Preterm birth remains a critical global health issue, contributing to approximately one-third of neonatal deaths worldwide. In Rwanda, complications of preterm birth contributed to the second cause on neonatal mortality with specifically two district hospitals (i.e. Kiziguro and Ngarama) located in Gatsibo district reported threefold higher preterm neonatal mortality as compared to national average. We aimed to determine the proportion and determinants of preterm neonatal mortality in two rural hospitals in Gatsibo district, Rwanda. We conducted a retrospective cross-sectional study using records of all preterm neonates admitted to Kiziguro and Ngarama hospital neonatal units, between January 2020 and December 2024. Data were extracted from neonatal files and maternity registers. Descriptive statistics were used to describe the study variables. Bivariate and multivariable logistic regression analyses were conducted to identify the determinants of preterm neonatal mortality. We reported odds ratios, 95% CIs, and p values, and we set the significance at the 95% confidence level. The majority of preterm deaths occurred at Kiziguro district hospital (21.0%, n = 1217). The determinants of preterm neonatal mortality were early gestational age (aOR = 2.47, 95% CI: 1.30-4.65), neonatal sepsis (aOR = 3.35, 95% CI: 1.98-5.69), hypothermia (aOR = 1.72, 95% CI: 1.12-2.66), need for special care unit services (aOR = 5.32, 95% CI: 2.61-11.96), poor respiratory support (aOR = 7.63; 95% CI: 3.69-15.80), poor bilirubin management (aOR = 2.82, 95% CI: 1.50-5.27), and inadequate kangaroo mother care practices (aOR = 51.82, 95% CI: 31.77-84.51). The proportion of preterm mortality was approximately similar to the national figures. Key determinants associated with preterm neonatal mortality included: early gestational age, maternal infections, inadequate kangaroo mother care (KMC), neonatal sepsis and inadequate respiratory support. Thus, continuous neonatal capacity building, improved KMC practices, appropriate use of neonatal equipment and regular cleanliness are recommended.

To synthesize evidence on the benefit-risk profile of antenatal corticosteroid (ACS) exposure in twin pregnancies and to explore effect modification by gestational age at birth and study design. PubMed, Embase, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials (from inception to October 2025) were searched using terms for twin pregnancy or multiple gestation and antenatal corticosteroids (eg, betamethasone, dexamethasone). In accordance with Preferred Reporting Items for Systematic Reviews and Meta-analysis (PROSPERO CRD420251275650), we included randomized controlled trials (RCTs) and observational studies comparing ACS exposure with no ACS in twin pregnancies and reporting neonatal outcomes. Observational studies were eligible only if they reported adjusted effect estimates accounting for relevant confounders. Primary outcomes were neonatal mortality and neonatal hypoglycemia; key secondary outcomes included neonatal intensive care unit (NICU) or special care unit admission and major respiratory outcomes. Risk of bias was assessed with version 2 of the Cochrane Risk of Bias tool and Risk of Bias in Non-randomized Studies of Interventions. Random-effects meta-analyses were conducted to estimate risk ratios (RRs) with 95% CIs. Heterogeneity was assessed with the I2 statistic, and small-study effects were evaluated when feasible. Prespecified subgroup analyses examined gestational age (less than 34 weeks vs 34 or more weeks) and study design. Sixteen studies (18,367 neonates, 8,723 ACS exposed) were included. Overall, the certainty of evidence was moderate to low. Exposure to ACS was not significantly associated with a reduction in neonatal mortality (RR 0.77, 95% CI, 0.59-1.01). Antenatal corticosteroid was not associated with a reduction in respiratory distress syndrome (RDS) overall (RR 1.11, 95% CI, 0.81-1.52), and gestational age-stratified analyses were nonsignificant; however, analyses restricted to RCTs suggested a higher risk of RDS among ACS-exposed neonates (P<.001). Exposure to ACS was associated with increased supplemental oxygen requirement (RR 1.72, 95% CI, 1.07-2.74), neonatal hypoglycemia (RR 1.80, 95% CI, 1.30-2.51), and NICU or special care unit admission (RR 1.33, 95% CI, 1.07-1.64), with consistent hypoglycemia effects across gestational ages. In twin pregnancies, ACS exposure was not consistently associated with improved neonatal outcomes, with no overall reduction in RDS and neonatal mortality. Associations with increased risks of hypoglycemia, oxygen requirement, and NICU or special care unit admission were observed. Given the moderate-to-low certainty of the available evidence, these findings should be interpreted cautiously. PROSPERO, CRD420251275650.

