First Week Of Life Research Articles

Perinatal death in the Nordic countries in relation to gestational age: The impact of registration practice.

Although perinatal death rates in the Nordic countries are among the lowest in the world, the risk of perinatal death is unevenly distributed across the Nordic countries, despite similarity in health care systems and pregnancy care. Birth registration practices across countries may explain some of the differences. We investigated differences in national registration of perinatal mortality within the Nordic countries and its impact on perinatal mortality according to gestational age. Each country provided information by answering a questionnaire about registration of perinatal deaths. Furthermore, we collected aggregated count data based on Medical Birth Registries (MBR) from all Nordic countries in 2000 to 2021. Perinatal mortality was defined as stillbirth or neonatal death occurring within first 7 days of life. Data were grouped into six groups by gestational age (GA): extremely preterm (>28 + 0 weeks, subdivided into 22 + 0-23 + 6 and 24 + 0-27 + 6), very preterm (GA 28 + 0-31 + 6), moderate preterm (GA 32 + 0-33 + 6), late preterm (GA 34 + 0-36 + 6), term (GA 37 + 0-40 + 6) and late term or post-term birth (GA ≥ 41 + 0). Perinatal mortality rate and risk ratio with 95% confidence intervals were calculated per country for each gestational age group. For Denmark, separate analyses included and excluded induced abortions. The study included 6 343 805 live births, 22 727 stillbirths and 8932 liveborn infants who died within the first week of life after GA 22 + 0. Further 25 057 births were included with GA < 22 + 0, unknown GA and as a result of induced abortion. Overall, perinatal mortality rates decreased during year 2000-2021 in all Nordic countries. After exclusion of induced abortions, the perinatal mortality rate was similar in the five Nordic countries. The perinatal mortality rate for extremely preterm born infants was highest in Denmark, whereas the highest rate among infants born late term/post-term was in Sweden. The perinatal mortality rate in the Nordic countries is still decreasing, especially in the group of extremely preterm born infants. This study supports the need for further standardization of birth registration practices to ensure the validity of international comparisons.

Early Conservative Physical Therapy Management of Babies With Obstetric Brachial Plexus Injury to Facilitate Spontaneous Recovery.

To evaluate the effect of early immobilization and proper handling techniques in infants with Obstetric Brachial Plexus Injury (OBPI) in the first 2weeks of life. Six 1-day-old infants (2 males and 4 females) with OBPI were included. The assessments were done at baseline, post-intervention, and 3-month follow-up, which involved a physical exam, Narakas classification, Active Movement Scale, and gross and fine motor skills evaluation. All infants had upper Erb's palsy. They had statistically significant improvement in the Active Movement Scale scores post-intervention with a large effect size. These improvements were maintained at follow-up. All infants achieved age-appropriate gross and fine motor skills with the affected upper limb at 3months of age. Early conservative physical therapy management had a statistically significant effect on enhancing spontaneous recovery and preventing further nerve injury in OBPI infants.

Effect of aluminum foil reflector on serum bilirubin and duration of phototherapy among term neonates undergoing phototherapy for hyperbilirubinemia: A randomized controlled trial

Background: Jaundice is a common clinical issue especially in the first week of life and one of the leading causes for readmission to the hospital. This study aimed to assess the effect of aluminium foil reflector on serum bilirubin level ,duration of phototherapy and duration of hospital stay. Methods: A randomized controlled trial was carried among 50 term neonatesin neonatal intensive care unit(NICU) .Term neonates were randomly assigned in to experimental and control group by block randomization. Consecutive sampling technique was used to enroll the neonates who met the inclusion criteria. During photo therapy neonates in the control group received standard careand the neonatesin the experimental group received standard care along with aluminium foil reflector around all the four sides of neonatal cot. Data were analysed using chi square test, fisher exact test and independentt-test. Results: After the intervention the serum bilirubin levels in the experimental and control groupswere13.20±3.35 and 14.07±3.12 respectively (P = 0.348),total duration of phototherapy in hours in experimental group and control groupswere 35.76±17.20 and 38.08±16.36 respectively(P = 0.627) and duration of hospital stay in days in experimental group and control group were 2.6±0.91 and 2.92±1.22 respectively (P = 0.299). Conclusion: Aluminium foil reflector aids in decreasing bilirubin level, reduced the duration of phototherapy and duration of hospital stay among term neonates.

