Syndromic and non-syndromic etiologies causing neonatal hypocalcemic seizures

BACKGROUND

The diagnosis of neonatal hypocalcemic seizures (HS) in newborns is made based on clinical signs and serum calcium level. Their etiology is broad and diverse, and timely detection and initiation of treatment is essential.

METHODS

We retrospectively reviewed 1029 patients admitted to the neonatal intensive care unit. Neonatal HS were diagnosed in 16 patients, and we compared etiologies and clinical outcomes, including clinical seizures and neurodevelopment at least over 1 year old.

RESULTS

The etiologies can be broadly categorized into 5 syndromic and 11 non-syndromic neonatal HS. Syndromic neonatal HS included 3 Digeorge syndrome, 1 Kleefstra syndrome and 1 Alström syndrome. Non-syndromic neonatal HS included 8 vitamin D deficiency, 1 hypoparathyroidism, and 2 hypoxic-ischemic encephalopathy. Patients with syndromic neonatal HS were found to have worse clinical outcomes than those with nonsyndromic HS. In eight patients with vitamin D deficiency, neurodevelopment was normal. Five of five patients (100%) with syndromic HS used two or more antiseizure drugs. However, among patients with non-syndromic neonatal HS, only one of 11 (9.1%) used more than one drug (p = 0.001).

CONCLUSION

This finding highlighted that syndromic hypocalcemic seizures in newborns have worse neurodevelopmental outcomes and are more often difficult to manage, and would benefit from a genetic diagnostic approach.

Premature delivery impacts the concentration of plasminogen activators and a plasminogen activator inhibitor and the plasmin activity in human milk

BACKGROUND AND AIMS

Plasmin in human milk partially hydrolyzes milk proteins within the mammary gland and may enhance the hydrolysis of milk proteins within the infant's stomach. This study examined the effects of extremely preterm (EP)-, very preterm (VP)-, and term-delivery on plasmin activity and the concentrations of plasminogen activators [urokinase-type plasminogen activator (uPA) and tissue-type plasminogen activator (tPA)], plasminogen activator inhibitor type 1 (PAI-1) and the complexes of PAI-1/uPA and PAI-1/tPA in human milk.

MATERIALS AND METHODS

Human milk samples were collected from mothers who delivered extremely preterm infants [24-27 weeks gestational age (GA), n = 20], very preterm infants (28-32 weeks GA, n = 12), and term infants (38-39 weeks GA, n = 8) during 2-72 days postnatally. Plasmin activity was determined using fluorometric substrate assay, whereas concentrations of uPA, tPA, PAI-1, the PAI-1/uPA complex and the PAI-1/tPA complex were quantified by ELISA.

RESULTS

Plasmin activity, uPA and tPA were detected in all human milk samples, PAI-1 and the PAI-1/uPA complex were present in 42.5 and 32.5% of milk samples, respectively, and the PAI-1/tPA complex was not detected. Plasmin activity was correlated negatively with postnatal age and postmenstrual age (PMA) in the VP group and positively with postnatal age in the term group. uPA and tPA concentrations decreased with increasing postnatal age in both EP and VP groups but did not correlate in the term group. uPA concentration was correlated positively with GA in the VP group and tended to be elevated with increasing GA in the combined three groups. In contrast, tPA concentrations were correlated negatively with GA and PMA in the combined three groups (P < 0.008) and with PMA in the EP and VP groups. PAI-1 concentration tended to be correlated positively with postnatal age in the combined three groups. No correlation was detected with the PAI-1/uPA complex.

CONCLUSION

Premature delivery impacted the plasmin activity and the concentrations of uPA, tPA, and PAI-1 in human milk. Whether these changes in milk plasminogen activators and inhibitors have a role in balancing the proteolytic digestion of premature infants remains to be investigated.

Serum Level of Alanine- and Aspartate-Aminotransferase Levels in Newborns in India

Background

Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) ≤40 IU/L is normal. This cutoff, although determined in adults, is widely used for newborns. We studied the reference ranges for ALT and AST in newborns in India.

Methods

We prospectively included babies with gestational age (GA) between 34 and 41weeks and birth weight (BW) ≥ 1500 g. We excluded the babies who either themselves or their mother had risk factors, which could cause elevation of serum levels of liver enzymes. Serum ALT and AST were measured in venous cord blood. The estimated percentile curves for ALT and AST, for BW and GA covariates, were drawn with General Additive Model for Location Scale and Shape (GAMLSS) with Box-Cox Power Exponential (BCPE).

Results

Five-hundred thirty-seven babies (Boys 53.3%; GA 34-36 wks 19.7%; appropriate for GA 74.9%; BW < 2500 g 20.5%) were included. Overall, mean [SD] serum ALT and AST were 44¹² IU/L and 52¹⁸ IU/L, respectively. The serum AST was significantly higher than the ALT level, regardless of gender, BW, GA, or fetal growth categories. The percentile curve against GA remained flat for ALT, although it showed a slight rise for AST. Serum levels of ALT and AST plotted against BW were also similar and showed an increase up to 2000 g and then remained stationary after that.

Conclusion

The serum levels of ALT and AST up to 44 IU/L and 52 IU/L, respectively, can be taken as normal in newborns with BW ≥ 2000 g or GA ≥34 weeks.

Maternal and neonatal factors associated with low birth weight among neonates delivered at the University of Gondar comprehensive specialized hospital, Northwest Ethiopia

INTRODUCTION

Low birth weight is a major contributory factor to infant mortality. Although low birth weight remains an important public health problem in Ethiopia, little emphasis is paid to its intervention as a means of reducing neonatal mortality. The aim of this study was to assess the magnitude of low birth weight and its associated maternal and neonatal factors in newborns delivered at the University of Gondar Comprehensive Specialized Hospital.

METHODS

Hospital-based cross-sectional study was conducted, and 481 study participants were selected using systematic random sampling methods. Pre-tested interviewer-administered questionnaires were used to collect the data. Bivariable and multivariable binary logistic regression was implemented. Finally, the odds ratio with a 95% CI and a p-value of <0.05 were used to identify factors associated with low birth weight.

RESULT

The prevalence of low birth weight was 12.5% (95% CI; 9.8, 15.7%). Preterm birth (AOR = 38; 95% CI: 15.3, 93.0), pregnancy-induced hypertension (PIH) (AOR = 2.6; 95%CI: 1.1, 6.4), maternal body mass index (BMI) of < 18.5 kg/m² (AOR = 6.8; 95% CI: 1.5, 31.1), and grand multiparity (AOR = 4.2; 95% CI: 1.2, 16) were factors positively associated with low birth weight. However, babies delivered from mothers with age > 35 years (AOR = 0.14:95% CI 0.03, 0.7) had lower odds of low birth weight.

CONCLUSION

In this study, the prevalence of low birth weight was higher than in the previous studies. The study revealed preterm birth, PIH, BMI of < 18.5 kg/m², and grand multiparity were independent factors that increase the low birth weight while maternal age > 35 years reduces the low birth weight. Therefore, healthcare professionals should emphasize the early identification and management of women with PIH, tackling prematurity, and preventing maternal malnutrition through nutritional counseling as much as possible.

[Laparoscopic phelps approach in children with inguinal hernia: a retrospective comparative study]

OBJECTIVE

To evaluate the effectiveness of a new method of inguinal hernia repair in children (PHELPS) first proposed by the authors compared to another laparoscopic method (SEAL).

MATERIAL AND METHODS

The study demonstrated the results of laparoscopic treatment of 729 patients with inguinal hernias. Of these, 255 patients underwent PHELPS procedure. Other 474 patients underwent SEAL procedure. The difference between both methods is that hernial ligature is passed around the hernial sac in case of PHELPS. SEAL procedure implies capture of tissues of anterior abdominal wall (muscles and aponeurosis) into this knot. We analyzed whether this factor can lead to less incidence of recurrence and hydrocele.

RESULTS

Both groups were comparable by age, body weight and gender. Median of surgery time including correction of unilateral and bilateral hernia was similar (20.0 [10.0; 20.0] min versus 15.0 [15.0; 20.0] min; p=0.666). We found faster patient recovery after PHELPS procedure for inguinal hernia including much less doses of postoperative analgesia (1.0 [1.0; 1.0] versus 1.0 [1.0; 2.0]; p<0.001) and shorter hospital-stay (8.0 [8.0; 8.0] hours versus 8.0 [8.0; 9.0] hours; p=0.010). There were no significant differences in the incidence of postoperative hydrocele (0 versus 6; p=0.097). Nevertheless, recurrence rate differed significantly (0 versus 17; p=0.001).

CONCLUSION

PHELPS procedure is characterized by lower incidence of recurrence and accelerated postoperative recovery compared to SEAL technique.

Newborns' clinical conditions are correlated with the neonatal assessment manual scorE (NAME)

OBJECTIVE

To investigate the relationship between the Neonatal Assessment Manual scorE (NAME) and newborns' clinical condition on a large number of infants. The NAME model was developed as an instrument to assess the infant's general conditions, especially in NICUs, by evaluating how the infant's body responds to an external stressor such as static touch. Previous studies, employing experienced assessors, showed good validity indices as well as high inter-rater reliability.

