Effectiveness of phototherapy with and without probiotics for the treatment of indirect hyperbilirubinaemia in preterm neonates: a randomised controlled trial.

INTRODUCTION: Raised serum bilirubin levels can cause kernicterus, and premature infants are at increased risk owing to metabolic immaturity. The standard treatment for neonatal jaundice is phototherapy, but probiotics alone can reduce the duration of phototherapy and hospitalisation. OBJECTIVES: To determine the effectiveness of phototherapy with and without probiotics for the treatment of indirect hyperbilirubinaemia in preterm neonates. PATIENTS AND METHODS: The open-labelled randomised controlled trial was conducted from January 2022 to January 2023 in the neonatal unit of the University of Lahore Teaching Hospital, Pakistan. A total of 76 preterm neonates who fulfilled the selection criteria were included and divided into two groups. Both groups received standard phototherapy. In Group B, a probiotic (Saccharomyces boulardii) 125 mg, twice daily, orally (in 5 cc of whichever milk the infant was receiving) was given until discharge from hospital. The primary outcome measurements were the duration of phototherapy and the length of hospitalisation. RESULTS: The mean (SD) duration of phototherapy was 36.55 (14.25) hours in Group A and 24.61 (9.25) hours in Group B (p <0.05). The mean (SD) duration of hospital stay was 47.36 (16.51) hours in Group A and 33.13 (8.93) hours in Group B (p <0.05). CONCLUSION: Oral probiotics (Saccharomyces boulardii) have a significant effect on the duration of phototherapy for neonatal hyperbilirubinaemia, and they decrease the chances of nosocomial infection. Exploration of clinical outcomes by investigating faecal flora and undertaking large randomised controlled trials of various probiotics are needed. ABBREVIATIONS: ABE: acute bilirubin encephalopathy; CNS: central nervous system; GA: gestational age; IVIG: intravenous immunoglobulin; KSD: kernicterus; NNU: neonatal unit; RCT: randomised controlled trial; S. boulardii: Saccharomyces boulardii.

Association of Serum Calcium Levels of Preterm Neonates at Birth with Calcium Intake from Foods and Supplements by Bedridden Women during Pregnancy.

Bone calcium turnover is aggravated in pregnant women recommended to bed rest. In the present cross-sectional study, we aimed to clarify whether preterm neonates would benefit from calcium supplementation during pregnancy. Forty-two mothers (37.5 ± 6.7 years), recommended bed rest at home, and 42 preterm neonates (24-37 weeks gestational age) were enrolled. Neonates' serum calcium was quantified at birth. Mothers' calcium intake from foods and supplements during pregnancy was assessed. Serum 25-OH-D was measured in both mothers and neonates at birth. Results showed that mothers' calcium intake from foods was significantly lower than the recommended daily reference value (p < 0.001), while total calcium intake including supplements was close to the calcium reference value of 1000 mg/day (p = 0.648). Neonates' serum calcium concentration was significantly higher in mothers receiving calcium supplementation during pregnancy compared to mothers who did not (p < 0.001). A significant association between neonates' serum calcium levels and mothers' calcium supplementation was evident, even when adjusted to mothers' age, pre-pregnancy BMI, gestational age, and neonates' birth weight (beta = +0.460, p = 0.025). A statistically significant correlation between neonates' and mothers' serum 25-OH-D levels was found (r = 0.891, p < 0.001). In conclusion, calcium status in preterm neonates, born by bedridden women, could be enhanced after calcium supplementation during gestation.

Beyond the cradle - Amidst microplastics and the ongoing peril during pregnancy and neonatal stages: A holistic review.

Advancements in research concerning the occurrence of microplastics (MPs) in human blood, sputum, urine, and breast milk samples have piqued the interest of the scientific community, prompting further investigation. MPs present in the placenta, amniotic fluid, and meconium raise concerns about interference with embryonic development, leading to preeclampsia, stillbirth, preterm birth, and spontaneous abortion. The challenges posed by MPs extend beyond pregnancy, affecting the digestive, reproductive, circulatory, immune, and central nervous systems. This has spurred scientists to examine the origins of MPs in distinct environmental layers, including air, water, and soil. These risks continue after birth, as neonates are continuously exposed to MPs through everyday items such as breast milk, cow milk and infant milk powder, as well as plastic-based products like feeding bottles and breast milk storage bags. It is the need of the hour to strike a balance amidst lifestyle changes, alternative choices to traditional plastic products, raising awareness about plastic-related health risks, and fostering collaboration between the scientific community and policymakers. This review aims to provide fresh insights into potential sources of MP pollution, with a specific focus on pregnancy and neonates. It is the first compilation of its kind so far that includes critical studies on recently reported discoveries.

