Neonatal Age Research Articles

Association between obesity in women with multiple gestations and adverse obstetric outcomes: a study of an American population database with over 136,000 unique deliveries.

The purpose of this study is to compare obese and non-obese women with multiple pregnancies to determine the effects on pregnancy, delivery, and neonatal outcomes. We conducted a retrospective population-based study utilizing data collected between 2004 and 2014 inclusively, from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample. A total of 137,303 multiple pregnancies were analyzed; 130,542 (95%) were non-obese, while 6761 (5%) were obese. An initial analysis was performed to identify the prevalence of obesity in women with multiple pregnancies. Subsequently, chi-square tests and binary logistic regression analyses were conducted to assess the association between obesity and multiple gestation in the context of obstetric complications. There was a statistically significant increase in the prevalence of obesity for women with multiple gestations (p < 0.0001). The obese group was at higher risk of pregnancy-induced hypertension (adjusted odd's ratio [aOR] = 1.89, 95% confidence interval [CI] = 1.77-2.02), gestational hypertension (aOR = 1.84, CI = 1.65-2.05), preeclampsia (aOR = 1.68, CI = 1.55-1.81), preeclampsia or eclampsia superimposed on pre-existing hypertension (aOR = 1.86, CI = 1.58-2.20), gestational diabetes mellitus (aOR = 2.65, CI = 2.44-2.87), and placenta previa (aOR = 0.57, CI = 0.39-0.85). They were more likely to have preterm premature rupture of membranes (aOR = 1.19, CI = 1.06-1.34), chorioamnionitis (aOR = 1.24, CI = 1.03-1.51), caesarean deliveries (aOR = 1.28, CI = 1.18-1.38), wound complications (aOR = 1.65, CI = 1.31-2.08), and transfusions (aOR = 0.77, CI = 0.67-0.89). They were less likely to have small for gestational age neonates (aOR = 0.88, CI = 0.79-0.97), though more likely to have neonates with congenital anomalies (aOR = 1.56, CI = 1.16-2.10). Obesity and multiple gestations are independent risk factors for adverse obstetric outcomes. Combined, when analyzed in a large population, obesity in multiple gestation increases the risk of maternal, delivery, and neonatal complications.

Evaluation of early extubation in the operating room for paediatric patients after congenital open-heart surgery.

Advances in surgical and perioperative care have reduced the need for prolonged mechanical ventilation in children following cardiac surgery. To evaluate the feasibility and assess the clinical outcomes of an early extubation strategy in the operating room for children undergoing congenital heart surgery, including neonates (age < 28 days). This is a retrospective analysis including congenital open-heart surgery cases. We excluded patients who remained open chest postoperatively or patients with severe hemodynamic instability and high inotropic support from the study. Study variables include age, gender, weight, preoperative cardiac diagnosis, preoperative diagnosis of genetic or chromosomal abnormalities, prematurity, preoperative mechanical ventilation (invasive or non-invasive), cardiopulmonary bypass time, circulatory arrest time, postoperative use of inotropes, duration of mechanical ventilation, postoperative respiratory complication, sepsis, bleeding or other complications, paediatric cardiac ICU stay, total hospital stay, incidence of failed extubation, and operative or postoperative mortality. This study included 163 patients who underwent congenital open cardiac surgery, out of these studied patients, 118 (72.4%) were extubated in the operating room. In total, 19.6% of studied patients had Down syndrome. Other genetic or chromosomal disorders were present among 8.6% of studied patients. There was a statistically significant difference between operating room extubation group and non-operating room extubation group regarding Risk Adjustment for Congenital Heart Surgery Score classification, postoperative paediatric ICU duration, postoperative hospital length of stay, vasoactive-inotrope score, duration of inotrope, open chest, and mortality. Extubation in the operating room after congenital open-heart surgery was successful in most of our patients, even following complex procedures.

