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Introduction: Meconium aspiration syndrome is a life-threatening respiratory disease due to the aspiration of meconium-stained amniotic fluid into the lungs, resulting in neonatal morbidity and mortality. Impacts of meconium aspiration syndrome include respiratory failure, intellectual disability, persistent pulmonary hypertension, and air leaks. But there is a paucity of literature in Ethiopia, especially in the study area regarding the study topic. The aim of this study is to assess the proportion of meconium aspiration syndrome and associated factors among neonates admitted at the neonatal intensive care unit in North West Comprehensive Specialized Hospital, Northwest Ethiopia, 2023. Methods: -An institutional-based cross-sectional study was conducted among 414mothers-neonate pairs from April 15–May 15/2023. Systematic random sampling was used to obtain study participants. Maternal interviews and a review of neonatal charts were used to gather data from 414 respondents. Then the collected data was entered and coded into EPi-Data version 4.6.0.2 and exported to STATA version 14 for analysis. Both the bi-variable and multi-variable logistic regression models were used for analysis. AOR and 95% CI were used to measure association and strength, with statistical significance assessed at a p-value < 0.05. Results: - A total of 414 neonate-mother pairs were involved with a 98% response rate. The overall prevalence of meconium aspiration syndrome was 23.43% with a 95% CI (19.6–27.8). Gestational age ≥ 41 wks (AOR = 4.8, CI = 2.02–11.22), labor duration ≥ 12 h (AOR = 2, 95%CI = 1.10–3.84), Premature Rupture of Membrane (AOR = 4.6, 95%CI = 1.12–10.12), oligohydramnios (AOR = 4.2, 95%CI, 2.17–8.14) and breech presentation (AOR = 6.9, 95%CI = 2.169–8.13) were significantly associated with meconium aspiration syndrome. Conclusion and recommendation: The prevalence of meconium aspiration syndrome was relatively high. And Postterm gestation, oligohydramnios, duration of labor, Premature Rupture of Membrane, and breech presentation increased the prevalence of meconium aspiration syndrome. Therefore, to reduce the risk of meconium aspiration syndrome, Health professionals should assess laboring women for the presence of these factors and should stay alert to detect MSAF early for better fetal and maternal health outcomes. [ABSTRACT FROM AUTHOR]

Objective: To determine the severity, complications, and outcomes of meconium aspiration syndrome (MAS) in neonates. Study Design: Cross-sectional study. Setting: Neonatal Intensive Care Unit (NICU) of the National Institute of Child Health, Karachi, Pakistan. Period: January 2024 to June 2024. Methods: Neonates aged 1-28 days of either gender, and having MAS were analyzed. Vital signs were noted and necessary laboratory investigations were done. Presenting clinical features and associated complications of MAS were noted. Outcome was noted in the form of discharged, admitted to pediatric unit, or mortality. Results: In a total of 92 neonates, 66 (71.7%) were male. The mean age was 12.47±6.55 days. Evaluation of MAS severity revealed mild, moderate, and severe cases among 2 (2.2%), 16 (17.4%), and 74 (80.4%) neonates, respectively. The most frequently noted complications were sepsis 65 (70.7%), hyperinflated lungs 55 (59.8%), respiratory distress 34 (37.0%), and pulmonary hypertension 31 (33.7%), were the most commonly associated complications of MAS. Two neonates left against medical advice so those were excluded from the final outcome analysis. In the remaining 90 neonates, mortality was reported in 6 (6.7%). Mortality had significant association with bluish skin at presentation (p=0.044), severe MAS (p=0.001), and pulmonary hypertension (p=0.001). Conclusion: Vast majority of the neonates (80.4%) presented with severe MAS which should raise alarm about the time identification of these high risk neonates. The most frequently noted MAS associated complications were sepsis, hyperinflated lungs, respiratory distress, and pulmonary hypertension. At presentation, bluish skin, pulmonary hypertension, and severe MAS were significantly associated with mortality. [ABSTRACT FROM AUTHOR]

Background: The risk of perinatal death and severe neonatal morbidity increases gradually after 41 weeks of pregnancy. We evaluated maternal and perinatal outcomes after a national shift from expectancy and induction at 42+0 weeks to a more active management of late-term pregnancies in Sweden offering induction from 41+0 weeks or an individual plan aiming at birth or active labour no later than 42+0 weeks. Methods and findings: Women with a singleton pregnancy lasting 41+0 weeks or more with a fetus in cephalic presentation (N = 150,370) were included in a nationwide, register-based cohort study. Elective cesarean sections were excluded. Outcomes during period 1, January 2017 to December 2019 (before the shift) versus outcomes during period 2, January 2020 to October 1, 2023 (after the shift) were analysed. For comparison, outcomes of pregnancies lasting 39+0 to 40+6 weeks (N = 358,548) were also studied. Primary outcomes were: First, peri/neonatal death (stillbirth or neonatal death before 28 days); second, composite adverse peri/neonatal outcome (peri/neonatal death, Apgar score <4 at 5 min, hypoxic ischemic encephalopathy grades 1–3, meconium aspiration syndrome, birth trauma, or admission to a neonatal intensive care unit (NICU) ≥4 days); third, composite adverse peri/neonatal outcome excluding admission to NICU; and fourth, emergency cesarean section. Secondary outcomes included the components of the primary composite outcomes. Relative risks (RRs) with 95% confidence intervals (CIs) for binary outcomes period 2 versus period 1 were computed using modified Poisson regression analyses with adjustments for maternal age, parity, body mass index (BMI), smoking, and educational level. Induction rates among pregnancies lasting 41+0 weeks or more increased from 33.7% in period 1 to 52.4% in period 2. Mean (standard deviation) gestational age at birth decreased from 290.7 (2.9) days to 289.6 (2.3) days. Infants born during period 2 were at lower risk of peri/neonatal death compared to infants born during period 1; 0.9/1,000 versus 1.7/1,000 born infants (adjusted RR 0.52; 95% CI [0.38, 0.69]; p < 0.001), and they had a lower risk of having the composite adverse neonatal outcome, both including (50.5/1,000 versus 53.9/1,000, adjusted RR 0.92; 95% CI [0.88, 0.96]; p < 0.001) or excluding NICU admission (18.5/1,000 versus 22.5/1,000, adjusted RR 0.79; 95% CI [0.74, 0.85]; p < 0.001). The cesarean section rate increased from 10.5% in period 1 to 11.9% in period 2 (adjusted RR 1.07; 95% CI [1.04, 1.10]; p < 0.001). For births at 39 to 40 weeks the adjusted RR for peri/neonatal death was 0.86 (95% CI [0.72, 1.02]). One limitation of the study is that we had no data on to what extent monitoring of fetal health was performed. Conclusions: A more active management of pregnancies lasting 41+0 weeks or more was associated with a decrease in peri/neonatal deaths, and a decrease in composite adverse peri/neonatal outcomes. Increased rate of emergency cesarean sections was observed. Women with pregnancies advancing towards 41 gestational weeks should be given balanced information on the benefits and risks of induction of labour at 41 weeks compared to expectant management until 42 weeks and be offered induction of labour at 41 weeks or active surveillance of pregnancies from 41 weeks in order to decrease peri/neonatal mortality. Karin Källén and colleagues evaluate maternal and neonatal outcomes after a national change in the management of late-term pregnancies in Sweden, hypothesising that early induction improves perinatal outcomes. Author summary: Why was this study done?: Rare but severe outcomes such as stillbirth, perinatal mortality, and severe neonatal and maternal morbidity are more common among late- and postterm pregnancies than among full-term pregnancies. Randomised clinical trials have shown decreased perinatal mortality by labour induction of late- and postterm pregnancies while real-world observational studies have shown conflicting results after such an intervention. What did the researchers do and find?: We have performed a register-based national study, which confirms earlier randomised clinical trials, demonstrating decreased rates of peri/neonatal mortality and a composite outcome of peri/neonatal mortality and severe neonatal morbidity including birth trauma after offering pregnant women induction of labour or an individual plan from 41 instead of 42 gestational weeks. An increase in cesarean sections was also observed. What do these findings mean?: Women with pregnancies advancing towards 41 gestational weeks should be given balanced information on the benefits and risks of induction of labour at 41 weeks compared to expectant management until 42 weeks and be offered induction of labour at 41 weeks or active surveillance of pregnancies from 41 weeks in order to decrease peri/neonatal mortality. One limitation of the study is that we had no data on to what extent monitoring of fetal health was performed. [ABSTRACT FROM AUTHOR]

