Fármacos antiepilépticos usados en el embarazo y sus consecuencias sobre los resultados fetales: una revisión de la literatura / Antiepileptic drugs used in pregnancy and their consequences on fetal outcomes: a review of the literature

Los riesgos teratogénicos ocasionados por la exposición intrauterina a fármacos antiepilépticos (FAE) son conocidos, por lo que su prescripción se mantiene bajo estricto control. Describir los efectos adversos fetales de la exposición a FAE durante la gestación, reportados en la literatura durante el período 2016-2022. Revisión sistematizada de estudios que reportaron los efectos adversos fetales inducidos por la exposición a FAE en mujeres embarazadas en tratamiento por diagnósticos neurológicos, principalmente de epilepsia. La búsqueda se realizó en PubMed, Cochrane, Web of Science, SCOPUS, Biblioteca Virtual en Salud, Lilacs y SciELO. Se identificaron 37 artículos distribuidos en 13 países de Asia, Europa, América del Norte y Oceanía. Se observaron resultados perinatales adversos, tanto físicos como cognitivos, en la mayoría de los estudios. Los fármacos identificados como los más utilizados en los últimos años fueron valproato, topiramato, carbamazepina, lamotrigina y levetiracetam. Los FAE tienen potencial teratogénico en distintos grados de riesgo, provocando anomalías congénitas o efectos adversos en múltiples sistemas del cuerpo humano, siendo los sistemas nervioso, circulatorio y osteomuscular los más afectados.

The teratogenic risks caused by intrauterine exposure to antiepileptic drugs (AED) are known, so their prescription is kept under strict control. To describe the fetal adverse effects AED exposure during gestation, reported in the literature during the period 2016-2022. Systematized review of studies that reported fetal adverse effects induced for the exposure to AED in pregnant women in treatment for neurological diagnoses, mainly epilepsy. The search was carried out in PubMed, Cochrane, Web of Science, SCOPUS, Virtual Health Library, Lilacs and SciELO. 37 articles distributed in thirteen countries in Asia, Europe, North America and Oceania were identified. Adverse perinatal outcomes, both physical and cognitive, were observed in most studies. The most common drugs identified were valproate, topiramate, carbamazepine, lamotrigine and levetiracetam. AED have teratogenic potential in different degrees of risk, causing congenital anomalies or adverse effects in multiple systems of the human body, being the nervous, circulatory and musculoskeletal systems the most affected.

Association of maternal clinical factors with neonatal respiratory morbidity in meconium‑stained labor among term parturients: A retrospective cohort study / Philippine Journal of Obstetrics and Gynecology

Objective@#This study aimed to determine the maternal clinical factors associated with neonatal respiratory morbidity and other adverse neonatal outcomes in meconium-stained labor among term parturients.@*Methodology@#A retrospective cohort study was done on admitted obstetric patients with term gestation and had meconium-stained labor. Maternal clinical factors such as age, parity, gestational age, manner of delivery, duration of labor, presence of term prelabor rupture of membranes (PROM), character of meconium-stained liquor (MSL), and presence of comorbidities were identified and analyzed to determine their association with neonatal respiratory morbidity and other adverse neonatal outcomes. @*Results@#In this study, there were 986 cases identified to have meconium-stained labor, and 168 developed neonatal respiratory morbidity. As to primary outcome, maternal clinical factors, such as age >35 years, multiparity, age of gestation >41 weeks, prolonged labor, presence of PROM, significant MSL upon admission, presence of change from nonsignificant to significant MSL, presence of intrauterine growth restriction, and hypertension, were all shown to be statistically significant. @*Conclusion@#The presence of maternal clinical factors in meconium-stained labor was observed to be a risk factor in developing neonatal respiratory morbidity and other adverse neonatal outcomes. Hence, identification of maternal risk factors and early detection of meconium-stained amniotic fluid are vital in administering timely intervention to labor and delivery to reduce neonatal complications.

