First Minutes Of Life Research Articles

Non-Invasive High Frequency Oscillatory Ventilation versus Continuous Positive Airway Pressure in Preterm Neonates With Respiratory Distress Syndrome

Abstract Background Respiratory distress syndrome (RDS) is the main cause of respiratory failure in preterm neonates, its incidence varies from 80% to 25% depending on gestational age. When optimal prenatal care is provided, the best approach to treat RDS, according to several recent trials, consists of providing continuous positive airway pressure (CPAP) from the first minutes of life using short binasal prongs or masks, followed by early selective surfactant administration for babies with worsening oxygenation and/or increasing work of breathing. Any effort must be done to minimize the time under invasive mechanical ventilation (IMV). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a new mode of non-invasive ventilation that connects non-invasive circuits to high-frequency ventilators, through which gas exchange is achieved by the superposition of high-frequency oscillation over continuous positive flow. Compared with other non-invasive ventilation modes, nHFOV combines the advantages of nCPAP and high-frequency ventilation, making it more effective at maintaining alveolar stability, eliminating CO2, and limiting barotrauma. Objective To investigate the effectiveness of nasal high frequency oscillatory ventilation in comparison to nCPAP as a primary mode of respiratory support in preterm neonates with respiratory distress syndrome. Methods This randomized controlled trial that was conducted on 90 neonates diagnosed with RDS at the Neonatal Intensive Care Units (NICUs), Ain Shams University Hospitals throughout six months. Results In the current study, there was a significant decrease in FiO2 needs in nHFOV group vs. nCPAP group, the median (IQR) (30% (21 to 37) vs. 31% (30 to 40) respectively, P-value=0.030), but non significant difference in RDS according to total Silverman score in nHFOV group vs. nCPAP group with median (IQR) total Silverman score (4 (4 to 5)vs. 4 (3 to 6) respectively, P-value= 0.474). Conclusion Using nHFOV is better than nCPAP in decreasing the need of FiO2.

Меконий (первородный кал): происхождение, состав, диагностический потенциал

The literature review substantiates the necessity of diagnosing and forecasting the outcomes of adverse perinatal exposures. A critical analysis of existing approaches was conducted. A conjecture is made about the diagnostic potential of the first stool, which is a unique source for gathering information about intrauterine development of a fetus. Given that meconium can be non-invasively collected from the first minutes of life, its study is particularly valuable for identifying perinatal risks in ill and preterm newborns. The authors justify its diagnostic value of meconium analysis for determining risk groups for intrauterine infections, poisoning with high-density metals, and even genetic and surgical pathologies of the gastrointestinal tract. All this promotes the refinement of diagnostic and treatment algorithms for various perinatal period diseases.

Assessing the Effectiveness of the Combined Apgar Scoring System in Predicting the Short-Term Outcomes of Newborns

Background: Many clinicians have used the Apgar scoring system to evaluate newborn babies at the first minutes of birth. Expanded and combined Apgar have been introduced due to the interventions done for babies in the first minutes of life. This study evaluates the predicting values of combined Apgar scores in short-term neonatal outcomes. Methods: A diagnostic test was conducted on alive preterm and term babies without major anomalies between October 2021 and August 2022. Infants with congenital heart disease, congenital metabolic disorders, and those transferred to another hospital were excluded. Demographic data, feeding volume, conventional, expanded, and combined Apgar scores were assessed at 5 minutes of birth and recorded. The area under the receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of the combined Apgar score to predict short-term outcomes (need to admission, duration of hospitalization, and oral feeding progression). Results: Of 599 babies (339 boys and 260 girls) with a mean gestational age of 35.3 ± 3.8 weeks (25 - 42 weeks), 280 (46.7%) babies were admitted. As the average Apgar score decreased, progression to full oral feeding was associated with longer delay. The area under the ROC curve for the Combined Apgar score was 80% and 55% in correlation with the need for admission and duration of hospitalization, respectively. Conclusions: This study showed that the 5th-minute combined Apgar score is a good predictor of the need for admission and oral feeding progression but does not seem suitable for predicting the duration of hospitalization.

