Search Results (2,223)

Background and Objectives: This study aimed to evaluate obstetric, neonatal, and oncologic outcomes of pregnancies complicated by a hydatidiform mole coexisting with a live fetus (HMCF) carried beyond viability, and to assess the impact of delivery mode on outcomes. Materials and Methods: A systematic review and individual participant data meta-analysis included HMCF cases progressing beyond 23 weeks. Obstetric and neonatal outcomes, delivery patterns, and oncologic risks were analyzed. Results: Among 118 pregnancies complicated by HMFC (124 newborns), most were complete moles (87%). Median delivery occurred at 31.6 weeks, with over half before 32 weeks. Common complications included vaginal bleeding (59%), preeclampsia (30%), and hyperthyroidism (18%). Cesarean delivery was performed in 79% of cases, often for mole-related factors, but was not associated with reduced maternal or oncologic risk. Neonatal deaths occurred exclusively in infants delivered ≤32 weeks, highlighting extreme prematurity as the key determinant of survival. Severe preeclampsia was strongly linked to earlier delivery. Conclusion: With close monitoring, continuation of HMCF pregnancies is possible. Neonatal mortality is mainly driven by prematurity, which appears to be an indirect consequence of HMFC through the development of mola-associated complications. Cesarean section does not appear to improve maternal and oncologic outcomes. Vaginal delivery can be considered when no standard contraindications exist. Full article

Coccidioidal meningitis (CM) is a rare but life-threatening complication of disseminated coccidioidomycosis, occurring in ~16% of cases, particularly among children in endemic regions such as the southwestern US and northern Mexico. Without timely diagnosis and antifungal therapy, pediatric CM is almost universally fatal within the first year. Hydrocephalus develops in up to 50% of cases. In 2000, Galgiani et al. established fluconazole as first-line therapy for CM. Subsequent guidelines refined management but did not specifically address pediatric patients (>1 month–≤19 years). No studies in the fluconazole era have systematically evaluated risk factors for complications in this population. We therefore conducted a systematic review and proportional synthesis of pediatric CM cases, focusing on CNS complications and outcomes. PubMed/MEDLINE, Embase (Ovid), and Web of Science were systematically searched (2000–2025). PROSPERO registration ID (1130290). Inclusion criteria encompassed epidemiological studies, case series, and case reports that described at least one pediatric case of CM or CNS involvement, confirmed by diagnostic methods. Cases in adults, neonates (<1 month), congenital infections, teratogenicity studies, reviews, or incomplete reports were excluded. Only cases with complete individual data (n = 48) were included. Methodological rigor was ensured using JBI Critical Appraisal Tools. Of 1089 studies, 31 met the inclusion criteria, representing 3874 pediatric cases. CM/CNS involvement was confirmed in 165 cases (4.25%; 95% CI: 3.6–4.9%), with hydrocephalus in 62 (37.5%). Among 48 case reports with complete data, fluconazole was first-line therapy in 65%. Serum CF titers ≥ 1:16 were associated with hydrocephalus plus stroke (p = 0.027) and independently predicted adverse outcomes (relapse/death; OR = 4.5, p = 0.037), whereas lifelong azole therapy was associated with improved outcomes (overall survival mean, 82 vs. 32 months; p = 0.002). Pediatric CM remains highly lethal, with hydrocephalus a frequent and severe complication. High serum CF titers (≥1:16) predict poor outcomes, emphasizing the urgent need for standardized, pediatric-specific diagnosis and management guidelines. Full article

Background: Neonatal seizures are critical neurological events with long-term implications for brain development. Standard antiseizure medications, such as phenobarbital, often yield suboptimal seizure control and may be associated with neurotoxicity. This narrative review explores the role of vitamin B6 as a precision therapy in neonatal seizure syndromes, particularly in pyridoxine-responsive conditions. Methods: We conducted a narrative review of the biochemical functions of vitamin B6, focusing on its active form, pyridoxal 5′-phosphate (PLP), and its role as a coenzyme in neurotransmitter synthesis. We examined the genetic and metabolic disorders linked to vitamin B6 deficiency, such as mutations in pyridox(am)ine 5’-phosphate oxidase (PNPO), Aldehyde Dehydrogenase 7 Family Member A1 (ALDH7A1), alkaline locus phosphatase (ALPL), and cystathionine β-synthase (CBS), and discussed the clinical rationale for empirical administration in acute neonatal seizure settings. Results: Vitamin B6 is essential for the synthesis of gamma-aminobutyric acid (GABA), dopamine, and serotonin, with PLP-dependent enzymes such as glutamic acid decarboxylase and aromatic L-amino acid decarboxylase playing central roles. Deficiencies in PLP due to genetic mutations or metabolic disruptions can result in treatment-resistant neonatal seizures. Early supplementation, especially in suspected vitamin B6-dependent epilepsies, may provide both diagnostic clarity and seizure control, potentially reducing exposure to conventional antiseizure medications. Conclusions: Vitamin B6-responsive epilepsies highlight the clinical value of mechanism-based, individualized treatment approaches in neonatology. Incorporating genetic and metabolic screening into seizure management may improve outcomes and aligns with the principles of precision medicine. Full article

