Newborn Examination Research Articles

Late diagnosis of anorectal malformation: how good is good enough?

PurposeNational data from the United Kingdom reported in 2016 have suggested that almost one quarter of babies with anorectal malformation (ARM) have a delay in diagnosis. The UK’s Newborn Infant Physical Examination dictates a perineal examination should be performed within 72 h of birth. We sought to describe a tertiary single-centre experience of late presentation in the most recent 5 years.MethodsA single-centre prospective registry of ARM patients (July 2018–March 2024) was analysed. Timing of presentation with anomaly was noted. Patients presenting > 72 h or having been discharged home were defined as a delayed diagnosis. Factors associated with delayed diagnosis were noted.ResultsSixty patients were included, of whom nine (15%) were diagnosed after 72 h [range 4–279 days]. This represents a non-significant improvement compared to 39/174 (22%) late diagnosed cases in the BAPS-CASS cohort from 2016 to 17 (p = 0.188). Presenting symptoms of obstruction (i.e. distension, vomiting, megarectum) were more common in late diagnosed patients (4/9 (44%) vs. 1/51(2%); p = 0.001). Anomalies producing meconium on the perineum were more likely to be diagnosed late (8/32 (25%) vs 1/28 (4%); p = 0.029). Complications and changes to clinical management for these cases are presented.ConclusionAlthough our regional rates of late diagnosis appear to be lower than previously reported national rates, there remains a significant number of infants who are diagnosed late especially those with visible perineal openings. These infants are more commonly symptomatic; entraining additional risks associated with an emergency presentation.

Procedural elements of the complete examination and screening of the healthy term neonate: a protocol for a scoping review and evidence map

IntroductionAll newborns undergo a Complete Examination and Screening of the Neonate (CESoN) to verify the general health and well-being of the neonate and to screen for signs and symptoms of...

Recommendations to Improve Neonatal Circumcision Training.

Although multiple specialties perform neonatal circumcision (NC), overall NC proceduralist availability is limited. The approach to training new practitioners varies. This study aims to describe NC training experiences, current practices, and make suggestions for future improvements. Perinatal physicians across 11 hospitals in a large Midwestern United States city who perform NC or who conduct newborn examinations and provide circumcision counseling were recruited for semistructured interviews about NC care. Interviews were transcribed; training-related comments underwent inductive and deductive qualitative coding. Themes related to circumcision training and recommendations for improving the experience of future circumcision learners were summarized. Twenty-three physicians (10 family medicine, 8 pediatrics, and 5 obstetrics; 78% currently perform circumcision) participated. All participants conducted newborn examinations and provided circumcision counseling, but only 21/23 were trained to perform circumcision. Several themes related to training emerged: (1) personal training experience, (2) training others to perform circumcision, and (3) current training needs and barriers. Most reported learning in residency by a "see one, do one, teach one" approach with minimal formal didactic or structured training. Compared with their personal experience, participants noted a shift toward more direct supervision and preprocedure preparation for current trainees. However, most reported that circumcision learning continues to be "hands-on." Participants desired a more structured approach for future trainees. Perinatal physicians noted a shift in the current NC training to a more hands-on approach than they experienced personally. Development of a structured NC curriculum was recommended to improve training.

Comparison of quality and interpretation of newborn ultrasound screening examinations for developmental dysplasia of the hip by basically trained nurses and junior physicians with no previous ultrasound experience.

We are obliged to give babies the chance to profit from a nationwide screening of developmental dysplasia of the hip in very rural areas of Mongolia, where trained physicians are scarce. This study aimed to compare the quality and interpretation of hip ultrasound screening examinations performed by nurses and junior physicians. A group of 6 nurses and 6 junior physician volunteers with no previous ultrasound experience underwent Graf's standard training in hands-on practice. Newborns were examined before discharge from the hospital, according to the national guideline. Two standard documentation images of each hip were saved digitally. The groups were compared on the proportion of good quality of sonograms and correct interpretation. Two Swiss supervisors' agreed diagnosis according to Graf was considered the final reference for the study purposes. A total of 201 newborns (402 hips or 804 sonograms) were examined in the study, with a mean age of 1.3±0.8 days at examination. Junior physicians examined 100 newborns (200 hips or 400 sonograms), while nurses examined 101 newborns (202 hips or 404 sonograms). The study subjects of the two groups were well balanced for the distribution of baseline characteristics. The study observed no statistically significant difference in the quality of Graf's standard plane images between the providers. Eventually, 92.0% (92) of the physician group and 89.1% (90) of the nurse group were correctly diagnosed as "Group A" (Graf's Type 1 hip) or "Non-Group A" hips (p = 0.484). The most common errors among the groups were a missing lower limb, wrong measurement lines, and technical problems. Our study provides evidence that while there might be a trend of slightly more technical mistakes in the nurse group, the overall diagnosis accuracy is similar to junior physicians after receiving standard training in Graf's hip ultrasound method. However, after basic training, regular quality control is a must and all participants should receive refresher trainings. More specifically, nurses need training in the identification of anatomical structures.

