Large skin defect in Type V aplasia cutis congenita treated with conservative treatment: a case report.

Aplasia cutis congenita (ACC) is a congenital disorder that can be classified into nine types, with Type I ACC being the most common. Type V ACC associated with fetus papyraceus is a rare subtype of ACC. We report the case of a Type V ACC in a male newborn with extensive abdominal skin defects. The patient received conservative treatment using hydrogel foam and silicone foam dressings. Approximately five weeks later, the patient was discharged when more than 60% of the skin had completed epithelialization. After discharge from West China Second University Hospital, Chengdu , the patient continued to be followed up regularly at the Burns and Plastic Surgery Clinic at local hospital in Gansu. We followed up the child by telephone. After 4 months of follow-up, scar tissue formation was observed in the trunk area. The infant is 2 years and 5 months old now, physical examination did not reveal any organ problems.

The effect of oral motor intervention with different initiation times to improve feeding outcomes in preterm infants: protocol for a single-blind, randomized controlled trial.

BACKGROUND: Premature infants commonly encounter difficulties with oral feeding, a complication that extends hospital stays, affects infants' quality of life, and imposes substantial burdens on families and society. Enhancing preterm infants' oral feeding skills and facilitating their transition from parenteral or nasal feeding to full oral feeding pose challenges for neonatal intensive care unit (NICU) healthcare professionals. Research indicates that oral motor interventions (OMIs) can enhance preterm infants' oral feeding capabilities and expedite the transition from feeding initiation to full oral feeding. Nonetheless, the most suitable timing for commencing these interventions remains uncertain. METHODS: This is a single-blind, randomized controlled trial. Preterm with a gestational age between 29+0 to 34+6 weeks will be eligible for the study. These infants will be randomized and allocated to one of two groups, both of which will receive the OMIs. The intervention commences once the infant begins milk intake during the early OMIs. Additionally, in the late OMIs group, the intervention will initiate 48 h after discontinuing nasal continuous positive airway pressure. DISCUSSION: OMIs encompass non-nutritive sucking and artificial oral stimulation techniques. These techniques target the lips, jaw, muscles, or tongue of premature infants, aiming to facilitate the shift from tube feeding to oral feeding. The primary objective is to determine the ideal intervention timing that fosters the development of oral feeding skills and ensures a seamless transition from parenteral or nasal feeding to full oral feeding among preterm infants. Furthermore, this study might yield insights into the long-term effects of OMIs on the growth and neurodevelopmental outcomes of preterm infants. Such insights could bear substantial significance for the quality of survival among preterm infants and the societal burden imposed by preterm birth. TRIAL REGISTRATION: chictr.org.cn ChiCTR2300076721. Registered on October 17, 2023.

Inspecting mother-to-infant microbiota transmission: disturbance of strain inheritance by cesarian section.

Introduction: The initial acquisition and subsequent development of the microbiota in early life is crucial to future health. Cesarean-section (CS) birth is considered to affect early microbial transmission from mother to infant. Methods: In this study, we collected fecal samples from 34 CS infants and their mothers from West China Second Hospital, Sichuan University to assess the microbiota developmental trajectory of mothers and infants. We explored mother-infant gut microbiome transmission via comparison with corresponding Finnish data. Results: Metagenomic analysis of gut microbiota profiles indicated that the communities of mothers and infants were distinct. The composition of the infant gut microbiome was highly variable but also followed predictable patterns in the early stages of life. Maternal communities were stable and mainly dominated by species from Bacteroidacea spp. We used PStrain to analyze and visualize strain transmission in each mother-infant pair. Excluding missing data, we included 32 mother-infant pairs for analysis of strain transmission. Most CS deliveries (65.6%, 21/32) did not demonstrate transmission of strains from mother to infant. To further explore the mother-infant strain transmission, we analyzed metagenomics data from Finnish mother-infant pairs. A total of 32 mother-infant pairs were included in the analysis, including 28 vaginal delivery (VD) infants and four CS infants. Strain transmission was observed in 30 infants, including 28 VD infants and two CS infants. All VD infants received transmitted stains from their mothers. Finally, a total of 193 strain transmission events were observed, comprising 131 strains and 45 species. Discussion: Taken together, our data suggested that delivery mode was an important factor influencing the mother-infant strain transmission.

Successfully removing a knotted epicutaneo-caval catheter inserted in a neonate: A case report and literature review.

Epicutaneo-caval catheter (ECC) has been widely used in neonatal intensive care units (NICUs). ECC line Knots in intravascular is an unexpected complication and has been reported in adults mostly. Few cases reported knot formation during ECC insertion and removal in neonates. In this case, we introduced a spontaneous knot formation during the insertion of the central catheter, which was finally successfully removed.

Predictive validity and reliability of two pressure injury risk assessment scales at a neonatal intensive care unit.

