Late Term Research Articles

The diagnostic value of pulmonary near-infrared spectroscopy in the early distinction of neonatal pneumonia from transient tachypnea of the newborn.

Pulmonary near-infrared spectroscopy (NIRS) is a new and promising tool for diagnosis of neonatal respiratory diseases (RD). The study aimed to determine the role of pulmonary regional oxygen saturation (pRSO2 ) values obtained by NIRS in the early distinction of neonatal pneumonia (NP) from transient tachypnea of the newborn (TTN). This prospective, observational, double-blind study was conducted in neonatal intensive care unit (NICU) between 2020 and 2021. Late preterm and term newborns hospitalized in the NICU due to the diagnosis of TTN and NP were included. Cerebral RSO2 and pRSO2 values were measured during the 1st, 24th, 48th, and 72nd hours of hospitalization, using NIRS. Of the eligible 40 infants, 65% (n: 26) were diagnosed as TTN and 35% (n: 16) as NP. The pRSO2 values were significantly higher in the TTN group than the NP group for both apexes (75.3 ± 8.7 vs. 69 ± 5.4, p: .018, respectively) and lateral lung (77.8 ± 6 vs. 72.7 ± 6.2, p: .016, respectively) in the 1st hour of hospitalization. There were significant differences in pRSO2 apex and pRSO2 lateral values between the 1st and 24th hours of hospitalization and the 24th and 48th hours in the NP group (p2 : .001 for both). The optimal pRSO2 apex cut-off value was >72% to predict the diagnosis of NP with a sensitivity of 78.6% and a specificity of 69.2%. Pulmonary NIRS may be considered as a feasible and promising diagnostic tool in late preterm and term infants with RD. It may also be helpful for the early differentiation of NP from TTN and the courses of these diseases.

A Pilot Single-Site Randomized Control Trial: Investigating the Use of Donor Milk in Late Preterm and Term Infants in the Neonatal Intensive Care Unit.

We aimed to study donor milk (DM) supplementation when mother's own milk (MOM) was unavailable in term and late preterm infants (LPIs) admitted to the neonatal intensive care unit (NICU). We hypothesized that this study would be feasible, defined by the rate of consent, diet adherence, and study completion. We further hypothesized that compared with formula supplementation, DM supplementation, for no longer than 7 days from birth, would be associated with an increase in breastfeeding attempts and the percentage of MOM (MOM%) without adversely affecting growth. Breastfeeding attempts and MOM% were assessed over 48 hours at the end of the intervention, which was defined as NICU discharge or at the end of supplementation, whichever came sooner. This was a pilot study (n = 32). Infants with a gestational age > 34 weeks admitted to the NICU were included. Infants were randomized to one of two groups: human milk (MOM + DM) or formula (MOM + F). The consent rate was 52%. Adherence to the study diet was 97%, and completion was 100%. When the MOM + DM group was compared with the MOM + F group, there was no difference in breastfeeding attempts (median [interquartile range]: 3.5 [1.5-6] vs. 1.5 [0.5-4] times, p = 0.1) or MOM% (60 vs. 59%, p = 0.9). Weight and length at multiple time points were similar when the groups were compared. A study randomizing term and LPIs in the NICU to DM or formula when MOM was unavailable is feasible. It remains unclear if DM improves breastfeeding success in this population. · A study that randomizes term and late preterm infants in the NICU to DM or formula supplementation when mother's own milk is not available is feasible.. · It remains unclear if DM compared to formula supplementation improves direct breastfeeding.. · In general, growth was similar in infants who received DM or formula as a supplement..

