The association of neonatal SARS-CoV-2 anti-spike protein receptor-binding domain antibodies at delivery with infant SARS-CoV-2 infection under the age of 6 months: a prospective cohort study.

OBJECTIVES: The aim of this study was to assess the association between neonatal SARS-CoV-2 antibody level at delivery and infant SARS-CoV-2 infection under the age of 6 months and to identify predictive factors for neonatal antibody level at delivery. METHODS: In a prospective observational study, conducted between September 2021 and mid-February 2022, cord blood sera were tested for SARS-CoV-2 anti-spike receptor-binding domain antibodies after maternal BNT162b2 vaccination or infection. Infants were followed up for 6 months for SARS-CoV-2 infection. RESULTS: Sixty-seven mother-infant dyads were enrolled; nine of those did not meet the eligibility criteria. Of the 58 mother-infant dyads included, 6-month follow-up data were available for 57 mother-infant dyads. The mean ± standard deviation log SARS-CoV-2 anti-spike antibody level at delivery was lower among infants who were COVID-19 positive versus negative during follow-up (3.41 ± 0.74 AU/mL, n = 12; vs. 3.87 ± 0.84 AU/mL, n = 46; p 0.036); a log titre of ≥4.07 AU/mL (11 750) at delivery was associated with a significantly lower likelihood of infant infection (1/26 vs. 11/32 in infants with antibody level of <4.07 log AU/mL, OR = 0.076 [95% CI, 0.076, 0.64], p 0.018). A spline curve model showed a linear decrease in antibody levels when the last dose was administered at ≤30 weeks of gestation (50 days before delivery), after which the antibody levels increased (R2 = 0.50). In multivariate analysis, more vaccine doses, prior maternal infection, and last administered dose at ≥31 weeks of gestation were associated with higher antibody levels at delivery. DISCUSSION: Higher anti-spike antibodies at delivery were associated with decreased risk of COVID-19 at the age of <6 months; the antibody level decreased linearly when the last dose was administered at ≤30 weeks of gestation. Future research should assess the effectiveness of a second booster during pregnancy against infant infection.

Risk factors associated with accidental fetal skin lacerations during cesarean delivery.

OBJECTIVE: To identify risk factors associated with accidental fetal skin lacerations (AFL) during cesarean section (CS). METHODS: This retrospective cohort study was obtained from the registry of two large medical centers between 2014 and 2019. The study group comprised all newborns identified with AFL. The rates of various potential risk factors were compared between the study group and a group of CS at which no AFL had occurred (the control group). RESULTS: Of the 14 666 CS deliveries, 48 cases of AFL (0.33%) were documented, 52% of these following urgent CS. Compared with the control group (n = 14 618), the only risk factors associated with AFL were premature rupture of membranes (PROM) (odds ratio [OR] 5.38, 95% convidence interval [CI] 2.97-9.74) and meconium-stained amniotic fluid (OR 6.50, 95% CI 2.55-16.54). In subgroup analysis by CS urgency, no significance for these factors was noted in elective CS group; but higher rates of both PROM and meconium-stained amniotic fluid were noted in the AFL during urgent CS (OR 14.23, 95% CI 6.30-32.16 and OR 15.36, (95% CI 5.65-41.75, respectively). CONCLUSIONS: During urgent CS, the surgeon should bear in mind that the presence of PROM or meconium-stained amniotic fluid should prompt extra care and application of preventive measures to decrease the rates of AFL.

[NEONATAL SKIN MANIFESTATION OF LANGERHANS CELL HISTIOCYTOSIS].

INTRODUCTION: Langerhans cell histiocytosis (LCH) is rare during the newborn period. The term is used to describe a disorder characterized by infiltration of Langerhans cells into various organs. Langerhans cells are derived from the bone marrow, and are a type of dendritic cells found primarily in the epidermis. LCH may involve multiple organ systems, the most common being the skin and the bones. Cutaneous involvement is very common in LCH, and is often the presenting symptom. The most classic presentation is that of seborrheic dermatitis like eruption. Papules, petechiae, erosions and vesicles were also described. In our present case we describe a neonate with vesiculopustular rash appearing immediately after birth with an unexpected diagnosis made by skin biopsy.

