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OBJECTIVE: To study the association between the Sarnat exam (SE) performed before and after therapeutic hypothermia (TH) and outcomes at 2 years in infants with moderate or severe hypoxic-ischaemic encephalopathy (HIE). DESIGN: Secondary analysis of the High-dose Erythropoietin for Asphyxia and EncephaLopathy Trial. Adjusted ORs (aORs) for death or neurodevelopmental impairment (NDI) based on SE severity category and change in category were constructed, adjusting for sedation at time of exam. Absolute SE Score and its change were compared for association with risk for death or NDI using locally estimated scatterplot smoothing curves. SETTING: Randomised, double-blinded, placebo-controlled multicentre trial including 17 centres across the USA. PATIENTS: 479/500 enrolled neonates who had both a qualifying SE (qSE) before TH and a SE after rewarming (rSE). INTERVENTIONS: Standardised SE was used across sites before and after TH. All providers underwent standardised SE training. MAIN OUTCOME MEASURES: Primary outcome was defined as the composite outcome of death or any NDI at 22-36 months. RESULTS: Both qSE and rSE were associated with the primary outcome. Notably, an aOR for primary outcome of 6.2 (95% CI 3.1 to 12.6) and 50.3 (95% CI 13.3 to 190) was seen in those with moderate and severe encephalopathy on rSE, respectively. Persistent or worsened severity on rSE was associated with higher odds for primary outcome compared with those who improved, even when qSE was severe. CONCLUSION: Both rSE and change between qSE and rSE were strongly associated with the odds of death/NDI at 22-36 months in infants with moderate or severe HIE.

OBJECTIVE: Selective serotonin reuptake inhibitor (SSRI) use is common in pregnancy. It is associated with delayed neonatal adaptation. Most previous studies have not adjusted for the severity of maternal mental health disorders or examined the impact of SSRI type and dosage. We examined whether treatment with SSRIs in late pregnancy (after 20 weeks) is associated with delayed neonatal adaptation independent of maternal depression and anxiety. DESIGN, SETTING AND PATIENTS: Retrospective population-based birth cohort of 280 090 term infants born at 15 Kaiser Permanente Northern California hospitals, 2011-2019. Individual-level pharmacy, maternal, pregnancy and neonatal data were obtained from electronic medical records. EXPOSURE: Dispensed maternal SSRI prescription after 20 weeks of pregnancy. MAIN OUTCOME MEASURES: Delayed neonatal adaptation defined as a 5 min Apgar score ≤5, resuscitation at birth or admission to a neonatal intensive care unit for respiratory support. Secondary outcomes included each individual component of the primary outcome and more severe neonatal outcomes (pulmonary hypertension, hypoxic-ischaemic encephalopathy and seizures). RESULTS: 7573 (2.7%) infants were exposed to SSRIs in late pregnancy. Delayed neonatal adaptation occurred in 11.2% of exposed vs 4.4% of unexposed infants (relative risk 2.52 (95% CI 2.36 to 2.70)). After multivariable adjustment, there was an association between SSRI exposure and delayed neonatal adaptation (adjusted OR 2.14 (95% CI 1.96 to 2.32)). This association was dose dependent. Escitalopram and fluoxetine were associated with the highest risk of delayed neonatal adaptation. CONCLUSIONS: Infants exposed to SSRIs have increased risks of delayed adaptation in a type and dose-dependent relationship, pointing toward a causal relationship.

AbstractPurposeMaterials and methodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONAs the group of technology-dependent children with long-term tracheostomy continues to expand, we aimed to explore parents’ lived experience of everyday life with a child dependent on long-term tracheostomy.Six parents of four children were interviewed and the transcripts analyzed using Giorgi’s descriptive phenomenology.All aspects of everyday life, parent-child interaction, and interaction with the surrounding outside world were affected by technology dependency. Parents played an active role by acting both as a protective shield between the outside world and the child and as an enabling bridge to help the child interact with the outside world. The active and involved role of parents is interwoven in all aspects, levels, and directions of interaction and everyday life. The lived experiences can be described in four themes: caution and risk awareness due to technology, meeting the demands of technology dependence, strained and constrained by technology dependence, and conflicted feelings about technology dependence.Long-term tracheostomy and technology-dependency affect and shape everyday life. Practical implications from the study suggest that re-design and co-design between all stakeholders involved are needed to support parental well-being, coping and enhance patient safety for this growing population and their parents.Long-term tracheostomy, technology, and technology-dependency affects everyday interaction and life for families and should therefore receive attention in rehabilitation for children with long-term tracheostomy.Rehabilitation should include support for parents as it is needed to address the straining experiences in everyday life, including emotional support and practical organization of home care nursing/assistance and medical care.Healthcare needs to adopt a broad and inclusive model of disability that also includes life-sustaining technology-dependency to address the needs of families with children with long-term tracheostomy.Long-term tracheostomy, technology, and technology-dependency affects everyday interaction and life for families and should therefore receive attention in rehabilitation for children with long-term tracheostomy.Rehabilitation should include support for parents as it is needed to address the straining experiences in everyday life, including emotional support and practical organization of home care nursing/assistance and medical care.Healthcare needs to adopt a broad and inclusive model of disability that also includes life-sustaining technology-dependency to address the needs of families with children with long-term tracheostomy. [ABSTRACT FROM AUTHOR]

In the last year, there have been many remarkable articles published in the Italian Journal of Pediatrics. This review highlights papers that can be potentially helpful in healthcare practice among the most cited or accessed papers on the journal website. We have chosen key articles on allergy, analgesics, cardiology, endocrinology, gastroenterology, genetics, global health, infectious diseases, neonatology, neurology and pulmonology. Advances in understanding risk factors, mechanisms, diagnosis, treatment options and prevention of pediatric diseases have been discussed and in the context of the subsequent steps. We think that progresses achieved in 2023 will have a significant impact on the management of diseases in childhood. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Discussion Guidelines for vancomycin therapeutic monitoring recommend using a Bayesian approach with a population pharmacokinetic model to estimate the 24 h area under the concentration‐time curve over first‐order equations. Thus, we performed an external evaluation of population pharmacokinetic models of vancomycin in neonates and compared Bayesian results with those observed in clinical practice via pharmacokinetic equations to improve therapeutic monitoring by proposing optimized initial dosing nomograms and assessing the feasibility of reduced blood sampling strategies using the most predictive models.Models were identified from the literature and evaluated via an external neonatal population. A priori predictive performance was first assessed by prediction‐based diagnostics, then by simulation‐based diagnostics and a posteriori analyses only if deemed satisfactory; model‐informed vancomycin exposure was also compared with reference first‐order pharmacokinetic equations. The best‐performing models were ultimately subjected to Monte Carlo simulations to develop new initial dosing nomograms offering the highest probability of achieving therapeutic target.A total of 28 population pharmacokinetic models were evaluated in the external dataset, which includes 72 neonates and 380 vancomycin concentrations. Eleven models had an adequate predictive performance with bias ≤ ± 15% and imprecision ≤$$ \le $$ 30%, while the Bayesian approach yielded over 75% agreement with reference exposure values in most cases. Nonetheless, Capparelli et al. and Mehrotra et al. models performed the best overall, showing the lowest imprecisions of 16.8% and 16.9%, respectively; both models recommended higher dosage regimens than the theoretical nomogram currently applied to favor therapeutic target attainment.We externally evaluated numerous neonatal population pharmacokinetic models of vancomycin and used the most predictive ones to advocate new initial dosing nomograms. Clinical implementation of the Bayesian approach could reduce the time needed to reach therapeutic target and limit the number of blood samples in newborns compared with traditional pharmacokinetic equations. [ABSTRACT FROM AUTHOR]

Tele-support in breastfeeding can be defined as any support provided by a service that connects health workers and/or lactation consultants with breastfeeding parents through video visits, although a telephone contact with the breastfeeding mother remains the first method of remote breastfeeding support. The tele-support in breastfeeding has increased significantly during the SARS-CoV2 pandemic worldwide and, given its effectiveness, may be maintained also after the pandemic. The Italian Society of Neonatology on the basis of: 1) two focus group studies on the tele-support in breastfeeding conducted in Italy with 11 Neonatal Intensive Care Unit nurses and 10 neonatologists, respectively, 2) a national survey on tele-support in breastfeeding addressing the Italian Neonatal Intensive Care Units, and 3) a review of the available experiences and literature, has provided a Position Statement, limitedly to the individual tele-support in breastfeeding. The Italian Society of Neonatology states that: 1) the tele-support in breastfeeding can be used when a consultation in person is not shortly available and may allow to select those situations that require an in-person visit; 2) the organization of a tele-support in breastfeeding session requires the use of a competent, dedicated healthcare staff (specifically trained and/or with adequate experience) and an appropriate methodology while preparing, running and concluding the support session. According to Italian Society of Neonatology the tele-support in breastfeeding may be an effective intervention to promote breastfeeding as a complementary method to the in-person assistance and should be possibly provided in an integrated manner by the Community Health Services and the Maternity Hospital. [ABSTRACT FROM AUTHOR]

