Infants of diabetic mothers and associated complications in neonatal intensive care unit in Misurata Center

Infants of diabetic mothers (IDM) are at an increased risk of various complications. The aim of this study is to evaluate the prevalence, demographic and clinical characters of IDM admissions to the neonatal intensive care unit, and the factors associated with morbidity and mortality. The study is a 1-year retrospective observational study involving all the cases of IDM admitted to the neonatal intensive care unit at Misurata. The study examined the association of the following ante- peri- and postnatal factors to the morbidity and mortality rate of IDM. A total of 103 IDM were admitted to the NICU with mother age range of 31- 35 years. About 84% of the mothers had multiple pregnancies, 81.5% of the IDM were born through C-section. 72% of the mothers had gestational diabetes. 59% of IDMs were females. Median gestational age was 36 ­ 38 weeks which was associated with higher mortality rate (p = 0.041) ,40% of them were post term. Macrosomia was the most common complication; 41%. About 22% had hypocalcemia and 12% had RDS. Six cases had congenital heart disease (CHD). About 26% of the cases required intravenous fluid (IVF) which had a significantly higher mortality rate (25% vs. 1.3%) (p = 0.008). IDM are at a higher risk of congenital and acquired morbidities and mortality. Delayed birth and the mode of delivery (elective or urgent Csection) are associated with the severity of the gestational diabetes which is significantly associated with higher mortality rate.

Late effects of caffeine use on sleep of infants born prematurely / Efeitos tardios do uso de cafeína no sono de crianças nascidas prematuras

ABSTRACT Objective: This study aimed to evaluate whether the therapeutic use of caffeine for premature newborns is associated with changes in sleep habits and the presence of obstructive sleep apnea in childhood. Methods: This is a cross-sectional single-center study in which the caretakers of 87 children aged 5-10 years, born full-term or preterm, treated or not with caffeine in the neonatal period, answered questionnaires to screen for obstructive sleep apnea (Pediatric Obstructive Sleep Apnea Screening Tool [PosaST]) and to characterize the sleep habits (Children's Sleep Habits Questionnaire [CSHQ]) of their children. ANOVA and linear regression tests were performed to verify possible differences between the groups. Results: Children born prematurely who were treated with caffeine woke up significantly later on weekdays than those born at term (09h±00h58 and 07h43±1h15, respectively, p=0.022) and had longer total daily sleep time also compared to those born at term (10h24±1h08 and 09h29±1h08, respectively, p<0.001). There was no significant difference between the three groups in overall PosaST and CSHQ scores. Conclusions: Caffeine use in the neonatal period did not impair sleep habits later in life and did not lead to increased obstructive sleep apnea scores in prematurely born children compared to those born at term.

RESUMO Objetivo: Avaliar se o uso terapêutico de cafeína para recém-nascidos prematuros se associa a alterações nos hábitos de sono e à presença de apneia obstrutiva do sono na infância. Métodos: Este é um estudo unicêntrico transversal no qual os responsáveis por 87 crianças com idades entre cinco e dez anos, nascidas a termo ou pré-termo e tratadas ou não com cafeína no período neonatal responderam a questionários para triagem de apneia obstrutiva do sono (Pediatric Obstructive Sleep Apnea Screening Tool - PosaST) e para a caracterização dos hábitos de sono (Children's Sleep Habits Questionnaire - CSHQ) de seus filhos. Foram realizados testes de variância (ANOVA) e de regressão linear para verificar possíveis diferenças entre os grupos. Resultados: As crianças nascidas prematuras que foram tratadas com cafeína acordaram significativamente mais tarde nos dias de semana do que as nascidas a termo (09h±00h58 e 07h43±1h15, respectivamente, p=0,022) e tiveram maior tempo total de sono diário também comparadas às nascidas a termo (10h24±1h08 e 09h29±1h08, respectivamente, p<0,001). Não houve diferença significativa entre os três grupos na pontuação geral dos questionários PosaST e CSHQ. Conclusões: O uso de cafeína no período neonatal não prejudicou tardiamente os hábitos de sono e não levou ao aumento dos escores de apneia obstrutiva do sono de crianças nascidas prematuras quando comparadas com crianças nascidas a termo.

Analysis of Bifidobacterium animalis subsp. lactis BB-12 ® and Lactobacillus rhamnosus GG on underweight and malabsorption in premature infants

SUMMARY OBJECTIVE: This study aimed to explore and analyze the therapeutic effect of the combination of Bifidobacterium animalis subsp. lactis BB-12® and Lactobacillus rhamnosus GG on underweight and malabsorption in premature infants. METHODS: This is a retrospective study. The clinical data of 68 premature infants admitted to Beijing United Family Hospital (Private Secondary Comprehensive Hospital, Chaoyang District, Beijing, China) from January 2016 to January 2022 were analyzed retrospectively. Preterm infants less than 37 weeks of gestational age admitted to the neonatal intensive care unit were included in the study. Patients with intestinal malformations, necrotizing enterocolitis, etc., who require long-term fasting were excluded. A telephone follow-up was performed 3-6 months after discharge. They were classified as treatment groups A and B according to the treatment plan. The treatment group A included parenteral nutrition, enteral nutrition, etc. In treatment group B, based on treatment group A, the premature infants were treated with Bifidobacterium animalis subsp. lactis BB-12® and Lactobacillus rhamnosus GG. The time to regain birthweight and the weight on day 30 were compared between the two groups, as was the duration of transition from parenteral nutrition to total enteral nutrition. RESULTS: The time of weight regain birthweight in group B was shorter than that in group A (t=-2.560; t=-4.287; p<0.05). The increase of weight on day 30 in group B was significantly higher than that in group A (t=2.591; t=2.651; p<0.05). The time from parenteral nutrition to total enteral nutrition in group B was shorter than that in group A (z=-2.145; z=-2.236; p<0.05). CONCLUSION: In the treatment of premature infants, the combination of Bifidobacterium animalis subsp. lactis BB-12® and Lactobacillus rhamnosus GG can have a better therapeutic effect on the underweight and malabsorption of premature infants, and this treatment method can be popularized in clinics.

