Journal of Pediatric and Neonatal Individualized Medicine (JPNIM) <p>The <strong>Journal of Pediatric and Neonatal Individualized Medicine (JPNIM)</strong> is a peer-reviewed interdisciplinary journal which provides a forum on new perspectives in pediatric and neonatal medicine. The aim is to discuss and to bring readers up to date on the latest in research and clinical pediatrics and neonatology. Special emphasis is on developmental origin of health and disease or perinatal programming and on the so-called ‘-omic’ sciences. Systems medicine blazes a revolutionary trail from reductionist to holistic medicine, from descriptive medicine to predictive medicine, from an epidemiological perspective to a personalized approach. The journal will be relevance to clinicians and researchers concerned with personalized care for the newborn and child. Also medical humanities will be considered in a tailored way.</p> <p>Article submission (original research, review papers, invited editorials and clinical cases) will be considered in the following fields: fetal medicine, perinatology, neonatology, pediatrics, developmental programming, psychology and medical humanities.</p> en-US <p>© Hygeia Press</p> <p> </p> <h3>Copyright and publishing rights</h3> <p>Regarding copyright, before publication, Authors declare that, in consideration of the action of JPNIM in reviewing and editing their submission, they transfer, assign, or otherwise convey all copyright ownership, including any and all rights incidental thereto, exclusively to the JPNIM Publisher (Hygeia Press di Corridori Marinella).</p> <div> <div> <div> <div> <div> <p>Authors have the opportunity to reuse figures, tables and selected text up to 250 words from their article as finally published, providing that full and accurate credit shall be given to publication in JPNIM and that modifications are noted (otherwise no changes may be made).</p> </div> </div> </div> </div> </div> (JPNIM Staff) (JPNIM Staff) OJS 60 The importance of screening for critical and severe congenital cardiac diseases by pulse oximetry in the early neonatal age – Position statement of the Hellenic Society of Perinatal Medicine (HSPM) <p class="p1"><strong>Background:</strong> From its first reported use in 2002, the efficiency of pulse oximetry (POX) screening in detecting critical and severe congenital heart disease (c/s-CHD) in term neonates in early days after delivery has been proved by numerous studies. It is low-cost, non-invasive, easy to use, repeatable, time-saving, applicable by even less-skilled nursing staff, proven to have excellent sensitivity and high specificity. When used in addition to the initial physician’s examination before dismissing a newborn home, this postnatal test can increase the clinical accuracy of detecting c/s-CHD. In this sense, it must be used as an early detecting screening test. Its use is more important during the period in which the patent ductus arteriosus (PDA) conceals the signs and symptoms of low cardiac output syndrome (LCOs) or severe cyanosis that will lead to notably hypoxia and acidosis. These free-of-symptoms babies that leave maternity units although critically ill, as well as those that are born at home and assessed by primary care, will benefit the most through a compulsory use of this test. Despite the benefits, it has failed to become a universal screening test for early detection of c/s-CHD, especially in Europe.</p> <p class="p1"><strong>Aim:</strong> To discuss the existing evidence on safe, effective, and efficient screening, using POX in combination with initial pre-discharge physical examination at the end of its stay under maternity services, including births out of medical facilities, for every term baby as a compulsory health screening test in Greece.</p> <p class="p1"><span class="s1"><strong>Methods:</strong> The authors, members of the Hellenic Society of Perinatal Medicine (HSPM), reviewed the existing up-to-date literature and the trend of using this test worldwide and especially in European countries. They also consulted with pioneers and experts in the field.</span></p> <p class="p1"><strong>Results:</strong> Based on published data, the authors clarify existing policies of using POX and initial clinical assessment, aiming to a standardized approach of screening and diagnostic follow-up, when needed. Key issues for future research and evaluation were identified and addressed.</p> <p class="p1"><span class="s1"><strong>Conclusions:</strong> The authors clarify existing policies in the use of POX, aiming to suggest the most appropriate way of using the test for compulsory screening term newborns during the early neonatal period in Greece. Special conditions of screening are being discussed. Public health organizations and private health agencies will have an important role in quality assurance and surveillance of this screening test aiming to significantly reduce morbidity and mortality from c/s-CHD in Greece.