Serial head circumference measurements should be used to classify congenital microcephaly.

BACKGROUND: Measuring the maximum occipitofrontal circumference only once at birth or within 24 h after birth may lead to misclassifications of microcephaly. This study compared the head circumference (HC) of newborns at birth or within 24 h after birth to their third day of life (DOL3) as well as evaluated maternal- and infant-specific factors associated with increased HC by DOL3. METHODS: This prospective study included 1131 live births between February and May 2019 with a gestational age > 27 weeks. All newborns had their HC measured at birth or within 24 h after birth as well as on DOL3 before discharge. HC measurements were performed by trained personnel using non-elastic tape measures. The World Health Organization (WHO) and Fenton Growth Charts were used as reference ranges for interpretation of full-term and preterm neonates, respectively. RESULTS: Paired sample t-test analyses found a statistically significant increase in HC measured on the DOL3 compared with HCs of the same newborns at birth or within 24 h of birth. The mean HC increase was 0.17 cm (95% confidence interval [0.13, 0.21], P < 0.001). The mean ± standard deviation HC within 24 h of birth and at DOL3 were 33.58 ± 1.53 cm and 33.75 ± 1.37 cm, respectively. Thirty-two newborns had HCs less than the third percentile (< P3) at birth, 25 of which had HC ≥ P3 at DOL3. After adjusting for mode of and presentation at delivery, newborns whose mothers experienced labor pains (ß = 0.31, P < 0.001) and were either symmetrically (ß = 0.59, P = 0.002) or asymmetrically small-for-gestational age (SGA; ß = 0.37, P = 0.03) had significantly increased HC at DOL3. On average, newborns whose mothers experienced labor pain had 0.31 cm increases in HC at DOL3. Symmetrical SGA newborns also had an average 0.59 cm increase in HC at DOL3. Parity and gestational age were not associated with changes in HC. CONCLUSIONS: Serial HC measurements on DOL3 or before newborns' discharge is crucial to classifying congenital microcephaly.

THE BURDEN OF INVASIVE NEONATAL GROUP B STREPTOCOCCAL (GBS) DISEASE IN THAILAND AND THE PHILIPPINES.

Group B Streptococcus (GBS) is a leading cause of meningitis and sepsis in infancy, but burden of disease data are scarce for Asia. We performed two hospital-based, prospective, descriptive, observational studies using similar protocols in the Philippines and Thailand to evaluate neonatal GBS disease epidemiology. Infants aged <90 days with a GBS-positive culture from normally sterile sites using routine microbiological standards were eligible for inclusion. Awareness of GBS symptoms was raised by informing all women at delivery and follow-up for 90 days post-delivery. Infections were classified as early onset disease (EOD) if they occurred within 6 days of birth and late Onset disease (LOD) if they occurred 7-89 days after birth. Due to ethical requirements in Thailand, consent for study participation, including periodic post-discharge telephone calls, was obtained at delivery. Parents in the Philippines gave consent for study participation at case identification. The clinical outcomes of GBS infections were recorded. During the 6-month study period, two cases (one fatal) of EOD were identified among 8,409 live births at the study hospitals in Thailand and three cases (two fatal) of EOD were identified among 11,768 live births reported at the study hospitals in the Philippines. Incidence rates per 1,000 live births were 0.2 (95% CI: 0.0-0.8) and 0.3 (95% CI: 0.1-0.8) in Thailand and the Philippines, respectively. There were no cases of reported LOD. The low number of cases precluded analysis of serotype distribution and case fatality rates. Large epidemiological studies are needed to better understand the factors influencing GBS infection incidence in Asia.

The effectiveness of parent manipulation on newborns with postural clubfoot: a randomized controlled trial.

OBJECTIVE: The aim of the present study was to determine the effectiveness of parent manipulation on newborns with postural clubfoot, as compared to newborns that receive no treatment in a randomized controlled trial. MATERIAL AND METHOD: Ninety-two healthy newborns, including 40 boys and 52 girls, (169 postural clubfeet, including 77 with bilaterally involvement) were included and categorized into two groups by simple randomization using the sealed opaque envelope technique. In Group A, the parent manipulation group, there were 14 boys and 33 girls in 85 postural clubfeet with 38 bilateral involvements. Manipulations were performed at least 20 times per day and the stimulation of the newborn's foot/ feet byparent finger was performed at least 100 times per day. In Group B, the group of newborns receiving no treatment, there were 26 boys and 19 girls in 84 postural clubfeet with 39 bilateral involvements. The follow-up periods for both groups were one, three, and four months after starting the manipulation. The success of the manipulation was measured by the foot appearance, which was normally performed by physical examination. RESULTS: A comparison of the characteristics of newborns and parents in both groups showed no statistical differences, except the sex of the newborn. All newborns in both groups were one to six days old. The success rate after 4 months of manipulation in Group A was 71.8%, but it was 81% in Group B with no manipulation; results indicate no statistically significant difference (p = 0.16). The severity of the postural clubfeet indicated no statistical difference in the results of either group (p = 0.3). All cases were followed up at one year with 14% of the studyparticipants dropping out in Group A and 11% dropping out of the study in Group B. All postural clubfeet disappeared in every case within one year of birth except one case in Group A that required casting and one case in Group B that required a prescription for orthopaedic shoes. CONCLUSION: No clinical or statistical differences were found between newborns who received parent manipulation for the treatment of postural clubfoot and newborns who received no treatment. Spontaneous recovery occurred in most of the cases within four months of birth or not more than one year after birth.

