Newborn behavioral observations system in rural Pakistan: A feasibility and acceptability study.

The Newborn Behavioral Observations (NBO) system is a relationship-based tool that helps parents recognize their infant's competencies and learn their behavioral cues, with the goals of enhancing parental responsiveness and satisfaction in the infant-parent relationship. In our study, a pediatrician integrated the NBO into 44 pediatric health care visits of infants in rural Pakistan villages, under the remote guidance of two U.S.-based child psychiatrists. A clinician then gave the mothers a survey about their experience of the NBO and found that the mothers were highly satisfied, reporting greater appreciation of their infant's strengths, greater understanding of their infant's behavioral cues, stronger attachment to their infant, and greater self-confidence as a mother. In their consideration of these results, the authors explore cultural reasons for the mothers' responses and generate hypotheses to inform an outcome study of a similar intervention. This was a feasibility and acceptability study and was not randomized, had no control group, and did not use objective measures of outcome.

El sistema de Observaciones de Comportamiento del Recién Nacido (NBO)™ es una herramienta basada en la relación que se enfoca en ayudar a los padres a reconocer las competencias de su infante y aprender sus señales de comportamiento, con el propósito de mejorar la sensibilidad y satisfacción del progenitor en la relación infante-progenitor. En este estudio de probabilidad y aceptabilidad, un clínico pediatra integró el NBO dentro de 44 visitas de cuidado de salud pediátricas a infantes en aldeas rurales en Pakistán, bajo la guía remota de dos siquiatras infantiles con base en los Estados Unidos. Entonces, un clínico les dio a las madres una encuesta acerca de su experiencia con el NBO y se encontró que las madres estaban altamente satisfechas, reportando un mayor aprecio por los puntos fuertes de sus infantes, una mayor comprensión de las señalas de comportamiento de sus infantes, una más fuerte afectividad hacia sus infantes, así como una mayor auto confianza como madre. En sus consideraciones de estos resultados, los autores exploran razones culturales para las respuestas de las madres y generan hipótesis como información para un estudio de resultado de una intervención similar.

Le système d'observation comportementale du nouveau-né (Newborn Behavioral Observations, abrégé selon l'anglais NBO system™) est un outil basé sur la relation se concentrant sur l'aide aux parents à reconnaître les compétences de leur nourrisson et à comprendre leurs signaux de comportement, se donnant pour but de mettre en valeur la réaction parentale et la satisfaction dans la relation nourrisson-parent. Dans cette étude de faisabilité et d'acceptabilité un clinicien en pédiatrie a intégré le NBO dans 44 visites de santé pédiatrique de nourrissons dans des villages du Pakistan rural, sous l'orientation professionnelle à distance de deux psychiatres de l'enfance basés aux Etats-Unis d'Amérique. Un clinicien a ensuite donné aux mères un questionnaires sur leur expérience du NBO et a trouvé que les mères étaient très satisfaites, faisant état d'une plus grande appréciation des forces de leurs nourrissons, d'une plus grande compréhension des signaux de comportement de leur nourrisson, d'un attachement plus fort à leur nourrisson et d'une plus grande confiance en soi en tant que mère. Dans leur considération de ces résultats les auteurs explorent les raisons culturelles expliquant les réponses des mères et génèrent des hypothèses pour informer une étude d'une intervention similaire.

Risk factors for healthcare-associated infections in newborns after surgery in a neonatal intensive care unit.

BACKGROUND: Health care-associated infections (HAIs) are a common cause of morbidity and mortality. There is little information on the risk factors associated with HAI in surgical newborns. OBJECTIVE: To identify the risk factors associated with healthcare-associated infections in surgical newborns. METHODS: Nested case-control study carried out during 2016-2017. Cases were newborns with healthcare-associated infections and controls were newborns without infection. Perinatal characteristics, use of antimicrobial prophylaxis, use of central venous catheter (CVC), mechanical ventilation, parenteral nutrition, age, and weight at the time of surgery, type of surgery, surgical wound classification, duration of surgery, number of surgical procedures, postsurgical HAIs and type of infection were registered. Univariate and multivariate analyses were performed. RESULTS: Seventy-one cases and 142 controls were included. The most frequent HAI was bloodstream infection (36.6%); the main microorganisms isolated in blood cultures were gram-positive cocci. Independent risk factors associated with HAIs in the multivariate analysis were CVC duration > 8 days (aOR = 17.2, 95% CI = 3.8-49.1), ≥ 2 surgeries (aOR = 16.5, 95% CI 5.8 -42.1) and abdominal surgery (aOR = 2.6, 95% CI = 1.2-6.6). CONCLUSION: Newborns undergoing surgery, mainly those with risk factors, require close monitoring during the postoperative period. CVC should be withdrawn as soon as possible.