The evolution of approach in the resuscitation of neonates born with meconium-stained amniotic fluid: a tale of two countries, China and U.S.A., in the past 60 years / 中国当代儿科杂志

Neonates born through meconium-stained amniotic fluid (MSAF) may develop complications including meconium aspiration syndrome, persistent pulmonary hypertension of newborn and death. The approach to the resuscitation of these neonates has significantly evolved for the past few decades. Initially, under direct visualization technique, neonates with MSAF were commonly suctioned below the vocal cords soon after delivery. Since 2015, Neonatal Resuscitation Program (NRP®) of the American Academy of Pediatrics has recommended against "routine" endotracheal suctioning of non-vigorous neonates with MSAF but favored immediate resuscitation with positive pressure ventilation via face-mask bagging. However, the China neonatal resuscitation 2021 guidelines continue to recommend routine endotracheal suctioning of non-vigorous neonates born with MSAF at birth. This review article discusses the differences and the rationales in the approach in the resuscitation of neonates with MSAF between Chinese and American NRP® guidelines over the past 60 years.

Clinical characteristics and risk factors for early-onset necrotizing enterocolitis in preterm infants with very/extremely low birth weight / 中国当代儿科杂志

OBJECTIVES@#To investigate the clinical characteristics and risk factors for early-onset necrotizing enterocolitis (NEC) in preterm infants with very/extremely low birth weight (VLBW/ELBW).@*METHODS@#A retrospective analysis was performed on the medical data of 194 VLBW/ELBW preterm infants with NEC who were admitted to Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. These infants were divided into early-onset group (onset in the first two weeks of life; n=62) and late-onset group (onset two weeks after birth; n=132) based on their onset time. The two groups were compared in terms of perinatal conditions, clinical characteristics, laboratory examination results, and clinical outcomes. Sixty-two non-NEC infants with similar gestational age and birth weight who were hospitalized at the same period as these NEC preterm infants were selected as the control group. The risk factors for the development of early-onset NEC were identified using multivariate logistic regression analysis.@*RESULTS@#Compared with the late-onset group, the early-onset group had significantly higher proportions of infants with 1-minute Apgar score ≤3, stage III NEC, surgical intervention, grade ≥3 intraventricular hemorrhage, apnea, and fever or hypothermia (P<0.05). The multivariate logistic regression analysis showed that feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, and hemodynamically significant patent ductus arteriosus were independent risk factors for the development of early-onset NEC in VLBW/ELBW preterm infants (P<0.05).@*CONCLUSIONS@#VLBW/ELBW preterm infants with early-onset NEC have more severe conditions compared with those with late-onset NEC. Neonates with feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, or hemodynamically significant patent ductus arteriosus have a higher risk of early-onset NEC.

Recent research on machine learning in the diagnosis and treatment of necrotizing enterocolitis in neonates / 中国当代儿科杂志

Necrotizing enterocolitis (NEC), with the main manifestations of bloody stool, abdominal distension, and vomiting, is one of the leading causes of death in neonates, and early identification and diagnosis are crucial for the prognosis of NEC. The emergence and development of machine learning has provided the potential for early, rapid, and accurate identification of this disease. This article summarizes the algorithms of machine learning recently used in NEC, analyzes the high-risk predictive factors revealed by these algorithms, evaluates the ability and characteristics of machine learning in the etiology, definition, and diagnosis of NEC, and discusses the challenges and prospects for the future application of machine learning in NEC.

Atuação da psicologia em unidade neonatal no contexto da pandemia da covid-19 / The work of psychology in a neonatal unit in the covid-19 pandemic / Actuación de la psicología en una unidad neonatal en el contexto de la pandemia de la covid-19

A pandemia de covid-19 provocou intensas mudanças no contexto do cuidado neonatal, exigindo dos profissionais de saúde a reformulação de práticas e o desenvolvimento de novas estratégias para a manutenção da atenção integral e humanizada ao recém-nascido. O objetivo deste artigo é relatar a atuação da Psicologia nas Unidades Neonatais de um hospital público de Fortaleza (CE), Brasil, durante o período de distanciamento físico da pandemia de covid-19. Trata-se de estudo descritivo, do tipo relato de experiência, que ocorreu no período de março a agosto de 2020. No contexto pandêmico, o serviço de Psicologia desenvolveu novas condutas assistenciais para atender às demandas emergentes do momento, como: atendimento remoto; registro e envio on-line de imagens do recém-nascido a seus familiares; visitas virtuais; e reprodução de mensagens de áudio da família para o neonato. Apesar dos desafios encontrados, as ações contribuíram para a manutenção do cuidado centrado no recém-nascido e sua família, o que demonstra a potencialidade do fazer psicológico.(AU)

