Neonatal Examination Research Articles

Neurophysiological and behavioral measures of pain during neonatal hip examination.

IntroductionThe aim of this study was to test the hypothesis that neonatal hip examination causes pain in newborns. Pain assessment using instruments such as the Premature Infant Pain Profile‐Revised (PIPP‐R) scale is recommended, but recently physiological and neurophysiological measures, for example, near‐infrared spectroscopy (NIRS) and galvanic skin response (GSR), have been used as well.MethodsHeart auscultation and hip examination were performed, and the response of the newborn was registered by NIRS optodes, GSR electrodes, and a pulse oximeter probe attached to the infant. The face of the newborn was filmed. Heart auscultation was used as a nonpainful reference.ResultsThe pain scores for hip examination were higher than for the heart auscultation. Near‐infrared spectroscopy showed a significant higher increase from baseline in oxygenated hemoglobin (HbO2) on both sides of the cortex at hip examination compared with at heart auscultation (P = .011 and P = .017). Mean PIPP‐R scores for the hip examination compared with heart auscultation increased from 3.0 to 8.1 (P = .000). The GSR analyses of hip examination compared with heart auscultation showed a significant increase in area under small peaks during the hip examination (P = .016), however, not when measured in peaks per second (P = .104). Interrater reliability was calculated for the NIRS interpretations, with an intraclass correlation coefficient (ICC) range of 0.93‐1.0 (P = .000).DiscussionPain in newborns can have negative consequences, and pain prevention and treatment are therefore important. We conclude that neonatal hip examinations are painful and that the pain should be treated, for example, with oral sweet solution. This is a change from present routines during neonatal hip examination and is hoped to lead to a change in national guidelines.

Clinical validation of a novel automated cell‐free DNA screening assay for trisomies 21, 13, and 18 in maternal plasma

ObjectiveTo evaluate clinical performance of a new automated cell‐free (cf)DNA assay in maternal plasma screening for trisomies 21, 18, and 13, and to determine fetal sex.MethodMaternal plasma samples from 1200 singleton pregnancies were analyzed with a new non–sequencing cfDNA method, which is based on imaging and counting specific chromosome targets. Reference outcomes were determined by either cytogenetic testing, of amniotic fluid or chorionic villi, or clinical examination of neonates.ResultsThe samples examined included 158 fetal aneuploidies. Sensitivity was 100% (112/112) for trisomy 21, 89% (32/36) for trisomy 18, and 100% (10/10) for trisomy 13. The respective specificities were 100%, 99.5%, and 99.9%. There were five first pass failures (0.4%), all in unaffected pregnancies. Sex classification was performed on 979 of the samples and 99.6% (975/979) provided a concordant result.ConclusionThe new automated cfDNA assay has high sensitivity and specificity for trisomies 21, 18, and 13 and accurate classification of fetal sex, while maintaining a low failure rate. The study demonstrated that cfDNA testing can be simplified and automated to reduce cost and thereby enabling wider population‐based screening.

Importance of early elevated maternal HbA1c levels in identifying adverse fetal and neonatal events

AimsThe aims of this study were to explore factors that associated with gestational diabetes mellitus (GDM), and to determine the relationship between early maternal HbA1c levels and adverse fetal or neonatal events, and to determine an optimal maternal glucose testing method in order to decrease the potential health risk for their offspring. MethodsFrom December 2015 to May 2016, a total of 6744 pregnant women were enrolled from Shanghai First Maternal and Infant Hospital affiliated to Tongji University prospectively in the nested case-control study. Each GDM case was matched with a healthy pregnant woman and followed up. Outcome analyses were conducted between GDM case and control groups, as well as elevated and normal maternal HbA1c levels, respectively. ResultsA total of 1836 women were included in the adverse fetal and neonatal events examination. For pregnant women with early HbA1c ≥ 5.2%, the adjusted risk ratios (RR) of respiratory distress syndrome (RDS), pneumonia and jaundice were 4.37 (95%CI 1.54–12.35), 2.03 (95%CI 1.24–3.33) and 1.49 (95%CI 1.01–2.20), respectively. After treatments, the frequency for the majority of events in GDM group was similar to that of healthy pregnant women. Moreover, the area under the curve (AUC) of early maternal HbA1c in predicting potential RDS is 0.734. HbA1c ≤ 4.9% excluded for RDS. ConclusionsCompared with women with normal HbA1c, those with an early elevated HbA1c level were more likely to develop adverse events, including RDS, pneumonia and jaundice. Early HbA1c testing can be used as an auxiliary method identifying potential RDS.

