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Abstract Background According to the World Health Organization’s recommendation, delayed cord clamping in term newborns can have various benefits. Cochrane metaanalyses reported no differences for mortality and early neonatal morbidity although a limited number of studies investigated long-term neurodevelopmental outcomes. The aim of our study is to compare the postnatal cerebral tissue oxygenation values in babies with early versus delayed cord clamping born after elective cesarean section. Methods In this study, a total of 80 term newborns delivered by elective cesarean section were included. Infants were randomly grouped as early (clamped within 15 s, n:40) and delayed cord clamping (at the 60th second, n:40) groups. Peripheral arterial oxygen saturation (SpO2) and heart rate were measured by pulse oximetry while regional oxygen saturation of the brain (rSO2) was measured with near-infrared spectrometer. Fractional tissue oxygen extraction (FTOE) was calculated for every minute between the 3rd and 15th minute after birth. (FTOE = pulse oximetry value-rSO2/pulse oximetry value). The measurements were compared for both groups. Results The demographical characteristics, SpO2 levels (except postnatal 6th, 8th, and 14th minutes favoring DCC p 0.05). rSO2 values were significantly higher while FTOE values were significantly lower for every minute between the 3rd and 15th minutes after birth in the delayed cord clamping group (p

Objective Cerebral oximetry using near-infrared spectroscopy (NIRS) is a noninvasive optical technology widely used in neonatology. The present study aimed to define reference ranges for cerebral tissue oxygen saturation (crSO 2) with a new four-wavelength NIRS device, Masimo O3 oximeter, during immediate transition after birth and compare values with those obtained previously with NIRO 200NX ®. Study Design This was a prospective observational study using Masimo O3 device to measure crSO 2 and regional cerebral fractional tissue oxygen extraction (cFTOE) in healthy term newborns delivered by primary cesarean section, during the 15 minutes after cord clamping. The neonates who required any medical support were excluded. The NIRS sensor was placed on the right forehead. Peripheral oxygen saturation and heart rate were continuously measured by pulse oximetry. Previous studies which established centiles for crSO 2 with NIRO 200NX were used for comparison. Results A total of 44 newborns were included. The median crSO 2 and cFTOE (interquartile range) at 2, 5, and 7 minutes was 54% (49–54), 71% (64–86), and 79% (73–84) and 0,25 (0,18–0,33), 0,19 (0,15–0,23), and 0,16 (0,12–0,21), respectively, with no further changes afterwards. The crSO 2 measurements were significantly higher with Masimo O3 compared with NIRO-200NX. Conclusion The present observational study presented reference ranges for crSO 2 and cFTOE measured with Masimo O3 oximeter during the immediate neonatal transition. Values obtained with O3 were higher than those obtained with other oximeters. For this reason, crSO 2 is device-specific so there must be known reference values for each oximeter to define therapeutic interventions based on crSO 2 and assess cerebral oxygenation in clinical studies. Key Points Masimo O3 uses four wavelengths to measure regional oxygen saturation value. O3 values of crSO 2 and cFTOE differ with other neonatal oximeters at birth. Knowledge of reference range of O3 at birth is essential to guide resuscitation. [ABSTRACT FROM AUTHOR]

Background: According to the World Health Organization's recommendation, delayed cord clamping in term newborns can have various benefits. Cochrane metaanalyses reported no differences for mortality and early neonatal morbidity although a limited number of studies investigated long-term neurodevelopmental outcomes. The aim of our study is to compare the postnatal cerebral tissue oxygenation values in babies with early versus delayed cord clamping born after elective cesarean section. Methods: In this study, a total of 80 term newborns delivered by elective cesarean section were included. Infants were randomly grouped as early (clamped within 15 s, n:40) and delayed cord clamping (at the 60th second, n:40) groups. Peripheral arterial oxygen saturation (SpO2) and heart rate were measured by pulse oximetry while regional oxygen saturation of the brain (rSO2) was measured with near-infrared spectrometer. Fractional tissue oxygen extraction (FTOE) was calculated for every minute between the 3rd and 15th minute after birth. (FTOE = pulse oximetry value-rSO2/pulse oximetry value). The measurements were compared for both groups. Results: The demographical characteristics, SpO2 levels (except postnatal 6th, 8th, and 14th minutes favoring DCC p < 0.05), heart rates and umbilical cord blood gas values were not significantly different between the groups (p > 0.05). rSO2 values were significantly higher while FTOE values were significantly lower for every minute between the 3rd and 15th minutes after birth in the delayed cord clamping group (p < 0.05). Conclusion: Our study revealed a significant increase in cerebral rsO2 values and a decrease in FTOE values in the delayed cord clamping (DCC) group, indicating a positive impact on cerebral oxygenation and hemodynamics. Furthermore, the DCC group exhibited a higher proportion of infants with cerebral rSO2 levels above the 90th percentile. This higher proportion, along with a lower of those with such parameter below the 10th percentile, suggest that DCC may lead to the targeted/optimal cerebral oxygenetaion of these babies. As a result, we recommend measuring cerebral oxygenation, in addition to peripheral SpO2, for infants experiencing perinatal hypoxia and receiving supplemental oxygen. [ABSTRACT FROM AUTHOR]

Abstract Background Necrotizing enterocolitis (NEC) and intracranial hemorrhage are severe emergencies in the neonatal period. The two do not appear to be correlated. However, our report suggests that parenchymal brain hemorrhage in full-term newborns may put patients at risk for NEC by altering intestinal function through the brain-gut axis. Case presentation We present a case of spontaneous parenchymal cerebral hemorrhage in a full-term newborn who developed early-stage NEC on Day 15. Conclusions It is possible to consider brain parenchymal hemorrhage as a risk factor for the appearance of NEC. Clinicians should be highly cautious about NEC in infants who have experienced parenchymal hemorrhage. This article is the first to discuss the relationship between parenchymal hemorrhage and NEC in full-term newborns.

Background: Necrotizing enterocolitis (NEC) and intracranial hemorrhage are severe emergencies in the neonatal period. The two do not appear to be correlated. However, our report suggests that parenchymal brain hemorrhage in full-term newborns may put patients at risk for NEC by altering intestinal function through the brain-gut axis. Case presentation: We present a case of spontaneous parenchymal cerebral hemorrhage in a full-term newborn who developed early-stage NEC on Day 15. Conclusions: It is possible to consider brain parenchymal hemorrhage as a risk factor for the appearance of NEC. Clinicians should be highly cautious about NEC in infants who have experienced parenchymal hemorrhage. This article is the first to discuss the relationship between parenchymal hemorrhage and NEC in full-term newborns. [ABSTRACT FROM AUTHOR]

