Pediatrics, Neonatology

Background: Prematurity is an important cause of neonatal mortality, and is defined as a delivery of a live neonate before 37 completed weeks of pregnancy. Aim: To assess the prevalence, risk factors and outcomes of preterm birth at the neonatology unit of the Bamenda Regional Hospital (BRH). Methods: This was a 4-years retrospective case-control study carried out from January 2016 to December 2019, including 365 preterm neonates and 365 matched term neonates. Binary logistic regression followed by multivariate logistic regression analysis were used to identify independent risk factors of prematurity. Results: The incidence of preterm birth was 18.5%. Multivariate analysis demonstrated that maternal primary and secondary education [Adjusted Odds ratio (AOR) 2.857 95%CI (1.120-7.487), 0.034], preterm premature rupture of membranes (PPROM) [AOR 2.737 95% CI (1.133-6.611), 0.025], and multiple pregnancy [AOR 4.772 95%CI (2.413-9.428), 0.000] were independent predictors of prematurity. Of the 365 preterm neonates included in the study, 39 (10.7%) died in the hospital. The major causes of death were apnoea (65%), neonatal infection (12.5%), and respiratory distress (12.5%). Conclusions: Preterm birth is still unacceptably high in the Bamenda Regional Hospital. Prevention in risk groups can go a long way to reduce this prevalence and associated morbidity.

We invite you all to the International conference on Pediatrics & Neonatology to be held in London, UK on March 14-16, 2019
Will you be interested to participate as a speaker/delegate?
You can learn more about the scientific sessions at http://pediatrichealthcare.alliedacademies.com/
Email: pediatrics@pediatricscongress.com

Introduction: Skin-to-skin contact (CPP) is the placement of the naked newborn on the mother’sbreast, covered only with a cap, sheet or gown.Objective: To determine the effect of skin-to-skin contact in the breastfeeding of infants in theNational Institute of Perinatology.Material and methods: Prospective, descriptive, observational, and cross-sectional study wasperformed, including a search for the information in the database of the Immediate Care Unitfor the Newborn from 1 August 2015 to 31 July 2016. The data obtained were Gestational age,weight, Apgar, maternal pathology, skin-to-skin contact, duration, and feeding.Results: There were 3175 births, with 2228 term neonates. CPP was performed in 1486 neona-tes (78.95%), with a weight of 2,045 to 4,200 g. The majority of patients who were breastfed(78.7%) had had skin-to-skin contact. Likewise, it was observed that CPP significantly favouredbreastfeeding (RR=143.28; 95% CI: 75.5-271.7).Discussion: CPP favours breastfeeding (99.2%), making the first food human milk, and reducingthe use of substitutes.Conclusions: Skin-to-skin contact is the best opportunity for the initiation of breastfeeding.The separation of mothers and their children at birth has become a common practice in thedelivery and operating rooms, due to hospital routines, placing the infant in a cradle of radiantheat, and initiating breastfeeding after one hour of life.

Hypospadias is a relatively common genital condition in which the urethral opening forms on the underside of the penis, as opposed to at the tip of the glans. Patients with hypospadias are typically referred for surgery during infancy or early childhood. Recent evidence, however, indicates that many individuals with hypospadias do not experience the functional or psychosocial difficulties that are commonly attributed to the condition, and that surgical intervention for hypospadias carries substantial risk of adverse outcomes. In this article, we review published outcomes data and conduct an in-depth analysis of the typical rationales for hypospadias surgery, taking into consideration both the potential benefits and harms of the procedure, as well as the existence of non-surgical alternatives. We argue, firstly, that most childhood surgeries for hypospadias are performed for anticipated future problems concerning function and cosmesis, rather than extant problems that serve to undermine the child’s well-being. Secondly, we contend that the surgery can be safely performed after an age of consent without increasing the absolute risk of surgical complications to an ethically meaningful degree. We conclude that surgery for hypospadias should typically be performed only if requested by the affected individual, under conditions of informed consent.

The Centers for Disease Control and Prevention (CDC) has announced a set of provisional guidelines concerning male circumcision, in which they suggest that the benefits of the surgery outweigh the risks. In this brief comment, I highlight a few of the key scientific and ethical issues worth considering in interpreting the CDC recommendations.