Background and Clinical Significance: Extremely premature infants face complex medical challenges requiring comprehensive multidisciplinary care. Gastrointestinal malformations, while rare, pose significant diagnostic and therapeutic challenges in this vulnerable population. Case Presentation: We report a case of an extremely premature infant born at 26 weeks gestation with very low birth weight (950 g) who developed a digestive pathology rarely encountered in neonatal intensive care: microcolon, which required surgical consultation and intervention, followed by an atypical postoperative course. Conclusions: The early recognition of gastrointestinal malformations in extremely premature infants requires high clinical suspicion and prompt multidisciplinary intervention. Despite complex postoperative course, favorable outcomes are achievable with coordinated care. Full article

Although clomipramine (CLO) is widely used as a serotonin reuptake inhibitor, its subchronic administration during the early stages of brain development leads to depressive-like behaviors in adulthood. High doses of CLO have been linked to mitochondrial impairment and increased reactive oxygen species in cells and adult animals. It is unknown whether subchronic administration of this drug at early ages can induce oxidative stress (OS) in adulthood. The objective of this study was to evaluate OS and cellular damage in the prefrontal cortex and limbic system (hippocampus and amygdala) of rats exposed to CLO neonatally. Methods: Forty male Wistar rats were divided into experimental (EXP) and control (CTRL) groups. The EXP animals received CLO (15 mg/kg, twice daily, subcutaneously, postnatal days 5–35); the CTRL animals received saline. At 55 and 85 days of age, the brains were collected for biochemical assays and histological analysis. Results: Rats exposed to neonatal CLO presented significant reductions in reduced glutathione (GSH) and increases in oxidized glutathione (GSSG) and malondialdehyde in both studied regions, especially on day 85. The GSH/GSSG ratio decreased, indicating persistent OS. Histology revealed neuronal degeneration, pyknotic nuclei, cell shrinkage, and disorganized tissue, which progressed from days 55 to 85. Conclusions: Early exposure to CLO can cause long-lasting neurochemical and structural alterations in the brain regions associated with the regulation of emotions and some behavioral responses that can persist over time and affect behavior in adulthood. Full article

Background: Congenital gastrointestinal anomalies (CGIAs) are the third most common congenital malformation globally, with a mortality rate reaching 39.8% in developing countries. Surgical intervention is often necessary for life-saving or corrective purposes. However, postoperative mortality in resource-limited settings can reach up to 50%. Identifying prognostic factors is essential to improve clinical management and inform family counseling regarding potential outcomes. Objectives: We aimed to develop a prognostic scoring system to predict postoperative mortality in neonates with CGIAs. Methods: This retrospective study analyzed medical records of neonates who underwent surgery for CGIAs between 2020 and 2024. Prognostic factors were identified using logistic regression analysis. Receiver operating characteristic (ROC) curves were used to determine optimal cutoff points for mortality prediction. Results: A total of 282 neonates were included; 121 (42.9%) died and 161 (57.1%) survived. Multivariate logistic regression identified sepsis, mechanical ventilation, prematurity, and upper gastrointestinal anomalies as independent predictors of mortality. A scoring system was developed, with a score > 3 yielding a sensitivity of 83.5% and specificity of 72.0%. The area under the ROC curve (AUC) was 0.840 (p < 0.001). Conclusions: We developed a simple and reliable scoring system to predict postoperative mortality in neonates with CGIAs, which may support clinical decision-making and family counseling. Full article

