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Sedation and anesthesia are often required in order to facilitate collection of high-quality imaging studies free of significant motion artifact for infants and neonates. Provision of safe sedation and anesthesia requires good communication between the ordering provider, radiologist, and anesthesiologist, careful pre-procedural evaluation of the patient, and availability of appropriate and sufficient equipment, drugs, personnel, and facilities. There are many additional factors to be considered for provision of safe sedation or anesthesia for infants and neonates—it is ideal to involve a fellowship-trained pediatric anesthesiologist in the planning and carry-out of these plans. In this review, we discuss some of the basic definitions of sedation and anesthesia, requirements for safe sedation and anesthesia, and many of the germane risks and additional considerations that factor into the delivery of a safe sedation or anesthesia plan for the imaging of an infant or neonate. [ABSTRACT FROM AUTHOR]

To explore whether rs2073244 at PAX9 increased susceptibility for full-term low birth weight infants and whether indoors passive smoking exposure has a combined effect with rs2073244 on newborn low birth weight (LBW), a 1:2 paired case–control study of LBW newborns was conducted at Xiamen University Affiliated Women and Children’s Hospital from March 2010 to October 2013. The rate of indoor passive smoking exposure in the LBW group was higher than it in the NBW group (p = 0.019). GG of PAX9 rs2073244 decreased the risk of LBW [OR = 0.38, 95% CI: (0.15-0.98)] and smaller HC [OR = 0.44, 95% CI:(0.20-0.98)]. The relative excess risk for LBW contributed by the additive interaction between the rs2073244 risk genotypes AG/AA and mother pregnancy passive smoking exposure was 10.679 (95%CI 1.728–65.975). Our study suggested that the AG/AA genotype of PAX9 rs2073244 might be a risk factor for LBW of full-term newborns, especially in maternal passive smoking. [ABSTRACT FROM AUTHOR]

Two cases of neonatal splenic hemorrhage with acute cardiorespiratory failure are described in this report. The first case involves a full-term neonate who was found unresponsive without any witnesses and could not be successfully resuscitated. A postmortem diagnosis revealed a splenic hemorrhage. Second case is an extremely premature neonate who experienced a witnessed cardiovascular collapse on the 14th day of life. Rapid cardiovascular support was administered, resulting in a positive outcome. While splenic hemorrhage is commonly associated with traumatic events, these cases highlight the need of considering spontaneous splenic hemorrhages as a potential cause of acute neonatal compromise, even in the absence of birth-related trauma (e.g., asphyxia, prolonged labor, clavicle fractures, brachial plexus injuries). This report emphasizes the importance of including splenic hemorrhage timely in the differential diagnosis of neonatal cardiorespiratory instability, especially in the absence of more common diagnoses, and discusses the challenges associated with its recognition and treatment. [ABSTRACT FROM AUTHOR]

Vancomycin has a narrow therapeutic window and a high inter‐individual pharmacokinetic variability, especially in neonates with fast maturational and pathophysiological changes, that needs individualized dosing. Physiologically based pharmacokinetic (PBPK) model and population pharmacokinetic (PopPK) model are both useful tools in model‐informed precision dosing, while the former is under research in application of vancomycin in neonates. This study aimed to develop a PBPK model of vancomycin in adult and pediatric population, and compared it with published PopPK model (priori or Bayesian method) in predicting vancomycin concentration in 230 neonatal patients (postmenstrual age, PMA, 25–45 weeks). The developed PBPK model showed a good fit between predictions and observations. PBPK model and PopPK model are complementary in different clinical scenarios of vancomycin application. The physiological‐change description of PBPK model showed a superior advantage in initial dosing optimization. As for subsequent dose optimization, PopPK Bayesian forecasting performed better than the PBPK estimation in neonates. However, initial precision dosing tools for early neonates (with PMA < 36 weeks) still need further exploitation. [ABSTRACT FROM AUTHOR]

This document contains abstracts from the Journal of Neonatal - Perinatal Medicine, covering a range of topics related to neonatal encephalopathy (NE) and its associated complications. The studies explore the efficacy of AI-based seizure-detection algorithms, the feasibility of EEG recordings in emergency transport, the validation of neonatal encephalopathy scores using neurophysiology measures, and the use of an automated seizure detection algorithm for neonatal EEG. Additionally, the document discusses the development and achievements of the HRB Neonatal Encephalopathy PhD Training Network (HRB NEPTuNE) research program, which aims to improve understanding, diagnosis, and management of NE. The text also includes studies on somatosensory evoked potentials (SEPs), red reflex assessment, catecholamine therapy, and neonatal ventriculitis. [Extracted from the article]

This document is a collection of abstracts from the 15th International Newborn Brain Conference. The abstracts cover a range of topics related to newborn brain health and development. One study focuses on perinatal hypoxic-ischemic brain damage and the activation of the caspase pathway. Another examines the yield of genetic testing in cases of posterior fossa anomalies. A third investigates the association between nighttime births and neonatal asphyxia or hypoxic ischemic encephalopathy. The fourth explores the incidence of multi-organ dysfunction in neonates with hypoxic ischemic encephalopathy. The fifth focuses on prenatal MRI brain findings associated with epilepsy. The final abstract examines the associations between cerebral metabolism/hemodynamic parameters and neurodevelopmental outcomes. The document also includes two medical cases, one involving infants with hypoxic-ischemic encephalopathy and genetic or congenital anomalies, and the other involving a patient with a rare metabolic disorder. These cases highlight the importance of genetic testing in diagnosing and managing congenital diseases. [Extracted from the article]

An established technology to create cloned animals is through the use of somatic cell nuclear transfer (SCNT), in which reprogramming the somatic cell nucleus to a totipotent state by enucleated oocyte cytoplasm is a necessary process, including telomere length reprogramming. The limitation of this technology; however, is that the live birth rate of offspring produced through SCNT is significantly lower than that of IVF. Whether and how telomere length play a role in the development of cloned animals is not well understood. Only a few studies have evaluated this association in cloned mice, and fewer still in cloned cows. In this study, we investigated the difference in telomere length as well as the abundance of some selected molecules between newborn deceased cloned calves and normal cows of different ages either produced by SCNT or via natural conception, in order to evaluate the association between telomere length and abnormal development of cloned cows. The absolute telomere length and relative mitochondrial DNA (mtDNA) copy number were determined by real-time quantitative PCR (qPCR), telomere related gene abundance by reverse-transcription quantitative PCR (RT-qPCR), and senescence-associated β-galactosidase (SA-β-gal) expression by SA-β-gal staining. The results demonstrate that the newborn deceased SCNT calves had significantly shortened telomere lengths compared to newborn naturally conceived calves and newborn normal SCNT calves. Significantly lower mtDNA copy number, and significantly lower relative abundance of LMNB1 and TERT , higher relative abundance of CDKN1A , and aberrant SA-β-gal expression were observed in the newborn deceased SCNT calves, consistent with the change in telomere length. These results demonstrate that abnormal telomere shortening, lower mtDNA copy number and abnormal abundance of related genes were specific to newborn deceased SCNT calves, suggesting that abnormally short telomere length may be associated with abnormal development in the cloned calves. • The association of telomere length and related genes with developmental abnormalities in cloned calves was investigated. • Shortened telomere length and reduced mtDNA copy number were specific to newborn deceased SCNT calves. • Abnormal telomere shortening may be associated with abnormal development in cloned cows. • To help further understand the role of telomeres in developmental barriers to cloned calves. • Telomeres and related genes may be able to serve as molecular targets to enhance live birth rates in cloned calves. [ABSTRACT FROM AUTHOR]