Background: Neonatal hypothermia is a worldwide problem that can lead to a high impact on neonatal health outcomes if appropriate thermal care measures are not implemented. Tackling neonatal hypothermia from the time of delivery with appropriate thermal care measures will increase neonatal survival and decrease complications related to hypothermia. Objective: The study aims to determine the predictors of neonatal hypothermia within six hours of birth and explore its preventive practices among postnatal mothers. Methods: This is a mixed-method sequential explanatory study. The first phase will be a quantitative study with a hospital-based analytical cross-sectional design. 325 neonates and their mothers will be randomly selected through a 4-stage sampling technique. The data will be collected using a structured questionnaire, checklist and documentary review. Descriptive and inferential statistics will be used to analyse the data. The second phase will be a descriptive qualitative study involving postnatal mothers who participated in a quantitative study. The data will be collected via in-depth interviews, and thematic analysis will be used to analyse the data. The findings of quantitative and qualitative studies will be triangulated in the discussion. Discussion: This study will provide a wide understanding of neonatal hypothermia in the region which will help healthcare providers who are caring for neonates to be informed about the current situation, evaluate the care they provide, and find the best way to adhere to thermal care measures. Moreover, the practices of postnatal mothers will be known, which will help to develop tailored interactions to address this problem. [ABSTRACT FROM AUTHOR]

AbstractObjectiveMethodsResultsConclusionThis study aimed to evaluate the effects of an anti-inflammatory diet (AID) combined with Infliximab (IFX) therapy on maternal and neonatal health outcomes in pregnant Chinese patients with inflammatory bowel disease (IBD).IBD patients treated with steady IFX maintenance therapy at the time of conception were randomly assigned to either the IBD-AID group (n = 49), which received an anti-inflammatory diet intervention during the third trimester, or the habitual diet group (n = 49). Primary outcomes included assessments of disease activity, inflammatory markers, and neonatal health. Secondary outcomes included health-related quality of life (HRQoL) in patients and functional gastrointestinal disorders (FGIDs) in infants.The IBD-AID intervention significantly reduced disease activity scores in IBD patients at 4 weeks post-intervention and 1 month postpartum compared to the habitual diet group, and also improved HRQoL. Serum C-reactive protein (CRP) and fecal calprotectin (FC) levels were significantly lower in the IBD-AID group at these times, with a trend towards lower levels at 6 months postpartum. Birth weight and Apgar scores were higher in the IBD-AID group but did not reach statistical significance. The incidence of at least one FGID in infants was significantly lower in the IBD-AID group (24.5%) compared to the habitual diet group (46.9%, p = 0.034).The IBD-AID intervention combined with IFX therapy significantly improved disease activity, inflammatory markers, and QoL in maternal IBD patients, and was associated with a lower incidence of FGIDs in infants, indicating benefits for both maternal and neonatal health. [ABSTRACT FROM AUTHOR]

Introduction: Chimeric antigen receptor T cells (CAR-Ts) targeting CD19 represent a significant advance in treatment for patients with relapsed/refractory B-cell malignancies. Although a significant minority of recipients are women during their reproductive years, there is a paucity of data regarding pregnancy and neonatal outcomes in women previously treated with CAR-T. This is important as maternal T cells are known to cross the placenta and into breastmilk during pregnancy and breastfeeding, respectively. Case Presentation: Here we present two successful pregnancies following CAR-T therapy where both neonates were initially breastfed. These represent the first cases of neonates born following CAR-T therapy comprehensively described in medical literature. Conclusion: Pregnancy following CAR-T therapy does not appear to be associated with adverse neonatal outcomes. Further work is required to delineate the outcomes in this population. [ABSTRACT FROM AUTHOR]

Introduction: While a patent ductus arteriosus (PDA) helps offload the right ventricle in the acute congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension, its role on long-term outcomes in CDH has not been investigated. Our objective was to examine associations of the PDA with long-term clinical outcomes in CDH. Methods: A single-center retrospective descriptive study of 122 CDH patients dichotomized by duration with PDA, as ≤14 versus >14 postnatal days (PND) and ≤30 versus >30 PND. Fisher’s exact test, Wilcoxon rank-sum test, and multiple linear and logistic regression analyses were used for analyses. Results: In unadjusted and adjusted for CDH severity comparisons, patients with PDA >14 PND and >30 PND had a higher risk of death, longer length of stay, mechanical ventilation duration, and need for tracheostomy, diuretics, and PH medications at discharge. Conclusion: A PDA beyond the newborn period is associated with adverse outcomes in infants with CDH. [ABSTRACT FROM AUTHOR]

Objective: To investigate pregnant women's preferences for risks of vaginal and caesarean birth, including possible impacts on future fertility. Methods: In this discrete choice experiment, low-risk nulliparous pregnant women recruited after 28 weeks of gestation evaluated eight choice sets, each between two different hypothetical births scenarios which intermixed the risks of planned caesarean or vaginal birth. Scenarios consisted of six attributes: pain, maternal health, neonatal health, risk of unplanned intervention, impact on fertility and risk of complications in the next pregnancy. All scenarios contained risks to neonatal health as neither vaginal nor caesarean birth guarantee an ideal outcome. Choice data were analysed using a conditional logistic regression model. Results: Between June and September 2023, 211 participants, including 34 from pilot interviews, completed the questionnaire. Influential attributes were maternal health (conditional odds ratio [COR] 1.29, 95% CI 1.17 to 1.42, p<0.001) and risk of unplanned intervention (COR 1.37, 95% CI 1.24 to 1.51, p<0.001), favouring caesarean birth. Conversely, impact on fertility (COR 0.75, 95% CI 0.68 to 0.83, p<0.001) and complications in the next pregnancy favoured vaginal birth (COR 0.90, 95% CI 0.82 to 1.00, p = 0.045). Conclusions: Participants weighed the included morbidity risks of planned caesarean and vaginal birth in a low-risk pregnancy approximately equally. To facilitate an informed birth decision, clinicians should, apart from neonatal outcomes, particularly consider discussing impacts on fertility, maternal health and the risks of unplanned intervention or future pregnancy complications. [ABSTRACT FROM AUTHOR]

Background: Macrosomia is a forgotten health problem that directly or indirectly affects maternal and neonatal health outcomes. There is a lack of evidence on the factors that affect macrosomia in eastern Ethiopia. This study aimed to assess the determinants of macrosomia among newborns delivered in Jigjiga City, Eastern Ethiopia. Methods: An institutional-based case-control study was conducted among 82 cases and 164 controls in Jigjiga City from June 25 to August 24, 2023. Bivariable and multivariable logistic regression were used to identify the determinants of macrosomia. An adjusted odds ratio (AOR) with a 95% confidence interval was used to report the strength of the association, and the statistical significance was declared at a p-value < 0.05. Results: This study found that lack of preconception care (AOR = 2.48, 95% CI: 1.29, 4.76); post-term pregnancy (AOR = 2.90, 95% CI: 1.16, 7.28); inadequate physical activity (AOR = 3.52, 95% CI: 1.55, 7.98), having previous macrosomia (AOR = 4.52, 95% CI: 2.18, 9.36), and gestational diabetic mellitus (AOR = 2.58, 95% CI: 1.10, 6.28) were the main risk factors of macrosomia. Conclusion: This study indicated that failed utilization of preconception care, inadequate physical activity during pregnancy, post-term pregnancy, gestational diabetic mellitus, and having previous macrosomia were the risk factors for fetal macrosomia. Encouraging women to utilize reproductive health services and providing special care for high-risk mothers are essential to reducing and preventing the level of fetal macrosomia and its consequences. [ABSTRACT FROM AUTHOR]

Inguinal hernia repair is one of the most performed procedures in children, but aspects of care remain controversial. The aim of this review was to provide a critical appraisal of recently published guidelines on the management of inguinal hernias in children, by the American Academy of Pediatrics (2023) and the European Pediatric Surgeons' Association Evidence and Guideline Committee (2022). This was achieved by delineating areas of controversy and reviewing the most relevant recent literature on these topics. Currently available moderate‐to‐low quality evidence recommends postponing hernia repair in premature infants until after discharge, to reduce the risk of respiratory difficulties and recurrence. Laparoscopic repair provides similar outcomes to open but may shorten operative time in bilateral cases. No clear recommendation can be made for contralateral exploration, therefore should be evaluated case by case. In preterm infants, consideration of regional anaesthesia may reduce post‐operative apnoea and pain, with no difference in neurodevelopment outcomes. [ABSTRACT FROM AUTHOR]

