Clinical Characteristics Of Neonates Research Articles

Neonatal outcomes of pregnant women with COVID-19 in a developing country setup

BackgroundCurrent evidence on vertical transmission of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) and neonatal outcome among exposed newborns is emerging and posing a challenge for preventive interventions. Perinatal transmission to the neonates especially during breastfeeding and rooming in is also relatively unknown.MethodsThis prospective observational study was conducted in Kalinga Institute of Medical Science (KIMS), Odisha state from 1st May to 20th October 2020. A total of 165 neonates born to SARS-CoV-2 infected mothers were enrolled. Real time polymerase chain reaction (RT PCR) testing was done in first 32 neonates in initial 24 h of life.ResultsThe clinical characteristics of 162 mothers & 165 neonates were analyzed. Mode of delivery was by caesarian section in most (n = 103, 60%) cases. Three (3/32, 9.4%) inborn and 6 outborn neonates were SARS-CoV-2 positive. Thirty-eight (23%) babies needed neonatal intensive care. Clinical characteristics of neonates were meconium-stained amniotic fluid (MSAF [23.63%]), prematurity (16.9%), respiratory distress (10.5%), moderate to severe hypoxic ischemic encephalopathy (3.6%), sepsis (7%) and hyperbilirubinemia (8.7%). Out of 138 stable babies kept on mother side and initiated breast feeding, none of them developed any signs and symptoms attributable to SARS-CoV-2. Five (3%) neonates died in COVID hospital of which one baby was SARS-CoV-2 positive.ConclusionThere was an increased rate of incidences of hypoxic ischemic encephalopathy, meconium stained liquor and cesarean section delivery in COVID hospital. We found a possible vertical transmission in 9.4% cases. None of the neonates developed sign and symptoms of SARS-CoV-2 infection during rooming in and breast feeding.

Group B streptococcus neonatal umbilical colonization managed by dry cord care in nurseries: A retrospective cohort study

Screening-based intrapartum antibiotic prophylaxis (IAP) has reduced the prevalence of early-onset group B Streptococcus (GBS) infection in newborns. Nevertheless, early-onset disease still occurs despite IAP, and IAP is not effective in preventing late-onset disease. This study aimed to determine the prevalence and risk factors of GBS neonatal umbilical colonization managed by dry cord care in Japan. Of 735 healthy newborns in the well-baby nursery at Saitama City Hospital, 353 from whom umbilical bacterial swabs were obtained before discharge were included in the analysis. Maternal and neonatal clinical characteristics were retrospectively reviewed. GBS was detected in 4.2% (15/353) of umbilical swabs; 13/15 (86.8%) were born to GBS-negative mothers. The median (IQR) age at umbilical swab collection was 4.0 (4.0-5.0) days. Comparison of clinical characteristics between GBS-positive and negative neonates revealed a significant difference in the proportion of vaginal deliveries (15/15 [100%] in GBS-positive neonates vs. 115/338 [34.0%] in GBS-negative neonates, p<0.0001). Of 15 GBS-positive neonates, 10 (66.7%) were also co-colonized with other enteric bacteria such as Escherichia coli. Vaginal delivery was a risk factor associated with GBS neonatal umbilical colonization in Japanese neonates. Co-colonization with multiple enteric bacterial species implicates vertical transmission of GBS from undetected carrier mothers during passage through the birth canal.

Maternal and Neonatal Outcomes of Pregnant Women with Clinically Confirmed COVID-19 Admitted at the Philippine General Hospital

