Low Weight Neonates Research Articles

Maternal and Perinatal Outcomes in Pregnant Women with Heart Disease: A Case-Control Study.

Objective: We analyzed the obstetric and cardiac characteristics and results of pregnant women with heart disease (HD) and compared their results with those of healthy controls. Methods: In this retrospective single-center case-control study, women with HD attended between 2010 and 2018 were matched at a 1:2 ratio (according to date of delivery, parity, and singleton or twin pregnancy) with controls without heart disease treated in the same referral center. Results: We identified 141 pregnant women with HD, of whom 132 reached 22 weeks of gestation and were paired with 264 healthy controls, for a total of 396 participants and 408 newborns. Most common HDs were congenital HD (53 women), arrhythmia (46), valvular HD (35), and cardiomyopathy (16), having women with more than one coexisting HD. During pregnancy or the puerperium, 19.9% of mothers experienced a major adverse cardiac event (MACE), with 5% requiring intensive care unit (ICU) admission. The rates of cesarean section were 37.1% in the case group and 18.2% in the control group, with an odds ratio (OR) of 2.66 (95% CI = 1.66-4.26, p < 0.001). We also found a higher use of general anesthesia, with an OR of 10.73 (95% CI = 2.32-49.75, p = 0.002); more prolonged hospitalizations, with an OR of 2.91 (95% CI 1.02-8.35, p = 0.023); and a higher incidence of low neonatal weight, with an OR of 1.96 (95% CI 1.09-3.52, p = 0.012). There were no differences between groups in terms of gestational age at delivery; however, we observed greater prematurity in women with HD, without reaching statistical significance. The rate of congenital heart disease among the newborns of mothers with HD was 13.2%. Conclusions: HD increases maternal morbidity during pregnancy and it is associated with higher rates of cesarean section and low birth weight.

COMPARATIVE OUTCOME OF NEONATES BORN TO SARS-COV2 (RTPCR TEST) POSITIVE MOTHERS IN 1ST, 2ND, AND 3RD WAVE OF COVID PANDEMIC AT A TERTIARY CARE HOSPITAL IN NORTH INDIA

Aims and Objectives: To access the incidence of perinatal transmission of SARS‑CoV‑2 virus from pregnant mothers having RTPCR test positive for SARS‑CoV‑2 virus to their newborn babies, to evaluate the morbidity and mortality in these neonates, and to compare the outcomes of these neonates during the first, second, and third waves of the COVID pandemic (March 2020–July 2022) admitted at a tertiary care health facility in North India (Punjab). Methods: Data were retrospectively gathered from hospital records for all neonates born to pregnant women who had tested positive for the virus using the RTPCR method from March 2020 to July 2022, when the SARS‑CoV‑2 pandemic was in full swing. In order to assess the relationship between various maternal and perinatal risk factors, a thorough history of the neonate and the pregnant mother was recorded. Results: During the COVID-19 outbreak, 168 neonates in total were born to mothers who tested positive for the SARS‑CoV‑2 virus. The majority of these neonates were healthy, although the premature birth rate was higher. Our study’s results show a statistically significant relationship between pregnancy-related issues and newborn problems like premature births, low neonatal weight, newborns exhibiting one or more disease symptoms, and poorer neonatal outcomes. Conclusions: According to our research, there was very little perinatal transmission of the SARS‑CoV‑2 virus from the pregnant mothers to the newborns. Although there were more premature babies, most of them managed to survive.

Platelet transfusion practices among neonatologists in Saudi Arabia: A nationwide cross-sectional survey.

