First Week Of Life Research Articles

Antibiotic duration and gastric dysmotility in preterm neonates.

Prolonged antibiotic use after birth is associated with neonatal feeding intolerance and functional gastrointestinal disorders (FGIDs). A gastric dysrhythmia (tachygastria) with frequencies >4-9 cycles per minute, measured by electrogastrography (EGG), is associated with FGIDs. The relationship between prolonged antibiotic use and % time spent in tachygastria is unknown in preterm infants. We aimed to compare weekly changes in % tachygastria between preterm infants receiving long (>48 h) versus short (≤48 h) courses of antibiotics for early onset sepsis evaluation (initiated at <3 days of life). This was a longitudinal, prospective cohort study of 88 preterm infants (<34 weeks' gestation) with weekly EGG recordings from the first week of life until 40 weeks' post-menstrual age, discharge, or death. We calculated % of EGG recording time in tachygastria and determined the mean across weekly sessions. A mixed effects model assessed variance in % tachygastria between the short- and long-antibiotic exposure groups across all weeks. Baseline characteristics were similar between the two groups. There was no difference in % tachygastria between short and long antibiotic exposure groups across nine postnatal weeks (p = 0.08). Early, prolonged antibiotic exposure among preterm infants may not lead to significant gastric dysrhythmia. Future studies including larger sample sizes and a "no antibiotic" exposure arm are essential in elucidating this potential relationship.

PSIV-14 Assessing sow and suckling pig hemoglobin status in a single lactation following one or two iron supplementations of piglets in a commercial farm

Abstract Newborn piglets are typically anemic at birth [defined as blood hemoglobin concentration (Hb) &amp;lt; 10 g/dL] and sow’s milk contains negligible amounts of iron; common commercial practice is one dose of injectable iron in the first week of life. However, a considerable proportion of piglets have decreased Hb at weaning which may have implications on post-wean performance. Thus, there is interest in additional iron supplementation before weaning. The primary objective of this study was to evaluate the impact of one or two iron supplementations on offspring performance. A total of 172 sows (parity 1 to 8) and litters (n = 2,378 piglets) were assigned in a randomized complete block design to Control [piglets received one injectable iron dose (400 mg)], SUPoral (injectable iron as Control plus oral iron supplement at 1oz/litter per day for 8 d before weaning), or SUPinject (injectable iron as Control plus 100 mg 7 d before weaning). According to barn stand protocol, the first iron dose was provided to all piglets on d 7 after the initiation of farrowing. Sow Hb status was determined at entry to farrowing house and weaning; -Hb status of all born alive piglets was measured within 28 of birth and at weaning. Analysis of variance compared the effect of iron supplementation, parity, and their interaction on piglet Hb status. Sow Hb at entry (9.3, 10.4, and 9.6 g/dL ± 0.15, respectively) was less (P &amp;lt; 0.001) for parity 4-8 sows than parity 1, with parity 2-3 intermediate and no difference between parity groups at weaning (9.5 g/dL ± 0.16). Litter size at birth (total or born alive) and preweaning mortality did not differ between treatments. Piglet Hb at birth was not different between treatments; however, 85% of piglets from parity 4-8 sows were deemed anemic at birth compared with 72 and 76% in parity 1 and 2-3 sows, respectively (P &amp;lt; 0.05). Immediately before additional iron supplementation, Control piglets had lower (P &amp;lt; 0.0001) Hb than SUPoral and SUPinject piglets (7.4 vs 8.0 and 8.1 g/dL ± 0.12, respectively). At weaning, there were no differences in piglet Hb by iron supplementation treatments (11.4 g/dL ± 0.07). However, the percentage of piglets within a litter deemed anemic at weaning was greater (30%; P &amp;lt; 0.011) in parity 4-8 sows compared with parity 1 sows at 13%. There was no difference in piglet body weight at weaning between treatment groups or by parity grouping. In this study, additional iron supplementation before weaning had minimal impact on piglet iron status or growth. The decreased Hb at entry in older sows combined with greater proportion of anemic piglets at birth or weaning suggests greater attention to sow iron intake may be warranted.