Validation of reference genes for cardiac RT-qPCR studies spanning the fetal to adult period

Many genes used as internal controls for mRNA expression studies are unstable (change) over development. This study determined an approach to validate reference genes for mRNA studies spanning the fetal period to adulthood in sheep hearts.•We determined the mRNA expression of 12 candidate reference genes (ACTB, GAPDH, H3-3A, HYAL2, PPIA, RNA18S1, RPL32, RPL37A, RPL41, RPLP0, RPS15, and YWHAZ) via RT-qPCR. Per RefFinder, which incorporates computational algorithms by BestKeeper, comparative delta Ct, GeNorm, and NormFinder, RPL32, RPL37A, HYAL2, ACTB and GAPDH were the most stable reference genes, although none were unchanged across all ages.•Systematical calculation of the geometric means of 3 reference genes revealed the combination of HYAL2, RPL32, and RPL37A was unchanged across the 5 fetal, neonatal, and adult ages.•We determined the most stable combination of reference genes for cardiac gene expression studies in sheep from fetus to newborn to adult; these steps are applicable to determine internal controls for mRNA studies in other organs, other species, and periods in which reference gene instability is high.

A Review of Modern and Traditional Approaches for the Management of Pulmonary Hypertension

Research Problem: Hypertension, either high blood pressure or pulmonary hypertension, both affect the life of patients in many ways. Research Questions: Does Pulmonary hypertension similar to high blood pressure? : Does it affect old age people or the neonatal age groups also? : What were the reasons for pulmonary hypertension? : Does pulmonary hypertension manageable with modern and traditional drugs? Literature Review: The purpose of the literature review is to identify the targeted therapy for pulmonary hypertension and also include the plants that may be effective for the management of pulmonary hypertension. Conclusion: The author has reviewed many targeted drugs that are presently used, and many are in research that was found effective in making the life of patients as normal as possible. : They also reviewed about 15 herbal plants which were found effective in the management of the disease. : As pulmonary hypertension is not treatable, it can only be managed by changing lifestyle and food habits; therefore, the authors emphasized reviewing the traditional approach for the management of pulmonary hypertension.

Urinary output of very low birth weight infants during the first weeks of life

Introduction: Daily urinary output (UOP) serves as important tool to identify acute kidney injury (AKI) in preterm infants. However, reference values for UOP, especially stratified for gestational age, are missing. Methods: This retrospective single-center study assessed UOP during the first 28 days of life in 128 very low birth weight (VLBW) infants. Results: VLBW infants exhibit a highly dynamic daily UOP profile in the first 28 days of life with a maximum at day 12 with 4.78 ml/kg bodyweight/h. In the subcohort of 64 extremely low gestational age neonates (ELGAN), the highest UOP is measured during the second week of life. Infants born before 24 weeks of gestation have significantly higher UOP than more mature infants. Conclusion: UOP is dynamic in the postnatal period and differs significantly between gestational age cohorts in the subgroup of ELGANs. These data might point to an adaption of the UOP threshold for neonatal AKI in preterm infants.

Routine 36‐week scan: prediction of small‐for‐gestational‐ age neonate

Routine 36‐week scan: prediction of small‐for‐gestational‐ age neonate

Placenta Thickness Mediates the Association Between AKIP1 Methylation in Maternal Peripheral Blood and Full-Term Small for Gestational Age Neonates

Background/Objectives: A-kinase-interacting protein 1 (AKIP1) has been discovered to be a pivotal signaling adaptor in the regulation of human labor and associated with preterm birth, but its effect on fetal growth was still unclear. Meanwhile, the regulation role of DNA methylation (DNAm) on placental and fetal development has been demonstrated. Therefore, we aimed to investigate the association of AKIP1 DNAm in maternal peripheral blood with placental development and full-term small for gestational age (FT-SGA) neonates, and to explore whether placenta mediate the association between AKIP1 DNAm and FT-SGA; Methods: This study was a case–control study including 84 FT-SGAs and 84 FT-AGAs derived from the Shenzhen Birth Cohort Study. The DNA methylation analysis of CpG in the target region of the AKIP1 gene was measured by the Sequenom MassARRAY EpiTYPER approach. Multiple-variable logistic and linear regression analyses were used to estimate the association between the DNAm of three validated CpG sites in the AKIP1 gene, placental thickness, and FT-SGA. Mediation analysis was used to examine the mediation effect of placental development on the association between the DNAm of AKIP1 and FT-SGA. Results: For every increment in standard deviation in the DNAm of CpG4 (cg00061907) at AKIP1, the risk of FT-SGA elevated by 2.01-fold (aOR = 2.01, 95%CI = 1.39~3.01), and the thickness of the placenta significantly decreased by a 0.19 standard deviation (β = −0.19, 95%CI = −0.32~ −0.06). Placental thickness mediated the 22.96% of the effect of the DNAm of CpG4 at AKIP1 on the risk of FT-SGA with statistical significance. Conclusions: The findings in the present study suggested the mediating effect of placental thickness on the association of the DNAm of AKIP1 in maternal peripheral blood and the risk of FT-SGA, providing new evidence for the mechanism of maternal epigenetics in placental and fetal development.

