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Les urgences chirurgicales néonatales regroupent un ensemble d'affections qui nécessitent une prise en charge immédiate et adéquate en raison d'une menace vitale ou fonctionnelle. Notre travail a pour but de déterminer la fréquence et les facteurs épidémiologiques ainsi que le pronostic à court et moyen termes. Nous rapportons une étude rétrospective des urgences chirurgicales néonatales colligées sur une période de 12 mois. Ont été inclus, tous les nouveau-nés admis dans le cadre d'une urgence chirurgicale, opérés ou non, durant la période néonatale. Les anomalies étaient dominées par 46,5 % par le tableau d'occlusion néonatale, 18,6 % des nouveau-nés avaient une atrésie de l'œsophage, 10,4 % une anomalie de la paroi abdominale, 9,3 % une anomalie thoracique et 5,8 % des anomalies neurologiques, 3,4 % admis pour des malformations de l'arbre urinaire et anomalies ORL et 2,3 % une cause tumorale. Sur le plan thérapeutique 79 % des nouveau-nés avaient bénéficié d'un geste chirurgical. L'évolution clinique est marquée par le décès de 32 patients, soit 37 %. Les urgences chirurgicales néonatales requièrent une prise en charge immédiate et adéquate. D'où l'intérêt du suivi des grossesses et du diagnostic anténatal et de l'examen systématique et minutieux du nouveau-né en salle de naissance afin d'améliorer la prise en charge et le pronostic. Neonatal surgical emergencies include conditions that require immediate and adequate management due to a vital or functional threat. Our paper aims to determine the frequency and epidemiological factors as well as the short- and long-term prognosis. We report a retrospective study of neonatal surgical emergencies collected over a period of 12 months. Included were all newborns admitted as part of a surgical emergency, operated on or not, during the neonatal period. The anomalies were dominated by 46.5% by the neonatal occlusion, 18.6% of the newborns had esophageal atresia, 10.4% an abdominal wall anomaly, 9.3% a thoracic anomaly and 5.8% neurological abnormalities, 3.4% admitted for malformations of the urinary tree and ENT abnormalities and 2.3% a tumor cause. Therapeutically, 79% of newborns had benefited from a surgical procedure. The clinical evolution is marked by the death of 32 patients that is 37%. Neonatal surgical emergencies require immediate and adequate management. Hence, the interest of monitoring pregnancies and antenatal diagnosis and systematic and careful examination of the newborn in the birth room in order to improve management and prognosis. [ABSTRACT FROM AUTHOR]

Introduction: The obesity pandemic is a source of problems in both developed countries. The obesity is associated with complications before and during pregnancy and even infant death. The study aims to find out the issue of obesity among women of reproductive age, particularly concerning its impact on maternal and fetal outcomes during pregnancy. Methods: This is a cross-sectional observational study using secondary data with medical records taken at Sebelas Maret University Hospital (UNS Hospital). Subjects were obese pregnant women who gave birth at UNS Hospital. Data from 284 single births were added maternal parameters, obstetric parameters, and newborn parameters were taken and then analyzed univariately, and bivariate analysis was carried out using the Kruskall-Wallis test and the Spearman test for comparison and correlation of each variable. Results: This study finds lower incidences of postdate pregnancy and instrumental deliveries among obese mothers, but a higher rate of emergency cesarean sections. Newborn anthropometric measurements increase with maternal BMI, indicating a direct association between maternal obesity and newborn health (p = 0.001), while APGAR scores show no significant differences among maternal BMI groups. The findings underscore the importance of addressing maternal obesity to improve both maternal and newborn health outcomes. Conclusion: The research indicates a correlation between maternal BMI, maternal obstetric characteristics, newborn anthropometric measurements, and APGAR scores. This suggests that interventions aimed at promoting healthy maternal BMI, beginning before conception, continuing throughout pregnancy, and extending into the post-pregnancy period, could potentially improve newborn health outcomes and give long-term health benefits. [ABSTRACT FROM AUTHOR]

Perinatal mental health challenges are prevalent in Africa, with estimates exceeding those observed in high-income countries. Significant obstacles in screening and care provision complicate interventions to address these challenges. This mini-review synthesises findings from relevant literature on perinatal mental health screening interventions in Africa. The review included studies on the prevalence of perinatal mental disorders, associated risk factors, existing care models, screening tool effectiveness, and the roles of healthcare providers and policymakers. As part of the methodology, academic databases such as EBSCOhost, Pubmed, PsycINFO, and CINAHL were searched using specific keywords and MeSH terms related to perinatal mental health, screening, and interventions in Africa. Boolean operators were employed to refine search results. Studies published in English within the past 15 years were included, focusing on African populations. The studies were critically appraised for methodological quality and relevance. Key findings were extracted and synthesised to provide a comprehensive overview of perinatal mental health screening in Africa. Results showed that the challenges to effective screening and care include a high burden of mental health issues, limited screening resources, and a shortage of mental health specialists and medications. Additionally, the lack of training for health workers, poorly coordinated referral systems, and stigma surrounding mental health further hinder effective screening. One in four pregnant women and one in five postpartum women in Africa experience mental health problems. To address these challenges, increasing awareness of perinatal mental health issues, training healthcare staff, developing context-specific solutions, and utilising telehealth and mobile health services are essential. These strategies could provide timely support and reduce the incidence of perinatal mental health challenges in Africa. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to investigate whether there are differences in carboxyhemoglobin, bilirubin and hemoglobin values of neonates born by normal spontaneous vaginal birth (NSVD) (without anesthesia) and elective spinal cesarean section (CS) and its effect on neonatal jaundice. Materials and Methods: A total of 110 healthy neonates without any risk factors for neonatal hyperbilirubinemia were included in the study. There were fifty-five neonates in both NVSD and spinal CS groups. COHb, bilirubin and Hb values which were measured from umbilical cord blood (as cord) and capillary blood taken from the heel 4-6 hours after birth (as post cord) were recorded. Results: No statistically significant difference was found between the groups in terms of birthweight, maternal age, APGAR scores, and gender (p>0.05). There was a statistical difference between the groups according to the mean of gestational age, and it was observed that the mean of gestational age in spinal CS group was lower than in NSVD group (38.30±1.2 and 39.16±1.39 respectively) (p=0.001). Umbilical cord COHb levels in spinal CS group were higher than in NSVD group, but there was no statistically significant difference between groups (1.01±0.15 and 0.99±0.20 respectively, p=0.22). Furthermore, the differences between groups in term of mean of bilirubin and Hb levels in cord and post cord were not statistically significant (>0.05). But, it was determined that post cord COHb levels were higher than in NVSD group, and this difference was statistically significant (p=0.028). Additionally, it was found that the mean rank of COHb, bilirubin, and Hb in cord and post cord values were statistically significantly different between the groups (p < 0.05). Conclusion: It should be kept in mind of that the anesthetic agent may also be a factor in bilirubin increases that occurs in neonatal hyperbilirubinemia without an underlying risk factor. [ABSTRACT FROM AUTHOR]

Background: Strategic action plans around newborn health evaluation are needed, to address the high neonatal mortality rate in Nepal. Surveillance systems, like Newborn Metabolic Screening (NBS), could reveal unrecognized drivers of neonatal death. NBS is not routinely performed in Nepal. Our objective was to determine the feasibility of establishing NBS, and its acceptability among healthcare providers and parents, in Nepal. Methods: This prospective cohort study was conducted between November 2021 and May 2022 in term/late preterm infants born at Paropakar Maternity Hospital, Kathmandu, screening for 6 disorders that can be confirmed and managed locally. Staff were trained on dried-blood spot collection and transport protocols, performance metrics were established, and assays were performed at an accredited laboratory in Bangalore, India. Surveys were developed to determine acceptability among health-care providers and parents. Results: Of 835 parents approached for the study, 825 (98.8%) consented. Parental surveys showed that 92% considered "no cost" option most important in choosing to participate in the study. Samples were transported to laboratories in Kathmandu and Bangalore in 36 ± 24 h, and 4.75 ± 1 days, which exceeded expected metrics of 24 and 48 h, respectively. Results were communicated to parents by 9.5 ± 2 days, which was within the expected metric window of 14 days. Abnormalities were reported in 13 infants and included 5 hemoglobinopathy traits (4 Hb E and 1 Hb D), 3 congenital hypothyroidism, 2 glucose-6-phosphate dehydrogenase deficiency, 1 congenital adrenal hyperplasia, 1 elevated acylcarnitine, and 1 biotinidase deficiency. Healthcare providers surveyed (n = 116) showed that 67% reported a moderate understanding of NBS; all indicated that screening would be beneficial. Most cited early diagnosis and treatment, as well as, providing risk to future pregnancies as significant benefits. 90% thought screening should be routinely performed. Conclusions: We demonstrate that it is feasible to introduce NBS in Nepal. Transport metrics were longer than expected due to COVID pandemic travel restrictions; however, it was possible to deliver results to families within 2 weeks of birth. Parents overwhelmingly considered "no cost" option as the most important in choosing to screen. A government-sponsored program will be a key factor in establishing NBS in Nepal. [ABSTRACT FROM AUTHOR]