The Effect of Oral Iron Supplementation/Fortification on the Gut Microbiota in Infancy: A Systematic Review and Meta-Analysis.

(1) Background: Iron is an essential metal for the proper growth and neurodevelopment of infants. To prevent and treat iron deficiency, iron supplementation or fortification is often required. It has been shown, though, that it affects the synthesis of gut microbiota. (2) Methods: This paper is a systematic review and meta-analysis of the effect of oral iron supplementation/fortification on the gut microbiota in infancy. Studies in healthy neonates and infants who received per os iron with existing data on gut microbiota were included. Three databases were searched: PUBMED, Scopus, and Google Scholar. Randomized controlled trials (RCTs) were included. Quality appraisal was assessed using the ROB2Tool. (3) Results: A total of six RCTs met inclusion criteria for a systematic review, and four of them were included in the meta-analysis using both the fixed and random effects methods. Our results showed that there is very good heterogeneity in the iron group (I2 = 62%), and excellent heterogeneity in the non-iron group (I2 = 98%). According to the meta-analysis outcomes, there is a 10.3% (95% CI: -15.0--5.55%) reduction in the bifidobacteria population in the iron group and a -2.96% reduction for the non-iron group. There is a confirmed difference (p = 0.02) in the aggregated outcomes between iron and non-iron supplement, indicative that the bifidobacteria population is reduced when iron supplementation is given (total reduction 6.37%, 95%CI: 10.16-25.8%). (4) Conclusions: The abundance of bifidobacteria decreases when iron supplementation or fortification is given to infants.

Treatment-related problems in neonates receiving parenteral nutrition: risk factors and implications for practice.

OBJECTIVES: Parenteral nutrition (PN) can be associated with several treatment-related problems (TRPs) and complications in neonatal settings. Thus, understanding the extent and type of these problems and related factors is pivotal to prevent negative consequences of these preparations. Thus, the aim of this study is to assess factors affecting TRPs in neonatal patients receiving PN. METHODS: This was a retrospective chart review of neonates receiving PN in NICU and other wards. We collected their demographics, and laboratory workup. TRPs related to PN preparations as well as their pharmacotherapy were the primary outcomes. RESULTS: Medical charts of 96 neonate were reviewed. The most encountered TRPs related to patients' pharmacotherapy were the lack of frequent monitoring (34.2%) and low dose (17.5%). For PN-related TPRs, a mismatch between patients' nutritional needs and PN composition was observed in third of the patients. Statistically significant positive correlations between number of medications during hospital stay and number of reported TRPs [(r = 0.275, p < 0.01) and (r = 0.532, p < 0.001)] were observed. CONCLUSION: In neonates who receive parenteral nutrition (PN), TRPs are often observed. These problems primarily arise from issues in patients' pharmacotherapy, namely monitoring and dosing. Identifying the risk factors for these TRPs emphasizes the full and effective integration of clinical pharmacists into the healthcare team, which can serve as a potential preventive strategy to lower the occurrence of TRPs.

Investigating the association between vitamin D dietary intake during pregnancy and incidence of clubfoot in neonates.

AIMS: Talipes equinovarus (clubfoot) is a congenital lower foot deformity that results from a neuromuscular deficiency, but the precise etiology remains elusive. Vitamin D is important for fetal neuromuscular development. In this study, we investigated the association between dietary vitamin D intake during pregnancy and incidence of clubfoot in neonates, since such a question has thus far been overlooked. METHODS: We conducted a secondary analysis of data collected in the United States, between 2007 and 2011 for a case-control study of children born with clubfoot. Participating mothers were interviewed by telephone about dietary and other health and life-style indicators. Exposure to vitamin D was recorded as the average daily intake of dietary vitamin D over a period of 6 months before pregnancy began. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression. RESULTS: The dataset included 2667 study participants, of which 663 were cases. Logistic regression showed no significant association between dietary vitamin D or log10 (Vitamin D) intake during pregnancy and incidence of clubfoot in neonates (OR = 1.00, CI = 1.00-1.00, OR = 1.51, CI = 0.83-2.82, respectively). No interaction in the regression model was found between vitamin D and other predictor variables. Results were not confounded by supplement intake of vitamin D during pregnancy. CONCLUSIONS: Results show no evidence of an association between dietary vitamin D intake and incidence of clubfoot in neonates. The lack of association is not confounded by consumption of vitamin D supplements during pregnancy.