Apgar Score and Neurodevelopmental Outcomes at Age 5 Years in Infants Born Extremely Preterm

The Apgar score is used worldwide as an assessment tool to estimate the vitality of newborns in their first minutes of life. Its applicability to estimate neurodevelopmental outcomes in infants born extremely preterm (EPT; <28 weeks' gestation) is not well established. To investigate the association between the Apgar score and neurodevelopmental outcomes in infants born EPT. This cohort study was conducted using data from the Effective Perinatal Intensive Care in Europe-Screening to Improve Health in Very Preterm Infants in Europe (EPICE-SHIPS) study, a population-based cohort in 19 regions of 11 European countries in 2011 to 2012. Clinical assessments of cognition and motor function at age 5 years were performed in infants born EPT and analyzed in January to July 2023. Apgar score at 5 minutes of life categorized into 4 groups (0-3, 4-6, 7-8, and 9-10 points). Cognitive and motor outcomes were assessed using the Wechsler Preschool and Primary Scale of Intelligence test of IQ derived from locally normed versions by country and the Movement Assessment Battery for Children-Second Edition. Parents additionally provided information on communication and problem-solving skills using the Ages and Stages Questionnaire, third edition (ASQ-3). All outcomes were measured as continuous variables. From the total cohort of 4395 infants born EPT, 2522 infants were live born, 1654 infants survived to age 5 years, and 996 infants (478 females [48.0%]) followed up had at least 1 of 3 outcome measures. After adjusting for sociodemographic variables, perinatal factors, and severe neonatal morbidities, there was no association of Apgar score with IQ, even for scores of 3 or less (β = -3.3; 95% CI, -10.5 to 3.8) compared with the score 9 to 10 category. Similarly, no association was found for ASQ-3 (β = -2.1; 95% CI, -24.6 to 20.4). Congruent results for Apgar scores of 3 or less were obtained for motor function scores for all children (β = -4.0; 95% CI, -20.1 to 12.1) and excluding children with a diagnosis of cerebral palsy (β = 0.8, 95% CI -11.7 to 13.3). This study found that low Apgar scores were not associated with longer-term outcomes in infants born EPT. This finding may be associated with high interobserver variability in Apgar scoring, reduced vitality signs and poorer responses to resuscitation after birth among infants born EPT, and the association of more deleterious exposures in the neonatal intensive care unit or of socioeconomic factors with greater changes in outcomes during the first 5 years of life.

Endobronchial surfactant administration in full-term newborn with respiratory distress syndrome

Neonatal respiratory distress syndrome is the leading cause of neonatal acute respiratory failure. Despite the successes achieved and the existing international recommendations, in some cases there is a severe course of this disease, which requires a personalized approach to the patient and intensive care measures.&#x0D; The article presents a case of successful treatment of acute respiratory distress syndrome in a full-term newborn complicated by pulmonary barotrauma using monobronchial administration of exogenous surfactant under X-ray control. In order to assess the course of the disease and the effectiveness of treatment, a retrospective analysis of medical documentation was carried out. From the first minutes of life, the child had respiratory disorders, which was the basis for non-invasive mechanical lung ventilation nCPAP (nasal continuous positive airway pressure). Progression of hypercapnia and hypoxemia was revealed over time, and therefore tracheal intubation was performed and convective mechanical ventilation was started with FiO2 = 1,0. Monobronchial administration of exogenous surfactant was a key element of the therapy that allowed to achieve stabilization of the condition and regression of gas exchange disorders with complete recovery of the patient.&#x0D; Monobronchial administration of surfactant in acute respiratory distress syndrome with heterogeneous lung involvement is an effective treatment option and can be used in clinical practice for refractory hypoxemia.

CESAREAN SECTION IN CASES OF STRESS-COMPROMISED PREGNANCY IN WOMEN WITH UNDIFFERENTIATED CONNECTIVE TISSUE DYSPLASIA.