Infection control challenges during 4 years of COVID-19 in a French psychiatric institution (2020-2024).

BackgroundCoronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, was first identified in late 2019 and went on to profoundly disrupt health care systems worldwide. The pandemic led to unprecedented increases in healthcare delivery costs, widespread disruption in medical supply chains, workforce instability, and a loss of typical inpatient caregiver support. These challenges affected all levels of care, from primary health services to highly specialized intensive care units (ICUs). Before vaccines were available, ICUs were overwhelmed by critically ill patients requiring mechanical ventilation, saturating capacity and straining staff.ObjectivesThis article seeks to examine the effect that COVID-19 had on ICUs globally, acknowledging its impact with an aim to identify solutions that can be used to help mitigate the overburdening of this limited resource in future pandemics.MethodsA narrative review approach was used, drawing on published literature, observational data, and institutional responses from 2020 to 2025, to analyze structural, operational, and clinical adjustments in ICU design and function.ResultsKey adaptations included physical redesigns, rapid infection-control upgrades, the use of negative pressure rooms, expansion of tele-ICU systems, and virtual family engagement strategies. These interventions were implemented to address ICU crowding, equipment shortages, and staff burnout, and helped to maintain continuity of care during surge conditions.ConclusionsThe COVID-19 pandemic demonstrated the need for ICUs to be more agile, scalable, and future-facing. Lessons learned highlight the importance of preparedness strategies that strengthen ICU resilience and support critical care delivery in future public health emergencies.

BackgroundTo reduce avoidable Special Newborn Care Unit (SNCU) admissions by 15% over a 4-month period through focused quality improvement (QI) interventions at a high-volume tertiary care hospital in Kolkata, India.MethodsThis QI study was conducted from August to November 2024. Baseline data revealed that 25% of weekly SNCU admissions were avoidable. A multidisciplinary team implemented evidence-based admission criteria, enhanced perinatal care practices, and strengthened postnatal monitoring. Key interventions included improved delivery room practices (respiratory support with CPAP, delayed cord clamping, early skin-to-skin contact, and early initiation of breastfeeding) and standardized triage protocols. Feeding support, prefeeding oromotor stimulation, antibiotic stewardship, and reverse transport to nearby SNCUs were also integrated. Four Plan-Do-Study-Act (PDSA) cycles supported infrastructure planning, staff training, protocol implementation, and sustainability.ResultsAvoidable admissions declined from 25% to 10% over 4-months. Bed occupancy dropped from a peak of 125% to 102%. Process indicators improved significantly: delayed cord clamping increased from 30% to 88%, early initiation of breastfeeding from 40% to 90%, and exclusive breastfeeding at discharge from 67% to 81%. Admissions for neonatal jaundice decreased following the implementation of updated AAP guidelines, with 21% of cases managed without phototherapy. Only five re-admissions (0.59%) and one emergency NICU transfer (0.13%) occurred.ConclusionsNeonatal care should extend beyond SNCU optimization to include strengthened delivery point and postnatal-ward practices. When integrated with protocol based SNCU management, this continuum helps reduce morbidity, ease overcrowding, enhance efficiency, and optimize resource utilization in high-burden, resource-limited settings.

Experiences with a Shared Position Between Specialized and Basic Palliative Care: A Qualitative Study.