Introduction Health agencies have called for research evaluating e-cigarette (EC) use in supporting prenatal smoking cessation. This study aimed to describe (1) the characteristics of smokers who begin using electronic cigarettes (ECs) during pregnancy, (2) how frequently smokers reduce or eliminate pre- and post-natal combustible cigarette (CC) use, and (3) the risk for neonatal health complications among smokers who initiate ECs during pregnancy. Aims and Methods Pregnant women using CCs exclusively during prepregnancy, who participated in a U.S. surveillance study, were classified by their reported late-pregnancy smoking behavior as CC-exclusive users, EC initiators, or quitters. EC initiators were further subclassified as dual users (used both ECs and CCs) or EC replacers (used ECs exclusively). Results Of 29 505 pregnant smokers, 1.5% reported using ECs during the last three pregnancy months. Among them, 29.7% became EC-exclusive users. EC initiators were disproportionately non-Hispanic White. Relative to quitters, EC initiators had lower income, were less likely to be married, have intended pregnancies, receive first-trimester prenatal care, and participate in a federal assistance program. Compared to CC-exclusive users, EC initiators overall, and dual users specifically, were more likely to reduce pre- and post-natal CC usage relative to prepregnancy levels. EC initiators' risk for neonatal health complications fell between quitters and CC-exclusive users, though the differences were not statistically significant. Conclusions Although EC initiators reduced CC use more than CC-exclusive users, only 29.7% reported complete CC cessation, and there was insufficient evidence of reduction in neonatal health complications relative to CC-exclusive users. Currently, ECs should not be considered a viable gestational smoking cessation strategy. Implications Health agencies have identified a critical need for research evaluating the use of e-cigarettes in supporting prenatal smoking cessation. Using the U.S. Pregnancy Risk Assessment Monitoring System surveillance study data, we provide real-world evidence that prenatal e-cigarette initiation as a smoking cessation tool is used infrequently among pregnant CCs smokers. Most using e-cigarettes in the last 3 months of pregnancy also used CCs. [ABSTRACT FROM AUTHOR]

Aim: To assess experience of care, well‐being of parents and children's development in a cohort of extremely premature infants born <24 weeks of gestation in Sweden from 2007 to 2018. Methods: A survey based on multiple questionnaires answered by 124/349 (35.5%) parents. Results: The median age of parents and children was 43 and 9 years, respectively; 74.2% were mothers. Parents expressed high healthcare satisfaction. Following discharge from neonatal care, the satisfaction with the infant's treatment, support from personnel and being respected as a parent significantly declined but remained high. The criteria for suspected developmental deviation according to the screening test early symptomatic syndromes eliciting neurodevelopmental clinical examinations‐questionnaire was fulfilled by 84.3%, 55.6% had suspected avoidant restrictive food intake disorder and 47.9% had visual perception problems. Parents experienced severe fatigue (48.6%) despite strong social support and family self‐efficacy. Economic support was provided to 30.6%, and 37.9% of children were enrolled in habilitation services. Conclusion: This study highlighted the substantial challenges faced by parents of infants born before 24 weeks of gestation, including decreased satisfaction post‐discharge, fatigue and concerns about children's well‐being. The findings underscore the need for comprehensive family‐centred support and long‐term multi‐professional follow‐up centres. [ABSTRACT FROM AUTHOR]

Objective Define and develop a set of entrustable professional activities (EPAs) to link clinical training and assessment of the hospital components of neonatal care in neonatology medical residency programs. Methods An exploratory study was conducted in two phases using a modified Delphi approach. In the first phase, a committee of five neonatology residency program coordinators drafted an initial set of EPAs based on the national matrix of competencies and on EPAs defined by international organizations. In the second phase, a group of neonatal care physicians and medical residents rated the indispensability and clarity of the EPAs and provided comments and suggestions. Results Seven EPAs were drafted by the coordinators´ committee (n = 5) and used in the content validation process with a group (n = 37) of neonatal care physicians and medical residents. In the first Delphi round, all EPAs reached a content validity index (CVI) above 0.8. The coordinators´ committee analyzed comments and suggestions and revised the EPAs. A second Delphi round with the revised EPAs was conducted to validate and all items maintained a CVI above 0.8 for indispensability and clarity. Conclusion Seven entrustable professional activities were developed to assess residents in the hospital components of neonatal care medicine. These EPAs might contribute to implementing competency-based neonatology medical residency programs grounded in core professional activities. [ABSTRACT FROM AUTHOR]

Background: Neonatal sepsis represents a significant cause of morbidity and mortality among infants in healthcare settings. This study explored nurses' experiences in preventing and managing neonatal sepsis in the Tamale metropolis. Methods: An exploratory, descriptive qualitative cross-sectional study design was used, and data was collected using semi-structured interviews. The sample size was determined at the point of data saturation of fifteen participants. Thematic analysis was employed to identify codes, subthemes, and themes within the interview transcripts. Results: Three major challenges nurses face in preventing and managing neonatal sepsis, including (1) the absence of a protocol for handling newborns upon admission, (2) an excessive workload that made it difficult for staff to follow infection prevention protocols, and (3) inadequate, obsolete and/or lack of equipment that caused devices to be overused. The nurses also identified critical psychological and emotional difficulties they encounter as a result of working within such a stressful environment. Other activities nurses conducted were handwashing before and after every procedure, infection prevention, and separating the babies in the incubator. In managing babies with neonatal sepsis, nurses provided daily treatment, hygiene care, and supported activities of living. The nurses also assert that the availability of resources, appropriate staff, and critical skills are important for preventing and managing neonatal sepsis. Conclusion: The lack of basic working consumables like gloves, syringes, and needles, inadequate staff, and lack of defined protocol of care were identified as critical challenges that hamper the care provided in neonatal care units. Hospital authorities must focus attention on addressing the critical challenges faced by neonatal care units. Also, measures should be instituted to address the emotional and psychological concerns associated with nursing care. Future research must consider the level of influence of each of the challenges enumerated on nurses' overall health. Plain language summary: In many developing countries deaths of under-five children are associated with neonatal sepsis - an acute infection that occurs in those less than 28 days old. Nurses are critical in the care and services rendered to these babies and their families in the neonatal care units. This study assessed the experiences of nurses in providing care to neonates. The data was collected using an interview guide among nurses working in neonatal care units in the Tamale metropolis. Analysis was done using the thematic data analysis method. Some challenges were identified by nurses to be associated with the care of babies with neonatal sepsis. These challenges included a lack of definitive protocols of care; higher workload; inadequate, obsolete, and lack of basic equipment and consumables. Nurses employed handwashing techniques to prevent infection among babies with neonatal sepsis. Services providers must focus attention on providing the requisite support to nurses caring for babies with neonatal sepsis to improve the care experiences. [ABSTRACT FROM AUTHOR]

