Asia Pacific journal of clinical nutritionXiaohan Guo, Xiaomin Wang, Xiaofeng Weng, Yuanqing Fu, Jun Tang, Wensheng Hu
BACKGROUND AND OBJECTIVES: The gestational weight gain (GWG) range during mid-to-late pregnancy associated with the lowest combined risk of adverse birth outcomes in women with gestational diabetes mellitus (GDM) remains unclear. This study aims to examine the associations between GWG and adverse birth out-comes among women with GDM. METHODS AND STUDY DESIGN: This study included a cohort of 1,673 pregnant women with GDM. GWG was defined as weight gain from pre-pregnancy to a measurement between 24 and 32 gestational weeks, residualized for gestational age and standardized as z-scores. Multivariable logistic regression models were used to assess associations between GWG z-scores (per 1-SD increase and categories: <-1, -1 to 1 [reference], and ≥1) and small for gestational age (SGA), large for gestational age (LGA), and preterm birth. Restricted cubic splines were fitted to explore nonlinear associations. RESULTS: Each 1-SD higher in GWG z-score was associated with lower odds of SGA (odds ratio [OR], 0.55; 95% confidence interval [CI], 0.43-0.71) and higher odds of LGA (1.48; 1.29-1.70). Compared with the reference group, women with GWG z-scores <-1 had higher odds of SGA and lower odds of LGA, whereas those with z-scores ≥1 showed the opposite pattern. No significant association was observed with preterm birth. Spline analyses indicated that a GWG z-score of approximately -0.07 (equal to 8.2 kg at 28 weeks) was associated with the lowest combined odds of SGA and LGA. CONCLUSIONS: Among women with GDM, both insufficient and excessive mid-to-late pregnancy GWG were associated with adverse size-for-gestational-age outcomes.
Problemy sotsial'noi gigieny, zdravookhraneniia i istorii meditsinyN V Batrak, I V Ivanova
The pregnancy that occurred due to in vitro fertilization is characterized by higher risk of development of gestational diabetes mellitus. The purpose of the study was to investigate course and outcomes of pregnancy resulted from in vitro fertilization in women with gestational diabetes mellitus, depending on time of its manifestation. The analysis of course of pregnancy, childbirth and condition of newborns in 179 women with gestational diabetes mellitus under pregnancy resulted from in vitro fertilization was carried out. It is established that early manifestation of gestational diabetes mellitus is associated with older age of pregnant women, higher rate of birth of large fetus in anamnesis, higher body mass index, more frequent prescription of insulin therapy to treat gestational diabetes mellitus, higher rate of development of early threatened miscarriage, isthmic cervical insufficiency, anemia, chronic arterial hypertension, gestational arterial hypertension, moderate preeclampsia, severe preeclampsia, premature normally placed placenta detachment, fetal growth retardation, chronic intrauterine fetal hypoxia, diabetic fetopathy, prenatal rupture of amniotic fluid, premature birth, more frequent birth of large fetus, development of fetal renal pyelectasia. The female patients with late manifestation of gestational diabetes mellitus had higher level of fasting plasma glycemia, frequent development of placenta previa, polyhydramnios, pathological and insufficient gain of body mass during pregnancy, dis-coordination of labor and clinically narrow pelvis during labor, more frequent operative delivery and early delivery. The gestational diabetes mellitus, developed both in early and late periods, complicates the course and childbirth under pregnancy resulted from in vitro fertilization, adversely affects state of the newborn. The study in depth is needed to establish possible mechanisms of development of gestational diabetes mellitus in this cohort of women with implementation of screening examinations and determination of further tactics of management of pregnancy depending on time of its manifestation.
Pakistan journal of pharmaceutical sciencesJiajia Ying
BACKGROUND: Given the high incidence of apnea of prematurity (AOP) and the repeated hypoxia-induced nerve damage, treatment optimization from the dosing perspective is critical. Caffeine is the current first-line therapeutic drug for AOP. However, the conventional dose results in low blood concentration compliance, with significant variation among individuals. OBJECTIVES: To explore the clinical efficacy and safety of a therapeutic drug monitoring (TDM)-guided individualized caffeine dosage regimen and its association with early neurobehavioral development and weight gain in preterm infants (PTIs). METHODS: In this retrospective propensity score-matched cohort study, 130 PTIs with AOP were included after 1:1 matching, with 65 infants in the TDM-guided individualized dosing group and 65 in the conventional fixed-dose group. Inter-group comparative assessments were conducted from the perspectives of blood drug concentration compliance rates, apnea control, adverse reactions, neurobehavioral development scores, clinical outcomes and weight gain rates. RESULTS: Compared with the conventional fixed-dose group, the TDM-guided individualized dosing group had a significantly higher target attainment rate of blood caffeine concentration (92.31% vs 70.77%; OR=5.22, 95% CI 1.68-12.74, P=0.002), lower apnea episode frequency at 4 weeks (MD -1.40 times/day, 95% CI -2.13 to -0.67, P<0.001), lower overall incidence of adverse reactions (6.15% vs 20.00%; OR=0.26, 95% CI 0.09-0.87, P=0.035), higher NBNA score at 40 weeks of corrected gestational age (MD 1.74, 95% CI 1.23-2.25, P<0.001), shorter hospital stay (MD -4.11 days, 95% CI -6.51 to -1.71, P=0.001) and faster weight gain rate (MD 7.88 g/day, 95% CI 3.21-12.55, P=0.001). CONCLUSION: The TDM-guided individualized caffeine dosing regimen was associated with improved precision of AOP treatment, better short-term therapeutic efficacy and safety, and higher early neurobehavioral assessment scores and weight gain in preterm infants within 6 months of corrected gestational age. Multicenter studies with longer follow-up are needed to further verify its long-term clinical benefits.
Acta anaesthesiologica ScandinavicaHannah Fovaeus, Johan Holmen, Zacharias Mandalenakis, Matilda Frisk Torell, Mattias Molin, Araz Rawshani, Albert Gyllencreutz Castellheim
BACKGROUND: National data on pediatric in-hospital cardiac arrest (pIHCA) are limited, and cohorts from highly specialized pediatric centers may not reflect the broader hospital population. We aimed to describe pIHCA reported across Swedish hospitals, with particular focus on hospitals outside the two national centers for highly specialized pediatric cardiac care. METHODS: This retrospective observational registry study included patients aged 0-18 years with pIHCA reported to the Swedish Registry for Cardiopulmonary Resuscitation between January 1, 2005 and September 25, 2025. Cases from the two highly specialized centers were analyzed separately and as part of the complete national registry-reported cohort. The primary outcome was 30-day survival; secondary outcomes included return of spontaneous circulation (ROSC) and 1-year survival. RESULTS: Among 525 pIHCA events, 344 occurred outside the two highly specialized centers and 181 at these centers. In the broader Swedish hospital population, 31.7% of arrests occurred on hospital wards, 26.2% in emergency departments, and 22.7% in intensive care units. CPR was initiated immediately in 81.4% of events. Forty-nine percent survived to 30 days, and 44% to 1 year. At the two highly specialized centers, infants, congenital heart disease, and arrests in intensive care units were substantially more common, and 30-day survival was 70%. CONCLUSION: Patient characteristics, arrest location, and survival differed substantially between the broader Swedish hospital population and the two highly specialized centers. These findings highlight the heterogeneity of pIHCA across hospital settings and the importance of considering hospital type and case mix when interpreting pIHCA data. EDITORIAL COMMENT: Pediatric patient in-hospital cardiac arrest is uncommon, though they registered in a national database in Sweden. This analysis presents 20 years of experience and follow-up for these cases describing associated factors.
Child: care, health and developmentSevilay Ergün Arslanlı, Edip Aygüler, Necla Kasımoğlu, İsa Çelik
AIM: This study aimed to investigate fathers' newborn care-related experiences, identify the factors affecting their participation in the care process and explore their support needs. METHODS: This qualitative study was conducted using a phenomenological design. Data were collected through in-depth face-to-face interviews conducted based on a semi-structured interview guide. The data were analysed using Colaizzi's phenomenological data analysis method. RESULTS: Fathers were willing to participate in newborn care and were particularly involved in practices such as feeding and basic hygiene care. Lack of experience, fear of harming the baby and lack of self-confidence regarding caregiving skills emerged as significant difficulties experienced by the fathers in newborn care. The fathers pointed out that their wives, healthcare professionals and family members were important sources of support, while demanding work schedules, limited paternity leave and traditional gender roles were among the leading barriers limiting their participation in caregiving. CONCLUSION: The fathers were willing to participate in newborn care, but their participation in the care process was limited owing to individual, social and structural barriers. It is believed that strengthening their caregiving skills and creating supportive environmental conditions will increase their participation in newborn care. IMPLICATIONS FOR PRACTICE: Healthcare professionals, particularly pediatric and neonatal nurses, should develop father-focused training programmes and provide guidance on care practices to encourage fathers to participate in newborn care actively. Developing policies that support paternity leave and family-centred care practices can also increase fathers' involvement in early infant care.
BACKGROUND: Unplanned births outside hospitals involve higher risks of complications for mothers and newborns and require special obstetric or pediatric skills. However, ambulance calls for childbirth are rare, making it difficult for ambulance staff to maintain their skills. In Europe, unplanned out-of-hospital deliveries constitute 0.10% to 0.61% of all births. The exact number of prehospital births in the Region of Southern Denmark remains unknown. The study aimed to determine the extent of unplanned prehospital births attended by the ambulance service outside hospitals in the Region of Southern Denmark from January 2016 through June 2024. We further aimed to identify where the unplanned pre-hospital births took place and to report any birth-related complications in the mothers or newborns encountered by ambulance staff. METHODS: The study was a cross-sectional study utilizing the pre-hospital electronic Patient Medical Record system over 8 years in a mixed urban-rural area with a population of 1.2 million people. All prehospital medical records for ambulance missions dispatched for childbirths were manually examined. The study period spanned from January 2016 through June 2024. RESULTS: Out of 1,137,222 ambulance dispatches, 3543 cases (0.31%) involved a dispatch code related to childbirth. Many labor incidents were considered uneventful by the prehospital personnel. Of all ambulance runs related to childbirth, we identified 310 births in the Region of Southern Denmark in which ambulance staff assisted with complicated out-of-hospital deliveries. An additional 10 labor cases were regarded as sufficiently complex that obstetric manoeuvres aimed at delaying the delivery of the baby were performed prehospitally, while the mother was rushed to hospital for delivery. CONCLUSION: Births outside the hospital while the mother is in the care of the EMS were rare, occurring in 0.03% of all ambulance missions. Most of the births took place without complications for both mother and neonate. In four cases, however, the neonate was in cardiac arrest and required resuscitation. Given the limited exposure to prehospital births, we suggest incorporating training in handling these rare events into routine training for prehospital caregivers. EDITORIAL COMMENT: This cohort study presents obstetrical cases that have been managed first in the prehospital setting by ambulance personnel. Obstetrical outcomes related to this are presented, and there are considerations for what can be desirable as preparation and competencies for ambulance responses for these types of cases.