Incidence of Neonatal Hypothermia in the Newborn Nursery and Associated Factors

Thermoregulation is a key component of well-newborn care. There is limited epidemiologic data on hypothermia in late preterm and term infants admitted to the nursery. Expanding on these data is essential for advancing evidence-based care in a population that represents more than 3.5 million births per year in the US. To examine the incidence and factors associated with hypothermia in otherwise healthy infants admitted to the newborn nursery following delivery. A retrospective cohort study using electronic health record data from May 1, 2015, to August 31, 2021, was conducted at a newborn nursery at a university-affiliated children's hospital. Participants included 23 549 infants admitted to the newborn nursery, from which 321 060 axillary and rectal temperature values were analyzed. Infant and maternal clinical and demographic factors. Neonatal hypothermia was defined according to the World Health Organization threshold of temperature less than 36.5 °C. Hypothermia was further classified by severity (mild: single episode, temperature 36.0-36.4 °C; moderate/severe: persistent or recurrent hypothermia and/or temperature <36.0 °C) and timing (early: all hypothermic episodes occurred within the first 24 hours after birth; late: any episode extended beyond the first 24 hours). Of 23 549 included infants (male, 12 220 [51.9%]), 5.6% were late preterm (35-36 weeks' gestation) and 4.3% were low birth weight (≤2500 g). The incidence of mild hypothermia was 17.1% and the incidence of moderate/severe hypothermia was 4.6%. Late hypothermia occurred in 1.8% of infants. Lower birth weight and gestational age and Black and Asian maternal race and ethnicity had the highest adjusted odds across all classifications of hypothermia. The adjusted odds ratios of moderate/severe hypothermia were 5.97 (95% CI 4.45-8.00) in infants with a birth weight less than or equal to 2500 vs 3001 to 3500 g, 3.17 (95% CI 2.24-4.49) in 35 week' vs 39 weeks' gestation, and 2.65 (95% CI 1.78-3.96) in infants born to Black mothers and 1.94 (95% CI 1.61-2.34) in infants born to Asian mothers vs non-Hispanic White mothers. In this cohort study of infants in the inpatient nursery, hypothermia was common, and the incidence varied by hypothermia definition applied. Infants of lower gestational age and birth weight and those born to Black and Asian mothers carried the highest odds of hypothermia. These findings suggest that identifying biological, structural, and social determinants of hypothermia is essential for advancing evidence-based equitable thermoregulatory care.

Gastric lavage and enteral feeding problems in late preterm and term neonates born with meconium stained amniotic fluid

Introduction: Prenatal issues such as pregnancy-induced hypertension, antepartum toxemia, obstructed or delayed labor, and fetal discomfort are standard in MSAF-positive pregnancies. In the early neonatal period, a proportion of infants born through meconium-stained amniotic fluid may swallow meconium and have nausea, vomiting, retching, various feeding issues such as poor sucking, and subsequent aspiration after vomiting. We conducted this observational study to see if stomach wash decreases the requirement for subsequent stomach wash in neonates born via MSAF soon after delivery, as indicated by feed intolerance. Methods: An observational study was performed on newborns diagnosed with meconium-stained liquor for a duration of 6 months. Results: From 1103 neonates, 110 (9.9%) were born with MSAF during the study period. Eight (8%) infants required additional stomach washing within the first 48 hours of life. 18 infants (18.0 %) experienced at least one episode of vomiting. Only 8 of them needed further gastric lavage to resume eating. Five out of one hundred infants (5/100) had regurgitation (more than one episode). No newborns required parental fluids in the first 48 hours. Baseline parameters like gestational age, birth weight, gender, mode of delivery, Apgar score at 1 and 5 minutes, and meconium consistency were observed. Conclusions: Gastric lavage has been frequently performed as part of crucial newborn care for infants with meconium-tainted amniotic fluid. According to the findings of this study, gastric lavage should be reserved for treating the relatively uncommon occurrence of feed intolerance in neonates born with MSL rather than being used as a routine prophylactic measure.

Study of etiological factors and immediate outcomes of neonatal seizure among preterm and term neonate in a tertiary health centre of Northern India