Background: Pneumococcal meningitis (PM) triggers apoptotic neuronal and progenitor cell death in the hippocampal dentate gyrus (DG), resulting in subsequent cognitive impairment. Microglia play a crucial role in PM-induced hippocampal damage. While the lasting effects of neonatal nutrition on health are well documented, the influence of early-life overfeeding on the host response to neuroinfections remains uncertain. This study aimed to examine whether neonatal overfeeding affects the outcome of PM in the hippocampus (HC). Material and methods: Overfeeding was induced by adjusting litter size immediately after birth. On the eleventh day of life, rats were intracisternally injected with Streptococcus pneumoniae or saline, followed by euthanasia after 24 hours for brain dissection. Histological analysis evaluated apoptosis in the DG and the extent of inflammatory infiltrate in the hippocampal fissure, while microgliosis was assessed by immunohistochemistry. The hippocampal transcriptome was analyzed using RNAseq, and the mRNA levels of specific inflammatory biomarkers were evaluated via RT-qPCR. Results: Overfed rats exhibited 40.5% greater body mass compared to their normal-fed counterparts. Intriguingly, PM-induced apoptosis in the DG was 50% lower in overfed rats. This effect was accompanied by significant alterations in the hippocampal transcriptional profile, particularly the lack of activation of the Programmed cell death pathway in overfed infected animals. RT-qPCR analysis of Aif1 and examination of Iba1-immunostained cells revealed mild microgliosis in the HC of infected-overfed animals. This reduced microglial reaction may be attributed to the diminished activation of interferon signaling pathways, as disclosed by the transcriptome analysis, potentially preventing microglial priming. Additionally, evidence of reduced neuroinflammation in overfed rats with PM was observed through the milder activation of pathways associated with Toll-like receptors, interleukins, and chemokine signaling. Furthermore, overfed animals exhibited increased transcription of proinflammatory Il6 and anti-inflammatory Il10 genes, with the latter showing higher expression even in the absence of PM, suggesting a priming effect of overfeeding on hippocampal immune cells. Conclusion: This study sheds light on the complex interplay between early-life overfeeding, immune response, and neuroprotection in infant rats with PM. The findings demonstrate the neuroprotective impact of early-life overfeeding in the context of PM, linked to the modulation of microglial function. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusions Maternal health and gestational control are crucial to improving the newborn's prognosis. This study analyses demographic and obstetric factors at the beginning of pregnancy related to neonatal health, assessing their impact on the risk of hospital admission and prematurity.Observational retrospective study conducted in Northeast Spain with data of 9560 newborns between February 2017 and February 2022. The following have been evaluated as risk factors for hospital admission: nulliparity, multiple gestation, fertilisation techniques, foreign maternal origin, maternal age, smoking and residential location, dividing the sample according to gestational age. Hypothesis testing and logistic regression were performed.Nulliparity, fertilisation techniques and multiple gestation represent a risk factor for neonatal admission (OR 22.48, 4.04 and 3.34, respectively), especially in premature newborns <32 weeks of GA (OR: 30.71, 10.71 and 22.76, respectively). Foreign maternal origin also adds risk of admission, both in term newborns (OR 1.26; CI: 1.10–1.43) and in premature babies <32 weeks of GA (OR 1.61; CI: 1.09–2.38). Tobacco does not present a significant risk of neonatal admission. The multivariate analysis model confirms the influence of the following factors in all the studied groups: nulliparity, multiple gestation and foreign maternal origin.Nulliparity and multiple pregnancies are both main risk factors for neonatal admission and premature delivery. The use of fertilisation techniques and the foreign origin of the mother significantly associate increased risk of admission and neonatal prematurity. These findings underscore the need for a comprehensive approach to prenatal care to improve neonatal prognosis and promote long‐term health in risk populations. [ABSTRACT FROM AUTHOR]

Introduction Material and Methods Results Conclusions Maternal‐neonatal healthcare services were severely disrupted during the COVID‐19 pandemic in even high‐income countries within the World Health Organization (WHO) European Region. The objective of this study was to compare trends in the quality of maternal and neonatal care (QMNC) in Sweden and Norway to 12 other countries from the WHO European Region during the COVID‐19 pandemic, and to identify domains for improvement.This cross‐sectional study included women giving birth in Europe from March 1, 2020 to December 31, 2022. Women answered an online, anonymous questionnaire which included 40 WHO Standard‐based Quality Measures collectively scored as the total QMNC index (0–400) and separately in four subdomains (0–100): provision of care, experience of care, availability of human and physical resources, and reorganizational changes due to COVID‐19. To assess reported QMNC changes over time, we used adjusted quantile regression models. ClinicalTrials.gov Identifier: NCT04847336.Of the 45151 women included in the study, 13 117 (29.1%) were from Sweden and Norway and 32034 (70.9%) from the 12 WHO European countries. The total QMNC index for Sweden and Norway (median: 325, IQR: 285–355) was higher than the 12 WHO European countries (median: 315, IQR: 265–350, p < 0.001) as were trends in QMNC index over time (Sweden and Norway median: 310–345; 12 WHO European countries median: 305–340). Sweden and Norway also had higher scores in three‐of‐four QMNC subdomains, with the 12 WHO European countries scoring higher only for reorganizational changes due to COVID‐19. In adjusted quantile models of the total QMNC index, Sweden and Norway had higher scores, with largest differences in the lower quantiles (p < 0.001 in all percentiles).Across Europe, there are significant gaps in the quality of maternal‐neonatal healthcare services. Although women giving birth in Sweden and Norway reported higher QMNC scores in all subdomains except for “reorganizational changes due to COVID‐19,” there is room for improvement and shared learning across Europe. Policymakers should prioritize long‐term investments in maternal and neonatal healthcare, ensuring that facilities are adequately equipped during public health crises and that all women have access to high‐quality, evidence‐based, equitable, and respectful care. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Objectives Search Strategy and Selection Criteria Data Collection and Analysis Main Results Conclusions Ninety‐eight percent of neonatal deaths worldwide occur in low‐ and middle‐income countries (LMICs), yet there is little bereavement care guidance available for these settings.To explore parents', families' and healthcare professionals' experiences of care after neonatal death in healthcare facilities in LMICs.Four databases were searched for peer‐reviewed literature, meeting the inclusion criteria of qualitative studies exploring the experiences of people who provided or received bereavement care following neonatal death in a LMIC healthcare setting.Data were collected by two independent reviewers, collated through line‐by‐line coding and then reciprocal and refutational translation, and analysed through Noblit and Hare's seven‐step meta‐ethnography approach to create first‐, second‐ and third‐order themes.Seven first‐order themes extracted from the literature included emotional responses, social relationships, staff and systems, religion, connecting with the baby, coping strategies and economic concerns. From these data, three third‐order themes arose: The individual, the healthcare setting and the community/context.Overarching themes in bereavement care shape grief responses and are often similar across geographical locations. Analysing these similarities allows a deeper understanding of the important elements of bereavement care and may be helpful to inform the creation of high‐quality, bereavement care guidelines suitable for use in LMIC settings. [ABSTRACT FROM AUTHOR]

Objective This study aimed to determine neonatal neurodevelopmental follow-up (NDFU) practices across academic centers. Study Design This study was a cross-sectional survey that addressed center-specific neonatal NDFU practices within the Children's Hospitals Neonatal Consortium (CHNC). Results Survey response rate was 76%, and 97% of respondents had a formal NDFU program. Programs were commonly staffed by neonatologists (80%), physical therapists (77%), and nurse practitioners (74%). Median gestational age at birth identified for follow-up was ≤32 weeks (range 26–36). Median duration was 3 years (range 2–18). Ninety-seven percent of sites used Bayley Scales of Infant and Toddler Development, but instruments used varied across ages. Scores were recorded in discrete electronic data fields at 43% of sites. Social determinants of health data were collected by 63%. Care coordination and telehealth services were not universally available. Conclusion NDFU clinics are almost universal within CHNC centers. Commonalities and variances in practice highlight opportunities for data sharing and development of best practices. Key Points Neonatal NDFU clinics help transition high-risk infants home. Interdisciplinary neonatal intensive care unit follow-up brings together previously separated outpatient service lines. This study reviews the current state of neonatal NDFU in North America. [ABSTRACT FROM AUTHOR]

BACKGROUND: Difficulty attracting physicians to work in rural and remote areas is a worldwide problem. Specific to pediatrics, barriers to recruitment include burdensome on-call rosters, a lack of career opportunities for partners and professional isolation. METHODS: To examine attitudes to working in a community hospital in Ireland, a mixed-methods sequential analysis approach was undertaken. Pediatricians-in training (70) and attending community pediatricians (25) completed surveys. Six semistructured interviews were used to triangulate survey results. RESULTS: Most trainees planned to stay in Ireland (66/70), with five (eight%) stating that a career in a community hospital was their first preference. Personal factors such as a partner's career prospects and closeness to family and friends were the most important deterrents to working in a community hospital for trainees. Both trainees and attendings were concerned regarding professional isolation. Trainees were concerned about the poor reputation of community units. This converged with attendings feeling their role was not adequately respected, even though their job had more variability and exposure to emergencies, with less support, than working in a large center. Both groups agreed that targeted postgraduate training pathways and better training opportunities within Ireland were the best way to improve recruitment. Financial bonuses were not highly ranked as potential incentives. Motivators for considering a career in community units included the desire to make an impact and to build something new. Concerns about job satisfaction, professional recognition, and limited support for service development were prevalent. CONCLUSION: This study reveals critical challenges and motivators influencing the shortage of pediatricians in Irish community units. Addressing these issues requires a multifaceted approach, incorporating targeted training, support structures, and recognition to enhance recruitment and retention in these underserved areas. Insights from the Irish context could be applied to improve recruitment and retention of pediatricians in regions with similar contexts. [ABSTRACT FROM AUTHOR]