The etiologies of thrombocytopenia are highly diverse; however, early neonatal thrombocytopenia might be more common among extremely low-weight neonates. Therefore, in this study, we aimed to examine the current neonatal platelet (PLT) transfusion practices in Saudi Arabia. This is a cross-sectional online survey study that was conducted between October and December 2022. Convenience sampling was used to recruit the participants. In this study, we developed a questionnaire based on an extensive literature review to examine current neonatal PLT transfusion practices. A total of 81 neonatologists participated. The vast majority of them (85.2%) were practicing in a level 3 neonatal intensive care unit, with 60.0% of them reporting that they transfuse PLTs over 1 hour. Around 53% reported that they typically order 10 mL/kg per PLT transfusion. Up to 34.6% of the study participants reported that they use pooled whole-blood-derived PLT products in their practicing unit. Almost half (48.0%) of the study participants reported that they have written guidelines for PLT transfusion in their practicing unit, with 81.1% reporting that the PLT transfusion threshold was stated in the guidelines. Neonatal thrombocytopenia is typically treated with PLT transfusions. PLT transfusion criteria should be lowered in light of recent evidence suggesting that doing so may be counterproductive. However, there is some disagreement about whether a PLT count constitutes a medical emergency requiring a transfusion for a newborn baby. Furthermore, there is a great deal of variation in the administration of PLT infusions in Saudi Arabia because of the absence of clear protocols. Strict neonatal PLT transfusion standards and carefully planned clinical research are needed to address the risks and/or benefits of these diverse methods.

Effects of maternal pulmonary arterial hypertension on fetal hemodynamics and maternal-fetal outcome in late pregnancy.

The aim of this study was to investigate the effects of maternal pulmonary arterial hypertension (PAH) on fetal hemodynamics in the third trimester and to identify hemodynamic indicators associated with adverse maternal and fetal outcomes. We recruited 48 pregnant women with PAH in the third trimester and 32 women with normal pregnancies as controls matched for age and gestational week. Fetal growth and hemodynamic parameters were assessed by two-dimensional and color Doppler. All cases were followed up until delivery and maternal and fetal outcomes were collected. High throughput sequencing method was used to determine differential miRNA patterns in plasma exposed to pulmonary arterial hypertension (PAH) in pregnant women. We then performed the validated of key differentially expressed miRNAs by real-time PCR. Compared with the normal and mild PAH groups, resistance index (RI), pulsatility index (PI) of the fetal umbilical artery (UA) and quantitative ductus venosus (QDV) blood flow were increased in subjects with moderate to severe PAH, while PI and the ratio of peak systolic velocity (PSV) to end-diastolic velocity (EDV) (S/D) of the middle cerebral artery (MCA) were decreased. Compared with the normal group, subjects in the mild and moderate PAH groups had lower neonatal weight, shorter neonatal height, and higher preterm birth rates. In addition, miRNA sequencing data showed that PAH affected the levels of 23 miRNAs in plasma. At the same time, we showed that PAH significantly decreased the level of miR-1255a and increased the level of miR-548ar-3p by real-time PCR. In the group of pregnant women with moderate to severe pulmonary hypertension, there was a higher proportion of preterm births and low birth weight babies. Hemodynamic changes in the fetal UA, MCA, and ductus venosus (DV) during late pregnancy were associated with adverse fetal outcomes. At the same time, miRNA sequencing results showed that miR-1255a and miR-548ar-3p may play an important role in the development of PAH.

Placental characteristics and neonatal weights among women with malaria-preeclampsia comorbidity and healthy pregnancies.

Malaria and preeclampsia are leading causes of maternal morbidity and mortality in sub-Saharan Africa. They contribute significantly to poor perinatal outcomes like low neonatal weight by causing considerable placental morphological changes that impair placental function. Previous studies have described the effects of either condition on the placental structure but the structure of the placenta in malaria-preeclampsia comorbidity is largely understudied despite its high burden. This study aimed to compare the placental characteristics and neonatal weights among women with malaria-preeclampsia comorbidity versus those with healthy pregnancies. We conducted a retrospective cohort study among 24 women with malaria-preeclampsia comorbidity and 24 women with healthy pregnancies at a County Hospital in Western Kenya. Neonatal weights, gross and histo-morphometric placental characteristics were compared among the two groups. There was a significant reduction in neonatal weights (P<0.001), placental weights (P = 0.028), cord length (P<0.001), and cord diameter (P<0.001) among women with malaria-preeclampsia comorbidity compared to those with healthy pregnancies. There was also a significant reduction in villous maturity (P = 0.016) and villous volume density (P = 0.012) with increased villous vascularity (P<0.007) among women with malaria-preeclampsia comorbidity compared to those with healthy pregnancies. Placental villous maturity and villous volume density are significantly reduced in patients with malaria-preeclampsia comorbidity with a compensatory increase in villous vascularity. This leads to impaired placental function that contributes to lower neonatal weights.

