Neonatal Symptoms Research Articles

Vertical Transmission of SARS-CoV-2 during Pregnancy: A Prospective Italian Cohort Study.

The extent of vertical transmission (VT) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from mothers their fetuses or neonates is still uncertain. We aimed to determine the incidence of VT. In this prospective cohort study. All mother diagnosed with SARS-CoV-2 infection at the time of delivery or up to 1 week prior and their neonates, managed in a tertiary referral hospital for pregnancy complicated by coronavirus disease 2019 (COVID-19) in Rome, from April 2 to December 22, 2020, were included. Maternal infection was defined as nasopharyngeal swab test results positive for SARS-CoV-2 reverse transcription-polymerase chain reaction (RT-PCR). Biological samples were collected before, at, and after delivery to test positivity for SARS-CoV-2 RT-PCR and anti-SARS-CoV-2-specific antibodies. The cohort included 95 women and 96 neonates with documented SARS-CoV-2 test results. Four neonates (4.2%) tested positive. The incidence of VT, according to the guidance criteria for diagnosing perinatal SARS-CoV-2 infection, was 5.2%. Neonatal symptoms were due to prematurity or fetal distress: symptomatic infants had lower median (min-max) gestational age, 38.1 (29.3-40.6) versus 39.3 (33.9-41.9) weeks (p = 0.036), and 1-minute and 5-minute Apgar scores, 9 (3-9) versus 9 (7-10) (p = 0.036) and 10 (6-10) versus 10 (8-10) (p = 0.012), respectively, than asymptomatic infants and needed more frequent assistance in the delivery room (22.2 vs 2.5%; p = 0.008). Only six (7.1%) neonates had anti-SARS-CoV-2-specific antibodies, despite the ongoing maternal infection. The incidence of VT is low as is the detection of specific anti-SARS-CoV-2 antibodies in cord blood when infection is contracted late in pregnancy. This would suggest poor protection of infants against horizontal transmission of the virus. · VT of SARS-CoV-2 from pregnant mothers to fetuses or neonates can be possible.. · In this prospective cohort study, the incidence of VT is found to be 5.2%.. · VT is low but exists..

Effects of prenatal exposure to maternal COVID-19 and perinatal care on neonatal outcome: results from the INTERCOVID Multinational Cohort Study

BackgroundThe effect of COVID-19 in pregnancy on maternal outcomes and its association with preeclampsia and gestational diabetes mellitus have been reported; however, a detailed understanding of the effects of maternal positivity, delivery mode, and perinatal practices on fetal and neonatal outcomes is urgently needed.ObjectiveTo evaluate the impact of COVID-19 on fetal and neonatal outcomes and the role of mode of delivery, breastfeeding, and early neonatal care practices on the risk of mother-to-child transmission.Study DesignIn this cohort study that took place from March 2020 to March 2021, involving 43 institutions in 18 countries, 2 unmatched, consecutive, unexposed women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge. COVID-19 in pregnancy was determined by laboratory confirmation and/or radiological pulmonary findings or ≥2 predefined COVID-19 symptoms. The outcome measures were indices of neonatal and perinatal morbidity and mortality, neonatal positivity and its correlation with mode of delivery, breastfeeding, and hospital neonatal care practices.ResultsA total of 586 neonates born to women with COVID-19 diagnosis and 1535 neonates born to women without COVID-19 diagnosis were enrolled. Women with COVID-19 diagnosis had a higher rate of cesarean delivery (52.8% vs 38.5% for those without COVID-19 diagnosis, P<.01) and pregnancy-related complications, such as hypertensive disorders of pregnancy and fetal distress (all with P<.001), than women without COVID-19 diagnosis. Maternal diagnosis of COVID-19 carried an increased rate of preterm birth (P≤.001) and lower neonatal weight (P≤.001), length, and head circumference at birth. In mothers with COVID-19 diagnosis, the length of in utero exposure was significantly correlated to the risk of the neonate testing positive (odds ratio, 4.5; 95% confidence interval, 2.2–9.4 for length of in utero exposure >14 days). Among neonates born to mothers with COVID-19 diagnosis, birth via cesarean delivery was a risk factor for testing positive for COVID-19 (odds ratio, 2.4; 95% confidence interval, 1.2–4.7), even when severity of maternal conditions was considered and after multivariable logistic analysis. In the subgroup of neonates born to women with COVID-19 diagnosis, the outcomes worsened when the neonate also tested positive, with higher rates of neonatal intensive care unit admission, fever, gastrointestinal and respiratory symptoms, and death, even after adjusting for prematurity.Breastfeeding by mothers with COVID-19 diagnosis and hospital neonatal care practices, including immediate skin-to-skin contact and rooming-in, were not associated with an increased risk of newborn positivity.ConclusionIn this multinational cohort study, COVID-19 in pregnancy was associated with increased maternal and neonatal complications. Cesarean delivery was significantly associated with newborn COVID-19 diagnosis. Vaginal delivery should be considered the safest mode of delivery if obstetrical and health conditions allow it. Mother-to-child skin-to-skin contact, rooming-in, and direct breastfeeding were not risk factors for newborn COVID-19 diagnosis, thus well-established best practices can be continued among women with COVID-19 diagnosis.

