Longitudinal growth trajectories and predictive risk factors for short stature in extremely preterm infants up to six years of age.

Identification of novel polyhalogenated carbazoles in cord serum and their associations with fetal growth.

Neonatal sepsis is a leading cause of morbidity and mortality worldwide and is often complicated by myocardial dysfunction. While left ventricular (LV) impairment has been widely described, right ventricular (RV) dysfunction remains underrecognized. Tricuspid annular plane systolic excursion (TAPSE) is a simple, reproducible echocardiographic parameter to assess RV systolic function. This study aimed to evaluate the association between neonatal sepsis and ventricular dysfunction, focusing on right-sided heart failure indicated by reduced TAPSE. This study design is an observational-analytic with a cross-sectional design involved all infants aged 1-28 days that were admitted into NICU wards between May-June 2023. There were 53 infants included and were divided into two main groups: those with sepsis and those without. Each group was further stratified into two sub-groups based on birth weight: (1) sepsis with BW <1500 g, (2) sepsis with BW ≥ 1500 g, (3) no sepsis with BW < 1500 g, and (4) no sepsis with BW ≥ 1500 g. No significant differences were observed in LV systolic or diastolic parameters between septic and non-septic groups (Tei index p=0.69, EF p=0.65, FS p=0.77, MAPSE p=0.78). However, TAPSE was significantly lower in septic neonates (median 0.8 cm) compared to non-septic infants (median 0.9 cm, p=0.03), particularly among those with low birth weight. Neonatal sepsis is associated with RV systolic dysfunction, while LV function remains preserved. Reduced TAPSE may reflect early right-sided heart failure secondary to sepsis-induced pulmonary and myocardial injury, supporting TAPSE as a valuable tool for early detection and monitoring.

Balancing anatomical limits and dynamic adaptation: Understanding the determinants of successful vaginal breech delivery.

Joint effects of prenatal endocrine disrupting chemicals and heavy metal mixture on birth size and maternal complication in the Korea children's environmental health cohort study.

Neonatal Sepsis from 2014-2024: The Resurgence of Gram-Negative Rods.

Former preterm and term infants are at risk for postanesthesia apnea, but the lack of uniform standards for monitoring and discharge criteria leads to inconsistent practice. The primary aim of this study was to identify major risk factors for postanesthesia apnea. This systematic review and meta-regression analysis used Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Agency for Healthcare Research and Quality guidelines. The literature search included English language case reports, case series, clinical studies, and clinical trials. Major databases were queried from inception to October 2025. A total of 6,191 articles underwent title and abstract screening, 491 underwent full-text screening, and 173 underwent detailed reviews. Data were extracted from 115 of 173 articles (98 studies, 17 case reports or series). Across studies (preterm or full term infants), the median incidence of apnea was 7.6% (range, 0 to 85%). Univariable meta-regression analysis (96 eligible articles) identified five significant predictors of apnea: gestational age, postmenstrual age at time of procedure, birth weight, procedure duration, and year of publication. Odds for apnea incidence decreased with later publication year, older gestational age at birth, older postmenstrual age at time of surgery, higher birth weight, and shorter procedure duration. A multivariable "best fitting model" (64 eligible articles) including publication year (1986 to 2025) and postmenstrual age (32 to 63 weeks) found a decrease in odds of apnea incidence with later publication year (odds ratio [OR], 0.936; CI, 0.91 to 0.964; P < 0.001) and higher postmenstrual age (OR, 0.889; CI, 0.828 to 0.954; P = 0.001). Recommended postanesthesia monitoring duration ranged from 6 to 24 h based on postmenstrual age. Meta-regression showed significantly lower apnea odds with neuraxial versus general anesthesia (OR, 0.236; CI, 0.094 to 0.592; P = 0.003). Postmenstrual age appears to be the strongest and most consistent risk factor for postanesthesia apnea; neuraxial anesthesia may reduce this risk. An individual participant data meta-analysis in a follow-up article will shed further light on the at-risk postmenstrual age threshold for increased risk and help refine monitoring recommendations for these vulnerable infants.

