Group B Streptococcus colonization status and antibiotic use during labour - a single-centre observational study.

OBJECTIVES: Group B streptococcus (GBS) colonization among pregnant women is the leading cause of neonatal infection. Intrapartum antibiotic prophylaxis (IAP) is the most effective method to reduce the incidents of neonatal sepsis. We describe compliance with GBS management and the implementation of IAP in the context of the long-term effect of antibiotics. MATERIAL AND METHODS: The study was conducted among 249 childbearing women hospitalized between January 2022 and February 2022 at University Clinical Center in Gdansk, Poland. The data were obtained from the questionnaire and medical records. We analyzed maternal colonization with GBS, compliance with GBS screening and treatment guidelines, risk factors contributing to GBS colonization, IAP administration, and neonatal congenital infection occurrence. RESULTS: Of all patients, 240 (96.4%) were screened for GBS, 215 (89.6%) between 35-37 weeks of gestation. Fifty (20%) were GBS-positive, 184 (74%) negative, 15 (6%) had unknown GBS status. There were no significant differences between the GBS-positive and GBS-negative groups in maternal age, mode of delivery, gestational age at birth, maternal comorbidities, parity, GBS status in previous pregnancies, and the development of infection among infants of both groups, regardless of IAP administration. Of all the studied women, 158 (63.5%) received antibiotics, 91 (36.5%) did not. The study showed the low positive and the high negative predictive value of the antenatal GBS screening test. CONCLUSIONS: We found that compliance with the universal GBS screening is widespread. The management of women with absent or only partial screening test requires assessing the risk factors before administering IAP.

Changing perspectives of medical staff after Human Milk Bank opening. A single-center retrospective study of a tertiary neonatal unit.

BACKGROUND: Breast milk is an exceptional source of nutrients for neonates, delivering a unique composition of bioactive ingredients such as immunoglobulins, hormones and oligosaccharides. Our research aimed to understand the attitude of medical staff towards milk donation and its use in the NICU (Neonatal Intensive Care Unit) and to determine the influence the milk bank has had on the feeding practices of our patients after the introduction of local Human Milk Bank (HMB). METHODS: Twelve closed-question questionnaires were distributed among employees from the Department of Neonatology and Obstetrics before and after (identical set of questions) the implementation of the HMB. The attitudes of staff towards different aspect of milk banking were recorded. RESULTS: We obtained 67 fully answered questionnaires in 2019 and 48 questionnaires in 2021. After comparing the responses, the analysis of how staff's attitudes have changed was performed. As a second step, four hundred sixty-eight neonates born consecutively in December 2018 (N.=171) and then in December 2019 (N.=297), before and after the HMB introduction, respectively, participated in the study at the Medical University of Gdansk, Poland. Patients' medical charts were retrospectively analyzed. Since the assemblage of the HMB, there has been a significant improvement in the staff's attitude towards the use of donor milk (DM) (68.7% before, 93.8% after HMB) and its safety (65.7% before, 97.9% after HMB). There was also a significant increment in feeding newborns using breast milk compared to formula milk. CONCLUSIONS: HMB allows for the collection of donor milk, matching mother's-own-milk by gestational age and stage of lactation, ensuring adequate composition for the targeted nutritional requirements of premature infants. These findings support the relevance of our study, highlighting the importance and benefits of expanding HMB worldwide and increasing education for mothers and medical staff regarding donor milk.

Prematurity and Low Birth Weight and Their Impact on Childhood Growth Patterns and the Risk of Long-Term Cardiovascular Sequelae.

Preterm birth (before 37 completed weeks of gestation) is a global health problem, remaining the main reason for neonatal mortality and morbidity. Improvements in perinatal and neonatal care in recent decades have been associated with a higher survival rate of extremely preterm infants, leading to a higher risk of long-term sequelae in this population throughout life. Numerous surveillance programs for formerly premature infants continue to focus on neurodevelopmental disorders, while long-term assessment of the impact of preterm birth and low birth weight on child growth and the associated risk of cardiovascular disease in young adults is equally necessary. This review will discuss the influence of prematurity and low birth weight on childhood growth and cardiovascular risk in children, adolescents and young adults. The risk of cardiovascular and metabolic disorders is increased in adult preterm survivors. In early childhood, preterm infants may show elevated blood pressure, weakened vascular growth, augmented peripheral vascular resistance and cardiomyocyte remodeling. Increased weight gain during the early postnatal period may influence later body composition, promote obesity and impair cardiovascular results. These adverse metabolic alterations contribute to an increased risk of cardiovascular incidents, adult hypertension and diabetes. Preterm-born children and those with fetal growth restriction (FGR) who demonstrate rapid changes in their weight percentile should remain under surveillance with blood pressure monitoring. A better understanding of lifelong health outcomes of preterm-born individuals is crucial for developing strategies to prevent cardiovascular sequelae and may be the basis for future research to provide effective interventions.