Introduction: The objectives of this study are to compare thyroid hormone levels in term asphyxiated newborns versus healthy controls and to determine potential correlations between the severity of birth asphyxia and the thyroid hormone levels. Materials and methods: A prospective case- control study was performed by comparing cases of birth asphyxia with the healthy controls. The primary outcomes included cord blood Thyroid Stimulating Hormone (cTSH), TSH and Free Thyroxine 4 (FT4) levels at 24-36 hours after birth. Correlations were sought between the severity of birth asphyxia with the thyroid hormone levels for the cases. Results: The study included 20 cases and 21 controls. Demographic data were similar for the two groups except for a significantly higher Caesarean section rate in the control group. There were no significant differences between the groups in the cord TSH and the 24-36 hours FT4 levels, but the median (IQR) TSH level at 24 to 36 hours was significantly lower in the case group than in the control group, (8.3 mIU/L(9.2) versus 14.1 mIU/L(7.6); p<0.05). The highest Thompson scores within the first six hours after birth was significantly correlated with lower TSH levels (r = -0.468; p<0.05). There was also a significant correlation between the Apgar score at 10 minutes and the level of FT4 at 24-36 hours after birth (r = 0.501; p<0.05). Conclusion: This study showed that TSH at 24-36 hours after birth was significantly lower in asphyxiated newborns. Selected parameters of the severity of birth asphyxia correlated with thyroid hormone levels at 24-36 hours. [ABSTRACT FROM AUTHOR]

Introduction: the indigenous population is vulnerable and there is limited understanding of their somatometric indicators and APGAR score at birth. Aim: the objective of the study was to explore the association of the condition of indigenous newborn (INB) on somatometric parameters and APGAR score at birth. Methods: this study employed an exploratory cross-sectional design, utilizing the registry of newborns (NB) from a private clinic. The APGAR score at one minute after birth, as well as nutritional indicators derived from measurements of weight, height, and perimeters, were taken into consideration. The statistical analysis involved the use of logistic regressions. Results: the analysis included 7413 NB (1.8 % INB), 52 % were male and 8.1 % were born preterm (gestational age < 37 weeks). In comparison to non-indigenous NB, the INB group showed a higher risk of malnutrition (8 % vs. 6.3 %; p < 0.001), a greater prevalence of excess weight (7.3 % vs. 1.8 %; p < 0.001), smaller head circumference (33.6 cm vs. 34.1 cm; p = 0.017), smaller abdominal circumference (30.9 cm vs. 31.5 cm; p = 0.011), and a higher occurrence of low APGAR scores (< 7) (8.7 % vs. 1.2 %; p < 0.001). Furthermore, the indigenous condition was independently associated with low birth weight (< 2.500 g) (OR, 0.4; 95 % CI, 0.2; 0.9), excess head circumference (OR, 2.7; 95 % CI, 1.5; 4.7), and APGAR score < 7 points (OR, 8.3; 95 % CI, 4.2; 16.5). Conclusions: the indigenous condition was associated with factors that have adverse effects on the health of NB, including reduced head circumference and suboptimal performance on the APGAR scale. These results emphasize the importance of improving access to and quality of prenatal healthcare services for indigenous communities. [ABSTRACT FROM AUTHOR]

With the continuous innovation of digital technology in my country at this stage and the design of medical imaging technology systems, the depth and breadth of the development of digital medical imaging technology have been greatly expanded. This paper focus on application of medical images in breast milk smearing of the umbilical nursing for full-term newborns. Objective: To explore the effect of breast milk application in umbilical nursing of full-term newborns. Methods: 596 full-term newborns were divided into three groups: Experimental Group, Control Group A and Control Group B, Experimental Group A treated with breast milk, control group a treated with 75% alcohol, and control group B treated with 37 ~ 42°C warm boiled water, the time of umbilical cord abscission, infection and other complications were compared among the three groups. The process was recorded by images. Results: According to the images, compared with the Control Group A and B, the experimental group significantly shortened the time of umbilical cord shedding, the difference was statistically significant (p < 0.001). Conclusion: The application of breast milk in umbilical region of full-term neonates can reduce the time of umbilical cord abscission without increasing the incidence of Omphalitis. [ABSTRACT FROM AUTHOR]

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

Aim: This randomised‐controlled trial aims to examine the effect of regional massage performed before blood collection on pain and vital signs in term newborns. Methods: The study sample consisted of a total of 96 term newborns, 49 in the experimental group and 47 in the control group, in the neonatal intensive care unit (NICU). Before the blood collection process, those in the experimental group received two (2) minutes of massage on their blood collection region, and their pain levels and vital signs were observed. Data were collected using a newborn information form, an intervention follow‐up form, and the Neonatal Infant Pain Scale (NIPS). Statistical analyses of the collected data included descriptive statistics, Chi‐squared test, independent‐samples t test, paired‐samples t test and Cohen's kappa statistic. A value of P < 0.05 was considered statistically significant. Results: While 51% (n = 49) of the newborns were included in the experimental group, 38.5% (n = 37) were born at the 38th gestational week. Their mean post‐natal age was 4.82 ± 4.04 days. The newborns in the experimental and control groups had similar demographic characteristics and blood collection experiences, and there was no statistically significant difference between them (P > 0.05). The mean crying time in the control group (56.9 ± 25.4 s) was significantly longer than that in the experimental group (30.6 ± 29.3 s) (P < 0.05). The newborns in the experimental group had shorter crying times, lower pain levels and heart rate, and higher oxygen saturation than those in the control group. Conclusion: The regional massage intervention reduced pain in term newborns. Therefore, neonatal nurses can be trained to use massage as an alternative infant care practice. [ABSTRACT FROM AUTHOR]

Background: When the umbilical cord is left unclamped after birth, a significant proportion of the blood from the placenta flows into the newborn, increasing the baby's blood volume by approximately 30%. Routine intervention of immediate cord clamping is harmful as it deprives the newborn access to their own blood, resulting in impaired physiological transition at birth and lower iron stores in early infancy. Iron deficiency in early life, even without anaemia, is linked with impaired neurodevelopment. Aim: The aim of this study was to accurately record birth to cord clamping interval at term vaginal births in a tertiary hospital in Aotearoa New Zealand and concurrently to examine some of the circumstances that may influence the timing of when the cord is cut. Method: This observational study was undertaken from August 2017 to April 2018. Participants were pregnant women having a vaginal birth at ≥37 weeks gestation. Data collected included birth to cord clamping interval, mode of birth (spontaneous or instrumental), maternal position for birth and practitioners involved in the birth. Descriptive statistics were used to summarise the data. Results: Participants were 55 women with term vaginal births. The median interval between birth and cord clamping was 3.5 minutes (IQR 2.18 - 5.68 mins). There was a longer median cord clamping time in the group who had a spontaneous birth (median 3.71; IQR 2.67 - 6.23) vs instrumental birth (2.08; IQR 0.55 - 2.30); with maternal side-lying position (6.37; IQR 4.15 - 9.48) vs lithotomy position (2.24; IQR 1.87 - 3.50); with midwife-facilitated birth (4.06; IQR 2.68 - 6.65) vs obstetric-facilitated birth (2.13; IQR 1.48 - 3.28); and when the neonatal team was not called to attend (4.73; IQR3.32 - 8.26) vs when they were called to attend (2.13; IQR 1.28 - 3.27). Discussion: The median cord clamping time of 3.5 minutes aligns with current local, national and international guidelines, although clamping times as short as 0.23 minutes were observed. The study provides a snapshot of practice at one tertiary hospital, examining data on a range of vaginal births, from uncomplicated midwifery-led births to complicated obstetric-led births requiring neonatal team attendance. By identifying some of the circumstances where cords are clamped early, we may be able to modify the associated factors for these births, thereby improving newborn health outcomes in the future. [ABSTRACT FROM AUTHOR]