Neonatal mortality during the war in Tigray: a cross-sectional community-based study

Neonatal mortality is among the key national and international indicators of health services. The global Sustainable Development Goal target for neonatal mortality is fewer than 12 deaths per 1000 livebirths, by 2030. Neonatal mortality estimates in the 2019 Ethiopian Demographic Health Survey found 25·7 deaths per 1000 livebirths. Subnational surveys specific to Tigray, Ethiopia, reported a neonatal mortality lifetime prevalence of 7·13 deaths. Another government report from the Tigray region estimated a neonatal mortality rate of ten deaths per 1000 livebirths in 2020. Despite the numerous interventions in Ethiopia's Tigray region to achieve the Sustainable Development Goals, the war has disrupted most health services, but the effect on neonatal mortality is unknown. Thus, this study aimed to investigate the magnitude and causes of neonatal mortality during the war in Tigray. A cross-sectional community-based study was conducted in Tigray to evaluate neonatal mortality that occurred from Nov 4, 2020, to May 30, 2022. Among the 31 districts, 121 tabias were selected using computer-generated random sampling, and 189 087 households were visited. We adopted a validated WHO 2022 verbal autopsy tool, and data were collected using an interviewer-administrated Open Data Kit. In the absence of the mother, other respondents to the verbal autopsy interview were household members aged 18 years and older who provided care during the final illness that led to death. 29 761 livebirths were recorded during the screening of 189 087 households. Verbal autopsy was administered for 1158 households with neonatal deaths. 317 neonates were stillborn, and 841 neonatal deaths were recorded with the WHO 2022 verbal autopsy tool from Nov 4, 2020, to May 30, 2022, in 31 districts. The neonatal mortality rate was 28·2 deaths per 1000 livebirths. 476 (57%) of the 841 neonatal deaths occurred at home and 296 (35%) in health facilities. A high rate of neonatal deaths was reported in rural districts (80% [673 of 841]) compared with urban districts (20% [168 of 841]), and 663 (79%) deaths occurred during the early neonatal period, in the first week of life (0-6 days). The leading causes of neonatal death were asphyxia (35% [291 of 834]), prematurity (30% [247 of 834]), and infection (12% [104 of 834]). Asphyxia (37% [246 of 663]) and infection (28% [50 of 178]) were the leading causes of death for early and late neonatal period deaths, respectively. Neonatal mortality in Tigray is high due to preventable causes. An urgent response is needed to prevent the high number of neonatal deaths associated with the depleted health resources and services resulting from the war, and to achieve the Sustainable Development Goal on neonatal mortality. UNICEF and United Nations Fund for Population Activities. For the Tigrigna translation of the abstract see Supplementary Materials section.

Longitudinal changes in bifidobacterial population during the first two years of life.

Early life microbiota encompasses of a large percentage of Bifidobacterium, while it is not sufficiently understood how the Bifidobacterium population develops after infant's birth. Current study investigated the longitudinal changes in Bifidobacterium population during the first two years of life in 196 term born infants (1,654 samples) using 16S rRNA-23S rRNA internal transcribed spacer (ITS) sequence analysis. Throughout the first two years of life, Bifidobacterium breve, Bifidobacterium longum subsp. longum and Bifidobacterium adolescentis were most dominant and prevalent in the Bifidobacterium population, while B. breve had the highest relative abundance and prevalence during the first week of life and it was taken over by B. longum subsp. longum around two years after birth. Sampling time points, early antibiotic(s) exposure (effect only measurable within a month after birth), delivery mode (effect still detectable two-months after birth) and feeding mode (effect lasted until six months after birth), significantly contributed to the overall variation in the bifidobacterial population. From six months onwards, introducing of solid food and cessation of breastfeeding were accompanied with drastic changes in the composition in bifidobacterial population. Altogether, current study confirmed the effect of potential contributors to the longitudinal changes within the bifidobacterial population during the first two years of life. Registered at https://clinicaltrials.gov: NCT02536560.

