Postnatal Group Research Articles

Prenatal Detection of D-TGA and Novel Interventional Program Decrease Time to Balloon Septostomy.

Infants with dextro-transposition of the great arteries (d-TGA) are at high risk for hemodynamic compromise in the immediate postnatal period due to dependence on intracardiac mixing for oxygen delivery. This period of profound hypoxemia may have long-term implications, as previous studies demonstrated patients with d-TGA are at increased risk for neurocognitive delays despite effective surgical correction in the neonatal period. Balloon atrial septostomy (BAS) is an established intervention that improves intracardiac mixing and perioperative hemodynamics. This retrospective study aimed to quantify the time from birth to BAS and compare short-term outcomes for patients with prenatal and postnatal diagnoses of d-TGA. We identified 68 newborns born with d-TGA who were admitted to our facility between 2013 and 2022 and required BAS within 48h after birth. Halfway through this study, our cardiac interventional team began traveling to a nearby delivery center where a bedside BAS could be performed prior to transferring the patient. We divided the patients into 3 groups-postnatal diagnosis (n = 27), prenatal diagnosis with rapid transport (n = 24), and prenatal diagnosis with interventional team performing a BAS at the delivery hospital (n = 17). The time from birth to BAS was significantly shorter for patients in the interventional program group (1.1h) compared to the rapid transport (4.5h) and postnatal diagnosis groups (9.3h, p value < 0.01). The interventional program group also had lower lactate levels and less acidotic pH compared to the other groups. There was no significant difference in lowest oxygen saturation level, pre-surgical neurologic complication rate, time to surgery, or hospital length of stay. The interventional program proved to be a safe and effective model, as there were no procedural complications and the time to BAS decreased. Long-term follow-up is needed to determine if abating this initial period of hemodynamic instability will lead to improved neurodevelopmental outcomes.

Regression of microcephaly as a protective factor of neuropsychomotor development in fetal surgery for occipital encephalocele.

Encephaloceles are neural tube closure defects characterized by herniation of intracranial contents through the skull, with a mortality rate of 33.3%. Approximately 50% of patients who survived have some degree of neuropsychomotor developmental impairment or seizures. This study aimed to analyze the relationship between good neuropsychomotor development (NPMD) in patients undergoing fetal occipital encephalocele correction and the reversal of microcephaly, comparing these outcomes with those observed in patients who underwent postnatal surgery. The 22 participants were categorized into two groups: 10 in the fetal group (FG) and 12 in the postnatal group (PNG). During the study, 1 patient was excluded from the FG and 2 patients were excluded from the PNG, totaling 19 patients in the study. All patients were diagnosed, evaluated, and monitored by the same healthcare service between July 2012 and July 2018. All participants were subjected to a careful developmental assessment using the Bayley Scale of Infant Development, Second Edition (BSID-II), up to 2years and 11months of age. Additionally, CP measurements were taken during the first year of life to monitor their progress. The relationship between microcephaly reversal and NPMD was studied. The CP adjusted for gestational age showed a tendency toward the reversal of progressive microcephaly after correction of encephaloceles in the FG. We found a statistically significant difference in the median BSID-II score between the PNG and FG. Patients in the FG maintained normal CP development in the first year of life, whereas those in the PNG remained microcephalic. The reversal of microcephaly in the FG directly influences good NPMD and can be considered a protective factor.

Influences of quality of maternal care and environmental enrichment on associative memory function in rats with early life lead exposure.

Children in low socioeconomic status (SES) communities are at higher risk of exposure to lead (Pb) and potentially more severe adverse outcomes from Pb exposures. While the factors encompassing SES are complex, low SES households often have less enriching home environments and parent-child interactions. This study investigated the extent to which environmental/behavioral factors (quality of maternal care and richness of the postnatal environment) may modify adverse effects from Pb exposure. Long-Evans female rats were randomly assigned to Control (no Pb), Early Postnatal (EPN: birth through weaning), or Perinatal (PERI: 14 days pre-mating through weaning) Pb exposure groups. From postnatal days (PNDs) 2-9, maternal care behaviors were observed, and dams were classified as low or high maternal care based on amounts of licking/grooming and arched back nursing. At weaning, pups were randomly assigned to enriched or non-enriched environments. At PND 55, animals began trace fear conditioning and associative memory was tested on days 1, 2, and 10 postconditioning. Control offspring showed no significant effects of maternal care or enrichment on task performance. Females with EPN-Pb exposure and males with PERI-Pb exposure living in the non-enriched environment and having an LMC mother had significant memory impairments at days 2 and 10 that were not observed in comparably housed animals with HMC mothers. Enriched animals had no deficits, regardless of maternal care status. These results show the potential for modulatory influences of maternal care and housing environment on protecting against or reversing at least one aspect of Pb-induced cognitive/behavioral dysfunction.

