Healthy Neonates Research Articles

Improving Early Initiation of Breastfeeding in Healthy Late Preterm Neonates Through Reformed Lactation Support Program: A Before and After Study

Background Early Initiation of Breastfeeding (EIBF) reduces neonatal mortality up to three times, particularly in preterm and low-birth weight infants. Existing Lactation Support Program (LSP) of the institute tackles breastfeeding-related issues to achieve EIBF as early as possible for all delivered healthy infants. LSP was reformed by introducing new policy in February 2021 to achieve EIBF <1 hour in all healthy delivered neonates. Aim The aim of the study was to study the efficacy of new lactation policy of LSP on rates of EIBF and time to attain the first breastfeeding in late preterm neonates of gestational age 35+0 weeks -36+6 weeks. Method A ‘before-and-after’ design was used to study the effect of the new policy on EIBF at a tertiary care institute in India from January 2018 to March 2023. Impact was assessed by comparing baseline data in pre-policy (group A) with that of new policy (group B). Result Among 417 babies included, 336 and 81 belonged to group A and B, respectively. EIBF rates were 42% and 99% in group A and group B, respectively ( p < .0001). Median time to initiate EIBF was 100 min IQR [85–117] in group A compared to 26 minutes IQR [19–37] in group B ( p < .0001). Conclusion Lactation support program is an invaluable key practice for attainment of EIBF. Through simple measures, significant improvement in EIBF was possible in healthy late preterm population. This LSP can be considered as ideal model to be adapted at national level to improvise EIBF.

Endometrioid carcinomas with sex cord-like formations and hyalinization: spontaneous pregnancy after conservative treatment

Endometrioid carcinoma with sex cord-like formations and hyalinization of the uterine corpus, or corded and hyalinized endometrioid adenocarcinoma (CHEC), is a rare morphological variant of endometrioid carcinoma, for which there is limited literature and few cases reports. Most researchers tend to consider CHEC as a low-grade cancer with a favorable prognosis. Full-staging surgery is the primary choice for this disease, and no case of CHEC has been previously reported to be treated conservatively. Here, we present the following case to explore the possibility of fertility-preserving treatment for young women with CHEC. A 23-year-old nulliparous patient diagnosed with presumed stage IA CHEC received fertility-sparing treatment at the Obstetrics and Gynecology Hospital of Fudan University and got a complete response (CR) after 10 months of conservative treatment. The patient subsequently became pregnant spontaneously, successfully conceived, and gave birth to a healthy male neonate without any sign of recurrence during 37 months follow-up after CR. The patient’s postpartum follow-up is continuing. Presently, CHEC is not included in the fertility-sparing field of any available guidelines. This case indicates that fertility-sparing treatment may be an option for highly selected patients with CHEC. Continuous follow-up remains mandatory to observe long-term outcomes.

Relative Adrenal Insufficiency in Full-Term and Preterm Neonates with Neonatal Sepsis

Background: Neonatal sepsis is the third most common cause of death in newborns and a significant issue for public health, particularly in developing nations. This study aimed to assess the hypothalamic-pituitary-adrenal axis (HPA) response in full-term and preterm newborns diagnosed with neonatal sepsis in the neonatal intensive care unit (NICU).
 Methods: This cross-section observational research was done on neonates who were categorized into two main groups Group I: Sepsis neonates who were further subdivided into two groups according to the gestational age into 30 full-term neonates with neonatal sepsis and 30 preterm neonates with neonatal sepsis. Group II: Included 30 healthy control neonates.
 Results: HSS score and C reactive protein (CRP) level were correlated with serum cortisol level at (9 am: r=-0.273, P<0.035 and r=-0.447, P<0.001), (9 pm: r=-0.447, P<0.001and r=-0.477, P<0.001) ACTH at (9 am: r=-0.314, P<0.015 and r=-0.377, P<0.003) and at (9 pm: r= -0.362, P<0.005 and r=-0.448, P<0.001) and cortisol level post ACTH stimulation (r=-0.345, 0.007 and r=-0.497, P<0.001) respectively. Regarding inotropes, sepsis type and oxygen support there was significant difference between both groups.
 Conclusions: 75% of the patients we evaluated with neonatal sepsis had relative adrenal insufficiency (RAI). ACTH and Cortisol values were correlated to CRP and HSS score as an inflammatory marker. This reflects suppressed HPA status in this critical clinical condition.