Background: Neonatal seizures result due to altered neurological functions like motor, behavioural and autonomic function. We conducted this study to assess the incidence, etiological factors, and immediate outcomes of neonatal seizures in term and preterm neonates. Methods: This prospective observational study included all neonates delivered in a tertiary health centre of New Delhi from Nov 2015 to Oct 2016 and admitted in Neonatal Intensive Care Unit with clinically identified seizures up to 28 days of postnatal age. Results: Out of 11,109 live births during the study period, 302 developed neonatal seizures with overall incidence of 2.71%. The early preterm (12.05%), very low birth weight babies (56.30%), and neonates in first 24 hrs of life (68.9%) had the highest incidence of neonatal seizures. The commonest seizure type was subtle seizures (52.3%). In early preterm commonest etiology was infection (31.3%) while in late preterm and term neonates most common etiology was Hypoxic ischaemic encephalopathy 59% and 72% respectively. Overall, HIE was the most common etiology (57%). Out of 302 cases, 81 (26.8%) cases have died. HIE was found to be the most common cause for mortality. Mortality was highest in early preterms (49.3%) and very low birth weight neonates (52.3%). Also, mortality was maximum among neonates having subtle seizures (29.1%) and seizures occurring within 24 hrs of life (30.8%). Conclusions: Persistently high incidence of neonatal seizures requires further strengthening of antenatal, natal, and post-natal health services. Early identification of neonatal seizures and timely intervention are very important for better outcomes.

Contributing factors of birth asphyxia in Thailand: a case–control study

BackgroundBirth asphyxia is of significant concern because it impacts newborn health from low to severe levels. In Thailand, birth asphyxia remains a leading cause of delayed developmental health in children under 5 years old. The study aimed to determine the maternal, fetal and health service factors contributing to birth asphyxia.MethodsA case–control design was conducted on a sample of 4256 intrapartum chart records. The samples were selected based on their Apgar scores in the first minute of life. A low Apgar score (≤ 7) was chosen for the case group (852) and a high Apgar score (> 7) for the control group (3408). In addition, a systematic random technique was performed to select 23 hospitals, including university, advanced and secondary, in eight health administration areas in Thailand for evaluating the intrapartum care service. Data analysis was conducted using SPSS statistical software.ResultsThe odds of birth asphyxia increases in the university and advanced hospitals but the university hospitals had the highest quality of care. The advanced and secondary hospitals had average nurse work-hours per week of more than 40 h. Multivariable logistic regression analysis found that intrapartum care services and maternal–fetal factors contributed to birth asphyxia. The odd of birth asphyxia increases significantly in late–preterm, late–term pregnancies, low-birth weight, and macrosomia. Furthermore, maternal comorbidity, non-reassuring, and obstetric emergency conditions significantly increase the odd of birth asphyxia. In addition, an excellent quality of intrapartum care, a combined nursing model, low nurse work-hours, and obstetrician-conducted delivery significantly reduced birth asphyxia.ConclusionBirth asphyxia problems may be resolved in the health service management offered by reducing the nurse work-hours. Excellent quality of care required the primary nursing care model combined with a team nursing care model. However, careful evaluation and monitoring are needed in cases of comorbidity, late–preterm, late–term pregnancies, low-birth weight, and macrosomia. Furthermore, increasing the obstetrician availability in obstetric emergencies and non-reassuring fetal status is important.

Factors Associated with Need for Intravenous Glucose Infusion for the Treatment of Early Neonatal Hypoglycemia in Late Preterm and Term Neonates.

The aim of this study was to determine which late-preterm (35-36 weeks' gestational age [GA]) and term neonates with early-onset hypoglycemia in the first 72 hours postnatal required a continuous glucose infusion to achieve and successfully maintain euglycemia. This is a retrospective cohort study of late preterm and term neonates born in 2010-2014 and admitted to the Mother-Baby Unit at Parkland Hospital who had laboratory-proven blood glucose concentration < 40 mg/dL (2.2 mmol/L) during the first 72 hours of life. Among the subgroup needing intravenous (IV) glucose infusion, we analyzed which factors predicted a maximum glucose infusion rate (GIR) ≥ 10 mg/kg/min. The entire cohort was randomly divided into a derivation cohort (n = 1,288) and a validation cohort (n = 1,298). In multivariate analysis, the need for IV glucose infusion was associated with small size for GA, low initial glucose concentration, early-onset infection, and other perinatal variables in both cohorts. A GIR ≥ 10 mg/kg/min was required in 14% of neonates with blood glucose value < 20 mg/dL during the first 3 hours of observation. The likelihood of a GIR ≥ 10 mg/kg/min was associated with lower initial blood glucose value and lower umbilical arterial pH. Need for IV glucose infusion was associated with small size for GA, low initial glucose concentration, early-onset infection, and variables associated with perinatal hypoxia-asphyxia. The likelihood of a maximum GIR ≥ 10 mg/kg/min was greater in neonates with lower blood glucose value during the first 3 hours of observation and lower umbilical arterial pH. · We studied 51,973 neonates ≥ 35 weeks' GA.. · We established a model predicting the need for IV glucose.. · We also predicted the need for a high rate of IV glucose..

