Neonatal Course Research Articles

Growth velocity of fetal sacrococcygeal teratoma as predictor of perinatal morbidity and mortality: multicenter study.

To identify prenatal predictors of poor perinatal outcome in fetuses with isolated sacrococcygeal teratoma (SCT). This was a retrospective study of fetuses with isolated (non-syndromic) SCT managed at one of five pediatric surgery and/or fetal medicine centers between January 2007 and December 2017. The primary outcome was the occurrence of poor perinatal outcome, defined as prenatal death (including termination), or neonatal death or severe compromise (hemorrhagic shock). Data regarding prenatal diagnosis (sonographic features both at referral and at the last ultrasound examination before pregnancy outcome, assessment of SCT growth velocity), perinatal complications and outcome, and neonatal course were analyzed to determine prenatal SCT characteristics associated with adverse perinatal outcome. Fifty-five fetuses were included, diagnosed with isolated SCT at a median gestational age of 22 (interquartile range, 18-23) weeks. There was a poor perinatal outcome in 31% (n = 17) of these cases, including intrauterine fetal demise (4%, n = 2), pregnancy termination (13%, n = 7) and neonatal severe compromise (15%, n = 8), leading to neonatal death in five cases. The overall survival rate after prenatal diagnosis of isolated SCT was 75% (n = 41 of 55). Earlier gestational age at diagnosis (P = 0.02), large tumor volume at referral (P < 0.001), presence of one or more hemodynamic complications (P = 0.02), fast tumor growth velocity (P < 0.001) and high tumor grade (highest tumor grade ≥ 3) (P = 0.049) were associated with poor perinatal outcome on univariate analysis. On stepwise logistic regression analysis, tumor growth velocity was the only remaining independent factor associated with poor perinatal outcome (odds ratio (OR) (per 1-mm/week increase), 1.48 (95%CI, 1.22-1.97), P = 0.001). The best predictive cut-off of tumor growth velocity for poor perinatal outcome was 7 mm/week (OR, 25.7 (95%CI, 5.6-191.3), P < 0.001), yielding a sensitivity of 88% and a specificity of 77%. Approximately 30% of fetuses with a diagnosis of isolated SCT have poor perinatal outcome. Tumor growth velocity ≥ 7 mm/week appears to be an appropriate discriminative cut-off for poor perinatal outcome. These results could help to inform prenatal management and counseling of parents with an affected pregnancy. © 2024 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

The Natural Course of Newborns with Transient Congenital Hypothyroidism.

The incidence of congenital hypothyroidism (CH) has increased worldwide over the last decades mainly due to the lowering of screening thresholds, resulting in an increased identification of newborns with transient CH. Several studies reported the prevalence and the predictive parameters of transient CH but reports on the long-term outcome are rare. This study aimed to assess the long-term course of neonates with transient CH. Neonates diagnosed with transient and permanent CH between the years 1998 to 2018 at the Pediatric Endocrine Institute of Ha'Emek Medical Center were enrolled in the study. Data were retrieved retrospectively from medical files. Included in the study were 76 newborns (45M,59%) with transient CH and 53 (25M,47%) with permanent CH. The major cause of transient CH was prematurity (29%) and subclinical hypothyroidism (30%). During retrospective follow-ups of up to 23 years, reinitiation of LT4 therapy was not required apart from four patients with underlying syndromic etiologies. Neurodevelopmental impairment occurred in 16% of children with transient CH compared with 29.4% in the permanent CH group. Transient CH is frequent among preterm infants but is limited to infancy. SCH frequently presents as overt hypothyroidism at birth but in most cases the requirement for LT4 supplemental therapy is limited to the first years of life, suggesting that long-term follow-up of thyroid function tests may be unnecessary for non-syndromic children. The high rate of neurodevelopmental impairment in newborns with transient CH emphasizes the need for neurodevelopmental monitoring in these patients.