Children with corpus callosum anomalies: clinical characteristics and developmental outcomes.

INTRODUCTION: Corpus callosum abnormalities are complex, aetiologically diverse, and clinically heterogeneous conditions. Counselling parents regarding their causes and associated syndromes, and predicting the neurodevelopmental and seizure risk prognosis, is challenging. MATERIAL AND METHODS: We describe the clinical characteristics, associated anomalies, and neurodevelopmental outcomes of children with agenesis of corpus callosum (ACC). Fifty-one neonates with ACC/hypoplasia of the corpus callosum were identified over a 17-year period, and their medical records were retrospectively reviewed. RESULTS: Patients were classified into two groups depending on the presence or absence of associated abnormalities. The first group (17 patients, 33.4%) presented with isolated callosal anomalies. The second group included 34 patients (66.6%) with associated cerebral and extracerebral anomalies. We achieved an identifiable genetic aetiology in 23.5% of our cohort. Magnetic resonance imaging was performed in 28 patients (55%), and of these 39.3% had additional brain anomalies. During the study period, five patients died early in the neonatal period and four were lost to follow up. Of the 42 followed patients, 13 (31%) showed normal neurodevelopment, 13 (31%) showed mild delay, and 16 (38%) had a severe delay. Fifteen (35.7%) had epilepsy. CONCLUSIONS AND CLINICAL IMPLICATIONS: We have confirmed that callosal defects are frequently accompanied by brain and somatic anomalies. Additional abnormalities were shown to be significantly associated with developmental delay and increased risk of epilepsy. We have highlighted essential clinical features that may provide diagnostic clues to physicians and we have given examples of underlying genetic disorders. We have provided recommendations about extended neuroimaging diagnostics and widespread genetic testing that may impact upon daily clinical practice. Paediatric neurologists may therefore use our findings to help base their decisions regarding this matter.

Contributors to Preterm Birth: Data from a Single Polish Perinatal Center.

Preterm birth may result from overlapping causes including maternal age, health, previous obstetric history and a variety of social factors. We aimed to identify factors contributing to preterm birth in respect to new social and environmental changes in the reproductive patterns. Our cross-sectional study included 495 mother-infant pairs and was based on maternal self-reporting in an originally developed questionnaire. Neonates were divided into two groups: 72 premature babies (study group) and 423 full-term babies (control group). We analyzed maternal, sociodemographic and economic characteristics, habits, chronic diseases, previous obstetric history and pregnancy complications. For statistical analysis, Pearson's Chi-squared independence test was used with a statistical significance level of 0.05. Preterm births were more common among mothers living in villages (p < 0.001) and with lower education level (p = 0.01). Premature births were also positively associated with mothers who were running their own businesses (p = 0.031). Mothers with a history of previous miscarriages gave birth at a significantly older age (p < 0.001). The most frequent pregnancy complications were hypothyroidism (41.4%), pregestational and gestational diabetes mellitus (DM; 17.8%) and hypertension (8.1%). Pregestational DM significantly influenced the occurrence of prematurity (p < 0.05). Pregestational DM, being professionally active, a lower education level and living outside cities are important risk factors of prematurity.

Development and validation of a method for the simultaneous analysis of fatty acid ethyl esters, ethyl sulfate and ethyl glucuronide in neonatal meconium: application in two cases of alcohol consumption during pregnancy.

Alcohol consumption during pregnancy constitutes one of the leading preventable causes of birth defects and neurodevelopmental disorders in the exposed children. Fatty acid ethyl esters (FAEEs), ethyl glucuronide (EtG) and ethyl sulfate (EtS) have been studied as potential biomarkers of alcohol consumption. However, most analytical approaches proposed for their analysis in meconium samples consist of separated extraction procedures requiring the use of two meconium aliquots, which is costly in terms of both time and materials. Therefore, the aim of this study was to develop and validate a method for the simultaneous extraction of 9 FAEEs, EtG and EtS from one meconium aliquot. The sample was homogenized using methanol, and then FAEEs were extracted with hexane while EtG and EtS were isolated using acetonitrile. Then, extracts were applied to solid-phase extraction columns and analysed by gas chromatography mass spectrometry (FAEEs) and liquid chromatography tandem mass spectrometry (EtG and EtS). Calibration curves were linear with r values greater than 0.99. The LODs ranged from 0.8 to 7.5 ng/g for FAEEs and were 0.2 ng/g and 0.8 ng/g for EtS and EtG, respectively. LOQs ranged from 5 to 25 ng/g for FAEEs and were 1 ng/g and 2.5 ng/g for EtS and EtG, respectively. Accuracies and precisions were between 93.8 and 107% and between 3.5 and 9.7%, respectively. The recovery values ranged from 89.1 to 109%. The method proved to be sensitive, specific, simple and fast and allowed for the reduction of the amount of organic solvent used for extraction compared to other published data while higher recoveries were obtained. The method was used for analysis of meconium samples in two cases of mothers who were consuming alcohol during pregnancy.