Consecuencias inmunológicas de la infección materna por VIH en el recién nacido no infectado / Immunologic consequences of maternal HIV infection in the uninfected newborn

Resumen Con la implementación de estrategias de cuidado perinatal, la tasa de transmisión vertical del virus de inmunodeficiencia humana (VIH) ha disminuido considerablemente en el mundo. A pesar de no mostrar cargas virales, los infantes expuestos al VIH no infectados (ENI) cursan en sus primeros meses de vida con mayores tasas de morbimortalidad. Esto se relaciona con enfermedades infecciosas por microorganismos oportunistas y menor respuesta a las vacunas en comparación con infantes sin exposición al virus, lo que sugiere alteraciones en su sistema inmunitario. En esta revisión abordamos diferentes evidencias de alteraciones en las respuestas inmunitarias innatas y adaptativas de infantes ENI que pudieran explicar esta disfuncionalidad inmunitaria. Adicionalmente, este conocimiento ayuda a entender cómo se desarrolla el sistema inmunitario desde los primeros momentos de gestación que servirán para encontrar alternativas de manejo y terapias para el bienestar de los infantes con esta condición.

Abstract With the implementation of perinatal care strategies, the rate of vertical transmission of human immunodeficiency virus (HIV) has decreased considerably worldwide. Despite the absence of viral loads, infants exposed to HIV not infected during gestation have higher morbidity and mortality rates. This is found to be related to infectious diseases by opportunistic microorganisms and lower response to vaccines in their first months of life compared to non-HIV exposed infants, suggesting alterations in their immune system. In this review we address different evidence of alterations in the innate and adaptive immune responses of HIV exposed infants that could explain their immune dysfunctionality. Additionally, this knowledge helps to understand how the immune system develops from the early stages of gestation and will serve to find management alternatives and therapies for the welfare of the infants with this condition.

Prácticas y creencias con el uso de plantas medicinales en lactantes de San Andrés Isla

Introducción: El uso de plantas medicinales es parte de la cultura tradicional de muchas poblaciones alrededor del mundo, se utilizan para prevenir enfermedades y preservar la salud de los individuos, siendo un conocimiento que conservan las madres y abuelas para el cuidado de la primera infancia. Sin embargo, existen muchos vacíos en la investigación con respecto al uso y propiedades de plantas medicinales en lactantes y población general. Objetivo: Analizar y describir las prácticas y creencias con el uso ancestral de plantas medicinales en lactantes de la comunidad raizal en San Andrés Isla. Materiales y métodos: Estudio cualitativo descriptivo etnográfico aplicado a una muestra por conveniencia de ocho abuelas de la comunidad Raizal de San Andrés Isla. Se realizó la descripción y el análisis de las ideas, prácticas sociales, comportamientos, creencias, significados y conocimientos en torno al uso de plantas medicinales en lactantes. Resultados: Aún se conservan los conocimientos ancestrales con el uso de plantas medicinales liderado por las abuelas. El uso de plantas medicinales en lactantes se rige únicamente por la necesidad de manejo de situaciones de salud. En esta investigación se encontraron 23 ejemplares de plantas medicinales de uso en lactantes, de estas son pocas las que se encuentran registradas en el vademécum colombiano de plantas medicinales. Discusión: Los hallazgos concuerdan con los resultados de otros estudios que evidencian la importancia de la tradición cultural en el cuidado de los lactantes, el protagonismo de la experiencia acumulada de las abuelas en estos saberes y prácticas; además de corroborar que el uso de plantas medicinales en lactantes se rige únicamente por la necesidad de cuidado ante situaciones de salud que lo ameritan. Solo dos ejemplares de las plantas medicinales clasificadas por las mujeres raizales de este estudio se encuentran referenciadas en el vademécum colombiano de plantas medicinales. Conclusiones: Las plantas medicinales abordan un amplio espectro de usos y propiedades que necesitan un extenso estudio para su registro y divulgación.

Introduction: The use of medicinal plants is part of the traditional culture of many populations around the world. Used to prevent diseases and preserve the health of individuals, it is a knowledge that mothers and grandmothers keep for early childhood care. However, there are many gaps in research regarding the use and properties of medicinal plants in infants and the general population. Objective: Analyze and describe the practices and beliefs with the ancestral use of medicinal plants in infants by the Raizal community in San Andrés Island. Materials and methods: It's a qualitative study with a descriptive ethnographic design applied to a convenience sample of 8 grandmothers from the Raizal community of San Andrés Island. We made out a description and analysis of the ideas, social practices, behaviors, beliefs, meanings, and knowledge about the uses of medicinal plants on infants. Results: The ancestral knowledge of medicinal plants use led by the grandmothers still persevered. The use of medicinal plants on infants administers only to the need of health situations. The investigation found 23 specimens of medicinal plants used in infant breastmilk, just a few plants found in this study are registered in the Colombian Vademecum of medicinal plants. Discussion: The findings agree with the results of other studies that show the importance of cultural traditions in the care of infants, the role of the accumulated experience of grandmothers in this knowledge and practices. In addition to corroborating that the use of medicinal plants in infants is governed solely by the need for care in health situations that warrant it. Only two specimens of the medicinal plants classified by the Raizal women in this study are referenced in the Colombian Vademecum of medicinal plants. Conclusion: Medicinal plants address a wide spectrum of uses and properties that need extensive study for their registration and dissemination.