STUDY DESIGN

Newborns were recruited at the "Vittore Buzzi" Pediatric Hospital NICU ward in Milan and their clinical conditions were collected through a standardized form-the complexity index. Two manual practitioners assessed all eligible newborns using the NAME scores. Data was analyzed using Kendall's τ correlation and odds ratio (OR) to assess the relationship between the NAME scores and the complexity index.

RESULTS

Two hundred two newborns (46% female; 34.1 w ± 4.3; birth weight of 2,093.4 gr ± 879.8) entered the study. The Kendall's correlation between the clinical conditions (complexity index) and the NAME score was -0.206 [95% CI: (-0.292, -0.116), p-value < 0.001], corresponding to an OR of 0.838 [95% CI: (0.757, 0.924), p-value < 0.001]. Further exploratory analyses showed significant correlation between gestational age, birth weight and NAME scores.

CONCLUSION

The present paper adds evidence to the NAME model validity by demonstrating its applicability in the clinical neonatological context.

Comparison Among Two Liquid Formulations of L-thyroxine in the Treatment of Congenital Hypothyroidism in the First Month of Life: A Pilot Study

The liquid formulation of L-thyroxine is the most used in the substitutive treatment of congenital hypothyroidism (CH). This formulation has higher TSH suppression rates with respect of L-thyroxine tablets and thus lower doses are indicated. Two types of liquid L-thyroxine (Tirosint^© and Tifactor^©) are currently approved in Italy for use in pediatric age and to date there are no data available in the Literature comparing the two liquid formulations. The aim of this study is to compare the efficacy of both formulations in normalizing TSH and fT4 levels in the first month of life and to compare the L-thyroxine requirement for both formulations over the same period. All newborns diagnosed with primary CH at the neonatal screening program in the Piedmont region of Italy in the period May 2020 - May 2021 were enrolled and divided into two groups according to the liquid formulation used: TS Group with Tirosint^© and TF Group with Tifactor^©. No difference was observed between the two groups considering the TSH at dried blood spot (DBS) at neonatal screening, the serum levels of TSH, fT4 and fT3 and initial dose of L-thyroxine. At 15 days the serum TSH in the TF Group was 0.08 ± 0.02 mcUI/ml, while in the TS Group it was 36.7 ± 14.7 mcUI/ml p=0.04). No differences were observed between the two groups considering fT4 levels and L-thyroxine requirement. Among the subjects in the TF Group, 5/9 showed suppressed TSH at 15 days after starting treatment, while none of the subjects in the TS Group showed TSH levels below the normal lower limit (p=0.011). Among the subjects in the TF Group, 5/9 patients showed suppressed TSH at 30 days after starting treatment, while 1/12 subjects in the TS Group showed TSH levels below the normal lower limit (p=0.017). In conclusion, this study confirms the efficacy in normalizing the thyroid hormonal profile in newborns with CH among the liquid solutions although the response seem to be different in timing therefore an individual approach is necessary considering the type of formulation used, the diagnostic category of CH and clinical features.

Endometrial thickness is associated with low birthweight in frozen embryo transfer cycles: A retrospective cohort study of 8,235 singleton newborns

OBJECTIVE

To explore the association between endometrial thickness (EMT) and adverse neonatal outcomes in frozen in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles.

METHODS

This retrospective study involved a total of 8,235 women under the age of 35 years who underwent IVF/ICSI cycles and received frozen embryo transfer (FET) at a tertiary-care academic medical from January 2015 to December 2019, resulting in a live singleton newborn. Patients were categorized into three groups depending on EMT: ≤7.5 mm, 7.5-12 mm and >12 mm. The primary outcome was low birthweight (LBW). The secondary outcomes were preterm birth (PTB), small-for-gestational age (SGA), large-for-gestational age (LGA) and high birthweight (HBW).

RESULTS

Compared with EMT >7.5-12 mm group, the risk of being born LBW was statistically significantly increased in the EMT ≤7.5 mm group (adjusted odds ratio [aOR] 2.179; 95% confidence interval [CI], 1.305-3.640; P=.003), while dramatically decreased in the EMT >12 mm group (aOR 0.584; 95% CI, 0.403-0.844; P=.004). Moreover, newborn gender and pregnancy complications were all independent predictors for LBW. Furthermore, a significant decrease in birthweight was found in the EMT ≤7.5 mm group as compared with EMT >7.5-12 mm group and EMT >12 mm group (3,239 ± 612 vs. 3,357 ± 512 and 3,374 ± 479 g, respectively), and similar result was found in term of gestational age (38.41 ± 2.19 vs. 39.01 ± 1.68 and 39.09 ± 1.5 weeks, respectively).

CONCLUSIONS

After frozen IVF/ICSI-ET, EMT ≤7.5 mm is independently associated with increased risk of LBW among women with singleton newborns. Therefore, we suggest that women with EMT ≤7.5 mm after achieving pregnancy by IVF/ICSI-ET treatment should warrant more attention to reduce the risk of delivering a LBW newborn.

Evaluation of presepsin as a diagnostic tool in newborns with risk of early-onset neonatal sepsis

OBJECTIVES

To evaluate the efficacy of presepsin (P-SEP) as a potential biomarker of early-onset neonatal sepsis (EOS) and compare it to other routinely used markers of inflammation. To establish the cut-off values of P-SEP for EOS.

STUDY DESIGN

184 newborns were prospectively recruited between January 2018 to December 2020. Newborns >34th gestational week with suspected infection were included up to 72 h after delivery, and divided into three categories (i.e., unlikely, possible, and probable infection) based on risk factors, clinical symptoms and laboratory results. Values of plasma P-SEP were sequentially analyzed.

RESULTS

Median values of P-SEP in newborns with probable infection were significantly higher compared to healthy newborns (p = 0.0000013) and unlikely infection group (p = 0.0000025). The AUC for discriminating the probable infection group from the unlikely infection group was 0.845 (95% Cl: 0.708-0.921). The diagnostic efficacy of P-SEP was highest when used in combination with IL-6 and CRP (0.97; 95% CI: 0.911-0.990). The optimal cut-off value of P-SEP was determined to be 695 ng/L.

CONCLUSION

P-SEP, when combined with IL-6 and CRP, may be utilized as a negative predictive marker of EOS (NPV 97.2%, 95% CI: 93.3-101), especially in newborns at low to medium risk of infection.

The Development and Neurophysiological Assessment of Newborn Auditory Cognition: A Review of Findings and Their Application

This review article introduces the basic principles of infants' neurophysiology, while summarizing the core knowledge of the anatomical structure of the auditory pathway, and presents previous findings on newborns' neural speech processing and suggests their possible applications for clinical practice. In order to tap into the functioning of the auditory pathway in newborns, recent approaches have employed electrophysiological techniques that measure electrical activity of the brain. The neural processing of an incoming auditory stimulus is objectively reflected by means of auditory event-related potentials. The newborn's nervous system processes the incoming sound, and the associated electrical activity of the brain is measured and extracted as components characterized by amplitude, latency, and polarity. Based on the parameters of event-related potentials, it is possible to assess the maturity of a child's brain, or to identify a pathology that needs to be treated or mitigated. For instance, in children with a cochlear implant, auditory event-related potentials are employed to evaluate an outcome of the implantation procedure and to monitor the development of hearing. Event-related potentials turn out to be an irreplaceable part of neurodevelopmental care for high-risk children e.g., preterm babies, children with learning disabilities, autism and many other risk factors.

Molecular Changes in the Glucokinase Gene (GCK) Associated with the Diagnosis of Maturity Onset Diabetes of the Young (MODY) in Pregnant Women and Newborns

BACKGROUND

Diabetes mellitus is the most common metabolic alteration in gestation. Monogenic diabetes or Maturity-Onset Diabetes of the Young (MODY) is a subtype caused by a primary defect in insulin secretion determined by autosomal dominant inheritance.

OBJECTIVES

This study aimed to analyze molecular changes of the Glucokinase gene (GCK) in pregnant women with hyperglycemia during gestation and in their neonates. Case Study and Methods: We collected 201 blood samples, 128 from pregnant patients diagnosed with hyperglycemia and 73 from umbilical cord blood from neonates of the respective patients. DNA extraction and polymerase chain reaction (PCR) were performed to identify molecular changes in the GCK gene.

RESULTS

In a total of 201 samples (128 from mothers and 73 from neonates), we found changes in 21 (10.6%), among which 12 were maternal samples (6.0%) and 9 were neonatal samples (4.5%). DNA sequencing identified two polymorphisms and one deleterious MODY GCK-diagnostic mutation.

CONCLUSION

The prevalence of molecular changes in the Glucokinase gene (GCK) and the deleterious MODY GCK-diagnostic mutation were 9.3% and 0.7%, respectively, in women with hyperglycemia during gestation and 12.5% and 1.3%, respectively, in their neonates. The deleterious MODY GCK mutation identified is associated with a reduction in GCK activity and hyperglycemia. In the other molecular changes identified, it was impossible to exclude phenotypic change despite not having clinical significance. Therefore, these changes may interfere with the management and clinical outcome of the patients.

[Melanotic neuroectodermal tumor of infancy. Clinical case of large fontanel tumor and literature review]

Melanotic neuroectodermal tumor of infancy (MNTI) is a neonatal tumor with progressive growth and high recurrence rate. Aggressive growth and localization of tumor often lead to significant cosmetic defects of cranial and facial bones. The authors report MNTI in a 6-month-old boy with lesion of the large fontanel. Total resection was followed by recurrence after 3 weeks. Repeated resection with subsequent radiotherapy was performed. The follow-up period was 6 months after repeated resection. There was no tumor growth throughout this period. Considering this case and world experience, we can conclude that treatment strategy for MNTI is still unclear.