Objectives. The effect of COVID-19 infection in pregnant women and her neonate is not well-understood, with no clear evidence for vertical transmission. This study aims to determine the maternal and neonatal clinical characteristics and the dyad’s outcomes among those infected with COVID-19 infection.&#x0D; Methods. An ambispective cross-sectional study involving pregnant women with confirmed COVID-19 infection was conducted at the Philippine General Hospital from April to August 2020. Two hundred nine obstetric patients were included, 14 of whom consented to specimen collection to determine vertical transmission.&#x0D; Results. The majority of pregnant women with COVID-19 infection and their neonates had good outcomes. Labor, delivery, and the immediate postpartum course were generally uneventful. The all-cause maternal morbidity rate was high at 75.6 per 100 cases during the five-month study period. COVID-19 related morbidities included the development of Guillain-Barré Syndrome. The in-hospital all-cause maternal mortality rate was 1.91 per 100 cases. The causes of maternal death were acute respiratory failure, septic shock, and congenital heart disease (atrial septal defect with Eisenmengerization). The in-hospital, all-cause neonatal mortality rate was 1.04 per 100 neonates of cases. The lone mother and infant deaths were in a postmortem rt-PCR swab negative mother with an rt-PCR swab positive live neonate who eventually succumbed after nine days of life. All 14 dyads with collected specimens that included amniotic fluid, placental tissue, umbilical cord, and neonate nasopharyngeal swab tested negative for SARS-CoV-2 rt-PCR.&#x0D; Conclusion. The prognosis for COVID-19 infected pregnant patients was generally good, with most of the patients discharged improved. Almost all of the neonates born to COVID-19-infected mothers were stable-term infants. There was no evidence for vertical transmission, as shown by negative rt-PCR results for all the additional specimens obtained.&#x0D; In general, the prognosis for COVID-19 infected dyads was good. The majority of the mothers were discharged well with their term infants. All possible maternal sources of COVID-19 infection to the neonate tested negative. This study provided no evidence for vertical transmission.

Primary ciliary dyskinesia: A neonatal disease?

In this volume of The Journal, Horani and Ferkol update our current understanding of primary ciliary dyskinesia and other ciliopathies. Although neonatologists may be tempted to bypass this article, it is relevant to newborn patients because ciliary function and diseases are of increasing importance in fetal development (eg, determination of body laterality) and neonatal illnesses. The authors report that the majority of infants with primary ciliary dyskinesia present with early and prolonged neonatal respiratory distress or with laterality disorders. Although laterality disorders are readily apparent on radiographs, it is not yet clear how neonatologists should think about these diseases in tachypneic infants because primary ciliopathies are rare diseases and tachypnea is a very common problem in newborn infants. Most neonatologists can recall unusual patients with prolonged tachypnea of undetermined etiology. These patients may be good candidates for further research so we can begin to identify distinguishing neonatal clinical characteristics that would allow for targeted follow up and early diagnosis of affected infants. Article page 15 ▸ Understanding Primary Ciliary Dyskinesia and Other CiliopathiesThe Journal of PediatricsVol. 230PreviewCiliopathies are a collection of disorders related to cilia dysfunction. Cilia are specialized organelles that project from the surface of most cells. Motile and primary (sensory) cilia are essential structures and have wide ranging functions. Our understanding of the genetics, pathophysiology, and clinical manifestations of motile ciliopathies, including primary ciliary dyskinesia (PCD), has rapidly advanced since the disease was linked to ciliary ultrastructural defects nearly 5 decades ago. We will provide an overview of different types of cilia, their role in child health and disease, focusing on motile ciliopathies, and describe recent advances that have led to improved diagnostics and may yield therapeutic targets to restore ciliary structure and function. Full-Text PDF

Maternal and perinatal characteristics and outcomes of pregnancies complicated with COVID-19 in Kuwait

BackgroundThe effect of SARS-CoV-2 infection in pregnant women and newborns is incompletely understood. Preliminary data shows a rather fluctuating course of the disease from asymptomatic or mild symptoms to maternal death. However, it is not clear whether the disease increases the risk of pregnancy-related complications. The aim of the study is to describe the maternal and neonatal clinical characteristics and outcome of pregnancies with SARS-CoV-2 infection.MethodsIn this retrospective national-based study, we analyzed the medical records of all pregnant women infected with SARS-CoV-2 and their neonates who were admitted to New-Jahra Hospital (NJH), Kuwait, between March 15th 2020 and May 31st 2020. During the study period and as part of the public health measures, a total of 185 pregnant women infected with SARS-CoV-2, regardless of symptoms, were hospitalized at NJH, and were included. Maternal and neonatal clinical manifestations, laboratory tests and treatments were collected. The outcomes of pregnancies included miscarriage, intrauterine fetal death (IUFD), preterm birth and live birth were assessed until the end date of the outcomes follow-up (November 10th 2020).ResultsA total of 185 pregnant women infected with SARS-CoV-2 were enrolled with a median age of 31 years (interquartile range, IQR: 27.5–34), and median gestational age at diagnosis of SARS-CoV2 infection was 29 weeks (IQR: 18–34). The majority (88%) of these women had mild symptoms, with fever (58%) being the most common presenting symptom followed by cough (50.6%). At the time of the analysis, out of the 185, 3 (1.6%) of the pregnant women had a miscarriage, 1 (0.54%) had IUFD which was not related to COVID-19, 16 (8.6%) had ongoing pregnancies and 165 (89%) had a live birth. Only 2 (1.1%) of these women developed severe pneumonia and required intensive care. A total of 167 neonates with two sets of twins were born with median gestational age at birth was 38 (IQR: 36–39) weeks. Most of the neonates were asymptomatic, and only 2 of them tested positive on day 5 by nasopharyngeal swab testing.ConclusionsIn this national-based study, most of the pregnant women infected with SARS-CoV-2 showed mild symptoms. Although mother-to-child vertical transmission of SARS-CoV-2 is possible, COVID-19 infection during pregnancy may not lead to unfavorable maternal and neonatal outcomes.