The aim: Assessment of abdominal delivery by cesarean section in preterm pregnancies in women with undifferentiated connective tissue dysplasia. Materials and methods: Analyzed were 3,371 cases of cesarean section deliveries in preterm pregnancies complicated by undifferentiated connective tissue dysplasia (UCTD). Based on a scoring assessment of external and visceral UCTD markers, three groups were identified: Group 1 included 466 patients with no signs of UCTD, Group 2 consisted of 798 patients with mild UCTD, and Group 3 comprised 2,107 patients with moderate to severe UCTD. The severity of connective tissue dysplasia manifestations was assessed based on external and internal signs of connective tissue dysplasia, as well as gynecological and obstetric history, indications for abdominal delivery in preterm pregnancies, and maternal and perinatal outcomes of the deliveries. Results: It has been established that in 71.4% of patients with stress-compromised pregnancies resulting in preterm birth and delivered by cesarean section, the most common indications were: inability of the uterine scar in 23.8%, breech presentation of the fetus in 19.1%, and detachment of the normally placed placenta in 4.9%. An unfavorable factor was moderate to severe connective tissue dysplasia, which led to a 5-fold increase in the likelihood of requiring a cesarean section. In addition, severe hypoxia in newborns was significantly more frequently observed in the first minutes of life in cases of moderate and severe UCTD. Conclusions: The conducted studies have shown that cesarean sections in cases of stress-compromised pregnancies resulting in preterm birth are performed significantly more often in cases of moderate to severe undifferentiated connective tissue dysplasia (UCTD). Moderate and severe UCTD have a substantial impact on obstetric and perinatal outcomes of deliveries, both at present and in the future.

Ethology and assessment of the physiological and somatic status of newborn piglets in industrial conditions

Purpose: to study the main physiological indicators of newborn piglets in industrial conditions; adaptation based on the obtained data of the generally accepted Apgar scale for intensive production.Materials and methods. 152 newborn piglets of a Landrace and Duroc mix, obtained from 12 different sows, were studied according to the existing methodology of the adapted Apgar scale in the conditions of an industrial pig farm. The sows from which the piglets were obtained were of different ages, clinically healthy. The sows were fed using the Dry Rapid feed distribution system, the sows had individual feeders, feeding with compound feed. All planned preventive measures (vaccination and deworming) were carried out according to the established schedule. From the first minutes of life, piglets were fed with colostrum and, later, sows' milk by selfsucking of the udder teats, then, for the introduction of complementary foods, on the 10th day, removable group feeders (pre-starter feeding) and nipple drinkers were provided. All piglets selected by us were examined immediately after birth and 5 and 20 minutes after birth. The assessment of their condition was carried out according to the following criteria: assessment of the general physical condition, the presence of visible developmental pathologies, activity, and the intensity of the sucking reflex. Assessment of the general condition, activity and presence of pathologies was carried out by general clinical methods - examination, palpation, auscultation. To assess the sucking reflex of each piglet, a reflexological method was used: a visual assessment of the sucking reflex on the nipples.Results. In the course of the research, not only the main physiological indicators (parameters, standards) of the above criteria applicable to newborn piglets in industrial conditions have been established, but also the generally accepted Apgar scale for intensive production has been adapted, which will allow you to quickly and reliably assess the morphophysiological state of newborn piglets, their physiological maturity, as well as to make a forecast regarding their further general condition and, based on these signs, to cull.

Tactile stimulation in very preterm infants and their needs of non-invasive respiratory support.

Despite the lack of evidence, current resuscitation guidelines recommend tactile stimulation in apneic infants within the first minutes of life. The aim was to investigate whether timing, duration or intensity of tactile stimulation influences the extent of non-invasive respiratory support in extremely preterm infants during neonatal resuscitation. In an observational study, we analyzed 47 video recordings and physiological parameters during postnatal transition in preterm infants below 320/7 weeks of gestational age. Infants were divided into three groups according to the intensity of respiratory support. All infants were stimulated at least once during neonatal resuscitation regardless of their respiratory support. Only 51% got stimulated within the first minute. Rubbing the feet was the preferred stimulation method and was followed by rubbing or touching the chest. Almost all very preterm infants were exposed to stimulation and manipulation most of the time within their first 15 min of life. Tactile stimulation lasted significantly longer but stimulation at multiple body areas started later in infants receiving prolonged non-invasive respiratory support. This observational study demonstrated that stimulation of very preterm infants is a commonly used and easy applicable method to stimulate spontaneous breathing during neonatal resuscitation. The concomitant physical stimulation of different body parts and therefore larger surface areas might be beneficial.

