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Cases of multisystem inflammatory syndrome in children (MIS-C-like disease), have rarely been reported in neonates. A 33-week gestational age twin B female neonate presented with respiratory distress, tachycardia, and abdominal distention at 15 days of age. Echocardiogram found reduced left ventricular ejection fraction to 33%. Cardiac enzyme levels were all elevated: creatine kinase-MB 6.1 ng/mL (normal 0–4.5 ng/mL), troponin-T 170 ng/L (normal < 14 ng/L) and NT-proBNP > 35,000 pg/mL (normal 250.0 to 3987.0 pg/mL). Multiplex PCR of nasopharyngeal swab material was negative for respiratory pathogens. Serological tests revealed negative anti-spike SARS-CoV-2 IgM but positive anti-nucleocapsid SARS-CoV-2 IgG in both the mother and the patient. The mother provided a history of COVID-19 during pregnancy at 19 weeks gestation. The patient was diagnosed with neonatal multisystem inflammatory syndrome (MIS-N) and successfully treated with intravenous immunoglobulin (two doses of 1 gm/kg/dose) and methylprednisolone (2 mg/kg/day for 5 days then tapered off). She later developed coronary vessel (LMCA and RCA) dilation. The non-identical twin A did not develop MIS-N, suggesting a role of host genetic background. Newborn infants born to SARS-CoV-2-infected mothers at any time during pregnancy should be closely monitored for MIS-N. The optimal treatment approaches to this syndrome and the prognosis require further study.

Objective: To determine the percentage of neonates who achieved therapeutic theophylline level (TTL) after receiving standard IV loading/maintenance aminophylline doses. To assess factors associated with achieving therapeutic theophylline concentrations and to describe adverse effects of aminophylline. Materials and Methods: This was a pilot, cross-sectional study. Preterm neonates ≤34 weeks’ gestation for which aminophylline was indicated for treatment of apnea were enrolled. Standard IV aminophylline dosage is 8 mg/ kg loading dose, followed by 1.5 mg/kg maintenance dose every 8 hours. Serum theophylline concentrations were measured prior to the 8th maintenance dose. Descriptive statistics, univariate and multivariate analyses were performed. Results: Twenty-five neonates (52% female) were enrolled: mean (standard deviation) gestational age and birth weight were 30.4 (2) weeks and 1,277 (415) grams, respectively. Aminophylline was initiated at a median (25%tile, 75%tile) postnatal age of 4 (1, 8) days. Baseline heart rate prior to the loading dose was 153 (13) beats-per-minute. Sixty percent of neonates achieved a therapeutic theophylline level. In the univariate analysis, being male and postnatal age ≤5 days were associated with successfully achieving a TTL. After adjusting for gender, postnatal age ≤5 days was the only factor associated with achieving a TTL (adjusted odds ratio 17.7, 95% confidence interval: 1.9, 164.4). Tachycardia and feeding intolerance were observed in 44% and 24% of neonates, respectively. Conclusion: Current IV aminophylline dosing conditions in Thailand achieved TTL in approximately two-thirds of neonates, suggesting therapeutic drug monitoring is beneficial for guiding dosing. A higher maintenance dose could be considered for neonates older than 5 days.

Background Before the advent of antenatal steroids, early non-invasive respiratory support (NIV), and intratracheal surfactant, antenatal terbutaline was also used to improve lung compliance and reduce the incidence of respiratory distress syndrome (RDS). Objectives The objective of this paper was to study the association between antenatal terbutaline and endotracheal intubation (ET) within the first 24 hours of life, RDS, bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) in infants with the gestational age (GA) of Method This was a retrospective medical record review of preterm infants delivered at a single tertiary care center from October 2016 to December 2020. Multivariable logistic regression was used to explore the association between antenatal terbutaline and neonatal respiratory support. Result 1,794 infants were included, 234 (13.0%) had the GA of Conclusion In a state-of-the-art neonatal care setting, antenatal terbutaline was associated with a reduction in ET during the first 24 hours in infants with the GA of Key Points

Background: The nutritional content of preterm human milk (HM) can be increased by adding human milk fortifier (HMF). Premature formula (PF) has been used as an alternative to HMF due to the high c...