Outcome of single-ventricle patients supported with extracorporeal membrane oxygenation

Background: Single ventricle heart disease can be left or right ventricle dominant congenital heart disease mostly associated with other risk factors like low birth weight, Preterm, chromosomal abnormality and all these risk factor associated with increase mortality. Methods: A retrospective chart review of paediatric patients from neonatal age to 14 years since 2012 to 2021, with supported by extracorporeal membrane oxygenation (ECMO) including both single ventricle heart physiology and biventricular heart, admitted in paediatric cardiac surgical intensive care unit in our hospital was conducted. All data were compared between single ventricle heart physiology and biventricular heart. Data was performed using commercially available software (SPSS), with statistical significance set p&lt;0.05. Results: We enrolled total 124 patients who underwent ECMO cannulation. 68 children had single ventricle, while 56 being biventricular heart. Most children acquired ECMO cannulation in CICU 63 (50.8%). Male to female ratio was 74:50. 70.2% children got the ECMO cannulation when they had already been operated for surgical repair. Conclusions: Paediatric ECMO utilization in SV is valuable and recently its utilization has been increased in it with improve survival.

Analysis of ultrasonographic measurements of inferior vena cava and abdominal aorta diameters in neonates

Objective: To analyze the ultrasonographic measurements of inferior vena cava (IVC) and abdominal aorta in healthy full-term neonates throughout the early postnatal period. Methods: Prospective observational study was conducted. A total of 132 healthy full-term neonates, who were born in the Department of Obstetrics of Kunshan First People's Hospital between May 1st and August 30th, 2023, were enrolled as the study subjects. Two-dimensional and M-mode ultrasonography were used to measure the maximum and minimum diameters of the IVC and abdominal aorta in the early postnatal period. The IVC collapsibility index, the ratio of maximum IVC diameter to abdominal aorta diameter, and the ratio of minimum IVC diameter to abdominal aorta diameter were calculated. These neonates were stratified by gender, birth mode, gestational age and birth weight (<3 000 or≥3 000 g), and independent sample t-test or Kruskal-Wallis test was used to compare the ultrasonography measurements by different groups. Results: Among the 132 neonates, 81 were males, with a gestational age of (39.2±1.0) weeks, and a birth weight of (3 326±409) g. There were no significant statistical differences in the the maximum and minimum diameters of the IVC and abdominal aorta assessed by both two-dimensional and M-modes between the first and second days (all P>0.05). Additionally, no statistical differences were observed in the ultrasonographic measurements among neonates of different sexes, birth modes, and gestational ages (all P>0.05); but there were statistically differences between the group with birth weight of <3 000 g and the group with birth weight of ≥3 000 g (all P<0.05). There were no statistically differences in IVC collapsibility index, the ratio of the maximum diameter of IVC to the diameter of abdominal aorta, and the ratio of the minimum diameter of IVC to the diameter of abdominal aorta between the group with birth weight of <3 000 g and the group with birth weight of≥3 000 g (all P>0.05). Conclusion: The diameters of the IVC and abdominal aorta in healthy full-term neonates during the early postnatal period are correlated with birth weight. The IVC collapsibility index and the ratio of IVC diameter to abdominal aorta diameter are unrelated to birth weight and can be used to assess newborn blood volume or right cardiac preload.