ANTECEDENTES: Las infecciones asociadas a la atención de la salud (IAAS) son causa frecuente de morbilidad y mortalidad. OBJETIVO: Identificar los factores de riesgo para el desarrollo de IAAS en recién nacidos (RN) sometidos a cirugía. MATERIAL Y MÉTODOS: Estudio de casos y controles anidado en una cohorte. Los casos fueron RN sometidos a cirugía, con IAAS y los controles, RN sometidos a cirugía sin IAAS. Se registraron datos perinatales, uso de profilaxis antimicrobiana, de catéter venoso central (CVC), ventilación mecánica, nutrición parenteral y sondas; edad y peso al momento de la cirugía, tipo de cirugía, clasificación de la herida quirúrgica, duración de la cirugía, número de procedimientos quirúrgicos y tipo de infección. Se realizó análisis univariado y multivariado. RESULTADOS: Se incluyeron 71 casos y 142 controles. Las IAAS más frecuentes fueron las infecciones sanguíneas (36.6 %); los principales microorganismos aislados en hemocultivos fueron cocos grampositivos. Los factores de riesgo asociados a IAAS en el análisis multivariado fueron duración del CVC > 8 días (RMa = 17.2), ≥ 2 intervenciones quirúrgicas (RMa = 16.5) y cirugía abdominal (RMa = 2.6). CONCLUSIONES: Los RN sometidos a cirugía, principalmente aquellos con factores de riesgo, requieren vigilancia estrecha durante el posoperatorio. El CVC debe ser retirado tan pronto sea posible.

Supporting early infant relationships and reducing maternal distress with the Newborn Behavioral Observations: A randomized controlled effectiveness trial.

Research points to the significant impact of maternal distress on the parent-infant relationship and infant development. The Newborn Behavioral Observations (NBO) is a brief intervention supporting the infant, the parent and their relationship. This randomized controlled trial examined the effectiveness of the NBO in a population with antenatal distress and risk of postnatal depression (PND). Pregnant, first-time mothers with current anxiety or depression symptoms or past mental illness were recruited from two Australian hospitals. Participants received three NBO sessions in the first month of life plus treatment as usual (TAU), or, TAU-only. Outcomes assessed at infant age 4 months included mother-infant interaction quality; maternal anxiety and depression symptoms; and depression diagnosis. Of 111 pregnant individuals randomized, 90 remained eligible and 74 completed the trial (82.2% retention). There were intervention effects on emotional availability F(6, 67) = 2.52, p = .049, Cohen's d = .90, with higher sensitivity and non-intrusiveness in the intervention group (n = 40) than the comparison group (n = 34). There was an intervention effect approaching significance for anxiety symptoms at 4 months (p = .06), and a significant effect over time (p = .014), but not for depression symptoms. Anxiety and depression symptoms significantly reduced to sub-clinical levels within the intervention group only. There were fewer depression diagnoses (n = 6) than expected across groups, with no observed intervention effect. No adverse intervention effects were seen. Exploratory analysis of sensory processing sensitivity suggested differential susceptibility to distress and intervention benefits. The NBO was accepted and exerted meaningful effects on relationship quality and distress; and may enhance the infant's interaction experience and maternal emotional adjustment in at-risk populations.

La angustia materna tiene impacto en las relaciones progenitor-infante y el desarrollo del infante. Las Observaciones del Comportamiento del Recién Nacido (NBO) es una intervención breve para apoyar al infante, al progenitor y la relación entre ellos. Este ensayo controlado al azar examinó la eficacia de NBO en un grupo de población con angustia antenatal y riesgo de depresión postnatal. En dos hospitales australianos, se reclutaron madres embarazadas, primerizas, con síntomas presentes de ansiedad o depresión, o enfermedad mental anterior. Las participantes recibieron tres sesiones de NBO en el primer mes de vida más el tratamiento como se acostumbra (TAU), o sólo TAU. Entre los resultados evaluados a los 4 meses se incluye la calidad de la interacción madre-infante, la ansiedad materna y síntomas de depresión, así como el diagnóstico de depresión. De las 111 mujeres embarazadas seleccionadas al azar, 90 quedaron siendo elegibles y 74 completaron el ensayo (retención 82.2%). La intervención mejoró significativamente la disponibilidad de interacción emocional F(6,67) = 2.52, p = .049, puntaje Cohen d = .90, y redujo síntomas de ansiedad a lo largo del tiempo (p = .014) entre quienes completaron el grupo de intervención (n = 40) versus el grupo comparativo (n = 34). El grupo de intervención mostró significativas reducciones en ansiedad y síntomas de depresión a niveles subclínicos, tanto en el examen previo como en el posterior. En el diagnóstico de depresión, no se observaron efectos de intervención. No se dio ningún efecto adverso de intervención. El proceso sensorial de la sensibilidad diferenció entre susceptibilidad a la angustia y los beneficios de la intervención. La NBO tuvo efectos en la calidad de la relación y la angustia; y pudiera haber mejorado la experiencia de interacción del infante y el ajuste emocional materno en los grupos clínicos de población.