The effect of non-invasive high-frequency oscillatory ventilation on the duration of non-invasive respiratory support in late preterm and term infants with transient tachypnea of the newborn: a randomized controlled trial.

Nasal continuous positive airway pressure (nCPAP) is one of the most commonly used non-invasive respiratory support modes in neonates with transient tachypnea of the newborn (TTN). Non-invasive high-frequency oscillatory ventilation (nHFOV) is a non-invasive respiratory support mode that has been increasingly used in neonatal respiratory disorders. This prospective randomized controlled study compared the efficacy of nHFOV and nCPAP in reducing the duration of non-invasive respiratory support. Late preterm and term infants > 34weeks' gestation were included in the study. The infants were randomly assigned to receive either nHFOV or nCPAP. Treatment was started with standard settings in both groups. Infants who met treatment failure criteria were switched to nasal intermittent mandatory ventilation for further positive-pressure support. A total of 60 infants were included in the study. Thirty of these infants were included in the nHFOV group and 30 were included in the nCPAP group. The median duration of non-invasive respiratory support was not significantly different between the two groups (21h [IQR: 16-68] for nHFOV vs 15h [IQR: 11-33] for nCPAP; p = 0.09). However, after adjusting for potential confounders, nHFOV was associated with a shorter duration of non-invasive respiratory support than nCPAP (adjusted mean difference: 16.3h; 95% CI: 0.7 to 31.9; p = 0.04). nHFOV was well tolerated and did not increase the risk of complications. Conclusion: Our findings suggest that nHFOV is an effective and safe ventilation mode for late preterm and term neonates with TTN. Trial registry: Clinicaltrials.gov (NCT03006354). Date of registration: December 30, 2016. What is Known: • nHFOV is a ventilation model that has been increasingly used for the management of RDS. • TTN is one of the most common causes of neonatal respiratory distress. What is New: • nHFOV is associated with shorter duration of non-invasive respiratory support and duration of oxygen support. • nHFOV may be a safe and effective alternative to nCPAP for neonates with TTN.

Determining the true incidence of seasonal respiratory syncytial virus-confirmed hospitalizations in preterm and term infants in Western Australia

Respiratory syncytial virus contributes to significant global infant morbidity and mortality. We applied a previously developed statistical prediction model incorporating pre-pandemic RSV testing data and hospital admission data to estimate infant RSV-hospitalizations by birth month and prematurity, focused on infants aged <1 year. The overall predicted RSV-hospitalization incidence rates in infants <6 months were 32.7/1,000 child-years (95 % CI: 31.8, 33.5) and 3.1/1,000 child-years (95 % CI: 3.0, 3.1) in infants aged 6-<12 months. Predicted RSV-hospitalization rates for infants aged <6 months were highest for infants born in April/May. Predicted rates for preterm infants born 29–32 weeks gestation were highest in March-May, whereas infants born >33 weeks had peak RSV-hospitalization rates from May-June, similar to late preterm or term births. RSV-hospitalization rates in the pre-pandemic era were highly seasonal, and seasonality varied with degree of prematurity. Accurate estimates of RSV-hospitalization in high-risk sub-groups are essential to understand preventable burden of RSV especially given the current prevention landscape.