Machine Learning to Improve Accuracy of Transcutaneous Bilirubinometry

Plain Language SummaryNeonatal jaundice is a common condition that might occur in the first week of life. Severe high bilirubin levels can lead to long-term problems like cerebral palsy, hearing impairment, and developmental delay. Therefore, newborns are usually evaluated for jaundice every day during their first week. To accurately assess jaundice, we need to measure the total bilirubin in the blood. However, daily blood draws for bilirubin measurements can be uncomfortable and may cause anemia in newborns. Thus, transcutaneous bilirubinometry is devised. It is a device that measures bilirubin through the skin and is commonly used because it is non-invasive. However, transcutaneous bilirubinometry has some accuracy issues. In this study, we successfully improved the accuracy of bilirubin measurement by combining machine learning with transcutaneous bilirubinometry. Being used alone, the transcutaneous bilirubinometer had an error of 1.08 mg/dL. However, combining transcutaneous bilirubinometry with machine learning, the error decreased to 0.80 mg/dL, which is a 25% of improvement. Using this approach, unnecessary blood draws could be reduced by up to 78%. If we incorporate this algorithm into transcutaneous bilirubinometry, this novel method has the potential to improve prediction accuracy and reduce the burden on babies.

Association of Standardized Parenteral Nutrition with Early Neonatal Growth of Moderately Preterm Infants: A Population-Based Cohort Study

In preterm infants, early nutrient intake during the first week of life often depends on parenteral nutrition. This study aimed to evaluate the influence of standardized parenteral nutrition using three-in-one double-chamber solutions (3-in-1 STD-PN) on early neonatal growth in a cohort of moderately preterm (MP) infants. This population-based, observational cohort study included preterm infants admitted to neonatal centers in the southeast regional perinatal network in France. During the study period, 315 MP infants with gestational ages between 320/7 and 346/7 weeks who required parenteral nutrition from birth until day-of-life 3 (DoL3) were included; 178 received 3-in-1 STD-PN solution (56.5%). Multivariate regression was used to assess the factors associated with the relative body-weight difference between days 1 and 7 (RBWD DoL1-7). Infants receiving 3-in-1 STD-PN lost 36% less body weight during the first week of life, with median RBWD DoL1-7 of −2.5% vs. −3.9% in infants receiving other PN solutions (p &lt; 0.05). They also received higher parenteral energy and protein intakes during the overall first week, with 85% (p &lt; 0.0001) and 27% (p &lt; 0.0001) more energy and protein on DoL 3. After adjusting for confounding factors, RBWD DoL1-7 was significantly lower in the 3-in-1 STD-NP group than in their counterparts, with beta (standard deviation) = 2.08 (0.91), p = 0.02. The use of 3-in-1 STD-PN provided better energy and protein intake and limited early weight loss in MP infants.

Role of Maternal Antibodies in the Protection of Broiler Chicks against Campylobacter Colonization in the First Weeks of Life

Thermophilic Campylobacter species are the most common cause of bacterium-mediated diarrheal disease in humans globally. Poultry is considered the most important reservoir of human campylobacteriosis, but so far, no effective countermeasures are in place to prevent the bacterium from colonizing broiler flocks. This study investigated maternal antibodies’ potential to offer protection against Campylobacter in broiler chicks via a field trial and an immunization trial. In the field trial, breeder flocks with high and low anti-Campylobacter antibody levels in the yolk were selected based on serological screening. Offspring were subsequently monitored for maternal antibodies and Campylobacter prevalence during early life. Although maternal antibodies declined rapidly in the serum of broilers, offspring from flocks with lower anti-Campylobacter antibody levels seemed to be more susceptible to colonization. In the immunization trial, breeders from a seropositive breeder flock were vaccinated with an experimental bacterin or subunit vaccine. Immunization increased antibody levels in the yolk and consequently in the offspring. Elevated maternal antibody levels were significantly associated with reduced Campylobacter susceptibility in broilers at 2 weeks old but not at 1 and 3 weeks old. Overall, the protective effect of maternal immunity should be cautiously considered in the context of Campylobacter control in broilers. Immunization of breeders may enhance resistance but is not a comprehensive solution.