Características de las lesiones no intencionales domésticas en niños entre 5 y 10 años que residen en barrios de Corrientes Capital, 2022 / Caracteristics of non-intencional domestic injuries in childrenbetween 5 and 10 years old who live in neighborhoods of Corrientes Capital, 2022

Objetivo: caracterizar las lesiones no intencionales domésticas en el hogar en niños de 5 a 10 años en dos barrios de Corrientes, Capital en el primer semestre del año 2022. Metodología: estudio observacional, descriptivo, transversal. Muestreo de tipo consecutivo. La muestra total fue de 185 encuestas aplicadas a los cuidadores principales en un período no mayor a 6 meses. Variables: edad del cuidador; sexo del cuidador; nivel educativo del cuidador principal; edad y sexo de niños/as; lesión no intencional y su frecuencia; circunstancias en que ocurren las lesiones no intencionales y modo de actuación ante el hecho de lesión no intencional. Resultados: grupo etario de los cuidadores principales de los niños/as con lesiones no intencionales fueron los adultos jóvenes (78%), siendo el género pre-dominante el femenino (78%); nivel de instrucción más alto obtenido corresponde al terciario incompleto (28%); los niños de 5 años de edad presentaron más lesiones no intencionales (27%), predominan-do el género femenino (57%). Las lesiones ocurrieron principalmente cuando se encontraban jugando (58%) y fueron principalmente las escoriaciones (20%); el modo de actuación más utilizado por los cuidadores principales correspondió a realización de primeros auxilios y posterior traslado al hospital (29%). Conclusiones: las lesiones no intencionales domésticas son muy frecuentes, entre ellas excoriaciones, quemaduras y contusiones. No hay grandes variaciones en sus tipos y frecuencias según el barrio en donde viven los infantes afectados. El modo de actuar más utilizado por el cuidador responsable ante estas lesiones son los primeros auxilios y el traslado a un hospital o cuidados en el hogar sin recurrir a un centro sanitario[AU]

Objectives: to characterize unintentional domestic injuries at home in children from 5 to 10 years old in two neighborhoods of Co-rrientes, Capital in the first semester of 2022. Methodology: obser-vational, descriptive, cross-sectional study. Consecutive type sam-pling. The total sample consisted of 185 surveys applied to the main caregivers in a period not exceeding 6 months. Variables: age of the caregiver; caregiver's sex; educational level of the main caregiver; age and sex of children; unintentional injury and its frequency; cir-cumstances in which unintentional injuries occur and mode of ac-tion in the event of unintentional injury. Results: age group of the main caregivers of children with unintentional injuries were young adults (78%), with the predominant gender being female (78%); highest level of education obtained corresponds to incomplete ter-tiary (28%); 5-year-old children presented more unintentional in-juries (27%), with a predominance of the female gender (57%). The injuries occurred mainly when they were playing (58%) and were mainly abrasions (20%); The mode of action most used by the main caregivers corresponded to first aid and subsequent transfer to the hospital (29%). Conclusions: unintentional domestic injuries are very frequent, including abrasions, burns and bruises. There are no great variations in its types and frequencies depending on the neighborhood where the affected infants live. The most used mode of action by the caregiver responsible for these injuries is first aid and transfer to a hospital or home care without resorting to a heal-th center[AU]

Objectivos: caracterizar as lesões domésticas não intencionais em crianças de 5 a 10 anos em dois bairros de Corrientes, Capital, no primeiro semestre de 2022. Metodologia: estudo observacional, descritivo, transversal. Amostragem de tipo consecutiva. A amos-tra total foi composta por 185 inquéritos aplicados aos cuidadores principais num período não superior a 6 meses. Variáveis: idade do cuidador; sexo do cuidador; escolaridade do cuidador principal; idade e sexo das crianças; lesão não intencional e sua frequência; circunstâncias em que ocorrem lesões não intencionais e modo de ação em caso de lesão não intencional. Resultados: a faixa etária dos principais cuidadores de crianças com lesões não intencionais eram adultos jovens (78%), com predomínio do sexo feminino (78%); o maior nível de escolaridade obtido corresponde ao ensino superior incompleto (28%); As crianças de 5 anos apresentaram mais lesões não intencionais (27%), com predominância do sexo feminino (57%). As lesões ocorreram principalmente durante o jogo (58%) e foram principalmente escoriações (20%); O modo de atuação mais utilizado pelos cuidadores principais correspondeu aos primei-ros socorros e posterior transferência para o hospital (29%). Con-clusões: lesões domésticas não intencionais são muito frequentes, incluindo escoriações, queimaduras e contusões. Não há grandes variações em seus tipos e frequências dependendo do bairro onde vivem os lactentes acometidos. A forma de atuação mais utilizada pelo cuidador responsável por estas lesões são os primeiros soco-rros e a transferência para um hospital ou cuidados domiciliários sem recorrer a um centro de saúde. caregivers corresponded to first aid and subsequent transfer to the hospital (29%). Conclusions: unintentional domestic injuries are very frequent, including abrasions, burns and bruises. There are no great variations in its types and frequencies depending on the neighborhood where the affected infants live. The most used mode of action by the caregiver responsible for these injuries is first aid and transfer to a hospital or home care without resorting to a heal-th center.Keywords: unintentional injury, infants, primary caregivers, accidents, home, housing, child, preschool[AU]

Diagnosis of urinary tract infection in infants under 3 months with fever without a source: reliability of urinalysis and urine culture / Diagnóstico de infección del tracto urinario en lactantes menores de 3 meses con fiebre sin foco identificado: fiabilidad del análisis de orina y urocultivo

