Neonatal Pathology Research Articles

Placental fetal vascular malperfusion in maternal diabetes mellitus.

To study the clinical and placental correlations in diabetic pregnancies in which placental histopathology included routine double E cadherin/CD34 immunostaining. Retrospective study of 229 cases of diabetic pregnancies, mostly with gestational diabetes mellitus. The cases were individually matched for gestational age at delivery with non-diabetic pregnancies to yield a comparative group of 229 cases. 23 independent clinical and 50 placental phenotypes (variables) were statistically compared by analysis of variance or Chi-square with application of the Bonferroni correction for multiple comparisons. The study group showed statistically significantly more common gestational hypertension, chronic hypertension, polyhydramnios, umbilical cord compromise, cesarean sections, macerated stillbirths, neonatal deaths, and fetal malformations. About a third of cases in each group showed lesions of maternal and fetal vascular malperfusion (FVM), the latter more common than reported in literature. The CD34 component of the double immunostaining increased the sensitivity of placental examination by highlighting clustered endothelial fragmentation of recent fetal vascular malperfusion or increasing the grade of fetal vascular malperfusion (on-going distal villous fetal vascular malperfusion with temporal heterogeneity). With the double immunostaining, FVM is as common as maternal vascular malperfusion pattern of placental injury in diabetic pregnancies with high prevalence of fetal congenital malformations. This is likely due to umbilical cord compression evoked by mass-forming fetal anomalies. Recognizing placental FVM may sensitize to the increased risk of neonatal systemic thrombotic pathology. However, several hypoxic lesions and patterns as well as those of shallow placental implantation were also seen with increased frequencies in diabetic pregnancies.

Recomendaciones del manejo perinatal y seguimiento del prematuro moderado y tardío

Problems related to prematurity are the main cause of morbidity in newborns and infants. Between 80% and 85% of preterm babies are born between 320 and 366 weeks of gestation. In Spain, there is no guide for the perinatal management and long-term follow-up of moderately and late preterm (MLPT) infants.For this reason, the SEN32-36 group of the Spanish Society of Neonatology has developed a guideline with recommendations for both perinatal management (prenatal care, initial care in the delivery room and ward, neonatal respiratory pathology, breastfeeding and feeding difficulties, hyperbilirubinaemia and hospital discharge) and long-term follow-up (neurodevelopment, nutrition and followup, prevention of respiratory disease after discharge and immunizations), grading them according to the Agency for Health Care Research and Quality scales of research quality and levels of evidence. The main goal was improving and standardizing the care of MLPT infants.

DEVELOPMENT OF INNOVATIVE MEDICAL DEVICES IN NEONATOLOGY: LITERATURE REVIEW

The aim of this study is to review the development of medical devices in neonatology, exploring technological advances, identifying innovations and challenges, and proposing recommendations for future research. The methodology involved a narrative review of the literature, searching databases such as PubMed, EBSCO, Cochrane, and IEEE Xplore, focusing on studies from the last ten years on medical devices for neonatology. The results highlight that technologies such as artificial intelligence and machine learning have improved the monitoring and prognosis of neonatal conditions, allowing for more precise and personalized interventions. 3D printing emerges as a promising tool for creating personalized medical devices, meeting the specific needs of each patient. Wearable devices for continuous monitoring of vital signs and advanced enteral and parenteral feeding devices have demonstrated a positive impact on neonatal health. Mechanical ventilators with gentler and smarter modes have reduced serious complications, and catheters with antimicrobial coatings have helped to reduce the incidence of neonatal sepsis. The conclusions indicate that technological innovations are fundamental to improving neonatal care. The integration of artificial intelligence, 3D printing and continuous monitoring has the potential to transform neonatology, improving clinical outcomes and the quality of life of newborns. However, challenges such as the variability of neonatal pathologies, cost and accessibility of devices and the need for adequate training of health professionals need to be addressed. Investment in continuous research, clinical validation and interdisciplinary training is recommended to ensure the effective adoption of these innovative technologies in daily clinical practices.