BACKGROUND: Sick neonates in TB endemic areas are at risk of nosocomial TB exposure.OBJECTIVE: To evaluate outcomes following contact investigation and isoniazid preventive treatment (IPT) in sick neonates exposed to healthcare personnel (HCP) with pulmonary TB.METHODS: Investigations were conducted following two exposure events in different neonatal intensive care units (NICUs). Details of the infants´ physical examination, chest X-ray and exposure history were recorded. Infants without TB disease were prescribed a 9-month course of IPT and followed for ≥1 year.RESULTS: Ninety infants were exposed in NICU A and 231 in NICU B (n = 321). The overall proportions of completing the 9-month IPT was 164/265 (61.8%): 40/79 (50.6%) in NICU A and 124/186 (66.7%) in NICU B (P = 0.01). The overall incidence of TB was 10.2% (24/236): 7.5% in NICU A and 11.2% in NICU B (P = 0.39). Contact investigation beginning >111 days after exposure was a risk factor for TB infection (P = 0.02).CONCLUSION: The risk of TB following nosocomial exposure in sick neonates was high, particularly when contact investigation was delayed. Our findings underscore the importance of hospital policies that promote early detection of TB in HCP, reduce transmission in NICUs, and facilitate rapid case investigation.

Background The World Health Organization (WHO) recommendations on infant feeding in the context of COVID-19 uphold standing recommendations for breastfeeding, non-separation, and skin-to-skin contact, including the use of donor human milk when mother’s own milk is not available. Insufficient guidance on the use of donor human milk and the role of human milk banks in the pandemic response COVID-19 clinical management guidelines in seven countries in Southeast Asia are not aligned with WHO recommendations despite the lack of evidence of transmission through either breastmilk or breastfeeding. The use of safe donor human milk accessed through human milk banks is also insufficiently recommended, even in countries with an existing human milk bank, leading to a gap in evidence-based management of COVID-19. This highlights long-standing challenges as well as opportunities in the safe, equitable, and resilient implementation of human milk banks in the region. Conclusions This statement reflects the expert opinion of the Regional Human Milk Bank Network for Southeast Asia and Beyond on the need to revisit national guidelines based on the best evidence for breastfeeding during the COVID-19 pandemic, to incorporate human milk bank services in national obstetric and newborn care guidelines for COVID-19 where possible, and to ensure that operations of human milk banks are adapted to meet the needs of the current pandemic and to sustain donor human milk supply in the long-term. The Network also recommends sustained engagement with the global human milk bank community.

Additional file 2. Additional recommendations. Additional recommendations for safe collection and processing of donor human milk during the COVID-19 pandemic. Presents additional measures to enhance safety procedures for donor screening and breastmilk expression to prevent possible contamination of collected donor human milk.

Additional file 1. KKHospital Guidance. Guidance on Breastfeeding and Breast Milk Feeding for Suspect and Confirmed COVID-19 - KK Women’s and Children’s Hospital, Singapore. Guidance on Breastfeeding and Breast Milk Feeding for Suspect and Confirmed COVID-19 - KK Women’s and Children’s Hospital, Singapore.

Hyperbilirubinaemia is a common cause of hospital admission of newborn infants; however, maternal visual assessment of jaundice may reduce unnecessary hospital visits.To investigate the validity of maternal visual assessment of neonatal jaundice to identify infants with hyperbilirubinaemia requiring phototherapy or who have significant hyperbilirubinaemia ≥239.4 µmol/L (14 mg/dL).A prospective study of the diagnostic accuracy of maternal visual assessment of jaundice was conducted at a university hospital in Bangkok. Mothers were trained to assess for neonatal jaundice using their infant's palms as a skin colour reference. Trained mothers who were blinded to transcutaneous bilirubin or serum bilirubin values assessed their infants and reported 'jaundice' or 'no jaundice', and determined jaundice severity using dermal icterus zones. Sensitivity and negative predictive values were used to assess the validity of visual assessment for neonatal jaundice.In 180 mothers, the median (min/max) transcutaneous or serum bilirubin value in their infants was 177.8 µmol/L (119.7-309.5). The sensitivity and negative predictive values (95% CI) of maternal assessment for detecting hyperbilirubinaemia requiring phototherapy were 91.7% (73.0-99.0) and 96.6% (87.9-99.1), respectively, and for identifying significant hyperbilirubinaemia were 92.9% (76.5-99.1) and 96.6% (87.9-99.1), respectively. The accuracy of maternal report of dermal zones for serum bilirubin levels was only 44.5%. In 56 infants who received a second jaundice assessment, the sensitivity of maternal assessment for detecting increased transcutaneous or serum bilirubin was 93.9% (83.1-98.7).Teaching mothers to visually assess their infants for neonatal jaundice was demonstrated to be feasible.CI, confidence interval; MB, microbilirubin; min/max, minimum/maximum; NPV, negative predictive value; OPD, outpatient department; PPV, positive predictive value; SD, standard deviation; TcB, transcutaneous bilirubin.

