The poor perinatal outcome was associated with age at admission within 24 hours, poor intrapartum care- seeking behaviour and the commencement of feeding before admission. Conclusion: The quality of antenatal care, intrapartum care, and delivery services appear to influence perinatal outcomes among referred babies with severe asphyxia.

Objective: To determine maternal and neonatal complications occurring at childbirth among adolescents. Materials and methods: This is a retrospective, descriptive study conducted from 1st July to 31st December 2019 at the maternity ward of the Sylvanus Olympio University Hospital Centre (CHU- SO), Lomé, Togo. The socio- demographic parameters of the mothers, details of prenatal and perinatal events and the clinical profile of the newborns at birth were studied. Results: The records of 332 adolescent mothers were studied. The average age of the mothers was 17.4 ± 1.5 years, with a range of 13-19 years. The pregnancies in two-thirds (66.3%) were supervised in centres without surgical facilities and by midwives in 83.1% of cases. A little over half of the mothers (53.3%) attended at least four antenatal clinic sessions, while 3.6% attended none. The modes of delivery were spontaneous vaginal (62.3%) and Caesarean section (35.2%). Complications of pregnancy were recorded in 12.9% of the mothers. There were statistically significant associations between the referred status of the mothers and haemorrhages, retained placenta and sepsis (p = 0.001, 0.038 and 0.011, respectively). There were no maternal deaths. The newborn babies required resuscitation in 6.3% of cases, while 7.0% were stillborn. There was a statistically significant relationship between the referred status of mothers and the occurrence of perinatal deaths (p = 0.0001). Conclusion: Adolescent mothers are at risk of complications during childbirth, and these risks are increased by poor antenatal care and attempted deliveries in centres without surgical facilities.

BACKGROUND: An ancillary study of the High-Dose Erythropoietin for Asphyxia and Encephalopathy (HEAL) trial for neonates with hypoxic-ischemic encephalopathy (HIE) and treated with therapeutic hypothermia examined the hypothesis that neonates randomized to receive erythropoietin (Epo) would have a lower seizure risk and burden compared with neonates who received placebo. METHODS: Electroencephalograms (EEGs) from 7/17 HEAL trial centers were reviewed. Seizure presence was compared across treatment groups using a logistic regression model adjusting for treatment, HIE severity, center, and seizure burden prior to the first dose. Among neonates with seizures, differences across treatment groups in median maximal hourly seizure burden were assessed using adjusted quantile regression models. RESULTS: Forty-six of 150 (31%) neonates had EEG seizures (31% in Epo vs 30% in placebo, p = 0.96). Maximal hourly seizure burden after the study drug was not significantly different between groups (median 11.4 for Epo, IQR: 5.6, 18.1 vs median 9.7, IQR: 4.9, 21.0 min/h for placebo). CONCLUSION: In neonates with HIE treated with hypothermia who were randomized to Epo or placebo, we found no meaningful between-group difference in seizure risk or burden. These findings are consistent with overall trial results, which do not support Epo use for neonates with HIE undergoing therapeutic hypothermia. IMPACT: In the HEAL trial of erythropoietin (Epo) vs placebo for neonates with encephalopathy presumed due to hypoxic-ischemic encephalopathy (HIE) who were also treated with therapeutic hypothermia, electrographic seizures were detected in 31%, which is lower than most prior studies. Epo did not reduce the proportion of neonates with acute provoked seizures (31% in Epo vs 30% in placebo) or maximal hourly seizure burden after the study drug (median 11.4, IQR 5.6, 18.1 for Epo vs median 9.7, IQR 4.9, 21.0 min/h for placebo). There was no anti- or pro-convulsant effect of Epo when combined with therapeutic hypothermia for HIE.