ARTICLE | doi:10.20944/preprints201609.0116.v1
Subject: Medicine & Pharmacology, Pediatrics Keywords: Neonate; qualitative research; Southeast Asia
Online: 29 September 2016 (11:17:06 CEST)
Global coverage and scale up of interventions to reduce newborn mortality remains low, though progress has been achieved in improving newborn survival in many low-income settings. An important factor in the success of newborn health interventions, and moving to scale, is appropriate design of community-based programs and strategies for local implementation. We report the results of formative research undertaken to inform the design of a newborn health intervention in Cambodia. Information was gathered on newborn care practices over a period of three months using multiple qualitative methods of data collection in the primary health facility and home setting. Analysis of the data indicated important gaps, both at home and facility level, between recommended newborn care practices and those typical in the study area. The results of this formative research have informed strategies for behavior change and improving referral of sick infants in the subsequent implementation study. Collection and dissemination of data on newborn care practices from settings such as these can contribute to efforts to advance survival, growth and development of newborns for intervention research, and for future newborn health programming.
REVIEW | doi:10.20944/preprints202201.0255.v1
Subject: Life Sciences, Microbiology Keywords: Trichosporon; trichosporonosis; neonate; hematologic disorder; malignancy
Online: 18 January 2022 (12:35:06 CET)
(1) Background: Trichosporon species have emerged as important opportunistic fungal pathogens, with Trichosporon asahii being the leading and most frequent cause of invasive disease. (2) Methods: We performed a global review focused on invasive trichosporonosis in neonates and pediatric patients with malignancies or hematologic disorders. We reviewed case reports and case series of trichosporonosis due to T. asahii published since 1994, year of the revised taxonomic classification. (3) Results: Twenty-four cases of invasive trichosporonosis were identified in neonates with presence of central venous catheter and use of broad-spectrum antibiotics recognized as main predisposing factors. Thirty-two cases were identified in children with malignancies or hematologic disorders, predominantly with severe neutropenia. Trichosporon asahii was isolated from blood in 24/32 (75%) pediatric cases. Cutaneous involvement was frequently observed in invasive trichosporonosis. Micafungin was the most commonly used prophylactic agent (9/22; 41%). Ten patients receiving prophylactic echinocandins were identified with breakthrough infections. Favorable outcome was reported in 12/16 (75%) pediatric patients receiving targeted monotherapy with voriconazole or combined with liposomal amphotericin B. Overall mortality in neonates and children with malignancy was 67% and 60%, respectively. (4) Conclusions: Voriconazole is advocated for the treatment of invasive trichosporonosis given the intrinsic resistance to echinocandins and poor susceptibility to polyenes.
BRIEF REPORT | doi:10.20944/preprints202005.0482.v1
Subject: Medicine & Pharmacology, Pediatrics Keywords: COVID19; preterm neonate; pneumonia; vertical transmission
Online: 31 May 2020 (16:39:43 CEST)
We report the first case of COVID 19 pneumonia in a preterm neonate in Mayotte, an overseas department of France. The respiratory distress with typical thoracic imaging lesions appears at 14 days of life. This case-report emphasizes the need for a cautious and close up follow-up for asymptomatic neonates born to mothers with COVID-19 infection. Vertical transmission cannot be excluded in this case.
