Newborn Child Research Articles

Hypogalactia as a cause of neonatal hypernatremia

Neonatal hypernatremia is a condition in which the concentration of sodium in the blood of a newborn child exceeds 145 mmol/l. The causes of this pathology may be kidney disease, endocrine problems, transdermal water loss, iatrogenic sodium overload. In addition, dehydration due to insufficient breastfeeding remains one of the important factors leading to hypernatremia. Clinical signs include: significant weight loss, decreased skin turgor, anxiety, fever, seizures, and direct hyperbilirubinemia. The main complications of this condition are intracranial hemorrhages, venous sinus thrombosis and acute renal tubule necrosis. Infusion therapy and adequate oral nutrition are used to correct hypernatremia. The article presents a clinical case of hypernatremia in a newborn child caused by hypogalactyly in the mother. The purpose of the demonstration is to raise awareness and alertness among pediatricians and neonatologists about the possibility of this problem.

PECULIARITIES OF THE EXOCRINE SECRETORY FUNCTION OF THE PANCREAS IN NEONATES WITH PERINATAL PATHOLOGY

Introduction. Post-asphyxia syndrome in newborn infants due to experienced intrauterine hypoxia and asphyxia at birth remains a relevant issue in neonatology. The intestines and glands of internal and external secretion are target organs of pathologic hypoxic influence. Their ischemic damage can be a cause of digestive disorders against the background of multiple organ damage of a newborn child. Objective of this study is to determine peculiarities of the exocrine secretory functions of the pancreas in full-term neonates with perinatal pathology. Material and methods. One hundred fifty five Full-term neonates with the signs of perinatal pathology were examined. I group included 82 neonates with severe perinatal pathology, II group – 73 moderate pathology, 50 healthy infants constitute III control group. Inclusion criteria were gestational age more than 37 full weeks, clinical-paraclinical signs of maladjustment syndrome at birth and/or during the early neonatal period, parents’ written consent to participate in the study. Exclusion criteria were gestational age less than 37 full weeks; congenital defects; low body weight (size) at birth; signs of infectious processes. Clinical examination of patients and biochemical blood tests were carried out on the base of the clinical laboratory of the Municipal Non-Profit Institution «Municipal Clinical Maternity Home №2» of Chernivtsi Municipal Council, and German-Ukrainian laboratory «Bukintermed» (Chernivtsi). The study was conducted in accordance with the 'Rules of Ethical Principles of Conducting Scientific Medical Research with Human Participation,' approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), EU Directive No. 609 (24.11.1986), the Order of the Ministry of Health of Ukraine No. 690 (23.09.2009), and the approval of the Biomedical Ethics Board of Bukovinian State Medical University. For statistical analysis, licensed software programs were used, including Statistica (StatSoft Inc., Version 7), Microsoft Excel (AtteStat, Version 12.5), and MedCalc Software Ltd (Version 22.021). Results and discussion. The examination groups were representative according to their gestational age and anthropometric parameters at birth, and gender characteristics. A comprehensive clinical-paraclinical examination of infants showed that severe disorders of infants in I group were caused by the signs of severe (13.4 %) and moderate (13.4 %) asphyxia at birth, meconium aspiration syndrome (20.7 %), severe respiratory disorders (53.6 %), hypoxic-ischemic damage of the central nervous system (39.0 %), convulsive syndrome (13.4 %), birth trauma (7.3 %) etc. Moderate maladjustment in infants from II group were associated with the signs of perinatal damage of the central nervous system (65.8 %), hemolytic diseases of the newborns (27.4 %), neonatal jaundice (28.8 %), respiratory disorders (35.6 %) etc. The condition of neonates from ІІІ group was satisfactory during the period of early postnatal adaptation. The results of additional examination methods found certain peculiarities of the exocrine secretory function of the pancreas in full-term neonates with perinatal pathology. Thus, blood amylase activity in the first day of life in the infants from І group was 0.39 ± 0.03 Un/L, ІІ group – 0.29±0.02 Un/L, ІІІ group – 0.14±0,01 Un/L (рІ-ІІ = 0.016, рІ-ІІІ < 0.0001, рІІ-ІІІ < 0.0001). According to the examination group, activity of the enzyme in the blood of infants at the end of their first week of life was 17.8 ± 0.81, 15.28 ± 0.22 and 14.81±0.06 Un/L respectively (рІ-ІІ = 0.006, рІ-ІІІ = 0.009, рІІ-ІІІ = 0.0435). The study found similar tendencies in changes of lipase activity in the blood of full-term infants. During the first day of life it was 0.35±0.01 Un/L in I group, ІІ group – 0.31±0.01 Un/L, ІІІ group – 0.32 ± 0.01 Un/L (рІ-ІІ = 0.003, рІ-ІІІ = 0.01, рІІ-ІІІ > 0.05). Activity of the enzyme in the blood of infants at the end of their first week of life was 19.7±0.22, 19.1±0.13 and 18.9±0.37 Un/L respectively (рІ-ІІ = 0.021, рІ-ІІІ > 0.05, рІІ-ІІІ > 0.05). Conclusion. The results obtained were indicative of a reliable increase of amylase and lipase activity in the blood of full-term neonates in all the examination groups in the dynamics of observation. It is associated with physiological stimulation of the exocrine secretory function of the pancreas in the early neonatal period. Attention should be paid to a direct correlation between an increased activity of the enzymes and severity of perinatal pathology both in the first day of life and at the end of the first week. It can be indicative of an excessive activation of pancreatic function due to pathologic hypoxic damage.