Abstract Background: Urinary tract infection (UTI) is infants´ most common serious bacterial infection. This study aimed to investigate the reliability of urianalysis (UA) to predict UTI, to specify the colony forming units (CFU)/ml threshold for diagnosis, and to identify variables that help suspect bacteremia in infants under 3 months with UTI. Methods: We reviewed clinical records of children under 3 months hospitalized for a fever without source and recorded age, sex, days of fever pre-consultation, temperature and severity at admission, discharge diagnoses, laboratory tests, and treatments. According to the discharge diagnosis, we divided them into UTIs (-) and (+) with or without bacteremia. Results: A total of 467 infants were admitted: 334 with UTI and 133 without UTI. In UTIs (+), the pyuria had a sensitivity of 95.8% and bacteria (+) 88.3%; specificity was high, especially for nitrites (96.2%) and bacteria (+) (92.5%). Positive predictive value (PPV) for nitrites was 95.9%, for bacteria 96.7%, and oyuria 92.5%. Escherichia coli was present in 83.8% of urine and 87% of blood cultures. UTIs with bacteremia had inflammatory urinalysis, urine culture > 100,000 CFU/ml, and higher percentage of C reactive protein (CRP) > 50 mg (p= 0.002); 94.6% of the urine culture had > 50,000 CFU. Conclusions: The pyuria and bacteria (+) in urine obtained by catheterization predict UTI. The cut-off point for diagnosis was ≥ 50,000 CFU/ml. No variables to suspect bacteremia were identified in this study.

Resumen Introducción: La infección del tracto urinario (ITU) es una infección bacteriana grave frecuente en lactantes. El objetivo de este trabajo fue investigar la fiabilidad del análisis de orina (AO) para predecirla, precisar el umbral de unidades formadoras de colonias (UFC)/ml para el diagnóstico y buscar variables que ayuden a sospechar de bacteriemia en lactantes menores de 3 meses con ITU. Métodos: Se revisaron fichas clínicas de lactantes menores de 3 meses hospitalizados por fiebre sin foco evidente, registrando edad, sexo, días de fiebre preconsulta, temperatura y gravedad al ingreso, diagnósticos de egreso, exámenes de laboratorio y tratamientos. Según diagnóstico de egreso, se separaron en ITU (-) y (+), con o sin bacteriemia. Resultados: Ingresaron 467 lactantes: 334 con ITU y 133 sin ITU. En ITU (+), la sensibilidad de la piuria fue de 95.8% y bacterias (+) 88.3%; la especificidad fue alta para nitritos (96.2%) y bacterias (+) (92.5%). El valor predictivo positivo (VPP) fue de 95.9% para nitritos, 96.7% para bacterias y 92.5% para piuria. Escherichia coli se encontró en el 83.8% de los urocultivos (UC) (+) y en el 87% de los hemocultivos (+). Las ITU con bacteriemia presentaron elementos inflamatorios, UC con ≥ 100,000 UFC/ml y mayor porcentaje de proteína C reactiva (PCR) > 50 mg/l (p= 0.002); el 94.6% de los UC (+) tuvo ≥ 50,000 UFC/ml. Conclusiones: La piuria y bacterias (+) en el AO son excelentes para pronosticar ITU en orina obtenida con sonda vesical y el punto de corte para el diagnóstico debe ser ≥ 50,000 UFC/ml. No encontramos señales que ayudaran a sospechar ITU con bacteriemia.

Patologías Oftalmológicas en lactantes menores de 6 meses en un servicio de oftalmopediatría de un hospital de referencia

Introducción: Las afecciones oftalmológicas en niños menores de 6 meses pueden producir alteraciones visuales e incluso la ceguera total. Objetivos: Describir la frecuencia y los tipos de patologías oftalmológicas en lactantes menores de 6 meses en un servicio de oftalmopediatría de un hospital infantil. Materiales y Métodos: estudio observacional, descriptivo, retrospectivo. Se revisó la base de datos del servicio de oftalmopediatría. Por muestreo de casos consecutivos fueron incluidos lactantes con edad ≤6 meses, que consultaron en el periodo de marzo a septiembre del 2022, en cuyas fichas figuraban el número telefónico. Variables: edad, sexo, motivo de consulta, antecedentes perinatales y de patologías oftalmológicas, resultado del examen oftalmológico y tratamiento. Los datos fueron analizados en SPSS con estadísticas descriptivas. El comité de ética aprobó el protocolo con consentimiento de los padres. Resultados: Ingresaron 137 lactantes con edad 2,9 ± 1,8 meses, peso de nacimiento 2995 ± 621, edad gestacional 38 ± 2,1 semanas, 53% varones, 31% para control, el 83%, con antecedente de patología ocular. Presentaron patología ocular el 32% (44/137), 59% (26/44) de origen congénito y 41%(18/44) adquiridas. El 18% (8/44) de las alteraciones oculares recibieron tratamiento quirúrgico. Conclusión: El 32% de los lactantes atendidos en el servicio de oftalmopediatria presentaron patologías oculares, de las cuales el 59% fueron congénitas, las dos más frecuentes la catarata congénita y la obstrucción del conducto nasolagrimal.