Perinatal asphyxia accounts for nearly one-quarter of neonatal complications worldwide, positioning as a primary driver of neonatal death and long-term health issues. For neonates identified with perinatal asphyxia, the probability of adverse outcomes fluctuates throughout their hospitalization, with distinct patient characteristics and medical variables impacting their recovery path differently at various points post-admission. Survival-based approaches that use duration of stay as the time scale are therefore essential for characterizing this time-varying risk in resourcelimited settings. A study was conducted on neonates admitted to the Neonatal Intensive Care Unit (NICU) and Special Newborn Care Units (SNCU) at Dr. Ram Manohar Institute of Medical Sciences (RMLIMS) in Lucknow, Uttar Pradesh, from January 1, 2024, to December 31, 2024, covering the period from admission to discharge. The event of interest was on perinatal asphyxia morbidity in neonates. Neonates who were discharged alive were treated as censored observations. We used semi-parametric Cox proportional hazards regression and parametric Weibull, Exponential, log-logistic, and Gompertz survival models to identify key predictors of perinatal asphyxia. Among these applied models, the Weibull proportional hazards model showed the best fit. The model's adequacy was confirmed with the Cox-Snell residual plot. Key significant predictors of perinatal asphyxia included the absence of cry at birth, a low five-minute APGAR score (Appearance, Pulse, Grimace, Activity, and Respiration), preterm gestational age, prolonged labor, fetal distress, and the need for resuscitation at birth. Weibull parametric survival models offer a solid framework for understanding time-dependent perinatal asphyxia risk in resource-limited NICU settings. The identified predictors define a clinically actionable risk profile spanning intrapartum events, neonatal condition at birth, and gestational maturity.

Globally, an estimated 2.3 million neonatal deaths occur annually, with over 90% concentrated in low- and middle-income countries (LMICs). As survival among preterm and low birth weight infants improves, there is a growing need to ensure survival with quality. Developmentally supportive care (DSC) and family participatory care (FPC) have emerged as evidence-based approaches that enhance neurodevelopment, reduce stress, and strengthen caregiver involvement, although their implementation in LMICs remains variable. This narrative review with systematic search strategy synthesizes global and Indian evidence on DSC and FPC, outlines key implementation models, and highlights contextual innovations and future priorities. A narrative review with systematic search strategy was conducted using PubMed, Scopus, WHO IRIS, Cochrane Library, UNICEF repositories, and Google Scholar. Eligible studies included human research evaluating DSC or FPC interventions in neonatal intensive care unit/special newborn care unit settings. Case reports, commentaries, and nonempirical studies were excluded. Evidence was synthesized thematically across developmental care, family engagement, health-system readiness, and clinical outcomes. DSC interventions, including protected sleep, positioning, sensory regulation, and pain mitigation, demonstrated improvements in neurodevelopment, breastfeeding, weight gain, and parental satisfaction. Family integrated care/FPC models from Canada, Australia, China, and India showed reduced parental stress, improved breastfeeding and growth, and, in some settings, lower infection rates and shorter hospital stay. Integration of kangaroo mother care (KMC/immediate KMC) further enhanced bonding and survival outcomes. India's policy frameworks (India Newborn Action Plan, LaQshya, and National Quality Assurance Standards) and state-led programs support contextual adaptation. DSC and FPC are essential components of high-quality neonatal care. Scalable, evidence-informed models such as India's DSC-FPC approach can advance national and global goals for neonatal survival and neurodevelopment.