Effects of subclinical Theileria orientalis Ikeda genotype infection on average daily gain ratios and a satisfactory rating in the breeding soundness exam in bull test stations in Virginia

Theileria orientalis Ikeda genotype is a tick borne hemoprotozo­an that typically causes economic losses in dairy and beef cattle in Australia, New Zealand and Japan. Acute clinical infections from T. orientalis Ikeda include anemia, icterus, ill-thrift and death. The acute phase of the infection has been associated with decreased libido in dairy bulls, decreased live weight gain in beef bulls and increased mortality in naïve adults and calves. A sequela to acute infections within a herd is persistent sub­clinical infections, which have been associated with decreased mean daily gain in suckling beef calves. In late 2017, T. orienta­lis Ikeda was detected in beef cattle from multiple counties in Virginia and was associated with anemia, weakness, late term abortions and death. As of 2022, T. orientalis Ikeda has been identified in beef cattle in 31 of 95 Virginia counties. Beef pro­duction, typically in naturally bred cow-calf operations, is the second largest agricultural commodity in Virginia. Central bull testing programs for performance evaluation and marketing of beef bulls has existed for over 60 years in Virginia. T. orienta­lis Ikeda was first detected at the Southwest bull test station in 2020 when screened at conclusion of the test. The objective of this study was to determine if subclinical infection with T. ori­entalis Ikeda affected the average daily gain (ADG) ratios of all bulls on test and the achievement of a satisfactory rating of the breeding soundness exam (BSE) for senior bulls.

Do Non-Invasive Parameters Correlate With Invasive Blood Pressure in Late Preterm and Term Infants With Shock?

Do Non-Invasive Parameters Correlate With Invasive Blood Pressure in Late Preterm and Term Infants With Shock?

The contribution of hypertensive disorders of pregnancy to late preterm and term admissions to neonatal units in the UK 2012-2020 and opportunities to avoid admission: A population-based study using the National Neonatal Research Database.

To quantify maternal hypertensive disorder of pregnancy (HDP) prevalence in late preterm and term infants admitted to neonatal units (NNU) and assess opportunities to avoid admissions. A retrospective population-based study using the National Neonatal Research Database. England and Wales. Infants born ≥34 weeks' gestation admitted to NNU between 2012 and 2020. Outcomes in HDP infants are compared with non-HDP infants using regression models. Hypertensive disorder of pregnancy, primary reason for admission, clinical diagnoses and resource use. 16 059/136 220 (11.8%) of late preterm (34+0 to 36+6 weeks' gestation) and 14 885/284 646 (5.2%) of term (≥37 weeks' gestation) admitted infants were exposed to maternal HDP. The most common primary reasons for HDP infant admission were respiratory disease (28.3%), prematurity (22.7%) and hypoglycaemia (16.4%). HDP infants were more likely to be admitted with primary hypoglycaemia than were non-HDP infants (odds ratio [OR] 2.1, 95% confidence interval [CI] 2.0-2.2, P < 0.0001). 64.5% of HDP infants received i.v. dextrose. 35.7% received mechanical or non-invasive ventilation. 8260/30 944 (26.7%) of HDP infants received intervention for hypoglycaemia alone (i.v. dextrose) with no other major intervention (respiratory support, parenteral nutrition, central line, arterial line or blood transfusion). The burden of maternal HDP on late preterm and term admissions to NNU is high, with hypoglycaemia and respiratory disease being the main drivers for admission. Over one in four were admitted solely for management of hypoglycaemia. Further research should determine whether maternal antihypertensive agent choice or postnatal pathways may reduce NNU admission.

Usefulness of Mean Gastric Emptying Time in Late Preterm and Term AGA and SGA Newborns to Determine Feeding Frequency—An Observational Study

Objectives The primary objective is to calculate and compare mean gastric emptying time in appropriate for gestational age (AGA) and small for gestational age (SGA) newborns. The secondary objective is to compare mean gastric emptying time in SGA babies with or without antenatal Doppler changes and to measure gastric spheroidal volume at various intervals in AGA and SGA newborns with or without antenatal Doppler changes. Methods This prospective observational study was carried over 3 months from November 2022 to January 2023. A total of 30 newborns were enrolled and their gastric spheroidal volume was calculated by ultrasound pre-feed and post-feed every 30 minutes till it reached within 10% of pre-feed volume which was taken as gastric emptying time. Mean gastric emptying time was compared among AGA and SGA newborns and amongst SGA with or without antenatal Doppler changes. Results Mean gastric emptying time of AGA was 124 ± ± 25.01 minutes and for SGA was 132 ± 29.57 minutes which was statistically nonsignificant. Mean gastric emptying time when compared between SGA neonates with or without antenatal Doppler changes was similar ( P value .43). The gastric spheroidal volume was significantly smaller in SGA newborns compared to their AGA counterparts in pre-feed state ( P value .01) and it persisted till 60 minutes post feed ( P value .028); however, the mean gastric emptying time is similar in both the groups. Conclusion Mean gastric emptying time of AGA and SGA newborns is similar and hence a feeding interval of 1.5 to 2.5 hours is appropriate for these late preterm and term newborns. Antenatal Doppler changes in SGA babies did not alter their gastric emptying time hence similar feeding frequency can be used in both.