Les recherches pointent vers un impact important de la détresse maternelle sur la relation parent-nourrisson et le développement du nourrisson. Les Observations Comportementale du Nouveau-né (abrégé ici OCN en français) est une intervention courte soutenant le nourrisson, le parent et leur relation. Cet essai contrôlé randomisé a examiné l'efficacité de l'OCN chez une population clinique avec une détresse anténatale et un risque de dépression postnatale. Des mères primipares enceintes avec des symptômes d'anxiété et de dépression ou de dépression passée ont été recrutées dans deux hôpitaux australiens. Les participants ont reçu trois séances OCN durant le premier mois de vie plus un traitement habituel ou seulement un traitement habituel. Les résultats ont été évalués à l'âge de quatre mois du nourrisson, y compris la qualité de l'interaction mère-nourrisson, l'anxiété maternelle, la dépression et les symptômes de stress de parentage, et le diagnostic de dépression. De 111 participantes enceintes randomisées, 90 sont demeurées éligibles et 74 ont complété l'étude (82,2% de rétention). On a trouvé des effets de l'intervention sur la disponibilité émotionnelle F(6, 67) = 2,52, p = ,049, d = ,90 de Cohen, avec une sensibilité plus élevée et un caractère non intrusif dans le groupe d'intervention (n = 40) dans le groupe de comparaison (n = 34). Il y avait des différences de groupe importantes dans les niveaux d'anxiété au fil du temps (p = ,014). L'anxiété et les symptômes de dépression ont été très largement réduits à des niveaux subcliniques au sein du groupe d'intervention. Aucun effet négatif d'intervention n'a été observé. Une analyse exploratoire de sensibilité du traitement sensoriel a révélé une susceptibilité différentielle à la détresse et aux bénéfices de l'intervention. L'OCN a été acceptée et a produit des effets significatifs sur la qualité de la relation et la détresse, et peut améliorer l'expérience d'interaction du nourrisson et l'ajustement émotionnel maternel chez les populations cliniques.

Breastfeeding and COVID-19.

The coronavirus disease 2019 (COVID-19) pandemic has affected all dimensions of health care, including exclusive breastfeeding assurance and its promotion. The risk of contagion and the consequences of the pandemic have raised concerns among future mothers or in those who are already breastfeeding due to the risk of possible transmission of the virus through breast milk, although active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not yet been detected in breast milk. The fear of contagion has favored mother-child isolation policies. So far, there is no evidence of vertical transmission, and the risk of horizontal transmission in the infant is similar to that of the general population. In infants with COVID-19, breastfeeding can even favorably change the clinical course of the disease.

La pandemia de enfermedad por coronavirus 2019 (COVID-19) ha afectado a todas las dimensiones de la atención en salud, entre ellas el aseguramiento de la lactancia materna exclusiva y su promoción. El riesgo de contagio y las consecuencias de la pandemia han provocado preocupación entre las futuras madres o las que se ya encuentran lactando debido al riesgo de una posible transmisión del virus a través de la leche materna. Aunque aún no se ha detectado el coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) activo en la leche materna. El miedo al contagio ha favorecido las políticas de aislamiento madre-hijo. Hasta el momento no existe evidencia de transmisión vertical y el riesgo de transmisión horizontal en el lactante es similar al de la población general. En lactantes con COVID-19 la lactancia materna incluso puede cambiar favorablemente el curso clínico de la enfermedad.

[Identification of behavioural and emotional problems in premature children in the primary care setting]. / Identificación de problemas de conducta y emocionales en niños prematuros en el ámbito de atención primaria.