CLINICAL AND LABORATORY ASPECTS IN DIAGNOSTICS OF THE FUNCTIONAL STATE OF THE HEPATOBILIARY SYSTEM IN PRETERM INFANTS

Resume. The insufficient information content of existing methods of diagnosis and treatment, the high incidence of complications, and the growing prevalence of digestive diseases in children in Ukraine justify the necessity for in-depth research in order to deepen understanding of the pathophysiological mechanisms underlying organ pathology with the ultimate goal of improving medical care for newborns.
 The aim of this study is to assess clinical and laboratory parameters characterizing the functional state of the hepatobiliary system in preterm infants.
 Participants and methods. The main group included 68 preterm infants of gestational age 32-33/6 weeks who had clinical signs of severe perinatal pathology; the comparison group involved 27 basically healthy infants of gestational age 34-36/6 weeks. A comprehensive examination of newborns with an assessment of the severity of perinatal pathology and a set of generally accepted biochemical blood parameters was performed. The research was conducted in compliance with the basic provisions of GCP (1996), the Council of Europe Convention on Human Rights and Biomedicine (April 4, 1997), the World Medical Association Declaration of Helsinki on the Ethical Principles of Scientific Medical Research Involving Human Subjects (1964-2008). The research protocol was approved by the Commission on Biomedical Ethics of Bukovinian State Medical University (Protocol No. 5 of 12.09.2015). Statistical processing of the study results was performed using the STATISTICA software (StatSoft Inc., USA, Version 10) MedCalc program (https://www.medcalc. org/index.php). Comparison of quantitative indicators with a normal distribution was performed using the Student's t-test at a statistical significance of p<0.05.
 Results and Discussion. With a burdened somatic history, unfavorable factors of pregnancy and childbirth in the mother, severe forms of diseases in preterm infants in the early neonatal period are accompanied by clinical signs of disorders of the functional state of the hepatobiliary system, in particular, an enlargement of the liver, hepatosplenic syndrome, edema, meteorism, jaundice, hemorrhagic manifestations, such as gastrointestinal bleeding, acholic stools, and hypoglycemia. Laboratory markers of severe functional hepatoniliary disorders include decreased levels of total protein, bilirubin, and glucose; increased levels of urea and cholesterol; reduced enzymatic activity of aspartate aminotransferase and lactate dehydrogenase. A significant decrease in the activity of the enzymes alanine aminotransferase and γ-glutamine transaminase and a decrease in the activity of alkaline phosphatase and Ca2+ level were also observed.
 Conclusions. The obtained results of clinical and laboratory parameters indicate the necessity to study the main pathophysiological syndromes of hepatobiliary system dysfunction in perinatal pathology, considering morphological and functional characteristics in preterm infants.

Listeriosis in the third trimester of pregnancy: the course of the disease and outcomes for the mother and fetus