Objective • Maternal gestational hypertension and chlamydia infection are recognized as common diseases of pregnancy, which are associated with an increased risk of antibiotic usage for newborns. Our study aimed to evaluate the association between co-existing maternal gestational hypertension and chlamydia infection during pregnancy and the risk of neonatal antibiotic use. Methods • Our study included 3 383 942 eligible subjects from the National Vital Statistics System (NVSS) database in 2019. Clinical characteristics, including a history of prepregnancy diabetes and hypertension, pregnancy complications, pregnancy infections, etc. were collected. Multivariate logistic regression analyses were used to examine the association between maternal gestational hypertension and chlamydia infection and the risk of the use of antibiotics for newborns. Simultaneously, we adopted attributable proportion (AP) and synergy index (S) to assess whether the interactions are statistically significant. Results • Of 3383942 participants, 61133 participants had antibiotic use and 3 322 809 did not. After adjusting for all covariates, gestational hypertension [odds ratio (OR) = 1.04; 95% confidence intervals (CI): 1.04-1.04] and chlamydia infection (OR = 1.32, 95% CI: 1.32-1.32) were associated with an increased risk of antibiotic use. Mothers with both gestational hypertension and chlamydia infection (OR = 1.94, 95% CI: 1.72-2.20) had a higher risk of antibiotic usage for newborns. Moreover, the synergistic interaction of gestational hypertension and chlamydia infection was found to be significant (AP = 0.12, 95% CI: 0.01-0.24; S = 1.34, 95% CI: 1.02-1.76). Finally, stratification analyses based on mothers’ age elucidated that the interaction was robust among the group with nonadvanced maternal age. Conclusion • Synergistic interaction between maternal gestational hypertension and chlamydia infection may significantly increase the risk of antibiotic usage for newborn. However, more studies are required in the future to confirm this association and elucidate the underlying mechanism. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Is early rescue ICSI (E-RICSI) an effective and safe technique compared to conventional ICSI? SUMMARY ANSWER Despite the higher multi-pronucleus (PN) rate compared to conventional ICSI, E-RICSI did not add extra risks to clinical and neonatal outcomes. WHAT IS KNOWN ALREADY Based on the finding that the second polar body was released in 80% of fertilized oocytes by 4 h after exposure to spermatozoa and in ∼90% of fertilized oocytes by 6 h, E-RICSI brings forward the timing of rescue ICSI to 6 h after initial insemination, and effectively prevents oocyte aging and embryo-uterus asynchrony. However, some researchers still voice concerns about the efficacy and safety of E-RICSI, and comparative studies are limited. STUDY DESIGN, SIZE, DURATION A retrospective cohort study was conducted on patients who underwent conventional ICSI or E-RICSI treatment between January 2015 and December 2020 at a university-affiliated hospital. Using 1:1 propensity score matching, 1496 cases entered each group. PARTICIPANTS/MATERIALS, SETTING, METHODS In total, 1496 couples undergoing conventional ICSI oocyte retrieval cycles and 1496 undergoing E-RICSI oocyte retrieval cycles were enrolled in this study, and basic clinical characteristics, embryologic data, clinical outcomes and neonatal data were compared between groups. The embryos in the E-RICSI group were divided into two subgroups: those fertilized by iIVF (IVF subgroup) and those fertilized by E-RICSI (E-RICSI subgroup); the embryologic data, clinical outcomes, and neonatal data for these subgroups were also compared with the conventional ICSI group. Logistic regression was used for statistical analysis with potential confounder adjustment. MAIN RESULTS AND THE ROLE OF CHANCE The 2PN rate, blastocyst formation rate, and viable blastocyst formation rate of the E-RICSI group were significantly lower compared to the conventional ICSI group (2PN rate: P  < 0.001; blastocyst formation rate: P  < 0.001; viable blastocyst formation rate: P  = 0.004), and the multi-PN rate in the E-RICSI group was significantly higher than the conventional ICSI group (P  < 0.001). However, the number of 2PN embryos, normal cleavage embryo rate, Day 3 high-quality cleavage embryo rate, and high-quality blastocyst rate were similar between groups. When considering the IVF embryos and E-RCSI embryos in the E-RICSI group independently, the 2PN rate of the conventional ICSI group was significantly lower than E-RICSI subgroup but higher than the IVF subgroup, whereas the blastocyst formation rate and viable blastocyst formation rate were higher than E-RICSI embryos but comparable to IVF embryos. As for the clinical and neonatal outcomes, the implantation rate of the E-RICSI subgroup was significantly lower than the IVF subgroup but comparable to the conventional ICSI group, while the low birthweight (LBW) rate was significantly lower compared with the conventional ICSI group but similar with the IVF subgroup. No other differences were observed among the three groups for cumulative clinical pregnancy rate, cumulative live birth rate, and the pregnancy outcomes per transfer including clinical pregnancy, ectopic pregnancy, miscarriage, and live birth, either in fresh or frozen embryo transfer cycles. Furthermore, neonatal outcomes, including cesarean section, sex ratio, LBW, preterm birth, and macrosomia, were similar among groups. LIMITATIONS, REASONS FOR CAUTION This study is limited by the retrospective design, limited sample size, and short follow-up period. However, our study underlies the need for large-scale, multi-center randomized controlled trials with long-term follow-up. WIDER IMPLICATIONS OF THE FINDINGS Short-term insemination (3 h) combined with E-RICSI may be a safe and effective method to prevent the occurrence of total fertilization failure, and patients with normal or borderline sperm could be encouraged to try IVF first. STUDY FUNDING/COMPETING INTEREST(S) This study was supported by grants from the National Key & Development Program of China (No. 2021YFC2700603) and the National Natural Science Foundation of China (No. 81801443). The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Subcutaneous fat necrosis of the newborn is a selflimited disorder of the panniculus that arises in the first six weeks of life. Some differential diagnoses may be difficult such as bacterial cellulitis or erysipelas. The prognosis is usually favorable but there are serious complications for which the patient must be regularly monitored, especially hypercalcemia. We report a case of a full-term newborn with a liquidated area of subcutaneous fat necrosis. A surgical incision was performed because of the discomfort and the lack of regression. Hypercalcemia and nephrocalcinosis appeared afterward. A set of clinical, biological, and histological arguments allows the diagnosis of subcutaneous fat necrosis. Followup to early detection and to manage such complications is necessary. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to analyze the associations of zinc serum levels in the blood cord with the general health status of neonates, along with the characteristics and outcomes in Ulin General Hospital, Banjarmasin. Design/Methodology/Approach: A cross-sectional study was conducted in October- November 2021. The subjects were divided into two groups based on the zinc serum level (≤67.5 µg/dl and >67.5 µg/dl). The cut-off was determined by the receiver operating characteristic (ROC). Findings: There were 35 subjects in the group with zinc serum level ≤67.5 µg/dl and 34 subjects in the group with zinc serum level >67.5 µg/dl. Neonates with zinc serum level over the cut-off significantly had a higher birth weight (p=0.038), lower incidence of prematurity (p=0. 02, OR 0.21; 95%CI: (0.05-0.84)), lower incidence of anemia (p=0.001, 95%CI: 0.1(0.012- .89)), neonatal jaundice (p=0.02, OR 0.3; 95%CI: 0.1-0.85), and neonatal infections (p=0.000 OR 0.008; 95%CI: 0.001-0.067). Conclusion: The zinc serum level of the blood cord is strongly associated with the general health status and outcomes of the newborn. It is also associated with the general health of neonates, birth weight, prematurity, the incidence of infection, jaundice, anemia of newborns, and the need for NICU during the treatment. Limitations: A relatively short period of observation and a small number of subjects due to the limitation of resources. Practical Implications: propose the importance of zinc intake in pregnancy as it strongly implicates the general health status and outcomes of neonates. Contribution to Literature: This study provides a cut-off value with significant results and encourages further investigation to determine the need and effects of early zinc supplementation. [ABSTRACT FROM AUTHOR]