OBJECTIVE: To demonstrate the usefulness, for use by the primary care pediatrician, of the BASC questionnaire (Behavior Assessment System for Children) for the early detection of psychological and behavioral problems in premature infants. DESIGN: Cross-sectional and descriptive study. SETTING: Primary care (Health Area IV of the Principado of Asturias) and Hospital Universitario Central de Asturias, Spain. PARTICIPANTS: Parents of 87 premature children with birth weight less than 1500g and 43 full-term controls, both aged 5-7 years. MAIN MEASUREMENTS: The BASC questionnaire (parent version) was applied. RESULTS: Preterm children presented a high rate of inactivity (Z = -4.125, P < 0.001), anxiety (Z = -2.801, P = 0.005) and internalization problems (Z = -2.148, P = 0.032), being more evident at 5 years of age. Preterm boys show higher levels of hyperactivity (Z = -2.082, P = 0.037) and behavioural problems (Z = -2.354, P = 0.019) than girls, who presented more attentional problems (Z = -2.345; P = 0.019). CONCLUSIONS: The BASC questionnaire is useful for the detection and early diagnosis at the primary care level of the behavioral and emotional problems of premature children.

Association between affective disorders presenting before and during pregnancy and pre-term birth, considering socio-demographic factors, obstetric factors, health conditions, and use of medication.

OBJECTIVE: To study the relationship between maternal affective disorders (AD) before and during pregnancy, and pre-term birth. DESIGN: Retrospective observational study. LOCATION: Sexual and reproductive health units at the Institut Català de la Salut (ICS) in Catalonia, Spain. PARTICIPANTS: Pregnant women with a result of live-born child from 1/1/2012 to 30/10/2015. INTERVENTIONS: Data were obtained from the ICS Primary Care electronic medical record. MAIN MEASUREMENTS: Diagnosis of AD before and during pregnancy, months of pregnancy, and possible confusion factors were collected. Descriptive statistical analysis (median, interquartile range, and absolute and relative frequency), bivariate analysis (Wilcoxon test and Chi-square test), and multivariate analysis (logistic regression) were performed. RESULTS: 102,086 women presented valid information for the study. Prevalence of AD during pregnancy was 3.5% (4.29% in pre-term and 3.46% in term births; p<0.004). Pregnant women with pre-term births presented a higher age, smoking habit, lower inter-pregnancy interval, and a lower socio-economic status. Pre-term birth was significantly associated to previous history of stress and dissociative disorder (SDD), anxiety, obsessive-compulsive disorder (OCD) and eating disorders (ED), and use of antidepressants. It was also associated to abuse of alcohol, smoking, and use of psychoactive substances, as well as SDD, ED, use of antipsychotics, and divorce during pregnancy. Multivariate analysis confirmed the relationship between pre-term birth and history of AD, SDD, ED, and smoking, but not with AD during pregnancy. CONCLUSIONS: Examining the previous history of SDD and ED in pregnant women, and SDD, and ED during pregnancy is highly relevant to avoid pre-term birth.

[Frecuencia y gravedad de la retinopatía del prematuro en una unidad de cuidados intensivos neonatales].

INTRODUCTION: Retinopathy of prematurity (ROP) is a disease where retinal blood vessels do not develop normally and may cause visual damage and blindness. OBJECTIVE: To determine the frequency and severity of ROP in preterm newborns. METHOD: A descriptive, comparative study was carried out within the 2009-2013 period. Patients' general characteristics were recorded, including gestational age and postmenstrual age at the moment of ophthalmologic examination, as well as ROP severity and type of treatment. RESULTS: A total of 326 preterm newborns were included: 47.8 % (n = 156) had ROP; in 21.1 % it was severe (stage ≥ 3). Median gestational age was 28 weeks in preterm newborns with ROP, median birth weight was 1000 g, and median postmenstrual age at ophthalmological examination was 36 weeks. Of the infants with ROP, 71.1 % received treatment: 63.4 % of those who had mild ROP and 100 % of those with severe ROP. CONCLUSIONS: ROP frequency was high, higher than that reported in developed countries and similar to that in developing countries. The frequency of severe ROP was also higher. It is necessary for effective programs for the detection and opportune treatment of ROP to be established.