Postnatal management of preterm infants with spinal muscular atrophy: experience from German newborn screening

BackgroundThe introduction of newborn screening (NBS) for spinal muscular atrophy (SMA) has increased the early diagnosis of 5q-associated SMA in presymptomatic and symptomatic preterm infants. National and international recommendations for treating preterms and newborns < 38 weeks of gestational age are unavailable. Our retrospective multicentre study aimed to evaluate the postnatal clinical course of preterm infants with 5q-associated SMA diagnosed since the implementation of NBS in Germany in 2021 and to summarize the German experience regarding the decision-making process for available treatment regimens for preterm infants with ≤ 3 survival of motor neuron 2 (SMN2) copies.ResultsTwelve preterm infants with 5q-associated SMA and a mean gestational age of 34.0 weeks (range: 26.1–36.8) and birth weight of 2022 g (range: 645–3370) were reported from 8/20 German SMA NBS follow-up centers using a pseudonymized questionnaire. Confirmatory diagnosis, including SMN2 copy number, was completed on average on postnatal day 13. All patients had a biallelic deletion of exon 7 or exons 7 and 8 of the survival of motor neuron 1 (SMN1) gene, with SMN2 copy numbers of two in 10 patients and three in two patients. The neonatal course was complicated by respiratory distress due to prematurity (n = 2), sepsis (n = 2), and jaundice (n = 2). At birth, 11 preterm infants (91.6%) were presymptomatic. However, the neurological status of one patient deteriorated at five weeks of age (postconceptional age of 41.8 weeks) prior to the start of treatment. Disease-modifying treatments were initiated in all patients at a mean postconceptional age of 38.8 weeks, with the majority receiving onasemnogene abeparvovec (83.3%, including 2 patients with prior risdiplam bridge therapy). Notably, consensus among participating experts from German neuromuscular centers resulted in 83.3% of patients receiving disease-modifying treatment at term.ConclusionsPremature infants with SMA require interdisciplinary care in close collaboration with the neuromuscular center. SMA NBS facilitates early initiation of disease-modifying therapy, ideally during the presymptomatic phase, which significantly influences the prognosis of the newborn.

An Investigation into how Primary Care Nurses Practices affect clinical competence in Emergency Maternal Obstetric and Newborn Care skills in Nakuru County

To reduce the risks of maternal morbidity, mortality and newborn death worldwide, the use of high-quality emergency obstetric and new born care (EMONC) was proposed to ensure women and their babies receive high-quality care. The government of Kenya with non-profit health programs have jointly invested resources with the aim of achieving SDG’s goal of zero rating maternal and neonatal death cases in the country. Despite these efforts, maternal and neonatal death cases have not reduced significantly. Most of the contributing factors to the deaths occur in the lower levels of the health care delivery system. Majority of the health care providers at these levels are the primary care nurses. It is on this background that the study sought to investigate how primary care nurses practice affect clinical competency in emergency maternal, obstetric, and new born care skills in Nakuru county. Madeleine Leininger’s Transcultural Theory of Nursing anchored the study. It deployed correlational cross-sectional survey design, targeting midwives and nurses in 184 KEPH level II and III facilities in all the 11 sub counties in Nakuru County. The study used stratified sampling technique to sample 126 health facilities distributed in every Sub County. A sample size of 196 primary health care nurses from the sampled facilities were involved. Key informant interview and questionnaires were used to collect both qualitative and quantitative data. To analyze data, SPSS version 26 was used to generate inferential and descriptive statistics, correlation analysis was carried using multiple regression model to ascertain the relationship between dependent and independent variables. Results found that Maternal and newborn care practice was found to have a significant positive relationship with competence in EmONC skills. (P&lt;0.05). This was achieved through clean and safe delivery, thermal care and cord care which were carried out in KEPH level II and III facilities. It was concluded that maternal and neonatal care practices had positive significant relationship with competent EmONC. The study advised that the practice of fundamental maternal and newborn care has to be improved. The primary care nurses should be culturally competent in engaging the community members. Through community-based health care efforts, mothers need to be sensitized about delayed bathing, umbilical cord care, feeding, and thermal care for newborns. Further, County Government of Nakuru should support programs that enables primary health care nurses pursue maternal and neonatal care courses. County Government of Nakuru should ensure ambulance services are easily accessible to all, equipment availability at all time, consistent supply of all drugs needed and the need to create awareness among women, family and community members on newborn and early neonatal care

Prenatal Diagnosis of Umbilical Cord Angiomyxoma: Case Studies and Literature Review of 45 Cases.