Clinico-etiological profile of neonates with jaundice in a tertiary care hospital of Northernmost India

Background: Neonatal jaundice is the most common problem in the first week of life leading to delayed hospital discharges and readmissions. Recognizing early neonatal hyperbilirubinemia plays a pivotal role in preventing serious complications. The aim of this study was to study the clinical profile and etiological factors leading to neonatal jaundice. Methods: This prospective observational study was conducted in the neonatal intensive care unit (NICU), department of pediatrics, government medical college, Srinagar, Jammu and Kashmir, India over a period of 6 months (August 2023 to January 2024). A total of 400 cases were enrolled for the study. Data collection was done by history taking, clinical examination and relevant laboratory investigations. Results: In this study, out of 400 jaundiced neonates, 236 (59%) were males and 164 (41%) were females, 342 (85.5%) were born at term and remaining 58 (14.5%) were preterm babies. Among 400 neonates studied, majority (80%) had birth weight ≥2500 gm. Only 80 (20%) had birth weight less than 2500 gm. Physiological jaundice was seen in 162 (40.5%) of the total cases. This was followed by ABO incompatibility (20%), Rh incompatibility (16.5%), sepsis (8%), idiopathic (5%), prematurity (4%), cephalhematoma (4%) and breastfeeding jaundice (2%). Conclusions: This study concludes that physiological jaundice is the most common cause of neonatal jaundice in our hospital. This was followed by ABO incompatibility, Rh incompatibility and sepsis. This highlights the importance of appropriate monitoring of neonates with these underlying risk factors.

Umbilical cord blood culture for early onset sepsis in preterm infants.

Umbilical cord blood culture (UCBC) may have a diagnostic utility for early onset sepsis (EOS) detection in preterm infants. It may prevent sampling the newborn and collect a higher volume of blood for pathogenic identification. Retrospective analysis at a tertiary care center in Canada of preterm infants ≤ 34 0/7 weeks' gestation with UCBC taken at birth. Of 505 admitted infants, 195 had UCBC. 170 UCBCs were negative; 44 of these had also negative neonatal blood culture (NBC). No infants with negative UCBC showed EOS symptoms in the first week of life. 25 UCBCs were positive: 18 were contaminants (all with negative NBC) and 7 were confirmed as EOS. 18 infants with UCBC contaminants remained asymptomatic. 7 EOS cases were identified, with varying bacteriological profiles; 5 displayed sepsis symptoms while 2 were asymptomatic. Risk of EOS increased with prolonged rupture of membranes. UCBC effectively detected EOS establishing it as a method with possibly better diagnostic performance than NBC in high-risk neonates. Further studies are needed to improve UCBC technique and lower contamination rates. Umbilical cord blood culture has a higher bacterial identification rate than peripheral venous blood culture for the early identification of early-onset sepsis in preterm infants. Umbilical cord blood cultures that showed no growth were reliable predictors of not developing early onset sepsis. Umbilical cord blood culture should be considered as part of the evaluation for early onset sepsis in the preterm infants.

Iron Supplementation of Pregnant Sows to Prevent Iron Deficiency Anemia in Piglets: A Procedure of Questionable Effectiveness.

In pigs, iron deficiency anemia (IDA) is a common disorder that occurs during the early postnatal period, leading to the stunted growth and increased mortality of piglets. The main cause of IDA is low iron stores in the liver of newborn piglets; these stores constitute the main source of iron needed to satisfy the erythropoietic requirements of the piglets in their first weeks of life. Insufficient iron stores in piglets are usually due to the inadequate placental iron transfer from the sow to the fetuses. Therefore, iron supplementation in pregnant sows has been implemented to enhance placental iron transfer and increase iron accumulation in the liver of the fetuses. Over the years, several oral and parenteral approaches have been attempted to supplement sows with various iron preparations, and consequently, to improve piglets' red blood cell indices. However, there is debate with regard to the effectiveness of iron supplementation in pregnant sows for preventing IDA in newborn piglets. Importantly, this procedure should be carried out with caution to avoid iron over-supplementation, which can lead to iron toxicity. This article aims to critically review and evaluate the use of iron supplementation in pregnant sows as a procedure for preventing IDA in piglets.