Caffeine intake during pregnancy and adverse outcomes: An integrative review.

Caffeine intake during pregnancy is common. Caffeine crosses the placenta, raising concerns about its possible deleterious effects on the developing embryo/fetus. Studies on this subject show conflicting results, and still there is no consensus on the recommended dose of caffeine during pregnancy. We performed an integrative review with studies from six databases, using broad MESH terms to allow the identification of publications that addressed the outcomes of caffeine use during pregnancy, with no date limit for publications, in English and Portuguese language. The research returned 16,192 articles. After removing duplicates, screening by title, abstract and full-text, we evaluated 257 and included 59 articles. We found association between caffeine intake and pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes. The effects were often dose dependent. No association with prematurity has been demonstrated, but one study showed a small reduction in gestational age with increasing doses of caffeine intake. Defining a safe dose for caffeine intake during pregnancy is a challenging task due to the heterogeneity in study designs and results, as well as the difficulty of reliably assessing the amount of caffeine consumed. In some studies, exposures below the recommended level of caffeine intake during pregnancy (200 mg/day), as suggested by the guidelines, were associated with pregnancy loss, low birth weight, cardiac and genital anomalies, higher body mass, and neurodevelopmental and neurobehavioral outcomes. Well-designed studies with reliable quantification of caffeine intake are needed to assess the safety of low doses during pregnancy.

Second infant spinal anesthetic: Incidence, dose modification, and adverse events after initial failure.

INTRODUCTION: Infant spinal anesthesia is an important technique in premature and ex-premature infants undergoing lower abdominal surgery. Previous studies of infant spinal anesthesia report high failure rates, but fail to adequately identify contributing factors. The aim of this study is to retrospectively review spinal anesthetics from a quaternary anesthetic centre to determine overall spinal failure rate, incidence of second spinal attempts and adverse events associated with a second spinal anesthetic. METHODS: A retrospective review of infant spinal anesthetics performed between May 2016 and June 2023. RESULTS: Five hundred and fifty-one infants (mean postmenstrual age 42.9 weeks and weight 3873 g) were included. The overall success rate on first attempt was 86.5% with a further 5.1% requiring a successful second spinal anesthetic after initial failure. Spinal anesthetic failure requiring conversion to general anesthesia occurred in 9.4% of cases The causes of failed spinal anesthetic were inability to access the subdural space (dry tap 4.2%), inadequate motor blockade (2.9%), and repeated bloody taps (2.2%). Spinal anesthetic failure was significantly increased in cases where the anesthetist was routinely performing less than 5 spinal anesthetics per year [OR 2.21 (95% CI 1.28, 3.83, p = .004)] but only weakly associated with years of pediatric anesthetic experience. Failure rates were 21.4% with styletted spinal needles and 9.2% for non styletted [OR 2.68 (95% CI 1.23-5.86, p = .012)]. The incidence of perioperative apnoea was 6.7% with the highest rate in infants in which failed spinal anesthesia required conversion to general anesthesia (25%). There were 28 cases where initial spinal anesthetic failed to produce adequate anesthesia and a repeat spinal anesthetic was performed. Repeat spinal anesthesia was successful in 92.8% of cases with awake caudal anesthesia successful in 7.2% of cases. In three cases high spinal blockade occurred, one after a single spinal and two after a repeat spinal. Both repeat spinal high block cases required intubation and brief resuscitation. CONCLUSION: Infant spinal anesthesia is associated with high success rates if experienced anesthetists are present or performing the block. Repeat spinal anesthesia may be associated with an increased incidence of high spinal block. Greater awareness of the slow onset of high block should promote techniques aimed at minimizing cephalad spread of local anesthetic including slight head up positioning during surgery.

Assessment of food supplements for the prevention of necrotizing enterocolitis in preterm neonates: A systematic review and network meta-analysis.