This case report describes a 5-day-old term infant with necrotizing enterocolitis (NEC). The clinical presentation, diagnostic reasoning, current literature, hospital course, and follow-up are discussed. Necrotizing enterocolitis is a gastrointestinal emergency characterized by severe inflammation and ischemic necrosis of the intestinal mucosa. Usually a condition of prematurity, NEC primarily occurs in very low birth weight premature infants. Necrotizing enterocolitis can be managed medically or surgically, depending on the severity. Although the etiology of NEC is unknown, the clinical presentation includes abdominal distention and tenderness, feeding intolerance, grossly bloody stools, and severe hypotension and acidosis. [ABSTRACT FROM AUTHOR]

Previous echocardiographic studies were mainly focused on preterm infants and early fetal-to-neonatal transition period, whereas little is known about changes in the parameters of the right ventricular (RV) function after 72 h of life. Our aim was to quantitatively characterize potential changes in RV function by echocardiography in healthy term newborns between the third and the seventh day of life. We conducted a prospective observational study in 35 full-term newborns, in whom we performed echocardiographic examinations on the third and the seventh day of life. We assessed RV function, output and afterload and found a significant increase in all tissue Doppler velocities as well as in RV longitudinal strain, a higher mean RV outflow tract velocity time integral and lower myocardial performance index (MPI'), whereas the tricuspid annular plane systolic excursion, RV filling pattern, and RV outflow tract acceleration time were not significantly different between the third and the seventh day of life. Conclusions: Increased RV systolic and diastolic myocardial velocities, cardiac output and longitudinal deformation and decreased RV MPI' between the third and the seventh day of life point to a reduction of RV afterload and adaptive myocardial maturation in term newborns during this period. Moreover, PW-TDI and 2D speckle-tracking echocardiography seem to be more sensitive for evaluating RV function in comparison with M-mode echocardiography and pulsed-wave Doppler analysis of RV filling. [ABSTRACT FROM AUTHOR]

Introduction: Screening for Congenital Heart Diseases (CHD) depends on the antenatal ultrasonography and clinical examination of the newborn, however both these methods have low detection rates and often life-threatening congenital heart diseases are missed. Pulse Oximetry (PO) is an easy, accurate, rapid, non invasive method of detecting hypoxaemia. The purpose of using PO to identify Critical Congenital Heart Disease (CCHD) is that clinically non detectable minimal hypoxaemia can be detected by pulseoximetry. Aim: To study the accuracy of pulse oxymetry as a screening tool for early detection of critical congenital heart diseases in asymptomatic newborns. Materials and Methods: This cross-sectional study was conducted in the Department of Paediatrics and the Postnatal Ward of Obstetrics and Gynaecology at Sri Venkateswara Medical College, Tirupathi, Andhra Pradesh, India, from January 2017 to December 2020. All the term asymptomatic newborns of age more than 24 hours were screened using PO. Screening was positive if a: PO was <90% in right hand or foot at any stage of screening, b was 90% to <95% on both; there was >3% absolute difference in oxygen saturation between the right hand and foot on three consecutive measures (each separated by one hour). All the screen positive babies were subjected to 2D echocardiography. All statistical analyses were performed using OpenEpi website epicalculator, and Chi-square's test was used to calculate the p-value. Results: The mean gestational age (weeks) was 38±4 days. Out of 14,400, PO screening was positive in 45 babies, and subsequent echocardiography detected CHD in 30 babies. The sensitivity was 66.67%, positive predictive value was 66.67%, negative predictive value was 99.90%, with a diagnostic accuracy of 99.79%. On 2D electrocardiography, 30 were true positive cases, whereas, false positives and false negatives were 15 each. Remaining 14340 newborns were true negatives. Conclusion: Pulse oximetry is a safe, accessible, feasible test that can be used for early detection of CCHD's that are often undetected on antenatal ultrasonography. [ABSTRACT FROM AUTHOR]

It has been suggested that desaturations and bradycardia precede acute life-threatening events (ALTE) and that ALTE is more common in the delivery room than later in life. However, frequency, duration and severity of desaturations in the first hours of life and additional risk factors have not readily been studied. Term neonates (n = 100) were monitored for the first two hours after birth by pulse oximetry. The impact of maternal and perinatal factors on the frequency and severity of desaturations (<85%) and bradycardia (<80/min) was evaluated. Desaturations were detected in 30%, prolonged desaturations in 25% of infants. Desaturations were observed significantly more often in infants born by planned Cesarean section (pCs) compared to other modes of delivery (pCs 20/49; others 10/51; p =.029). Desaturations were also more frequent in infants diagnosed with neonatal infection (NI) or infants born to a mother with gestational diabetes (GDM), although not significantly. No bradycardia <80/min was detected. In our collective 4% of healthy term neonates had prolonged, clinically relevant desaturations in the first hours after birth. The mode of delivery and maternal risk factors may increase the risk for these events. However, our cohort was too small to detect any ALTE or SIDS and determine potential risk factors for these events. Our data lay ground for a large-scale prospective trial to investigate whether the mode of delivery could be an indication for general pulse oximetry monitoring of newborn in the delivery room. [ABSTRACT FROM AUTHOR]

We aimed to compare the rate of morbidity and mortality of late preterm and term infants during hospitalization in the third-level neonatal intensive care unit (NICU). 743 late preterm and 489 term infants who were born and followed up in the third level NICU were evaluated retrospectively. The birth weight, mode of delivery, gestational week, gender, duration of hospitalization, problems in neonatal and post-discharge period, and rate of mortality were investigated. The rate of mortality and morbidity were compared between the groups. Respiratory distress syndrome (RDS) was the most common (40.3%) cause of hospitalization. The rate of necrotizing enterocolitis, RDS and bronchopulmonary dysplasia was significantly higher in late preterms. Sixty-two (8.3%) of the late preterms and 88 (18%) of the term babies died. Congenital anomalies (55%) were the major cause of mortality in the term group, whereas RDS (35%), surgical interventions, long-term hospitalization, and infection were the main causes of mortality in the late preterm group. The high mortality rate in our study was because our study included only the babies hospitalized in the 3rd level NICU. It must be kept in mind that late preterms experience most of the problems of ongoing prematurity; therefore, they should not be delivered unless there is absolute obstetric and/or fetal indication. [ABSTRACT FROM AUTHOR]

Introduction: Screening for Congenital Heart Diseases (CHD) depends on the antenatal ultrasonography and clinical examination of the newborn, however both these methods have low detection rates and often life-threatening congenital heart diseases are missed. Pulse Oximetry (PO) is an easy, accurate, rapid, non invasive method of detecting hypoxaemia. The purpose of using PO to identify Critical Congenital Heart Disease (CCHD) is that clinically non detectable minimal hypoxaemia can be detected by pulseoximetry. Aim: To study the accuracy of pulse oxymetry as a screening tool for early detection of critical congenital heart diseases in asymptomatic newborns. Materials and Methods: This cross-sectional study was conducted in the Department of Paediatrics and the Postnatal Ward of Obstetrics and Gynaecology at Sri Venkateswara Medical College, Tirupathi, Andhra Pradesh, India, from January 2017 to December 2020. All the term asymptomatic newborns of age more than 24 hours were screened using PO. Screening was positive if a: PO was 3% absolute difference in oxygen saturation between the right hand and foot on three consecutive measures (each separated by one hour). All the screen positive babies were subjected to 2D echocardiography. All statistical analyses were performed using OpenEpi website epicalculator, and Chi-square’s test was used to calculate the p-value. Results: The mean gestational age (weeks) was 38±4 days. Out of 14,400, PO screening was positive in 45 babies, and subsequent echocardiography detected CHD in 30 babies. The sensitivity was 66.67%, positive predictive value was 66.67%, negative predictive value was 99.90%, with a diagnostic accuracy of 99.79%. On 2D electrocardiography, 30 were true positive cases, whereas, false positives and false negatives were 15 each. Remaining 14340 newborns were true negatives. Conclusion: Pulse oximetry is a safe, accessible, feasible test that can be used for early detection of CCHD’s that are often undetected on antenatal ultrasonography.