Statistical analysis plan for the FiO2-C trial: effects of closed-loop automatic control of the inspiratory fraction of oxygen (FiO2-C) on outcomes of extremely preterm infants—a randomized-controlled parallel group multicentre trial for safety and efficacy

BackgroundExtremely low gestational age neonates (ELGANs, i.e. those born before 28 weeks postmenstrual age (PMA)) often require supplemental oxygen and frequently experience intermittent hypo- and hyperoxemic episodes. Exposure to episodes with inadequate oxygen concentrations has been shown to be associated with an increased risk of retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), neurodevelopmental impairment (NDI) and death. Closed-loop automatic control of the inspiratory fraction of oxygen (FiO2-C) reduces number and duration of hypo- and hyperoxemic episodes in ELGANs. Its impacts on clinically important short- and long-term outcomes such as ROP, BPD, NEC, NDI and mortality have not yet been studied.MethodsAn outcome-assessor-blinded, multicentre, randomized-controlled, parallel-group trial for superiority was designed to study the effects of FiO2-C (provided by standard infant ventilators) in addition to routine manual control (RMC) during respiratory support, compared to RMC only, on short- and long-term clinical outcomes in ELGANs. Two co-primary composite outcomes were defined: (i) death, severe ROP, BPD or NEC, assessed at 36 weeks PMA or, in case of ROP, until complete vascularization of the retina; (ii) death or NDI (defined as language/cognitive delay, motor impairment, severe visual impairment or hearing impairment), assessed at 2 years corrected age.ResultsPrimary outcomes will be compared between the two intervention groups using a Cochran-Mantel-Haenszel test. The factors considered for randomization (centre, sex and gestational age at birth (< 26 weeks and ≥ 26 weeks)) will be used to define strata. Results will be presented as adjusted odds ratios with two-sided 95% and 97.5% confidence intervals and two-sided p values.ConclusionsThe statistical analyses for the FiO2-C trial were defined in the study protocol and specified in detail in this statistical analysis plan published prior to any statistical analysis. This is in accordance with the Declaration of Helsinki and the International Conference on Harmonization Good Clinical Practice guidelines.Trial registrationClinicalTrials.gov NCT03168516. Registered on May 30, 2017.

The association of Helicobacter pylori with adverse pregnancy outcomes in three European birth cohorts

BackgroundHelicobacter pylori is a prevalent infection that may complicate pregnancy, but evidence remains limited, controversial and may not apply to all pregnant women.ObjectiveThis study aims to evaluate whether Helicobacter pylori is a risk factor for adverse pregnancy outcomes and to identify vulnerable subpopulations.Study designMultiplex serology was utilized to measure blood levels of immunoglobulin G against eight Helicobacter pylori antigens in 1372 pregnant women from three European birth cohorts: BiB (United Kingdom), Rhea (Greece) and INMA (Spain). Outcomes of interest included gestational diabetes mellitus, gestational hypertension, preeclampsia, preterm birth and small for gestational age neonates, as well as prenatal anxiety and depression. Adjusted logistic regression models were used to evaluate the association between Helicobacter pylori seropositivity (overall and by antigen) and antigen specific antibody levels with the outcomes. We examined effect modification of the associations by ethnicity.ResultsHelicobacter pylori seropositivity was detected in 18.8% (258/1372) of pregnant women. Preeclampsia was the least common outcome (26/830). Helicobacter pylori seropositivity was associated with the development of two or more adverse pregnancy outcomes (gestational hypertension, gestational diabetes, preterm birth, small gestational age and preeclampsia) [OR:1.32 (95% CI: 1.06–1.65), p-value: 0.01], especially in women with high antibody levels to OMP antigen [OR: 2.12 (95% CI: 1.62–2.76), p-value: 0.001]. Women with high antibody levels to Helicobacter pylori antigens GroEL and NapA were more likely to develop preeclampsia [OR: 2.34 (95% CI: 1.10–8.82), p-value: 0.03; OR: 4.09 (95% CI: 1.4-11.93), p-value 0.01)]. Helicobacter pylori seropositivity increased the odds of developing any hypertensive disorder during pregnancy among women of western ethnicity (948/1372) [OR:3.35 (95% CI: 1.29–8.74), p-value 0.03].ConclusionOur study suggests that Helicobacter pylori seropositivity is a risk factor for multiple adverse pregnancy outcomes and particularly in women of western origin for hypertensive disorders during pregnancy. Moreover, pathogen specific characteristics reflected in the antibody responses against OMP, GroEL and NapA seem to determine disease associations.