A Moving Target: Studying the Effect of Continuous Transcutaneous CO2 Monitoring in ELBW Infants During an Equipoise Shift

Objectives: To assess whether continuous non-invasive pCO2 monitoring by transcutaneous pCO2 monitor (TCpCO2) among extremely low birth weight (ELBW) premature infants, during the first week of life, will decrease the rate of high-grade intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) or the combined outcome of IVH/PVL and death. Methods: This was a prospective, observational, multicenter study. Due to ethical constraints, allocation was based on TCpCO2 monitor availability. ELBW infants were either monitored by TCpCO2 monitor (Sentec, Therwil, Switzerland) (study group), or recruited to the control group if a TCpCO2 monitor was not available. Results: A total of 32 ELBW infants participated in the study. The size of the study group (106 infants) and the control group (26 infants) differed because monitor availability increased during the study period reflecting change in standard of care. The groups had comparable gestational age and baseline characteristics. No difference was found in the rate of IVH/PVL in the study vs. control groups (10% vs. 4%; p = 0.7, respectively), or in the combined outcome of PVL/IVH and death (16% vs. 15%; p = 1.0, respectively). Conclusions: This study demonstrates the challenges in conducting a prospective controlled trial in a rapidly evolving medical field. While the study began with a clear equipoise, this balance shifted as the care team gained more experience with TCpCO2 monitoring among the study population, despite the absence of new clinical evidence to justify such a shift. Consequently, the small control group limited our ability to draw definitive conclusions regarding the study’s objective. However, our findings may increase awareness of continuous non-invasive pCO2 monitoring in extremely premature infants.

Neonatal Brain MRI: Periventricular Germinal Matrix Mimicking Hypoxic-ischemic White Matter Injuries.

As pregnancy progresses, the germinal matrix volume decreases. Residual periventricular germinal matrix may be mistaken for hypoxic-ischemic white matter injury. This study aims to determine the prevalence and imaging characteristics of these findings. This retrospective study analyzed brain MRIs of newborns from 2012-2023, performed within the first week of life. MRIs were done for suspected hypoxic-ischemic injuries, post-natal neurological symptoms, and evaluation of prenatally diagnosed structural anomalies. Image analysis targeted the remnants of the frontal periventricular germinal matrix, assessing its imaging characteristics, including diffusion, T1, and T2 signal characteristics, and laterality. Frontal migrating cell bands were also assessed. Seventy newborns were included (mean gestational age at delivery was 38.3 ± 2.1 weeks, mean scan age 5.1 ± 1.9 days). Frontal periventricular gray matter was detected in 39 newborns (90% bilateral) on T2-weighted images, negatively correlated with gestational age (r = -0.31, p = 0.013); none showed decreased ADC or shortened T1 signal compared with the basal ganglia. Frontal periventricular bands were found in 37 newborns (97.3% bilateral), strongly correlating with periventricular gray matter (r = 0.71, p < 0.001). No correlation was found between clinical hypoxic-ischemic injuries and these features. The presence of frontal periventricular gray matter observed in early neonatal MRIs, without decreased ADC values or shortened T1 signal, is developmental, reflecting a late maturation phase. Careful interpretation of MRI characteristics, including diffusion, T1, and T2 signal intensities, is necessary before attributing these findings to hypoxic-ischemic white matter injury.

Machine learning models of cerebral oxygenation (rcSO2) for brain injury detection in neonates with hypoxic-ischaemic encephalopathy.