INTRODUCCIÓN: La retinopatía del prematuro (ROP) es una enfermedad en la que los vasos sanguíneos de la retina no se desarrollan normalmente, lo que puede ocasionar daño visual y ceguera. OBJETIVO: Identificar la frecuencia y gravedad de la ROP en recién nacidos prematuros. MÉTODO: Estudio descriptivo comparativo realizado en el periodo 2009-2013. Se registraron características generales de los pacientes, edad posnatal y edad posconcepcional al momento de la exploración oftalmológica, así como gravedad y tratamiento de la ROP. RESULTADOS: Se incluyeron 326 recién nacidos prematuros: 47.8 % (n = 156) tuvo ROP, en 21.1 % fue grave (estadio ≥ 3). La mediana de la edad gestacional fue de 28 semanas en los recién nacidos prematuros con ROP, el peso al nacer fue de 1000 g y la edad posconcepcional a la exploración oftalmológica fue de 36 semanas. De los niños con ROP, 71.1 % recibió tratamiento, 63.4 % de aquellos que tuvieron ROP leve y 100 % de aquellos con ROP grave. CONCLUSIONES: La frecuencia de ROP fue alta, mayor a la reportada en los países desarrollados y similar a la de otros países en desarrollo. La frecuencia de ROP grave también fue mayor. Es necesario establecer programas efectivos de detección y tratamiento oportuno de ROP.

Tuberculosis in infants less than 3 months of age. / Tuberculosis en lactantes menores de 3 meses.

A review was conducted on infants less than 3 months of age diagnosed with tuberculosis between 1978 and 2014. Eight patients were diagnosed (1.4% of paediatric tuberculosis cases): 3 confirmed congenital tuberculosis, 3 suspected (endometrial biopsy was not performed), and 2 postnatal tuberculosis. Tuberculin skin test was negative in two patients. Diagnostic performance of culture (7/7, 100%) and PCR (3/3, 100%) of gastric aspirates was higher than that of acid-fast bacilli smears (5/8, 62%) and IGRA test (1/3, 33%). Three patients developed miliary disease, and one died. In conclusion, tuberculosis in this age group is rare, severe, and difficult to diagnose. In cases lacking known postnatal contacts, maternal genital tuberculosis should be ruled out by endometrial biopsy.

Análisis del rótulo y características de los jabones utilizados en la piel del recién nacido.

OBJETIVO: Analizar la información del rótulo, y las características físicas y fisicoquímicas de los jabones usados en recién nacidos (RN). MÉTODO: Estudio cuantitativo y descriptivo de 17 jabones comercializados en San Pablo, Brasil. Se analizó la información del rótulo (tensioactivos, pruebas de seguridad y descripción del valor de pH), y las características físicas (color y fragancia) y fisicoquímicas (valor de pH) del producto; las dos últimas, en laboratorio. RESULTADOS: Se identificaron 27 tipos de tensioactivos: 70,3% (n=19) aniónicos, 18,5% (n=5) anfóteros y 11,1% (n=3) no iónicos. El 37% (n=10) tuvo un potencial moderado de irritación. En cuanto a las pruebas de seguridad, la mayoría de las formulaciones (94,1%) citó "dermatológicamente probado". Sólo 42% citó "oftalmológicamente probado". La translucidez estuvo presente en 23,5% (n=4) de los jabones. Todas las formulaciones presentaron fragancia. El promedio más alto de valor de pH fue de jabones en barra tradicionales (9,94 DE 0,81). CONCLUSIÓN: Las formulaciones analizadas indicaron un potencial de irritación bajo o moderado. Cuatro jabones líquidos y uno en barra combinados tuvieron valores cercanos a los del pH de la piel del RN, y mostraron ser adecuados para la homeostasis de la barrera cutánea. Aunque las formulaciones citaron "dermatológicamente probado", no todas citaron "oftalmológicamente probado". Este estudio proporciona elementos para seleccionar un jabón adecuado para el RN.

[Indoor air pollution by fine particulate matter in the homes of newborns]. / Contaminación intradomiciliaria por material particulado fino (MP2,5) en hogares de recién nacidos.

INTRODUCTION: Air pollution by particulate matter (PM) is a major public health problem. In Chile, the study has focused on outdoor air and PM10, rather than indoor air and PM2.5. Because newborns and infants spend most of their time at home, it is necessary to evaluate the exposure to indoor air pollution in this susceptible population. OBJECTIVE: To determine concentration of PM2.5 in the homes of newborns and identify the emission sources of the pollutants. PATIENTS AND METHOD: The PM2.5 concentration ([PM2.5]) was collected over a 24hour period in 207 households. Baseline sociodemographic information and environmental factors (heating, ventilation, smoking and house cleaning), were collected. RESULTS: The median [PM2.5] was 107.5µg/m3. Family history of asthma was associated with lower [PM2.5] (P=.0495). Homes without heating showed a lower median [PM2.5], 58.6µg/m3, while those using firewood, kerosene, and electricity ranged between 112.5 and 114.9, and coal users' homes reached 162.9µg/m3. Wood using homes had significant differences (P=.0164) in median [PM2.5] whether the stove had complete combustion (98.2µg/m3) vs. incomplete (112.6µg/m3), or a salamander stove (140.6µg/m3). Cigarette smoking was reported in 8.7% of the households, but was not associated with the [PM2.5]. Ventilation was associated with a higher median [PM2.5] (120.6 vs. 99.1µg/m3, P=.0039). CONCLUSION: We found homes with high [PM2.5]. Residential wood consumption was almost universal, and it is associated with the [PM2.5]. Natural ventilation increased MP2.5, probably due to infiltration from outside.

