Symptomatic Newborns Research Articles

Perinatal Outcomes of Non-Primary Maternal Cytomegalovirus Infection: A 15-Year Experience

Objective: To evaluate perinatal outcomes in case of non-primary maternal cytomegalovirus (CMV) infection. Methods: We performed a retrospective cohort study of pregnant women with active CMV infection referred to our unit over a 15-year period (January 2000 to December 2014). Non-primary infection was diagnosed on the basis of the results of confirmatory serological and virological tests (avidity test, immunoblotting, real-time PCR-DNA). The vertical transmission rate and the percentage of symptomatic congenital infection were determined in this group of patients. Results: A total of 205 pregnant women were enrolled. Congenital infection occurred in 7 (3.4%) fetuses/neonates. Symptomatic disease was present at birth in 3 of the 7 congenitally infected neonates (1.5%). Two out of 3 symptomatic newborns presented a pathologic second-trimester ultrasound scan. Conclusion: Maternal immunity offers substantial protection against intrauterine transmission of CMV infection, but not against disease once the fetus is infected.

Neonatal Effects after Selective Serotonin Reuptake Inhibitors and Benzodiazepines Administration during Pregnancy

Aims: To evaluate whether the co-administration of benzodiazepines (BDZ) and selective serotonin and serotonin/norepinephrine reuptake inhibitors (SSRI/SNRI) during pregnancy is associated with an increased risk of abstinence symptoms in the newborns. Methods: Twenty six neonates exposed in utero to SSRI/SNRI were studied. The presence of symptoms possibly due to neonatal abstinence syndrome, BDZ exposure, weight, age at birth and duration of hospitalization were recorded. Blood levels of SSRI/SNRI and BDZ were measured in all neonates. Results: Neonatal blood levels of SSRI/SNRI were within or below normal adult therapeutic range in 21 newborns (81%). Thirteen newborns (50%) were symptomatic. Neonates born from mothers receiving co-administration of SSRI/SNRI and BDZ had a higher risk of developing symptoms as compared to those whose mother was not receiving BDZ (9/13, 69% versus 4/13, 31%, p ≤ 0.05). At birth, symptomatic newborns displayed a significatively lower weight and gestational age than asymptomatic neonates (2609 ± 301 vs 3112 ± 310 g, and 36 ± 1 vs 39 ± 1 week, respectively, p < 0.001). No relationship was found between symptoms and neonatal blood levels of either SSRI/SNRI or BDZ. Conclusions: Our results suggest that the co-administration of SSRI/SNRI and benzodiazepines during pregnancy may be associated with an increased risk of neonatal symptoms. However, these symptoms are not related to blood levels and may be attributed to prematurity leading to a longer hospital stay.

Congenital and perinatal complications of chikungunya fever: a Latin American experience

During the years 2014 and 2015, the Region of the Americas underwent a devastating epidemic of chikungunya virus (CHIKV) of the Asian genotype, resulting in millions of affected individuals. However, epidemiological and clinical information on this experience is scarce. Prior knowledge of congenital and neonatal illness caused by CHIKV is limited and almost exclusively based on data obtained from a single outbreak of the East/Central/South African (ECSA) genotype. The effect of chikungunya fever (CHIKF) on pregnancy outcomes and its consequences for infants born to infected mothers at the peak of the epidemic wave in Latin America are reviewed herein. Epidemiological and clinical data on maternal and neonatal infections were collected prospectively and analyzed. One hundred sixty-nine symptomatic newborns with CHIKF seen at four large regional maternity hospitals in three different Central and South American countries were evaluated prospectively. The outcomes of pregnancies in symptomatic infected mothers at two of these clinical centers were also analyzed. The observed vertical transmission rate ranged between 27.7% and 48.29%. The incidence of congenital disease was unrelated to the use of cesarean section or natural delivery. The case fatality rate (CFR) at the only center that reported deaths was 5.3%. The most common clinical manifestations included fever, irritability, rash, hyperalgesia syndrome, diffuse limb edema, meningoencephalitis, and bullous dermatitis. Severe complications included meningoencephalitis, myocarditis, seizures, and acute respiratory failure. Leukocytosis with neutrophilia and normal or increased platelets was a common finding, and in those with signs of meningeal involvement, moderate lymphocytic pleocytosis with normal glucose and protein levels was typical. This study presents the largest number of symptomatic neonates with CHIKF analyzed so far in any region and is the first involving infection with the Asian genotype of CHIKV. Although the clinical manifestations found were similar to those reported previously, the percentage of neurological complications was lower. The CFR was comparatively high. Chikungunya represented a substantial risk for neonates born to symptomatic parturients during the chikungunya outbreak in the Americas Region, with important clinical and public health implications.

