Term Newborns Research Articles

Promotion of breastfeeding in Italian Maternity Hospitals: a pre-intervention study

BackgroundIn Italy, exclusive breastfeeding (EBF) rates at hospital discharge range unsatisfactorily between 20–97%.MethodsIn 2023, the Project for Hospital Policy on Breastfeeding (HPB) has been launched to promote breastfeeding in Italian Maternity Hospitals (MHs) as a joint initiative of the Italian Scientific Societies involved in perinatal care together with the National Midwife (FNOPO) and Nurse (FNOPI) Boards and with Vivere Onlus, a family association. The HBP Project has been designed as an uncontrolled before-after study to increase EBF rate at hospital discharge in the population of healthy, term infant with a normal weight at birth following an intervention bundle comprising: 1) Establishment of a local hospital Working Group; 2) Adoption of a hospital policy; 3) Implementation of breastfeeding monitoring; 4) Training for perinatal care professionals; 5) Enhanced implementation of the practices of skin-to-skin contact (SSC) and mother-baby rooming-in; 6) Development/Improvement of perinatal care protocols.ResultsWe report the pre-intervention assessment of 89 out of the 111 enrolled MHs (80.2%) at the beginning of the Project (Time 1 or T1). Almost all MHs (96.6%) have a multi-professional Breastfeeding Working Group, while a hospital policy on breastfeeding is available only in 48.2%. Moreover, only 56.2% of the 9,777 perinatal health workers have been trained in breastfeeding. Over a 1-month period, SSC has been practiced in the delivery room by 76.9% of 6,304 term healthy newborn infants and rooming-in by 83.4% of 6,735 healthy term newborns of normal weight at birth. Over a 4-month period, 69.1% of 33,367 healthy term newborns of normal birth weight were exclusively breastfed at hospital discharge. Noticeably, EBF rate of MHs ranges from 4% up to 100%, the second quartile being 73%.ConclusionAt T1 of the HPB Project, breastfeeding rates at hospital discharge for healthy, term infants with a normal weight at birth appear to be suboptimal among Italians MHs. Particularly, the range of EBF rates among participating centers is wide, with 50% of the MHs having EBF rate lower than 73%. Therefore, the ongoing HPB Project might represent not only an opportunity to increase the initiation of breastfeeding and to improve quality of health care in the whole study group of MHs, but possibly also to level differences between centers.

Risk factors for neonatal admission from the beginning of pregnancy in Northeast Spain.

Maternal health and gestational control are crucial to improving the newborn's prognosis. This study analyses demographic and obstetric factors at the beginning of pregnancy related to neonatal health, assessing their impact on the risk of hospital admission and prematurity. Observational retrospective study conducted in Northeast Spain with data of 9560 newborns between February 2017 and February 2022. The following have been evaluated as risk factors for hospital admission: nulliparity, multiple gestation, fertilisation techniques, foreign maternal origin, maternal age, smoking and residential location, dividing the sample according to gestational age. Hypothesis testing and logistic regression were performed. Nulliparity, fertilisation techniques and multiple gestation represent a risk factor for neonatal admission (OR 22.48, 4.04 and 3.34, respectively), especially in premature newborns <32 weeks of GA (OR: 30.71, 10.71 and 22.76, respectively). Foreign maternal origin also adds risk of admission, both in term newborns (OR 1.26; CI: 1.10-1.43) and in premature babies <32 weeks of GA (OR 1.61; CI: 1.09-2.38). Tobacco does not present a significant risk of neonatal admission. The multivariate analysis model confirms the influence of the following factors in all the studied groups: nulliparity, multiple gestation and foreign maternal origin. Nulliparity and multiple pregnancies are both main risk factors for neonatal admission and premature delivery. The use of fertilisation techniques and the foreign origin of the mother significantly associate increased risk of admission and neonatal prematurity. These findings underscore the need for a comprehensive approach to prenatal care to improve neonatal prognosis and promote long-term health in risk populations.