Umbilical arterial lactate levels after normal vaginal and elective cesarean delivery: The role of a longer active second stage most significant in high levels after vaginal delivery.

To evaluate umbilical arterial lactate concentrations after spontaneous vaginal delivery and after elective Cesarean delivery, and to study the simultaneous effects of maternal and obstetric variables in high lactate levels in vaginally delivered healthy term singletons. The birth register study included information about the umbilical artery lactate values and clinical perinatal data from 7723 women and their singleton newborns (7301 spontaneous vaginal and 422 elective cesareans) from Kuopio University Hospital, Finland. High lactate levels were evaluated more extensively among healthy term neonates (N = 6541), to evaluate high levels after normal vaginal labors. The mean lactate level was significantly lower after elective cesarean compared to vaginal delivery (2.42 [0.94] vs. 3.56 [1.62] mmol/l; p < 0.0001). Consequently, the 90th percentile limit values were 3.60 and 5.80 mmol/L. Among healthy term newborns born vaginally, higher lactate values (≥5.80 mmol/L) were independently associated with a longer duration of the active second stage of labor (ORs 1.91-10.97) and duration of ruptured fetal membranes (ORs 1.36-2.46), higher gestational age at birth (ORs 1.41-1.86), null parity (OR 2.17), maternal infection (OR 1.81) and short maternal stature (OR 1.45). We report 90th/95th limits for umbilical arterial lactate values in relation to the various durations of labors for term newborns who are delivered by the vaginal route. Even though the high umbilical lactate levels may indicate serious birth asphyxia, levels after vaginal birth reflect the physiological stress and subclinical transient asphyxia frequently seen in normal vaginal deliveries.

Urinary Concentration of Renal Biomarkers in Healthy Term Neonates: Gender Differences in GST-pi Excretion.

BACKGROUND Serum creatinine, the criterion standard in assessment of renal function, is not reliable for the neonatal period because of its dependence on renal immaturity and maternal creatinine levels. Thus, it is important to study other biomarkers of renal function in neonates. The present study aimed to measure the urinary concentration of renal biomarkers: calbindin, clusterin, GST-pi (glutathione-S-transferase-alpha), KIM-1 (kidney injury molecule 1), MCP-1 (monocyte chemoattractant protein-1), and B2M (beta 2-microglobulin) in healthy term neonates. MATERIAL AND METHODS In the study, we included 80 healthy term neonates - 40 females and 40 males. We collected the neonates' urine on their first day of life. Urinary concentrations of calbindin, clusterin, KIM-1, MCP-1, and B2M were assessed using an immunoassay for kidney toxicology research. Because dilution of the urine affects the concentrations of urinary biomarkers, we normalized them to the concentration of urinary creatinine (Cr) and present them as biomarker/Cr ratios. RESULTS We obtained the following values of the assessed biomarker/Cr ratios (median [Q1-Q3]): calbindin/Cr.: 197.04 (56.25-595.17), KIM-1/Cr: 0.09 (0.04-0.18), MCP-1/Cr: 0.05 (0.02-0.14), B2M/Cr: 126.12 (19.03-342.48), GST-pi/Cr in boys: 1.28 (0.46-3.77), GST-pi/Cr in girls: 8.66 (2.51-27.82), clusterin/Cr: 4.55 (1.79-12.97) ng/mg Cr. CONCLUSIONS We showed the urinary levels of calbindin, clusterin, GST-pi, KIM-1, MCP-1, B2M in white, West Slavic, healthy term neonates. We found that in there is an association between female sex and a higher urinary GST-pi excretion, but urinary excretion of calbindin, clusterin, KIM-1, MCP-1, and B2M is sex-independent. The urinary levels of the assessed biomarkers do not depend on the method of delivery.