Prenatal (Second Trimester and Third Trimester) and Postnatal (Third and Fourth Week After Birth) Developmental Radiological Investigation of Sheep Skulls.

The skull is a complex, vital structure made up of many bones. It has been observed that studies on skulls help to determine species and sex. In recent years, craniometric studies have been frequently used to determine morphometric features in animals. In our study, 150 skulls were studied, 50 from the second trimester (25 males and 25 females), 50 from the third trimester (25 males and 25 females), and 50 from the third and fourth week after birth (25 males and 25 females). The skulls were sectioned by computerised tomography and stored in DICOM format. From the images, nine different measurements and five index calculations were made. The similarities and differences between species were determined by ignoring sex differences. Correlation analyses were performed to compare measurement parameters between animal species. In addition, the results of statistical analyses between sexes were evaluated without species distinction. SL, CW and ICI parameters were highly statistically significant between measurements in the second trimester, third trimester and postnatal group (p < 0.01). In the third trimester, the EHC measurement parameter was found to be highly significant between males and female (p < 0.01). In Table5, the CL parameter was positively correlated with CW, IHC, EHC, ILC, ELC, FMW and FMH. There are very few studies on foetal development. It is predicted that the data obtained can be used in zoo-archaeology, anatomy, surgery and forensic medicine. In addition, radiographic determination of craniometric features will help in the treatment and prognosis of diseases.

Prenatal surgery in fetal myelomeningocele with severe ventriculomegaly.

Prenatal myelomeningocele (MMC) repair is performed to decrease risk for treatment of hydrocephalus after birth and to preserve motor function. Some centers may not consider patients candidates for surgery if severe ventriculomegaly is present and there is no expected benefit in decreased risk for hydrocephalus treatment. This study sought to compare postnatal outcomes of fetuses with MMC and severe ventriculomegaly (>15mm) who underwent prenatal repair, with fetuses with severe ventriculomegaly who underwent postnatal repair and fetuses with ventriculomegaly (<15mm) who underwent prenatal repair. This was a retrospective study of fetuses with MMC that underwent prenatal or postnatal repair between 2012 and 2021 at a single institution. The cohort was divided based on preoperative fetal ventricular size into two groups, those with severe ventriculomegaly (≥15 mm) and those without severe ventriculomegaly (<15 mm). Fetal ventricular size was measured by MRI prior to surgery using the standardized approach and the mean of the left and right ventricle was used for analysis. Motor function of lower extremities was assessed at the time of referral by ultrasound and if flexion-extension movements of the ankle were seen, it was considered as preserved S1 motor function. Postnatal outcomes including motor function of lower extremities assessed at birth and need for diversion procedure for hydrocephalus treatment during the first year of life were collected and compared between groups. Data was presented as median and range or number and percentages as appropriate. P value >0.05 was considered statistically significant. Multivariate regression analysis was used to adjust for potential confounders. 154 patients were included in this study: 145 patients underwent fetal surgery (101 fetoscopic and 44 open hysterotomy) and 9 patients with severe ventriculomegaly underwent postnatal repair. Among the 145 patients who underwent fetal surgery, 22 presented with severe ventriculomegaly. Prenatally repaired fetuses with severe ventriculomegaly at referral were at a significantly higher need for hydrocephalus treatment by 12 months than those without severe ventriculomegaly (62% vs. 29%, p<0.01). However, motor function assessment at birth was similar between both prenatally repaired groups (OR=0.92, 95% CI [0.33-2.59], p=0.88) adjusted for the anatomical level of the lesion. The prenatally repaired group with severe ventriculomegaly had better preserved motor function levels at birth compared to the postnatal repair group with severe ventriculomegaly (L3 with 11.1% S1 motor function; p=<0.01 and p=<0.01). Prenatally repaired patients with severe ventriculomegaly had an 18.9 times chance of having an intact motor function at birth [95% CI (1.2 - 290.1)] adjusted for ethnicity, presence of clubfeet at referral, and gestational age at delivery compared to postnatal repair. There was not a significant difference in the need for hydrocephalus treatment in the first year of life between prenatal and postnatal repair of patients with severe ventriculomegaly (61.9% vs 87.5%, p=0.18). Although fetuses with MMC and severe ventriculomegaly do not seem to benefit from fetal surgery in terms of postnatal hydrocephalus treatment, they benefit from increased chance of preserved motor function at birth. Results from this study highlight the benefits of having prenatal MMC repair for cases with severe ventriculomegaly at referral to preserve motor function. This article is protected by copyright. All rights reserved.