Background: Very low birth weight (VLBW) infants with patent ductus arteriosus (PDA) have high morbidity and mortality. Studies suggest an association between PDA and duration of ventilatory support, but the additional number of ventilation days due to severe PDA is unknown. Methods: We performed a case-control study of VLBW infants born ≤ 32 weeks of gestational age between 2006 and 2014 at our institution. Infants in the study had a moderate to large PDA on echocardiogram in the first week of life and were divided into two groups based on PDA severity. Ventilation days were compared for PDA severity groups and ventilation duration-related risk factors. Adjusted multiple linear regression was used to estimate the association between PDA severity and ventilation duration. Results: The median number of ventilator days for infants with spontaneous PDA closure (8.5 days) vs. infants with severe PDA (29 days) differed significantly (P ≤ 0.001). We found that infants with severe PDA had a longer duration of ventilation than infants who closed spontaneously—approximately eight days. Conclusion: Severe PDA in VLBW infants is independently associated with a longer duration of ventilation compared to spontaneous PDA closure. Future studies should explore this association and clinical options for improving patient outcomes. [ABSTRACT FROM AUTHOR]

Background: Vaginal discharge (VD) is a common symptom in women during the reproductive period, especially during pregnancy. Pathological VD during pregnancy is an important public health concern because it has a sociopsychological impact on women and influences fetomaternal outcomes. Aims and Objectives: The study aims to estimate the prevalence of pathological discharge in pregnant women. The study also focuses on the demographic profile and various risk factors associated with pathological VDs and their consequences on fetal and maternal health. Materials and Methods: A prospective observational study was conducted in the Department of Obstetrics and Gynecology in a tertiary care center in Northern India. A total of 150 pregnant women with complaints of VD in the second and third trimesters with confirmation on speculum examination were recruited and evaluated for the etiology of discharge. Patients were followed until delivery and data regarding fetomaternal outcomes was collected. Results: The prevalence of pathological VD among enrolled women was 39.33% and various etiologies were candidiasis (15.33%), bacterial vaginosis (10.66%), aerobic vaginitis (8.67%), and trichomoniasis (4.67%). These infections were significantly related to pre-term delivery and pre-term pre-labor rupture of membranes. Furthermore, the incidence of prematurity, and low birth weight neonates requiring neonatal intensive care unit care was significantly high in babies born to mothers with pathological VD. Conclusion: Vaginal infections affect both maternal and neonatal health, thus, increasing the likelihood of poor perinatal outcomes. Hence, we propose that routine screening for pathological VD for all pregnant women should be introduced into standard antenatal care. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B and C are significant viral infections in pregnancy with high risk of maternal and neonatal complications. This study was conducted to determine the prevalence of hepatitis B and C viral infections and correlates among pregnant women who attended antenatal care (ANC) unit of General and Civil Service Hospitals, Ilorin, Nigeria. Methodology: This was a descriptive cross-sectional study of 282 consented pregnant women randomly selected from the ANC units of two hospitals in Ilorin. Blood samples were collected from the pregnant women and tested for hepatitis B virus (HBV) surface antigen (HBsAg) and anti-hepatitis C virus (HCV) antibody using Enzyme Linked Immunosorbent Assay (ELISA) technique. Socio-demographic and obstetrics information of the pregnant women and potential risk factors for HBV and HCV infections were collected using a pretested structured questionnaire. Statistical analysis was done using SPSS version 22.0 Results: Majority of the women were married (78.4%), from monogamous families (57.8%), do not share sharp objects (65.6%), have not received blood transfusion (65.3%), have no history of organ transplantation (91.1%), and multigravida (61.4%,) in their first (36.9%), second (37.2%) and third (25.9%) trimesters of pregnancy. Overall, 22.3% and 1.4% tested positive for HBsAg and anti-HCV respectively. Family background of the study participants showed significant (p˂0.05) association with HBsAg positivity. None of the other analysed variables showed any significant association with both HBsAg and anti-HCV positivity. Conclusion: This result showed high prevalence of HBV but low prevalence of HCV infections among pregnant women in the study setting. Improved surveillance and routine screening for HBV and HCV for women attending ANC is recommended to reduce disease burden and help achieve WHO goal of eliminating viral hepatitis as a major public health threat by 2030. [ABSTRACT FROM AUTHOR]

Introduction: We evaluated the relative effects of newer versus older medications for neonatal conditions and trends in margin of superiority across generations. Materials and Methods: We assessed network meta-analyses (NMAs) on neonatal pharmacological interventions identified from MEDLINE, Cochrane, and PROSPERO. Interventions were chronologically arranged based on the earliest study and compared for their effects against placebo or no treatment and their immediate predecessor. We assessed the time trend in effect sizes using the Mann-Kendall test. Results: From 8,048 retrieved records, 10 neonatal NMAs covering 352 trials and 102,653 participants were included. Compared to placebo, 56/61 (91.8%) interventions showed superiority with 23 (37.7%) statistically significant. Compared to previous generation, 47/72 (65.3%) showed superiority with 3 (4.2%) statistically significant. No significant trends in effect sizes were observed across generations for most conditions (p = 0.09–1). Conclusions: We found no evidence that newer generation medications in neonatal care are consistently more effective than older generation medications. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to determine the frequency of ROP development in premature infants hospitalized in the neonatal intensive care unit and/or referred to the ROP Diagnostic Unit of our hospital and to emphasize the importance of cooperation between ophthalmologists and neonatologists in the treatment and follow-up of infants with ROP. Materials and Methods: The findings of 287 premature infants who were followed and treated in the neonatal intensive care unit between January 2017 and November 2022 and then referred to the ROP Diagnostic Unit were retrospectively analyzed. They were classified according to birth weight and gestational age. They were divided into 4 groups according to birth weight (under 1000 g, between 1000-1250 g, between 1250-1500 g and over 1500 g) and 3 groups according to gestational age (under 28 weeks, between 29-32 weeks and over 33 weeks). ROP development rates were determined in these groups. Those who developed retinopathy of prematurity were classified according to their stages. Results: A total of 287 premature infants (141 boys and 146 girls) were included in the study. Twenty-eight of the premature babies were Syrian (9.8%). Mean gestational age at birth was 32.34 weeks (min. 24, max. 37) and mean birth weight was 1830.12 g (min. 750 g, max. 4000 g). 34 babies (11.8%) had stage 1 ROP and 12 babies (4.1%) had stage 2 ROP. 14 babies (4.9%) had plus. Due to the rapid progression of the clinic, 20 patients (7%) with stage 2 or higher ROP and plus were referred to an advanced center with ROP treatment center certification. Conclusion: Premature babies born under 34 weeks of gestation should be examined for retinopathy of prematurity. Early diagnosis of retinopathy of prematurity is very important to prevent blindness due to ROP, even if treatment is not possible according to local conditions. [ABSTRACT FROM AUTHOR]

In the global public health discourse, involving men in maternal and neonatal health is regarded as crucial for positive outcomes in both health and development. In South Africa, health interventions designed to promote male partner involvement among low-income indigenous populations have been framed within social constructivist notions of masculinities and have produced mixed outcomes. This has necessitated calls to explore alternative approaches, including the need to decolonise men and masculinities studies in Africa. As part of one phase of formative research for a mixed-method project aimed at adapting a male involvement intervention for the context of Sesotho-speaking men and women in the Free State, we applied a multi-site case study research design and collected qualitative data using focus group discussions and key informant interviews. Verbatim-recorded transcripts were translated, transcribed, and thematically analysed with NVIVO 14. The results indicate that customary practices in pregnancy, delivery, and newborn care are not static and vary between families based on belief systems, socioeconomic status, geographical setting (peri-urban/rural), and kinship networks of care. Therefore, these practices and beliefs should be understood, affirmed, and contested within the complex African-centred material and immaterial worldviews on personhood in which they were generated, transmitted, rejected, or adopted. It is recommended that a decolonised approach to male partner involvement in this context must be cognisant of the intersections of racial and gendered power relations, contestations in beliefs and practices, the resilient effect of colonialism on indigenous gender systems, as well as contemporary global entanglements that inform North–South power relations on the best practices in maternal and newborn health in the public health sector in South Africa. [ABSTRACT FROM AUTHOR]