Detection of Chlamydia and Chlamydia-like organisms in bovine placental tissue.

This study aimed to investigate the presence of Chlamydia spp. and Parachlamydia acanthamoebae in bovine placental tissue originating from abortion and non-abortion cases in Belgium. Placentas of 164 late term bovine abortions (last trimester of gestation) and 41 non-abortion (collected after calving) cases were analysed by PCR for Chlamydia spp., Chlamydia abortus, C. psittaci and P. acanthamoebae. Additionally, a subset of 101 (75 abortion and 26 non-abortion cases) of these placenta samples were also analysed by histopathology to detect possible Chlamydia-induced lesions. In 5.4% (11/205) of the cases, Chlamydia spp. were detected, and three of those cases were positive for C. psittaci. Parachlamydia acanthamoebae was detected in 36% (75/205) of the cases, being 44% (n = 72) in abortions and 7.3% (n = 3) in non-abortions cases (p < .001). None of the cases was positive for C. abortus. Purulent and/or necrotizing placentitis with or without vasculitis was observed in 18.8% (19/101) of the histopathologically analysed placenta samples. In 5.9% (6/101) of the cases, placentitis was observed along with vasculitis. In the abortion cases, 24% (18/75) of the samples showed purulent and/or necrotizing placentitis, while purulent and/or necrotizing placentitis was visible in 3.9% (1/26) of the non-abortion cases. Placental lesions of inflammation and/or necrosis were present in 44% (15/34) of the cases where P. acanthamoebae was detected, while inflammation and/or necrosis was present in 20.9% (14/67) of the negative cases (p < .05). The detection of Chlamydia spp. and especially P. acanthamoebae, in combination with correlated histological lesions such as purulent and/or necrotizing placentitis and/or vasculitis in placental tissue following abortion, suggests a potential role of this pathogen in cases of bovine abortion in Belgium. Further in-depth studies are necessary to unravel the role of these species as abortifacient agents in cattle and to include them in bovine abortion monitoring programmes.

Incidence Rate and Associated Factors of Early Onset Sepsis Among Neonate Born at ≥35 Weeks' Gestation in Thai Tertiary Hospital.

This study aimed to find the incidence rate and associated factors of EOS in neonates with 35 weeks of gestational age or more at Panyananthaphikkhu Chonprathan Medical Center (PCMC) in order to develop effective prevention and treatment strategies to reduce neonatal mortality. A cross-sectional study was done in a single-center neonatal intensive care unit at PCMC. Data were collected from October 2016 to September 2021 from all neonates with 35 weeks of gestational age or more with EOS and randomly collected from neonates with 35 weeks of gestational age or more without EOS. The associated factors of EOS were shown as an odds ratio by multivariate analysis of binary logistic regression. In this study, 595 neonates were enrolled and divided into 2 groups - EOS group (193 neonates) and non-EOS group (402 neonates). The incidence rate of EOS was 21.23/1000 live births, comprising 2 culture-positive EOS neonates (0.22/1000 live births) and 191 culture-negative EOS neonates (21/1000 live births). The common clinical manifestations in the EOS group were respiratory distress (157 neonates, 81%), temperature instability (43 neonates, 22.3%) and poor feeding (39 neonates, 20.2%). Statistically significant relationship (p-value < 0.05) was found in prolonged rupture of membrane (OR 11.7, 95% CI: 2.54-53.88), low birth weight (OR 2.3, 95% CI: 1.25-4.4) and normal Apgar score at 5 minutes after birth (OR 0.5, 95% CI: 0.31-0.71). Our study shows that the incidence rate of culture positive EOS in late preterm and term is very low. EOS was significantly associated withprolonged rupture of membrane and low birth weight whereas lower rate of EOS was significantly associated with normal Apgar score at 5 minutes after birth. Efforts to recognize these factors early and effectively resuscitate neonates may reduce and prevent neonatal morbidity and mortality.