Nursing in critical careNana Wu, Xia Chen, Jie Fu, Liwen Ding, Hong Zhou, Tiantian Xiao
BACKGROUND: Point-of-care ultrasound (POCUS) is increasingly used in paediatric and neonatal critical care, but evidence on nurse-led bedside POCUS remains limited and fragmented. AIMS: This scoping review aimed to map the evidence on nurse-led bedside POCUS in paediatric and neonatal critical care nursing practice, examine implementation factors and identify evidence gaps relevant to nursing research, education and clinical practice. METHODS: Following JBI methodology and PRISMA-ScR guidance, we searched PubMed, Embase, CINAHL, Web of Science, Cochrane Library and CNKI from inception to October 2025. Eligibility followed the PCC framework. Two reviewers independently screened records and extracted data using a standardized form. Study characteristics were synthesized descriptively, and implementation factors were deductively analysed using the COM-B framework. RESULTS: Thirty-four studies were included, mainly from the United States and China. Nurse-led POCUS applications included vascular access, respiratory assessment, catheter localization, cardiac or hemodynamic evaluation, bladder assessment and education or competency development. Outcomes included clinical (procedural success and diagnostic accuracy), process (timeliness and workflow efficiency) and nurse-related (competency, confidence and role development). Safety-related outcomes were the least reported. Implementation was influenced by training, equipment, protected time, institutional support, collaboration and patient safety concerns. The automatic motivation domain, referring to unconscious drivers such as habits and emotional responses, was not addressed by any study. CONCLUSIONS: Nurse-led POCUS is an emerging but unevenly developed component of paediatric and neonatal critical care. Brief training may support initial competency, but sustained implementation is constrained by underdeveloped quality assurance, unclear career pathways and limited attention to motivational processes. RELEVANCE TO CLINICAL PRACTICE: Future nursing research and clinical programmes may look beyond short-term training outcomes to consider competency standards, longitudinal supervision, quality assurance, educational approaches combining foundational POCUS training with structured workplace supervision and sustainable integration into routine care delivery.
Sexual healthManoji Gunathilake, Jerry L J Chen, Alice Ishwar, Puja Thapa, Roxana Sherry, Natasha Tatipata, Vicki Krause
BACKGROUND: This retrospective study describes the clinical outcomes and management of people diagnosed with syphilis during pregnancy and their newborns at risk of congenital syphilis in the Northern Territory (NT), Australia between 2013 and 2023. METHODS: Demographic, clinical, and contact tracing information on all pregnancies with syphilis diagnosed prior to or during pregnancy, and clinical information of neonates, were sourced from spreadsheets and the NT Syphilis Register Information System. RESULTS: A total of 380 pregnancies were monitored, of which 186 pregnancies were identified as at risk of mother-to-child transmission of syphilis. Reinfection accounted for 13.8% of the 181 new syphilis infections. Of the 188 neonates, there were 11 cases of congenital syphilis, including 1 case of stillbirth. All congenital syphilis cases occurred when maternal syphilis was diagnosed in the third trimester or at the time of childbirth. While maternal treatment was completed in all pregnancies, 22 (11.8%) received treatment less than 30 days prior to childbirth or were untreated at the time of childbirth. Initial treatment was inadequate in 10 pregnancies (5.4%). A lack of four-fold reduction in rapid plasma reagin (RPR) titres by the time of childbirth due to delayed diagnosis and treatment was significantly associated with neonatal congenital syphilis (P < 0.001), with a median RPR of 1:8. Among identified contact/s, 54 (43.2%) tested positive for syphilis. CONCLUSION: Early detection, treatment, and follow-up of maternal syphilis before and during pregnancy are key measures to prevent congenital syphilis. Universal syphilis screening with repeat testing should be incorporated into antenatal care to minimise stigma.
Zhonghua yi xue yi chuan xue za zhi = Zhonghua yixue yichuanxue zazhi = Chinese journal of medical geneticsYujie Zhou, Xuelian Zhao, Xu Wang, Teng Hao, Shuaquan Li, Xiaojing Yao, Na'na Li, Wentao Zang, Xige Wang, Erfeng Yuan, Sibao Li
OBJECTIVE: To summarize the early recognition clues, genetic characteristics, and short-term outcomes of children with Diamond-Blackfan anemia (DBA) in order to provide a reference for the differential diagnosis of severe anemia in early infancy. METHODS: A retrospective analysis was conducted on 11 children clinically diagnosed with DBA at the Department of Pediatric Hematology of the Third Affiliated Hospital of Zhengzhou University between May 2020 and December 2024. Their general condition, initial presentation, associated phenotypes, lab and bone marrow examination results, genetic testing results, treatment methods, and follow-up outcomes were collected and analyzed. This study was approved by the Medical Ethics Committee of the hospital (Ethics No.: 2026-056). RESULTS: A total of 11 clinically diagnosed children were included, 6 of whom had onset in the neonatal period and 5 in infancy. Severe anemia in early infancy was a common feature, with hemoglobin levels ranging from 16 to 71 g/L (median value = 42 g/L), and mean corpuscular volume (MCV) being mostly normal or elevated. All 11 bone marrow examinations showed reduced erythroid lineage. Seven cases had confirmed structural malformations, and five cases had developmental delays. In terms of genetics, five DBA-related genes were involved, with RPS19 being the most common. Ten cases had pathogenic/likely pathogenic or DBA-related supportive variants detected, and one case had an RPS29 variant of uncertain significance related to the phenotype. All children had a history of blood transfusions. Among the 10 cases that could be followed up, glucocorticoid treatment was temporarily effective in six cases, three developed iron overload, two relapsed, and one underwent hematopoietic stem cell transplantation and survived. CONCLUSION: Early identification of DBA should focus on the core combination of severe anemia in early infancy, normal or increased MCV, reduced reticulocytes, and suppressed erythroid lineage in the bone marrow, while also considering the presence of congenital anomalies. Genetic testing has facilitated to clarify the molecular typing and explain the phenotypes. The absence of typical malformations does not rule out DBA, and infants with early severe anemia should undergo bone marrow and genetic evaluation as soon as possible.
European journal of pediatricsLina Alsherbini, Mohanned Alrahili, Talal Aljarbou, Saif Alsaif, Abdulaziz Homedi, Theodore Dassios, Kamal Ali
To evaluate the association between bronchopulmonary dysplasia (BPD) severity and post-discharge growth during the first year of corrected age in very preterm infants, including recovery from established growth failure at hospital discharge. This retrospective cohort included 1,106 infants born before 32 weeks' gestation, classified using the Jensen BPD definition as no BPD (n = 768), mild (n = 142), moderate (n = 154), or severe BPD (n = 42). Weight, length, and head circumference z-scores were assessed from birth to 12 months corrected age. Longitudinal growth trajectories and time to recovery from discharge growth failure were evaluated using adjusted models. Increasing BPD severity was associated with progressively poorer anthropometric outcomes at discharge and 12 months (all p < 0.001). At 12 months, severe BPD remained independently associated with lower weight (β - 0.596, 95% CI - 1.134 to - 0.057; p = 0.030), length (β - 0.800, 95% CI - 1.443 to - 0.156; p = 0.015), and head circumference (β - 1.177, 95% CI - 2.001 to - 0.353; p = 0.005) z-scores. Among infants with growth failure at discharge, severe BPD was associated with slower recovery of weight (HR 0.40, 95% CI 0.19-0.81; p = 0.011), length (HR 0.25, 95% CI 0.14-0.48; p < 0.001), and head circumference (HR 0.23, 95% CI 0.08-0.72; p = 0.012). Median recovery was not reached for any anthropometric domain in severe BPD; corresponding 12-month recovery probabilities were 41.3%, 42.6%, and 30.1%, respectively. Conclusion: Severe BPD was independently associated with persistent impairment in weight, length, and head circumference and substantially delayed recovery from established growth failure during infancy. These findings support structured longitudinal growth monitoring and targeted nutritional follow-up after discharge.
Cancer causes & control : CCCXiaoxin Wu, Huadong Liang, Qianqian Wu, Xinjing Li
PURPOSE: To describe age- and latency-specific patterns of excess incidence of malignant brain and other nervous system tumors after cancer diagnosed before age 40 years. METHODS: We studied first primary malignancies other than brain and other nervous system cancers in SEER 8 (1975-2023). Standardized incidence ratios (SIRs) compared observed with population-expected events across diagnosis age groups and latency intervals. A supplementary competing risk analysis estimated cumulative incidence. RESULTS: Among 276,844 individuals contributing 3,970,462 person-years, 345 tumors occurred versus 236.97 expected (SIR, 1.46; 95% confidence interval [CI], 1.31-1.62; excess absolute risk [EAR], 2.72 per 100,000 person-years). SIRs were 5.20 at ages 0-14, 1.84 at 15-19, 1.17 at 20-29, and 1.23 at 30-39 years. Age patterns varied by latency (interaction p = .0012). At 10 or more years, the childhood SIR was 4.64 (95% CI, 3.22-6.49). The 20-year cumulative incidence after the 2-month landmark was 0.257% (95% CI, 0.193-0.341%) after childhood cancer. CONCLUSION: In this population-based descriptive analysis, childhood cancer survivors had the greatest relative excess incidence, which remained evident beyond 10 years. Absolute excess and cumulative incidence were small. Joint assessment of diagnosis age and latency characterized patterns obscured by the overall estimate.