221 newborn-screened neonates with medium-chain acyl-coenzyme A dehydrogenase deficiency: Findings from the Inborn Errors of Metabolism Collaborative.

There is limited understanding of relationships between genotype, phenotype and other conditions contributing to health in neonates with medium-chain acyl-coenzyme A dehydrogenase deficiency (MCADD) identified through newborn screening. Retrospective analysis of comprehensive data from a cohort of 221 newborn-screened subjects identified as affected with MCADD in the Inborn Errors of Metabolism - Information System (IBEM-IS), a long term follow-up database of the Inborn Errors of Metabolism Collaborative, was performed. The average age at notification of first newborn screen results to primary care or metabolic providers was 7.45days. The average octanoylcarnitine (C8) value on first newborn screen was 11.2μmol/L (median 8.6, range 0.36-43.91). A higher C8 level correlated with an earlier first subspecialty visit. Subjects with low birth weight had significantly lower C8 values. Significantly higher C8 values were found in symptomatic newborns, in newborns with abnormal lab testing in addition to newborn screening and/or diagnostic tests, and in subjects homozygous for the c.985A>G ACADM gene mutation or compound heterozygous for the c.985A>G mutation and deletions or other known highly deleterious mutations. Subjects with neonatal symptoms, or neonatal abnormal labs, or neonatal triggers were more likely to have at least one copy of the severe c.985A>G ACADM gene mutation. C8 and genotype category were significant predictors of the likelihood of having neonatal symptoms. Neonates with select triggers were more likely to have symptoms and laboratory abnormalities. This collaborative study is the first in the United States to describe health associations of a large cohort of newborn-screened neonates identified as affected with MCADD. The IBEM-IS has utility as a platform to better understand the characteristics of individuals with newborn-screened conditions and their follow-up interactions with the health system.

Effects of Balloon Pulmonary Valvuloplasty as Preoperative Palliation for Tetralogy of Fallot.

We investigated the effect of balloon pulmonary valvuloplasty (BPV) as a palliative procedure for patients with tetralogy of Fallot (TOF). This was a retrospective single-center study conducted between 2008 and 2014. We classified patients into three groups according to palliation: treatment with BPV (group I), with a Blalock-Taussig shunt (group II), and with infundibulectomy (group III). The growth of the pulmonary valve (PV) annulus and need for transannular patching (TAP) during total correction were compared between groups. Forty-eight patients were enrolled: 31, 10, and 7 in groups I, II, and III, respectively. The mean ages at palliation were 26.3 ± 23.6, 21.5 ± 16.4, and 15.2 ± 4.2 days in groups I, II, and III, respectively (P = .867). The success rate of BPV was 90.3%. The initial PV z-score before palliation did not differ between groups I, II, and III (-3.14 ± 1.44, -3.84 ± 1.47, and -3.71 ± 1.68; P = .494); the preoperative PV z-score before total correction was larger in group I than in group II (-1.19 ± 1.14 and -3.05 ± 1.19; P = .001), and also larger in group III than in group II (group III: -1.10 ± 0.90; P = .003). The change in pulse oxygen saturation differed significantly between the three groups (P = .031), particularly between groups I and II (P = .010), and the change in PV z-score was greater in groups I and III than in group II (P < .001). TAP during total correction was performed in 29.0%, 90.0%, and 16.7% of groups I, II, and III, respectively (P = .001; group I vs. II, P = .001; group II vs. III, P = .008). BPV was an effective and safe palliation that increased pulmonary blood flow and promoted growth of the PV annulus in selected symptomatic newborns with TOF.