Feeds Alone versus Intravenous Fluids and Feeds for Treatment of Mild Hypernatremia in Otherwise Healthy Neonates – An Open-labeled Randomized Controlled Noninferiority Trial

Background: The treatment of hypernatremia in newborns is usually done by giving intravenous (IV) fluids. Methodology: This study aimed to determine whether treating neonates with hypernatremia using oral feeds was not inferior by a margin of 10% to treatment with IV fluids and feeds in achieving a safe decline in serum sodium. A decrease in serum sodium ≤0.5 mEq/L/h over 24 h of treatment was considered a safe decline. Neonates with serum sodium 150–155 mEq/L were randomized to receive oral feeds ad libitum (Group A) or 5% dextrose +0.45% normal saline (D5 ½ NS) and oral feeds (group B). Results: There were 43 neonates in Group A and 42 neonates in Group B. It was found that a safe decline in serum sodium was seen in 60.5% of Group A neonates and 47.6% of Group B neonates (P = 0.246). There was no significant difference in the duration of treatment or duration of hospital stay. Group B babies had more weight gain compared to Group A. No complications were observed in the groups. Conclusion: Treating mildly hypernatremic neonates with serum sodium 150–155 mEq/L using oral feeds alone may not be inferior to IV fluids with oral feeds in achieving a safe decline in serum sodium.

INTERRELATIONSHIP BETWEEN INDICATORS OF LOCAL AND SYSTEMIC INFLAMMATORY REACTION IN NEWBORNS WITH NEONATAL ENCEPHALOPATHY

Introduction. Neonatal encephalopathy is one of the most common diseases in newborns. Several factors influence the development of neonatal encephalopathy including adverse obstetric history, fetal distress, meconium-containing amniotic fluid and cesarean section. In moderate and severe neonatal encephalopathy, damage to internal organs, local and systemic inflammation may occur. Cytokines, which are activated in the central nervous system and released in response to its damage, play an important role in brain inflammation caused by neonatal encephalopathy. C-reactive protein is also a possible biomarker of neonatal encephalopathy severity, being considered a protein of the innate immune system with anti-inflammatory properties. The state of the inflammatory response can be influenced by a local inflammatory reaction, as a result of which children with neonatal encephalopathy have been shown to have increased levels of fecal calprotectin in the first weeks of life. Also, one of the results of the transferred inflammatory reaction is a change in the composition of the neonatal intestinal microbiome. Objective. To study risk factors for neonatal encephalopathy in newborns, the features of the relationship between local and systemic inflammatory response parameters in asphyxia of varying degrees, and the features of severity and control of inflammatory response parameters. Materials and methods. The study was conducted in 119 full-term newborns, of which 87 children had neonatal encephalopathy and 32 healthy children. To determine the features of severity and control of inflammatory response parameters, group A was identified, which included 60 newborns, 46 of them with moderate neonatal encephalopathy, 14 with severe neonatal encephalopathy. The study was conducted using a culture method to determine the composition of the intestinal microbiome in feces. Using a semi-automated Thermo Scientific Multiskan FC enzyme immunoassay analyzer, the level of fecal calprotectin in feces and C-reactive protein and interleukins 1β and 10 in the blood serum were estimated by the enzyme immunoassay. The results were analyzed using SPSS version 28.0. The correlation between the parameters was analyzed using the Pearson correlation coefficient. The odds ratio was used to quantitatively describe the closeness of the relationship between the features in the statistical population. Binary logistic regression was used to determine the dependencies of the severity of the inflammatory reaction and create a model for calculating its severity. Results. Risk factors for neonatal encephalopathy included mother’s acute respiratory infections and fetal distress. Bifidobacterium levels were positively correlated throughout the study, and there was also a relationship with lactobacilli in the control and non-probiotic treated neonatal encephalopathy groups. E. coli values were positively associated with opportunistic pathogens in the control and probiotic treated groups. Fecal calprotectin was negatively correlated with birth weight and height, Apgar scores, and gestational age. Fecal calprotectin levels were positively correlated with E. coli and opportunistic pathogens in healthy neonates. In children with neonatal encephalopathy interleukin 1β and 10 values were positively associated with fecal calprotectin, interleukin 1β were positively correlated with interleukin 10 and C-reactive protein. Conclusions. The most significant risk factors for the development of neonatal encephalopathy are mother’s acute infectious diseases and fetal distress. The severity of hypoxia/asphyxia at birth correlated with the levels of interleukin 1β and 10 at 2 and 5 weeks of life, and Bifidobacterium at 2 weeks of life. The severity of the inflammatory response in the study population was characterized by a change in the level of interleukin 1β and Bifidobacterium at 2 weeks and a change in the level of interleukin 10 at 5 weeks