Effect of COVID-19 infection on pregnancy and the possibility of vertical transmission from infected pregnant mothers to fetuses

Coronavirus disease 19 has been predominant in China then transmitted to different countries. The study aimed to evaluate the recent evidences from published papers of potential risks of COVID-19 contagion through gestation and if vertical transmission is possible?. We reviewed several studies on the effect of COVID-19 through pregnancy by using published articles up to June, 2021. Infection with COVID-19 during pregnancy may increase risk of pregnancy problems such as preterm birth and PPROM in few cases, but other researchers establish no COVID-19 contagion was revealed in neonates. Vertical transmission of COVID-19 is feasible, and happens in a small percentage of infected mothers, but other researchers demonstrated no vertical transmission of COVID-19. According to the narrow data, there is no enough evidence for congenital defects to fetuses of infected mother and no sure for vertical transmission. More research must be done to prove the effect of COVID-19 on the fetuses and vertical transmission.

Feasibility of nasal NO screening in healthy newborns

BACKGROUND

Nasal nitric oxide (nNO) measurement is recommended as a first line screening test for primary ciliary dyskinesia (PCD). While reliable velum- and non-velum-closure techniques exist for preschool children and older individuals, no data are available for neonates.

AIMS

To determine feasibility of nNO screening and nNO concentration in healthy newborns in the first week of life.

METHODS

Nasal NO was analyzed in tidal breathing during natural sleep using a CLD-88 sp NO analyzer (chemoluminescence sensor) and a NIOX MINO (electrochemical sensor). Test success and nNO concentration were determined and compared between the two devices.

RESULTS

Nasal NO was measured in 62 healthy neonates within the first week of life. Feasibility of nNO measurement was 100% for at least one nostril and 85.5% for both nostrils using the chemoluminescence device, but significantly lower with the electrochemical device (85.5% and 53.2%; p < .001). Median nNO concentration was 38 ppb (interquartile range, 27-55; range, 9-100) with the ECOMEDICS device and 23 (15-33, 8-59) with the NIOX MINO (p < .001), with a trend towards higher values for older subjects. None of the subjects exceeded nNO levels of 100 ppb.

CONCLUSION

Measurement of nNO using a chemoluminescence device is highly feasible in newborns during natural sleep. However, nNO levels are considerably lower compared to the published data for older individuals and in the range of a PCD reference group of infants between 4 and 8 weeks of age, potentially resulting in a great overlap with subjects with PCD in this age group. Therefore, screening for PCD using nasal NO might not be useful in the first week of life. Upon clinical suspicion, other diagnostic tests such as high-speed video analysis of the cilia should be applied.

Early Blood Glucose Level Post-Admission Correlates with the Outcomes and Oxidative Stress in Neonatal Hypoxic-Ischemic Encephalopathy

The antioxidant defense system is involved in the pathogenesis of neonatal hypoxic-ischemic encephalopathy (HIE). To analyze the relationship between first serum blood glucose levels and outcomes in neonatal HIE, seventy-four patients were divided, based on the first glucose level, into group 1 (>0 mg/dL and <60 mg/dL, n =11), group 2 (≥60 mg/dL and <150 mg/dL, n = 49), and group 3 (≥150 mg/dL, n = 14). Abnormal glucose levels had poor outcomes among three groups in terms of the clinical stage (p = 0.001), brain parenchymal lesion (p = 0.004), and neurodevelopmental outcomes (p = 0.029). Hearing impairment was more common in group 3 than in group 1 (p = 0.062) and group 2 (p = 0.010). The MRI findings of group 3 exhibited more thalamus and basal ganglion lesions than those of group 1 (p = 0.012). The glucose level was significantly correlated with clinical staging (p< 0.001), parenchymal brain lesions (p = 0.044), hearing impairment (p = 0.003), and neurodevelopmental outcomes (p = 0.005) by Pearson’s test. The first blood glucose level in neonatal HIE is an important biomarker for clinical staging, MRI findings, as well as hearing and neurodevelopment outcomes. Hyperglycemic patients had a higher odds ratio for thalamus, basal ganglia, and brain stem lesions than hypoglycemic patients with white matter and focal ischemic injury. Hyperglycemia can be due to prolonged or intermittent hypoxia and can be associated with poor outcomes.

Study of the association of the nutritional profile of pregnant women with the birth weight of newborns in Morocco

Background

Low birth weight (LBW) is an important predictor of neonatal morbidity and mortality. It reflects the nutritional status of the mother and the quality of health care services during pregnancy.

Objective

The objective of this study is to determine the factors associated with low birth weight of children born to Moroccan pregnant women in the province of El Jadida.

Material and Methods

This cross-sectional case-control study was carried out in the maternity ward of El Jadida provincial hospital on 344 parturient women, half of whom had given birth to children with an LBW and the other half of children with normal weight (NW) at birth. Information on maternal gestational and socioeconomic characteristics as well as eating habits was collected using a questionnaire and anthropometric measurements were taken on the newborns.

Results

The study identified 172 parturient who gave birth to newborns with LBW and 172 parturient who gave birth to newborns of NW. The proportions of LBW are greater in first-time mothers (50.6%) and professionally inactive (86.6%). The mean weight of LBW newborns is 2013.95 ± 372.95g compared to 3380 ± 217.59g for NW newborns. The determined factors associated with LBW are the low socio-economic level (OR = 3.18; 95% CI: 1.09-9.23), insufficient monitoring of prenatal consultation (OR = 2.91; 95% CI: 1, 71-4.95), origin from rural areas (OR = 0.52; 95% CI: 0.30-0.91) and lack of nutritional education (OR = 0.17; 95% CI: 0, 09-0.34). The daily calcium intake in mothers of newborns with LBW is 33.82% of the recommended daily allowance (RDA), the daily iron requirement coverage was 50%, folates 66, 16% and zinc 87.72% of the RDA.

Conclusions

Well-targeted and coordinated education and awareness-raising actions on early pregnancy and feeding pregnant women could have a positive impact on improving the birth rate of children with a weight deficit.

Experience in the diagnosis of group B Streptococcus infections in pregnant women and newborns in a perinatal center

Serogroup B streptococci (Streptococcus agalactiae) are one of the main etiological agents responsible for the occurrence of severe perinatal infections in both postpartum women and newborns. The experience of microbiological diagnostics of infections caused by streptococcus serogroup B (GBS) according to the data of the microbiological laboratory of the perinatal center is generalized. In the study of biomaterial from patients, the proportion of positive cultures of Streptococcus agalactiae was 2.2% in cervical samples, 8.8% in vaginal contents, 6.6%; 2.8% and 0.7% in amniotic fluid, placenta and urine, respectively. In 57% of cases, GBS was released at a concentration of more than 5 lg / ml and in 73% of cases as part of polymicrobial associations with other opportunistic microorganisms. In the biomaterial from newborns, GBS was found in 2.5% of positive findings in blood samples, 4.6% in tracheobronchial lavages and 2.7% in detachable skin of the armpit when taking material immediately after childbirth and 1, 1% and 0.7%, respectively, during examination in the second stage of nursing. 5 cases of GBS isolation in newborns ended in early neonatal mortality with definitive diagnoses of congenital pneumonia and IUI of newborns, while there was only partial coincidence of the results of microbiological studies of the genital tract of the mother and biomaterials from the newborn. Relatively frequent findings of GBS in newborns of the high-risk group in intensive care unit indicate intrauterine infection with this pathogen. The examination of smears from the cervical canal is not informative in relation toGBS infection in comparison with the examination of the vaginal contents and recto-vaginal smears. The results of the introduction of microbiological screening and its effectiveness in real practice to prevent the development of early and late forms of GBS infections in newborns require further analysis.

Group B Streptococci Vaginal-Recto Colonization, Vertical Transmission to Newborns, Antimicrobial Susceptibility Profile and Associated Factors in Selected Health Facilities of Bahir Dar City: A Cross-Sectional Study

BACKGROUND

Group B streptococci (GBS) is an important pathogen involved in stillbirths, neonatal deaths and neurological defects, and the occurrence of multi-drug resistance (MDR) is an alarming issue. This study determined the prevalence of GBS colonization in pregnant women and newborns, the proportion of vertical transmission, antimicrobial susceptibility profiles of isolates, and the factors associated with colonization and vertical transmission.

METHODS

A cross-sectional study was conducted from March 1, 2021 to June 30, 2021, at selected health facilities of Bahir Dar city. Vaginal-recto swabs from 292 pregnant women and pooled ear, nasal and umbilical swabs from 292 newborns were collected. GBS were identified following standard microbiological protocols. Antimicrobial susceptibility testing was performed using modified Kirby-Bauer disk diffusion method and interpreted by the accepted 2020 CLSI M100 guidelines. Logistic regression analysis was computed.

