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OBJECTIVE The etiology of anemia in premature neonates is multifactorial and may involve anemia of inflammation mediated by hepcidin. Hepcidin expression is suppressed by vitamin D. We aimed to investigate the interrelationship between hepcidin, anemia, and vitamin D status in preterm infants. STUDY DESIGN Preterm infants aged 1 to 5 weeks were prospectively recruited at the neonatal intensive care unit of the Dana Dwek Children Hospital. Blood counts and serum levels of hepcidin, ferritin, iron, 25-hydroxyvitamin D [25(OH)D] and C-reactive protein (CRP) were measured and compared between anemic and nonanemic preterm infants. RESULTS Forty-seven preterm infants (mean ± standard deviation gestational age at birth 32.8 ± 1.1 weeks, 66% males) were recruited. In total, 36% of the preterm infants were vitamin D deficient [25(OH)D

Polychlorinated Biphenyls (PCBs) are widespread environmental contaminants. PCBs have endocrine disrupting properties which raises concerns regarding their effect on the developing fetus. This study aimed to examine the association between prenatal exposure to PCBs and anogenital distance (AGD) in newborns. Serum concentrations of PCB congeners -118, -138, -153 and -180 were measured in 175 pregnant women presenting to the delivery room. AGD was measured in their newborns. Regression models were used to estimate associations between maternal PCB exposure and infant anogenital measurements, controlling for possible confounding variables. Mean maternal serum concentrations were 2.95 ± 2.18 ng/g, 4.62 ± 3.54 ng/g, 7.67 ± 6.42 ng/g and 5.10 ± 3.91 ng/g for congeners -118, -138, -153 and -180, respectively. Higher maternal concentrations of PCBs were associated with reduced AGD measures in male infants. Higher maternal concentrations of PCB-138 and PCB-153 were associated with reduced ano-scrotal distances and higher maternal concentrations of all four PCB congeners were associated with reduced ano-penile distances. No significant associations were found between any PCB congener and any AGD measure in female newborns. This study demonstrates that intrauterine exposure to PCBs may be associated with reduced AGD in male newborns. More research is needed to reveal the implications for adult reproductive health.

ObjectivesReports on neonatal morbidity (NM) among refugees in developed countries remain inconsistent. We aimed to compare NM among infants of African refugees in Israel to the native population based on a large population sample.DesignA case–control study.SettingA tertiary hospital in Israel.ParticipantsData on hospital-based live births of refugee women and their newborns who were born in 2014 and 2017 were retrieved from medical records. Perinatal and neonatal data were compared between the refugee group and the native residents matched for gestational age and year of birth as well as within the refugee group.Primary outcomePrevalence of NM among African refugees in Israel.ResultsNewborns delivered by 357 refugee women (mean age 30.2 years) and 357 controls (mean age 32.2 years) were analysed. Both groups were similar for the newborns’ weight and gestational age. There were no significant differences in NM between the groups. A within-refugee comparison conducted between 2014 and 2017 yielded significant differences in birth weight (3051.4 vs 3373.6 gr, pConclusionsWe conclude that NM among neonates born to refugee mothers was not higher than that of neonates born to native Israeli mothers. We suggest that successful implementation of health policies for refugees has improved their accessibility to mother–child health services.

This paper will describe the use of through-silicon vias (TSVs) in a readout application-specific integrated circuit (ASIC) chip to replace wire bonds in the assembly of cadmium zinc telluride (CZT) X-ray detector arrays for space telescope applications. The TSV packaging approach includes solder bump connections from the back of the ASIC to the underlying board. This approach will greatly reduce the spacing between adjacent detectors in an array, eliminate potential damage to wires during assembly, and avoid any interference, which the wires can pick up during operation. We report a TSV-last integration process for the mixed signal ASIC chip used to read signals from the CZT detectors. The TSVs were integrated into existing ASIC wafers without any required redesign, and formed as blind vias from the frontside of the ASIC in metal-free areas adjacent to the wire bond pads. The TSVs were then connected to the bond pads using a routing metal layer. The wafers were bonded to temporary carriers and thinned from the backside, revealing the TSVs. After forming the redistribution lines (RDL) and under bump metallization (UBM), the wafers were released from the carriers and solder bumps were attached for subsequent assembly processes. In the sections that follow, we will review the details of the ASIC wafer post-processing, including TSV fabrication, wafer thinning, frontside and backside metallization layers, and solder bumping. We will report electrical testing of TSV daisy chains and isolation test structures. Also, results of ASIC functionality testing, performed before and after TSV insertion, will be discussed.