Objective: To assess neurodevelopmental outcomes and growth in high-risk infants post discharge from a level 3 newborn unit.Methodology: Eligible high-risk infants were enrolled in this longitudinal follow-up study, and anthropometric measurements were interpreted using the WHO Anthro software (WHO, Geneva, Switzerland) at three, six, nine, and 12 months corrected age (CA). Neurodevelopment assessment was done using the Developmental Assessment Scale for Indian Infants (DASII) at six- and 12-month CA. Logistic regression analysis was used to identify risk factors associated with developmental delays.Result: Among 296 high-risk infants, 194 completed 12-month follow-up; seven died (2.4%), and 95 were lost to follow-up. Motor delay affected 29 (12.6%) at six months and 15 (7.7%) at 12 months; corresponding figures for mental delay were nine (4%) and seven (3.6%). At 12 months, the strongest predictors of motor delay were shock (OR: 78.1; 95% CI: 26.6, 228), hypoxic-ischemic encephalopathy (HIE) (OR: 65.5; 95% CI: 14.1, 304), and meningitis (OR: 25.9; 95% CI: 8.2, 82.1). Significant predictors for mental delay included HIE (OR: 92.6; 95% CI: 12, 113.6), shock (OR: 79.6; 95% CI: 23.3, 271.7), meningitis (OR: 42; 95% CI: 9.3, 188), and ventilator support >24 hours (OR: 13; 95% CI: 6.4, 26.6). Other factors like birth weight <1000 grams (OR: 5.7; 95% CI: 2.0, 15.9) and sepsis (OR: 2.6; 95% CI: 1.4, 4.9) also remain significant risks throughout the first year. Growth faltering was greatest for weight/length-for-age Z-scores at three months and head circumference at nine months.Conclusion: Neurodevelopmental delays declined by 12 months but persisted in a vulnerable subset, with shock, HIE, and meningitis emerging as the strongest predictors. Growth faltering was most evident in early weight/length indices and later in head circumference.

Background:Solid organ transplant (SOT) recipients in Canada are particularly vulnerable to adverse hospital outcomes, especially during admissions involving a COVID-19 diagnosis. Limited evidence exists regarding how risks vary across different organ types and the extent to which a COVID-19 diagnosis influences hospital outcomes. This study aims to examine the association of organ subtypes on hospital morbidity and mortality, both in the presence and absence of a COVID-19 diagnosis in a large, nationally representative Canadian cohort.Methods:We used data from the Canadian Organ Replacement Register and the Discharge Database to examine hospitalization rates and in-hospital outcomes among all available adult SOT recipients with functioning grafts in Canada (excluding Quebec and Manitoba) from January 2021 to December 2022. In-hospital outcomes included transfer to a special care unit (SCU) and hospital mortality. Comparisons between organ subtypes (kidney, liver, heart, lung, and other/multi-organ) were conducted separately for admissions with and without a diagnosis of COVID-19, using kidney transplant (KT) recipients as the reference group. We included all admissions with a COVID-19 diagnosis irrespective of whether it was the primary reason for admission or not. Rates of hospitalization, SCU transfer, and mortality were analyzed using negative binomial or Poisson regression models (adjusted for age and sex) and reported using incidence rate ratios (IRRs) with 95% confidence intervals (CIs).Results:Among 23 497 SOT recipients, the majority (14 628, 62%) were KT recipients. Within this cohort, 2428 individuals (10.3%) experienced a total of 2925 hospitalizations with a COVID-19 diagnosis. In comparison, 7808 (33.2%) individuals experienced 17 656 hospitalizations without a COVID-19 diagnosis. Lung transplant recipients were more likely to be hospitalized (IRR = 1.65, 95% confidence interval CI: 1.52-1.80) and die in hospital (IRR = 1.2, 95% CI: 1.05-1.34) than KT recipients during admissions involving a COVID-19 diagnosis. In contrast, heart and liver transplant recipients were less likely to be hospitalized or experience a poor outcome. For hospitalizations without a COVID-19 diagnosis, lung and other/multi-organ transplant recipients were more likely than KT recipients to be hospitalized (IRR = 1.94, 95% CI: 1.76-2.15; IRR = 1.81, 95% CI: 1.45-2.26, respectively), transferred to an SCU (IRR = 1.89, 95% CI: 1.58-2.27; IRR = 1.81, 95% CI: 1.45-2.26, respectively), and die in hospital (IRR = 2.04, 95% CI: 1.84-2.27; IRR = 1.57, 95% CI: 1.33-1.85; respectively).Conclusion:SOT recipients in Canada, especially lung transplant recipients, experience high rates of hospitalization, SCU admission, and in-hospital mortality. Notable differences observed between organ subtypes for admissions with and without a COVID-19 diagnosis may reflect differences in immunosuppressive medication regimens, informing areas for future research.