RESULTS

Overall, 54 (18.5%) of pregnant women and 22 (7.5%) of newborns had GBS colonization. The proportion of GBS vertical transmission was 22 (40.7%). Group B Streptococcus isolates scored susceptibility to penicillin, ampicillin and vancomycin with 88.9%, 90.7%, and 96.3% for pregnant women and 86.4%, 90.9% and 95.9% for newborns, respectively. A high percentage of non-susceptibility was found for clindamycin and erythromycin with 33.3% and 25.9% for pregnant women and 31.8% and 22.7% from newborns, respectively. Besides, 19 (35.2%) GBS from pregnant women and 8 (36.4%) from newborns were MDR. Group B streptococci colonization was significantly associated with delivery before 37th week of gestation (AOR=2.77, 95% CI 1.14-6.68) and history of stillbirth (AOR=3.13, 95% CI 1.13-8.70).

CONCLUSION

Pregnant women vaginal-recto GBS colonization and transmission to newborns connected with MDR are a matter of concerns. Although non-susceptible GBS isolates are obtained, penicillin and vancomycin are relatively effective. The use of clindamycin, erythromycin and ceftriaxone should be guided by antimicrobial susceptibility testing. Genetic analysis is recommended to exactly identify the epidemiology of GBS strains, vertical transmission and antimicrobial resistance at the country level.

Parallel Loop Binding Compression Suture, a Modified Procedure for Pernicious Placenta Previa Complicated With Placenta Increta

Objective: To evaluate the efficacy and safety of parallel loop binding compression suture of the lower uterus during cesarean section in pernicious placenta previa complicated with placenta increta.

Methods: This retrospective study was performed in patients with pernicious placenta previa complicated with placenta increta or percreta between November 2014 and December 2020 at the Qilu Hospital of Shandong University. Patients underwent parallel loop binding compression suture surgery were defined as study group, and patients underwent traditional surgery with figure-of-eight sutures as the main hemostatic method were defined as control group. Postpartum hemorrhage was evaluated as the primary outcome. The secondary outcomes included age, gestational weeks, operative time, fetal childbirth time, prevention of hysterectomy, blood transfusion, duration of postoperative catheterization, duration of antibiotic treatment, and postoperative hospitalization (days). Additionally, neonatal outcomes were evaluated.

Results: A total of 124 patients were enrolled in the study, including 38 patients receiving parallel loop binding compression suture surgery in the study group, and 86 patients in the control group. With parallel loop binding compression suture, the average operation time was significantly reduced (109.0 ± 33.5 vs. 134.4 ± 54.2 min, p = 0.00), and the volume of blood lost were also decreased (2152.6 ± 1169.4 vs. 2960.5 ± 1963.6 ml, p = 0.02), which correspondingly reduced RBC transfusion (7.2 ± 3.5 vs. 10.3 ± 8.7 units, p = 0.03) and FFP transfusion (552.6 ± 350.3 vs. 968.0 ± 799.8 ml, p = 0.00). The fetal childbirth time was extended (14.1 ± 5.6 vs. 11.0 ± 8.0 min, p = 0.03), however, there was no increase in NICU admission rates (36.9 vs. 34.9%, p = 0.83). Except for one premature infant (32 weeks) death in the control group, all infants at our hospital were safely discharged after treatment.

Conclusion: Parallel loop binding compression suture is an effective, swift, practical, and safe method to reduce postpartum bleeding in women with pernicious placenta previa, complicated with placenta increta. Besides, it has no adverse effects on newborns.

Is Lung Ultrasound Helpful in COVID-19 Neonates?-A Systematic Review

Background: The SARS-CoV-2 infection has occurred in neonates, but it is a fact that radiation exposure is not recommended given their age. The aim of this review is to assess the evidence on the utility of lung ultrasound (LUS) in neonates diagnosed with COVID-19. Methods: A systematic literature review was performed so as to find a number of published studies assessing the benefits of lung ultrasound for newborns diagnosed with COVID and, in the end, to make a comparison between LUS and the other two more conventional procedures of chest X-rays or CT exam. The key terms used in the search of several databases were: “lung ultrasound”, “sonography”, “newborn”, “neonate”, and “COVID-19′. Results: In total, 447 studies were eligible for this review, and after removing the duplicates, 123 studies referring to LU were further examined, but only 7 included cases of neonates. These studies were considered for the present research paper. Conclusions: As a non-invasive, easy-to-use, and reliable method for lung lesion detection in neonates with COVID-19, lung ultrasound can be used as a useful diagnosis tool for the evaluation of COVID-19-associated lung lesions. The benefits of this method in this pandemic period are likely to arouse interest in opening new research horizons, with immediate practical applicability.

The Influence of Prenatal Fumonisin Exposure on Bone Properties, as well as OPG and RANKL Expression and Immunolocalization, in Newborn Offspring Is Sex and Dose Dependent

The current study examined the effects of exposure of pregnant dams to fumonisins (FBs; FB1 and FB2), from the seventh day of pregnancy to parturition, on offspring bone metabolism and properties. The rats were randomly divided into three groups intoxicated with FBs at either 0, 60, or 90 mg/kg b.w. Body weight and bone length were affected by fumonisin exposure, irrespective of sex or dose, while the negative and harmful effects of maternal FBs’ exposure on bone mechanical resistance were sex and dose dependent. The immunolocalization of osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-Β ligand (RANKL), in bone and articular cartilage, indicated that the observed bone effects resulted from the FB-induced alterations in bone metabolism, which were confirmed by the changes observed in the Western blot expression of OPG and RANKL. It was concluded that the negative effects of prenatal FB exposure on the general growth and morphometry of the offspring bones, as a result of the altered expression of proteins responsible for bone metabolism, were dose and sex dependent.

Prevalence of methylmalonic acidemia among newborns and the clinical-suspected population: a meta-analyse

IMPORTANCE

Knowing the scale of rare inborn errors is important for screening and resource allocation. Evidence on the prevalence of methylmalonic acidemia (MMA) among newborns and the clinical-suspected population from large-scale screening programs needs to be systematically synthesized.

OBJECTIVE

To estimate the worldwide prevalence of MMA for newborns and the clinical-suspected population and explore the differences in different regions, periods, and diagnostic technologies.

DATA SOURCES

MEDLINE, Embase, CRD, Cochrane Library, Scopus, CINAHL, and PROSPERO. Study Selection: All studies reporting the epidemiology characteristics of MMA were selected.

DATA EXTRACTION AND SYNTHESIS

Characteristics of study, subjects, and epidemiology were extracted, random-effect models were used for meta-analyses.

MAIN OUTCOME AND MEASURE

Pooled prevalence of MMA.

RESULTS

This study included 111 studies. The pooled prevalence of MMA worldwide was 1.14 per 100,000 newborns (1516/190,229,777 newborns, 95% CI: 0.99-1.29) and 652.11 per 100,000 clinical-suspected patients (1360/4,805,665 clinical-suspected individuals, CI: 544.14-760.07). Asia and Africa got a higher pooled prevalence of MMA. The prevalence of MMA in newborns increased through the years, while that in the clinical-suspected population decreased. Collecting blood ≥ 72 h after birth had a higher pooled prevalence of MMA than collecting during 24 h-72 h after birth. The combining-use of MS/MS and GC/MS had a higher pooled prevalence than the single-use of MS/MS or GC/MS. Prevalence of cbl C, mut, cbl B, cbl A, isolated MMA, combined MMA and homocystinuria, vitamin B12-responsive MMA was synthesized.

CONCLUSIONS AND RELEVANCE

Prevalence of MMA among newborns was extremely low, but considerably high in the clinical-suspected population, indicating the need for more efficient newborn screening strategies and closer monitoring of the high-risk population for the early signs of MMA. Asia and Africa should attach importance to the high prevalence of MMA. Further diagnostic tests were recommended for the combining-use vs single-use of MS/MS and GC/MS and for collecting blood after 72 h vs during 24-72 h after birth.

Key Challenges and Future Directions When Running Auditory Brainstem Response (ABR) Research Protocols with Newborns: A Music and Language EEG Feasibility Study

Although many musical intervention studies exist in the wider framework of neuroscience and psychology, the preliminary importance of feasibility studies is rarely discussed. Adding to this fact the limited research existing on the therapeutic and restorative potential of music exposure during early developmental periods, pushed us to concentrate on investigating newborns’ perception of music and its impact on the brain. Here, we explore the feasibility of a randomized controlled trial (RCT) approach when measuring and comparing the neurophysiological perception of music versus language on the brainstem of newborns using auditory brainstem response (ABR). Twenty-five healthy full-term infants were recruited, eight of which were measured within their first 10 days postpartum. The evaluation of the study’s feasibility appealed to five main objectives that essentially answer the question: Can our protocol work? Each objective proposes questions based on Orsmond and Cohn’s guiding framework, designed to assess, and assist feasibility in understanding barriers toward a study’s success. Our results justify that newborns are well capable of undergoing the study and given meticulous considerations and improvements on the intervention resources. The procedure’s communication and technical obstacles are resoluble. Moreover, assimilation of external factors to adapt, such as the culture variation and the ABR protocol implementation are necessary. The study was well received in the selected region (Middle East), and the recording procedure showed potential outcomes for a comprehensive RCT.

Beyond neonatal seizures - epileptic evolution in preterm newborns: a systematic review and meta-analysis

OBJECTIVE

To assess the potential risk of developing epilepsy in preterm newborns with neonatal seizures (NS). Two electronic databases (PubMed and Web of Sciences) were searched from inception to December 2020. Studies that investigated the outcome of epilepsy in neonates with NS were included.