The current state of the problem of intestinal microbiota according to pediatricians

The mechanisms of formation of the intestinal microbiota, its influence on the health of the child, participation in physiological and pathological processes are considered. Microorganisms enter the body of the fetus in utero, then the newborn child receives the microflora from the mother during childbirth. The results of molecular genetic studies indicate that the process of microbial colonization of a child is determined by the characteristics of nutrition. Of great importance in the formation of normal microflora belongs to breastfeeding. The gut microbiota interacts with various parts of the body, influencing the pathogenesis of many local and systemic diseases. The most important mechanisms for the formation of diseases in children depending on anomalies in the structure of the microbiome are considered. Understanding the processes of formation of intestinal microflora allows us to develop effective methods for the prevention and correction of microecological and motor disorders in the age aspect.

The effects of Moringa oleifera leaves on the nutritional status of children under five years

Children's health status is important for determining the human quality of life. Thus, the first life of a newborn child is critical because the consequences of disturbances that occur in children can be permanent. Moringa oleifera has been known as a miracle tree with many health benefits, including for children. The study aimed to evaluate the effect of Moringa oleifera in different forms (boiled soup and biscuit) in improving the nutritional status of children under five years old. The study was a quasi-experiment with a pre-posttest non-equivalent control group design. The sampling technique used was purposive sampling, with a total of forty-eight participants divided into two groups (24 participants for the Moringa soup group and 24 participants for the Moringa biscuit group). The interventions were given for 30 days. The result shows that children's weight was significantly altered after the intervention in both groups (p<0.001). Height was not significantly changed after the intervention in the Moringa soup group (p = 0.100) and in the Moringa biscuit group (p = 0.317). In conclusion, both Moringa soup and biscuits effectively improve weight in children under five years of age.

Clinical case of successful thrombolysis in a newborn with thrombosis of the left renal vein