</span></p> Andreas C. Petropoulos, George Daskalakis, Fani Anatolitou, Makarios Eleftheriadis, Panos Antsaklis, Athina Moutafi, Panagiotis Petropoulos, Anastasia Varvarigou, Antonia Charitou Copyright (c) 2021 © Hygeia Press Mon, 28 Jun 2021 00:00:00 +0200 Laryngomalacia, GER, and sleep apnea are BRUEing – Sometimes! <p>Brief resolved unexplained events (BRUE) constitute the newest nomenclature of near-miss SIDS, later on termed ALTE. These events have been putatively assigned to the sleeping state and suspected to involve airway obstruction. The current study in the Journal (Nosetti et al., 2021, <a href="" target="_blank" rel="noopener"></a>) identifies laryngomalacia and gastroesophageal reflux as being frequently associated with BRUE. The potential implications of such associations are discussed.</p> <p> </p> David Gozal Copyright (c) 2021 © Hygeia Press Fri, 04 Jun 2021 00:00:00 +0200 Demographic, clinical, and laboratory characteristics of children with confirmed Coronavirus disease 2019 (COVID-19) in Bali <p class="p1"><span class="s1"><strong>Introduction:</strong> The Coronavirus disease 2019 (COVID-19) has become a global issue since the disease was first reported in Wuhan, China, in December 2019. The proportion of COVID-19 cases in children is less than in adults, with highly variable incidence rates. Milder clinical manifestations occur in children than adults. Children with comorbidities are more likely to develop more severe symptoms and require hospitalization. Monitoring of laboratory results in confirmed cases of COVID-19 is crucial. </span></p> <p class="p1"><span class="s1"><strong>Methods:</strong> This study was a retrospective study on data collected from the Bali Branch of Indonesia Pediatric Society COVID-19 Team and the Bali Provincial Government Health Department, Indonesia, from March 2020 until February 2021. The study population included children aged 0-18 years with laboratory-confirmed COVID-19. Subjects were selected using the total sampling method.</span></p> <p class="p1"><span class="s1"><strong>Results:</strong> During the study period, 3,674 children were confirmed to have COVID-19. In this study, the majority of age was 12-18 years. Nineteen (0.5%) were neonates with a vertical transmission source. The most prevalent source of transmission was living in the same house, which was found in 1,811 cases (49.3%). Out of 181 confirmed cases of COVID-19 treated at Sanglah Hospital, Denpasar, 49 (27.1%) had comorbidities. In 2,701 (73.5%) cases, the subjects were found to be asymptomatic. 652 (17.7%) subjects had fever, 771 (21%) had cough, and only 17 (0.5%) had anosmia. A total of 139 (3.8%) subjects had symptoms of shortness of breath, and only 4 subjects required treatment with a ventilator. Regarding the infection markers, lactate dehydrogenase (LDH), C-reactive protein (CRP), D-dimer, and procalcitonin showed higher levels in the critical group compared to other groups.</span></p> <p class="p1"><span class="s1"><strong>Conclusion:</strong> The highest incidence of COVID-19 occurs in children aged 12-18 years, and the most frequent sources of close contact come from household contacts. Most children who have confirmed COVID-19 have asymptomatic clinical manifestation. The most common clinical </span><span class="s2">manifestation was cough (21%). Increased infection </span><span class="s1">markers such as LDH, CRP, procalcitonin and D-dimer occur in critically ill COVID-19 patients.</span></p> Ni Putu Siadi Purniti, I Gusti Lanang Sidiartha, Ida Bagus Subanada, Ayu Setyorini Mestika Mayangsari, I Gusti Ayu Dwi Aryani, I Putu Dwi Adi Copyright (c) 2021 © Hygeia Press Wed, 22 Sep 2021 00:00:00 +0200 Off-label and unlicensed drug treatments in Neonatal Intensive Care Units: a systematic review <p class="p1"><span class="s1">Newborns are particularly susceptible to off-label and unlicensed (OLUL) drug treatments, especially in the intensive care setting, inferring from dosing regimens and indications supported in older populations and built on non-neonatal pathophysiology. This use leads to unpredictable drug effectiveness and safety and, therefore, an increased probability of medication errors and adverse drug reactions. An extensive literature search was conducted in MEDLINE, Scopus, and Web of Science for papers published from 2011 to 2020 considering OLUL drug use in Neonatal Intensive Care Units (NICUs). Of the 902 studies retrieved, 618 after duplicates were removed, 74 full texts were carefully assessed for eligibility and, in the end, 23 published studies were included, representing a total of 6,762 patients in 80 NICUs worldwide. Considering overall prescriptions, 43.5% were OL and 11.1% were UL. Most studies found that more than 50% of the newborns were exposed to at least 1 OLUL drug and 10 of them reported a rate higher than 90%. Most prescribed drug classes in an OL manner were anti-infectives for systemic use drugs, including ampicillin and gentamicin, followed by nervous system drugs such as fentanyl. The most prescribed drug class in a UL manner was nervous system drugs, being caffeine the most prescribed one. The main reasons for OL prescribing included age and dose, and for UL prescribing, modifications of licensed drugs, extemporaneous preparations, or changes in the pharmaceutical forms. Very preterm, lower birth weight, disease severity, and longer length of stay in the NICU were associated with higher OLUL prescribing. These findings show that despite recent attempts by international regulatory authorities to develop more clinical trials in the pediatric population, OLUL drug use is still widespread, particularly among newborns in NICUs. More efforts must be made by these regulatory entities to ensure the development of safer drugs for the neonatal period.