METHODS

Case-control, cross-sectional and cohort studies were included. Data synthesis was undertaken via systematic review and meta-analysis of available evidence. All review stages were conducted by three independent reviewers. We analysed data on neonates with NS who developed post-neonatal epilepsy (PNE) based on the data reported in the selected articles. We then investigated the development of PNE in term and preterm neonates.

RESULTS

The initial search led to 568 citations, of which 12 were selected for the review and six were eligible for meta-analysis. Results of the meta-analysis showed no significant difference in the risk of developing PNE between full-term infants with NS (pooled OR [pOR]=0.92: 95% CI: 0.58-1.44) and preterm neonates.

SIGNIFICANCE

Gestational age does not seem to be an independent predictor for the development of PNE in neonates with NS. More data are needed to explore the relationship between seizures in the neonatal period and epilepsy later in life.

[ORGANIZATION OF MEDICAL CARE FOR CHILDREN WITH A NEW CORONAVIRUS INFECTION IN PATIENT CONDITIONS ON THE EXAMPLE OF THE CHILDREN'S CITY CLINICAL HOSPITAL NAMED AFTER Z. A. BASHLYAEVA]

The article presents an analysis of the work of the largest children's COVID-19 center in Moscow, organized on the basis of the Children's City Clinical Hospital named after Z. A. Bashlyaeva of the Moscow City Health Department. From March to November 2020 at the COVID-19 Center were hospitalized 2,837 patients with suspected/confirmed diagnosis of COVID-19, in total in 2020 1,876 children with a confirmed diagnosis of COVID-19 were treated, 58 (3%) children were in serious condition in the intensive care unit, of which children 11-18 years old were 25%. At the 2020 neonatal COVID-19 center, 215 newborns were observed with suspected COVID-19 diagnosis. The diagnosis of COVID-19 was confirmed in 18 children, while 8 newborns came from the home of COVID-19. In the Center for rehabilitation, where children aged 0 to 3 years old who were born with very low and extremely low body weight are observed, dispensary observation for children who have undergone COVID-19 is organized. 45 children who were observed fell ill with the new coronavirus infection. There were no deaths among children with COVID-19.

Improving Care in Neonatal Intensive Units During the COVID-19 Pandemic: A Survey on Electronic Health Communication

BACKGROUND

A novel virus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started spreading through Italy and the world from February 2020, and the pandemic threatened the family-centred care (FCC) model used in the neonatal intensive care unit (NICU). Teleconferences and video calls were employed to keep parents in contact with their babies. This study aimed to evaluate satisfaction and stress levels between parents in the telematic family-centred care group (T-FCC) versus the FCC group and the no Family-Centred Care (N-FCC) group. Methods A prospective cohort pilot study was carried out from April to May 2020. A parental stressor scale and the NICU satisfaction questionnaire were administered to parents at the time of discharge of their newborns. Parents in T-FCC group could see their newborns via video calls, while those in the FCC and N-FCC groups were extracted from our previously published database. Results Parents in the T-FCC group were more satisfied and less stressed than those in the N-FCC group. Experiences of the mothers and fathers in the T-FCC group were similar. However, the FCC group showed the best results. Conclusion The T-FCC group showed satisfaction with the quality of information received about their babies and felt that their privacy was considered and respected by the medical staff. Parents were also less stressed because they could monitor what happens to the baby through a video, however, they could not intervene if there was a problem. Data support the use of video calls to improve insight into clinical conditions and communication between doctors, nurses, and parents during the pandemic.

Approach to Neurological Channelopathies and Neurometabolic Disorders in Newborns

Ion channel disorders (channelopathies) can affect any organ system in newborns before 2 months of life, including the skeletal muscle and central nervous system. Channelopathies in newborns can manifest as seizure disorders, which is a critical issue as early onset seizures can mimic the presentation of neurometabolic disorders. Seizures in channelopathies can either be focal or generalized, and range in severity from benign to epileptic encephalopathies that may lead to developmental regression and eventually premature death. The presenting symptoms of channelopathies are challenging for clinicians to decipher, such that an extensive diagnostic survey through a precise step-by-step process is vital. Early diagnosis of a newborn's disease, either as a channelopathy or neurometabolic disorder, is important for the long-term neurodevelopment of the child.

Assessment of Chromosomal Damage in Umbilical Blood Lymphocytes of Newborns from Kragujevac in Central Serbia Born 18 Years after Environmental Contamination

The measurement of micronuclei (MN) in umbilical blood lymphocytes of newborns are increasingly used in cytogenetic epidemiology as one of the preferred methods for assessing chromosomal damage resulted from maternal exposure to mutagen. In the present study, we evaluated the effect of strong environmental contamination (EC) (which occured in the City of Kragujevac, Central Serbia in 1999) on the MN frequency in group of 22 newborns born in Kragujevac 18 years after EC, using cytokinesis-block micronucleus (CBMN) assay. The mean MN frequency in umbilical lymphocytes of these newborns was 5.14 ± 2.17/1,000 binucleated (BN) cells, which is significantly lower than mean MN frequency of newborns born 12 months after contamination (9.36 ± 5.60/1,000 BN cells). Sex of newborns, age of mothers, cigarette smoking, and number of pregnancies did not affect the MN frequency of newborns. Our results showed that in utero exposure to environmental pollution affected genome instability of the fetuses, but that by improving the quality of environmental conditions there was a decrease in mean MN frequency of newborns born 18 years after contamination. In general, genome of umbilical lymphocytes shows a realistic picture of all changes in body and the environment.

Deficient neural encoding of speech sounds in term neonates born after fetal growth restriction

Infants born after fetal growth restriction (FGR)-an obstetric condition defined as the failure to achieve the genetic growth potential-are prone to neurodevelopmental delays, with language being one of the major affected areas. Yet, while verbal comprehension and expressive language impairments have been observed in FGR infants, children and even adults, specific related impairments at birth, such as in the ability to encode the sounds of speech, necessary for language acquisition, remain to be disclosed. Here, we used the frequency-following response (FFR), a brain potential correlate of the neural phase locking to complex auditory stimuli, to explore the encoding of speech sounds in FGR neonates. Fifty-three neonates born with FGR and 48 controls born with weight adequate-for-gestational age (AGA) were recruited. The FFR was recorded to the consonant-vowel stimulus (/da/) during sleep and quantified as the spectral amplitude to the fundamental frequency of the syllable and its signal-to-noise ratio (SNR). The outcome was available in 45 AGA and 51 FGR neonates, yielding no differences for spectral amplitudes. However, SNR was strongly attenuated in the FGR group compared to the AGA group at the vowel region of the stimulus. These findings suggest that FGR population present a deficit in the neural pitch tracking of speech sounds already present at birth. Our results pave the way for future research on the potential clinical use of the FFR in this population, so that if confirmed, a disrupted FFR recorded at birth may help deriving FGR neonates at risk for postnatal follow-ups.

Newborn Hearing Screening: Analysing the Effectiveness of Early Detection of Neonatal Hearing Loss in a Hospital in Greece

Introduction The introduction of newborn hearing screening programs (NHSP) has drastically contributed to the early diagnosis of hearing loss (HL) in children, with the prospect of children developing speech as early as possible. This retrospective study aims to present and discuss the preliminary results of the NHSP at the University Hospital of Patras, Greece, highlighting the strengths and weaknesses of the program. The evaluation of the implementation of NHSP is important to confirm the effectiveness of the process and elaborate system failures. Materials The study describes the results of previous data collected from the NHSP in the Rio hospital of Patra and analyzed the conditions of the sample collected. The random sample involved newborns born between November 2018 - December 2020 at the University Hospital in Patra, Greece, which was assessed using transient evoked otoacoustic emissions (TEOAEs). Testing was performed twice per week on Thursday and Friday with a random sample, specifically examining the babies in the hospital these days. From the 2014 newborns assessed, 1491 were healthy neonates, while the other 523 required hospitalization in the neonatal unit. Results In total, there were 2014 live births; 1491 healthy neonates were screened with TEOAEs. Of them, 44 did not pass the first test. After retesting one month later, 31 passed the test, while the other 13 were referred to a hearing centre for further audiological testing with auditory brainstem response (ABR) tests. Two infants never showed up for the follow-up appointment. Of the remaining 11, six infants had normal hearing, three had otitis media with effusion or other conductive HL. The last two infants had HL. Specifically, one had bilateral sensorineural HL greater than 40db, and one had unilateral sensorineural HL greater than 40db. Risk factors were identified in 523 newborns admitted to the unit. The most common risk factors identified were the use of ototoxic drugs, low Apgar scores, and prematurity. Of all the newborns, 491 passed the test the first time, and the rest 32 infants came back 1-2 months after leaving the neonatal unit. All the babies who had failed in the first screening test appeared for the follow-up appointment for the second screening test. Of these, 24 babies passed the test, but eight did not. Of these, four were diagnosed with media otitis with effusion or other conductive HL. Sensorineural HL was identified in the last four babies using ABR tests. In detail, two had unilateral sensorineural HL greater than 40db, while two had bilateral sensorineural HL greater than 40db. Conclusion In conclusion, we found that for the NHS programs to be effective, they must be implemented long-term and have monetary support. Early diagnosis and cochlear implantation are the keys to excellent outcomes. Cooperation between different specialties and a patient-centred approach will help physicians holistically face neonatal HL. Building trust between the parents and doctor is essential for the program's success and reducing the lost-to-follow-up rate. To run a successful program, trained staff, equipment, and financial support are required. However, the gold standards for the success of the program are proper implementation of the program, close follow-up, strict adherence to the guidelines in the neonatal intensive care unit (NICU), and the early detection and diagnosis of HL.