Application-specific integrated circuits (ASICs) are commonly used to efficiently process the signals from sensors and detectors in space. Wire bonding is a space-qualified technique of making interconnections between ASICs and their substrate packaging board for power, control, and readout of the ASICs. Wire bonding is nearly ubiquitous in modern space programs, but their exposed wires can be prone to damage during assembly and subject to electric interference during operations. Additional space around the ASICs needed for wire bonding also impedes efficient packaging of large arrays of detectors. Here, we introduce the through silicon vias (TSV) technology that replaces wire bonds and eliminates their shortcomings. We have successfully demonstrated the feasibility of implementing TSVs to existing ASIC wafers (a.k.a. a via-last process) developed for processing the x-ray signals from the x-ray imaging CdZnTe detectors on the Nuclear Spectroscopic Telescope Array small explorer telescope mission that was launched in 2012. While TSVs are common in the semiconductor industry, this is the first (to our knowledge) successful application for astrophysics imaging instrumentation. We expect that the TSV technology will simplify the detector assembly and thus will enable significant cost and schedule savings in assembly of large area CdZnTe detectors.

Objectives: The aim of the study is to compare the effect of very advanced maternal age (≥45 years) on maternal and neonatal outcomes of twin and singleton pregnancies.Materials and methods: This r...

We have recently showed that Wolfgang Amadeus Mozart's music significantly lowers resting energy expenditure (REE) in preterm infants. Whether or not this effect is specific to Mozart is unknown.To study whether familiar ("ethnic") music has the same effect on REE in preterm infants as music by Mozart.A prospective, randomized clinical trial with cross-over was conducted in 9 healthy, appropriate weights for gestational age, gavage fed, preterm infants. Infants were randomized to be exposed to a 30-minute period of Mozart music or "ethnic" music or no music over 3 consecutive days. Metabolic measurements were performed by indirect calorimetry.A total of 27 REE measurements were performed. On average REE was lower in preterm infants who were exposed to "ethnic" music compared to preterm infants who were exposed to music by Mozart (p=0.388). REE was lower in preterm infants who didn't listen to music at all compared to Mozart (p=0.014) or to "ethnic" (p=0.134).Exposure to music by Mozart significantly elevated REE in healthy preterm infants compared to preterm infants who didn't listen to music at all. Nevertheless a trend of lower REE was demonstrated when preterm infants listened to "ethnic" music compared to Mozart.We were unable to demonstrate a significant decrease in REE by exposure of preterm infants to Mozart- or "familiar" music. At this time point we cannot recommend music therapy for preterm infants in order to lower the REE. We speculate that a larger study sample might show a definite effect.

Objective To describe the containment of a widespread silent outbreak of vancomycin-resistant Enterococcus faecium (VRE-fm) in the Tel-Aviv Medical Center (TASMC) neonatal intensive care unit (NICU). Methods Setting - an NICU, participants - 49 cases of VRE-fm-colonized neonatal inpatients. Results A newborn was transferred from the TASMC NICU to another hospital and screened positive for VRE-fm upon arrival. All TASMC NICU patients were then immediately screened for VRE and 21/38 newborns were identified as VRE carriers. Interventional measures were strictly enforced. By the end of the outbreak, 49 cases of VRE carriage had been identified. There were no VRE clinical infections. The source of the outbreak was not identified. Conclusion Our study highlights the importance of screening implementation in a NICU setting since this outbreak could have been prevented by active screening of all out-born transfer patients and by having adopted mandatory screening into the NICU’s routine procedures. Screening for multi-drug resistant organisms upon admission of all transferred patients to the NICU has been implemented.