[Deficiency of surfactant protein: Case report]. / Déficit congénito de proteína de surfactante: caso clínico.

INTRODUCTION: Congenital surfactant deficiency is a condition infrequently diagnosed in newborns. A clinical case is presented of surfactant protein B deficiency. A review is performed on the study, treatment and differential diagnosis of surfactant protein deficiencies and infant chronic interstitial lung disease. CASE REPORT: The case is presented of a term newborn that developed respiratory distress, recurrent pulmonary opacification, and a transient response to the administration of surfactant. Immunohistochemical and genetic studies confirmed the diagnosis of surfactant protein B deficiency. CONCLUSIONS: Pulmonary congenital anomalies require a high index of suspicion. Surfactant protein B deficiency is clinically progressive and fatal in the majority of the cases, similar to that of ATP binding cassette subfamily A member 3 (ABCA3) deficiency. Protein C deficiency is insidious and may present with a radiological pulmonary interstitial pattern. Due to the similarity in the histological pattern, genetic studies help to achieve greater certainty in the prognosis and the possibility of providing adequate genetic counselling.

What to do with an obstructed newborn. / Qué hacer con el recién nacido obstruido.

Bowel obstruction is the most common abdominal emergency in newborns. Managing bowel obstruction is a challenge for both clinicians and radiologists. The clinical presentation is nonspecific, and both the diagnosis and subsequent management are based on imaging studies. The traditional approach to studying obstructed newborns consists of plain-film abdominal X-rays and contrast-based studies of the gastrointestinal tract. Ultrasonography has proven useful in bowel obstruction, thus avoiding the use of ionizing radiation in certain cases, so diagnostic strategies should include it as a first-line technique. Using an appropriate combination of these techniques, it is possible to reach an accurate diagnosis quickly, orienting treatment and decreasing complications.

Roles and responsibilities in newborn care in four African sites.

OBJECTIVES: To explore roles and responsibilities in newborn care in the intra- and postpartum period in Nigeria, Tanzania and Ethiopia. METHODS: Qualitative data were collected using in-depth interviews with mothers, grandmothers, fathers, health workers and birth attendants and were analysed through content and framework analyses. RESULTS: We found that birth attendants were the main decision-makers and care takers in the intrapartum period. Birth attendants varied across sites and included female relatives (Ethiopia and Nigeria), traditional birth attendants (Tanzania and Nigeria), spiritual birth attendants (Nigeria) and health workers (Tanzania and Nigeria). In the early newborn period, when the mother is deemed to be resting, female family members assumed this role. The mothers themselves only took full responsibility for newborn care after a few days or weeks. The early newborn period was protracted for first-time mothers, who were perceived as needing training on caring for the baby. Clear gender roles were described, with newborn care being considered a woman's domain. Fathers had little physical contact with the newborn, but played an important role in financing newborn care, and were considered the ultimate decision-maker in the family. CONCLUSION: Interventions should move beyond a focus on the mother-child dyad, to include other carers who perform and decide on newborn care practices. Given this power dynamic, interventions that involve men have the potential to result in behaviour change.

[Mother-newborn relational risk - Study of prevalence and associated variables]. / Riesgo relacional madre-recién nacido. Estudio de prevalencia y variables asociadas.

INTRODUCTION: Clinical evidence reveals the importance of mother-newborn bonding experience for health promoting and maintenance of human life. If the newborn lacks care and affection, she/he may develop an attachment disorder. A predictive scale regarding the risk of mothernewborn relationships is available, which makes possible an early intervention to prevent the development of relational disorders. The aim of this study is to apply the Kimelman measurement scale to determine the relational risk in mother-newborn pairs, as well as the prevalence and the associated biopsychosocial variables. PATIENTS AND METHODS: A cross-sectional study with a probabilistic sample of 333 mother-infant pairs in postpartum maternity at Temuco hospital. The Kimelman mother-newborn attachment assessment guide was used. Biopsychosocial variables were obtained from the mothers studied. The association of biopsychosocial variables with relational risk was analyzed using OR and confidence intervals of 95%. RESULTS: The prevalence of high relational risk was 43.8%. The associated biopsychosocial variables included, women with no steady partner, single parent, teenage mothers, unwanted and unplanned pregnancy. CONCLUSION: Almost half of the mothers were in the high risk group. Early identification of relational risk and its related variables could help in the intervention in this vulnerable group.