COVID-19 IN PREGNANT WOMEN AND THEIR NEWBORNS : A REVIEW

The outbreak of the Coronavirus disease 2019 (COVID-19) in China in December 2019 is a pandemic all over the world. COVID-19 raised concerns about the possibility of vertical transmission of the virus from mother to fetus. This literature review aims to explore the available knowledge of presents current studies about developing COVID-19 in pregnant women and their newborns also review clinical features of neonates born to mothers with COVID-19, vertical transmission of COVID-19 from infected pregnant mothers to neonates, breasfeeding during the COVID-19, the risk of COVID-19 may increase preterm birth. COVID-19 in children is characterized by fever and cough, where fever and cough are the most common symptoms. Poor prognosis is very rare in COVID-19 in children. However, as this virus is spreading globally and becoming a global pandemic, it should not be ignored that its incidence will increase in pregnant women and high-risk groups. This review provides an important picture for further studies of COVID-19 infection in children.Keywords: COVID-19, Pandemic, Mother, Newborn, Neonates, Breastfeeding, Transmission, Vertical.

Newborn Screening for Congenital Hypothyroidism: the Benefit of Using Differential TSH Cutoffs in a 2-Screen Program.

Analysis of a 2-screen program for congenital hypothyroidism (CH) was performed using differential dried-blood spot thyrotropin (bTSH) cutoffs of 10 mU/L at first screening (all infants) and 5 mU/L at second screening (selected infants). This work aimed to characterize CH infants identified by the second screening and compare infants with bTSH of 5.0 to 9.9 and 10 mU/L or greater on second screening. Maternal and neonatal clinical features were retrospectively analyzed for 119 CH babies detected on the second screen in the Lombardy region of Italy, 2007 to 2014. Fifty-two (43.7%) of the 119 CH neonates showed bTSH values ranging from 5.0 to 9.9 mU/L at the second screening (low bTSH group) and 67 (56.3%) bTSH of 10.0 mU/L or greater (high bTSH group). The frequency of thyroid dysgenesis and eutopic gland was similar in both groups, as was the frequency of permanent and transient CH. Moreover, a high frequency of extrathyroidal malformations was found in both groups. The percentage of preterm infants (57.7% vs 23.9%, P < .001) and infants admitted to the neonatal intensive care unit (50.0% vs 17.9%, P < .001) was significantly higher in the low vs the high bTSH group. In addition, maternal treatment with glucocorticoids in pregnancy was significantly more frequent in the low bTSH group than in the high bTSH group (11.5% vs 1.5%, P = .042), as well as maternal hypothyroidism and/or goiter (26.9% vs 10.4%, P = .036). This study has demonstrated that a lower TSH cutoff at the second screening can detect additional cases of CH and that a second bTSH cutoff of 5.0 mU/L is appropriate for identifying preterm newborns and babies with associated risk factors.