Neurodevelopmental outcome in children between one and five years after persistent pulmonary hypertension of term and near-term newborns

BackgroundPersistent pulmonary hypertension of the newborn (PPHN) is a serious condition that affects 1–2 per 1,000 newborns. Scientific data report the existence of neurological developmental abnormalities between 10 and 30%, but the description of these disorders linked with this situation of cerebral hypoxia and haemodynamic failure remains poorly documented.ObjectiveThe main goal of this study was to describe the prevalence of neuro-psychomotor developmental disorders in children aged between one and five years old who have been hospitalised at birth in a neonatal intensive care unit for the management of PPHN.MethodsAll of the newborns ≥34 weeks of gestational age (WGA) with PPHN, treated with inhaled nitric oxide in our neonatal intensive care unit between January 2015 and December 2019 were retrospectively enrolled. An ASQ-3 standardised questionnaire, adapted to the appropriate age (12, 24, 36, 48 and 60 months) was performed by the parents.ResultsFifty-five children (81% of answers) with a median age of 36 months (11–68), whose real age was close to the one of the questionnaire (12, 24, 36, 48 and 60 months), have been included in this study. There was 47% of pathological score [borderline: less than 1 standard deviation (SD) or suspect: less than 2SD] in at least one of the five studied domains, mainly in communication (25%) and individual and social skills (22%), despite a high overall score of 250 [220; 285] out of 300 that improved with age.ConclusionThis study showed a significant prevalence of neuro-psychomotor developmental disorders which justifies making more accessible a prolonged and adapted follow-up for early and multidisciplinary screening and management of these children with PPHN history. Larger cohorts are needed to better explore long term outcome of these vulnerable term neonates.

A rare case report of hemolysis in a newborn: hereditary elliptocytosis

IntroductionHereditary Elliptocytosis (HE) comprises clinically and genetically heterogeneous red cell membranopathies resulting from defects in the horizontal linkage between red blood cell (RBC) membrane and cytoskeletal proteins, which affect mechanical stability and deformability, thereby reducing RBC lifespan. The principal defect in HE is due to dysfunction or deficiency of RBC cytoskeletal proteins.Case descriptionThis study reported a case of severe hemolysis occurring within one day after birth in a term newborn. High-throughput sequencing was used to characterize the pathogenic gene variation in this child and to study the correlation between the identified variation and its corresponding phenotypic characteristics.ConclusionHE is caused by monoallelic mutations, which justify the phenotypic heterogeneity observed in patients. Furthermore, molecular analysis using high-throughput sequencing enables diagnosis in disorders with highly variable heterogeneity. HE can also present with severe hemolysis during the neonatal period.

Gestational Diabetes : A Cross-Section of Factors and Complications in Mothers and Newborns in Southern Morocco

By way of introduction, the prevalence of gestational diabetes varies between 1% and 14%, in Morocco, a single study conducted in Dakhla in southern Morocco in 2019, estimates that the prevalence of GD is 7.7% in accordance with the recommendations of the American Diabetes Association, hence the need to explore the epidemiological profile in southern Morocco.  Methodology:- A cross-sectional descriptive analytical correlational epidemiological survey of 202 pregnant women during the period 2021-2022, conducted at the Dakhla regional hospital centre, which attempts to describe the individual, biological and gynecological-obstetric risk factors in pregnant women with gestational diabetes. As well as maternal and neonatal complications. The study also analyses the effect of hospital performance on the management of parturients.  Results:- The prevalence of GD is high in the age group [35,41] and over 42 years, mainly among illiterate. Several risk factors have been identified for GD : age, high preconceptional BMI, low level of education, polycystic syndrome, history of urinary infection, positive vaginal swab for Streptococcus B, and complications for mothers and newborns revolving around Dystocic delivery, macrosomia and hypoglycaemia in newborns. There is also retinopathy in premature babies due to candida albicans and early bacterial infection due to GSB in full- term newborns.

Study of the Evolution of a Cohort Of Low-Birth-Weight Newborns at Neonatal Discharge: A Perspective on Health and Sustainable Development Goals

Aims: This study aims to analyze the evolution of a cohort of low-birth-weight newborns at neonatal discharge, identifying key health outcomes and socio-economic factors. The goal is to inform strategies aligned with Sustainable Development Goal 3 (SDG 3), focusing on improving neonatal health, reducing child mortality, and promoting equitable access to healthcare. Method: A 12-month prospective cohort study was conducted from June 2020 to July 2021 at the neonatal and nutrition referral center of the Rabat children's hospital. The study included all newborns admitted with a birth weight under 2500g, regardless of the cause of hospitalization. Results: Among 200 low-birth-weight newborns, 42.5% showed extra-uterine growth retardation at discharge. Of these, 50.6% were full-term newborns and 36% were premature infants. Full-term newborns regained birth weight in an average of 5.96±4.07 days, with a median of 4 days. For premature infants, weight recovery averaged 11±8.09 days, with a median of 8 days. Conclusions: The study assessed the progress of low-birth-weight full-term and premature babies at discharge. Tailored nutritional management is crucial, requiring an adaptable strategy from the start and continued adjustments based on clinical progress. Of the cohort, 36.03% were hypotrophic premature infants, and 50.6% were full-term low-birth-weight babies. Enhancing neonatal care quality remains a key challenge, emphasizing the need for collaboration among healthcare professionals to ensure growth monitoring and meet the specific needs of this vulnerable group.