Purpose: This study investigated the influence of nursing informatics competency and clinical decision-making ability on patient safety competency among clinical nurses.Methods: A cross-sectional study was conducted from November to December 2023 with 201 nurses working in general and tertiary hospitals. Data were analyzed using descriptive statistics, the independent t-test, analysis of variance, Pearson’s correlation analysis, and hierarchical multiple regression.Results: Patient safety competency was positively correlated with nursing informatics competency (r=.51, &lt;i&gt;p&lt;/i&gt;&lt;.001) and clinical decision-making ability (r=.52, &lt;i&gt;p&lt;/i&gt;&lt;.001). Hierarchical multiple regression analysis indicated that clinical decision-making ability (β=.38) and nursing informatics competency (β=.38) were the strongest predictors of patient safety competency, with working in special care units (β=.18) also contributing significantly. Together, these variables explained 42.8% of the variance in patient safety competency.Conclusion: This study demonstrated significant associations among clinical decision-making ability, nursing informatics competency, and patient safety competency among clinical nurses. By examining the integrated relationships among these competencies, the findings provide empirical evidence for understanding factors that may influence patient safety outcomes in increasingly digitalized healthcare environments.

Objective: Sickle cell hemoglobinopathies are the most prevalent inherited blood disorders.According to the World Health Organization (WHO), around 5% of the global population carries a gene for an inherited hemoglobin (HB) disorder.This study is to identify the various maternal outcomes among pregnant women with sickle cell disease (SCD) at a tertiary healthcare center and to identify the various fetal outcomes among babies born to pregnant women with SCD at a tertiary healthcare center.It will also help us in assessing the role of proper antenatal care (ANC) to reduce maternal and perinatal mortality in pregnant women with SCD and in the neonate.Materials and methods: This cross-sectional study was conducted over 18 months at a tertiary care hospital in Burla, Sambalpur.A total of 122 pregnant women diagnosed with SCD were included.Exclusion criteria encompassed pre-existing renal or liver disease, multifetal gestation, and other conditions potentially confounding the study.Results: The mean age of homozygous sickle cell disease (HbSS) type known as SCD (SS) mothers was 26.26 years.The maximum number of pregnant mothers was in the 21-25 age-group.The mean gravida was 1.9 in SS mothers, and most of the antenatal patients in this study were identified as primigravidae.The mean parity was noted to be 1.43 in SS mothers.Previous abortion history of one spontaneous abortion was seen to be 95.08% of SS mothers, and two or more was 4.92% in SS mothers.The mean body mass index (BMI) was 19.43 kg/m 2 in SS mothers.Mean Hb was 8.8 gm% in SS mothers.It was observed in the study that 2.01% SS mothers had severe to very severe anemia, and 62.01% had moderate anemia.A total of 66.2% of SS mothers required blood transfusion (BT).The mean serum bilirubin (S. bilirubin) level in SS mothers was 1.50 mg%.The maximum number of pregnant mothers in all groups was in the S. bilirubin group of 0-5.0 mg%.The presence of urine albumin (2+ and 3+) was seen in 14.7% of SS mothers.The study showed that hypertensive disorder of pregnancy (HDP) was seen in 10.5% of SS mothers.The presence of urine albumin also correlated with HDP.The maternal complications, such as crisis, were seen in 8.5% of SS mothers.The postpartum hemorrhage (PPH) and mortality in the SS mothers were 3.2-1.6%,respectively.Maternal mortality was seen in 2 (1.6%) cases of SS mothers, out of which 1 (50%) was attributed to crisis [vaso-occlusive crisis (VOC) and acute chest syndrome (ACS)], and the other death was attributed to co-morbidities like eclampsia and other complications like fetal growth restriction (FGR) were seen in 14.1% of SS mothers.The number of vaginal deliveries (VDs) in the case of SS mothers was 23.7%.The number of pregnant mothers who underwent lower segment cesarean section (LSCS) was 72.21%, and instrumental delivery was 4.09% in SS mothers, respectively.The incidence of preterm deliveries in SS mothers was 18.86%.Low-birth-weight (LBW) babies in SS mothers accounted for 31.9%.There was a low APGAR score in the babies of SS mothers, which is 13.6%.It was observed that 12 (75%) neonates delivered by LSCS and 4 (25%) neonates delivered by VD to SS mothers had low APGAR scores, respectively.Stillborn babies (fresh and macerated) were found in 4% of SS mothers.Total perinatal death was found in 8.1% of babies.It was observed that special newborn care unit (SNCU) admissions were higher among babies of SS mothers, which was 41.9%.Neonatal complications like hypoxic ischemic encephalopathy (HIE) were at 5.98%, anemia was 7.69%, and jaundice was at 7.69% in babies born to SS mothers.Septicemia was found in 5.12% of babies born to SS mothers, respectively. Conclusion:Our study shows that close monitoring of individual pregnancy with SCD can result in a good fetomaternal outcome.Therefore, all these cases require special attention in view of the correction of anemia by BT and prevention of vaso-occlusive complications of SCD, which will give a better prognosis.Adverse fetal outcomes are more common with SCD than general population.Fetal complications are mainly jaundice, neonatal anemia, HIE, and neonatal death.A multidisciplinary approach is required for the comprehensive management of women with SCD so that complications can be dealt with carefully.