</span></p> Fábio Reis, Rita Pissarra, Henrique Soares, Paulo Soares, Hercília Guimarães Copyright (c) 2021 © Hygeia Press Tue, 27 Jul 2021 00:00:00 +0200 Effect of Holder pasteurization on macronutrients and energy content of pooled donor human milk <p class="p1"><span class="s1"><strong>Background:</strong> Donor human milk (DHM) is the best option for preterm nutrition when mother’s milk is unavailable. For its proven benefits on the life and health of premature babies, DHM should be part of the essential newborn care. The fortification of human milk is necessary to ensure adequate growth and consequent good neurodevelopment. Holder pasteurization is routinely practiced in human milk banks (HMBs) to ensure safety of DHM but can impact the macronutrient content. The aim of this study was to explore the effect of Holder pasteurization on fat, protein, lactose and energy content of DHM and compare our data with the literature. </span></p> <p class="p1"><span class="s1"><strong>Methods:</strong> Protein, lactose, fats and energy of 100 DHM pools from 87 women were analyzed before and after Holder pasteurization using Miris HMA™ (Human Milk Analyzer, Miris AB, Uppsala, Sweden), with the infrared spectroscopic method. The mean macronutrient contents before and after Holder pasteurization were compared using paired t-tests, and the variations in the concentration of the components were calculated as Delta%. The data obtained were compared to other studies with the same purpose.</span></p> <p class="p1"><span class="s1"><strong>Results:</strong> We observed a reduction in fat (3.12 ± 1.64 vs 2.55 ± 0.85, with Delta% -14.9 ± 13.0 and p-value &lt; 0.0001), T protein (1.05 ± 0.26 vs 0.89 ± 0.20, with Delta% -8.9 ± 63.0 and p-value &lt; 0.0001), energy content (61.38 ± 18.66 vs 55.00 ± 8.27, with Delta% -8.1 ± 9.4 and p-value 0.0001), while no significant changes were observed for lactose content (6.35 ± 0.80 vs 6.43 ± 0.58, with Delta% 6.5 ± 56.7 and p-value 0.3735). Data in the literature on the effect of Holder pasteurization on DHM macronutrients are variable, and the only constant element is the non-variation of the carbohydrate content.</span></p> <p class="p1"><span class="s1"><strong>Conclusion:</strong> Holder pasteurization decreased protein, fat and energy content of DHM. The lactose content has not been affected after the Holder pasteurization. After having assessed a remarkable variation in the macronutrient content in comparison with other studies, the adjustable fortification, especially if based on the composition data, might be more accurate. In addition, despite the fact that Holder pasteurization is actually the method recommended by the international HMB guidelines, as it provides a compromise between microbiological safety and nutritional/biological quality of DHM, studies on alternative methods capable of treating DHM preserving the milk’s components are desirable.</span></p> Pasqua Anna Quitadamo, Leonilde Sorrentino, Giuseppina Palumbo, Liliana Cianti, Massimiliano Copetti, Maria Assunta Gentile, Pierpaolo Cristalli, Massimo Pettoello Mantovani Copyright (c) 2021 © Hygeia Press Wed, 29 Sep 2021 00:00:00 +0200 Potential effects of lactoferrin as antiviral and neoadjuvant therapy in pediatric patients with viral gastroenteritis <p class="p1"><span class="s1">Viral gastroenteritis is a prevalent disease in children. Each year, around 111 million children suffer from viral gastroenteritis. Clinical features such as fever, nausea, vomiting, and diarrhea may result in severe cases requiring hospitalization. Current therapies of this disease are symptomatic therapies, which are focused on patient rehydration. Previous studies found that lactoferrin (LF) is a milk protein known to have antiviral potential, suggesting the possibility of utilizing it as an alternative therapy for viral gastroenteritis. This literature review aims to determine the potential effects of LF in treatment and prevention, thereby reducing the incidence and severity of viral gastroenteritis. A literature search for related articles published in the past 20 years was performed on PubMed, EBSCOhost, ProQuest </span><span class="s2">and another source</span><span class="s1"> using the main keywords “lactoferrin, viral, and gastroenteritis”. There were 6 articles assessed in this review. Several clinical trials have shown that giving LF supplements could significantly reduce the duration and the severity of gastroenteritis, especially with high doses of LF (0.49-1 g). Therefore, the efficacy of LF in pediatric gastroenteritis worked in a dose-dependent manner. However, mixed results were reported in the clinical trials assessing the efficacy of LF against viral gastroenteritis, but this could be due to the low doses of LF used. In conclusion, LF could be used as a complementary treatment against pediatric gastroenteritis, but further studies using high LF doses against pediatric viral gastroenteritis need to be evaluated further.