Hypoxic-ischemic syndrome (HIS) and Hypoxic-ischemic encephalopathy (HIE) are conditions that affect term and premature babies, with different pathophysiology and different brain disorders. HIE appears in 1-6 / 1000 live births and 26/1000 live births in developing countries. 15-20% die in the early neonatal period, while surviving babies have severe neurological impairment, including cerebral palsy, epilepsy, visual and hearing impairment, cognitive impairment, intellectual, behavioural, and social disorders. The hypoxic-ischemic event occurs before, during or after birth. The reasons may be related to the mother, the way of birth, the placenta, and the newborn. The criteria for diagnosis of HIE include a combination of perinatal factors, the need for resuscitation, standard neurological examinations, neurophysiological monitoring, neuroimaging methods and biochemical markers. The most effective treatment for HIE is hypothermia in combination with pharmacological therapy. HIE and HIS are problem that still persist in developing countries due to inadequate obstetric care, neonatal resuscitation, and hypothermia. Current and emerging research for HIE examines new markers for early recognition, treatment, and appropriate neuroprotection of high-risk term and premature infants. [ABSTRACT FROM AUTHOR]

Background. Alkaline phosphatase is an enzyme that catalyzes the hydrolysis of esters in an alkaline environment. Four isoenzymes have been identified in the human body: placental alkaline phosphatase (PLALP isoenzyme), intestinal alkaline phosphatase (IAP), hepatic/bone/renal alkaline phosphatase (L/B/K ALP) and germ cell alkaline phosphatase (GCALP). The uses of ALP in neonatology have been intensively studied, and associations have been demonstrated between elevated alkaline phosphatase levels and hypocalcemia and hypophosphatemia in premature infants, the onset of early osteopenia and the occurrence of necrotizing enterocolitis. Objective. The current study aimed to demonstrate the correlation between elevated alkaline phosphatase levels in blood from the umbilical cord and elevated transcutaneous bilirubin levels that indicated phototherapy. Material and methods. The study included 250 term newborns within 01-06.2018 and 31 had indication for phototherapy, and 219 without indication for phototherapy, in a tertiary maternity hospital in Bucharest, Romania. Alkaline phosphatase was determined in the umbilical cord serum. Results. The values of the alkaline phosphatase were from 145 to 417 U/l for the newborns without phototherapy and the treated group was beetween 320 and 602 U/l. The values of the alkaline phosphatase were not influenced by the birth weight, Apgar score, and gender. Conclusions. Alkaline phosphatase may represent a predictive marker for the need for phototherapy in term neonates, but further extended studies are required on larger groups of patients.

Background: Prone positioning is a common practice after vaginal birth promoting skin to skin contact and has been associated with improved oxygenation in mechanically ventilated neonates in the recent analysis. Neonates of women not in labor delivered via C-section are at increased risk of respiratory distress; it is unclear whether vigorous neonates without a need of resuscitation would benefit from prone positioning immediately after birth.Objective: To determine whether prone positioning of vigorous term neonates for the first 5 min after scheduled cesarean delivery will decrease the incidence of respiratory distress and therapeutic interventions, characterized by the frequency and duration of respiratory support (RS).Design/methods: In a single center, randomized parallel clinical trial, vigorous term neonates delivered via scheduled cesarean delivery were positioned prone or supine and their heart rate, oxygen saturation and signs of respiratory distress were recorded at 1-min intervals for the first 5 min. Infants not reaching target oxygen saturations suggested by the neonatal resuscitation guidelines received RS via Neopuff in supine position; respiratory support was discontinued once oxygen saturation targets were met and infant was free of respiratory symptoms. Primary outcomes measured were frequency and duration of RS, secondary outcomes were admission to the NICU for respiratory distress, length of stay, heart rate and oxygen saturation during the initial 5 min of life.Results: Two hundred twenty-five neonates in prone and 231 in supine position completed the study out of 500 randomized subjects. Frequency of RS (31 versus 30%, p = .93), mean RS duration (4.08 versus 4.39 min; p = .71), frequency of admission to the NICU (5% in both groups; p = .95) and mean length of stay (0.14 versus 0.28 days; p = .42) were similar between the prone and supine groups. The supine cohort had higher initial oxygen saturation (p = .02) as well as heart rate (p = .004).Conclusions: Prone or supine positioning of term neonates after scheduled cesarean delivery resulted in comparable respiratory outcomes including the need for resuscitation in the first minutes of life. [ABSTRACT FROM AUTHOR]

ObjectiveTo define a quantitative stratification algorithm for the risk of early-onset sepsis (EOS) in newborns ≥ 34 weeks' gestation.MethodsWe conducted a retrospective nested case-control study that used split validation. Data collected on each infant included sepsis risk at birth based on objective maternal factors, demographics, specific clinical milestones, and vital signs during the first 24 hours after birth. Using a combination of recursive partitioning and logistic regression, we developed a risk classification scheme for EOS on the derivation dataset. This scheme was then applied to the validation dataset.ResultsUsing a base population of 608,014 live births ≥ 34 weeks' gestation at 14 hospitals between 1993 and 2007, we identified all 350 EOS cases

Abstract Background Experiments have shown improved cardiovascular stability in lambs if umbilical cord clamping is postponed until positive pressure ventilation is started. Studies on intact cord resuscitation on human term infants are sparse. The purpose of this study was to evaluate differences in clinical outcomes in non-breathing infants between groups, one where resuscitation is initiated with an intact umbilical cord (intervention group) and one group where cord clamping occurred prior to resuscitation (control group). Methods Randomized controlled trial, inclusion period April to August 2016 performed at a tertiary hospital in Kathmandu, Nepal. Late preterm and term infants born vaginally, non-breathing and in need of resuscitation according to the ‘Helping Babies Breathe’ algorithm were randomized to intact cord resuscitation or early cord clamping before resuscitation. Main outcome measures were saturation by pulse oximetry (SpO2), heart rate and Apgar at 1, 5 and 10 minutes after birth. Results At 10 minutes after birth, SpO2 (SD) was significantly higher in the intact cord group compared to the early cord clamping group, 90.4 (8.1) vs 85.4 (2.7) %, P