Clinical features and neonatal outcomes of neonatus with mother suspected COVID-19 in Malang, Indonesia: a serial-cases, single-centre

Background: The COVID-19 pandemic has affected every facet of life, beginning with the first hours and days after birth, some have argued that the prudent course is to isolate infants from mothers with suspected or confirmed COVID-19. This serial-cases showed the neonate’s outcome with mother suspected COVID-19.&#x0D; Cases: Four neonates were born from mother with suspected or confirmed with COVID-19. The neonates were born with 7-9 APGAR score and within normal limit. All of the patients were discharged from the hospital after two days of isolation in the hospital with negative Nucleic Acid Test of SARS-CoV-2 results.&#x0D; Conclusion: The clinical characteristics of neonates and neonatal outcome appear very good, and these outcomes are achieved with intensive, active management, which might be the best practice in resuscitation, stabilization, bathing the baby before going to the isolation ward, and management the patient in the isolation ward

Associations of COVID-19 Pandemic with Clinical Manifestations Among the Uninfected Pregnant Women in China: A Combined Cohort Study

Background: Whether coronavirus disease 2019 (COVID-19) pandemic would affect pregnancy-associated factors of uninfected pregnant women was rarely reported.Methods: A total of 32,277 pregnant women from six sites (Hubei Province, Guangdong Province, Hebei Province, Shandong Province, Yunnan Province and Beijing City) were finally recruited. We conducted a retrospective combined cohort study to analyze the associations between the number of prenatal examinations (NPE), delivery gestational week (DGW), the risk of caesarean section (CS), stillbirth, neonatal weight, preterm birth, macrosomia, small for gestational age (SGA), large for gestational age (LGA) and the COVID-19 in two time-periods, the pre-pandemic period (P-2019, 1/1/19-5/31/19) and the pandemic period (P-2020, 1/1/20-5/31/20).Findings: After adjusting for other covariates, we found the NPE, DGW, and SGA were negatively associated with the COVID-19 pandemic, whereas the CS and preterm birth rates were positively associated with the COVID-19, with adjusted relative risks (aRRs) of 1.11 [95% confidence interval (CI) 1.06–1.17] and 1.37 (95% CI: 1.02–1.84) respectively in Hubei. For Guangdong, the associations of CS and preterm birth with the COVID-19 were similar in Hubei. In contrast, limited associations were evident in other areas, except for a positive association with macrosomia [aRR = 1.26 (95% CI: 1.03–1.55)] in Beijing.Interpretation: The CS and preterm birth rates increased slightly in areas that were more affected by the pandemic than other areas among uninfected pregnant women. NPEs were not significantly interrupted and most maternal and neonatal clinical characteristics were within the normal ranges.Funding: National Key Research and Development Program, National Natural Science Foundation of China and National Health Commission Capacity Building and Continuing Education Center.Declaration of Interests: All authors declare to have no conflict of interest.Ethics Approval Statement: The study was approved by the Peking University ethics board (no. IRB00001052-20025).

Continuous elevation of plasma asprosin in pregnant women complicated with gestational diabetes mellitus: A nested case-control study

IntroductionTo investigate the expression of asprosin, a novel insulin resistance-related factor, in plasma and placenta of pregnant women with and without gestational diabetes mellitus (GDM). MethodsThis is a nested case-control study within the prospective study named Early Diagnosis of Gestational Diabetes Mellitus (EDoGDM). Forty pregnant women with GDM and forty control cases with normal glucose tolerance (NGT) were recruited in the present study. Asprosin levels were tested by ELISA in maternal plasma at 18–20 and 24–28 gestational weeks and before delivery, as well as in umbilical plasma. Asprosin concentrations were compared between GDM and NGT groups, and the relationship between asprosin and other parameters were analyzed. Expression of asprosin in placenta was examined by Western blot and immunohistochemistry. ResultsAsprosin was elevated in plasma of GDM pregnant women and their offspring, after adjusted by maternal and neonatal clinical characteristics and lipid profiles. Asprosin was expressed in placenta from both GDM and NGT pregnant women. DiscussionProtein asprosin is expressed in human placenta and is elevated in the plasma of pregnant women complicated with GDM and their offspring. As an insulin resistance-related factor increased before 20 gestational weeks, asprosin may play a role as a potential early biomarker of GDM.