Congenital human cytomegalovirus (HCMV) infection is the most common vertically transmitted viral infection, and it affects 1 in 200 live births worldwide. While neonates are often asymptomatic at birth, congenital HCMV infection can result in long-term complications, including microcephaly, sensorineural hearing loss, and neurodevelopmental abnormalities. Developing antiviral strategies for the treatment and prevention of congenital HCMV infections is a global public health priority. However, licensed anti-HCMV vaccines are not yet available, and therapeutic options for use during pregnancy remain limited. The complement system is a crucial component of the innate immune system that plays essential roles in both fetal development and maternal defense against infectious pathogens. In cases of congenital HCMV infection, complement may contribute to the successful containment of the virus, but dysregulation and overactivation could concurrently drive tissue-damaging inflammation. This review discusses the known roles of the complement system in fetal development and in HCMV pathogenesis and synthesizes existing research to develop the hypothesis that a dysregulated complement system is a key mechanism in the development of congenital HCMV-related pathogenesis and neurodevelopmental sequelae. We explore how HCMV may perturb the complement system during pregnancy and use one inhibitor example to illustrate the broader potential of targeting complement in limiting disease. Full article

Polyamine (PA) spermine (SPM) (i) plays an essential role in the function of neurons, while (ii) accumulating predominantly in glial cells by an unknown mechanism. In addition, the translocation of SPM synthesis and redistribution in the developing and maturating retinas remains unclear. Therefore, the expression of the SPM-synthesizing enzyme, spermine synthase (SpmS), was compared in rat retinas on postnatal days 3, 21, and 120 using immunocytochemistry, Western blot (WB), and ImageJ analyses. The anti-glutamine synthetase (GS) antibody identified glial cells, and DAPI labeled the cell nuclei. At postnatal day 3 (P3), the neonatal retina shows widespread SpmS expression throughout most neuroblast cells, but absent in the developing synaptic layers and Müller cell (MCs) processes. By day 21 (P20), SpmS becomes strongly expressed in neurons, and not in glia. On day 120 (P120), SpmS was observed in synaptic areas, with significantly less presence in neuronal soma and still none in MCs. WBs showed a decrease in SpmS expression during maturation. Therefore, glial cells do not synthesize SPM, and the accumulation of SPM in MCs found earlier suggests that glial cells take up SPM via a hypothetical high-affinity SPM transporter. In glia, SPM regulates glial connexin (Cx43) and potassium (Kir4.1) channels, being a key player in CNS diseases and aging. Full article

Background/Objectives: Childbirth is a natural and joyfully anticipated life event for parents and relatives. Yet, in some cases, it can be a medical emergency requiring immediate intervention, i.e., neonatal resuscitation. The majority of newborns breathe spontaneously; a small number, though, may receive basic life support (assisted transition), and an even smaller but clinically significant number require advanced life support (resuscitation). Within the context of family-centered care, the presence of parents during resuscitation has emerged as a factor with potential implications for emotional adjustment, communication with healthcare providers, and early parent–infant bonding. However, the presence of family members during neonatal resuscitation remains a subject of ongoing debate among healthcare professionals (HCPs). Despite increasing recognition of its potential benefits, HCPs’ views on parental presence during such critical procedures have not been extensively investigated in Greece. This study aims at developing and validating a tool to assess healthcare professionals’ views on parental presence during neonatal resuscitation. Methods: A preliminary questionnaire was developed based on the principles of family-centered care and adapted to the Greek population. The first phase included expert assessment of validity, clarity, and relevance using a modified Delphi method. Item Content Validity Index (I-CVI) and Scale CVI (S-CVI) were calculated. Pilot testing was conducted to assess test–retest reliability. Reliability was assessed using the Intraclass Correlation Coefficient (ICC) and Bland–Altman analyses. The study followed the principles of the Declaration of Helsinki, ensuring anonymity, informed consent, and confidentiality. Results: The questionnaire includes 37–50 items allocated in four sections. It demonstrated excellent content validity (CVI = 1.00) and good test–retest reliability (ICC = 0.86). Qualitative feedback indicated that the tool is user-friendly and comprehensive. Interestingly, participants expressed genuine concerns regarding the implementation of parental presence in neonatal resuscitation. Conclusions: The questionnaire development process led to a comprehensive tool, ready for large-scale testing in order to further establish its validity and internal consistency. Full article