An early-onset preeclampsia study of C19MC: DNA methylation in the spermatozoa and, DNA methylation and expression in the placental villi.

Although VACTERL association is a recognized entity in patients with esophageal atresia (EA), its impact on surgical outcomes remains unclear. This study aimed to evaluate the influence of VACTERL association and chromosomal anomalies (VACTERL-CA) on the surgical outcomes of EA patients, offering novel insights into risk stratification. All patients enrolled in the European Pediatric Surgeons' Association (EUPSA) Esophageal Atresia Registry (EAR) between July 2014 and December 2017 were included. Patients were classified into two groups: those with VACTERL-CA and those without these anomalies (non-VACTERL). Groups were compared for demographics, associated malformations, surgical approach, complications, and outcomes. Among 372 patients, 22% (n = 82) were classified as VACTERL-CA. This group had significantly lower gestational age (35.9 weeks vs. 37.1 weeks, p = 0.004), birth weight (2,312 g vs. 2,663 g, p < 0.001), and APGAR scores at 5 and 10 minutes (p = 0.005). Surgical strategies, including rates of primary anastomosis (88% in both groups), did not differ. Anastomotic leak and stricture rates were similar; however, recurrent fistula was more common in VACTERL-CA (4.9% vs. 1.0%, p = 0.023). Overall mortality was higher in VACTERL-CA (14.6% vs. 5.2%, p = 0.003), largely due to associated anomalies such as cardiac or neurologic conditions, whereas EA-related mortality was more frequent in non-VACTERL (1% vs. 0%). Sepsis was also more frequent in VACTERL-CA (10.9% vs. 4.5%, p = 0.033). In multivariate analysis, low birth weight (adjusted odds ratios [aOR]: 0.95 per 100 g, p = 0.010) and cardiac malformations (aOR: 2.33, p = 0.002) were independently associated with VACTERL-CA. EA patients with VACTERL-CA represent a high-risk subgroup characterized by prematurity, major cardiac defects, and increased sepsis risk. These findings highlight the need for early cardiac screening, standardized infection-prevention bundles, and tailored multidisciplinary care to improve survival and reduce preventable complications.

Pregnancy in multiple sclerosis (MS) is associated with reduced relapse activity, though the postpartum period carries a heightened risk of disease reactivation. Continuation of natalizumab late gestation has been proposed to mitigate this rebound effect and maintain disease stability. This retrospective study included 62 women with MS with initial pregnancy plans. Of those 32 continued natalizumab infusion until the 34th week of gestation and 30 discontinued natalizumab treatment upon confirmation of pregnancy. Participants were assessed pre- and within three months postpartum for disability status (EDSS), relapse occurrence, and MRI activity (presence of gadolinium-enhancing [GdE+] lesions). Neonatal anthropometric parameters (birth weight, length, head circumference) were also recorded. Within the natalizumab group, outcomes improved from baseline (last preconception assessment) to the postpartum follow-up (≤3 months after delivery) with lower EDSS scores (p=0.003), marked reductions in relapse frequency and GdE+lesions (p<0.001 for both). The non-natalizumab group showed smaller reductions in relapse rates and no significant change in MRI activity. Between-group comparisons at postpartum follow-up revealed lower EDSS scores (p=0.028), fewer relapses (p=0.029), and fewer GdE+lesions (p=0.001) in the natalizumab group. Neonatal anthropometric parameters did not differ significantly between groups and WHO Child Growth Standards (p>0.05). Continuing natalizumab treatment until late pregnancy was associated with better postpartum clinical and radiological outcomes. Neonatal anthropometric measures were comparable to reference child growth standards. These findings support that late pregnancy natalizumab continuation may be a viable high efficacy strategy for women with highly active MS.