Listeriosis mainly affects immunocompromised people, including pregnant women. Listeriosis is 17 times more common in pregnancy than in the population and lead to severe complications for the fetus or newborn. In Russia 644 cases of listeriosis were registered from 2005 to 2017. Every case of listeriosis in pregnant women requires a special analysis. This will increase the alertness of doctors and their awareness of the features of this disease and its treatment in pregnant women.Aims – to study the features of listeriosis in the third trimester of pregnancy, the outcomes of the disease for the pregnant woman and the fetus.Materials and methods. We studied 4 cases of listeriosis in the third trimester of pregnancy, identified in the Clinical Infectious Hospital named after S.P. Botkin in the period from 2020 to 2021.Results. All patients were admitted to the hospital in the third trimester of pregnancy with suspected acute respiratory viral infection, from 1 to 4 days after the onset of the disease. The leading symptom was fever. Leukocytosis was in a clinical blood test, and the value of C-reactive protein and procalcitonin were increased. L. monocytogenes was identified after childbirth during bacteriological examination of mothers and newborns. All the women gave birth during the first day after admission to the hospital. Two women had vaginal deliveries, and two women delivered by cesarean section. All children were born alive, but they all were transferred to the children’s hospital for additional treatment. Finally, one child died, and the other three recovered.Conclusions. Listeriosis of pregnant women is a severe infectious disease that leads to perinatal losses. The search for laboratory techniques that could be widely and routinely used in pregnant women with fever for early identification of L. monocytogenes is relevant. Early identification of this pathogen will make it possible to reasonably choose antibiotics and their dosages, improve prognoses for mother and child.

The ocular anterior segment examination of perinatal newborns by wide-field digital imaging system: a cross-sectional study

PurposeThe aim of this study was to evaluate and summarize the developmental rules of the ocular anterior segment of neonates by means of wild-field digital imaging system.MethodsWe used the wide-field digital imaging system to sequentially capture images of the neonates’ eyes within 42 days after delivery, including the ocular surface, anterior segment, and fundus. At the same time, basic information at the time of birth and examination was collected.ResultsAmong 248 newborns, 51.21% were male. Abnormalities of the anterior segment such as visualization of anterior chamber angle vessels (79.03%) and iris vessels (51.21%), iris process (42.34%), persistent pupillary membranes (19.35%), albinism, congenital cataracts, corneal leucoma, and subconjunctival hemorrhage were observed in this study. There were significant differences in the appearance of iris vessels among different sex, gestational age and birth weight, postmenstrual age and weight at the time of examination and iris color groups. The iris vessels were more visualized in males relative to females (OR = 6.313, 95% CI 2.529–15.759). The greater the postmenstrual age at the time of examination, the lower the visualization of iris vessels (OR = 0.377, 95% CI 0.247–0.575). In addition, although visualization of anterior chamber angle vessels differed within the birth gestation age and weight at examination groups, there was no significant correlation by regression analysis.ConclusionsThe anterior segment of perinatal neonates can be visualized by the wide-field digital imaging system. The neonatal iris and anterior chamber angle are immature, and the visible vessels at the anterior chamber angle that vanish later than the surface of the iris are characteristic structures.

Ocular Involvement in Congenital Infections - TORCH.

This review summarises the ophthalmological findings in congenital infections. Intrauterine infections are an important cause of childhood blindness. The most common infections are grouped under the acronym TORCH, which stands for Toxoplasma gondii, others, rubella, CMV, and herpes simplex. Overall, these infections are not very common in first-world countries during pregnancy, but are of particular importance because of the threat to vision. Diagnosis of infection or reactivation is a gynaecological challenge. However, ophthalmological examination of newborns can be appropriately targeted if the causative agent is known. The most important therapeutic agents used in the newborn are summarised.

The impact of the introduction of selective screening in the UK on the epidemiology, presentation, and treatment outcomes of developmental dysplasia of the hip.

Developmental dysplasia of the hip (DDH) can be managed effectively with non-surgical interventions when diagnosed early. However, the likelihood of surgical intervention increases with a late presentation. Therefore, an effective screening programme is essential to prevent late diagnosis and reduce surgical morbidity in the population. We conducted a systematic review and meta-analysis of the epidemiological literature from the last 25 years in the UK. Articles were selected from databases searches using MEDLINE, EMBASE, OVID, and Cochrane; 13 papers met the inclusion criteria. The incidence of DDH within the UK over the last 25 years is 7.3/1,000 live births with females making up 86% of the DDH population (odds ratio 6.14 (95% confidence interval 3.3 to 11.5); p < 0.001). The incidence of DDH significantly increased following the change in the Newborn and Infant Physical Examination (NIPE) guidance from 6.5/1,000 to 9.4/1,000 live births (p < 0.001). The rate of late presentation also increased following the changes to the NIPE guidance, rising from 0.7/1,000 to 1.2/1,000 live births (p < 0.001). However, despite this increase in late-presenting cases, there was no change in the rates of surgical intervention (0.8/1,000 live births; p = 0.940). The literature demonstrates that the implementation of a selective screening programme increased the incidence of DDH diagnosis in the UK while subsequently increasing the rates of late presentation and failing in its goal of reducing the rates of surgical intervention for DDH.