Thrombosis occurring in the neonatal period is a nosology with a large number of complications, often leading to disability and death. This article highlights the successful treatment of a newborn child with renal vein thrombosis using systemic thrombolysis. A clinical case of successful systemic thrombolysis in a full-term boy in the early neonatal period with thrombosis of the left renal vein and transition of the floating part of the thrombus to the inferior vena cava is presented. A child aged 3 days was admitted to the neonatal intensive care unit from a maternity hospital, where thrombosis was suspected. Gross hematuria was observed. Laboratory data revealed thrombocytopenia and increased levels of fibrinogen and D-dimer. Ultrasound showed a sharp increase in the volume of the left kidney, a diffuse change in its parenchyma, a sharp depletion of blood flow, and accumulation of fluid in the perinephric tissue on the left, and a thrombus was observed in the lumen of the left renal vein with the presence of a floating part extending into the inferior vena cava. Thrombolytic therapy with the drug alteplase was started in combination with an infusion of unfractionated heparin. Doses were selected based on coagulogram parameters. On day 2 of therapy, hematuria resolved. On day 4 of therapy, the alteplase infusion was completed, and heparin therapy was continued. On day 13, the child was switched to a low-molecular-weight-heparin therapy. Dynamic ultrasound revealed size reduction, recanalization and further thrombus lysis, and normalization of intrarenal blood flow and kidney size. No renal dysfunction was recorded during observation. The child was transferred to the further care unit at aged 14 days and was discharged home at the age of 25 days in satisfactory condition on ongoing anticoagulant therapy under outpatient supervision of a hematologist. During follow-up observation at aged 1.5 months of life, no clinical, laboratory, and ultrasound indicators of renal function disorders were noted. Currently, there are no approved recommendations and protocols for individual thrombosis in newborns, although this particular age group is due to the vulnerability of hemostasis to the development of a thrombotic process.

Cell-type specific methylation changes in the newborn child associated to obstetric pain relief

Although it is widely known that various pharmaceuticals affect the methylome, the knowledge of the effects from anesthesia is limited, and nearly nonexistent regarding the effects of obstetric anesthesia on the newborn child. Using sequencing based-methylation data and a reference-based statistical deconvolution approach we performed methylome-wide association studies (MWAS) of neonatal whole blood, and for each cell-type specifically, to detect methylation variations that are associated with the pain relief administered to the mother during delivery. Significant findings were replicated in a different dataset and followed-up with gene ontology analysis to pinpoint biological functions of potential relevance to these neonatal methylation alterations. The MWAS analyses detected methylome-wide significant (q<0.1) alterations in the newborn for laughing gas in granulocytes (two CpGs, p<5.50x10-9, q = 0.067), and for pudendal block in monocytes (five CpGs across three loci, p<1.51 x10-8, q = 0.073). Suggestively significant findings (p<1.00x10-6) were detected for both treatments for bulk and all cell-types, and replication analyses showed consistent significant enrichment (odds ratios ranging 3.47–39.02; p<4.00×10−4) for each treatment, suggesting our results are robust. In contrast, we did not observe any overlap across treatments, suggesting that the treatments are associated with different alterations of the neonatal blood methylome. Gene ontology analyses of the replicating suggestively significant results indicated functions related to, for example, cell differentiation, intracellular membrane-bound organelles and calcium transport. In conclusion, for the first time, we investigated and detected effect of obstetric pain-relief on the blood methylome in the newborn child. The observed differences suggest that anesthetic treatment, such as laughing gas or pudendal block, may alter the neonatal methylome in a cell-type specific manner. Some of the observed alterations are part of gene ontology terms that previously have been suggested in relation to anesthetic treatment, supporting its potential role also in obstetric anesthesia.

To Study the Correlation of Maternal Serum Vitamin D Levels and Infant Serum Vitamin D Levels With Infant Birth Weight: A Single-Centre Experience From the Bundelkhand Region, India.