Septic Thrombophlebitis of the Umbilical Vein Complicating an Intrahepatic Umbilical Venous Catheter in a Premature Newborn

Septic thrombophlebitis of the umbilical vein (SVT) is a serious pathology in neonates, characterized by inflammation of the umbilical vein due to bacterial infection, with 90% of cases linked to the use of central venous catheters (CVCs). This inflammation can lead to thrombus formation as part of the immune system's response. Premature newborn, 33 weeks gestation, delivered vaginally, with history of gestational diabetes, twin pregnancy, macrosomia and premature rupture of membranes (57 hours), initially well adapted to extrauterine life, with a birth weight of 1575 g. The infant was admitted to neonatology for respiratory distress, and an intrahepatic umbilical catheter was inserted. On the 5th day of hospitalization, the infant developed a nosocomial Klebsiella pneumoniae infection, complicated by a fulminant hemorrhagic syndrome with hematemesis and melena. The clinical course was further complicated by multivisceral failure, requiring hepatic Doppler ultrasound, which revealed umbilical vein thrombosis. The newborn was treated with curative doses of Lovenox, while targeted antibiotic therapy was maintained for three weeks after negative blood cultures, resulting in significant clinical and biological improvement. Based on this case, we conclude that it is advisable to think about umbilical vein thrombosis and to perform an abdominal ultrasound in the presence of any digestive hemorrhage in a newborn or an intrahepatic or peripheral umbilical venous catheter, or in subjects at risk (hypotrophy, polycythemia, transfusion on the catheter) in order to screen for possible umbilical or portal vein thrombosis.

Seroepidemiological study of Epstein-Barr virus infection in reproductive age women in Bulgaria

Abstract Background At the present stage, studies on the involvement of Epstein-Barr virus (EBV) in neonatal pathology are rare. Establishing seroprevalence among women of reproductive age has important epidemiological significance in order to determine the risk of infection during pregnancy and intrauterine infection of the fetus. The aim of the study is to determine the seroepidemiological status of EBV in reproductive age women. Methods We conducted a prospective seroepidemiological study in which 96 healthy women of reproductive age (18 to 49 years) were tested during the period December 2023 - January 2024 in Medical Center “Clinical Institute for Reproductive Medicine”- Pleven, Bulgaria. Participants were surveyed on a voluntary basis. The exclusion criteria were: presence of autoimmune disorder, immunosuppressive states, malignancy and populations at risk such as persons under 18 years of age and pregnant women. The presence of specific antibodies were detected using a standardized Anti-EBV VCA IgM, Anti-EBV VCA IgG and Anti-EBV EBNA-1 IgG ELISA kits. The demographic and anamnestic data were collected for each participant in Case Report Form. Results The average age of the women was 34.41±5.44 years. Dominating were women with higher education (76.04%) living in urban areas (91.67%). The results of the seroepidemiological study of markers for EBV show that 98.96% of women of reproductive age are seropositive. There was no significant correlation between the presence of antibodies and socio-demographic indicators (living area, education and number of family members). Conclusions The results of this study imply that only 1.04% of the reproductive age women in Pleven region are susceptible to infection with EBV. Although interpretation of the serological status indicates a low risk of primary infection, active monitoring of high-risk groups pregnant women is necessary because of the possibility of EBV reactivation. Key messages • On-going monitoring of the seroepidemiological EBV status in reproductive age women is necessary to determining the possibility of EBV reactivation and to reduce the teratogenic risk of the infection. • Seroepidemiological surveillance of markers for EBV infection in reproductive age women is part of effective preventive measures at the public health level.

The knowledge of medical staff on the impact of noise on neonatal intensive care units patients and its application in practice.