Triagem auditiva neonatal em hospital da Rede Cegonha

Objective: To evaluate the profile of neonates who underwent neonatal hearing screening (NHS) and their mothers in a public hospital linked to the Rede Cegonha program, concerning sociodemographic characteristics and health outcomes. Methods: Cross-sectional, retrospective and documentary study, based on data from medical records of a maternal and child hospital in the city of Porto Alegre, Rio Grande do Sul. The sample consisted of 1,818 mother-baby dyads, who performed NHS from May 2014 to May 2015. The results of the NHS and maternal and neonatal clinical characteristics were analyzed. For data analysis, the statistical program SPSS version 21.0 was used. Results: Of the 1,818 neonates who underwent NHS, 359 (19.74%) had some risk indicator for hearing loss. Neonatal failure in NHS was associated with risk indicators for hearing impairment (presence of congenital HIV, p = 0.035; congenital cytomegalovirus, p = 0.048; and exposure to ototoxic drugs, p = 0.011) and between absence of any risk indicator for hearing impairment with respiratory dysfunction (p = 0.043) and neonatal sepsis (p = 0.021). In neonates without these indicators, this association occurred in those whose mothers had urinary tract infection during pregnancy (p = 0.015). Conclusion: Significant associations were found between NHS failure and maternal and infant characteristics that are not considered as risk indicators for hearing impairment.

The relationship between the location of neonatal clavicular fractures and predisposing factors.

The aim was to investigate the maternal and fetal predisposing factors of clavicle fracture locations in newborns. A retrospective evaluation was made of 77 clavicle fractures identified from a total of 33,480 live newborns between September 2016 and September 2018 at a single center in Turkey. Fractures were grouped according to the Allman classification: Group I mid third, Group II lateral distal third, Group III medial proximal third of the clavicle, respectively. Demographic features compared between the groups included maternal age, parity and height and infantile gestational age, gender, birth weight and length. Neonatal clinical features were also compared between the three groups and included mode of delivery, Apgar score, fracture laterality, time to diagnosis, mode of diagnosis, and presence of symptoms of brachial plexus palsy. There were no statistically significant differences between the three groups when the demographic characteristics of the mothers and newborns were compared. In terms of clinical characteristics Group 3 contained a higher proportion of patients with symptoms of brachial plexus palsy than Group 1 (61.5% versus 22%, p = 0.017). There was no statistically significant difference between Groups 2 and 3 and Groups 1 and 2. A significant association was found between the occurrence of brachial plexus palsy and fracture of the medial third of the clavicle (Allman type III).

Confounders for Neonatal Intensive Care Unit Admission ın Neonates of Mothers with Preeclampsia

Objective: The aim of this study was to investigate the effect of some maternal and neonatal clinical parameters on the neonatal intensive care unit admission rates of neonates born to mothers who had preeclampsia. Study Design: Study included 402 singleton pregnant women with preeclampsia who admitted to Maternal-Fetal Medicine Unit of Zeynep Kamil Children and Women’s Health Training and Research Hospital. Pregnancies with uterine rupture, chorioamnionitis and congenital malformations were excluded. Some maternal and neonatal clinical characteristics were assessed to predict neonatal intensive care unit admission.Results: Among 402 neonates, 140 (35%) of them had an indication for neonatal intensive care unit admission, among 140 neonates, 136 (97%) of them were preterm neonates. Comparison of groups with and without neonatal intensive care unit admission indicated significant differences between groups in terms of gestational age, Apgar scores at 1st and 5th minutes, birth weight, some maternal laboratory parameters (Hemoglobin, hematocrit, alanine aminotransferase, aspartate aminotransferase, albumin). In multivariate analysis, among all study population, gestational age at delivery, birth weight and Apgar scores were found to be significantly associated with neonatal intensive care unit admission. On the other hand, in subgroup of term neonates, none of the variables was shown to be associated with neonatal intensive care unit admission.Conclusion: Gestational age at delivery and the birth weight are the main risk factors for neonatal intensive care unit admission of neonates born to mothers who had preeclampsia.

PREDICTORS OF POSITIVE BLOOD CULTURE AND DEATH AMONG NEONATES WITH SUSPECTED NEONATAL SEPSIS IN ABEOKUTA, SOUTH-WEST NIGERIA