Female dominance over males is more frequent in Malagasy lemurs than in other primate clades, but patterns of female–male dominance vary among species, and few data are available for one particularly species‐rich genus, Lepilemur. We investigated the types, temporal distribution, and outcome of female–male agonistic conflicts in the Milne‐Edwards' sportive lemur (Lepilemur edwardsi). Ten L. edwardsi belonging to five social units were equipped with radio collars and observed during 79 focal follows between May and November 1998. We quantified agonistic conflicts, monthly conflict rates, and documented the winner and context for all conflicts. Female–male agonistic conflicts (N = 162) occurred at a mean rate of 0.21 conflicts/hour within groups. Agonistic conflicts peaked during the birth season and occurred mostly in unknown or infant proximity contexts. Females won 96% of all decided agonistic conflicts (N = 154). Other outcomes occurred only when females were with infants during the birth season. In that context, one female sometimes withdrew from her pair partner, and another female withdrew or fled from an extra‐group male whose attacks eventually led to infanticide. Our results suggest female dominance in pair‐living L. edwardsi. We hypothesize that elevated female aggression may convey fitness benefits to female Lepilemur because it generally allows females to intervene quickly and efficiently on behalf of their infants against nonfather males who may approach the newborn infants when they are parked in vegetation. Highlights: Intersexual conflicts occurred on a regular basis (0.21 conflicts/hour) in the nocturnal Lepilemur edwardsi.Conflicts peaked during the birth season and infant proximity was an important behavioral context for conflicts.Females won 97% (n = 134) of all decided conflicts within social units and female dominance is thus suggested for L. edwardsi. [ABSTRACT FROM AUTHOR]

Cerebral monitoring during immediate fetal-to-neonatal transition is of increasing interest. The cerebral fractional tissue oxygen extraction (cFTOE) is a useful parameter to gain insight in the balance between tissue oxygen delivery and consumption during this complex process. The aim of this study was to review the literature on cFTOE during the first 15 min immediately after birth. A systematic qualitative literature research was last performed on 23 November 2023 of PubMed and EMBASE with the following search terms: neonate, infant, newborn, transition, after birth, delivery room, NIRS, near-infrared spectroscopy, spectroscopy, cFTOE, cerebral fractional tissue oxygenation extraction, cerebral oxygenation, and fractional oxygen extraction. Additional published reports were identified through a manual search of references in retrieved articles and in review articles. The methodological quality of the included studies was assessed by predefined quality criteria. Only human studies with data of cFTOE in the first 15 min after birth were included. Accordingly, exclusion criteria were defined as no measurement of cFTOE or no measurement within the first 15 min after birth. Across all studies, a total of 3566 infants (2423 term, 1143 preterm infants) were analysed. Twenty-five studies were identified describing cFTOE within the first 15 min after birth. Four studies established reference ranges for cFTOE and another four studies focused on the effect of pre-/perinatal circumstances on cFTOE in the first 15 min after birth. Six studies investigated the course of cFTOE after transition in infants without complications. Eleven studies analysed different potentially influencing parameters on cFTOE during transition. Conclusion: This systematic review provides a comprehensive insight on cFTOE during uncomplicated transition as well as the influence of perinatal circumstances, respiratory, haemodynamic, neurological, and laboratory parameters in preterm and term infants. What is Known: • The NIRS-measured cerebral fractional tissue oxygen extraction (cFTOE) is a useful parameter to estimate the balance between oxygen delivery and consumption. • During normal transition, the cFTOE decreases in the first minutes after birth and then remains at a stable plateau. What is New: • The cFTOE is a promising parameter that gives additional information on cerebral oxygenation and perfusion in preterm and term infants. • Several hemodynamic, metabolic, respiratory, and perinatal factors are identified, influencing the oxygen extraction of the newborn's brain after birth. [ABSTRACT FROM AUTHOR]

Inappropriate perioperative fluid load can lead to postoperative complications and death. This retrospective study was designed to investigate the association between intraoperative fluid load and outcomes in neonates undergoing non-cardiac surgery. From April 2020 to September 2022, 940 neonates who underwent non-cardiac surgery were retrospectively enrolled and their perioperative data were harvested for further analysis. According to recorded intraoperative fluid volumes defined as ml.kg−1 h−1, patients were mandatorily divided into quintile with fluid load as restrictive (quintile 1, Q1), moderately restrictive (Q2), moderate (Q3), moderately liberal (Q4), and liberal (Q5). The primary outcomes were defined as prolonged length of hospital stay (LOS) (postoperative LOS ≥ 14 days), complications beyond prolonged LOS, and 30-day mortality. Secondary outcomes included postoperative complications within 14 days of hospital stay. The intraoperative fluid load was in Q1 of 6.5 (5.3–7.3) (median and IQR); Q2: 9.2 (8.7–9.9); Q3: 12.2 (11.4–13.2); Q4: 16.5 (15.4–18.0); and Q5: 26.5 (22.3–32.2) ml.kg−1 h−1. The odd of prolonged LOS was positively correlated with an increase fluid volume (Q5 quintile: OR 2.602 [95% CI 1.444–4.690], P = 0.001), as well as complications beyond prolonged LOS (Q5: OR 3.322 [95% CI 1.656–6.275], P = 0.001). The overall 30-day mortality rate was increased with high intraoperative fluid load but did not reach to a statistical significance after adjusted with confounders. Furthermore, the highest quintile of fluid load (26.5 ml.kg−1 h−1, IQR [22.3–32.2]) (Q5 quintile) was significantly associated with longer postoperative mechanical ventilation time compared with Q1 (Q5: OR 2.212 [95% CI 1.101–4.445], P = 0.026). Conclusion: Restrictive intraoperative fluid load had overall better outcomes, whilst high fluid load was significantly associated with prolonged LOS and complications after non-cardiac surgery in neonates. Trial registration: Chictr.org.cn Identifier: ChiCTR2200066823 (December 19, 2022). What is Known: • Inappropriate perioperative fluid load can lead to postoperative complications and even death. What is New: • High perioperative fluid load was significantly associated with an increased length of stay after non-cardiac surgery in neonates, whilst low fluid load was consistently related to better postoperative outcomes. [ABSTRACT FROM AUTHOR]

Currently, there is no consensus regarding the relationship between neonatal transfer and duration of hospitalization in cases of impaired mother-infant bonding (MIB). This study aimed to determine whether neonatal transfer and duration of hospitalization of newborns increase the risk for impaired MIB. The MIB Scale was used to assess impaired MIB 1 year after delivery, using data from the Japan Environment and Children's Study. A score ≥ 5 points indicated impaired MIB. Multiple logistic regression analyses were performed to estimate the association between neonatal transfer and duration of hospitalization of newborns with the risk of impaired MIB. A total of 66,402 pregnant women were included in the study. The overall incidence rate of impaired MIB was 11.2 %. The mean duration of hospitalization of newborns was 7.1 ± 6.4 days. After adjusting for potential confounders, neonatal transfer (adjusted odd ratio (OR): 1.13 [95 % confidence interval (CI)), 1.01–1.27]) and duration of hospitalization of newborns (adjusted OR 1.007; 95 % CI 1.003–1.010) were associated with impaired MIB. The area under the receiver operating characteristic curve for the duration of hospitalization of newborns for impaired MIB was 0.53. Maternal childhood abuse and neglect history were not evaluated, and information regarding whether the infants were admitted to the neonatal intensive care unit was unavailable. Japanese women whose newborns underwent neonatal transfer should be followed up for at least 1 year after delivery, regardless of the duration of hospitalization of newborns. • We report whether newborn hospitalization duration indicates MIB impairment. • Neonatal transfer was associated with a MIB impairment 1 year after delivery. • Related neonates should be monitored for at least 1 year after delivery. [ABSTRACT FROM AUTHOR]

