First Week Of Birth Research Articles

Perinatal risk factors for late neonatal severe acute kidney injury in very low birth weight infants: a retrospective study.

This study aimed to identify the perinatal risk factors of severe acute kidney injury (AKI) occurring after the first week of birth in very low birth weight (VLBW) infants who survived up to the first week. We conducted a single-center, retrospective cohort study on VLBW infants (birth weight, <1,500 g) delivered at <32 weeks of gestational age (GA) from January 2012 to December 2022. We classified AKI based on changes in serum creatinine and urine output based on the modified The Kidney Disease: improving Global Outcomes (KDIGO) neonatal AKI criteria. Stage 2-3 AKI were considered as severe AKI (sAKI). We performed logistic regression analysis to evaluate risk factors for late neonatal severe AKI identified in the second week after birth. We included 274 VLBW infants. The prevalence of late neonatal severe AKI (sAKI) was 27.4%, with the diagnosis rate of sAKI being higher early after birth. Logistic regression analysis revealed that the factors associated with late neonatal sAKI were small for gestational age (SGA) (OR, 3.02; P = 0.032), endotracheal intubation in the delivery room (OR, 2.79; P = 0.022), necrotizing enterocolitis (NEC) (OR, 12.41; P = 0.029), and decreased minimum weekly fluid balance <0 (OR, 2.97; P = 0.012). SGA, intubation in the delivery room, and NEC were associated factors for late neonatal sAKI in VLBW infants. The association of no weekly weight gain with increased late neonatal sAKI risk indicates its use in guiding fluid therapy and aids in biomarker research.

Clinical profile and associated comorbidities of cerebral palsy in children visiting Orotta National Referral Hospital, Eritrea: a cross-sectional study

BackgroundCerebral Palsy (CP) is one of the most common physical disabilities in children. This study aimed to explore the clinical spectrum of CP at Orotta National Referral and Teaching Hospital, including CP subtypes, gross motor function, patterns of associated comorbidities, and possible risk factors in children aged 2 to 12 years.MethodsA hospital-based cross-sectional study was conducted from January to April 2022 in 153 children with suspected motor symptoms. The Surveillance of CP in Europe (SCPE) decision tree was used as an inclusion criteria guideline and the evaluation of the participants was done using a standardized questionnaire and clinical examination. Descriptive statistics, chi-square test, and logistic regression were employed to statistically analyze the data.ResultsEighty-four children who fulfilled the clinical criteria were included in the study. The median age was 5-years [IQR: 3.8] with an equal distribution of males and females. Quadriplegic CP was the most common subtype (51.2%) followed by unilateral (hemiplegic) CP (22.6%), and dyskinetic CP (14.3%). Most children had severe gross motor impairment GMFCS level IV-V and females were almost three times more likely to have GMFCS level IV/V than males (AOR: 2.70; CI: 1.08–6.72; p-value = 0.033.) More than half (52.4%) of the neonates either did not cry within five minutes and/or needed breathing resuscitation, 55.3% had to be admitted to the NICU with a median of 5 days’ hospital stay. Between the first week of birth and the first year of life, 28.6% had trouble feeding, 26.2% had an infection, 10.7% had difficulty breathing, 20.2% had seizures and 6% had jaundice. Feeding problems (64.3%), speech problems of some sort (91.7%), and epilepsy (46.4%) were the most commonly associated comorbidities with CP.ConclusionsThe clinical profile of the CP patients was found to be dominated by the spastic subtype and moderate to severe disability. Since perinatal risk factors were found to be dominant, strengthening maternal and child healthcare systems is recommended to minimize incidents of preventable risk factors and the burden of the disability.

Neonatal outcomes of preterm infants with pulmonary hypertension: clustering based on prenatal risk factors.