</span></p> Alver Prasetya, Robby Soetedjo, Gabriel Tandecxi, Brigitte Leonie Rosadi, Edward Davis, Maureen Miracle Stella, Ignatius Ivan, Linawati Hananta Copyright (c) 2021 © Hygeia Press Sat, 26 Jun 2021 00:00:00 +0200 Relationship between laryngomalacia and sleep-related breathing disorders in infants with brief resolved unexplained events <p class="p1"><strong>Introduction:</strong> Brief resolved unexplained events (BRUE) occur during infancy. It is characterized by one or more symptoms, including skin color change, shortness of breath and unresponsiveness. Laryngomalacia is the most frequent cause of stridor in infants and results in the collapse of the supraglottic structures during inspiration and intermittent obstruction of the upper airways. To our knowledge, the relationship between BRUE and laryngomalacia has been little investigated.</p> <p class="p1"><strong>Methods:</strong> The medical records of 448 children (age &lt; 12 months) treated for BRUE between July 2011 and March 2018 and followed up until March 2020 were retrospectively reviewed. Endoscopic evaluation was performed using a flexible fibrolaryngoscope. All patients underwent a brief polysomnography and 24-h cardiorespiratory monitoring. Cardiorespiratory and oxygen saturation monitoring was continued at home; 94% of patients underwent follow-up.</p> <p class="p1"><strong>Results:</strong> Laryngeal fiberoptic endoscopy revealed laryngomalacia in 11% of children with a clinical history of BRUE. Laryngomalacia was associated with obstructive/mixed apnea in 67%. Home cardiorespiratory monitoring showed a gradual reduction in the number of respiratory events during follow-up and complete resolution of laryngomalacia in 88% of patients.</p> <p class="p1"><strong>Conclusions:</strong> This is the first report that showed follow-up data from cases of BRUE with laryngomalacia. The improvement in laryngomalacia alone, although not complete, was sufficient to improve obstructive events.</p> Luana Nosetti, Francesca De Bernardi, Eleonora Sica, Patrizia Latorre, Massimo Agosti, Paolo Castelnuovo, Giulia Cocciolo, Marco Zaffanello Copyright (c) 2021 © Hygeia Press Fri, 04 Jun 2021 00:00:00 +0200 Socioeconomic factors affecting exclusive breastfeeding in the first 6 months of life <p class="p1"><strong>Introduction:</strong> Despite the well-known positive effects of exclusive breastfeeding (EBF) in the first 6 months of life, several studies have indicated its inadequacy in Iran. This study has investigated the socioeconomic factors affecting EBF in the first 6 months of life.</p> <p class="p1"><strong>Methods:</strong> The study population included 6- to 12-month-old children referred to Arak healthcare centers with their mothers for vaccination and healthcare in 2019. Sampling was performed according to Cochran formula. The questionnaires were completed by asking mothers and also reference to the family documents. The relationship between EBF and household socioeconomic variables was examined using Kaplan-Meier survival analysis. The multivariate logistic regression was used to assess adjusted and unadjusted odds ratios for factors affecting EBF and the relationship between household variables and breastfeeding.</p> <p class="p1"><strong>Results:</strong> Mothers completed a total number of 517 questionnaires (97%). Working mothers (OR = 2.3 [1.77, 2.91]), mothers with higher education (OR = 1.02 [0.68, 1.35]) and higher physical activity (OR = 1) breastfed their infants more than others up to 6 months (p &lt; 0.05). There was no significant relationship between sex of the child, household income, maternal BMI, pregnancy complications, previous abortion, and type of delivery with EBF (p &gt; 0.05).</p> <p class="p1"><strong>Conclusion: </strong>The results indicated that mothers who belonged to low socioeconomic groups breastfed their infants less than other groups. This necessitates planning and taking interventional healthcare, educational, and financial support measures in this group.</p> Javad Nazari, Abbas Esmaili, Eshrat-Sadat Mousavi, Pari Mirshafiei, Saeed Amini Copyright (c) 2021 © Hygeia Press Wed, 04 Aug 2021 00:00:00 +0200 The effect of table salt as a treatment of umbilical granuloma in neonates <p class="p1"><span class="s1"><strong>Introduction:</strong> Umbilical granuloma is a widespread problem that may cause anguish to the parents. </span></p> <p class="p1"><span class="s1"><strong>Patients and method:</strong> A randomized controlled study was conducted on 85 neonates aged 2-4 weeks (42 males and 43 females) with a diagnosis of umbilical granuloma. They were randomly divided into 2 groups; group A included 42 patients (20 males and 22 females), and group B included 43 patients (21 males and 22 females). Parents of group A patients were instructed to use a small amount of common salt on the granuloma after cleaning it, and to cover the salt by blaster for 