PENDAHULUAN Neonatus adalah bayi baru lahir yang berusia sampai dengan 28 hari. Pada masa tersebut terjadi perubahan yang sangat besar dari kehidupan di dalam rahim dan terjadi pematangan organ hampir pada semua sistem. Bayi hingga usia kurang satu bulan merupakan golongan umur yang memiliki risiko gangguan kesehatan paling tinggi, berbagai masalah kesehatan bisa muncul. Sehingga tanpa penanganan yang tepat, bisa berakibat fatal. Neonatal dengan komplikasi adalah neonatal dengan penyakit dan atau kelainan yang dapat menyebabkan kecacatan dan atau kematian, seperti asfiksia (Kementerian Kesehatan, 2015). Komplikasi yang menjadi penyebab kematian terbanyak yaitu asfiksia, bayi berat lahir rendah, dan infeksi (Riskesdas, 2007). Asfiksia saat lahir menjadi penyebab kurang lebih 23% dari sekitar 4 juta kematian neonatus di seluruh dunia setiah tahunnya (Kitamura et al, 2010). Komplikasi ini sebetulnya dapat dicegah dan ditangani, namun terkendala oleh akses ke pelayanan kesehatan, kemampuan tenaga kesehatan, keadaan sosial ekonomi, sistem rujukan yang belum berjalan dengan baik, terlambatnya deteksi dini, dan kesadaran orang tua untuk mencari pertolongan kesehatan. Penanganan neonatal dengan komplikasi adalah penanganan terhadap neonatal sakit dan atau neonatal dengan kelainan atau komplikasi/kegawatdaruratan yang mendapat pelayanan sesuai standar oleh tenaga kesehatan (dokter, bidan atau perawat) terlatih baik dirumah, sarana pelayanan kesehatan dasar maupun sarana pelayanan kesehatan rujukan. Pelayanan sesuai standar antara lain manajemen Asfiksia Bayi Baru Lahir, atau standar operasional pelayanan lainnya (Kementerian Kesehatan, 2015). Sekitar 10% bayi baru lahir membutuhkan bantuan untuk mulai bernapas saat lahir; dan kurang dari 1% membutuhkan tindakan resusitasi ekstensif agar selamat. Sebaiknya kurang lebih 90% bayi baru lahir menjalani transisi dari kehidupan intrauterin ke ekstra uterin tanpa kesulitan. DEFINISI " Asphyxia is defined as progressive hypoxemia and hypercapnea accompanied by the progressive development of metabolic acidosis. The definition has both clinical and biochemical components, and indicates that, unless the process is reversed, it will lead to cellular damage and ultimately death of the patient " (www.cambridge.org). FISIOLOGI PERNAPASAN: TRANSISI INTRA KE EKSTRAUTERIN Sebelum lahir, seluruh oksigen yang digunakan oleh janin berasal dari difusi darah ibu ke darah janin melewati membran plasenta. Hanya sebagian kecil darah janin yang mengalir ke paru-paru janin. Paru janin tidak berfungsi sebagai jalur transportasi O2 atau ekskresi CO2 ataupun keseimbangan asam basa pada janin. Paru-paru janin mengemband dalam uterus akan tetapi kantung-kantung udara yang akan menjadi alveoli berisi cairan bukan udara. Selain itu pembuluh arteriol konstriksi (mengkerut) karena tekanan parsial oksigen (PO2) pada janin rendah. Sebelum lahir, sebagian besar darah dari sisi kanan jantung tidak dapat memasuki paru karena resistensi yang lebih rendah yaitu melewati duktus arteriosus menuju aorta. Setelah lahir, bayi tidak lagi terhubung dengan plasenta dan akan bergantung pada paru-paru sebagai sumber oksigen. Oleh sebab itu dalam hitungan detik, cairan paru dalam alveoli harus diserap. Paru-paru harus terisi udara yang mengandung oksigen dan pembuluh darah paru harus

INTRODUCCIÓN: La disponibilidad y comercialización de la inmunoglobulina G humana ha modificado el curso y pronóstico de diversas enfermedades. Hoy en día representa el tratamiento de primera línea para al menos 10 enfermedades y de segunda línea, empírico o de indicación compasiva en otras alteraciones. La mayor parte de estas enfermedades son excepcionales (afectan a menos de 1 de cada 2000 individuos), por lo que la generación de evidencia robusta derivada de ensayos clínicos aleatorizados y controlados no es común.



OBJETIVO: desarrollar Elaborar o Emitir un Consenso Mexicano para la prescripción de Inmunoglobulina G Humana como tratamiento de reemplazo e inmunomodulación con un enfoque de medicina basada en evidencias.