Introduction: Ophthalmological conditions in children under 6 months can cause visual disturbances and even total blindness. Objectives: To describe the frequency and types of ophthalmological pathologies in infants under 6 months of age in a pediatric ophthalmology service at a children's hospital. Materials and Methods: this was an observational, descriptive and retrospective study. The database of the ophthalmopediatric service was reviewed. By sampling consecutive cases, infants aged ≤6 months, who consulted from March to September 2022 and whose records included the telephone number were included. Variables: age, sex, chief complaint, perinatal history and ophthalmological pathologies, result of ophthalmological examination and treatment. Data were analyzed in SPSS with descriptive statistics. The ethics committee approved the protocol and parental consent was obtained. Results: 137 infants, aged 2.9 ± 1.8 months, birth weight 2995 ± 621, gestational age 38 ± 2.1 weeks, of which 53% were male were selected for this study. 31% presented for a routine follow-up, 83% had a history of ocular pathology. 32% (44/137) presented ocular pathology, 59% (26/44) congenital and 41% (18/44) acquired. 18% (8/44) of the ocular alterations received surgical treatment. Conclusions: 32% of the infants seen in the ophthalmopediatric service presented ocular pathologies, of which 59% were congenital, the two most frequent being congenital cataracts and nasolacrimal duct obstruction.

Fetal hemoglobin, blood transfusion, and retinopathy of prematurity in preterm infants: An observational, prospective study

Purpose: The objective of this study was to identify the association between fetal hemoglobin (HbF) concentration, blood transfusion, and retinopathy of prematurity (ROP) in preterm infants. Methods: This was an observational, prospective study. A total of 410 preterm infants born with <36 weeks gestational age and <2.0 kg birth weight in a tertiary care center of central India for a period of 1 year were included in this study. Clinical data were obtained from case notes. HbF of infants was measured in the blood sample using high?performance liquid chromatography at the first visit and after 1 month follow?up and was analyzed statistically. Dilated fundus examination was done as per ROP screening guidelines, and ROP was classified as per the International Classification of Retinopathy of Prematurity (ICROP), 2021. The study subjects were divided into two groups based on the status of ROP. The relationship among HbF, blood transfusion, and ROP was evaluated in both the groups. The relationship between other clinical characteristics and various neonatal risk factors was also studied between the groups. Results: A total of 410 preterm infants were included in this study, of which 110 infants had ROP (26.8%). Blood transfusion was found to be significantly associated with the development of ROP. Higher fraction of HbF (%) was associated with a lower prevalence of ROP. HbF was also inversely related with the severity of ROP. Conclusion: Replacing HbF by adult hemoglobin during blood transfusion may promote the development of ROP. Conversely, maintaining a higher percentage of HbF may be a protective factor against ROP.

Rehabilitation using neurodevelopmental and sensory integration therapy approaches in an 8-month-old infant with self-gratification behavior: A case report

Self-gratification behavior is a normal behavior in infants or children and is usually misdiagnosed with dystonic development delays, repeated movement disorders, or even epilepsy. This case report aims to share our clinical experience in managing a child with self-gratification disorder through physical therapy techniques. An 8-month-old female infant presents with concerns related to poor social interaction, reduced play, irritable behavior, frequent crossing, and stiffness in the legs which she started showing at 3 months of age. She was earlier diagnosed with dystonic developmental delay and referred for a thorough development and sensory assessment. Rehabilitation with sensory integration and neurodevelopmental techniques was delivered to the child. Ages and Stages Questionnaire, Denver’s score, and Sensory profile were assessed at 8–9 months, 9–10 months, and 10–11 months to monitor prognosis. There was a significant improvement in self-gratification habits and improved attention in the child. Self-gratification behavior is a normal behavior in infants or children and is usually misdiagnosed. Treatment mainly constitutes neurodevelopment, sensory integration techniques, and parent education.

Determinación de valores de corte de 17 hidroxiprogesterona ajustados por edad gestacional para la pesquisa neonatal de la hiperplasia suprarrenal congénita / Assessment of gestational age-adjusted 17-hydroxyprogesterone cut-off values for neonatal screening of congenital adrenal hyperplasia

La pesquisa neonatal de hiperplasia suprarrenal congénita se realiza mediante la determinación de 17 hidroxiprogesterona (17OHP) en gotas de sangre seca en papel de filtro. Los bebés prematuros presentan valores más elevados que los bebés de término, siendo de utilidad contar con límites de corte apropiados. Nuestro objetivo fue actualizar los valores de corte de 17OHP ajustados por edad gestacional para la metodología en uso a nivel nacional por las jurisdicciones asistidas por el "Programa Nacional de Fortalecimiento de la Detección Precoz de Enfermedades Congénitas". La 17OHP se determinó utilizando el kit comercial de enzimo-inmunoanálisis (ELISA competitivo), Elizen Neonatal 17OHP Screening (Zentech, Bélgica). Se obtuvieron límites de corte utilizando percentiles de la distribución de los valores de 17OHP para cada edad gestacional. La sensibilidad obtenida fue 100%, especificidad 98,76 %, tasa de falsos positivos 1,24 % y el valor predictivo positivo 1,12 %. Destacamos la importancia de disponer de límites de corte adecuados a la población. La armonización de los mismos permitirá resultados comparables entre los programas regionales de pesquisa neonatal (AU)

Newborn screening for congenital adrenal hyperplasia is performed by the measurement of 17-hydroxyprogesterone (17OHP) in dried blood spots on filter paper. Premature infants have higher values than full-term infants, and appropriate cutoff values are useful. Our aim was to update the cut-off values of 17OHP adjusted for gestational age for the methodology used at a national level in regions assisted by the "National Program for Strengthening the Early Detection of Congenital Diseases". 17OHP was determined using the commercial enzyme-linked immunosorbent assay (competitive ELISA) kit, Elizen Newborn 17OHP Screening (Zentech, Belgium). Cut-off values were obtained using percentiles of the distribution of 17OHP values for each gestational age. Sensitivity was 100%, specificity 98.76%, false positive rate 1.24%, and positive predictive value 1.12%. It is important to have cut-off values that are adjusted to the population. Harmonization will allow for the comparison of results among regional newborn screening programs (AU)

Impact of Saccharomyces boulardii on jaundice in premature infants undergoing phototherapy