Journal of medical Internet researchShaojuan Peng, Xinyu Zhao, Zhenquan Wu, Duo Yuan, Na Duan, Kaixuan Cui, Zhen Yu, Weihua Yang, Wenbin Wei, Wei Chi, Guoming Zhang
BACKGROUND: Retinopathy of Prematurity (ROP) is a leading cause of preventable childhood blindness; yet, a global shortage of experienced pediatric ophthalmologists impedes timely diagnosis and treatment. While emerging AI chatbots are promising clinical decision-support tools in some ophthalmic diseases, their performance in ROP diagnosis and providing treatment suggestions remains uncertain. OBJECTIVE: This study aimed to compare the performance of Google's Gemini 2.5 Pro and OpenAI's ChatGPT o4-mini in ROP diagnosis and providing treatment suggestions against the gold standard of clinical consensus. METHODS: A retrospective analysis was conducted on 70 infants (140 eyes) with treatment-requiring ROP, each providing structured clinical text data and wide-field fundus images. We adopted a 2-stage prompting strategy for AI chatbots, instructing them first to generate ROP diagnoses (including zone, stage, and presence of plus disease), and subsequently to provide treatment suggestions. After collecting the generated responses, we assessed their performance by comparing the consistency of their diagnosis and treatment suggestions with the consensus gold standard. Furthermore, 2 independent specialists quantitatively assessed the outputs of Gemini 2.5 Pro and ChatGPT o4-mini using the ROP-specific Global Quality Score (GQS), which is a 5-point scale ranging from 1 (unusable) to 5 (excellent). Statistical significance was set at P<.05, and all statistical analyses were performed using R (version 4.4.1; R Foundation for Statistical Computing). RESULTS: For the tasks of ROP zoning and staging, the consistency rates between Gemini 2.5 Pro and ChatGPT o4-mini were 79.3% (111/140) vs 85.7% (120/140; zone), 64.3% (90/140) vs 70.0% (98/140; stage), respectively. For the task of treatment requirement, the rates (also referred to as sensitivity) were 93.6% (131/140) vs 90.7% (127/140), respectively. None of these differences were statistically significant (P>.05). However, Gemini 2.5 Pro showed significantly better performance in plus disease identification (consistency: 108/140, 77.1% vs 80/140, 57.1%; P=.006), while ChatGPT o4-mini demonstrated significantly higher guideline adherence in treatment modality suggestions based on gold-standard ROP diagnoses (consistency: 91/140, 65.0%; vs 55/140, 39.3%; P=.01). Compared to Gemini 2.5 Pro, ChatGPT o4-mini performed better in providing ROP treatment suggestions (GQS score; P=.001), while the 2 AI chatbots had comparable GQS scores in diagnostic tasks. CONCLUSIONS: ChatGPT o4-mini shows greater promise in generating evidence-based treatment suggestions based on gold-standard diagnoses, whereas Gemini 2.5 Pro shows advantages in visual interpretation, supporting its potential for targeted ROP diagnostic screening, particularly in identifying plus disease. As these AI chatbots continue to evolve, their performance merits further validation using larger cohorts.
BMJ case reportsSujith Botsa, Sanjana Somanath Hansoge, Nishant Banait, Amit Kumar
This case report details a neonate diagnosed with arthrogryposis multiplex congenita (AMC), specifically the amyoplasia subtype, presenting with bilateral talipes equinovarus, elbow contractures, ulnar deviation of the wrists and clinodactyly. Additional clinical findings included mild developmental dysplasia of the hips and a small atrial septal defect. Genetic analysis revealed heterozygous variants of uncertain significance in the SYNE1 and CHD4 genes, both of which were inherited from asymptomatic parents. While SYNE1 is associated with autosomal recessive AMC type 3 and CHD4 with Sifrim-Hitz-Weiss syndrome, the contribution of these genes to this patient's phenotype remains unclear. This case underscores the diagnostic complexities of AMC and highlights the necessity for further genetic investigations and long-term follow-up to clarify genotype-phenotype correlations.
Annals of medicineSuiyuan Lin, Jingming Yao, Qingxian Fu, Yali Wu, Shiqu Deng, Bin Wang
BACKGROUND: Urinary tract infections (UTIs) are common in pediatrics. This study aimed to develop and validate a machine learning model for predicting urine culture positivity in children with suspected UTIs and to characterize regional pathogen and antimicrobial resistance profiles. METHODS: Clinical and laboratory data were collected from children with suspected UTIs. Variables were selected via univariate analysis, LASSO regularization, and recursive feature elimination. Machine learning models were constructed using selected variables, followed by validation and interpretability analysis. A web application was developed to assist in the early prediction of urine culture positivity. RESULTS: Infants aged 0-12 months accounted for 61.10% of enrolled children. The overall positive rate of urine culture was 42.17%, higher in boys. Gram-negative bacteria dominated the pathogen spectrum, with the two major strains exhibiting high rates of resistance to first- to third-generation cephalosporins and susceptibility to β-lactam/β-lactamase inhibitor combinations and carbapenems. Seven variables were used to construct seven machine learning models, among which the random forest (RF) model yielded the best performance, with an AUC of 0.814 (95% CI: 0.742-0.875), and sensitivity of 0.770 (95% CI: 0.662-0.865). A web-based calculator was established for individualized prediction. CONCLUSIONS: We developed an RF-based online tool using seven routine laboratory parameters, demonstrating favorable predictive performance for pediatric urine culture positivity. Furthermore, our mapped local pathogen and antimicrobial resistance profiles help clinicians initiate rational empirical antibiotic therapy.
BMJ openLuna Khanal, Karina Cernioglo, Jennifer T Smilowitz, J Bruce German, Mark A Underwood, Kara Kuhn-Riordon, Nicole T Cacho
INTRODUCTION: An adequate supply of a mother's own milk plays a critical role in optimising health outcomes for at-risk hospitalised infants. Insufficient milk production disproportionately affects the mothers of these infants. In the USA, metoclopramide is the only approved drug available for off-label use as a galactagogue. Nicotinamide riboside (NR), a direct precursor to nicotinamide adenine dinucleotide (NAD+), has been shown in a murine model to augment high-quality milk production and enhance cognitive and physical development of pups. Human testing with NR has been limited, and studies in lactating individuals have not been performed. The aim of this study is to assess the feasibility of NR supplementation in mothers whose infants are admitted to the neonatal intensive care unit (NICU) for at least 4 weeks. METHOD AND ANALYSIS: This double-blind, randomised, placebo-controlled pilot feasibility trial aims to investigate NR supplementation in mothers of infants who are anticipated to be hospitalised in the NICU for at least 4 weeks. We plan to enroll 40 mother-infant pairs with the expectation that 30 will complete the study (n=15 in each group). The intervention period with maternal NR supplementation or placebo supplementation and maternal milk, urine and blood sampling will be 19 days, including an enrollment day.The primary endpoint of the study includes feasibility of enrolling ≥50% of eligible mothers. Secondary endpoints include compliance, adherence or withdrawal from the protocol. Similarly, the study will assess the difference in mean milk volume, macronutrient and micronutrient content, human milk glycans, milk and urine metabolites and infant feeding practice between the two groups. Optional secondary endpoints include differences in serum prolactin, liver function, plasma lipidome, serum metabolites, serum cellular communication network factor 3 concentrations, serum NAD+-related precursors and intermediates between mothers of the two groups. Exploratory outcomes include changes in mothers' weight and infants' developmental and NICU outcomes. Safety endpoints include the frequency of adverse events. ETHICS AND DISSEMINATION: The Institutional Review Board (IRB) protocol version date is 1 June 2026, approved by the IRB at the University of California Davis Medical Center (approval number: 1557473). Study investigators will communicate trial results to participants, healthcare professionals and the public through peer-reviewed publications and presentations at scientific conferences. Trial results will also be reported on ClinicalTrials.gov and made available through PubMed Central, in accordance with regulatory requirements. Deidentified participant data will be available to qualified researchers upon request after publication. Approved requests will be granted access within 12 months and are subject to study team and IRB approval and a data use agreement. TRIAL REGISTRATION NUMBER: NCT04614714.
BMJ openHaribondhu Sarma, Salvador Amaral, Milena Santos Lay, Lesy Careca Atok, Tessa Oakley, Nevio Sarmento, Domingos Soares, Kathryn Bright, Carolina Da Costa Maia, …
INTRODUCTION: Child undernutrition remains a major public health problem in low- and middle-income countries. Timor-Leste has one of the highest childhood stunting rates worldwide, affecting an estimated 47% of children under 5 years. Repeated exposure to enteric pathogens is increasingly recognised as a contributor to malnutrition, yet the interplay between enteric infection, environmental exposure and socioeconomic factors remains poorly understood in this setting. This protocol describes a longitudinal birth cohort study, conducted within a One Health framework, examining early-life enteric pathogen exposure and its relationship with nutritional outcomes in Timor-Leste. METHODS AND ANALYSIS: This mixed-methods longitudinal birth cohort study, part of the Bacteria, Enteropathy and Nutrition research programme, is being conducted in three municipalities of Timor-Leste (Dili, Ermera and Ainaro) from November 2024 to October 2027. We will recruit 450 infants at birth and follow them for 24 months, with home visits at 3 monthly intervals in year 1 and 6 monthly intervals in year 2. Faecal, food, water, soil and domestic animal samples will be tested for bacterial, viral and parasitic pathogens; child growth will be assessed using anthropometry. Structured surveys, household observations and in-depth interviews will capture food safety practices, feeding behaviours and socioeconomic factors. Associations between enteric infection and child growth will be assessed using multivariable regression and longitudinal mixed-effects models; qualitative data will be analysed thematically. ETHICS AND DISSEMINATION: Ethical approval has been granted by the Human Research Ethics Committee and Veterinary Research Ethics Committee of the Ministry of Health, Timor-Leste (1827/INSP-TL/UEPD-AL/X/2024), Menzies School of Health Research (EC00153) and the Australian National University (H/2024/0964). Written informed consent will be obtained from parents or guardians. Findings will be disseminated through peer-reviewed publications, conference presentations, community workshops and policy briefs in English and Tetum.