We describe two cases of umbilical cord (UC) angiomyxoma diagnosed prenatally by sonography in the second trimester of pregnancy. In both cases, a complex mass was detected at the placental insertion site, characterized by an echoic nodule surrounding the umbilical vessels and distal edematous Wharton's jelly. Follow-up scans showed that the mass grew mainly at the expense of its edematous component, with normal uteroplacental Dopplers throughout the remaining of the pregnancy. However, late-onset fetal growth restriction complicated the progress of pregnancy, requiring delivery by Cesarean section at 37 weeks' gestation in both cases. Neonatal courses were unremarkable. An extensive review of the English literature was also performed, collecting 45 similar cases including ours. Our experience as well as the review of the literature confirms that UC angiomyxoma is an uncommon, sporadic condition that is usually detected incidentally during prenatal sonography and presents as an isolated finding. Nevertheless, it represents a high-risk condition for pregnancy complications including prematurity, fetal growth restriction, and fetal demise.

Influence of morbidity, early nutritional intake, and total energy: protein ratio on longitudinal extrauterine growth restriction of very preterm newborns at term-equivalent age: an observational study.

To evaluate the influence of early nutritional intake on the growth pattern of very preterm infants. This was an observational study including 109 newborns (< 32weeks gestational age). Perinatal morbidities, nutritional therapy (first four weeks of life), and weight, length, and head circumference (HC) growth at term-equivalent age were evaluated. Growth restriction was defined as a difference > 1.2 SD between the birth and term age measurements. Growth restriction at term-equivalent age: 52.3% (weight), 42.9% (length), and 22% (HC). Morbidities were positively correlated with nutrition therapy and negatively correlated with the total energy provision: protein ratio. The duration of parenteral nutrition, the time to reach full enteral feedings, and the total energy provision: protein ratio were significantly correlated. Nutrient intake influenced weight, length, and HC growth, and cumulative energy deficit was significantly associated with HC growth restriction. Conclusion: Perinatal morbidities interfere with nutritional therapy and early nutrient intake, leading to insufficient energy and energy provision: protein ratio for growth. What is Known: • The intake of macronutrients early in life, mainly protein, is important for the optimal growth of pretem infants. • The severity of morbidities and low gestational ages impact the nutritional management of preterm infants. What is New: • The number of morbidities, reflecting the severity of the neonatal clinical course, had a detrimental effect on the nutritional therapy and nutrients intake. • The inadequate energy provision per gram of protein ratio was significantly associated with growth restriction in all growth measures at the second week of life, persisting for head circumference up to the fourth week, highlighting the importance of its measurement, as it could be a precocious sign of development risk.

Dependence of Successful Airway Management in Neonatal Simulation Manikins on the Type of Supraglottic Airway Device and Providers' Backgrounds.

Supraglottic airway devices such as laryngeal masks and i-gels are useful for airway management. The i-gel is a relatively new device that replaces the air-inflated cuff of the laryngeal mask with a gel-filled cuff. It remains unclear which device is more effective for neonatal resuscitation. We aimed to evaluate the dependence of successful airway management in neonatal simulators on the device type and providers' backgrounds. Ninety-one healthcare providers performed four attempts at airway management using a laryngeal mask and i-gel in two types of neonatal manikins. The dependence of successful insertions within 16.7 s (75th percentile of all successful insertions) on the device type and providers' specialty, years of healthcare service, and completion of the neonatal resuscitation training course was assessed. Successful insertion (p = 0.001) and insertion time (p = 0.003) were associated with using the i-gel vs. laryngeal mask. The providers' backgrounds were not associated with the outcome. Using the i-gel was associated with more successful airway management than laryngeal masks using neonatal manikins. Considering the limited effect of the provider's specialty and experience, using the i-gel as the first-choice device in neonatal resuscitation may be advantageous. Prospective studies are warranted to compare these devices in the clinical setting.

Sleep-related breathing disorders in infants with spina bifida repaired prenatally and postnatally.