[Hospital Admissions due to cyanosis episodes in newborns with gestational age of 34 weeks or more]. / Hospitalización por episodios de cianosis en recién nacidos de edad gestacional igual o mayor a 34 semanas.

OBJECTIVES: A retrospective study was performed between January 2007 and December 2012 to assess the admission rates of newborns due to episodes of cyanosis PATIENTS AND METHOD: Retrospective study that included all the newborns hospitalized with episodes of cyanosis between January 2007 and December 2012. In them were employed two study protocols that considered first and second line tests, the latter in view of recurrence of events. The first line protocol considered general biochemical tests, chest x-ray and echocardiography in selected cases, while the second line protocol included electroencephalogram, electrocardiogram, nuclear magnetic resonance of the brain, expanded metabolic screening, pyruvic acid, lactic acid, and in case of seizures, cytochemical, and culture of cerebrospinal fluid (CSF) and PCR (polymerase chain reaction) for herpes. RESULTS: A total of 98 (2.8%) out of 3,454 newborns were admitted due to episodes of cyanosis. Gestational age: 37.8+1.4 weeks, birth weight: 3,145+477 g. Maternal age: 32+4.8 years. Disease was present in 19.4% of mothers; gestational diabetes (8.1%), pregnancy induced hypertension (5.1%), intrahepatic cholestasis (3.1%), and intrauterine growth retardation (3.1%). Gender: 48.8% male, 51.2% female (NS). Birth: caesarean section, 68.4%, and vaginal delivery, 31.6%. Age on admission 1.9+1.4 days. Hospital stay: 4.2+4.2 days. First line tests were performed in 100% of patients with 39.8% fulfilling the criteria for second line study. A condition was detected in 21.4%, with convulsive syndrome was the most frequent (33%). Newborns with an identified condition had 3.8+2.7 episodes versus 1.5+2,4 in those without diagnosis (NS). A home oxygen monitor was given to 15.4%. There were no re-admissions. CONCLUSIONS: Most newborns admitted due to cyanosis are discharged with a condition of unknown origin. In this study, convulsive syndrome was the most frequent cause.

[Successful endovascular treatment of thoracic aortic aneurysm secondary to infection of the umbilical artery catheter in preterm infants]. / Tratamiento endovascular exitoso de aneurisma de aorta torácica secundario a infección de catéter de arteria umbilical en un recién nacido pretérmino.

UNLABELLED: Aortic aneurysms (AA) in the paediatric population are uncommon. The use of umbilical catheters in neonates has been associated with infections and, on some occasions, the formation of aortic aneurysms. The surgical repair of these aneurysms is one type of treatment; however, percutaneous intervention with stents could provide an alternative treatment route, with fewer complications. The aim of this report is to present the therapeutic scope of a hybrid procedure, in which the combined surgical and percutaneous technique offers a less invasive alternative to open surgery for the repair of aortic aneurysms or their main branches. CLINICAL CASE: The case concerns a pre-term newborn of 30 weeks weighing 1,335 g. An umbilical catheter was introduced, which was withdrawn at 14 days due to an infection. It developed as Staphylococcus aureus with sepsis. The echocardiogram and Angio-CT confirmed AA, which were managed using a hybrid procedure of surgery and the endovascular implantation of 2 coated stents (Atrium V12 XR Medical Corp, Hudson, NH). The post-procedure clinical follow-ups, including abdominal echo-tomography, confirmed the success of the treatment. CONCLUSION: The endovascular aortic aneurysm repair procedure in premature newborns may be considered when deciding treatment of this disease, and could avoid the risks associated with open surgery. However, follow-up and monitoring is required while the patient grows up, due to the possibility that the implanted stents require re-dilating. The outcomes of neonatal endovascular procedures in the future are unknown.

[Radiological evaluation of congenital tumors]. / Radiografía del abdomen en Urgencias. ¿Una exploración para el recuerdo?