An approach to neonatal lamb post-mortem examinations

Neonatal lamb mortality is a significant threat to welfare and production in commercial sheep flocks and is defined as the death of lambs during the first week of life with the predominant risk period being the first 48 hours. Lamb mortality between scanning and sale ranges from 10 to 25%, with examples of losses between 0 to 48 hours old ranging from 5.9% to 12.5%. Lamb post-mortem examinations are a tool which can facilitate achieving further understanding of the scale and cause of losses for flocks. We discuss an approach to postmortem examinations on neonatal lambs, the common differentials affecting lambs between 0 and 48 hours old, and discuss the role of farmers in surveillance.

Prenatal diagnosis of Pallister–Killian syndrome

Pallister–Killian syndrome (PKS) was first described by Pallister et al. in 19771. This syndrome is the result of partial tetrasomy of the short arm of chromosome 12, but the mechanism that leads to the formation of isochromosome 12p in PKS is not clear, though it is thought to be related to parental, particularly maternal, age2,3. Prenatal diagnosis of PKS is usually incidental on karyotyping in cases of advanced maternal age, increased nuchal translucency thickness or a fetal anomaly detected on ultrasound4. We report a case of PKS suspected on prenatal ultrasound examination, which presented with cystic fibrosis. A 34-year-old woman, para 3, had prenatal care at a specialized ultrasonography clinic in Goiânia, Brazil after initial prenatal care in Barreiras, Brazil showed fetal hydrocephalus. She and her husband, who was 56, were healthy at the time of the appointment and were non-consanguineous, with no family history of congenital malformations. The mother had been treated for epilepsy in childhood and two previous pregnancies ended in miscarriage. Serial ultrasound examinations showed hydrocephalus with the lateral ventricles measuring 16.9 mm (Figure 1), hypoplasia of the nasal bone, nuchal fold of 7.5 mm, atrophic gut and hypotrophic genitalia. Ultrasound-guided amniocentesis and karyotyping at 23 weeks of gestation revealed male fetal sex and the presence of cells with the additional isochromosome (karyotype, 47,XY,+i(12p)(?)), prompting a diagnosis of PKS. Physical examination of the term neonate revealed a webbed neck, low-set ears, frontal bossing, disproportionately sized hands and feet for body size, ambiguous genitalia and suspected hydrocephalus (Figure 2). Serial chest X-rays detected persistent pneumonia and cardiomegaly, while laboratory tests showed late sepsis and cystic fibrosis. The neonate survived 41 days postpartum. One variation in this case from those in the literature is the presence of cystic fibrosis, which significantly complicated the neonate's clinical condition and compromised his life expectancy. We believe this is the first report of cystic fibrosis associated with PKS. On the day prior to demise, the neonate had a non-specific allergic reaction with a cutaneous rash on the lower limbs that improved with corticosteroid treatment, as well as a coagulation disorder with profuse bleeding at the puncture points for central access and gasometry. The cause of these clinical intercurrences was not identified in the patient's medical records and no association of these findings with PKS was found in the medical literature3. Ultrasound and karyotyping made it possible to diagnose PKS prenatally, prepare adequately for delivery and guide genetic counseling. There is no specific therapy for PKS, but affected children can improve clinically with early intervention and special education programs. Further clinical research is needed to investigate if the presence of cystic fibrosis is an integrating and complicating part of the syndrome or whether this finding was merely sporadic. This case emphasizes the importance of routine ultrasonographic practice in prenatal care as a method of early detection of fetal malformations, making possible genetic study which constitutes the gold standard for diagnosis of PKS as well as the determination of prognosis.