30 minutes to keep it in place; after that, the blaster had to be removed, and the umbilicus was cleaned with sterile cotton and water to remove the salt. The procedure was repeated for 3 days straight. Group B was treated once by applying clean dry silver nitrate sticks (concentration of 20%) on the granuloma; contact with normal skin was avoided. The procedure was performed by the researcher himself at his clinic. Statistical analysis was done by using Fisher Exact test. </span></p> <p class="p1"><span class="s1"><strong>Results:</strong> In group A, 39 (92.9%) responded to treatment by salt, while 3 (7.1%) of them did not respond. In group B, 41 (95.3%) responded to treatment by silver nitrate, while 2 (4.7%) did not respond. There was no significant difference between the two groups, with p-value = 0.676. </span></p> <p class="p1"><span class="s1"><strong>Conclusion:</strong> Umbilical granuloma can be treated with topical application of common salt; such a method can be considered a valid alternative for its effectiveness, safety, and simplicity. </span></p> Mazin Mahmoud Fawzi Copyright (c) 2021 © Hygeia Press Wed, 09 Jun 2021 00:00:00 +0200 Category II non-reassuring fetal heart rate pattern and risk of admission to Neonatal Intensive Care Unit <p class="p1"><span class="s1"><strong>Background:</strong> The relationship between non-reassuring fetal heart rate (FHR) pattern, acidemia at birth and neonatal morbidity remains unclear. Our aim was to compare low versus high pH cord blood infants of women detected with a Category II FHR pattern for which the impact is unclear. </span></p> <p class="p1"><span class="s1"><strong>Methods: </strong>A prospective study of 185 low-risk pregnant women in labor at &gt; 37<sup>0/7</sup> weeks of gestation with a singleton fetus was conducted at a single center. Category II trace was defined by the presence of tachycardia or bradycardia, variable and late decelerations, marked variability at least 30 minutes in the 120 minutes prior to delivery. The primary outcome included the need for resuscitation and Neonatal Intensive Care Unit (NICU) admission. The cohort was also stratified into three categories according to admission to NICU and pH threshold ([i] umbilical artery blood pH &lt; 7.15 and admitted; [ii] pH &gt; 7.15 and admitted; [iii] not admitted).</span></p> <p class="p1"><span class="s1"><strong>Results:</strong> 23% (43/185) of infants of women detected with Category II FHR pattern needed NICU admission. Category II FHR pattern was associated with low pH at birth, and the need for resuscitation was more frequent among infants in the lower pH group (73% vs. 10%, p &lt; 0.05). Indices of right (tricuspid annular plane systolic excursion [TAPSE]: 7.3 ± 0.9 mm) and left ventricular performance (fractional shortening: 31% ± 8.9%, transmitral E’/A’ 0.9 ± 0.3) were low compared to normative data for healthy infants. CK, CK-MB, and left-to-right/bidirectional shunts at PFO and PDA were higher overall at 72 hours of age.</span></p> <p class="p1"><span class="s1"><strong>Conclusions:</strong> Category II FHR is associated with resuscitation at birth, NICU admission, and length of hospitalization. </span></p> Laura Mihaela Suciu, Amalia Fagarasan, Claudiu Marginean, Adrianne Rahde Bischoff, Patrick J. McNamara Copyright (c) 2021 © Hygeia Press Mon, 26 Jul 2021 00:00:00 +0200 Pediatricians’ storytelling about positive, negative, and turning professional experiences <p class="p1"><span class="s1"><strong>Background: </strong>The present study aims to explore narratives about positive, negative, and turning autobiographical memories of pediatricians, evaluating differences among the three types of narratives in terms of their structure and exploring emerged contents of narratives.</span></p> <p class="p1"><span class="s1"><strong>Methods:</strong> </span>Nineteen<span class="s1"> pediatricians employed in a pediatric hospital of central Italy took part in the study by narrating the low point, the high point, and the turning point of their professional experience. Researchers identified the narrative structure of collected stories. A content analysis was performed to identify the emerged themes of low points, high points, and turning points.</span></p> <p class="p1"><span class="s1"><strong>Results:</strong> Results show that pediatricians perform better-structured narratives when they focus on low and high episodes than turning ones (Friedman test = 15.176; p = 0.001). Furthermore, low points deal with the relationship with patients and the management of emotions due to their suffering and death, high points are related to both relational and individual issues as feeling gratitude from patients, professional upgrades and success, while turning points are more related to personal and individual issues like economic growth and the achievement of resident position.</span></p> <p class="p1"><span class="s1"><strong>Discussion:</strong> Authors discuss the importance of storytelling and autobiographical memory disclosure as a tool to help physicians to deal with the emotional impact of their professional experiences with patients.