Atomic layer deposition (ALD) is a viable means to add corrosion protection to copper metal. Ultrathin films of Al2O3, TiO2, ZnO, HfO2, and ZrO2 were deposited on copper metal using ALD, and their corrosion protection properties were measured using electrochemical impedance spectroscopy (EIS) and linear sweep voltammetry (LSV). Analysis of ∼50 nm thick films of each metal oxide demonstrated low electrochemical porosity and provided enhanced corrosion protection from aqueous NaCl solution. The surface pretreatment and roughness was found to affect the extent of the corrosion protection. Films of Al2O3 or HfO2 provided the highest level of initial corrosion protection, but films of HfO2 exhibited the best coating quality after extended exposure. This is the first reported instance of using ultrathin films of HfO2 or ZrO2 produced with ALD for corrosion protection, and both are promising materials for corrosion protection.

By comparing the pseudocapacitive performance of ALD V2O5 in micro-, meso-, and macro-porous carbon electrodes, we describe the fundamental limits to ALD in very fine pores for pseudocapacitive charge storage. Comparing experimental trends with an ALD coating model, we find that the thermal V2O5 ALD process using vanadium triisopropoxide (VTIP) and water is unable to deposit in pores where the pore diameter is below a critical diameter of 13 A. By adding the ALD V2O5 layer onto activated carbon electrodes, we find that the energy storage capacity could be increased by 144% for carbon with micropores and macropores, whereas for carbon black powder containing only macropores (i.e. a low surface area resulting in a relatively small starting capacity) the ALD coating increased the capacity more than 40-fold. To understand the ALD coating limits, the pores of the carbon electrodes were modeled as a series of connected tubes, and the volume of V2O5 deposited determined experimentally was compared to the calculated deposition limit. Pores below this critical diameter were sealed and decreased the accessible volume for V2O5 deposition by more than half, decreasing the maximum capacity. The effect of the pore sealing by the ALD process on the capacitive response of the activated carbon based electrodes was also studied. This work highlights the intrinsic capabilities and limitations of coating microporous materials using ALD.

Background Prematurity is an important risk factor for the fulminate form of neonatal enteroviral infection. Pulmonary hemorrhage is a morbid complication that should be anticipated and managed aggressively due to its fatal outcome. Objective To emphasize the significance of pulmonary hemorrhage as a complication of severe enterovirus infection in preterm neonates. Study design This report is a description of the clinical history, medical management and clinical outcomes of two pairs of preterm twin newborns (30 weeks and 36 weeks) with fulminant infection due to Coxsackievirus B (CBV) infection. Results Maternal fever was reported in both deliveries and it was a factor in the decision for urgent cesarean section of the 30-week twins. Three of the four infants failed to survive. Their clinical course involved multiple organ system failure complicated with profound disseminated intravascular coagulopathy and pulmonary hemorrhage. Pulmonary bleeding leading to hypovolemic shock and respiratory failure was the direct cause of death in two cases. Conclusions This small series of preterm neonates with the diagnosis of CBV sepsis highlights the importance of correct diagnosis of maternal enterovirus infection in order to extend pregnancy and allow the fetus time to passively acquire protective antibodies. This report emphasizes the morbid complication of pulmonary hemorrhage as a result of enterovirus infection that should be anticipated and managed aggressively due to its potentially fatal outcome. Moreover, evaluation and observation of the asymptomatic twin is recommended in order to detect early signs of infection and deterioration in that sibling as well.