Use of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual GLP-1/glucose-dependent insulinotropic polypeptide (GIP) receptor agonists is increasing among reproductive-aged women for obesity, diabetes, polycystic ovary syndrome (PCOS), and cardiometabolic disease. However, the safety of these agents in pregnancy and lactation remains sparse, while inadvertent first-trimester exposure is becoming more common. The aim of this review is to systematically evaluate maternal, fetal, neonatal, and lactation outcomes following preconception, in-pregnancy, or postpartum exposure to GLP-1 and dual GLP-1/GIP receptor agonists. We conducted a systematic review of PubMed/MEDLINE, Web of Science, Scopus, and the Cochrane Library from inception to 23 September 2025. Human studies reporting exposure to GLP-1 or dual GLP-1/GIP receptor agonists during preconception, pregnancy, or lactation were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias using validated tools. Given clinical heterogeneity, findings were synthesised narratively in accordance with PRISMA 2020 guidelines. Thirty-six studies met the inclusion criteria. Across large observational cohorts, periconceptional or early-pregnancy exposure to GLP-1-based therapies was not consistently associated with increased risk of major congenital malformations in adjusted analyses, fetal growth restriction, stillbirth, or neonatal mortality compared with insulin-treated or disease-matched controls. Maternal outcomes, including gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and gestational weight gain, were heterogeneous without a reproducible safety signal. Indeed, in women with PCOS, GLP-1RAs seem promising in various aspects. Lactation data were sparse; one pharmacokinetic study reported no detectable semaglutide transfer into human milk. Current evidence suggests that preconceptional or early-pregnancy exposure to GLP-1-based therapies is not consistently associated with increased maternal, fetal, or neonatal risk, although data on continued use throughout gestation remain limited.

Schizophrenia and autism share neurobiological mechanisms and overlapping clinical features, often resulting in the emergence of autistic traits in early stages of psychosis. The PANSS Autism Severity Score (PAUSS) provides a rapid measure of autistic features within the standard PANSS assessment. We aimed to determine the prevalence of autistic features in first-episode psychosis (FEP), characterise their clinical, cognitive, and functional profile, and examine their impact on 2-year outcomes. A total of 328 FEP patients were included from the PEPs multicentre cohort, followed for 2 years. Autistic features were rated using PAUSS (cut-off ≥ 30), yielding autistic (n = 38) and non-autistic (n = 290) groups. Sociodemographic, clinical, cognitive, and functional variables were analysed. Longitudinal analyses examined symptomatic remission rates and trajectories of psychopathology and functioning using logistic regression and mixed-model ANOVA. The autistic group represented 11.6% of the sample. At baseline, they exhibited lower birth weight, greater medication side effects, higher general psychopathology and depressive severity, and poorer global functioning. Cognitively, they showed significant deficits in working memory, social cognition, and cognitive reserve compared to the non-autistic group. Over 2 years, this group was 3.6 times less likely to achieve symptomatic remission and consistently exhibited higher symptom severity and lower functioning across all follow-ups. Autistic features in FEP identify a subgroup with a possible distinct profile of neurodevelopmental markers, greater cognitive and functional impairments, and poorer clinical outcomes. Early identification may guide more personalised interventions, although further research is needed to refine PAUSS specificity and develop targeted, tailored treatments.

The role of public health interventions in modifying associations between prenatal exposures to ambient air pollution and extreme heat with child health outcomes: A systematic review.