Supernumerary Kidney Associated With Other Genitourinary and Cardiovascular Anomalies In A dysmorphic Infant: A Rare Case Report

The supernumerary kidney, also known as the accessory kidney, is one of the rarest congenital anomalies of the genitourinary system without sufficient epidemiological studies. It is defined as having more than two kidneys with each kidney having its own vasculature, collecting system, and capsule. To date, there are few cases documented in literature worldwide. We hereby present the first reported supernumerary kidney case in a preterm 2-month-old infant with dysmorphic features associated with an ectopic kidney and coarctation of the aorta. The coexistence of cardiovascular anomalies and genitourinary anomalies indicates a shared embryologic origin and genetic linkage, underscoring the importance of screening both systems when anomalies are identified in either. Newborn screening ultrasonographic examinations are crucial for detecting congenital anomalies, especially in infants with pertinent medical history or physical features, leading to better outcomes through timely diagnosis and intervention.

The Efficiency of First Trimester Screening Test: A Retrospective Study in a Referral Center in Turkey

Objective: To investigate the effectivity of first trimester screening test applied in in a referral center in Ankara, Turkey. Materials and Methods: The records of 2015 patients who underwent the first trimester screening test between January 2016 and December 2017 were retrospectively screened. We did not take the patients who does not postpartum newborn examination, whose pregnancies resulted as abortion and who did not sustain the routine pregnancy control visits. Invasive diagnostic test was recommended to patients who has high-risk test results. Amniocentesis was applied to the patients who accepted the procedure. We reached the newborn examination results of the patients who did not have amniocentesis result. Amniocentesis was recorded with the patient's new registrar record. Sensitivity, specificity, positive predictive value and negative predictive value were calculated according to biochemical and combined risks respectively. Results: According to the combined risk of first trimester screening test, the sensitivity was 80%, specificity was 95.9%, positive predictive value was 6,25% and negative predictive value was 99,9%. Sensitivity was determined as 60%, specificity 88.6%, positive predictive value 1.7% and negative predictive value 99.9% according to biochemical risk. Conclusions: The first trimester screening test is an effective prenatal test for the detection of chromosomal anomalies. Adding NT measurement to biochemical parameters increases the efficiency of the test significantly.

Is there room for prompt routine ophthalmic examination in neonates with congenital cytomegalovirus (CMV) infection during the neonatal period?

To establish the clinical necessity of routine targeted ophthalmic examination of newborns with congenital cytomegalovirus (CMV) infection during the neonatal period. This retrospective study included consecutive neonates that were referred for ophthalmological screening within the context of a proven congenital CMV infection. The presence of CMV-related ocular and systemic findings was determined. Among the 91 patients included in this study, 72 (79.12%) were symptomatic with one or more of the following manifestations: abnormal brain ultrasound (42; 46.15%), small for gestational age (29; 31.87%), microcephaly (23; 25.27%), thrombocytopenia (14; 15.38%), sensory neural hearing loss (13; 14.29%), neutropenia (12; 13.19%), anemia (4; 4.4%), skin lesions (4; 4.4%), hepatomegaly (3; 3.3%), splenomegaly (3; 3.3%), direct hyperbilirubinemia (2; 2.2%). Not one single neonate in this cohort had any of the ocular findings surveyed. The presence of ophthalmological findings among neonates with congenital CMV infection during the neonatal period is infrequent, suggesting that routine ophthalmological screening may be safely deferred for the post-neonatal period.

Congenital rubella syndrome surveillance in India, 2016–21: Analysis of five years surveillance data