BACKGROUND: The network meta-analysis (NMA) investigated the efficacy of six food supplements, namely glutamine, arginine, lactoferrin, prebiotics, synbiotics, and probiotics, in preventing necrotizing enterocolitis in premature infants. METHODS: MEDLINE, Embase, and Cochrane Library were searched. Randomized controlled trials comparing different food supplements for premature infants were included. RESULTS: Probiotics (OR, 0.47; 95% CrI, 0.33-0.63), arginine (OR, 0.38; 95% CrI, 0.14-0.98), glutamine (OR, 0.30; 95% CrI, 0.079-0.90), and synbiotics (OR, 0.13; 95% CrI, 0.037-0.37). were associated with a decreased incidence of NEC. Only probiotics (OR, 0.81; 95% CrI, 0.69-0.95) and lactoferrin (OR, 0.74; 95% CrI, 0.54-0.92) achieved lower risk of sepsis. Probiotics (OR, 0.58; 95% CrI, 0.40-0.79), prebiotics (OR, 0.23; 95% CrI, 0.043-0.86), and synbiotics (OR, 0.15; 95% CrI, 0.035-0.50) were associated with lower odds of mortality. Probiotics (MD, -2.3; 95% CrI: -3.7- -0.63) appeared to have earlier age of attainment of full feeding. CONCLUSIONS: Based on this NMA, probiotics and synbiotics had the potential to be the top two preferable food supplements.

Artificial intelligence in early detection and prediction of pediatric/neonatal acute kidney injury: current status and future directions.

Acute kidney injury (AKI) has a significant impact on the short-term and long-term clinical outcomes of pediatric and neonatal patients, and it is imperative in these populations to mitigate the pathways leading to AKI and be prepared for early diagnosis and treatment intervention of established AKI. Recently, artificial intelligence (AI) has provided more advent predictive models for early detection/prediction of AKI utilizing machine learning (ML). By providing strong detail and evidence from risk scores and electronic alerts, this review outlines a comprehensive and holistic insight into the current state of AI in AKI in pediatric/neonatal patients. In the pediatric population, AI models including XGBoost, logistic regression, support vector machines, decision trees, naïve Bayes, and risk stratification scores (Renal Angina Index (RAI), Nephrotoxic Injury Negated by Just-in-time Action (NINJA)) have shown success in predicting AKI using variables like serum creatinine, urine output, and electronic health record (EHR) alerts. Similarly, in the neonatal population, using the "Baby NINJA" model showed a decrease in nephrotoxic medication exposure by 42%, the rate of AKI by 78%, and the number of days with AKI by 68%. Furthermore, the "STARZ" risk stratification AI model showed a predictive ability of AKI within 7 days of NICU admission of AUC 0.93 and AUC of 0.96 in the validation and derivation cohorts, respectively. Many studies have reported the superiority of using biomarkers to predict AKI in pediatric patients and neonates as well. Future directions include the application of AI along with biomarkers (NGAL, CysC, OPN, IL-18, B2M, etc.) in a Labelbox configuration to create a more robust and accurate model for predicting and detecting pediatric/neonatal AKI.

Effects of copper, zinc, and manganese source and inclusion during late gestation on beef cow-calf performance, mineral transfer, and metabolism.

