Neonatal Soft Tissue Research Articles

Investigating the suitability of newly developed epoxy-based equivalent tissues for newborn and 5-year-old in paediatric radiology

The varied radiological applications of tissue equivalent (TE) materials encompass quality checks, diagnostic imaging, and dose evaluations. However, the availability of compounds representing paediatric patient tissues for scientific use in lower diagnostic photon energy spectra is limited. In this study, several TE substitutes were developed to replicate the radiographic characteristics of neonatal soft tissue (ESST-NB), neonatal skeletal tissue (ESTB-NB), and equivalent tissues of a 5-year-old child (ESST and ESBT, respectively) within these energy ranges. The ORNL stylized computational model series was utilised as the primary reference for obtaining the desired elemental ratios. The density, effective atomic number, CT numbers, and electron densities obtained for the developed tissue substitutes exhibited a close resemblance to those of the reference phantom system, demonstrating a high level of accuracy and agreement. Furthermore, in order to accommodate constraints related to material selection and production, significant correlations were established between the obtained data and the reference values for mass densities, mass attenuation coefficients, and mass energy-absorption coefficients. In comparison to the ORNL reference samples, the neonates TE substitutions showed maximum discrepancies μ/ρ ranging from +1.6% to −3.01% and μen/ρ from +1.15% to −1.4% throughout an energy range from 47 keV to 66 keV. For the TE materials representing a 5-year-old, the corresponding comparable data ranges were +1.09% to −3.02% and +1.92% to −2.53%. These tissues may then be utilised to produce physical phantoms for neonates and 5-year-old as a result of the great concordance established between the newly built TE materials and the reference data.

The OdonAssist inflatable device for assisted vaginal birth—the ASSIST II study (United Kingdom)

Decreasing rates of assisted vaginal birth have been paralleled with increasing rates of cesarean deliveries over the last 40 years. The OdonAssist is a novel device for assisted vaginal birth. Iterative changes to clinical parameters, device design, and technique have been made to improve device efficacy and usability. This study aimed to determine if the feasibility, safety, and efficacy of the OdonAssist device were sufficient to justify conducting a future randomized controlled trial. An open-label nonrandomized study of 104 participants having a clinically indicated assisted vaginal birth using the OdonAssist was undertaken at Southmead Hospital, Bristol, United Kingdom. Data were also collected from participants who consented to participate in the study but for whom trained OdonAssist operators were not available, providing a nested cohort. The primary clinical outcome was the proportion of births successfully expedited with the OdonAssist. Secondary outcomes included clinical, patient-reported, operator-reported, device and health care utilization. Neonatal outcome data were reviewed at day 28, and maternal outcomes were investigated up to day 90. Given that the number of successful OdonAssist births was ≥61 out of 104, the hypothesis of a poor rate of 50% was rejected in favor of a good rate of ≥65%. Between August 2019 and June 2021, 941 (64%) of the 1471 approached, eligible participants consented to participate. Of these, 104 received the OdonAssist intervention. Birth was assisted in all cephalic vertex fetal positions, at all stations ≥1 cm below the ischial spines (with or without regional analgesia). The OdonAssist was effective in 69 of the 104 (66%) cases, consistent with the hypothesis of a good efficacy rate. There were no serious device-related maternal or neonatal adverse reactions, and there were no serious adverse device effects. Only 4% of neonatal soft tissue bruising in the successful OdonAssist group was considered device-related, as opposed to 20% and 23% in the unsuccessful OdonAssist group and the nested cohort, respectively. Participants reported high birth perception scores. All practitioners found the device use to be straightforward. Recruitment to an interventional study of a new device for assisted vaginal birth is feasible; 64% of eligible participants were willing to participate. The success rate of the OdonAssist was comparable to that of the Kiwi OmniCup when introduced in the same unit in 2002, meeting the threshold for a randomized controlled trial to compare the OdonAssist with current standard practice. There were no disadvantages of study participation in terms of maternal and neonatal outcomes. There were potential advantages of using the OdonAssist, particularly reduced neonatal soft tissue injury. The same application technique is used for all fetal positions, with all operators deeming the device straightforward to use. This study provides important data to inform future study design.