Primary HCMV infection in pregnancy from classic data towards metabolomics: An exploratory analysis

BackgroundHuman cytomegalovirus (HCMV) is one of the most frequent risk of viral infections during pregnancy. The aim of this study was to evaluate the metabolic profile in amniotic fluid (AF) samples obtained from HCMV-infected, and uninfected fetuses in order to elucidate changes in metabolic pathways during congenital HCMV infection and to recognize new potential diagnostic and/or prognostic biomarkers. MethodsA retrospective cohort study was conducted on 63 pregnant women: 20 contracted primary HCMV infection during pregnancy and, subsequently, transmitted the virus to the fetus (transmitters); 20 contracted the infection without transmitting the virus to the fetus (non-transmitters); 23 who underwent amniocentesis for cytogenetic-based diagnosis were considered controls. Metabolomics analysis was performed by using the hyphenated technique Gas chromatography-mass spectrometry (GC–MS) followed by a multivariate statistical approach. Four PLS-DA models were generated: controls vs. transmitters; controls vs. non-transmitters; transmitters vs. non-transmitters; and asymptomatic infected vs. symptomatic infected newborns. Subsequently, these models were exploited for network mapping. ResultsCompared with controls, HCMV transmitters showed significantly increased levels in glutamine, glycine, serine, pyruvic acid, threonine, threonic acid, and cystine; conversely, unknown U1715 and U1804, glutamic acid, U1437, fructose, sugar-like A203003 and A203005, and tyrosine levels were found decreased. In non-transmitters, glutamine, serine, glycine, threonic acid, threonine, 1-monostearin, urea, and cystine were found increased, while sorbitol, unknown U1804, sugar-like A203003, U1751, xylitol, leucine and fructose were decreased. The comparison between transmitters and non-transmitters did not produce a statistically significant model. Unlike controls' profile, a common feature of HCMV infected subjects (transmitters and non-transmitters) was the activation of glutamine-glutamate and pyrimidine metabolic pathways. In addition, a clusterization for asymptomatic vs. symptomatic outcome was also observed due to alteration of fatty acids biosynthesis. ConclusionsMetabolomics approach could highlight the significant modification of maternal and placental status during HCMV infection for both transmitter and non-transmitter subjects. A further separation was observed for asymptomatic vs. symptomatic HCMV congenital infections model. Therefore, metabolomics may be a promising tool to improve the accuracy of an early diagnosis, and the management of HCMV pregnancy-related infections.

Impact of a cytomegalovirus kinase inhibitor on infection and neuronal progenitor cell differentiation

Human cytomegalovirus (HCMV) is the leading cause of congenital infections. Symptomatic newborns present with a range of sequelae including disorders of the CNS such as visual impairment, microcephaly, mental retardation and hearing loss. HCMV congenital infection causes gross changes in brain morphology and disturbances in glial and neuronal distribution, number and migration. In these studies, we have evaluated the effectiveness of the antiviral maribavir in inhibiting HCMV infections of ES cell-derived neuronal progenitor cells (NPC). We used EZ-spheres generated from H9 ES cells which are pre-rosette NPCs that retain long-term potential to differentiate into diverse central and peripheral neural lineages following directed differentiation. Our results demonstrate that the maribavir disrupts HCMV replication and viral yield in undifferentiated EZ-sphere-derived NPCs. In addition, we observed that maribavir limits HCMV replication and reduces the percentage of infected cells during differentiation of NPCs. Finally, early steps in differentiation are maintained during infection by treating with maribavir, likely an indirect effect resulting from decreased viral spread. Future studies of NPC proliferation and differentiation during infection treated with maribavir could provide the impetus for studying maribavir as an antiviral agent for congenital HCMV disease.

Profil clinique et bactériologique des infections néonatales bactériennes à l’Hôpital Laquintinie de Douala, Cameroun