Molecular autopsy by trio exome sequencing (ES) and postmortem examination in fetuses and neonates with prenatally identified structural anomalies

PurposeTo determine the diagnostic yield of combined exome sequencing (ES) and autopsy in fetuses/neonates with prenatally identified structural anomalies resulting in termination of pregnancy, intrauterine, neonatal, or early infant death. MethodsES was undertaken in 27 proband/parent trios following full autopsy. Candidate pathogenic variants were classified by a multidisciplinary clinical review panel using American College of Medical Genetics and Genomics (ACMG) guidelines. ResultsA genetic diagnosis was established in ten cases (37%). Pathogenic/likely pathogenic variants were identified in nine different genes including four de novo autosomal dominant, three homozygous autosomal recessive, two compound heterozygous autosomal recessive, and one X-linked. KMT2D variants (associated with Kabuki syndrome postnatally) occurred in two cases. Pathogenic variants were identified in 5/13 (38%) cases with multisystem anomalies, in 2/4 (50%) cases with fetal akinesia deformation sequence, and in 1/4 (25%) cases each with cardiac and brain anomalies and hydrops fetalis. No pathogenic variants were detected in fetuses with genitourinary (1), skeletal (1), or abdominal (1) abnormalities. ConclusionThis cohort demonstrates the clinical utility of molecular autopsy with ES to identify an underlying genetic cause in structurally abnormal fetuses/neonates. These molecular findings provided parents with an explanation of the developmental abnormality, delineated the recurrence risks, and assisted the management of subsequent pregnancies.

Role of Vitamin-D Deficiency in Term Neonates with Late-Onset Sepsis: A Case-Control Study.

To find the relationship between vitamin-D levels and late-onset sepsis (LOS) in term neonates. This case-control study was conducted in neonatal intensive care unit of a tertiary care teaching institution in central India. Full-term neonates with culture-proven LOS were taken as cases. Maternal and neonatal demography, clinical examination and investigations were recorded. Correlation of vitamin-D deficiency (<20 ng/ml) with LOS was assessed. Total 225 term neonates including 175 cases and 50 controls were included. Maternal and neonatal demographic profile was comparable. The mean vitamin-D level in cases (12.28 ± 6.11 ng/ml) was significantly lower than that in controls (14.88 ± 7.2 ng/ml) (p = 0.002). Total 151 (86.29%) neonates out of 175 cases and 37 (74%) out of 50 controls had the vitamin-D deficiency (p = 0.00003). On multiple regression analysis, neonatal sepsis (p = 0.00003) was found to be significantly associated with vitamin-D deficiency. This study shows that vitamin-D deficiency in term neonates may predispose them to LOS.

Neonatal Growth, Neurotrophine, Zinc, and Ferritin Concentration in Normal and Iron Deficience Pregnancy: An Observational Analitic Study.

BACKGROUND:Anemia in pregnancy was one of the national problems. Insufficient iron deposits before pregnancy and inadequate iron intake during pregnancy could lead to iron deficiency anaemia in pregnancy, followed by iron deficiency in neonates.AIM:This study aimed to assess the molecular relationship of maternal iron deficiency with the function of the neonatal central nervous system to know the cognitive aspects of learning ability of children.METHODS:This study was an observational analytic study with cross-sectional design underwent in RSUP Dr M. Djamil Padang, RSI Ibnu Sina Padang, and RSU BMC Padang. The sample size was 80 pregnant women at term. After a maternal and neonatal physical examination, maternal and umbilical blood samples were obtained to assess maternal ferritin levels and neonates ferritin, neurotrophin and zinc levels using the Enzyme-Linked Immunosorbent Assay (ELISA). Data were analysed using the IBM SPSS Statistics for Windows. The independent sample t-test was performed to assess the relationship for normally distributed data and Mann-Whitney test for abnormal data distribution with significance level p < 0.05.RESULTS:There were differences in mean neonatal ferritin (p < 0.001), neonatal neurotrophin (p < 0.001), and neonatal zinc (p < 0.001) to normal maternal ferritin levels (≥ 15 μg/ml) and low maternal ferritin levels (< 15 μg/ml). The difference in mean neonatal head circumference (0.92; CI95% -0.79-0.98) was associated with neonatal ferritin levels.CONCLUSIONS:The mean neonatal ferritin, neurotrophin, and zinc levels were found lower in iron deficiency maternal. Maternal iron deficiency correlates with neonate growth, iron deficiency, and neurotrophin expression that affected neonate cognition.

