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Objective: To examine the relationship between gestational COVID-19 and perinatal-neonatal outcomes., Study Design: Prospective cohort study. Neonates born at Hospital del Mar (Barcelona) between 2020 and 2022 were classified into two cohorts according to their mother's COVID-19 status during pregnancy. Prenatal and postnatal variables were compared between the COVID-19 and the control cohort, and depending on timing and severity of maternal infection., Results: We included 2701 neonates and observed higher rates of respiratory distress (5.7% vs 3.3%, p = 0.044) and pathological jaundice (7.7% vs 4.1%, p = 0.007) in the COVID-19 cohort, without differences between trimesters. We did not find statistically significant differences in other perinatal outcomes. The logistic regression analyses showed that maternal COVID-19 was not a risk factor for prematurity (OR:1.23;CI:0.75-2.03; p = 0.407)., Conclusions: Infants born to mothers with COVID-19 during pregnancy in our hospital showed higher rates of respiratory distress and pathological jaundice, without increased rates of prematurity or other morbidities., Competing Interests: Competing interests: The authors declare no competing interests. Ethics approval: This study was conducted in line with the principles of the Declaration of Helsinki. All methods were performed in accordance with the relevant guidelines and regulations. Approval was granted by the Ethics Committee of Hospital del Mar (ref. 2022/10495). Consent to participate: Informed parental consent was obtained from all individual participants as required by the Ethics Committee of Hospital del Mar (ref. 2022/10495)., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Measurement of transcutaneous bilirubin (TcB) is a non-invasive, widely used technique to estimate serum bilirubin (SB). However, its reliability in multiethnic populations during and after phototherapy is still controversial even in covered skin. The aim of this study was to determine the reliability of TcB in covered (cTcB) and exposed (eTcB) skin during and after phototherapy in a multiethnic population of term and preterm neonates according to Neomar's neonatal skin color scale. Prospective, observational study comparing SB and TcB. We determined SB when clinically indicated and, at the same time, measured cTcB under a photo-opaque patch and eTcB next to it with a jaundice meter (Dräger JM-105TM). All dyads TcB-SB were compared, both globally and according to skin color. We obtained data from 200 newborns (color1: 44, color2: 111, color3: 41, color4: 4) and compared 296 dyads TcB/SB. Correlation between cTcB and SB is strong during (0.74-0.83) and after (0.79-0.88) phototherapy, both globally and by color group. The SB-cTcB bias depends on gestational age during phototherapy and on skin color following phototherapy. The correlation between eTcB and SB during phototherapy is not strong (0.54), but becomes so 12 h after discontinuing phototherapy (0.78).  Conclusions: Our study supports the reliability of cTcB to assess SB during and after phototherapy, with differences among skin tones after the treatment. The use of cTcB and Neomar's scale during and mainly after phototherapy may help reduce the number of blood samples required. What is Known: • Controversies exist on the reliability of jaundice meters during and after phototherapy in covered skin. Only a few studies have analyzed their accuracy in multiethnic populations, but none has used a validated neonatal skin color scale. What is New: • We verified correlation between serum and transcutaneous bilirubin in covered skin in a multiethnic population depending on skin color based on our own validated neonatal skin color scale during and after phototherapy., (© 2024. The Author(s).)

Objective: Fetal face measurements in prenatal ultrasound can aid in identifying craniofacial abnormalities in the developing fetus. However, the accuracy and reliability of ultrasound measurements can be affected by factors such as fetal position, image quality, and the sonographer's expertise. This study assesses the accuracy and reliability of fetal facial measurements in prenatal ultrasound. Additionally, the temporal evolution of measurements is studied, comparing prenatal and postnatal measurements., Methods: Three different experts located up to 23 facial landmarks in 49 prenatal 3D ultrasound scans from normal Caucasian fetuses at weeks 20, 26, and 35 of gestation. Intra- and inter-observer variability was obtained. Postnatal facial measurements were also obtained at 15 days and 1 month postpartum., Results: Most facial landmarks exhibited low errors, with overall intra- and inter-observer errors of 1.01 mm and 1.60 mm, respectively. Landmarks on the nose were found to be the most reliable, while the most challenging ones were those located on the ears and eyes. Overall, scans obtained at 26 weeks of gestation presented the best trade-off between observer variability and landmark visibility. The temporal evolution of the measurements revealed that the lower face area had the highest rate of growth throughout the latest stages of pregnancy., Conclusions: Craniofacial landmarks can be evaluated using 3D fetal ultrasound, especially those located on the nose, mouth, and chin. Despite its limitations, this study provides valuable insights into prenatal and postnatal biometric changes over time, which could aid in developing predictive models for postnatal measurements based on prenatal data., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