Bone mineral density and geometric morphometrics: Indicators of growth in the immature pars basilaris

The pars basilaris forms a central component of the immature basicranium and owing to its resilience to post-mortem and taphonomic changes, holds significance across evolutionary, clinical, and forensic contexts. While size and shape parameters of the pars basilaris have been investigated, little is known about the influence of the underlying bone mineral density on the morphometry of this bone during growth. This study aimed to investigate the development and growth of the pars basilaris with specific reference to changes in bone density patterning and development of osteological features, during the prenatal and early postnatal periods of life. A total of 109 pars basilari were sourced from the Johannesburg Forensic Paediatric Collection, University of the Witwatersrand, South Africa. The study sample was subdivided into early prenatal (<30 gestational weeks), prenatal (30–40 gestational weeks) and postnatal (birth to 7.5 months) groups and micro-CT scanned to assess bone mineral density patterns across seven regions of interest. Size and shape changes were analysed using 11 digitized landmarks and geometric morphometrics. When comparing across age groups, the assessed dimensions increased with growth manifesting as a deepening at the anterior border of the foramen magnum, development of the lateral angles and widening of the bone at the lateral projections and spheno-occipital synchondrosis. However, no significant changes in the distribution of bone mineral density were observed. An appreciation of morphological changes and bone quality at specific growth sites in the pars basilaris is essential when analyzing remains of unknown provenance for the purposes of identification in disaster victim settings.

Health Disparities and Route of Repair of Fetal Myelomeningocele-Prenatal Versus Postnatal Repair

Background: Spina bifida (SB) is a relatively common birth defect with the highest prevalence among Hispanics. A randomized controlled trial (MOMS) demonstrated that prenatal repair yielded improved outcomes compared to postnatal repair. However, the social determinants of health can significantly impact the overall well-being of affected individuals or their eligibility for some of these evidenced-based interventions. Methods: We conducted a retrospective observational study to describe and compare the mean Child Opportunity Index (COIs) scores among patients treated at a free-standing children’s hospital who underwent either prenatal or postnatal repair of SB from January 1&amp;lt;sup&amp;gt;st&amp;lt;/sup&amp;gt;, 2012, to December 31&amp;lt;sup&amp;gt;st&amp;lt;/sup&amp;gt;, 2021. We excluded patients with identifiable maternal and fetal contraindications to prenatal repair, as per the MOMS trial eligibility, apart from those pertaining to socio-economic status. RESULTS: Among a total cohort of 51 fetuses, 86% (n = 44) underwent postnatal repair for SB, while 14% (n = 7) received prenatal repair. Patients who underwent prenatal repair exhibited lower COI scores across all domains (education, health, and environment, social and economic) on national, state, and metro levels compared to the postnatal group. Our cohort showed a higher percentage of primary commercial insurance in the prenatal (fetal) surgery group (57.14%) versus the postnatal surgery group (47.73%), without attaining statistical significance (p=0.25). Conclusion: While COI scores across all domains were lower in the prenatal cohort, our data does not suggest a statistically significant difference between prenatal and postnatal surgery groups. This highlights the need for future studies with larger sample sizes to further explore and define this relationship.

An Evaluation of the Health Economics of Postnatal Depression Prevention and Treatment Strategies in China: A Cost-Effectiveness Analysis.

The primary objectives of this study are to assess the cost-effectiveness of early postnatal screening and prenatal psychological interventions for the prevention and treatment of postpartum depression (PPD) among Chinese pregnant women. Additionally, we aim to explore the most cost-effective prevention and treatment strategies for PPD in China. We used TreeAge 2019 to construct a decision tree model, with the model assuming a simulated queue size of 10,000 people. The model employed Monte Carlo simulation to assess the cost-effectiveness of PPD prevention and treatment strategies. Transfer probabilities were derived from published studies and meta-analyses. Cost and effectiveness data were obtained from published sources and relevant studies. Incremental cost-effectiveness ratios (ICERs) were used to describe the results, with willingness-to-pay (WTP) thresholds set at China's gross domestic product (GDP) per capita. Compared to the usual care group, the cost per additional quality-adjusted life year (QALY) for the early postnatal screening group and the prenatal psychological interventions is USD 6840.28 and USD 3720.74, respectively. The cure rate of mixed treatments for PPD has the greatest impact on the model, while patient participation in treatment has a minor impact on the cost-effectiveness of prevention and treatment strategies. Both early postnatal screening and prenatal psychological interventions are found to be highly cost-effective strategies for preventing and treating PPD in China. Prenatal psychological interventions for pregnant women are the most cost-effective prevention and treatment strategy. As such, from the perspective of national payers, we recommend that maternal screening for PPD be implemented in China to identify high-risk groups early on and to facilitate effective intervention.