Placental Histopathological Alterations in COVID-19 Infected Pregnancies

Aim: The ongoing global COVID-19 pandemic, caused by the SARS-CoV-2 virus, has generated significant apprehensions in maternal-fetal medicine. Initially considered to affect the respiratory system primarily, recent findings have indicated that the pandemic has far-reaching implications for various physiological functions, particularly in pregnant individuals. This study focused on examining the influence of COVID-19 on placental histopathology in pregnant women infected with SARS-CoV-2.&#x0D; Material and Methods: We conducted a comparative study involving two groups of pregnant women with similar demographic characteristics: a group testing positive for COVID-19 (n=31) and a control group of COVID-19-negative pregnant women (n=31). After delivery, placental tissues were collected and subjected to comprehensive histopathological examination to determine any potential alterations in the placenta induced by SARS-CoV-2 infection.&#x0D; Results: Our study revealed substantial histopathological alterations in pregnant women with COVID-19 placentas. Notably, the COVID-19 group displayed a higher incidence of cesarean deliveries, possibly due to concerns related to maternal-fetal transmission and respiratory complications. Furthermore, neonates born to mothers in the COVID-19 group had significantly lower birth weights. Several placental histopathological changes, including villous fibrin deposits, thrombosis, intervillous hemorrhage, agglutination, avascular fibrotic villi, and syncytial knots, were markedly increased in the COVID-19 group, indicating compromised fetal blood circulation. Although not statistically significant, trends toward elevated villous infarction, fetal vascular malperfusion, and chorioamnionitis were observed.&#x0D; Conclusion: Our study underscores the potential risks associated with COVID-19 on placental health, maternal well-being, and neonatal outcomes. We must understand the underlying physiological mechanisms behind these pathological changes to provide optimal maternal-fetal care during this ongoing crisis. Comprehensive and multicentric studies are urgently required to confirm and expand our findings.