Neonatal sepsis, a bacterial infection of blood in the first month of life is a common cause of morbidity and mortality in developing countries and factors associated with positive blood culture and perinatal deaths among neonates are rarely described. This study was conducted at the Special Baby Care Unit of Federal Medical Centre, Abeokuta (FMCA), Southwest Nigeria, to identify the predictors of positive blood culture and deaths due to neonatal sepsis among neonates admitted with clinical diagnosis of septicemia between January and April 2013. Data on socio-demographic characteristics, peripatal events and clinical characteristics of neonates were collected on proforma designed for the study. Blood culture was done on Brain Heart Infusion broth and Thioglycolate broth followed by identification of isolates using conventional methods. Serum Procalcitonin (PCT) and Serum C reactive protein (CRP) Levels were determined by immunochromatographic and immuno-turnidimetric assay respec-tively. The neonates were monitored until discharge from the hospital. Among 180 neonates admitted during the study period, there were 85 cases of clinically suspected sepsis. Forty (47.1%) were males and 45(52.9%) were females while 55 (63.5%) neonates and 30 (36.5%) neonates presented with early and late onset sepsis respectively. Positive blood culture was found in 19 (22.4%) of the neo-nates; 14 (73.7%) of neonates with positive blood cultures had early onset neonatal sepsis and 5 (26.3%) had late onset sepsis. Factors that predicted positive blood culture in both early and late onset neonatal sepsis were mode of delivery (p=0.033), estimated gestational age (p=0.039), and CRP (p=0.000). None of the clinical characteristics was found to be statistically significant with positive blood culture. Deaths occurred in 27 (36%) of neonates. The case-fatality rate was 29%. Predictors of death were booking status (p=0.011), birth after prolonged labour (p=0.014), place of delivery (p=0.001), place of antenatal care (p=0.021), respiratory distress (p=0.034), poor cry (p=0.040), con-vulsion (p=0.011) and PCT (p=0.001). Our findings suggest that mode of delivery and estimated ges-tational age are significantly associated with positive blood culture in both early and late onset neona-tal sepsis. Mortality from neonatal sepsis is high in this study. Booking status, place of delivery, place of antenatal care significantly contributed to mortality suggesting that antenatal and perinatal care remains associated with neonatal mortality.

Late onset sepsis: comparison between coagulase-negative staphylococci and other bacteria in the neonatal intensive care unit

Objective: To compare demographic and clinical features of neonates with late-onset sepsis due to coagulase-negative-staphylococcus with those due to other bacterial pathogens.Study design: Retrospective, population-based cohort study. Data on infants less than 90 days old diagnosed with late-onset bacterial sepsis in the neonatal intensive care unit were reviewed. Univariable and multivariable analysis were performed.Results: Two hundred and sixteen sepsis episodes were identified: coagulase-negative-staphylococcus caused 113 (52.3%) and other pathogen 103 (47.7%). Patients with coagulase-negative-staphylococcus sepsis had lower gestational age and younger age at onset, higher rates of parenteral nutrition exposure and normal temperature, lower rates of necrotizing enterocolitis, meningitis and neutropenia than patients with sepsis caused by other pathogens. In multivariable analysis, parenteral nutrition was the only independent risk factor for coagulase-negative-staphylococcus sepsis (odds ratio: 3.5, 95% confidence interval: 1.4–8.6).Conclusions: Initial empiric treatment for suspected sepsis should be targeted for other pathogens than coagulase-negative-staphylococci and vancomycin treatment should be reserved for infants with specific risk factors and according to local antimicrobial susceptibility.

Viral Alt Solunum Yolu Enfeksiyonu Nedeniyle Yatırılan Yenidoğanların Epidemiyolojik ve Klinik Özellikleri

Viral Alt Solunum Yolu Enfeksiyonu Nedeniyle Yatırılan Yenidoğanların Epidemiyolojik ve Klinik Özellikleri

Gastric outlet obstruction caused by an ectopic pancreas in a neonate: A case report

We herein report a neonate who presented with non-bilious vomiting at one day of age caused by a prepyloric ectopic pancreas. Ultrasonography clearly detected the presence of a submucosal mass preoperatively, which was treated with local gastric resection. Only 9 neonates with a symptomatic pyloric or prepyloric ectopic pancreas have been previously reported in the literature. Therefore, we reviewed and discussed the clinical features of neonates with this type of ectopic pancreas.

NEONATAL CHARACTERISTICS AND TEMPERAMENT PREDICT BEHAVIOR PROBLEMS IN CHILDREN BORN PRETERM

Introduction: the preterm birth is a risk factor for child developmental and behavioral problems. Objective: to examine whether neonatal clinical characteristics of infants born preterm, as well as temperament assessed in toddlerhood, predict behavior problems during the preschool years. Methods: twenty-one children born preterm with very low birth weight were assessed longitudinally at three different ages: in the neonatal period, during toddlerhood, and in preschool. Medical charts were reviewed to assess infants’ clinical illness characteristics at the neonatal phase. Mothers fulfilled the Early Childhood Behavior Questionnaire for assessing temperament at the toddlerhood and the Child Behavior Checklist-1.5-5 for assessing children’s behavior problems at the preschool age. Results: very low birth weight associated with child temperament at the toddlerhood predicted behavior problems at the preschool age. High levels of excitement about expected pleasurable activities as well as low levels of inhibitory control increased the chance of exhibiting externalizing behavior problems. Otherwise, high levels of both gross and fine motor activation increased the chance of exhibiting internalizing behavior problems. Conclusion: prematurity associated with temperament of poor self-regulation in developmental processes comprises a multiple-risk condition for clinical behavior problems in the preschool age.