Breastfeeding has abundant biological and psychological benefits. Effective breastfeeding requires good latching on, which is possible when the infant is able to cup around the maternal areola with his tongue. One of the most common conditions resulting in poor latching on is tongue-tie.To determine the prevalence of tongue-tie with subsequent breastfeeding difficulties and other factors affecting the success of breastfeeding in newborn infants.This was a prospective, cross-sectional study of healthy Thai infants without contraindications for breastfeeding. Physical examination of the infants and mothers and their breastfeeding practices were assessed between 24 and 48 hours of life.2679 mother-infant dyads were recruited. The study detected a prevalence of 16% for severe tongue-tie, 37.9% of which was associated with breastfeeding difficulties. Using multiple logistic regression analysis, moderate (adjusted OR 13.3, 95% CI 7.2-24.5) and severe (adjusted OR 62, 95% CI 34.1-112.8) tongue-tie, short nipples (adjusted OR 1.5, 95% CI 1.1-2.2), mothers feeling the infant's tongue on the nipple area (adjusted OR 3.4, 95% CI 2.2-5.2) and mothers' inability to feel the infant's tongue (adjusted OR 11.8, 95% CI 4.3-32.4) independently increased the risk of breastfeeding difficulties.Tongue-tie is not uncommon and is associated with breastfeeding difficulty in newborn infants. Mothers of infants with severe tongue-tie should be closely and individually coached during breastfeeding and followed up, especially during the first critical weeks of the infant's life.

Umbilical cord blood gas values are better indicators of perinatal asphyxia than Apgar scores. Many studies have reported normal ranges of umbilical cord blood gases, which vary greatly due to many factors. This study aimed to establish the reference values of umbilical cord blood gases of normal cesarean newborns in a university hospital setting.Blood samples from the umbilical artery and vein were collected from 160 newborns delivered by elective cesarean section. The indications for caesarean section were not due to fetal distress, intrauterine growth retardation, or non-reassuring fetal heart rate. The blood samples were collected immediately after birth in the operating room and then sent for blood-gas analysis. The blood-gas values were statistically analyzed and reported.The cord blood collected from 160 newborns was analyzed in this study. Seventy-eight percent (115) of the parturients were hypotensive before delivery. All Apgar scores at one and five minutes after delivery were at least 7. The calculated reference range of the umbilical arterial pH was 7.18-7.42, of pO₂was 6.43-29.43 mmHg, of pCO₂was 33.44-66.56 mmHg, and of HCO₃was 15.60-30.70 mEq/L. The reference range obtained for the umbilical venous pH was 7.28-7.44,for pO₂was 13.97-37.13 mmHg, for pCO₂was 30.70-57.0 mmHg, and for HCO₃was 18.50-29.90 mEq/L.The study determined normal reference values as a result of umbilical cord blood gas analyses.

Background: Neonatal hypoglycemia can cause serious longterm neurodevelopmental outcome. A valid point-of-care glucometer is needed for diagnosis of neonatal hypoglycemia which is in a lower blood glucose range than diabetic patients. Aim: To estimate validity of two point-of-care glucometers for diagnosis of neonatal hypoglycemia and to determine the cut-off values for which standard laboratory confirmatory test are no longer needed. Methods: There were 180 blood specimens included. Nova StatStripTM and SureStepTM were operated at the bedside immediately after blood drawn. Laboratory tests were done within one hour. Results: On average, most of the blood glucose read-outs from Nova StatStripTM and SureStepTM were higher than laboratory plasma glucose throughout the glucose range with mean differences of 11.2±8.4 mg/dL and 13.7±6.8 mg/dL, respectively. Sensitivity, specificity, positive and negative predictive values were demonstrated. (Table 1) To obtain 100% negative predictive values, the cut-off levels were 63 mg/dL and 62 mg/dL for Nova StatStripTM and SureStepTM, respectively. Table Conclusions: None of the glucometers studied has sufficient validity to replace laboratory testing in diagnosing hypoglycemia. Confirmatory plasma glucose for diagnosis of hypoglycemia is needed when point-of-care glucometer readings are between 39 and 63 mg/dL for Nova StatStripTM and between 39 and 62 mg/dL for SureStepTM.