Abstract Objectives To evaluate the therapeutic effect of Saccharomyces boulardii supplementation on jaundice in premature infants undergoing phototherapy. Methods In this article, the authors reviewed 100 hospitalized jaundiced premature infants under 35 weeks of gestational age. All infants were assigned to a control group (n= 45) and a treatment group (n= 55) randomly. The infants in the treatment group received S. boulardii supplementation by undergoing phototherapy and the infants in the control group were only treated by phototherapy. The total serum bilirubin levels were detected before and at the end of phototherapy, and transcutaneous bilirubin levels were measured on the 1st, 4th, 8th and 15th day of treatment. The duration of jaundice resolution and phototherapy, stool frequency, and characteristics were compared after phototherapy. Results The duration of jaundice resolution and phototherapy were shortened. Total serum bilirubin level was lower than the control group at the end of phototherapy (p < 0.05). Transcutaneous bilirubin levels decreased more significantly on the 8th and 15th day of treatment (p < 0.05), while there were no significant differences on the post-treatment 1st and 4th day (p > 0.05). In addition, bowel movements including stool frequency and Bristol Stool Form Scale ratings of stools also improved after treatment. Conclusions S. boulardii in combination with phototherapy is effective and safe in reducing bilirubin levels and duration of phototherapy, accelerating jaundice resolution in premature infants with jaundice. The procedure also provided an ideal therapeutic effect of diarrhea induced by phototherapy to promote compliance and maternal-infant bonding.

Outcomes of endoscopic percutaneous suture lateralization for neonatal and infantal bilateral vocal ford paralysis

Abstract Objective: Bilateral Vocal Fold Paralysis (BVFP) is a rare but significant resource of respiratory distress in neonates and infants. The objective of this study was to evaluate the efficacy and functional outcomes of Endoscopic Percutaneous Suture Lateralization (EPSL) for the treatment of BVFP in neonates and infants. Methods: A case series study of nine patients undergoing EPSL for BVFP between January 2019 and June 2021 was conducted. All patients were candidates for tracheostomy prior to EPSL. Demographic features including gender, age at diagnosis and surgery, main symptoms, airway comorbidities, airway support, and etiology were collected preoperatively. Patients were evaluated for breathing, swallowing and phonation postoperatively. Surgical success was defined as the ability to avoid tracheostomy. Functional Endoscopic Evaluation of Swallowing (FEES) was conducted to identify aspiration. Voice evaluation was based on clinical observation. Results: Nine patients underwent ten EPSL procedures (one in the left vocal fold, and nine in the right vocal fold). Eight patients (8/9) were able to successfully avoid tracheostomy and feed orally without aspiration after the procedure. One patient experienced clinical improvement in respiratory support requirements and underwent laparoscopic nissen and gastrostomy tube placement. At the last follow-up, two patients regained normal voice, two patients had mild dysphonia, and five patients had moderate dysphonia. Five patients showed partial return of the contralateral vocal fold function. Conclusion: EPSL is an effective and safe treatment for neonatal and infantal BVFP, which enables patients free from tracheostomy without significant impact on swallowing function or phonation. Level of evidence: Level 4.

Study to evaluate the relation between weight gain in infants and occurrence of retinopathy of prematurity

Purpose: Retinopathy of prematurity (ROP) is a leading cause of childhood blindness. Capturing serial daily postnatal weight gain can act as an innovative, low?cost method of risk stratification. We aim to study the relation between weight gain in infants and occurrence of ROP. Methods: The prospective, observational study was conducted on 62 infants. ROP screening was done based on the Rashtriya Bal Swasthya Karyakram (RBSK) criteria. Infants were classified into no ROP (n = 28), mild ROP (n = 8), and treatable ROP (n = 26) groups. Average daily postnatal weight gain was measured and its relation to development of ROP was studied. All statistical calculations were done using Statistical Package for the Social Sciences (SPSS) 21 version (SPSS Inc., Chicago, IL, USA) statistical program for Microsoft Windows. Results: Mean rate of weight gain in no ROP group, mild ROP group, and treatable ROP group was 33.12, 27.19, and 15.31 g/day, respectively (P = 0.001). Mean gestational age and birth weight in treatable group (n = 26) were 31.38 weeks and 1572.31 g, respectively. Receiver operating curve analysis revealed a cutoff of 29.33 g/day for ROP and 21.91 g/day for severe ROP. Conclusion: We concluded that, babies with poor weight gain of below 29.33 g/day are at high risk for ROP and babies with wight gain of 21.91 g/day are at high risk for severe ROP. These babies should be followed meticulously. So, the rate of weight gain of a preterm can help us to prioritize babies.

Mid upper arm circumference cutoffs for identifying underweight and severe underweight among infants less than six months: A Hospital Based Cross-Sectional study

Background: Prevalence of undernutrition among infants <6 months are very high in India. WAZ is the most sensitive predictor of mortality among infants <6 months as compared to other anthropometric parameters. However, taking weight and calculating z-score in the community setting have many challenges. Taking mid upper arm circumference (MUAC) is more feasible in a field setting. Methodology: A cross-sectional study was conducted with 419 infants <6 months in a tertiary care hospital in India to identify appropriate MUAC cutoffs for identifying underweight (WAZ<-2) and severe underweight (WAZ<-3) among infants <6 months by calculating sensitivities, specificities and Youden indices. Cohen kappa coefficients were calculated to assess agreements between MUAC and WAZ cutoffs. Results: The MUAC cut-offs for underweight and severe underweight were calculated as 11cm (Youden Index: 0.503; sensitivity: 83.4%; specificity: 66.9%) and 10.9cm (Youden Index: 0.504; sensitivity: 76.3%; specificity: 74.1%), respectively. Kappa coefficients to diagnose underweight with MUAC<=11cm was highest at 0.48. Conclusions: The MUAC cut-off of 11cm could reliably be used to screen infants <6 months with underweight and severe underweight for providing appropriate care in the Indian settings.