Purpose: Although it is known that timely initiation of breastfeeding (TIB) has beneficial effects on newborn and maternal health as well as increasing exclusive breastfeeding for first 6 months, global and regional desired TIB rates have not been reached yet. This study aimed to evaluate the effect of the "Neonatal Baby Service" (NBS) on TIB. Material and Methods: The descriptive and cross-sectional study was carried out at NBS and obstetrics and gynecology service (OGS) of Aksaray University Training and Research Hospital in Turkey between September 01 and December 31, 2021. A total of 486 newborns who were born between 32-40 weeks, weighed over 2000 g and were not separated from their mothers during the first 2 hours were included in the study. Results: TIB rate was found 80.5% (n=391). TIB rate were found to be significant as 83.1% (n=296) in the NBS, and 73.1% (n=95) in the OGS (p=0.013). When breastfeeding problem were analysed, it was found to be 46.9% in OGS and 28.9% in the NBS (p<0.001). TIB rates in newborns (92.6%) born by normal vaginal mode were significantly higher than the other groups (p<0.001). The rate of skin-skin contact (SSC) in 0-30 minutes was found to be remarkable as 59.6% in the NBS and 33.8% in the OGS (p<0.001). Conclusions: It was shown that the NBS service, which only focuses on newborns during the period from delivery to discharge in the hospital, increases the rates of SCC and TIB. [ABSTRACT FROM AUTHOR]

Congenital cutaneous candidiasis (CCC) is a rare condition in neonates, mainly in term neonates, that develops in the 1st week of life. Its broad clinical spectrum makes it challenging to differentiate it from other exanthemas in the newborn. The involvement of palms and soles and the presence of pustules are important clinical clues for the differential diagnosis, with cultural examination confirming the diagnosis by identification of Candida spp. Treatment of clinically stable term neonates without evidence of invasive disease is currently controversial. We report a case of CCC in a term newborn with no evidence of invasive disease that evolved into a clinical cure after systemic and topical antifungal treatment. [ABSTRACT FROM AUTHOR]

Background: Research on sedentary behavior and effects on maternal and newborn outcomes has been inconclusive. The objective of this report was to correlate sedentary time with maternal and fetal anthropometric measurements and compare the effect on sedentary time based on meeting prenatal activity guidelines. Methods: Healthy pregnant women (N = 61) in their second trimester (24-28 wk gestation) provided 7-day accelerometry data. Outcomes, including neonatal weight, length, and body fat percentage, were collected 24 to 48 hours after delivery. Placenta weight was measured immediately after delivery. Gestational weight gain was calculated by subtracting self-reported prepregnancy weight from measured weight at 38 weeks gestation. Correlations between sedentary time and outcomes were tested with Spearman and Pearson coefficient of correlations in all women separately and in accordance with the 2019 Canadian prenatal exercise guidelines. Results: No significant associations were found between sedentary time and the selected outcomes, even when compared by prenatal exercise level. There was no difference in total time spent sedentary between active (576.7 [52.8] min) and inactive women (599.3 [51.6] min). Conclusions: Meeting exercise recommendations during pregnancy does not significantly decrease total sedentary time. Future studies should aim to evaluate the health effects of both decreasing sedentary time and meeting prenatal exercise guidelines. [ABSTRACT FROM AUTHOR]

The current study evaluated the radon content in drinking water from several sources in the Moga district of Punjab, India, using a scintillation-based detector (groundwater and surface water). The average radon content in water was 3.48 Bq L-1, with a standard deviation of 2 Bq L-1, and a range from 0.88 Bq L-1 to 8.82 Bq L-1. The health risk for newborn (1-2 years), children (8-12 years), and adults have also been calculated using the ingestion and inhalation doses (above 17 years). The average annual effective dose that resulted was found to be much lower than the WHO-recommended safe level of 0.1 mSvy-11. Therefore, it can be stated that the population of the examined area is not significantly at danger for radiological health due to radon in water. [ABSTRACT FROM AUTHOR]

Background: The morbidity of early-term newborns (ETNBs) is associated with the immaturity of their organs and maternal biological factors (MBF). In this study, we determined the relationship between MBF and early-term birth. In addition, we assessed the role of gestational age (GA) and MBF in the morbidity of ETNBs compared with full-term newborns (FTNBs). Methods: This retrospective cohort included ETNBs and FTNBs. The frequency of morbidities was compared between groups stratified by GA with the X2 test or Fisher's exact test. The association of MBF with GA and morbidity was calculated using binomial regression models between the variables that correlated with the morbidity of the ETNBs using Spearman's correlation. A significance level of 5% was estimated for all analyses. Results: The probability of morbidity at birth for ETNBs was 1.9-fold higher than for FTNBs (37.5% vs. 19.9%), as they required more admission to the neonatal unit and more days of hospitalization; the most frequent pathology was jaundice. The MBF associated with early term birth were hypertensive disorders of pregnancy (aRR = 1.4, 95% confidence interval (CI): 1.3-1.6), intrauterine growth restriction (aRR = 1.5, 95%CI: 1.3-1.6), and chronic hypertension (aRR = 1.6, 95%CI: 1.4-1.8). No association was found between MBF and morbidity at 37 and 38 weeks. Conclusions: The morbidity among ETNBs is related to physiological immaturity. The adverse MBF favor a hostile intrauterine environment, which affects fetal and neonatal well-being. [ABSTRACT FROM AUTHOR]

Introduction: Craniofacial anomalies (CFAs) are a manifold group of malformations in the growth of the head and face. Congenital anomalies are the major cause for pregnancy termination, infant mortality as well as childhood morbidity. The occurrence of congenital CFAs in the Indian population remains unlashed. Objectives: The objective of the study is to assess the frequency of incidence and types of CFAs and also their association with maternal risk factors. Materials and Methods: A cross-sectional survey was conducted on the mothers/babies delivered for 60 days at Vanivilas Hospital, Bengaluru. The anomalies were broadly classified as major and minor, further by structure as cranial, oral, nasal, auricular, and ocular. Data were analyzed to determine the association of these anomalies with mother's age, gestational age, gender, and weight of the baby. Results: Out of 2251 deliveries, 158 were dead of which 12 (7.6%) had major CFAs. About 0.8% of major anomalies and 3.0% of minor anomalies occurred. The most common major craniofacial anomaly observed was anencephaly. In minor anomalies, anomalies of the oral cavity included gingival cyst, tongue-tie, epulis, and natal teeth. Mothers with age >35 years and gestational age <37 weeks had higher risk for major CFAs. Conclusions: This study provides baseline information for future prevention and better management of patients likely to have babies with congenital major and minor CFAs. [ABSTRACT FROM AUTHOR]

The article deals with the legal requirements for cosmetic procedures on minors, especially tattoos, piercings, and beauty treatments. It explains that the capacity to consent and written consent from the legal guardians are necessary for such procedures. The legal regulations for piercings and tattoos on minors are explained, including the disclosure of risks and contraindications. It is determined that written consent from the person to be pierced or tattooed, as well as from the legal guardians, is required. Piercings may be done starting from the age of 14, while tattoos may only be done from the age of 16. Aesthetic treatments and surgeries may only be performed on mature minors who have reached the age of 16. [Extracted from the article]