It is necessary to treat neonatal pain because it may have short- and long-term adverse effects. Frenotomy is a painful procedure where sucking, a common strategy to relieve pain, cannot be used because the technique is performed on the tongue. In a previous randomized clinical trial, we demonstrated that inhaled lavender essential oil (LEO) reduced the signs of pain during neonatal frenotomy. We aimed to find out whether inhaled vanilla essential oil (VEO) is more effective in reducing pain during frenotomy than LEO. Randomized clinical trial with neonates who underwent a frenotomy for type 3 tongue-ties between May and October 2021. Pain was assessed using pre and post-procedure heart rate (HR) and oxygen saturation (SatO2), crying time, and NIPS score. Neonates were randomized into "experimental" and "control" group. In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for 2 min. We placed a gauze pad with one drop of LEO (control group) or of VEO (experimental group) under the neonate's nose for 2 min prior to and during the frenotomy. We enrolled 142 neonates (71 per group). Both groups showed similar NIPS scores (2.02 vs 2.38) and crying times (15.3 vs 18.7 s). We observed no differences in HR increase or in SatO2 decrease between both groups. We observed no side effects in either of the groups., Conclusions: We observed no appreciable difference between LEO and VEO; therefore, we cannot conclude which of them was more effective in treating pain in neonates who underwent a frenotomy., Trial Registration:  This clinical trial is registered with www., Clinicaltrials: gov with NCT04867824., What Is Known: • Pain management is one of the most important goals of neonatal care as it can have long-term neurodevelopmental effects. • Lavender essential oil can help relieve pain due to its sedative, antispasmodic, and anticolic properties., What Is New: • Lavender and vanilla essential oils are safe, beneficial, easy to use, and cheap in relieving pain in neonates who undergo a frenotomy for type 3 tongue-ties., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Neonatal pain may affect long-term neurodevelopment and must be treated. Frenotomy is a painful procedure wherein a common strategy to relieve pain (sucking) cannot be used because the technique is performed on the tongue. Lavender essential oil (LEO) has sedative and antispasmodic properties and has been successfully used to treat pain during heel puncture and vaccination. Our aim was to demonstrate if the use of inhaled LEO is effective in reducing pain during frenotomy in healthy, full-term neonates., Methods: We conducted a randomized clinical trial in neonates who underwent a frenotomy between August 2020 and April 2021. We assessed pain using pre and post-procedure heart rate and oxygen saturation, crying time and Neonatal Infant Pain Scale (NIPS) score. Patients with type 3 tongue tie were randomized into the "experimental group" and "control group". In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for two minutes. In the experimental group, we also placed a gauze pad with one drop of LEO under the neonate's nose for two minutes prior to and during the frenotomy., Results: We enrolled 142 patients (71 per group). The experimental group showed significantly lower NIPS scores (1.88 vs 2.92) and cried almost half the amount of time (14.8 vs. 24.6 seconds, P = 0.006). Comparing with the control group, we observed no side effects in either of the groups., Conclusions: We observed a significant decrease in crying time and lower NIPS scores in the neonates who received inhaled LEO and underwent a frenotomy for type 3 tongue-ties. Thus, we recommend using inhaled LEO during neonatal frenotomies., (© 2022. Children's Hospital, Zhejiang University School of Medicine.)

Prenatal alcohol exposure is the leading preventable cause of cognitive deficit in developed countries and can lead to fetal alcohol spectrum disorder (FASD). This term encompasses a wide range of physical, mental, behavioral, and cognitive effects that result from damage caused by exposure to alcohol during intrauterine life. Alcohol consumption among the general population is common in Eastern European countries and especially among women at risk of social exclusion, who are the ones who lose or give up custody of their children. A high number of these children are adopted in Spain and many of them present neurocognitive and behavioral disorders, causing FASD to be a public health problem in our country. In many occasions this clinical spectrum is delayed or under-diagnosed due to the overlapping of neuropsychological symptoms caused by the abandonment. A neurocognitive and behavioral profile specific for FASD has not been defined and all the symptoms are common to other etiologies. The aim of this work is to review the neuropsychological profile in the diagnosis of FASD., (Copyright © 2021 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: To determine the prevalence of substance abuse among our pregnant women and the characteristics of their pregnancies, deliveries and new-born infants., Methods: Retrospective observational study of infants born between January 1, 2009 and December 31, 2017 in our centre to substance-abusing mothers and compared with our 2002-2008 study., Results: Heroin use is decreasing, while cannabis and methamphetamine use are increasing. We observed a decrease in withdrawal associated with methadone and benzodiazepine use and an increase in breastfeeding in benzodiazepine and cannabis users. The infants of mothers who use heroin and cocaine are discharged to the mother's home less often. We observed a predominance of substance abuse among Spanish women except for methamphetamines, where the majority of users are Filipino., Conclusions: The increase in cannabis use and the decrease in heroin and cocaine use have improved gestational control. Methamphetamine use is associated with serious social risks., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)