Characterization of HCN channel subtypes at hypoglossal motoneurons throughout postnatal maturation in mice

The inspiratory phase of breathing includes a stiffening of the upper airway to decrease airway resistance and is mediated by excitatory motor output from hypoglossal motoneurons (XII MNs). This excitation decreases from wakefulness to sleep. This decrease in excitation is in large part due to increasing acetylcholine levels, which activate muscarinic acetylcholine receptors (mAChRs) that have a net inhibitory effect in adult preparations. By contrast, activation of mAChRs in neonatal rodent preparations has a net effect of potentiating inspiratory burst amplitude. Therefore, characterizing changes in muscarinic effects at XII MNs across postnatal maturation will help elucidate the mechanism underlying the shift from muscarinic excitation to inhibition. mAChRs modulate several effector ion channels including the hyperpolarization activated cyclic nucleotide gated (HCN) channel. HCN channels give rise to I h, a mixed cation current activated at hyperpolarized membrane potentials. I h additionally shows upregulation at XII MNs with postnatal maturation. Since there are four HCN subtypes (HCN1-4), the reported changes in I h may be caused by changes in HCN channel subtype levels. HCN1 and HCN2 are most prominent in adult XII MNs, whereas the expression of HCN1-4 in neonates is unknown. Thus, the purpose of this research is to characterize changes in HCN gene and channel expression levels at XII MNs across postnatal maturation. We hypothesis that both HCN1 and HCN2 subtypes will increase with postnatal maturation, and that HCN2 has higher levels than HCN1. To test this hypothesis, we used neuroanatomical techniques to evaluate changes in expression patterns of the four HCN proteins at the XII nuclei across postnatal maturation in CD-1 mice. We performed double-labeled immunofluorescence experiments against HCN1 and HCN2 and co-labeled with choline acetyltransferase (ChAT) on 20μm transverse brainstem slices across six postnatal age groups under identical conditions: P0-P1, P4-P6, P9-P10, P12-P14, P17-P19, and adult. Images of the XII nuclei were collected using a confocal microscope. ImageJ was used to determine the average XII MN HCN subtype intensity across postnatal maturation. Preliminary data suggest that HCN1 (n=2) channels undergo a decrease in expression at P17-19 before a final increase in adulthood (P0-1= 97-100%, P4-6= 92-100%, P9-10= 85-95%, P12-14= 77-97%, P17-19= 61-67%, adult= 71-82%). By contrast, preliminary data suggest that HCN2 (n=2) expression intensity remained relatively consistent with a decrease in labeling intensity at P4-6 (P0-1= 97-100%, P4-6=62-84%, P9-10= 45-95%, P12-14= 67-90%, P17-19= 50-93%, adult= 75-100%). These modest changes in labeling intensity of HCN channel subtypes may not contribute to the observed shift of mAChR modulation at XII MNs from excitation to inhibition with postnatal maturation. Biomedical Sciences, College of Graduate Studies; Department of Physiology, College of Graduate Studies, Midwestern University; NIH/NHLBI Funding: R15HL148870. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Distribution of muscarinic acetylcholine receptors in hypoglossal motoneurons across postnatal maturation