Paediatric neurovascular anomalies associated with the vein of Galen (VG) comprise of a spectrum of rare, complex, and life-threatening conditions. In this group, the "vein of Galen aneurysmal dilatation" (VGAD) is a distinct entity that often presents with progressive neurological symptoms in older children. Acute haemorrhage in VGAD is uncommon. We present an unusual presentation of VGAD in a neonate and discuss the challenges faced in the management. [ABSTRACT FROM AUTHOR]

Introduction: Myelomeningocele (MMC) is a prevalent form of neural tube defect. Despite advancements in treatment, MMC still poses significant health risks, including complications leading to chronic disability and mortality. Identifying prognostic risk factors for early outcomes is crucial for tailored intervention strategies. Methods: This prospective study involved newborns and infants diagnosed with MMC who underwent surgery between 2020 and 2023 at Urmia University of Medical Sciences. Demographic data and surgical outcomes were collected, and participants were followed up for six months. Statistical analyses were conducted using descriptive statistics, Chi-Square, and independent t-test. Results: The study included 29 MMC cases, with an incidence rate of 1.4 per 10,000 live births. Lesions were predominantly located in the lumbar spine. Although mortality rates appeared to increase with ascending lesion sites, this trend was not statistically significant. Short-term outcomes revealed high morbidity and mortality rates, with neurological deficits being the most prevalent complication. Multivariable analysis identified head circumference as a significant predictor of adverse outcomes (IRR = 1.37, 95% CI = 1.02 to 1.86, p = 0.04). Furthermore, an increase in birth weight was associated with a reduction in the incidence of requiring a ventriculoperitoneal shunt (IRR = 0.99, 95% CI = 0.998 to 0.999, p = 0.02). Conclusion: This prospective study highlights prognostic risk factors for early outcomes in MMC patients, emphasizing the need for personalized intervention strategies. By addressing modifiable risk factors and implementing targeted interventions, healthcare providers can strive to improve outcomes and enhance the quality of life for MMC patients. [ABSTRACT FROM AUTHOR]

Hearing loss is the most prevalent neurosensory disorder in humans, with significant implications for language, social and cognitive development if not diagnosed and treated early. The present systematic review and meta-analysis aimed to determine the rate of hearing screening pass and genetic screening failure [universal newborn hearing screening (UNHS) pass/genetic failure] and to investigate the advantages of combining newborn hearing and genetic screening for newborn hearing impairment. The PubMed, Embase and Cochrane databases were searched from inception to September 2023 to identify studies reporting the combination of neonatal hearing screening with genetic screening. Duplicate literature, unpublished literature, studies with incomplete data, animal experiments, literature reviews and systematic studies were excluded. All the data were processed by STATA15.1 statistical software. A total of nine cross-sectional studies were included in this meta-analysis. The sample sizes ranged from 1,716 to 180,469, and there were a total of 377,688 participants. The pooled results revealed that the prevalence of passing the UNHS while failing genetic screening was 0.31% (95% CI, 0.22-0.41%). The prevalence of UNHS pass and gap junction protein beta 2 and solute carrier family 26 member 4 variant screen failure was 0.01% (95% CI, 0.00-0.02%) and 0.00% (95% CI, 0.00%), respectively, while the prevalence of mitochondrially encoded 12S RRNA variant screening failure and UNHS pass was 0.21% (95% CI, 0.18-0.26%). Combined screening has a significant advantage over pure hearing screening, especially in terms of identifying newborns with mitochondrial gene mutations that render them sensitive to certain medications. In clinical practice, decision-makers can consider practical circumstances and leverage the benefits of combined newborn hearing and genetic screening for early diagnosis, early counseling, and early intervention in patients with hearing loss. [ABSTRACT FROM AUTHOR]

Aim: Sudden unexpected postnatal collapse is a life‐threatening event and may occur in any newborn infant. Safe skin‐to‐skin contact, and awareness of sudden unexpected postnatal collapse are key to its prevention. The aim of this study was to survey the presence of skin‐to‐skin contact and/or sudden unexpected postnatal collapse protocols in the 70 perinatal centres in the Netherlands. Methods: We performed a survey among Dutch paediatricians to examine the safe skin‐to‐skin contact and sudden unexpected postnatal collapse protocols. Results: We received data from 59/70 (85%) perinatal centres. At least one case of sudden unexpected postnatal collapse was reported in 35/59 (59%) of these centres. Nearly half the centres had safe skin‐to‐skin contact and/or sudden unexpected postnatal collapse protocols. Ultimately, 16 protocols were available for analysis. They showed considerable differences in the type of perinatal care provided. Most protocols lacked recently published insights on safe skin‐to‐skin contact. Besides, protocols failed to incorporate awareness of and knowledge on how to prevent sudden unexpected postnatal collapse. Conclusion: This study underlines the importance of drawing up uniform, multidisciplinary guidelines containing recommendations for the prevention of sudden unexpected postnatal collapse in the Netherlands. [ABSTRACT FROM AUTHOR]

The renewed focus on eye growth in preterm‐born children was primarily triggered by Danish cohort studies, including the Copenhagen Project, which focused on children born from 1959–1961. The retinotoxic effects of excessive oxygen on premature neonates had long been clarified and therapeutically adjusted for. Later, ultrasound oculometry and keratometry established that ocular size deficits, linked to development, also occurred in normally developing children, not just frail outliers. This indicated that general catch‐up had not been achieved. This paper discusses whether one early segment of eye development does not occur in preterm, and here even in more robust neonates, without later compensation. [ABSTRACT FROM AUTHOR]

Aim: To analyse the evidence of non‐invasive neurally adjusted ventilatory assist (NIV‐NAVA) in preterm neonates compared to nasal continuous positive airway pressure (nCPAP) or nasal intermittent positive pressure ventilation (NIPPV). Methods: We performed a systematic review and meta‐analysis of randomised controlled trials and included studies where NIV‐NAVA was analysed in preterm (<37 gestational weeks) born neonates. Our main outcomes were the need for endotracheal intubation, the need for surfactant therapy, and reintubation rates. Risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. Results: A total of five studies were included. The endotracheal intubation rate was 25% in the NIV‐NAVA group and 26% in the nCPAP group (RR 0.91, CI: 0.56–1.48). The respective rates for surfactant therapy were 30% and 35% (RR 0.85, CI: 0.56–1.29). The reintubation rate in neonates previously invasively ventilated was 8% in the NIV‐NAVA group and 29% in the nCPAP/NIPPV group (RR 0.29, 95%CI: 0.10–0.81). Evidence certainty was rated as low for all outcomes. Conclusions: NIV‐NAVA as the primary respiratory support did not reduce the need for endotracheal intubation or surfactant therapy. NIV‐NAVA seemed to reduce the reintubation rate after extubation in pre‐term neonates. [ABSTRACT FROM AUTHOR]

This paper analyzes the role of newborn gender in household investment decisions. Parenting a new baby is associated with a reduction of the share of financial wealth held as cash and an increase in risky investments. The reallocation is however gender‐heterogeneous: the increase in the share of both total and financial wealth allocated to risky assets when parenting girls is reduced for households parenting boys. The effect is driven by the first child. Parents of newborn girls hold riskier portfolios because they make financial decisions influenced by their expectations on the autonomy and financial independence of newborns in adulthood. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years. Method: Prospective cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at term-equivalent age, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson’s correlation. The study considered a significance level of 0.05. Results: There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley. [ABSTRACT FROM AUTHOR]