A 3-days old infant with neonatal soft tissue sarcoma: a case report

Background :The incidence of sarcomas occurs in less than 1% of all malignant tumors but sarcoma is the cause of 2% of total cancer deaths. Based on the National Registry the incidence of neonatal sarcomas is 2.6 per million live births.Case Description : A baby girl aged 3 days, complaining of a mass on the patient's left thigh since birth. the mass was large from birth and there was only one on the left thigh. In the prenatal history, the mother and baby with routine ANC history to the midwife, and never having a control with an obstetrician, the mother was not sick during pregnancy and took medication during pregnancy outside of a doctor's prescription. In the perinatal history, the baby was born to mother G1P1A0, gestational age at term, was born by cesarean section, with birth weight 2800 grams, was born crying, active movement, reddish color, vomiting (-) genitalia (+) anus (+)Conclusion : Soft tissue sarcomas (STS) require proper diagnosis and management. The results of rhomboid flap in the tumor resection area are better than skin grafts of similar shape and location and provide cosmetic advantages with very few complications.

Non-rhabdomyosarcoma soft tissue sarcoma in a neonate, a rare and aggressive disease: case report

Neonatal soft tissue sarcomas are a rare group of tumors. The behavior and aggressiveness of neonatal STS is variable. Surgical excision has been noted to be most important factor affecting outcome. However, when non-mutilating surgery is not possible, or resection is incomplete, chemotherapy and radiotherapy have been tried with variable success. We encountered a case of a neonate having large soft tissue mass at anterior abdominal wall. Biopsy and immunohistochemistry confirmed it as undifferentiated soft tissue sarcoma. Surgical excision was incomplete with margin positivity. His disease showed recurrence in short duration of time and despite adjuvant chemotherapy, progression was noted. The child abandoned the treatment and died within 3 months of life.

Outcome analysis of neonatal abscess and necrotizing fasciitis at a tertiary center

Background: Skin and soft tissue involvement (SSTI) in neonates usually present as pustulosis, cellulitis, abscesses, necrotizing fasciitis, toxic shock syndrome, and staphylococcal scalded skin syndrome. Early diagnosis and appropriate management are essential for a good outcome. The pattern of neonatal skin and soft tissue infections in fifty neonates presenting at a tertiary referral center is described. Materials and Methods: Data of fifty neonates presenting with skin and soft tissue infection were retrospectively analyzed on the basis of age at presentation, sex, weight, subtype of SSTI, anatomical site, predisposing factors, pus culture, blood culture, management, and outcome. Results: The mean age of presentation was 18.42 days. There were 21 males and 29 females. The mean weight at presentation was 2.83 kg. Forty-one patients had localized abscesses; six had necrotizing fasciitis and three neonates had cellulitis. The thigh was the most common area involved in patients with localized abscesses. Back and anterior abdominal wall were the most commonly involved sites in patients of necrotizing fasciitis. Total leukocyte counts were increased in all patients. Blood culture was positive in two patients with necrotizing fasciitis. Secondary suturing was required in one patient with a large raw area in the region of the axilla. Hospital stay ranged from 3 to 4 days for localized abscesses to 10–45 days for necrotizing fasciitis. Conclusion: There has been an increase in the incidence of neonatal soft tissue infections. Immediate recognition and diagnosis are essential to avoid morbidity and mortality.

Neonatal sarcoma

Though some neonatal soft tissue tumours have identical biology and natural history to the same tumours in older children many tumours in this age group have a distinct and more favourable behaviour and mandate less aggressive treatment; many being curable by surgical resection alone. Accurate histological diagnosis is essential. In those instances where adjunctive chemotherapy is indicated it is essential to modify paediatric chemotherapy dosages and regimes to minimise the risk of serious adverse effects. Radiotherapy should be avoided due to its severe adverse effects on growth and the risk of inducing secondary malignancies.