Upper airway patency is decreased during rapid eye movement (REM) sleep due to loss of genioglossus (primary tongue protruder) tongue muscle tone. During REM sleep, hypoglossal motoneurons (XII MNs), which innervate genioglossus, receive less excitatory noradrenergic drive and may be inhibited by activation of muscarinic acetylcholine receptors. Data from intact adult rats during natural sleep implicates an inhibitory effect of muscarinic acetylcholine receptors on XII MNs. However, data using the rhythmic slice preparation from neonatal mice indicate that muscarine has a net excitatory effect on inspiratory burst amplitude at XII MNs. Our project examines the changes to distribution of muscarinic acetylcholine receptors (mAChRs) at XII MNs across postnatal maturation. We hypothesize there is an increase in inhibitory (M2) and decrease in excitatory (M1, M3, M5) mAChRs at XII MNs with postnatal maturation. We performed double-labeled immunofluorescence experiments on perfused transverse brainstem slices (20μm) under identical conditions across six postnatal age groups: P0-P2, P3-P5, P6-P10, P11-P13, P14-P17, and adult against mAChR targets M1, M2, M3, M5. Slices were co-labeled with choline acetyltransferase (ChAT) and 4’,6-diamidino-2-phenylindole (DAPI). Images were collected using a confocal microscope. 10 individual XII MNs were identified in each slice using positive ChAT labeling as well as anatomical location. ImageJ was used to determine the average XII MN mAChR subtype intensity. Preliminary data (n = 3) indicate that M1 receptors showed a transitory increase in labeling intensity in XII MNs followed by a decrease across development (P1=89±11%, P4-5=100%, P9=76±18%, P12-13=67±8%, P17=67±4%, adult=56±7%, p = 0.13). M3 (n = 3) showed a trend for a transient increase in labeling intensity at P17 (P1=78±41%, P4-5=87±3%, P9=61±13%, P12-13=86±34%, P17=100%, adult=80±23, p = 0.60). M5 (n = 3) expression intensity decreased consistently over maturation (P1=100%, P4-5=92±34%, P9=75±23%, P12-13=70±10%, P17=66±14%, adult=39±12%, p = 0.0257). In contrast, M2 (n = 3) receptor expression intensity remained relatively consistent across maturation (P1 = 88±23%, P4-5 = 100%, P9=88±10%, P12-13 = 75±15%, P17 = 86±18%, adult = 75±10%). These data partly support our hypothesis of a decrease in expression intensity of excitatory M1, M3, and M5 receptor subtypes into adulthood. Contrary to our hypothesis, we observed minimal change in the expression intensity of inhibitory M2 receptors across maturation. The decrease in labeling intensity of excitatory muscarinic receptor subtypes may support the observed shift in muscarinic modulation from excitation to inhibition with postnatal maturation. Arizona Alzheimer's Consortium, NIH. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Postnatal care provided by UK midwifery units and the impact of the COVID-19 pandemic: A survey using the UK Midwifery Study System (UKMidSS)

BackgroundPostnatal care supports healthy transitions to parenthood, mother-infant relationships, and breastfeeding establishment. Highly valued by women and families, it is often an area where parents report low satisfaction compared with other areas of maternity care. Most research about postnatal care is hospital-focused. Little is known about postnatal services provided by midwifery units, and any changes to this provision since the COVID-19 pandemic. AimTo describe postnatal care services provided by UK midwifery units and examine the extent to which provision was affected by the COVID-19 pandemic. MethodsWe carried out a national survey online between January–June 2022 using the United Kingdom Midwifery Study System (UKMidSS). We asked about postnatal care provision in alongside midwifery units (AMU) and freestanding midwifery units (FMU), before the COVID-19 pandemic (July–December 2019) and shortly after restrictions were eased (January–June 2022). FindingsOverall 131 (67 %) midwifery units responded to the survey, 76 (62 %) AMUs and 55 (75 %) FMUs, from 75 % of eligible NHS organisations. In 2022, 66 % of AMUs reported that women typically stayed for 6–24 h after a straightforward birth, while 70 % of FMUs reported typical postnatal stays of <6 h. For 2019, significantly more FMUs reported providing outpatient postnatal services compared with AMUs (98 % vs 57 %, p < 0.001). From 2019 to 2022 there were significant reductions in partners staying overnight in midwifery units (65 %–42 %, p < 0.001), and in the provision of outpatient postnatal breastfeeding groups (23 %–15 %, p < 0.01) and other postnatal groups (7 %–2 %, p = 0.02). ConclusionsThe findings document the ways in which postnatal care provision differs between AMUs and FMU, with potential consequences for choice and experience for women. They are also congruent with evidence that maternity care was adversely affected by the COVID-19 pandemic, including a reduction in postnatal visiting for partners and in postnatal group support services.

Exploring inheritance, and clinical penetrance of distal Xq28 duplication syndrome: insights from 47 new unpublished cases

BackgroundDistal Xq28 duplication, or int22h1/int22h2-mediated Xq28 duplication syndrome, leads to cognitive impairment, neurobehavioral issues, and facial dysmorphisms. Existing literature has limited information on clinical traits and penetrance.MethodsWe identified cases of distal Xq28 duplication (chrX: 154,126,575–154,709,680, GRCh37/hg19) through a review of clinical records and microarray reports from five centers, encompassing both postnatal and prenatal cases, with no prior family knowledge of the duplication.ResultsOur search found 47 cases across 26 families, with duplications ranging from 208 to 935 Kb. In total, 8 out of 26 index cases featured a 200–300 kb partial duplication, mainly from Armenian/Caucasian Jewish backgrounds. Most prenatal cases showed no major fetal ultrasound malformations. Of cases with known inheritance mode (15 out of 26), maternal inheritance was more common (80%). The study identified seven male carriers of the duplication from six unrelated families, indicating partial penetrance in males.ConclusionOur study provides key insights into distal Xq28 duplication. Most prenatal tests showed no major fetal ultrasound issues. Maternal inheritance was common, with unaffected mothers. In the postnatal group, a balanced gender distribution was observed. Among male family members, two fathers had ADHD, one was healthy, and one brother had mild symptoms, indicating partial penetrance in males.