Primary ciliary dyskinesia in Volendam: Diagnostic and phenotypic features in patients with a CCDC114 mutation.

Primary ciliary dyskinesia (PCD) is a heterogeneous disease, with impaired mucociliary clearance causing respiratory tract infections. A founding CCDC114 mutation has led to a relatively homogeneous and large Dutch PCD population in Volendam. Our aim was to describe their phenotype. Therefore, all Volendam PCD patients seen at the Amsterdam UMC were included in this study. Data were collected on lung function, microbiology, radiology, and ear‐nose‐throat (ENT) symptoms. A mixed effects model estimated lung function decline in %point per year (95% confidence interval [CI]). Thirty‐three (60%) out of approximately 56 Volendam PCD patients were treated at our center and included in this study. Only 30% of patients had situs inversus. FEV1 declined in children (−1.43%/year, CI: −1.80/−1.05), but not in adults (0.01%/year, CI: −0.36/0.38). Pseudomonas aeruginosa was cultured in 21% of children and 60% of adults, respectively. Patients who have been infected at some point with P. aeruginosa had a steeper decline in FEV1 as compared to patients that have never been infected. Neonatal symptoms (79%) and ENT problems (94%) were common; fertility issues however, were not (11%) common. Compared to other PCD cohorts, the Volendam/CCDC114 patients have a moderately severe phenotype with lung function decline predominantly occurring in childhood.

Association between prenatal and neonatal factors and occurrence of asthma symptoms in six-year-old children.

The objective was to estimate association between prenatal and neonatal factors and asthma symptoms in children at six years of age. A cross-sectional study using secondary data from a cohort study with a sample of 578 children was carried out. Data were analyzed using three levels hierarchical Poisson Regression. Of the 578 children included in the study, 43.4% (95% CI 39.4; 47.4) had asthma symptoms. The variables with significantly higher prevalence of symptoms and asthma at six years of age were: male gender, with 5% higher prevalence (PR = 1.05 95% CI 1.01; 1.11) (p = 0.043); children of pregnant women presenting infectious diseases with 7% higher prevalence (PR = 1.07; 95% CI 1.02; 1.13) (p = 0.011); children who were not breastfed, with a 12% higher prevalence (PR = 1.12; 95% CI 1.02; 1.24) (p = 0.022) and children with respiratory problems in the first month of life, with a 14% higher prevalence (PR = 1.14; 95% CI 1.01; 1.29) (p = 0.033). It could be concluded that male gender, time-independent breastfeeding deprivation and respiratory problems in the first month of life were independently associated with asthma symptoms at six years of age. The occurrence of infectious diseases during pregnancy was the only factor with intrauterine physiology that was associated with the occurrence of asthma symptoms at six years of age.