BackgroundIn India, facility-based surveillance for congenital rubella syndrome (CRS) was initiated in 2016 to estimate the burden and monitor the progress made in rubella control. We analyzed the surveillance data for 2016–2021 from 14 sentinel sites to describe the epidemiology of CRS. MethodWe analyzed the surveillance data to describe the distribution of suspected and laboratory confirmed CRS patients by time, place and person characteristics. We compared clinical signs of laboratory confirmed CRS and discarded case-patients to find independent predictors of CRS using logistic regression analysis and developed a risk prediction model. ResultsDuring 2016–21, surveillance sites enrolled 3940 suspected CRS case-patients (Age 3.5 months, SD: 3.5). About one-fifth (n = 813, 20.6%) were enrolled during newborn examination. Of the suspected CRS patients, 493 (12.5%) had laboratory evidence of rubella infection. The proportion of laboratory confirmed CRS cases declined from 26% in 2017 to 8.7% in 2021. Laboratory confirmed patients had higher odds of having hearing impairment (Odds ratio [OR] = 9.5, 95% confidence interval [CI]: 5.6–16.2), cataract (OR = 7.8, 95% CI: 5.4–11.2), pigmentary retinopathy (OR = 6.7, 95 CI: 3.3–13.6), structural heart defect with hearing impairment (OR = 3.8, 95% CI: 1.2–12.2) and glaucoma (OR = 3.1, 95% CI: 1.2–8.1). Nomogram, along with a web version, was developed. ConclusionsRubella continues to be a significant public health issue in India. The declining trend of test positivity among suspected CRS case-patients needs to be monitored through continued surveillance in these sentinel sites.

A Cohort Study on the Effects of Maternal High Serum Iodine Status During Pregnancy on Infants in Terms of Iodine Status and Intellectual, Motor, and Physical Development.

The objective of the present study was to explore the effects of maternal iodine excess during pregnancy on infants' neurodevelopment and physical development. A total of 143 mother-child pairs were enrolled in this cohort study. Maternal blood samples were collected during the obstetric examination. A mother-child questionnaire survey was conducted, and infants' blood samples were collected during the newborn physical examination. Infants' single-spot urine samples were collected, and intellectual, motor, and physical development were assessed at 2months of age. The median (IQR) maternal serum iodine concentrations (SICs) in the first, second, and third trimesters of pregnancy were 91.2 (74.4, 102.2) μg/L, 81.2 (70.6, 94.8) μg/L, and 82.0 (68.9, 100.3) μg/L, respectively. In the first trimester of pregnancy, infants' psychomotor developmental index (PDI), body mass index (BMI) and weight-for-length Z score (WLZ) were higher with maternal suitable SIC (40 ~ 92μg/L) than with maternal excess SIC (P < 0.05). Infants' PDI, BMI, weight-for-age Z score (WAZ) and WLZ were negatively correlated with maternal SIC (P < 0.05). Maternal excess SIC had a slightly negative effect on infants' MDI (OR = 1.304, P = 0.035, 95% CI = 1.019 ~ 1.668), PDI (OR = 1.124, P = 0.001, 95% CI = 1.052 ~ 1.200) and BMI (OR = 0.790, P = 0.005, 95% CI = 0.669 ~ 0.933). In the third trimester, infants' length-for-age Z score (LAZ) was higher with maternal high SIC (> 92μg/L) (P = 0.015), and maternal SIC was positively correlated with infants' urine iodine concentration (UIC) (P = 0.026). Maternal iodine excess in the first trimester had a slightly negative effect on infants' intellectual, motor, and physical development. In the third trimester, maternal iodine excess only may have a positive impact on infants' height. Additionally, maternal iodine status was closely related to infants' iodine status.

Клінічні особливості перебігу неонатального сепсису з урахуванням запальної відповіді організму

The study of the clinical features of the course of neonatal sepsis depending on the level of C-reactive protein and presepsin in the dynamics makes it possible to distinguish a cohort of children with a «severe» course of sepsis, who require complex monitoring of life-supporting functions. Purpose - to study the clinical features of the course of neonatal sepsis and to distinguish the signs of «severe» sepsis for the purpose of an individualized approach to the choice of treatment tactics. Materials and methods. 56 medical records of newborns with neonatal sepsis were analyzed. Depending on the level of the inflammatory response, two observation groups were formed. The clinical Group I included 25 patients with neonatal sepsis with a level of C-reactive protein (CRP) &lt;20 mg/l (boys - 52.0%, city residents - 80.0%). The Group II was formed by 31 newborns with sepsis, in whom the content of CRP in the blood was &gt;20 mg/l (boys - 62.8% (p&gt;0,05), city residents - 57.1% (p&gt;0,05)). The content of presepsin in the blood serum of newborns of both comparison groups exceeded 300 pg/ml. According to the main clinical characteristics, these groups were comparable. According to the time of manifestation of clinical signs of sepsis, the distribution by groups was gomogenous. Results. A comprehensive clinical examination of newborns with neonatal sepsis on the 1st and the 3rd day of treatment gave reason to believe that signs of organ dysfunction are not associated with the severity of acute-phase indicators of the immunological response. However, on the 7th day of treatment, in patients with higher indicators of the inflammatory response, the preservation of signs of organ dysfunction, namely certain neurological, respiratory, hemodynamic disorders, changes in nutritional status, were noted. Conclusions. A comprehensive clinical examination of newborns with neonatal sepsis in the dynamics revealed that the preservation of more pronounced signs of organ dysfunction is inherent in patients with higher inflammatory response rates on the 7th day of inpatient treatment. Based on the obtained data, it is shown that the cohort of children with neonatal sepsis was heterogeneous with certain characteristic features depending on immunological reactivity. The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the parents was obtained for the research. No conflict of interests was declared by the authors.