The COVID-19 pandemic brought intense changes to neonatal care and required health professionals to reformulate practices and develop new strategies to ensure comprehensive and humanized care for newborn. This study aims to report the experience of the Psychology Service in the Neonatal Units of a public hospital in Fortaleza, in the state of Ceará, Brazil, during the social distancing period of the COVID-19 pandemic. This descriptive experience report study was conducted from March to August 2020. During the pandemic, the Psychology Service developed new care practices to meet the emerging demands of that moment, such as remote care, recordings and online submission of newborns' pictures and video images for their family, virtual tours, and reproduction of family audio messages for the newborns. Despite the challenges, the actions contributed to the maintenance of a care that is centered on the newborns and their families, which shows the potential of psychological practices.(AU)

La pandemia de la COVID-19 ha traído cambios intensos en el contexto de la atención neonatal, que requieren de los profesionales de la salud una reformulación de sus prácticas y el desarrollo de nuevas estrategias para asegurar una atención integral y humanizada al recién nacido. El objetivo de este artículo es reportar la experiencia del Servicio de Psicología en las Unidades Neonatales de un hospital público de Fortaleza, en Ceará, Brasil, durante el periodo de distanciamiento físico en la pandemia de la COVID-19. Se trata de un estudio descriptivo, un reporte de experiencia, que se llevó a cabo de marzo a agosto de 2020. En el contexto pandémico, el servicio de Psicología desarrolló nuevas conductas asistenciales para atender a las demandas emergentes del momento, tales como: atención remota; grabación y envío em línea de imágenes del recién nacido; visitas virtuales; y reproducción de mensajes de audio de la familia para el recién nacido. A pesar de los desafíos encontrados, las acciones contribuyeron al mantenimiento de la atención centrada en el recién nacido y su familia, lo que demuestra el potencial de la práctica psicológica.(AU)

Cuidados de enfermagem para prevenção de lesão de pele em recém-nascidos pré-termo: Revisão integrativa / Atención de enfermería para la prevención de lesiones cutáneas en recién nacidos pretérmino: Revisión integrativa / Nursing care for prevention of skin injury in pre-term newborn: Integrative review

Objetivo: descrever o que tem sido escrito cientificamente sobre a adequação da assistência da enfermeira no centro cirúrgico no cenário da pandemia por Covid-19. Método: Trata-se de uma revisão integrativa de literatura. Como critérios de inclusão, elegeu-se: artigos completos disponíveis em português e inglês, publicados a partir de 2020, ano que deu início a pandemia até janeiro de 2022. Para organização e análise dos dados, recorreu-se ao Método de Análise de Conteúdo. Resultados: Foram selecionados 8 artigos. Como categorias de análise, emergiram os seguintes temas: o estabelecimento de protocolos operacionais específicos para a realização de cirurgias durante a pandemia da Covid-19 e a necessidade de readequação dos profissionais de saúde e a importância da enfermeira neste contexto. Conclusão: A enfermeira teve papel fundamental em todo o processo de estruturação e direcionamento do cuidado ao paciente, destacando seu potencial como protagonista no processo de cuidar em saúde. (AU)

Objective: to describe what has been scientifically written about the adequacy of nurse assistance in the surgical center in the context of the Covid-19 pandemic. Methodology: This is an integrative literature review. As inclusion criteria, the following were chosen: full articles available in Portuguese and English, published from 2020, the year the pandemic started until January 2022. For data organization and analysis, the Content Analysis Method was used . Results: Eight articles were selected. As categories of analysis, the following themes emerged: the establishment of specific operational protocols for performing surgeries during the Covid-19 pandemic and the need to readjust health professionals and the importance of the nurse in this context. Considerations: The nurse played a fundamental role in the entire process of structuring and directing patient care, highlighting her potential as a protagonist in the health care process.(AU)