Advances in prenatal repair of myelomeningocele (MMC) have improved outcomes involving different organ systems. There is limited data on respiratory outcomes following prenatal surgical repair. We hypothesize there is no difference in respiratory outcomes between spina bifida (SB) patients who have undergone prenatal versus postnatal repair. We performed a retrospective study of 46 infants <1 year with SB seen at Children's Hospital Los Angeles from 2004-2022. Demographic data, timing of closure, neonatal course, Chiari II malformation (CIIM), ventriculoperitoneal shunt (VPS), polysomnography (PSG) results, and need for supplemental oxygen were collected. Unpaired t-test and Chi-square Test were used to analyze results. 31/46 had prenatal repair of MMC; average age at repair was 27 weeks post-conception (PCA). Average age at postnatal repair was 37 PCA. There was no difference in age at PSG. There was no difference in CIIM presence (p=0.61). 60% of patients with postnatal repair and 23% in the prenatal group underwent VPS placement (p=0.01). Patients with SB who've undergone closure of neural tube defect have persistent central apneas, obstructive apneas, and significant hypoxemia. There were no differences in the frequency or severity of sleep-disordered breathing in those with prenatal repair versus postnatal repair.

Frequency and risk factors of retinopathy of prematurity: a 5-year single-center study in a Tertiary Care Hospital

Aim Our study aimed to determine the frequency of retinopathy of prematurity (ROP) in a cohort of premature infants screened for ROP, to confirm the efficacy of our screening program used in the NICU to avoid childhood blindness. In addition, we aimed to study the associated risk factors affecting ocular status including birth weight (BW), gestational age (GA), mechanical ventilation, length of intensive care unit (ICU) stay, and number of ROP follow-up. Methods This was a retrospective cohort study conducted from March 2016 to March 2021. Data were retrieved from the records of preterm infants admitted to the neonatal intensive care unit in King Faisal Specialist Hospital and Research Center in Riyadh, Saudi Arabia. The included data: Comprised perinatal data such as sex, BW, GA, multifetal gestation, and delivery type. Neonatal course: Need for surfactant, oxygen therapy, and mechanical ventilation (MV) duration. Neonatal complications: Chronic lung diseases [(respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD)], sepsis, neonatal jaundice, patent ductus arteriosus (PDA), hydrocephalus, and intraventricular hemorrhage (IVH). ROP examination: stage, zone, plus disease, extent, treatment, and number of the follow-up. Results In all, 337 preterm infants met the screening criteria and were included in the study. The majority (52%, n=177) were male; 148 (43.9%) were products of multifetal gestation, the mean GA was 29.35±2.77, and the median BW was 1195.1±338 gm. Caesarean section was the main mode of delivery in 80.5% of our sample (269 babies). ROP was detected in 181 (53.7%) infants, of which 110 (32.6%) had Stage 1, 57 (17%) Stage 2, and 14 (4.15%) had Stage 3. The majority (89.4%) were involved in zone 2–3, and five patients had the plus disease (1.48%). The number of ROP follow-up ranged between 2 and 25 visits either in the NICU or in the eye clinic following their discharge with a mean of 2.347. Conclusion The incidence of ROP in our sample was high relative to other local studies, which was related to the relatively high number of multifetal gestations with high chance of low birth weight as our center is an expert facility in in vitro fertilization. Male patient had a high incidence of development of different stages of ROP. Preterm babies with complicated neonatal course like NEC, Chronic Lung Disease, and IVH had high incidence of development of ROP.

Risk Factors and Outcomes for Cerebral Palsy With Hypoxic-Ischemic Brain Injury Patterns Without Documented Neonatal Encephalopathy.