The present study was designed to test the potential utility of regional cerebral oxygen saturation (rcSO2) in detecting term infants with brain injury. The study also examined whether quantitative rcSO2 features are associated with grade of hypoxic ischaemic encephalopathy (HIE). We analysed 58 term infants with HIE (>36weeks of gestational age) enrolled in a prospective observational study. All newborn infants had a period of continuous rcSO2monitoring and magnetic resonance imaging (MRI) assessment during the first week of life. rcSO2Signals were pre-processed and quantitative features were extracted. Machine-learning and deep-learning models were developed to detect adverse outcome (brain injury on MRI or death in the first week) using the leave-one-out cross-validation approach and to assess the association between rcSO2 and HIE grade (modified Sarnat-at 1h). The machine-learning model (rcSO2 excluding prolonged relative desaturations) significantly detected infant MRI outcome or death in the first week of life [area under the curve (AUC)=0.73, confidence interval (CI)=0.59-0.86, Matthew's correlation coefficient=0.35]. In agreement, deep learning models detected adverse outcome with an AUC=0.64, CI=0.50-0.79. We also report a significant association between rcSO2 features and HIE grade using a machine learning approach (AUC=0.81, CI=0.73-0.90). We conclude that automated analysis of rcSO2 using machine learning methods in term infants with HIE was able to determine, with modest accuracy, infants with adverse outcome. De novo approaches to signal analysis of NIRS holds promise to aid clinical decision making in the future. KEY POINTS: Hypoxic-induced neonatal brain injury contributes to both short- and long-term functional deficits. Non-invasive continuous monitoring of brain oxygenation using near-infrared- spectroscopy offers a potential new insight to the development of serious injury. In this study, characteristics of the NIRS signal were summarised using either predefined features or data-driven feature extraction, both were combined with a machine learning approach to predict short-term brain injury. Using data from a cohort of term infants with hypoxic ischaemic encephalopathy, the present study illustrates that automated analysis of regional cerebral oxygen saturation rcSO2, using either machine learning or deep learning methods, was able to determine infants with adverse outcome.

Changes in Skin Barrier Function in Neonates: Daily Variation and Impact of Bathing.

The skin barrier function is an important predictor of neonatal barrier defects. This study aimed to investigate the daily changes in skin barrier function and the impact of bathing on skin barrier function in neonates. We assessed the transepidermal water loss (TEWL) and stratum corneum hydration (SCH) on the forehead, cheek, volar forearm, and chest from days 2 to 7 and at 1 month after birth. Additionally, we measured the values after bathing and compared them with the pre-bathing values. Sixty-six neonates were involved in the assessment, and each value at the four sites showed significant correlations. TEWL remained stable between days 2 and 7, but SCH significantly increased at most sites. Both significantly increased by 1.5-2 times in 1 month. After bathing, TEWL increased by more than 20% but decreased again after 3 h. TEWL did not change significantly with age during the first week of life. To minimize the effects of bathing, TEWL should be measured at least 3 h after bathing.

Environmental stress and salivary cortisol levels in preterm infants.

Preterm infants are exposed to numerous environmental stressors during their Neonatal Intensive Care Unit (NICU) stay, particularly during the first week after birth. The aim of this study is to assess whether salivary cortisol levels are correlated with Neonatal Infant Stressor Scale (NISS) scores in preterm infants during the first week of life. We also quantified the changes in both NISS scores and cortisol levels in the first week, and whether cortisol levels are associated with gestational age. Preterm infants (n = 38, birth weight <1250 g and/or gestational age <29 weeks) were included. Saliva samples were collected on day 0-3 (early) and day 4-7 (late), and cortisol concentrations were measured by immunoassay. NISS scores were assessed retrospectively for the six hours preceding each saliva collection. NISS scores were not significantly correlated with salivary cortisol levels at either time point. However, infants born at <28 weeks gestation had higher median cortisol levels than infants born at >28 weeks (p = 0.0068), and there was also a significant inverse relationship between NISS score and gestational age (p = 0.04). There was no significant difference between the early and late time points for either NISS scores or cortisol levels. Cortisol levels are elevated in infants <28 weeks gestation but do not correlate with NISS scores. NISS scores are inversely related to gestational age, likely reflecting increased exposure to interventions and invasive procedures for the smallest infants.