Dysbiosis of the initial stool microbiota increases the risk of developing necrotizing enterocolitis or feeding intolerance in newborns

Several perinatal factors influence the intestinal microbiome of newborns during the first days of life, whether during delivery or even in utero. These factors may increase the risk of developing necrotizing enterocolitis (NEC) by causing dysbiosis linked to a NEC-associated microbiota, which may also be associated with other gastrointestinal problems. The objective of our study was to evaluate the potential risks associated with microbial shifts in newborns with gastrointestinal symptoms and identify the intestinal microbiota of neonates at risk for NEC.During the study period, 310 preterm and term newborns’ first passed meconium occurring within 72 h of birth were collected, and the microbiome was analyzed. We identified the risk factors in the NEC/FI group. Regarding microbiota, we compared the bacterial abundance between the NEC/FI group at the phylum and genus levels and explored the differences in the microbial composition of the 1st stool samples. A total of 14.8% (n = 46) of the infants were diagnosed with NEC or FI. In univariate analysis, the mean gestational age and birth weight were significantly lower in the NEC/FI group (p < 0.001). Prolonged rupture of membranes (PROM) > 18 h, chorioamnionitis, and histology were significantly higher in the NEC/FI group (p < 0.001). Multivariate analysis showed that gestational age (GA), prolonged membrane rupture (> 18 h), and early onset sepsis were consistently associated with an increased risk of NEC/FI. Infants diagnosed with NEC/FI exhibited a significantly lower abundance of Actinobacteria at the phylum level than the control group (p < 0.001). At the genus level, a significantly lower abundance of Streptococcus and Bifidobacterium which belong to the Actinobacteria phylum, was observed in the NEC/FI group (p < 0.001). Furthermore, the NEC/FI had significantly lower alpha diversities (Shannon Index,3.39 vs. 3.12; P = 0.044, respectively). Our study revealed that newborns with lower diversity and dysbiosis in their initial gut microbiota had an increased risk of developing NEC, with microbiota differences appearing to be associated with NEC/FI. Dysbiosis could potentially serve as a predictive marker for NEC- or GI-related symptoms.

Comparing peripheral limb and forehead vital sign monitoring in newborn infants at birth.

To study the feasibility of measuring heart rate (HR) and oxygen saturation (SpO2) on the forehead, during newborn transition at birth, and to compare these measurements with those obtained from the wrist. Vital signs were measured and compared between forehead-mounted reflectance (remittance) photoplethysmography sensor (fhPPG) and a wrist-mounted pulse oximeter sensor (wrPO), from 20 enrolled term newborns born via elective caesarean section, during the first 10 min of life. From the datasets available (n = 13), the median (IQR) sensor placement times for fhPPG, ECG and wrPO were 129 (70) s, 143 (68) s, and 159 (76) s, respectively, with data recorded for up to 10 min after birth. The success rate (percentage of total possible HR values reported once sited) of fhPPG (median = 100%) was higher compared to wrPO (median = 69%) during the first 6 min of life (P < 0.005). Both devices exhibited good HR agreement with ECG, achieving >95% agreement by 3 (fhPPG) and 4 (wrPO) min. SpO2 for fhPPG correlated with wrPO (r = 0.88), but there were significant differences in SpO2 between the two devices between 3 and 8 min (P < 0.005), with less variance observed with fhPPG SpO2. In the period of newborn transition at birth in healthy term infants, forehead measurement of vital signs was feasible and exhibited greater HR accuracy and higher estimated SpO2 values compared to wrist-sited pulse oximetry. Further investigation of forehead monitoring based on the potential benefits over peripheral monitoring is warranted. This study demonstrates the feasibility of continuously monitoring heart rate and oxygen saturation from an infant's forehead in the delivery room immediately after birth. Significantly higher SpO2 measurements were observed from the forehead than the wrist during the transition from foetal to newborn life. Continuous monitoring of vital signs from the forehead could become a valuable tool to improve the delivery of optimal care provided for newborns at birth.