Preterm infants are at high risk of developing respiratory distress syndrome (RDS). Mutations in the genes encoding for surfactant proteins B and C or the ATP-binding cassette transporter A3 (ABCA3) are rare but known to be associated with severe RDS and interstitial lung diseases. The exact prevalence of these mutations in the general population is difficult to determine, as they are usually studied in connection with clinical symptoms. Most cases are not captured due to variability in expression or diagnosis. It is estimated that they affect a small percentage of the population, with mutations in ABCA3 most commonly identified in association with severe lung diseases in newborns. Even heterozygous ABCA3-mutations can increase the risk and severity of RDS in neonates. The expression of these proteins is developmentally regulated, increases with gestational age, and is crucial for the function of pulmonary surfactant at birth. Additional lung stressors, such as meconium aspiration syndrome or pulmonary infections, can lead to a complex clinical picture associated with severe courses. This case report describes an extremely preterm female infant with suspected meconium aspiration syndrome, severe RDS, Mycoplasma pneumoniae infection, and a heterozygous ABCA3-mutation. The report discusses the clinical presentation, diagnostic evaluation, and therapeutic interventions, emphasizing the complexities associated with multiple pulmonary conditions in the context of extreme prematurity. At the limits of viability, therapeutic options for severe respiratory insufficiency are limited compared to older children. The developmental neurological prognosis following prolonged relative hypoxia is a crucial factor to consider in discussions about changing treatment goals. Particularly in severe cases, pulmonary infections and genetic changes in surfactant metabolism must be considered in newborns with RDS. [ABSTRACT FROM AUTHOR]

This article discusses a rare case of Persistent Pulmonary Hypertension of the Newborn (PPHN) in a preterm neonate due to sertraline exposure during pregnancy. The neonate experienced severe respiratory distress shortly after birth, requiring invasive ventilation and various drug therapies to manage the condition. Through comprehensive diagnostics and targeted therapies, including PDA stenting, the patient's PPHN improved over time. The case underscores the importance of thorough evaluation and combined treatment approaches for optimizing outcomes in neonatal PPHN. [Extracted from the article]

Introduction: It is well known that both women with polycystic ovary syndrome (PCOS) and women with gestational diabetes mellitus (GDM) have increased risks of adverse pregnancy outcomes, but little is known whether the combination of these two conditions exacerbates the risks. We explored risk estimates for adverse pregnancy outcomes in women with either PCOS or GDM and the combination of both PCOS and GDM. Material and Methods: Nationwide register‐based historical cohort study in Sweden including women who gave birth to singleton infants during 1997–2015 (N = 281 806). The risks of adverse pregnancy outcomes were estimated for women exposed for PCOS‐only (n = 40 272), GDM‐only (n = 2236), both PCOS and GDM (n = 1036) using multivariable logistic regression analyses. Risks were expressed as odds ratios with 95% confidence intervals (CIs) and adjusted for maternal characteristics, including maternal BMI. Women with neither PCOS nor GDM served as control group. Maternal outcomes were gestational hypertension, preeclampsia, postpartum hemorrhage, and obstetric anal sphincter injury. Neonatal outcomes were preterm birth, stillbirth, shoulder dystocia, born small or large for gestational age, macrosomia, low Apgar score, infant birth trauma, cerebral impact of the infant, neonatal hypoglycemia, meconium aspiration syndrome and respiratory distress. Results: Based on non‐significant PCOS by GDM interaction analyses, we found no evidence that having PCOS adds any extra risk beyond that of having GDM for maternal and neonatal outcomes. For example, the adjusted odds ratio for preeclampsia in women with PCOS‐only were 1.18 (95% CI 1.11–1.26), for GDM‐only 1.77 (95% CI 1.45–2.15), and for women with PCOS and GDM 1.86 (95% CI 1.46–2.36). Corresponding adjusted odds ratio for preterm birth in women with PCOS‐only were 1.34 (95% CI 1.28–1.41), GDM‐only 1.64 (95% CI 1.39–1.93), and for women with PCOS and GDM 2.08 (95% CI 1.67–2.58). Women with PCOS had an increased risk of stillbirth compared with the control group (aOR 1.52, 95% CI 1.29–1.80), whereas no increased risk was noted in women with GDM (aOR 0.58, 95% CI 0.24–1.39). Conclusions: The combination of PCOS and GDM adds no extra risk beyond that of having GDM alone, for a number of maternal and neonatal outcomes. Nevertheless, PCOS is still an unrecognized risk factor in pregnancy, exemplified by the increased risk of stillbirth. [ABSTRACT FROM AUTHOR]

Objectives: To describe the prevalence, risk factors, and outcomes for neonatal air leak syndrome and its subtypes (pneumothorax, pneumomediastinum, pneumopericardium, pulmonary interstitial emphysema, and pneumoperitoneum), evaluate variables associated with the development of air leak, and analyze the national trend of neonatal air leak syndrome in the United States. Methods: A retrospective cross-sectional analysis of neonates was performed using the Kids' Inpatient Database. Univariate and multivariable analyses were used to compare neonates with and without air leak syndrome and its subtypes using the 2016 and 2019 data. Data from 1997 to 2019 were used for trend analysis. Results: Of 7.7 million neonatal discharges, 41,814 developed air leak syndrome (5.41/1,000 discharges) in 2016 and 2019, with a mortality rate of 7.2%. Pneumothorax was the most common air leak syndrome (4.3/1,000 discharges). The risk of air leak syndrome increased with decreasing gestational age on univariate analysis. On multivariable analysis, gestational age had a variable effect on developing air leaks depending on the type of air leak syndrome. The presence of meconium aspiration syndrome, congenital diaphragmatic hernia, persistent pulmonary hypertension, and the use of invasive mechanical ventilation were associated with an increased risk of air leak syndrome. There was an increased linear trend in neonatal air leak syndrome prevalence in the United States from 1997 to 2019. Conclusions: Air leak syndrome remains a serious and significant issue among the neonatal population and is associated with high morbidity and mortality. We present a national prevalence and outcomes of various neonatal air leak syndromes in the United States. [ABSTRACT FROM AUTHOR]

Background: Lungs are adversely affected by repeated exposure to thinner fumes. This study aimed to examine the pulmonary toxic effects of chronic thinner inhalation and the possible protection by chamomile administration. Adult male Wistar rats were exposed to thinner fumes for 8 weeks (4 h/day, 6 days/week), while chamomile flower extract (400 mg/kg body weight) was given orally during thinner exposure for the same period. Results: The study showed lung damage following chronic thinner exposure through increased cytochrome P2E1 (CYP2E1), superoxide anion (O2•−), hydrogen peroxide (H2O2), and malondialdehyde (MDA), with decreased antioxidant enzymes; superoxide dismutase (SOD), and catalase (CAT). Moreover, an elevation of lung enzymes; alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), and lactate dehydrogenase (LDH) with depletion in total protein and albumin contents in serum and bronchoalveolar lavage fluid were observed. Thinner exposure also exhibited increased lung deoxyribonucleic acid (DNA) damage, transforming growth factor-β1 (TGF-β1), insulin-like growth factor-1 (IGF-1), hydroxyproline (HYP), and collagen type 1 (COL-1), with decreased serum surfactant protein-A (SP-A), total and differential leukocytes (WBCs) count, except for neutrophils. Histological investigations revealed deteriorative changes along with accumulated collagen fibers affecting the lung and other respiratory organs. Conclusion: Supplementation of chamomile extract succeeded in preventing thinner-induced lung oxidative stress, enzyme leakage, surfactant deficiency, DNA damage, fibrosis, and histological injury. Therefore, consumption of chamomile extract could be recommended for alleviating thinner-induced health hazards and lung toxicity. [ABSTRACT FROM AUTHOR]

High-flow oscillatory ventilation (HFOV) is a common rescue treatment in infants and children with respiratory failure. This type of ventilation is an effective technique in numerous diseases that affect a child in the postnatal period, such as ARDS, meconium aspiration syndrome (MIS), postnatal pulmonary bleeding and idiopathic pulmonary hypertension (IPH). Although this ventilation technique is commonly recognized as a valuable therapeutic option in the general pediatric population, this is not the same for children with congenital cardiovascular diseases. The key mechanism of oscillatory ventilation is continuous positive pressure administered within the airways via a small tidal volume at high frequency. Tidal volumes are between 1 and 3 mL/kg delivered at 5–15 Hz, equivalent to 300–900 breaths per minute. A few older studies conducted on humans and animals highlight that HFOV may be dangerous for congenital heart patients. According to these evidences, hemodynamic parameters such as blood pressure, wedge pressure, central venous pressure, heart rate and inotrope level can be dangerously changed for patients with congenital heart disease; therefore, oscillatory ventilation should be avoided. Numerous retrospective studies have pointed out how oscillatory ventilation constitutes a valid therapeutic option in children with congenital heart disease. Recently, new evidences have highlighted how hemodynamic parameters are modified in a non-significant way by this type of ventilation, remaining beneficial as in the normal pediatric population. This narrative review aims to describe the mechanisms of oscillatory ventilation and collect all the available evidences to support its use in pediatric patients with congenital heart problems. [ABSTRACT FROM AUTHOR]