Early stress during NICU stay and parent-reported health-related quality of life after extremely preterm birth: an exploratory study with possible targets for early intervention.

The association between neonatal intensive care unit (NICU) related stress in preterm infants and their health-related quality of life (HRQoL) in the first year following preterm birth remains unexplored. Understanding this association is crucial for enhancing preventive and supportive measures for infants and parents within and beyond the NICU. From a single center observational cohort study, we included infants with gestational ages below 30 weeks and/or birth weights under 1,000 grams. HRQoL was quantified using the Infant Quality of Life Instrument (IQI) at 3-, 6-, 9- and 12-months corrected age, covering seven domains. NICU stress was quantified using the Neonatal Infant Stressor Scale (NISS) for the first week of life. We performed Spearman's correlation analyses to test this association. Of the 45 included infants, the IQI was completed for 27 (60%) at 3, 15 (33%) at 6, 14 (31%) at 9 and 15 (33%) at 12 months. The HRQoL sum scores were related to neonatal stress at 9 and 12 months (ρ = 0.643 and 0.591, p = 0.013 and p = 0.019, respectively) but not at 3 and 6 months (ρ = -0.001 and -0.077 respectively, p > 0.05). Higher NICU stress tended to be associated with more respiratory and mood problems throughout the first year. From a parental perspective on infant HRQoL, extremely preterm infants with higher stress exposure show more problems in the second half-year of life, mainly breathing and possibly mood-related problems. This knowledge may help improve our neonatal care, both during NICU stay and in follow-up clinics, by implementing targeted interventions.

Arterial hypertension in infants with congenital diaphragmatic hernia following surgical repair.

Pulmonary hypertension (PH) and cardiac dysfunction are established comorbidities of congenital diaphragmatic hernia (CDH). However, there is very little data focusing on arterial hypertension in CDH. This study aims to investigate the incidence of arterial hypertension in neonates with CDH at hospital discharge. Archived clinical data of 167 CDH infants who received surgical repair of the diaphragmatic defect and survived for > 60days were retrospectively analyzed. Blood pressure (BP) values were averaged for the last 7days before discharge and compared to standard BP values for sex, age, and height provided by the AHA in 2004. BP values reaching or extending the 95th percentile were defined as arterial hypertension. The use of antihypertensive medication was analyzed at discharge and during hospitalization. Arterial hypertension at discharge was observed in 19 of 167 infants (11.3%) of which 12 (63%) were not receiving antihypertensive medication. Eighty patients (47.9%) received antihypertensive medication at any point during hospitalization and 28.9% of 152 survivors (n = 44) received antihypertensive medication at discharge, although in 45.5% (n = 20) of patients receiving antihypertensive medication, the indication for antihypertensive medication was myocardial hypertrophy or frequency control. BP was significantly higher in ECMO compared to non-ECMO patients, despite a similar incidence of arterial hypertension in both groups (13.8% vs. 10.1%, p = 0.473). Non-isolated CDH, formula feeding, and minimal creatinine in the first week of life were significantly associated with arterial hypertension on univariate analysis. Following multivariate analysis, only minimal creatinine remained independently associated with arterial hypertension. Conclusion:This study demonstrates a moderately high incidence of arterial hypertension in CDH infants at discharge and an independent association of creatinine values with arterial hypertension. Physicians should be aware of this risk and include regular BP measurements and test of renal function in CDH care and follow-up. What is Known: • Due to decreasing mortality, morbidity is increasing in surviving CDH patients. • Pulmonary hypertension and cardiac dysfunction are well-known cardiovascular comorbidities of CDH. What is New: • There is a moderately high incidence of arterial hypertension in CDH infants at discharge even in a population with frequent treatment with antihypertensive medication. • A more complicated hospital course (ECMO, higher degree of PH, larger defect size) was associated with a higher risk for arterial hypertension.