Vitamin D deficiency during pregnancy can have severe effects on both the mother and the newborn child. The main aim of this study was to assess the impact of maternal vitamin D levels on the birth weight of the newborn by analysing the vitamin D levels in pregnant women at full term and their newborn. The cross-sectional, hospital-based study was conducted with 150 consecutive women in labour presenting with a singleton term pregnancy at a large tertiary centre in the Bundelkhand region, India. Maternal and infant blood samples were obtained at the time of delivery. Umbilical cord blood was collected from infants, while maternal venous blood was drawn simultaneously. All relevant data were gathered, including the assessment of 25-hydroxy vitamin D3 levels in both mother and infant. The birth weight of the infant was measured, and statistical analysis was performed to find an association between maternal vitamin D level to birth weight and vitamin D level of the infant. Most pregnant women had low vitamin D levels in this study. The results revealed a significant positive correlation between maternal serum vitamin D levels and infant birth weight (p < 0.001), suggesting that lower maternal vitamin D levels were associated with low birth weight in infants. Additionally, infant serum vitamin D levels showed a positive correlation with maternal vitamin D levels (p < 0.001), indicating that higher maternal vitamin D levels tend to have infants with higher vitamin D levels at birth. These findings suggest a potential correlation of maternal vitamin D status to birth weight and vitamin D level of newborns, and further research is needed to confirm and better understand this relationship. Additionally, other factors such as maternal nutrition, genetics, lifestyle factors, and environmental influences may contribute to birth weight outcomes.

The Murder of a Newborn Child by a Mother: a Terminological Aspect

The Murder of a Newborn Child by a Mother: a Terminological Aspect

Correlation of Parenting Styles and Oral Health Behavior of Children with Down Syndrome in Banjarmasin

Background: Parental, Down syndrome is a trisomy chromosomal genetic disorder that leads newborn child having more than one chromosome so that could interfere the normal growth of the body due to an excess of protein level. Children with Down syndrome have different oral health problems compared to the general population. They need assistance to maintain their oral health because of mental and physical deficiencies as well as limitations in optimally cleaning their teeth. Objective: To analyze the relationship between parenting styles and oral health behavior of children with Down syndrome in Banjarmasin Special Needs School, Indonesia. Materials and Method: This is an observational analytic study with cross-sectional approach. Sample was taken using simple random sampling technique and a cross-sectional sample formula obtained for 32 respondents. The instrument used a parenting style questionnaire and a behavioral modification questionnaire for children's oral health. Results: Democratic (87.5%) compared switch order parenting styles. It was found that there were more children with Down syndrome in the category of moderate behavior (59%) than children with good behavior (38%) and poor behavior (3%). The results of the Somers'd test data analysis obtained a significance value of 0.034 (p&lt;0.05) and the correlation value obtained was 0.571, which means that the correlation strength is moderate with a positive correlation direction (unidirectional). Conclusion: The more democratic the parents use as parenting style the better the oral health behavior of children with Down syndrome will be.

CLINICAL CASE OF RARE SMITH-MAGENIS SYNDROME IN NEWBORN CHILD

Aim. The purpose of the work is a comprehensive analysis of chromosomal pathology based on own detection of a rare clinical case of Smith-Magenis syndrome in a newborn child, the results of which may be useful for the detection and prevention of hereditary diseases. Materials and methods. Based on the analysis of literature data, it was found that clinical cases of rare (SMS) in newborns occur with a frequency of 1 in 25,000–1:15,000. This syndrome is caused by a chromosomal rearrangement that leads to the loss of significant segments of one chromosome from the 17th pair of chromosomes. There is a deletion of genetic material in the region of chromosome 17 (17p11.2), which is why SMS is sometimes called 17p syndrome. In this work, the analysis of clinical symptoms and laboratory-instrumental examinations, the main of which are cytogenetic (karyotyping) and molecular genetic methods, were used to confirm the diagnosis of the disease. The results were obtained during the study of the biological material of the lymphocyte culture of the peripheral blood of the child, mother and father. As a result of the cytogenetic study of the child, the karyotype 46, ХУ, del(17) (p11.2p11.2) was established, that is, a male karyotype with an interstitial deletion in the short arm of chromosome 17 within the band 17p11.2. The mother's karyotype is 46, XX, no chromosomal abnormalities were detected. The father's karyotype is 46, XU, no chromosomal abnormalities were detected. A molecular genetic study of blood leukocytes was conducted to establish the presence of microdeletions/microduplications in the corresponding loci. The result of the study is rsa17p11.2(P245)x1. Chromosome imbalance was established in the form of RAI1, DRC3, LLGL1 gene deletion in the 17p11.2 region, which verifies Smith-Magenis syndrome. Conclusions. In the work, a comprehensive analysis of chromosomal pathology was carried out based on the own detection of a clinical case of a rare Smith-Magenis syndrome in a newborn child. A detailed anamnesis, clinical manifestations, a set of laboratory-instrumental studies, the main ones of which are cytogenetic (karyotyping) and molecular genetic methods, are used for targeted examination, verification of the diagnosis and assessment of disease manifestations. The biological material of the peripheral blood culture (lymphocytes, leukocytes) of the child and parents was used. The results of a comprehensive analysis of chromosomal pathology based on one's own clinical case of the rare Smith-Magenis syndrome in a child of the neonatal period can draw the attention of primary care physicians to the study of syndromes of hereditary diseases and, in the differential diagnosis of patients, direct them to a medical-genetic consultation for cyto- and molecular-genetic studies.