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Acalvaria is a rare congenital malformation of unknown etiopathogenesis that affects the development of the skull and surrounding muscular structures. There is scant literature regarding the pathophysiology, and no standardized guidelines exist for patient management. Herein, we present a case of acalvaria in a newborn and our multidisciplinary approach from diagnosis to 1 year of age. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions The primary objective of this study is to determine the impact of a standardised feeding protocol for infants with gastroschisis on early enteral feeds, suck feeds, management of gastric residuals and breastfeeding at discharge. Secondary objectives were evaluation of growth, length of stay in neonatal intensive care unit (NICU), the duration of total parental nutrition (TPN), blood‐culture confirmed sepsis and serum bilirubin level (SBR).This single‐centre retrospective quality improvement project included infants admitted to a quaternary care NICU for management of gastroschisis from 2010 to 2021. The Gastroschisis feeding protocol, a standardised pathway for managing the feeding of infants with gastroschisis, was implemented in this NICU in 2016. The outcomes of infants in the pre‐feeding protocol and post‐feeding protocol groups were compared.Of the 100 infants included in the study, 49 were in the post‐feeding protocol group. The baseline characteristics of the study population did not differ statistically in both groups. In post‐feeding protocol group, there was significant reduction in the time to the first enteral feed (P value <0.0001) and first suck feed (P value = 0.002). The median length of stay in the post‐feeding protocol group was significantly lower by 11 days (P value = 0.001). Duration of TPN was 241 h higher in the pre‐feeding protocol group (P value 0.0007).Implementation of a feeding protocol in infants with gastroschisis led to earlier initiation of enteral feeds and suck feeds. There is a likelihood of reduction in the use of TPN and duration of admission in NICU. [ABSTRACT FROM AUTHOR]

Background: Birthweight has an impact on newborn's future health outcomes. Maternal factors, including age, delivery mode, HIV status, gestational age, parity and obstetric complications (preeclampsia or eclampsia [PE], antepartum hemorrhage [APH] and sepsis), however, have been shown as risk factors of low birthweight (LBW) elsewhere. For data-guided interventions, we aimed to identify predictors of LBW and compare newborn birthweights between different groups of maternal factors at Rev. John Chilembwe Hospital in Phalombe district, Malawi. Methods: Using a retrospective record review study design, we extracted data from maternity registers of 1244 women and their newborns from October, 2022 to March, 2023. Data were skewed. Median test was used to compare median birthweights. Chi-square or Fisher's exact tests were used to compare proportions of LBW among different groups of maternal factors. Multivariable logistic regression with stepwise, forward likelihood method was performed to identify predictors of LBW. Results: Median birthweight was 2900.00g (interquartile range [IQR]: 2600.00g to 3200.00g). Prevalence of LBW was 16.7% (n = 208). Proportions of LBW infants were higher in women with PE, APH, including women with sepsis than controls (10 [47.6%] of 21 vs 7 [58.3%] of 12 vs 191 [15.8%] of 1211, p <.001). Lower in term and postterm than preterm (46 [5.5%] of 835 vs 2 [3.7%] of 54 vs 160 [45.1%] of 355, p <.001). The odds of LBW infants were higher in preterm than term (AOR = 13.76, 95%CI: 9.54 to 19.84, p <.001), women with PE (AOR = 3.88, 95%CI: 1.35 to 11.18, p =.012), APH, including women with sepsis (AOR = 6.25, 95%CI: 1.50 to 26.11, p =.012) than controls. Conclusion: Prevalence of LBW was high. Its predictors were prematurity, PE, APH and sepsis. Interventions aimed to prevent these risk factors should be prioritized to improve birthweight outcomes. [ABSTRACT FROM AUTHOR]

Background: The timing of cord clamping has become a focal point for neonatal caregivers due to the promising outcomes associated with delayed cord clamping, which is a simple and cost-effective method to enhance the survival and well-being of preterm infants. While initially the rationale behind delaying clamping was to facilitate increased placental transfusion, research has unveiled additional hemodynamic benefits. Summary: Experimental studies have demonstrated improved circulatory transition when clamping is postponed until the lungs are adequately aerated. This suggests that infants requiring assistance during the transition phase may benefit from stabilization while still attached to the cord. The Aeration, Breathing, and then Clamping (ABC) project aimed to translate these experimental findings into clinical practice. Key Message: In this review, we will discuss the insights gained and lessons learned from the project’s implementation. [ABSTRACT FROM AUTHOR]

Background: Deaths occurring during the neonatal period contribute close to half of under-five mortality rate (U5MR); over 80% of these deaths occur in low- and middle-income countries (LMICs). Poor maternal antepartum and perinatal health predisposes newborns to low birth weight (LBW), birth asphyxia, and infections which increase the newborn's risk of death. Methods: The objective of the study was to assess the association between abnormal postpartum maternal temperature and early infant outcomes, specifically illness requiring hospitalisation or leading to death between birth and six weeks' age. We prospectively studied a cohort of neonates born at Mbarara Regional Referral Hospital in Uganda to mothers with abnormal postpartum temperature and followed them longitudinally through early infancy. We performed a logistic regression of the relationship between maternal abnormal temperature and six-week infant hospitalization, adjusting for gestational age and 10-minute APGAR score at birth. Results: Of the 648 postpartum participants from the parent study who agreed to enrol their neonates in the sub-study, 100 (15%) mothers had abnormal temperature. The mean maternal age was 24.6 (SD 5.3) years, and the mean parity was 2.3 (SD 1.5). There were more preterm babies born to mothers with abnormal maternal temperature (10%) compared to 1.1% to mothers with normal temperature (p=˂0.001). While the majority of newborns (92%) had a 10-minute APGAR score > 7, 14% of newborns whose mothers had abnormal temperatures had APGAR score ˂7 compared to 7% of those born to mothers with normal postpartum temperatures (P = 0.02). Six-week outcome data was available for 545 women and their infants. In the logistic regression model adjusted for gestational age at birth and 10-minute APGAR score, maternal abnormal temperature was not significantly associated with the composite adverse infant health outcome (being unwell or dead) between birth and six weeks' age (aOR = 0.35, 95% CI 0.07–1.79, P = 0.21). The 10-minute APGAR score was significantly associated with adverse six-week outcome (P < 0.01). Conclusions: While our results do not demonstrate an association between abnormal maternal temperature and newborn and early infant outcomes, good routine neonate care should be emphasized, and the infants should be observed for any abnormal findings that may warrant further assessment. Target journal: BMC Pregnancy and Childbirth (https://bmcpregnancychildbirth.biomedcentral.com/). [ABSTRACT FROM AUTHOR]

In the current paper, we examined the dimensional structure of parenting using a bifactor model of observed parenting domains during infancy. We validated our parenting dimensions by examining correlations with indicators of family well‐being and child development. Data come from a longitudinal cohort that recruited a diverse sample of mothers (56.5% White) and their newborn child (50.7% males). Parenting was assessed using multiple indicators at an average of 18 months (N = 397). Bifactor modelling revealed a general latent dimension of sensitivity and two unique dimensions indexing emotional input and cognitive input. We found a pattern of shared and unique correlations of the three parenting dimensions with family and child well‐being. The most robust correlations were with the general sensitivity dimension, which we argue cuts across parentings behaviors and is fundamental to development. [ABSTRACT FROM AUTHOR]