MATERIALES Y MÉTODOS: Se integró un grupo multidisciplinario de especialistas en diversas áreas de la medicina en México, con la finalidad de emitir un análisis crítico y sistematizado de la evidencia clínica disponible para la prescripción de la inmunoglobulina G humana. Se revisaron las bases de datos MEDLINE, EMBASE, BVS-LILACS, NGS, NICE, CENETEC, Imbiomed, TripDatabase y Medigraphic. Para el análisis de la información se utilizaron algoritmos con términos Medical Subject Headings (MeSH) o Descriptores en Ciencias de la Salud (DeCS) específicos para cada enfermedad, con la intención de identificar guías de práctica clínica u otro tipo de guías, revisiones sistemáticas, metanálisis, ensayos clínicos aleatorizados, estudios clínicos, estudios descriptivos u observacionales y análisis de costobeneficio. Para el estudio de la evidencia se organizaron ocho grupos de trabajo, de acuerdo con el campo de conocimiento y la experiencia de los especialistas. Se formularon preguntas clínicas con el constructo PICO, por su acrónimo en inglés: Patients (pacientes o población),  Intervention (intervención de interés), Comparison (comparación con otra intervención) y Outcome (desenlace de interés). Después de discutir las evidencias correspondientes y responder las preguntas, se redactó un documento con declaraciones específicas por indicación y calidad de evidencia con el esquema GRADE. Las declaraciones fueron sometidas a evaluación y consenso por todo el grupo de trabajo y se elaboró un documento con el formato actual para validación externa por los principales representantes de las academias y los colegios de las áreas del conocimiento incluidas, para finalmente publicarlo como tratamiento de referencia en la prescripción de la inmunoglobulina G humana en México.



CONCLUSIONES: La integración del consenso representa un esfuerzo en aras de proporcionar a los clínicos de instituciones de segundo y tercer nivel de atención en salud de México. Además de proporciona un instrumento validado para la prescripción correcta de inmunoglobulina G humana como tratamiento de reemplazo e inmunomodulación. Este documento debe actualizarse de manera continua, debido al activo campo de investigación clínica en diferentes aplicaciones de la medicina.

VSD is a hole in the wall separating the two lower chambers of the heart.

In normal development, the wall between the chambers closes before the fetus is born, so that by birth, oxygen-rich blood is kept from mixing with the oxygen-poor blood. When the hole does not close, it may cause higher pressure in the heart or reduced oxygen to the body.

Abstract:
Introduction: Pregnant women who become infected with chickenpox at the end of
pregnancy have a higher potential risk of the newborn the purchase. If the mother develops
the rash of chickenpox about five days before or two days after birth, the newborn
will be in high risk of developing clinical symptoms of severe neonatal
varicella-associated complications.
Case: This is a male of 11 days old infected with the varicella-zoster treated with intravenous
acyclovir, intravenous immunoglobulin (IVIG) and support measures, which despite
the severity of the condition not Complications developed and successfully solved.
Conclusion: Well-controlled studies on the use of acyclovir in newborns have not been
reported so far. Management suggests using acyclovir and IVIG when not available varicella-
zoster immunoglobulin (VZIG), handling is associated with an adequate rate of
survival or even higher compared to the high mortality refer some series in the past.
The IVIG has been used to prevent chickenpox after exposure, when VZIG is not available.
The clinical efficacy of IVIG is not exactly known.

KEYWORDS: Herpes zoster. Neonatal varicella. Acyclovir. Intravenous immunoglobulin
Resumen: Introducción: Las mujeres embarazadas que contraen la infección por varicela al término de la gestación presentan un riesgo potencial mayor de que el recién nacido la adquiera. Si la madre desarrolla la erupción de la varicela alrededor de cinco días antes o dos días después del parto, el recién nacido se encontrará en alto riesgo de desarrollar un cuadro clínico de varicela neonatal severa asociada a complicaciones. Caso: Se trata de un varón de 11 días de nacido con infección por el virus de la varicela-zóster, tratado con aciclovir intravenoso, inmunoglobulina intravenosa (IGIV) y medidas de apoyo, en el que a pesar de la gravedad del cuadro clínico no desarrolló complica-ciones y se solucionó exitosamente. Conclusión: Estudios bien controlados sobre el uso de aciclovir en los recién nacidos no se han reportado hasta el momento actual. Se sugiere el manejo con el uso de aciclovir e IGIV cuando no se disponga de inmunoglobulina varicela-zóster (IGVZ), el manejo se asocia con una adecuada tasa de supervivencia e inclusive mayor en comparación con la alta mortalidad que refieren algunas series en el pasado. La IGIV se ha utilizado para prevenir la varicela después de la exposición, cuando la IGVZ no está disponible. La efi-cacia clínica de la IGIV no se conoce con exactitud.

Background: Bubble continuous positive airway pressure is a well-established modality for providing ventilatory support to spontaneously breathing infants. It has been used in a variety of clinical situations.