Background: 100% soybean oil emulsions (SO100) are associated with poor docosahexaenoic acid (DHA) and arachidonic acid (ARA) status in extremely low birth weight (ELBW) infants. A multi‐oil emulsion with 15% fish oil (FO15) contains more DHA and ARA than SO100. This study compares clinical outcomes, namely growth and fatty acids, in ELBW infants who received S0100 or FO15. Methods: This observational study included ELBW infants born between 2014 and 2019 who received SO100 or FO15 for >7 days. Gas chromatography/mass spectrometry was used to measure erythrocyte fatty acids. Results: The mean ± SD gestational age was 27 ± 3 and 26 ± 2 weeks for SO100 (n = 43) and FO15 (n = 43), respectively (P = 0.2). DHA (−0.3 ± 0.10% per week, P = 0.026, for FO15 vs −0.2 ± 0.05% per week, P < 0.001, for SO100) and ARA (−0.8 ± 0.21% per week for FO15 vs −0.9 ± 0.17% per week for SO100; P < 0.001 for both) declined in both groups with no difference between groups (P interaction > 0.7 for both). After controlling for days to reach full feeds, the mean difference in weight z score trajectories was similar (Est = −0.08; 95% CI, −0.82 to 0.04; P = 0.2), and SO100 was associated with a nonsignificant increased odds for cholestasis (odds ratio, 3.1; 95% CI, 0.96–10.2; P = 0.059). There was no difference in other clinical comorbidities. Conclusions: In comparison with ELBW infants who received SO100, infants who received FO15 still demonstrated a decline in DHA and ARA. Growth and other clinical outcomes were unchanged. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the role of postnatal verbal and visual education in improving breastfeeding selfefficacy (BSE) and factors effective in weight gain or loss in the first ten days. Materials and Methods: Conducted between March-June 2020, this prospective study included a total of 145 healthy women with third-trimester pregnancies who received postpartum breastfeeding education (verbal and visual). Prenatal (pre-training) and postnatal (post-training) BSE Scale-Short Form (BSES-SF) scores, birth weights, The Edinburgh Postnatal Depression Scale and LATCH scale scores at the 10th day after birth, 10thday newborn weight and differences in birth weight were recorded. Grouping was done according to whether or not the newborn reached birth weight at day 10 (decreased weight: DW group, same or increased weight: SIW group). Results: Mean maternal age was similar in the DW (30.61 ± 4.72) and the SIW groups (30.47 ± 4.88). Median BSES-SF scores after training were significantly higher than before training (p<0.001). Multiple logistic regression analysis revealed that regular follow-up during pregnancy (p=0.014) and high LATCH score (p<0.001) were independently associated with being in the SIW group on the 10th day, whereas additional formula feeding (p=0.006) and high EPDS score (p=0.004) were independently associated being in the DW group. Conclusion: BSE can be improved by using postnatal verbal and supervised video breastfeeding training. LATCH and EPDS scores can be used to easily identify mothers at high risk for postpartum breastfeeding problems and depression. [ABSTRACT FROM AUTHOR]

Objective: Pneumonia is an important disease that causes sepsis in newborns and constitutes the majority of deaths due to infections, especially in developing countries. Pulse oximeters that are widely used in clinics, can determine heart rate, arterial oxygen saturation, additionally perfusion index (PI). In this study, the role of PI in determining the severity and prognosis of the disease in newborns with late-onset pneumonia (LOP); the relationship between PI and respiratory support need and Silverman Anderson Retraction Score (SAS) were aimed to determine. Material and Methods: In this prospective study, 30 term newborns diagnosed with late-onset pneumonia (LOP) were at the time of hospitalization,at the 24th hours of their treatment, and discharge; in the control group, PI measurements were made from the right upper extremity every 10 seconds for 3 minutes at the discharge of 30 term healthy newborns between December 2017 and June 2018. By comparing the data, it was aimed to determine the relationship of PI with the severity of the disease, prognosis, need for respiratory support and Silverman Anderson Retraction Score (SAS). Results: Their mean birth weights was 2000 - 4600 g the mean was 3570 g in the study, 2800 - 4100 g the mean was 3610 g in the control group and there was no significant difference (p>0.05); Gestational ages were 365/7 - 413/7, mean 392/7 in the study group, 373/7 - 405/7 in the control group, mean 396/7 weeks, and the statistical difference between the groups was not significant (p>0.05). The ratio of female/male was similar in the groups. Their median age was 9.5 days (3-27) in the control, 21 days (5-28) in the study group, and higher in the study group (p<0.05). The median capillary refill time was 1.7 seconds in the control, 1.6 seconds in the study group, and similar between the groups. The mean PI was 2.3±0.9 in the control group. In the study group, it was 3.6±1.2 on hospitalization, 3.2±1.2 on the first day, 3.4±0.7 at discharge. In the study group, PI values on hospitalization and first day were higher (p<0.05). There were reticular infiltration 50% bilateral, 30% right paracardiac, 10% left paracardiac, 3.3% right lower lobe. Alpha hemolytic streptococci in 1 (3.3%), Acinetobacter iwoffii in 1 (3.3%), Respiratory syncytial virus 6 (20%), Coronavirus 4 (13.3%), Rhinovirus 2 (6.7%) and Influenza A 1 (3.3%) patient were determined. We applied free flow oxygen 17 (56.7%), oxygen by hood 5 (16.7%), heated humidified high-flow nasal cannula 1 (3.3%), nasal continuous airway pressure 4 (13.3%), nasal intermittent positive pressure ventilation 4 (13.3%) cases. PI was higher in the patients needing positive pressure on admission (p<0.05). A positive correlation was found between SAS and PI on admission in the study group (p=0.008). The number of patients whose PI decreased during hospitalization increased over time. It was concluded that more accurate results can be achieved by measuring PI using more patients, more sensitive probes and technically more advanced monitors. New studies should be conducted to determine the role of PI in demonstrating well-being and early detection of life-threatening conditions in the healthy newborns. [ABSTRACT FROM AUTHOR]

Disorders of sex development (DSD) are a heterogeneous group of pathologies that result in an alteration in sex determination or differentiation. DSD are estimated to affect 1: 4,500 newborns and according to the 2006 Chicago Consensus classification, DSD can be divided into three categories: those with a 46 XX karyotype, those with a 46 XY karyotype and those relating to sex chromosomes. It is crucial to correctly identify the pathology already in the first days of life to direct the patient and his family to the best path of care. For this reason, the role of the pediatrician is fundamental in the correct identification of the clinical picture and in supporting the family during the long process that involves the management of these patients. To make a diagnosis, it is necessary to follow a path led by a multidisciplinary team that includes several steps such as the execution of the genetic analysis, the evaluation with diagnostic imaging methods and laboratory evaluations. The therapeutic management, on the other hand, is still very complex even if in recent years we have moved from an attitude of early gender reassignment to an approach of watchful waiting to let the patient choose when she/he is mature enough to do so, which gender she/he feels to belong. It should not be forgotten that throughout this process the pediatrician must be both supportive and clinically active in the management of the child and his family. [ABSTRACT FROM AUTHOR]

Abdominal emergencies in neonates require surgical management in almost all cases and complications may include bowel perforation, sepsis, shock, and even death. Radiological imaging has become a very important aid in the clinical setting as it shortens time to diagnosis. The objective of this review is to discuss the more prevalent neonatal gastrointestinal emergencies, review appropriate imaging options, and illustrate common radiological presentations of these entities. Despite advancements in imaging techniques, it is important to keep in mind that neonates have a higher susceptibility to the adverse effects of ionizing radiation, and therefore radiography and ultrasonography remain the main diagnostic modalities for ruling out the diseases with the worst prognosis. Other modalities (fluoroscopy, computed tomography, and magnetic resonance imaging) may have limited use in very specific conditions. All providers in an emergency department should be familiar with the basic radiological findings that may indicate a gastrointestinal emergency, especially in health institutions that do not have 24-h radiologist coverage. [ABSTRACT FROM AUTHOR]