India's Special Newborn Care Units are critical for reducing preventable neonatal deaths. Systematic evaluation of admission patterns provides evidence for targeted healthcare improvements. Birth asphyxia dominates rural neonatal morbidity. Focused investments in intrapartum monitoring, resuscitation training, and rapid referral systems are essential for reducing preventable deaths.

Introduction and aimsSelf-medication appears to be a common practice for dental pain. However, in France, its prevalence and patterns in dentistry have never been studied. The primary objective was to assess the prevalence and self-medication behaviours in two at-risk populations: patients consulting for acute pulpal or periapical pain and patients with dental anxiety requiring treatment under general anaesthesia. The secondary objective was to examine the influence of socio-behavioural factors on these practices.MethodBetween April 2021 and May 2023, the behaviours of two at-risk population regarding self-medication were analysed in a cross-sectional observational study. The first population regrouped patients referred to an endodontic postemergency care unit after visiting the emergency service of a dental hospital. These patients were referred due to acute pulpal or periapical pain (Endodontic Group). The second population regrouped patients referred to a special care unit for dental treatment under general anaesthesia due to dental anxiety (Anxiety Group). Self-medication behaviours of the two at-risk populations were analysed with 5 self-administered questionnaires (self-medication, EPICES, IDAF-4C, Pain Catastrophizing Scale, Socio-demographic data). Comparisons between the two population were done using Pearson’s chi-square and Student’s t tests.ResultsDuring the study period, 43 patients were included in the endodontic group and 66 in the anxiety group. Socio-demographic and behavioural data differed between the two groups. However, self-medication prevalence was similar (51.2% in the Endodontic Group vs 45.5% in the Anxiety Group), as were self-medication behaviours (types and number of substances used, methods of acquisition, knowledge). No socio-demographic or behavioural factors explained these attitudes.ConclusionSelf-medication in dentistry is often overlooked or poorly managed. Preventive measures and patient education on the proper use of medication are essential.Clinical relevanceStandardized cooperation protocols should be developed involving dentists and community pharmacists to optimize the management of patients suffering from dental pain.

Enhancing evidence-based practices and person-centered care during induction of labor: Insights from a quality improvement study conducted in a low-resource setting.