IntroductionL'Organisation Mondiale de la Santé a estimé la survenue globale de décès néonatal à 2,8 millions en 2015, dont 47,6% étaient dues aux infections. Ces infections peuvent survenir chez un nouveau-né de 0 à un mois de vie, pouvant aller jusqu’à 3 mois.MéthodesC'est une étude prospective allant du 1er mars au 30 juin 2015 au Service de néonatologie de l'Hôpital Laquintinie de Douala. Etaient inclus tout nouveau-né symptomatique avec ou sans critère anamnestique et tout nouveau-né asymptomatique, présentant au moins un risque infectieux et ayant au moins une culture positive ou une anomalie de la numération formule sanguine ou une protéine C réactive positive.RésultatsDes 310 nouveau-nés admis, 300 ont été retenus pour infection néonatale, soit une incidence de 96,8%. Nous avons réalisé 104 cultures dont 25 positives, soit une incidence de l'infection néonatale confirmée de 24%. Les facteurs associés à l'infection étaient la prématurité inexpliquée <35 semaines d'aménorrhée(45,1%) et la réanimation néonatale (34,8%). La fièvre (56%) et les troubles neurologiques (48,8%) étaient les manifestations cliniques les plus fréquentes. Les Gram négatifs étaient les germes les plus fréquents (56%). L'imipenème (95%) et l'amikacine (66,7%) étaient les antibiotiques les plusefficaces. L’évolution était favorable dans 66,4% des cas et le taux de décès était de 33,6%.ConclusionCette étude révèle une forte prévalence de l'infection dans cet hôpital. L’écologie bactérienne est dominée par les Gram négatifs, on note une importante résistance aux antibiotiques usuels et une mortalité assez élevée.

Congenital cytomegalovirus infection among twin pairs

Objective: The purpose of this study was to describe the fetal/neonatal cytomegalovirus (CMV) status according to chorionicity and outcome in twin pregnancies diagnosed with CMV.Methods: An opportunistic diagnosis of CMV infection was performed in a tertiary referral center. All cases diagnosed in twin pregnancies (2006–2011) were included. Prenatal diagnosis was performed by CMV-DNA in the amniotic fluid (AF) of both fetuses only on the evidence of sonographic findings in either one or both twins. Neonatal screening was selectively assessed in symptomatic newborns, preterm, and infants born to HIV-infected mothers. Congenital infection was considered in the presence of CMV-DNA in AF, fetal tissues or newborn urine within the first 2 weeks of life, and symptomatic disease with clinical findings at birth or autopsy.Results: A total of six twin pregnancies with congenital CMV infection were diagnosed, five dichorionic and one monochorionic diamniotic. Only one sibling was infected among dichorionic pregnancies, two diagnosed prenatally, and three after birth. In the monochorionic pregnancy, the diagnosis was performed prenatally and the two fetuses were infected and severely damaged.Conclusions: Congenital CMV infection in twins might be related, among other factors, to chorionicity, and in DC twins a non-concordant infection can be expected.

Characterization and six-month follow-up on a cohort of newborns with congenital syphilis.

Congenital syphilis is a preventable disease. However, the incidence in Colombia has increased and reached the figure of 3.28 cases per 1,000 live births in 2011. To characterize newborns with congenital syphilis and describe follow-up over 6 months following their diagnosis and treatment. Between August, 2011, and February, 2012, in Hospital La Victoria, sede Instituto Materno Infantil, newborns with congenital syphilis were identified and treated. Clinical and laboratory follow-up was carried out for six months until it was determined that the disease was cured. The analyzed variables included patients' clinical and laboratory characteristics. In this period, we identified 29 cases that met the criteria of congenital syphilis, with a frequency in the institution of one case per 69 births. There was one stillbirth and one neonatal death, four were premature, and five had growth restriction. Of the 28 live births, 15 were asymptomatic. There were two cases with neurosyphilis, representing 15% of symptomatic newborns. Follow-up was done on 18 out of 27 children (66.6%), including most symptomatic cases and the two cases of neurosyphilis. All cases showed the expected decrease in VDRL titers without clinical sequelae, meeting the criteria of being cured. A high incidence of the disease, failure to prevent it, varied expression in its presentation, and the effectiveness of treatment in the neonatal period were evidenced in this study.

Low total IgM values and high cytomegalovirus loads in the blood of newborns with symptomatic congenital cytomegalovirus infection.

Neurological outcomes differ considerably between symptomatic and asymptomatic infants with congenital cytomegalovirus (CMV) infection. Our objective was to characterize laboratory markers in symptomatic newborns in comparison with asymptomatic newborns with congenital CMV infection. Ten newborns with symptomatic and 13 newborns with asymptomatic congenital CMV infection were included in this 3-year prospective cohort study. Total immunoglobulin M (IgM), CMV-IgM, CMV antigenemia, and CMV-DNA in blood and urine were measured and their positive rates and quantitative values compared between the symptomatic and asymptomatic groups. Fifty percent of newborns in the symptomatic group were positive based on total IgM; this was significantly lower than in the asymptomatic group (100%). Quantitative total IgM values were significantly lower, and there were significantly more copies of CMV-DNA in the blood of symptomatic newborns than in asymptomatic newborns (median values for total IgM: 14 vs. 43 mg/dL and blood CMV-DNA: 3.2×102 vs. 3.5×101 copies/106 white blood cells). CMV-IgM, CMV antigenemia, and urine CMV-DNA did not differ significantly between groups. Low total IgM values and high blood CMV loads were associated with the presence of symptoms in newborns with congenital CMV infection.