Accuracy of the StatStrip versus SureStep Flexx glucose meter in neonates at risk of hypoglycemia.

The study was performed to evaluate the accuracy of the StatStrip (SS) and SureStep Flexx (SF) glucose meters compared to plasma glucose in infants at risk for neonatal hypoglycemia and to determine the effect of bilirubin and hematocrit on the results. A prospective cross-sectional study was conducted on 172 venous blood glucose samples from infants who had initial low point-of-care (POC) glucose tests measured simultaneously by SS and SF. Plasma glucose levels were compared to both POC instruments, and the effect of bilirubin and hematocrit levels on mean glucose differences were analysed. Mean (SD) plasma glucose was 2.12 (0.45) mmol/L; (range, 1.11-3.06 mmol/L). Mean (1.96SD) glucose differences of the SS versus SF were 0.21 (0.70) mmol/L and -0.04 (0.78) mmol/L, respectively. SS sensitivity was 94.7 % with an 86.1 % negative predictive value (NPV) at 2.8 mmol/L, while the SF had a 100 % sensitivity and NPV at the same cut-off level. No correlations were identified between mean glucose differences and either hematocrit or bilirubin levels in both glucose meters. Both the SS and SF glucose meters have limited use when compared to plasma glucose. Hence, they can only be employed as screening tools in at-risk neonates with an appropriate, predetermined cut-off level. Hematocrit and bilirubin levels did not affect the accuracy of both devices.

Effectiveness of conventional phototherapy versus Super light-emitting diodes phototherapy in neonatal hyperbilirubinemia.

BACKGROUND: Neonatal hyperbilirubinemia is very common. Phototherapy has been used for decades to prevent severe hyperbilirubinemia, which can cause kernicterus. OBJECTIVE: To compare the effectiveness of two phototherapy devices in reducing plasma bilirubin and duration of phototherapy in non-severe hyperbilirubinemia. MATERIAL AND METHOD: This was an open-label randomized controlled trial. Forty healthy infants aged between 1 and 5 days with non-severe hyperbilirubinemia, but to the level requiring phototherapy, were recruited. The phototherapy unit used in the "blue-light" group was the Siriraj Phototherapy Lamp with 6 special blue fluorescent tubes. The phototherapy unit used in the "light-emitting diodes (LEDs)" group was the Bilitron 3006 with 5 super LEDs. RESULTS: Twenty infants were included in each group. Demographic data and baseline clinical characteristics of infants in both groups were comparable. Median rate (25%, 75%tile) ofplasma bilirubin decreasing during phototherapy in the "blue light" was significantly higher than in the "LEDs" group [0.16 (0.09, 0.25) and 0.10 (0.02, 0.17) mg/dL/hour, respectively; p = 0.03]. Duration of phototherapy in "blue light" group was shorter than in "LEDs" group but was not statistically significant. CONCLUSION: A locally invented phototherapy device with special blue fluorescent tubes can be more effective than the more expensive commercial super LEDs phototherapy device in decreasing plasma bilirubin.

Inhaled nitric oxide in preterm infants: an individual-patient data meta-analysis of randomized trials.

BACKGROUND: Inhaled nitric oxide (iNO) is an effective therapy for pulmonary hypertension and hypoxic respiratory failure in term infants. Fourteen randomized controlled trials (n = 3430 infants) have been conducted on preterm infants at risk for chronic lung disease (CLD). The study results seem contradictory. DESIGN/METHODS: Individual-patient data meta-analysis included randomized controlled trials of preterm infants (<37 weeks' gestation). Outcomes were adjusted for trial differences and correlation between siblings. RESULTS: Data from 3298 infants in 12 trials (96%) were analyzed. There was no statistically significant effect of iNO on death or CLD (59% vs 61%: relative risk [RR]: 0.96 [95% confidence interval (CI): 0.92-1.01]; P = .11) or severe neurologic events on imaging (25% vs 23%: RR: 1.12 [95% CI: 0.98-1.28]; P = .09). There were no statistically significant differences in iNO effect according to any of the patient-level characteristics tested. In trials that used a starting iNO dose of >5 vs ≤ 5 ppm there was evidence of improved outcome (interaction P = .02); however, these differences were not observed at other levels of exposure to iNO. This result was driven primarily by 1 trial, which also differed according to overall dose, duration, timing, and indication for treatment; a significant reduction in death or CLD (RR: 0.85 [95% CI: 0.74-0.98]) was found. CONCLUSIONS: Routine use of iNO for treatment of respiratory failure in preterm infants cannot be recommended. The use of a higher starting dose might be associated with improved outcome, but because there were differences in the designs of these trials, it requires further examination.