BMJ (Clinical research ed.)Zhongsong Zhang, Alexander Ploner, Verena Sengpiel, Nestory Kasheshi, Bo Jacobsson, Joakim Dillner, Pär Sparén, Cecilia Kärrberg, Jiayao Lei
OBJECTIVE: To evaluate the association between quadrivalent human papillomavirus vaccination before pregnancy and subsequent risk of adverse pregnancy outcomes. DESIGN: Nationwide, population based matched case-control study. SETTING: Population of Sweden, from 1 January 2006 to 31 December 2023. PARTICIPANTS: 624 713 singleton births among nulliparous women aged 16-35 years in Sweden between 2006 and 2023; 92 620 (14.8%) women had received quadrivalent human papillomavirus vaccination before pregnancy. MAIN OUTCOME MEASURES: Risk of adverse pregnancy outcomes associated with quadrivalent human papillomavirus vaccination, with preterm birth (<37 weeks), including its subtypes, and spontaneous preterm birth as primary outcomes and preterm prelabour rupture of membranes, prelabour rupture of membranes, small for gestational age infant (<10th centile), severe small for gestational age infant (<3rd centile), stillbirth, and neonatal mortality as secondary outcomes. Effect modification by age at human papillomavirus vaccination was assessed. Conditional logistic regression was used to estimate odds ratios and adjusted odds ratios with 95% confidence intervals (CIs). RESULTS: After adjustment for confounders, quadrivalent human papillomavirus vaccination was associated with lower odds of all included adverse pregnancy outcomes. Statistically significant associations were observed for preterm birth (<37 weeks) (adjusted odds ratio 0.95, 95% CI 0.91 to 0.99), very preterm birth (28 weeks to 31 weeks) (0.85, 0.75 to 0.97), spontaneous preterm birth (0.95, 0.91 to 0.99), preterm prelabour rupture of membranes (0.93, 0.87 to 1.00), and severe small for gestational age infant (0.92, 0.87 to 0.97). Risk reduction was generally more pronounced among women vaccinated at younger ages. CONCLUSIONS: Quadrivalent human papillomavirus vaccination before pregnancy was associated with a lower risk of adverse pregnancy outcomes, particularly among women vaccinated at earlier ages, extending benefits of human papillomavirus vaccination beyond cancer prevention.
Gut microbesAnna Voulgari-Kokota, Els Janson, Ineke Heikamp de Jong, Jan Knol, Ruurd van Elburg, Niek E van der Aa, Lisa M Hortensius, Jeroen Dudink, Caroline G M de Theij…
Preterm birth, a major cause of brain injury, is often linked to dysregulated gut microbiome development. This association underscores microbial metabolic function as a modifiable target to support neurodevelopment. In this secondary analysis of data derived from a randomized controlled trial (Trial Registration: ISRCTN96620855), we tested whether daily nutritional supplementation with Bifidobacterium breve M-16V, short- and long-chain oligosaccharides, and L-glutamine could steer the gut microbiome of very and extremely preterm infants toward communities that support brain maturation. The gut microbiome was profiled with longitudinal shotgun metagenomics at nine time points during the intervention, which started at 48-72 h after birth and continued until 36 weeks postmenstrual age. Additionally, MRI scans were conducted when infants reached term-equivalent age to evaluate brain maturation. Supplementation promoted the early establishment of Bifidobacterium-rich communities in the test group, with enhanced capacity for amino acid biosynthesis and pyruvate fermentation towards acetate and lactate production. Integration of microbiome data with brain developmental markers post hoc showed that the same functions were markedly reduced in infants with delayed white-matter myelination. By integrating microbiome functional capacity profiling and evaluation of brain maturation via MRI, this study demonstrated that early microbial modulation could influence brain development, positioning the preterm gut microbiome as a clinically actionable target.
European journal of pediatricsNikolina Zdraveska, Aco Kostovski, Thilo Reich, Deborah K Hill, Lobke M Gierman, Timothy M Bahr
UNLABELLED: Previous publications have reported the accuracy of the Picterus Jaundice Pro (Picterus JP), a smartphone-based medical device app for screening neonatal jaundice prior to phototherapy. The purpose of this study was to evaluate the accuracy of the Picterus JP app before and during phototherapy. Between April 2025 and April 2026, newborns whose total serum bilirubin concentration (TSB) reached or exceeded the American Academy of Pediatrics phototherapy thresholds were enrolled in the study after written informed consent was obtained from their parent or legal guardian. A Picterus JP scan was obtained from the chest of the newborn (within 60 min of the TSB blood sample collection), a light-occlusive patch was placed on the newborn's chest, and phototherapy was initiated. Then, up to five Picterus JP scans per newborn were obtained from the newborn's chest, from the region covered by the phototherapy patch, within one hour of the blood collection for subsequent TSBs. We calculated diagnostic accuracy statistics to summarize the accuracy of Picterus JP. A total of 137 paired Picterus JP-TSB measurements were analyzed. Overall, Picterus JP correlated well with TSB (r = 0.720; bias - 38.5 µmol/L; RMSE 73.7 µmol/L). Restricted to a phototherapy course of ≤ 3 days, correlation was strong before phototherapy (n = 45 measurements; r = 0.849; bias - 46.5 µmol/L; RMSE 65.3 µmol/L) and weaker during phototherapy (n = 83 measurements; r = 0.520; bias - 40.7 µmol/L; RMSE 79.6 µmol/L), although the magnitude of bias and RMSE was similar in both periods. The relative (fractional) decline in Picterus JP during phototherapy correlated well with the relative decline in TSB (n = 97 paired change measurements; r = 0.752), and the direction of the bilirubin trend agreed between methods in 83% of assessed trajectories. A fixed offset correction reduced the bias during phototherapy from - 40.7 to + 5.8 µmol/L. CONCLUSION: Although the correlation between Picterus JP results and TSB measurements decreased during phototherapy, the direction of change in Picterus JP results almost always agreed with the direction of change in associated TSB measurements. This suggests that Picterus JP may be useful for monitoring bilirubin trends and treatment response during phototherapy, while also providing non-invasive bilirubin assessment before treatment initiation. WHAT IS KNOWN: • Total serum bilirubin (TSB) is the reference standard for guiding phototherapy but requires invasive blood draws; smartphone-based tools are validated mainly before phototherapy. WHAT IS NEW: • Picterus JP tracked bilirubin trends during phototherapy despite reduced correlation; an offset correction reduced bias, extending validation to severe hyperbilirubinemia.
BACKGROUND: Protected sleep is a core component of developmental supportive care in neonates. However, the overstimulating neonatal intensive care unit (NICU) environment and procedures often disrupt neonatal sleep periods. With improving neonatal survival rates in low- and middle-income countries like India, focus must shift towards ensuring neurologically intact outcomes. We implemented a point of care quality improvement initiative using environmental modification to improve sleep duration in neonates admitted to the low dependency unit (LDU) of our NICU. METHODS: This prospective quality improvement study was conducted at a tertiary care teaching hospital in North India from May to August 2024. All stable neonates admitted to the LDU during the study period were enrolled. Four sequential plan-do-study-act (PDSA) cycles were implemented, targeting cyclic lighting, noise reduction through alarm management and equipment repair, staff sensitisation and caregiver involvement. The primary outcome was the proportion of neonates achieving adequate sleep duration of more than 16 hours/day. RESULTS: A total of 625 neonates were enrolled across three phases (baseline: n=115; implementation: n=312; post implementation: n=198). The proportion of neonates achieving adequate sleep increased from 15.7% at baseline to 62.2% during implementation and sustained at 58.1% post implementation. Mean sleep duration increased significantly from 12.95±3.22 to 16.38±3.12 hours/day (p<0.001). Environmental parameters also improved, with daytime mean light intensity reducing from 486±124 to 285±98 lux and mean noise levels decreasing from 62.4±8.3 to 52.8±6.5 dB. CONCLUSION: Simple, low-cost environmental modifications implemented through sequential PDSA cycles can significantly improve sleep duration in NICU neonates.
European journal of pediatricsAnouk Minodier, Brigitte Fauroux, Laurianne Coutier, Céline Delestrain, Sylvain Renolleau, Pierre-Henri Jarreau, Alice Hadchouel
UNLABELLED: Management of severe bronchopulmonary dysplasia (sBPD) remains challenging and poorly standardized. In 2021, France established multidisciplinary team meetings (MDT) dedicated to sBPD patients. This study described discussed patients, their outcomes and physicians' satisfaction. This multicenter retrospective observational and uncontrolled study included patients presented between June 2021 and September 2024 at the MDT. Data were collected from medical records and the RespiFil database. Questionnaires evaluated physicians' satisfaction and patient outcomes. The data of 38 patients, median gestational age 26 weeks and median age at presentation 46 weeks' postmenstrual age, were analyzed. Systemic steroids were administered before 36 weeks in 31/36 (86%) of the patients. Ventilatory weaning was recommended in 23/37 patients (62%). Recommendations were fully followed in 30/36 patients (83%). Satisfaction was rated between 8 and 10/10 on a 10-point scale by 28/30 physicians (93%). Physicians rated the benefit they perceived for their patients between 8 and 10 on a 10-point scale in 27/36 patients (75%). The frequency of the meetings needed to be increased over time to meet the demand of physicians. At a median follow-up of 11 months, 32/38 patients (84%) were reported as clinically improved and 24/34 lived patients (71%) were weaned from ventilatory support and oxygen. CONCLUSION: This descriptive study shows that sBPD MDT is feasible, well accepted by referring physicians, with high adherence to recommendations. By supporting coordinated and individualized care, they may help harmonize practices across centers. Comparative studies are now needed to evaluate their impact on patient outcomes. WHAT IS KNOWN: • Management of severe bronchopulmonary dysplasia (sBPD) remains challenging owing to its multifactorial origin and the lack of standardized treatment. • Multidisciplinary team meetings (MDT) are well-established, effective tools in oncology and rare diseases. WHAT IS NEW: • This study is the first multicenter report describing the implementation, feasibility and sustainability of an sBPD-dedicated MDT. • 93% of responding physicians reported high satisfaction, and recommendations were fully followed in 83% of cases supporting the feasibility and acceptability of this model, whose impact on clinical outcomes remains to be prospectively evaluated.
Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and GynaecologyKübra Kurt Bilirer, Hale Özer Çaltek, Barış Boza, Selvi Aydın Şenel, Hamdullah Pekkolay, Mehmet Gümüştaş
BACKGROUND: Foetal situs abnormalities, including situs inversus totalis (SIT), right atrial isomerism (RAI) and left atrial isomerism (LAI), are associated with substantial variation in cardiac anatomy and postnatal outcomes. This study aimed to compare prenatal characteristics, associated abnormalities, perinatal outcomes, postnatal management and survival among foetuses with SIT, RAI and LAI. METHODS: This retrospective cohort study included 73 foetuses prenatally diagnosed with SIT (n = 12), RAI (n = 24) or LAI (n = 37) at a tertiary foetal cardiology and perinatology centre between 2021 and 2025. Prenatal cardiac and extracardiac findings, pregnancy and neonatal outcomes, postnatal surgical management pathways, and survival were evaluated. Survival was assessed using Kaplan-Meier's analysis, and factors associated with 1-year mortality were examined using Cox proportional hazards regression. RESULTS: Cardiac phenotypes differed significantly among groups. Interrupted inferior vena cava (IVC) occurred predominantly in LAI, whereas aortic-IVC juxtaposition, double-outlet right ventricle, anomalous pulmonary venous return and unbalanced atrioventricular septal defect were more frequent in RAI. Arrhythmias occurred exclusively in LAI. Postnatal surgical management pathways differed significantly among groups (p = 0.001), with univentricular pathway most frequent in RAI. Survival distributions did not differ significantly among SIT, RAI and LAI (log-rank p = 0.193). Exploratory multivariable analysis showed an association between right ventricular outflow tract obstruction (RVOTO) and increased 1-year mortality (HR 4.79, 95% CI 1.51-15.10; p = 0.008). CONCLUSIONS: Prenatally diagnosed SIT, RAI and LAI demonstrate distinct cardiac phenotypes and postnatal management requirements. Prognosis appears to depend not only on the laterality phenotype but also on specific cardiac morphology, with RVOTO emerging as an important prognostic marker. Detailed segmental foetal echocardiography may improve prenatal risk stratification, counselling and postnatal management planning.
INTRODUCTION: Neonatal intensive care unit (NICU) evacuation poses distinct operational and ethical challenges because neonates often depend on continuous life-sustaining technologies and specialized care. Although several neonatal or pediatric disaster triage systems have been proposed, actual NICU evacuation cannot be ethically or practically tested under controlled disaster conditions. A reproducible framework comparing evacuation-order strategies is therefore needed. STUDY OBJECTIVE: This study aimed to develop and apply a reproducible simulation framework for NICU evacuation-order evaluation and, within that framework, to compare structured triage with evacuation without triage and quantitative with categorical neonatal triage approaches. METHODS: A retrospective simulation study was conducted using routinely recorded clinical triage assessments from a tertiary NICU, comprising 1,079 patient evaluations in 162 neonates across 49 triage days. During clinical practice, clinical severity and triage status had been recorded using the Neonatal Therapeutic Intervention Scoring System (NTISS), Neonatal Extrication Triage (NEXT), and Simple Triage and Rapid Treatment for Neonates, Revised (START-Neo-R); NEXT was a quantitative six-domain resource-dependency score ranging from zero to 12, whereas START-Neo-R was a five-level categorical neonatal triage system. Three evacuation strategies were evaluated: descending-order evacuation using NEXT, descending-order evacuation using START-Neo-R, and evacuation without triage. Evacuation-order performance was quantified using the Total Evacuation Score (TES), defined as the time integral of cumulative NTISS scores among patients remaining in the NICU across sequential evacuation steps. The TES distributions were compared descriptively across strategies rather than inferentially. RESULTS: Within the 49 observed triage days, both structured triage strategies generated TES distributions shifted lower than those from evacuation without triage. In the direct comparison between NEXT and START-Neo-R, the worst-case TES under NEXT was lower than more than one-half of the START-Neo-R TES distribution on 34 of the 49 observed triage days (69.4%). CONCLUSION: In this simulation study using real-world NICU data, TES provided a reproducible framework for comparing neonatal evacuation-order strategies under explicit assumptions. Within this TES-based framework, structured triage generated TES distributions shifted lower than those from evacuation without triage, and NEXT showed a more favorable distribution-based pattern than START-Neo-R on most observed days. These findings suggest that TES-based evaluation may help identify triage strategies that support more transparent and testable NICU evacuation planning.
BMJ openVictoria Cornelius, James P Boardman, David Quine, Sabita Uthaya, Shalini Ojha, Hilary S Wong, Annemarie Lodder, Lauren Ingledow, Peter Bradley, James M S Waso…
INTRODUCTION: Enteral feed type is widely believed to affect brain growth and development directly as well as influencing the risk of necrotising enterocolitis (NEC), a leading cause of death and neuro-impairment in extremely preterm babies. Own mother's milk (OMM) enhances neurodevelopment and reduces NEC. However, most babies born below 29 weeks gestation require some supplementary feeds during their neonatal unit stay because their mothers are unable to express sufficient milk. The available options, pasteurised human donor milk (pHDM) and preterm formula (PTF), differ markedly in nutrient and non-nutrient composition and cost. Non-definitive data suggest superiority of pHDM over PTF in relation to NEC risk, but no benefits have been shown in important corroboratory outcomes: surgical NEC, death, blood stream infection and neurodevelopmental impairment.Human milk macronutrient content is variable and often low, hence some clinicians practise routine protein-carbohydrate fortification. Others fear that cow-milk derived fortifiers may increase NEC risk or may provide excessively high protein intakes dangerous to neurodevelopment and metabolic health. These uncertainties compromise patient care and safety and are strong justification for randomised evaluation. METHODS AND ANALYSIS: COLLABORATE is an efficient UK-wide, real-world data-enabled, 2-randomisation, group-sequential adaptive trial embedded in routine clinical practice. The primary outcome is survival to 34 weeks postmenstrual age without NEC surgery. The aim is to resolve two longstanding nutritional uncertainties for babies born below 29 weeks gestation: whether pHDM or PTF is the optimal supplement should there be an insufficiency of OMM; and whether OMM and pHDM require routine protein-carbohydrate fortification. Based on the assumption that 50% of participants will take part in both randomisations, total recruitment is targeted at 3252 (5% between-arm primary outcome difference; α=0.05; minimum 87% power). ETHICS AND DISSEMINATION: COLLABORATE is funded by the UK National Institute for Health and Care Research, sponsored by Imperial College London and approved by the UK Health Research Authority (reference 25/LO/0697). Recruitment commenced in April 2026. Results will be shared through academic and lay publications, conferences, workshops, social media and strong personal networks. TRIAL REGISTRATION NUMBER: ISRCTN10443084.
PloS oneMasawa K Nyamuryekung'e, Kokila Lakhoo, Salome Maswime
BACKGROUND: Structural birth defects cause disproportionate neonatal and under-five morbidity and mortality in low- and middle-income countries, where 90-95% of births and associated deaths occur; however, health-system readiness for prevention uptake, early detection, and management remains poorly understood. Anorectal malformations account for 33-40% of the paediatric surgical workload in sub-Saharan Africa, making it a tracer condition for evaluating Tanzania's capacity across primary, secondary, and tertiary prevention levels. Although delayed detection, high postoperative morbidity, and referral dysfunction are documented, the upstream preconception, antenatal, delivery, and postnatal profile, parental lived experience, external benchmarking of paediatric surgical capacity, and feasibility of a context-specific preoperative checklist remain to be quantified within the Tanzanian clinical environment. METHODS: This multi-phase mixed-methods protocol comprises four phases. In Phase I, all mother-newborn dyads where the infant has an anorectal malformation presenting to Muhimbili National Hospital will be enrolled in a cross-sectional study quantifying preconception, antenatal, delivery, and postnatal prevention uptake; multivariable logistic regression will identify predictors of early detection; the sample size will be derived via Cochran's formula using finite population correction. Phase II will use descriptive phenomenology through purposive in-depth interviews with parents exploring socio-cultural access determinants, analysed via the Stevick-Colaizzi-Keen method. Phase III will conduct a facility-level survey against the Optimal Resources for Children's Surgery checklist at four tertiary hospitals; domain-specific and total compliance scores will be calculated, gaps quantified against benchmarks, and centres compared using Friedman tests and chi-square or Fisher's exact tests. Phase IV will test feasibility of a preoperative anorectal malformation checklist at Muhimbili National Hospital, examining practicality and acceptability (non-parametric comparisons). DISCUSSION: This study will produce a system-level appraisal of Tanzania's capacity to prevent, detect, and manage major structural birth defects using anorectal malformation as a tracer condition. Findings will inform policy, guide resource allocation, and support targeted interventions.
PloS oneMiguel San Sebastián, Osvaldo Fonseca-Rodriguez, Wilmer Tarupi, Sara Castel-Feced
BACKGROUND: There is a scarcity of cancer studies in the Amazon region. This study aimed to analyse trends in cancer incidence within the Ecuadorian Amazon between 1990 and 2019, identifying the most prevalent cancer types and assessing their provincial and temporal distribution. METHODS: A retrospective analysis was conducted using data from the Quito population-based cancer registry, focusing on patients whose habitual residence was in the Amazonian provinces of Sucumbíos, Orellana, Napo, and Pastaza. Age- and sex-standardised incidence rates were calculated, employing Segi's world standard population as the reference. RESULTS: A total of 4,881 cancer cases were identified, revealing a 357% increase in the number of recorded cancer cases from the first to the last study period. Among men, the most common cancer types were stomach, prostate, and non-melanoma skin cancers, whereas in women, cervical, breast, and thyroid cancers predominated. Notably, there was a particularly high increase in prostate and breast cancer cases. CONCLUSIONS: The findings indicate an important increase in recorded cancer cases and age-standardized incidence rates in the Ecuadorian Amazon, highlighting the urgent need to enhance healthcare infrastructure and cancer registry systems in the region. Targeted prevention and early detection programmes tailored to the specific needs of this population are urgently needed.