“Mom's a bit different”: The challenges of first-time mothers with cerebral palsy in caring for their children from birth until age three

This qualitative study examines childcare challenges and adaptive strategies among first-time Czech mothers with cerebral palsy (CP) in caring for children aged 0–3. Data obtained from ten semi-structured interviews were analyzed using selected procedures of situational analysis. The results were structured around three major themes: (1) The decision to become a mother and preparation for childcare tasks; (2) Challenges in childcare and adopted childcare strategies; (3) Social support received to manage childcare challenges. Along with findings related to the women with CP preparing themselves for the maternal role and childcare tasks, i.e. by attending a prenatal course to learn a suitable hand grip to safety hold their baby or to choose a suitable pram, the participants identified a number of practical childcare challenges they encountered postpartum. The first-time mothers initially tended to delegate challenging childcare tasks, such as lifting and carrying the newborn child, bathing and dressing or changing nappies, to family members or friends, with this support contributing to gradual development of the women's childcare methods to become an independent caregiver. Our findings underline the importance of sharing the lived experiences of mothers with CP with professional communities as well as the general public through formal education programs and informal community outreach.

Dimensions of parenting during infancy: Testing a latent bifactor model

AbstractIn the current paper, we examined the dimensional structure of parenting using a bifactor model of observed parenting domains during infancy. We validated our parenting dimensions by examining correlations with indicators of family well‐being and child development. Data come from a longitudinal cohort that recruited a diverse sample of mothers (56.5% White) and their newborn child (50.7% males). Parenting was assessed using multiple indicators at an average of 18 months (N = 397). Bifactor modelling revealed a general latent dimension of sensitivity and two unique dimensions indexing emotional input and cognitive input. We found a pattern of shared and unique correlations of the three parenting dimensions with family and child well‐being. The most robust correlations were with the general sensitivity dimension, which we argue cuts across parentings behaviors and is fundamental to development.

Evaluating the impact of the global evidence, local adaptation (GELA) project for enhancing evidence-informed guideline recommendations for newborn and young child health in three African countries: a mixed-methods protocol

BackgroundPoverty-related diseases (PRD) remain amongst the leading causes of death in children under-5 years in sub-Saharan Africa (SSA). Clinical practice guidelines (CPGs) based on the best available evidence are key to strengthening health systems and helping to enhance equitable health access for children under five. However, the CPG development process is complex and resource-intensive, with substantial scope for improving the process in SSA, which is the goal of the Global Evidence, Local Adaptation (GELA) project. The impact of research on PRD will be maximized through enhancing researchers and decision makers’ capacity to use global research to develop locally relevant CPGs in the field of newborn and child health. The project will be implemented in three SSA countries, Malawi, South Africa and Nigeria, over a 3-year period. This research protocol is for the monitoring and evaluation work package of the project. The aim of this work package is to monitor the various GELA project activities and evaluate the influence these may have on evidence-informed decision-making and guideline adaptation capacities and processes. The specific project activities we will monitor include (1) our ongoing engagement with local stakeholders, (2) their capacity needs and development, (3) their understanding and use of evidence from reviews of qualitative research and, (4) their overall views and experiences of the project.MethodsWe will use a longitudinal, mixed-methods study design, informed by an overarching project Theory of Change. A series of interconnected qualitative and quantitative data collections methods will be used, including knowledge translation tracking sheets and case studies, capacity assessment online surveys, user testing and in-depth interviews, and non-participant observations of project activities. Participants will comprise of project staff, members of the CPG panels and steering committees in Malawi, South Africa and Nigeria, as well as other local stakeholders in these three African countries.DiscussionOngoing monitoring and evaluation will help ensure the relationship between researchers and stakeholders is supported from the project start. This can facilitate achievement of common goals and enable researchers in South Africa, Malawi and Nigeria to make adjustments to project activities to maximize stakeholder engagement and research utilization. Ethical approval has been provided by South African Medical Research Council Human Research Ethics Committee (EC015-7/2022); The College of Medicine Research and Ethics Committee, Malawi (P.07/22/3687); National Health Research Ethics Committee of Nigeria (01/01/2007).