Delayed subaponeurotic fluid collection (DSFC): systematic review and case report.

DSFC (delayed subaponeurotic fluid collection) is a benign pathology associated with the first weeks of life and scarcely described in the literature. Normally characterized by a lack of trauma and/or cranial fracture, it is associated with a history of instrumental delivery and the use of fetal electrodes. Taking it in consideration in the differential diagnosis of neonatal scalp swelling becomes important. The objective of this work is to expand knowledge on this entity: history, clinical characteristics, diagnosis, and treatment. This article describes a new clinical case and conducts a systematic review according to the PRISMA criteria. Sixty-seven cases are included, they are summarized in a table. DSFC appears generally 15-16weeks after birth. The diagnosis is mainly clinical, based on a history of instrumental birth, labor dystocia, or trauma, and with compatible symptoms and evolution. It may be supported by complementary tests such as ultrasound and or CT of the skull in doubtful cases. The treatment of choice is only conservative, and all cases resolve spontaneously and completely after an average of 4weeks.

Nutritional support during the first week for infants with bronchopulmonary dysplasia and respiratory distress: a multicenter cohort study in China

BackgroundBronchopulmonary dysplasia (BPD) is a major complication affecting the survival rate and long-term outcomes of preterm infants. A large, prospective, multicenter cohort study was conducted to evaluate early nutritional support during the first week of life for preterm infants with a gestational age < 32 weeks and to verify nutritional risk factors related to BPD development.MethodsA prospective multicenter cohort study of very preterm infants was conducted in 40 tertiary neonatal intensive care units across mainland China between January 1, 2020, and December 31, 2021. Preterm infants who were born at a gestational age < 32 weeks, < 72 h after birth and had a respiratory score > 4 were enrolled. Antenatal and postnatal information focusing on nutritional parameters was collected through medical systems. Statistical analyses were also performed to identify BPD risk factors.ResultsThe primary outcomes were BPD and severity at 36 weeks postmenstrual age. A total of 1410 preterm infants were enrolled in this study. After applying the exclusion criteria, the remaining 1286 infants were included in this analysis; 614 (47.7%) infants were in the BPD group, and 672 (52.3%) were in the non-BPD group. In multivariate logistic regression model, the following six factors were identified of BPD: birth weight (OR 0.99, 95% CI 0.99–0.99; p = 0.039), day of full enteral nutrition (OR 1.03, 95% CI 1.02–1.04; p < 0.001), parenteral protein > 3.5 g/kg/d during the first week (OR 1.65, 95% CI 1.25–2.17; p < 0.001), feeding type (formula: OR 3.48, 95% CI 2.21–5.49; p < 0.001, mixed feed: OR 1.92, 95% CI 1.36–2.70; p < 0.001; breast milk as reference), hsPDA (OR 1.98, 95% CI 1.44–2.73; p < 0.001), and EUGR ats 36 weeks (OR 1.40, 95% CI 1.02–1.91; p = 0.035).ConclusionsA longer duration to achieve full enteral nutrition in very preterm infants was associated with increased BPD development. Breastfeeding was demonstrated to have a protective effect against BPD. Early and rapidly progressive enteral nutrition and breastfeeding should be promoted in very preterm infants.Trial registrationThe trial was registered in the Chinese Clinical Trial Registry (No. ChiCTR2000030125 on 24/02/2020) and in www.ncrcch.org (No. ISRCTN84167642 on 25/02/2020).

The Morphological Image of Fat Body and Tergal Gland Cells in Uninseminated Apis mellifera Queen Bees.