To investigate association of prenatal risk factors and neonatal outcomes of preterm infants with pulmonary hypertension (PH). A prospective cohort study of very-low-birth-weight infants born at 22-29 weeks' gestation who received PH-specific treatment during hospitalization. Infants were classified using a two-step cluster analysis based on gestational age (GA), small-for-gestational-age (SGA), exposure to antenatal corticosteroids (ACS), histologic chorioamnionitis (HCA), and oligohydramnios. Among 910 infants, six clusters were identified: cluster A (HCA, n = 240), cluster B (oligohydramnios, n = 79), cluster C (SGA, n = 74), cluster D (no-ACS, n = 109), cluster E (no dominant parameter, n = 287), and cluster F (HCA and oligohydroamnios, n = 121). Cluster A was used as a reference group for comparisons among clusters. Compared to cluster A, cluster C (aHR: 1.63 [95% CI: 1.17-2.26]) had higher risk of overall in-hospital mortality. Clusters B (aHR: 1.52 [95% CI: 1.09-2.11]), D (aHR: 1.71 [95% CI: 1.28-2.30]), and F (aHR: 1.51 [95% CI: 1.12-2.03]) had higher risks of receiving PH-specific treatment within the first week of birth compared to cluster A. These findings may provide a better understanding of prenatal risk factors contributing to the development of PH. Pulmonary hypertension (PH), presenting as hypoxic respiratory failure, has complex etiologies in preterm infants. Although multifactorial risks for the development of PH in preterm infants are known, few studies have classified infants with similar etiologies for PH. Each cluster has distinct patterns of prenatal condition and neonatal outcome.

High Detection Frequency of Vaccine-Associated Polioviruses and Non-Polio Enteroviruses in the Stools of Asymptomatic Infants from the Free State Province, South Africa.

Enterovirus (EV) infections are widespread and associated with a range of clinical conditions, from encephalitis to meningitis, gastroenteritis, and acute flaccid paralysis. Knowledge about the circulation of EVs in neonatal age and early infancy is scarce, especially in Africa. This study aimed to unveil the frequency and diversity of EVs circulating in apparently healthy newborns from the Free State Province, South Africa (SA). For this purpose, longitudinally collected faecal specimens (May 2021-February 2022) from a cohort of 17 asymptomatic infants were analysed using metagenomic next-generation sequencing. Overall, seven different non-polio EV (NPEV) subtypes belonging to EV-B and EV-C species were identified, while viruses classified under EV-A and EV-D species could not be characterised at the sub-species level. Additionally, under EV-C species, two vaccine-related poliovirus subtypes (PV1 and PV3) were identified. The most prevalent NPEV species was EV-B (16/17, 94.1%), followed by EV-A (3/17, 17.6%), and EV-D (4/17, 23.5%). Within EV-B, the commonly identified NPEV types included echoviruses 6, 13, 15, and 19 (E6, E13, E15, and E19), and coxsackievirus B2 (CVB2), whereas enterovirus C99 (EV-C99) and coxsackievirus A19 (CVA19) were the only two NPEVs identified under EV-C species. Sabin PV1 and PV3 strains were predominantly detected during the first week of birth and 6-8 week time points, respectively, corresponding with the OPV vaccination schedule in South Africa. A total of 11 complete/near-complete genomes were identified from seven NPEV subtypes, and phylogenetic analysis of the three EV-C99 identified revealed that our strains were closely related to other strains from Cameroon and Brazil, suggesting global distribution of these strains. This study provides an insight into the frequency and diversity of EVs circulating in asymptomatic infants from the Free State Province, with the predominance of subtypes from EV-B and EV-C species. This data will be helpful to researchers looking into strategies for the control and treatment of EV infection.

Anaesthetic Management during Balloon Atrial Septostomy in Transposition of Great Arteries

&lt;strong&gt;Background: &lt;/strong&gt;Transposition of the great arteries (TGA) is a congenital heart defect that can cause death in 30% of the first week of birth, 50% in the first month, 70% in 6 months, and 90% in the first year, thus requiring immediate corrective action in neonates with rapid early detection. The purpose of this case study is to highlight management considerations in TGA cases in the Balloon Atrial septostomy (BAS) procedure.&lt;p&gt;&lt;strong&gt;Discussion:&lt;/strong&gt; A 1-day-old newborn girl was brought to Dr. Moewardi General Hospital in February 2022. The patient had a history of cyanosis when she cried and was born with an APGAR score of 6.7.8. The lips were cyanotic on physical examination, with a SpO2 of 77% with a nasal O2 of 2 lpm. The echocardiography results obtained TGA, ASD II, PFO, and PDA. The patient then underwent a BAS procedure. Anesthesia management was performed using ketamine for induction, air bar, O2, and sevoflurane for maintenance of anesthesia. The operation was successful, and postoperative care was carried out. Anesthesia management aims to keep SVR and PVR to a minimum, with a PVR lower than SVR, to prevent desaturation in the patient. A decrease in PVR also can increase pulmonary blood flow, allowing more blood to be mixed and higher oxygen saturation in the blood for the patient.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion:&lt;/strong&gt; The principle of anesthesia management in TGA cases is to avoid a reduction in cardiac output and SVR and keep the PVR lower than the SVR.&lt;/p&gt;

A Rare Cause of Paroxysmal Movement Disorder Associated with TBC1D24 Gene Mutation in Two Siblings.