Evaluating vertical transmission of sexually transmitted infections to newborns

INTRODUCTION

Sexually transmitted infections are among the most frequent infections affecting pregnant women. We assessed the transmission of hepatitis B virus, human immunodeficiency virus type 1 and Treponema pallidum to newborns from infected parturients.

METHODOLOGY

An observational, cross-sectional, analytical facility-based survey was conducted among 57 newborns in Irene Neto Maternity, Lubango city, Huíla province, Angola. Hepatitis B virus DNA molecular identification was done through nested PCR. Human immunodeficiency virus type 1 proviral DNA detection was carried out by two successive nested PCRs. Real-time PCR was performed to examine the presence of T. pallidum DNA. Amplicons from PCR positive samples were sequenced for identity search and genotype assignment.

RESULTS

Hepatitis B virus DNA genotype E was detected in 3/41 (7.3%) newborns from HBsAg (hepatitis B surface antigen) positive mothers. To analyse the association between mothers HBeAg (hepatitis B e antigen) positivity and hepatitis B virus vertical transmission to newborns, a Fisher's exact test was performed, showing a highly significant association (p = 0.006). Human immunodeficiency virus type 1 provirus or T. pallidum DNA was not detected in any newborn.

CONCLUSIONS

To prevent hepatitis B virus vertical transmission in Angola it is important to promote universal antenatal screening, expanding hepatitis B virus markers (viral load and/or HBeAg), risk-based infected mothers' antiviral therapy and newborn passive immunoprophylaxis.

Development of Mobile Application for Assessment of Basic Echocardiographic Parameters in Apparently Healthy Population

Background: Development of tools, making for easier assessment of the age- and body size-specific echocardiographic parameters in the general population, becomes increasingly important. Materials and Methods: The application was developed on the basis of the previously designed model of normal values for basic echocardiographic parameters. The source population for the normal values was 10,604 apparently healthy people aged from 1 day to 65 years old, in which optimal visualization of the heart in the parasternal and apical echocardiographic views could be obtained. The whole population surveyed was categorized into three age groups. The predicted parameters were calculated by the group-specific regression equations. Deviation from the norm for one or another echocardiographic parameter was determined based on the value of z-score. Results: The mobile application was designed for the medical community and allows for a selective assessment of basic echocardiographic parameters in apparently healthy people with high accuracy. The application has a friendly graphical interface and provides color output on display of the results obtained. Discussion: The value of this application is in its uniqueness, since having analyzed available scientific works on mobile applications in medicine we could hardly find similar developments. Conclusions: Using the mobile application can save a doctor's time by simplifying the process of entering initial data, automating calculations, and providing convenient displaying of results. From this perspective, the application developed can become a useful tool in the sphere of telemedicine, in particular-the mobile medicine for remote consultation of patients.

Urinary Metabolomic Profile of Neonates Born to Women with Gestational Diabetes Mellitus

Gestational diabetes mellitus (GDM) is one of the most frequent pregnancy complications with potential adverse outcomes for mothers and newborns. Its effects on the newborn appear during the neonatal period or early childhood. Therefore, an early diagnosis is crucial to prevent the development of chronic diseases later in adult life. In this study, the urinary metabolome of babies born to GDM mothers was characterized. In total, 144 neonatal and maternal (second and third trimesters of pregnancy) urinary samples were analyzed using targeted metabolomics, combining liquid chromatographic mass spectrometry (LC-MS/MS) and flow injection analysis mass spectrometry (FIA-MS/MS) techniques. We provide here the neonatal urinary concentration values of 101 metabolites for 26 newborns born to GDM mothers and 22 newborns born to healthy mothers. The univariate analysis of these metabolites revealed statistical differences in 11 metabolites. Multivariate analyses revealed a differential metabolic profile in newborns of GDM mothers characterized by dysregulation of acylcarnitines, amino acids, and polyamine metabolism. Levels of hexadecenoylcarnitine (C16:1) and spermine were also higher in newborns of GDM mothers. The maternal urinary metabolome revealed significant differences in butyric, isobutyric, and uric acid in the second and third trimesters of pregnancy. These metabolic alterations point to the impact of GDM in the neonatal period.

Clinical Characteristics of Newborns Born to Mothers with COVID-19

(1) Background: According to the literature, most outcomes of neonates born to mothers infected with SARS-CoV-2 are favorable. This study aimed to assess the clinical characteristics of newborns born to infected women in a tertiary center in Poznan, Poland. (2) Methods: The study comprised 101 newborns delivered by women infected with SARS-CoV-2. The control group consisted of 101 newborns born before the pandemic. Data were collected retrospectively from the medical records. (3) Results: Most newborns of SARS-CoV-2-positive mothers were delivered by cesarean section-83.17% vs. 40.59% in the control group (p < 0.05). The groups did not differ in Apgar scores and the need for resuscitation. Newborns of SARS-CoV-2-positive mothers were more likely to present with respiratory distress and require respiratory support. The most common diagnosis was transient tachypnea of the newborn, not correlated with the mode of delivery. Newborns of the study group were never exclusively breastfed, 0% vs. 64.36% (p < 0.05). None of the patients in the study group was tested positive for the virus. (4) Conclusions: Infants born to SARS-CoV-2-positive mothers seem to be more at risk of moderate respiratory failure than other newborns. Separation of mother-baby dyads results in a dramatic fall in breastfeeding in the short-term post-partum period.

Age-related changes in thyroid hormones, some serum oxidative biomarkers and trace elements and their relationships in healthy Saanen goat kids during the first three month of age

BACKGROUND

Early-life diseases in dairy animals are main causes of economic loss in livestock production. Oxidative stress (OS) and thyroid hormones are important inter-related components in the normal physiology of this critical period of life. However, limited information regarding their physiology in goat kids is available. This study was conducted to investigate the age-related changes of thyroid hormones, some serum oxidative biomarkers and trace elements in healthy Saanen goat kids.

METHODS

Nineteen newborn healthy Saanen goat kids (14 females and five males) were studied longitudinally from birth until three months of age. Blood sampling was performed 24-48 h after birth and was repeated on 10 ± 2, 28 ± 2, 56 ± 2 and 84 ± 2 days of age. The serum levels of thyroid hormones, malondialdehyde (MDA), reduced glutathione (GSH), total antioxidant capacity (TAC), selenium (Se), manganese (Mn) and molybdenum (Mo) were measured.

RESULTS

Age-related changes were observed for all measured variables except for MDA (p < 0.05). A decreasing trend was detected throughout the study in thyroid hormones, T3: T4 ratio and Mn (p < 0.01). Some factors decreased from birth to day 10 (Se) or day 28 (TAC and GSH) and followed by an increasing trend that extended to day 84 (p < 0.01). There were significant correlations between thyroid hormones and TAC, as well as Mn levels (p < 0.05).

CONCLUSIONS

These results imply that specific age-related reference values are essential for proper interpretation of the serum level of thyroid hormones and Mn in Saanen goat kids during the first three months of life. In addition, given the high level of thyroid hormones particularly during the first days of life, and their relationship with oxidative biomarkers and trace elements, improving the antioxidant system in this critical period is essential.

Monogenic Syndromes with Congenital Heart Diseases in Newborns (Diagnostic Clues for Neonatologists): A Critical Analysis with Systematic Literature Review

Congenital heart disease (CHD), the most common major congenital anomaly, is associated with a genetic syndrome (chromosomal anomalies, genomic disorders, or monogenic disease) in 30% of patients. The aim of this systematic review was to evaluate if, in the neonatal setting, clinical clues that orient the diagnostic path can be identified. For this purpose, we revised the most frequent dysmorphic features described in newborns with CHD, comparing those associated with monogenic syndromes (MSG) with the ones reported in newborns with genomic disorders. For this systematic review according to PRISMA statement, we used PubMed, Medline, Google Scholar, Scopus database, and search terms related to CHD and syndrome. We found a wide range of dysmorphisms (ocular region, ears, mouth, and/or palate and phalangeal anomalies) detected in more than half of MSGs were found to be associated with CHDs, but those anomalies are also described in genomic rearrangements syndromes with equal prevalence. These findings confirmed that etiological diagnosis in newborns is challenging, and only the prompt and expert recognition of features suggestive of genetic conditions can improve the selection of appropriate, cost-effective diagnostic tests. However, in general practice, it is crucial to recognize clues that can suggest the presence of a genetic syndrome, and neonatologists often have the unique opportunity to be the first to identify abnormalities in the neonate.

Informing the Development of a Standardized Clinical Definition of Neonatal Abstinence Syndrome: Protocol for a Modified-Delphi Expert Panel

Background

Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome that most commonly results from prenatal opioid exposure. Every 15 minutes, an infant is born in the United States with signs of NAS. The field lacks a standardized clinical definition of NAS, complicating discussions on programmatic and policy development to support opioid-exposed mothers and infants.

Objective

The goal of this paper is to describe a protocol for a systematic expert panel process to inform the development of a clinical definition of NAS.