Factors associated with clinically apparent congenital urethra anomalies among pediatric patients attending Muhimbili National Hospital, Dar Es Salaam, Tanzania

BackgroundDespite the clinically apparent congenital urethra anomalies being one of the common causes of admission in pediatric urology, yet little is known about its associated factors, especially in third world countries. Understanding associated factors of clinically apparent congenital urethra anomalies is important in prevention and in genetic counseling that may help in reducing the incidence of their occurrence.MethodsHospital-based cross-sectional prospective study conducted among pediatric patients admitted to pediatric surgery unit at Muhimbili National Hospital from July 2021 to March 2022. Socio-demographic and clinical characteristics were collected from participant’s parent or guardian. Patients were examined thoroughly for clinically apparent congenital urethra anomalies and associated genital-urinary tract anomalies. Analysis was done using SPPS version 23 with descriptive statistics for categorical variables and univariate and multivariate logistic regression for association between presence of clinically apparent urethra anomaly and associated factors at 95% CI. A p-value of < 5 was considered statistically significant.ResultsOverall proportion of clinically apparent urethra anomaly was 24.4% (94 out of 386) with hypospadias being the commonest anomaly (23.6%); others were epispadias in 2 patients (0.5%) and bladder exstrophy in one patient (0.3%). Among hypospadias cases, sub-coronal (37.4%) and mid-shaft (29.6%) were the most prevalent. About 9.6% had associated anomalies cryptorchidism being the commonest in 8 (8.5%) patients. There was no any factor that was independently associated with development of clinically apparent congenital urethra anomalies. However, folic acid supplementation, maternal hypertension, environmental exposure to pesticides and familial history of congenital urethra anomalies were related to higher proportion of the anomalies despite no any significant relationship detected.ConclusionHypospadias is the commonest clinically apparent congenital urethra anomalies with cryptorchidism being the most prevalent associated genital-urinary tract anomaly. No associated factor has shown significant relationship with clinically apparent congenital urethra anomalies; however, attention is called to maternal hypertension, environmental exposure, especially pesticides and familial history of congenital urethra anomalies for detailed study. Proper examination of newborns is encouraged for early detection of such anomalies and hence planning for early intervention.

ПРЕНАТАЛЬНЫЙ И НЕОНАТАЛЬНЫЙ СКРИНИНГ НОВОРОЖДЕННЫХ

Thorough observation after childbirth and additional examination of newborns based on prenatal and neonatal screening, including the screening of blood, hearing, congenital heart defects and other organs and systems, and in case of indications for hereditary diseases - the genetic examination, does allow not only at the clinical, but also at the pre-clinical stage the planning of preventive and therapeutic measures for newborns and early-age children. This read offers a working algorithm for prenatal and neonatal screening of newborns.

Newborns death risk factors after surgical interventions in the early neonatal period