626 CARDIOVASCULAR DISEASE PHENOTYPES IN PREGNANCY: GESTATION, PERIPARTUM, AND LONG-TERM OUTCOMES

Abstract Background Maternal cardiovascular physiology is affected by changes that may be impaired in women with cardiovascular disease. Management of these pregnancies is challenging, as prevalence of late childbearing and of women with congenital heart disease achieving pregnancy is increasing. Objective This single-center prospective study sought to evaluate the effects of maternal cardiovascular disease (CVD) on pregnancy outcome and, after birth, on maternal and fetal morbidity and mortality. Methods 140 patients with cardiovascular disease prior to pregnancy (congenital or acquired) or cardiovascular disease developed during pregnancy were enrolled at our tertiary referral hospital between 2011 and 2021. Baseline data included cardiovascular risk factors, cardiological therapy, mWHO class in pregnancy, 12-lead EKG, and transthoracic echocardiography. Birth-related data included gestational age at delivery; neonatal weight, Apgar score at 1 and 5 minutes from birth; admission to neonatal ICU. A medium-to-long term follow-up of these patients was carried out by telemedicine. The primary endpoint was pregnancy outcome in terms of live births, week of delivery and fetal growth. Secondary endpoints included neonatal complications, maternal adverse cardiovascular events (death from cardiovascular causes, sustained arrhythmia, acute heart failure, postpartum cardiac surgery) and adverse obstetric events (spontaneous abortion, fetal loss, intrauterine death, neonatal death, SGA, prematurity, frequency of caesarean sections). Results Six cohorts were identified: adult congenital heart disease (ACHD); arrhythmias; valvular heart disease (VHD); ischemic CVD; cardiomyopathies and myopericarditis (CM/MYO); aortic disease. Heart disease prior to pregnancy was the most common setting (88%), mainly including ACHD (54%), followed by VHD (15%) and arrhythmias (11%). The pregnancy-onset cardiovascular diseases (12%) were predominantly CM/MYO (53%), mainly peripartum dilated cardiomyopathy, followed by arrhythmias (35%). Intermediate and high-risk classes (mWHO II-III, III and IV) were observed in 94 patients (67%). There were no maternal deaths; acute heart failure occurred in 6% of patients with no significant difference between groups. Sustained arrhythmias were found in 7% of the total cases, with a significantly higher prevalence in the cohort with preexisting arrhythmia (p &amp;lt;0.05). Cardiac surgery was performed in 4% of the patients, all in the ACHD cohort. Live births were 135 (94%); fetal deaths were 5 (one spontaneous abortion, 3 fetal losses and one neonatal death). Caesarean section was performed in 74% of patients. The mean gestational age at birth was low in all groups (36.6 ± 4.6 weeks), as well as the neonatal weight in grams (2676.9 ± 698.3) and the percentile of neonatal weight (37.8 ± 25.2). Reduced LVEF was significantly associated with low neonatal weight in the mWHO risk class IV patients (p = 0.04). At a mean follow-up of 26 months, cardiac surgery was significantly higher in the group of aortic disease (50% in diseases of the aorta, 8% in the ACHD group, 7% in the CM/MYO group, no events in other groups; p = 0.007), despite the small sample under investigation. Conclusions We provide insights of how, by strict and timely follow-up and a multidisciplinary approach implemented before pregnancy and throughout gestation, good outcomes can be achieved in pregnancies with congenital or acquired cardiovascular disease, despite the high prevalence of intermediate and high-risk patients.

Predictors of postpartum hemorrhage in vaginal deliveries

In this study we aimed to identify the risk factors for acute postpartum hemorrhage in pregnant women. We investigated a number of potential risk factors, including the maternal age, gestational age, parity, birth weight, single or multiple pregnancies, episiotomy, tears requiring vaginal or perineal suturing, and placental retention. Data from 1628 deliveries performed from 2019 to 2020 were included. The maternal age ranged between 18 to 41 years, with a mean age of 26.6±3.2 years. The average blood loss postpartum was 234.4±229.7 ml. Among traditionally delivered patients, 309 (18.9%) experienced standard postpartum hemorrhage while of 27 (1.65%) had severe postpartum blood loss. Retained placenta was the major risk factor for both standard and severe postpartum hemorrhage (OR=4.31, 95% CI 1.85-10.04, p&lt;0.001 vs OR=10.25, 95% CI 2.13-49.2, p&lt;0.01). Similarly multiple pregnancy, macrosomia as well as episiotomy was associated with any postpartum hemorrhage. Women with previous history of deliveries and low weight neonates were less likely to experience postpartum hemorrhage (OR=0.69, 95% CI 0.54-0.90, p=0.006 and OR=0.54, 95% CI 0.29-0.97, p=0.04). Risk variables for postpartum hemorrhage were macrosomia, retained placenta, episiotomy, multiple pregnancy, and the necessity for perineal suture.

Frequency of placental malaria and its associated factors in northwestern Colombia, pooled analysis 2009-2020.