A Rare Cause of Paroxysmal Movement Disorder Associated with TBC1D24 Gene Mutation in Two Siblings.

Relationship between risk factors of hearing loss and the results of otoacoustic emission in newborns

Objective Congenital hearing loss is a disabling and multi-factorial disease that affects on newborn and children. This study aims to demonstrate the relationship between risk factors for hearing loss and the results of Otoacoustic emission in Iranian newborns. Methods We have retrospectively considered 536 newborns admitted to the Audiology Department of a Children’s Hospital in the north of Iran. Transient Evoked Otoacoustic Emissions (TEOAEs) was recorded during the first week of birth, and the risk factors of hearing loss were collected. Results We found that parent relatives and family history were significantly correlated with OAEs refer results. Moreover, hyper-bilirubinemia indicated a significant correlation only with first right OAEs. There was a significant correlation between gender and first left and right OAEs. Other risk factors such as seizure, transient tachypnoea of the newborn (TTN) and respiratory distress syndrome (RDS), and lip cleft had a significant correlation with first left and right OAEs results; however, these correlations were not relatively highlighted. Conclusions Generally, our data confirm that hearing screening is an absolute necessity in the greater number of newborns. People who got consanguineous marriages should be aware of high incidence of the congenital hearing loss due to parent relatives and family history.

Antenatal Anemia: Predictor of Poor Maternal and Perinatal Outcome

Objective: To assess the impact of antenatal anemia on maternal and perinatal outcome. Design of the study: Prospective Cohort study Place of Study: was conducted at antenatal clinic of Creek General Hospital, United Medical and Dental College, Karachi, Pakistan. Methodology: One hundred and thirty-five singleton anemic pregnant women who satisfied the inclusion criteria were included in the study. Enrolled patients were analyzed in detail, sociodemographic and obstetric characteristics recorded and followed till delivery after their informed consent. Haemoglobin estimation was done at first visit &amp; anaemia was graded according to WHO criteria and statistical analysis were done. Results: The study population included 135 antenatal anemic women. Mean ± SD of maternal age was 25.8±5.12 years. Mild anemia was found in 31.1%, moderate in 59.2% and 9.6% women were diagnosed with severe anemia. Anemia was diagnosed in 1.5% of antenatal women in 1st trimester, 54.8% in 2nd trimester and 43.7% in 3rd trimester. Majority of patients were booked (87.4%), out of them 25.9% were diagnosed with mild anemia, 55.6% with moderate and 5.9% were severely anemic, while 12.59% were non-booked of those 5.2% were diagnosed with mild, 3.7 % with moderate and severe anemia each (p-value=0.003%). Maternal complications in antenatal and postnatal period included Preterm labour (13.33%), Pregnancy induced hypertension/ Pre-eclampsia (8.88%), Gestational diabetes mellitus (7.40%), oligohydramnios (11.85%) , antepartum hemorrhage (5.92%) and Postpartum hemorrhage (5.18%). 50.37% of pregnant women delivered vaginally while in 49.62 % abdominal delivery was conducted (Emergency-37 %, Elective -12.6%). Regarding Neonatal outcomes, Low Birth weight was found in 80% of cases which was highly significant, 20.7% were delivered by mildly anemic, 52.6% by moderately and 6.7% by severely anemic mothers (p value- 0.009). NICU admission within the first week of birth was needed in 47.40%, Still Birth (0.74%), Low APGAR scores (20.74%) and unfortunately two Neonatal Deaths occurred as well (1.48%). Conclusion: Antenatal anemia is still a prevalent public health issue in developing countries. Provided that anemia is a straightforward predictor of poor maternal and fetal outcome, intensive prophylactic strategies to be implemented for timely diagnosis and management. The authorities should play their active role in refining policies to remediate the principal risk factors, provision of basic health care, reinforce proper antenatal care, maintain regular availability of iron and supplements for correction of anemia and other nutritional deficiencies. Keywords: Anemia, Maternal and fetal outcome, Obstetric