Introduction The relationship between e-cigarette and cigarette harm perceptions and tobacco behaviors may vary by age. We examined longitudinal associations of harm perceptions with tobacco use behaviors among adults who smoke cigarettes. Aims and Methods Data were from Waves 4 (2016–2018) and 5 (2018–2019) of the Population Assessment of Tobacco and Health survey. Weighted multivariable logistic regressions identified independent associations between relative and absolute e-cigarette and cigarette harm perceptions at baseline and continued smoking, dual use, complete switching, and quit intention at follow-up, stratified by age (young adults [YAs] 18–24, middle-aged adults [MAs] 25–44, and older adults [OAs] ≥45) among U.S. adults who smoke (n  = 8231). Results Perceiving e-cigarettes as less harmful than cigarettes was associated with higher odds of complete switching from cigarettes to e-cigarettes (adjusted odds ratio [aOR] overall: 1.52; MAs: 1.68). Perceiving e-cigarettes as very/extremely harmful was associated with lower odds of dual use (overall aOR: 0.75; MAs: 0.72) and higher odds of quit intention (aOR OAs: 1.34). Perceiving cigarettes as very/extremely harmful was associated with lower odds of continued smoking (overall aOR: 0.69; MAs: 0.76; OAs: 0.53), and higher odds of complete switching (overall aOR: 1.65; MAs: 1.86) and quit intention (overall aOR: 1.58; MAs: 1.42; OAs: 1.80). No findings reached significance for YAs. Discussion E-cigarette relative and absolute harm perceptions were associated with different tobacco behaviors by age. Low cigarette harm perceptions were similarly associated with continued smoking and lower quit intentions in MAs and OAs. Future research should explore what beliefs inform these perceptions and age-related differences. Implications The associations between harm perceptions and subsequent tobacco behaviors differed by age among adults who smoke. This study adds that low relative harm perceptions of e-cigarettes can promote complete switching among MAs who smoke. High absolute harm perceptions of e-cigarettes may deter dual use among MAs. Additionally, high absolute harm perceptions of cigarettes may reduce smoking and increase cigarette smoking quit intentions among MAs and OAs. Future research is needed to understand the beliefs that support harm perceptions among different age groups, why their effects differ by age, and what factors influence YAs' tobacco use behaviors. [ABSTRACT FROM AUTHOR]

Background: Presently, the efficacy of neonatal resuscitation techniques via interventions such as oral, nasal, and endotracheal suction for preventing meconium aspiration syndrome (MAS) after delivery has not been satisfactory. Objective: This study aimed to investigate the role of intratracheal instillation of budesonide on oxidative stress in MAS. Methods: Sixty-two neonates with MAS admitted to Huai'an Maternity and Child Healthcare Hospital from January 2018 to June 2020 were divided into a study group (intratracheal instillation of 2 ml budesonide suspension; n = 31) and a control group (intratracheal instillation of 2 ml normal saline; n = 31). Collect data from two groups of patients and evaluate clinical outcomes, including oxygenation index (OI), as well as serum total oxidant status (TOS), total antioxidant capacity (TAC), oxidative stress index (OSI) and 8-Isoprostane before treatment and 72h after admission. Results: We found no statistical differences in mortality, complication rate, total oxygen inhalation time, OI before treatment and 72h after admission between the two groups of neonates with MAS, while the duration of invasive respiratory support in the study group was significantly shorter than in the control group. Also, serum TAC, TOS, OSI and 8-isoprostane levels were not statistically different before treatment between the two groups. After 72h of admission, OSI and 8-Isoprostane in neonates with MAS in the study group were much lower than those in the control group. TOS, OSI, 8-Isoprostane in the control group and 8-Isoprostane in the study group were significantly higher than those before treatment. As for TAC and TOS, no significant differences were observed between the two groups. Conclusion: Intratracheal instillation of budesonide was shown to alleviate oxidative stress and shorten invasive ventilation time in neonates with MAS. [ABSTRACT FROM AUTHOR]

Background: Treprostinil is a prostacyclin analogue that is frequently used in the pediatric and adult population to treat pulmonary hypertension; however, it is not often a drug of choice for patients in the neonatal intensive care unit (NICU). Purpose: To evaluate the efficacy of treprostinil as a treatment for pulmonary hypertension of the neonate. Data Sources: Electronic databases such as PubMed, CINAHL, and Embase were used for this literature review. Twelve articles within the last 10 years (2014-2024) were included in this review. Study Selection: 136 articles were identified and primary research studies published in English and with patients younger than one year of age were included. Duplicates were removed and studies discussing genetics and congenital heart disease were excluded. Data Extraction: Abstracts were reviewed and articles referencing treprostinil use in the NICU were included for review. Independent extraction was completed by author. Results: Findings showed treprostinil to have a therapeutic benefit in infants with congenital diaphragmatic hernias and possibly with premature infants. Some adverse effects were noted, one of which included hypotension; however, management strategies exist to mitigate this effect. Implications for Practice and Research: Initiating treprostinil in the NICU may help decrease the severity of persistent pulmonary hypertension of the newborn (PPHN) which can help reduce neonatal morbidity and mortality. Future research is needed to determine the optimal timeframe to initiate treprostinil in the NICU; the duration of treatment; use in other conditions that can cause PPHN (i.e. meconium aspiration syndrome); and the other potential effects it may have for the preterm infant. [ABSTRACT FROM AUTHOR]

The article focuses on the case of a newborn girl who experienced cardiorespiratory arrest at delivery and was admitted to the neonatal intensive care unit (NICU). Topics include the maternal medical history and complications during pregnancy, the neonatal resuscitation process, and the management of the newborn's critical condition following birth.

Introduction: Neonatal respiratory conditions are leading causes of mortality and morbidity during the neonatal period. This review evaluated 11 management interventions for respiratory distress syndrome (RDS), apnoea of prematurity (AOP), meconium aspiration syndrome (MAS), transient tachypnea of the newborn (TTN), as well as bronchopulmonary dysplasia (BPD) as a potential complication from respiratory care in low- and middle-income countries (LMICs). Methods: Two different methodological approaches were completed: (1) updating outdated reviews and pooling all LMIC studies and (2) re-analysis of LMIC studies from up-to-date reviews. Review updates were conducted between October 2022 and February 2023 and followed systematic methodology. A total of 50 studies were included across four review updates and seven review re-analyses. Results: Findings indicate that bubble CPAP (RR 0.74, 95% CI: 0.58–0.96) and prophylactic CPAP (RR 0.39, 95% CI: 0.26–0.57) for RDS reduced the risk of treatment failure compared to other ventilation types or supportive care, respectively. Postnatal corticosteroids reduced BPD assessed as oxygen requirement at 36 weeks’ postmenstrual age (RR 0.56, 95% CI: 0.41–0.77). All other outcomes were found to be non-significant across remaining interventions. Conclusions: Our findings indicate that prophylactic and bubble CPAP may provide some benefit by reducing treatment failure compared to other pressure sources. The safety and efficacy of other management interventions for RDS, AOP, BPD, MAS, and TTN remains uncertain given limited evaluations in LMICs. Future research should conduct adequately powered trials in underrepresented LMIC regions, investigate long-term outcomes, and evaluate cost-effectiveness. [ABSTRACT FROM AUTHOR]

Introduction: Meconium aspiration syndrome (MAS) may cause severe pulmonary and neurologic injuries in affected infants after birth, leading to long-term adverse pulmonary or neurodevelopmental outcomes. Methods: This retrospective population-based cohort study enrolled 1,554,069 mother-child pairs between 2004 and 2014. A total of 8,049 infants were in the MAS-affected group, whereas 1,546,020 were in the healthy control group. Children were followed up for at least 3 years. According to respiratory support, MAS was classified as mild, moderate, and severe. With the healthy control group as the reference, the associations between MAS severity and adverse pulmonary outcomes (hospital admission, intensive care unit (ICU) admission, length of hospital stay, or invasive ventilator support during admission related to pulmonary problem) or adverse neurodevelopmental outcomes (cerebral palsy, needs for rehabilitation, visual impairment, or hearing impairment) were accessed. Results: MAS-affected infants had a higher risk of hospital and ICU admission and longer length of hospital stay, regardless of severity. Infants with severe MAS had a higher risk of invasive ventilator support during re-admission (odds ratio: 17.50, 95% confidence interval [CI]: 7.70–39.75, p < 0.001). Moderate (hazard ratio [HR]: 1.66, 95% CI: 1.30–2.13, p < 0.001) and severe (HR: 4.94, 95% CI: 4.94–7.11, p < 0.001) MAS groups had a higher risk of adverse neurodevelopmental outcome, and the statistical significance remained remarkable in severe MAS group after adjusting for covariates (adjusted HR: 2.28, 95% CI: 1.54–3.38, p < 0.001) Conclusions: Adverse pulmonary or neurodevelopmental outcomes could occur in MAS-affected infants at birth. Close monitoring and follow-up of MAS-affected infants are warranted. [ABSTRACT FROM AUTHOR]