SARS‐CoV‐2 infection during pregnancy has severe consequences on maternal and neonatal health. Presently, vaccination stands as a critical preventive measure for mitigating infection‐related risks. Although the initial clinical trials for the COVID‐19 vaccines excluded pregnant women, subsequent investigations have indicated mRNA vaccinations' effectiveness and short‐term safety during pregnancy. However, there is a lack of information regarding the potential biodistribution of the vaccine mRNA during pregnancy and lactation. Recent findings indicate that COVID‐19 vaccine mRNA has been detected in breast milk, suggesting that its presence is not confined to the injection site and raises the possibility of similar distribution to the placenta and the fetus. Furthermore, the potential effects and responses of the placenta and fetus to the vaccine mRNA are still unknown. While potential risks might exist with the exposure of the placenta and fetus to the COVID‐19 mRNA vaccine, the application of mRNA therapies for maternal and fetal conditions offers a groundbreaking prospect. Future research should leverage the unique opportunity provided by the first‐ever application of mRNA vaccines in humans to understand their biodistribution and impact on the placenta and fetus in pregnant women. Such insights could substantially advance the development of safer and more effective future mRNA‐based therapies during pregnancy. [ABSTRACT FROM AUTHOR]

Aim: As herpes simplex virus (HSV) in infancy is not a mandatory notifiable condition in Australia, completeness of ascertainment by the Australian Paediatric Surveillance Unit (APSU) has been difficult to evaluate to date. We evaluated case capture in Queensland (QLD) and Western Australia (WA) using statewide laboratory and clinical data and complementary surveillance data collected via the APSU. Methods: HSV polymerase chain reaction positive results in infants (0–3 months) from 2007 to 2017 were obtained from statewide public pathology providers in QLD and WA. Clinical data were extracted from patient records and compared to APSU reported cases. Results: A total of 94 cases of HSV disease in infancy (70 QLD; 24 WA) were identified from laboratory data sets, compared to 36 cases (26 QLD; 10 WA) reported to the APSU. In total there was 102 unique cases identified; 28 cases were common to both data sets (seven skin eye mouth (SEM) disease, 13 central nervous system (CNS) disease and eight disseminated disease). Active surveillance captured 35% (36/102) of cases overall including 74% (14/19) of CNS, 71% (10/14) of disseminated and 17% (12/69) of SEM disease cases, respectively. Surveillance reported cases had a higher case‐fatality rate compared to those not reported (14% vs. 3%, P = 0.038). Neurological sequelae at discharge were comparable between the groups. Conclusion: Active surveillance captures one third of hospitalised HSV cases in QLD and WA, including the majority with severe disease. However, morbidity and mortality remain high. Future studies on HSV will rely on observational studies. Enhanced case ascertainment through combined laboratory and surveillance data is essential for better understanding and improving outcomes. [ABSTRACT FROM AUTHOR]

Aim: Evaluate the additional burden of centralised neonatal care on families of extremely preterm infants cared for away from their planned hospital of birth. Methods: Retrospective cohort study using national data for infants 23+0 to 27+6 weeks of gestation admitted for neonatal care from 2011 to 2016. The number of transfers on the first day of life (potential maternal–infant separation), time away from the maternal booking hospital (BH) and distance from the maternal residence were quantified. Results: Of 14 719 included infants, 2803 (19%) underwent postnatal transfer on the first day of life. A total of 8622 (59%) infants were cared for away from their BH for a median of 39 days (interquartile range [IQR] 15–69), 30% spending >60 days away over a median of two episodes (range 1–12). Median return road travelling distances for parents to their local BH was 13 km (IQR 8–26), but this increased to 74 km (IQR 32–148) for those cared for in a non‐BH. Conclusion: Centralised neonatal care improves infant outcomes but introduces additional burdens on the families of extremely preterm infants cared for away from their BH. Additional support, including accommodation and financial aid, could help minimise the impact on these families, facilitate family integrated care and improve parental wellbeing. [ABSTRACT FROM AUTHOR]

Low- and middle-income countries face limited critical care capacity due to constraints in staffing, resources, and technology. "Smart ICUs" that integrate telehealth to augment care delivery, communication, and data integration have the potential to bridge these gaps and reduce preventable morbidity and mortality. While their efficacy has been well validated in adult populations, applications of Smart-ICU services in the neonatal population have not been studied. Neonatal intensive care units (NICUs) in India using a common Smart-NICU platform, developed by CloudPhysician, utilize a hub-and-spokes framework along with locally designed technology to facilitate remote patient care in collaboration with local health systems. In this article, we investigate the operational characteristics and performance outcomes for Smart-NICU deployment from the 18 NICUs and 214 beds deployed to date. These findings highlight the potential impact of Smart-NICUs and establish generalizable principles for implementation in low-resource settings. [ABSTRACT FROM AUTHOR]

Background: Neonatal health is one of the targets for the sustainable development goals (SDGs) that aim to reduce neonatal mortality to at least as low as 12 per 1 000 live births in 2030. However, the world is not on track to achieve this target. The problem has worsened in many low-income countries, including Ethiopia, due to a fragile health system, as well as health crises such as the COVID-19 pandemic, conflict, food insecurity and climate change. According to the Mini Ethiopian Demographic Health Survey, neonatal mortality is unacceptably high in Ethiopia in general, and in Amhara region in particular. Despite these facts, there is a paucity of information on the quality of neonatal health service provision in comprehensive specialized hospitals in Amhara region. Therefore, this study is aimed at assessing the quality of neonatal health services in terms of outcome (neonatal mortality) and its causes in comprehensive specialized hospitals in Amhara region. Methods: A multi-center retrospective study was conducted (from September 1–30/2022) on 315 neonates in four comprehensive hospitals with chart review. Data were collected through death audit with standardized neonatal death audit tool. Data were entered into Epi-data 3.1 and exported to SPSS 20 for analysis. Descriptive analysis was used to describe and summarize the data in an informative manner. Results: From 315 neonatal deaths, about two-thirds, 205 (65.1%), were from rural areas. Nearly half, 151 (48%), of the mothers had complications and delivered outside a health facility. About 36 (11.4%), 45 (14.3%), and 21 (6.7%) neonates' mothers had 1st, 2nd, and 3rd delays, respectively. About 59 (19%) of mothers had membrane rupture before the onset of labor and 23 (7.3%) had meconium-stained liquor. Almost three-fourths, 226 (71.7%), of the deaths were low birth weight (< 2500 gram). About 25 (8%) of neonates had congenital anomalies, 65% of them had fast breathing and 54.6% were preterm. Conclusion: Higher proportions of neonatal deaths were observed among neonates with rural residence, low birth weight, mothers' complications and neonates admitted for fast breathing. Histories of abortion, complications, congenital anomalies, and the 3 delays contributed to neonatal deaths. [ABSTRACT FROM AUTHOR]

New health technologies are constantly developing. However, their impacts on health and implications for health systems are not always clear. Faced with this situation, in the last 45 years, Health Technology Assessment (HTA) has taken an important role in the decision-making process related to the implementation of technologies in healthcare systems. According to the Core Model® EUnetHTA, a "full HTA" should cover nine domains: health problems and current use of technology, description and technical characteristics, safety, clinical effectiveness, costs and economic evaluation, ethical analysis, organizational aspects, patients and social aspects, legal aspects. In all domains of a HTA, the approach is evidence-based and uses epidemiological data, systematic reviews to gather the best level of proofs regarding clinical efficacy and safety of interventions and comparators and organizational and economic models. One exception is the ethical analysis, that uses value-based approach. Although in Neonatal Intensive Care Units (NICUs) there are highly advanced technological environments, HTA has not yet been widely used in this field for determining the "value" of the diagnostic and therapeutic procedures. An example of diagnostic tool used in NICUs is the near-infrared spectroscopy (NIRS), a noninvasive device that enables real-time monitoring of the condition of peripheral tissues in critically ill newborns. The availability of this diagnostic tool could improve the choice of the most appropriate treatment to the clinical situation of the newborn. The expected benefit of NIRS motivates the need of a full HTA. Conclusion: HTA is still little used in Neonatal Critical Care, but it may be the appropriate tool to determine the "value" of technologies used in this field. The implementation of clinical trials and HTA may help in an evidence-based evaluation of new technologies for the neonatal critical care. This could facilitate the rapid introduction of the best health technologies into clinical practice. What is Known: • Health Technology Assessment (HTA) has taken an important role in the decision-making process related to the implementation of technologies in healthcare systems • The centrality of ethics in HTA has been known. In fact, ethics is everywhere in HTA, and value judgments permeate all levels of HTA What is New: • HTA is still little used in Neonatal Critical Care, but it may be the appropriate tool to determine the "value" of technologies used in this field • The implementation of clinical trials and HTA may help in an evidence-based evaluation of new technologies for the neonatal critical care and in introduction of the best and ethically acceptable health technologies into clinical practice. [ABSTRACT FROM AUTHOR]