Knowledge about placental malaria (PM) is insufficient in the world, and incipient in Colombia where studies are few and recent. In this country, PM has been reported by Plasmodium vivax, Plasmodium falciparum, and mixed infection. The objective was to determine the frequency of PM and its associated clinical-epidemiological factors in mothers and neonates in northwestern Colombia, 2009–2020. A Retrospective pooled analysis with 602 placentas captured in five investigations. The diagnosis of PM was made with thick blood smear (TBS) and qPCR. The groups with and without PM were compared using the Chi-square test, Mann-Whitney test, and crude and adjusted prevalence ratios in a log-binomial model. The prevalence of PM was 27.7% with 92% (155/167) of submicroscopic cases; 41.3% by P. vivax, 44,3% by P. falciparum, and 14.4% by mixed infections. In the multivariate adjustment, PM was associated with the diagnosis of congenital malaria, low neonatal weight, gestational malaria, maternal anemia, previous malaria during pregnancy, and age between 25–43 years. This research is the investigation with the largest number of subjects for studying PM in Colombia, in the ecoepidemiological zone that produces more cases of malaria per year, finding a high prevalence of submicroscopic PM that caused serious maternal (anemia) and neonatal (congenital malaria and low neonatal weight) effects. The results show limitations in the timely diagnosis and treatment, given that the epidemiological surveillance program in Colombia is based on thick blood smear, which generates a substantial underestimation of the magnitude of PM, with serious effects and clinical risks. It is urgent to demand that the health authorities adopt measures such as prenatal control visits as soon as the pregnancy begins, monthly implementation of TBS, and active search for infected pregnant women in their homes and workplaces.

Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study

BackgroundThe effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed.ObjectiveTo evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission.Study DesignIn this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices.ResultsA total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2–9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2–4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity.Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity.ConclusionIn this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

Effect of Depressive Disorders and Their Pharmacological Treatment during Pregnancy on Maternal and Neonatal Outcome.

Purpose: Depressive disorders are related to obstetrical and neonatal complications. The purpose of this study is to evaluate the outcomes of pregnancy in women suffering from depressive disorders, who are treated or not treated with pharmacotherapy during pregnancy. Methods: The maternal and neonatal outcomes of 281 pregnant women with depressive disorders (D group—DG), who delivered their babies at Sant’Anna Hospital of Turin, were compared with those of a control group of 200 depression-free, healthy, pregnant women, who were matched for maternal age (C group—CG). Of the depressed patients, those who received pharmacotherapy during pregnancy (DG-Tr, n = 199, 70.8%) were compared with those who did not (DG-Untr, n = 82, 29.2%). The comparisons were performed using χ2 tests for categorical variables and ANOVA for continuous variables. A linear regression analysis was run to examine the association between APGAR scores at 5 min and certain clinical variables. Results: The women in DG showed higher rates of cesarean section, preterm delivery, induction of labor and SGA babies, and low neonatal weights and 5-min APGAR scores, compared to the untreated patients. Those treated with psychotropic drugs showed lower rates of cesarean section, but lower 5-min APGAR scores, compared to those who were untreated. However, after controlling for confounding variables, the 5-min APGAR scores were linearly associated with neonatal weight and not with the use of psychotropic treatment. No significant differences were observed between the treated and untreated women, regarding the rates of preterm delivery, induction of labor, SGA and low neonatal weight. Conclusion: In pregnant patients with depressive disorders, poorer outcomes are expected vs. healthy controls. Pharmacological treatment is associated with a reduced rate of cesarean section, without inducing other complications for the mother and the newborn.

Retesting the hypothesis that early Diphtheria-Tetanus-Pertussis vaccination increases female mortality: An observational study within a randomised trial

BackgroundThere are worrying indications that diphtheria-tetanus-pertussis (DTP) vaccine has negative non-specific effects for females. We previously found, in a trial of early-Bacillus Calmette-Guérin (BCG) to low weight (LW) neonates, that receiving early-DTP (before 2 months of age), was associated with increased female mortality compared with no-DTP/delayed-DTP. Within a subsequent LW trial, we aimed to retest this observation. MethodsBetween 2010 and 2014, in Guinea-Bissau, 2,398 infants were randomised 1:1 to early-BCG (intervention) or delayed-BCG (standard practice for LW neonates) and visited at 2, 6 and 12 months of age to assess nutritional and vaccination status. DTP is recommended at 6 weeks of age. We examined the effect of having “early-DTP” versus “no-DTP” at the time of the 2-month visit on all-cause mortality between the 2- and 6-month visits in Cox models stratified by sex and adjusted for BCG-group and 2-month-weight-for-age (z-scores) providing adjusted mortality rate ratios (aMRRs). We analysed to which extent conditions varied between the present and the previous LW trials and how that might have affected the overall result of comparing the early-DTP and the no-DTP groups. ResultsAt the time of the 2-month visit, 75% (1,795/2,398) had received DTP. Those vaccinated had better anthropometric indices than no-DTP infants at birth and by 2 months of age. Between the 2- and 6-month visits, 29 deaths occurred. The early-DTP/no-DTP aMRR was 1.09 (95% CI: 0.44–2.69); 1.19 (0.45–3.15) for females and 0.77 (0.14–4.19) for males. Compared to the previous study, the present study cohort had 56% (30–72%) lower overall mortality, fewer no-DTP infants, higher BCG vaccination coverage and several more oral polio vaccine campaigns. ConclusionWe did not find that early-DTP was associated with increased female mortality as found in a previous study; differences in results may partly be due to a decline in overall mortality and changes in vaccination practices.