Noise is an undesirable environmental factor whose control and reduction should be standard in every Neonatal Intensive Care Unit. Its impact can have negative effects on both the mental and physical health of the body. Newborns, especially premature infants, are particularly sensitive to the negative effects of noise. the negative impact of noise can be reduced through appropriate behaviour of the medical staff. Aim. The aim of the study is to analyse the knowledge of medical staff on the impact of noise on newborns staying in Neonatal Intensive Care Units and to evaluate its use in practice. Methods. A total of 104 respondents working in neonatal wards participated in the study. The survey was conducted online using social media. The study employed the diagnostic survey method with a self-designed questionnaire. The first part of the ques- tionnaire concerned the aspects of knowledge on the impact of noise on hospitalised new- borns; the second part addressed the socio-demographic issues of the medical staff. Results. Training on noise exposure for newborns is not common in the workplace. There are no recommendations regulating noise standards and control equipment. The surveyed individuals do not have in-depth knowledge about acceptable noise levels in newborn rooms. Only one in three employees was able to provide the correct answers in this regard. Older employees with longer experience and residents of large cities scored higher in knowledge than younger individuals. Those with a higher level of knowledge and satisfaction with their work and earnings show the greatest care in reducing noise intensity in the ward. Conclusions. In neonatal pathology wards and (NICUs), noise standards and recom- mendations are more common than in physiology wards. Employees caring for new- borns need training on the sources and impact of noise on babies. it is necessary to limit the noise generated by the staff, such as loud conversations, slamming furniture, placing objects on incubators, or moving equipment.

A new spectrum of neonatal urethral pathologies in the era of early vesicoamniotic shunting?

Intrauterine vesicoamniotic shunting (VAS) was shown to affect survival of male fetuses with megacystis in suspected lower urinary tract obstruction (LUTO). Data on postnatal management are largely lacking. We aim to describe the pathologies diagnosed in children born after vesicoamniotic shunt placement in early pregnancy for megacystis. All newborns with previous intrauterine VAS treated in our institution were analyzed retrospectively. We evaluated the clinical spectrum of urethral pathologies. We also compared patients who received a shunt before the 17th gestational week with those who received it later. Between 2014 and 2023, 26 patients (all male) with a history of VAS for suspected LUTO were treated in our institution postnatally. Five fetuses with dislocated shunts underwent re-implantation in utero. Overall, premature birth before the 38th week of gestation was observed in 14 patients. Seven patients received a Harrison® shunt whereas 19 received a Somatex® shunt. Twelve patients required surgical shunt removal under general anesthesia due to shunt migration/embedding. Posterior urethral valves were found in 10/26 patients, 10/26 patients showed a urethral hypoplasia [Fig.1] and two patients had urethral duplications. In two patients, we identified a prune belly syndrome. One patient had posterior and anterior urethral valves. One patient had a high grade bilateral vesicoureteral reflux without LUTO. The 11 patients shunted early (before 17GW) showed a trend towards a higher proportion of urethral hypoplasia in the early shunt group (54% vs. 26%) without statistical significance. In our observation, patients treated with VAS had a noticeable high proportion of complex urethral pathologies such as urethral hypoplasia. These data should be taken into consideration for prenatal counselling of parents and planning of postnatal management.

Short-term neurologic outcomes in pediatric extracorporeal membrane oxygenation are proportional to bleeding severity graded by a novel bleeding scale.

This study aimed to characterize the severity of bleeding and its association with short-term neurologic outcomes in pediatric ECMO. Multicenter retrospective cohort study of pediatric ECMO patients at 10 centers utilizing the Pediatric ECMO Outcomes Registry (PEDECOR) database from December 2013-February 2019. Subjects excluded were post-cardiac surgery patients and those with neonatal pathologies. A novel ECMO bleeding scale was utilized to categorize daily bleeding events. Poor short-term neurologic outcome was defined as an unfavorable Pediatric Cerebral Performance Category (PCPC) or Pediatric Overall Performance Category (POPC) (score of >3) at hospital discharge. This study included 283 pediatric ECMO patients with a median (interquartile range [IQR]) age of 1.3years [0.1, 9.0], ECMO duration of 5days [3.0, 9.5], and 44.1% mortality. Unfavorable PCPC and POPC were observed in 48.4% and 51.3% of patients at discharge, respectively. Multivariable logistic regression analysis included patient's age, cannulation type, duration of ECMO, need for cardiopulmonary resuscitation, acute kidney injury, new infection, and vasoactive-inotropic score. As the severity of bleeding increased, there was a corresponding increase in the likelihood of poor neurologic recovery, shown by increasing odds of unfavorable neurologic outcome (PCPC), with an adjusted odds ratio (aOR) of 0.77 (confidence interval [CI] 0.36-1.62), 1.87 (0.54-6.45), 2.97 (1.32-6.69), and 5.56 (0.59-52.25) for increasing bleeding severity (grade 1 to 4 events, respectively). Similarly, unfavorable POPC aOR (CI) was 1.02 (0.48-2.17), 2.05 (0.63-6.70), 5.29 (2.12-13.23), and 5.11 (0.66-39.64) for bleeding grade 1 to 4 events. Short-term neurologic outcomes in pediatric ECMO are proportional to the severity of bleeding events. Strategies to mitigate bleeding events could improve neurologic recovery in pediatric ECMO.