To determine effects of Cu, Zn, and Mn source and inclusion during late gestation, multiparous beef cows [n = 48; 649 ±â€…80 kg body weight (BW); 5.3 ±â€…0.5 body condition score (BCS)] were individually-fed hay and supplement to meet or exceed all nutrient recommendations except Cu, Zn, and Mn. From 91.2 ±â€…6.2 d pre-calving to 11.0 ±â€…3.2 d post-calving, cows received: no additional Cu, Zn, or Mn (control, CON), sulfate-based Cu, Zn, and Mn (inorganic, ITM) or metal methionine hydroxy analogue chelates (MMHAC) of Cu, Zn, and Mn at 133% recommendations, or a combination of inorganic and chelated Cu, Zn, and Mn (reduce and replace, RR) to meet 100% of recommendations. Data were analyzed with treatment and breeding group (and calf sex if P < 0.25 for offspring measures) as fixed effects, animal as experimental unit, and sampling time as a repeated effect for serum, plasma, and milk measures over time. Post-calving cow liver Cu was greater (P ≤ 0.07) in MMHAC compared with all other treatments. Calves born to RR had greater (P ≤ 0.05) liver Cu than ITM and CON, and MMHAC had greater (P = 0.06) liver Cu than CON. Liver Mn was less (P ≤ 0.08) for RR calves than all other treatments. Calf plasma Zn was maintained (P ≥ 0.15) from 0 to 48 h of age in ITM and MMHAC but decreased (P ≤ 0.03) in CON and RR. Gestational cow BW, BCS, and metabolites were not affected (P ≥ 0.13) by treatment, but gestational serum thiobarbituric acid reactive substances (TBARS) were greater (P = 0.01) for CON than MMHAC. Treatment did not affect (P ≥ 0.13) calf birth size, vigor, placental size and minerals, or transfer of passive immunity. Neonatal calf serum Ca was greater (P ≤ 0.05) for MMHAC than all other treatments; other calf serum chemistry and plasma cortisol were not affected (P ≥ 0.12). Pre-suckling colostrum yield, and lactose concentration and content, were greater (P ≤ 0.06) for MMHAC compared with ITM and RR. Colostral triglyceride and protein concentrations were greater (P ≤ 0.08) for RR than MMHAC and CON. Cow lactational BW and BCS, milk yield and composition, and pre-weaning calf BW and metabolism were not affected (P ≥ 0.13) by treatment. Lactational serum TBARS were greater (P = 0.04) for RR than CON at day 35 and greater (P ≤ 0.09) for MMHAC at day 60 than all other treatments. Source and inclusion of Cu, Zn, and Mn altered maternal and neonatal calf mineral status, but calf size and vigor at birth, passive transfer, and pre-weaning growth were not affected in this study.

Parenteral Nutrition in the Neonatal Intensive Care Unit: Intravenous Lipid Emulsions.

Intravenous lipid emulsions (ILEs) are a source of nonprotein calories and fatty acids and help promote growth in preterm infants and infants with intestinal failure. An ILE dose and oil source determines its fatty acid, phytosterol, and vitamin E delivery. These factors play a role in the infant's risk for essential fatty acid deficiency and cholestasis, and help modulate inflammation, immunity, and organ development. This article reviews different ILEs and their constituents and their relationship with neonatal health.

Displacement of human milk during fortification: An experimental study.

BACKGROUND: This study quantified the displacement of human milk by commercial human milk fortifiers (HMFs) and infant formulas. METHODS: Commercial liquid HMFs and powder infant formulas were added to pasteurized pooled donor human milk in triplicate, stirred, and weighed. The difference in weight between unfortified and fortified human milk at 22, 24, 26, 27, 28, and 30 kcal/ounce was calculated. RESULTS: The displacement of human milk by liquid HMFs and powder infant formulas and powder HMF was highly associated with energy density. A human milk-derived HMF displaced significantly more human milk when compared with bovine milk-derived HMFs at equivalent energy densities. Similarly, powder infant formulas displaced less human milk when compared with a powder HMF, and the addition of hydrolyzed powder infant formulas resulted in less human milk displacement when compared with nonhydrolyzed powder infant formulas. CONCLUSIONS: The displacement of human milk by commercial liquid HMFs and infant formulas must be considered when selecting a fortifying strategy.

In parenteral nutrition-fed piglets, fatty acids vary by lipid emulsion and tissue sampled.

BACKGROUND: Children with intestinal failure without liver disease may be given soy-based lipid emulsion (SLE) or mixed lipid emulsion (MLE; containing soy, medium-chain triglyceride, olive, and/or fish oils). Both differ in essential fatty acid content: MLE has added arachidonic acid (AA) and docosahexaenoic acid (DHA). The aim of this study, in neonatal piglets, was to compare serum and tissue fatty acid composition when the emulsions were given at unrestricted doses. METHODS: We compared SLE (n = 15) and MLE (n = 15) at doses of 10-15 g/kg/day in parenteral nutrition (PN). On day 14 we collected serum and tissues. Using gas-liquid chromatography, percentage fatty acids were measured in serum, brain, and liver phospholipid. Comparisons were made to reference values from litter-matched controls (n = 8). RESULTS: Comparing median values, linoleic acid (LA) was lower for MLE vs SLE in serum (-27%), liver (-45%), and brain (-33%) (P < 0.001). AA was lower for MLE in serum (-25%), liver (-40%), and brain (-10%). DHA was higher for MLE in serum (+50%), liver (+200%), and brain (+10%). AA levels were lower for MLE vs control piglets in serum (-81%), liver (-63%), and brain (-9%). DHA levels were higher in serum (+41%), liver (+38%), and brain (+19%). CONCLUSION: This study in piglets has shown that, at unrestricted doses, MLE treatment is associated with low serum and tissue AA compared with SLE and healthy litter-matched controls. Although not yet proven, low tissue AA levels may have functional consequences, and these data support current practice avoiding MLE dose restriction.