A novel GCM2 mutation identified in an infant with familial isolated hypoparathyroidism

Background: Isolated hypoparathyroidism comprises a set of heterogeneous inherited diseases associated with abnormal calcium metabolism exclusively due to parathyroid hormone (PTH) deficiency. Isolated hypoparathyroidism can be either sporadic or inherited. Genetic causes that impair the synthesis or secretion of PTH, such as calcium-sensing receptor and PTH defects, or defects in the development of the parathyroid gland [glial cell missing 2, (GCM2)], have been established as causes of familial isolated hypoparathyroidism. Transcription factor GCM2 is a crucial regulator of parathyroid gland homeostasis. Transmission of pathogenic variants encoding GCM2 occurs in an autosomal recessive or dominant manner. Case Presentation: Herein, we describe the case of a 12-year-old boy, born to consanguineous parents, who presented with abnormal movement during the first week of birth. Laboratory results revealed hypocalcemia, hyperphosphatemia, and low PTH levels. Genetic testing detected a novel homozygous variant in the GCM2 gene, c.391C&amp;gt;T (p.Arg131*). Although this variant has not been previously described, it is likely the pathogenic cause of this condition. Conclusion: To the best of authors&amp;apos; knowledge, this variant has not been listed in any database. Proper replacement therapy is likely to have good long-term outcomes for our patient.

Effect of Community-Initiated Kangaroo Mother Care on Fecal Biomarkers of Gut Function in Low Birth Weight Infants in North India: A Randomized Clinical Trial.

This individually randomized trial was conducted to estimate the effect of promoting community-initiated Kangaroo Mother Care (ciKMC) in low birth weight (LBW) infants on gut inflammation and permeability. Participants included 200 stable LBW infants (weighing 1,500-2,250 g) in North India enrolled between May and October 2017. The ciKMC intervention included promotion and support of continuous skin-to-skin contact and exclusive breastfeeding through home visits. The mothers in the intervention arm were supported to practice ciKMC until 28 days after birth, i.e., the neonatal period, or till the baby wriggled out of KMC position, if earlier. Infant stool specimens were collected during the first week of birth, and within 1 week after end of the neonatal period. Concentrations of fecal neopterin (nmol/L), myeloperoxidase (ng/mL), and alpha-1-antitrypsin (μg/mL) were determined using ELISA, and composite enteric enteropathy (EE) score at the end of the neonatal period was calculated by principal component analysis. We did not find any substantial difference in means between the ciKMC and control arm infants in the log-transformed values of neopterin (0.03; 95% CI -0.15 to 0.21), myeloperoxidase (0.28; 95% CI -0.05 to 0.61) and alpha-1-antitrypsin (0.02; 95% CI -0.30 to 0.34). The mean (SD) composite EE score was 13.6 (7.5) in the ciKMC and 12.4 (8.3) in the control arm infants, and the adjusted difference in means was, 0.4 (95% CI -1.8 to 2.7). Our findings suggest that the promotion of ciKMC did not affect gut inflammation and permeability in our target population of LBW infants in North India.

Efek Kefir Terhadap Kadar Superokdidase Dismutase, Malondialdehyde Pada Mencit Balb/C Diinduksi Streptococcus Agalactiae

Streptococcus agalactiae are pathogenic bacteria which cause vaginal infection. Vaginal and cervical infections in pregnant women can reduce elasticity of the membranes that cause premature rupture of membranes. This can also impact to neonatal morbidity and mortality in first week of birth. Kefir is known as a probiotic that can act as an immunomodulator. The role of kefir is believed to improve the immune system. The role of kefir in preventing infection is still rarely studied, especially as an immunomodulator and in reducing the number of pathogenic bacteria.This study aimed to evaluate superoxide dismutase (SOD) level, Malondialdehyde (MDA) level, and the population of the colonization Streptococcus agalactiae in BALB-C mice fed kefir. This study was true experimental with post test only control group design. Sample was BALB-C mice induced by Streptococcus agalactiae. SOD and MDA level was examined by enzyme-linked immunosorbent assay (ELISA) and Streptococcus agalactiae identification by colony count. The results of the one-way ANOVA analysis showed there was no significant differences between all groups for SOD levels (P 0.393). In the level of MDA there was also no difference between all groups (P 0.204). Whereas in the number of Streptococcus agalactiae colonies there was a significant difference (P 0.000) with the smallest number of colonies found at dose of 0.5 ml / day. Conclusion: kefir as a probiotic drink did not affect to the SOD and MDA level of BALB/ C mice induced by Streptococcus agalactiae, but kefir affected to number of Streptococcus agalactiae colonies. Further research needs to show the relation of kefir as probiotics with proinflammatory and other anti-inflammatory parameters such as interleukin and immunological vaginal mucosa.