Israel is a country with a sunny climate; however, vitamin D deficiency and insufficiency are common findings in certain populations whose exposure to sunlight is limited. Medical residency is known for long indoor working hours, thus theoretically limiting the opportunities for sun exposure.To evaluate whether the vitamin D status among residents in a single medical center in Tel Aviv is below the normal range.Forty-six residents (28 females, 18 males, average age 33.9 ± 2.8 years) in three residency programs (internal medicine, general surgery/obstetrics and gynecology, pediatrics) were recruited. Demographic data, personal lifestyle, physical activity details and sun exposure duration were obtained by a questionnaire. Serum levels for 25(OH)D were analyzed by a radioimmunoassay.The mean serum 25(OH)D concentration was 29.8 ± 5.8 ng/ml. According to Institute of Medicine definitions, none of the residents were vitamin D deficient and only two residents (4%) were vitamin D insufficient (15 ng/ml each). The level of 25(OH)D was similar among the various medical specialties. The 25(OH)D levels correlated with the duration of sun exposure and the number of offspring (regression analysis: R2 = 9.2%, P0.04 and R2 = 8.9%, P0.04, respectively), but not with nutritional data, blood chemistry, or extent of physical activity.Most of the residents maintained normal or near normal 25(OH)D levels, indicating that the residency program itself did not pose a significant risk for vitamin D deficiency.

Long-term storage of human milk (HM) requires freezing at low temperatures, the consequences of which upon macronutrients are unclear. To test the null hypothesis that HM freezing and storage for a range of 1 to 10 weeks at −80 °C does not affect HM fat, protein, lactose and energy contents. Samples of HM were obtained from 20 mothers (60 samples) of preterm infants (25 to 35 weeks gestation), who routinely expressed their milk, every 3 h, using an electric pump, from the second to the seventh week after delivery. All samples were frozen at −80 °C for 8 to 83 days (43.8 days average). After thawing and homogenization, energy and macronutrient contents were measured using an HM analyzer. Fat, carbohydrates and energy contents were significantly lower in thawed HM than in fresh HM (fat, fresh vs thawed: 3.72±1.17 vs 3.36±1.19 g/100 ml, P

Atomic layer deposition (ALD) shows promise for forming thin films on temperature-sensitive materials, such as polymers, for applications in filtration, sensing, etc. However, traditional batch ALD generally proceeds slowly and requires controlled, low-pressure equipment. One approach to combat this limitation is spatial ALD, which uses moving substrates through zones of reactant exposure. To date, studies of spatial ALD have primarily explored growth on planar and nonporous substrates. Here, the authors demonstrate a proof-of-concept atmospheric pressure flow-through spatial ALD reactor specifically designed for through-porous substrates, such as fiber webs. This paper describes detailed gas flow modeling and experimental analysis of their prototype reactor. Model results identify precursor gas flow rates, channel spacing, and the distance between the substrate and reactor surfaces as key factors to achieve uniform deposition. Using a previously developed surface wetting protocol, the authors experimentally verify operating conditions for uniform ALD alumina on polypropylene as a model fiber substrate. Under good ALD conditions, the spatial ALD reactor can complete ∼60 cycles/min over a large substrate area, which is 60 times faster than batch ALD. The authors quantify growth saturation conditions and find that under reduced gas flow rates or slow fiber translation speeds, a transition from ALD to chemical vapor deposition-like growth can be induced. Additionally, the authors demonstrate that fiber mat properties such as mat density and air permeability play important roles in the penetration depth of the precursors and, therefore, the conditions needed to achieve ALD. Overall, this work demonstrates a proof-of-concept reactor for high throughput ALD on porous substrates, and identifies important design challenges and considerations for future high-throughput ALD.