Antioxidant Levels in Cord Blood of Term Low Birth Weight Neonates Requiring Delivery Room Resuscitation

Objective: The objective of this study was to evaluate the serum levels of various antioxidants, namely, vitamin A and E, superoxide dismutase (SOD), catalase, and glutathione peroxidase (GPx) in the cord blood of term low birth weight (LBW) neonates who required delivery room resuscitation (DRR). Materials and Methods: This case control study included 37 term LBW neonates who needed DRR as cases and 44 term neonates as controls (15 term LBW and 29 term normal birth weight) who did not require resuscitation at birth. Neonates suffering from major congenital malformations, infection, or hemolytic disease were excluded. Standard methods were used to measure the levels of vitamin A, vitamin E, SOD, catalase, and GPx levels in the cord blood. Results: Vitamin A and E levels were significantly low in cases compared to term LBW controls as well as term normal birth weight controls. Levels of SOD, GPx, and catalase were comparable in different study groups. Conclusion: Our study shows that term LBW neonates requiring DRR had significantly low levels of vitamin A and E in their cord blood. This might compromise their ability to tolerate oxidative stress during DRR.

Intelligent Neonatal Sepsis Early Diagnosis System for Very Low Birth Weight Infants

Neonatal sepsis is a critical pathology that particularly affects the neonates in intensive care, especially if they are preterm and low birth weight, with an incidence varying between 1and 40% according to the onset (early or late) of the disease. Prompt diagnostic and therapeutic interventions could reduce the high percentage of mortality that characterises this pathology, especially in the premature and low weight neonates. The HeRO score analyses the heart rate variability and represents the risk of contracting sepsis because of the hospitalization in the neonatal intensive care unit up to 24 h before the clinical signs. However, it has been demonstrated that the HeRO score can produce many false-positive cases, thus leading to the start of unnecessary antibiotic therapy. In this work, the authors propose an optimised artificial neural network model able to diagnose sepsis early based on the HeRO score along with a series of parameters strictly connected to the risk of neonatal sepsis. The proposed methodology shows promising results, outperforming the diagnostic accuracy of the only HeRO score and reducing the number of false positives, thus revealing itself to be a promising tool for supporting the clinicians in the daily clinical practice.

Bajo peso al nacer: Factores asociados a la madre

El bajo peso al nacimiento (BPN) constituye uno de los problemas de salud pública más comunes tanto a nivel nacional como mundial, por su asociación al mayor riesgo de morbimortalidad neonatal. Con el objetivo de identificar la incidencia y factores maternos asociados a neonatos con bajo peso al nacer, se realizó un estudio no experimental, descriptivo, transversal en 198 neonatos y sus madres en el área de neonatología del Hospital José Carrasco Arteaga de la ciudad de Cuenca durante el período octubre 2017-mayo 2018. El componente de observación y análisis fue la historia clínica tanto del recién nacido como de su madre. Los datos fueron expresados en frecuencias absolutas y relativas. Para establecer la relación entre el bajo peso neonatal y los factores de riesgo maternos se empleó la prueba de chi cuadrado (X2). Se consideró estadísticamente significativo un valor de p &lt; 0.05. La incidencia de BPN fue de 11.1%. En el análisis estadístico, los factores asociados a BPN fueron la ganancia baja de peso durante el embarazo (p=0.001) y el número de gestas (p=0.03). No se observó asociación significativa entre BPN y controles prenatales, periodo intergenésico, diabetes gestacional, preeclamsia y la presencia de enfermedades en el periodo gestacional. Concluyendo; el número de casos de niños con bajo peso al nacer fueron similares a los encontrados en otros estudios. Los factores asociados a BPN fueron la ganancia baja de peso durante el embarazo y el número de gestas.