Prelacteal feeding among infants within the first week of birth in eastern Uganda: evidence from a health facility-based cross-sectional study

BackgroundPrelacteal feeding hinders early initiation of breastfeeding and exclusive breastfeeding but is understudied in Uganda. We examined the prevalence and factors associated with prelacteal feeding among postpartum mothers in Kamuli district in rural eastern Uganda.MethodsWe conducted a cross-sectional study between December 2020 and January 2021 at four large healthcare facilities and randomly sampled mother-baby pairs attending postnatal care and immunization clinics. Prelacteal feeding was defined as giving anything to eat or drink to a newborn other than breast milk within the first 0–3 days of life. Data were collected using a researcher-administered questionnaire and summarized using frequencies and percentages. The Chi-squared, Fisher’s exact, and Student’s t-tests were used for comparison while the factors independently associated with prelacteal feeding were determined using modified Poisson regression analysis, reported as an adjusted prevalence risk ratio (aPRR) with corresponding 95% confidence intervals (CI).ResultsOf 875 participants enrolled, 319 (36.5%) practiced prelacteal feeding. The likelihood of prelacteal feeding was lower among participants who were unemployed (aPRR 0.70; 95% CI 0.5, 0.91), married (aPRR 0.71; 95% CI 0.58, 0.87), had received health education on infant feeding practices (aPRR 0.72; 95% CI 0.60, 0.86), had a spontaneous vaginal delivery (aPRR 0.76; 95% CI 0.61, 0.95), had delivered in a health facility (aPRR 0.73; 95% CI 0.60, 0.89), and who knew that prelacteal feeding could lead to difficulties in breathing (aPRR 0.70; 95% CI 0.57, 0.86). Conversely, prelacteal feeding was more likely among participants who had attended antenatal care at a public health facility during the most recent pregnancy (aPRR 2.41; 95% CI 1.71, 3.39) and those who had travelled more than 5 km to a health facility for postnatal care services (aPRR 1.46; 95% CI 1.23, 1.72).ConclusionsThe prevalence of prelacteal feeding among postpartum mothers in rural eastern Uganda is slightly higher than the national average. Accordingly, there is a need to continuously educate mothers and staff on infant feeding practices to tackle the factors influencing prelacteal feeding and promote appropriate infant and young child feeding practices as emphasized in the baby-friendly health facility initiative policy.

The Implications of Breastfeeding Self-Efficacy on Prelacteal Feeding in First Week of Birth

Breastfeeding is a special and joyful event that most mothers and their babies experience. Exclusive breastfeeding (breastfeeding only for babies until they are six months old) is an activity that is very beneficial for both mother and baby. The low achievement of exclusive breastfeeding often begins with giving prelacteal intake in the first days of the baby's life because of the low understanding of the baby's mother about the importance of breastfeeding. This study links the relationship between breastfeeding self-efficacy and prelacteal feeding in the first week of birth. This type of research is correlational with a cross-sectional approach. The population in this study were breastfeeding mothers in the first week of the baby's birth; the number of samples was 50 people with purposive sampling technique. The data was collected using the BSE-SF questionnaire and observation—data analysis with univariate and bivariate chi-square tests to determine the relationship between the two variables. The study results with a p-value of 0.000 0.05, so it was concluded that there was a relationship between breastfeeding self-efficacy and the provision of prelacteal nutrition in the first week of birth. This research can then be used to reference further breastfeeding guidance strategies.