Objetivo: describir lo que científicamente se ha escrito sobre la adecuación de los cuidados de enfermería en el centro quirúrgico en el contexto de la pandemia de la Covid-19. Método: Esta es una revisión integradora de la literatura. Como criterios de inclusión, se eligieron: artículos completos disponibles en portugués e inglés, publicados a partir de 2020, año de inicio de la pandemia, hasta enero de 2022. Para la organización y análisis de los datos, se utilizó el Método de Análisis de Contenido. Resultados: Se seleccionaron ocho artículos. Como categorías de análisis, surgieron los siguientes temas: el establecimiento de protocolos operativos específicos para la realización de cirugías durante la pandemia de Covid-19 y la necesidad de readecuación de los profesionales de la salud y la importancia del enfermero en este contexto. Conclusión: La enfermera jugó un papel fundamental en todo el proceso de estructuración y dirección del cuidado del paciente, destacando su potencial como protagonista en el proceso de atención a la salud.(AU)

Enterocolitis necrosante posterior a evento aislado de taquicardia supraventricular: reporte de un caso de presentación neonatal atípica / Necrotizing enterocolitis after an isolated event of supraventricular tachycardia. Case report of atypical neonatal presentation

La taquicardia supraventricular (TSV) es la principal taquiarritmia en el recién nacido (RN) que requiere una resolución urgente. Por su parte, la enterocolitis necrosante (ECN) es la emergencia gastrointestinal más común que afecta principalmente a RN prematuros. Aunque estas se reconocen como patologías distintas, la bibliografía sugiere que los episodios de TSV pueden predisponer a los pacientes a la ECN a través de alteraciones en el flujo sanguíneo mesentérico y una disminución de la perfusión tisular. Se presenta aquí el caso clínico de un neonato prematuro que desarrolló un cuadro de ECN luego de un evento aislado de TSV con bajo gasto cardíaco

Supraventricular tachycardia (SVT) is the main tachyarrhythmia in the newborn (NB) that requires urgent resolution. Necrotizing enterocolitis (NEC) is the most common gastrointestinal emergency that mainly affects premature infants. Although these conditions are recognized as distinct pathologies, literature reports suggest that episodes of SVT may predispose patients to NEC secondary to disturbances in mesenteric blood flow and a decrease in tissue perfusion. We present here the clinical case of a premature neonate who developed NEC after an isolated SVT event with low cardiac output

Hipoglucemia neonatal en hijos de madres con diabetes mellitus gestacional. Comparación de la incidencia según el tratamiento materno / Neonatal hypoglycemia in infants born to mothers with gestational diabetes mellitus. Comparison of its incidence based on maternal treatment

Introducción. La hipoglucemia neonatal es una complicación de la diabetes mellitus gestacional Son pocos los estudios que avalan la pesquisa sistemática en este grupo poblacional durante las primeras horas de vida. Objetivos. Evaluar la asociación entre tratamiento materno recibido (dieta versus insulina) y el desarrollo de hipoglucemia, e identificar los factores de riesgo asociados. Población y métodos. Estudio observacional, analítico y retrospectivo realizado en en las sedes de Buenos AIres y San Justo de un hospital general de tercer nivel entre el 1 de enero de 2017 y el 31 de diciembre de 2018. Se estimó la incidencia de hipoglucemia (≤47 mg/dl) en recién nacidos según el manejo de la diabetes materna y se realizó un análisis multivariable para evaluar factores asociados. Resultados. Se incluyeron 195 pacientes. No se encontró diferencia estadística en la incidencia de hipoglucemia según el tratamiento materno recibido (45,3 % versus 39,7 %; p = 0,45) ni se identificaron factores de riesgo asociados. Modificando el valor de corte a ≤40 mg/dl, tampoco se encontraron diferencias en la incidencia (23,4 % versus 19 %, p = 0,48); no obstante, los pacientes hipoglucémicos presentaron un hematocrito significativamente mayor y una menor prevalencia de lactancia exclusiva al egreso. El análisis multivariable mostró una asociación independiente entre alto peso al nacer con hipoglucemia que requiere corrección. Conclusiones. La incidencia de hipoglucemia neonatal en la población estudiada no presentó diferencia según el tratamiento materno recibido. El estudio realizado fundamenta el control de la glucemia en estos niños en la práctica diaria.