Objectives: To evaluate the immediate outcome of PTLBW neonates with respiratory distress by using Bubble Continuous Positive Airway Pressure (BCPAP).
Materials and Methods: This Clinical Trial (Quasi-Experimental study) was conducted from 1st April 2013 to 30th September 2014 in the SCABU of Dhaka Shishu (Children) Hospital. Total 172 preterm babies with a gestational age <35 weeks, presented with clinical signs of respiratory distress were included in the study and among them 85 cases were taken as BCPAP group who were treated by bubble CPAP and 87patients who could not be treated by BCPAP due to unavailability of BCPAP machine at that time were taken as control. Effects of BCPAP were assessed by comparing the clinical conditions, oxygen saturation and arterial blood gas status. Written informed consent from guardian was taken.

Results: Mean gestational age, weight and age at the time of admission were comparable in two groups (BCPAP vs Control: GA 31±1.61 vs 30±1.93 weeks, birth weight 1454±284 vs 1435±228gm, age 28±13 vs 31±19hrs). It was found that duration of O2 need was significantly (p<0.05) less in BCPAP group than the control group (5.61±1.61 vs8.49±3.22 days), significantly (p<0.05) less duration to improve respiratory distress (3.69±1.55 vs 7.67±2.76 days) and hospital stay (8.74±3.72 vs 12.67±11.75 days) was required in BCPAP group. Requirement of mechanical ventilation (IMV) was also less in BCPAP group (27.06% vs 51.72%, P<0.05).

Conclusion: This study found that CPAP is an effective modality of treatment of PTLBW neonates with respiratory distress.

Keywords: Bubble CPAP, PTLBW, Respiratory distress.

This paper presents a case report on the remarkable clinical and biological effects of “ASEA redox supplement” (ASEA-rs) oral solution (co-administered with L-carnitine and omega-3 fatty acids plus multivitamins dietary supplements) in a ~3-year-old boy with Duchenne muscular dystrophy (DMD) from Romania. ASEA-rs was tested on both animals and humans. In vitro studies on various human cells showed that ASEA-rs is a very potent NRF2 selective activator (with transient effect): the studies conducted in vivo (on both animals and humans) also support this main pharmacological mechanism of ASEA-rs, with no toxicity up to high doses (in contrast with corticosteroids which are usually reserved in Romania for DMD children with age above 4 years, given their toxicity profile and adverse effects including immunosuppression, growth delay, osteopenia, osteoporosis and overweight) and a satisfactory bioavailability especially in the vital organs (in which NRF2 also reaches its highest intracellular cytoplasmatic concentrations), which assures the strong NRF2 activation effects of ASEA-rs indirectly observed in vivo. ASEA was clearly demonstrated to activate tissular lipases (probably also via NRF2 pathway) and to significantly increase some fatty acids serum levels that are further internalized by skeletal muscles and myocardium and used as “fuel” by muscular cells (myocytes) (and cardiomyocytes), partially sparing the glycogen reserves of myocytes/cardiomyocytes and so raising the resistance of skeletal muscles to effort and possibly the resistance and contractility of myocardium. Based on its demonstrated potent selective NRF2 activation effect, its beneficial effects on muscle effort resistance and its safety profile, I have prescribed ASEA-rs to this ~3-year-old child with DMD, with a minimal set of clinical signs at his age, but with significant biological alternations in the biochemical markers of muscular damage (rhabdomyolysis): the results (after the first 3 months with ASEA-rs, associated with L-carnitine and omega-3 fatty acids plus multivitamins supplements) were a significant reduction in the creatine (phospho)kinase (CK/CPK) and CK-MB isoform serum levels. Keywords: ASEA redox supplement (ASEA-rs) oral solution, 3-year-old boy, Duchenne muscular dystrophy (DMD), Romania, NRF2 selective activator, tissular lipase activator, skeletal muscles and myocytes, myocardium and cardiomyocytes, corticosteroids, creatine (phospho)kinase (CK/CPK), CK-MB isoform
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Conventional medicine has long since conditioned the human mind into swallowing pills with the thumb rule " A pill for every ill ". Over time however, people from all over the world have come to realize that this is not true. This, after suffering from the stated and unstated side-effects of the very drugs/medicines that are supposed to cure them from diseases and conditions. Read more ..