English

AIMS: 1. To know the various risk factors of neonatal hypoglycemia and their incidence among the babies admitted in tertiary care hospital, ASRAM, Eluru. 2. To know the outcome of neonatal hypoglycemia in both symptomatic and asymptomatic newborns in tertiary care hospital, ASRAM, Eluru. DESIGN: Prospective study. SETTING: Tertiary hospital based study over 24 months. METHODS: Blood glucose values are measured using Reagent Strip method (Glucotrend2 of USA. and confirmed by Laboratory Diagnosis The blood glucose values were measured at 1, 2, 4, 6, 12, 24, 36, 48 and 72 hours of life or till discharge whichever is earlier. RESULTS: A total of 150 cases where observed of which 59 cases (33.3%) developed hypoglycemia. The common risk factors observed are low birth weight in 23(46%), sepsis in 12(24%), IDM in 5 (10%), asphyxia in 4(8%) and 6 cases (12%) have no risk factors. 76.9% of the cases have developed hypoglycemia at the first hour of life. In our study 52% of neonates with hypoglycemia have recovered well with oral feeds given at 30mins.The remaining 48% required glucose infusion. Only 1 case had recurrent hypoglycemia (2%) even on glucose infusion and it is controlled with single dose hydrocortisone. CONCLUSIONS: Hypoglycemia is a common in the newborns, and a high index of suspicion is required to identify it early. It is also an easily treatable problem, in most occasions. Hypoglycemia in the newborn if detected and treated early will prevent adverse neurodevelopmental outcome.

Valeur diagnostique des critères de suspicion d’infection néonatale précoce : bilan dix ans après les recommandations de l’Anaes

Because clinical symptoms and biological markers are neither sensitive nor specific, newborns are frequently suspected of having an infection. In France, 30-50% of newborns are suspected of having early-onset sepsis (EOS) and many of them undergo laboratory tests and empirical antibiotic treatments while awaiting results. The aim of this study was to evaluate the diagnostic value of various suspicion criteria for EOS as recommended by the Anaes since 2002, and the value of umbilical cord blood procalcitonin (PCT), currently assayed in our maternity ward. This 4-year retrospective study in the CHU of Nantes included hospitalized newborns with suspected early neonatal infection. Infection status was established according to the Anaes definitions and clinical evolution. The study included 2151 newborns. Among anamnestic criteria, only prematurity significantly increased the risk of EOS (relative risk of 3.1; 95% CI 1.4-7.0). The relative risk of infection for a symptomatic newborn was 12.2 (95% CI 4.9-30.2; P<0.0001). Laboratory test results were the most predictive criteria. The relative risk to be infected was 291.6 (95% CI 70.7-1,214.0; P<0.0001) with a blood cord PCT value>0.6 ng/L. The positive post-test probability was 28% (95% CI: 23-33) and the negative post-test probability was close to 0 (95% CI: 0-0). Clinical criteria of postnatal life adaptation are more predictive of early-onset neonatal infection than anamnestic criteria are. The blood cord PCT value could be a helpful marker in the identification of infected newborns. PCT measured in umbilical cord blood could be included in a general algorithm in order to identify as soon as possible newborns with a high risk of EOS.