Perinatal hypoxic-ischemic brain injury is a leading cause of term-born cerebral palsy, the most common lifelong physical disability. Diagnosis is commonly made in the neonatal period by the combination of neonatal encephalopathy (NE) and typical neuroimaging findings. However, children without a history of neonatal encephalopathy may present later in childhood with motor disability and neuroimaging findings consistent with perinatal hypoxic-ischemic injury. We sought to determine the prevalence of such presentations using the retrospective viewpoint of a large multiregional cerebral palsy registry. Patient cases were extracted from the Canadian Cerebral Palsy Registry with gestational age >36 weeks, an MRI pattern consistent with hypoxic-ischemic injury (HII, acute total, partial prolonged, or combined), and an absence of postnatal cause for HII. Documentation of NE was noted. Maternal-fetal risk factors, labor and delivery, neonatal course, and clinical outcome were extracted. Comparisons were performed using χ2 tests and multivariable logistic regression with multiple imputation. Propensity scores were used to assess for bias. Of the 170 children with MRI findings typical for HII, 140 (82.4%, 95% confidence interval [CI] 75.7%-87.7%) had documented NE and 29 (17.0%, 95% CI 11.7%-23.6%) did not. The group without NE had more abnormalities of amniotic fluid volume (odds ratio [OR] 15.8, 95% CI 1.2-835), had fetal growth restriction (OR 4.7, 95% CI 1.0-19.9), had less resuscitation (OR 0.03, 95% CI 0.007-0.08), had higher 5-minute Apgar scores (OR 2.2, 95% CI 1.6-3.0), were less likely to have neonatal seizures (OR 0.004, 95% CI 0.00009-0.03), and did not receive therapeutic hypothermia. MRI was performed at a median 1.1 months (interquartile range [IQR] 0.67-12.8 months) for those with NE and 12.2 months (IQR 6.6-25.9) for those without (p = 0.011). Patterns of injury on MRI were seen in similar proportions. Hemiplegia was more common in those without documented NE (OR 5.1, 95% CI 1.5-16.1); rates of preserved ambulatory function were similar. Approximately one-sixth of term-born children with an eventual diagnosis of cerebral palsy and MRI findings consistent with perinatal hypoxic-ischemic brain injury do not have documented neonatal encephalopathy, which was associated with abnormalities of fetal growth and amniotic fluid volume, and a less complex neonatal course. Long-term outcomes seem comparable with their peers with encephalopathy. The absence of documented neonatal encephalopathy does not exclude perinatal hypoxic-ischemic injury, which may have occurred antenatally and must be carefully evaluated with MRI.

Tiny Lungs, Big Differences: Navigating the Varied COVID-19 Landscape in Neonates vs. Infants via Biomarkers and Lung Ultrasound.

Due to their susceptibilities, neonates and infants face unique SARS-CoV-2 challenges. This retrospective study will compare the illness course, symptoms, biomarkers, and lung damage in neonates and infants with SARS-CoV-2 infection from February 2020 to October 2023. This study was conducted at two hospitals in Timisoara, Romania, using real-time multiplex PCR to diagnose and lung ultrasonography (LUS) to assess lung involvement. Neonates had a more severe clinical presentation, an increased immune response, and greater lung involvement. Neonates had more PCR-positive tests (p = 0.0089) and longer hospital stays (p = 0.0002). In neonates, LDH, CRP, and ferritin levels were higher, indicating a stronger inflammatory response. Reduced oxygen saturation in neonates indicates respiratory dysfunction. The symptoms were varied. Infants had fever, cough, and rhinorrhea, while neonates had psychomotor agitation, acute dehydration syndrome, and candidiasis. This study emphasizes individualized care and close monitoring for neonatal SARS-CoV-2 infections. Newborn lung ultrasonography showed different variances and severity levels, emphasizing the need for targeted surveillance and therapy. Newborns have high lung ultrasound scores (LUSS), indicating significant lung involvement. Both groups had initial lung involvement, but understanding these modest differences is crucial to improving care for these vulnerable populations.

Using Backward Design to Develop a Neonatal Course for Baccalaureate Nursing Students.

Using Backward Design to Develop a Neonatal Course for Baccalaureate Nursing Students.

Prenatal diagnosis of fetal neurogenic megacystis associated with lethal congenital contractural syndrome 2

Abstract Objectives To describe the prenatal diagnosis, unique clinical features, clinical and genetic evaluation, and the pregnancy and neonatal course of two siblings affected by Lethal Congenital Contractural Syndrome 2 (LCCS2). Case presentation We present two cases of LCCS2, a rare autosomal recessive disorder in the arthrogryposis multiplex spectrum of syndromes whose sine qua non feature is the presence of nonobstructive, neurogenic megacystis. The prenatal diagnosis of this syndrome has not been previously reported. This syndrome has been previously studied in detail in an Israeli-Bedouin kindred but it has not been reported in the Americas. Conclusions These two cases illustrate the diagnostic and therapeutic dilemmas associated with this rare genetic abnormality. LCCS2 can be seen in other patient populations besides Israeli-Bedouin. They also suggest the presence of phenotypic variability in the clinical outcomes. Finally, they underscore the need for specialized diagnostic capabilities, the involvement of multidisciplinary teams to support challenging family situations, and the need for shared decision-making.

Necrotizing enterocolitis in premature infants at different gestation ages.