The morphological changes in fat body cells, tergal gland cells, and the surface areas of the cell nuclei were determined in queen bees of the subspecies Apis mellifera carnica. This study focused on 1-, 8-, and 20-day-old uninseminated females kept in colonies, analyzing cells from three locations in the abdomen: the sternite, and tergites III and V. The oenocytes in the sternites were large, oval/circular with a centrally located nucleus, while in tergites III and V, they were small and triangular in the 1-day-old queens. During the first week of life, these cells in tergites III and V change their shape to oval and increase their sizes. The initially light yellow and then dark yellow granularities in the oenocytes of the fat body appear along with the advancing age of the queens. The trophocytes (sternites, tergites III and V) in the 1-day-old queens were completely filled with droplets of different sizes. In the 8- and 20-day-old queens, the number and size of the droplets decreased in the trophocytes of tergites III and V. The tergal gland cells had a centrally located cell nucleus in the 1-, 8- and 20-day-old queens. The dark granularities in these cells were visible only in the 20-day-old queens. Different morphological images of the fat body at the sternite, and tergites III and V, and the difference in the size of the oenocyte cell nuclei may indicate various functions of the fat body depending on its location. Characterization of the changes in the morphology of the fat body, taking into account its segmental character, and the tergal glands requires further research in older queens, e.g., one-year-old, brooding queens.

THE EFFECT OF MASSAGE ON SERUM BILIRUBIN LEVELS AND NEONATUS BODY WEIGHT WITH PHOTOTHERAPY

Approximately 25-50% of newborns experience physiological hyperbilirubinemia in the first week of life, 80% occur in premature babies and 60% in full-term babies. Hyperbilirubinemia can be toxic and dangerous, such as encephalopathy. At Ummi Hospital, Bogor, the number of babies born from January to April 2021 was 704, and 11.4% had hyperbilirubinemia and no baby massage intervention had been carried out. Massage for newborns with hyperbilirubinemia reduces bilirubin levels and increases the baby's weight. This study aims to find out whether massage can reduce serum bilirubin levels and increase the weight of hyperbilirubinemia babies who receive phototherapy. This research was conducted in the perinatology room at Ummi Hospital, Bogor, Indonesia with ethical permit no. 02/KEPK/X/2021. The research design used a quasi-experimental pretest-posttest with a control group design, with a sample of 40 hyperbilirubinemia babies. After analysis using the dependent t-test and independent t-test, the results of the study showed that there was no significant difference between body weight before the intervention and after the intervention with p &gt; 0.05 in the intervention group (p=0.054) and the control group (p =0.286). There was a significant difference in bilirubin levels (p&lt;0.05) before and after the intervention in both the intervention group and the control group (p=0.001). Conclusion: Phototherapy alone or combined with massage can reduce serum bilirubin levels in babies. Adding massage to provide comfort to the baby and other benefits.

Clinical case: kinking ductus fetal report

We present the case of a pregnant woman with a 35+5 week fetus referred for suspected fetal heart malformation. The fetal echocardiogram showed a dilated and tortuous ductus without signs of heart failure. It was managed conservatively. After birth, a ductal aneurysm was observed. It evolves normally, closing within the first week of life and without complications for the newborn. The course is asymptomatic and echocardiography prior to discharge showed complete closure of the ductus arteriosus at 7 days of life.

Antibiotic Use in Late Preterm and Full-Term Newborns

Antibiotic treatment saves lives in newborns with early-onset sepsis (EOS), but unwarranted antibiotic use is associated with resistant bacteria and adverse outcomes later in life. Surveillance is needed to optimize treatment strategies. To describe antibiotic use in association with the incidence and mortality from EOS among late-preterm and full-term newborns. The Sweden Neonatal Antibiotic Use study was a nationwide observational study that included all late-preterm and full-term neonates born from January 1, 2012, to December 31, 2020, in neonatal units of all levels. All hospital live births from 34 weeks' gestation during the study period were included in the study. Data were collected from the Swedish Neonatal Quality Register and the Swedish Medical Birth Register. Data were analyzed from August 2022 to May 2023. Admission for neonatal intensive care during the first week of life. The main outcomes were the usage of intravenous antibiotics during the first week of life, the duration of antibiotic therapy, the rate of culture-proven EOS, and mortality associated with EOS. A total of 1 025 515 newborns were included in the study; 19 286 neonates (1.88%; 7686 girls [39.9%]; median [IQR] gestational age, 40 [38-41] weeks; median [IQR] birth weight, 3610 [3140-4030] g) received antibiotics during the first week of life, of whom 647 (3.4%) had EOS. The median (IQR) duration of antibiotic treatment in newborns without EOS was 5 (3-7) days, and there were 113 antibiotic-days per 1000 live births. During the study period there was no significant change in the exposure to neonatal antibiotics or antibiotic-days per 1000 live births. The incidence of EOS was 0.63 per 1000 live births, with a significant decrease from 0.74 in 2012 to 0.34 in 2020. Mortality associated with EOS was 1.39% (9 of 647 newborns) and did not change significantly over time. For each newborn with EOS, antibiotic treatment was initiated in 29 newborns and 173 antibiotic-days were dispensed. This large nationwide study found that a relatively low exposure to antibiotics is not associated with an increased risk of EOS or associated mortality. Still, future efforts to reduce unwarranted neonatal antibiotic use are needed.