Diagnosing congenital cytomegalovirus by saliva on Guthrie paper.

BACKGROUND: In recent years, interest in universal newborn screening for congenital cytomegalovirus (cCMV) has intensified. consequently, reliable and simple methods of mass screening for cCMV, are essential. Herein, we present a novel approach of using polymerase chain reaction (PCR) in saliva with direct inoculation onto Guthrie paper. Our aim was to determine the diagnostic accuracy of real- time PCR in saliva rolled directly onto Guthrie paper in diagnosing cCMV infection. OBJECTIVES: To evaluate the diagnostic accuracy of real-time PCR analysis of dried saliva on Guthrie paper as a future approach for mass screening of newborns in diagnosing cCMV infection. STUDY DESIGN: This prospective, blinded study was performed in a tertiary cytomegalovirus (CMV) clinic from May 2018 through January 2019. Forty-two cCMV positive newborns and 41 without cCMV, were enrolled and tested for CMV using PCR from their saliva placed onto Guthrie paper and from their saliva using standard methods. Specificity and sensitivity of dried saliva PCR versus gold-standard methods were analyzed. RESULTS: Forty-two out of 42 (100 %) CMV positive infants showed positive PCR in the dried saliva on the Guthrie paper. All (100 %) controls exhibited negative PCR results. Congenital CMV infection was identified with a sensitivity of 100 % (95 % C.I. = 91.4%-100.00%) and specificity of 100 % (95 % C.I. = 91.4%-100.00%). DISCUSSION: CMV testing with saliva real-time PCR on Guthrie paper displayed a high sensitivity and specificity, rendering it a powerful screening test. The accuracy, simplicity of sampling, storage and transportation and the potential reliance on existing logistic resources, establishes this method as a candidate for cCMV universal screening programs.

Induction of labor versus expectant management after successful external cephalic version.

BACKGROUND: External cephalic version (ECV) is a common procedure for women carrying a breech-presenting fetus, in an effort to avoid a cesarean birth. The benefit of immediate labor induction after ECV vs. expectant management is undetermined. We aimed to evaluate whether induction of labor immediately after a successful ECV improves the chances of a vaginal delivery compared with expectant management. METHODS: Retrospective analysis of 296 women who underwent successful ECV performed in term singleton gestations (2007-2018) in the Rabin Medical Center. Mode of delivery and other obstetrical and neonatal outcomes were compared between women undergoing immediate labor induction after ECV and those managed expectantly. RESULTS: Of 296 women after successful ECVs, 54 (18.2%) underwent immediate labor induction and 242 (81.8%) were managed expectantly. Immediate induction was associated with higher parity (2.4 vs 1.7, P = .03) and lower mean birthweight (3128 vs 3346 g, P < .01). Mode of delivery was similar between groups, and no other significant differences in obstetrical and neonatal adverse outcomes were noted. DISCUSSION: In our cohort, immediate labor induction after successful ECV apparently had no benefits in terms of obstetrical or neonatal complications, and did not reduce the risk of cesarean birth. Therefore, expectant management seems reasonable and safe.

Hematologic Adverse Events Associated With Prolonged Valganciclovir Treatment in Congenital Cytomegalovirus Infection.