Objectives: This study aims to assess the predictive capability of synthetic MRI in assessing neurodevelopmental outcomes for extremely preterm neonates with low-grade Germinal Matrix-Intraventricular Hemorrhage (GMH-IVH). The study also investigates the potential enhancement of predictive performance by combining relaxation times from different brain regions. Materials and methods: In this prospective study, 80 extremely preterm neonates with GMH-IVH underwent synthetic MRI around 38 weeks, between January 2020 and June 2022. Neurodevelopmental assessments at 18 months of corrected age categorized the infants into two groups: those without disability (n = 40) and those with disability (n = 40), with cognitive and motor outcome scores recorded. T1, T2 relaxation times, and Proton Density (PD) values were measured in different brain regions. Logistic regression analysis was utilized to correlate MRI values with neurodevelopmental outcome scores. Synthetic MRI metrics linked to disability were identified, and combined models with independent predictors were established. The predictability of synthetic MRI metrics in different brain regions and their combinations were evaluated and compared with internal validation using bootstrap resampling. Results: Elevated T1 and T2 relaxation times in the frontal white matter (FWM) and caudate were significantly associated with disability (p < 0.05). The T1- FWM, T1-Caudate, T2-FWM, and T2-Caudate models exhibited overall predictive performance with AUC values of 0.751, 0.695, 0.856, and 0.872, respectively. Combining these models into T1-FWM + T1-Caudate + T2-FWM + T2-Caudate resulted in an improved AUC of 0.955, surpassing individual models (p < 0.05). Bootstrap resampling confirmed the validity of the models. Conclusion: Synthetic MRI proves effective in early predicting adverse outcomes in extremely preterm infants with GMH-IVH. The combination of T1-FWM + T1- Caudate + T2-FWM + T2-Caudate further enhances predictive accuracy, offering valuable insights for early intervention strategies. [ABSTRACT FROM AUTHOR]

Pseudorabies virus is a major pathogen in the pig industry, causing substantial economic losses. The emergence of pseudorabies virus variant strains in China has led to extensive spread, raising concerns about their potential impact. However, the differences in pathogenicity between the classical strains and the variant strains of genotype II are not well understood. In this study, we isolated three pseudorabies virus strains to evaluate their replication characteristics and to examine the differences in virulence genes among various subgenotypes strains. Additionally, a piglet infection model was utilized to investigate the clinical features of infection, tissue tropism, and the inflammatory responses induced by these strains. Our results showed that the genotype II variant strains (MS, XJ, LS, and CZ) had significantly larger plaque sizes and higher replication capacities than the genotype II classical strain Fa. The animal experiments revealed significant differences in pathogenicity among the pseudorabies virus subgenotype strains, with the variant strains showing higher mortality rates, more severe clinical symptoms, increased nasal virus shedding, and a more robust inflammatory response compared to the genotype II classical strain. There were also notable differences in tissue tropism among the strains. In terms of tissue viral loads, the genotype II variant strains did not exhibit a significant advantage over the genotype I classical strain. Furthermore, our findings indicate that antibodies against the genotype II classical strains have a reduced neutralizing capacity against the genotype II variant strains. On the other hand, antibodies against the genotype II variant strains displayed similar neutralizing abilities against both classical and variant strains. Overall, these findings offer important insights into the distinctions among pseudorabies virus subgenotypes and their implications for the clinical control of pseudorabies virus infections in pig farming. [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) is the leading cause of acute lower respiratory tract infections (LRTIs) and hospital admissions in early childhood. Recent advancements in novel preventive therapies, including extended half‐life monoclonal antibodies and antenatal vaccination, have afforded new opportunities to significantly reduce the burden of this infection. Nirsevimab is a novel monoclonal antibody that provides sustained protection against RSV for at least 5 months among newborns and young children. It has received regulatory approval in numerous countries and is being implemented across various settings. Two pivotal Phase 3 trials (MELODY, HARMONIE) demonstrated significant reductions in RSV‐associated LRTI hospitalisations following nirsevimab administration, with treatment efficacy of 62.1% and 83.2%. Emerging real‐world data from early adopters of nirsevimab corroborates these findings. Studies from Spain, Luxembourg, France and the USA report effectiveness rates between 82% and 90% in preventing RSV‐associated hospitalisations among infants entering their first RSV season. Current implementation strategies for nirsevimab have primarily focused on seasonal administration for all infants, aligned to local RSV seasons, and often include catch‐up doses for those born before the season begins. Available cost‐effectiveness analyses indicate that while nirsevimab offers significant potential public health benefits, its adoption must carefully consider economic factors such as treatment costs, implementation strategies tailored to local viral epidemiology, and logistics for vaccine delivery. Overall, nirsevimab presents a promising opportunity to alleviate the burden of severe RSV infections in young children. However, ongoing surveillance and refinements in implementation strategies are crucial to optimise its impact and ensure sustainability across diverse health‐care settings. [ABSTRACT FROM AUTHOR]

Background: Newborn resuscitation algorithms have since the turn of the century been more evidence-based. In this review, we discuss the development of American Heart Association (AHA) and the International Liaison Committee on Resuscitation (ILCOR)’s algorithm for newborn resuscitation from 1992–2024. We have also aimed to identify the remaining gaps in non-evidenced practice. Summary: Of the 22 procedures reviewed in the 2020 ILCOR recommendations, the evidence was either low, very low, or non-existing. The strength of recommendation is weak or non-existing for most topics discussed. Several knowledge gaps are also summarized. The special challenge for low- and middle-income countries (LMIC) is discussed. Key Messages: Newborn resuscitation is still not evidence-based, although great progress has been achieved the recent years. We have identified several knowledge gaps which should be prioritized in future research. The challenge of obtaining evidence-based knowledge from LMIC should be focused on in future research. [ABSTRACT FROM AUTHOR]