A Mobile Computer-Aided Diagnosis of Neonatal Hyperbilirubinemia using Digital Image Processing and Machine Learning Techniques

Neonatal Hyperbilirubinemia, or jaundice, is a harmful disease found in newborns, a symptom of which is the yellowish discoloration of the skin. Visual examination is most frequently used for screening of Hyperbilirubinemia in neonates, however, blood specimen collection is the gold standard to identify the disease and its severity. We propose a Mobile Computer-Aided Diagnosis (mCADx) tool to identify the Neonatal Hyperbilirubinemia symptom using advanced digital image processing and data mining techniques. The mCADx was developed in a cross-platform environment. The mCADx works with smart devices run on either iOS or Android operating systems. With ethical committee approval, we collected and studied image data of 178 infant subjects with different jaundice severity levels. The severity of the disease was examined from blood test results, which were annotated by medical specialists. Data mining techniques included Decision Trees, k Nearest Neighbor, and the Conventional Neural Network was investigated in the dataset. An in-depth comparison between techniques was performed and discussed. The classification results in CNN gained the highest accuracy at 0.8099, 0.9251, 0.8086. This novel work can assist in identifying Neonatal Hyperbilirubinemia in newborns after discharging from the hospital. Reoccurring Neonatal Hyperbilirubinemia can be found with minimum awareness of parents. Limitations and future works were discussed in this work.

Double aortic arch with atretic proximal left arch.

Aortic arch anomalies are rare and represent about 1% of all congenital cardiac lesions. Double aortic arch with atretic proximal left arch is one of the rare causes of respiratory symptoms in neonates, often missed by preoperative imaging studies. Preoperative identification and differentiating this entity from other arch anomalies is imperative to plan appropriate surgical management.

Severe Neonatal COVID Pneumonia With Cytokine Storm

COVID infection is not as common in children as in adults. In the first wave, symptomatic SARS-CoV-2 infection was less common with mild symptoms in children and neonates. But in the second wave, more children and neonates were affected with severe manifestations. COVID infection in neonates is mostly asymptomatic and published data from various neonatal units of India shows that most COVID positive newborns have good prognosis; poor outcomes are due to perinatal complications and rarely due to COVID. 1 However, in the second wave, newborns too were affected. We are presenting the case of a preterm neonate who developed severe COVID pneumonia on day 10 of life with cytokine storm and succumbed to death.

How clinicians can support women in making decisions about psychopharmacological treatments in pregnancy

How clinicians can support women in making decisions about psychopharmacological treatments in pregnancy

Parechovirus A Infection of the Intestinal Epithelium: Differences Between Genotypes A1 and A3.

Human parechovirus (PeV-A), one of the species within the Picornaviridae family, is known to cause disease in humans. The most commonly detected genotypes are PeV-A1, associated with mild gastrointestinal disease in young children, and PeV-A3, linked to severe disease with neurological symptoms in neonates. As PeV-A are detectable in stool and nasopharyngeal samples, entry is speculated to occur via the respiratory and gastro-intestinal routes. In this study, we characterized PeV-A1 and PeV-A3 replication and tropism in the intestinal epithelium using a primary 2D model based on human fetal enteroids. This model was permissive to infection with lab-adapted strains and clinical isolates of PeV-A1, but for PeV-A3, infection could only be established with clinical isolates. Replication was highest with infection established from the basolateral side with apical shedding for both genotypes. Compared to PeV-A1, replication kinetics of PeV-A3 were slower. Interestingly, there was a difference in cell tropism with PeV-A1 infecting both Paneth cells and enterocytes, while PeV-A3 infected mainly goblet cells. This difference in cell tropism may explain the difference in replication kinetics and associated disease in humans.

Association Between Neonates With Laryngomalacia and Neonatal Abstinence Syndrome.

Laryngomalacia (LM) is the most common congenital anomaly of the larynx. The cause of LM is still largely unknown, but a neurological mechanism has gained the most acceptance. There have not been any studies examining the prevalence of LM in infants with Neonatal Abstinence Syndrome (NAS). The aim of our study is to determine if infants with NAS are more likely to be diagnosed with LM. This study was a population-based inpatient registry analysis. We examined nationwide neonatal discharges in 2016 using the Kids' Inpatient Database (KID). Only patients listed as neonates were included. The International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes for neonatal withdrawal symptoms from maternal use of drugs of addiction (P96.1) and diagnoses denoting LM were used. To quantify associations between the LM and NAS groups, prevalence rates and odds ratios (ORs) were used. There were 3 970 065 weighted neonatal discharges in the 2016 KID. Among patients included in our dataset, 0.809% (32 128) had NAS and 0.075% (2974) had LM. There was an increased odds ratio for neonates with NAS and LM (OR of 2.85, 95% CI = 2.24-3.63) compared to infants without NAS. Multiple logistic regression accounting for possible confounders produced an adjusted OR of 1.68 (95% CI = 1.29-2.19). Our study found an association between NAS and LM. This suggests that prenatal exposure to opioids or possibly the sequelae of withdrawal symptoms may be risk factors for the development of LM.