Assessment of the stretched penile length in Sri Lankan newborns

Evaluation of the external genitalia is important in the routine neonatal examination, since abnormalities of the genitalia give clues to underlying endocrine disorders or structural malformations. The objectives of the study were to document the stretched penile length (SPL) of healthy term neonates born following an uncomplicated delivery at a tertiary care hospital in Sri Lanka, and to establish the normative data for the SPL for Sri Lankan neonates. This was a cross sectional observational study, carried out at post natal wards of the Castle Street Hospital for Women, Sri Lanka. The study was done on 369 stable newborns delivered at the gestational age of 37 to 42 weeks. A complete neonatal examination was performed by the principal investigator and the measurements of the weight, length, head circumference and stretched penile length were obtained. Mean penile length and statistically significant difference of penile length (SD) values were calculated. The correlation of mean penile length, period of gestation, birth weight and length were analysed. The SPL positively correlated with the length of the baby. There is no statistically significant correlation of birth weight, head circumference and gestational age with the SPL. The mean SPL for term Sri Lankan new-borns was 3.03cm ± 0.37cm and the -2SD value was 2.29cm. Since the -2SD of SPL was 2.29cm, measurements less than this should be considered as micropenis.

PLACENTA PREVIA;

Objectives: To determine the maternal and fetal outcomes in patients presented with major degree of placenta previa at tertiary care Hospital. Study Design: Descriptive cases series study. Setting: Department of Gynaecology and Obstetrics of Liaquat University Hospital Hyderabad. Period: One year from March 2015 to February 2016. Subject and Methods: All patients with major degrees of placenta previa were included in study. Following delivery the examination of neonate was carried out thoroughly including congenital abnormalities, weight of baby and Apgar score. Babies and mothers were examined within postoperative wards till stitches removal and systematically examined for any postoperative complication. All the data was entered in the proforma. Results: Total 50 patients with major degrees of placenta previa were selected. Majority of the women 40% belonged to the age group of 30-35 years. Most of the women 92.0%, were symptomatic and presented with painless vaginal bleeding. Elective cesarean section was performed among 20% patients while 80% patients underwent emergency cesarean section. 70% patients delivered preterm and 30% delivered at term. 3(6%) fetals were still births and 1(2.0%) presented macerated still birth. 16% fetuses developed respiratory distress syndrome, 6% had intrauterine growth restriction and only one had congenital abnormality (spina bifida). Neonatal weight less than 2500-grams was among 90%. Perinatal mortality was 6(12.0%), and according to maternal outcome, mortality rate was low i.e. just 1 subjects passed away. Conclusion: Major degree of placenta previais a significant contributor of obstetric hemorrhage in 02nd and 03rd trimesterof pregnancy as well as it adversely correlates with feto-maternal outcomes. Instant moving the case of obstetric hemorrhage to hospitals, precise diagnosis, sufficient transfusion provision, intervention without delay can reduce the fetomaternal morbidity and mortality.

Oximetry and neonatal examination for the detection of critical congenital heart disease: a systematic review and meta-analysis.

Background: Undiagnosed congenital heart disease in the prenatal stage can occur in approximately 5 to 15 out of 1000 live births; more than a quarter of these will have critical congenital heart disease (CCHD). Late postnatal diagnosis is associated with a worse prognosis during childhood, and there is evidence that a standardized measurement of oxygen saturation in the newborn by cutaneous oximetry is an optimal method for the detection of CCHD. We conducted a systematic review of the literature and meta-analysis comparing the operational characteristics of oximetry and physical examination for the detection of CCHD. Methods: A systematic review of the literature was conducted on the following databases including published studies between 2002 and 2017, with no language restrictions: Pubmed, Science Direct, Ovid, Scopus and EBSCO, with the following keywords: oximetry screening, critical congenital heart disease, newborn OR oximetry screening heart defects, congenital, specificity, sensitivity, physical examination. Results: A total of 419 articles were found, from which 69 were selected based on their titles and abstracts. After quality assessment, five articles were chosen for extraction of data according to inclusion criteria; data were analyzed on a sample of 404,735 newborns in the five included studies. The following values were found, corresponding to the operational characteristics of oximetry in combination with the physical examination: sensitivity: 0.92 (CI 95%, 0.87-0.95), specificity: 0.98 (CI 95%, 0.89-1.00), for physical examination alone sensitivity: 0.53 (CI 95%, 0.28-0.78) and specificity: 0.99 (CI 95%, 0.97-1.00). Conclusions: Evidence found in different articles suggests that pulse oximetry in addition to neonatal physical examination presents optimal operative characteristics that make it an adequate screening test for detection of CCHD in newborns, above all this is essential in low and middle-income settings where technology medical support is not entirely available.