BACKGROUND: Infant mortality refers to the death of an infant before their first birthday. In 2021, approximately 3.8 million infants died worldwide. While interventions have reduced infant mortality rate (IMR) globally, Sub-Saharan Africa (SSA), particularly East Africa, still faces high IMR. Despite many studies, evidence regarding on the impact of spatial effects remain limited. This study aimed to incorporate spatial random effects to identify factors associated with infant mortality. METHODS: Secondary data analysis was conducted using a total weighted sample of 101,532 infants from DHS data collected between 2015 and 2022 in East Africa. STATA version 14 was used for data cleaning, and R version 4.3.1 was used for data analysis. A Bayesian spatial frailty analysis model was fitted, and convergence was checked using trace plot. The model goodness of fit was assessed using Cox-snell residual plot. RESULTS: The IMR was 39.83 per 1000 live births (95% CI: 35.81-44.27). Breastfeeding initiation time after 24 hours (HR = 4.033, 95% CrI: 3.869-4.207), not having antenatal care (ANC) follow-up (HR = 1.534, 95% CrI: 1.259-1.869), maternal age between 15 and 24 years (HR = 1.256, 95% CrI: 1.11-1.411), low birth weight (HR = 1.575, 95% CrI: 1.388-1.770), plurality (HR = 4.0, 95% CrI: 3.334-4.746), parity more than ten (HR = 2.173, 95% CrI-1.4413.125), parity between five and ten (HR = 1.264, 95% CrI: 1.075-1.472), being a male child (HR = 1.276, 95% CrI: 1.149-1.411), and maternal employment status (HR = 0.740, 95% CrI: 0.606-0.909) were factors associated with infant mortality. High frailty was detected in northern and southwestern Malawi and in the western regions of Mozambique, Zambia, and Burundi. CONCLUSION: The pooled IMR was higher than the global estimate of IMR. Infant mortality was associated with maternal, infant, and reproductive factors. In addition, high spatial frailty was observed in some areas, suggesting the presence of unmeasured regional factors related to geographic location. These findings call attention to the need for policies that focus on strengthening antenatal care coverage, promoting early initiation of breastfeeding, improving maternal socioeconomic empowerment, and prioritizing high-frailty areas through resource allocation to reduce infant mortality.
BMJ openRitah Nantale, David Mukunya, Julius N Wandabwa, Agnes Napyo, Albert Ssesanga, Eunice Akello, Kenneth Tulya-Muhika Mugabe, Brenda Nambozo, Faith Oguttu, John S…
OBJECTIVE: To assess the effect of introducing the Moyo device for continuous intrapartum fetal heart rate monitoring (FHRM) on the detection of abnormal fetal heart rate patterns and perinatal mortality. DESIGN: We conducted a quasi-experimental quality improvement project using a before-and-after approach. During the preimplementation phase, intermittent FHRM was done using the existing standard of care (Pinard or a hand-held fetal Doppler). In the postimplementation phase, we introduced the Moyo device (Laerdal Global Health, Stavanger, Norway) for continuous intrapartum FHRM. We used the non-participant observation technique to collect data. SETTING: Mbale Regional Referral Hospital in Eastern Uganda, 6 November 2023 to 17 August 2024. PARTICIPANTS: We enrolled 1544 women with high-risk pregnancies. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was perinatal mortality, defined as death in labour and up to 24 hours postnatal. The secondary outcomes included detection of abnormal fetal heart rates, Apgar scores less than 7 at 1 and 5 min and mode of birth. We conducted generalised linear regression models of the binomial family with a log link and robust variance estimation. RESULTS: Mortality preimplementation was 5.1%; following the introduction of the Moyo device, it fell to 3.2%, a non-statistically significant reduction of 37% (adjusted prevalence ratios (aPRs): 0.63 (95% CI 0.39 to 1.02)). There was a 14.8% increase in the number of women whose fetal heart rate was monitored and documented during the postimplementation period (81.1% vs 95.9%) and detection of abnormal fetal heart rate was increased by 41% (aPR: 1.41 (95% CI 1.10 to 1.82)). The rate of caesarean section deliveries was similar in the preimplementation and postimplementation period (59.5% vs 63.1%, p=0.144). Newborn morbidities were lower in the postimplementation phase compared with the preimplementation phase: Apgar score <7 at 1 min (aPR: 0.67; 95% CI 0.54 to 0.85), Apgar score <7 at 5 min (aPR: 0.57; 95% CI 0.39 to 0.84), transfer of newborn to postnatal ward (aPR: 1.11; 95% CI 1.05 to 1.17), and transfer of newborn to the neonatal unit (aPR: 0.72; 95% CI 0.59 to 0.87). CONCLUSIONS: Introduction of the Moyo device for continuous FHRM was associated with a reduction in perinatal morbidity among women with high-risk pregnancies. We recommend a stepped-wedge trial to evaluate the cost-effectiveness of scaling up the use of Moyo in lower-health facilities.
Severe Factor V deficiency (parahaemophilia) is a rare autosomal recessive coagulation disorder with a highly variable clinical phenotype. We report the incidental detection of isolated severe Factor V deficiency (<1% activity) in a completely asymptomatic primigravida during routine preoperative evaluation prior to an elective caesarean section. Despite marked prolongation of prothrombin time and activated partial thromboplastin time, the patient had no prior bleeding history. Mixing studies and a normal thrombin time localised the defect to the common pathway, which was confirmed by factor assay. Management involved multidisciplinary planning, peri-operative fresh frozen plasma transfusion and avoidance of neuraxial anaesthesia. The patient underwent caesarean section under general anaesthesia and delivered a healthy neonate without maternal or neonatal complications. This case highlights the poor correlation between plasma Factor V levels and bleeding phenotype and underscores the diagnostic value of thrombin time in evaluating common pathway coagulation defects.
BMJ openTandekile Lubelwana Hafver, Frankie Achille, Valerie Reinthaler, Sumanth Nagraj, Susan Banda, Willem Odendaal, Idriss I Kallon, Moriam Chibuzor, Dachi Arikpo, …
OBJECTIVES: To optimise the dissemination of clinical practice guideline (CPG) summary infographics on newborn and child health to healthcare workers (HCWs) in Malawi, Nigeria and South Africa. DESIGN: Qualitative user testing using think-aloud interviews with local HCWs to identify their preferences for and barriers to using CPG summary infographics. PARTICIPANTS: 26 HCWs involved in newborn and child healthcare, including participants from Lilongwe (n=8), Calabar (n=10) and Cape Town (n=8). INTERVENTIONS: Draft CPG summary infographics on newborn and child health topics explored by participants during interviews. PRIMARY AND SECONDARY OUTCOMES: Participants' perceptions of the infographics in terms of findability, usability, understandability, desirability, identification, accessibility, credibility, usefulness and value. RESULTS: Most participants found the infographics easy to understand and appreciated the visual design. However, participants had difficulty interpreting the strength of recommendations and were sometimes unclear about the target population and distinction between interventions and comparators. Navigation and the use of medical terminology also presented challenges, while some images did not reflect the local clinical environments. Perceptions of usefulness varied across guideline topics and countries. CONCLUSIONS: User testing identified important barriers to the use of CPG summary infographics. Feedback informed revisions to the infographics before final dissemination, including clarifying the meaning of recommendation strength, adjusting terminology, bringing key content to the foreground and refining imagery. Early engagement with end users in the development of CPG dissemination products can help ensure that recommendations are clearly conveyed and that the content and visuals are appropriate to local clinical contexts and needs.
BMJ paediatrics openFlorence Vunoro Murila, Martin Jalemba Aluvaala, Fred Were, Moses Madadi Obimbo
BACKGROUND: Despite the high burden of global childhood hearing loss, compliance with universal newborn hearing screening (UNHS) guidelines is low in many low- and middle-income countries, including Kenya. Preterm infants are especially prone to an increased risk of hearing loss due to the associated perinatal and neonatal morbidities. The objectives of this study were to investigate the prevalence and risk factors of failed hearing screening in preterm newborns. METHODS: We conducted a hospital-based prospective cohort study of preterm infants at the Kenyatta National Hospital (KNH) and the Mbagathi County Referral Hospital newborn units (NBUs) in Nairobi, Kenya. Those born at ≤34 weeks' gestational age were recruited and underwent Automated Auditory Brainstem Response (AABR) screening before their discharge. Infant characteristics, maternal demographics, pregnancy complications and neonatal illnesses were documented. Logistic regression was used to assess associations between risk factors and failed hearing screening. RESULTS: Screening was done on 376 infants. The average gestational age was 30.8 weeks and more than half were female (54.5%). Among these, 27 infants were referred (failed hearing screening either in one or both ears), a prevalence of 7.2%. There was no significant correlation with any maternal characteristics like age, attendance of antenatal care and pregnancy complications. However, after multivariable adjustment, clarithromycin remained independently associated (p=0.01) while asphyxia had a borderline association (p=0.05). CONCLUSION: We report a prevalence of failed newborn hearing screening by AABR of 7.2% among preterm infants, substantially higher than the global baseline estimates for the general newborn population. Clarithromycin and birth asphyxia were the only factors associated with a failed hearing screening. These findings underscore the importance of implementing and strengthening UNHS programmes in Kenya and sub-Saharan Africa, with targeted follow-up of preterm and high-risk infants to enable early detection and intervention.