The high prevalence of smoking in Southeast Asia (SEA) means pregnant women face exposure to tobacco smoke that may affect the health of their fetus. This study determined fetal exposure to tobacco smoke by meconium analysis for cotinine in 3 locations in SEA: Bulacan Province, Philippines (N=316), Bangkok, Thailand (N=106) and Singapore City (N=61). Maternal exposure to tobacco smoke was 71.1% (1.3% active; 69.8% passive) in Bulacan, 57.5% (0.9% active; 58.6% passive) in Bangkok and 54.1% (11.5% active; 42.0% passive) in Singapore. Fetal exposure to tobacco smoke (by meconium analysis) was 1.3% (Bulacan), 4.7% (Bangkok) and 13.1% (Singapore); however, a large proportion of infants who tested positive for cotinine (65%) were born to mothers who gave no history of either active or passive exposure to environmental tobacco smoke. Fetal exposure to tobacco smoke is a major health problem.

The use of supplemental oxygen in uncomplicated cesarean deliveries under spinal anesthesia has been thoroughly investigated during recent decades. The aim of this study was to determine the benefits for both mother and infant of administering supplemental, low-dose oxygen via a nasal cannula versus having no supplement (i.e., room air only). Healthy parturients at term undergoing elective cesarean section under spinal anesthesia were randomly allocated into two groups: an oxygen group (n=170), who received 3 LPM oxygen via a nasal cannula; and a room-air group (n=170), who were assigned to breathe room air. Maternal oxygen saturation was measured continuously by using pulse oximeter. The desaturation was determined by oxygen saturation

The study was performed to evaluate the accuracy of the StatStrip (SS) and SureStep Flexx (SF) glucose meters compared to plasma glucose in infants at risk for neonatal hypoglycemia and to determine the effect of bilirubin and hematocrit on the results. A prospective cross-sectional study was conducted on 172 venous blood glucose samples from infants who had initial low point-of-care (POC) glucose tests measured simultaneously by SS and SF. Plasma glucose levels were compared to both POC instruments, and the effect of bilirubin and hematocrit levels on mean glucose differences were analysed. Mean (SD) plasma glucose was 2.12 (0.45) mmol/L; (range, 1.11–3.06 mmol/L). Mean (1.96SD) glucose differences of the SS versus SF were 0.21 (0.70) mmol/L and −0.04 (0.78) mmol/L, respectively. SS sensitivity was 94.7 % with an 86.1 % negative predictive value (NPV) at 2.8 mmol/L, while the SF had a 100 % sensitivity and NPV at the same cut-off level. No correlations were identified between mean glucose differences and either hematocrit or bilirubin levels in both glucose meters. Both the SS and SF glucose meters have limited use when compared to plasma glucose. Hence, they can only be employed as screening tools in at-risk neonates with an appropriate, predetermined cut-off level. Hematocrit and bilirubin levels did not affect the accuracy of both devices.

To compare the effectiveness and safety of two instillation methods of combined 0.75% tropicamide and 2.5% phenylephrine at 0, 5 minutes (min) with the same combined regimen at 0,30 minutes in preterm infants.A prospective, cross-over, randomized controlled trial was performed to compare 0, 5-min instillation (Method A) of combined 0.75% tropicamide and 2.5% phenylephrine with 0, 30-min instillation (Method B) of the same regimen. Forty-two preterm infants scheduled for screening retinopathy of prematurity (ROP) were randomly assigned to two groups. Group 1 was defined as preterms applied by Method A at first examination then by Method B 1-4 weeks apart whereas vice versa in Group 2. Pupil size, heart rate (HR), systolic and diastolic blood pressure (SBP, DBP) were recorded before and after eye-drop instillation.Mean time to 7-mm pupil size was no statistically significant difference between the two methods (Method A 46.47 min, Method B 46.58 min; p = 0.894). Method B has mean longer time to maintain 7-mm pupil size than Method A (Method A 67.67 min, Method B 75.33 min); but not statistically significant different (p = 0.323). HR, SBP and DBP were not significant change between the two methods.Both instillation methods produced consistently sufficient mydriasis and safety for evaluation peripheral fundus. Method B has slight longer mydriatic effect than Method A; thus giving more time to evaluate infant's eye for ophthalmologists.