Prevalence of thyroid dysfunction in neonates receiving parenteral nutrition in the intensive care unit

Abstract Objective: The use of parenteral nutrition (PN) formulations that do not contain iodine can contribute to the deficiency of this mineral, potentially leading to hypothyroidism and, ultimately, neurocognitive impairments. This study aimed to evaluate TSH alterations in newborns receiving PN. Methods: Retrospective study of neonatal intensive care unit patients receiving PN for > 15 days. Nutritional, anthropometric, and biochemical variables (TSH, T4, CRP) were analyzed. Hypothyroidism was defined by TSH > 10 mU/L. Results: Two hundred newborns were evaluated [156 (78%) preterm, 31±5 weeks of gestational age, 112 (56%) with very or extremely low birth weight]. The median (IQR) hospital stay was 68 (42-110) days, PN duration was 31 (21-47) days, and 188 (94%) patients also received enteral nutrition. Overall, 143 (71.5%) newborns underwent at least one TSH measurement. The prevalence of hypothyroidism was 10.5%. The Median PN duration in this group was 51 (34-109) days. Among those with hypothyroidism, 10 received Lugol's solution and six levothyroxine. Thirteen patients received prophylactic Lugol's solution with a median PN duration of 63 (48-197) days. TSH levels correlated positively with PN duration (r = 0.19, p = .02). Conclusions: The present data suggest that changes in TSH and T4 levels are present in neonates receiving PN for > 15 days, suggesting this population may be at risk for developing hypothyroid-ism. Therefore, the authors suggest that TSH and T4 measurements should be included as routine in neonatal patients receiving PN for > 15 days if PN formulations are not supplemented with iodine, and that iodine supplementation be provided as necessary.

Analysis of Related Factors Affecting the Risk Assessment of Death during Hospitalization of Extremely Low Birth Weight Infants / 中山大学学报(医学科学版)

ObjectiveTo explore the influencing factors of different scores on predicting death risk of extremely low birth weight infants （ELBWI）. MethodsA total of 186 cases of ELBWI admitted by the Children's Hospital affiliated to Nanjing Medical University and the Lishui Branch of the Affiliated Zhongda Hospital of Southeast University were admitted from January 1， 2019 to January 1， 2021， and 125 ELBWIs were finally included after screening by inclusion and exclusion criteria. There were 47 cases in the death group and 78 cases in the survival group. General data and the items of score for neonatal acute physiology version Ⅱ （SNAP-Ⅱ）， simplified version of the score for neonatal acute physiology perinatal extension （SNAPPE-Ⅱ）， clinical risk index for babies （CRIB）， clinical risk index for babies Ⅱ （CRIB-Ⅱ） and the national critical illness score （NCIS） were collected. Univariate and multivariate analysis was performed and nomogram was evaluated using receiver operating characteristic curve （ROC）. ResultsIt was found that systolic blood pressure， maximum inhaled oxygen concentration， BE value and birth weight were important factors in ELBWI mortality risk assessment ［systolic blood pressure OR： 0.968， 95%CI： 0.938-0.999， P=0.043； maximum inhaled oxygen concentration OR： 1.020， 95%CI： 1.006-1.034， P=0.006； BE OR： 0.868， 95%CI： 0.786-0.959， P=0.005； birth weight OR： 0.994， 95%CI： 0.991-0.997， P=0.000］. ROC showed that the area under the curve of the above four variables is 0.71， and the 95% confidence interval is 0.610-0.799， which is better than CRIB score. ConclusionLower systolic blood pressure， higher inhaled oxygen concentration， higher BE and lower birthweight are important influencing factors to predict the death risk of ELBWI. The above four items should be included in the newly developed score assessment to obtain a more effective ELBWI prediction system.

Comprehensive promotion of perinatal collaboration for extremely preterm infants / 中华围产医学杂志

Extremely preterm infants (EPIs) are extremely immature in organ development, vulnerable to various comorbidities after birth, and may result in high mortality and disability rates. The short- and long-term prognosis of EPIs is closely related to early management. In-depth collaboration between obstetricians and pediatricians is the key to improving their quality of life. Compared to developed countries, there is much to improve in the Chinese mainland, especially in perinatal collaboration. The attitude towards EPI treatment, prenatal prophylaxis, intrauterine transport, delivery room warmth, respiratory management in the delivery room, breastfeeding, family integrated care, cord blood stem cell therapy, and other issues in the field of perinatal collaboration in China is discussed in this article, to promote the collaborative work in related fields further.