Objective: To develop and evaluate the predictive value of a simplified lung ultrasound (LUS) method for forecasting respiratory support in term infants. Methods: This observational, prospective, diagnostic accuracy study was conducted in a tertiary academic hospital between June and December 2023. A total of 361 neonates underwent LUS examination within 1 h of birth. The proportion of each LUS sign was utilized to predict their respiratory outcomes and compared with the LUS score model. After identifying the best predictive LUS sign, simplified models were created based on different scan regions. The optimal simplified model was selected by comparing its accuracy with both the full model and the LUS score model. Results: After three days of follow-up, 91 infants required respiratory support, while 270 remained healthy. The proportion of confluent B-lines demonstrated high predictive accuracy for respiratory support, with an area under the curve (AUC) of 89.1% (95% confidence interval [CI]: 84.5-93.7%). The optimal simplified model involved scanning the R/L 1–4 region, yielding an AUC of 87.5% (95% CI: 82.6-92.3%). Both the full model and the optimal simplified model exhibited higher predictive accuracy compared to the LUS score model. The optimal cut-off value for the simplified model was determined to be 15.9%, with a sensitivity of 76.9% and specificity of 91.9%. Conclusions: The proportion of confluent B-lines in LUS can effectively predict the need for respiratory support in term infants shortly after birth and offers greater reliability than the LUS score model. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Conclusion The length of newborns shows seasonal fluctuations, but the patterns of these fluctuations vary greatly. This study analyses the fluctuation in birth length by birth month and temporal changes in Austrian newborns from the 1984 to 2021 birth cohorts.A total of 2 317 927 singleton‐term births between 1984 and 2021 in Austria were included in this retrospective population‐based cohort study. A strict inclusion criterion was the Austrian citizenship of the mother. The effect of month of birth (MOB) on birth length was estimated using a multivariable linear model adjusting for maternal educational level, newborn sex, gestational age, year of birth (YOB) of the newborn, and parity of the mother.Newborn length varied by MOB, but there was also a temporal trend. In the birth cohorts up to 2004, the longest newborns were born in February, while from 2008 onward, the longest birth lengths were observed in the summer months.In this Austrian population‐based sample, birth length shows nonrandom fluctuations by birth month. These patterns, however, varied considerably over time. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is the leading cause of neonatal mortality accounting for 35% of all neonatal deaths worldwide, and the second most frequent cause of death for under five children. Despite different efforts, preterm neonatal mortality is still persistently high in Ethiopia. Little is known about death and its predictors among preterm neonates in the study area. Objective: This study is aimed at estimating the incidence of mortality and its predictors among preterm neonates admitted to the NICU of NEMMCSH. Methods and materials: : A hospital-based prospective follow-up study was conducted from January to November 2022. A total of 197 preterm neonates were selected consecutively and followed. The Kaplan-Meier survival and failure curves were used to describe the proportion of deaths over time and to compare groups. The independent effects of covariates on the hazard of death were analyzed using a multivariable Cox proportional hazard model. Results: Preterm neonates were followed for 1840 person-days. The mean time to death was 5.68 days (SD = 5.54). The incidence of mortality was 26.08 (95% CI: 19.65, 34.61) per 1000 person days. Preterm neonates of mothers with eclamsia (AHR = 3.03), preterm neonates who have not received KMC (AHR = 2.26), and preterm neonates who have not exclusively breastfed (AHR = 4.4) had higher hazards of death as compared to their counterparts. Conclusion and recommendation: : The mean time to death was 5.68 days (SD = 5.54). The incidence of mortality was 26.08 per 1000 person days. Eclamsia, KMC, and exclusive breastfeeding were significant predictors of death among preterm neonates. The role of KMC in reducing mortality rates and improving outcomes has to be emphasized for mothers and families. Caregivers have to ensure that mothers and families receive adequate support and resources to facilitate KMC, including access to lactation support, counseling, and assistance with practical aspects of caregiving. Counseling and practical support to enhance exclusive breastfeeding initiation and continuation have to be strengthened. Special attention has to be given to the preterm neonates of mothers with eclampsia. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Lung ultrasound (LU) and clinical parameters evaluated during the first postnatal hour potentially predict the length of CPAP therapy in newborns with respiratory distress.In a single‐centre, prospective observational pilot study, 130 newborns ≥36 weeks gestational age were assessed using standardised LU at 30 and 60 min postnatally. Various clinical parameters were evaluated influencing CPAP duration (<1 vs. ≥1 h) using univariate and multivariate analyses.Lung ultrasound score >5, FiO2 > 0.21 and respiratory acidosis 30 min postnatally were associated with CPAP ≥1 h. Our model showed good diagnostic quality (ROC AUC = 0.87) and was confirmed by classification and regression tree (CART) analysis. Additional LU findings like double lung point and pleural line abnormalities were frequently observed, with good interrater reliability for LU interpretation (ICC = 0.76–0.77).Newborns with postnatal respiratory distress at risk for prolonged CPAP therapy can be identified based on specific LU and clinical parameters assessed 30 min postnatally. Despite the need for validation in an independent sample, these findings may lay the groundwork for a prediction tool. LU proved feasible and reliable for assessing respiratory status in this population, highlighting potential utility in clinical practice. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions Gastro‐oesophageal reflux is common in newborns, especially in premature infants. Treatment by medication is controversial as the drugs prescribed have not been consistently proven to be effective and are known to have adverse effects. This study sought to identify trends in the prescription of anti‐reflux medication in a large group of French neonatal units.Data on prescriptions of anti‐reflux treatments—proton pump inhibitors (PPIs), antacids, histamine‐2 receptor antagonists (H2RAs), and prokinetics—from 2014 to 2022 for infants with a corrected gestational age <45 weeks, were extracted from a prescription database (Logipren®) used by 63 French neonatal units, and then analysed.Of all infants recorded in the database during the study period (n = 152 743), 10.2% (n = 15 650) were prescribed anti‐reflux medication (95% confidence interval [CI] 10.0–10.4%), mainly as monotherapy (77.5%). The rate was higher in the subgroup of preterm infants born before 28 weeks of gestation (n = 9493) (20.6%, 95% CI 19.8–21.4%; n = 1956). PPIs were the most commonly prescribed anti‐reflux medications (6.9% of infants, 95% CI 6.8–7.0), followed by antacids (5.2%, 95% CI 5.1–5.3%), while H2RAs and prokinetics were rarely prescribed. Over the period, the prescription rate remained stable for PPIs, decreased for H2RAs (τ = −0.86, P = .02), and, among preterm infants born at gestational ages of 28–31 or 32–36 weeks, increased for antacids.Anti‐reflux medications were frequently prescribed by neonatal units, especially for extremely premature infants. Most of these prescriptions were for PPIs and antacids. [ABSTRACT FROM AUTHOR]

Background: The mortality rate is approximately 20% and the frequency of neurodevelopmental sequelae in surviving newborns is approximately 30% in perinatal asphyxia; hypoxic-ischemic encephalopathy (HIE) is brain dysfunction due to lack of oxygen and blood supply to the brain. Aims and Objectives: This study was conducted to predict the pattern of neuromotor outcome as early as 3 months using Hammersmith Infant Neurological Examination (HINE) in term hypoxic babies and its relation with the Thompson score (HIE score). Materials and Methods: One-hundred twenty four term newborns with hypoxic babies were admitted to the neonatal care unit from January 2021 to August 2021. Thompson scoring was done on admission and subsequently reviewed. Discharged babies were followed up at 3 months, 6 months, and 1 year of age. A neurological examination (HINE) was done in this high-risk follow-up clinic. Maximum Thompson score was correlated with neurological score at various months. The earliest predictability of neurological examination was done at 3 months and was correlated with the neurological examination done at 12 months. Results: The correlation between the Thompson score and the 3-month score is -0.65 indicating a strong negative association between the two measurements. The correlation between 3 months and 6 months and 1-year neurological scores was moderately associated with each other. Conclusion: The maximum Thompson score was significantly higher in the mortality group compared to the discharged group. Thompson score has a significant correlation with the 3, 6, and 12-month neurological scores examined by HINE. The 3-month neurological outcome has a very significant correlation with the 1-year outcome. [ABSTRACT FROM AUTHOR]

Background: As hyperbilirubinemia is one of the key contributors to brain damage and is crucial to identify those instances that are at risk as it is more prevalent and severe among the preterms. Many studies are available in the literature for terms babies but there is paucity of data for pre terms. Aims and Objectives: The aim of this study was to assess serum bilirubin at 24 h of live birth as a indicator of significant hyperbilirubinemia in preterm neonates. Materials and Methods: It was a prospective observational study conducted in the department of pediatrics of tertiary care center, Jodhpur on 150 preterms born within 33-36 weeks 6 days after considering the exclusion criteria in the study. Area under the receiver operating characteristic (ROC) curve was used to identify significant hyperbilirubinemia within 1 week of life, along with it the cutoff value of total serum bilirubin (TSB) at 24 h of life was calculated. Results: A total of 150 enrolled preterm newborns were followed up. TSB at 24 h of life was proved to be significant using the ROC curve, where area under the curve is 0.96 which was statistically significant. Among 150 preterms, 70 newborns with TSB >4.2 mg/dL developed jaundice, and 65 babies (98.48%) required phototherapy. Hence, preterms with TSB >4.2 mg/dL have a significant risk of developing hyperbilirubinemia. (Sensitivity: 98.48%, specificity: 94.05%, negative predictive value: 98.75%, and positive predictive value: 92.86%). Conclusion: TSB for preterms at 24 h of life can support to predict the significant hyperbilirubinemia successfully. Preterms with cutoff value of serum bilirubin level >4.2 mg/dL are observed to be more prone to develop significant hyperbilirubinemia requiring appropriate intervention at the earliest. [ABSTRACT FROM AUTHOR]