Obesity may lead to pulmonary dysfunction through complex and incompletely understood cellular and biochemical effects. Altered lung lipid metabolism has been identified as a potential mechanism of lung dysfunction in obesity. Although murine models of obesity demonstrate changes in pulmonary surfactant phospholipid composition and function, data in humans are lacking. We measured untargeted shotgun lipidomes in two bronchoalveolar lavages (BALs) from apical and anteromedial pulmonary subsegments of 14 adult subjects (7 males and 7 females) with body mass indexes (BMIs) ranging from 24.3 to 50.9 kg/m2. The lipidome composition was characterized at the class, species, and fatty acyl/alkyl level using total lipid molecular ion signal intensities normalized to BAL protein concentration and epithelial lining fluid volumes. Multivariate analyses were conducted to identify potential changes with increasing BMI. The alveolar lipidomes contained the expected composition of surfactant-associated phospholipids, sphingolipids, and sterols in addition to cardiolipin and intracellular signaling lipid species. No significant differences in lipidomes were detected between the two BAL regions. Though a small number of lipid species were associated with BMI in multivariate analyses, no robust differences in lipidome composition or specific lipid species were identified over the range of body habitus. The magnitude of obesity alone does not substantially alter the alveolar lipidome in patients without lung disease. Differences in lung function in patients with obesity and no lung disease are unlikely related to changes in alveolar lipid composition. NEW & NOTEWORTHY: Altered lung lipid metabolism has been identified as a potential mechanism of lung dysfunction in obesity, but data in humans are lacking. We measured the alveolar lipidome in bronchoalveolar lavages from subjects with healthy lungs with a wide range of body mass index. There were no differences in lipidome composition in association with the magnitude of obesity. In patients with healthy lungs, obesity alone does not alter the alveolar lipidome. [ABSTRACT FROM AUTHOR]

Objective We aimed to determine the composite maternal hemorrhagic outcome (CMHO) among individuals with and without hypertensive disorders of pregnancy (HDP), stratified by disease severity. Additionally, we investigated the composite neonatal adverse outcome (CNAO) among individuals with HDP who had postpartum hemorrhage (PPH) versus did not have PPH. Study Design Our retrospective cohort study included all singletons who delivered at a Level IV center over two consecutive years. The primary outcome was the rate of CMHO, defined as blood loss ≥1,000 mL, use of uterotonics, mechanical tamponade, surgical techniques for atony, transfusion, venous thromboembolism, intensive care unit admission, hysterectomy, or maternal death. A subgroup analysis was performed to investigate the primary outcome stratified by (1) chronic hypertension, (2) gestational hypertension and preeclampsia without severe features, and (3) preeclampsia with severe features. A multivariable regression analysis was performed to investigate the association of HDP with and without PPH on a CNAO which included APGAR <7 at 5 minutes, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, seizures, neonatal sepsis, meconium aspiration syndrome, ventilation >6 hours, hypoxic–ischemic encephalopathy, or neonatal death. Results Of 8,357 singletons, 2,827 (34%) had HDP. Preterm delivery <37 weeks, induction of labor, prolonged oxytocin use, and magnesium sulfate usage were more common in those with versus without HDP (p < 0.001). CMHO was higher among individuals with HDP than those without HDP (26 vs. 19%; adjusted relative risk [aRR] = 1.11, 95% CI: 1.01–1.22). In the subgroup analysis, only individuals with preeclampsia with severe features were associated with higher CMHO (n = 802; aRR = 1.52, 95% CI: 1.32–1.75). There was a higher likelihood of CNAO in individuals with both HDP and PPH compared to those with HDP without PPH (aRR = 1.49, 95% CI: 1.06–2.09). Conclusion CMHO was higher among those with HDP. After stratification, only those with preeclampsia with severe features had an increased risk of CMHO. Among individuals with HDP, those who also had a PPH had worse neonatal outcomes than those without hemorrhage. Key Points Individuals with HDP had an 11% higher likelihood of CMHO. After stratification, increased CMHO was limited to those with preeclampsia with severe features. There was a higher likelihood of CNAO in those with both HDP and PPH compared to HDP without PPH. [ABSTRACT FROM AUTHOR]

PPHN is a common cause of neonatal respiratory failure and is still a serious condition that is associated with high mortality. Objectives: To analyze the clinical characteristics and outcomes of SARS-CoV-2 infection in neonates with PPHN to identify neonatal cases at risk to develop severe illness. Methods: For this systematic review, we adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, Embase, CINAHL, and PubMed for studies on the development of COVID-19 in neonates with PPHN, published from 1 December 2019 to 29 February 2024, with an English language restriction. Results: Of the 2406 papers that were identified, 21 articles were included in the systematic review. Studies involving thirty-six neonates with PPHN and infected with SARS-CoV-2 were analyzed (twenty-nine survived, six died, and one is still hospitalized). The main causes of PPHN in neonates who had COVID-19 were neonatal respiratory distress syndrome (NRDS) (41.7%), meconium-stained amniotic fluid (MSAF) (16.7%), preterm premature rupture of membranes (PPROM) (11.1%), hypoxic ischemic encephalopathy (HIE) (5.5%), pneumonia (5.5%), and idiopathic (2.8%). Most of those neonates were male (33.3%), belonged to Indian ethnicity (50%), and were delivered via caesarean section (44.4%). COVID-19 in cases with PPHN commonly occurred in neonates born with a pregnancy range from 32 to <37 weeks (moderate to late preterm) (36.1%). The maternal severity of COVID-19 was reported to be severe in three cases only (8.3%); however, SARS-CoV-2 infection in neonates with PPHN was either severe (44.4%) or critical (22.2%). Most of these neonates experienced acute respiratory distress syndrome (ARDS) (58.3%). Early and late multisystem inflammatory syndrome in neonates (MIS-N) were reported in 50% and 11.1%, respectively. A high proportion of neonates were admitted to the intensive care unit (ICU) (58.3%) or needed mechanical ventilation (MV) (47.2%). Neonates with concurrent PPHN and SARS-CoV-2 infection who died had worse severity of COVID-19 [i.e., severity of COVID-19 was critical in 10% (neonates with PPHN who survived group) vs. 83.3% (neonates with PPHN who died group); p = 0.026]. Neonates with PPHN and COVID-19 had a higher relative risk of death if they received more antibiotics (RR 4.14, 95% CI 0.64–6.88) and if their COVID-19 was defined as critical (RR 2.84, 95% CI 0.86–9.39). Male neonates with PPHN and COVID-19 (RR 2.60, 95% CI 0.30–1.17) and those requiring prolonged invasive positive pressure ventilation (RR 2.22, 95% CI 0.64–7.73) also showed an increased relative risk for death. Conclusions: COVID-19 in neonates with PPHN is challenging and may be associated with increased mortality, severity, ICU admission, ARDS, MIS-N, and MV usage. The results should be interpreted with caution owing to the small number of studies and substantial heterogeneity and indicate a need for future research in this area. Due to its benefits, testing for SARS-CoV-2 should be encouraged for newborns with symptoms consistent with COVID-19, especially in neonates with a history of SARS-CoV-2 exposure. Effective protection measures should be implemented during delivery and post-delivery care as necessary. [ABSTRACT FROM AUTHOR]

Objective: To explore the high-risk factors for neonatal pulmonary hemorrhage and analyze the therapeutic effect of high-frequency oscillatory ventilation on neonatal pulmonary hemorrhage. Method: 100 newborns with pulmonary hemorrhage admitted from January 2021 to December 2023 were selected as the observation group, and 100 healthy newborns were selected as the control group. The independent influencing factors of the high risk of neonatal pulmonary hemorrhage were analyzed. Subsequently, 100 newborns with pulmonary hemorrhage were randomly divided into two groups: the conventional group received conventional mechanical ventilation, and the high-frequency group received high-frequency oscillatory ventilation. Compare the relevant indicators between two groups of pediatric patients. Results: Premature infants, intrauterine distress, meconium aspiration, concurrent infectious pneumonia, neonatal asphyxia, and respiratory distress syndrome are independent factors for the onset of neonatal pulmonary hemorrhage (P<0.05); At T2, T3, and T4, both groups of children showed a decrease in Ol and PaCO2, with the high-frequency group lower than the conventional group and an increase in PaO2, with the high-frequency group higher than the conventional group (P<0.05); The incidence of complications in the high-frequency group was significantly lower than that in the conventional group (P<0.05). Conclusion: Premature infants, intrauterine distress, meconium aspiration, concurrent infectious pneumonia, neonatal asphyxia, and respiratory distress syndrome are independent risk factors for neonatal pulmonary hemorrhage. Key monitoring measures should be taken to prevent the occurrence of pulmonary hemorrhage. For newborns with pulmonary hemorrhage, high-frequency oscillatory ventilation treatment can be adopted to improve their blood gas indicators and prognosis, and reduce the incidence of complications. [ABSTRACT FROM AUTHOR]