Background: In Nepal, neonatal mortality fell substantially between 2000 and 2018, decreasing 50% from 40 to 20 deaths per 1,000 live births. Nepal's success has been attributed to a decreasing total fertility rate, improvements in female education, increases in coverage of skilled care at birth, and community-based child survival interventions. Methods: A verbal autopsy study, led by the Integrated Rural Health Development Training Centre (IRHDTC), conducted interviews for 338 neonatal deaths across six districts in Nepal between April 2012 and April 2013. We conducted a secondary analysis of verbal autopsy data to understand how cause and age of neonatal death are related to health behaviors, care seeking practices, and coverage of essential services in Nepal. Results: Sepsis was the leading cause of neonatal death (n=159/338, 47.0%), followed by birth asphyxia (n=56/338, 16.6%), preterm birth (n=45/338, 13.3%), and low birth weight (n=17/338, 5.0%). Neonatal deaths occurred primarily on the first day of life (27.2%) and between days 1 and 6 (64.8%) of life. Risk of death due birth asphyxia relative to sepsis was higher among mothers who were nulligravida, had <4 antenatal care visits, and had a multiple birth; risk of death due to prematurity relative to sepsis was lower for women who made ≥1 delivery preparation and higher for women with a multiple birth. Conclusions: Our findings suggest cause and age of death distributions typically associated with high mortality settings. Increased coverage of preventive antenatal care interventions and counseling are critically needed. Delays in care seeking for newborn illness and quality of care around the time of delivery and for sick newborns are important points of intervention with potential to reduce deaths, particularly for birth asphyxia and sepsis, which remain common in this population. [ABSTRACT FROM AUTHOR]

Methamphetamine (MA) is the second most commonly used illicit drug in the world, after cannabis. There are limited data on the outcomes of pregnant MA users but there is rapidly emerging evidence to suggest that they are more vulnerable, marginalized and impoverished compared with other drug‐using mothers. MA use during pregnancy is associated with worse pregnancy outcomes and significantly higher rates of co‐existing health and psychosocial problems. Newborn infants exposed to MA are at increased risk of perinatal complications, present differently at birth to infants exposed to other drugs of dependency such as opioids and have poorer neurological adaptation and feeding difficulties. Sparse literature from neuroimaging and cohort studies suggests that the neurocognitive deficits in MA exposed children persist, even into adulthood. Current clinical practice guidelines for the care of substance exposed pregnant women are opioid‐centric with little attention paid to the consequences of prenatal MA exposure. [ABSTRACT FROM AUTHOR]

Background: Severe valvular heart disease, especially stenosis, is a contraindication for conception according to the World Health Organization. This is still encountered in countries with a high rheumatic fever prevalence. The objective of this study was to determine predictors of maternal cardiac, obstetric and neonatal complications in pregnant women with severe valve disease.Methods: This is an observational retrospective cohort study of all pregnant women with severe heart valvulopathy who gave birth between 2010 and 2017.Results: We included 60 pregnancies in 54 women. Cardiac complications occurred during 37 pregnancies (61%). In multivariate analysis, parity (aOR =2.41, 95% CI[1.12-5.16]), revelation of valvulopathy during pregnancy (aOR = 6.34; 95% CI[1.26-31.77]), severe mitral stenosis (aOR = 6.98, 95% CI[1.14-41.05],) and systolic pulmonary arterial pressure (aOR =1.08, 95% CI[1.01-1.14]) were associated with cardiac complications. Obstetrical complications were noted during 19 pregnancies (31.8%). These complications were associated with nulliparity (aOR = 5.22; 95% CI[1.15-23.6]), multiple valve disease (aOR = 5.26, 95% CI[1.19-23.2]), systolic pulmonary arterial pressure (aOR =1.04, 95% CI[1.002-1.09]), and treatment with vitamin K antagonists (aOR = 8.71, 95% CI[1.98-38.2]). Neonatal complications were noted in 39.3% of newborns (n = 61) and these were associated with occurrence of obstetric complications (aOR = 16.47, 95% CI[3.2-84.3]) and revelation of valvulopathy during pregnancy (aOR = 7.33, 95% CI[1.4-36.1]).Conclusions: Revelation of valvular heart disease during pregnancy is a predictor of not only cardiac but also neonatal complications. Valvular heart disease screening during pre-conceptional counseling is thus crucial. [ABSTRACT FROM AUTHOR]

Background: Like many countries, the government of Bangladesh also imposed stay-at-home orders to restrict the spread of severe acute respiratory syndrome coronavirus-2 (COVID-19) in March, 2020. Epidemiological studies were undertaken to estimate the early possible unforeseen effects on maternal mortality due to the disruption of services during the lockdown. Little is known about the constraints faced by the pregnant women and community health workers in accessing and providing basic obstetric services during the pandemic in the country. This study was conducted to explore the lived experience of pregnant women and community health care providers from two southern districts of Bangladesh during the pandemic of COVID-19. Methods: The study participants were recruited through purposive sampling and non-structured in-depth interviews were conducted. Data was collected over the telephone from April to June, 2020. The data collected was analyzed through a phenomenological approach. Results: Our analysis shows that community health care providers are working under tremendous strains of work load, fear of getting infected and physical and mental fatigue in a widely disrupted health system. Despite the fear of getting infected, the health workers are reluctant to wear personal protective suits because of gender norms. Similarly, the lived experience of pregnant women shows that they are feeling helpless; the joyful event of pregnancy has suddenly turned into a constant fear and stress. They are living in a limbo of hope and despair with a belief that only God could save their lives. Conclusion: The results of the study present the vulnerability of pregnant women and health workers during the pandemic. It recognizes the challenges and constraints, emphasizing the crucial need for government and non-government organizations to improve maternal and newborn health services to protect the pregnant women and health workers as they face predicted waves of the pandemic in the future. [ABSTRACT FROM AUTHOR]

One third of all neonatal deaths are caused by intrapartum-related events, resulting in neonatal respiratory depression (i.e., failure to breathe at birth). Evidence-based resuscitation with stimulation, airway clearance, and positive pressure ventilation reduces mortality from respiratory depression. Improving adherence to evidence-based resuscitation is vital to preventing neonatal deaths caused by respiratory depression. Standard resuscitation training programs, combined with frequent simulation practice, have not reached their life-saving potential due to ongoing gaps in bedside performance. Complex neonatal resuscitations, such as those involving positive pressure ventilation, are relatively uncommon for any given resuscitation provider, making consistent clinical practice an unrealistic solution for improving performance. This review discusses strategies to allow every birth to act as a learning event within the context of both high- and low-resource settings. We review strategies that involve clinical-decision support during newborn resuscitation, including the visual display of a resuscitation algorithm, peer-to-peer support, expert coaching, and automated guidance. We also review strategies that involve post-event reflection after newborn resuscitation, including delivery room checklists, audits, and debriefing. Strategies that make every birth a learning event have the potential to close performance gaps in newborn resuscitation that remain after training and frequent simulation practice, and they should be prioritized for further development and evaluation. [ABSTRACT FROM AUTHOR]

Positive pressure ventilation of the non-breathing newborn is a critical and time-sensitive intervention, considered to be the cornerstone of resuscitation. Many healthcare providers working in delivery units in high-resource settings have little opportunity to practise this skill in real life, affecting their performance when called upon to resuscitate a newborn. Low-dose, high-frequency simulation training has shown promise in low-resource settings, improving ventilation performance and changing practice in the clinical situation. We performed a randomised controlled study of low-dose, high-frequency simulation training for maintenance of ventilation competence in a multidisciplinary staff in a busy teaching hospital in Norway. We hypothesised that participants training according to a low-dose, high-frequency protocol would perform better than those training as they wished. Our results did not support this, although the majority of protocol participants were unable to achieve training targets. Subgroup analysis comparing no training to at least monthly training did identify a clear benefit to regular simulation practice. Simulated ventilation competence improved significantly for all participants over the course of the study. We conclude that frequent, short, simulation-based training can foster and maintain newborn ventilation skills in a multidisciplinary delivery unit staff in a high-resource setting. [ABSTRACT FROM AUTHOR]