Objective Although the Accreditation Council for Graduate Medical Education and American Board of Pediatrics (ABP) provide regulations and guidance on fellowship didactic education, each program establishes their own didactic schedules to address these learning needs. Wide variation exists in content, educators, amount of protected educational time, and the format for didactic lectures. This inconsistency can contribute to fellow dissatisfaction, a perceived poor learning experience, and poor attendance. Our objective was to create a Neonatal–Perinatal Medicine (NPM) fellow curriculum based on adult learning theory utilizing fellow input to improve the perceived fellow experience. Study Design A needs assessment of current NPM fellows at Cincinnati Children's Hospital was conducted to guide the development of a new curriculum. Fellow perception of educational experience and board preparedness before and after introduction of the new curriculum was collected. Study period was from October 2018 to July 2021. Results One hundred percent of the fellows responded to the needs assessment survey. A response rate of 100 and 87.5% were noted on mid-curriculum survey and postcurriculum survey, respectively. Key themes identified and incorporated into the curriculum included schedule structure, content, and delivery mode. A new didactic curriculum implementing a consistent schedule of shorter lectures grouped by organ system targeting ABP core content was created. After curriculum implementation, fellows had higher self-perception of board preparedness, and overall improved satisfaction. Conclusion Our positive experience in implementing this curriculum provides a framework for individual programs to implement similar curricula, and could be utilized to aid in development of national NPM curricula. Key Points Fellowship didactic education varies significantly resulting in learner dissatisfaction and poor attendance. Widespread need to restructure didactic curricula exists. Our study provides a framework for future curricula. [ABSTRACT FROM AUTHOR]

Pregnant women considered at risk for coronavirus disease (COVID-19), the virus can cause some pregnancy complications such as miscarriages, intrauterine growth restrictions and even lead to a premature birth. The objective of this study was to characterize the newborns of mothers with a hypothesis or confirmed case of COVID 19 who were admitted to a neonatal isolation unit. The research was carried out through the analysis of the records of neonates, of both genders, admitted to the COVID unit between 2020 and 2021, regardless of their length of stay in the unit and their clinical situation. Most mothers were from Fortaleza, gestational age ranged between 28 and 41 weeks, the presence of neonatal infection was not relevant compared to maternal swab and cesarean delivery was the most practiced. Regarding the possible consequences generated for the newborn due to maternal COVID 19, we can conclude that COVID 19 does not have relevant repercussions for the newborns in the sample, as well as we cannot identify the presence of vertical transmission from mother to baby within the sample. [ABSTRACT FROM AUTHOR]

Purpose and background: Parental peer support is part of the Family Integrated Care model in NICUs. However, little attention has been devoted to the specific content and organization of parental peer support programs. This scoping review aimed to identify (1) the preferred content of a parental peer support intervention, (2) the organizational processes, and (3) the suggested educational curriculum for peer support providers within existing programs in neonatal care. Discussion: Parental peer support programs have the goal to provide emotional support, information and assistance, and are to empower parents in the NICU. To achieve these goals, veteran parents receive training in communication skills, roles and boundaries, mental health, (non)medical aspects in the NICU and post-discharge preparation. Data on the organizational components remain limited. Hence, the question remains how the organization of a parental peer support program, and the training and supervision of veteran parents should be managed. Implications for research and practice: This scoping review provides a variety of aspects that should be considered when developing and implementing a parental peer support program in the NICU. Program development preferably involves NICU staff at an early stage. Future research should focus on the support of diverse populations in terms of culture, social economic status and gender, and on the effects of parental peer support on parent and infant. [ABSTRACT FROM AUTHOR]

This article uses machine learning techniques as fuzzy and neuro-fuzzy ANFISs, to develop and compare prediction models capable of relating pregnant women's exposure to air pollutants, such as Nitrogen Dioxide and Particulate Matter, the mother's age, and the number of prenatal consultations to the incidence of premature birth. In the current literature, studies can be found that relate prematurity to the exposure of pregnant women to NO2, O3, and PM10; to Toluene and benzene, mainly in the window 5 to 10 days before birth; and to PM10 in the week before birth. Both models used logistic regression to quantify the effects of pollutants as a result of premature birth. Datasets from Brazil—Departamento de Informatica do Sistema Único de Saúde (DATASUS) and Companhia Ambiental do Estado de São Paulo (CETESB)—were used, covering the period from 2016 to 2018 and comprising women living in the city of São José dos Campos (SP), Brazil. In order to evaluate and compare the different techniques used, evaluation metrics were calculated, such as correlation (r), coefficient of determination (R2), Root Mean Square Error (RMSE), Mean Absolute Percentage Error (MAPE), Mean Square Error (MSE), and Mean Absolute Error (MAE). These metrics are widely used in the literature due to their ability to evaluate the robustness and efficiency of prediction models. For the RMSE, MAPE, MSE, and MAE metrics, lower values indicate that prediction errors are smaller, demonstrating better model accuracy and confidence. In the case of (r) and R2, a positive and strong result indicates alignment and better performance between the real and predicted data. The neuro-fuzzy ANFIS model showed superior performance, with a correlation (r) of 0.59, R2 = 0.35, RMSE = 2.83, MAPE = 5.35%, MSE = 8.00, and MAE = 1.70, while the fuzzy model returned results of r = 0.20, R2 = 0.04, RMSE = 3.29, MSE = 10.81, MAPE = 6.67%, and MAE = 2.01. Therefore, the results from the ANFIS neuro-fuzzy system indicate greater prediction capacity and precision in relation to the fuzzy system. This superiority can be explained by integration with neural networks, allowing data learning and, consequently, more efficient modeling. In addition, the findings obtained in this study have potential for the formulation of public health policies aimed at reducing the number of premature births and promoting improvements in maternal and neonatal health. [ABSTRACT FROM AUTHOR]

Preeclampsia is a multifactorial gestational syndrome characterized by increased blood pressure during pregnancy associated with multiorgan involvement. The impact of this disease on maternal and neonatal health is significant, as it can lead to various fetal comorbidities and contribute to the development of maternal comorbidities later in life. Consistent evidence has shown that the microbiota acts as a regulator of the immune system, and it may, therefore, influence the development of preeclampsia by modulating immune factors. This narrative review aims to investigate the role of the immune system in the pathogenesis of preeclampsia and to summarize the most recent literature on the possible link between preeclampsia and alterations in the intestinal microbiota. To this end, we conducted a literature search, aiming to perform a narrative review, on PubMed and Embase from January 1990 to March 2024, focusing on the latest studies that highlight the main differences in microbial composition between patients with and without preeclampsia, as well as the effects of microbial metabolites on the immune system. From the review of 28 studies assessing the intestinal microbiota in preeclamptic women, preeclampsia could be associated with a state of dysbiosis. Moreover, these patients showed higher plasmatic levels of endotoxin, pro-inflammatory cytokines, and T helper 17 cells; however, the findings on specific microbes and metabolites that could cause immune imbalances in preeclampsia are still preliminary. [ABSTRACT FROM AUTHOR]

Background: This paper focuses on the period from 2019 to 2021 and investigates the factors associated with the high prevalence of C-section deliveries in South India. We also examine the nuanced patterns, socio-demographic associations, and spatial dynamics underlying C-section choices in this region. A cross-sectional study was conducted using large nationally representative survey data. Methods: National Family Health Survey data (NFHS) from 2019 to 2021 have been used for the analysis. Bayesian Multilevel and Geospatial Analysis have been used as statistical methods. Results: Our analysis reveals significant regional disparities in C-section utilization, indicating potential gaps in healthcare access and socio-economic influences. Maternal age at childbirth, educational attainment, healthcare facility type size of child at birth and ever pregnancy termination are identified as key determinants of method of C-section decisions. Wealth index and urban residence also play pivotal roles, reflecting financial considerations and access to healthcare resources. Bayesian multilevel analysis highlights the need for tailored interventions that consider individual household, primary sampling unit (PSU) and district-level factors. Additionally, spatial analysis identifies regions with varying C-section rates, allowing policymakers to develop targeted strategies to optimize maternal and neonatal health outcomes and address healthcare disparities. Spatial autocorrelation and hotspot analysis further elucidate localized influences and clustering patterns. Conclusion: In conclusion, this research underscores the complexity of C-section choices and calls for evidence-based policies and interventions that promote equitable access to quality maternal care in South India. Stakeholders must recognize the multifaceted nature of healthcare decisions and work collaboratively to ensure more balanced and effective healthcare practices in the region. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion The aim of the present study was to evaluate the obstetric complications associated with isolated fetal congenital heart disease (CHD) by comparing pregnancies with and without this condition.In this retrospective matched comparative study at Siriraj Hospital, Thailand, we included 233 postnatally confirmed fetal CHD cases and 466 unaffected fetuses. Controls were selected at a 2:1 ratio, ensuring that they matched the cases in terms of maternal age, parity, and history of preterm deliveries.Fetal CHD was significantly associated with an increased risk of spontaneous preterm labor (30% vs 9.7%; adjusted odds ratio [aOR] 2.42; 95% confidence interval [CI]: 1.35–4.36; P = 0.003), delivery before 34 gestational weeks (11.6% vs 0.6%; aOR 12.33; 95% CI: 3.32–45.78; P < 0.001), and pre‐eclampsia (11.6% vs 2.8%; aOR 2.19; 95% CI: 1.01–4.76; P = 0.047). Newborns with CHD were significantly more likely to be small for gestational age (10.7% vs 5.2%; aOR 2.09; 95% CI: 1.11–3.94; P = 0.022). Intriguingly, a prenatal diagnosis of CHD was associated with a reduced risk of preterm delivery in affected pregnancies (P = 0.002).Pregnancies affected by isolated fetal CHD demonstrated a higher propensity for several adverse outcomes. These findings underscore the importance of prenatal CHD detection and tailored perinatal care to potentially improve both pregnancy outcomes and neonatal health. [ABSTRACT FROM AUTHOR]