Spleen Morphogenesis during the Neonatal Period in Rats Exposed to Endocrine Disruptor DDT

Spleen morphogenesis during the neonatal period in rats exposed in prenatal and postnatal development to low doses of dichlorodiphenyltrichloroethane (DDT), a persistent universal pollutant with endocrine disrupting properties, was studied. More intensive formation of periarterial lymphoid sheaths and marginal zone and simultaneously decreased rate of B-cell differentiation in the spleen were revealed. A higher content of differentiating T-cells and a lower number of cytotoxic T-lymphocytes by the end of the first week of life indicates a decrease in the differentiation of the latter. A lower content of neutrophils in the marginal zone also indicates a delay in the rate of functional development of lymphoid tissue, as opposed to morphological, in rats developing under exposure to low doses of DDT.

Role of ACSBG1 in Brain Lipid Metabolism and X-Linked Adrenoleukodystrophy Pathogenesis: Insights from a Knockout Mouse Model.

"Bubblegum" acyl-CoA synthetase (ACSBG1) is a pivotal player in lipid metabolism during mouse brain development, facilitating the activation of long-chain fatty acids (LCFA) and their incorporation into lipid species that are crucial for brain function. ACSBG1 converts LCFA into acyl-CoA derivatives, supporting vital metabolic processes. Fruit fly mutants lacking ACSBG1 exhibited neurodegeneration and had elevated levels of very long-chain fatty acids (VLCFA), characteristics of human X-linked adrenoleukodystrophy (XALD). To explore ACSBG1's function and potential as a therapeutic target in XALD, we created an ACSBG1 knockout (Acsbg1-/-) mouse and examined the effects on brain FA metabolism during development. Phenotypically, Acsbg1-/- mice resembled wild type (w.t.) mice. ACSBG1 expression was found mainly in tissue affected pathologically in XALD, namely the brain, adrenal gland and testis. ACSBG1 depletion did not significantly reduce the total ACS enzyme activity in these tissue types. In adult mouse brain, ACSBG1 expression was highest in the cerebellum; the low levels detected during the first week of life dramatically increased thereafter. Unexpectedly, lower, rather than higher, saturated VLCFA levels were found in cerebella from Acsbg1-/- vs. w.t. mice, especially after one week of age. Developmental changes in monounsaturated ω9 FA and polyunsaturated ω3 FA levels also differed between w.t. and Acsbg1-/- mice. ACSBG1 deficiency impacted the developmental expression of several cerebellar FA metabolism enzymes, including those required for the synthesis of ω3 polyunsaturated FA, precursors of bioactive signaling molecules like eicosanoids and docosanoids. These changes in membrane lipid FA composition likely affect membrane fluidity and may thus influence the body's response to inflammation. We conclude that, despite compelling circumstantial evidence, it is unlikely that ACSBG1 directly contributes to the pathology of XALD, decreasing its potential as a therapeutic target. Instead, the effects of ACSBG1 knockout on processes regulated by eicosanoids and/or docosanoids should be further investigated.

Ventricular Dysfunction in Patients With Congenital Diaphragmatic Hernia Who Die After Repair

BackgroundQuantitative echocardiographic (echo) measures of ventricular function predict mortality in pediatric pulmonary hypertension (PH), but studies in congenital diaphragmatic hernia (CDH)-related PH are limited. Few studies report quantitative echo data beyond the first week of life in CDH non-survivors. MethodsA single-center retrospective, cross-sectional, cohort study included CDH patients born between January 2013 and April 2022 who survived to surgical repair but died during the neonatal hospitalization. Quantitative measures of right (RV) and left ventricular (LV) size and function including tricuspid annular plane systolic excursion Z-score (TAPSEZ), RV fractional area change (FAC), RV/LV ratio, LV eccentricity index, LV M-mode dimensions, and RV/LV systolic strain were performed offline on the last echocardiogram before death. Data were compared between patients who died ≤30 days after repair (“early”) vs. >30 days after repair (“late”) using the Wilcoxon rank sum test. ResultsTwenty-five (11 early, 14 late) deceased patients had echo images available for analysis. LV size by end-diastolic dimension Z-score was smaller in patients who died early vs. late after repair [-3.03 (−3.93, −2.51) vs. −0.24 (−2.11, 0.53), p = 0.021]. There were trends toward worse RV function (TAPSEZ, RVFAC, RV global and free wall strain) and LV function (apical 4 chamber strain) in patients who died early vs. late after repair. ConclusionThese preliminary findings support future study of the impact of ventricular hypoplasia and dysfunction on mortality and opportunities for risk stratification based on quantitative echo findings in CDH. Level of EvidenceCohort study, 4.