Factors associated with breastfeeding rates at 1 month of age: Focusing on newborn feeding behaviours in a Japanese maternity hospital.

This study investigated the relationship between newborn feeding behaviour and feeding type among month-old babies and explored maternal and neonatal factors associated with breastfeeding rates at 1 month of age. This observational study was conducted in Japan with healthy mothers and full-term newborns. Newborn feeding behaviours were assessed using the Japanese Infant Breastfeeding Assessment Tool (IBFAT) within approximately 1 day of birth. Obstetric and newborn characteristics, including newborn feeding behaviours, were investigated in relation feeding type (breast milk or mixed milk) at 1 month of age. This study included 176 mother-newborn pairs. IBFAT scores were significantly higher in the breast-milk group (Median (M) = 10.5, Interquartile Ranges (IQR): 9.0-11.0) than in the mixed-milk group (M = 10.0, IQR: 7.5-11.0) (P = 0.046). Additionally, the sucking pattern of breastfeeding was showing a greater distribution of higher scores in the breast-milk group (M = 2.0, IQR: 2.0-2.5) than in the mixed-milk group (M = 2.0, IQR: 1.5-2.5) (P = 0.015). Compared to mothers who received epidural analgesia or synthetic oxytocin, primiparas who did not receive them were more likely to breastfeed (epidural analgesia: (33.3% vs. 65.8%, P = 0.004); synthetic oxytocin: (42.0% vs. 78.6%, P = 0.018)). For multiparas, Apgar and IBFAT scores were associated with feeding type at 1 month of age. This study found that newborns' effective and sustained sucking within 1 day of birth is an important factor for breastfeeding at 1 month of age. When assessing feeding type, maternal factors such as epidural analgesia should be the focus for primiparas, while neonatal factors such as feeding behaviour should be prioritised for multiparas.

Impact of high-flow nasal oxygen therapy on postoperative atelectasis and reintubation rate after paediatric cardiac surgery.

Airway problems emerging after congenital cardiac surgery operations may have an impact on mortality and morbidity. Recently, to improve alveolar gas exchange and reduce respiratory effort, high-flow nasal cannula (HFNC) has started to be used in paediatric cases. This study aimed to evaluate the potential effects of high-flow nasal oxygen therapy on postoperative atelectasis development and reintubation rate in paediatric cardiac surgery patients. This study was conducted retrospectively in term newborns and infants younger than six months of age who underwent congenital cardiac surgery operation from 1 November 2022 to 1 November 2023 and were followed in the paediatric cardiac ICU. Patients who were receiving mechanical ventilator support at least 12 hours postoperatively were evaluated for the development of postoperative atelectasis and reintubation in the first 3 days of extubation. The patients were grouped as HFNC and non-HFNC users. Demographic characteristics, surgery type, and ICU clinical follow-up data were obtained from medical records. The results were statistically evaluated. A total of 40 patients who did not use HFNC in the early postoperative period and 40 patients with HFNC in the late period during the study period were included in the study. The median age was 1 month (IQR 15 days-2 months) with equal gender distribution. Among patients, 70% of them were in the neonatal age group. Reintubation rates in the first 72 hours in HFNC users and non-HFNC users were 2.5% and 12.5%, respectively (p < 0.05). The median postoperative atelectasis scores at 24, 48, and 72 hours of extubation were 2 versus 2.5 (p > 0.05), 1.5 versus 3.5 (p < 0.05), and 1 versus 3 (p < 0.05) in HFNC users and non-HFNC users, respectively. HFNC therapy may have a positive effect on preventing atelectasis and reducing the reintubation rate in the early postoperative period.

Duration of a standard phototherapy course in jaundiced newborns with no neurotoxicity risk.