P197: Fractional thigh volume: a new soft tissue parameter for fetal growth assessment

Previous attempts to quantify fetal soft tissue by conventional sonography have been difficult. Fractional thigh volume measurements, obtained by three-dimensional ultrasonography (3DUS) were evaluated for this purpose, using Individualized Growth Assessment (IGA). Longitudinal sonographic studies of normal fetuses were performed to obtain standard biometry and fractional thigh volumes. Fractional thigh volumes were based on 50 percent of the femoral diaphysis length. Start points, the theoretical age at which an anatomical parameter can first be identified, were calculated from linear functions relating the cube root of fractional limb volume to menstrual age prior to 28.5 weeks'. Regression analysis was used to fit Rossavik functions (P = c(t) k + s(t), where P is the anatomic parameter, t is menstrual minus start point, and c, k, s are model coefficients) to individual growth trajectory data. Rossavik models specified from the linear slopes of growth curves before 28.5 weeks were used to predict TVol during the third trimester and at birth. Neonatal growth status was determined from anatomic measurements and 3DUS within 48 hours of delivery. 22 fetuses (14 females, 8 males) were prospectively studied between 17.4 and 39.3 weeks, menstrual age. The mean birthweight was 3296 ± 253 (SD) grams. All neonates had normal modified Neonatal Growth Assessment Scores. The mean start point (9.0 ± 1.4 weeks') was consistent with completion of thigh development at 8.5 weeks', determined from embryological studies. Rossavik models fit the TVol trajectories very well (mean R2 = 99.8 ± 0.2). By fixing the k coefficient at its mean (2.976), the fit did not change and the variabilities of coefficients c and s were reduced. The mean percent deviation between observed and predicted TVol measurements was − 0.048 ± 7.5% (n = 72) during the third trimester. Neonatal TVol measurements in 12 infants, corrected for systematic error (− 16.7%) led to an averaged signed deviation of − 1.8 ± 9.2% from predicted values. IGA standards for fractional thigh volume provide a new approach for characterizing soft tissue growth. Normal growth trajectories and neonatal soft tissue volume can be accurately predicted from growth models specified by fractional thigh volume data obtained before 28.5 menstrual weeks. The normal variability for these predicted TVol measurements is about one-third of what has been reported for fetal thigh circumference. This parameter may allow earlier detection and improved monitoring of fetuses with soft tissue abnormalities such as IUGR and macrosomia.

Three‐dimensional sonographic evaluation of fetal soft tissue deposition

Objectives: To evaluate fetal nutritional status in utero and to detect intrauterine growth restriction and macrosomia by use of three‐dimensional ultrasonography.Methods: Fifty‐two fetuses from 28 to 41 weeks gestation were studied within 1 week before delivery using a transabdominal three‐dimensional transducer. The fetal nutrition score values were determined from a qualitative assessment of the amount of subcutaneous tissue present at three locations (face, ribs, and buttocks) on the antenatal three‐dimensional ultrasonograms. Fetal nutritional status, using fetal nutrition score, was compared with those by modified neonatal nutrition score and ponderal index, respectively.Results: There was a significant linear correlation between fetal nutrition score and modified neonatal nutrition score. Fetal or neonatal nutrition score correlated well with birth weight and neonatal crown‐heel length, respectively. However, no significant correlation between ponderal index and fetal nutrition score or modified neonatal nutrition score was evident. Ponderal index also did not correlate with birth weight and neonatal crown‐heel length, respectively.Conclusion: We do cast doubt on the usefulness of the ponderal index for measurement of neonatal soft tissue and muscle mass. Fetal nutrition score using three‐dimensional ultrasonography provides a novel means of evaluating the nutritional status of the fetus in utero, and should be useful for predicting the extreme in fetal growth earlier.

Neonatal soft tissue sarcomas: The influence of pathology on treatment and survival

Introduction: A multi-institutional study was conducted by the Children's Cancer Group (CCG) to evaluate all soft tissue sarcomas diagnosed within the first month of life. Methods: A retrospective study by 11 CCG institutions of patient records from 1971 to 1991 were reviewed for demographic data, pathology, therapy, and outcome. Results: 32 neonates with soft tissue sarcomas were identified. There were 21 boys and 11 girls. Pathology was equally divided into three groups: Congenital fibrosarcoma (CFS) (12), rhabdomyosarcoma (RMS) (11), and non-RMS soft tissue sarcomas (NRSTS) (9). Anatomic sites consisted of head/neck (11), extremity (9), trunk (8), pelvis (3), and unknown (2). Overall survival rate was 59% ( 19 32 ). Conclusion: Soft tissue sarcomas in the neonate comprise three general groups with survival rates dependent on pathology and extent of disease.