BACKGROUND: Valganciclovir (2/d) therapy for 6 months in neonates with symptomatic congenital cytomegalovirus (cCMV) infection improves hearing and neurodevelopmental outcome. The only reported adverse event was neutropenia. Since 2009, our protocol for symptomatic cCMV infection was a 1-year treatment of 2/d for the first 3 months followed by 9 months of 1/d. METHODS: A retrospective study. Infants with cCMV treated with valganciclovir for 1 year were recruited. Data of drug-related hematologic adverse events were collected. RESULTS: One hundred sixty infants were eligible; 46 (28.8%) had experienced at least 1 episode of neutropenia (58 episodes), the majority (39/46, 84.8%) during the first 3 months of treatment and 7 (15.2%) during the last 9 months of treatment. Grades 3 and 4 neutropenia occurred in 9 (5.6%) children, almost exclusively during the first 3 months of treatment. Anemia (hemoglobin <9 g/dL) was recorded in 12 (7.5%) children during the first 3 months of 2/d treatment. Four children presented with hemoglobin levels <7 g/dL and needed a blood transfusion. One child was diagnosed with transient pure red cell aplasia. No long-term adverse events were recorded. CONCLUSIONS: Although prolonged valganciclovir treatment for cCMV is safe, a close monitoring of the white blood cell count and hemoglobin levels is warranted. Much lower rates of grades 3 and 4 neutropenia were observed than previously reported, probably owing to our unique treatment protocol. Nevertheless, drug-induced anemia should be of primary concern. The optimal protocol assessing clinical outcome, concurrently with potential side effects, has not yet been determined.

Ultrasonographic demonstration of the superior ophthalmic vein in the orbit of premature infants with and without retinopathy of prematurity.

Retinopathy of prematurity (ROP), which develops due to abnormal retinal vascularization in premature babies, can lead to irreversible vision loss. B-scan ocular ultrasonography is a noninvasive examination which makes it possible to image the eye and orbit. Our purpose was to echographically assess the orbit of premature babies with and without retinopathy of prematurity (ROP), with a focus on the superior ophthalmic vein (SOV) which is normally not detected by orbital ultrasound. A prospective study design was used after approved by the local institutional review board. ROP was diagnosed by routine ophthalmoscopic exam. Orbital ultrasound was performed by a single experienced ophthalmologist and ultra-sonographer who was masked to the routine ROP screening results. The results of the ophthalmoscopic exam were compared to the orbital ultrasound findings. The study group was divided into those diagnosed with ROP and those not diagnosed with ROP and were found to be comparable by age and weight at the time of the US examination. The SOV was dilated in 21 of 22 eyes (95.4%) with ROP and in only 5 of 32 eyes (15.6%) without ROP. The present study suggests an association between ROP and dilatation of the SOV.

Time to normalization of intracranial pressure secondary to intraventricular hemorrhage and the need for retinopathy of prematurity treatment in infants diagnosed with both conditions.

PURPOSE: To determine whether time to normalization of increased intracranial pressure (ICP) caused by intraventricular hemorrhage (IVH) is associated with retinopathy of prematurity (ROP) treatment in premature infants diagnosed with both conditions. METHODS: The medical records of all premature infants born at ≤ 35 weeks' gestation and/or birth weight of ≤ 1500 g diagnosed with both any stage of ROP and any grade of IVH, with or without secondary increased ICP (defined as ≥ 20 cm H(2)O) were retrospectively reviewed. Adjusting for birth weight and gestational age, we compared time to normalization of increased ICP in infants treated for increased ICP only with that of infants treated for both increased ICP and ROP. RESULTS: A total of 21 infants were included. ICP levels normalized at a significantly older postnatal age in infants treated for both increased ICP and ROP (100 days) than in those treated for elevated ICP alone (45 days), after we adjusted for the results for birth weight and gestational age (P = 0.049). CONCLUSIONS: Earlier control of increased ICP secondary to IVH may reduce the need for ROP treatment in premature babies initially diagnosed with both conditions.

Risk factors for pneumothorax in very low birth weight infants.