</span></p> Chiara Fioretti, Enrica Ciucci, Daniela Carpenzano, Laura Vagnoli, Andrea Smorti Copyright (c) 2021 © Hygeia Press Mon, 23 Aug 2021 00:00:00 +0200 Ischemia-modified albumin as a novel marker for diagnosis of necrotizing enterocolitis in newborn infants <p class="p1"><strong>Background:</strong> Necrotizing enterocolitis (NEC) is the most common neonatal gastrointestinal emergency. Ischemia-modified albumin (IMA) is a marker of oxidative stress and ischemia. Its role in early diagnosis of NEC has been little investigated so far.</p> <p class="p1"><strong>Aim: </strong>The objective of our research was to study the role of serum IMA in diagnosis of NEC in newborn infants.</p> <p class="p1"><strong>Material and methods: </strong>The study was carried out on 80 neonates; 40 with NEC and 40 controls, subjected to serum IMA dosage with ELISA.</p> <p class="p1"><span class="s1"><strong>Results:</strong> There was a highly statistically significant increase in IMA in both preterm (60.59 ± 34.97 U/ml) and full-term infants with NEC (60.50 ± 29.88 U/ml) compared to their controls (11.28 ± 3.09 U/ml; 5.34 ± 1.88 U/ml). The positive predictive value of IMA in preterm and full-term with NEC was 100% and 94.74%, while the negative predictive value was 80% and 90.48%, respectively. There was a statistically significant increase in serum level of IMA in stage II NEC compared to stage I NEC as well as in non-survivor cases. Significant positive correlation between serum IMA level and duration of recovery from NEC was detected.</span></p> <p class="p1"><strong>Conclusions:</strong> IMA is a sensitive marker for diagnosis of NEC in full-term and preterm infants and can predict severity of NEC and death.</p> Safaa ELMeneza, Asmaa Okasha, Manal Abd El-Hafez, Naeema Hussein Copyright (c) 2021 © Hygeia Press Tue, 25 May 2021 00:00:00 +0200 Delivery room management of infants with less than 27 weeks of gestational age <p class="p1"><span class="s1"><strong>Background: </strong>The medical management of a preterm birth is a challenge, and there is not a definite consensus on how to deal with this situation. The aim of this study was to evaluate the effect of delivery room (DR) management on clinical condition (temperature, peripheral oxygen saturation, blood glucose level, hemoglobin level, mean blood pressure and pH) on the Neonatal Intensive Care Unit (NICU) admission of preterm infants born before 27<sup>+0</sup> weeks of gestational age (GA). </span></p> <p class="p1"><span class="s1"><strong>Methods:</strong> This study was performed among all preterm infants with a GA between 23<sup>+0</sup> and 26<sup>+6</sup> weeks admitted to the Level III NICU of Centro Hospitalar Universitário de São João (Porto, Portugal) between 1<sup>st</sup> January 2005 and 31<sup>st</sup> December 2018. Maternal demographics, gestation information, infants’ characteristics, DR and NICU data were evaluated. </span></p> <p class="p1"><span class="s1"><strong>Results:</strong> A total of 65 preterm neonates were included in this study. The admission pH was associated to the administration of epinephrine in DR (B = -0.786; p = 0.003; 95%CI [-1.282; -0.290]); blood glucose level to body weight at birth (B = 0.253; p = 0.006; 95%CI [0.078; 0.428]) and epinephrine in DR (B = 72.719; p = 0.02; 95%CI [12.530; 132.908]); body temperature to epinephrine administrated in DR (B = -1.703; p = 0.001; 95%CI [-2.692; -0.714]); and hemoglobin level to early continuous positive airway pressure (CPAP) in DR (B = 6.008; p = 0.013; 95%CI [1.356; 10.660]).</span></p> <p class="p1"><span class="s1"><strong>Conclusion: </strong>DR procedures can have negative or positive effects on early outcomes of preterm newborns. It is crucial to research more about their impact to optimize the NICU management of this particular and challenging neonatal group and support the neonatologists’ clinical decisions.</span></p> Rita Ferreira, Inês Durães, Valerie Vieira, Henrique Soares, Filipa Flor-de-Lima, Hercília Guimarães Copyright (c) 2021 © Hygeia Press Thu, 05 Aug 2021 00:00:00 +0200 The effects of physical activity on some physiological indices of mother and neonate <p class="p1"><span class="s1"><strong>Background:</strong> Physical activity can bring about more favorable health results for both mother and neonate. </span></p> <p class="p1"><span class="s1"><strong>Objectives: </strong>The purpose of this study was to investigate the effect of physical activity on some physiological indices of mother and neonate.</span></p> <p class="p1"><span class="s1"><strong>Design and methods: </strong>In this <em>ex post facto</em> study, 60 pregnant women (age 26.9 ± 4.0 years, height 161.8 ± 5.2 cm and weight 63.0 ± 4.9 kg) were selected from health centers and private clinics in Shiraz, Iran. Based on the score obtained from completion of a physical activity questionnaire during pregnancy, the participants were classified into 4 groups: 1) active, 2) inactive, 3) becoming active, and 4) becoming inactive. The maternal type of delivery, body weight and body fat percentage, as well as the neonatal birth weight and height and Apgar score at 1 and 5 minutes, were measured. To analyze the data, a one-way ANOVA and Tukey’s post hoc test were used at the level of p ≤ 0.05.