OBJECTIVE: To compare the malposition rates of endotracheal tubes (ETTs) when the insertional length (IL) is determined by a weight-based nomogram versus when IL is determined by palpation of the ETT tip.DESIGN: Open-label, randomized controlled trial (RCT).SETTING: Level III neonatal intensive care unit (NICU).SUBJECTS: All newborn babies admitted in NICU requiring intubation.INTERVENTIONS: Subjects were randomly allocated to one of three groups, wherein IL was determined by (i) weight-based nomogram alone, (ii) weight-based nomogram combined with suprasternal palpation of ETT tip performed by specially trained neonatology fellows, or (iii) combination of weight-based and suprasternal methods by personnel not specially trained.PRIMARY OUTCOME: Rate of malposition of ETT as judged on chest X-ray (CXR).RESULTS: Fifty seven babies were randomized into group 1(n = 15), group 2 (n = 20), and group 3 (n = 22). The proportion of correct ETT placement was highest in group 2, being 66.7%, 83.3%, and 66.7% in groups 1 through 3, respectively (P value = 0.58). No complication was attributable to palpation technique.CONCLUSION: Suprasternal palpation shows promise as a simple, safe, and teachable method of confirming ETT position in neonates.© 2013 Blackwell Publishing Ltd.

Mastocytosis, first described by Nettleship and Tay in 1869 as cutaneous mast cell disease, is characterized by the proliferation and accumulation of mast cells in primarily skin and bone marrow and various other tissues e.g. the liver, spleen and lymph nodes. The abnormal increase and activity of mast cells in different tissues leads to different clinical tables. Although not clear about the frequency, in one study the prevalence in children referred to dermatology clinics was reported as 1/500. The most common type of childhood mastocytosis is urticaria pigmentosa, which is characterized by skin disease. Systemic mastocytosis is very rare in childhood. In skin mastocytosis, diagnosis is often made with clinical experience, since the disease is not recognized by most physicians in practice and thus it usually does not come to mind in the differential diagnosis, which usually leads to delay. Our aim in this review is to discuss about the diagnosis and management of childhood mastocytosis in the light of the recent literature.

Through 2005 a new simulation pediatric centre linked to
the Faculty of Medical Sciences (The New University of Lisbon) became effective at Dona Estefânia Hospital,
Lisbon. The main innovation was concerned with the
opportunities of simu lation procedures practice devoted to
the 5 th year medical students using manikins. This study
aimed to describe the functioning of the mentioned learning
– teaching setting and to assess the feedback and suggestions from the trainees and trainers as a keystone of future
planning.
All the trainees regarded this training model as very relevant
for their apprenticeship as a complement of clinical practice
with real patients. Most of them expressed the need for high
amounts of time available for the training and for more diversity of manikins. According to the trainers experiences there
is a need to improve some logistic issues and to maximize the
facilities opening this setting to the post-graduation trainees
whose implications are to improve the protocol rules between
the faculty and the hospital.
In summary, we recognize the limitations to this study regar ding the findings drawn from the qualitative and subjective
collected data delivered by medical students and from
expertise of trainers. However, this survey, which may be
consi dered as an internal audit, suggests the need for
changes in the curriculum and for improvement of essential
logistic issues.
Key-words: medical undergraduation, post-graduation residency, continuing medical education, skills teaching-learning, simulation centre, technical procedures

Observation of the quality of endogenously generated “General Movements” has been proved to be a reliable and sensitive tool in the assessment of fragile neonates. The absence of fidgety movements at 2–4 months post-term is highly predictive of Cerebral Palsy. On the contrary, the presence of a poor repertoire pattern during the writhing period is not reliable in predicting motor or neurobehavioral disorders at any stage of development.To examine if the presence of a PR pattern at 1 month post-term was associated with lower neurodevelopmental quotients at 2 years.General Movements evaluation at 1 and 3 months and the Griffiths Scales of Mental Development at 2 years were administered to a sample of very preterm infants. Infants were divided into two groups: poor repertoire pattern group and normal pattern group. Student's t Test and Chi squared test and ANOVA were used to compare neonatal variables and results between the two groups.79 very preterm infants (birthweight ≤ 1500 g or gestational age ≤ 32 weeks), born January 2003 to December 2006 who had a follow-up at 2 years.Griffiths developmental quotient at 2 years.The Poor Repertoire group had lower Gestational Age, lower Birth Weight, lower Apgar scores at birth and lower Developmental Quotient at 2 years. Eye and Hand Coordination (subscale D) was the domain mostly responsible for such a difference. Quality of fidgety movements (normal or abnormal fidgety) at 3 months did not show any correlation with outcome measures at 2 years.The presence of a PR pattern at 1 month post-term seems to predict lower neurodevelopmental scores at 2 years especially in the domain of eye and hand coordination. Longer follow-up is necessary in order to ascertain if such difference will continue to persist at older ages.