In this study, we aimed to determine an ordinary/empiric/standard phototherapy treatment protocol for duration without controlling total serum bilirubin (TSB) levels after initiating phototherapy in early-term and full-term jaundiced newborns who had no hyperbilirubinemia neurotoxicity risk factors. We compared two groups, each receiving either 24 h (Group I) or 18 h (Group II) of continuous phototherapy in terms of demographic characteristics and efficacy (rate of decrease in TSB levels with phototherapy). No control TSB measurements were performed in the study groups until the end of phototherapy for the predetermined durations. Declines in TSB after phototherapy were significantly greater in Group I than in Group II, both in terms of mg/dl (11.81 ± 2.93 mg/dl vs. 10.75 ± 2.48 mg/dl, P = .0008) and percentage (56.71 ± 9.06% vs. 52.86 ± 8.37%, P = .0002). However, the rate of TSB reduction after phototherapy in mg/dl/h (0.59 ± 0.13 mg/dl/h vs. 0.49 ± 0.12 mg/dl/h, P = <.0001) and percentage per hour (2.93 ± 0.37% vs. 2.36 ± 0.46%, P = <.0001) were significantly higher in Group II than in Group I. This indicates an inverse time-response relationship between the duration of phototherapy and the response rate in the study groups. Although the 24-h phototherapy course showed greater efficacy concerning the primary bilirubin outcome measures (decline in TSB in mg/dl and %), the 18-h course of phototherapy treatment provided better hourly outcomes and reached its saturation point around the 18th hour. Therefore, an 18-h phototherapy without TSB monitoring until the end of the phototherapy should be considered for jaundiced newborns lacking neurotoxicity risk factors.

A-062 Determination Neonatal 17-Hydroxyprogesterone Cutoff Levels for Congenital Adrenal Hyperplasia in Korea: 3 years' experience

Abstract Background Newborn screening for congenital adrenal hyperplasia (CAH) is a crucial practice with significant global adoption. While it offers substantial benefits, it also presents challenges due to high false positive rates, which can lead to mental strain for families and unnecessary hospital visits. Our research delved into the impact of birth weight (BW), gestational age (GA), and GA combined with sampling time on 17-hydroxyprogesterone (17-OHP) concentration. Specifically, we aimed to establish appropriate 17-OHP cutoff values for preterm, low birth weight weight (LBW), and sick newborns. Methods A total of 2,429 newborns born between October 2020 and January 2024 were screened for CAH. Samples were collected from neonates on a filter paper with a heel prick method. The 17-OHP concentration was measured by AutoDELFIA Neonatal 17-hydroxyprogesterone kit (PerkinElmer, Turku, Finland). This assay is a solid phase, time-resolved fluoroimmunoassay based on the competitive reaction between europium labeled 17-OHP and sample 17-OHP for a limited amount of binding sites on 17-OHP specific polyclonal antibodies. The 99.5 percentile was applied to the cutoff of 17-OHP for CAH. Results 17-OHP concentrations in newborns with lower BW and GA were significantly higher than those in normal BW and term newborns. 17-OHP concentration showed a statistically significant negative correlation with BW (r = -0.512, p &amp;lt; 0.001) and GA (r = -0.578, p &amp;lt; 0.001). Not only the full-term subgroup, but also preterm subgroups had a same tendency of 17-OHP concentration decrease with increasing sampling time. Application of newly establishing 99.5 percentile cutoff criteria significantly reduced recall rates to 1.02%, 0.81%, and 1.45% according to each criterion of BW, GA, and GA with sampling time, respectively. Conclusions This research introduces novel 17-OHP cutoff values for preterm, low birth weight (LBW), and sick newborns in the context of congenital adrenal hyperplasia (CAH). We analyzed the distribution of these cutoff values, considering factors such as birth weight, gestational age, and the timing of sample collection. Notably, applying the newly established cutoff criteria led to a significant reduction in false positive rates. Our laboratory’s data can serve as a valuable reference for other institutions aiming to set appropriate cutoffs, thereby minimizing unnecessary follow-up tests and enhancing the efficiency of CAH screening. As we continue to accumulate additional data, further reserch in this field remains promising.

A-153 Study of the evaluation of fragment flag and percentage schistocyte count in MINDRAY® BC-6800 PLUS in a public pediatric hospital in Argentina