Ten minutes to save a baby: a narrative review of newborn assessment during first minutes of life and relationship to outcomes

Ten minutes to save a baby: a narrative review of newborn assessment during first minutes of life and relationship to outcomes

Resuscitation of very preterm infants with 30% vs. 50% oxygen: a randomized controlled trial

Background Preterm infants are susceptible to the damaging effects of hyperoxia which may lead to bronchopulmonary dysplasia (BPD) and intestinal damage. Hyperoxia also affects intestinal microbiota. The optimal initial FiO2 for the resuscitation of premature infants is unknown.&#x0D; Objective To determine the effect of different initial oxygen concentrations on BPD, oxidative stress markers, damage to the gastrointestinal mucosa, and the intestinal microbiome.&#x0D; Methods We conducted an unblinded, randomized controlled clinical trial in premature infants requiring supplemental oxygen in the first minutes of life. Infants started at an FiO2 of either 30% (low) or 50% (moderate), which was adjusted to achieve target oxygen saturations (SpO2) of 88-92% by 10 minutes of life using pulse oximetry. The primary outcome was incidence of BPD. Secondary outcomes included markers of oxidative stress [oxidized glutathione (GSH)/reduced glutathione (GSSG) ratio and malondialdehyde (MDA)], intestinal integrity indicated by fecal alpha-1 antitrypsin (AAT), and intestinal microbiota on fecal examination.&#x0D; Results Eighty-four infants were recruited. There was no significant difference in rates of BPD between the 30% FiO2 and 50% FiO2 groups (42.8% vs. 40.5%, respectively). Nor were there significant differences in GSH/GSSG ratios, MDA concentrations, fecal AAT levels, or changes in facultative anaerobic and anaerobic microbiota between groups.&#x0D; Conclusion In premature infants resuscitated using low vs. moderate initial FiO2 levels, we find no significant differences in BPD incidence, markers of oxidative stress, intestinal mucosa integrity, or intestinal microbiota.

Effects of Umbilical Cord Management Strategies on Stem Cell Transfusion, Delivery Room Adaptation, and Cerebral Oxygenation in Term and Late Preterm Infants.

Background:The umbilical cord blood contains a high concentration of stem cells. There is not any published study evaluating the amount of stem cells that have the potential to be transferred to the infant through placental transfusion methods as delayed cord clamping (DCC) and umbilical cord milking (UCM). The aim of this study is to measure the concentrations of endothelial progenitor cell (EPC) and CD34+ hematopoietic stem cell (HSC) in the placental residual blood volume (PRBV), and evaluate the delivery room adaptation and cerebral oxygenation of these infants.MethodsInfants with ≥36 gestational weeks were randomized to receive DCC (120 s), UCM, or immediate cord clamping (ICC). EPC and CD34+ HSC were measured by flow cytometry from the cord blood. PRBV was collected in the setup. The cord blood gas analysis and complete blood count were performed. The heart rate (HR), oxygen saturation (SpO2), and cerebral regional oxygen saturation (crSO2) were recorded.ResultsA total of 103 infants were evaluated. The amount of PRBV (in ml and ml/kg) was higher in the ICC group (p < 0.001). The number of EPCs in the PRBV content (both ml and ml/kg) were the highest in the ICC group (p = 0.002 and p = 0.001, respectively). The number of CD34+ HSCs in PRBV content (ml and ml/kg) was similar in all groups, but nonsignificantly higher in the ICC group. The APGAR scores at the first and fifth min were lower in the ICC group (p < 0.05). The mean crSO2 values were higher at the 3rd and 10th min in the DCC group (p = 0.042 and p = 0.045, respectively). cFOE values were higher at the 3rd and 10th min in the ICC group (p = 0.011 and p < 0.001, respectively).ConclusionThis study showed that placental transfusion methods, such as DCC and UCM, provide both higher blood volume, more stem cells transfer to the infant, and better cerebral oxygenation in the first minutes of life, whereas many lineages of stem cells is lost to the placenta by ICC with higher residual blood volume. These cord management methods rather than ICC do not require any cost or technology, and may be a preemptive therapeutic source for diseases of the neonatal period.