Objective:Classic congenital adrenal hyperplasia (CAH) secondary to 21-hydroxylase deficiency is characterized by increased prenatal adrenal androgen secretion. There are a small number of reports in the literature showing higher birth weight and length in CAH newborns.Methods:We analyzed birth weight and length data of 116 German newborns (48 boys, 68 girls) with classic CAH who were born during the period from 1990 to 2017. All children have been followed or are currently treated as outpatients in our clinic. All children were born at term. The mothers were healthy and their pregnancies were uneventful. The diagnosis of CAH was confirmed by molecular analyses of the CYP21A2 gene. Birth data were calculated as standard deviation (SD) scores according to German reference values.Results:Weight and length in male CAH newborns (mean ± SD) (3601±576 g; 52.4±2.85 cm) were significantly higher than in female CAH newborns (3347±442 g; 51.2±2.55 cm), but male-female differences in the CAH cohort were lost when the data were converted into SD scores. The birth sizes of the CAH newborns did not differ from the reference group. The birth sizes also did not differ between the different CAH genotypes. Maternal age, mode of delivery and maternal parity had no influence on birth size.Conclusion:Our data show that prenatal hyperandrogenism does not affect fetal growth.

Background: Anterior fontanel is an integral element of an infant craniofacial system. There are six fontanels in the newborn skull, namely anterior, posterior, two mastoid, and two sphenoid fontanels. The anterior fontanel is the largest, prominent, and most important for clinical evaluation. Sex, race, genetics, gestational age, and region are the principal factors that influence anterior fontanel size. There exist inconclusive findings on the size of anterior fontanel in newborns. Therefore, this systematic review and meta-analysis aimed to determine the pooled mean size of anterior fontanel among term newborns and to identify the pooled mean difference of anterior fontanel size between males and females.Methods: PubMed/Medline, Google Scholar, Science Direct, JBI Library, embase, and Cochrane Library databases were systematically searched. All essential data were extracted using a standardized data extraction format. The heterogeneity across studies was assessed using the Cochrane Q test statistic, I2 test statistic, and p-values. A fixed-effect model and random effect model were used to estimate the pooled mean size of anterior fontanel and the pooled mean difference between male newborns and female newborns, respectively. To deal with heterogeneity, sub-group analysis, meta-regression analysis, and sensitivity analysis were considered. JBI quality appraisal checklist was used to evaluate the quality of studies.Results: In this meta-analysis, 8, 661 newborns were involved in twenty-six studies. Among studies, 13 conducted in Asia, 7 in Africa, 5 in America, and 1 in Europe. The pooled mean size of anterior fontanel was 2.58 cm (95% CI: 2.31, 2.85 cm). The pooled mean size of anterior fontanel for Asia, Africa, America, and Europe region was 2.49, 3.15, 2.35, and 2.01 cm, respectively. A statistically significant mean difference was detected between male and female newborns (D + L pooled MD = 0.15 cm, 95% CI: 0.02, 0.29 cm).Conclusion: The pooled estimate of this review does provide the mean value of the anterior fontanel size in the newborns. There was a statistically significant mean fontanel size difference between male and female newborns. Therefore, male newborns had a significantly larger mean size than female newborns.

Purpose: The mature central autonomic network includes connectivity between autonomic nervous system brainstem centers and the cerebral cortex. The study objective was to evaluate the regional connectivity between the cerebral cortex and brainstem autonomic centers in term newborns by measuring coherence between high-density electroencephalography and heart rate variability as measured by electrocardiography. Methods: Low-risk term newborns with birth gestational age of 39–40 weeks were prospectively enrolled and studied using time-synced electroencephalography and electrocardiography for up to 60 min before discharge from the birth hospital. The ccortical autonomicc nervous system association was analyzed using coherence between electroencephalography-delta power and heart rate variability. Heart rate variability measured the parasympathetic tone (root mean square of successive differences of heart rate) and sympathetic tone (standard deviation of heart rate). Results: One hundred and twenty-nine low-risk term infants were included. High coherence delta-root mean square of successive differences was found in central, bitemporal, and occipital brain regions, with less robust coherence delta-standard deviation in the central region and bitemporal areas. Conclusions: Our findings describe a topography of ccortical autonomicc connectivity present at term in low-risk newborns, which was more robust to parasympathetic than sympathetic brainstem centers and was independent of newborn state. [ABSTRACT FROM AUTHOR]

Background: Anterior fontanel is an integral element of an infant craniofacial system. There are six fontanels in the newborn skull, namely anterior, posterior, two mastoid, and two sphenoid fontanels. The anterior fontanel is the largest, prominent, and most important for clinical evaluation. Sex, race, genetics, gestational age, and region are the principal factors that influence anterior fontanel size. There exist inconclusive findings on the size of anterior fontanel in newborns. Therefore, this systematic review and meta-analysis aimed to determine the pooled mean size of anterior fontanel among term newborns and to identify the pooled mean difference of anterior fontanel size between males and females. Methods: PubMed/Medline, Google Scholar, Science Direct, JBI Library, embase, and Cochrane Library databases were systematically searched. All essential data were extracted using a standardized data extraction format. The heterogeneity across studies was assessed using the Cochrane Q test statistic, I2 test statistic, and p -values. A fixed-effect model and random effect model were used to estimate the pooled mean size of anterior fontanel and the pooled mean difference between male newborns and female newborns, respectively. To deal with heterogeneity, sub-group analysis, meta-regression analysis, and sensitivity analysis were considered. JBI quality appraisal checklist was used to evaluate the quality of studies. Results: In this meta-analysis, 8, 661 newborns were involved in twenty-six studies. Among studies, 13 conducted in Asia, 7 in Africa, 5 in America, and 1 in Europe. The pooled mean size of anterior fontanel was 2.58 cm (95% CI: 2.31, 2.85 cm). The pooled mean size of anterior fontanel for Asia, Africa, America, and Europe region was 2.49, 3.15, 2.35, and 2.01 cm, respectively. A statistically significant mean difference was detected between male and female newborns (D + L pooled MD = 0.15 cm, 95% CI: 0.02, 0.29 cm). Conclusion: The pooled estimate of this review does provide the mean value of the anterior fontanel size in the newborns. There was a statistically significant mean fontanel size difference between male and female newborns. Therefore, male newborns had a significantly larger mean size than female newborns. [ABSTRACT FROM AUTHOR]

Timely detection of severe infratentorial hemorrhage in neonates is crucial, especially in case of life-threatening brain stem compression and/or acute obstructive hydrocephalus, which need lifesaving neurosurgical intervention. Although the detection of infratentorial hemorrhage by ultrasound scanning is often considered as difficult, the use of additional acoustic windows and recognition of characteristic ultrasound features facilitate early diagnosis. In this case series, we report on newborns with severe, symptomatic infratentorial hemorrhage detected primarily by cranial ultrasound. We demonstrate the characteristic ultrasound features present in all cases and discuss how ultrasound diagnosis contributed to early diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Electroencephalography (EEG) is the reference tool for the analysis of brain function, reflecting normal and pathological neuronal network activity. During the neonatal period, EEG patterns evolve weekly, according to gestational age. The first analytical criteria for the various maturational stages and standardized neonatal EEG terminology were published by a group of French neurophysiologists training in Paris (France) in 1999. These criteria, defined from analog EEG, were completed in 2010 with digital EEG analysis. Since then, this work has continued, aided by the technical progress in EEG acquisition, the improvement of knowledge on the maturating processes of neuronal networks, and the evolution of critical care. In this review, we present an exhaustive and didactic overview of EEG characteristics from extremely premature to full-term infants. This update is based on the scientific literature, enhanced by the study of normal EEGs of extremely premature infants by our group of neurophysiologists. For educational purposes, particular attention has been paid to illustrations using new digital tools. [ABSTRACT FROM AUTHOR]