Clinical characteristics of human platelet antigen (HPA)-1a and HPA-5b alloimmunised pregnancies and the association between platelet HPA-5b antibodies and symptomatic fetal neonatal alloimmune thrombocytopenia.

SummaryFetal neonatal alloimmune thrombocytopenia (FNAIT) is caused by maternal alloantibodies directed against the human platelet antigens (mostly HPA‐1a or HPA‐5b) of the (unborn) child and can lead to severe bleeding. Anti‐HPA‐1a‐mediated FNAIT shows a severe clinical outcome more often than anti‐HPA‐5b‐mediated FNAIT. Given the relatively high prevalence of anti‐HPA‐5b in pregnant women, the detection of anti‐HPA‐5b in FNAIT‐suspected cases may in some cases be an incidental finding. Therefore we investigated the frequency of anti‐HPA‐5b‐associated severe bleeding in FNAIT. We performed a retrospective nationwide cohort study in cases with clinical suspicion of FNAIT. HPA antibody screening was performed using monoclonal antibody‐specific immobilisation of platelet antigens. Parents and neonates were typed for the cognate antigen. Clinical data were collected by a structured questionnaire. In 1 864 suspected FNAIT cases, 161 cases (8·6%) had anti‐HPA‐1a and 60 (3·2%) had anti‐HPA‐5b. The proportion of cases with severe bleeding did not differ between the cases with anti‐HPA‐1a (14/129; 11%) and anti‐HPA‐5b (4/40; 10%). In multigravida pregnant women with a FNAIT‐suspected child, 100% (81/81) of anti‐HPA‐1a cases and 79% (38/48) of anti‐HPA‐5b cases were HPA‐incompatible, whereas 86% and 52% respectively were expected, based on the HPA allele distribution. We conclude that anti‐HPA‐5b can be associated with severe neonatal bleeding symptoms. A prospective study is needed for true assessment of the natural history of anti‐HPA‐5b mediated FNAIT.

Neonatal FeNO, risk factors, and respiratory morbidity in infants: A cohort study.

Respiratory symptoms in infancy are more common in premature infants. Nitric oxide (NO) is involved in prenatal and neonatal lung development. Measurement of exhaled NO is easy and well-tolerated by neonates. We investigated whether neonatal exhaled NO can be used to predict subsequent respiratory symptoms. Furthermore, we sought to determine prenatal and postnatal factors associated with increased respiratory symptom risk during the first year of life in premature and mature infants. Tidal fractional exhaled NO (FeNO) was measured in a birth cohort (n = 135) of premature and mature infants, up to six times during the first month of life. Primary outcomes were troublesome respiratory symptoms (TRS) and doctor-diagnosed asthmatic bronchitis (AB) at 1 year of age. The correlation between FeNO and TRS changed significantly in an age-dependent pattern in moderately premature infants (p = .02). Moderately premature infants with a low FeNO of 2 ppb on postnatal Day 3 had a 48% (95% confidence interval [CI]: 17%-80%) probability of TRS, compared with a probability of 12% (95% CI: 1%-64%) for otherwise similar infants with a FeNO of 11 ppb. Respiratory syncytial virus infection and parental smoking significantly increased the TRS risk in premature infants. Parental asthma and maternal antibiotic use during pregnancy significantly increased the TRS risk in mature infants. An age-specific association between neonatal FeNO and respiratory symptoms was seen in moderately premature infants. TRS risk was associated with postnatal factors in premature and prenatal factors in mature infants.