Chronic hypertensive disorders in pregnancy are associated with adverse maternal and perinatal outcomes. Hemodynamic-guided management has been proposed to optimize antihypertensive therapy. This study evaluates outcomes before and after the introduction of the USCOM® device - a non-invasive hemodynamic monitor - into clinical practice for tailoring antihypertensive treatment. A retrospective, monocentric descriptive study was conducted at the AOU Policlinic of Modena. USCOM® was implemented in March 2022. The control group included 22 pregnant individuals with chronic hypertensive disorder (HD) from 2021, while the USCOM group included 46 individuals from 2023 who received USCOM® hemodynamic monitoring to tailor antihypertensive therapy. Patients with missing delivery data or gestational hypertension were excluded. Maternal and neonatal outcomes were collected retrospectively from electronic medical records and analyzed using SPSS v.28. Continuous variables were presented as means with standard deviations, and categorical variables as counts and percentages. No significant differences in maternal characteristics were observed between groups. The USCOM group showed a significantly lower incidence of low-birthweight (<2500 g) newborns (6.5% vs. 36.4%; P=0.004) and longer gestational age (38.9 vs. 37.4 weeks; P=0.049). Although not statistically significant, trends indicated fewer extremely preterm births (<34 weeks; P=0.096) and lower Neonatal Intensive Care Unit (NICU) admissions (P=0.096). Multivariate analysis confirmed USCOM® evaluation as the only significant factor reducing the risk of low birth weight (adjusted odds ratio [aOR] 0.118, P=0.004), adjusted for parity, ethnicity, and prepregnancy Body Mass Index (BMI). While larger studies are needed to confirm these findings, the implementation of USCOM® in routine clinical practice may contribute to improved neonatal outcomes in pregnancies complicated by chronic hypertensive disorders.

Volatile organic compounds exposure and all health outcomes: An umbrella review and evidence map.

Association of prenatal exposure to criteria air pollutants and traffic-related air toxics with adverse birth outcomes: A population-based cohort study in California (1990-2021).

A case report of Coffin-Siris syndrome and autism spectrum disorder in an extremely low birth weight infant with de novo ARID1B nonsense variant: The role of genetic analysis

Investigation and control of a meticillin-resistant Staphylococcus aureus (MRSA) outbreak in a Level 2 neonatal unit in England: findings from a cohort study.

The development of neonatal intensive care has substantially reduced infant mortality, still, infants remain at high risk for adverse outcomes. Safe care relies on adequate nurse staffing and an appropriate skill mix, which is especially important in neonatal intensive care as infants are extremely vulnerable to harm when quality lapses occur. Although international guidelines recommend optimal nurse-to-patient ratios for neonatal care, these standards have not been fully implemented, leaving it unclear whether current staffing levels align with recommendations for safe staffing. To benchmark the acuity-adjusted registered nurse staffing provision ratio in neonatal intensive care and determine the skill mix distribution and variation of nursing staff across shifts. This retrospective cohort study included infant data from a 16-week period in 2022 in three neonatal intensive care units with a common administration at a university hospital. Data were obtained from the hospital's data repository and the Swedish Neonatal Quality Register, including 609 neonatal admissions and 345 nursing staff members working 1008 shifts. Infants' daily acuity levels were assessed using an adapted version of the British Association of Perinatal Medicine's guideline, classifying infants into three levels: intensive care, high dependency care, and special care. Staffing provision was measured as the number of worked hours per shift, staff category, and unit. The registered nurse provision ratio was defined as the number of registered nurse hours provided divided by the recommended hours. A ratio below 1.0 indicates understaffing. The population's total in-hospital days were 4674, and the mean birth weight was 2843 g (SD 1029), with 57.0 % being boys. The proportion of registered nurses relative to nursing assistants ranged from 22.2 % to 85.7 %, with a median of 46.5 %. Registered nurses with specialist education accounted for a median of 73.0 % of total registered nurse hours. Within each unit, the mean acuity-adjusted number of registered nurses recommended by the British Association of Perinatal Medicine's standard was relatively consistent across shift types and between weekdays and weekends. However, the required number of registered nurses between individual shifts showed considerable variation, ranging from 2.5 to 10.3. During the inclusion period, 81.2 % of the shifts had a registered nurse provision ratio below 1.0, suggesting that most shifts did not meet the recommendations for staffing levels. This study highlights a shortfall in registered nurse staffing relative to recommended levels. Ensuring adequate registered nurse staffing levels is crucial for maintaining high-quality neonatal care and improving infant outcomes.

Site-Level fine-tuning with progressive layer freezing: Towards robust prediction of bronchopulmonary dysplasia from day-1 chest radiographs in extremely preterm infants