Characteristics of kidney diseases in children aged 0-3 years old / 中华肾脏病杂志

Objective:To investigate the characteristics of renal disease spectrum in children aged 0-3 years old, and to evaluate the clinical value of renal biopsy in children aged 0-3 years old with renal diseases.Methods:It was a retrospective analysis study. The children aged 0-3 years old with kidney diseases receiving renal biopsy and having complete clinical data in Shanghai Children's Hospital from January 1, 2009 to December 31, 2020 were enrolled. The clinical and pathological data of the children were collected. The spectrum of renal diseases, clinical phenotype, renal pathology, and the relationship between renal pathology/genotype and clinical phenotype were analyzed.Results:A total of 117 children aged 0-3 years old with kidney diseases were enrolled in the study, accounting for 6.5% (117/1 790) of all children (0-18 years old) with renal biopsies during the same period. There were 77 males and 40 females. The age was (2.20±0.51) years old (5-35 months). All cases of renal biopsies in children aged 0-3 years old were successful without serious complications. Nephrotic syndrome was the common clinical phenotype of kidney diseases in children aged 0-3 years old (59.0%, 69/117), followed by hematuria and proteinuria (29.1%, 34/117). Primary glomerular disease (69.2%, 81/117) was the major clinical type of renal diseases, followed by hereditary kidney diseases (29.1%, 34/117), in which Alport syndrome was the main hereditary kidney disease (79.4%, 27/34). Renal pathological types of children aged 0-3 years old were mainly distributed in minimal change disease (30.8%, 36/117), followed by glomerular minor lesion (26.5%, 31/117), mesangial proliferative glomerulonephritis (15.4%, 18/117), and focal segmental glomerulosclerosis (10.3%, 12/117). Among 40 children aged 0-3 years old with hematuria with/without proteinuria, 25 cases were diagnosed as Alport syndrome by abnormal immunofluorescence of type IV collagen in renal tissues. Among the 28 children with kidney diseases who underwent genetic testing, 23 cases had gene mutations, mainly in COL4A5 gene (60.9%, 14/23), among which 4 children had gene mutations in 8 children with refractory nephrotic syndrome. Among the children aged 0-3 years old with clinical manifestations of hematuria, the proportion of gross hematuria in children diagnosed with Alport syndrome (59.3%, 16/27) was significantly higher than that in children without Alport syndrome (20.0%, 3/15, χ2=5.999, P=0.014). Conclusions:Primary glomerular disease is the principal type of kidney diseases in children aged 0-3 years old, followed by hereditary kidney disease. Attention should be paid to children aged 0-3 years old with gross hematuria. Renal biopsy in children aged 0-3 years old is safe and reliable, and it is an essential means for the diagnosis of renal diseases. Renal biopsy combined with gene testing can better understand the etiology of kidney diseases and guide treatment in children aged 0-3 years old.

Role of Nrf2/GPX4 signaling pathway-mediated ferroptosis in midazolam-induced reduction of HIBD in neonatal rats / 中华麻醉学杂志

Objective:To evaluate the role of nuclear factor-erythroid 2-related factor 2 (Nrf2)/glutathione peroxidase-4 (GPX4) signaling pathway-mediated ferroptosis in midazolam-induced reduction of hypoxic-ischemic brain damage (HIBD) in neonatal rats.Methods:Ninety healthy 7-day-old neonatal rats, weighing 16-20 g, were divided into 6 groups ( n=15 each) using the random number table method: sham operation group (Sham group), HIBD group, low-dose midazolam (10 mg/kg) group (group L), medium-dose midazolam (20 mg/kg) group (group M), high-dose midazolam (40 mg/kg) group (group H), and Nrf2 inhibitor ML385 group (group I). The HIBD model was developed by ligating the left carotid artery and exposing to a hypoxic condition for 2 h in anesthetized animals. Starting from 2nd day after developing the model, the corresponding doses of midazolam were intraperitoneally injected in midazolam groups, the equal volume of normal saline was intraperitoneally injected in Sham and HIBD groups, midazolam 40 mg/kg and Nrf2 inhibitor ML385 30 mg/kg were intraperitoneally injected once a day for 8 consecutive days in group I. The rats were weighed and subjected to the Morris water maze test after the end of administration. Blood samples were taken from the abdominal aorta after the end of the Morris water maze test, and then the animals were sacrificed to remove the brain for determination of the concentrations of serum iron, interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) (by enzyme-linked immunosorbent assay), contents of iron and GSH in hippocampal tissues (by ultraviolet spectrophotometry and micro method), the number of Nrf2/neuronal nuclear antigen (NeuN) and GPX4/NeuN positive cells (by immunofluorescent staining), and expression of Nrf2, GPX4, and 4-hydroxynonaenoic acid (4-HNE) in hippocampal tissues and for microscopic examination of the pathological changes of hippocampal neurons in brain tissues (after HE staining and Nissl staining). Results:Compared with Sham group, the first time to arrival at platform was significantly prolonged, the number of crossing the origional platform was reduced, and the time of staying at the target quadrant was shortened, the iron content in the hippocampal tissues was increased, the content of GSH and the number of Nrf2/NeuN and GPX4/NeuN positive cells were decreased, the expression of Nrf2 and GPX4 was down-regulated, the expression of 4-HNE was up-regulated, the concentrations of serum iron, IL-6 and TNF-α were increased, and the injury to hippocampal neurons was marked in HIBD group ( P<0.05). Compared with HIBD group, the first time to arrival at platform was significantly shortened, the number of crossing the origional platform was increased, and the time of staying at the target quadrant was prolonged, the iron content in the hippocampus tissues was decreased, the content of GSH and the number of Nrf2/NeuN and GPX4/NeuN positive cells were increased, the expression of Nrf2 and GPX4 was up-regulated, the expression of 4-HNE was down-regulated, the concentrations of serum iron, IL-6 and TNF-α were decreased ( P<0.05), and the injury to hippocampal neurons was significantly reduced in H, M and L groups. Compared with group H, the first time to arrival at platform was significantly prolonged, the number of crossing the origional platform was reduced, and the time of staying at the target quadrant was shortened, the iron content in the hippocampus tissue was increased, the content of GSH and the number of Nrf2/NeuN and GPX4/NeuN positive cells were decreased, the expression of Nrf2 and GPX4 was down-regulated, the expression of 4-HNE was up-regulated, the concentrations of serum iron, IL-6 and TNF-α were increased ( P<0.05), and the injury to hippocampal neurons was aggravated in group I. Conclusions:The mechanism by which midazolam reduces HIBD may be related to activation of the Nrf2/GPX4 signaling pathway and inhibition of hippocampal neuronal ferroptosis in neonatal rats.