Neonatal Community-acquired Raoultella Ornithinolytica Septicemia

Raoultella ornithinolytica is an opportunistic, aquaphilic and Gram-negative bacterium. Immune deficiency states and indwelling catheters provide a basis for most of the infections arising. R. ornithinolytica septicemia (ROS) is extremely rare in neonates but can be life threatening. Community-acquired ROS has not been described in neonates before. The diagnosis of neonatal septicemia is occasionally complicated by unusual clinical presentations. Pyloric stenosis is manifested by projectile, nonbilious vomiting and late findings, including weight loss, dehydration and electrolyte abnormalities beyond 4–6 weeks old. Community-acquired neonatal septicemia symptoms can sometimes be confused with symptoms of gastrointestinal obstructions in patients without risk factors for sepsis. Early diagnosis and appropriate antibiotics are essentials for a good prognosis in neonatal septicemia. Herein, we present a novel case of community-acquired ROS with an unusual presentation in a term infant and a review of the literature about ROS in the neonatal period.

Frequencies, sensitivity pattern and molecular characterization of bacterial isolates in blood in neonatal sepsis.

Objective: To determine frequency, molecular characterization and sensitivity of bacterial isolates against commonly used antibiotics in neonatal sepsis. Study Design: Cross Sectional study. Setting: Department of Pathology Sahara Medical College Narowal. Period: October 2019 to March 2020. Material &amp; Methods: Neonates admitted in neonatal intensive care unit (NICU) of study institution having signs and symptoms of neonatal symptoms such as fever, irritability, seizures, anorexia and lethargy, were included in the study using consecutive sampling technique. Blood sample from all study patients taken and sent for culture to determine bacterial isolates and antibiotic sensitivity against commonly used antibiotics for neonatal sepsis. Bacterial isolates identification was done using standard bacteriological technique performed by modified Kirby &amp; Bauer disc diffuse method as per Clinical and Laboratory standards institute (CLSI) guidelines. Results: Total 200 cases were studied having neonatal sepsis and admitted in NICU including 58% female and 42% male children. Bacterial growth occurred in 10.5% samples and in 89.5% samples no bacterial growth seen. There were 1% samples with gram positive and 9.5% samples with gram negative bacterial isolates. Klebsiella was the commonest organism isolated in 38.1% cases out of total positive isolates. There were 72.5% neonates having age 1-14 days and 27.5% neonates having age 15-28 days. Conclusion: Gram negative bacteria are common cause of neonatal sepsis, out of which Klebsiella is the commonest organism. Antimicrobial drug resistance in different infections is a serious emerging issue.

Neonatal Outcomes in Pregnant Women Infected with COVID-19 in Babol, North of Iran: A Retrospective Study with Short-Term Follow-Up.

During the coronavirus disease 2019 (COVID-19) pandemic, the number of pregnant women and neonates suffering from COVID-19 increased. However, there is a lack of evidence on clinical characteristics and neonatal outcomes in pregnant women with COVID-19. We evaluated short-term outcomes (4 weeks postdischarge) and symptoms in neonates born to mothers infected with COVID-19. In this retrospective cohort study, we included all neonates born to pregnant women with COVID-19 admitted to Ayatollah Rohani Hospital, Babol, Iran, from February 10 to May 20, 2020. Clinical features, treatments, and neonatal outcomes were measured. Eight neonates were included in the current study. The mean gestational age and birth weight of newborns were 37 ± 3.19 weeks (30₊6-40) and 3077.50 ± 697.64 gr (1720-3900), respectively. Apgar score of the first and fifth minutes in all neonates was ≥8 and ≥9 out of 10, respectively. The most clinical presentations in symptomatic neonates were respiratory distress, tachypnea, vomiting, and feeding intolerance. This manifestation and high levels of serum C-reactive protein (CRP) in three infants are common in neonatal sepsis. The blood culture in all of them was negative. They have been successfully treated with our standard treatment. Our pregnant women showed a pattern of clinical characteristics and laboratory results similar to those described for nonpregnant COVID-19 infection. This study found no evidence of intrauterine or peripartum transmission of COVID-19 from mother to her child. Furthermore, the long-term outcomes of neonates need more study.