Introduction. Neonatal hypoglycemia is a complication of gestational diabetes mellitus. Few studies have been conducted to support a systematic screening in the first hours of life of this population group. Objectives. To assess the association between the treatment administered to the mother (diet vs. insulin) and the development of hypoglycemia, and to identify associated risk factors. Population and methods. Observational, analytical, and retrospective study carried out at the Buenos Aires and San Justo maternal centers of a general, tertiary care hospital between 01-01-2017 and 12-31-2018. The incidence of neonatal hypoglycemia (≤ 47 mg/dL) based on the management of maternal diabetes was estimated and a multivariate analysis was done to assess related factors. Results. A total of 195 patients were included. No statistical difference was found in the incidence of hypoglycemia based on the treatment administered to the mother (45.3% vs. 39.7%; p = 0.45) and no associated risk factors were identified. Once the cutoff point was changed to ≤ 40 mg/dL, no differences were found in the incidence either (23.4% versus 19%, p = 0.48); however, patients with hypoglycemia had a significantly higher hematocrit level and a lower prevalence of exclusive breastfeeding upon discharge. Multivariate analysis showed an independent association between a high birth weight and hypoglycemia, requiring correction. Conclusions. The incidence of neonatal hypoglycemia in the studied population did not vary based on the treatment received by the mother. This study supports the control of glycemia in these infants in daily practice.

Informe sobre transmisión vertical de la hepatitis B en el Hospital Materno Infantil Sardá de la Ciudad de Buenos Aires durante el período 2018-2020 / Report on vertical transmission of hepatitis B at Hospital Materno Infantil Sardá in the City of Buenos Aires for the period 2018-2020

La hepatitis B es una infección vírica que afecta al hígado, puede dar lugar tanto a un cuadro agudo como a una enfermedad crónica, y se transmite por la vía sexual, vertical y parenteral. En este informe, se describe la situación mundial y nacional de esta patología, y su transmisión vertical, así como la caracterización de niños expuestos al virus durante el embarazo, nacidos en el Hospital Materno Infantil Ramón Sardá entre 2018 y 2021.

Transfusão de hemácias em neonatos pelo cateter central de inserção periférica: revisão integrativa / Red blood cell transfusions in newborn infants through peripherally inserted central catheter: an integrative review / Transfusión de glóbulos rojos en neonatos a través de catéter central de inserción periférica: revisión integradora

Objetivo: identificar na literatura as implicações relacionadas à transfusão de hemácias, por meio do Cateter Central de Inserção Periférica, em neonatos. Métodos: revisão integrativa realizada nas bases de dados Web of Science, Scopus, Biblioteca Virtual em Saúde e PUBMED. Incluíram-se publicações em inglês, espanhol e português, disponíveis na íntegra, sem data limite. Resultados: selecionaram-se quatro (100,0%) pesquisas que abordaram hemólise das hemácias e dois deles (50,0%), também, versaram sobre obstrução do cateter durante a transfusão. Os estudos evidenciaram ocorrência de hemólise relacionada à velocidade de infusão e ao tempo de armazenamento das hemácias, porém sem relevância clínica. Referente à obstrução, observou-se ocorrência em apenas um cateter de 38 acompanhados em um estudo; no outro, não houve obstrução, sendo as transfusões consideradas tecnicamente viáveis. Conclusão: urgem estudos clínicos primários que avaliem as consequências clínicas das transfusões de hemácias por esse tipo de cateter, em neonatos.

Objective: this study aimed to identify in literature the implications related to red blood cell (RBC) transfusions, through Peripherally Inserted Central Catheter, in neonates. Methods: this is an integrative review conducted in the Web of Science, Scopus, Virtual Health Library, and PubMed databases. Publications in English, Spanish and Portuguese, available in full, without date limit, were included. Results: four (100.0%) studies that addressed hemolysis of RBCs were selected, of which two (50.0%) also addressed catheter obstruction during transfusion. Studies revealed the occurrence of hemolysis related to infusion rate and storage time of RBCs, however without clinical relevance. Regarding obstruction, it was verified in only one catheter out of 38 followed-up in a study; in the other, there was no obstruction and transfusions were considered technically feasible. Conclusion:there is urgent need for primary clinical studies to assess clinical consequences of red blood cell transfusions through this type of catheter in neonates.