Evaluation of Serum Vitamin D Level in Full-Term Neonates with Hypoxic–Ischemic Encephalopathy

Background Vitamin D has a role in minimizing the extent of neuronal cell injury and death in neonatal hypoxic–ischemic encephalopathy (HIE). Aim To assess the serum level of vitamin D in full-term babies with HIE. Patients and methods This case–control study was conducted on 40 full-term neonates. Cases were grouped into two groups: group A: 30 full-term neonates diagnosed as HIE; clinical diagnosis was based on Sarnat staging. Group B: 10 healthy full-term neonates. Patients in group A were further subdivided into three equal groups: group A1: grade I HIE, group A2: grade II HIE, and group A3: grade III HIE. Results The following investigations were done for groups A and B: Apgar score after 1 and 5 min, convulsions, metabolic acidosis need for respiratory support, blood urea, serum creatinine, C-reactive protein level, serum calcium levels, and 25(OH) vitamin D measurements at 12 and 72 h postnatal. Apgar score, pH, total and ionized calcium, and 25(OH)-D were significantly reduced in HIE (specially grade III), while blood urea, serum creatinine, and C-reactive protein were significantly higher in HIE neonates (grade III). Conclusion We could assume that the more severe the grade of HIE, the worse are the laboratory findings.

Cerebellar volume and functional connectivity in neonates predicts social and emotional development in toddlers.

Over the past decade, a growing body of research in adults has emphasized the role of the cerebellum in social and emotional cognition. This has been further supported by findings of delayed social and emotional development in toddlers with cerebellar injury during the fetal and newborn periods. However, the contributions of the cerebellum to social-emotional development in typically developing newborns are unclear. To bridge this gap in knowledge, we used multimodal MRI to investigate associations between cerebellar structure and function in 88 healthy neonates (mean ± sd of postmenstrual age, = 42.00 ± 1.91 weeks) and social-emotional development at 18-months assessed using the Infant-Toddler Social-Emotional Assessment (ITSEA) (mean age on ITSEA: 18.32 ± 1.19 months old). We found that cerebellar volume was not associated with ITSEA domain scores at 18 months. We further demonstrated cerebellar functional gradient (FGR) defined using principal component analysis (PCA) was associated with Externalizing domain (linear regression model, false-discovery-rate-adjusted p = 0.013). This cluster (FGR7) included the left dentate, right VI, left Vermis VIIIb, and right V lobules. Finally, we demonstrated that either structural or functional features of the cerebellum reliably predicted scores on the Externalizing and Internalizing domains (correlation between actual and predicted scores: for structural, Fisher's z = 0.48 ± 0.01 for Internalizing, p = 0.01; for functional, Fisher's z = 0.45 ± 0.01 for Externalizing, p = 0.02; with permutation test). Collectively, our findings suggest that the cerebellum plays an important role in social-emotional development during the critical early stages of life.

Analyzing Cardiovascular Response in Neonates with Perinatal Asphyxia by Combining Echocardiographic, Electrocardiographic, and Biochemical Parameters: Collaborating Bench and Bedside in Low- and Middle-income Country Setups