Abstract Background Schistocytes are fragmented red blood cells (FRCs) that arise from the mechanical destruction of red blood cells (RBCs). They indicate the possible presence of a thrombotic microangiopathy (TMA). TMA includes hemolytic uremic syndrome (HUS) and thrombotic thrombocytopenic purpura(TTP). ICSH defined schistocytes as 4 well stablish shapes always smaller than intact RBCs. The gold standard for the identification of schistocytes is microscopic evaluation. A schistocyte count should be considered clinically meaningful if it represent the main morphological RBCs abnormality in the periferic blood smear (PBS). The results should be expressed as a percentage, after counting at least 1000 RBCs in optimal areas of the PBS. The cut off for TMA was previously stablished in above 1% (adult population) and a higher percentaje in pre term newborns (above 5%). Some blood cell count analyzers have a flag for FRC, and some of them also provide methods for an automated FRC count, through the measurement of forward scatter and the intensity of fluorescence or 2-dimensional optical analysis. The Mindray® BC 6800 PLUS provides a flag for fragments and the research FRC% parameter that quantifies fragmented RBCs. When the flag and the FRC% are combined, can bring value to diagnostic TMA. Objetives Evaluate the sensitivity and specificity of the fragment flag to predict schistocyte on the PBS of pediatric samples. Evaluate the utility of FRC% as TMA diagnostic tool and compare with the gold standard. Methods 725 pediatric samples were analyzed (0-18 years).16 of them was patient samples diagnosed with TMA. All blood cell counts were determined using Mindray®BC-6800 PLUS. Cut off 1% was considered for FRC% in TMA. Inclusion criteria for TMA samples include thrombocytopenia, increased lactate dehydrogenase and decreased hemoglobin concentration. Schistocyte counting was carried out from May-Grunwald-Giemsa-stained PBS according to the recommendations proposed by ICSH. Only ICSH established shapes were kept as valid. Results Regarding the sensitivity of the fragment flag, it was 84.62% with a specificity of 91.13% to detect the presence of schistocytes in PBS samples. In the Bland-Altman analysis, the FRC% shows a difference with a tendency to underestimation with respect to the observation on the PBS, which was less at lower percentages of schistocytes. The sensitivity of the FRC% to TMA was 75% while the specificity was 94.36% and a negative predictive value (NPV) of 99.41%. Conclusions Fragments flag represents a potentially powerful tool for screening of squistocytes in pediatric samples. Although sensibility and NPV for FRC% authomatical counts were acceptable, a few false-negative samples were found. Presence of FRC% below a threshold of 1% could exclude TMA.However PBS microscopic observation is still the gold standard to determine squistocytes presence. For the purpose of complete our study and to get further larger scale prospective data, we started collecting all data for all samples entering the laboratory in order to improve an authomatical method that should have a more rapid turn-around time at lower costs.

Early parental vocal contact in neonatal units: rationale and clinical guidelines for implementation.

This paper aims to present clear and evidence-based proposals for the integration of Early Parental Vocal Contact into the clinical practices of neonatal units. In the first part, we present a comprehensive rationale exploring the ontogenesis of voice perception in both term and preterm newborns that establishes a foundational understanding. This knowledge serves as a crucial starting point for developing evidence-based auditory and multisensory interventions aimed at fostering the developmental trajectory of preterm infants. Drawing insights from neuroscience and brain development, our proposals underscore the significance of tailoring auditory environments within neonatal settings. Special attention is given to the unique needs of preterm infants, factoring in their gestational age and maturation levels. In the second part clinical guidelines for implementation are provided and healthcare professionals are supported to assist parents in modulating their vocal interactions, aligning them with the infant's responses. Furthermore, we provide practical suggestions for engaging in discussions with parents about the content, duration, and frequency of vocal interventions. Finally, we delve into the potential roles of caregivers, parents, and health professionals within this enriched parental vocal interactional environment. Our perspective is firmly grounded in an infant and family-centered developmental care philosophy, aiming to enhance the overall well-being and the neurodevelopment of preterm infants in neonatal units.

Effects of skin-to-skin contact on mental health outcomes in the parents of full-term newborns: A systematic review and meta-analysis of randomized clinical trials

BackgroundThe postpartum period can be emotionally challenging for parents, with documented levels of anxiety, stress, and depression. While the benefits of skin-to-skin contact (SSC) are well-known, its impact on the mental health of parents of full-term newborns has been less studied. Objective: We aimed to assess the effects of SSC in mental health outcomes in the parents of full-term newborns. MethodsIn this systematic review, a comprehensive search was conducted to identify randomized clinical trials (RCTs) comparing SSC versus no SSC and assessing mental health outcomes. Meta-analyses were performed whenever possible, and the GRADE approach was used to rate the certainty of evidence. ResultsWe included 9 RCTs with 1201 participants. Regarding the risk of bias, the most affected domains were selective reporting, blinding, and allocation concealment. Regarding parental anxiety, SSC may reduce it at short-term, while it is unsure its effect at mid-term and it may not have any effect at long-term. Regarding Psychological stress, SSC may not have an impact at mid- and long-term. Regarding delivery-related post-traumatic stress symptoms, SSC may not have an impact at short-, mid-, and long-term. Regarding depressive symptoms, the evidence is uncertain at short- and mid-term. LimitationsFor the assessed outcomes, certainty of the evidence was low or very low. ConclusionSSC may reduce parental anxiety at short-term, while it may not have an impact in psychological stress and delivery-related post-traumatic stress symptoms. Moreover, the evidence is uncertain regarding its effect in long-term anxiety and depressive symptoms.