ARTICLE | doi:10.20944/preprints202107.0680.v1
Subject: Medicine & Pharmacology, Allergology Keywords: NEC; Surgical; Medical; Risk factor; Outcome; Neonate
Online: 30 July 2021 (09:11:09 CEST)
Background: Necrotizing enterocolitis (NEC) is one of the leading causes of death in newborns, however, little is understood of which patients can be treated medically or require surgery. The purpose of our study is to analyze the associated factors of surgically treated patients compared to patients requiring only medical treatment. Methods: Patients diagnosed with necrotizing enterocolitis over a period of 14 years in a single children’s hospital were retrospectively enrolled. Demographics and clinical data patients were collected and analyzed. Results: A total of 189 patients with NEC were included. Surgically treated patients had a lower gestational age (P = .018), body weight at birth (P = .034), and percentage of exclusive breast milk feeding (P= .001). They had increased comorbidity with respiratory distress syndrome (RDS) (P = .005), number of days of antibiotic use (P = .014), and length of hospital stay (P = .000). In multivariate logistic analysis, a lower percentage of exclusive breast milk feeding (OR = 0.366, 95% CI: 0.164-0.817) and a longer hospital stay (OR = 1.010, 95% CI: 1.001- 1.019) was associated with surgical NEC. Conclusion: Comparing medical and surgical NEC, a significantly lower percentage of surgical NEC patients were exclusively fed breast milk and their hospital stays were longer.
Online: 25 February 2020 (11:38:47 CET)
Background: Coronavirus disease 2019 (COVID-19) is a new viral respiratory disease and whether pregnant women are at increased risk of infection is unknown. Viral pneumonia is an important indirect cause of maternal death. Little is known about the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during pregnancy. Objective: To describe the clinical characteristics of COVID-19 in pregnancy and their newborn infant, and we sought to explored whether the SARS-CoV-2 can be intrauterine vertically transmitted. Study Design: The study was a case series study conducted in the obstetric ward of Tongji Hospital affiliated to Huazhong University of science and technology, Wuhan, China. Demographic, clinical, laboratory and radiological profiles of the SARS-CoV-2 infection case series. A systematic testing procedure for SARS-CoV-2 infection using oropharyngeal swab, placenta tissue, vaginal mucus, and breast milk of mothers. and oropharyngeal swab, umbilical cord blood, and serum of newborns was conducted. Results: We have conducted the most thorough virological assessment to date, and we include a longer clinical observation in mother-infant dyads during hospitalization. The clinical course and outcomes of three pregnant women who acquired SARS-CoV-2 infection late pregnancy are described in mother-infant dyads. Two had caesarean delivery in their third trimester. All patients showed an uneventful perinatal course, and a successful outcome. No infants became infected by vertical transmission or during delivery. Conclusion: No evidence to suggest the potential risk of intrauterine vertical transmission in the case series and further in-depth study is needed. Both the pregnancy woman and infant showed fewer adverse maternal and neonatal outcomes.
ARTICLE | doi:10.20944/preprints202012.0725.v1
Subject: Medicine & Pharmacology, Allergology Keywords: extracorporeal membrane oxygenation; meconium aspiration syndrome; neonate; Hub and Spoke; outcomes
Online: 29 December 2020 (09:29:49 CET)
The neonatal Hub and Spoke (HandS) ECMO approach provides emergent ECMO implantation to support neonates in severe cardio-respiratory life-threatening conditions at secondary (Spoke) centers, and a safe transfer to the ECMO center (Hub). We report a retrospective review of 11 neonates fom January 2014 to January 2020, presenting with life-threatening conditions and treated by HandS ECMO team in Spoke hospitals. Protocols and checklists were arranged by a local group of ECMO experts and shared with all the hospitals located in North-Eastern Italy. At the emergent call, all patients were cared for at the Spoke hospitals, receiving maximal respiratory and cardiovascular support (including high frequency oscillatory ventilation, inhaled nitric oxide, and major inotropic intravenous infusion). All but 3 patients were affected by life-threatening meconium aspiration syndrome. Median duration of ECMO support and hospitalization were 4 days (range 2-32) and 30 days ( range 8-50), respectively. All but 2 patients with congenital diaphragmatic hernia, were weaned off ECMO and discharged home without complications. At a median follow up of 14.4 months (1.3-74.8), all survivors were alive and in good clinical conditions, without medications, and normal somatic growth. All but one had normal neuropsychological development. We conclude that HandS ECMO model for treating neonates in life-threatening conditions is effective and successful. A specialized multidisciplinary team and common organizational protocols shared between Hub and Spoke centers are the key-points for success. While excellent results occur with MAS (100% survival), treatment was not successful in CDH, in which other that HandS ECMO issues are implied. Lessons learned from our experience are presented and discussed in this article.