Neonatal infection due to Cryptococcus neoformans is extremely rare. We report a case of a 21-day-old neonate diagnosed with cryptococcal septicemia who was successfully treated with amphotericin B. He was born to a human immunodeficiency virus (HIV) seronegative mother. This report alerts general pediatricians and neonatologists to consider Cryptococcus neoformans infection as a possible cause of sepsis in newborn infants.

Magnetic resonance imaging (MRI), as an adjunct to ultrasonography, has become a promising tool in prenatal diagnosis and therapy. In this report, the authors described a case of giant solid mass arising in the fetal neck region diagnosed by prenatal sonographic examination at the gestational age of 33 weeks'. MRI was used to confirm the diagnosis, and to assist fetal airway assessment. Due to the concern of fetal airway compromise, the ex utero intrapartum treatment (EXIT) was strategically planned with help from specialists in the according fields. This allowed the authors to secure the fetal airway before fetomaternal circulation was disconnected. It was performed successfully through Cesarean section at the time of birth. Histopathology revealed infantile myofibroma, which is a rare form of such a tumor arising on the fetal head and neck region diagnosed prenatally.

To determine the prevalence and significant risk factors for pathologic hearing screening test results in high-risk neonates and the feasibility of implementing hearing screening program using automated otoacoustic emission (OAE)/ auditory brain stem response (ABR) device performed by trained nursing staffs.Single-center prospective, descriptive study.All neonates admitted to the Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, who met the high-risk criteria according to Joint Committee of Infant Hearing 1994, American Academy of Pediatrics, were screened with one-step protocol using an automated OAE/ABR device (AccuScreen, GN Otometrics, Denmark). Infants who failed 2 consecutive OAE tests were reconfirmed by ABR prior to discharge. Descriptive analysis was used for the prevalence of pathologic hearing test results, age at screening, duration of procedure, number of risk factors per infant. Univariate analysis using Chi-square test and multiple logistic regression analysis were used for identification of significant risk factors.Five hundred and seven infants were identified to be at-risk in an 18-month study period. The prevalence of pathologic hearing screening test was 6.7% with unilateral and bilateral pathologic results in 13 and 21 infants (2.6% and 4.1%). Only craniofacial anomalies and mechanical ventilation5 days were shown to be independent significant risk factors (42-fold and 4-fold increased risk). Median age at screening test performed was 19 days (range 1-149 days) and almost all infants (97.3%) were screened within 3-month postnatal age. The mean time for hearing screening procedure was 10.7 +/- 8.0 minutes (range 2-60 minutes), 98.1% of procedure was accomplished within 30 minutes.Hearing screening using automated OAE/ABR devices in high-risk neonates revealed approximately 7% of pathologic results with almost two-thirds having bilateral affected. The significant independent risk factors in this study population were craniofacial anomalies and mechnical ventilation5 days. The protocol of having trained nursing staffs to perform the screening yielded good results, i.e., the coverage of screened infants within 3 months of age (97%), feasible duration of procedure.