Adjuvant High Dose Erythropoietin with Delayed Therapeutic Hypothermia in Neonatal Hypoxic-Ischemic Encephalopathy

BackgroundTherapeutic hypothermia (TH) is the standard of treatment for moderate to severe HIE. However, half of asphyxiated babies have a disability despite undergoing hypothermia. Erythropoietin (EPO) is a potential neuroprotective agent. ObjectiveTo evaluate the benefits of high-dose EPO combined with TH on brain magnetic resonance imaging (MRI) scores and neurodevelopmental outcomes in neonates with moderate-to-severe HIE, especially in neonates who received TH between 6–12 h of birth. MethodsThis prospective, single-blinded, randomized, placebo-controlled trial enrolled term newborns with moderate to severe HIE admitted to neonatal ICU between April 2018 and April 2022. Hypothermia was started within 12 hours of age. Infants were randomized to receive EPO 1000 units/kg or an equal volume of normal saline (placebo) on days 1,2,3,5 and 7 of age in combination with hypothermia. ResultsFifty-seven neonates with moderate-to-severe HIE were recruited; ten were excluded. Forty-seven patients were included: 32 received TH within 6 hours (group I) and 15 TH was started within 6–12 h of birth (group II). The clinical characteristics of mothers, infants, maternal complications, and resuscitations performed during the perinatal period showed no statistical differences between EPO and placebo groups I and II. The MRI scores and brain injury patterns did not differ between the EPO and placebo groups. There is no statistical significance in either group's seizure and severe EEG background (initial and after rewarming) between EPO and placebo in each group. There were no differences in developmental outcomes (Abnormal Denver II >2 area, GMFCS >1), BSID-III score (cognitive, language, and motor), or disability (hearing impairment and impaired vision) between the EPO and placebo Groups I and II at 12 and 18 months. ConclusionsAmong term infants with moderate-to-severe HIE, TH with EPO administration, compared with TH alone, did not reduce brain injury on MRI or reduce the risk of neurological sequelae both in TH within 6 h and in patients who received TH late later (6–12 h). Further studies on the benefit of EPO injection alone or before TH in situations where TH cannot be performed are required.

Is buprenorphine maternal dose associated with neonatal opioid withdrawal syndrome severity?

Neonatal opioid withdrawal syndrome (NOWS) is a drug withdrawal syndrome occurring mainly after in utero opioid exposure. Buprenorphine is commonly used for opioid withdrawal. Studies are conflicted about a potential dose effect OBJECTIVE: The aim of our study was to investigate the impact of buprenorphine maternal maintenance therapy on the NOWS based on NOWS duration, birth weight and therapy. We conducted a retrospective study analysing data from infants admitted for NOWS in two Neonatal Intensive Care Unit between January 2010 and December 2020. Nonpreterm infants born to mothers who were treated with buprenorphine or therapy during pregnancy and who had a Lipsitz score of 4 or higher. A total of 75 term newborns were hospitalized for the treatment of NOWS from mother substituted with buprenorphine during the study inclusion period. The duration of NOWS differed significantly between all dose cohorts, with higher doses of maternal buprenorphine maintenance correlating with longer length of NOWS duration. Infants exposed to high doses required 17 days [10; 23], while infants exposed to intermediate doses required 7 days [2; 16] and infants exposed to low doses required 3 days [2; 5], with p-values < .003. Infants exposed to high doses required a longer time to regain their birth weight and higher morphine doses as therapy compared to others. Infants exposed to low doses, intermediate doses, and high doses of buprenorphine demonstrated dose-dependent increases in the durations of hospitalization, respectively. Increased doses of maternal buprenorphine during pregnancy are correlated with NOWS severity. Our study shows that increased doses of maternal buprenorphine during pregnancy are correlated with NOWS severity. Exploring low doses and having different ranges are a new argument to define the impact of maternal buprenorphine consumption.