Parameters of physical development of term newborns with Intrauterine Growth Retardation, born in a 3B Level Perinatal Centre of St. Petersburg State Pediatric Medical University in 2022

BACKGROUND: Intrauterine growth retardation of a newborn child is an current problem in neonatology, obstetrics and pediatrics. Due to intrauterine development disorders, these newborns have increased morbidity and mortality rates. In the presence of Intrauterine growth retardation, the likelihood of developing complications in the early neonatal period increases (birth asphyxia, meconium aspiration, hypoglycemia, polycythemia, etc.), and the risk of developing infections and neurological disorders) is increased. AIM: The aim of this study is to study the parameters of physical development of term newborns born in the Perinatal Centre 3B level of the St. Petersburg State Pediatric Medical University in 2022 year, to determine the frequency and structure of disorders associated with Intrauterine growth retardation and malnutrition depending on the gestational age of term newborns for a differential approach in the management of children with Intrauterine growth retardation by neonatologists and paediatricians. MATERIALS AND METHODS: There were analyzed 1000 hospital neonatal records of newborns children born at the Perinatal Centre of Level 3B of St. Petersburg State Pediatric Medical University in 2022 year. Of these, 55 term babies were born with Intrauterine growth retardation. The study examined the physical development of term newborns, determined the frequency and structure of disorders associated with intrauterine growth retardation and malnutrition, depending on the gestational age of term newborns. RESULTS: Retardation of intrauterine growth and development in newborn children born in level 3B centres are represented by low body weight in relation to gestational age in 63.6% of cases, trophic disorders with normal body weight and reduced weight/length ratio in 34.6% of cases, and low height index with normal body weight in 1.8% of cases. Severe physical developmental disorders were found only in children with low body weight: in 13% of cases of low birth weight for gestational age, and in 55% of cases of small fetal size for gestational age. CONCLUSIONS: the distribution of physical development disorders (ICD code P05.2) in term infants, depending on the degree of maturity has a linear trend and occurs with maximum frequency (50%) in late term newborns, which is associated with the onset of aging of the placenta and the intensification of existing, even compensated, placental insufficiency.

Special psychophysical condition as a circumstance that mitigates punishment in Art. 117 of the Criminal Code of Ukraine