Pneumothorax is one of the air leak syndrome and is more common in the newborn period than in any other childhood periods. It can be divided into spontaneous pneumothorax and secondary pneumothorax from underlying lung pathology or assisted ventilation. Pneumothorax results in longer hospital stays and even deaths in some cases. To date, there are few studies that focus on identifying risk factors of pneumothorax. We conducted this study to ascertain risk factors for pneumothorax, in order to create a guideline to prevent this condition.This is a retrospective case-control study. CASEs were infants with the diagnosis of pneumothorax (P25.1 Pneumothorax originating in the perinatal period) between January 2001 and December 2004. Controls were those whose birth times followed in the immediate chronology to the cases.control ratio was 1:2. Univariate analysis was used to compare the two groups. Odds ratio and 95% confidence interval were used to identify possible risk factors. Statistical significance was considered as p0.05.There are 44 cases and 88 controls. Risk factors are shown as Odds ratio and 95% confidence interval. Infant factors associated with higher risk of pneumothorax are male (2.6; 1.2, 5.6), low birth weight (19.3; 2.3, 160.2), vacuum extraction (20.9; 1.1, 403.4), meconium-stained amniotic fluid (4.5; 1.8, 11.0), low 1-minute Apgar score (78.3; 4.5, 1357.8), and the administration of bag and mask positive-pressure ventilation (29.0; 3.6, 233.5). Maternal factor associated with higher risk of pneumothorax is poor antenatal care (3.5; 1.04, 11.9).All pregnant women should be encouraged to have good antenatal care. Mother who has complication(s) during pregnancy and delivery should receive special care to prevent perinatal depression. For mothers with meconium-stained amniotic fluid, close fetal monitoring and tracheal suction for meconium after delivery should be appropriately considered to prevent meconium aspiration. Finally, neonatal resuscitation, when needed, should be done very carefully by following the American Heart Association and the American Academy of Pediatrics guidelines, especially for bag and mask positive-pressure ventilation.

BACKGROUND: The accurate diagnosis of neonatal alloimmune thrombocytopenia is essential in the effective treatment of potentially serious bleeding in neonates. CASE REPORT: Reported here is a case of a full-term female baby who was delivered by vacuum extraction from a gravida 1 para 1 healthy mother. She presented with generalized petechiae and bilateral cephalhematoma, which she had had since birth. At 7 hours of life, she had an upper gastrointestinal hemorrhage and was found to have severe anemia and marked thrombo-cytopenia. Coagulation screening tests were normal. The diagnosis of neonatal alloimmune thrombocytopenia was suspected, and maternal serum was collected for further study. The baby was treated with a single dose of hydrocortisone (10 mg/kg) and IVIG (400 mg/kg) while waiting for irradiated platelets from her mother. After 30 mL of a transfusion of maternal platelets, the baby's platelet count rose dramatically, from 15,000 to 162,000 per μL, and it remained stable at that level. She was discharged on the 10th hospital day in good condition. During the follow-up period of 8 months, her growth and development were satisfactorily normal, as well as her platelet count. A high-titered platelet antibody was detected in the maternal serum by use of a solid phase platelet adherence technique. RESULTS: The specificity of the platelet antibody was identified as anti-Naka by the mixed passive hemagglutination test method. CONCLUSION: These findings suggested a diagnosis of NAIT caused by anti-Naka.

Background: Neonatal hyperbilirubinemia is very common. Phototherapy has been used for decades to prevent severe hyperbilirubinemia, which can cause kernicterus. We compare the effectiveness of two phototherapy devices in reducing plasma bilirubin and duration of phototherapy in non-severe hyperbilirubinemia. Materials and Methods: This was an open-label randomized controlled trial. Forty healthy infants aged between 1 and 5 days with non-severe hyperbilirubinemia, but to the level requiring phototherapy, were recruited. The phototherapy unit used in the “blue-light” group was the Siriraj Phototherapy Lamp with 6 special blue fluorescent tubes. The phototherapy unit used in the “light-emitting diodes (LEDs)” group was the Bilitron 3006 with 5 super LEDs. The distance between both devices and the infants was fixed at 30 cm. Results: There were 20 infants in each group. Mean gestational age was 38.0 ± 1.5 weeks. Baseline clinical characteristics of infants in both groups were comparable. Median rate of plasma bilirubin decreasing during phototherapy in “blue light” was significantly less than in “LEDs” group. [median (25%, 75%tile) 0.16 (0.09, 0.25) and 0.10 (0.02, 0.17) mg/dL/hr, respectively; p = 0.03]. Duration of phototherapy with “blue light” was not statistically different from phototherapy with “LEDs” [median (25%, 75%tile) 23.0 (19.0, 30.8) and 30.0 (22.3, 40.3) hr, respectively; p = 0.11]. Conclusion: A locally invented phototherapy device with special blue fluorescents tubes can be more effective than the more expensive commercial super LEDs phototherapy device in decreasing plasma bilirubin.