Analysis of the regional distribution differences of common variations of the MMACHC gene in cblC methylmalonic acidemia patients

Objective: To analyze regional differences in MMACHC gene variations among patients with cblC-type methylmalonic acidemia (MMA) in China and to explore the relationship between these variations and neonatal screening, biochemical markers and prognosis. Methods: Retrospective case summary. Clinical and laboratory data, including general condition, biochemical markers and genetic analysis, were collected from 1 859 cblC MMA patients from 2005 to 2023. Patients were divided into 7 groups according to their regions: north China, northeast China, east China, central China, south China, southwest China and northwest China. They were also classified into neonatal screening and non-neonatal screening groups. Mann-Whitney U and Kruskal-Wallis tests were used to compare biochemical marker levels. In contrast, the Chi-square test was applied to compare MMACHC gene variant frequencies, neonatal screening proportion, onset age and prognosis between groups. Results: Among 1 859 cases of cblC MMA, 1 019 were male and 840 were female, with a consultation age of 1.0 (0.1, 5.0) month. A total of 1 787 cases carried compound heterozygous or homozygous variants and only 1 variant site was identified in 72 cases. The 10 most frequent variants were c.609G>A (1 238 cases), c.658_660delAAG (343 cases), c.80A>G (284 cases), c.482G>A (239 cases), c.567dupT (191 cases), c.656_658delAGA (131 cases), c.217C>T (109 cases), c.394C>T (105 cases), c.445_446delTG (51 cases) and c.1A>G (50 cases). The frequency of the c.609G>A was the lowest in northwest China (28.8% (44/154), χ²=-18.42, P<0.05). The frequency of the c.567dupT was the most common in southwest China (25.0% (20/80), χ²=71.70, P<0.001) and c.656_658delAGA had the highest frequency in northeast China (9.3% (19/205), χ²=32.08, P<0.001). Non-missense variants (91.2% (62/68), 88.5% (46/52)) and early-onset patients (90.0% (36/40), 94.4% (34/36)) were both more prevalent in southwest and south China (χ²=14.95, 31.69, both P<0.05). The proportion of neonatal screening was the lowest in south China (22.2% (8/36), χ²=98.48, P<0.05), where the mortality rate was the highest (19.1% (4/21), χ²=38.98, P<0.001). East China exhibited the highest frequency of missense variants (21.5% (339/1 579)), the highest proportion of patients identified through neonatal screening (54.5% (465/853)), and a more significant proportion of patients with good prognosis (36.6% (227/621), χ²=14.57, 93.49, 38.98, all P<0.05). In addition, the c.482G>A variant was more frequent in patients diagnosed by neonatal screening compared to those diagnosed by other methods (8.3% (132/1 586) vs. 5.9% (122/2 060), χ²=7.97, P<0.05). Conclusions: The frequency of MMACHC gene variation varies across different regions. The c.609G>A was least frequent in northwest China, c.567dupT was most common in southwest China, and c.656_658delAGA was most prevalent in northeast China. South China had the lowest neonatal screening rate and the highest mortality. At the same time, east China exhibited the highest frequency of missense variants, the highest proportion of patients identified through neonatal screening and the best prognosis. The c.482G>A variant was more frequent in patients diagnosed by neonatal screening compared to those diagnosed by other methods.

Cross-sectional Hospital-based Investigation on Clinical Characteristics of Pediatric Staphylococcus aureus Isolates in a Beijing Hospital from 2013 to 2022.