OBJECTIVES: To identify risk factors for pneumothorax in very low birth weight infants. DESIGN: Retrospective case-control study. SETTING: Neonatal intensive care unit in a pediatric tertiary care center. PATIENTS: Very low birth weight infants. INTERVENTIONS: All very low birth weight infants with pneumothorax born during the period January 1997 through December 2002 were identified. These infants were matched to infants without pneumothorax for gestational age, birth weight, and gender. Perinatal, neonatal, and treatment variables were collected for all infants. MEASUREMENTS AND MAIN RESULTS: Very low birth weight infants with pneumothorax were compared with those without. Univariate analysis was performed using the paired Student's t-test for continuous variables and the McNemar test for categorical variables. All variables were entered into a stepwise logistic regression model using a paired case-control design. Statistical significance was defined at p < .05. Seventy-four of 679 very low birth weight infants (10.9%) admitted to the neonatal intensive care unit developed a pneumothorax and were matched to 74 control infants. Multivariate analysis showed that only factors present on the day of pneumothorax were associated with pneumothorax. An increased risk of pneumothorax was associated with maximal, peak inspiratory pressure (odds ratio [OR] 1.33, 95% confidence interval [CI] 1.07, 1.66), minimal Fio2 (OR 2.18, 95% CI 1.14, 4.17), pulmonary hemorrhage (OR 27.5, 95% CI 2.3, 337), and maximal arterial CO2 (OR 1.94, 95% CI 1.13, 3.34), while a decreased risk was associated with maximal positive end-expiratory pressure (OR 0.71, 95% CI 0.56, 0.91). CONCLUSIONS: Pneumothorax is associated with factors present on day of pneumothorax and not with initial ventilation variables or initial severity of lung disease. Decreasing the risk of pneumothorax requires rigorous control of ventilation, including optimizing positive end-expiratory pressure and minimizing peak inspiratory pressure.

The existence of gender difference in IL-1Ra gene polymorphism.

Interleukin-1beta (IL-1beta) and its endogenous antagonist IL-1 receptor antagonist (IL-1ra) play an important role in various inflammatory responses. The production of IL-1 and IL-1ra is regulated by genotypic and nongenotypic factors and is different between men and women. The aim of this study was to examine the existence of gender difference in the genetic polymorphism of these two cytokines. The genotypes of IL-1beta-511 biallelic polymorphism and that of IL-1Ra (IL-1RN) penta-allelic polymorphism were determined in 319 healthy Jewish subjects, 156 female and 163 male, using PCR amplification. The results showed that there was a gender difference in IL-1Ra gene polymorphism expressed by a higher incidence of IL1RN*1/IL1RN*1 homozygotes and a lower occurrence of IL1RN*1/IL1RN*2 heterozygotes in men compared with women. Furthermore, allele IL1RN*1 was more frequent in men, whereas allele IL1RN*2 was more prevalent in women. There was no difference in IL-1beta gene polymorphism between the two genders. It is conceivable that the gender difference in IL-1Ra gene polymorphism found in the current study may affect IL-1 and IL-1ra levels. This diversity might be one of the causes for the sex differences in immune response observed in various conditions, such as autoimmune diseases, pain perception, and premature delivery.

Neonatal thrombocytosis following G-CSF treatment.

Thrombocytosis is defined as an elevation of the platelet count to more than 500,000/mm(3). Primary thrombocytosis rarely occurs in the pediatric age group and is usually caused by a clonal bone marrow disorder. The more common phenomenon is secondary thrombocytosis which is a reactive process. Table 1 lists the main causes of secondary thrombocytosis. Complications of severe thrombocytosis include bleeding and thromboses. Unless additional risk factors are present, secondary thrombocytosis is not associated with a significant risk of thromboembolic events, regardless of the degree of elevation of the platelet count. The aim of this case report is to add a new possible cause of neonatal thrombocytosis.

Congenital pyriform aperture stenosis.

Nasal airway obstruction is a potentially life-threatening condition in the newborn. Neonates are obligatory nasal breathers. The pyriform aperture is the narrowest, most anterior bony portion of the nasal airway, and a decrease in its cross-sectional area will significantly increase nasal airway resistance. Congenital nasal pyriform aperture stenosis (CNPAS) is a rare, unusual form of nasal obstruction. It should be considered in the differential diagnosis of any neonate or infant with signs and symptoms of upper airway compromise. It is important to differentiate this level of obstruction from the more common posterior choanal stenosis or atresia. CNPAS presents with symptoms of nasal airway obstruction, which are often characterized by episodic apnea and cyclical cyanosis.