Congenital Cytomegalovirus Is the Second Most Frequent Cause of Bilateral Hearing Loss in Young French Children

In children with congenital cytomegalovirus (cCMV), greater than 50% of symptomatic newborns and 8.5% to 18% of asymptomatic newborns will have hearing loss, either present at birth or delayed in onset. This prospective study was undertaken to evaluate the extent of cCMV among causes of hearing loss in French children younger than 3 years and to assess their characteristics in relation to cCMV status. Children younger than 3 years with hearing loss were prospectively enrolled. Cytomegalovirus polymerase chain reaction (PCR) assays were performed on dried blood spots from these children’s Guthrie cards and considered positive when CMV presence was confirmed. Brain computed tomography (CT) or magnetic resonance imaging and temporal bone CT scans were obtained. Normal hearing, mild loss, moderate loss, severe loss, and profound loss were defined when the child was able to hear a stimulus of 0 to 20, 21 to 40, 41 to 70, 71 to 90, and 91 dB or greater, respectively. Results of genetic analysis of the connexin 26 (GJB2) and connexin 30 (GJB2) genes were recorded. The prevalence of cCMV infection was estimated together with its 95% confidence interval. Of 114 eligible children, 100 with bilateral hearing loss were enrolled at a median age of 15 months and included in the analysis. Hearing loss in the best ear was not recorded for 2 children and was mild in 1 child, moderate in 22 children, severe in 16, and profound in 59. Results of brain and temporal bone imaging were available for 77 children and genetic analysis of the GJB2 and GJB2 genes for 55 children. Cytomegalovirus PCR was positive in 8 children, and cCMV infection prevalence was 8.0% (95% confidence interval, 2.7%–13.3%). Prevalence of cCMV was 13.7% (n = 8) in the 59 children with profound bilateral hearing loss, a significant association (P = 0.02). Children with cCMV were significantly more likely to have delayed development (P = 0.027) and abnormalities on the brain CT scan (P = 0.0005). Two of the 8 children with cCMV had at least 1 other risk factor for hearing loss, including neonatal intensive care unit stays or familial history of hearing loss. None of the 8 children with cCMV were born prematurely, but 4 had a small birth weight for their gestational age, and 1 child had microcephaly. In 2 children, the diagnosis of cCMV infection had been made before inclusion in the study. For the other 6 children, the diagnosis of cCMV was made retrospectively because of the positive CMV PCR result. In 61 patients (71.8%), the origin of hearing loss was genetic. Mutations of GJB2 and/or GJB2 genes were found in 22 patients (25.9%). In 1 patient (1.2%), hearing loss was due to a mutation in the otoferlin gene. In 13 patients (15.3%), a syndromic origin included Waardenburg syndrome, Usher syndrome, Angelman disease, mucopolysaccharidosis, and another metabolic disease. In 8 patients (9.4%), a malformation was found in the temporal bone on CT scan that was considered genetic. A genetic origin also was highly probable in 10 with a history of 1 family member with hearing loss before age 40 years and consanguineous parents in 7. Prematurity was the cause of hearing loss in 6 children (7.1%). Congenital CMV was present in 8 (9.4%) of the 85 patients with a complete workup and was the second most common individual cause of bilateral hearing loss after connexin mutations. The prevalence of cCMV indicates only the proportion of cCMV among French children with bilateral hearing loss and not the prevalence of cCMV in the total population of children with hearing loss. Because universal neonatal hearing screening is underway in France, it may be possible to diagnose cCMV in infants with confirmed hearing loss and to implement early intervention with antiviral treatment.

Preventing a Broken Heart: Critical Screening for Congenital Heart Disease

Newborn Care Poster Presentation Purpose for the Program To develop an interdisciplinary program of universal screening for congenital cardiac heart disease (CCHD) based on the 2011 American Academy of Pediatrics recommendations for the 4,000 term and late‐preterm infants cared for in our mother–baby unit. Proposed Change Before implementation of this evidence‐based practice change, only symptomatic newborns had screening and diagnostic evaluation. Through the CCHD screening program, all newborns receiving care in the mother–baby unit benefit from early screening to determine the risk of CCHD. Based on positive‐pulse oximetry screening, infants at risk receive a predischarge diagnostic echocardiogram and evaluation by a pediatric cardiologist, with follow‐up as indicated. Implementation, Outcomes, and Evaluation An interdisciplinary committee of physicians, nurses, and advanced practice nurses met to review the literature, evaluate current practice, and develop plans for implementation of CCHD risk identification and referral for diagnostic and cardiology follow‐up. Implementation strategies included the following: developed a policy for newborn CCHD screening; revised preprinted order sets/protocols; developed procedure for pulse oximetry screening; completed physician education, nurse education, and competencies related to the screening program; obtained additional equipment; established the coordination of diagnostic echocardiogram and cardiology referrals for positive‐pulse oximetry screens; revised documentation forms to include CCHD screen/referrals; developed patient teaching guidelines and written education materials; and established the communication of the results to the newborn's primary care provider. This collaborative initiative resulted in a change in the standard of practice to improve the outcomes and safety of newborns that may be at risk of morbidity and mortality due to unknown cardiac factors. Screening through pulse oximetry provides an inexpensive, noninvasive tool to identify newborns with structural heart defects, which usually are associated with hypoxia and physiologic changes in the newborn period that could have significant sequelae. Parents receive education about CCHD and the importance of postscreening follow‐up with primary care providers or pediatric cardiology based on the results of the newborn CCHD screen. Implications for Nursing Practice The CCHD screening program is an example of interdisciplinary collaboration among nursing, medicine, and cardiology for universal identification, early diagnosis, and management of asymptomatic newborn cardiac pathology to prevent morbidity and mortality. Through assessment, pulse oximetry screening, and patient teaching, nurses are integral to the safety and well‐being of newborns. This timely implementation of the 2011 American Academy of Pediatrics CCHD recommendations promotes the organization's mission of patient safety and can be a model to others for establishing CCHD screening programs.