Meningitis in neonates having late onset sepsis.

Objectives: Majority of the researchers reporting incidence and etiology surrounding neonatal sepsis along with meningitis are from developed countries while limited work is noticed from developing countries where overall burden of these disease are immense. The current study was aimed to determine the frequency of meningitis in children having late-onset sepsis (LOS). Study Design: Descriptive Case Series study. Setting: Department of Pediatrics Medicine, Nishter Medical University Multan and DHQ Teaching Hospital, Dera Ghazi Khan. Period: From July to December 2019. Material &amp; Methods: A total of 206 neonates of both gender, older than 72 hours, admitted and diagnosed with sepsis were enrolled. Meningitis was labeled in a neonate if his/her cerebrospinal fluid (CSF) contains &gt; 30 leukocytes/mm3, and any one of these two: protein &gt;200mg/dl or sugar &lt;40mg/dl. Results: Out of a total of 206 neonates having LOS, majority, 111 (53.9%) were male and 73 (35.4%) were aged 3 to 7 days. Overall, mean weight was found to be 2.68+0.51 kg. A total of 84 (40.8%) neonates were preterm. Frequency of meningitis was found in 44 (21.4%) neonates. Neonates having low body weight and being preterm were noted to have significant associations (p value &lt; 0.05) with meningitis. Conclusion: Frequency of meningitis in neonates with LOS was high. Low body weight and preterm neonates having LOS were found to have significant association with the presence of meningitis.

Biofilm Formation and Antibiotic Resistance of Cronbacter sakazakii and Its Implication Ininfant Food Contaminations

Cronobacter sakazakii is an opportunistic foodborne pathogen that causes diseases like meningitis, necrotizing enterocolitis, and bacteremia in immunocompromised, low weight individuals, neonates, infants, and elders. Cronobacter sakazakii has the ability to persist in extremely dried foods such as powdered infant formula (PIF). Infant food contamination by this bacterium is attributed to biofilm which are microbial communities attached to biotic or abiotic surfaces using a self-produced matrix of extracellular polymeric substances.

A longitudinal study on the relationship between mother\u2019s personality trait and eating behaviors, food intake, maternal weight gain during pregnancy and neonatal birth weight

BackgroundMany factors such as social and behavioral are related to appropriate weight gain during pregnancy, and there is much of importance to find them. The aim of the study was to explore the association of personality traits, with eating behaviors, food intake, maternal weight gain during pregnancy as well as the neonatal birth weight.MethodsThis is a longitudinal and cross-sectional study. Eating behaviors were assessed using the Dutch Eating Behavior Questionnaire (DEBQ), and the NEO personality inventory was used to assess personality in pregnant subjects. A validated food frequency questionnaire was used to determine food intake. Three hundred and sixty pregnant subjects from Ahvaz (the capital city of Khuzestan province, Iran) were followed from the 20th week of pregnancy until delivery.ResultsHigh neuroticism was associated with higher consumption of highly energetic foods (p < 0.05) and less consumption of vegetables (p < 0.01), also was related with lower weight gain during pregnancy and neonatal birth weight (p < 0.05). Openness to experience, extraversion and agreeableness were linked with higher consumption of vegetables (p < 0.05). Conscientiousness predicted lower neonatal weight (odds ratio: 1.20, confidence interval: 1.07–1.34, p < 0.01).ConclusionsIdentification of personality traits would help to change the lifestyle and improve management guidelines.