Staphylococcus aureus (S. aureus) was a prevalent pathogenic bacterium among children. Due to the extensive use of antibiotics, the sensitivity of S. aureus to these drugs has gradually declined. Since the 1960s, methicillin-resistant Staphylococcus aureus (MRSA) has emerged and spread worldwide, becoming a primary cause of both healthcare-associated (HA) and community-acquired (CA) infections. This retrospective study aimed to highlight the significance of S. aureus among bacteria isolated from children in Beijing, China, and to elucidate its antimicrobial resistance patterns. Data on all S. aureus infections from 2013 to 2022 were collected from the microbiology department of Beijing Children's Hospital. Only the first isolate from the same kind of specimen was analyzed. Antimicrobial susceptibility tests were carried out by Vitek 2 automated system (bio Mérieux, France) or Kirby-Bauer disc diffusion method, according to the guidelines recommended by the Clinical and Laboratory Standards Institute (CLSI). During the decade-long research period, a total of 47,062 bacterial isolates were isolated from 433,081 submitted specimens, with 6477 of these isolates identified as S. aureus. The majority of patients with S. aureus infections belonged to the age group of infants under one-year-old, accounting for 37.9% of cases. S. aureus isolates were predominantly found in the Pneumology Department, and the most common source of these isolates was lower respiratory tract specimens, comprising 34.3% of the total. The resistance rates of S. aureus to penicillin and erythromycin were notably high, at 89.5% and 73.8%, respectively. In contrast, the resistance rates to linezolid, vancomycin, rifampicin, and moxifloxacin were remarkably low, at 0.0%, 0.0%, 1.3%, and 3.9%, respectively. The detection rate of MRSA was 27.8%. MRSA isolates were predominantly found in the newborn group, ICU, and sterile body fluids. In our study, the most prevalent specimen type was derived from the lower respiratory tract, whereas the highest positive rate was observed in ear secretions. These findings underscored the pressing necessity for ongoing antimicrobial resistance (AMR) surveillance and the revision of treatment guidelines, particularly given the elevated detection of MRSA in ICU wards, sterile body fluids, and the neonatal age group. MRSA exhibited significant resistance to all β-lactam antibiotics, erythromycin, and ciprofloxacin. Therefore, future research endeavors should prioritize examining specific antimicrobial resistance populations and potential intervention strategies, as these were vital in mitigating the dissemination of antimicrobial-resistant isolates.

Impact of early cleft lip and palate surgery on maxillary growth in 5- and 10-Year-old patients with unilateral cleft lip and palate: a cross-sectional study

ObjectivesThis study evaluated maxillary growth and dental arch relationships at 5 and 10 years of age in patients with unilateral cleft lip and palate (UCLP) who underwent early cleft lip and palate surgery.Methods28 patients with UCLP who underwent cleft lip surgery in neonatal age and cleft palate surgery at average age of 7 months without orthodontic treatment (intervention group) were measured for intercanine and intermolar distances and for dental arch length. These measurements were compared with those of 30 healthy participants in a control group. Dental arch relationships in the intervention group were evaluated by 5-YO index at 5 years and the GOSLON Yardstick score at 10 years of patients’ age.ResultsPatients in the intervention group had significantly shorter mean intercanine distance and arch length than control patients at both 5 and 10 years of age (p<.001 for all). There were no significant differences in intermolar distance at both 5 (p = .945) and 10 years (p = .105) of patients’ age. The average 5YO index increased from 2.46 to an average GOSLON 10-year score of 2.89 in intervention group.ConclusionIntercanine distance and dental arch length of patients with UCLP are significantly reduced at 5 and 10 years after early cleft lip and palate surgeries compared to the healthy population. Dental arch relationships at 5 and 10 years of patients with UCLP show comparable outcomes to those reported by other cleft centers.Clinical significanceThis study evaluates maxillary growth in UCLP patients 5 and 10 years of age who underwent early primary lip and palate surgery.