Effective Ventilation Mode in Early Neonatal Sepsis, Bilateral Pneumonia, and Pulmonary Hypertension in a Very Low Birth Weight Newborn (Case Report)

The aim was to demonstrate an alternative approach to respiratory therapy in respiratory failure complicated by pulmonary hypertension when conventional ventilation and high-frequency oscillatory ventilation are ineffective.Patient and study methods. We analyzed laboratory data, ventilatory parameters and hemodynamic parameters during ventilation in a child with birth weight of 1300 grams and respiratory failure complicated by pulmonary hypertension. Dynamic selection of parameters and modes of pulmonary ventilation with transition to Airway Pressure Release Ventilation (APRV) mode is presented. Chest radiography and echocardiography were used.Results. The use of APRV mode when traditional approaches were ineffective allowed «stabilization» of the lungs by alveolar recruitment without deep sedation and muscle relaxation. On day 20 after birth, the infant was weaned. On day 29, the infant was transferred to the neonatal pathology unit for further management, and on day 49, the infant was discharged in stable condition.Conclusion. In neonates with severe respiratory failure, the use of the APRV mode as an alternative to ineffective conventional ventilation requires further investigation and the development of guidelines for its use.

Questions and controversies in the management of hypotension in preterm infants

Hypotension is a frequent condition that affects preterm infants during the first days of life, within the transition period to an extra uterine environment, or associated with neonatal pathology. Persistent hypotension in the neonatal period is associated with increased neonatal morbidity and mortality. Understanding neonatal hemodynamics is the first step in approaching hypotensive neonatal patients. Treating hypotension should be to restore impaired blood flow and maintain cellular metabolism. Neonatologists should look beyond values of blood pressure and check for markers of low systemic blood flow and inadequate organ perfusion. There are many anti-hypotensive agents, but choosing the most appropriate intervention should take into consideration the underlying pathophysiologic process, the effectiveness versus side effects of the drug, and medium and long-term developmental outcomes. This article intends to review the therapeutic options for neonatal hypotension to offer the clinicians support for an evidence-based choice.

Development and Validation of a Realistic Neonatal Intestinal Jejunoileal Atresia Simulator for the Training of Pediatric Surgeons.

Background: Neonatal surgical pathology presents highly technical complexity and few opportunities for training. Many of the neonatal surgical entities are not replicable in animal models. Realistic 3D models are a cost-effective and efficient alternative for training new generations of pediatric surgeons. Methods: We conceptualized, designed, and produced an anatomically realistic model for the open correction of jejunoileal atresia. We validated it with two groups of participants (experts and non-experts) through face, construct, and content validity questionnaires. Results: The model was validated by eleven experts and nine non-experts. The mean procedure time for the experts and non-experts groups was 41 and 42 min, respectively. Six non-experts and one expert did not complete the procedure by the designed time (45 min) (p = 0.02). The mean score of face validity was 3.1 out of 4. Regarding construct validity, we found statistically significant differences between groups for the correct calculation of the section length of the antimesenteric border (Nixon's technique) (p < 0.01). Concerning content validity, the mean score was 3.3 out of 4 in the experts group and 3.4 out of 4 in the non-experts group. Conclusions: The present model is a realistic and low-cost valid option for training for open correction of jejunoileal atresia. Before drawing definitive conclusions, future studies with larger sample sizes and blinded validators are needed.