BACKGROUND: The mortality rate of children operated on in the early neonatal period remains high, despite the combined efforts of surgeons, anesthesiologists, clinical pharmacologists, and many other specialists.&#x0D; AIM: to determine the risk of death of children in the period of birth, after surgical interventions carried out in the period of the neonatal period.&#x0D; MATERIALS AND METHODS: A retrospective study was conducted between two groups of children treated at the Perinatal Center of the Pediatric University. The main group included 77 newborns operated on in the early neonatal period and died in the first 28 days of life. The control group included 287 children operated on in the perinatal period and survived 28 days.&#x0D; RESULTS: In the main group, the percentage of defects detected prenatally was statistically significantly lower; statistically significantly more often multiple congenital malformations and congenital malformations of the cardiovascular system were diagnosed. Risk factors for the death of newborns after surgery performed in the perinatal period have been established: features of the somatic status of mothers (chronic nicotine intoxication, hypertension and arterial hypertension, chronic serum hepatitis B and C, pathology of the urinary system and thyroid gland, cervical ectopia), obstetric gynecological history (chronic inflammation of the organs of the lower floor of the genital tract, two or more abortions in multiparous women, placental insufficiency in history during a previous pregnancy, previous delivery by caesarean section), course of pregnancy (threatening abortion, acute respiratory viral infections, exacerbations of chronic infectious diseases, early toxicosis, carriage of Cytomegalovirus and Herpes simplex types 1 and 2, asymptomatic bacteriuria, gestational anemia, circulatory failure, fetal malnutrition, abnormalities in the amount of amniotic fluid diagnosed by ultrasound study in the 3rd trimester of pregnancy), childbirth (breech presentation of the fetus and meconium staining of amniotic fluid), afterbirth conditions (chlamydial and ascending infection).&#x0D; CONCLUSIONS: In pregnant women with prenatally diagnosed congenital malformations of the fetus, it is necessary to conduct bacteriological studies, emergency histological examination of the placenta to identify possible microbial damage, as well as timely examination and treatment of newborns and upcoming / undergone surgery.

Comparison of prenatal ultrasound with MRI in the evaluation and prediction of fetal orofacial clefts

BackgroundOrofacial clefts (OFCs) are common craniofacial abnormalities. This study aimed to compare the diagnostic and predictive values of prenatal ultrasonography (US) and magnetic resonance imaging (MRI).MethodsWe reviewed the newborn physical examinations or fetal autopsy data with OFCs. Between January 2013 and December 2018, the diagnoses resulting from prenatal US and MRI examination were compared retrospectively with the postpartum diagnoses. The diagnostic prediction of prenatal imaging was then determined.Results334 infants were identified with OFCs by either newborn physical exam or stillborn autopsy. For detection of OFCs by US, the total accuracy (ACC), true positive rate (TPR), true negative rate (TNR), positive predictive value (PPV), and negative predictive value (NPV) were 99.9% (111,178/110,286), 81.9% (230/281), 99.9% (109,948/110,005), 80.1% (230/287), and 99.9% (109,948/109,999), respectively. For MRI, the ACC, TPR, TNR, PPV, and NPV were 99.8% (4,125/4,132), 89.8% (44/49), 99.9% (4,081/4,083), 95.7% (44/46), and 99.9% (4,081/4,086), respectively. When we compared the predictive values between prenatal US and MRI, there were significant differences in the PPV of OFCs (P < 0.05), NPV of OFCs (P < 0.05), TPR of CLO (P < 0.001), PPV of CLP (P < 0.05), and TPR of CPO (P < 0.05).ConclusionOur results suggest that prenatal US could be effective for diagnosing and ruling out fetal OFCs. Diagnostic confidence is significantly improved when fetal MRI is used to assess fetal OFCs as an adjunct to US examination.

Perinatal mental healthcare: Developing skills in midwifery students

Midwives have a pivotal role in screening for risk factors for mental illness and psychosocial vulnerabilities in women during the perinatal period. They also have a key responsibility to provide women with the appropriate resources to support their mental wellbeing. Midwives can lack confidence and/or feelings of competence regarding these skills.Care of women in the context of their perinatal mental health is a core midwifery skill that deserves practical learning during pre-registration education, just as the more ‘hands on’ skills such as abdominal palpation, labour and birth support or newborn examination. However, there is limited opportunity for students to gain clinical placement experiences that are specific to perinatal mental health (PMH).This discussion paper describes an innovative teaching and learning project that aimed to improve confidence in students’ ability to conduct screening, support, and referral of women experiencing mental ill health. The project involved the development of an Objective Structured Clinical Examination (OSCE) and audio visual resources to support learning and teaching and clinical placement. Feedback was collected to inform the refinement of the first OSCE, and to assist in the design of the audio visual resources that are now displayed publicly on the Australian College of Midwives website at https://www.midwives.org.au/Web/Web/Professional-Development/Resources.aspx?hkey=12c2360e-d8b9-4286-8d0a-50aeaeca9702.