A survey of the management of newborns with severe hemophilia in Canada.

To determine the practice patterns of Canadian hematologists and neonatologists/paediatricians who care for newborns with hemophilia, with regard to vitamin K administration, use of empirical clotting factor replacement therapy, neuroimaging and timing of hematology consultation. Hematologists and neonatologists/paediatricians, identified from membership lists of Canadian professional organizations, were provided electronic and/or paper versions of the survey instrument. Questions were posed in the context of specific clinical scenarios. Differences in response proportions between groups were compared for selected questions. There were 171 respondents among 616 eligible persons who were sent the survey; 58 respondents had recent experience managing a newborn with hemophilia. There was a consensus not to provide empirical treatment to well newborns after uncomplicated deliveries, to provide empirical treatment to symptomatic newborns and to obtain neuroimaging for symptomatic newborns. Systematic differences between hematologists and neonatologists/paediatricians existed with regard to the timing of hematology consultation when the diagnosis of hemophilia had not been confirmed antenatally, the route of vitamin K administration for newborns with hemophilia and the choice of product to use for empirical treatment of a symptomatic newborn. The observed lack of consensus regarding important management decisions indicates a need for ongoing research in the care of newborns with hemophilia. Systematic differences between hematologists and neonatologists/paediatricians suggest a role for improved communication and collaboration between these two groups of practitioners.

Is there any need for a shunt in the treatment of tetralogy of Fallot with one source of pulmonary blood flow?†

In symptomatic patients, performing a primary repair of tetralogy of Fallot (TOF), irrespective of age or placing a shunt, remains controversial. The aim of the study was to analyse the policy of primary correction. Between May 2005 and May 2012, a total of 87 consecutive patients with TOF, younger than 6 months of age, underwent primary correction. All patients had one source of pulmonary blood flow, with or without a patent ductus arteriosus. The median age at surgery was 106 ± 52.3 days (8-180 days). Twelve patients (13.8%) were newborns. Two groups were analysed: group I, patients <1 month of age; group II, patients between 2-6 months of age. There was no early or late death at 7 years of follow-up. There was no difference in bypass time or hospital stay between the two groups, but the Aristotle comprehensive score (P < 0.0001), ICU stay (P = 0.030) and the length of ventilation (P = 0.014) were significantly different. Freedom from reoperation was 87.3 ± 4.3% and freedom from reintervention was 85.9 ± 4.2% at 7 years, with no difference between the two groups. Neurological development was normal in all patients, but 1 patient in Group II had cerebral seizures and showed developmental delay. Growth was adequate in all patients, except those with additional severe non-cardiac malformations that caused developmental delay. Eighty-five per cent of the patients were without cardiac medication. Even in symptomatic neonates and infants <6 months of age, primary repair of TOF can be performed safely and effectively. One hundred per cent survival at 7 years suggests that early primary repair causes no increase in mortality in the modern era. Shunting is not necessary, even in symptomatic newborns, thus avoiding the risk of shunt-related complications and repeated hospital stays associated with a staged approach.