Background: There are very few previous studies regarding ocular screening done in term neonates. Retinal hemorrhages can occur in babies during delivery. Aims: To evaluate the correlation of retinal findings with the duration of second stage of labor in term neonates and mode of delivery. Settings and Design: This was a cross-sectional, observational study done on term newborns in a tertiary care centre. Convenience sampling was done. Subjects and Methods: Neonates were examined in the postnatal ward using handheld slit lamp and indirect ophthalmoscope. Fundus examination was done after dilating the pupils with 0.5% tropicamide and 2.5% phenylephrine eyedrops. Second stage of labor and mode of delivery were noted. Chi-square test and independent sample t-test were used to analyze the data. Results: One hundred and fifty infants were screened, of which 75 (50%) had retinal hemorrhages. Chi-square test showed statistical significance with duration of second stage of labor and occurrence of retinal hemorrhages (P < 0.001). Patients with second stage of labor shorter than 30 minutes of duration were found to have more chances of having retinal hemorrhages. Independent sample t-test used for association between mode of delivery and retinal hemorrhages showed patients born of normal vaginal delivery to have more chances of having hemorrhages (P = 0.006). Chi-square test showed statistical significant association with the presence of hemorrhages and day of evaluation (P < 0.001). Conclusion: Retinal hemorrhages were found to be common in full-term babies whose second stage of delivery was shorter than 30 minutes of duration.

BACKGROUND: Transient tachypnea of the newborn(TTNB) is the most common respiratory morbidity in late preterm and term babies and is pathophysiologically related to delayed lung fluid clearance after birth. Mimicking low physiological fluid intake in the initial period of life may accelerate the recovery from TTNB. In a randomized controlled trial, we compared the roles of restricted versus standard fluid management in babies with TTNB requiring respiratory support. METHODS: This parallel group,non-blinded, stratified randomized controlled trial was conducted in a level III neonatal unit of eastern India. Late preterm and term babies with TTNB requiring continuous positive airway pressure (CPAP) were randomly allocated to standard and restricted fluid arms for the first 72 hours (hrs). Primary outcome was CPAP duration. RESULTS: In total, 100 babies were enrolled in this study with 50 babies in each arm. CPAP duration was significantly less in the restricted arm (48[42, 54] hrs vs 54[48,72] hrs, p = 0.002). However, no difference was observed in the incidence of CPAP failure between the two arms. In the subgroup analysis, the benefit of reduced CPAP duration persisted in late preterm but not in term infants. However, the effect was not significant in the late preterm babies exposed to antenatal steroid. CONCLUSION: This trial demonstrated the safety and effectiveness of restrictive fluid strategy in reducing CPAP duration in late preterm and term babies with TTNB. Late preterm babies, especially those not exposed to antenatal steroid were the most benefitted by this strategy. [ABSTRACT FROM AUTHOR]

Background: Assumption that resolution of acute kidney injury (AKI) is followed by complete renal recovery has been challenged by recent studies in adults and children. However, data in term newborns are scarce. This study was done to observe deranged renal parameters and hence risk factor for chronic kidney disease at 6 months of age in term newborns who develop AKI due to various causes. Methods: This was a descriptive cohort study in term newborns developing AKI (nRIFLE). Sixty-one babies completed the study for final analysis. After 6 months of follow-up, clinical and laboratory renal parameters were studied. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0. Results: The median gestational age of cohort was 38 weeks, and the mean birth weight and length were 2.8 ± 0.45 kg and 48.3 ± 2.25 cm, respectively. Sepsis was the most common etiological factor in 54% cases of AKI followed by birth asphyxia (34%). The median age and serum creatinine at diagnosis of AKI were 4 days and 2.7 mg/dL, respectively. Nearly 77% of cases (n = 47) were oliguric and the median value of fractional excretionof sodium was 0.87 (0.688–1.335). One (1.64%) neonate was in risk stage, 8 (13.11%) in injury, and 52 (85.246%) in failure stage. At 6 months of follow-up, 41% (n = 25) had decreased serum bicarbonate values. Four out of 61 patients (6.56%) had reduced estimated glomerular filtration rate, while 15 (24.59%) had hyperfiltration. Overall, 63.93% (n = 39) of the cases had one or more renal parameters deranged at 6 months. Conclusion: A large proportion of term newborns with AKI continue to have deranged renal parameters, therefore they need careful monitoring for long duration. [ABSTRACT FROM AUTHOR]

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Background. Alkaline phosphatase is an enzyme that catalyzes the hydrolysis of esters in an alkaline environment. Four isoenzymes have been identified in the human body: placental alkaline phosphatase (PLALP isoenzyme), intestinal alkaline phosphatase (IAP), hepatic/bone/renal alkaline phosphatase (L/B/K ALP) and germ cell alkaline phosphatase (GCALP). The uses of ALP in neonatology have been intensively studied, and associations have been demonstrated between elevated alkaline phosphatase levels and hypocalcemia and hypophosphatemia in premature infants, the onset of early osteopenia and the occurrence of necrotizing enterocolitis. Objective. The current study aimed to demonstrate the correlation between elevated alkaline phosphatase levels in blood from the umbilical cord and elevated transcutaneous bilirubin levels that indicated phototherapy. Material and methods. The study included 250 term newborns within 01-06.2018 and 31 had indication for phototherapy, and 219 without indication for phototherapy, in a tertiary maternity hospital in Bucharest, Romania. Alkaline phosphatase was determined in the umbilical cord serum. Results. The values of the alkaline phosphatase were from 145 to 417 U/l for the newborns without phototherapy and the treated group was beetween 320 and 602 U/l. The values of the alkaline phosphatase were not influenced by the birth weight, Apgar score, and gender. Conclusions. Alkaline phosphatase may represent a predictive marker for the need for phototherapy in term neonates, but further extended studies are required on larger groups of patients. [ABSTRACT FROM AUTHOR]