Background: Preterm birth is the leading cause of childhood mortality, and respiratory distress syndrome is the predominant cause of these deaths. Early continuous positive airway pressure is effective in high-resource settings, reducing the rate of continuous positive airway pressure failure, and the need for mechanical ventilation and surfactant. However, most deaths in preterm infants occur in low-resource settings without access to mechanical ventilation or surfactant. We hypothesize that in such settings, early continuous positive airway pressure will reduce the rate of failure and therefore preterm mortality. Methods: This is a mixed methods feasibility and acceptability, single-center pilot randomized control trial of early continuous positive airway pressure among infants with birthweight 800–1500 g. There are two parallel arms: (i) application of continuous positive airway pressure; with optional oxygen when indicated; applied in the delivery room within 15 min of birth; transitioning to bubble continuous positive airway pressure after admission to the neonatal unit if Downes Score ≥ 4 (intervention), (ii) supplementary oxygen at delivery when indicated; transitioning to bubble continuous positive airways pressure after admission to the neonatal unit if Downes Score ≥ 4 (control). A two-stage consent process (verbal consent during labor, followed by full written consent within 24 h of birth) and a low-cost third-party allocation process for randomization will be piloted. We will use focus group discussions and key informant interviews to explore the acceptability of the intervention, two-stage consent process, and trial design. We will interview healthcare workers, mothers, and caregivers of preterm infants. Feasibility will be assessed by the proportion of infants randomized within 15 min of delivery; the proportion of infants in the intervention arm receiving CPAP within 15 min of delivery; and the proportion of infants with primary and secondary outcomes measured successfully. Discussion: This pilot trial will enhance our understanding of methods and techniques that can enable emergency neonatal research to be carried out effectively, affordably, and acceptably in low-resource settings. This mixed-methods approach will allow a comprehensive exploration of parental and healthcare worker perceptions, experiences, and acceptance of the intervention and trial design. Trial registration: The study is registered on the Pan African Clinical Trials Registry (PACTR) PACTR202208462613789. Registered 08 August 2022. https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23888. [ABSTRACT FROM AUTHOR]

Background: The evaluation and management of neonatal respiratory pathologies require precise and careful diagnostic approaches, particularly in preterm infants who are at higher risk of respiratory complications. This research compares lung ultrasound (LUS) and chest X-ray for diagnosing and monitoring respiratory conditions in preterm and term neonates. Methods: We conducted a prospective analysis of the imaging practices for neonatal respiratory pathologies in a cohort of 82 preterm and term infants with a gestational age ranging from 31-41 weeks presenting with respiratory distress syndrome (RDS) diagnostically categorized based on clinical and paraclinical investigations, who were admitted to the neonatal intensive care unit (NICU) immediately after birth. Results: The most common diagnosis was moderate RDS, which affected 17 neonates, followed by moderate transient tachypnea of the newborn (TTN) in 16 patients, severe RDS in 14 patients and meconium aspiration syndrome (MAS) in 12 patients. Additionally, seven patients presented with mild RDS and six were diagnosed with congenital pneumonia. There were four cases of severe TTN, four cases of mild TTN and only two cases of pneumothorax. This study identified the ultrasound and radiological findings and aimed to highlight the current trend in the evaluation and management of respiratory conditions in preterm and term neonates. The results demonstrate an increasing trend in the use of ultrasound due to its advantages, especially in preterm patients who are at higher risk of respiratory impairment. Conclusion: The benefits of ultrasound, including absence of radiation and dynamic imaging capabilities, make it a valuable tool for ongoing assessment and management. While X-rays remain an important imaging tool in certain clinical scenarios, their use should be judicious to minimize radiation exposure. These findings support the continued integration of ultrasound in neonatal practice and suggest further research into optimizing imaging protocols to improve long-term outcomes for neonates. [ABSTRACT FROM AUTHOR]

This article provides information on several neonatal emergencies that can occur within the first week of life. It covers conditions such as respiratory distress syndrome, congenital heart defects, sepsis, duodenal atresia, vitamin K deficiency bleeding, necrotizing enterocolitis, intestinal malrotation, and congenital adrenal hyperplasia. The article emphasizes the importance of prompt diagnosis, management, and treatment for these emergencies. It also highlights the significance of recognizing and transferring cases of congenital heart disease to a pediatric center, the need for immediate surgical intervention in cases of malrotation and volvulus, and the importance of prompt diagnosis and supportive measures for intestinal atresia. Additionally, the article discusses the symptoms, diagnosis, and treatment options for congenital adrenal hyperplasia. It also mentions other neonatal emergencies such as neonatal sepsis, neonatal hypoglycemia, and neonatal hyperbilirubinemia, emphasizing the importance of early detection and treatment for these conditions. [Extracted from the article]

This document provides concise summaries of various research studies on different topics. The studies cover a range of subjects, including the effects of exercise on breast cancer patients, the role of a protein in hypertension, and the effects of hypoxia on the heart and skeletal muscle. Other studies explore topics such as the effects of lauric acid on diabetic rats, the assessment of VO2max in triathletes, and the effects of nano/microplastics on leukocyte behavior in mice. [Extracted from the article]

A thin film of pulmonary surfactant lines the surface of the airways and alveoli, where it lowers the surface tension in the peripheral lungs, preventing collapse of the bronchioles and alveoli and reducing the work of breathing. It also possesses a barrier function for maintaining the blood-gas interface of the lungs and plays an important role in innate immunity. The surfactant film covers the epithelium lining both large and small airways, forming the first line of defense between toxic airborne particles/pathogens and the lungs. Furthermore, surfactant has been shown to relax airway smooth muscle (ASM) after exposure to ASM agonists, suggesting a more subtle function. Whether surfactant masks irritant sensory receptors or interacts with one of them is not known. The relaxant effect of surfactant on ASM is absent in bronchial tissues denuded of an epithelial layer. Blocking of prostanoid synthesis inhibits the relaxant function of surfactant, indicating that prostanoids might be involved. Another possibility for surfactant to be active, namely through ATP-dependent potassium channels and the cAMP-regulated epithelial chloride channels [cystic fibrosis transmembrane conductance regulators (CFTRs)], was tested but could not be confirmed. Hence, this review discusses the mechanisms of known and potential relaxant effects of pulmonary surfactant on ASM. This review summarizes what is known about the role of surfactant in smooth muscle physiology and explores the scientific questions and studies needed to fully understand how surfactant helps maintain the delicate balance between relaxant and constrictor needs. [ABSTRACT FROM AUTHOR]

The presence of meconium-stained amniotic fluid (MSAF) is a critical indicator of fetal distress, associated with increased neonatal morbidity and mortality. The aim of this study was to evaluate the potential of maternal blood parameters to predict the presence of meconium-stained amniotic fluid (MSAF) in term pregnancies. Data were retrospectively analyzed from healthy pregnant women who presented to Samsun Education and Research Hospital between 2014 and 2023 and delivered either by normal spontaneous delivery or cesarean section. The study included healthy pregnant women aged 18 and over who gave birth between 37 and 42 weeks of gestation. The non-invasive laboratory parameters investigated were neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SIRI), aggregate index of systemic inflammation (AISI), and procalcitonin levels. Results showed that NLR, MLR, SIRI, AISI, and procalcitonin levels were significantly higher in the MSAF group. The ROC curve analysis demonstrated that SIRI (cutoff: 3.55) had an AUC of 0.826 (sensitivity: 89.2%, specificity: 71.8%). AISI (cutoff: 1340.39) had an AUC of 0.749 (sensitivity: 75.8%, specificity: 70.9%). NLR (cutoff: 3.58) showed an AUC of 0.757 (sensitivity: 87.5%, specificity: 56.3%). MLR (cutoff: 0.55) presented an AUC of 0.822 (sensitivity: 87.5%, specificity: 74.8%). However, SII demonstrated negligible and statistically non-significant diagnostic value. PLR and procalcitonin exhibited lower diagnostic efficacy. This study demonstrates that NLR, MLR, SIRI, AISI, and procalcitonin are effective non-invasive biomarkers for predicting the presence of MSAF in term pregnancies. These parameters can assist clinicians in anticipating fetal distress and the risk of meconium aspiration syndrome (MAS), thereby improving perinatal outcomes through timely intervention. [ABSTRACT FROM AUTHOR]