In this article, we consider tumors that are diagnosed during pregnancy or in the first three months of life. This is a heterogeneous group of neoplasms with special biological and epidemiological characteristics that differentiate them from tumors arising in children or adults. In the last two decades, the prenatal detection of congenital tumors has increased due to the generalized use of prenatal sonographic screening. Advances in imaging techniques, especially in fetal magnetic resonance imaging, have enabled improvements in the diagnosis, follow-up, clinical management, and perinatal treatment of these tumors. This image-based review of the most common congenital tumors describes their histologic types, locations, and characteristics on the different imaging techniques used.

New reference nomograms for the study of ventricular size in preterm infants.

INTRODUCTION: Transfontanellar brain ultrasound is an essential tool for monitoring the size of the ventricles in preterm neonates and has many advantages over other alternative diagnostic techniques, including its accessibility and non-use of ionizing radiation. When considering the normal ventricular size, it is essential to have reference measurements based on age-matched populations. The objective of this article is to present our reference measures, based on a sample of preterm infants that we have studied. METHODS: A retrospective observational study was conducted. Measurements of the Levene index, frontal horn thickness, and Evans index were obtained in preterm neonates from 25 to 45 weeks, over a period of 5 years, between January 2016 and December 2020. After applying the exclusion criteria, a sample of 199 patients and 350 ultrasound scans were obtained. The independent samples t-test and the Mann-Whitney test were used for the comparison of samples. RESULTS: The distribution of the right and left Levene indices was normal (Shapiro-Wilk test with p = 0.16 and 0.05, respectively), unlike the thickness distribution of the frontal horns (p < 0.05 on both sides). No significant differences were detected between the sexes (p = 0.08). A linear correlation was found between the biparietal diameter and the Levene index. CONCLUSION: From the results obtained in our study, we present reference tables for ventricular size, with the 3rd, 25th, 50th, 75th, and 97th, being the first ones made in our country.

Relevance of enteroviruses in neonatal meningitis.

INTRODUCTION: Enterovirus (EV) infections are the most frequent infections in the neonatal period and in many cases lead to hospital admission of the newborn (NB). The aim of this study was to determine the incidence of EV in the etiology of neonatal meningitis and to define the clinical characteristics of newborns with EV meningitis. MATERIAL AND METHOD: Retrospective observational cohort study. Including 91 NBs with meningitis and gestational age greater than 34 weeks gestational age (GA) attended in our center over a period of 16 years. RESULTS: The percentage of NBs with EV meningitis was higher than that of NBs with bacterial meningitis (BM) and accounted for 78% (n=71). Half of the NBs with EV infection had a history of epidemic environment among their caregivers. Fever was present in 96% of cases as a clinical sign and, in general, sensory disturbances represented the main neurological alterations. Antibiotics (ATB) were given to 71.4% of patients with EV infection. Detection of EV in CSF samples showed a high sensitivity for the diagnosis of EV meningitis. The most frequently implicated EV types were echovirus 11, coxsackievirus B5, echovirus 18, 25 and 7. CONCLUSIONS: The results of this series show that enterovirus infection is a common cause of neonatal meningitis. These data underline the importance of rapid EV testing of infants with suspected meningitis. This allows early diagnosis and reduces antibiotic treatment, hospitalization time and related costs.

Arterial hypertension and smoking in pregnant women in the Valencian Community: maternal and neonatal outcomes.

OBJECTIVE: Hypertension and smoking during pregnancy have been linked to various adverse maternal and fetal outcomes. The objective of this work is to study how the smoking influences the development of hypertension, its effects on the pregnant woman, and on the newborn. MATERIALS AND METHODS: An observational study in two phases was carried out: the descriptive first phase allows characterization of the sample and the analytical second phase is a case-control nested in a retrospective cohort corresponding to pregnancy. RESULTS: A total of 712 women were included in the study. Of the 672 (94.4%) non-hypertensive women, 533 (79.3%) were non-smoking and 139 (20.7%) smoking. For the 40 (5.6%) hypertensive women, 30 (75.0%) were non-smoking and 10 (25.0%) smoking. The prevalence of hypertension was of 5.6%. Women who quit smoking before pregnancy saw a reduced risk of hypertension. For women who smoke during pregnancy, those of younger ages, with a normal body mass index, who are primiparous, employed and with a low-medium level of education have higher risk of hypertension. The risk of hypertension according to the level of physical activity during leisure time follows a "U" shape, with those who perform light physical activity at the lowest risk of hypertension. Hypertensive women have a higher risk of small for gestational age newborns. Smoking does not pose an additional risk for adverse outcomes once hypertension is diagnosed. CONCLUSIONS: Future studies should aim to determine the role of smoking habit in the appearance of hypertension in pregnancy in order to establish adequate intervention guidelines that may aid in reducing the prevalence of hypertension.