Little is known about circadian variations of macronutrients content of expressed preterm human milk (HM). This study evaluated diurnal variations of macronutrients and energy content of preterm HM over the first 7 weeks of lactation and tested the hypothesis that values obtained during a morning sample are predictive of those obtained from an evening sample.Expressed HM was obtained from 32 mothers of preterm infants (26-33 weeks in gestational age), who routinely expressed all their milk every 3 hours from the beginning of the second to the seventh week after delivery. One aliquot was obtained from the first morning expression and the second from the evening expression. Energy and macronutrients contents were measured using an HM analyzer.Mean fat and energy contents of all samples obtained during the whole period were significantly higher in evening samples (p0.0001). There were no significant differences between morning and evening carbohydrates and protein contents. Concentrations of protein, carbohydrates, and fat from morning samples were predictive of evening concentrations to different extents (R(2) = 0.720, R(2) = 0.663, and R(2) = 0.20, respectively; p0.02). The predictability of evening values by morning values was not influenced by the week of lactation at sampling or by individual patients. In repeated-measures analysis of variance performed on 11 patients who completed the whole 7-week period, over time, there was a significant decrease in fat, energy, and protein contents, whereas carbohydrates content remained unchanged. Day-night differences remained significant only for fat content.Circadian variations in fat and energy concentrations of HM are consistent over the first 7 weeks of lactation. There are no consistent circadian variations in HM protein and carbohydrates. Over a given day, there are little variations in protein and carbohydrates content, but fat concentrations are more variable, and evening values are less well predicted by morning sample analysis than values for protein or carbohydrates.

Aim The US Food and Drug Administration has said that oral preparations containing benzocaine should only be used in infants under strict medical supervision, due to the rare, but potentially fatal, risk of methemoglobinemia. This study aimed to determine the analgesic effect of topical application of benzocaine prior to lingual frenotomy in infants with symptomatic tongue-tie. We hypothesised that the duration of crying immediately following frenotomy with topical benzocaine would be shorter than with no benzocaine. Methods This randomised controlled study compared the length of crying after lingual frenotomy in term infants who did, or did not, receive topical application of benzocaine to the lingual frenulum prior to the procedure. Results We recruited 21 infants to this study. Crying time was less than one minute in all of the subjects. The average length of crying in the benzocaine group (21.6 ± 13.6 sec) was longer than the length of crying in the control group (13.1 ± 4.0 sec), p = 0.103. Conclusion Contrary to our hypothesis, infants who were treated with topical benzocaine did not benefit from topical analgesia in terms of crying time. The use of benzocaine for analgesia prior to lingual frenotomy in term infants should therefore be discouraged.

Objective: The aim of the current study was to determine whether secular changes have occurred in the breastfeeding literature, in terms of number and type of yearly published articles and impact factor of journals publishing these articles. Research Design and Setting: In order to evaluate all Medline articles related to breastfeeding, we used the Internet URL www.ncbi.nlm.nih.gov/entrez and searched for articles recorded from January 1, 1992 through December 31, 2011 using as a key word “breast milk,” “breast feeding,” or “human milk.” We specifically studied randomized controlled trials (RCTs), clinical trials, case reports, meta-analyses, letters to the editor, reviews, systematic reviews, practice guidelines, and editorials. Results: There was a linear increase over the years in all articles recorded, from approximately 1,100/year in 1992 to 2,100/year in 2011 (i.e., an approximately 1.9-fold increase [R2=0.995, p=0.001]). Concomitant with the yearly increase in the number of published RCTs per year, there was a linear increase in the number of journals publishing articles on breastfeeding per year (from approximately 20 in 1992 to >60 in 2011 [R2=0.811, p

We present a 5-year-old boy with multiple hematomas associated with chronic cholestasis. A week before admission he suffered minor trauma at day care. The next day he complained of trunk and limb pain and orthopedic consultation, including leg x-rays, revealed no abnormalities. Over the next 5 days multiple hematomas developed over his body and increased in size. In the Emergency Department he was in pain and looked sick but alert. He had fever and tachycardia, with normal blood pressure and respiratory status and physical examination showed several hematomas on the legs, which increased in size during observation in the Emergency Department over 2 hours. Blood work revealed multiple coagulation abnormalities, and International Normalized Ratio was 12. Intravenous phytonadione (vitamin K1) was immediately administered with normalization of coagulation abnormalities within 1 hour and the hematomas stopped growing in size. In addition to missing follow-up with the Pediatric Gastroenterology Department, social service agency inquiry found he had not taken his medications for several months. With severe abnormal bleeding and hepatic disease, intravenous vitamin K1 may be lifesaving, even before obtaining confirmatory blood work, fresh-frozen plasma, or blood transfusion.