Background and Objectives: Maternal telomere length (TL) has been proposed as a potential biomarker of biological aging and pregnancy outcomes, yet evidence in Central and Eastern European populations remains scarce. This study aimed to investigate the association between maternal TL and neonatal parameters in a clinically healthy cohort. Materials and Methods: We conducted a prospective observational study including 134 mother–infant pairs at the “Pius Brînzeu” Emergency County Clinical Hospital, Timișoara. All deliveries were performed by cesarean section for maternal indications unrelated to fetal condition. Maternal blood samples were collected at admission, and relative TL was measured by quantitative PCR. Neonatal outcomes included birth weight, length, head circumference, gestational age, and Apgar scores. Results: Longer maternal TL was positively correlated with birth weight (r = 0.515, p < 0.001), length (r = 0.559, p < 0.001), head circumference (r = 0.468, p < 0.001), gestational age (r = 0.444, p < 0.001), and Apgar scores at 1 (r = 0.714, p < 0.001) and 5 min (r = 0.684, p < 0.001). Logistic regression showed that shorter maternal TL independently predicted suboptimal 1 min Apgar (<8), with an adjusted odds ratio of 0.68 (95% CI: 0.51–0.91). Conclusions: Maternal TL is strongly associated with neonatal growth and vitality measures, supporting its potential as a simple, non-invasive biomarker for perinatal risk assessment. Full article

Porcine epidemic diarrhea virus (PEDV), the causative agent of porcine epidemic diarrhea (PED), induces vomiting, watery diarrhea, and severe dehydration in pigs. It exhibits particularly high lethality in neonatal piglets, posing a significant threat to the global swine industry and inflicting substantial economic losses. The host innate immune system serves as the primary defense against viral invasion; however, PEDV employs multiple strategies to evade this response. This review systematically summarizes the multiple molecular mechanisms by which PEDV evaded the host’s innate immunity, including interfering with host intracellular signaling pathways by virally encoded proteins, antagonizing the host’s antiviral factors and related immune genes to suppress the innate immune responses, and regulating the autophagy process of the host cells, thereby achieving the escape of the host’s innate immunity. A comprehensive understanding of how PEDV subverts innate immunity is crucial for developing effective control strategies and therapeutics. This review aims to provide novel insights and potential targets for combating PED. Full article

A healthy gut microbiota in calves is necessary for optimal performance and development. Considering that probiotics have been shown to improve gut microbiota, the aim of this study was to investigate the effects of Clostridium butyricum on growth performance, blood parameters, and gut microbiota in Hanwoo calves. In total, 92 calves from two farms were randomly assigned to four groups: a control and three treatment groups that received increasing doses of C. butyricum (CB1, CB2, and CB3) during the first 5 days after birth. Independent experiments were conducted at each farm with different measurements, where body weight was monitored and blood, rumen, and fecal samples were collected to assess physiological responses and microbial profiles. Notably, significant differences were observed in blood amylase and acid–base parameters, suggesting that C. butyricum supplementation may enhance metabolic stability and buffering capacity. Microbial profiling revealed preserved alpha diversity and compositional shifts in both the rumen and fecal microbiota. Particularly, there was an increase in the relative abundances of Prevotella and Muribaculaceae and a decrease in the abundances of the pathogenic genera Escherichia and Shigella in calves fed C. butyricum-supplemented diets. These changes, along with a trend toward a reduced frequency and severity of diarrhea, suggest that C. butyricum supplementation may support gut health and promote stable early growth in neonatal calves. Full article