Threshold and Correlation of Total Serum Bilirubin with Screening Automated Auditory Brainstem Response Among Newborns with Hyperbilirubinemia in National Hospital Abuja

Objective To determine the total serum bilirubin (TSB) cut-off value predictive of hearing impairment among newborns with hyperbilirubinemia at the National Hospital Abuja. Setting This was a cross-sectional study conducted in the Special Care Baby Unit (SCBU) and Neonatal Intensive Care Unit (NICU) of National Hospital Abuja between August 2020 and February 2021. Methods A universal sampling of eligible participants was done, and consent was obtained from the parent. Using the TSB and results of hearing screening carried out with the Otoport advance from Otodynamics®, the proportion of automated auditory brainstem response (AABR) screening failure was determined, and the receiver’s operating characteristics (ROC) curve coordinates were used to find the threshold bilirubin level for the risk of hearing loss. The Spearman-Rho correlation assessed the relationship between TSB level and AABR findings. Results 160 newborns below 28 days of age, delivered at 34 weeks gestation and above, who had clinical jaundice were recruited. The prevalence of screening AABR failure in at least one ear was 26.2%. The correlation between TSB and AABR was weakly positive (rs = .189, p = .093) and the TSB cut-off for AABR failure was 16.3 mg/dl (sensitivity 45.5%, specificity 81%, Youden’s-J statistic = 0.265). Conclusion The TSB threshold for AABR screening failure was 16.3 mg/dl, but TSB did not correlate well with screening AABR. Serum bilirubin above 15 mg/dl in late preterm and term neonates should be actively treated with phototherapy and/or exchange blood transfusions where feasible, particularly in resource-poor settings.

Apelin and Visfatin Expression in Placental Tissue in Women With Preeclampsia and Overweight/Obesity.

Preeclampsia (PE) is a multifunctional and multisystem disorder. Several factors favor the development of PE, including obesity. Cytokines are also expressed in the placenta, predisposing to local alterations that favor the development of distinct pathological processes, including PE. This study aimed to evaluate the apelin and visfatin mRNA expression in the placental tissue of women with preeclampsia and overweight/obesity and correlates with maternal and fetal variables. A cross-sectional analytical study was performed with 60 pregnant women and their newborns. Clinical, anthropometric, and laboratory variables were collected. Placental tissue samples were obtained, and the apelin and visfatin mRNA expression levels were assessed by qRT-PCR. The main findings evidenced lower levels of apelin expression in overweight/obese women, accompanied by a negative correlation with BMI and pre-pregnancy weight; a higher expression of apelin was also observed in women with late PE and no personal history of PE. For visfatin levels, higher expression levels were observed in women with late PE and term delivery. Furthermore, a positive correlation was observed between visfatin levels and fetal anthropometric parameters, such as weight, length, and head circumference. Apelin levels were less expressed in overweight/obese women. Apelin and visfatin levels were correlated/associated with maternal-fetal variables.

Outcome of Continuous Positive Airway Pressure (CPAP) Administration in Delivery Room for Neonates with ≧35 Weeks of Gestational Age with Respiratory Distress: A Randomized Control Trial in a Tertiary Care Hospital