Development and validation of a realistic type III esophageal atresia simulator for the training of pediatric surgeons

BackgroundThe technical complexity and limited casuistry of neonatal surgical pathology limit the possibilities of developing the necessary technical competencies by specialists in training. Esophageal atresia constitutes the paradigm of this problem. The use of synthetic 3D models for training is a promising line of research, although the literature is limited.MethodsWe conceptualized, designed, and produced an anatomically realistic model for the open correction of type III oesophageal atresia. We validated it with two groups of participants (experts and non-experts) through face, construct, and content-validity questionnaires.ResultsThe model was validated by nine experts and nine non-experts. The mean procedure time for the experts and non-experts groups was 34.0 and 38.4 min, respectively. Two non-experts did not complete the procedure at the designed time (45 min). Regarding the face validity questionnaire, the mean rating of the model was 3.2 out of 4. Regarding the construct validity, we found statistically significant differences between groups for the equidistance between sutures, 100% correct in the expert group vs. 42.9% correct in the non-expert group (p = 0.02), and for the item “Confirms that tracheoesophageal fistula closure is watertight before continuing the procedure”, correctly assessed by 66.7% of the experts vs. by 11.1% of non-experts (p = 0.05). Concerning content validity, the mean score was 3.3 out of 4 for the experts and 3.4 out of 4 for the non-experts.ConclusionsThe present model is a cost-effective, simple-to-produce, and validated option for training open correction of type III esophageal atresia. However, future studies with larger sample sizes and blinded validators are needed before drawing definitive conclusions.

Pediatric Cranial Ultrasound Revisited: A Comprehensive Review.

Cranial ultrasound (CUS) is an indispensable tool in the evaluation of intracranial pathology in premature and term neonates and older infants. Familiarity with standard cranial ultrasound techniques and parameters, normal anatomy, and commonly encountered abnormalities is crucial for providing appropriate care for these patients. This review provides a comprehensive overview of cranial ultrasound in clinical practice.

Quality improvement in neonatal care through enhanced patient safety and clinical risk management: a before-and-after study about neonatal sepsis.

Neonatal sepsis, classified into early-onset and late-onset based on symptom timing, poses significant risks of morbidity and mortality, especially in low birth weight infants. Effective clinical risk management protocols are crucial in reducing these risks. This before-and-after study evaluated the impact of a newly implemented clinical risk management protocol in the Neonatology and Neonatal Intensive Care Unit (NICU) at Policlinico Hospital-University of Bari. The study included 399 neonates over three years, comparing pre- and post-protocol outcomes. Data collection focused on maternal and neonatal demographics, infection rates, and hospital stay lengths. Statistical analysis included t-tests, Wilcoxon-Mann-Whitney tests, and logistic regression models. The study found no significant differences in neonatal pathologies or demographics between pre- and post-protocol groups. However, post-protocol implementation showed a notable reduction in umbilical venous catheter (UVC) infections (p = 0.018) and improved hospital stay lengths. Blood and urine cultures did not show significant changes in microbial patterns post-protocol. The findings underscore the effectiveness of structured clinical risk management protocols in enhancing neonatal outcomes, particularly in reducing specific infection risks. Despite the study's limitations, including its observational nature and sample size, the results advocate for broader adoption and further research on these protocols in diverse healthcare settings. The positive outcomes highlight the importance of continuous clinical risk management efforts in high-risk neonatal environments.

Lung Ultrasound and Ultrasound Score: A Useful Tool in Neonatal Intensive Care Units for the Diagnosis and Therapeutic Management of Newborns With Respiratory Pathology.