Severe polyhydramnios as neonatal presentation of Bartter’s syndrome type IV

Abstract Introduction: Bartter’s syndrome comprises a heterogeneous group of inherited salt-losing tubulopathies. There are two forms of clinical presentation: classical and neonatal, the most severe type. Types I and II account for most of the neonatal cases. Types III and V are usually less severe. Characteristically Bartter’s syndrome type IV is a saltlosing nephropathy with mild to severe neonatal symptoms, with a specific feature - sensorineural deafness. Bartter’s syndrome type IV is the least common of all recessive types of the disease. Description: the first reported case of a Portuguese child with neurosensorial deafness, polyuria, polydipsia and failure to thrive, born prematurely due to severe polyhydramnios, with the G47R mutation in the BSND gene that causes Bartter’s syndrome type IV. Discussion: there are few published cases of BS type IV due to this mutation and those reported mostly have moderate clinical manifestations which begin later in life. The poor phenotype-genotype relationship combined with the rarity of this syndrome usually precludes an antenatal diagnosis. In the presence of a severe polyhydramnios case, with no fetal malformation detected, normal karyotype and after maternal disease exclusion, autosomal recessive diseases, including tubulopathies, should always be suspected.

HIRSCHSPRUNG’S DISEASE: OUR INSTITUTIONAL EXPERIENCE

BACKGROUND: Hirschsprung's disease is one of the most important causes of functional intestinal obstruction in the paediatric age group. The clinical characteristics of patients with Hirschsprung's disease at a tertiary referral centre were studied over a 22-month period. Aims and Objectives: To study the demography, including Age, Sex, various clinical presentations, types, segment involved, surgery, complications and survival in patients with Hirschsprung's disease at a tertiary care referral centre in Rajasthan, India. Materials and methods: This was a prospective observational study between October 2018 and June 2020, over 22 months, at tertiary referral centre in North-Western India. Clinical data were tabulated, various presentations of the disease were studied, intra-operative ndings were noted and post-operative course was studied. Results: 82 cases of Hirschsprung disease were admitted, of which 66 were male and 16 were female. Of these, 10 presented in the neonatal age group, 25 during infancy (1 month to 1 year of age) and the rest – 47 patients presented beyond infancy. The commonest symptoms in infants and older children was chronic constipation, whereas delayed passage of meconium, abdominal distension and bilious vomiting were among the common symptoms in neonates. The patients underwent exploratory laparotomy with multiple biopsies and diversion colostomies. 43 patients underwent the denitive procedure. In all the 43 patients, Martin's modication of Duhamel's procedure, was the surgery performed. Complications included persistence of constipation, enterocolitis, and a few cases of anastomotic leak.

Prevalence of common symptoms of neonatal illness in Northwest Ethiopia: A repeated measure cross-sectional study.

BackgroundThe neonatal period is the most vulnerable stage of life. In Ethiopia, neonatal illness is common and the reduction in neonatal mortality is not as significant as for under-five mortality.ObjectivesTo determine the prevalence and factors associated with neonatal illness symptoms reported by mothers delivering in health facilities in Northwest Ethiopia.MethodsA repeated measure cross-sectional study design was employed to collect data from 358 randomly selected deliveries in 11 health facilities from November 2018 to March 2019. A pretested and interviewer-administered structured questionnaire adapted from the literature was employed to record neonatal outcomes (illnesses and/or deaths) at birth, 24 hours, 7th, 14th and 28th day from birth. Cleaned data was exported to STATA version 14 software for analysis. Multilevel analysis was used to identify individual and facility-level characteristics associated with neonatal illness symptoms.ResultsThe prevalence of neonatal illness symptoms was 27.8% (95% CI; 23.2, 32.8) of the 338 babies born alive and the neonatal mortality rate was 41/1000 live births (14/338). The most common symptoms or conditions of neonatal illness reported by mothers’ in the study area were possible serious bacterial infections (95.8%, 90/94), localized bacterial infections (43.6%, 41/94), low birth weight (23.4%, 22/94), diarrhea (18.1%, 17/94), prematurity (14.9%, 14/94), and jaundice (7.5%, 7/94). Among the babies who died, neonates who had possible serious bacterial infections, low birth weight, localized bacterial infections, and prematurity took the highest proportions with 100% (14/14), 64.3% (9/14), 50% (7/14), and 42.9% (6/14), respectively. Having a maximum of 3 children (AOR = 1.96; 95% CI = 1.1–3.6), having twins or triplets during pregnancy (AOR = 2.43; 95% CI = 1.1–6.1), and lack of antenatal counseling (AOR = 1.83; 95% CI = 1.1–3.3) were among the maternal factors associated with neonatal illness. Having low birth length (AOR = 7.93; 95% CI = 3.6–17.3), and having a poor breastfeeding quality (AOR = 2.37; 95% CI = 1.4–4.0) were found to be the neonatal factors associated with neonatal illness.ConclusionsThis study indicated a high prevalence of neonatal illness symptoms in Northwest Ethiopia. Therefore, early detection, referral and better management of symptoms or conditions with a high mortality, like sepsis and low birth weight are compulsory to save the lives of many neonates. Strengthening the health extension programme to improve antenatal care service utilization and breastfeeding quality of neonates among postpartum women is crucial.