Background: PPHN is a common cause of neonatal respiratory failure and is still a serious condition and associated with high mortality. Objectives: To compare the demographic variables, clinical characteristics, and treatment outcomes in neonates with PHHN who underwent ECMO and survived compared to neonates with PHHN who underwent ECMO and died. Methods: We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline and searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus and Nature for studies on the development of PPHN in neonates who underwent ECMO, published from January 1, 2010 to May 31, 2023, with English language restriction. Results: Of the 5689 papers that were identified, 134 articles were included in the systematic review. Studies involving 1814 neonates with PPHN who were placed on ECMO were analyzed (1218 survived and 594 died). Neonates in the PPHN group who died had lower proportion of normal spontaneous vaginal delivery (6.4% vs 1.8%; p value > 0.05) and lower Apgar scores at 1 min and 5 min [i.e., low Apgar score: 1.5% vs 0.5%, moderately abnormal Apgar score: 10.3% vs 1.2% and reassuring Apgar score: 4% vs 2.3%; p value = 0.039] compared to those who survived. Neonates who had PPHN and died had higher proportion of medical comorbidities such as omphalocele (0.7% vs 4.7%), systemic hypotension (1% vs 2.5%), infection with Herpes simplex virus (0.4% vs 2.2%) or Bordetella pertussis (0.7% vs 2%); p = 0.042. Neonates with PPHN in the death group were more likely to present due to congenital diaphragmatic hernia (25.5% vs 47.3%), neonatal respiratory distress syndrome (4.2% vs 13.5%), meconium aspiration syndrome (8% vs 12.1%), pneumonia (1.6% vs 8.4%), sepsis (1.5% vs 8.2%) and alveolar capillary dysplasia with misalignment of pulmonary veins (0.1% vs 4.4%); p = 0.019. Neonates with PPHN who died needed a longer median time of mechanical ventilation (15 days, IQR 10 to 27 vs. 10 days, IQR 7 to 28; p = 0.024) and ECMO use (9.2 days, IQR 3.9 to 13.5 vs. 6 days, IQR 3 to 12.5; p = 0.033), and a shorter median duration of hospital stay (23 days, IQR 12.5 to 46 vs. 58.5 days, IQR 28.2 to 60.7; p = 0.000) compared to the neonates with PPHN who survived. ECMO-related complications such as chylothorax (1% vs 2.7%), intracranial bleeding (1.2% vs 1.7%) and catheter-related infections (0% vs 0.3%) were more frequent in the group of neonates with PPHN who died (p = 0.031). Conclusion: ECMO in the neonates with PPHN who failed supportive cardiorespiratory care and conventional therapies has been successfully utilized with a neonatal survival rate of 67.1%. Mortality in neonates with PPHN who underwent ECMO was highest in cases born via the caesarean delivery mode or neonates who had lower Apgar scores at birth. Fatality rate in neonates with PPHN who underwent ECMO was the highest in patients with higher rate of specific medical comorbidities (omphalocele, systemic hypotension and infection with Herpes simplex virus or Bordetella pertussis) or cases who had PPHN due to higher rate of specific etiologies (congenital diaphragmatic hernia, neonatal respiratory distress syndrome and meconium aspiration syndrome). Neonates with PPHN who died may need a longer time of mechanical ventilation and ECMO use and a shorter duration of hospital stay; and may experience higher frequency of ECMO-related complications (chylothorax, intracranial bleeding and catheter-related infections) in comparison with the neonates with PPHN who survived. [ABSTRACT FROM AUTHOR]

Background: Small (SGA) and large (LGA) for gestational age infants have higher risks of infant morbidity when compared to those who are appropriate for gestational age (AGA). Increasing pre-pregnancy maternal BMI and gestational weight gain (GWG) are associated with higher risks of LGA and lower risks of SGA infants; however, their direct effects on infant morbidity are unknown. Therefore, we intended to 1) assess how maternal pre-pregnancy BMI, GWG, and birthweight (categorized as SGA, AGA or LGA) affect infant morbidity and 2) estimate at entry of care the risk of infant morbidity according to pre-pregnancy BMI and possible GWG. Methods: we used Consortium on Safe Labor data, a retrospective observational cohort study collecting pregnancy and birth data from 2002 to 2008 in 12 US centers. The association between maternal BMI, GWG and infant morbidity was estimated in singleton gestations delivering ≥ 37 weeks using binomial logistic regression. Hypoxic composite neonatal morbidity was defined as any the following: stillbirth, neonatal death, resuscitation at birth, NICU admission, intracranial hemorrhage, PVH grade III and IV, neonatal seizures, NEC, meconium aspiration, CPAP or mechanical ventilation, RDS, and sepsis. Traumatic composite neonatal morbidity included shoulder dystocia or birth injuries. Results: In this study of 110,594 mother-infant dyads, a total of 8,369 (7.6%) infants experienced hypoxic, while 2,134 (1.9%) developed traumatic morbidity. The risk of hypoxic morbidity among SGA, AGA and LGA infants increased when mothers were overweight (aOR 1.26 [95%CI 1.18–1.34]) or obese (class 1: aOR 1.3 [1.2–1.4]; class 2: aOR 1.7 [1.5–1.9]; class 3: aOR 1.8 [1.6–2]) as opposed to normal weight, and when GWG exceeded (aOR 1.08 [1.02–1.014]) rather than remained within recommendations. The risk of traumatic morbidity increased with maternal obesity (class 1: aOR 1.3 [1.1–1.5]), whilst it dropped with GWG below recommendations (aOR 0.7 [0.6–0.8]). The risk of hypoxic events estimated at entry of care increased with maternal overweight (aOR 1.27 [1.19–1.35]) or obesity (class 1: aOR 1.4 [1.2–1.5]; class 2: aOR 1.7 [1.5–1.9]; class 3: aOR 1.8 [1.6–2.1]), and with possible GWG above (aOR 1.09 [1.03–1.015]) recommendations. The risk of traumatic morbidity increased with overweight (aOR 1.1 [1–1.3]) or obesity (class 1: aOR 1.4 [1.2–1.6]; class 2: aOR 1.3 [1–1.6]), with possible GWG above (aOR 1.2 [1–1.3]), as opposed to below recommendations (aOR 0.7 [0.6–0.8]). Conclusions: While maternal pre-pregnancy BMI and GWG equally affected traumatic morbidity, the former had a greater impact on hypoxic complications. Therefore, weight control prior to pregnancy is at least as effective as avoiding excessive gestational weight gain to prevent neonatal morbidity. [ABSTRACT FROM AUTHOR]

Objective:To explore the application effect of closed thoracic drainage tube combined with high-frequency oscillatory ventilation on neonatal meconium aspiration syndrome with respiratory failure. Methods:Sixty newborns with meconium aspiration syndrome and respiratory failure admitted to our hospital from January 2018 to January 2024 were selected. They were divided into an observation group and a matched group, with 30 cases. Children in the matched group adopted conventional mechanical ventilation and chest closed drainage, and children in the children in the observation group adopted chest closed drainage tube combined with high-frequency oscillatory ventilation to compare relevant indicators. Results:The total response rate in the observation group was high compared with the matched group (P＜0. 05); Before treatment, there was no significant difference in the pH value, PaCO2, SaO2, and PaO2 levels between the two groups of children (P＞0. 05). Post-treatment, PaCO2 decreased, and pH, SaO2 and PaO2 increased in the two groups, with the same trend compared with the control group (P＜0. 05); There was no difference in MAP and HR between the two groups of children before and Post-treatment (P＞0. 05); There was no difference in the incidence of complications between the two groups of children (P＞0. 05); Before treatment, there was no difference in MAP and HR between the two groups of children (P＞0. 05). Post-treatment, the MAP of the two groups of children increased, and the observation group was higher than the matched group, while HR decreased. The observation group was higher than the matched group (P＜0. 05); There was no difference in the incidence of complications between the two groups of children (P＞0. 05). Conclusion: For newborns with meconium aspiration syndrome combined with respiratory failure and pneumothorax, the use of closed thoracic drainage combined with high-frequency oscillatory ventilation can improve clinical efficacy, improve blood gas indicators, stabilize vital signs, and have high safety. [ABSTRACT FROM AUTHOR]

Administration of oxygen microbubbles (OMBs) has been shown to increase oxygen and decrease carbon dioxide in systemic circulation, as well as reduce lung inflammation and promote survival in preclinical models of hypoxia caused by lung injury. However, their impact on microenvironmental oxygenation remains unexplored. Herein, we investigated the effects of intraperitoneal administration of OMBs in anesthetized rats exposed to hypoxic ventilation (FiO2 = 0.14). Blood oxygenation and hemodynamics were evaluated over a 2 h time frame, and then organ and tissue samples were collected for hypoxic and metabolic analyses. Data showed that OMBs improved blood SaO2 (~14%) and alleviated tissue hypoxia within the microenvironment of the kidney and intestine at 2 h of hypoxia. Metabolomic analysis revealed OMBs induced metabolic differences in the cecum, liver, kidney, heart, red blood cells and plasma. Within the spleen and lung, principal component analysis showed a metabolic phenotype more comparable to the normoxic group than the hypoxic group. In the spleen, this shift was characterized by reduced levels of fatty acids and 2-hydroxygluterate, alongside increased expression of antioxidant enzymes such as glutathione and hypoxanthine. Interestingly, there was also a shuttle effect within the metabolism of the spleen from the tricarboxylic acid cycle to the glycolysis and pentose phosphate pathways. In the lung, metabolomic analysis revealed upregulation of phosphatidylethanolamine and phosphatidylcholine synthesis, indicating a potential indirect mechanism through which OMB administration may improve lung surfactant secretion and prevent alveolar collapse. In addition, cell-protective purine salvage was increased within the lung. In summary, oxygenation with intraperitoneal OMBs improves systemic blood and local tissue oxygenation, thereby shifting metabolomic profiles of the lung and spleen toward a healthier normoxic state. [ABSTRACT FROM AUTHOR]