Background: In certain developing countries neonatal mortality rates still showed a slower decline. Many factors
were attributed to neonatal mortality that varies from one country to another. This study investigated factors attributed
to neonatal mortality in Sudan.
Methods: Data was collected from 72 neonatal deaths records at Albuluk pediatrics' teaching hospital, and then it was
analyzed using a modified three delays model to determine contributing delays.
Results: 31.9% of neonatal mortality occurred on the first day after birth and 86.1% thereafter. Newborn
characteristics showed that more than half of dead newborn were male and more than 80% admitted in the age of
more than 2 days although there was 26% of involved newborn were preterm. About two third of deliveries were
home deliveries and only 52% of the mothers were in regular antenatal care. The leading causes of death were sepsis
and pneumonia in 83% followed by birth asphyxia in 11% of total neonatal mortality. Regarding the three delays
audit; delay in decision making were present in 54.2% and that was due to inability of the mothers to recognize
danger signs, delay in reaching the health care facility was present in 9.8% of the neonatal mortality, while delay in
initiation of treatment in the healthcare facility was present in only 6.9%.
Conclusions: Maternal knowledge of neonatal danger signs and decision to seek medical care is a major contributor
for neonatal mortality in this study. Further efforts should be exerting to raise knowledge of the mothers about danger
signs of neonatal illness.

Abstract:
The total in blood of bilirubin in newborns of 35 weeks gestation o more is in greater
than 25 mg/dL, it is considered a medical emergency and the exchange transfusion should be performed immediately. This should only be performed by trained personnel
in the intensive care unit, always weighing the benefits against the risks. The case of a
new born of 40.4 weeks of age gestation is informed with ABO hemolytic disease treatment
with exchange transfusion with used old reconstituted blood of 30 days. The exchange
transfusion is a procedure with high morbidity and mortality in the
management of the hemolytic disease in the new born. To minimize the complications
mainly of metabolic type it is recommended when used fresh (< 7 days old) reconstituted
blood. The case of a new born of 40.1 weeks of age gestation is informed with Rh
hemolytic disease treatment with exchange transfusion with used old reconstituted
blood of 30 days.

KEYWORDS: Exchange transfusion. Hemolytic disease. Hyperbilirubinemia. Encephalopathy.

Background: Despite worldwide efforts to reduce neonatal mortality, 44% of under-five deaths occur in the first 28 days of life. The primary causes of neonatal death are preventable or treatable. This study describes the presentation, management and outcomes of hospitalized newborns admitted to the neonatal units of two rural district hospitals in Rwanda after the 2012 launch of a national neonatal protocol and standards.

ABSTRACT
Oral squamous papilloma (OSP) is a benign proliferation of the stratified squamous epithelium, which results in a verocious or papillary exophytic mass. A child female patient 5 year old suspected to have oral papilloma underwent excisional biopsy for histopathologic analysis. The lesions were round, whitish and softened/flaccid.The histopathologic examination revealed hyperparakeratosis, occasional basal hyperplasia, and koilocyte-like cells in the specimen

Purpose: 1p36 deletion syndrome is the most common terminal deletion syndrome, with an incidence of 1/5,000 newborns. But 22q13 duplications seem to be exceedingly rare. A combined 1p36 deletion and 22q13 duplication was more rarely observed and presented variability of clinical features, which increases the importance of reporting additional cases in order to better characterize genotype-phenotype correlations.

Methods: A boy and a fetus from a single family with combined 1p36 deletion and 22q13 duplication characterized by array CGH and MLPA were described here.

Results: The proband presented severe developmental delay, hypotonia, epilepsy, feeding difficulties with failure to thrive, tracheal malformation,
clinodactyly, strephexopodia, fair skin, facial dysmorphism and died at 1 year of age. Array CGH uncovered a 9.3-Mb deletion of 1p36 plus a 6.655-Mb duplication of 22q13in the proband. This rearrangement was confirmed by MLPA. When his mother was pregnant again, array CGH detected an almost identical rearrangement with that of the proband. She terminated the pregnancy at 24 weeks gestation. The fetus was female and had similar facial dysmorphism as the proband. Karyotypes of parents are all normal.

Conclusions: Most of the features in the proband were similar to those associated with both isolated 1p36 deletions and 22q13 duplications.
However, tracheal malformation, fair skin and strephexopodia were only observed in our patient. Given that 22q13 duplications are rare and not as well characterized as 1p36 deletions, we attributed these features to 22q13 duplications. Importantly, we emphasize importance of prenatal diagnosis of females who had such abnormal pregnancy.