The article is devoted to elucidating the essence of a special psychophysical condition as a circumstance that mitigates the punishment in Art. 117 of the Criminal Code of Ukraine «Intentional murder by the mother of her newborn child.» It has been established that this type of murder is a privileged murder. It has been proven that it has an extremely powerful effect on the psycho-emotional state of a woman giving birth and the process of giving birth to a child, which is recognized as a stressful factor, as a result of which she may lose the ability to behave adequately. Emphasis is placed on the presence of certain features of the psychophysical state in a woman during the commission of a murder, which are caused by a combination of emotional tension caused by pregnancy and childbirth and the mental processes that accompanied them, which weaken the mother’s ability to be aware of her actions and control them. The factors that can cause disorders of the psycho-emotional state of a woman are singled out: the coincidence of difficult personal and family circumstances; divorce from the child’s father; unwanted pregnancy; difficult financial situation; negative microenvironment. It was established that there is no indication in the disposition of Art. 117 of the Criminal Code on the presence of a special psychophysiological condition of a woman as a mandatory feature of this criminal offense, which creates some problems in the qualification of criminal offenses. It has been proven that a mitigating circumstance in the case of a mother committing the murder of her newborn child during childbirth or immediately after it should be recognized precisely the psychopathic state that led to a mental disorder, which does not exclude the sanity of the person, but significantly weakens the possibility of realizing such actions and manage them. It was found that a woman in the process of childbirth cannot be considered as fully aware of her actions and in control of them. At the same time, it is not excluded that a woman at the time of childbirth or immediately after it may be in a state of morbid mental disorder, that is, be of limited sanity, in connection with which it is concluded that in such a case a special psychophysical state may coincide with limited sanity. It was concluded that the existence of a privileged type of murder provided for in Art. 117 of the Criminal Code, caused only by the possibility of the existence of a special psychophysiological state of a woman during childbirth or immediately after it. It is proposed to improve the current wording of Art. 117 of the Criminal Code by means of a legally defined indication of the need to establish the fact that a woman is in a special psychophysiological state.

Reasons for the Murder of a Newborn Child by a Mother and Criminal Liability for it

Reasons for the Murder of a Newborn Child by a Mother and Criminal Liability for it

The case of a rare chromosomal disease in a newborn child

The case of a rare chromosomal disease in a newborn child

Prevalence and risk factors of malaria among pregnant women presenting at the antenatal clinic in Hoima Regional Referral Hospital

Malaria, according to the World Health Organization (WHO), is a life-threatening disease caused by parasites that are transmitted to people through the bites of infected female Anopheles mosquitoes. Malaria infection during pregnancy is a significant public health problem with substantial risks for the pregnant woman, her fetus, and the newborn child. In Uganda, the overall burden of malaria is high, and its adverse outcomes for the infected mother and the unborn child are widespread. This study was designed to assess the prevalence of malaria in pregnancy and its associated factors among pregnant women presenting at the antenatal clinic in Hoima Regional Referral Hospital. A hospital-based cross-sectional study was conducted. The study was conducted in the antenatal clinic of Hoima Regional Referral Hospital, in the Hoima district of Western Uganda from from February 2022 to April 2022. A sample size of 204 was used. Data was coded and entered into IBM SPSS version 25. Data was then analyzed and the Chi-square test and logistic regression were done to find the associated factors of malaria in pregnancy at a 95% confidence interval. Results shows that the prevalence of malaria in pregnant women attending Hoima Regional Referral Hospital was 17.6%. This study showed that pregnant women remain particularly vulnerable to malaria and that the prevalence of malaria in pregnant women attending Hoima Regional Referral Hospital is high. Therefore, seminars and media education programmes should be started or put in place to educate women on the risk of malaria during pregnancy. Girl child education should be promoted by the government, as educated women are associated with a lower of malaria during pregnancy. Keywords: Malaria, Anopheles mosquitoes, Plasmodium falciparum, Pregnant women

Тактика лікування гігантської тератоми шиї в новонародженої дитини: клінічний випадок

Teratoma can be diagnosed with ultrasound examination and screening, which is carried out in intrauterine period of the fetal development. Early diagnostics of the pathology is of the great importance of its treatment. The detailed management of newborns with giant neck teratoma have not been found in current literature. Furthermore, there is no information concerning preparation of the patient for the radical operation. The aim is to present the clinical case of surgical treatment of giant neck teratoma in newborn child using EXIT-procedure (intrauterine treatment to establish a functioning airway) and angiography before the radical excision of the tumor. The clinical case describes the diagnostics and treatment of newborn child with giant neck teratoma, who was taken to the first clinical Lviv association “St. Nicholas hospital”. The tumor was diagnosed intrauterine. The child underwent EXIT-procedure. Selective angiography and embolization of carotid branches were carried out on third day after birth. The surgical intervention regarding the removal of the tumor, which was removed radically with blood loss up to 50 ml, was performed on fourth day after birth. Conclusions. Prenatal screening with alpha-protein detection in mother blood is essential for diagnostics of probable pathologies of the fetal development. EXIT-procedure has led to save lung ventilation and effective support of the cardiovascular system. The selective angiography allowed to assess the bloodstream within branches of the internal carotid artery. The embolization of the branches of the external carotid artery, which vascularized the tumor, led to minimization of the blood loss up to 50 ml. As the removal of tumor was radical, further specialized treatment was not needed. The research was carried out in accordance to principles of the Helsinki declaration. The informed consent of the child’s parents was given for conducting the research. The authors declare no conflict of interest.