Pulmonary ultrasound has become a fundamental tool for the early detection and management of major neonatal lung diseases in neonatal intensive care units (NICUs). The advantages of this imaging investigation include its rapid execution and information acquisition, non-invasive nature, early diagnosis establishment, dynamic monitoring, and usefulness in therapeutic management. Regarding therapeutic management, the lung ultrasound (LUS) score is used as a basic tool for indicating surfactant administration. Performing and interpreting pulmonary ultrasounds requires an experienced clinician capable of recognizing anatomical structures, understanding the limitations of the technique, and correlating the obtained data with the patient's clinical picture. A series of diagnostic characteristics of pulmonary ultrasonography for neonatal lung pathologies have been described, making pulmonary ultrasound a useful tool in establishing differential diagnoses. This study evaluates the effectiveness of ultrasonography in determining the severity of lung pathologies in newborns and its impact on therapeutic decision-making, including surfactant administration and continuous positive airway pressure (CPAP) support. Newborns admitted to the NICUwith various respiratory conditions underwent LUS scoring. The study analyzed the relationship between LUS scoring and the severity of conditions such as pneumonia, respiratory distress syndrome, meconium aspiration syndrome, transient tachypnea of the newborn, and pneumothorax. The correlation between LUS scoring, surfactant administration, and CPAP requirements was also examined.

Metabolic Pathways in Hydrocephalus: Profiling with Proteomics and Advanced Imaging.

Hemorrhagic hydrocephalus is a common pathology in neonates with high mortality and morbidity. Current imaging approaches fail to capture the mechanisms behind its pathogenesis. Here, we discuss the processes underlying this pathology, the metabolic dysfunction that occurs as a result, and the ways in which these metabolic changes inform novel methods of clinical imaging. The imaging advances described allow earlier detection of the cellular and metabolic changes, leading to better outcomes for affected neonates.

Cannabidiol decreases histological intestinal injury in a neonatal experimental model of necrotizing enterocolitis

BackgroundNecrotizing enterocolitis (NEC) is a severe inflammatory bowel disease in neonates. Our group has developed an experimental model of NEC, with an effectiveness of 73%. Cannabidiol (CBD) is an innovative treatment for neonatal cerebral hypoxic-ischemic pathologies due to its neuroprotective effect, as a potent anti-inflammatory and reducing oxidative stress substance.Our aim was to evaluate the effect of CBD on intestinal lesions in an experimental model of NEC.ResultsMortality and intestinal histological damage was significantly lower in the CBD group compared to the rest (p<0.05), establishing CBD as a protective factor against the development of NEC (OR=0.0255; 95% CI=0.0015-0.4460). At IHQ level (TUNEL technique), a lower cell death rate was also observed in the CBD group compared to the VEH group (p<0.05).ConclusionsIn our experimental model, intraperitoneal CBD acts as a protective factor against NEC, resulting in less histological damage and a lower rate of intestinal cell death.

Neonatal outcomes in women with diabetes mellitus — analysis of DAPSY data

BACKGROUND: Hyperglycemia in pregnancy is associated with short- and long-term implications for children. Nevertheless, the effects of different types of diabetes mellitus and treatment methods on the neonatal outcomes are to be investigated. AIM: The aim of this study was to evaluate the contribution of different types of maternal diabetes mellitus to the risk of adverse neonatal outcomes. MATERIALS AND METHODS: This retrospective cohort study included women (n = 3261) who delivered at the Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott, Saint Petersburg, Russia in 2008–2017. The following comparison groups were used: type 1 diabetes mellitus (n = 506; 1a, continuous subcutaneous insulin injections; 1b, multiple daily insulin injections), type 2 diabetes mellitus (n = 229; 2a, diet; 2b, insulin therapy), gestational diabetes mellitus (n = 2387; 3a, diet; 3b, insulin therapy), and control (n = 139). The main birth outcomes assessed included weight and length of newborns, Apgar score at birth and at 5 minutes after birth, and pathological conditions such as fetal macrosomia, syndrome of infant of mother with gestational diabetes mellitus or diabetic mother (P70.0–P70.1), light (P05.0) or small for gestational age (P05.1), intrauterine growth restriction, prematurity (P07), neonatal hypoglycemia (P70.4), and neonatal respiratory distress syndrome (P22). The secondary birth outcomes assessed included birth trauma (P10–P15), stillbirth (P95), disturbances of cerebral status of newborn (P91), and congenital malformations, deformations and chromosomal abnormalities (Q00–Q99). RESULTS: Pregestational diabetes mellitus is strongly associated with adverse neonatal outcomes. Type 1 diabetes mellitus women had the highest risks for fetal macrosomia and diabetic fetopathy, neonatal hypoglycemia, prematurity, and congenital malformations (odds ratio 3.54, 20.2, 5.59, 4.24 and 3.92 respectively). In type 2 diabetes mellitus patients, the risks of low birth weight, intrauterine growth restriction and birth trauma (odds 9.14, 5.42 and 6.3 respectively) were higher. For women with gestational diabetes mellitus, these risks were lower. CONCLUSIONS: This study provides a comprehensive analysis of the major neonatal pathology in patients with different types of diabetes mellitus, taking into account the treatment method. Preconception care and optimal glycemic control are necessary to reduce the risk of obstetric and perinatal complications in women with pregestational types of diabetes mellitus. Further research into the health status of this cohort of children at a later age is required.