Abstract Background: Perinatal asphyxia (PA) is a neonatal emergency causing multi-organ dysfunction, and neurological insult called hypoxic-ischemic encephalopathy (HIE). The traditional focus is on neuroprotection. However, the immature cardiovascular system simultaneously undergoes tremendous hypoxic-ischemic insult especially during the secondary phase of HIE. The hemodynamic consequences, comprehensive cardiac assessment, and care are often overlooked in bedside practice. Objective: The objective is to quantitatively document myocardial dysfunction in neonates with PA using electrocardiography (ECG), echocardiography, and cardiac enzymes (creatinine kinase-MB [CK-MB], B-type natriuretic peptide [BNP], and troponin I). Design and Methods: This was a single center, case–control prospective study. Sixty-four neonates with PA were enrolled. Myocardial function was assessed by clinical, ECG, echocardiography, and biomarkers assay. The same number of healthy neonates was taken as control. Results: 15 (23.4%) had mild, 28 (43.7%) moderate, and 21 (32.8%) severe HIE in the case arm. Abnormal ECG was observed in 42 (65.6%), of which 20 (47.6%) had Grade I, 13 (30.9%) Grade II, 8 (19.04%) Grade III, and 1 (2.38%) had Grade IV changes. Serum levels of CK-MB, BNP and Troponin I were raised in 29 (45.3%), 30 (46.8%) and 10 (15.6%) neonates, respectively. Echocardiographic parameters such as ductal shunting pattern, mitral and tricuspid regurgitation, pulmonary hypertension, and systolic and diastolic ventricular function were significantly abnormal in cases versus controls as demonstrated by P value. Conclusion: Abnormal ECG, echocardiography, and cardiac enzymes in PA are markers and prognosticators of cardiac injury affecting overall outcomes in neonates with PA. Early detection can help in better management and survival of these neonates.

Risk Factors Associated with Neonatal Mortality and Their Status: A Matched Case-Control Study in Kurdistan.

Neonatal mortality is a significant public health issue that can often be prevented. The present study was designed and conducted to determine the causes of neonatal mortality and the status of their mothers in Kurdistan Province in 2019. In this matched case-control study, the case group comprised 171 deceased neonates, while the control group consisted of 171 healthy neonates, along with their mothers' status in Kurdistan Province in 2019. for each case in each city, one control from the same city within the same week of the case's birth was randomly selected. Data were collected using a checklist containing information on the neonates and their mothers. The analysis was performed using STATA 17 software, which involved descriptive tests and analytical tests. These included frequency calculation, chi-square test, conditional logistic regression, and a stepwise backward elimination method for multivariate analysis with (P = 0.1). A significance level of P < 0.05 was considered. The results, after matching the odds ratio with a CI 95% using the backward method, showed a significant association between prematurity (OR:15.99, 95%CI:4.38-58.31), complications during pregnancy (OR:8.64, 95% CI:2.80-26.66), weight gain during pregnancy (OR:3.04, 95% CI:1.06-8.70). The findings of our study suggest a positive association between neonatal mortality and specific maternal and neonatal factors, namely neonatal prematurity, complications during pregnancy, and inappropriate weight gain during pregnancy. Therefore, there is a compelling need to implement effective measures to control these identified risk factors, with the goal of reducing neonatal mortality.

Comparison of the Changes in Blood Carboxyhemoglobin and Bilirubin Levels and Their Effects on Neonatal Hyperbilirubinemia in Neonates Born by Cesarean Section versus Vaginal Delivery

Aim: The study aimed to investigate whether there are differences in carboxyhemoglobin, bilirubin and hemoglobin values of neonates born by normal spontaneous vaginal birth (NSVD) (without anesthesia) and elective spinal cesarean section (CS) and its effect on neonatal jaundice. Materials and Methods: A total of 110 healthy neonates without any risk factors for neonatal hyperbilirubinemia were included in the study. There were fifty-five neonates in both NVSD and spinal CS groups. COHb, bilirubin and Hb values which were measured from umbilical cord blood (as cord) and capillary blood taken from the heel 4-6 hours after birth (as post cord) were recorded. Results: No statistically significant difference was found between the groups in terms of birthweight, maternal age, APGAR scores, and gender (p&gt;0.05). There was a statistical difference between the groups according to the mean of gestational age, and it was observed that the mean of gestational age in spinal CS group was lower than in NSVD group (38.30±1.2 and 39.16±1.39 respectively) (p=0.001). Umbilical cord COHb levels in spinal CS group were higher than in NSVD group, but there was no statistically significant difference between groups (1.01±0.15 and 0.99±0.20 respectively, p=0.22). Furthermore, the differences between groups in term of mean of bilirubin and Hb levels in cord and post cord were not statistically significant (&gt;0.05). But, it was determined that post cord COHb levels were higher than in NVSD group, and this difference was statistically significant (p=0.028). Additionally, it was found that the mean rank of COHb, bilirubin, and Hb in cord and post cord values were statistically significantly different between the groups (p &lt; 0.05). Conclusion: It should be kept in mind of that the anesthetic agent may also be a factor in bilirubin increases that occurs in neonatal hyperbilirubinemia without an underlying risk factor.