ЗАБОЛЕВАЕМОСТЬ И ПРЕДИКТОРЫ ЛЕТАЛЬНОГО ИСХОДА У НЕДОНОШЕННЫХ НОВОРОЖДЕННЫХ С ГЕСТАЦИОННЫМ ВОЗРАСТОМ МЕНЕЕ 32 НЕДЕЛЬ, ПОЛУЧИВШИХ ПОРАКТАНТ АЛЬФА РАЗНЫМИ МЕТОДАМИ

The aim of the study – to analyze the morbidity and search for predictors of death in premature infants with a gestational age (GA) of 32 weeks or less, born in perinatal centers and received Poractant alfa (PA) in the treatment of respiratory distress syndrome (RDS), in order to improve the quality of medical care for premature babies. Materials and methods of research: a multicenter prospective open-label non-randomized continuous comparative study was conducted in five perinatal centers from 2020 to 2021. A total of 264 patients, and inclusion criteria: GA less than 32 weeks, the need for PA replacement therapy in the first minutes of life, the first dose of PA – 200 mg/kg, the second dose of PA – 100 mg/kg, strict adherence to the study protocol. Children who did not require PA therapy in the delivery room, who received other types of surfactants, as well as those with congenital malformations, genetic and/or chromosomal abnormalities, early neonatal sepsis, and deviations from the study protocol were excluded. Children were divided into 3 groups: group 1 (200 children) – invasive PA (ETT), group 2 (19 children) – PA injection by INSURE method, group 3 (45 children) – PA injection by LISA method. Results: the median birth weight of all 264 children was 1090.0 g, GA – 28.0 weeks. The median age of the first PA injection is 10.0 [10.0; 10.0] min of life. PA was reintroduced in 20.1% (53/264) of children, invasive mechanical ventilation (IV) was required in 82.6% (218/264) of cases, high-frequency oscillatory mechanical ventilation (HFOV) – in 24.0% (59/264 ). The incidence of bronchopulmonary dysplasia was 37.5% (99/264) of cases and prevailed in the ETT group in comparison with LISA (43.0% versus 27.0%, respectively, p=0.043) and INSURE (43.0% versus 5.0 %, p=0.001). Predictors of death were low gestational age and birth weight, surgical stage of necrotizing enterocolitis, hemodynamically significant patent ductus arteriosus, grade III intraventricular hemorrhage, and pulmonary hemorrhage. The development of the latter in the first 72 hours of life increases the risk of death by 19.7 times. Conclusions: minimally invasive administration of PA by INSURE and LISA methods associated with reduce of morbidity and improves outcomes in premature infants who less than 32 weeks of GA. Pulmonary hemorrhage was the most dangerous among the predictors of death, increasing the risk of death by almost 20 times.

Early neonatal features of juvenile offenders

Objective: Identification of perinatal risk factors as differential predictors of violent and non-violent crimes among children and adolescents who come under the attention of juvenile departments of the internal affairs bodies of the Russian Federation.Methods: Study of the perinatal history data of 148 juvenile offenders of comparable age (13-16 years old), selected using continuous sampling method in the course of a clinical observational cohort retrospective study.Results: Children from the control group in half of the cases were “late premature” (48%), with protein-energy malnutrition (frequency of occurrence of FGRP 56.8% BMI 56.1 ± 13.65). The beginning of their life was accompanied by a low score according to Apgar scale (6.9 ± 1.81). From the first minutes of life, they required urgent therapy in the delivery room (35.9%) and subsequent treatment at the ICU (25.7%) due to the damage of the respiratory system (asphyxia 11.5%, RDS 19.6%, episodes of apnea 16.2 %) and increasing dysfunction of the central nervous system (IVH II-IV grade 24.3%). Subsequently, they demonstrated a disruption of early neonatal adaptation and a clinical picture of the realization of intrauterine fetal developmental disorders, which arose both as a result of improper metabolism and of a prolonged oxygen starvation (adrenal hypoplasia 27.7%, cardiomyopathy 29.7%, hypoxia 48.6%).Conclusions: The initial protein-energy deficiency revealed in the course of the study if accompanied by the course of both acute and chronic oxygen starvation could influence the formation of destructive behavior in the group of juvenile offenders.