Prevalence of Toxoplasma Infection in Mexican Newborns and Children: A Systematic Review from 1954 to 2009

Introduction. Recent studies in Mexico have shown that from 20/10,000 to 58/10,000 newborns with Toxoplasma infection could be undetected. The aim of this study was to determine the weighed prevalence of T. gondii infection and describe the epidemiological transition of infection in newborns. Methods. Research literature reporting Toxoplasma infection prevalence in Mexican newborns and children were searched in five international databases. Weighted prevalence was calculated by inverse variance-weighted method in asymptomatic and symptomatic study groups, and the epidemiological transition was estimated by a lineal regression analysis. Results. The weighed prevalence in 4833 asymptomatic newborns was 0.616%, CI95% (0.396%–0.835%) (P < 0.001), whereas, among 895 symptomatic newborns, the weighed prevalence was 3.02%, CI 95% (1.91%–4.1%) (P < 0.001). A downward trend of 0.25%/year represented an accumulated decrease of −13,75% in the prevalence in the symptomatic newborns throughout 55 years, whereas, in the asymptomatic children, the prevalence was similar over the course of the years. Conclusion. The high-weighted prevalence of congenital Toxoplasma infection in newborns justifies that Toxoplasma gondii testing be included in the screening programs for women during pregnancy and newborns in Mexico. A rapid diagnosis and treatment strategy could aid in limiting a potential damage to the newborns.

Lack of efficacy of a starch-thickened preterm formula on gastro-oesophageal reflux in preterm infants: a pilot study

Background: Gastro-oesophageal reflux (GOR) is common in preterm infants; conservative interventions (i.e. dietary changes) should represent the first-line approach. Aim: To evaluate by combined pH and impedance monitoring (pH-MII) the effect of a new preterm formula thickened with amylopectin (TPF) on GOR features in symptomatic preterm infants. Methods: Twenty-eight symptomatic preterm newborns underwent a 24-hour pH-MII; each baby received eight meals (four of TPF and four of a preterm formula [PF]). GOR indexes (number, acidity, duration and height of GORs) after TPF and PF meals were compared by Wilcoxon Signed Ranks Test. Viscosity of PF and TPF was measured. Results: TPF significantly decreased the number of acid GORs detected by pH-monitoring (TPF vs. PF: median 20 vs. 24.5, p = 0.009), while it had no influence on Reflux Index (RIpH), nor on acid and non-acid GOR indexes detected by MII, GOR physical features, and GOR height. TPF’s viscosity was extremely higher than PF’s, and further increased at pH 3 after the addition of pepsin. Conclusions: The new formula was found to reduce the number of acid GORs detected by pH-monitoring; it did not reduce neither total oesophageal acid exposure nor non-acid GORs. At present its extended clinical use cannot be recommended.

Management and outcome of Ebstein's anomaly in children

To assess clinical presentation, treatment, and outcome of children with Ebstein's anomaly. Data on long-term outcome of children with Ebstein's anomaly are scarce. Retrospective analysis of all children with Ebstein's anomaly treated between February, 1979 and January, 2009 in a single tertiary institution. Primary outcomes included patient survival and need for intervention, either cardiac surgery or catheter intervention. A total of 42 patients were diagnosed with Ebstein's anomaly at a median age of 5 days ranging from 1 day to 11.7 years. Symptoms included cyanosis, heart murmur, and/or dyspnoea. Associated cardiac anomalies occurred in 90% of the patients. Average follow-up was 9.5 plus or minus 7.0 years. The overall mortality rate was 14%. Of the six patients, three died postnatally before treatment. Cardiac surgery and/or catheter-guided interventions were required in 33 patients (79%). Cardiac surgery was performed in 21 (50%) patients at a median age of 9.1 years (range 0.1-16.5 years), including biventricular repair in 13 (62%), one-and-a-half chamber repair in seven (33%), and a staged single-ventricle repair in one. Peri-operative mortality was 4%. Catheter-guided interventions consisted of device closure of an atrial septal defect in three cases and radiofrequency ablation of accessory pathways in nine patients. The estimated 10-year survival was 85.3 plus or minus 5.6%. In children, Ebstein's anomaly is usually diagnosed in the first year of age. Even though children with Ebstein's anomaly often require an intervention, their peri-operative mortality is low and long-term survival is good. Symptomatic newborns requiring an intervention may have a worse outcome.