REVIEW | doi:10.20944/preprints202008.0090.v2
Subject: Medicine & Pharmacology, Veterinary Medicine Keywords: Piglet; castration; pain; behaviour; peri-operative; vocalisation; nociception; neonate; anaesthesia; analgesia.
Online: 11 August 2020 (10:10:24 CEST)
Analgesic products for piglet castration are critically needed. This requires extensive animal experimentation such as to meet regulatory-required proof of efficacy. At present, there are no validated methods of assessing pain in neonatal piglets. This poses challenges for investigators to optimize trial design and to meet ethical obligations to minimize the number of animals needed. Pain in neonatal piglets may be subtle, transient and / or variably expressed and, in the absence of validated methods, investigators must rely on using a range of biochemical, physiological and behavioural variables, many of which appear to have very low (or unknown) sensitivity or specificity for documenting pain, or pain-relieving effects. A previous systematic review of this subject was hampered by the high degree of variability in the literature base both in terms of methods used to assess pain and pain mitigation, as well as in outcomes reported. In this setting we provide a narrative review, to assist in determining the optimal methods currently available to detect piglet pain during castration and methods to mitigate castration-induced pain. In overview, the optimal outcome variables identified are nociceptive motor and vocal response scores during castration, and quantitative sensory-threshold response testing and pain-associated behaviour scores following castration.
REVIEW | doi:10.20944/preprints202105.0301.v1
Subject: Medicine & Pharmacology, Allergology Keywords: Hepatitis E virus; Genotype; Epidemic hepatitis; Sporadic hepatitis; Pregnancy; Foetus; Neonate; Vaccine
Online: 13 May 2021 (13:52:29 CEST)
The adverse relationship between viral hepatitis and pregnancy in developing countries was seen as a reflection of retrospective biased hospital-based data collection by the West. However, the discovery of HEV from an epidemic of non-A, non-B hepatitis in Kashmir and documenting increased incidence and severity of hepatitis E in pregnancy from a house-to-house survey unmasked the unholy alliance. Among the family of HEV’s, genotype (gt)-1, with a unique ORF4-encoded protein enhancing viral polymerase activity and viral replication, is the sole HEV that shows this adverse relationship. The epidemics caused by HEV-gt1 and not by HEV-gt2 show adverse relationship with pregnancy. The pathogenesis of the unholy alliance is complex and at present not well understood. Possibly multiple factors play a role in causing severe liver disease in the mother including: infection, replication and damage to the maternal-foetal interface by HEV-gt1; vertical transmission of HEV to foetus causing severe foetal/neonatal hepatitis; and combined viral and hormone related immune dysfunction of diverse nature in the mother promoting viral replication. Management is multidisciplinary and needs a close watch for the development and management of ALF. Preliminary data suggest beneficial maternal outcomes by early termination of pregnancy in patients with lower grades of encephalopathy.