Prognostic Significance of Central Skull Base Remodeling in Chiari II Malformation.

Outward convexity of the basiocciput and posterior atlanto-occipital membrane are common in patients with Chiari II malformation associated with an open neural tube defect. We aimed to determine if the severity of these findings correlated with the need for future hydrocephalus treatment. A retrospective chart and imaging review identified patients who underwent open neural tube defect repair at a quaternary care pediatric hospital from July 2014 through September 2022. Patients were classified by the need for hydrocephalus treatment and whether they received prenatal or postnatal neural tube defect repair. Measurements of imaging parameters related to posterior fossa maldevelopment and skull base remodeling were performed. Compared with 65 patients who did not require hydrocephalus treatment, 74 patients who required treatment demonstrated statistically significantly greater mean basiocciput convexity (P < .001). While the mean basiocciput length in the hydrocephalus treatment group was smaller (P < .001), the ratio of basiocciput convexity to length was larger (P < .001). Notably, 100% of patients with a basiocciput convexity of ≥4 mm required hydrocephalus treatment. The mean posterior atlanto-occipital membrane convexity was significantly greater for patients who required hydrocephalus treatment in the postnatal group (P = .02), but not the prenatal group (P = .09). Pediatric patients with Chiari II malformation who ultimately required surgical hydrocephalus treatment had greater outward convexity of the basiocciput but had greater posterior atlanto-occipital membrane outward convexity only if the repair was performed postnatally. Together these measurements may be useful in predicting the need for hydrocephalus treatment.

Predictors and timing of hydrocephalus treatment in patients undergoing prenatal versus postnatal surgery for myelomeningocele.

Although hydrocephalus rates have decreased with intrauterine surgery for myelomeningocele (MMC), 40%-85% of children with MMC still go on to develop hydrocephalus. Prenatal ventricle size is known to be associated with later development of hydrocephalus; however, it is not known how prediction measures or timing of hydrocephalus treatment differ between pre- and postnatal surgery for MMC. The goal of this study was to determine anatomical, clinical, and radiological characteristics that are associated with the need for and timing of hydrocephalus treatment in patients with MMC. The authors retrospectively identified patients from Barnes Jewish Hospital or St. Louis Children's Hospital between 2016 and 2021 who were diagnosed with MMC prenatally and underwent either pre- or postnatal repair. Imaging, clinical, and demographic data were examined longitudinally between treatment groups and hydrocephalus outcomes. Fifty-eight patients were included (27 females, 46.6%), with a mean gestational age at birth of 36.8 weeks. Twenty-three patients (39.7%) underwent prenatal surgery. For the overall cohort, the ventricle size at prenatal ultrasound (HR 1.175, 95% CI 1.071-1.290), frontal-occipital horn ratio (FOHR) at birth > 0.50 (HR 3.603, 95% CI 1.488-8.720), and mean rate of change in head circumference (HC) in the first 90 days after birth (> 0.10 cm/day: HR 12.973, 95% CI 4.262-39.486) were identified as predictors of hydrocephalus treatment. The factors associated with hydrocephalus in the prenatal cohort were FOHR at birth > 0.50 (HR 27.828, 95% CI 2.980-259.846) and the rate of change in HC (> 0.10 cm/day: HR 39.414, 95% CI 2.035-763.262). The factors associated with hydrocephalus in the postnatal cohort were prenatal ventricle size (HR 1.126, 95% CI 1.017-1.246) and the mean rate of change in HC (> 0.10 cm/day: HR 24.202, 95% CI 5.119-114.431). FOHR (r = -0.499, p = 0.008) and birth HC (-0.409, p = 0.028) were correlated with time to hydrocephalus across both cohorts. For patients who underwent treatment for hydrocephalus, those in the prenatal surgery group were significantly more likely to develop hydrocephalus after 3 months than those treated with postnatal surgery, although the overall rate of hydrocephalus was significantly higher in the postnatal surgery group (p = 0.018). Clinical and imaging factors associated with hydrocephalus treatment differ between those receiving pre- versus postnatal MMC repair, and while the overall rate of hydrocephalus is lower, those undergoing prenatal repair are more likely to develop hydrocephalus after 3 months of age. This has implications for clinical follow-up timing for patients treated prenatally, who may live at a distance from the treatment site.

Being a "Good Parent" to a NICU Infant With a Major Congenital Anomaly.