Background: Perinatal hemorrhagic stroke in late preterm and term neonates is understudied. We describe two-month and two-year neurological outcomes in a prospective cohort.Methods: Neonates ≥36 weeks' gestation with spontaneous hemorrhagic stroke (parenchymal and intraventricular) presenting at age ≤28 days were enrolled between March 2007 and May 2015 at three tertiary pediatric centers. Hemorrhagic transformation of arterial ischemic stroke or cerebral sinovenous thrombosis was excluded. The Pediatric Stroke Outcome Measure (PSOM) assessed outcomes. Wilcoxon signed-rank tests evaluated change over time.Results: Twenty-six neonates were included (median age: 1 day, interquartile range [IQR] 0 to 16; median gestational age: 38.3 weeks, IQR 37.0 to 39.0). Hemorrhage was isolated intraventricular in seven (27%), isolated intraparenchymal in six (23%), and a combination in 10 (39%). Three neonates (12%) died during hospitalization; one died later due to cardiac disease. Among 22 survivors, outcomes were assessed at a median of 2.1 months (IQR 1.7 to 3.3) in 96% and 1.9 years (IQR 1.3 to 2.0) in 73%. Median PSOM scores were 0.0 (IQR 0.0 to 1.0) and 0.25 (IQR 0.0 to 1.3), respectively. At two years, 45% of patients had no or nonimpairing deficits (PSOM <1.0), 30% had mild deficits (PSOM 1.0 to 2.0), and 5% had moderate deficits (PSOM 2.5 to 4.5). Over time, 31% worsened and 6% improved. Although total PSOM scores did not change significantly (P = 0.08), language subscores worsened (P = 0.009). No child developed epilepsy.Conclusions: Perinatal hemorrhagic stroke survivors had favorable outcomes in early childhood; at two years moderate to severe deficits occurred in 5%. Language deficits may emerge over time, warranting close follow-up. [ABSTRACT FROM AUTHOR]

Objective: Many perinatal risk factors such as mother's age and premature birth have been identified for childhood asthma and wheezy child. Some observational studies have shown a relationship between childhood asthma and hyperbilirubinemia and/or phototherapy. We aimed to investigate the relationship between neonatal jaundice and the incidence of wheezing and other respiratory tract diseases in the first year. Material and Method: Term newborns (n=254) who were admitted to the primary NICU between January 2017 and December 2018 due to the indirect hyperbilirubinemia also who received phototherapy, and healthy newborns (n=254) who were without anomalies and hyperbilirubinemia as control group were included in the study. Infants in both groups were evaluated for 12 months in terms of respiratory diseases and wheezing attacks. The clinical and demographic data obtained from patient records and the type/frequency of respiratory diseases were confirmed by calling the families. Results: Of the patient's group, 142 (55.9%) were male, the mean birth week was 38.07±1.57 and 158 (62.2%) were delivered by cesarean section. The total bilirubin level was 15.26±2.66 mg/dl at hospitalization and 8.20±2.51 mg/dL at discharge. The mean phototherapy time was 2.91±1.83 days. In the one-year follow-up, of the patients, 94 (37%) had wheezing, 54 (21.2%) had only upper respiratory tract infections, and 6 (2.3%) had other lower respiratory tract problems. Infants who were diagnosed as wheezy child had significantly higher phototherapy time than infants without wheezing (p<0.05). There were 71 (%27.9) children diagnosed as wheezy child in the control group, and there was a significant difference between the two groups (p<0.05). Conclusion: The history of taking phototherapy with jaundice in the neonatal period may be a risk factor for wheezy child development. Large-scale studies are needed on this subject. [ABSTRACT FROM AUTHOR]

Transient tachypnea of the newborn is a mild breathing problem. It affects babies during the first hours of life. Tachypnea means fast breathing rate, and usually affects term newborns, more likely those delivered by Csection. The problem usually goes away without treatment in 3 days or less. Only a small number of all newborn babies get this breathing problem. Your baby's healthcare provider may use a chest X-ray to help diagnose the problem. On X-ray, the lungs look streaked and overinflated. The symptoms of this breathing problem may be similar to other more serious respiratory problems. These include lung infection (pneumonia) or premature lungs (respiratory distress syndrome). Often transient tachypnea of the newborn is diagnosed when symptoms go away in the first few hours to days of life. The Aim of this study was to evaluate and describe the frequency and course of perinatal and postnatal factors in neonates experiencing transient tachypnea during the first hours of life and to determine risk factors for complications of this condition. Methods: This was prospective opservational study during the period of six months in 2019, at the University Clinic for Gynecology and Obstetrics in Skopje. In the evaluation process were included newborn children born later than 34 gestational weeks, admitted to the Neonatal Department. The correlation between gestational age and need of oxygen support was determined, and the overall outcome of those newborns presented. If necessary, X-ray of lungs was performed. Results: In this study 2268 newborns were evaluated, born as late preterm (35th and 36th gestational age) and term newborns. None of the evaluated newborns was admitted to the Intensive Neonatal Care Unit. The C-section rate in the facility during this period for the evaluated newborns was 38,5%. Transient tachypnea was detected in 178 newborn babies, 65/178 were late preterm and 113/178 were term newborns. The proportion of preterm/term newborns was 246/2022. The accurate diagnosis has to be confirmed with X-ray in 30% of all of them presenting unclear signs of respiratory problems. The condition was resolved by its own in 83%, and the other have developed symptoms of more severe respiratory diseases, as respiratory distress syndrome in premature infants, congenital pneumonia, or respiratory condition of extra-pulmonary origin. Discussion: Transient tachypnea of the newborn occurs in approximately 1 in 100 preterm infants and 3.6-5.7 per 1000 term infants. It is most common in infants born by Cesarian section without a trial of labor after 35 weeks' gestation. It is self-limiting condition and the symptoms are resolved spontaneously, excluding some cases which could be complicated. The likelihood of complications is 1-2%. Conclusion: Transient tachypnea is very common cause of respiratory condition in neonates. Fortunately, the prognosis is very good, but when managing transient tachypnea of the newborn, it is imminent to observe for development of respiratory fatigue and signs of clinical deterioration that may suggest some other diagnoses. [ABSTRACT FROM AUTHOR]

Pregnancy-induced hypertension (PIH), especially preeclampsia, is a major cause of maternal and perinatal morbidity and mortality worldwide. The impact of PIH on birth outcomes has not been extensively studied. PIH has been confirmed to increase significantly the risk of low birth weight by both increasing preterm birth as well as reducing fetal growth. Low birth weight or IUGR babies have been associated with the occurrence of several chronic diseases in later life. However, to date, there have been few studies on the effects of PIH on infant growth and neonatal wellbeing. The purpose of this study was to evaluate the fetal growth and wellbeing of newborns born of mothers with confirmed pregnancy induced hypertension. Material and methods: This was prospective opservational study during the period of the last year, 1st of July 2018 up to the end of June 2019 conducted at the University Clinic for Gynecology and Obstetrics in Skopje. As pregnancy induced hypertension is defined the condition of blood pressure equal to or greater than 130/90 mmHg on more than two occasions greater than six hours apart without proteinuria after 21 weeks of gestation. All other more severe conditions are defined as pre-eclampsia or eclampsia. As outcome was considered the birth weight, gestational age and white blood cells count. IUGR was defined as birth weight below the tenth percentile of expected weight for gestational age. Also maternal age and BMI were considered as conjoined risk factor for the birth weight. Results: In this study, 4726 newborns were born at the University Clinic for Gynecology and Obstetrics, and for analysis were considered 4273 newborns who were late preterm (35 and 36 gestational weeks) or term newborns. Two groups were evaluated: control group of 200 consecutively born newborns (late preterm and term) of healthy mothers and 100 newborns (late preterm and term) consecutively born of mothers with confirmed diagnosis of PIH, which constituted the study group. Within the control group, the proportion of Small for Gestational Age-SGA was 6,3%, and in the group of mothers with PIH was 9,5% (p<0,05). The maternal mean age of the hypertensive mothers was (32.8±5.0) years while that of normotensive mothers was (26.6±3.7) years, and there was not statistical significance (p>0.05). The Body Mass Index was higher in hypertensive mothers, compared to the healthy mothers (31,3±2.02 vs. 27.8±2.8). The mean gestational age of the study group was (35.8±1.8) weeks compared to that in control group (37.4±1.2) weeks. The number of White Blood Cells (WBC) count in newborns of hypertensive mothers was 21.4±5.3x109/L compared with the control group, 18.5±3.12x109/L (p=0.005). Neonatal thrombocytopenia was found in 32% of neonates of preeclamptic mothers while it's found only in 9.5% of neonates in control group p<0,002. Discussion: The limitation of this study was the lack of data about maternal smoking, life style, etc. There is limited number of studies examining the correlation between fetal growth and PIH, and every information is of great value. The fact is that this condition can progress in more severe degree of hypertension and deleterious effects on the mother itself and on her child, if not treated on time. Conclusion: A change in infant growth of the IUGR baby itself (e.g. catch-up growth) such as in the critical early infant period may also have long-term effects on health later in life, and this change of postpartum growth may be influenced by PIH. Therefore, it is important to study postpartum infant growth patterns of babies born to mothers with PIH, and to determine if there are differences in infant growth between babies with and those without IUGR. And, the most important action is to monitor and treat pregnancy induced hypertension and prevent more severe condition of pre-eclampsia. [ABSTRACT FROM AUTHOR]