Normal values of the resistivity index of the pericallosal artery with and without compression of the anterior fontanelle.

Resistivity index (RI) of the pericallosal artery as is commonly measured during head ultrasound (US) examination in neonates. Some studies have shown that RI measured with gentle compression of the fontanelle provides additional information in cases of neonatal brain anomalies. The purpose of this study was to establish normal RI values with and without compression in a large population of neonates with normal cranial ultrasound as a function of gestational age. The authors of this retrospective study reviewed the RI of 323 infants with normal gray-scale cranial US and with a gestational age ranging 26-42weeks. We conducted the exams both with and without compression of the anterior fontanelle and we studied changes in RI depending on gestational age, gender and type of delivery. Infants with a gestational age of more than 35weeks tended to have a lower RI (P=0.011). The compression of the anterior fontanelle emphasized the change in RI with increasing gestational age, with higher gestational ages having a lower RI (P<0.001). The results concerning the percentage change between baseline RI and RI with compression showed that infants with higher gestational ages have a smaller percentage change in RI (P=0.002). We established the normal values for RI from 26weeks to 42weeks of gestation. The results of the study show the importance of taking the gestational age into consideration when evaluating the RI.

Postnatal Ultrasound to Determine the Surgical Strategy for Congenital Diaphragmatic Hernia.

To compare defect sizes in congenital diaphragmatic hernia (CDH) measured by postnatal ultrasound (US) between neonates who underwent thoracoscopic surgery and neonates who underwent open surgery and between neonates who underwent primary repair and those who underwent patch repair; additionally, to compare the accuracy of US diagnosis with that of surgical diagnosis for the location of the diaphragmatic hernia and the hernial contents. We included 8 neonates who underwent preoperative US evaluations of CDH. We compared anterior-to-posterior diaphragm defect sizes between thoracoscopic and open surgery approaches and between primary and patch repair by using the Mann-Whitney U test. The diaphragm was divided into 3 segments: anterior, lateral, and posterior. We evaluated the location of the diaphragmatic hernia and the hernial contents. Four neonates who underwent open surgery had larger diaphragmatic hernias than those who underwent thoracoscopic surgery (mean ± SD, 30.5 ± 5.6 versus 16.3 ± 3.3 mm; P = .030). They were also larger in neonates who underwent patch repair than in those who underwent primary repair (33.0 ± 3.0 versus 17.6 ± 4.2 mm; P = .037). Detection of anterior and lateral diaphragm segments was consistent between US and surgical findings. Three of 4 neonates who underwent open surgery and all 3 neonates who underwent patch repair did not show the lateral segment. The hernial contents were also consistent between US and surgical findings. Postnatal US examinations of neonates with CDH could provide surgeons with useful information to determine the surgical approach and repair method. However, since our study cohort was small, further studies are needed with a larger number of neonates with CDH.

Legal and ethical considerations for midwives performing the neonatal infant physical examination

The newborn and infant physical examination (NIPE) is part of a national screening programme in the UK that involves the first full physical assessment of the newborn. The examination aims to identify conditions and diseases early in order for prompt intervention and treatment to be arranged. Historically, the examination has lain solely in the paediatrician's remit; however, the more recent shift in midwifery care provision has led to a focus on midwifery-led care, continuity of carer and seamless care, which has brought the NIPE into the midwife's sphere of practice. There has been increasing evidence demonstrating that the midwife is the most suitable practitioner to conduct the NIPE following appropriate training; however, this has not been evaluated in recent years. Midwives are supported professionally, legally and ethically to conduct this examination, provided that they work within their sphere of practice and professional guidelines.