Cryptorchidism: An update of advances in its diagnosis and treatment

The absence of one or both testicles in the scrotal position is defined as cryptorchidism. It occurs in 1 - 8 % of full-term newborns and up to 45 % of preterm newborns. Its detection is of great importance due to its association with fertility disorders and the risk of malignancy. The National Endocrinology Committee of the Sociedad Argentina de Pediatría decided to prepare an update document on advances in the diagnosis and treatment of cryptorchidism that contributes to the performance of pediatric practice and allows recognition of conditions that may be accompanied by cryptorchidism, but need more evaluation and referral to a specialist, such as alterations/differences in sexual development, anorchia, genetic syndromes, among others. The first-line treatment is early orchiopexy before 12 to 18 months, always in the hands of pediatric surgeons.

Comparison of One-Year Post-Operative Evolution of Children Born of COVID-19-Positive Mothers vs. COVID-19-Negative Pregnancies Having Congenital Gastrointestinal Malformation and Having Received Proper Parenteral Nutrition during Their Hospital Stay.

Background: The long-term effects on neonates born of COVID-19-positive pregnancies are still unclear. Congenital gastrointestinal malformations (CGIMs) often require urgent surgical intervention and antibiotic coverage. We aim to compare the health status at one-year post-surgical follow-up of cases of CGIM born of COVID-19-positive pregnancies to those of non-COVID-19 pregnancies. Methods: We conducted a comparative, observational study of 41 patients who underwent surgery at our hospital for congenital gastrointestinal malformations in 2022. They were initially treated with antibiotics and parenteral nutrition, which was later replaced with enteral nutrition gradually after the surgery. We then analyzed the data related to their growth and development during their 12-month follow-up visit at our outpatient clinic. We classified the children born of COVID-19-positive mothers as Group 1 (n = 14) and those born of mothers without COVID-19 symptoms or with unconfirmed status as Group 2 (n = 33). Results: Forty-one patients showed up for a one-year follow-up (between 11 and 13 months of life). Hence, the final Group 1 comprised 12 and Group 2 comprised 29 children. The patients were categorized based on their anatomical location. Of the cohort, 56.09% were preemies, and 43.91% were full-term newborns. We used seven parameters to evaluate both groups based on growth and developmental milestones: verbal skills, cognitive development, weight gain, height achieved, fine motor movements, gross motor movements, and social/emotional behavior. Group 1 children showed a significant decrease in height and weight compared to Group 2 children. In Group 1, 83.33% of patients were prescribed antibiotics, while only 10.34% in Group 2 were in the same situation. There were no cases of malabsorption syndrome in Group 2, but 16.66% of patients in Group 1 had it, with patients being operated on for duodenal malformations. None of the infants had necrotizing enterocolitis, post-surgical complications, or sepsis. All the children received antibiotics to prevent infection before and after surgery. No mortality was noted. Conclusions: In our one-year follow-up study, it was seen that even after surgical correction of congenital gastrointestinal malformations, children born of COVID-19-positive pregnancies can suffer serious growth and developmental delays, and gastrointestinal health issues might be more common. Since the long-term effects of COVID-19-positive pregnancies are not yet clear, larger cohort-based studies are required in this domain. Antibiotics destroy gut microbiota, especially in cases of gastrointestinal malformations and surgical resections. Growth and developmental milestones can not only be affected by CGIMs but also be further delayed by COVID-19 infections.

Vitamin D Deficiency and Maternal Diseases as Risk Factors for the Development of Macrosomia in Newborns.

Background: The aim is to assess the association between the level of vitamin D, maternal diseases, and macrosomia in newborns. Methods: This study included 258 full-term newborns (86 newborns with macrosomia; and 172 newborns with normal weight). Enzyme immunoassays for the determination of vitamin D were performed. Results: Newborns with macrosomia were statistically significantly more likely to have severe vitamin D deficiency compared with control (13.5 ± 6.7 ng/mL vs. 21.3 ± 12.1 ng/mL; p < 0.05). In the main group, severe deficiency was found in 40.7% of newborns, in the control group this rate was 5.8% (χ2 = 71,788, df = 3, p < 0.001). Multiple regression analysis shows that statistically significant risk factors for the development of macrosomia were vitamin D deficiency in the cord blood (OR = 2.29), maternal age over 36 years old (OR = 19.54), and hypothyroidism (OR = 9.35). Conclusion: the results of our study demonstrate relationship between macrosomia in newborns and vitamin D deficiency in the cord blood, maternal overweight and obesity, maternal age and thyroid disease.