Legal Case Study of Severe IVF Incidents Worldwide: Causes, Consequences, and High Emotional, Financial, and Reputational Costs to Patients and Providers

Background In light of the changing legislative and regulatory landscape concerning reproductive rights and fertility treatments worldwide and a growing number of patients who use assisted reproductive technology (ART)/in vitro fertilization (IVF) treatments to overcome their reproductive challenges (cancer patients, those needing genetic screening, members of the LGBTQIA+ community, and patients who have trouble conceiving naturally) and achieve their family-building goals, ART/IVF clinics face numerous operational and legal challenges, which come at great emotional, reputational, and financial costs to patients and providers. Objectives Fertility treatment related incidents and resulting legal cases vary in severity, scope, and outcomes. Local legal and regulatory environment for patients and ART/IVF providers increase the complexity. The authors aimed to identify the causes of lawsuits against ART/IVF providers and how legal outcomes varied between cases. Study design The data on U.S. IVF incidents was collected from Lexis Nexis, Westlaw, Bloomberg Law, and CaseLaw databases, newspaper and magazine articles, legal reviews, peer-reviewed journals, and online publications. For international cases, HFEA reports, and industry and online publications were queried. The searches were not time restrained but was carried out from January 2022 to April 2023. RESULTS Two hundred five IVF incidents (84.9% U.S., 2.9% U.K., 12.2% other), excluding large-scale tank and alarm failures and power disruptions, which affected 307 people (79.8%, 3.3%, 16.9%) and/or 258 specimens (84.5%, 2.7%, 12.8%), resulting in 76 lawsuits (65.8%, 7.89%, 26.3%) were identified worldwide, and categorized by error types. Specimen mix-ups were the most prevalent type (95.0%). Meanwhile, ten failed storage and alarm incidents caused most damage, affecting &gt;1800 patients and &gt;8100 specimens, and resulting in 181 initial lawsuits. CONCLUSIONS Overreliance on manual protocols, irregular/skipped audits, and human error were responsible for IVF incidents reviewed. Damaged, destroyed, or lost embryos and embryo transfer to the wrong recipient have lifelong devastating effects on patients, for many of whom IVF was their last chance for parenthood due to cancer treatment, infertility, and/or age. To complicate the cases, embryo mix-ups resulted in custody disputes over the newborn child(ren), as in Manukyan v. CHA Health Systems, and loss of identity in children and parents. U.S. babies born to embryo mix-ups are reunited with their genetic parents, following the legal precedent of Perry-Rogers v. Fasano. Many countries, however, grant the custody of the child(ren) to birth parents. Most lawsuits were dismissed or settled. The combination of changing abortion and personhood laws in several states of the US can further complicate the issue, as they might put patients and providers in legal jeopardy, following routine ART/IVF procedures. This may include preimplantation genetic testing, short- and long-term embryo storage, and embryo disposal. These state laws will limit patient options and restrict ART/IVF clinic operations. Owing to all these factors, in this study, we can only make educated estimates about the true scope of the issue and its financial cost to ART/IVF providers, which might range from thousands to millions of USD. Lawsuits also come at a great reputational cost for patients, their families and providers, so the latter might benefit from embracing digitization of records, automation, robotics, and AI as a standard of care in their practice.