Aim: To compare X-ray signs in different gestational and body weight groups of patients with NEC. Materials and Methods: We conducted a retrospective study, enrolling 52 preterm newborns with symptoms of NEC regardless of onset time, who underwent treatment at Neonatal Intensive Care Units in Municipal Non-commercial enterprise "City Children Hospital №2", Odesa. The patients were split into 3 clinical groups: very preterm newborns (VPN), moderately preterm newborns (MPN), and moderately preterm newborns with intrauterine growth restriction (MPN+IUGR). Results: In the VPN group NEC was diagnosed at stage II (58,82±12,30) % and III (41,18±12,30) % by Bell MJ, р>0,05. In the group MPN+IUGR, NEC stage II (33,33±14,21) % and stage III (66,66 ±14,21) %, р>0,05, were equally observed. In the MPN group, NEC was diagnosed at stage I (41,67±10,28) % and II (58,33±10,28) %, р>0,05, without prevalence of any. Also only localized forms were observed. In VPN, we observed localized forms in most cases, while diffuse forms were diagnosed in (11,76±8,05) % cases, р<0,05. In the MPN+IUGR group, we found diffuse form of the NEC in half of the cases - (50,00±15,08) %. In the VPN and MPN+IUGR groups, NEC developed at 13,23±0,39 and 14,33±1,19 days, respectively. However, in MPN without IUGR, NEC developed at 17,75±0,55 days, significantly later than in the MPN+IUGR group, р<0,05. Conclusions: We have described distinct features of NEC in MPN with IUGR. Compared to MPN without IUGR, NEC had more severe course and earlier manifestation in such neonates.

A real-life prospective blinded evaluation of placental biometry and macroscopic morphology from 1008 unselected consecutive pregnancies

IntroductionThe study of the macroscopic appearance of the placenta may represent a useful tool to understand the pathophysiology of adverse pregnancy outcomes. The aim of this study was to evaluate biometry and morphology of placentas in relation to maternal, neonatal and pregnancy course characteristics. MethodsClinical and placental data (biometry and macroscopic features of chorionic disk and adnexa) from unselected consecutive singleton pregnancies were recorded at the same Institution. Placental efficiency was approximated as ratio between fetal and placental weight (FPR). The total population was grouped according to the presence of any maternal comorbidity or pregnancy complication (group 1), neonatal complications diagnosed only at birth (2) and absence of any comorbidity (3). Multi-adjusted general linear and logistic regression models were performed to analyze associations between groups and placental biometry and morphology. ResultsThe study population counted 1008 pregnancies: 576 (57.2 %) classified as group 1, 76 (7.5 %) as group 2 and 356 (35.3 %) uncomplicated controls (group 3). In multivariate models adjusted for confounding factors, no significant differences in placental biometry and macroscopic features were observed among the three groups. Maternal BMI was significantly associated with higher placental and birth weight and lower FPR; moreover FPR was significantly higher in pregnancies carrying males compared to female neonates. DiscussionMaternal comorbidity or pregnancy disease was not associated with significant changes in placental macroscopic biometry and morphology. Conversely, maternal pregestational BMI and fetal sex impact on placental biometry and efficiency, suggesting different intrauterine adaptations in obese mothers and in male and female fetuses.

Three-year follow-up results of two children born from a transplanted uterus.

To evaluate the 3-year follow-up results of two children delivered at our institution in 2019 from mothers with a transplanted uterus. Observational data on pregnancy outcomes, neonatal course, and growth trajectory in two children born to mothers after uterus transplantation, including 3-year follow-up and neurodevelopmental status assessed using the Bayley Scales of Infant and Toddler Development, third edition (Bayley-III). Both children were born prematurely via uneventful caesarean sections, to mothers with Mayer-Rokitansky-Küster-Hauser syndrome and a transplanted uterus. An acute caesarean section was performed in one mother because of the onset of regular uterine contractions at 34 weeks and 6 days of pregnancy; in the other mother, an elective caesarean section was performed at 36 weeks and 2 days of gestation. The children were born healthy with no congenital malformations. They had an uneventful postnatal course and showed a normal growth trajectory during 3 years of follow-up. The Bayley-III neurodevelopmental scores of both children were within the normal ranges at ages 2 and 3 years. Though pregnancy after uterus transplantation is associated with the risk of premature delivery, no abnormalities were observed in the neonatal course and 3-year follow-up results, including the neurodevelopmental status, of two children born prematurely to mothers with a transplanted uterus. This is the first report on neurodevelopmental outcomes in children born after uterus transplantation. More data on children born after this radical procedure of uterine factor infertility treatment are required to support our promising results.