Objective: To evaluate obstetric and perinatal outcomes among small for gestational age (SGA) infants born to patients diagnosed with Gestational diabetes mellitus (GDM). Materials and methods: A multicenter retrospective cohort study between 2005 and 2021. The perinatal outcomes of SGA infants born to patients with singleton pregnancy and GDM were compared to SGA infants born to patients without GDM. The primary outcome was a composite adverse neonatal outcome. Infants with known structural/genetic abnormalities or infections were excluded. A univariate analysis was conducted followed by a multivariate analysis (adjusted odds ratio [95% confidence interval]). Results: During the study period, 11,662 patients with SGA infants met the inclusion and exclusion criteria. Of these, 417 (3.6%) SGA infants were born to patients with GDM, while 11,245 (96.4%) were born to patients without GDM. Overall, the composite adverse neonatal outcome was worse in the GDM group (53.7% vs 17.4%, p < 0.01). Specifically, adverse neonatal outcomes such as a 5 min Apgar score < 7, meconium aspiration, seizures, and hypoglycemia were independently associated with GDM among SGA infants. In addition, patients with GDM and SGA infants had higher rates of overall and spontaneous preterm birth, unplanned cesarean, and postpartum hemorrhage. In a multivariate logistic regression assessing the association between GDM and neonatal outcomes, GDM was found to be independently associated with the composite adverse neonatal outcome (aOR 4.26 [3.43–5.3]), 5 min Apgar score < 7 (aOR 2 [1.16–3.47]), meconium aspiration (aOR 4.62 [1.76–12.13]), seizures (aOR 2.85 [1.51–5.37]) and hypoglycemia (aOR 16.16 [12.79–20.41]). Conclusions: Our study demonstrates that GDM is an independent risk factor for adverse neonatal outcomes among SGA infants. This finding underscores the imperative for tailored monitoring and management strategies in those pregnancies. [ABSTRACT FROM AUTHOR]

Background: To evaluate the safety and efficacy of 2.5 and 1.25 mg nebulized salbutamol on Transient Tachypnea of the Newborn (TTN) compared with placebo. Methods: We conducted a triple-blind, phase II/III parallel randomized controlled trial in two university-affiliated hospitals with neonatal intensive care units. Newborns with a confirmed diagnosis of TTN, with gestational age >35 weeks and gestational weight >2 kg were included. Cases of asphyxia, meconium aspiration syndrome, and persistent pulmonary hypertension were excluded. Ninety eligible patients were randomly allocated in three intervention groups (2.5 mg salbutamol, 1.25 mg salbutamol, and placebo), and a single-dose nebulized product was prescribed 6 hours after the birth. Safety outcomes included postintervention tachycardia, hyperglycemia, hypokalemia, and changes in blood pressure. To evaluate the efficacy, the duration of postintervention tachypnea, TTN clinical score, and clinical and paraclinical respiratory indices were assessed. Parents, Outcome assessors, and data analyzer were blind to the intervention. Results: There was no adverse reaction, including tachycardia, hypokalemia, and jitteriness. Both groups of salbutamol recipients showed significant improvement regarding respiratory rate, TTN clinical score, and oxygenation indices compared with the placebo (p-values <0.001). Nonstatistically significant higher hospital stay was observed in the placebo group. Single 2.5 mg salbutamol nebulization showed a little better outcome than the dose of 1.25 mg, although we could not find statistical superiority. Conclusion: The newly applied single high dose of 2.5 mg nebulized salbutamol is safe in treating TTN and leads to notable faster improvement of respiratory status without any considerable adverse reaction. Registry code: IRCT20190328043133N1. [ABSTRACT FROM AUTHOR]

This article explores the challenges of studying the effects of elective induction of labor (eIOL) compared to expectant management (EM) during pregnancy. The authors discuss the methodological issues in comparing outcomes between the two approaches due to differences in time at risk. They highlight the findings of the ARRIVE study, which found associations between eIOL and neonatal morbidity and caesarean birth, but stress the importance of considering time at risk when interpreting these results. The article suggests using measures of frequency that account for varying times at risk to enable valid comparisons and calls for further research to determine the best approach for comparing outcomes between eIOL and EM. [Extracted from the article]

Background: Globally, 2.6 million stillbirths are estimated to occur each year. The causes of stillbirth are often unknown but can be attributed to various causes. Therefore, identifying the determinants of stillbirth is quite important for applying further meaningful interventions. The purpose of this study was to identify the determinants of stillbirth among deliveries conducted at selected public hospitals in the West Shoa Zone, Oromia, Ethiopia. Methods: A hospital-based unmatched case‒control study with a 1:4 ratio was conducted. A total of 431 (87 cases and 344 controls) participants were involved. A systematic random sampling method was used for control selection. Data were collected using interview administered questionnaire and analysed using SPSS version 26 software. Binary logistic regression analyses were performed for the independent variables and outcome variables. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated to assess the strength of the associations, and statistical significance was declared at P value < 0.05. Results: In this study, 428 mothers who delivered (85 patients and 343 controls) participated, for a 99.3% response rate. Preeclampsia/eclampsia (AOR = 13.43, 95% CI: 5.67–31.82), other health conditions (AOR = 5.39, 95% CI: 2.34–12.46), mal-presentation (AOR = 3.42, 95% CI: 1.50–7.76), umbilical cord accidents (AOR = 2.57, 95% CI: 1.11–5.93), meconium-stained amniotic fluid problems (AOR = 5.01, 95% CI: 2.15–11.67) and low birth weight (AOR = 2.91, 95% CI: 1.28–6.59) were identified as determinant variables of stillbirth. Conclusions: Low birth weight, referral status, meconium-stained amniotic fluid problems, umbilical cord accidents, mal-presentation and preeclampsia/eclampsia were identified as independent determinants of stillbirth. Therefore, hospitals and health workers are recommended to focus on identifying and preventing these factors. [ABSTRACT FROM AUTHOR]

Objective This study aimed to evaluate the effect of the 2015 Neonatal Resuscitation Program recommendations of no routine endotracheal suctioning for nonvigorous neonates on the incidence of meconium aspiration syndrome (MAS) and death. We hypothesized that the revised guidelines have not changed the outcome of MAS/death. Study Design This was a single-center retrospective cohort study. We recorded data on nonvigorous neonates born at gestational age > 37 weeks, who were divided into period 1, n = 95 (before the new guidelines, January 1, 2013–December 31, 2015) and prospective period 2, n = 91 (after the implementation of new guidelines, January 1, 2017–December 31, 2020). Primary outcomes included MAS and death. Secondary outcomes included respiratory neonatal intensive care unit (NICU) admission, length of NICU stay, and feeding difficulties. Results No significant differences in the occurrence of MAS (11 vs. 17%) (odds ratio [OR] of 1.46 [95% confidence interval [CI]: 0.59–3.55]) or death (1 vs. 3%) (OR of 2.00 [95% CI: 0.18–21.57]) among the two periods were observed. In period 2, there was an increased NICU respiratory admission (37 vs. 61%), with an OR of 2.31 (95% CI: 1.10–4.84). More neonates in period 2 required subsequent intubation for respiratory failure in the delivery room (12 vs. 28%) with an OR of 2.03 (95% CI: 1.02–4.51); p -value of 0.05. Conclusion Our study did not observe a significant difference in the incidence of MAS or death between the two periods since the 2015 guidelines. However, the incidence of NICU respiratory admission increased. Key Points Nonvigorous neonates born through MSAF who did not undergo ET suctioning soon after birth did not have increased incidence of MAS or death, but had increased NICU respiratory admissions. A large Multi-center RCT may give more clear verdict on the outcomes of these newborns. [ABSTRACT FROM AUTHOR]

Lung type 2 pneumocytes (T2Ps) and alveolar macrophages (AMs) play crucial roles in the synthesis, recycling and catabolism of surfactant material, a lipid/protein fluid essential for respiratory function. The liver X receptors (LXR), LXRα and LXRβ, are transcription factors important for lipid metabolism and inflammation. While LXR activation exerts anti-inflammatory actions in lung injury caused by lipopolysaccharide (LPS) and other inflammatory stimuli, the full extent of the endogenous LXR transcriptional activity in pulmonary homeostasis is incompletely understood. Here, using mice lacking LXRα and LXRβ as experimental models, we describe how the loss of LXRs causes pulmonary lipidosis, pulmonary congestion, fibrosis and chronic inflammation due to defective de novo synthesis and recycling of surfactant material by T2Ps and defective phagocytosis and degradation of excess surfactant by AMs. LXR-deficient T2Ps display aberrant lamellar bodies and decreased expression of genes encoding for surfactant proteins and enzymes involved in cholesterol, fatty acids, and phospholipid metabolism. Moreover, LXR-deficient lungs accumulate foamy AMs with aberrant expression of cholesterol and phospholipid metabolism genes. Using a house dust mite aeroallergen-induced mouse model of asthma, we show that LXR-deficient mice exhibit a more pronounced airway reactivity to a methacholine challenge and greater pulmonary infiltration, indicating an altered physiology of LXR-deficient lungs. Moreover, pretreatment with LXR agonists ameliorated the airway reactivity in WT mice sensitized to house dust mite extracts, confirming that LXR plays an important role in lung physiology and suggesting that agonist pharmacology could be used to treat inflammatory lung diseases. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate the diverse etiologies leading to the need for mechanical ventilation in neonates and to analyze the outcomes associated with this intervention. Materials and Methods: A prospective observational study was conducted on a cohort of 60 neonates admitted to the neonatal intensive care unit (NICU) at Gandhi Hospital during a specified period. Data were collected from medical records, including demographic information, clinical presentation, and diagnostic findings. Etiologies necessitating mechanical ventilation were categorized, and relevant clinical parameters were assessed. Outcomes such as survival rates, duration of ventilation, and potential complications were analyzed. Results: The study included a total of 60 neonates who required mechanical ventilation during the study period. The primary etiologies identified encompassed a range of conditions including respiratory distress syndrome (RDS), meconium aspiration syndrome (MAS), congenital anomalies, sepsis, and neurological disorders. Each etiology was further analyzed for its contribution to the need for mechanical ventilation and associated outcomes. The outcomes revealed varying survival rates among different etiological groups. Additionally, the duration of mechanical ventilation was assessed, and potential complications such as ventilator-associated pneumonia, bronchopulmonary dysplasia, and intraventricular hemorrhage were investigated. Conclusion: This study sheds light on the intricate web of etiological factors leading to mechanical ventilation in neonates and provides valuable insights into the associated outcomes. Understanding the diverse challenges faced by neonates requiring mechanical ventilation is crucial for improving clinical management strategies and ultimately enhancing the overall care and survival rates of this vulnerable population. The findings of this study contribute to the existing body of knowledge on neonatal care and may guide future research and clinical practices in the field of neonatology [ABSTRACT FROM AUTHOR]