Diagnostic Accuracy of Cord Bilirubin to Predict the Need for Phototherapy in Healthy Neonates >35-Week Gestational Age: A Systematic Review and Meta-Analysis.

Objective: Early discharge puts neonates at risk of delayed detection of jaundice and resulting neurological injury. In these neonates, we can use cord bilirubin to make predictions. In this meta-analysis, we assessed the diagnostic accuracy of cord bilirubin in predicting the need for phototherapy (AAP-2004 or NICE-2010 charts). Methods: We searched the databases of PubMed, Embase, Cochrane Library, Google Scholar, and Index Medicus for Southeast Asian Region. We included all observational studies that assessed the diagnostic accuracy of cord bilirubin. A bivariate model was used to pool the data in prespecified range of cord bilirubin levels (<1.5 mg/dl, 1.5-2.0 mg/dl, 2.0-2.5 mg/dl, 2.5-3.0 mg/dl, and >3.0 mg/dl). Data were pooled separately for studies including all neonates (no risk stratification), high-risk neonates (Rh and/or ABO incompatibility only), and low-risk neonates (excluded Rh and ABO incompatibility). Results: Of the 1990 unique records, we studied 153 full texts and included 54 studies in the meta-analysis. For all the three groups of studies, the highest diagnostic odds ratio was noted for a cord bilirubin cut-off of 2.5-3.0 mg/dl (all neonates: 22.5, 95% CI: 21.1, 22.9; high-risk neonates: 75.5, 95% CI: 63, 85.7; low-risk neonates: 91.9; 95% CI: 64, 134.14). Using the same cut-off, the studies including all neonates without risk stratification had a pooled sensitivity of 0.31 (95% CI: 0.18, 0.47) and a pooled specificity of 0.98 (0.96, 0.99) in predicting the need for phototherapy. In studies on high-risk neonates, the pooled sensitivity was 0.8 (0.39, 0.96) and pooled specificity was 0.95 (0.78, 0.99). In studies on low-risk neonates, the pooled sensitivity was 0.74 (0.39, 0.93) and pooled specificity of 0.97 (0.91, 0.99). We noted significant heterogeneity and a high risk of bias in the index test's conduct. Conclusion: A cord bilirubin cut-off of 2.5-3 mg/dl has good diagnostic accuracy in predicting the need for phototherapy in neonates. Registration number: CRD42020196216.

The Prevalence of Low Birth Weight Among Newborn Babies and Its Associated Maternal Risk Factors: A Hospital-Based Cross-Sectional Study.

Background Low birth weight (LBW) is at the forefront of 100 core health issues that are used as indicators to assess the global nutrition monitoring framework as reported by the World Health Organization (WHO). Several factors could contribute to LBW, which essentially include intrauterine growth retardation and premature delivery/birth. Moreover, LBW predisposes neonates to several developmental disturbances including both physical and mental disorders. Given that LBW is more common in poor and developing countries, there is not much reliable data that could be used to formulate strategies for controlling this problem. This study, therefore, attempts to assess the prevalence of LBW among newborn babies and its associated maternal risk factors. Methods This hospital-based cross-sectional study was carried out between June 2016 and May 2017 (one year) and included 327 LBW babies. A predefined and prevalidated questionnaire was used to obtain data for the study. The data collected included age, religion, parity, birth spacing, pre-pregnancy weight, weight gain during pregnancy, height, mother's education, occupation, family income, socioeconomic status, obstetric history, previous history of stillbirths and abortions, and history of any LBW baby. Results The prevalence of LBW was noted to be 36.33%. The occurrence of LBW babies was predominant among mothers who were aged <19 years (62.26%) and >35 years (57.14%). Grand multipara women showed the highest rates (53.70%) of LBW babies. Additionally, LBW was predominantly noticed among newborns (46.66%) with a birth spacing of <18 months, those born to mothers with pre-pregnancy weight of <40 Kg (94.04%), mothers with a height of <145 cm (83.46%), mothers who gained <7 kg during the pregnancy (82.20%), illiterate mothers (43.75%), and mothers who were agricultural workers (63.76%). Other maternal factors that could predispose to LBW included lower monthly income (66.25%), low socioeconomic status (52.90%), less number of antenatal visits (59.65%), low blood hemoglobin (100%), history of strenuous physical activities (48.66%), smoking and/or tobacco chewing habit (91.42%), alcoholism (66.66%), lack of iron and folic acid supplementation during pregnancy (64.58%), history of stillbirths (51.51%), and mothers suffering from chronic hypertension, preeclampsia, and eclampsia (47.61%), and tuberculosis (75%). Religion-wise, Muslim mothers revealed the highest prevalence (48.57%) of LBW, followed by Hindus (37.71%) and Christians (20%). The mother's age, pre-pregnancy weight, weight gain during pregnancy, height of the mother, hemoglobin concentration, weight of the baby, and length of the newborn (p≤0.05) could influence the health of the newborn. However, maternal infections, previous bad obstetrics history, presence of systemic illnesses, and protein and calorie supplementation (p≥0.05) had no significant impact on birth weight. Conclusions The results showed that multiple factors are responsible for LBW. Maternal factors such as weight, height, age, parity, weight gained during pregnancy, and anemia during pregnancy could predispose to delivering LBW babies. Additionally, other risk factors for LBW identified in this study were the literacy level of mothers, occupation, family income, socioeconomic status, antenatal care, strenuous physical activity during pregnancy, smoking/tobacco chewing, alcohol/toddy consumption, and iron and folic acid supplementation during pregnancy.