A Retrospective Study Evaluating Guideline Adherence of Neonatal Parenteral Nutrition in a Belgian Neonatal Intensive Care Unit.

Introduction Clinical nutrition for preterm and critically ill neonates remains a challenge. Preterms are often hemodynamically and metabolically compromised, which limits infusion volumes of nutrients and hinders achieving recommended nutrient intakes. While guidelines provide recommended ranges for parenteral nutrition (PN) intakes, they generally recommend enteral nutrition as soon as possible. Thus, in clinical practice, gradually increasing EN intakes complicates assessments of PN guideline adherence. Via a pragmatic approach, we assessed adherence to PN recommendations for macronutrients and energy as stated in the 2018 guidelines of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Methods In this retrospective study, we assessed the nutrition of preterm and critically ill term neonates from the neonatal intensive care unit of the University Hospital Brussels. We analyzed intakes for the first week of life, in which critically ill neonates at our center usually receive the majority of nutrients via PN. The PN-based provision of macronutrients and energy was analyzed descriptively in relation to the ESPGHAN 2018 recommendations. Results Macronutrients and energy provision gradually increased until they reached recommended or targeted values. Compared to term neonates, energy and lipid provision for preterms increased faster, while amino acid provision exceeded the ESPGHAN 2018 recommendations. Conclusions This study adds clinical practice data to the severely understudied field of the ESPGHAN 2018 PN guideline compliance. Using a pragmatic assessment of our nutrition protocols, we found the need to reduce the amount of amino acids per kg body weight per day to meet guideline recommendations.

Nasopharyngeal Dysbiosis Precedes the Development of Lower Respiratory Tract Infections in Young Infants, a Longitudinal Infant Cohort Study

Background Infants suffering from lower respiratory tract infections (LRTIs) have distinct nasopharyngeal (NP) microbiome profiles that correlate with severity of disease. Whether these profiles precede the infection or are a consequence of it, is unknown. In order to answer this question, longitudinal studies are needed. Methods We conducted a retrospective analysis of NP samples collected in a longitudinal birth cohort study of Zambian mother-infant pairs. Samples were collected every two weeks from 1-week through 14-weeks of age. Ten of the infants in the cohort who developed LRTI were matched 1:3 with healthy comparators. We completed 16S rRNA gene sequencing on the samples each of these infants contributed and compared the NP microbiome of the healthy infants to infants who developed LRTI. Results The infant NP microbiome maturation was characterized by transitioning from Staphylococcus dominant to respiratory-genera dominant profiles during the first three months of life, similar to what is described in the literature. Interestingly, infants who developed LRTI had distinct NP microbiome characteristics before infection, in most cases as early as the first week of life. Their NP microbiome was characterized by the presence of Novosphingobium, Delftia, high relative abundance of Anaerobacillus, Bacillus, and low relative abundance of Dolosigranulum, compared to the healthy controls. Mothers of infants with LRTI also had low relative abundance of Dolosigranulum in their baseline samples compared to mothers of infants that did not develop an LRTI. Conclusions Our results suggest that specific characteristics of the NP microbiome precede LRTI in young infants and may be present in their mothers as well. Early dysbiosis may play a role in the causal pathway leading to LRTI or could be a marker of underlying immunological, environmental, or genetic characteristics that predispose to LRTI.