Orphanet journal of rare diseasesLucia Laugwitz, Pascal Martin, Nils Janzen, Sebastian Hegert, Thomas Neiße, Madeleine Wacker, Jan Kern, Nadja Kaiser, Christiane Kehrer, Annina-Clarissa Jaeger…
BACKGROUND: Metachromatic leukodystrophy (MLD) is a rapidly progressive leukodystrophy that leads to severe disability and early death if untreated. Autologous hematopoietic stem and progenitor cell gene therapy (HSPC-GT, atidarsagene autotemcel, arsa-cel) for early onset subtypes and allogenic hematopoietic stem cell transplantation (HSCT) for late onset disease substantially alters disease progression for early onset disease when administered before symptom onset, creating a strong rationale for newborn screening (NBS). At the same time, NBS technique for MLD in dried blood spots has recently been demonstrated to be robust and highly accurate. The aim was to give real-world results from the world's first NBS pilots for clinical management and treatment of identified children. METHODS: Between September 2021 and July 2025, 359,282 newborns underwent NBS for MLD in two different laboratories in Germany and Austria using a three-tier algorithm integrating sulfatide quantification, arylsulfatase A (ARSA) activity measurement, and ARSA sequencing. Screen-positive infants underwent a predefined care pathway including standardized confirmatory diagnostics, genotype-based and biochemical prediction of disease onset, clinical assessment and management guiding early treatment and surveillance at the qualified treatment center (QTC) in Tübingen. RESULTS: Nine newborns screened positive and all were confirmed to have MLD (detection rate approximately 1 per 40,000). Based on genotype and leukocyte ARSA enzyme activity, disease onset prediction was possible in all of them. Seven infants were classified as having pre-symptomatic early-onset MLD and were referred for HSPC-GT. All treated infants showed preserved neurological function up to 30 months after treatment (median 18.5 months). Two infants predicted to develop late-onset MLD entered structured surveillance for treatment with HSCT and have remained clinically asymptomatic for CNS signs of disease. No false-positive or known false-negative results were observed. CONCLUSION: These results from our pilot programs demonstrate that NBS enables reliable early identification of MLD and support streamlined care pathways leading to timely intervention. Importantly, this study provides real-world evidence illustrating that NBS for MLD can enable timely, pre-symptomatic treatment and structured surveillance within standard national healthcare systems. These findings further substantiate the value of NBS for MLD at a critical moment as several countries consider national implementation of MLD screening.
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal ObstetriciansMeng Hou, Weihong Wang, Meili Pei, Lu Zeng, Fanfan Gao
OBJECTIVE: Fetal foramen ovale restriction (FO-R) is an abnormal intracardiac flow disorder that may affect fetal cardiac hemodynamics and perinatal management. This retrospective cohort study aimed to characterize the echocardiographic features, associated abnormalities, and perinatal outcomes of pregnancies complicated by fetal FO-R, providing clinical evidence for obstetric decision-making. METHODS: A total of 283 fetuses diagnosed with FO-R by fetal echocardiography were enrolled. The diagnostic criteria were defined as a foramen ovale (FO) diameter <3 mm and a Doppler flow velocity >40 cm/s. Maternal clinical data, fetal echocardiographic findings, delivery details, and neonatal follow-up outcomes were collected and analyzed systematically. RESULTS: The incidence of FO-R was 1.88% among all fetal echocardiographic examinations. The median gestational age at diagnosis was 35 + 4 weeks, with 11.7% of cases diagnosed before 32 weeks of gestation. Coexisting pregnancy complications or fetal abnormalities were observed in 51.6% of cases, while 41.2% presented with isolated FO-R. Right heart enlargement was the most common associated cardiac finding (74.6%). The cesarean delivery rate was 64.7%, with fetal distress as the leading indication (24.0%). Multivariate analysis showed that FO diameter, timing of diagnosis, and presence of right heart enlargement did not significantly influence the delivery mode (all p > 0.05). Among 240 neonates with complete follow-up data, 27.1% had postnatal cardiac abnormalities, 93.8% of which resolved spontaneously within one year. Only 1.7% of neonates had persistent congenital heart defects. CONCLUSION: Fetal FO-R is mostly diagnosed in the third trimester and is frequently associated with right heart enlargement. Importantly, FO-R does not independently require cesarean delivery or preterm birth. Neonatal outcomes of fetuses with FO-R are generally favorable, with a high rate of spontaneous resolution of postnatal cardiac findings, which supports conservative obstetric management for most cases.
European journal of pediatricsWalusa Assad Gonçalves-Ferri, Vitor Coca Sarri, Cristina Helena F Ferreira, Maria Eduarda Vidoto Martins, Beatriz Tosetto Nogueira, Jucille Meneses, Felipe Yu …
UNLABELLED: Necrotizing enterocolitis (NEC) is a severe condition in preterm infants. Few therapies are available to slow disease progression or reduce the need for surgery. This study aims to assess if mild controlled hypothermia as an adjunctive treatment reduces surgical intervention in preterm infants with NEC. A single-center intervention was conducted from 2019 to 2023 and compared with an external, contemporaneous prospective cohort study. Infants weighing less than 1500 g with moderate NEC were enrolled. One center administered mild hypothermia and served as the intervention cohort. The other seven centers served as contemporaneous controls and provided standard care. The intervention group received mild controlled hypothermia. This targeted a core esophageal temperature of 35.5 °C (± 0.5 °C) for 48 h after NEC diagnosis, in addition to standard medical management. The control group received standard care and maintained normothermia. The primary outcome was the need for surgical intervention due to NEC. All-cause mortality was analyzed using subdistribution hazard ratios (SHR) for competing risks. Inverse probability of treatment weighting (IPTW) adjusted for baseline differences to strengthen causal inference. Among 285 preterm infants, 92 were in the intervention group. This group required fewer surgical interventions (14.13% vs. 46.11%; adjusted relative risk [aRR], 0.30; 95% confidence interval [CI], 0.17-0.53) and showed lower mortality risk (0.59; 95% CI, 0.38-0.93) compared to the control group (n = 193). The incidence of severe neurological outcomes was similar between groups; informative missingness was addressed using deterministic MNAR sensitivity analyses. Conditional inference tree analysis identified hypothermia as the primary protective factor against surgery. CONCLUSION: Mild controlled hypothermia may reduce the need for surgical intervention and improve survival rates, indicating its potential as a promising adjunctive therapy. WHAT IS KNOWN: • Necrotizing enterocolitis (NEC) affects preterm very low birth weight (VLBW) infants with sufficient severity to require surgical intervention. Mortality rates reach 50% in the most vulnerable subgroups. Current medical management has not demonstrated efficacy in halting disease progression or reducing the need for surgery. • Preclinical and pilot studies suggest that adjunctive mild hypothermia (35.5 °C) reduces intestinal inflammation and oxidative stress in NEC. However, no adequately powered multicenter trial has evaluated its clinical effectiveness as an adjunctive therapy. WHAT IS NEW: • Adjunctive mild hypothermia was associated with decreased rates of surgical intervention and reduced all-cause mortality. • Exploratory analyses indicated that adjunctive mild hypothermia was the factor most strongly associated with avoidance of surgery.
BMJ paediatrics openSidra Shafique, Reem Donia, Jocelyn A Srigley, Vanessa Paquette, Claire Hamilton, Bonita Lee, Julie Choudhury, Sarah Khan, Ashraf Kharrat, Cynthia Joly, Shikha…
The escalation of antibiotic-resistant organisms (AROs) represents a formidable challenge to clinical practice and public health globally. Within the landscape of Gram-positive pathogens, methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci remain the most prevalent threats. Concurrently, the rise of Gram-negative AROs, including multidrug-resistant Escherichia coli, Klebsiella pneumoniae and carbapenem-resistant Enterobacterales, has severely curtailed available therapeutic options. These pathogens are associated with significant morbidity and mortality in neonatal intensive care units, where the combination of immunological immaturity and the requirement for invasive interventions places infants at heightened risk. This narrative review synthesises current evidence regarding the microbiology, evolving epidemiology and preventative strategies for AROs within neonatal healthcare settings.
BMJ paediatrics openMona Noureldein, Vincent So, Lamia M Hayawi, Ayman Saker, Laurent Renesme, Anne Tsampalieros, Nadya Ben Fadel
OBJECTIVE: To evaluate the prognostic accuracy of amplitude-integrated electroencephalography (aEEG), cerebral near-infrared spectroscopy (cNIRS) and targeted neonatal echocardiography (TnECHO) for predicting 2-year outcomes (neurodevelopment and/or death) in infants with hypoxic-ischaemic encephalopathy (HIE) treated with therapeutic hypothermia (TH). DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE, Embase, CINAHL and the Cochrane Library (2002-16 April 2025). PROSPERO registration: CRD42023387592. ELIGIBILITY CRITERIA: Prognostic studies including infants ≥35 weeks' gestation with HIE treated with whole-body TH and reporting neurodevelopmental impairment at 18-24 months and/or death. DATA EXTRACTION AND SYNTHESIS: Data were extracted independently. Risk of bias was assessed using Quality in Prognosis Studies. Pooled sensitivity, specificity, diagnostic ORs (DORs) and area under the curve (AUC) estimates were calculated using random-effects models. RESULTS: 37 studies (n=2721) were included; 24 (n=1989) contributed to meta-analysis. Abnormal aEEG background at 36 hours predicted adverse 2-year outcomes with sensitivity 0.83 (95% CI 0.70 to 0.92), specificity 0.88 (95% CI 0.79 to 0.93), DOR 33.06 (95% CI 12.87 to 84.94), AUC (0.88). Absence of sleep-wake cycling had high specificity 0.93 (95% CI 0.88 to 0.96), DOR 30.19 (95% CI 14.47 to 63.01) and AUC 0.88. Abnormal cNIRS demonstrated potential prognostic value at 36-48 hours with specificity 0.97 (95% CI 0.13-1.00), DOR 26.74 (95% CI 4.55 to 157.14) and AUC (0.86) at 36 hours. Acute pulmonary hypertension showed low overall discrimination, DOR 2.17 (95% CI 1.35 to 3.47) and (AUC 0.40). Right ventricular dysfunction showed higher specificity but substantial heterogeneity. CONCLUSIONS: Abnormal aEEG background at 36 hours provides reliable bedside prognostic information for 2-year outcomes in HIE. cNIRS may offer complementary value, whereas there is limited evidence supporting the utility of TnECHO alone. Multimodal methods may improve early prognostication.