Background: Elective caesarean section at term, performed in the absence of labour, is associated with increased risk of neonatal respiratory morbidity due to impaired lung fluid clearance. Antenatal corticosteroid administration has been proposed to mitigate this risk, but evidence regarding its efficacy in term neonates remains inconclusive. Objectives: To evaluate the effect of antenatal corticosteroid administration on neonatal outcomes, including resuscitation requirements, Apgar scores, and neonatal unit admissions, in term neonates delivered by elective caesarean section. Material and Methods: A retrospective study was conducted on 700 term neonates (?37 weeks gestation) delivered by planned lower segment caesarean section (LSCS). The study group (n=350) comprised neonates whose mothers received antenatal corticosteroids prior to delivery, while the control group (n=350) did not receive corticosteroids. Primary outcomes measured included need for resuscitation (bag-and-mask ventilation and endotracheal intubation), Apgar scores at 1 and 5 minutes, admission to Special Baby Care Unit (SBCU), and requirement for Neonatal Intensive Care Unit (NICU) care. Incidence and relative risk (RR) were calculated to assess outcomes. Results: The study and control groups were comparable with respect to maternal age (30 vs. 30.5 years), neonatal sex distribution (male 54.3% vs. 52.3%), birth weight (3200 g vs. 3274 g), and amniotic fluid characteristics (clear 92% vs. 91%). The corticosteroid group demonstrated lower incidence across all measured outcomes: bag-and-mask resuscitation (6.6% vs. 9.7%, P=0.129), endotracheal intubation (0.9% vs. 2.3%, P=0.224), 1-minute Apgar score <8 (6.9% vs. 10.3%, P=0.105), 5-minute Apgar score <8 (5.4% vs. 9.1%, P=0.059), SBCU admission (3.1% vs. 6.9%, P=0.024), and NICU care requirement (1.4% vs. 3.4%, P=0.086). SBCU admission was the only outcome achieving statistical significance. Conclusion: Antenatal corticosteroid administration was associated with a statistically significant reduction in SBCU admission among term neonates delivered by elective caesarean section. While all other neonatal outcomes exhibited a favourable trend in the corticosteroid group, they did not attain statistical significance, suggesting a potential benefit that warrants further investigation through larger, multi-centre randomised controlled trials.

Background: Neonatal mortality represents a major public health concern characterised by complex survival dynamics and substantial aetiological heterogeneity. Appropriate survival modelling of time-to-event data is essential for elucidating disease-specific risk profile during the critical first 28 days of life. Neonatal mortality in intensive care settings exhibits an early-peak hazard profile inadequately captured by semiparametric methods alone. Comparative evaluation of parametric proportional hazard (PH) models that explicitly parameterise the baseline hazard provides both superior fit diagnostics and direct hazard quantification. Objectives: To compare parametric survival models and identify the optimal distributional fit for neonatal mortality data, and to determine prognostic factors using the best-fitted model for neonatal outcome. Methods: A prospective study design was used to collected the data of 686 neonates admitted to the Neonatal Intensive Care Unit (NICU) and Special Newborn Care Unit (SNCU) at Dr. Ram Manohar Lohia Institute of Medical Sciences (RMLIMS), Lucknow, was followed from admission until death, discharge, transfer, or day 28. Four survival models were fitted and compared by Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC). The proportional hazards (PH) assumption was assessed via Schoenfeld residuals with global test. Discriminative ability was evaluated using Harrell's C-concordance statistic Results: Among 686 neonates, 155 (22.59%) died during follow-up. The Weibull PH model achieved the best fit (AIC = 827.77; BIC = 927.44). Key independent predictors included extreme prematurity, congenital malformations, perinatal asphyxia, neonatal sepsis, induced labour, and multiparity. The global Schoenfeld test supported the proportional hazards assumption (p = 0.0976). Harrell's C = 0.7948 indicated good discriminative performance. Conclusions: The Weibull PH model provides the best parametric characterisation of neonatal mortality hazard dynamics. Extreme prematurity, critical clinical diagnoses, and induced labour are dominant independent hazard determinants, consistent across all model specifications.