Reducing the frequency of unnecessary rectal biopsies by combined interpretation of clinical and radiological findings in Egyptian children with suspected Hirschsprung’s disease

IntroductionHirschsprung’s disease (HD) should be considered in children with neonatal-onset constipation. Clinical differentiation between HD and idiopathic constipation (IC) is difficult in late presenting infants. Consequently, paediatric surgical centres receive numerous referrals for rectal biopsies, requiring admissions and GA, particularly if suction biopsy is unavailable, and in older children. MethodsForty-two cases referred for rectal biopsy, were studied for clinical features, single contrast enema, as compared to rectal biopsy findings, to determine the statistical reliability towards achieving a diagnosis. ResultsThe mean age at presentation was 106days in HD patients, and 172days in IC. Significant neonatal clinical features were present in 54%. Delayed passage of meconium was present in 86% of HD, compared to 14% of IC (p=0.001). Rectal examination found a tight segment in 90% of HD, and a distended anorectum in 64% of IC (p=0.005). The sensitivity of contrast enema was 86%, and the specificity was 90%. The histological analysis of strip rectal biopsy was sensitive in 93%, and inconclusive in 7%. ConclusionThis audit generated a checklist of 6 clinical and 3 radiological criteria, to differentiate HD from ID, including clinically (1) neonatal onset; (2) male sex; (3) congenital anomalies, dysmorphic features and/or family history of HD; (4) delayed meconium passage; (5) enterocolitis or significant bowel obstruction/impaction; (6) tight segment on rectal examination; and radiologically (7) funnelled transition zone or a reversed rectosigmoid index (<1); (8) delayed evacuation of contrast after 24h; and (9) absent distension of the anorectum with contrast, absent mucosal irregularities, and absent sigmoid looping.

Trends and determinants of gastric bacterial colonization of preterm neonates in a NICU setting.

BackgroundNewborn gastrointestinal (GI) tract is considered sterile but rapidly acquires a diverse microbiota from its intimate environment. Early acquisition of a bacterial species in the upper GI tract may play a role in establishing the colonic microbiota. There is paucity of molecular data on the upper GI tract microbiota in preterm neonates.MethodsGastric aspirates from 22 neonates with an average gestational age 27.7 weeks (±2.8), weighing 973.2 grams (±297.9) admitted to a neonatal intensive care unit were collected prospectively from weeks 1-4 of life. All samples were evaluated for microbiota using 16S rRNA-based Denaturing Gradient Gel Electrophoresis. Bacterial species colonization and its association with maternal and neonatal demographics, and neonatal clinical characteristics were analyzed.Results Bacteroides spp. was the predominant species in all four weeks. Bifidobacterium spp. colonization was significantly higher in exclusively breast milk fed compared to partially breast milk (PBM) fed neonates in first (p = 0.03) and third (p = 0.03) week of life. Anaerobic bacteria colonization decreased from first through fourth week of life (p = 0.03). Aerobic bacteria colonization was highly dynamic throughout the four week period. Premature rupture of membrane (p = 0.05) and birth outside of study hospital (p = 0.006) influenced the acquisition of bacteria in the first week of life. Birth weight was positively correlated with total number of bacterial species (p = 0.002) and anaerobes (p = 0.004) in PBM-fed neonates during the fourth week of life. H. pylori and Ureaplasma were not detected in any of our samples.ConclusionGastric bacterial colonization in preterm neonates is unstable during early weeks of life. Delayed oral feeding and use of antibiotics may be responsible for paucity of bacterial species. Monitoring of the gastric microbiota and concurrent examination of stool microbiota may yield important information on the utility of gastric signature patterns for predicting colon microbiota that may drive GI and immune dysfunctions.