A Case Report on Congenital Mesoblastic Nephroma

Aims: This study aims to provide a comprehensive review of the epidemiology, genetic underpinnings, clinical presentation, and management strategies of congenital mesoblastic nephroma (CMN), with a focus on the diagnostic and therapeutic challenges that distinguish it from other neonatal renal tumors such as Wilms’ tumor. By presenting a unique case of a neonate diagnosed with CMN and undergoing tumor resection, we seek to highlight the complexities of perinatal care in such cases and the potential for life-threatening complications despite early intervention. Furthermore, the study underscores the importance of early and accurate differentiation between CMN subtypes, as well as the role of histopathology in guiding treatment approaches. Presentation of Case: A female neonate was born at 34+2 weeks gestation, presenting with a retroperitoneal mass on the left kidney, identified prenatally via ultrasound. Delivered by cesarean section due to polyhydramnios and anemia, a palpable intraabdominal mass was noted during examination. Imaging confirmed a heterogeneous solid lesion suggestive of nephroblastoma. The patient underwent nephroureterectomy, with histopathology confirming congenital mesoblastic nephroma. Despite successful resection, the patient died at 9 days of age from refractory catecholamine septic shock, with complications including neonatal sepsis, gastrointestinal bleeding, and femoral artery thrombosis. Discussion: Congenital mesoblastic nephroma is the most common renal tumor in neonates, often misdiagnosed as Wilms’ tumor. It typically presents before 2 months of age and is associated with translocation (12;15)(p13;q25). The prognosis for classical CMN is excellent, while the cellular variant is more aggressive. Surgical excision is the primary treatment, but the neonate's age necessitates careful management to mitigate risks. In this case, multiple complications contributed to the poor outcome despite timely intervention. Conclusion: CMN is a rare renal tumor in neonates, requiring accurate diagnosis through histopathology. While prognosis is generally favorable, complications from prematurity can adversely affect survival.

Bronchopulmonary dysplasia to predict neurodevelopmental impairment in infants born extremely preterm.

Bronchopulmonary dysplasia (BPD) in extremely low gestational age neonates (ELGANs) was associated with neurodevelopmental impairment (NDI). However, the best endpoint of BPD assessment to predict subsequent NDI remains unclear. We re-analyzed the PREMILOC trial, previously designed to test the effect of prophylactic hydrocortisone on survival without BPD at 36 weeks of postmenstrual age (BPDW36) in ELGANs, to compare predictive models of NDI considering baseline characteristics, respiratory course up to and BPD status at 36 or 40 weeks of postmenstrual age (BPDW36/BPDW40). Among 404/519 (77.8%) infants enrolled in the trial alive at 2 years of age, all neurocognitive scores were available for 302 (74.8%) patients. Gestational diabetes and sex were identified as the only statistically significant baseline predictors of NDI. Adding BPDW40 to this baseline model was found to be superior to predict NDI compared to BPDW36, leading to a mean difference of the developmental quotient of -6.7 points (95% confidence interval: -10.0 to -3.50, P < 0.001). The prophylactic hydrocortisone treatment effect on survival without BPDW40 was found to be highly significant (OR = 2.08 [95% confidence interval: 1.36 to 3.17], P < 0.001). These data suggest a better accuracy of BPDW40 to predict NDI in ELGANs, an important finding for future clinical trials and research in drug development. EudraCT number 2007-002041-20, ClinicalTrial.gov number, NCT00623740. The best endpoint to assess BPD as a surrogate to predict neurocognitive impairment in infants born extremely preterm remains unclear. This study strongly suggests a better discriminative value of BPD as assessed at 40 weeks of postmenstrual age (instead of 36 weeks) to predict neurocognitive impairments at 2 years of age in children born extremely preterm. This study supports the switch up to 40 weeks of the primary outcome chosen in future clinical trials designed to prevent BPD. Our data also provide evidence of the beneficial effect of HC on preventing BPD at full-term equivalent age.

Outcome of Surgery in a Patient with Blindness and Inter- Hemispheric Cyst: A Case Report

Interhemispheric cysts are rare congenital condition which is also associated with corpus callosum agenesis. Most patients present at neonatal age or early childhood with some neurological deficiency. Some patients may present at older age. Here we present a patient with acute blindness of the right eye and dimness of vision of the left eye. He had no mental retardation or other neurological deficit. His fundus showed bilateral papilloedema. His MRI showed an interhemispheric cyst with agenesis of the corpus callosum. He was urgently operated in this hospital. The cyst was approached through interhemispheric fissure. It was excised and communicated with the third ventricle. His post-operative period was uneventful. Immediately after surgery he had improvement of his vision over a period of two week. He could return to normal life following discharge. Therefore, prompt surgical intervention is important for saving vision of these patients. Bang. J Neurosurgery 2024; 13(2): 165-169