OBJECTIVE: This study was conducted to determine the frequency of otitis media in preterm neonates using otoendoscopy and tympanometry.
STUDY DESIGN: Prospective study.
SETTING: Wayne State University, Hutzel Women's Hospital Neonatal Intensive Care Unit.
SUBJECTS AND METHODS: Eighty-six preterm infants were included (gestational age <36 weeks). Otoendoscopy and tympanometry were performed to detect the presence of otitis media. Kappa statistic and logistic regression were used for statistical analysis.
RESULTS: Otoendoscopy was performed in 85 patients. The frequency of otoendoscopy-diagnosed otitis media was 72.9% (62/85). Tympanometry could be performed on 69.76% of the ears. There was 73.5% agreement between the findings of tympanometry and those of otoendoscopy. The association between the presence of otitis media and gestational age at birth was statistically significant. The lower the gestational age, the higher the frequency of otoendoscopy-diagnosed otitis media (P = .001).
CONCLUSION: Otoendoscopically diagnosed otitis media is frequent in preterm neonates. There was agreement between the results of tympanometry and those of otoendoscopy. The frequency of otitis media increased with lower gestational age.

Objective:

The objective of the study was to study the performance of cerebrospinal fluid (CSF) procalcitonin as a marker for bacterial meningitis in neonates, and to determine its optimal ‘cutoff’ in CSF that can be called significant for the diagnosis.

Study Design:

Neonates qualifying for lumbar puncture were prospectively studied. Procalcitonin and established CSF parameters were recorded.

Results:

At a cut-off value of 0.33 ng ml−1, CSF procalcitonin had a sensitivity of 0.92, specificity of 0.87, with positive and negative likelihood ratios of 7.13 and 0.092, respectively. The area under the curve for different CSF parameters was: 0.926 (0.887 to 0.964) (P<0.001) for procalcitonin, 0.965 (0.956 to 0.974) for total leukocyte count, 0.961 (0.94 to 0.983) for neutrophil count, 0.874 (0.825 to 0.923) for protein, 0.946 (0.914 to 0.978) for sugar and 0.92 (0.955 to 0.992) for CSF:serum sugar ratio. The lumbar puncture was traumatic in 36 (21.4%) patients; out of these 15 (41.7%) had bacterial meningitis and 21 (58.3%) had no meningitis. In traumatic lumbar tap group, the median (IQR) CSF procalcitonin in patients with and without meningitis was 1.41 (0.32-3.42) ng/ml and 0.21(0.20-0.31) ng/ml respectively (p<0.05).

Conclusions:

Procalcitonin measurement has diagnostic efficiency similar to the established CSF markers. Routine assessment of procalcitonin in clean non-contaminated CSF may not yield additional information, but it may have clinical utility in situations where diagnosis of meningitis is in dilemma, as in the case of blood contamination of CSF in traumatic lumbar punctures.

Acute otitis media (AOM) is a multifactorial disease with a significant socioeconomic impact. The pathogenesis of AOM is attributed to a variety of well-established internal and extrinsic factors. Recent evidence strongly points to bacterial biofilm formation as an important contributor to this disease entity. The nasopharynx is a likely reservoir for infection with subsequent seeding of pathogens to the middle ear via planktonic shedding. Various modalities have been used to directly detect biofilm formation in the middle ear mucosa of children with AOM. Further insights into this disease may lead to new strategies for prevention and treatment.

Recent medical ethics literature has proposed the acceptability of killing new-born infants, calling it “after-birth abortion” which is another euphemism of infanticide. This letter to the editor looks at the history behind this thinking and analyzes the serious problems associated with this proposal.

CONTEXT: The eutectic mixture of lidocaine (EMLA) cream has been used to reduce the pain during venipuncture in infants.
abstract
OBJECTIVE: To determine the efficacy and safety of EMLA in infants <3 months of age requiring venipuncture in comparison with nonpharmacological interventions in terms of pain reduction, change in physiologic variables, and methemoglobinemia.
DATA SOURCES: Medline, Embase, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science, and gray literature were searched from inception to August 2017, without language restrictions.
STUDY SELECTION: We selected randomized controlled trials in which researchers compared EMLA with nonpharmacological interventions.
DATA EXTRACTION: Two reviewers independently performed abstract screening and full-text review, and extracted the data and assessed the risk of bias.
RESULTS: Ten randomized controlled trials (907 infants) were included. EMLA revealed little or no effect in reduction of pain (standardized mean difference: 0.14; 95% confidence interval [CI]: −0.17 to 0.45; 6 trials, n = 742; moderate-quality evidence) when EMLA was compared with sucrose, breastfeeding, or placebo. In comparison with placebo, EMLA revealed a small-to-moderate effect on increasing methemoglobin levels (mean difference: 0.35; 95% CI: 0.04 to 0.66; 2 trials, n = 134; low-quality evidence). There was an increased risk of blanching of the skin in the EMLA group (relative risk: 2.63; 95% CI: 1.58 to 4.38; 2 trials, n = 123; I2 = 84%, very low–quality evidence).
LIMITATIONS: Our results may not be applicable to older infants.
CONCLUSIONS: EMLA reveals minimal benefits in terms of reduction of pain due to venipuncture procedure in comparison with placebo and no benefit in comparison with sucrose and/or breastfeeding. Moreover, it produced an elevation in methemoglobin levels and skin blanching.