Neonatal resuscitation virtual training course: Use of an educational platform by medical students at a public university in Peru

IntroductionSatisfactory performance in Neonatal Resuscitation requires continuous training, and several technologies can enhance its scope. This study was carried out to evaluate the use of an educational platform by medical students in a Neonatal Resuscitation virtual course. Materials and methodsDescriptive study with the data available on the Neonatal Resuscitation virtual course platform, evaluating the use of a population corresponding to the total number of undergraduate Medicine students from the Universidad Nacional Mayor de San Marcos (UNMSM) who enrolled as students to take the Paediatrics course in the last year of their studies during the years 2018 and 2019 in Lima, Peru. ResultsData from 379 sixth-year medical students in the 2018-I, 2019-I, and 2019-II semesters were included. Students entered the virtual course an average of 23 days before taking their online exam, and the average theory review time in the virtual system was 120 min. Students with outstanding performance in their scores completed 2 virtual exams, but there was no difference in the other characteristics. ConclusionsThe sequence developed in the Neonatal Resuscitation virtual course, which begins with "learn, see, and practice", offers a greater capacity to retain the knowledge and skills acquired. The virtual offer of the theoretical component of Neonatal Resuscitation allows the use of innovative tools that make it possible to achieve a high performance of medical students when completing the virtual course of Neonatal Resuscitation.

C3 (Clinical Case) Late Presentation of Radial Nerve Palsy Secondary to Extravasation of Peripherally Inserted Catheter in a Neonate: What Paediatricians Need to Know

Abstract Introduction/Background Peripherally inserted central catheters (PICC) are an essential and common procedure in neonatal intensive care units (NICUs). Peripheral nerve injuries secondary to PICC extravasation are a rare occurrence in neonates, who commonly recover with no sequalae. Rarely, extravasation results in compression and ischemia involving adjacent nerves, muscles or joints. Peripheral nerve injury may be induced by compression from tissue infiltration or irritation by the infiltrate. Timely diagnosis and treatment are essential to avoid complex or irreversible nerve damage, such as compartment syndrome, requiring extensive interventions. Isolated radial nerve injury in infants and neonates is limited to a few cases reported in the literature, which have been commonly related to in-utero compression or birth injury due to peripheral positioning. We report a late presentation of an isolated radial nerve injury secondary to PICC extravasation in a preterm infant, leading to neuropraxia and long-term impairment of hand function. Case Description An extreme preterm female infant (245/7 weeks’ gestation, 640 grams) was admitted to the NICU with a complex neonatal course. At 6 days after birth, a right antecubital PICC was inserted for vascular access and to provide parenteral nutrition. It was removed after 18 days following extravasation. Two months later, she developed a right wrist drop, flexed fingers, and edema of the right hand. Her right wrist flexion, elbow flexion, shoulder joint range of motion, and sensation remained intact. A Doppler study showed a small non-occlusive clot in the right brachial vein, attributed to the previous PICC. She was unable to voluntarily open her right hand or extend her metacarpophalangeal (MCP) or interphalangeal (IP) joints (see Figure A, below). Clinical diagnosis of radial nerve palsy was made, and she was referred to physiotherapy (PT) and occupational therapy (OT). Splinting, passive exercise and left-hand constraint resulted in some improvement of the right hand’s strength. At 12 months of age, she had left hand preference with limited active extension of right MCPs and IPs (Figure B). She received a Botox injection to the right-hand flexors to allow strengthening of the extensor muscles. Follow-up at 18 months showed full extension of the index and middle finger MCPs and IPs, but residual lag in ring and small finger IPs. Discussion To our knowledge, this is the first case report of isolated radial nerve injury in an infant following PICC extravasation and soft tissue infiltration. Interestingly, the clinical signs of radial nerve injury in this case presented almost two months after PICC extravasation. Additionally, the left-hand preference and limitation of the active extension of the fingers of the right hand remained at one year of corrected age. Given that this has exceeded the expected recovery time of radial nerve palsy, Botox injection was performed with good response and near age-appropriate development of fine motor skills at 18 months of corrected age. Paediatricians should be aware that the manifestation of potential nerve injury in neonates may have a delayed presentation. Neurology consultation to confirm the diagnosis and rule out other causes of muscle weakness, and referral to PT/OT, are crucial for managing infants and neonates with peripheral nerve injury because treatment is largely focused on splinting and passive motion exercise. Generally, radial nerve palsy carries a relatively good prognosis, with complete functional recovery within 1-6 months. The fact that this case developed long-term complications with impaired right-hand function, despite nerve recovery, raises concerns about the prognosis. Conclusion Peripherally inserted central venous catheters are an everyday procedure in the NICU. Radial nerve palsy secondary to venous catheter extravasation is rare in infants and neonates. Clinicians should be aware of the clinical signs of radial nerve palsy and initiate consultation and referral to physiotherapy and occupational therapy early. Families can be reassured of the good prognosis and functional recovery.