66 Survival and school-age outcomes of extremely premature neonates with intraventricular hemorrhage

Abstract Background Extremely low gestational age (ELGA) neonates are at risk for intraventricular hemorrhage (IVH) and periventricular hemorrhagic infarction (PVHI). There is no clear consensus on the prognosis of these conditions. Objectives The aim of this study was to compare the survival, and the neurodevelopmental outcomes (NDO) at school-age for neonates with IVH and/or PVHI, to those without. Design/Methods This retrospective single-center study (2012-2017) included neonates less than 26 weeks gestational age (GA) who received resuscitation and early intensive care. Imaging data were collected from cranial US for the presence of IVH described by Papile grading. Survival was defined as survival to discharge. NDO were classified as no neurodevelopmental impairment (NDI), no NDI with multidisciplinary referrals, and the adverse outcome was defined as NDI at school-age. NDI included any diagnosis of cerebral palsy, global developmental delay, intellectual disability, visual or hearing impairment. Autism spectrum disorder (ASD) was included as an outcome of interest. Results 164 infants met inclusion criteria, of whom 156 survived resuscitation. Mean GA was 24 weeks and 6 days (SD 6 days) and mean birth weight 701g (SD 125g), grade I-II IVH was present in 43 (28%) infants, and grade III-IV IVH was present in 48 (31%) infants. Survival was 45% for those with bilateral grade III-IV IVH, 53% for unilateral grade III-IV IVH, 78% for bilateral grade I-II IVH, 80% for unilateral grade I-II IVH, and 81% for no IVH groups. 108 infants survived to discharge and 90 had complete follow up at school age. 30% of children had NDI and ASD was diagnosed in 12%. Logistic regression for adverse outcome demonstrated an adjusted odds-ratio (OR) 0.30 (95% CI 0.14, 0.56) for gestational age (p &amp;lt;0.001). The logistic regression resulted in adjusted OR 0.72 (95% CI 0.21, 2.37) for grade I-II IVH and OR 1.43 (95% CI 0.4, 5.03) for Grade III-IV IVH (p=0.63). Conclusion In neonates born ELGA, survival decreased with increasing severity of IVH. Decreasing GA, but not severity of IVH, was predictive of neurodevelopmental impairment. Extremely preterm infants born &amp;lt; 26 weeks are at high risk of NDI and of ASD.

White matter functional networks in the developing brain.

Functional magnetic resonance imaging (fMRI) is widely used to depict neural activity and understand human brain function. Studies show that functional networks in gray matter undergo complex transformations from neonatal age to childhood, supporting rapid cognitive development. However, white matter functional networks, given the much weaker fMRI signal, have not been characterized until recently, and changes in white matter functional networks in the developing brain remain unclear. Aims to examine and compare white matter functional networks in neonates and 8-year-old children. We acquired resting-state fMRI data on 69 full-term healthy neonates and 38 healthy 8-year-old children using a same imaging protocol and studied their brain white matter functional networks using a similar pipeline. First, we utilized the ICA method to extract white matter functional networks. Next, we analyzed the characteristics of the white matter functional networks from both time-domain and frequency-domain perspectives, specifically, intra-network functional connectivity (intra-network FC), inter-network functional connectivity (inter-network FC), and fractional amplitude of low-frequency fluctuation (fALFF). Finally, the differences in the above functional networks' characteristics between the two groups were evaluated. As a supplemental measure and to confirm with literature findings on gray matter functional network changes in the developing brain, we also studied and reported functional networks in gray matter. White matter functional networks in the developing brain can be depicted for both the neonates and the 8-year-old children. White matter intra-network FC within the optic radiations, corticospinal tract, and anterior corona radiata was lower in 8-year-old children compared to neonates (p < 0.05). Inter-network FC between cerebral peduncle (CP) and anterior corona radiation (ACR) was higher in 8-year-olds (p < 0.05). Additionally, 8-year-olds showed a greater distribution of brain activity energy in the high-frequency range of 0.01-0.15 Hz. Significant developmental differences in brain white matter functional networks exist between the two group, characterized by increased inter-network FC, decreased intra-network FC, and higher high-frequency energy distribution. Similar findings were also observed in gray matter functional networks. White matter functional networks can be reliably measured in the developing brain, and the differences in these networks reflect functional differentiation and integration in brain development.

Perinatal smoking and sleep disorders in neonatal age: A systematic review

Perinatal smoking and sleep disorders in neonatal age: A systematic review