Quantitative label-free mass spectrometry reveals content and signaling differences between neonatal and adult platelets

BackgroundRecent clinical studies have shown that transfusions of adult platelets increase morbidity and mortality in preterm infants. Neonatal platelets are hyporesponsive to agonist stimulation, and emerging evidence suggests developmental differences in platelet immune functions. ObjectivesThis study was designed to compare the proteome and phosphoproteome of resting adult and neonatal platelets. MethodsWe isolated resting umbilical cord blood–derived platelets from healthy full-term neonates (n = 8) and resting blood platelets from healthy adults (n = 6) and compared protein and phosphoprotein contents using data-independent acquisition mass spectrometry. ResultsWe identified 4770 platelet proteins with high confidence across all samples. Adult and neonatal platelets were clustered separately by principal component analysis. Adult platelets were significantly enriched in immunomodulatory proteins, including β2 microglobulin and CXCL12, whereas neonatal platelets were enriched in ribosomal components and proteins involved in metabolic activities. Adult platelets were enriched in phosphorylated GTPase regulatory enzymes and proteins participating in trafficking, which may help prime them for activation and degranulation. Neonatal platelets were enriched in phosphorylated proteins involved in insulin growth factor signaling. ConclusionUsing label-free data-independent acquisition mass spectrometry, our findings expanded the known neonatal platelet proteome and identified important differences in protein content and phosphorylation between neonatal and adult platelets. These developmental differences suggested enhanced immune functions for adult platelets and presence of molecular machinery related to platelet activation. These findings are important to understanding mechanisms underlying key platelet functions as well as the harmful effects of adult platelet transfusions given to preterm infants.

Back Abscess and Cellulitis due to Multidrug-Resistant Staphylococcus aureus Infection in Previously Healthy Neonate

We report a case of a nine-day-old male baby who was born term, spontaneously with normal birth weight, a history of forty-eight hours of premature rupture of membrane, and no history of early-onset sepsis. He suffered from fever followed by a small red bump on his back, which worsened, extended, and became an ulcer in the right axilla. The pediatric surgeon performed the debridement and modern wound care without a skin graft. The pus culture isolated. Staphylococcus aureus, resistant to oxacillin and at least three other non-?-lactam antibiotics. We then administered vancomycin for fourteen days. The patient was discharged after thirty-one days of hospitalization. Multidrug-resistant Staphylococcus aureus infection in neonates can manifest as severe progressive skin and soft tissue disease. However, proper management could deal with the prognosis.

Neonatal hypernatremic dehydration in breastfed neonates: a prospective study unmasking the influences of breastfeeding practices and early weight monitoring

Introduction: Hypernatremic dehydration in neonates is an uncommon but serious reason for re-hospitalization, especially in exclusively breastfed neonates. The aim was to study the incidence, associated maternal and neonatal characteristics and risk factors, and presenting features of neonatal hypernatremic dehydration (NHD). Methods: A prospective study design was employed to enroll full-term newborns admitted with serum sodium concentrations of ≥145 mEq/L from April 2022 to March 2023 at a tertiary care rural hospital. Maternal and neonatal characteristics and breastfeeding practices of these mother-baby pairs were recorded and observed. Healthy control for every mother-baby pair was taken. Ethical clearance and informed consent were obtained from mothers. Result: 34 newborns out of total 672 NICU admissions were admitted due to NHD, with an incidence of 4.7%. Primiparous mothers were 23 (67.6%) in the cases and 10 (29.4%) in the control group (p = 0.0017). Disparity in maternal breastfeeding practices of cases, such as delayed initiation time 2.3 h vs. 1.27 h (p < 0.0001), less frequency of breastfeeding 6.5 times vs. 9.3 times (p < 0.0001), and duration of breastfeeding sessions 23.3 min vs. 32 min (p = 0.0014) respectively in cases and controls were found to be potential contributing factors. 61.7% of mothers had breast issues in the cases and 17.6% in the control group (p = 0.0002) with average LATCH score of 4.29 in cases as compared to 8.08 in controls (p < 0.0001) at time of baby’s admission to NICU. The average neonatal age at presentation was six days and average weight loss was 11.4% in cases vs. 2.8% in controls (p < 0.0001). The main presenting features were excessive weight loss 30 (88.2%), lethargy 20 (58.8%), jaundice 18 (52.9%) and fever 14 (41.1%). Conclusion: Neonatal hypernatremic dehydration (NHD) poses a significant clinical challenge, particularly in full-term, exclusively breastfed healthy neonates. We found an incidence of 4.7%. Delayed initiation of breastfeeding, inadequate breastfeeding techniques, and maternal breast-related issues were significant contributors to NHD. Primiparous mothers were found to be at higher risk, emphasizing the need for targeted breastfeeding education and support for primiparous mothers. The study reaffirmed the critical role of frequent and effective duration of breastfeeding and daily weight monitoring for preventing NHD.