AWARENESS OF MOTHER WITH BABY PACIFIER

Introduction: Pacifiers consist of a latex or silicone nipple with a firm plastic shield and handle and are available in different forms and sizes. This is used in infant for colling and calming effect on infant however, it is related to many disadvantage and side effect on teeth of the infants. In this study we aimed to a Assess the interrelation between different on-nutritive sucking habits, pacifier use and thumb/digit sucking. Besides, Investigate the relationships between various non-nutritive sucking habits and occlusion in the primary dentition. Methodology: Following a comprehensive literature review, the questionnaire was designed and used for data collection. Then, a cross‐sectional survey was distributed throughout the internet for two months (October - November 2019) to 200 mothers in Riyadh, Saudi Arabia. The mothers answered 16 questions, where 5 of them were self-administered, while the others followed the pacifier and their effect on Breastfeeding and teeth. Initially, the participants have answered inquiries about the demographic information. Results: The results of our study include 202 mothers in which 55.9 % were between 18 -30 years old while 88.6 % of married while 6.4 % were widowed and the rest were divorced. Moreover, 67.3 % of mothers in this study started breast feeding but stopped it, while 15.3 % still breast feeding partially, 12.9 % still breasting feeding exclusively and 4.5 % never breast fed during the process of the survey. 58.9 % of mothers agree about the use of pacifier with their infants where younger mothers were more intended to agree about using of pacifier. Considering the reason behind using of pacifier, mothers reported that 74.3 % of mothers using pacifier because of its comfort or soothing effect. Moreover, 47.1 % of the sample thought that best time to start using pacifiers is from first week of birth and 49 % of mothers in this study thought that pacifier should be used for 4 hours per day. Finally, most of mother thought that the ideal time of pacifier cessation before the first year (45%). Conclusion: As with all infant care practices, there may be multiple factors influencing the parental decision to use or not use a pacifier for the infant. Some of these factors (e.g., concerns about nipple confusion, dental concerns) may be the result of misinformation. As pacifier use has been associated with a reduced risk for SIDS, it is important for health care providers to understand and be able to address the concerns that parents may have about pacifier use. In the hospital setting, providers should be aware that parents may have strong preferences about getting educated regarding pacifier use and its consequences.

Comparison of hyperbilirubinemia incidence between the newborns of zinc-taking and non-zinc-taking mothers during the third trimester of pregnancy.

Background: Identification and control of the risk factors for hyperbilirubinemia can reduce the incidence and complications of this condition. Serum zinc level in newborns is reported to be one of the factors affecting the severity and incidence of neonatal hyperbilirubinemia. Therefore, the present study was conducted to compare hyperbilirubinemia incidence in neonates of zinc-taking and non-zinc-taking mothers.Methods:In this observational study, we compared the incidence of hyperbilirubinemia during the first week of birth between newborns whose mothers had received zinc supplement during the third trimester of pregnancy (case group) with those whose mothers had not taken zinc supplement (control group). The checklist of newborns’ conditions in both case and control groups was completed based on the obtained data regarding the infants, mothers, and laboratory findings. Data was analyzed using chi-squared test and t-test.Results:The mean serum levels of zinc were 79.76±15 mg/dl and 70.93±15.67mg/dl in mothers who had received zinc during the third trimester and those who had not taken zinc supplement, respectively. The mean serum level of zinc in newborns who underwent phototherapy was 41.68±9.21 mg/dl, while it was 68.53±20.85 mg/dl in neonates who did not receive phototherapy. In addition, 36% of the neonates whose mothers had not received zinc required phototherapy, while only 11% of newborns whose mothers had taken zinc supplement received phototherapy.Conclusion:Zinc consumption during the third trimester of pregnancy increased the serum zinc level in both newborns and mothers and reduced the incidence and severity of idiopathic hyperbilirubinemia requiring treatment.

The Comparison of Serum Vitamin D Level in the Term Neonates With and Without Sepsis in Children Hospital of Bandar Abbas City, Iran From 2016 to 2017