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

Objective Hemodynamically significant patent ductus arteriosus (hsPDA) in preterm neonates is associated with end-organ injury including intraventricular hemorrhage. Early treatment may reduce morbidities but may result in overtreatment. This study aimed to examine the association between commonly obtained echocardiographic markers within the first 12 hours of life and eventual treatment of an hsPDA. Study Design Patients with <32 weeks' gestational age had blinded echocardiograms done within the first 12 hours of life as part of research protocols. Subsequent treatment of the patent ductus arteriosus (PDA) was determined by the clinical team independent of echocardiogram results. t -tests and chi-square tests were done for continuous data and categorical outcomes. A receiver operating curve was created to optimize cutoff values. Results Among 199 neonates studied (mean time of echocardiogram 6.7 h after birth), those needing PDA treatment had higher left ventricular output (LVO), right ventricular output (RVO), and superior vena cava (SVC) flow (p -values 0.007, 0.044, and 0.012, respectively). Cutoffs for predicting PDA treatment were LVO > 204 mL/kg/min (63% sensitivity, 66% specificity), RVO > 221 mL/kg/min or SVC flow > 99 mL/kg/min (sensitivities 70 and 43%, specificities 48 and 73%, respectively). Conclusion Preterm neonates with higher markers of cardiac output in the first 12 hours of birth later required PDA treatment. These data are the first to use standard cardiac output measures in the first 12 hours of life to predict the need for future PDA treatment. Further prospective studies will need to be performed to corroborate these associations between echocardiographic markers and clinical outcomes/morbidities. Key Points Early diagnosis of hsPDA may prevent severe morbidity and death. There are echocardiographic markers beyond duct size and flow direction that may aid early diagnosis. Cardiac output markers within the first 12 hours of life may predict need for treatment of hsPDA. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to assess the current neonatal nutritional practices in Taiwan and promote consensus on standardized protocols. Methods: An online questionnaire comprising 95 items on parenteral nutrition (PN) and enteral nutrition (EN) practices was distributed to neonatal care units across Taiwan via email between August and December 2022. The responses were compared with the recommendations from the European Society for Pediatric Gastroenterology Hepatology and Nutrition for preterm infant care. Results: Most of the 35 neonatal units, comprising 17 level III and 18 level II units, that participated in this study adhered to standard PN protocols; however, only 30% of units used protein-containing solutions as the initial fluid. Over half of the neonatal units provided calcium, phosphate, and magnesium at less than the recommended dosage. Trophic feeding commenced within 48 h in 88% of the units, with the mother's milk used as the first choice. All the units preferred commencing advanced feeding at <25 mL/kg/day. Conclusions: Most nutrient protocols for preterm infants in neonatal units in Taiwan meet recent guidelines, but discrepancies such as lower mineral supplements in PN and a slower advancement of enteral feeding increase nutritional risk. These issues warrant further research. [ABSTRACT FROM AUTHOR]

Background/aim: Phthalates are the materials used for plasticizing polyvinyl chloride. Di-(2-Ethylhexyl) phthalate (DEHP) is one of the phthalates most frequently used in a wide range of applications, including medical equipment such as endotracheal and feeding tubes, intravenous catheters, central lines, extracorporeal membrane oxygenation sets, total parenteral nutrition bags, blood product sets, and intravenous pump lines, respiratory sets in neonatal intensive care units (NICUs). Studies have shown that phthalates, including DEHP, can cross the placenta and blood-brain barrier, possibly leading to neurodevelopmental impairment in vitro and in vivo. However, the molecular mechanisms affected by phthalate exposure have not been explored in depth. This study aimed to illuminate the effects of DEHP on neuroinflammation at the molecular level using neonatal microglial cells as the model. Materials and methods: Mouse BV-2 neonatal microglia cells were exposed to DEHP under controlled conditions. Cellular toxicity was assessed via a cell viability assay and specific markers were used to evaluate the apoptosis/necrosis, cellular iron content, reactive oxygen species (ROS), and organelle integrity. Proinflammatory proteins were quantified using enzyme-linked immunosorbent assay, while ferroptosis was assessed using a ferroptosis blocker, and affected gene expressions were determined using quantitative reversetranscriptase real-time polymerase chain reaction (RT-PCR). Results: The results revealed that high concentrations of DEHP exposure increased toxicity via increased levels of ROS and inflammation. Elevated ROS levels were observed to increase the tendency for mitochondrial-lysosomal disruption, bringing about apoptosis or necrosis. Moreover, iron homeostasis was dysregulated by DEHP, which putatively triggered ferroptosis in a dose-dependent manner. Conclusion: This study indicates that neonatal exposure to DEHP may be linked to neurodevelopmental impairment via inflammationrelated cell death and ferroptosis. The prevalence of DEHP in NICU medical devices raises concerns about potential neurodevelopmental deficits, including disorders like autism and mental retardation. These findings highlight the urgency of addressing DEHP exposure in neonatal care. [ABSTRACT FROM AUTHOR]

From the moment of birth, the newborn gastrointestinal tract is infiltrated by various bacteria originating from both maternal and environmental sources. These colonizing bacteria form a complex microbiota community that undergoes continuous changes until adulthood and plays an important role in infant health. The maturation of the infant gut microbiota is driven by many factors and follows a distinct patterned trajectory, with specific bacterial taxa establish in the intestine in accordance with developmental milestones as the infant grows. In this review, we highlight how elements such as diet and host physiology select for specific microbial functions and shape the composition of the bacterial community in the large intestine. [ABSTRACT FROM AUTHOR]

The article focuses on neonatal bacterial meningitis, a life-threatening infection with high mortality and morbidity rates in neonates. Topics discussed include the leading causes of meningitis, particularly Group B Streptococcus, risk factors associated with infection, and the critical importance of early diagnosis and treatment.

The article highlights the significance of early relationship health between parents and infants, particularly in the context of high-risk babies in intensive care. Topics discussed include the critical role of safe, stable nurturing relationships (SSNRs) in a child's development, the challenges faced by parents of medically fragile infants, and the necessity of non-separation practices to foster emotional and physiological connections.

BACKGROUND: Diagnostic autopsy has been in use for long to determine the cause of death. Since recently however ‘Minimally Invasive Tissue Sampling’ (MITS) is introduced to determine definitive cause of neonatal death. This study describes locally established facilitators to introduce MITS procedures to determine cause of neonatal death in Ethiopia. METHODS: Exploratory study was conducted in Butajira community where twenty-two key informants representing community opinion leaders’ health care workers, five in depth interviews with parents who recently lost neonates and eight FGDs with community members were completed to generate evidences in line with the research question. Interviews and discussions were audio recorded, transcribed verbatim and analysed facilitated by open-code software. Thematic analysis was applied to identify and interpret patterns of the evidences RESULTS: In Butajira, ANC and delivery in health facilities was found to have improved over the years. Yet, child death remains an outstanding problem. While different factors were identified to cause the death of a child, relatively few participants choose to accept newborn death as a natural occurrence or will of the creator. Majority of the study participants expressed interest to know definitive cause of death using MITS. Yet, awareness about MITS and how it works was unanimously desired. It was found that husbands and wives are key to authorize MITS procedure while community opinion leaders including religious leaders were identified as key to influence parental decisions for the procedure CONCLUSION: Building awareness of the community members and engagement of opinion leaders is critical to introduce MITS. [ABSTRACT FROM AUTHOR]