Standardization of sucking patterns during breastfeeding in healthy term neonates: Across-sectional study.

Nutritive disorders like sucking and swallowing problems are common in infants. The necessity for a clinical tool to assess these issues has never been more evident. This study aims to evaluate sucking patterns and standardize them in healthy neonates. A cross-sectional study involving 223 neonates breastfeeding in the Maternity Ward of Shahid Sayyad Shirazi Hospital, Gorgan, Iran, from April to September 2021 was conducted. Neonatal swallowing skills (maximum sucking pressure and number of sucking actions) were assessed using a swallowing skill assessment device. The 95% confidence interval for maximal sucking pressure and the number of sucking actions within a normal distribution were estimated. Out of 223 infants, 112 (50.2%) were female, 176 (74.9%) were delivered via cesarean section, and their mean birth weight was 3154.48±371.48 grams. The maximum sucking pressure was -6.82, with a 95% confidence interval of (-13.21, -3.52) in infants. The mean number of sucking actions within a 15-second interval was 6.74, with a 95% confidence interval of (2.23, 20.37). Regarding this data and the high prevalence of sucking disorders in preterm infants worldwide, we can employ this information in conjunction with an oral-motor skill assessment tool to evaluate infant sucking patterns in hospitals, clinics, and during home visits.

Health problems experienced by women during the first year postpartum: A systematic review.

During pregnancy and childbirth, health issues can arise that can negatively influence women's postpartum health. Although it is imperative to identify these health problems in order to tailor care to women's needs, they often remain unrecognized. A comprehensive overview of postpartum health problems does not exist in the current literature. This systematic review aimed to explore the health problems experienced by women residing in high-income countries during the first year postpartum. Scientific databases were searched for articles on health problems experienced by women during the first year postpartum, published between January 2000 and 2 July 2021. Studies investigating the experiences of healthy women from the age of 18 years, residing in high-income countries, who gave birth to a healthy neonate, were included. Identified health issues were divided into five categories and presented in an overview. A total of 25 articles were eligible for inclusion. In all, 83 health problems were identified and divided into five different categories (physical health problems, mental health problems, social health problems, problems related to feeding the infant, and other challenges). Common health issues postpartum were exhaustion, urinary incontinence, painful breasts, depressive symptoms, problems related to sexuality and sleep, lack of social support, and problems with breastfeeding. This systematic review contributes to a wider understanding of postpartum health problems and can be used to adapt healthcare to women's needs. It distinguishes itself from previous studies by the wide variety of identified health problems and its specific focus on women's experiences in the postpartum period.

Assessment of hemostatic profile in neonates with necrotizing enterocolitis using Rotational Thromboelastometry (ROTEM).