The sixth edition of Neonatal Resuscitation program (NRP 2011) recommends the use of delivery room Continuous Positive Airway Pressure (DR CPAP) for neonates with respiratory distress in the delivery room irrespective of gestational age. However, there is no convincing evidence of benefit of DR CPAP amongst late preterm and term neonates. Methodology This single center, open label, randomized control trial was carried out in a tertiary care teaching hospital. Neonates delivered with GA ≧ 35 weeks developing labored breathing in the delivery room or requiring free flow oxygen to maintain SPO2 in target range were randomized to receive DR CPAP or free flow oxygen (DR FFO). The early neonatal outcome in the DR, and for those requiring NICU admission, was recorded. Results 131 neonates were enrolled in the study, 62 (47.32 %) neonates were randomized to DR CPAP while 69 (52.67 %) to DR FFO group. There was no statistically significant difference observed among neonates from both groups who improved in the DR ( P value:.55) or those shifted to NICU in view of respiratory distress ( P value:.54). There was no significant difference in the modified Downes score amongst 2 groups at the time of NICU admission ( P value:.39). Conclusion This randomized control trial showed no significant difference in the delivery room or early neonatal outcome after the administration of DR CPAP or FFO amongst neonates with gestational age ≧ 35 weeks presenting with respiratory distress. Robust evidence needs to be generated to support the current recommendation of administering DR CPAP irrespective of gestation age.

Inhaled nitric oxide use in newborns.

Inhaled nitric oxide (iNO), a selective pulmonary vasodilator, is used as a therapeutic modality in infants with hypoxemic respiratory failure (HRF) associated with persistent pulmonary hypertension of the newborn (PPHN). iNO should ideally be initiated following echocardiographic confirmation of PPHN. Use of iNO is recommended in late preterm and term infants who develop HRF despite optimal oxygenation and ventilation strategies. However, routine iNO use in preterm infants on respiratory support is not recommended. iNO may be considered as a rescue modality in preterm infants with early-onset HRF when associated with prolonged rupture of membranes or oligohydramnios, or late-onset HRF in the context of bronchopulmonary dysplasia-associated pulmonary hypertension (PH) with severe right ventricular failure. A trial of iNO may also be considered for infants with congenital diaphragmatic hernia with persistent HRF despite optimal lung recruitment, and with echocardiographic evidence of supra-systemic PH and adequate left ventricular function.

Clinical and laboratory features and prognostic factors for outcome of progressive multifocal leukoencephalopathy in HIV-infected patients

Objective: To analyze clinical and laboratory features to predict the outcome of progressive multifocal leukoencephalopathy (PML) in HIV-infected patients.Materials and methods: Retrospective analysis of medical histories of HIV-infected patients with CNS lesions in 2015–2017, and dynamic monitoring of HIV patients with CNS lesions in 2018–2019, who were intensive care unit (ICU) in Infectious Clinical Hospital No. 2 of the Department of Health of Moscow.Results and discussion: A total 196 patients with encephalitis/meningoencephalitis: 124 (63%) patients with detected JCPyV in the cerebrospinal fluid (CSF) — study group (JCPyV+), 72 patients with undetectable JCPyV in CSF — comparison group (JCPyV–). Late terms of hospitalization were noted, mainly in the JCPyV+ group (mean — 58±6 days). The majority of patients had severe immunodeficiency, in the JCPyV+ group the number of patients with CD4&lt;200 cells/μl was significantly higher than in the JCPyV– group (87.8% and 75.8%, p&lt;0.05). Only 22% of patients received antiretroviral therapy (ART) prior to hospitalization. The main clinical manifestations of PML in the study were: paralysis and paresis of the limbs, speech impairment, cognitive disorders in combination with cerebral symptoms in the absence of meningeal signs. In 87.8% patients with positive JCPyV DNA no other pathogens were detected in the CSF; in the patients without PML the detection of infectious agents in the CSF was also rare (14.3%). The disease led to the death for 78% patients in the JCPyV+ group and 72% JCPyV– group, p&gt;0.05. The chance of survival was 2.5 times higher for patients admitted to hospital less than 14 days after deterioration (OR=2.468 [95% CI: 1.244–4.898]). Patients with CD4&lt;200 cells/μL were 5.5 times more chance to die than patients with higher CD4 rates (OR=5.449 [95% CI: 2.388–12.431]). There was no relationship between the concentration of JCPyV DNA and HIV RNA in the CSF and their impact for the disease outcome.Conclusion: Survival prognosis for PML during treatment in ICU was worser for patients hospitalized after 14 days from the onset of symptoms and with CD4&lt;200 cells/μL. Early ART initiation for all HIV-positive individuals significantly reduces the number of opportunistic infections and improve life expectancy.