Perinatal Delivery in Women with Retrochorial Hematomas in the First Trimester

The objective: an analysis of the peculiarities of childbirth and the condition of newborns in women with retrochorial hematoma (RCH) in the I trimester of pregnancy. Materials and methods. At the beginning of the study, 100 pregnant women 18–44 years old (mean age 28.08±3.5 years) were examined – 70 women included in the main group and 30 – control one. In 10 cases out of 70, the pregnancy was interrupted in the I trimester on the background of RCH. Sixty patients of the main group, in whom the pregnancy progressed, were divided into two subgroups: subgroup A (n=39) – primigravida pregnant women with the threat of abortion due to RCH; subgroup B (n=21) – multigravida women with complicated obstetrical and gynecological history and RCH. The control group (n=30) included primi- and multigravida women with physiological course of the current and previous pregnancies. All women had a complete clinical and laboratory examination. The patients with a risk of abortion and RCH received pathogenetical therapy for pregnancy preservation (sedative, anti stress therapy, spasmolytics, hormonal support (progestogens), fibrinolysis inhibitors, anticoagulants and antiplatelet agents, tocolytics). The condition of newborns in the first minutes of life was assessed by the Apgar scale, if necessary, rehabilitation measures were applied. Results. The majority of patients in all groups had complicated obstetrical and gynecological history: 22.5% of patients in subgroup A, 30% – subgroup B, 16.6% – control group, and half of them were diagnosed two or more somatic diseases. Every third patient of the main group (7 (17.9%) women in subgroup A and 5 (23.8%) in subgroup B) delivered by cesarean section, in the control group – 5 (16.6%) persons. Spontaneous vaginal childbirth in the main group had 71.7% of the women, in the control group – 80%, premature birth – 2 (5.1%) women in subgroup A, 4 (19%) – subgroup B and 1 (3,3%) case – control group. The average duration of pregnancy in the main group was 37.3±2.4 weeks, in the control group – 39.4±0.3 weeks. In the main group 54 (90%) full-term newborns were born, in the control group – 29 (96.7%); premature infants – 2 (5.1%) in subgroup A, 4 (19%) – subgroup B, 1 (3.3%) – control group. In the main group the frequency of infants birth with hypoxia, who needed resuscitation and intensive care, was more than 2 times higher compared to the control group (5 (8.3%) and 2 (6.7%) infants, respectively). Newborns of subgroups A and B, due to intrauterine hypoxia, had pathological conditions such as morphological and functional immaturity, neurological disorders, signs of intrauterine infection, but not a single child needed to be transferred to a specialized department for the second stage of care. Conclusions. Preservation of pregnancy in the patients with a risk of abortion and RCH in the I trimester is possible in 85.7% of cases. Pregnant women with complicated obstetrical and gynecological history are at risk for preterm birth. The infants born in women with the threat of abortion and the formation of RCH in the I trimester belong to the risk group of intrauterine hypoxia and infectious complications. Comprehensive pathogenetical therapy helps to prolong pregnancy, reduce the incidence of early reproductive losses, improve perinatal outcomes and reduce the incidence of perinatal morbidity.

Changes in lipid-synthesizing function of the liver in congenital cytomegalovirus infection in death newborns