</span></p> <p class="p1"><span class="s1"><strong>Results:</strong> The mean weight gain in pregnant women in the active group was significantly lower than that of the inactive group (p ≤ 0.05), but there was not a significant difference between the becoming active and becoming inactive groups (p &gt; 0.05). Participation in physical activity does not affect the body fat percentage and type of pregnancy in pregnant women (p &gt; 0.05). Additionally, participation in physical activity does not have a significant effect on the neonate’s growth and health (p &gt; 0.05).</span></p> <p class="p1"><span class="s1"><strong>Conclusions:</strong> It seems that although the participation of pregnant mothers in physical activity is associated with a lower weight gain in pregnancy, there is no significant effect on other physiological indices of mother and neonate.</span></p> Seyed Ali Hosseini, Niloofar Arabpour, Nasibeh Kazemi, Saeedeh Shadmehri, Iman Fathi Copyright (c) 2021 © Hygeia Press Wed, 30 Jun 2021 00:00:00 +0200 Amerigo Filia (1873-1925) and the first School of Pediatrics in the island of Sardinia <p class="p1"><span class="s1">Amerigo Filia was born on July 18, 1873, in Sassari, Sardinia, Italy. After attaining his Medicine degree at the University of Turin in 1900, he went to Rome to study Pediatrics at the School of Pediatrics directed by Professor Luigi Concetti. His academic career began in Sassari when he was appointed as teacher of Pediatrics in 1911, becoming Full Professor in 1917, Dean of the School of Medicine and Surgery in 1918 and, finally, Rector of the University in 1919. He distinguished himself as the founder of the Pediatric Clinic and the School of Pediatrics in Sassari, both being the first ones in Sardinia, and as the promoter of the restoration of the front of the main building of the University of Sassari (“<em>Palazzo dell’Università</em>”), as well as of new buildings to host Scientific Institutes and Clinics. Moreover, in 1923, he succeeded in preventing the suppression of Sassari University as a consequence of the “Gentile” reform. As documented by his scientific publications, Filia’s research activity included both experimental and clinical studies focusing on the renal excretion of high dose of arsenic, the effects of <em>Lactobacilli</em> in infantile enteritis, as well as on renal tuberculosis and pulmonary echinococcosis in children. Amerigo Filia died suddenly on December 21, 1925, in Rome, where he was participating in a university competition as a committee member.</span></p> Maria Grazia Clemente, Patrizia Cincinnati, Luigi Cataldi, Roberto Antonucci Copyright (c) 2021 © Hygeia Press Tue, 21 Sep 2021 00:00:00 +0200 Recurrent intraparenchymal brain hemorrhage in an infant with factor XIII deficiency <p class="p1">Factor XIII deficiency is an autosomal recessive disorder with an incidence of 1 in 1-5 million. On activation factor XIII stabilizes clot formation by cross-linking fibrin strands. Deficiency is characterized by severe bleeding due to impairment in clot formation. We describe a case of a child presenting with drowsiness following a trivial fall and trauma to the head. An emergency CT scan of the brain was suggestive of acute on chronic (recurrent) hemorrhage. Intraoperatively he was noted to have an intraparenchymal multiloculated cystic cavity with a thinned out cortex in the right frontal region. The child underwent right frontal craniotomy and decompression of an intracerebral hemorrhage. He was subsequently diagnosed to have factor XIII deficiency. He is presently on monthly cryoprecipitate prophylaxis with which he has not experienced a recurrence of a similar episode.</p> Devdeep Mukherjee, Dibyendu De, Satyajit Das, Gopikrishna Kurasa Copyright (c) 2021 © Hygeia Press Tue, 25 May 2021 00:00:00 +0200 Presurgical nasoalveolar molding: an advantageous adjunctive neonatal therapy for cleft lip and palate defects in 2 clinical cases <p class="p1"><span class="s1">The most common congenital craniofacial anomalies are labial-alveolo-palatal clefts. Infants with these deformities may have problems and limitations with breathing, feeding, speaking, hearing, as well as psychological problems. </span></p> <p class="p1"><span class="s1">The treatment protocol for these patients is carried out using an interdisciplinary approach. </span></p> <p class="p1"><span class="s1">Thus, in addition to surgical reconstruction, presurgical neonatal orthopedics have shown considerable advantages in the treatment of such malformations. </span></p> <p class="p1"><span class="s1">Recently, presurgical nasoalveolar molding (PNAM) has been introduced to prevent nasal deformities, and to obtain a satisfactory surgical result and good psychological reintegration. </span></p> <p class="p1"><span class="s1">This article describes, through 2 clinical cases, the technique of preparation of PNAMs, their surgical and clinical advantages, as well as the role of a multidisciplinary approach in effectively managing disorders related to labio-alveolo-palatal clefts. </span></p> Sara