This study aimed to explore the hemostatic profile of neonates with necrotizing enterocolitis (NEC) using Rotational Thromboelastometry (ROTEM) and to investigate if ROTEM parameters have the capacity to play a role in the differentiation of NEC from sepsis at the disease onset. This observational study included 62 neonates (mean gestational age 31.6 weeks and mean birth weight 1620g) hospitalized in a neonatal intensive care unit. The neonates were categorized in three groups: neonates with NEC (Bell stage II and above), neonates with sepsis and healthy neonates and they were matched 1:1:1 with regards to gestational age, delivery mode, and sex. Clinical, laboratory data as well as measurements of ROTEM parameters at disease onset were recorded. ROTEM parameters differed between neonates with NEC and neonates with sepsis, indicating that NEC results in accelerated clot formation and higher clot strength compared to sepsis. The EXTEM CFT and A10 parameters demonstrated the highest diagnostic performance for NEC in terms of discrimination between NEC and sepsis (AUC, 0.997; 95% CI: 0.991-1.000 and 0.973; 95% CI: 0.932-1.000, respectively). Neonates with NEC manifested accelerated clot formation and higher clot strength compared to septic and healthy neonates, as these were expressed by ROTEM parameters. This work reports data on the hemostatic profile of neonates with necrotizing enterocolitis (NEC) using Rotational Thromboelastometry (ROTEM) and the capacity of ROTEM parameters in differentiating of NEC from sepsis at the disease onset. Neonates with NEC present acceleration of coagulation and exhibit a hypercoagulable profile, as this is expressed by ROTEM parameters, in comparison to septic and healthy neonates. ROTEM parameters demonstrated a good diagnostic capacity in differentiating NEC from sepsis at the disease onset.

Kord Kanı ve Yenidoğan Plazma Beyin Natriüretik Peptid Düzeyleri ile Doğum Şekli Arasındaki İlişki

Fetal-to-neonatal adaptation involves many complex mechanisms. Cardiovascular biomarkers may help to understand fetal and maternal physiology in pregnancy and during the perinatal transition period. In this present study, our aim was to assess the association between delivery type and brain natriuretic peptide (BNP) levels in healthy full-term neonates. Forty-eight neonates born by vaginal delivery (n=25) and cesarean section (n=23) were included in the study. Plasma BNP levels were measured at cord blood samples. In addition antropometric measurements and physical examination were evaluated at first day of life. BNP levels measure and clinical evaluation were repeated 3 days later after birth. The median cord and infant BNP levels were similar in vaginal and cesarean delivery. There was no difference between the median cord and infant BNP levels in vaginal deliveries [54.0 pg/ml (q1-q3: 40.0-111.5) and 66.0 pg/ml (q1-q3: 43.0-90.0) respectively, p=0.619]. However, the median infant BNP level was statistically significantly higher than the median cord BNP level [56.0 pg/ml (q1-q3: 39.0-84.0) and 75.0 pg/ml (q1-q3: 54.0-145.0), p=0.027] in cesarean deliveries. Uncomplicated vaginal deliveries were not associated with high BNP levels and thus fetal cardiac distress. Increased levels of BNP levels on the 3rd day in elective cesarean deliveries may be predictive of delayed postnatal pulmonary and cardiac adaptation.

Analgesic Effect of Low-Level Laser Therapy before Heel Lance for Pain Management in Healthy Term Neonates: A Randomized Controlled Trial.

Currently, the prevention, assessment, and management of procedural pain in neonates continues to challenge clinicians and researchers. Objective. To investigate the analgesic effect of low-level laser therapy (LLLT) during heel lance compared to breast milk (BM) feeding in healthy term neonates. In this randomized controlled trial, healthy term neonates who underwent heel lance were randomly assigned to an LLLT or a BM group. The LLLT group received laser therapy to the heel lance site for 20 s before heel lance. The BM group received 5 mL expressed BM via a syringe before heel lance. The primary outcomes were behavioral responses. The secondary outcomes were physiological responses and levels of salivary cortisol and α-amylase. A total of 125 neonates were included, of whom 55 in the LLLT group and 59 in the BM group completed the study. There were no significant differences in latency to first cry and cry duration between the two groups. The squeeze time was significantly shorter in the LLLT group than in the BM group (p = 0.047). There were no significant differences in pain scores, heart rate, respiratory rate, oxygen saturation, and blood pressure before and after heel lance between the two groups. There were no significant differences in salivary cortisol and α-amylase levels in the LLLT group before and after heel lance; however, the differences were significant in the BM group. These findings suggest that the analgesic effect of LLLT is similar to that of BM during heel lance in healthy term neonates. LLLT has potential as an analgesic treatment.