Prevalence of stunting and associated factors among neonates in Shebadino woreda, Sidama region South Ethiopia; a community-based cross-sectional study 2022.

INTRODUCTION: Stunting is a syndrome that begins at conception and leads to severe, irreversible physiological, physical and cognitive damage as an irreversible consequence of nutritional deficiencies and recurrent infections. Although multiple studies have been conducted in Ethiopia to show the magnitude of stunting and factors, all are concentrated on children aged between 6 to 59 months. Therefore, this study was done to determine the prevalence and associated factors of stunting at birth among new-borns. METHODS: A community-based cross-sectional study design was employed on 512 neonates in Shebadino Woreda, Sidama Region South Ethiopia 2022. A multistage sampling technique was employed. The data was collected door-to-door using pretested and structured questionnaires, through face-to-face interviews. The collected data were cleaned manually, coded, entered into Epidata version 4.6, and exported to SPSS version 26 software for analysis. Bi-variable analysis was conducted to assess the association of independent variables with the outcome variable. Variables with a p-value < 0.25 in bi-variable logistic regression were further analyzed using multivariable logistic regression. The odds ratio (OR) with 95% CI was used as a measure of association, and variables that had a p-value less than 0.05 in the multivariable logistic regression were considered as significantly associated variables. RESULT: The prevalence of stunting in this study was 27.5%: 95% CI 22.6 to 31.9. Factors such as residence (AOR = 4.1, 95% CI: 1.49, 11.25), ANC follow up (AOR = 2.66, 95% CI: 1.34, 5.27), started taking Amessa (AOR = 3.48, 95% CI: 1.27, 9.55) and Sex of the neonate (AOR = 2.15, 95% CI: 1.54, 5.23) were significantly associated with stunting at a p-value of < 0.05. CONCLUSION: About 27% of neonates were stunted, which implies, it require a quick public health measurement. New-born who were live in rural area and those who were started traditional medication (Amessa) were more stunted. Besides this, stunting was prevalently observed among a mother who had no ANC follow-up and male neonates. Thus, the regional health bureau and Shebedino woreda health office should increase awareness creation to bring behavioural change at community level to prevent traditional medication usage, ANC follow-up and giving priority for those who live in rural area.

Feasibility, Sustainability, and Effectiveness of the Implementation of "Facility-Team-Driven" Approach for Improving the Quality of Newborn Care in South India.