Background: Predicting short-term mortality in patients receiving palliative care can help tailor interventions, manage expectations, and improve end-of-life planning. This study explores whether candidiasis, particularly in patients on corticosteroids, is associated with increased 30-day mortality. Methods: We conducted a retrospective study of patients admitted to a specialized palliative care unit in 2022. Data collected included demographics, candidiasis diagnosis (oral/esophageal), corticosteroid use, and mortality. Patients with candidemia were excluded. Of 59 deaths in the unit, 35 had complete records and met inclusion criteria. Results: Of the 35 patients analyzed, 71.4% were female; the median age was 61. Ten patients developed candidiasis, all with advanced cancer and functional decline. Among candidiasis cases, 30-day mortality was 60% versus 0% in those without. Median time from candidiasis diagnosis to death was 19 days. Among corticosteroid users, candidiasis was associated with significantly higher short-term mortality. Conclusions: Candidiasis in patients receiving palliative care—particularly those on corticosteroids—may indicate imminent death. These findings suggest its potential as a simple prognostic marker in resource-limited settings, meriting further prospective validation.

Background:Mucocutaneous fungal infections, particularly oral and genital candidiasis, are the most common fungal diseases in neonatal populations. Although generally mild, non-invasive Candida infections can serve as sources of colonization increasing the risk of progression to invasive candidiasis, especially in preterm neonates.Objective Design, Setting, Patients, and Interventions:This study aimed to describe the infection prevention and control (IPC) measures, including contact precautions, disinfection of environment and shared devices and the review of hand hygiene protocols implemented during an outbreak of neonatal Candida spp. infections in a newborn nursery and special care unit of a secondary hospital, and to analyze associated neonatal and maternal risk factors.An observational cohort study was conducted following the identification of an outbreak between April and June 2024. A case was defined as a neonate with clinical signs of oral or genital candidiasis and/or microbiological confirmation from mucosal swabs.Results:125 neonates and mothers were included, 16 neonates (12.8%) met the case definition. Female sex, small-for-gestational-age status, Apgar score <7, and need for phototherapy were significantly associated with infection. Maternal primiparity also showed a significant association, whereas maternal vaginal Candida colonization and antibiotic exposure did not. After the implementation of IPC measures, decline of cases was observed. All affected neonates received antifungal therapy and recovered fully without progression to invasive disease.Conclusion:This outbreak demonstrates that even full-term neonates can be at risk for mucocutaneous Candida infection. The application of IPC measures highlights the importance of surveillance, and environmental sanitation in controlling infection transmission.

People with young-onset dementia (YOD), defined as symptom onset before the age of 65, have mortality rates five to eight times higher than those of the general population of similar age. However, survival studies focused on individuals living in the community rather than those residing in nursing homes. This study aimed to estimate survival rates, its determinants, and causes of death in nursing home residents with YOD. Survival data from the BEYOnD (2005-2018) and Care4Youngdem (2016-2021) cohort studies. YOD special care units of 20 nursing homes in the Netherlands. Nursing home residents with YOD (N = 385). Kaplan-Meier estimates were used to determine survival times. Cox regression analysis examined factors associated with mortality, including age, sex, dementia type, and cardiovascular and pulmonary diseases. Hazard ratios were pooled using a random-effects meta-analysis. Median survival after diagnosis was 8.9 years (95 % CI 7.8-10.1) in BEYOnD and 7.9 years (95 % CI 6.9-9.0) in Care4Youngdem. Median survival after admission was 6.3 (95 % CI 5.3-7.2) and 5.0 (95 % CI 4.4-5.6) years, respectively. In the pooled model, higher age at diagnosis (HR 1.06 per year increment) and male sex (HR 1.36) were significantly associated with higher mortality; dementia type and comorbidities were not. Cachexia or dehydration was the most frequent cause of death (35.3 %). Nursing home residents with YOD have long survival times, in particular women and those diagnosed at younger ages. Our results highlight important considerations for prognostication and organizing long-term care. NL-OMON23226 (Registry: OMON).