In the United States, up to one-third of infants with a congenital anomaly require neonatal intensive care unit (NICU) hospitalization. Parents of these infants may have different decision-making priorities, which may be influenced by the timing of the infant's diagnosis. (1) To compare the ranked importance of decision-making beliefs for parents of infants who received a prenatal versus postnatal congenital diagnosis and (2) explore how parents describe their decision-making beliefs. A cross-sectional, sequential mixed-methods pilot design was applied to collect quantitative data using the Good Parent Ranking Exercise and further explore parents' decision-making beliefs through qualitative interviews. Maximum difference scaling/hierarchical Bayes estimation and content analysis were used to analyze the quantitative and qualitative data, respectively. Forty mothers completed the Good Parent Ranking Exercise and 20 mothers completed qualitative interviews. Four of the top 5 ranked parenting beliefs were shared by mothers in the prenatal and postnatal groups. Mothers in the postnatal group ranked "focusing on my child's quality of life" higher. Qualitative interviews revealed that previously identified decision-making beliefs were consistent in this NICU parent population, with 1 additional belief identified. Mixed-methods analysis revealed high concordance between the prenatal and postnatal groups. NICU nurses need to know that decision-making beliefs for parents who receive a prenatal versus postnatal congenital diagnosis, while largely similar, may have differences. Future research should explore decision-making beliefs in demographically diverse parent groups (ie, fathers, partnered vs nonpartnered couples) and effective strategies for promoting NICU parents' decision-making beliefs.

An investigation of endometrial vascularity in normally menstruating women and those in other physiological states using 3D ultrasound imaging.

This study aimed to determine the normal vasculature indices of the endometrium and to correlate them with those in various physiological states. Women undergoing ultrasound at the Feto-Maternal Center, Qatar in 2020-2021 as part of their gynecologic evaluation were enrolled into the study. They were divided into those with normal menses and no additional pathology, those following spontaneous miscarriage, postpartum and menopausal. Three-dimensional (3D) evaluation of the endometrial vasculature was done and the parameters quantified included vascularization index (VI), flow index (FI), vascularization flow index (VFI), endometrial thickness, endometrial volume and uterine volume. JASP, an open-source statistical analysis software, was used for analysis and an independent t-test to compare the vascularity indices. A multivariate regression analysis was also done to look at the factors affecting the endometrial vascular indices within the luteal phase. A total of 461 women were studied: 122 in the follicular phase, 199 in the luteal phase, 90 after a spontaneous miscarriage, 29 postpartum, and 16 menopausal. The vascularity indices were highest after miscarriage and lowest postnatally. There were no significant effects of age, gravida, para, or abortions on VI and VFI. However, there was a significant positive effect of age on FI (P = 0.019) There was a significant increase in endometrial volume and thickness in the luteal phase as compared to follicular phase (P < 0.01), but there was no difference in the vascularity indices. The uterine and endometrial volume in the postnatal group were nearly double that of the luteal group (P value <0.01 and 0.014, respectively). There was a significant decrease in flow index in the postnatal group compared to the luteal group (P < 0.01), suggesting low flow intensity in the postnatal group. Endometrial vascular indices measured using 3D Doppler can be used to determine normal vascular indices and vary with physiological states such as after miscarriages, postnatally and in the menopausal states.

SOX2 and SOX9 Expression in Developing Postnatal Opossum (Monodelphis domestica) Cortex.

(1) Background: Central nervous system (CNS) development is characterized by dynamic changes in cell proliferation and differentiation. Key regulators of these transitions are the transcription factors such as SOX2 and SOX9. SOX2 is involved in the maintenance of progenitor cell state and neural stem cell multipotency, while SOX9, expressed in neurogenic niches, plays an important role in neuron/glia switch with predominant expression in astrocytes in the adult brain. (2) Methods: To validate SOX2 and SOX9 expression patterns in developing opossum (Monodelphis domestica) cortex, we used immunohistochemistry (IHC) and the isotropic fractionator method on fixed cortical tissue from comparable postnatal ages, as well as dissociated primary neuronal cultures. (3) Results: Neurons positive for both neuronal (TUJ1 or NeuN) and stem cell (SOX2) markers were identified, and their presence was confirmed with all methods and postnatal age groups (P4-6, P6-18, and P30) analyzed. SOX9 showed exclusive staining in non-neuronal cells, and it was coexpressed with SOX2. (4) Conclusions: The persistence of SOX2 expression in developing cortical neurons of M. domestica during the first postnatal month implies the functional role of SOX2 during neuronal differentiation and maturation, which was not previously reported in opossums.