Aim. To assess the change in the lipid-synthesizing function of the liver in congenital cytomegalovirus infection (CMVI) in dead newborns.Materials and methods. The study of the lipid spectrum of umbilical cord blood in the first minutes of life was carried out in 59 full-term newborns with antenatal ontogenesis, unburdened and burdened with congenital CMVI. The first group consisted of 25 newborns of early neonatal age (control group) from mothers without moderate and severe obstetric and somatic pathology, as well as respiratory viral diseases and sexually transmitted infections. The second group included 18 children of the same age (comparison group), whose mothers suffered exacerbation of CMVI in the second trimester of pregnancy, which did not lead to antenatal viral aggression. The third group was represented by 16 newborns with congenital CMVI. The life expectancy of children was 2-5 days. In the first group, the main cause of death of children was prolonged ante- and intranatal hypoxia, atelectasis and hyaline membranes of the lungs, in the second group – prolonged antenatal hypoxia, intranatal hypoxia and atelectatic, hyaline and edematous-hemorrhagic pneumopathies, and in the third group – congenital CMVI, which manifested itself as cerebral ischemia of moderate and severe degree, meningoencephalitis, ventriculomegaly, pseudocysts of the vascular plexus and subarachnoid hemorrhages, monocytosis, vesiculopustulosis, hepatitis and pneumonia. In the blood serum from the umbilical vein during biochemical analysis, the concentration (mmol/L) of total cholesterol, high-density lipoproteins, low-density lipoproteins and triglycerides was estimated.Results. In newborns of the second group in the blood serum from the umbilical cord vein, the concentration of total cholesterol was 1.90±0.04 mmol/L, high-density lipoproteins – 1.49±0.06 mmol/L, low-density lipoproteins - 0.26±0,02 mmol/L and triglycerides – 0.49±0.03 mmol/L (in the first group, respectively, 1.93±0.06 mmol/L, p&gt;0.05; 1.37±0.06 mmol/L, p&gt;0.05; 0.43±0.02 mmol/L, p&lt;0.001; 0.45±0.02 mmol/L, p&gt;0.05). In the third group, compared with the second one, there was a decrease in the level of total cholesterol to 1.79±0.04 mmol/L (p&lt;0.05) and high-density lipoproteins – to 1.28±0.06 (p&gt;&lt;0.05) against the background of an increase in triglyceride concentration up to 0.59±0.03 mmol/L (p&gt;&lt;0.05). Conclusion. The above changes in the lipid-synthesizing function of the liver indicate a direct and indirect effect of congenital CMVI on the morphological structure of hepatocytes and the activity of enzyme systems. Key words: full-term newborns, congenital cytomegalovirus infection, total cholesterol, high-density lipoproteins, lowdensity lipoproteins, triglyceride&gt;˂ 0.05) and high-density lipoproteins – to 1.28±0.06 (p&lt;0.05) against the background of an increase in triglyceride concentration up to 0.59±0.03 mmol/L (p&gt;&lt;0.05). Conclusion. The above changes in the lipid-synthesizing function of the liver indicate a direct and indirect effect of congenital CMVI on the morphological structure of hepatocytes and the activity of enzyme systems. Key words: full-term newborns, congenital cytomegalovirus infection, total cholesterol, high-density lipoproteins, lowdensity lipoproteins, triglycerides&gt;˂ 0.05) against the background of an increase in triglyceride concentration up to 0.59±0.03 mmol/L (p˂ 0.05).Conclusion. The above changes in the lipid-synthesizing function of the liver indicate a direct and indirect effect of congenital CMVI on the morphological structure of hepatocytes and the activity of enzyme systems.

Abdominal Neuroblastoma and Early Onset Acinetobacter Septicemia in a Newborn

Background: Neonatal sepsis is a leading cause of mortality and morbidity in the first month of life. The underlying risk factors for early-onset infection (in the first 3 days of life) are prematurity, low birth weight, maternal history of infection, difficult delivery, male gender, twin pregnancy, and congenital malformations. Acinetobacter is a nosocomial infection and rarely caused the early-onset-sepsis and meningitis. The most common neonatal tumor is neuroblastoma; however, it is not defined as a risk factor for early-onset sepsis. Case report: A 13-day-old newborn female was referred to our hospital due to ventriculitis, persistent meningitis, and an abdominal mass. She was a term neonate delivered by cesarean section from a mother with a nearly normal pregnancy with no complications, such as chorioamnionitis, prolonged rupture of membrane, urinary tract infection, preeclampsia, and diabetes. A fetal abdominal mass was detected on the left kidney in prenatal sonography. The patient was admitted to the Neonatal Intensive Care Unit in the first minutes of life because of respiratory distress and cyanosis. Subsequently, mechanical ventilation, endotracheal surfactant instillation, and antibiotic therapy were prescribed. Due to the deterioration of the general condition, fever, seizure, and hematuria on the third day, sepsis workup and changing the antibiotics were performed. Blood culture and cerebrospinal fluid (CSF) were positive for Acinetobacter baumannii. Persistent positive CSF culture led to the diagnosis of ventriculitis which was confirmed by brain computed tomography scan (CTS) and ventricular tap. The condition of the patient got better after intraventricular amikacin injection in addition to intravenous colistin and piperacillin. Postnatal sonography and CTS confirmed the abdominal neuroblastoma. Chemotherapy was initiated after the complete treatment of sepsis, meningitis, and ventriculitis. This case report presents a term and female neonate with early-onset neonatal sepsis and meningitis, caused by an unusual microorganism, and a prenatal history of abdominal neuroblastoma. Conclusion: By this case report, the clinicians are suggested to consider the Acinetobacter baumannii as the cause of fulminant sepsis and meningitis in a term neonate with no underlying risk factors for infection.  Keywords

Neonatal thermal response to childbirth: Vaginal delivery vs. caesarean section.