COVID-19 in Neonates, A Case Series Study from Tertiary Neonatal Centers in Iran

Introduction: The Novel coronavirus, sars-cov-2, is responsible for the recent pandemic. Although it mostly affects adults, children of all ages, including neonates, can become ill with Covid-19, as well. The real prevalence rate of coronavirus disease 2019 (COVID-19) in children is unknown. However, the severity of symptoms in children and neonates is less than in adults. Regarding the new presentation of this disease, the current study has reported a case series of COVID-19 in neonates. Case Presentation: In this article, 10 neonates with COVID- 19 admitted to our neonatal intensive care units are reported. All reported neonates had general suspicious symptoms of COVID- 19 with positive results for SARS-CoV-2 assessed by polymerase chain reaction (PCR) from the nasopharynx area or nose of the patients. All neonates, except for two of them, were term neonates. One case had open-heart surgery for congenital heart disease (transposition of the great arteries (TGA)). The mean patients age was 7.8 days on admission. The most frequent symptom was fever. Severe respiratory symptoms were reported in two cases. Also, abnormal radiologic findings in the chest X-ray were detected in two cases. Regarding the lack of significant respiratory symptoms in most of the patients, the lung computed tomography (CT) scan was taken just from one neonate. Leukopenia (WBC &lt; 5000/mm3) was detected in one case, with no lymphopenia in all neonates. The positive C-reactive protein test was not found in all cases. No patient was treated by special anti-viral agents for COVID-19, and usual antibiotic treatment for neonatal sepsis was administered for all cases. All patients, except for one, survived with no significant sequela of the disease. Conclusions: This study demonstrated that clinical manifestations, as well as laboratory and radiologic findings of COVID-19, are milder in neonates than in the older ages. Hence, it can be argued that the prognosis of COVID-19 in the neonatal period is generally good.

Assessment of Neonatal Abstinence Syndrome Surveillance - Pennsylvania, 2019.

The incidence of neonatal abstinence syndrome (NAS), a withdrawal syndrome associated with prenatal opioid or other substance exposure (1), has increased as part of the U.S. opioid crisis (2). No national NAS surveillance system exists (3), and data about the accuracy of state-based surveillance are limited (4,5). In February 2018, the Pennsylvania Department of Health began surveillance for opioid-related NAS in birthing facilities and pediatric hospitals* (6). In March 2019, CDC helped the Pennsylvania Department of Health assess the accuracy of this reporting system at five Pennsylvania hospitals. Medical records of 445 infants who possibly had NAS were abstracted; these infants had either been reported by hospital providers as having NAS or assigned an International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) hospital discharge code potentially related to NAS.† Among these 445 infants, 241 were confirmed as having NAS. Pennsylvania's NAS surveillance identified 191 (sensitivity = 79%) of the confirmed cases. The proportion of infants with confirmed NAS who were assigned the ICD-10-CM code for neonatal withdrawal symptoms from maternal use of drugs of addiction (P96.1) was similar among infants reported to surveillance (71%) and those who were not (78%; p = 0.30). Infants with confirmed NAS who were not assigned code P96.1 typically had less severe signs and symptoms. Accurate NAS surveillance, which is necessary to monitor changes and regional differences in incidence and assist with planning for needed services, includes and is strengthened by a combination of diagnosis code assessment and focused medical record review.