To compare the predictive ability and reliability of two pressure injury (PI) assessment tools, the Neonatal/Infant(N/I) Braden Q and Braden QD scale, in neonates. A prospective and cross-sectional study. This study was conducted in the neonatal intensive care unit (NICU) of a tertiary-level university hospital in China between April and June 2023. A total of 410 patients were included in this study. Risk assessment was performed with the N/I Braden Q scale, followed immediately with the Braden QD scale once daily. Risk assessment was terminated when the PI developed or the patient was discharged from the NICU or died. Each patient's final risk assessment was considered in the data analysis. The area under the curve (AUC) of the two scales was 0.879 and 0.857, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and Cronbach's α coefficient of the N/I Braden Q Scale scores were 0.844, 0.833, 0.30, 0.984 and 0.806, respectively. The Braden QD scale scores were 0.938, 0.733, 0.229, 0.993 and 0.727, respectively. Both scales are valid and reliable in predicting the risk of PI in the NICU. The N/I Braden Q Scale was better to distinguish patients at PI risk and not at PI risk than the Braden QD scale. The literature is limited on this topic. This study provides insight into the comparison of different pressure injury risk assessment scales. The findings of this study may guide nurses to choose a suitable tool to assess the risk of pressure injury in neonates.

Comparing different scoring systems for predicting mortality risk in preterm infants: a systematic review and network meta-analysis.

Background: This study aimed to compare the predictive values of eight scoring systems (Neonatal Critical Illness Score [NCIS], Neonatal Therapeutical Intervention Score System [NTISS], Clinical Risk Index for Babies [CRIB], Clinical Risk Index for Babies II [CRIB-II], Score for Neonatal Acute Physiology Perinatal Extension [SNAPPE], Score for Neonatal Acute Physiology Perinatal Extension II [SNAPPE-II], Score for Neonatal Acute Physiology [SNAP], and Score for Neonatal Acute Physiology II [SNAP-II]) for the mortality risk among preterm infants. Methods: The Embase, PubMed, Chinese Biomedical Database, Web of Science, and Cochrane Library databases were searched to collect studies that compared different scoring systems in predicting the mortality risk in preterm infants from database inception to March 2023. Literature screening, data extraction, and bias risk assessment were independently conducted by two researchers. Subsequently, the random-effects model was used for the network meta-analysis. Results: A total of 19 articles were included, comprising 14,377 preterm infants and 8 scoring systems. Compared to CRIB-II, NCIS, NTISS, SNAP-II, and SNAPPE-II, CRIB demonstrated better predictive efficiency for preterm infant mortality risk (P < 0.05). Relative to CRIB, CRIB-II, and SNAPPE, SNAP-II had worse predictive efficiency for preterm infant mortality risk (P < 0.05). The surface under the cumulative ranking curve of the eight scoring systems was as follows: CRIB (0.980) > SNAPPE (0.718) >SNAP (0.534) >CRIB-II (0.525) >NTISS (0.478) >NCIS (0.422) >SNAPPE-II (0.298) >SNAP-II (0.046). Conclusion: The CRIB scoring system showed the highest accuracy in predicting preterm infant mortality risk and was simple to perform. Therefore, CRIB selection can be prioritized in clinical practice. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=434731, PROSPERO (CRD42023434731).

Silver dressing in the management of an infant's urachal anomaly infected with methicillin-resistant Staphylococcus aureus: A case report.

BACKGROUND: Symptomatic urachal anomalies are rare disorders. The management of urachal remnants has historically been surgical excision because of the connection between urachal remnants and risk of malignancy development later in life. However, recent literature suggests that urachal anomalies that do not extend to the bladder can be treated with conservative management. In this case, we report a newborn with an infected urachal remnant who was treated with a combination of antibiotics and a silver-based dressing and finally recovered well. CASE SUMMARY: Female baby A, weighing 2.88 kg at 38+5 wk of gestational age, was referred to the hospital because of a red, swollen umbilicus approximately 2 cm × 2 cm in size with yellow purulent exudate. Through physical and ultrasound examination, the baby was finally diagnosed with a urachal anomaly. We first used oxacillin to prevent infection for 3 d. On the 4th day, microbiology testing of the umbilical exudate revealed the presence of methicillin-resistant Staphylococcus aureus (MRSA). We changed the treatment with oxacillin to vancomycin for systemic infection and treated the umbilical inflammation with a silver sulfate dressing. After 5 d, the symptoms of the umbilicus disappeared, and we discontinued silver dressing application. On the 12th day, umbilical exudate testing was negative for MRSA. On the 14th day, the baby's blood testing showed a white blood cell count of 14.7 × 109/L, neutrophil percentage of 27.8%, and C-reactive protein level of 1.0 mg/L, suggesting that the infection had been controlled. We stopped treatment, and the baby was discharged with no complications. In this case, the infected urachal anomaly was cured with silver dressing and antibiotic application instead of surgical methods, which was a different course from that of some other urachal remnant cases. CONCLUSION: Anomalies that do not connect with the bladder can be treated with nonoperative management, including application of conservative antibiotics and local intervention with silver-based dressings. Silver sulfate dressings are absolutely safe for neonates with judicious use, and they play an established role in preventing infection without resistance, which is a common problem with other antibiotics and antiseptics.