ntroducción: Los prematuros pueden presentar lesiones por reperfusión hiperóxica, por lo quese deben evitar niveles nocivos de oxígeno.Objetivo: Determinar, durante la reanimación neonatal de recién nacidos de 27 a 30 semanasde edad gestacional, los requerimientos de oxígeno, el porcentaje de saturación y su relacióncon la morbilidad neonatal.Material y métodos: Estudio transversal observacional y analítico. Se incluyeron neonatos de27 a 30 semanas de gestación; se excluyeron neonatos con malformaciones congénitas mayoresy las defunciones antes de las 36 semanas de edad gestacional corregida. Se dividieron en grupo1, neonatos de 27 y 28 semanas, y grupo 2, neonatos de 29 y 30 semanas; se analizaron variablesmaternas y neonatales con requerimiento de FiO2y saturación de oxígeno a los 5 y 10 minutos,así como el desarrollo de morbilidad neonatal.Resultados: Ingresaron 39 neonatos en el grupo 1 y 31 en el grupo 2. La FiO2en promediopara el grupo 1 a los 5 minutos fue del 77.56%, y para el grupo 2, del 64.9% (p = 0.045). Elgrupo 1 necesitó mayor concentración de oxígeno para alcanzar saturaciones > 80%. Hubo unaumento de riesgo para hemorragia intraventricular (OR 3.21; IC95%: 1.07-9.60) en el grupo 1.La morbilidad no tuvo relación con la saturación de oxígeno durante la reanimación neonatal

RESUMEN Los tumores de la boca son raros en los recién nacidos, la mortalidad de estos casos depende del tamaño y localización del tumor. Se informa el caso de un recién nacido de 39 semanas de gestación con una tumoración bucal extirpada por cirugía, egresan-do sin complicaciones. SUMMARY Tumors of the mouth are rarely seen in newborn children, and it's fatality rate depend on the size of the tumor and place were is it located. Here is reported a 39 weeks of gestation newborn with epignathus, same it was extirpated by surgery without complications.

Background The incidence of retinopathy of prematurity (ROP) is higher in Indonesia than in high-income countries. In order to reduce the incidence of the disease, a protocol on preventing, screening and treating ROP was published in Indonesia in 2010. To assist the practical implementation of the protocol, meetings were held in all Indonesia regions, calling attention to the high incidence of ROP and the methods to reduce it. In addition, national health insurance was introduced in 2014, making ROP screening and treatment accessible to more infants. Objective To evaluate whether the introduction of both the guideline drawing attention to the high incidence of ROP and national health insurance may have influenced the incidence of the disease in Indonesia. Setting Data were collected from 34 hospitals with different levels of care: national referral centres, universitybased hospitals, and public and private hospitals. Methods A survey was administered with questions on admission numbers, mortality rates, ROP incidence, and its stages for 2016-2017 in relation to gestational age and birth weight. Results We identified 12 115 eligible infants with a gestational age of less than 34 weeks. Mortality was 24% and any stage ROP 6.7%. The mortality in infants aged less than 28 weeks was 67%, the incidence of all-stage ROP 18% and severe ROP 4%. In the group aged 28-32 weeks, the mortality was 24%, all-stage ROP 7% and severe ROP 4%-5%. Both mortality and the incidence of ROP were highest in university-based hospitals. Conclusions In the 2016-2017 period, the infant mortality rate before 32 weeks of age was higher in Indonesia than in high-income countries, but the incidence of ROP was comparable. This incidence is likely an underestimation due to the high mortality rate. The ROP incidence in 2016-2017 is lower than in surveys conducted before 2015. This decline is likely due to a higher practitioner awareness about ROP and national health insurance implementation in Indonesia. HKWCHC, Harapan Kita Women and Children's Hospital (National Centre for Women and Children's Health); OH, other hospitals; ROP, retinopathy of prematurity; RSCM/NRH, Ciptomangunkusumo Hospital (national referral hospital); UBH, university-based hospital.