OBJECTIVES: The primary objective of the study was to assess the feasibility and sustainability of the implementation of the point of care quality improvement (POCQI) methodology for improving the quality of neonatal care at the level 2 special newborn care unit (SNCU). Additional objective was to evaluate the effectiveness of the quality improvement (QI) and preterm baby package training model. METHODS: This study was conducted in a level-II SNCU. The study period was divided into baseline; intervention and sustenance phases. The primary outcome i.e., feasibility was defined as completion of training for 80% or more health care professionals (HCPs) through workshops, their attendance in subsequent review meetings and, successful accomplishment of at least two plan-do-study-act (PDSA) cycles in each project. RESULTS: Of the total, 1217 neonates were enrolled during the 14 mo study period; 80 neonates in the baseline, 1019 in intervention and 118 in sustenance phases. Feasibility of training was achieved within a month of initiation of intervention phase; 22/24 (92%) nurses and 14/15 (93%) doctors attended the meetings. The outcomes of individual projects suggested an improvement in proportion of neonates being given exclusive breast milk on day 5 (22.8% to 78%); mean difference (95% CI) [55.2 (46.5 to 63.9)]. Neonates on any antibiotics declined, proportion of any enteral feeds on day one and duration of kangaroo mother care (KMC) increased. Proportion of neonates receiving intravenous fluids during phototherapy decreased. CONCLUSIONS: The present study demonstrates the feasibility, sustainability, and effectiveness of a facility-team-driven QI approach augmented with capacity building and post-training supportive supervision.

The development of intrinsic timescales: A comparison between the neonate and adult brain.

In human adults and other mammals, different brain regions have distinct intrinsic timescales over which they integrate information, from shorter in unimodal sensory-motor regions to longer in transmodal higher-order regions. These have been related to cognitive performance and clinical symptoms, but it remains unclear how they develop. We asked if there are regional differences in timescales at birth that could shape learning by acting as an inductive bias, or if they develop later as the temporal statistics of the environment are learned. We used resting-state fMRI to characterise timescales in human neonates and adults. They were highly consistent across two independent neonatal groups, but in both sensory-motor and higher order areas, timescales were longer in infants compared to adults, as might be expected from their less developed myelination, and recent evidence of longer neural segments in infants watching naturalistic stimuli. In adults, we replicated the finding that transmodal areas have longer timescales than sensory-motor areas, but in infants the opposite pattern was found, driven by long infant timescales in the somotomotor network. Across regions within single brain networks, both positive (limbic) and negative (visual) correlations were found between neonates and adults. In conclusion, neonatal timescales were found to be highly structured, but distinct from adults, suggesting they act as an inductive bias that favours learning on longer timescales, particularly in unimodal regions and then develop with experience or maturation. This "take it slow" initial approach might help human infants to create more regularised, holistic representations of the input less bound to fleeting details, which would favour the development of abstract and contextual representations.

Jaundice and its associated factors among neonates admitted to selected referral hospitals in southwest oromia, Ethiopia: Multi-center cross-sectional study.

Background: Jaundice is a common clinical problem during the first month of birth throughout the world. Mainly, it is the leading cause of neonatal morbidity and mortality in developing countries. Objectives: The aimed of this studied was to assess predictors of jaundice among neonates admitted to selected referral hospitals in southwest Oromia, Ethiopia, 2021. Methods: An Institutional based cross-sectional study was implemented among 205 admitted neonates at selected referral hospitals in southwest Oromia, Ethiopia from October 05 to November 5, 2021. Jimma medical center (JMC), Wollega University referral hospital (WURH), and Ambo University Referral hospital (AURH) were selected by simple random sampling technique. A pretested structured interviewer-administered questionnaire and medical record review was used to collect data. Both binary and multivariable logistic regression analyses were performed to identify factors associated with neonatal jaundice. Logistic regression analyses were performed to identify factors associated with neonatal jaundice. Statistical Significance was declared at P-value less than 0.05 in the final model, and if the confidence interval does not include the null hypothesis value. Results: The prevalence of neonatal jaundice was 20.5% (95%CI: 1.74-1.85). The mean age of neonates was 8.6 ± 7.8 days. Traditional medicine use during current pregnancy (AOR: 5.62, 95%CI: 1.07, 9.52), Rh incompatibility (AOR: 0.045, 95%CI: 0.01, 0.21), gestational age (AOR: 4.61, 95%CI: 1.05, 10.3), premature rupture of membrane (AOR: 3.76, 95%CI: 1.58, 8.93) and hypertension (mother) (AOR: 3.99, 95%CI: 1.13, 14.02) were factors significantly associated with neonatal jaundice. Conclusion: Neonatal jaundice was relatively higher in the current study. Traditional medicine use, Rh incompatibility, premature ruptures of membrane, hypertension, and preterm gestational age were factors associated with neonatal jaundice.