Fetal alcohol spectrum disorders - diagnostic difficulties in the neonatal period and new diagnostic approaches.

Fetal alcohol spectrum disorders (FASD) is a group of disorders that can occur in children whose mothers consumed alcohol in pregnancy. Diagnosis of fetal alcohol syndrome is based on the appearance of growth deficiency, the presence of the three key features of facial dysmorphism (short palpebral fissures, thin upper lip, smooth or flattend philtrum) and/or disorders in the central nervous system (minimum 3) and prenatal exposure to alcohol (confirmed if possible). Early diagnosis of fetal alcohol syndrome - after birth or in infancy - is very often impossible or very difficult due to the incomplete manifestation of the key dysmorphic features. The latest reports offer the chance of diagnosing children in the neonatal period. The research focuses on the analysis of ethanol metabolites in the biological tissues in pregnant women or newborns. These unique ethanol metabolites include: fatty acid ethyl esters (FAEE) present in the meconium, blood, hair of the mother and the newborn, ethyl glucuronide in the placenta and meconium, urine, nails and hair, and phosphatidylethanol (PEth) found in the infant blood. The presence of fatty acid ethyl esters in the meconium could be a non-invasive and cost-effective method of early detection of disorders associated with prenatal alcohol exposure.

Agreement and reproducibility of radiological signs in NEC using The Duke Abdominal Assessment Scale (DAAS).

PURPOSE: Necrotizing enterocolitis (NEC) is associated with high morbidity and mortality. Abdominal radiography is currently an imaging modality of choice in NEC. Recently, a numeric scale of radiological signs in NEC-The Duke Abdominal Assessment (DAAS) was introduced. The aim of this study was to measure the intra- and inter-observer agreement on the radiological signs of NEC according to DAAS to access the feasibility of this scale. MATERIALS AND METHODS: We have retrospectively analyzed 87 radiographs performed in a group of 43 high-risk neonates with suspected NEC. Radiographs were assessed by 6 independent observers: two pediatric radiologists, two radiology residents, and two neonatologists. Data were analyzed using κ statistics as a measure of intra- and inter-observer agreement. RESULTS: Fair-to-good intra-observer agreement was noted for all but one of observers. However, with the wide range in κ values, we found only fair inter-observer agreement detecting signs of NEC according to DAAS. There was a higher intra-group agreement in radiology practitioners, with the highest among experienced pediatric radiologists. CONCLUSION: However, with high observer variability in interpretation of all radiologic signs, we did not confirm that Duke Abdominal Assessment Scale could reliable facilitate reporting of abdominal radiographic findings in neonates with suspected NEC.

Spina bifida--a follow-up study of neonates born from 1991 to 2001.

AIMS: To follow the development of children born with myelomeningocoele. METHODS: We followed 54 infants born with myelomeningocele between 1991 and 2001 in the Obstetrical Department of the Medical University of Gdansk, Poland. RESULTS: The mortality rate for live births was 40.8%. 13.0% of the children were stillborn and 5.5% were lost for observation. Late diagnosis, a high localization of the lesion, the presence of other malformations, and low birth weight increased the risk of death. Diagnosis was most commonly made in the 31-35(th) week of pregnancy. For 18.5% of the subjects, the diagnosis was postnatal. There was no correlation between the time and mode of delivery and mental development. Only some of the children were able to walk, to use braces, or use a wheelchair. Most of the children had poor bladder and bowel control. We found a correlation between these dysfunctions and the level of myelomeningocele. CONCLUSIONS: Myelomeningocoele is associated with high rates of mortality and severe psychomotoric retardation. The localization of the lesion has an impact on survival rate and sphincter control. Mental development depends on neonatal condition after delivery. Mode of delivery does not influence the child's further development.