Journal of global healthRahima Yasin, Yvonne Tam, Arjumand Rizvi, Tyler Vaivada, Ayesha Arshad Ali, Robert E Black, Jai K Das, Zulfiqar A Bhutta
BACKGROUND: Antenatal care strategies encompass a series of interventions delivered to expectant mothers to optimise both their health outcomes and those of their neonate. We summarise the most recent effect estimates for maternal immunisation, screening and management of infections, pre-existing chronic diseases such as hypertension and diabetes, nutrition, psychosocial interventions for smoking cessation, pre-term pre-labour rupture of membranes, administration of corticosteroids for foetal lung maturation, and induction of post-term labour. METHODS: We synthesised effect estimates for antenatal and intrapartum interventions using PubMed and CENTRAL searches (2022-2023) and in consultation with a technical advisory group to determine whether and how new meta-analysed effect estimates could be incorporated into the Lives Saved Tool (LiST) model, as well as which of these estimates should be updated and which should be retained. RESULTS: Tetanus toxoid vaccination during the antenatal period lead to a significant reduction in neonatal mortality. Antibiotics for pre-term pre-labour rupture of membranes and administration of corticosteroids for foetal lung maturation lead to significant reductions in neonatal mortality due to sepsis and prematurity, respectively. Nutritional interventions including balanced protein and energy supplementation and multiple micronutrient supplementation reduced the risks of small-for-gestational-age babies. Insecticide-treated bed-nets for malaria, antibiotic treatment of syphilis, and post-term induction of labour demonstrated significant reductions in the risks of stillbirth. The effect estimates for preterm births contributed to the LiST model for interventions including treatment of asymptomatic bacteriuria, omega-3 fatty acid supplementation, calcium supplementation, and provision of low-dose aspirin for pre-eclampsia, which projected significant reductions in the risks of small-for-gestational-age babies. CONCLUSIONS: The evidence described here highlights the potential impact of implementing high-yield healthcare packages in context-specific settings to effectively improve neonatal survival. These estimates can be used as inputs to model the impact of antenatal care interventions using the LiST.
BMC pregnancy and childbirthMenna Alaa El-Khouly, Mazen Mohammed Mahgoub, Mahmoud E Abd-Elkareem, Noreen M El-Bayaa, Jana M Farouk, Mariam M Fouad, Habiba Mohammed Salah, Ahmed Khaled Saa…
BACKGROUND: Preeclampsia is a leading cause of maternal and neonatal morbidity and mortality worldwide, yet effective pharmacological preventive strategies remain uncertain. Statins, metformin, and vitamin D, alone or combined with omega-3, have been investigated for potential protective effects, but comparative evidence is limited. OBJECTIVE: To compare the effectiveness of statins, metformin, and vitamin D in preventing preeclampsia and related adverse outcomes among high-risk pregnant women. METHODS: A systematic review and network meta-analysis of randomized controlled trials was conducted. PubMed, Scopus, Web of Science, Cochrane, and Epistemonikos were searched from September 11, 2020, to September 11, 2025. Eight trials involving 4,078 high-risk pregnant women were included. Participants were randomized to statins, metformin, or vitamin D at different doses versus placebo. The primary outcome was the incidence of preeclampsia. Secondary outcomes included gestational hypertension, preterm birth, low birth weight, neonatal intensive care unit admission, gestational diabetes, respiratory distress syndrome, and perinatal outcomes. Risk ratios with 95% confidence intervals were calculated, and interventions were ranked using the surface under the cumulative ranking probabilities. RESULTS: Eight randomized controlled trials were analyzed. Compared with placebo, higher-dose vitamin D supplementation showed associations with lower estimated risks of preeclampsia, particularly vitamin D 4,000 IU/day (risk ratio 0.21, 95% confidence interval 0.06-0.72) and 60,000 IU monthly (risk ratio 0.36, 95% confidence interval 0.19-0.70). These relative effects corresponded to approximate absolute risk differences of 8% and 6%, respectively, based on observed baseline risks, and reflect associations rather than proven causality. Estimates were derived from limited direct evidence within sparse networks. These dose-specific vitamin D regimens had the highest probabilistic ranking for preeclampsia within the network, but these rankings should be interpreted as exploratory rather than definitive. Higher-dose vitamin D was also associated with trends toward lower event rates of preterm births and low-birth-weight infants, although estimates were imprecise. Evidence for statins and metformin was inconsistent, with wide confidence intervals. SUCRA rankings suggested vitamin D as the highest relative ranking probability overall intervention within the network, followed by statins; however, these rankings remain exploratory given the limited network structure. These associations were derived from limited direct evidence within sparse networks and should be interpreted cautiously. Probabilistic rankings and SUCRA values reflect relative positioning within the network rather than comparative effectiveness. CONCLUSION: In high-risk pregnancies, higher-dose vitamin D regimens were associated with lower estimated risks of preeclampsia compared with placebo; however, these findings are based on limited, heterogeneous, and partly indirect evidence from sparse networks. The certainty of evidence is low, and the observed effect sizes should not be interpreted as evidence of clinical effectiveness. These findings are best considered hypothesis-generating and are intended to inform the design of future studies rather than guide clinical practice. Evidence for statins and metformin remains limited and inconsistent. Overall, further large, well-designed randomized trials are required before firm clinical recommendations can be made.
Journal of global healthJiayu Xu, Zhihan Zhang, Guanran Zhang, Yanlin Qu, Zhenyu Wu, Xiaodong Sun, Da He, Huixun Jia
BACKGROUND: Retinopathy of prematurity (ROP) is one of the leading causes of childhood blindness globally, but particularly in middle-income countries, where neonatal survival has improved faster than access to specialist ophthalmic care. Although telemedicine and artificial intelligence (AI)-assisted screening show promise for improving access to ROP screening, their economic value within decentralised health systems remains uncertain. To explore this issue, we evaluated the cost-effectiveness of community-based AI-assisted ROP screening in China compared with telemedicine and traditional bedside screening. METHODS: We developed a decision tree model to estimate lifetime health outcomes and societal costs for a hypothetical cohort of 100,000 preterm infants eligible for ROP screening. We compared three strategies: community-based AI-assisted screening, community-based telemedicine screening, and bedside screening at specialist healthcare facilities. Separate parameter sets were applied for urban and rural settings. Costs were assessed from a societal perspective. RESULTS: Community-based AI-assisted screening was the most cost-effective strategy in both urban and rural settings. In the base-case analysis, telemedicine screening dominated bedside screening (meaning it was less costly and more effective), and AI-assisted screening further dominated telemedicine screening. AI-assisted screening incurred the lowest lifetime costs (USD 1,507 per infant in urban and USD 2,581 in rural areas) and the greatest health benefits (29.7138 quality-adjusted life-years (QALYs) in urban and 29.5835 QALYs in rural areas). Compared with bedside screening, AI-assisted screening was dominant, with incremental cost-effectiveness ratios of USD -7,307 per QALY gained in urban and USD -3,688 per QALY gained in rural settings. Findings were robust across scenario and sensitivity analyses, with AI-assisted screening ceasing to be cost-effective only at extremely low treatment-requiring ROP incidence (<0.7%) or low screening coverage (11%) in rural areas. CONCLUSIONS: Community-based AI-assisted ROP screening is likely the most cost-effective strategy in China. By expanding access to early eye care while reducing societal costs, it may support equitable service delivery and offer a scalable model for other regions facing similar resource constraints.
European journal of pediatricsJudit Mari, Claus Klingenberg, Flavia Rosa-Mangeret, Laura Sára Mlinarics, Miklós Szabó, Andrea Valek, Judit Klára Kiss, Gyula Tálosi
UNLABELLED: Neonatal sepsis remains a challenge in perinatal medicine. We aimed to estimate incidence of culture positive early-onset sepsis (CP-EOS), causative pathogens and overall antibiotic exposure in newborn infants in Hungary. Retrospective national registry analysis (2020-2023). Data were mainly collected from the Hungarian National Perinatal Registry covering all level II-III neonatal intensive care units (NICUs) in Hungary. The number of livebirths in each gestational age group was provided by Hungarian Central Statistical Office. Overall CP-EOS incidence was 0.41/1,000 livebirths (0.20/1,000 ≥ 35 weeks gestation, 7.0/1,000 < 35 weeks gestation). Main pathogens were Escherichia coli (33.3%) and Group B streptococci -GBS (24.5%). Ten of 49 (20.4%) infants with E. coli sepsis died. No GBS related mortality occurred. Lumbar puncture was only performed in 30/147 (20.4%) of the CP-EOS cases. No cases of isolated meningitis occurred in the absence of CP-EOS. Newborns presenting with respiratory distress in the first 72 h were five times more likely to receive antibiotics (OR 4.9 CI 4.6-5.2) than infants without respiratory distress. Overall, 63.9% of NICU-treated neonates received antibiotics for a median (IQR) duration of 5 (3-8) days. A minimum of 3.2% of all neonates in Hungary received antibiotics, acknowledging that some more neonates are treated on postnatal wards and Level I NICUs which are not included in the perinatal registry. A substantial number (15.6%) of blood cultures were taken without subsequent antibiotic commencement. CONCLUSIONS: Our results provide the first national incidence estimates for CP-EOS in Central-Eastern Europe. The study identified high antibiotic use with a concurrently relatively low EOS incidence. The results support implementing new strategies to reduce unnecessary antibiotic exposure in the newborn period. WHAT IS KNOWN: • Neonatal early-onset sepsis (EOS) causes substantial neonatal morbidity, prompting widespread, frequent empirical antibiotic use. • Unnecessary early-life antibiotic exposure shifts the infant gut microbiota and increases risks for long-term adverse health outcomes. WHAT IS NEW: • This first nationwide Central-Eastern European study reveals a low EOS incidence (0.41/1,000 live births) but high NICU antibiotic exposure (63.9%) in Hungary. • Escherichia coli has overtaken GBS as the leading EOS pathogen, causing significant mortality primarily in preterm infants.