Methods

We will conduct two three-round online modified-Delphi panels using the ExpertLens system and will follow the recommendations for Conducting and REporting of DElphi Studies (CREDES). One panel will focus on developing key components of a clinical definition of NAS, and the second panel will focus on neonatal opioid withdrawal syndrome (NOWS), which is a term that has come into use to differentiate opioid-exposed infants from infants exposed to other substances in utero. However, there is lack of agreement on the precise clinical definition of NOWS and how it is distinct from or overlaps with NAS. Each panel will complete two rating rounds and a discussion round using a similar protocol. We will analyze all rating data descriptively and determine the presence of agreement within and between the two panels. We will also perform thematic analysis of the qualitative comments to contextualize the panel findings.

Results

The panels were convened between October 29 and December 17, 2020. Their results were disseminated and discussed at a national conference on NAS that took place on March 17-18, 2021.

Conclusions

A standardized clinical definition of NAS will help to better characterize NAS incidence and to design effective clinical, public health, and policy interventions to support opioid-exposed mother-infant dyads.

International Registered Report Identifier (IRRID)

DERR1-10.2196/25387

Detection of an Autism EEG Signature From Only Two EEG Channels Through Features Extraction and Advanced Machine Learning Analysis

BACKGROUND AND OBJECTIVE

In 2 previous studies, we have shown the ability of special machine learning systems applied to standard EEG data in distinguishing children with autism spectrum disorder (ASD) from non-ASD children with an overall accuracy rate of 100% and 98.4%, respectively. Since the equipment routinely available in neonatology units employ few derivations, we were curious to check if just 2 derivations were enough to allow good performance in the same cases of the above-mentioned studies.

METHODS

A continuous segment of artifact-free EEG data lasting 1 minute in ASCCI format from C3 and C4 EEG channels present in 2 previous studies, was used for features extraction and subsequent analyses with advanced machine learning systems. A features extraction software package (Python tsfresh) applied to time-series raw data derived 1588 quantitative features. A special hybrid system called TWIST (Training with Input Selection and Testing), coupling an evolutionary algorithm named Gen-D and a backpropagation neural network, was used to subdivide the data set into training and testing sets as well as to select features yielding the maximum amount of information after a first variable selection performed with linear correlation index threshold.

RESULTS

After this intelligent preprocessing, 12 features were extracted from C3-C4 time-series of study 1 and 36 C3-C4 time-series of study 2 representing the EEG signature. Acting on these features the overall accuracy predictive capability of the best artificial neural network acting as a classifier in deciphering autistic cases from typicals (study 1) and other neuropsychiatric disorders (study 2) resulted in 100 % for study 1 and 94.95 % for study 2.

CONCLUSIONS

The results of this study suggest that also a minor part of EEG contains precious information useful to detect autism if treated with advanced computational algorithms. This could allow in the future to use standard EEG from newborns to check if the ASD signature is already present at birth.

Trends in hospitalizations of newborns with hyperbilirubinemia and kernicterus in United States: an epidemiological study

BACKGROUND

Hyperbilirubinemia is one of the most common diagnosis in newborn nurseries in United States. Universal pre-discharge bilirubin screening decreased the incidence of extreme hyperbilirubinemia and risk of kernicterus.

OBJECTIVES

We sought to assess temporal population trends of hyperbilirubinemia, kernicterus and usage of phototherapy, intravenous immunoglobulin (IVIG), and exchange transfusion.

DESIGN/METHODS

Data from Healthcare Cost and Utilization Project (HCUP)-the Kids' Inpatient Database (KID) obtained for years 1997-2012. All neonatal discharges with ICD-9 codes for neonatal jaundice (774.2, 774.6), kernicterus (773.4, 774.7) and procedure codes for phototherapy (99.83), IVIG infusion (99.14), exchange transfusion (99.01) were extracted. We compared the trends of diagnosis of hyperbilirubinemia, kernicterus, use of phototherapy, IVIG, and exchange transfusion.

RESULTS

During the study period, the proportion of infants diagnosed with hyperbilirubinemia increased by 65% (9.4% vs. 15.5%; p<.001) in term infants and 34.5% (33.5% vs. 45%; p<.001) in preterm infants, respectively. Rate of kernicterus discharges significantly reduced from 7 to 1.9 per 100,000 newborns. Overall, the number of exchange transfusions has decreased by 67% during study period while phototherapy and IVIG use increased by 83% and 170%, respectively.

CONCLUSIONS

In last two decades, there was a significant decrease in neonatal discharges with a history of exchange transfusion or with a diagnosis of kernicterus. However, there was a significant increase in number of neonates discharged home with a history of phototherapy during birth hospitalization and decreased number of exchange transfusions were observed during the study period. Incremental implementation of universal predischarge bilirubin screening and treatments based on 2004 AAP recommended risk-based strategies might have contributed to timely interventions in infants with significant hyperbilirubinemia.

Is N-terminal pro-brain type natriuretic peptide a useful marker in newborns with heart defects?

BACKGROUND

Heart diseases are currently a significant cause of morbidity and mortality in newborns. The existing diagnostic methods are often not sufficient or, in many cases, cannot be used. Great advances have been achieved in medical knowledge concerning biomarkers for the diagnosis of circulatory system disorders in adult patients. Among these biomarkers, N-terminal pro-brain type natriuretic peptide (NT-proBNP) plays a main role. However, in the existing literature, there is not enough data concerning the physiological features of this biomarker in newborns and its potential use in neonatal cardiac diagnostics.

OBJECTIVES

To evaluate the diagnostic usefulness of NT-proBNP measurements in correlation with other markers of circulatory failure and myocardial damage in newborns with heart defects.

MATERIAL AND METHODS

This study involved 126 newborns. Patients were divided into 2 main groups: group I included infants with congenital heart defects (CHD) and group II (control) included healthy neonates. Newborns with CHD were further divided into 2 subgroups: group Ia with simple shunts and group Ib with combined heart defects. Patients in group I were further divided according to the hemodynamic significance of CHD. The NT-proBNP level was evaluated using the CARDIAC proBNP immunologic test (Cobas h232; Roche Diagnostics, Basel, Switzerland).

RESULTS

The NT-proBNP concentrations were significantly higher in newborns with CHD compared to healthy ones. Newborns with combined heart defects had higher levels of NT-proBNP than newborns with simple shunts. The NT-proBNP concentrations in newborns with CHD correlated with echocardiographic parameters of hemodynamic significance and with left ventricular ejection fraction (LVEF). Additionally, NT-proBNP correlated with clinical symptoms of heart failure (HF; Ross classification, Reithmann's score).

CONCLUSIONS

Statistically significant differences in NT-proBNP level between newborns with heart defects and healthy controls were shown. In newborns with heart diseases, significant correlations were found between NT-proBNP level and the type of heart defect (simple shunt or combined defects), the hemodynamic significance of the defect, LVEF, and the clinical intensity of HF.

Newborns from women infected with COVID-19: somatic and metabolic status

To date, there are limited data regarding manifestations of new coronavirus infection in infants born of SARS-CoV-2 infected mothers, so the aim of this study is to investigate somatic and metabolic status of newborn infants born to mothers diagnosed with COVID-19. The investigation was carried out on the bases of Laboratory Diagnostic Department of Samara Regional Clinical Hospital named after V.D. Seredavin and the Department of Fundamental and Clinical Biochemistry with Laboratory Diagnostics of Samara State Medical University. Under observation were 85 newborns, including 35 born of healthy mothers and 50 born of COVID-19 mothers.The somatic status of all newborns was assessed using the Apgar scale at the 1st and 5th minutes after birth. Also all newborns had general and biochemical blood tests and newborns from mothers with COVID-19 were tested for the presence of SARS-CoV-2 RNA in oral and nasopharyngeal swabs. Thus, the study of somatic status revealed that of 50 neonates from women infected with COVID-19, only 18% were practically healthy, the rest had signs of prematurity, hypotrophy, perinatal CNS damage, diabetic fetopathy, pulmonary atelectasis, delayed intrauterine development, asphyxia. The metabolic state is characterised by decreased haemoglobin and platelets, increased concentration of total protein, including C-reactive protein, high transaminase activity, decreased sodium and chloride content. These parameters of general and biochemical blood tests can be considered as indicators for the evaluation of the condition of newborns from mothers with COVID-19.

Assessment of the Impact of Clothing Structures for Premature Babies on Biophysical Properties

This article presents research on ergonomics and physiological comfort of protective clothing. Biophysical properties of selected three-layer textile assemblies that differ in geometry and raw material composition for the production of types of mummy sleeping bags for premature babies were investigated. The tests included measurements of air permeability, thermal resistance and water vapor resistance (both by means of human skin model), thermal insulation, and water vapor resistance (both using newborn manikin). Experimental research was supplemented by modeling the thermal insulation of the assemblies by designing their 3D models using selected CAD software and applying the finite volume method. The obtained results allowed the evaluation of the influence of different geometry and the raw material composition of the proposed assemblies on the performance parameters of protective clothing.

Hydrogen sulfide content in pregnant women with preeclampsia in late gestation and their newborns

We examined 70 women who were 22-40 weeks pregnant and their newborns. Of these, 15 women with moderate PE made up group 1, 22 women with severe PE-group 2, and 55 women with uncomplicated pregnancy without hypertensive disorders - the control group. Blood was collected from women when they were admitted to the clinic, and blood was taken from newborns for 3-5 days of life. The concentration of hydrogen sulfide was determined by the method of K. Qu et al [17]. There was a decrease in the level of hydrogen sulfide in the blood serum of women whose pregnancy was complicated by severe preeclampsia. In newborns born to mothers with preeclampsia, an increase in the concentration of hydrogen sulfide was detected in the blood, which is probably a compensatory reaction aimed at restoring vascular homeostasis during early postnatal adaptation.