Impact of Refeeding Syndrome on the Short-Term Clinical Outcomes of Very-Premature Infants.

Refeeding syndrome (RFS) is a potentially life-threatening condition that can occur in preterm infants if nutritional support is initiated or increased after a period of starvation or malnutrition. The current study aimed to examine the short-term clinical outcomes of RFS in preterm infants born at ≤32 weeks of gestation. Infants with a gestational age of ≤32 weeks and a birth weight of <1500 g who were born and admitted to the level III neonatal intensive care unit and received parenteral nutrition upon admission were retrospectively evaluated. The modified log Poisson regression with generalized linear models and a robust variance estimator was applied to adjust the outcomes of infants. In total, 760 infants met this study's inclusion criteria. Of them, 289 (38%) developed RFS. RFS was significantly associated with a composite outcome of mortality and intraventricular hemorrhage. Based on the multivariate Cox regression analysis adjusted for significant potential confounders, RFS was significantly associated with increased mortality risk, with a hazard ratio for death in infants with RFS being 1.74-fold higher compared to those without RFS. Preterm infants born at ≤32 weeks of gestation who develop RFS within the first week of life are at increased risk for both intraventricular hemorrhage and mortality. This study underscores the need for standardized clinical approaches for managing RFS in the neonatal intensive care unit to improve outcomes. Future research should establish a unified RFS definition and conduct clinical trials to optimize parenteral nutrition strategies for this vulnerable population.

Comparison of Clinical Diagnosis and Autopsy Findings of Early Neonatal Deaths: Diagnostic Challenges and the Value of Autopsy in Identifying Rare Pathologies.

In a non-forensic hospital setting, neonatal death within the first week of life is often related to premature birth and/or lung diseases. Without post-mortem examination, the identification of the cause of death may be challenging. Autopsy can confirm the clinical diagnosis, uncover additional information or change the diagnosis. Our study aimed to assess the correlation between the clinical diagnosis and post-mortem findings in early neonatal deaths. The retrospective study included autopsy cases with neonatal deaths within the first 7 days of life (arbitrary time interval 2006-2021). Discrepancies between clinical and histopathological findings were classified into 3 groups: (i) full agreement, (ii) additional findings discovered by autopsy, or (iii) autopsy changed the diagnosis. A cohort of 27 cases could be identified and lung pathologies were the most common finding (56%). Additional findings could be discovered in 48% of cases. Major discrepancies which changed the clinical diagnosis could be found in 11% (n = 3/27) of cases. Frequently, post-mortem examinations validate the clinical diagnosis while revealing crucial information in a few cases. In these discrepant cases, autopsy findings can provide information for genetic counselling and quality control of clinical management.

Association of early dysglycemia with intraventricular hemorrhage and mortality in very low birth weight infants.

To investigate the combined effect of hyperglycemia and hypoglycemia on intraventricular hemorrhage (IVH) and mortality recognizing that previous research has predominantly focused on examining these conditions independently. This study included very preterm infants who were born at King Saud Medical City, a tertiary referral center, and admitted to a level 3 neonatal intensive care unit between January 2020 and January 2024. Modified log-Poisson regression with generalized linear models and a robust variance estimator (Huber-White) were used to adjust for potential confounding factors. A total of 554 infants met the inclusion criteria. Hyperglycemia and/or hypoglycemia developed in 75.5% (418) patients within the first postnatal week. During the study period, IVH occurred in 28.5% (N = 158), and severe IVH occurred in 13% (72) infants. In addition, 13.7% (76) of infants died during the study period. The multivariate regression revealed an association between the isolated hyperglycemia, combined exposure of hypo- and hyperglycemia, and development of IVH (relative risk [RR], 2.10; 95% confidence interval [CI], 1.36, 3.25; RR, 2.33; 95% CI, 1.34, 4.06, respectively). Severe IVH was significantly associated with isolated hyperglycemia (adjusted relative risk [aRR], 2.46; 95% CI, 1.16, 5.23). Death was associated with combined hypo- and hyperglycemia (adjusted hazardous ratio [aHR], 3.19; 95% CI, 1.23, 8.26).Conclusion: Combined hyper- and hypoglycemia in the first week of life of premature babies increases the risk and severity of IVH and neonatal mortality.