Ankyloglossia, or tongue-tie, is a congenital anomaly in which a short lingual frenulum or a highly attached genioglossus muscle restricts tongue movement. The reported prevalence of neonatal ankyloglossia varies between less than 1 and 12.1% depending upon the study population and criteria used to define and grade ankyloglossia. Our hypothesis was that ankyloglossia had a higher prevalence among our newborn population than previously reported. We conducted an observational, transversal cross-sectional study which included all neonates born in our center between January 1 and December 31, 2018, and actively assessed for tongue-tie. We considered "clinically significant" or "symptomatic" ankyloglossia using the Hazelbaker tool for appearance and function when the mother experienced nipple pain or bruises, or when the neonate had difficulty latching onto the breast. A total of 1392 neonates were born at our center in 2018. Tongue-tie was identified in 645 infants (46.3%), of which 453 were symptomatic (70.2%). Thus, clinically significant ankyloglossia was present in 32.5% of the neonates born in 2018. Their distribution according to Coryllos's types were as follows: 45 type 1 (7.0%), 230 type 2 (35.6%), 321 type 3 (49.8%), and 42 type 4 (6.5%).Conclusion: The prevalence of symptomatic ankyloglossia in our population is higher (32.5%) than studies have reported to date. Actively assessing for tongue-tie increases its diagnosis. What is Known: • There are four types of tongue-tie according to Coryllos (1, 2, 3, and 4), of which the two anterior types (1 and 2) are the most apparent and easy to diagnose. • The reported prevalence of ankyloglossia generally varies from < 1 to 12.1%, although some recent studies report a higher prevalence. What is New: • We found a prevalence of neonatal ankyloglossia of 46.3%, of which 70.2% was symptomatic (clinically significant ankyloglossia was present in 32.5% of the neonates born in 2018 at our hospital). • Actively assessing for ankyloglossia and posterior tongue-ties, which are likely more often undiagnosed, increases its diagnosis.

Measurement of transcutaneous bilirubin (TcB) is widely used to estimate serum bilirubin (SB). However, its reliability depending on skin tone is still controversial. Ethnic classification does not correlate well with skin tone. We aimed to determine the reliability of transcutaneous bilirubin in a multiethnic population based on skin color according to our neonatal skin color scale. We conducted a prospective, observational study comparing SB and TcB among different skin colors. With the blood sample routinely obtained at 48-72 h for the screening of inborn errors of metabolism, we determined SB and TcB with a jaundice meter. We obtained data from 1359 newborns (color 1 337, color 2 750, color 3 249, color 4 23) and analyzed 1549 dyads SB/TcB. Correlation between TcB and serum bilirubin was very good (R 2 = 0.908-0.956), globally and by color group, with slight differences between darker and lighter skin colors. Bland-Altman plots showed different mean bias depending on skin color. Conclusions: Our study not only supports the reliability of TcB to assess SB regardless of skin color, but also supports the fact that TcB tends to overestimate SB in a higher degree in dark-skinned neonates. This may help reduce the number of blood samples for newborns. What is Known: • Jaundice meters are extensively used to diagnose neonatal hyperbilirubinemia, although controversies exist on their reliability depending on skin color. • Only a few studies have analyzed their accuracy in multiethnic populations, but none has used a validated neonatal skin color scale. What is New: • We verified correlation between serum and transcutaneous bilirubin in a multiethnic population depending on skin color after classifying our neonates into color groups with our own validated neonatal skin color scale.

Ethnic classification does not correlate well with skin tone. As there are no neonatal skin color scales, we aimed to create and validate one of our own. After creating the scale and briefly training our staff, we conducted a prospective, observational study to assess reproducibility and correlation of each scale color with the melanin and erythema indexes and transcutaneous bilirubin. The reliability of our color scale was measured using Kappa agreement (and its 95% confidence interval) and the concordance index by comparing inter-observer classification of neonatal skin color. We also calculated inter-rater agreement with the intraclass correlation coefficient (ICC). The Kendall tau-b correlation coefficient was used to test the correlation between our color scale and the Mexameter® MX 18. We obtained data from 258 newborns. Inter-observer agreement on color assignment was 83.2%. Median melanin index was significantly different among the 4 color groups, whereas erythema index and transcutaneous bilirubin were not.Conclusions: Our proposed neonatal skin color scale correlates well with the melanin index at 24 h of life, increasing from colors 1 to 4, and the only chromophore different among our four color groups is melanin. Scale color assignment is reproducible. Therefore, it can be used to classify neonatal skin color. Further research is warranted to assess the clinical relevance of these findings. What is known: • Classifying neonates by skin color is difficult because to date there are no skin color scales available based on real skin tone regardless of ethnicity or country of origin. • Skin color differs among individuals from a given ethnic group and depends, among others, on melanin and hemoglobin. What is new: • We created a neonatal skin color scale based on real skin color. • We conducted a study to validate it, and confirmed a good inter-observer agreement in color assignment as well as a good correlation between each color in the scale and the median melanin level.