Chapter 3 - Development of the human olfactory system

This chapter focuses on the development of the human olfactory system. In this system, function does not require full neuroanatomical maturity. Thus, discrimination of odorous molecules, including a number within the mother's diet, occurs in amniotic fluid after 28-30 weeks of gestation, at which time the olfactory bulbs are identifiable by MRI. Hypoplasia/aplasia of the bulbs is documented in the third trimester and postnatally. Interestingly, olfactory axons project from the nasal epithelium to the telencephalon before formation of the olfactory bulbs and lack a peripheral ganglion, but the synaptic glomeruli of the future olfactory bulb serves this function. Histologic lamination of the olfactory bulb is present by 14 weeks, but maturation remains incomplete at term for neuronal differentiation, synaptogenesis, myelination, and persistence of the normal transitory fetal ventricular recess. Myelination occurs postnatally. Although olfaction is the only sensory system without direct thalamic projections, the olfactory bulb and anterior olfactory nucleus are, in effect, thalamic surrogates. For example, many dendro-dendritic synapses occur within the bulb between GABAergic granular neurons and periglomerular neurons. Moreover, bulbar synaptic glomeruli are analogous to peripheral ganglia of other sensory cranial nerves. The olfactory tract contains much gray as well as white matter. The olfactory epithelium and bulb both incorporate progenitor cells at all ages. Diverse malformations of the olfactory bulb can be detected by clinical examination, imaging, and neuropathology; indeed, olfactory reflexes of the neonate can be reliably tested. We recommend that such testing be routine in the neonatal neurologic examination, especially in children with brain malformations, endocrinopathies, chromosomopathies, genetic/metabolic disorders, and perinatal hypoxic/ischemic encephalopathy.

Fetal Cerebellar Vermis Assessment by MRI. What Does It Add?

Background: Posterior fossa anomalies (PFAs) are considered one of the commonest brain anomalies identified by the fetal imaging techniques. The current study aims to estimate the significance of cerebellar vermis assessment by fetal MRI in fetal brain malformations. Patients and Methods: The study was conducted at a tertiary University hospital in Upper Egypt. Data were gathered prospectively from sixty pregnant women with sonographically diagnosed fetal brain malformations referred for Magnetic Resonance Imaging (MRI) between April 2015 and May 2019 followed by postpartum neonatal MRI brain examination for non-terminated and live birth cases. Results: Of the sixty fetuses with brain malformations, additional cerebellar vermis findings were seen on MRI in 10 cases (16.6%). Fetal MRI sensitivity, specificity, positive and negative predictive values were 100% that were in correlation with those of prenatal ultrasound turned out to be significantly higher. Conclusion: This study recommends fetal MRI for cerebellar vermis assessment in fetal brain malformations to guide the clinical management.

Stable Preterm infants can have better Neurobehavioral state after 5 days of AVTK (Audio, Visual, Tactile, Kinesthetic) Stimulation

The immature brain, lungs, gastrointestinal tract and skin of preterm infants are particularly susceptible to injury and abnormal development and function, often leading to long-term neurological and health problems. The present study was aimed to evaluate the effectiveness of AVTK (Audio, Visual, Tactile and Kinesthetic) stimulation on neurobehavioral state among preterm. Quasi experimental-one group pre and posttest with control group design was used in this study. Purposive sampling technique was used for selecting 30 samples. The tools used for the study were demographic, clinical variables and modified Morgan's Neonatal Neurobehavioral Examination Tool. The intervention was given for the duration of 30 minutes, twice a day for 5 days. Results showed that there were significant differences between control and experimental group. The unpaired t’ test value showed statistical significance (t= 3.76). In relation to the demographic variable there were no significant association with post test scores in control and experimental group. AVTK was quiet significantly effective in enhancing the neurobehavioral state among preterm.

Association of Prenatal Ultrasonographic Findings With Adverse Neonatal Outcomes Among Pregnant Women With Zika Virus Infection in Brazil