Background: Neonatal sepsis is one of the most important causes of infant’s death, and the identification of its factors has been the subject of many studies. Some new evidence suggested the role of vitamin D in the occurrence of sepsis in infants. Objectives: The aim of this study was to compare serum levels of vitamin D in neonates with sepsis in the first week of birth and healthy neonates. Methods: This case-control study was performed on 72 term neonates (36 neonates with sepsis as case and 36 healthy neonates as control group) who refereed to Bandar Abbas children’s hospitals, Bandar Abbas, Iran, during 2016-2017. Results: Serum vitamin D levels were measured in all infants and their mothers in both sepsis and control groups. In addition, data collected, including sex, birth weight, C-reactive protein (CRP), and duration of hospitalization in neonates with sepsis. Mean serum level of vitamin D was 18.52 ±11.49 ng/mL in sepsis and 20.52 ±13.75 ng/mL in control group neonates (P≥0.05). The mean maternal serum level of vitamin D in sepsis group was 22.44 ±11.26 ng/mL and in control group was 24.36 ±12.82 ng/mL (P≥0.05). There was a positive correlation between maternal and neonatal vitamin D levels in the sepsis group (r=0.803) and the control group (r=0.756). However, there was no significant difference between vitamin D level and CRP (P=0.148) and length of stay (P=0.396) in the sepsis group. Conclusion: Although the results of the present study showed a correlation between serums vitamin D levels in mothers and neonates with neonatal sepsis, there was no significant vitamin D level between neonates with and without sepsis.

MHealth intervention "ImTeCHO" to improve delivery of maternal, neonatal, and child care services-A cluster-randomized trial in tribal areas of Gujarat, India.

BackgroundThe coverage of community-based maternal, neonatal, and child health (MNCH) services remains low, especially in hard-to-reach areas. We evaluated the effectiveness of a mobile-phone–and web-based application, Innovative Mobile-phone Technology for Community Health Operations (ImTeCHO), as a job aid to the government’s Accredited Social Health Activists (ASHAs) and Primary Health Center (PHC) staff to improve coverage of MNCH services in rural tribal communities of Gujarat, India.Methods and findingsThis open cluster-randomized trial was conducted in 22 PHCs in six tribal blocks of Bharuch and Narmada districts in India. The ImTeCHO mobile-phone–and web-based application included various technology-based job aids to facilitate scheduling of home visits, screening for complications, counseling during home visits, and supportive supervision by PHC staff. Primary outcome indicators were a composite index calculated based on coverage of important MNCH services and coverage of at least two home visitations by ASHA within the first week of birth. Primary analysis was intention to treat (ITT). Generalized Estimating Equation (GEE) was used to account for clustering. Eleven PHCs each were randomly allocated to the intervention (280 ASHAs, population: 234,134) and control (281 ASHAs, population: 242,809) arms. The intervention was implemented from February, 2016 to January, 2017. At the end of the implementation, 6,493 mothers were surveyed. Most of the surveyed women were tribal (5,571, 85.8%), and reported having a government-issued certificate for living below poverty line (4,916, 75.7%). The coverage of at least two home visits within first week of birth was 32.4% in the intervention clusters compared to 22.9% in the control clusters (adjusted effect size 10.2 [95% CI: 6.4, 14.0], p < 0.001). Mean number of home visits within first week of birth was 1.11 and 0.80 for intervention and control clusters, respectively (adjusted effect size 0.34 [95% CI: 0.23, 0.45], p < 0.001). The composite coverage index was 43.0% in the intervention clusters compared to 38.5% (adjusted effect size 4.9 [95% CI: 0.2, 9.5], p = 0.03) in the control clusters. There were substantial improvements in coverage home visits by ASHAs during antenatal period (adjusted effect size 15.7 [95% CI: 11.0, 20.4], p < 0.001), postnatal period (adjusted effect size 6.4, [95% CI: 3.2, 9.6], p <0.001), early initiation of breastfeeding (adjusted effect size 7.8 [95% CI: 4.2, 11.4], p < 0.001), and exclusive breastfeeding (adjusted effect size 13.4 [95% CI: 8.9, 17.9], p < 0.001). Number of infant and neonatal deaths was similar in the two arms in the ITT analysis. The limitations of the study include potential risk of inaccuracies in reporting events that occurred during pregnancy by the mothers and the duration of intervention being 12 months, which might be considered short.ConclusionsIn this study, we found that use of ImTeCHO mobile- and web-based application as a job aid by government ASHAs and PHC staff improved coverage and quality of MNCH services in hard-to-reach areas. Supportive supervision, change management, and timely resolution of technology-related issues were critical implementation considerations to ensure adherence to the intervention.Trial registrationStudy was registered at the Clinical Trial Registry of India (www.ctri.nic.in). Trial number: CTRI/2015/06/005847. The trial was registered (prospective) on 3 June, 2015. First enrollment was done on 26 August, 2015.