Newborns, regardless of the method of termination of pregnancy, are exposed to the first exogenous stress factors during delivery. The purpose of the study was to evaluate the differences in newborns’ thermal response to vaginal (VD) vs caesarean section (CS) delivery. The temperature was measured during the first minutes of life within 122 healthy full-term newborns, on the forehead, chest and upper-back by infrared camera (FLIR T1030sc HD). The lowest temperatures were recorded in the forehead of VD newborns (significantly difference with CS; p < 0.001), the warmest was the chest. A significant correlation was found between the duration of the second stage of natural childbirth and surface temperature and pO2 in the newborn blood. The temperatures of selected body surface areas correlate highly positively, regardless of the mode of delivery. In the case of healthy neonates, with normal birth weight and full-term, VD creates more favourable conditions stimulating the mechanisms of adaptation for a newborn than CS.

Genotype\u2013phenotype correlation in two Polish neonates with alveolar capillary dysplasia

BackgroundAlveolar capillary dysplasia (ACD) is a rare cause of severe pulmonary hypertension and respiratory failure in neonates. The onset of ACD is usually preceded by a short asymptomatic period. The condition is refractory to all available therapies as it irreversibly affects development of the capillary bed in the lungs. The diagnosis of ACD is based on histopathological evaluation of lung biopsy or autopsy tissue or genetic testing of FOXF1 on chromosome 16q24.1. Here, we describe the first two Polish patients with ACD confirmed by histopathological and genetic examination.Case presentationThe patients were term neonates with high Apgar scores in the first minutes of life. They both were diagnosed prenatally with heart defects. Additionally, the first patient presented with omphalocele. The neonate slightly deteriorated around 12th hour of life, but underwent surgical repair of omphalocele followed by mechanical ventilation. Due to further deterioration, therapy included inhaled nitric oxide (iNO), inotropes and surfactant administration. The second patient was treated with prostaglandin E1 since birth due to suspicion of aortic coarctation (CoA). After ruling out CoA in the 3rd day of life, infusion of prostaglandin E1 was discountinued and immediately patient’s condition worsened. Subsequent treatment included re-administration of prostaglandin E1, iNO and mechanical ventilation. Both patients presented with transient improvement after application of iNO, but died despite maximized therapy. They were histopathologically diagnosed post-mortem with ACD. Array comparative genomic hybridization in patient one and patient two revealed copy-number variant (CNV) deletions, respectively, ~ 1.45 Mb in size involving FOXF1 and an ~ 0.7 Mb in size involving FOXF1 enhancer and leaving FOXF1 intact.ConclusionsBoth patients presented with a distinct course of ACD, extra-pulmonary manifestations and response to medications. Surgery and ceasing of prostaglandin E1 infusion should be considered as potential causes of this variability. We further highlight the necessity of thorough genetic testing and histopathological examination and propose immunostaining for CD31 and CD34 to facilitate the diagnostic process for better management of infants with ACD.

Simulation to Support Standardization of Delivery Room Management of the Very Low Birth-Weight Infant.

The birth of a very low birth-weight (VLBW) infant occurs infrequently, especially in the community hospital setting. It is critical that the team managing care of the infant in its first minutes of life follow evidence-based resuscitation guidelines and practices to optimize outcomes for this population. To implement a simulation program in a community hospital setting that supports standardized evidence-based delivery room practices of the premature infant born less than 30 weeks' gestation. Two VLBW emergent delivery scenarios were developed utilizing the neonatal resuscitation program scenario template. Special care nursery interprofessional team members from a community hospital were invited to participate in the simulation program (n = 28). Participants were asked to complete a neonatal version of the Emergency Response Confidence Tool, then view a short presentation related to delivery room management of VLBW infants. Participants attended a simulation program and completed the confidence tool after simulation. The simulation facilitator and unit educator documented team actions during each simulation session. Fifteen opportunities for improvement within 4 simulation sessions were identified and categorized. Fourteen paired pre- and postsurveys were analyzed. Reported confidence increased in 22 of 23 resuscitation-related items. Education and simulation programs providing opportunities to experience high-risk, low-frequency VLBW delivery situations can assist in identifying areas for improvement and may improve team member confidence. Additional research is needed to assess whether results would be similar if this program were provided at all levels of neonatal care throughout the healthcare system.

Incidence of newborn resuscitative interventions at birth and short-term outcomes: a regional population-based study

ObjectivesTo determine the incidence and characteristics of resuscitative interventions at different gestational ages and short-term outcomes after resuscitation.Design, setting and patientsA prospective observational study in an unselected population at Stavanger...