Validity and Reliability of the Korean Version of the Postpartum Bonding Questionnaire (K-PBQ)

Purpose: We evaluated the validity and reliability of the Korean version of the Postpartum Bonding Questionnaire (K-PBQ) among Korean parents with children under 12 months of age.Methods: The K-PBQ was translated considering Korean cultural validity through translation, back-translation, and expert panel review. Construct validity was tested by conducting both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) with data from 308 couples (N=616). Convergent and discriminant validity were performed using correlations between the K-PBQ and instruments measuring the concepts of attachment, postnatal depression, and dyadic adjustment. The reliability of the K-PBQ was calculated using Cronbach’s ⍺ coefficients.Results: EFA revealed that the 25-item K-PBQ was composed of two factors: impaired bonding (17 items) and the burden of infant care (8 items). The results of the final model fit were acceptable. Known-group validity showed that the K-PBQ score of the postnatal depressed group was significantly higher than that of the non-depressed group. The Cronbach’s ⍺ of the K-PBQ was .95.Conclusion: The K-PBQ was verified as a valid and reliable scale to measure postpartum bonding among parents with children under 12 months of age in Korea. It may contribute to facilitating further research on parent-infant bonding.

Clinical Features, Diagnosis, and Treatment of Congenital and Neonatal Tuberculosis: A Retrospective Study

Introduction: Limited studies have explored the clinical features, treatment, and prognosis of neonatal tuberculosis (TB). Here, we attempted to delineate the clinical characteristics of neonatal TB, which may help clinicians further understand this disease. Methods: A retrospective analysis of neonates diagnosed with congenital and/or neonatal TB disease from January 2010 to December 2020 was performed. Information on the demographic and epidemiological features, clinical symptoms, laboratory and imaging examinations, therapeutic regimens, and outcomes was collected. Kaplan-Meier analysis was used to present the time to disease onset, time to diagnosis, etc. Results: Forty-eight cases of neonatal TB were classified into congenital (n = 33) and postnatal (n = 15). The median time to disease onset in postnatal group was significantly longer than that in congenital group. Positive results for gastric fluid acid-fast bacilli, TB culture, Xpert MTB/RIF, interferon-γ release assay (IGRA), and tuberculin skin test were detected in 26/48 (54.2%), 14/34 (41.2%), 11/18 (61.1%), 19/29 (65.5%), and 8/24 (33.3%) patients, respectively. For lymphadenopathy, computed tomography (CT) scans showed a higher detection rate than did X-ray (80.0% vs. 0). Of the 48 infants, 44/48 (91.7%) received anti-TB therapy, and 33/44 (75%) were clinically improved or cured after 22.1 months (interquartile range: 12.4–27.7) of follow-up. Drug-induced liver injury occurred in 14/44 (31.8%) patients. Discussion/Conclusion: IGRA and Xpert MTB/RIF showed good positive rate in neonatal TB infection/disease. In cases where TB is presumed but etiological evidence is lacking, low-dose CT could be considered. Prompt treatment under careful surveillance is important for preventing mortality and avoiding severe adverse effects.

Congenital Heart Diseases: Risk Factors and Ultrasound Diagnostic Potential at the First Screening

Introduction: Due to the high incidence of congenital heart diseases (CHD) it is important to identify risk factors for abnormal organogenesis. There is a crucial medical need to understand cardiogenesis and possible markers of abnormalities in fetuses.Objective: To determine risk factors for CHD in pregnant women and their partners and assess CHD markers on the first ultrasound screening.Materials and methods: We analyzed 221 medical records of pregnant women with prenatally diagnosed fetal CHD and divided the patients into 2 groups: group I (n = 177) with CHD compatible with postnatal development and group II (n = 44) with CHD incompatible with postanatal development. We evaluated physical findings and somatic and reproductive history in both groups. We retrospectively analyzed 2272 ultrasound scans and first screening markers: nuchal translucency (NT) thickness and ductus venosus pulsatility index (DVPI).Results: We identified possible risk factors for fetal CHD: body mass index, P = .000; age of menarche, P = .037; chronic tonsillitis, Р = .046; cervical erosion, Р = .045; vulvovaginal candidiasis, Р = .005; vaginitis, Р = .027; cervicitis, Р = .027; chronic hepatitis B and C viruses, Р = .005; respiratory tract infection with fever during the current pregnancy, Р = .012. We built 500 networks with the highest performance for a predictive model and found that the model’s predictors did not fully represent the risk factors for CHD. CHD with increased NT thickness (≥2.5 mm) was detected in 2.24% of cases. NT thickness and DVPI were 3.37 ± 0.92 mm and 1.098 ± 0.158, respectively. According to our correlation analysis, increased DVPI and NT thickness were associated with CHD (R = 0.510).Conclusions: It is not possible to identify risk factors for CHD in fetuses by medical history, reproductive history and physical status of pregnant women, and unhealthy habits of their sexual partners. Increased NT thickness and DVPI moderately correlate with CHD incidence.