Objective: Classic congenital adrenal hyperplasia (CAH) secondary to 21-hydroxylase deficiency is characterized by increased prenatal adrenal androgen secretion. There are a small number of reports in the literature showing higher birth weight and length in CAH newborns. Methods: We analyzed birth weight and length data of 116 German newborns (48 boys, 68 girls) with classic CAH who were born during the period from 1990 to 2017. All children have been followed or are currently treated as outpatients in our clinic. All children were born at term. The mothers were healthy and their pregnancies were uneventful. The diagnosis of CAH was confirmed by molecular analyses of the CYP21A2 gene. Birth data were calculated as standard deviation (SD) scores according to German reference values. Results: Weight and length in male CAH newborns (mean ± SD) (3601±576 g; 52.4±2.85 cm) were significantly higher than in female CAH newborns (3347±442 g; 51.2±2.55 cm), but male-female differences in the CAH cohort were lost when the data were converted into SD scores. The birth sizes of the CAH newborns did not differ from the reference group. The birth sizes also did not differ between the different CAH genotypes. Maternal age, mode of delivery and maternal parity had no influence on birth size. Conclusion: Our data show that prenatal hyperandrogenism does not affect fetal growth. [ABSTRACT FROM AUTHOR]

In our study we aimed to demonstrate the relationship between the serum iron levels, and tears quality and quantity in term newborns. This study was conducted at a single institution between March 2013 and May 2013. A total of 46 newborns were prospectively enrolled. Serum iron levels were measured via the umbilical cord blood. Infants were divided into two groups according to their serum iron levels. Group A, serum iron level ≤70 μg/dL (n = 27) and Group B, serum iron level > 70 μg/dL (n = 19). The evaluation of the osmolarity was tested by using the TearLab Osmolarity System (TearLab Co, San Diego, CA, USA). The assessment of quantity was performed by using Schirmer I test. Osmolarity testing and Schirmer I test (with/without anesthesia) were performed bilaterally on the 1st day of life by an ophthalmologist. The outcomes of Schirmer I and tear osmolarity showed no statistically significant difference between right and left eyes of any infant in the groups. Moreover, there was no statistical difference between sexes in these two groups. Osmolarity was found to have a moderate negative correlation coefficient with serum iron level (r = −0.4, p

The article reviews the available data on investigations in the field of electrolyte (calcium, magnesium), hormonal (insulin, leptin) and hemostasis disturbances in term newborns from women with gestational diabetes; possible mechanisms of their development are also highlighted. The review describes changes in blood glucose concentration in term newborns from women with gestational diabetes, and their impact on the child's condition. In addition to already known factors causing macrosomia and other metabolic disorders in term neonates, the role of leptin (peptide hormone that regulates energy metabolism) is quite discussable. Low leptin levels lead to the development of obesity. It is also confirmed, that leptin influences brain development of the newborn, leading to later cognitive deficits in children from women with GDM. The aim of the review is to summarize the available data on investigations in the field of electrolyte (calcium, magnesium), hormonal (insulin, leptin) and hemostasis disturbances in term newborns from women with gestational diabetes.

Background: Hypoxic ischemic encephalopathy is main complication of the birth asphyxia. The objective of the study was to determine the frequency of outcome of term newborns with hypoxic ischemic encephalopathy(HIE). Material & Methods: This cross sectional study was done at Neonatology Unit of National Institute of Child Health, Karachi, from July, 2014 to January, 2015. Sample size was 162 cases selected through consecutive sampling technique. Mean age was 7.74 ±3.87 days. Males were 100 (61.7%) and females were 62 (38.3%). All neonates of either gender from birth to 14 days of life presented with gestational age >37 weeks &

Background: Hypoxic ischemic encephalopathy is main complication of the birth asphyxia. The objective of the study was to determine the frequency of outcome of term newborns with hypoxic ischemic encephalopathy(HIE). Material & Methods: This cross sectional study was done at Neonatology Unit of National Institute of Child Health, Karachi, from July, 2014 to January, 2015. Sample size was 162 cases selected through consecutive sampling technique. Mean age was 7.74 ±3.87 days. Males were 100 (61.7%) and females were 62 (38.3%). All neonates of either gender from birth to 14 days of life presented with gestational age >37 weeks &<42weeks and having history of initiate and sustain failure of breathing for ≥one minute after birth were enrolled. Patient was followed up till 14 days and final outcome was assessed in terms of mortality and improvement. The stages of hypoxic ischemic encephalopathy were assessed on the basis of Sarnat staging. Final outcome (improved / mortality) was assessed on 14thday of admission. All the data i.e. age of neonate in days, age groups, gestational age in weeks, gender, outcome (improved and mortality) HIE stages were entered in the pre designed proforma. Results: There were 64 (39.50%) patients with HIE stage I, 62 (38.30%) with HIE stage II and 36 (22.2%) patients with HIE stage III. Improved outcome was observed in 137 (84.6%) while death was observed in 25 (15.40%) patients. Conclusion: Severity of HIE (stage III) was found significantly associated with mortality. [ABSTRACT FROM AUTHOR]

In neonatal Ebstein's anomaly of the tricuspid valve, prolonged ductal patency in patients without anatomic pulmonary valve atresia can be deleterious. Circular shunts may develop in patients with different degrees of pulmonary and tricuspid insufficiency. Closure of the arterial duct may result in haemodynamic improvement in particular scenarios. The transcatheter approach is a valuable closure alternative despite some technical difficulties in large-sized arterial ducts and low birth weight neonates. Herein, we report on two consecutive term newborns with Ebstein's anomaly and large arterial ducts in whom mechanical stimulus of the arterial duct during failed attempts of transcatheter closure led after two days to definitive closure followed by good clinical outcomes.