Congenital Zika virus infection causes a spectrum of adverse birth outcomes, including severe birth defects of the central nervous system. The association of prenatal ultrasonographic findings with adverse neonatal outcomes, beyond structural anomalies such as microcephaly, has not been described to date. To determine whether prenatal ultrasonographic examination results are associated with abnormal neonatal outcomes in Zika virus-affected pregnancies. A prospective cohort study conducted at a single regional referral center in Rio de Janeiro, Brazil, from September 1, 2015, to May 31, 2016, among 92 pregnant women diagnosed during pregnancy with Zika virus infection by reverse-transcription polymerase chain reaction, who underwent subsequent prenatal ultrasonographic and neonatal evaluation. Prenatal ultrasonography. The primary outcome measure was composite adverse neonatal outcome (perinatal death, abnormal finding on neonatal examination, or abnormal finding on postnatal neuroimaging). Secondary outcomes include association of specific findings with neonatal outcomes. Of 92 mother-neonate dyads (mean [SD] maternal age, 29.4 [6.3] years), 55 (60%) had normal results and 37 (40%) had abnormal results on prenatal ultrasonographic examinations. The median gestational age at delivery was 38.6 weeks (interquartile range, 37.9-39.3). Of the 45 neonates with composite adverse outcome, 23 (51%) had normal results on prenatal ultrasonography. Eleven pregnant women (12%) had a Zika virus-associated finding that was associated with an abnormal result on neonatal examination (adjusted odds ratio [aOR], 11.6; 95% CI, 1.8-72.8), abnormal result on postnatal neuroimaging (aOR, 6.7; 95% CI, 1.1-38.9), and composite adverse neonatal outcome (aOR, 27.2; 95% CI, 2.5-296.6). Abnormal results on middle cerebral artery Doppler ultrasonography were associated with neonatal examination abnormalities (aOR, 12.8; 95% CI, 2.6-63.2), postnatal neuroimaging abnormalities (aOR, 8.8; 95% CI, 1.7-45.9), and composite adverse neonatal outcome (aOR, 20.5; 95% CI, 3.2-132.6). There were 2 perinatal deaths. Abnormal findings on prenatal ultrasonography had a sensitivity of 48.9% (95% CI, 33.7%-64.2%) and a specificity of 68.1% (95% CI, 52.9%-80.1%) for association with composite adverse neonatal outcomes. For a Zika virus-associated abnormal result on prenatal ultrasonography, the sensitivity was lower (22.2%; 95% CI, 11.2%-37.1%) but the specificity was higher (97.9%; 95% CI, 88.7%-99.9%). Abnormal results on prenatal ultrasonography were associated with adverse outcomes in congenital Zika infection. The absence of abnormal findings on prenatal ultrasonography was not associated with a normal neonatal outcome. Comprehensive evaluation is recommended for all neonates with prenatal Zika virus exposure.

Predictive Value of Midline Spikes on Pediatric EEG for Seizure and Developmental Outcome.

Midline spikes are epileptiform discharges localized to the midsagittal regions of the brain. Isolated midline spikes are rare, but more common in children. Our objective was to determine whether midline spikes are predictive of seizure characteristics and neurodevelopment. EEGs and clinical information of 123 children with isolated midline spikes, and EEG follow-up within 12 to 24 months, were reviewed and compared with controls. Most children with midline spikes had seizures (91%), with an equal predisposition to focal or generalized seizure semiology. There was no difference between the midline spike and control groups in terms of neonatal complications, seizure characteristics (type, frequency, and etiology), and neurologic examination findings. In patients with abnormal neuro-maging, deep gray or white matter abnormalities were more frequent in the midline group (41% vs. 13%, P = 0.02). The midline group had a higher risk of development delay (DD) than controls (43% vs. 29%, odds ratio: 1.8, 95% CI [1.1-3.2], P = 0.03). A higher risk of DD was also noted in the midline group in those aged less than 4 years (52% vs. 26%, odds ratio: 3.1, 95% CI [1.0-9.2], P = 0.04) and in those without seizures (40% vs. 17%, odds ratio: 3.16, 95% CI [1.1-8.8], P = 0.03). This is the largest reported group of patients with midline spikes. Midline spikes have a strong association with seizures and DD. Our data suggest that midline spikes result from heterogeneous etiologies, are more common in young children, and are not benign.

Early Neurodevelopmental Outcome of Very Low Birthweight Neonates with Culture-positive Blood Stream Infection: A Prospective Cohort Study.

AimOur study aimed to evaluate the early neurodevelopmental outcomes of very low birthweight (VLBW) neonates with culture-proven sepsis compared with VLBW neonates without sepsis.Materials and methodsOur study included 80 VLBW neonates with blood culture-proven sepsis and 80 VLBW neonates without sepsis. For each neonate with sepsis, a control neonate of matching gender and gestational age was selected. We evaluated weight, length, and head circumference and conducted Hammersmith neonatal neurological examinations for each participant. We also conducted Developmental Assessment Screening II and vision and hearing impairment screening during a follow-up evaluation.ResultsWe noted a developmental delay in 11 (23.4%) neonates with sepsis and two (3%) without sepsis at six months of age. The median developmental quotient, motor quotient, and mental quotients were significantly lower in the neonates with sepsis compared to those without sepsis.ConclusionsOur findings suggest that sepsis significantly affects mortality and neurodevelopmental outcomes at six months in VLBW neonates. Therefore, preventive measures for sepsis in VLBW neonates is crucial, and those with culture-positive sepsis will require close monitoring and follow-up evaluations.