Regulators of placental antibody transfer through a modeling lens.

Infants are vulnerable to infections owing to a limited ability to mount a humoral immune response and their tolerogenic immune phenotype, which has impeded the success of newborn vaccination. Transplacental transfer of IgG from mother to fetus provides crucial protection in the first weeks of life, and maternal immunization has recently been implemented as a public health strategy to protect newborns against serious infections. Despite their early success, current maternal vaccines do not provide comparable protection across pregnancies with varying gestational lengths and placental and maternal immune features, and they do not account for the dynamic interplay between the maternal immune response and placental transfer. Moreover, progress toward the rational design of maternal vaccines has been hindered by inadequacies of existing experimental models and safety challenges of investigating longitudinal dynamics of IgG transfer in pregnant humans. Alternatively, in silico mechanistic models are a logical framework to disentangle the processes regulating placental antibody transfer. This Review synthesizes current literature through a mechanistic modeling lens to identify placental and maternal regulators of antibody transfer, their clinical covariates, and knowledge gaps to guide future research. We also describe opportunities to use integrated modeling and experimental approaches toward the rational design of vaccines against existing and emerging neonatal pathogen threats.

8721 A Case of Congenital Hyperinsulinism Manifesting as Transient Hypoglycemia During Illness Due to Mosaic Variant of Unknown Significance in ABCC8

Abstract Disclosure: E.E. Bell-Sambataro: None. L. Mamilly: None. Background: Congenital hyperinsulinism (CHI) is characterized by inappropriate secretion of insulin during periods of low blood glucose. CHI can lead to significant complications such as seizures, developmental delays and neurologic damage. CHI can be caused by multiple genetic variants. The most common genetic etiologies are loss of function mutations in the genes ABCC8 and KCNJ11 encoding the pancreatic Beta (β)-cell ATP-sensitive potassium channel causing over secretion of insulin from the β-cells. We report a challenging pediatric case with a clinical presentation of CHI in an infant with a de novo mosaic ABCC8 gene variant of unknown significance manifesting only during times of illness. Clinical Case: A male infant born at 36 weeks gestational age was transferred to a tertiary center NICU secondary to seizure activity and hypoglycemia after the 24 hours of life with glucose levels as low as 32 mg/dL. His birth weight was normal and there was not maternal history of diabetes mellitus. The hypoglycemia persisted throughout the first week of life and required a glucose infusion rate of 11 mg/kg/min, without success in obtaining a critical sample. He had multiple seizures and MRI brain showed signs of hypoglycemic encephalopathy. Subsequently, he was weaned off IV dextrose and completed a 6 hour safety fast prior to discharge. Rapid genome testing resulted in a de novo, mosaic variant of unknown significance in ABCC8 (C.3622G&amp;gt;A resulting in amino acid substitution p.Glu1208Lys). His family reported significant but transient hypoglycemia during times of illness. At the age of 11 months, he was hospitalized for significant hypoglycemia during an episode of acute gastroenteritis and was treated with dextrose-containing fluids for 36 hours. A subsequent diagnostic fasting study resulted in hypoglycemia within 5.5 hours with capillary glucose of 49 mg/dL. At the time of hypoglycemia, beta hydroxybutyrate was inappropriately low at 0.78 mm, insulin level was suppressed &amp;lt;2 mcIU/mL. Glucagon (30 mcg/Kg) was administered after the initial sample was drawn with a significant increase in glucose from 49 mg/dL to 103 mg/dL. Based on the positive glucagon response and low serum ketone, the clinical diagnosis of CHI was made and diazoxide was initiated while awaiting other results. After the second dose of diazoxide, all glucose levels remained above 80 mg/dL. He was sent home on a continuous glucose monitor and diazoxide. Conclusion: CHI can occur due to autosomal recessive or autosomal dominant ABCC8 loss-of-function mutations of which more than half are not responsive to diazoxide. In this case report, we describe the diagnosis of hyperinsulinemic hypoglycemia in an infant with an ABCC8 variant classified with unknown significance. We describe a good initial response to diazoxide in normalizing blood glucose levels in this infant. Presentation: 6/2/2024

Perinatal and Neonatal Chikungunya virus Transmission: a case series.