Molecular genetic determinants of virulence of Streptococcus agalactiae isolated from pregnant women and newborns in St. Petersburg and the Leningrad region in 2010–2023

Introduction. Colonization of the reproductive organs of pregnant women with group B streptococci (GBS; Streptococcus agalactiae) can lead to severe perinatal and neonatal pathology. In modern conditions, aside from the prevention of antenatal infection of the fetus during childbirth using antibacterial drugs, vaccination is also necessary. In this regard, surveillance of GBS genotypes is an important task. Objective. To determine the molecular genetic determinants of virulence of Streptococcus agalactiae isolated from pregnant women and newborns, and to monitor the distribution of capsular polysaccharides types and pili profiles in GBS clinical isolates. Materials and methods. The study used clinical isolates of GBS (n = 420) isolated from pregnant women and newborns in 2010–2023.The bacteriological method was used for isolation of S. agalactiae. PCR method was used to determine the types of capsular polysaccharides, pili, and whether the strains belonged to the hypervirulent sequence type ST-17. Results. During 13 years of observation, the predominance of Ia, III and V genotypes of GBS capsular polysaccharides was noted both in pregnant women and in newborns. The frequency of occurrence of genotype Ib increased from 0.7 to 6.7%, genotype V from 12.1 to 24.4%, and the prevalence of genotype III decreased significantly from 41.1 to 21.1%. Hypervirulent sequence type ST-17 was detected in 6 pregnant women and 2 newborns. However, there were no signs of neonatal infection in these children. More than half of all clinical isolates of S. agalactiae had pili genotypes PI-1 + PI-2a, as well as pili genotypes PI-2a and PI-1 + PI-2b. The distribution of pili types did not change over 13 years of the surveillance period. Conclusion. Surveillance of the GBS capsular polysaccharides and pili genotypes is necessary for the development of effective preventive vaccines.

Fungal microbiota in newborn infants with and without respiratory distress syndrome.

Pneumocytis jirovecii infection in preterm newborns has recently been associated with neonatal respiratory distress syndrome and bronchopulmonary dysplasia. Changes in the bacterial microbiota of the airways have also been described in infants with bronchopulmonary dysplasia. However, until now there has been no information on the airway mycobiota in newborns. The purpose of this study was to describe the airway mycobiota in term and preterm newborns and its possible association with respiratory distress syndrome. Twenty-six matched preterm newborns with and without respiratory distress syndrome were studied, as well as 13 term babies. The identification of the fungal microbiota was carried out using molecular procedures in aspirated nasal samples at birth. The ascomycota phylum was identified in 89.7% of newborns, while the basidiomycota phylum was found in 33.3%. Cladosporium was the predominant genus in both term and preterm infants 38.4% vs. 73% without statistical differences. Candida sake and Pneumocystis jirovecii were only found in preterm infants, suggesting a potential relationship with the risk of prematurity. This is the first report to describe the fungal microbiota of the airways in term and preterm infants with and without respiratory distress syndrome. Although no differences have been observed, the number of cases analyzed could be small to obtain conclusive results, and more studies are needed to understand the role of the fungal microbiota of the airways in neonatal respiratory pathology.