Background & objective: Neonates admitted and treated in the Neonatal Intensive Care Unit (NICU) often receive painful invasive procedures. In such situations, the treating physicians often find themselves in a fix regarding the use of analgesics to relieve their actual or potential pain. It has been observed that the sucking often distracts the neonates from their mild to moderate pain. We conducted this study to analyze the effectiveness of non-nutritive sucking as an analgesic for neonates who were to receive invasive procedures. Methodology: This experimental study implemented a post-test-only control group design, involving 64 neonates in the NICU, selected using a simple random sampling technique, who were then divided into two groups, with 32 neonates each in a treatment group and a control group. The treatment group was given non-nutritive sucking, while the control group was given standard intervention, then the pain response was measured in both groups. Next, the pain levels of the two groups were compared using the Mann-Whitney U test. Results: The measurement results showed that there was a difference in the mean scores of pain response between treatment and control group, respectively 1.53125 and 5.8125. The P-value of the difference test was 0.000000004252, so that it could be interpreted that there was a significant difference in pain levels between the two groups. Conclusion: On the basis of the results of our study, it is concluded that non-nutritive sucking is an effective method for reducing the pain response in neonates during invasive procedures. [ABSTRACT FROM AUTHOR]

Salinity, light intensity, and oxygen concentration are key environmental factors that significantly affect biological processes and the composition and dispersion of Moina biomass. Evaluating the effectiveness of probiotic enrichment in improving population density, growth rate, and neonate production can provide valuable details on the effectiveness of probiotics in enhancing the resilience and viability of Moina micrura under suboptimal circumstances. The purpose of this research project is to assess the efficacy of two probiotics, Bacillus pocheonensis strain S2 and Lysinibacillus fusiformis strain A1, in improving the population density, growth rate, and reproductive output in M. micrura across various environmental conditions. Moina micrura were treated with each probiotic at a volume of 5 x 105 CFU/ml under different levels of salinity (0, 2, 4, and 6 ppt), light intensity (800, 1,000, 1,500, and 2,000 lux), and oxygen concentration (80, 70, 60, and 50%). The results indicated that M. micrura treated with L. fusiformis A1 at 0 ppt attained the highest population density (6 ± 0.90 Ind./ml), growth rate (0.355 ± 0.030 µ), and number of offspring production (5 ± 0.75 Ind./ml). The highest point of population density (5 ± 0.07 Ind./ml), growth rate (0.381 ± 0.002 µ) and number of offspring (7 ± 0.41 Ind./ml) of M. micrura were obtained while treated with B. pocheonensis S2 at light intensity of 1,500 lux. Similarly, the highest population density (5 ± 0.60 Ind./ml), growth rate (0.365 ± 0.190 µ), and offspring production (2 ± 0.25 Ind./ml) of M. micrura were observed during enrichment with B. pocheonensis S2 at 70% oxygen concentration. Therefore, these results suggested that the optimum conditions for enriching M. micrura with B. pocheonensis S2 are salinity of 0 ppt, 70% oxygen concentration, and a light intensity level of 1,500 lux. [ABSTRACT FROM AUTHOR]

Objective, Design, and Methods Although 17-hydroxyprogesterone (17OHP) has historically been the steroid assayed in the diagnosis of congenital adrenal 21-hydroxylase deficiency (CAH-21D), its C11-hydroxylated metabolite, 21-deoxycortisol (21DF), which is strictly of adrenal origin, is assayed in parallel in this pathology. This steroid (21DF) is oxidized by 11beta-hydroxysteroid dehydrogenase type 2 into 21-deoxycortisone (21DE). In the context of CAH-21D confirmation testing, confounding factors (such as intensive care unit admission, stress, prematurity, early sampling, and variations of sex development) can interfere with the interpretation of the gold-standard biomarkers (17OHP and 21DF). Since its tissue concentrations are especially high in the placenta, we hypothesized that 21DE quantification in the neonatal periods could be an interesting biomarker in addition to 17OHP and 21DF. To verify this hypothesis, we developed a new mass spectrometry-based assay for 21DE in serum and applied it to newborns screened for CAH-21D. Results In newborns with CAH-21D, the mean serum levels of 21DE reached 17.56 ng/mL (ranging from 8.58 ng/mL to 23.20 ng/mL), and the mean 21DE:21DF ratio was 4.99. In contrast, in newborns without CAH-21D, the 21DE serum levels were low and not statistically different from the analytical 21DE limit of quantification (0.01 ng/mL). Conclusion Basal serum 21DE appears to be a novel sensitive and specific biomarker of CAH-21D in newborns. [ABSTRACT FROM AUTHOR]

An intravenous (IV) administration of midazolam may result in seizure-like activity or movement. This report describes 5 neonates who developed seizure-like movements after IV midazolam injection. The patients presented between 2019 and 2022 and were admitted to a neonatal intensive care unit located within an academic centre in Muscat, Oman. The abnormal movements occurred shortly after IV bolus administration of midazolam. None of the patients experienced seizure-like movements after receiving midazolam infusions. The seizure-like movements were aborted either spontaneously or by antiseizure medications. In addition, seizure recurrence was not observed in any of the infants during the later stages of their treatment. Since this adverse effect might be related to the speed of the bolus administration, IV midazolam must be given as a slow bolus over 2-3 minutes followed by a slow flush of normal saline. To prevent midazolam's potential adverse effect on newborns, neonatal caregivers must be aware of it. [ABSTRACT FROM AUTHOR]

Purpose: To determine the obstetric factors affecting the development of depressed skull fracture in neonates. Materials and methods: This was a retrospectively cohort study on neonates born between July 2016 and August 2021. Neonates diagnosed with depressed skull fractures within one week of birth through X-ray and/or brain ultrasonography were included, and their mothers' obstetric characteristics were reviewed. Results: There were 12 cases in 6791 live births. Five women were over 35 years old. All except two were nulliparous. Five cases were delivered from labor induction and others presented with spontaneous labor. Except for two cases, delivery occurred within an hour after full cervical dilatation. Two cases were assisted by vacuum. None displayed fetal distress signs such as low Apgar scores below 7, meconium staining, and umbilical cord pH under 7.2. All depressed fractures were found in the right parietal area. Three cases resulted in focal hyperechoic lesion in brain ultrasonography and two of them showed small hemorrhage-like lesion in magnetic resonance imaging. All depressed skull fractures improved within 6 months in followed X-rays or ultrasonography. Conclusions: There was no definitely associated obstetric condition for depressed skull fracture of neonates although nulliparous women were majority of the affected cases. [ABSTRACT FROM AUTHOR]

Worldwide trends to delay childbearing have increased parental ages at birth. Older parental age may harm offspring health, but mechanisms remain unclear. Alterations in offspring DNA methylation (DNAm) patterns could play a role as aging has been associated with methylation changes in gametes of older individuals. We meta‐analyzed epigenome‐wide associations of parental age with offspring blood DNAm of over 9500 newborns and 2000 children (5–10 years old) from the Pregnancy and Childhood Epigenetics consortium. In newborns, we identified 33 CpG sites in 13 loci with DNAm associated with maternal age (PFDR < 0.05). Eight of these CpGs were located near/in the MTNR1B gene, coding for a melatonin receptor. Regional analysis identified them together as a differentially methylated region consisting of 9 CpGs in/near MTNR1B, at which higher DNAm was associated with greater maternal age (PFDR = 6.92 × 10−8) in newborns. In childhood blood samples, these differences in blood DNAm of MTNR1B CpGs were nominally significant (p < 0.05) and retained the same positive direction, suggesting persistence of associations. Maternal age was also positively associated with higher DNA methylation at three CpGs in RTEL1‐TNFRSF6B at birth (PFDR < 0.05) and nominally in childhood (p < 0.0001). Of the remaining 10 CpGs also persistent in childhood, methylation at cg26709300 in YPEL3/BOLA2B in external data was associated with expression of ITGAL, an immune regulator. While further study is needed to establish causality, particularly due to the small effect sizes observed, our results potentially support offspring DNAm as a mechanism underlying associations of maternal age with child health. [ABSTRACT FROM AUTHOR]