Large-scale epidemics in countries with high birth rates can create a concerning scenario where pregnant people are more likely to transmit the virus. Additionally, increased international mobility has made arboviruses a growing problem for travelers. The increased risk of vertical transmission has been related to maternal viremia near delivery. Such transmission leads to severe infection of newborns and may be associated with subsequent neurological impairment including cerebral palsy. This case series provides an overview of clinical and laboratory findings in pregnant individuals with confirmed CHIKV infection as well as the clinical effects on their newborn emphasizing the severity of neonatal chikungunya. an ambispective case series enrolled newborns with confirmed exposure to CHIKV in utero or in the neonatal period. during the delivery period, the transmission rate among viremic individuals was approximately 62% (18/29). Fever, irritability, rash, and poor feeding in the first week of life were critical signs of neonatal chikungunya, highlighting its severity. Close monitoring of healthy newborns during the first week of life is essential in areas affected by CHIKV epidemics, and in offspring of pregnant travelers who visited the outbreaks zones. This case series is intended to increase neonatologists' awareness of the possibility of mother-to-child transmission of CHIKV among newborns with a sepsis-like presentation. Prioritizing CHIKV vaccination for women of childbearing age should also be considered.

Evaluation of efficacy of oral calcium phosphate as an adjunct to standard-of-care regular phototherapy in cases of neonatal jaundice: a hospital-based double-blind, randomised, placebo-controlled trial

ObjectiveNeonatal jaundice is the most common cause of neonatal morbidity and rehospitalisation in the first week of life, affecting approximately 60% of term and 80% of preterm neonates, with 10%...

Murine neonatal cardiac regeneration depends on Insulin-like growth factor 1 receptor signaling.

Unlike adult mammals, the hearts of neonatal mice possess the ability to completely regenerate from myocardial infarction (MI). This observation has sparked vast interest in deciphering the potentially lifesaving and morbidity-reducing mechanisms involved in neonatal cardiac regeneration. In mice, the regenerative potential is lost within the first week of life and coincides with a reduction of Insulin-like growth factor 1 receptor (Igf1r) expression in the heart. Igf1r is a well-known regulator of cardiomyocyte maturation and proliferation in neonatal mice. To test the role of Igf1r as a pivotal factor in cardiac regeneration, we knocked down (KD) Igf1r specifically in cardiomyocytes using recombinant adeno-associated virus (rAAV) delivery and troponin T promotor driven shRNAmirs. Cardiomyocyte specific Igf1r KD versus control mice were subjected to experimental MI by permanent ligation of the left anterior descending artery (LAD). Cardiac functional and morphological data were analyzed over a 21-day period. Neonatal Igf1r KD mice showed reduced systolic cardiac function and increased fibrotic cardiac remodeling 21days post injury. This cardiac phenotype was associated with reduced cardiomyocyte nuclei mitosis and decreased AKT and ERK phosphorylation in Igf1r KD, compared to control neonatal mouse hearts. Our in vivo murine data show that Igf1r KD shifts neonatal cardiac regeneration to a more adult-like scarring phenotype, identifying cardiomyocyte-specific Igf1r signaling as a crucial component of neonatal cardiac regeneration.

Non-invasive detection of bilirubin concentrations during the first week of life in a low-resource setting along the Thailand–Myanmar border

BackgroundNeonatal hyperbilirubinaemia (NH) is a common problem worldwide and is a cause of morbidity and mortality especially in low-resource settings.MethodsA study was carried out at Shoklo Malaria Research Unit (SMRU)...