Background: Assessment of heart rate (HR) is essential during newborn resuscitation, and comparison of dry-electrode ECG technology to standard monitoring by 3-lead ECG and Pulse Oximetry (PO) is lacking. Methods: NeoBeat, ECG, and PO were applied to newborns resuscitated at birth. Resuscitations were video recorded, and HR was registered every second. Results: Device placement time from birth was median (quartiles) 6 (4, 18) seconds for NeoBeat versus 138 (97, 181) seconds for ECG and 152 (103, 216) seconds for PO. Time to first HR presentation from birth was 22 (13, 45) seconds for NeoBeat versus 171 (129, 239) seconds for ECG and 270 (185, 357) seconds for PO. Proportion of time with HR feedback from NeoBeat during resuscitation from birth was 85 (69, 93)%, from arrival at the resuscitation table 98 (85, 100)%, and during positive pressure ventilation 100 (95, 100)%. For ECG, these proportions were, 25 (0, 43)%, 28 (0, 56)%, and 33 (0, 66)% and for PO, 0 (0, 16)%, 0 (0, 16)%, and 0 (0, 18)%. All p < 0.0001. Conclusions: NeoBeat was faster to place, presented HR more rapidly, and provided feedback on HR for a larger proportion of time during ongoing resuscitation compared to 3-lead ECG and PO. [ABSTRACT FROM AUTHOR]

Background: A Pressure Ulcer (PU) is a severe event and could create discomfort to newborns. In newborns, one of mostly stricken location by PU is occipital area. Recent studies have highlighted that Cord Blood Platelet Gel (CBPG) might be a better alternative compared to traditional treatment. We report two cases of occipital PU treated with CBPG. Case report: Two male infants showing occipital PU were treated with standard local treatment, but no improvement was observed. After parental informed consent was obtained, CBPG application on PU was performed every 48 h. In these two cases of PU, a fast improvement in healing was observed since the first application of CBPG. The PU healed resulted in a scar after 53 and 50 days (Case 1 and Case 2, respectively) from development. No complications or infections were reported. Conclusions: CBPG contains many angiogenetic and growth factors, these characteristics make it indicated in treating soft tissue injuries. It would seem to be safe and an effective treatment of neonatal PUs reducing the time of the healing and the hospitalization and the infectious risks. Further studies are needed to evaluate long term aesthetic and functional results of PU treated with CBPG. [ABSTRACT FROM AUTHOR]

Dehydration with hyponatremia can occur from a variety of causes and can be potentially fatal to infants. Pseudohypoaldosteronism type 1 (PHA1) is a rare disease that can cause severe dehydration along with hyponatremia and hyperkalemia because of renal tubular unresponsiveness to mineralocorticoids. Autosomal dominant PHA1 (ADPHA1, OMIM #177735) is caused by inactivating mutations in the NR3C2 gene, which encodes the mineralocorticoid receptor, and it can lead to renal salt-wasting, dehydration, and failure to thrive during infancy. Here, we report a case of a 20-day-old female neonate who presented as severe dehydration with hyponatremia and polyuria. We suspected that her diagnosis might be PHA1 based on markedly elevated plasma renin activity and serum aldosterone levels. For the genetic diagnosis of PHA1, we performed targeted exome sequencing of all causative genes of PHA1, but the result was negative. We confirmed by chromosomal microarray that a novel heterozygous microdeletion was found in the 4q31.23 region spanning exons 7–9 of the NR3C2 gene, and the patient was diagnosed with ADPHA1. In conclusion, our patient is a case of ADPHA1 that developed into a salt-wasting crisis in the neonatal period due to a microdeletion of the 4q31.23 region inherited from her father. [ABSTRACT FROM AUTHOR]

Background: Low birth weight is weight less than 2500 g or 5.5 lb. at birth. Globally, more than 20 million infants (15-20%) are born with a low birth weight each year. Birth weight is the primary indicator of the health status of neonates and is the primary factor that determines the infant's physical, survival, and mental growth. Thus, the study aimed to investigate the determinants of low birth weight among newborn babies delivered at Tirunesh Beijing General Hospital, Addis Ababa, Ethiopia.Methods: We performed a facility-based unmatched case-control study among 453 (151 cases and 302 controls) deliveries conducted at Tirunesh Beijing General Hospital. Birth records and maternal antenatal care (ANC) files were reviewed from March 1 to April 30, 2019. Consecutive sampling was employed to select study participants. Data were entered into Epi-data version 4.2.1 and analyzed using SPSS version 25 statistical software. Descriptive statistics and logistic regression analysis were computed to identify independent determinants of low birth weight. A p-value of ≤0.05 was used to declare statistical significance.Result: Four hundred fifty-three birth records of babies (151 cases and 302 controls) were reviewed. Women who reside in rural area [AOR (CI) = 3.12 (1.63-5.98)], being merchant [(AOR (CI) = 2.90 (1.03-8.22)], danger sign during pregnancy [(AOR (CI) = 4.14 (1.68-10.2)], and maternal weight during pregnancy [(AOR (CI) = 4.94 (3.26-7.52)] were found to be a significant determinants of low birth weight.Conclusion: Residence, occupation, danger signs, and maternal weight during pregnancy were significant determinants of low birth weight. Socioeconomic development, early detection and management of complications, and encouraging nutrition and weight during pregnancy are crucial for minimizing the risk of delivering low birth weight babies. [ABSTRACT FROM AUTHOR]

Extremely low birth weight infants (birth weight ≤1000 g) have a significantly lower nephron number. The glomerular filtration rate (GFR) is usually sufficient under normal conditions but is unable to meet the needs during stress, which results in acute kidney injury (AKI). We describe the case of an extremely low birth weight infant (970 g) with a gestational age of 27 weeks (immature preterm) who was mechanically ventilated because of hyaline membrane disease. AKI with anuria and a rise in serum creatinine to 3.4 mg/ dL developed in the second week. Diuresis was restored after diuretics and dopamine were administered intravenously and kidney function recovered in the next two weeks. However, he slowly became hypertensive, so intravenous enalapril was introduced in the 6th week. After the third dose, he suffered another AKI. After cessation of enalapril, kidney function recovered over the next few days. Although angiotensin-converting enzyme inhibitors (ACEi) may cause kidney injury, it can be used with great caution in the treatment of hypertension or heart failure in preterm infants. There remains a real dilemma of whether enalapril should be used in extremely low birth weight immature infants. [ABSTRACT FROM AUTHOR]

Background: Identification and control of the risk factors for hyperbilirubinemia can reduce the incidence and complications of this condition. Serum zinc level in newborns is reported to be one of the factors affecting the severity and incidence of neonatal hyperbilirubinemia. Therefore, the present study was conducted to compare hyperbilirubinemia incidence in neonates of zinc-taking and non-zinc-taking mothers. Methods: In this observational study, we compared the incidence of hyperbilirubinemia during the first week of birth between newborns whose mothers had received zinc supplement during the third trimester of pregnancy (case group) with those whose mothers had not taken zinc supplement (control group). The checklist of newborns' conditions in both case and control groups was completed based on the obtained data regarding the infants, mothers, and laboratory findings. Data was analyzed using chi-squared test and t-test. Results: The mean serum levels of zinc were 79.76±15 mg/dl and 70.93±15.67mg/dl in mothers who had received zinc during the third trimester and those who had not taken zinc supplement, respectively. The mean serum level of zinc in newborns who underwent phototherapy was 41.68±9.21 mg/dl, while it was 68.53±20.85 mg/dl in neonates who did not receive phototherapy. In addition, 36% of the neonates whose mothers had not received zinc required phototherapy, while only 11% of newborns whose mothers had taken zinc supplement received phototherapy. Conclusion: Zinc consumption during the third trimester of pregnancy increased the serum zinc level in both newborns and mothers and reduced the incidence and severity of idiopathic hyperbilirubinemia requiring treatment. [ABSTRACT FROM AUTHOR]

Introduction. Skin lesions in close proximity to the lumbosacral region should be assessed in newborns, since they may be the first sign of hidden spinal dysraphism. Clinical case. We present the case of a newborn without significant prenatal history. On the first day of life, a 1 cm diameter nodular lesion was found at the lumbar level of the right paravertebral region, with a vascular stain surrounding the base of the lesion. Neurological examination was normal. A soft tissue ultrasonography was carried out. It showed no continuity with the lumbar spinal canal. As a result of the lesion increasingly growing, resection was decided upon six months later. Pathological examination confirmed diagnosis - Hoffmann-Zurhelle nevus. Discussion. Hoffmann-Zurhelle nevus is an infrequent cutaneous hamartomatous lesion in newborns. Treatment is always surgical in order to avoid potential growth-related complications. [ABSTRACT FROM AUTHOR]