Although pulmonary embolism (PE) is a frequent complication in COVID-19, its consequences remain unknown. We performed pulmonary function tests, echocardiography and computed tomography pulmonary angiography and identified blood biomarkers in a cohort of consecutive hospitalized COVID-19 patients with pneumonia to describe and compare medium-term outcomes according to the presence of PE, as well as to explore their potential predictors. A total of 141 patients (56 with PE) were followed up during a median of 6 months. Post-COVID-19 radiological lung abnormalities (PCRLA) and impaired diffusing capacity for carbon monoxide (DLCOc) were found in 55.2% and 67.6% cases, respectively. A total of 7.3% had PE, and 6.7% presented an intermediate–high probability of pulmonary hypertension. No significant difference was found between PE and non-PE patients. Univariate analysis showed that age > 65, some clinical severity factors, surfactant protein-D, baseline C-reactive protein, and both peak red cell distribution width and Interleukin (IL)-10 were associated with DLCOc < 80%. A score for PCRLA prediction including age > 65, minimum lymphocyte count, and IL-1β concentration on admission was constructed with excellent overall performance. In conclusion, reduced DLCOc and PCRLA were common in COVID-19 patients after hospital discharge, but PE did not increase the risk. A PCRLA predictive score was developed, which needs further validation. [ABSTRACT FROM AUTHOR]

The article presents a case study of a newborn admitted to a small community medical center with complications following delivery. Topics include the mother's prenatal challenges and the diagnosis of placental abruption, the newborn's critical condition with evidence of meconium aspiration and respiratory distress, and the delayed response in care that led to the eventual need for intubation and transport to a more advanced facility.

Objective The International Liaison Committee on Resuscitation (ILCOR) 2015 gave a weak recommendation based on low certainty of evidence against routine endotracheal (ET) suctioning in non-vigorous (NV) neonates born through meconium-stained amniotic fluid (MSAF) and suggested for immediate resuscitation without direct laryngoscopy. A need for ongoing surveillance post policy change has been stressed upon. This study compared the outcomes of NV MSAF neonates before and after implementation of the ILCOR 2015 recommendation. Study Design This was a prospective cohort study of term NV MSAF neonates who underwent immediate resuscitation without ET suctioning (no ET group, July 2018 to June 2019, n = 276) compared with historical control who underwent routine ET suction (ET group, July 2015 to June 2016, n = 271). Results Baseline characteristics revealed statistically significant higher proportion of male gender and small for gestational age neonates in the prospective cohort. There was no significant difference in the incidence of primary outcome of meconium aspiration syndrome (MAS) between the groups (no ET group: 27.2% vs ET group: 25.1%; p = 0.57). NV MSAF neonates with hypoxic ischemic encephalopathy (HIE) was significantly lesser in the prospective cohort (no ET group: 19.2% vs ET group: 27.3%; p = 0.03). Incidence of air leaks and need for any respiratory support significantly increased after policy change. In NV MSAF neonates with MAS, need for mechanical ventilation (MV) (no ET group: 24% vs ET group: 39.7%; p = 0.04) and mortality (no ET group: 18.7% vs ET group: 33.8%; p = 0.04) were significantly lesser. Conclusion Current study from a developing country indicates that immediate resuscitation and no routine ET suctioning of NV MSAF may not be associated with increased risk of MAS and may be associated with decreased risk of HIE. Increased requirement of any respiratory support and air leak post policy change needs further deliberation. Decreased risk of MV and mortality among those with MAS was observed. Key Points Not performing ET suction in NV MSAF infants is not associated with increase in the incidence of MAS. Initiating immediate resuscitation without ET suctioning was associated with decreased risk of HIE but increased receipt of any respiratory support and air leak. Large multicentric trial is required to generate robust evidence. [ABSTRACT FROM AUTHOR]

Objectives: The paediatric intensive care unit changed heparin infusion dosing from a variable weight-based concentration to a fixed concentration strategy, when smart pump-based drug library was introduced. This change meant significantly lower rates of infusion were needed for the same dose of heparin in the neonatal population. We performed a safety and efficacy assessment of this change. Methods: We performed a retrospective single-centre evaluation based on data from respiratory VA-extracorporeal membrane oxygenation (ECMO) patients weighing ≤5 kg, pre and post the change to fixed strength heparin infusion. Efficacy was analysed by distribution of activated clotting times (ACT) and heparin dose requirements between the groups. Safety was analysed using thrombotic and haemorrhagic event rates. Continuous variables were reported as median, interquartile ranges, and non-parametric tests were used. Generalised estimating equations (GEE) were used to analyse associations of heparin dosing strategy with ACT and heparin dose requirements in the first 24 h of ECMO. Incidence rate ratios of circuit related thrombotic and haemorrhagic events between groups were analysed using Poisson regression with offset for run hours. Results: 33 infants (20 variable weight-based, 13 fixed concentration) were analysed. Distribution of ACT ranges and heparin dose requirements were similar between the two groups during the ECMO run and this was confirmed by GEE. Incidence rate ratios of thrombotic (fixed v weight-based) (1.9 [0.5–8], p =.37), and haemorrhagic events (0.9 [0.1–4.9], p =.95) did not show statistically significant differences. Conclusions: Fixed concentration dosing of heparin was at least equally effective and safe compared to a weight-based dosing. [ABSTRACT FROM AUTHOR]

Vitamin A plays a key role in lung development, but there is no consensus regarding the optimal vitamin A dose and administration route in extremely low birthweight (ELBW) infants. We aimed to assess whether early postnatal additional high-dose fat-soluble enteral vitamin A supplementation versus placebo would lower the rate of moderate or severe bronchopulmonary dysplasia or death in ELBW infants receiving recommended basic enteral vitamin A supplementation. This prospective, multicentre, randomised, parallel-group, double-blind, placebo-controlled, investigator-initiated phase 3 trial conducted at 29 neonatal intensive care units in Austria and Germany assessed early high-dose enteral vitamin A supplementation (5000 international units [IU]/kg per day) or placebo (peanut oil) for 28 days in ELBW infants. Eligible infants had a birthweight of more than 400 g and less than 1000 g; gestational age at birth of 32+0 weeks postmenstrual age or younger; and the need for mechanical ventilation, non-invasive respiratory support, or supplemental oxygen within the first 72 h of postnatal age after admission to the neonatal intensive care unit. Participants were randomly assigned by block randomisation with variable block sizes (two and four). All participants received basic vitamin A supplementation (1000 IU/kg per day). The composite primary endpoint was moderate or severe bronchopulmonary dysplasia or death at 36 weeks postmenstrual age, analysed in the intention-to-treat population. This trial was registered with EudraCT, 2013-001998-24. Between March 2, 2015, and Feb 27, 2022, 3066 infants were screened for eligibility at the participating centres. 915 infants were included and randomly assigned to the high-dose vitamin A group (n=449) or the control group (n=466). Mean gestational age was 26·5 weeks (SD 2·0) and mean birthweight was 765 g (162). Moderate or severe bronchopulmonary dysplasia or death occurred in 171 (38%) of 449 infants in the high-dose vitamin A group versus 178 (38%) of 466 infants in the control group (adjusted odds ratio 0·99, 95% CI 0·73–1·55). The number of participants with at least one adverse event was similar between groups (256 [57%] of 449 in the high-dose vitamin A group and 281 [60%] of 466 in the control group). Serum retinol concentrations at baseline, at the end of intervention, and at 36 weeks postmenstrual age were similar in the two groups. Early postnatal high-dose fat-soluble enteral vitamin A supplementation in ELBW infants was safe, but did not change the rate of moderate or severe bronchopulmonary dysplasia or death and did not substantially increase serum retinol concentrations. Deutsche Forschungsgemeinschaft and European Clinical Research Infrastructures Network (ECRIN). [ABSTRACT FROM AUTHOR]