Subject: Medicine & Pharmacology, Allergology Keywords: COVID-19; pandemic; lockdown; Neonate services; disease spectrum; interrupted time-series analysis
Online: 20 January 2021 (15:59:41 CET)
(1) Introduction: The unprecedented coronavirus disease 2019 (COVID-19) epidemic has caused millions of infections worldwide and represents a significant challenge facing modern health care systems. This study was conducted to investigate the impact of lockdown measures on regional neonate services, which might be used to predict the long-term effects of medical behavior. (2) Methods: Using hospital information system (HIS) Statistics data from 4 January 2019 to 27 August 2020, an interrupted time-series analysis was employed to compare changes and trends in hospital admissions and disease spectrum before and after the lockdown interventions. Furthermore, this study was designed to evaluate whether the pandemic influenced newborns' healthcare behavior. (3) Results: Overall, 13,540 infants were admitted to the NICU during the pre-COVID period (n = 12082) and COVID-impacted period (n =4558). The patients' age at admission were younger than that of the pre-COVID-19 period (median age 5d vs. 6d after birth, p＜0.001). The overall number of neonate visits consistently decreased from the first days of the lockdown measures (24 January 2020). The disease spectrum for respiratory system, infectious diseases, and gastrointestinal disease indicated no declined immediately after intervention(p =0.079, p =0.113, p =0.060, respectively). There was an immediate decline in the volume of Jaundice-related conditions (p<0.001) after lockdown measures. The percentage of patients who suffer from respiratory system and infectious diseases has decreased (p =0.005 and p =0.002). However, a relatively high percentage of patients admitted to the neonatal intensive care unit (NICU) presented with Jaundice-related conditions (p <0.001). (4) Conclusions: In summary, the COVID-19 pandemic profoundly impacted the regional neonate services. However, it is still unclear what might be the effect of long-term effects from pandemic.
ARTICLE | doi:10.20944/preprints202002.0356.v1
Subject: Medicine & Pharmacology, Pediatrics Keywords: pulse oximetry; congenital heart disease; neonate; hypoxemia; Latin America; Ibero-American Society of Neonatology
Online: 24 February 2020 (14:08:22 CET)
Congenital heart disease (CHD) is among the 4 more common causes of infant mortality in Latin America. Pulse oximetry screening (POS) is useful for early diagnosis and improved outcomes of critical CHD. We describe POS implementation efforts in Latin American countries guided and/or coordinated by the Ibero American Society of Neonatology (SIBEN) as well as the unique challenges that are faced for universal implementation. SIBEN collaborates to improve neonatal quality of care and outcomes. A few years ago, a Clinical Consensus on POS was finalized. Since then, we participated in 12 Latin American countries to educate neonatal nurses and neonatologists on POS and to help with its implementation. The findings reveal that despite wide disparities in care that exist between and within countries, and the difficulties and challenges for implementing POS, significant progress was made. We conclude that universal POS is not easy to implement in Latin America but, when executed, not only it has been of significant value for babies with CHD but also for many with other hypoxemic conditions. The successful and universal implementation of POS in the future is essential to reduce the mortality associated with CHD and other hypoxemic conditions and will ultimately lead to the survival of many more Latin American babies. POS saves newborns’ lives in Latin America.
ARTICLE | doi:10.20944/preprints202208.0135.v1
Subject: Medicine & Pharmacology, Pharmacology & Toxicology Keywords: physiologically based pharmacokinetic modelling; propofol; low cardiac output; pharmacokinetics; neonate; developmental pharmacology; asphyxia; hypothermia; pediatrics; pharmacokinetics
Online: 8 August 2022 (06:12:36 CEST)
Background: pathophysiological changes like low cardiac output (LCO) impact pharmacokinetics, but its extent may be different throughout pediatrics compared to adults. Physiologically based pharmacokinetic (PBPK) modelling enables further exploration. Methods: A validated propofol model was used to simulate the impact of LCO on propofol clearance across age groups using the PBPK platform, Simcyp® (version 19). The hepatic and renal extraction ratio of propofol was then determined in all age groups. Subsequently, dose explorations were conducted under LCO conditions, targeting a 3 µg/mL (80-125%) propofol concentration range. Results: Both hepatic and renal extraction ratios increased from neonates, infants, children to adolescents and adults. The relative change in clearance following CO reductions increased with age, with the least impact of LCO in neonates. The predicted concentration remained within the 3 µg/mL (80-125%) range under normal CO and LCO (up to 30%) conditions in all age groups. When CO was reduced by 40-50%, a dose reduction of 15% is warranted in neonates, infants and children, 25% in adolescents and adults. Conclusions: PBPK driven, the impact of reduced CO on propofol clearance is predicted to be age-dependent, proportionally greater in adults. Consequently, age group specific dose reductions for propofol are required in LCO conditions.