Newborns' early attuning to hand-to-mouth coordinated actions

Already inside the womb, fetuses frequently bring their hands to the mouth, anticipating hand‐to‐mouth contact by opening the mouth. Here, we explored whether 2‐day‐old newborns discriminate between hand actions directed towards different targets of the face—that is, a thumb that reaches the mouth and a thumb that reaches the chin. Newborns looked longer towards the thumb‐to‐mouth compared to the thumb‐to‐chin action only in the presence, and not absence, of anticipatory mouth opening movements, preceding the thumb arrival. Overall, our results show that newborns are sensitive to hand‐to‐face coordinated actions, being capable to discriminate between body‐related actions directed towards different targets of the face, but only when a salient visual cue that anticipates the target of the action is present. The role of newborns’ sensorimotor experience with hand‐to‐mouth gestures in driving this capacity is discussed.

An R848-Conjugated Influenza Virus Vaccine Elicits Robust Immunoglobulin G to Hemagglutinin Stem in a Newborn Nonhuman Primate Model

Eliciting broadly protective antibodies is a critical goal for the development of more effective vaccines against influenza. Optimizing protection is of particular importance in newborns, who are highly vulnerable to severe disease following infection. An effective vaccination strategy for this population must surmount the challenges associated with the neonatal immune system as well as mitigate the inherent immune subdominance of conserved influenza virus epitopes, responses to which can provide broader protection. Here, we show that prime-boost vaccination with a TLR7/8 agonist (R848)-conjugated influenza A virus vaccine elicits antibody responses to the highly conserved hemagglutinin stem and promotes rapid induction of virus neutralizing stem-specific antibodies following viral challenge. These findings support the efficacy of R848 as an effective adjuvant for newborns and demonstrate its ability to enhance antibody responses to subdominant antigenic sites in this at-risk population.

Morphological basis of radial nerve dysfunction in newborns differs from that of no radial nerve dysfunction in adults in C5-C6-C7 injuries to the brachial plexus: a cadaveric study

OBJECTIVE

Injuries to the upper and middle trunks of brachial plexus result in dysfunction of radial nerves in newborns but do not in adults. We hypothesized that the radial nerve had a lower proportion of myelinated nerve fibers (MNFs) from the lower trunk in newborns than in adults, and in newborns those MNFs were less developed than MNFs in the radial nerve from the middle and upper trunks.

METHODS

We dissected bilateral brachial plexus of six newborn and six adult cadavers. The radial nerve and its fascicles were separated proximally to posterior divisions of the upper, middle and lower trunks, and fascicles of the radial nerve were harvested from three trunks to calculate respective percentage of MNFs accounting for the total number of MNFs in the radial nerve. We determined diameters of axons and g-ratios of MNFs in the radial nerve from three trunks.

RESULTS

Compared with adults, the percentage of MNFs in the radial nerve from the lower trunk was lower (p < 0.05), from the middle trunk higher (p < 0.05) and from the upper trunk similar (p > 0.05) in newborns, though MNF counts from three trunks were higher in newborns, respectively (p < 0.01, all). In newborns, MNFs in the radial nerve from the lower trunk had smaller axonal diameters and higher g-ratios than those from the middle and upper trunks (p < 0.017, all), while in adults there were no such differences.

CONCLUSIONS

Lower proportion of MNFs in the radial nerve from the lower trunk in newborns than in adults, and in newborns immaturity of MNFs from the lower trunk relative to MNFs from the middle and upper trunks may be the major morphological basis of difference in clinical appearances of radial nerve palsy caused by injuries to C5-C6-C7 between newborns and adults.

Prenatal Particulate Matter (PM) Exposure and Natriuretic Peptides in Newborns from Mexico City

(1) Background: The aim of this study was to assess associations between particulate matter (PM) exposure and natriuretic peptide concentrations in cord blood from newborns. (2) Methods: we conducted a cross-sectional study in Mexico City with 101 pregnant women from CIMIGEN Hospital. Atrial natriuretic peptide (ANP), B-type natriuretic peptide (BNP) and C-type natriuretic peptide (CNP) were measured in plasma from cord blood in 51 newborns by ELISA. We estimated PM exposure (PM2.5 and PM10) at first, second and third trimester of pregnancy. (3) Results: The median and interquartile range for ANP, BNP and CNP plasma concentrations were 66.71 (46.92-80.23), 98.23 (73.64-112.30) and 1129.11 (944.10-1452.02) pg/mL, respectively. PM2.5 and PM10 levels for the whole pregnancy period were 22.2 µg/m³ and 41.63 µg/m³, respectively. Employing multivariable linear regression models adjusted for maternal age, newborn sex, smoking before pregnancy, maternal occupation and newborns' length and height, we observed a 2.47 pg/mL (95%CI: -4.67, -0.27) decrease in BNP associated with PM2.5 exposure during second trimester. Adjusted for the same set of confounders, third trimester PM10 exposure was inversely associated with ANP concentrations (beta estimate: -0.90; 95% CI: -1.80, -0.03). Neither PM10 nor PM2.5 were associated with CNP at any trimester of pregnancy. (4) Conclusions: Prenatal exposure to particulate matter was associated with ANP and BNP decrease in newborns.

Epidemiological Aspects of Maternal and Congenital Toxoplasmosis in Panama

In Panama, epidemiological data on congenital toxoplasmosis are limited, making it difficult to understand the scope of clinical manifestations in the population and factors that may increase the risk of infection. This study provides insight into the epidemiological situation of maternal and congenital toxoplasmosis in Panama and contributing information on the burden of this disease in Central America. Blood samples were collected from 2326 pregnant women and used for the detection of anti-T. gondii antibodies. A high seroprevalence (44.41%) was observed for T. gondii infection in pregnant women from different regions of Panama, with an estimated incidence rate of congenital toxoplasmosis of 3.8 cases per 1000 live births. The main risk factors associated with T. gondii infection using bivariate statistical analysis were an elementary level education and maternal age range of 34-45 years. Multivariate statistical analyses revealed that in some regions (San Miguelito, North and West regions), the number of positive cases correlated with the presence of pets, stray dogs and the consumption of poultry. In other regions (East and Metropolitan regions), the absence of pets was considered a protective factor associated with negative cases, while the presence of stray cats and the age range of 25-34 years did not represent any risk in these regions.

Systematic Review and Meta-Analyses of Incidence for Group B Streptococcus Disease in Infants and Antimicrobial Resistance, China

We performed a systematic review and meta-analysis of the incidence, case-fatality rate (CFR), isolate antimicrobial resistance patterns, and serotype and sequence type distributions for invasive group B Streptococcus (GBS) disease in infants <1–89 days of age in China. We searched the PubMed/Medline, Embase, Wanfang, and China National Knowledge Infrastructure databases for research published during January 1, 2000–March 16, 2018, and identified 64 studies. Quality of included studies was assessed by using Cochrane tools. Incidence and CFR were estimated by using random-effects meta-analyses. Overall incidence was 0.55 (95% CI 0.35–0.74) cases/1,000 live births, and the CFR was 5% (95% CI 3%–6%). Incidence of GBS in young infants in China was higher than the estimated global incidence (0.49 cases/1,000 live births) and higher than previous estimates for Asia (0.3 cases/1,000 live births). Our findings suggest that implementation of additional GBS prevention efforts in China, including maternal vaccination, could be beneficial.

Clinical Characteristics, Management, and Short-Term Outcome of Neonates Born to Mothers with COVID-19 in a Tertiary Care Hospital in India

INTRODUCTION

We describe the clinical characteristics, management, and short-term outcomes of SARS-CoV-2 neonates born to mothers with COVID-19 in a tertiary care hospital in Mumbai, India.

METHODS

The study is a retrospective analysis of 524 neonates born to mothers with COVID-19 admitted from 14th April 2020 to 31st July 2020.

RESULTS

SARS-CoV-2 infection was detected in 6.3% of the newborns of the mothers with COVID-19. No significant differences were observed between maturity at gestation, birth weight and sex of SARS-CoV-2 infected and noninfected newborns. The risk of sepsis was 4.09 [95% confidence interval (95% CI) 1.28-13.00] fold higher in the neonates with SARS-CoV-2 as compared to the noninfected group (p = 0.031). Poor feeding was significantly more common among SARS-CoV-2 infected neonates (12.1%) as compared to the noninfected neonates (2.7%) (p = 0.017). There was a total of 13 neonatal deaths, of which 3 deaths occurred in SARS-CoV-2 infected neonates (9%) while 10 (2.04%) in the SAR-CoV-2 negative group. The risk of neonatal death was higher in SARS-CoV-2 infected newborns [odds ratio (OR) 4.8; 95% CI 1.25-18.36].

CONCLUSION

Neonatal SARS-CoV-2 infection is observed in almost 6% of neonates born to mothers with perinatal COVID-19. There is a higher risk of adverse outcomes such as neonatal sepsis and death in the SARS-CoV-2 infected as compared to the noninfected neonates.