Background: Pulmonary hypertension (PH) in newborns is a rare but serious condition and potentially life-threatening disorder, often initially confused with congenital heart disease due to overlapping echocardiographic findings in the late third trimester. Evidence on prenatal predictors of postnatal PH is limited. We aimed to describe detailed third-trimester echocardiographic findings associated with postnatal PH in infants with prenatally suspected CoA based on a retrospective case series. Methods: We reviewed 18 years of fetal echocardiography (2004–2022) in a tertiary maternal–fetal–neonatal center. We identified fetuses with suspected coarctation of the aorta (CoA) in late gestation who were delivered at term (≥37 weeks) and had prolonged neonatal hospitalization (>10 days) without cardiac surgery or catheterization. Z-scores for cardiac dimensions were calculated. All examinations were performed by experienced fetal cardiologists. Postnatal evaluations confirmed PH based on echocardiographic and clinical findings. Results: Among 19,836 fetuses examined, 138 were prenatally suspected of CoA. In 70 cases, this diagnosis was not confirmed postnatally (false positives). Of these, eight infants (0.04% of the total cohort) developed postnatal PH. Postnatally, all eight neonates required intensive care. Prenatal features included ventricular/atrial disproportion (7/8), cardiomegaly (8/8), main pulmonary artery dilatation (10.2 ± 2.2 mm; Z-score +2.7 ± 1.3), tricuspid regurgitation (8/8), pulmonary regurgitation (4/8), and interventricular septal hypertrophy (>4.5 mm in 5/8). Postnatal evaluations confirmed PH based on echocardiographic criteria (elevated right ventricular pressure, septal flattening/bowing, right ventricular dilation or dysfunction, and abnormal shunt direction) combined with clinical compromise. All infants received prostaglandin E1 (PGE1) initially; none required extracorporeal membrane oxygenation-ECMO. Three died, while five survived with medical management (oxygen, inhaled nitric oxide, sildenafil). Conclusions: Specific functional abnormalities on late third-trimester echocardiography may indicate impaired pulmonary vascular adaptation and predict postnatal PH, particularly in cases initially suspected of CoA. Recognition and awareness of these findings can guide delivery planning, neonatal surveillance, and timely intervention. Prospective multicenter studies are needed to validate these associations and refine prenatal screening protocols. Full article

Patent ductus arteriosus (PDA) constitutes a significant clinical condition, frequently associated with a spectrum of complications that may profoundly compromise the health status of neonates, particularly those born preterm. Multiple predisposing factors—including prematurity, low birth weight, and respiratory insufficiency—have been consistently documented in the scientific literature. In this study, we investigated the influence of genetic polymorphisms in genes associated with the arachidonic acid–prostaglandin metabolic pathway. Specifically, we analyzed polymorphisms in genes encoding phospholipase A2 (rs10798059, rs1549637, rs4375, rs1805017, rs1051931), cyclooxygenase-1 (rs1236913), prostaglandin synthase 2 (rs13283456), and the prostaglandin E2 receptor EP4 (rs4613763). The study cohort comprised 99 preterm neonates born between 24 and 32 weeks of gestation. Genetic analyses were performed to identify polymorphisms in the aforementioned genes. Statistical evaluation demonstrated that selected polymorphic were significantly associated with an increased risk of patent ductus arteriosus development. This study represents a preliminary step toward elucidating the contribution of genetic variability to the pathogenesis of patent ductus arteriosus. Improved understanding of these molecular mechanisms may facilitate the early identification of neonates at increased risk and support the implementation of targeted monitoring and preventive strategies in this high-risk population. Full article

Background: Supported infant-directed singing (IDS) for parents and their preterm infants has proven beneficial for parents and preterm infants’ health and relationship building. Studying parent–infant contingent interactions through behavioral observations is an established method for assessing the quality of interactions. Very few studies have measured contingency between parent and preterm infants in the neonatal period during supported IDS. Methods: We conducted a feasibility study to assess the possibility of analyzing parent–very preterm infant dyads’ contingency during supported IDS in the NICU. We recruited four mother–infant dyads and video-recorded a single music therapy (MT) session before their discharge from the hospital. Two independent researchers coded three selected segments (beginning, middle, and end) from each video, according to adapted behavioral scales with inter-rater agreement analysis. Contingency between infant and maternal behaviors was analyzed. Results: Twelve video segments were coded. High inter-rater agreements (Cohen’s kappa) were found for infant eye-opening (0.93), hand positions (0.79), and head orientation (0.94), as well as maternal head orientation (0.95) and vocalizations (0.95). During supported IDS, increased infant head orientation toward the mother, eyes closed, as well as maternal head orientation toward the infant (all p < 0.001), were recorded compared to no IDS. Direction of the maternal head toward her infant was contingent on the infant’s closed eyes, extended hands, and head not toward mother. Conclusions: This feasibility study demonstrates contingency between mothers and their preterm infants’ specific behaviors during IDS. These interactions can be analyzed through video segments with high inter-rater agreement. The method described might help in evaluating other modalities that might be related to contingency. Recent advances in AI can make this tool easier to accomplish, with further studies to evaluate the importance of contingency for child development. The findings suggest that supported IDS influences infant attention and regulation. Full article