Background/Objectives: Congenital cytomegalovirus (cCMV) is the leading infectious cause of sensorineural hearing loss and neurodevelopmental disabilities, with prompt detection (<21 days of life) required to enable accurate diagnosis and anti-viral treatment where clinically appropriate. International guidelines recommend cCMV screening for infants who do not pass their Universal Newborn Hearing Screening (UNHS). This study aimed to explore parental experiences of targeted cCMV screening through the UNHS in Victoria, Australia between 2019 and 2020 (HearS-cCMV study). Methods: A qualitative study comprising 18 semi-structured interviews with parents who took saliva swabs from their infants who did not pass their UNHS. A maximum variation sampling strategy was used with data analysed using thematic analysis. Results: Four themes described 18 parents' experiences of cCMV screening: (1) parents' lack of CMV awareness prior to cCMV screening; (2) overall positive experience; (3) varied understanding of CMV post screening; and (4) parents were glad to screen their infant for cCMV. Enablers of targeted cCMV screening included the swab being simple and non-invasive, being easier to complete in the hospital than at home, and the screening being well delivered by the staff. Barriers included a potential increase in anxiety, especially with false positives, and the timing of cCMV screening coinciding with their infant not passing UNHS being difficult for some parents. Conclusions: Parent experiences of targeted cCMV screening were positive. Increasing public knowledge of cCMV and training staff members to complete the CMV swab would reduce the risk of false positives and associated parental anxiety. This would facilitate successful routine targeted cCMV screening. [ABSTRACT FROM AUTHOR]

Autopsy of infants can provide vital information about the cause of death and contributes to the detection of diagnostic errors, especially in a low- or middle-income country. To observe the clinicopathological agreement in neonatal deaths in neonatal intensive care units (NICU) and comment on the additional information retrieved by autopsy. A retrospective observational study was conducted in the NICU from January 2020 to December 2022. Neonatal deaths were analyzed, and clinical details and autopsy findings were collected. Both clinical and pathological diagnoses were classified according to the Goldman classification. Twenty-two newborn infants were enrolled. The mean gestational age was 33.5 (±4.38) weeks, and the median birth weight was 1510 (1005–2100) g. There was complete concordance between clinical and pathological diagnosis in 11 (50%) cases. Major diagnostic errors occurred in 41% of cases. Respiratory system disorders (lung infections, airway anomalies) accounted for six (54%) cases of missed diagnosis. Our study showed that the diagnosis was revised after autopsy in about one-third of cases, and newer findings were identified in one-fifth of cases. [ABSTRACT FROM AUTHOR]

Objective: To assess whether labour variables (i.e. individuals characteristics, labour characteristics and medical interventions) impact maternal and newborn microbiomes. Design: Prospective monocentric study. Setting: Saint‐Joseph Hospital tertiary maternity unit, in Paris, France. Population: All consecutive primiparous women with a physiological pregnancy and term labour from 15 April to 1 June 2017. Methods: 16S ribosomal RNA gene sequencing of the maternal vaginal, newborn skin and newborn oral microbiomes from 58 mother–baby dyads. Main outcome measures: Analysis of the effects of 19 labour variables on the composition and diversity of these microbiomes. Results: The 19 labour variables explained a significant part of the variability in the vaginal, newborn oral and skin microbiomes (44%–67%). Strikingly, duration of rupture of membranes was the single factor that explained the greatest variability (adjusted R2: 7.7%–8.4%, p ≤ 0.002) and conditioned, by itself, the compositions of the three microbiomes under study. Long duration of rupture of membranes was specifically associated with a lower relative abundance of the Lactobacillus genus (1.7‐fold to 68‐fold reduction, p < 0.0001) as well as an increase in microbiome diversity, including genera implicated in nosocomial infections. The effects of duration of rupture of membranes were also present in newborns delivered by non‐elective caesarean section. Conclusions: Maternal and newborn microbiomes were greatly affected by labour variables. Duration of rupture of membranes, even in non‐elective caesarean sections, should be considered in epidemiological and microbiological studies, as well as in vaginal seeding practices. [ABSTRACT FROM AUTHOR]

Cefotaxime is commonly used in treating bacterial infections in neonates. To characterize the pharmacokinetic process in neonates and evaluate different recommended dosing schedules of cefotaxime, a physiologically-based pharmacokinetic (PBPK) model of cefotaxime was established in adults and scaled to neonates. A whole-body PBPK model was built in PK-SIM® software. Three elimination pathways are composed of enzymatic metabolism in the liver, passive filtration through glomerulus, and active tubular secretion mediated by renal transporters. The ontogeny information was applied to account for age-related changes in cefotaxime pharmacokinetics. The established models were verified with realistic clinical data in adults and pediatric populations. Simulations in neonates were conducted and 100 % of the dosing interval where the unbound concentration in plasma was above the minimum inhibitory concentration (f T >MIC) was selected as the target index for dosing regimen evaluation. The developed PBPK models successfully described the pharmacokinetic process of cefotaxime in adults and were scaled to the pediatric population. Good verification results were achieved in both adults' and neonates' PBPK models, indicating a good predictive performance. The optimal dosage regimen of cefotaxime was proposed according to the postnatal age (PNA) and gestational age (GA) of neonates. For preterm neonates (GA < 36 weeks), dosages of 25 mg/kg every 8 h in PNA 0–6 days and 25 mg/kg every 6 h in PNA 7–28 days were suggested. For term neonates (GA ≥ 36 weeks), dosages of 33 mg/kg every 8 h in PNA 0–6 days and 33 mg/kg every 6 h in PNA 7–28 days were recommended. Our study may provide useful experience in practicing PBPK model-informed precision dosing in the pediatric population. [ABSTRACT FROM AUTHOR]

This review aimed to assess the usefulness of various magnetic resonance imaging (MRI) techniques for the quantification of neonatal white matter myelination. The Scopus, PubMed, and Web of Science databases were searched to identify studies following the PRISMA (preferred reporting items for systematic reviews and metaanalyses) statement using quantitative MRI techniques to examine samples collected from neonates to quantify myelin.Twelve studieswereultimately included.The results demonstrated that in validation studies, relaxometry is the most frequently explored approach (83.33%), followed by magnetization transfer imaging (8.33%) and a new automatic segmentation technique (8.33%). Synthetic MRI is recommended for quantifying myelin in neonates because of several advantages that outweigh a few negligible limitations. [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) has a significant impact on the short-term and long-term clinical outcomes of pediatric and neonatal patients, and it is imperative in these populations to mitigate the pathways leading to AKI and be prepared for early diagnosis and treatment intervention of established AKI. Recently, artificial intelligence (AI) has provided more advent predictive models for early detection/prediction of AKI utilizing machine learning (ML). By providing strong detail and evidence from risk scores and electronic alerts, this review outlines a comprehensive and holistic insight into the current state of AI in AKI in pediatric/neonatal patients. In the pediatric population, AI models including XGBoost, logistic regression, support vector machines, decision trees, naïve Bayes, and risk stratification scores (Renal Angina Index (RAI), Nephrotoxic Injury Negated by Just-in-time Action (NINJA)) have shown success in predicting AKI using variables like serum creatinine, urine output, and electronic health record (EHR) alerts. Similarly, in the neonatal population, using the "Baby NINJA" model showed a decrease in nephrotoxic medication exposure by 42%, the rate of AKI by 78%, and the number of days with AKI by 68%. Furthermore, the "STARZ" risk stratification AI model showed a predictive ability of AKI within 7 days of NICU admission of AUC 0.93 and AUC of 0.96 in the validation and derivation cohorts, respectively. Many studies have reported the superiority of using biomarkers to predict AKI in pediatric patients and neonates as well. Future directions include the application of AI along with biomarkers (NGAL, CysC, OPN, IL-18, B2M, etc.) in a Labelbox configuration to create a more robust and accurate model for predicting and detecting pediatric/neonatal AKI. [ABSTRACT FROM AUTHOR]