Background: Large for gestational age infants (LGA) have increased risk of adverse short-term perinatal outcomes. This study aims to develop a multivariable prediction model for the risk of giving birth to a LGA baby, by using biochemical, biophysical, anamnestic, and clinical maternal characteristics available at first trimester.Methods: Prospective study that included all singleton pregnancies attending the first trimester aneuploidy screening at the Obstetric Unit of the University Hospital of Modena, in Northern Italy, between June 2018 and December 2019.Results: A total of 503 consecutive women were included in the analysis. The final prediction model for LGA, included multiparity (OR = 2.8, 95% CI: 1.6-4.9, p = 0.001), pre-pregnancy BMI (OR = 1.08, 95% CI: 1.03-1.14, p = 0.002) and PAPP-A MoM (OR = 1.43, 95% CI: 1.08-1.90, p = 0.013). The area under the ROC curve was 70.5%, indicating a satisfactory predictive accuracy. The best predictive cut-off for this score was equal to - 1.378, which corresponds to a 20.1% probability of having a LGA infant. By using such a cut-off, the risk of LGA can be predicted in our sample with sensitivity of 55.2% and specificity of 79.0%.Conclusion: At first trimester, a model including multiparity, pre-pregnancy BMI and PAPP-A satisfactorily predicted the risk of giving birth to a LGA infant. This promising tool, once applied early in pregnancy, would identify women deserving targeted interventions.Trial Registration: ClinicalTrials.gov NCT04838431 , 09/04/2021. [ABSTRACT FROM AUTHOR]

Background: Diabetes Mellitus (DM) is a major cause of maternal, fetal, and neonatal morbidities. Our objective was to estimate the effect of both pre-pregnancy and gestational DM on the growth parameters of newborns in the Qatari population.Methods: In this population-based cohort study, we compared the data of neonates born to Qatari women with both pre-pregnancy and gestational diabetes mellitus in 2017 with neonates of healthy non-diabetic Qatari women.Results: Out of a total of 17020 live births in 2017, 5195 newborns were born to Qatari women. Of these, 1260 were born to women with GDM, 152 were born to women with pre-pregnancy DM and 3783 neonates were born to healthy non-diabetic (control) women. The prevalence of GDM in the Qatari population in 2017 was 24.25%. HbA1C% before delivery was significantly higher in women with pre-pregnancy DM (mean 6.19 ± 1.15) compared to those with GDM (mean 5.28 ± 0.43) (P <0.0001). The mean birth weight in grams was 3066.01 ± 603.42 in the control group compared to 3156.73 ± 577.88 in infants born to women with GDM and 3048.78 ± 677.98 in infants born to women with pre-pregnancy DM (P <0.0001). There was no statistically significant difference regarding the mean length (P= 0.080), head circumference (P= 0.514), and rate of major congenital malformations (P= 0.211). Macrosomia (Birth weight > 4000 gm) was observed in 2.7% of the control group compared to 4.8% in infants born to women with GDM, and 4.6% in infants born to women with pre-pregnancy DM (P= 0.001). Multivariate logistic regression analysis demonstrated that higher maternal age (adjusted OR 2.21, 95% CI 1.93, 2.52, P<0.0001), obesity before pregnancy (adjusted OR 1.71, 95% CI 1.30, 2.23, P<0.0001), type of delivery C-section (adjusted OR 1.25, 95% CI 1.09, 1.44, P=0.002), and body weight to gestational age LGA (adjusted OR 2.30, 95% CI 1.64, 2.34, P<0.0001) were significantly associated with increased risk of GDM.Conclusion: Despite the multi-disciplinary antenatal diabetic care management, there is still an increased birth weight and an increased prevalence of macrosomia among the infants of diabetic mothers. More efforts should be addressed to improve the known modifiable factors such as women's adherence to the diabetic control program. Furthermore, pre-pregnancy BMI was found to be significantly associated with gestational DM, and this is a factor that can be addressed during pre-conceptional counseling. [ABSTRACT FROM AUTHOR]

Background: Postpartum depression is a widespread disorder, adversely affecting the well-being of mothers and their newborns. We aim to utilize machine learning for predicting risk of postpartum depression (PPD) using primary care electronic health records (EHR) data, and to evaluate the potential value of EHR-based prediction in improving the accuracy of PPD screening and in early identification of women at risk.Methods: We analyzed EHR data of 266,544 women from the UK who gave first live birth between 2000 and 2017. We extracted a multitude of socio-demographic and medical variables and constructed a machine learning model that predicts the risk of PPD during the year following childbirth. We evaluated the model's performance using multiple validation methodologies and measured its accuracy as a stand-alone tool and as an adjunct to the standard questionnaire-based screening by Edinburgh postnatal depression scale (EPDS).Results: The prevalence of PPD in the analyzed cohort was 13.4%. Combing EHR-based prediction with EPDS score increased the area under the receiver operator characteristics curve (AUC) from 0.805 to 0.844 and the sensitivity from 0.72 to 0.76, at specificity of 0.80. The AUC of the EHR-based prediction model alone varied from 0.72 to 0.74 and decreased by only 0.01-0.02 when applied as early as before the beginning of pregnancy.Conclusions: PPD risk prediction using EHR data may provide a complementary quantitative and objective tool for PPD screening, allowing earlier (pre-pregnancy) and more accurate identification of women at risk, timely interventions and potentially improved outcomes for the mother and child. [ABSTRACT FROM AUTHOR]

Objective: To evaluate cardiac function and structural changes in children of diabetic mothers in the fetal and neonatal period using Doppler-echocardiographic data. Method: A prospective, descriptive observational study conducted in a private and tertiary care service for high-risk pregnant women. It included 48 children of mothers with gestational diabetes mellitus (GDM) considered clinically compensated during pregnancy, with a single fetus and absence of malformations. Myocardial thickness, shortening fraction, left ventricular (LVMPI) and right ventricular (RVMPI) myocardial performance index, and mitral and tricuspid valve E/A ratio were evaluated in 96 echocardiographic exams with Doppler. Results: The hypertrophic cardiomyopathy was 29% vs 6% p = 0.006 in the prenatal and postnatal periods respectively. The shortening fraction was 0% vs 6% p = 0.242 in the fetuses and newborns respectively. The myocardial performance index of the right ventricle was 12% vs 54% p = 0.001, and on the left ventricle 27% vs 60% p = 0.001 in the prenatal and postnatal periods respectively. The ratio of mitral valve E/A waves was 6% vs 50% p = 0.001 and the ratio of tricuspid valve E/A waves was 0% vs 27% p = 0.001 in the fetuses and newborns respectively. Conclusion: A decrease in the rate of myocardial hypertrophy and changes in cardiac function parameters were observed in the fetal and neonatal periods. [ABSTRACT FROM AUTHOR]

Objective: To study the presenting clinical and demographic features, risk factors, and outcome of infants with late vitamin K deficiency bleeding. Methods: Over a 5-year study period, the presenting clinical features and outcome of all 47 infants observed aged less than 6 months, who were diagnosed with late-onset primary and secondary VKDB by detailed history, physical examination, and laboratory findings were evaluated. Confirmed primary late VKDB was diagnosed when no cause other than breastfeeding could be found, while in the secondary subtype additional risk factors compromising the vitamin K effect were diagnosed. Results: Secondary late VKDB (83%, 39 patients) was more common than the primary subtype. The mean age of patients was 10.50 ± 5.75 and 9.74 ± 6.04 weeks in primary and secondary VKDB subtypes, respectively, and the age of infants did not have a significant difference (p > 0.05). The male to female ratio was 2.13:1. The residency, place and mode of delivery, gestational age, and types of feeding of patients did not have a significant difference between VKDB subtypes. The skin and gastrointestinal tract (GIT) (40.4%) followed by intracranial hemorrhage (ICH) (32%), were common sites of bleeding. Neurological complications were seen in 21% of patients; however, lethality was 23%, and the outcome of patients did not have a significant difference (p > 0.05) between VKDB subtypes. Conclusion: Secondary late VKDB is more common than the primary subtypes, and late VKDB is still a serious disease in developing countries, including Iraq, when vitamin K prophylaxis isn't routinely used at birth. [ABSTRACT FROM AUTHOR]