Incidence of thrombocytopenia following phototherapy in hyperbilirubinemic neonates in Ardabil City

Background: Jaundice is one of the most common problems in neonatal period. In 60% of term and 80% of preterm neonates are seen during the first week of birth and most cases are physiologic. Hyperbilirubinemia is the most common cause of jaundice in newborns. Phototherapy is used to treat it, which seems to be safe. Some studies showed that thrombocytopenia is one of the side effects of phototherapy. The aim of this study was to investigate the relationship between thrombocytopenia and phototherapy in newborns.Methods: This is a descriptive study that has been done on 100 neonates with jaundice which requiring phototherapy. A blood sample was taken at the admission time, 24 hours late, end of the phototherapy and 48 hours after the end of phototherapy to measure the bilirubin and the number of platelets along with other necessary tests for the study of hyperbilirubinemia. Data collected by a checklist and analyzed by statistical methods in SPSS version 19.Results: Of all neonates, 55% were boy and 45% were girl with mean age of 8.86 days. The mean platelet count before phototherapy, 24 hours late, at the end of phototherapy, and 48 hours after phototherapy were 298170, 288540, 282620 and 266310, respectively which was statistically significant during time.Conclusions: The results of this study showed that phototherapy can lead to a significant reduction in platelet count in newborns. Also, there wasn’t seen any case of thrombocytopenia following phototherapy in the present study.

MICRORNAS REGULATE CARDIOMYOCYTE PROLIFERATION IN THE EARLY POSTNATAL PERIOD

The regenerative capacity of the mammalian heart is lost in the first week after birth when cardiomyocytes (CM) stop proliferating, become binucleated, and permanently exit the cell cycle. However, the molecular signals that drive CM from a proliferative to quiescent state remain poorly defined. We have previously shown that CM only proliferate in the first 12 hours after birth. Our transcriptomic analyses revealed that a differential expression of cell cycle factors exists during the cessation of cell division, binucleation and cell cycle exit in the first week of birth. Cell cycle factors have been shown to be regulated by microRNAs (miRNAs) which act as post-transcriptional gene silencers. Therefore, we hypothesized that specific miRNAs regulate cell cycle progression and that manipulation of these miRNAs promotes proliferation of CM in the neonate murine heart. Profiling of miRNAs from wild type murine hearts at 12h after birth (n=4/group) was performed using nCounter® miRNA mouse assays (Nanostring) and screened for cell cycle targets by miRSystem software. Preliminary analysis has shown that 14 miRNAs are differentially expressed during the proliferative burst that occurs at 12 hours after birth (p≤0.01) (Figure 1). These results have been confirmed in murine hearts by RT-qPCR. We have identified a unique subset of miRNAs that are significantly differentially expressed when CM transition from a proliferative to non-proliferative state 12h post-birth. These findings are promising and will guide our future work that will assess their role in the re-initiation of proliferation in the mammalian heart.

Multiple subependymal pseudocysts in neonates play a role in later attention deficit hyperactivity and autistic spectrum disorder

To assess the long-term neurodevelopmental outcome of normal-term neonates who were accidentally found to exhibit subependymal pseudocysts (SEPCs), frontal horn cysts, or choroid plexus cysts through cranial ultrasound (CUS) examination in a neonatal health examination. In total, 5569 neonates received CUS examination as an item in a health examination during the first week of birth between 2002 and 2012. Among them, 5147 infants fulfilled the inclusion criteria. The participants were aged between 5 and 15yearsat the time when the data were collected. We retrospectively collected these data and interpreted their statistical significance by using one-way analysis of variance, Chi-square test with Yate's correction and odds ratios. The presence of SEPCs was significantly correlated with developmental delay and developmental disability, particularly with attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD). The risk of ADHD or ASD was significantly higher in participants with multiple SEPCs, among whom the odds ratios for ADHD and ASD were 6.50 (95% confidence interval [CI]=2.27-18.64) and 28.54 (95% CI=5.98-136.36), respectively, higher than those for the total study population. Our data revealed multiple SEPCs in normal-term neonates as a risk factor for neurobehavioral outcome, particularly in ADHD and ASD. Simultaneously, the utility of CUS examination as a health examination item for neonates was confirmed.