Objetivo: identificar en la literatura las implicaciones relacionadas con la transfusión de glóbulos rojos, por Catéter Central de Inserción Periférica, en neonatos. Métodos: revisión integrativa, en las bases de datos Web of Science, Scopus, Biblioteca Virtual en Salud y PUBMED. Se incluyeron publicaciones en inglés, español y portugués, disponibles en totalidad, sin fecha límite. Resultados: seleccionaron cuatro (100,0%) estudios que abordaban la hemólisis de glóbulos rojos y dos de ellos (50,0%) la obstrucción del catéter durante la transfusión. Los estudios señalaron ocurrencia de hemólisis relacionada con velocidad de infusión y tiempo de almacenamiento de los glóbulos rojos, pero sin relevancia clínica. Sobre la obstrucción, se observó en catéter de 38 seguidos en un estudio; en otro, no hubo obstrucción, y las transfusiones se consideraron técnicamente factibles. Conclusión:se necesitan estudios clínicos primarios para evaluar las consecuencias clínicas de las transfusiones de glóbulos rojos a través de este tipo de catéter en los recién nacidos.

Estado nutricional de la mujer embarazada y su relación con las complicaciones de la gestación y el recién nacido / Nutrition status of pregnant women and its relationship with complications of pregnancy and the newborn

RESUMEN: El estado nutricional materno determina las condiciones de salud y nutricionales del recién nacido, así como las complicaciones durante el embarazo y el parto. Se realizó el estudio en 894 mujeres que tuvieron su parto en los Hospitales de la ciudad de Loja Ecuador durante el periodo enero - junio del 2019. Se determinó la antropometría de la madre y de su hijo, así como se tomó datos de complicaciones durante el embarazo y el parto, de su historia clínica. Además, se efectuó la correlación entre el estado nutricional pre-gestacional de la madre con el recién nacido, de igual forma con el estado de salud de la madre. El objetivo de este trabajo fue determinar el estado nutricional pre-gestacional y su relación con la condición de salud y nutricional del niño. El IMC pre-gestacional reportó 47,3 % de sobrepeso y obesidad y 2,6 % de bajo peso. En un porcentaje mayor al 10 % las madres con sobrepeso y obesidad tuvieron hijos grandes para la edad gestacional, de igual forma las madres con bajo peso tuvieron el 26,1 % recién nacidos pequeños. Las principales complicaciones de las madres relacionadas con sobrepeso y obesidad fueron: diabetes gestacional, hemorragia postparto y pre-eclampsia durante el embrazo. Importante señalar la alta frecuencia de infecciones de las vías urinarias 53,9 % (478); y vaginitis 22,3 % (199); aunque estas no están directamente relacionadas con procesos metabólicos como etiología, más si están favorecidos por ellos. Durante el parto la complicación más frecuente fue el parto distócico con un 8,9 % (77), además del total de partos el 41,8 % (374) terminaron en cesárea, de estos el 51, 6 % (193) corresponden a sobrepeso y obesidad. Las complicaciones del recién nacido fueron: Síndrome de dificultad respiratoria aguda, asfixia neonatal e hipoglicemia. En conclusión, el estado nutricional pre-gestacional de la madre está relacionado directamente con el estado de salud y nutricional del recién nacido.

SUMMARY: The maternal nutritional status determines the health and nutritional conditions of the newborn, as well as complications during pregnancy and childbirth. The study was carried out in 894 women who had their delivery in the Hospitals of the city of Loja Ecuador during the period January - June 2019. The anthropometry of the mother and her child was determined, as well as data on complications during pregnancy and delivery, from their clinical history. In addition, the correlation was made between the pre-gestational nutritional status of the mother with the newborn, in the same way with the health status of the mother. The objective of this work was to determine the pre-gestational nutritional status and its relationship with the health and nutritional condition of the child. The pre-gestational BMI reported 47.3 % overweight and obesity and 2.6 % underweight. In a percentage higher than 10 %, mothers with overweight and obesity had large children for gestational age, in the same way, mothers with low weight had 26.1 % small newborns. The main complications of the mothers related to overweight and obesity were: gestational diabe- tes, postpartum hemorrhage and pre-eclampsia during pregnancy. It is important to note the high frequency of urinary tract infections 53.9% (478); and vaginitis 22.3% (199; although these are not directly related to metabolic processes such as etiology, more if they are favored by them. During delivery, the most frequent complication was dystocic delivery with 8.9 % (77), in addition to the total deliveries 42.5 % (374) that ended in cesarean section, of which 51.6 % (193) correspond to overweight and obesity. The complications of the newborn were: Acute respiratory distress syndrome, neonatal asphyxia and hypoglycemia. In conclusion, the pre-gestational nutritional status of the mother is directly related to the health and nutritional status of the newborn.