Comparative Study on the Clinical Characteristics of Transient Tachypnea of Newborns according to the Need for Invasive Mechanical Ventilation

Purpose: Transient tachypnea of the newborn (TTN) is the most prevalent respiratory disease worldwide. Many neonates with TTN generally demonstrate spontaneous improvement. However, only few patients present with severe complications. This study aimed to investigate the differences in clinical features to identify neonates at risk for further complications.Methods: Between January 2015 and December 2020, 267 neonates who developed dyspnea within 6 h of birth were delivered at a gestational age of at least 37 weeks. The experimental group (group E) included 44 neonates who required invasive mechanical ventilation, whereas the control group (group C) included 223 neonates who required only observation or non-invasive respiratory support. We analyzed the differences in clinical and perinatal factors between the two groups.Results: Gestational age and pH on arterial blood gas analysis at admission were significantly lower in group E (&lt;i&gt;p&lt;/i&gt;&lt;0.05). Clinical findings, such as moaning, tachypnea (&gt;90 breaths/min), and pneumothorax, were more frequently observed in group E (&lt;i&gt;p&lt;/i&gt;&lt;0.05).Conclusion: Moaning, tachypnea (&gt;90 breaths/min), and need for respiratory assistance (fraction of inspired oxygen concentration ≥0.25) are predictive factors for increased risk of progression to a more severe disease course in neonates with TTN. Additional studies are needed to identify definitive factors that can differentiate TTN that improves spontaneously from TTN that requires intensive care.

Postoperative outcome of neonatal emergency surgeries in a tertiary care institute-A prospective observational study.

Neonatal surgical mortality continues to be high in developing countries. A better understanding of perioperative events and optimization of causative factors can help in achieving a favorable outcome. The present study was designed to evaluate the perioperative course of surgical neonates and find out potential factors contributing to postoperative mortality. This prospective observational study enrolled neonates, undergoing emergency surgical procedures in a tertiary care institute. Primary outcome was 6 weeks postsurgical mortality. The babies were observed till discharge and subsequently followed up telephonically for 6 weeks after surgery. Multivariable logistic regression analysis of various parameters was performed. Out of the 324 neonates who met inclusion criteria, 278 could be enrolled. The median age was 4 days. Sixty-two (27.7%) neonates were born before 37 weeks period of gestation (POG), and 94 (41.8%) neonates weighed below 2.5 kg. The most common diagnoses was trachea-esophageal fistula (29.9%) and anorectal malformation (14.3%). The median duration of hospital stay for survivors was 14 days. The in-hospital mortality was 34.8%. Mortality at 6 weeks following surgery was 36.2%. Five independent risk factors identified were POG < 34 weeks, preoperative oxygen therapy, postoperative inotropic support postoperative mechanical ventilation, and postoperative leukopenia. In neonates where invasive ventilation was followed by non-invasive positive pressure ventilation in the postoperative period, risk of postoperative surgical mortality was significantly reduced. Present study identified preterm birth, preoperative oxygen therapy, postoperative positive pressure ventilation, requirement of inotropes, and postoperative leukopenia as independent predictors of 6-week mortality. The possibility of early switch to noninvasive positive pressure ventilation was associated with a reduction in neonatal mortality.