Objective: Serum levels of creatinine in neonates are quite variable and suffer interference from the immature kidney and maternal creatinine concentration. The aim of this study was to measure novel biomarkers of glomerular and tubular function in healthy preterm neonates at 72 h and 3 weeks of life. Methods: Urine samples were collected in 40 preterm neonates with 28-34 incomplete weeks of gestational age. None of the participants had comorbidities, malformations and infections. The samples were collected at 72 h of life and at 3 weeks after birth. Measurements of Calbindin, Collagen IV, FABP1, αGST, IP-10, KIM-1, Osteoactivin, Renin, TFF-3, TIMP-1, α-1-Microglobulin, Albumin, Clusterin, Cystatin C, EGF, Lipocalin-2/NGAL and Osteopontin were performed using panels 1 and 2 of multiplex kits of kidney injury. Data were analyzed using the software GraphPad Prism version 6.0. Results: The preterm neonates included 55% of males with gestational age of 30 ± 1 weeks. The most frequent maternal condition associated with preterm birth was preeclampsia (80%). Molecules related to glomerular function showed a significant increase in the concentrations obtained at 3 weeks of life compared to 72 h of life. Markers related to tubular injury (KIM-1 and NGAL) also showed an increase. On the other hand, cystatin C did not change. Conclusion: The elevation of molecules related to glomerular function indicates an increase of glomerular filtration rate from 72 h up until 3 weeks of life, which was not clearly detected with the measurement of cystatin C. [ABSTRACT FROM AUTHOR]

Background: Antenatal women experience an increased level of mood and anxiety symptoms, which have negative effects on mothers' mental and physical health as well as the health of their newborns. The relation of maternal depression and anxiety in pregnancy with neonate outcomes is well-studied with inconsistent findings. However, the association between antenatal mood instability (MI) and neonatal outcomes has not been investigated even though antenatal women experience an elevated level of MI. We sought to address this gap and to contribute to the literature about pregnancy neonate outcomes by examining the relationship among antenatal MI, depression, and anxiety and neonatal outcomes. Methods: A prospective cohort of women (n = 555) participated in this study at early pregnancy (T1, 17.4 ± 4.9 weeks) and late pregnancy (T2, 30.6 ± 2.7 weeks). The Edinburgh Postnatal Depression Scale (EPDS) was used to assess antenatal depressive symptoms, anxiety was measured by the EPDS anxiety subscale, and mood instability was measured by a visual analogue scale with five questions. These mood states together with stress, social support, as well as lifestyle were also examined in relation to neonatal outcomes using chi-square tests and logistic regression models. Results: Mood instability, depression, and anxiety were unrelated to adverse neonatal outcomes. Only primiparous status was associated with small for gestational age after Bonferroni correction. Conclusions: We report no associations between antenatal mood symptoms including MI, depression, and anxiety and neonatal outcomes. More studies are required to further explore the relationship between antenatal mood instability, depression, and anxiety and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to evaluate the maternal and neonatal characteristics affecting the survival of Extremely Low Birth Weight (ELBW) infants at Federal Teaching Hospital, Ido-Ekiti (FETHI). Study design: A retrospective study in which the clinical records of ELBW infants admitted between January 2013 and December 2017 were reviewed. The main outcome was survival of the participants. The maternal and neonatal variables of discharged babies were compared with those that died using with Chi square analysis and Student's t-tests. p-value was set at 0.05. Study Participants: All ELBW infants managed in FETHI during the study period. Results: 1236 babies were admitted into the neonatal unit during the study period out of which 33 (2.7%) were ELBW babies. The mean gestational age (GA) and mean birthweight (BW) of the ELBW babies were 27.2 ± 2.7 weeks and 780 ± 130g respectively. The overall survival rate was 30.3%. The mean GA of survivors versus non-survivors was 28.1 ± 1.7 weeks versus 26.8 ± 2.9 weeks (p = 0.210). The mean BW of the survivors was 870 ± 50g versus 740 ± 130g (p = 0.005) for the non-survivors. Significantly associated with survival were maternal age above 20 years (p < 0.026), neonatal age at presentation less than 24 hours (p <0.005) and BW ≥ 800g (p <0.005). Conclusion: Though the survival of ELBW infants in this study is still low (30.3%); birthweight ≥ 800g, early hospital presentation and a maternal age greater than 20 years old greatly improve the chances of survival. [ABSTRACT FROM AUTHOR]

Spinal muscular atrophy (SMA) is a genetic neuromuscular disorder that results in progressive muscle atrophy and weakness. As new therapies for SMA have been developed, newborn screening for SMA can lead to early diagnosis and treatment. The objective of this study was to gather the general population's view on screening of SMA in newborns in Japan. A questionnaire survey was conducted on two general population groups in Japan. A total of 269 valid responses were obtained. In the general population, about half of the participants had no knowledge about SMA, and more than 90% did not know about new therapies for SMA. Conversely, more than 95% of the general population agreed with screening newborns for SMA because they believed that early diagnosis was important, and treatments were available. This study revealed that the general population in Japan mostly agreed with screening for SMA in newborns even though they did not know much about SMA. Newborn screening for SMA is promising, but it is in very early stages. Therefore, SMA newborn screening should be performed with sufficient preparation and consideration in order to have a positive impact on SMA patients and their families. [ABSTRACT FROM AUTHOR]

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Perinatal asphyxia (PA) is the 3rd most common cause of neonatal death and one of the most common causes of severe neurological impairments in children. Current tools and measurements mainly based on the analysis of clinical evaluation and laboratory and electrophysiological tests do not give consistent data allowing to predict the severity of hypoxic-ischemic encephalopathy (HIE) until a magnetic resonance imaging (MRI) score is performed. The aim of this work is to evaluate the usefulness of the new index, called Thermal Index (TI) in the assessment of the degree of brain damage in newborns in the course of therapeutic hypothermia (TH) due to PA. This was a prospective, observational, pilot study which did not require any changes in the applicable procedures. Analysis has been applied to six newborn babies treated with TH in Neonatal/Paediatric ICU in University Hospital in Opole in 2018 due to PA. They all met criteria for TH according to the current recommendations. Brain MRI was performed after the end of TH when the children were brought back to normal temperature, with the use of a 1.5 T scanner, using T1-, T2-weighted images, fluid-attenuated inversion recovery (FLAIR), inversion recovery (IR), susceptibility-weighted imaging (SWI), and diffusion-weighted imaging (DWI). The images were assessed using MRI score according to the scoring system proposed by Weeke et al. The Thermal Index assessing endogenous heat production was calculated according to the formula proposed in this paper. A high, statistically significant positive correlation was found between MRI scores and TI values (0.98; p = 0.0003) in the 1st hour of therapy. High correlation with MRI assessment, the non-invasiveness of measurements and the availability of results within the first few hours of treatment, allow authors to propose the Thermal Index as a tool for early evaluating of the brain injury in newborns treated with TH. Further research is required to confirm the usefulness of the proposed method. [ABSTRACT FROM AUTHOR]

(1) Background: Hypertensive disorders of pregnancy (HDP) include gestational hypertension (GH), chronic hypertension (CH), preeclampsia (PE), and preeclampsia superimposed on chronic hypertension (CH with PE). HDP is associated with several short and long-term perinatal and neonatal complications, such as newborn growth restriction and death. This study aimed to establish the association between HDP, newborn growth abnormalities, and neonatal outcome. (2) Methods: This is a single-center retrospective cohort study of 63651 singleton deliveries. (3) Results: Univariate analysis showed a significantly increased risk of intrauterine and neonatal death associated with maternal hypertension and growth disorders. There were differences between growth charts used, with the highest risk of stillbirth for SGA defined by the Intergrowth chart (OR 17.2) and neonatal death for newborn growth restriction (NGR) based on Intergrowth (OR 19.1). Multivariate analysis showed that NGR is a stronger risk factor of neonatal death than SGA only. (4) Conclusions: HDP is significantly associated with growth abnormalities and is an independent risk factor of adverse outcomes. The presence of newborn growth restriction is strongly associated with the risk of neonatal death. The choice of growth chart has a substantial effect on the percentage of diagnosis of SGA and NGR. [ABSTRACT FROM AUTHOR]