Evaluation of the clinical effect of an artificial intelligence-assisted diagnosis and treatment system for neonatal seizures in the real world: a multicenter clinical study protocol / 中国当代儿科杂志

Neonatal seizures are the most common clinical manifestations of critically ill neonates and often suggest serious diseases and complicated etiologies. The precise diagnosis of this disease can optimize the use of anti-seizure medication, reduce hospital costs, and improve the long-term neurodevelopmental outcomes. Currently, a few artificial intelligence-assisted diagnosis and treatment systems have been developed for neonatal seizures, but there is still a lack of high-level evidence for the diagnosis and treatment value in the real world. Based on an artificial intelligence-assisted diagnosis and treatment systems that has been developed for neonatal seizures, this study plans to recruit 370 neonates at a high risk of seizures from 6 neonatal intensive care units (NICUs) in China, in order to evaluate the effect of the system on the diagnosis, treatment, and prognosis of neonatal seizures in neonates with different gestational ages in the NICU. In this study, a diagnostic study protocol is used to evaluate the diagnostic value of the system, and a randomized parallel-controlled trial is designed to evaluate the effect of the system on the treatment and prognosis of neonates at a high risk of seizures. This multicenter prospective study will provide high-level evidence for the clinical application of artificial intelligence-assisted diagnosis and treatment systems for neonatal seizures in the real world.

Risk factors for necrotizing enterocolitis and establishment of prediction model of necrotizing enterocolitis in preterm infants / 中国当代儿科杂志

OBJECTIVES@#To investigate the risk factors for necrotizing enterocolitis (NEC) in preterm infants, and to establish a scoring model that can predict the development and guide the prevention of NEC.@*METHODS@#A retrospective analysis was performed on the medical data of preterm infants who were admitted to the Department of Neonatology,Bethune First Hospital of Jilin University, from January 2011 to December 2020. These infants were divided into two groups: NEC (298 infants with Bell II stage or above) and non-NEC (300 infants). Univariate and multivariate analyses were performed to identify the factors influencing the development of NEC. A nomogram for predicting the risk of NEC was established based on the factors. The receiver operator characteristic (ROC) curve and the index of concordance (C-index) were used to evaluate the predictive performance of the nomogram.@*RESULTS@#The multivariate logistic regression analysis showed that grade ≥2 intracranial hemorrhage, peripherally inserted central catheterization, breast milk fortifier, transfusion of red cell suspension, hematocrit >49.65%, mean corpuscular volume >114.35 fL, and mean platelet volume >10.95 fL were independent risk factors for NEC (P<0.05), while the use of pulmonary surfactant, the use of probiotics, and the platelet distribution width >11.8 fL were protective factors against NEC (P<0.05). The nomogram showed good accuracy in predicting the risk of NEC, with a bootstrap-corrected C-index of 0.844. The nomogram had an optimal cutoff value of 171.02 in predicting the presence or absence of NEC, with a sensitivity of 74.7% and a specificity of 80.5%.@*CONCLUSIONS@#The prediction nomogram for the risk of NEC has a certain clinical value in early prediction, targeted prevention, and early intervention of NEC.

Expert consensus on standard clinical management of neonatal hypoglycemia in China (2021) / 中国当代儿科杂志

There are many high-risk factors for neonatal hypoglycemia, and persistent severe hypoglycemia can lead to irreversible neurological damage and bring a great burden to family and society. Early standardized prevention and clinical management can effectively reduce the incidence rate of neonatal hypoglycemia and brain injury induced by hypoglycemia; however at present, there is still a lack of unified clinical management guidelines for neonatal hypoglycemia in China, and different medical institutions follow different clinical guidelines developed by other countries for the management of neonatal hypoglycemia. In order to further standardize the clinical management of neonatal hypoglycemia, this consensus is developed by the Group of Neonatology, Pediatric Society, Chinese Medical Association. This consensus provides 21 recommendations to address related clinical issues in the prevention, monitoring, and management of hypoglycemia in neonates with a gestational age of ≥35 weeks.