Sabir, Mohamed Azhari, Hasnaa Rokhssi, Nadia Merzouk, Oussama Bentahar Copyright (c) 2021 © Hygeia Press Tue, 06 Jul 2021 00:00:00 +0200 Extremely preterm infant weighing 350 g: too small to survive? <p class="p1">Every year around 15 million premature neonates are born in the world, and this number is continuously increasing. The incidence of premature birth varies between 5% and 18% throughout the world. Despite advancements in medicine and technology and increased evidence-based diagnostic and treatment recommendations, prematurity is the most common cause of death among children under 5 years of age. The sequelae in the survivors of extreme prematurity are mental disability, cognitive impairment, cerebral palsy, blindness, deafness and chronic illness. Considering ethical and economic implications, neonatal survival and morbidity prognosis, resuscitation of neonates of borderline gestation differs in various countries and many international organisations do not recommend active resuscitation and treatment of newborns of up to 25 weeks of gestation. We present a case study of one of the smallest newborns in the world and the smallest newborn known to survive in Lithuania.</p> Ieva Šliaužienė, Vaida Aleksejūnė, Viktorija Ambroževičiūtė, Ilona Aldakauskienė, Rūta Jolanta Nadišauskienė, Rasa Tamelienė Copyright (c) 2021 © Hygeia Press Mon, 07 Jun 2021 00:00:00 +0200 A rare case of persistent fetal intestinal hyperechogenicity – Question <p class="p1"><span class="s1">A 24-year-old pregnant woman with an <em>in vitro</em> fertilization (IVF)-assisted pregnancy was examined at 12 weeks of gestation with a fetal ultrasound showing intestinal hyperechogenicity. The maternal anamnesis revealed 3 previous miscarriages, 2 due to ectopic pregnancies. Fetal karyotype and screening for cystic fibrosis performed on both parents were normal. Another ultrasound examination at 27 weeks showed fetal intestinal and gastric dilation and moderate polyhydramnios. The day before delivery, an ascitic effusion was found, not associated with pleural or pericardial effusion. At 29 weeks and 6 days of gestation, an emergency cesarean section was performed for absent variability of the cardiotocographic tracing. </span></p> <p class="p1"><span class="s1">The female newborn birth weight was 1,390 g. Apgar scores were 5 at 1 minute and 7 at 5 minutes. The patient was intubated in the Delivery Room and remained on mechanical ventilation until she was transferred to the Neonatal Intensive Care Unit (NICU), then she was ventilated in high-frequency oscillatory ventilation (HFOV). At the time of admission to the NICU, in addition to severe respiratory insufficiency (the saturation was at the lower limits, with FiO<sub>2</sub> = 1), at the clinical examination she had moderate pale skin and globose abdomen with generalized tenderness. The nasogastric tube was positioned correctly, and 6 ml of gastric fluid mixed with blood were aspirated. It was possible to insert the rectal tube only for 1.5 cm. </span></p> <p class="p1"><span class="s1">To better understand the case, anteroposterior (AP) and translateral chest-abdomen X-rays were performed.</span></p> <p class="p1">1. What do you see in these X-rays?</p> <p class="p1">2. Which further investigations would you suggest?</p> <p class="p1">3. What is your diagnosis?</p> Paolo Figliolini, Martina Rossano, Fabiola Guerra, Giulia Di Pietro, Maria Antonietta Marcialis, Maria Cristina Pintus Copyright (c) 2021 © Hygeia Press Fri, 24 Sep 2021 00:00:00 +0200 A rare case of persistent fetal intestinal hyperechogenicity – Answer <p class="p1">In our case, the hyperechogenicity of the fetal intestine was observed for the first time during the 12<sup>th</sup> week sonography and was not resolved later. At the ultrasound checkup at 27 weeks, there was intestinal and gastric dilation; during the following one, at 29 weeks, a peritoneal effusion was also evident. The conditions of the fetus worsened rapidly, and the cardiotocographic trace showed a very reduced cardiac variability that required an urgent cesarean section.</p> <p class="p1"><span class="s1">The abdominal ultrasound per­formed immedi­ately after birth revealed corpuscolar abdominal free fluids. The bowel loops were dilated, with very thick walls, filled with corpuscle material.</span></p> <p class="p1">The child’s clinical condition worsened rapidly. The oxygen saturation was at the lower limit even after the administration of Curosurf®. For this reason, it was not possible to transfer the patient to the Pediatric Surgery Department. So the surgeon performed a paracentesis in the Neonatal Intensive Care Unit (NICU), subtracting about 100 cc of hemorrhagic fluid. After a transitory improvement, the little girl died.</p> <p class="p1">The autopsy confirmed the presence of an intestinal volvulus with extensive hemorrhagic necrosis of the whole ileum, with dilated loops filled with hemorrhagic fluid, in the absence of intestinal malrotation.</p> Paolo Figliolini, Martina Rossano, Fabiola Guerra, Giulia Di Pietro, Maria Antonietta Marcialis, Maria Cristina Pintus Copyright (c) 2021 © Hygeia Press Fri, 24 Sep 2021 00:00:00 +0200