Differential determinants of patent ductus arteriosus closure for prematurity of varying birth body weight: A Retrospective Cohort Study

Patent ductus arteriosus (PDA) remains a critical issue in prematurity care. To predict the PDA closure early, we aimed to clarify the association of PDA closure with the initial postnatal 24-hour clinical characteristics and maternal and gestational histories of preterm neonates. A retrospective cohort study was conducted in a pediatric-neonatal-intensive-care-unit from 2008 to 2013. Data relating to birth histories, maternal histories, and clinical data from the first 24h of life were analyzed according to three types of PDA closure-non-treated, medically-responsive, and surgically-ligated PDA and birth body weights (BBWs). Univariate analysis was performed using non-parametric analysis and Chi-square test or Fisher's exact test. Multivariate analysis was performed using multinomial logistic regression to determine the independent risk factors for the PDA closure. This study involved 682 preterm infants with median gestational age of 31 (interquartile, IQR: 28-34) weeks and BBW of 1360 (IQR: 1085-1861) g. Inclusively, 16.7% of (P)DAs underwent medical and/or surgical treatment. For very low birth body weight (VLBW) neonates, surfactant use not only predicted the requirement of PDA treatment, but together with dopamine use and the larger amount of first 24-hour intravenous fluid (IVF) per kilogram of BBW, it also predicted the possibility of surgical ligation. Meanwhile, the cut-off values of the IVF amount (87 and 89.5ml/kg/day, respectively) might predict the PDA treatment necessity and surgical ligation. For neonates with BBW ≥1500g, placenta previa and lower BBW and systolic blood pressure (SBP) predicted the risk of treatment for PDA and its treatment response. Neonatal care for PDA in prematurity should be meticulously personalized. Surfactant use, dopamine administration and the first 24-hour IVF management may be critical for PDA closure in VLBW neonates. Antepartum history of placenta previa, BBW and SBP control may be important for BBW≥1500g.

Galleria mellonella as a Novelty in vivo Model of Host-Pathogen Interaction for Malassezia furfur CBS 1878 and Malassezia pachydermatis CBS 1879.

Malassezia furfur and Malassezia pachydermatis are lipophilic and lipid dependent yeasts, associated with the skin microbiota in humans and domestic animals, respectively. Although they are commensals, under specific conditions they become pathogens, causing skin conditions, such as pityriasis versicolor, dandruff/seborrheic dermatitis, folliculitis in humans, and dermatitis and otitis in dogs. Additionally, these species are associated with fungemia in immunocompromised patients and low-weight neonates in intensive care units with intravenous catheters or with parenteral nutrition and that are under-treatment of broad-spectrum antibiotics. The host-pathogen interaction mechanism in these yeasts is still unclear; for this reason, it is necessary to implement suitable new host systems, such as Galleria mellonella. This infection model has been widely used to assess virulence, host-pathogen interaction, and antimicrobial activity in bacteria and fungi. Some advantages of the G. mellonella model are: (1) the immune response has phagocytic cells and antimicrobial peptides that are similar to those in the innate immune response of human beings; (2) no ethical implications; (3) low cost; and (4) easy to handle and inoculate. This study aims to establish G. mellonella as an in vivo infection model for M. furfur and M. pachydermatis. To achieve this objective, first, G. mellonella larvae were first inoculated with different inoculum concentrations of these two Malassezia species, 1.5 × 106 CFU/mL, 1.5 × 107 CFU/mL, 1.5 × 108 CFU/mL, and 11.5 × 109 CFU/mL, and incubated at 33 and 37°C. Then, for 15 days, the mortality and melanization were evaluated daily. Finally, the characterization of hemocytes and fungal burden assessment were as carried out. It was found that at 33 and 37°C both M. furfur and M. pachydermatis successfully established a systemic infection in G. mellonella. M. pachydermatis proved to be slightly more virulent than M. furfur at a temperature of 37°C. The results suggest that larvae mortality and melanization is dependent on the specie of Malassezia, the inoculum concentration and the temperature. According to the findings, G. mellonella can be used as an in vivo model of infection to conduct easy and reliable approaches to boost our knowledge of the Malassezia genus.