Search Results (936)

Background: Atopic dermatitis is a chronic inflammatory skin disease in children, frequently associated with skin barrier dysfunction, immune dysregulation, and dysbiosis. Infected, treatment-resistant lesions may increase disease severity and complicate management, particularly in the presence of Staphylococcus aureus colonization. Objectives: To characterize the microbiological profile of infected, non-responsive pediatric atopic dermatitis, evaluate short-term clinical outcomes following individualized treatment, and identify predictors of disease severity. Methods: This observational analytical study included 41 children with atopic dermatitis recruited at Saint Constantin Hospital, Brașov, Romania, between September 2025 and February 2026. Eligible patients fulfilled the Hanifin and Rajka criteria and presented with infected, treatment-resistant lesions. Skin cultures were subjected to an antibiogram and antifungigram. Disease severity was assessed using the Patient-Oriented Eczema Measure (POEM) and SCORAD at baseline, 7 days, and 30 days. Repeated-measures ANOVA, mixed ANOVA, and hierarchical linear regression were used for statistical analysis. Results: Staphylococcus aureus was the predominant pathogen, followed by other bacterial species. Both POEM and SCORAD scores improved significantly over the 30-day follow-up, with marked improvement after 7 days and further reduction by day 30. Although patients with S. aureus colonization and those receiving systemic therapy tended to have higher disease severity, neither factor significantly influenced the trajectory of clinical improvement. Baseline disease severity was the strongest predictor of 30-day POEM and SCORAD outcomes, whereas demographic and perinatal characteristics did not independently predict short-term clinical outcomes. Conclusions: Individualized management was associated with significant improvements in clinician-assessed disease severity and patient-reported symptoms during the 30-day follow-up. Staphylococcus aureus, particularly methicillin-sensitive S. aureus (MSSA), was the most frequently isolated pathogen. Baseline disease severity was the strongest predictor of short-term clinical outcomes, whereas the evaluated demographic and perinatal characteristics did not provide additional predictive value in this cohort. Larger prospective controlled studies are needed to confirm these findings. Full article

Background and Objectives: The World Health Organisation (WHO) promotes respectful, woman-centred care during childbirth, aimed at preserving women’s autonomy, their sense of control and the fulfilment of their expectations. Loss of control during childbirth has been linked to a poorer birth experience and adverse emotional consequences in the postpartum period. To analyse the maternal and perinatal factors associated with perceived control and support during childbirth, and their relationship with childbirth satisfaction in women in Spain. Materials and Methods: A cross-sectional study was conducted with postpartum women who had given birth within the previous six months in Spain. Validated instruments were used, including the “Support and Control in Birth” (SCIB) scale and the “Birth Satisfaction Scale-Revised” (BSS-R). Sociodemographic, obstetric and neonatal variables were also collected. Associations were assessed using multiple linear regression models. Results: A total of 302 postpartum women participated, with a mean age of 35.2 years (SD = 4.18), of whom 70.2% (n = 212) were primiparous. Satisfaction with childbirth (BSS-R) was the strongest positive association with all dimensions of the SCIB: internal control (adjusted mean difference [aMD] = 0.56; 95% CI: 0.48, 0.64), external control (aMD = 0.75; 95% CI: 0.61, 0.89), support (aMD = 0.89; 95% CI: 0.77, 1.01) and overall score (aMD = 2.34; 95% CI: 2.13, 2.56). Greater pain intensity was associated with a lower perception of internal control (aMD = −1.00; 95% CI: −1.31, −0.70). In comparison with adherence to the birth plan, non-adherence showed a negative association with the support dimension (aMD = −7.71; 95% CI: −10.72, −4.71) and with the overall SCIB score (aMD = −10.21; 95% CI: −16.01, −4.42). Women’s active participation in decision-making was positively associated with perceived control and support (aMD = 7.15; 95% CI: 2.21, 12.09). Conclusion: A greater perception of support and control during labour is associated with a more positive birth experience. Deviation from the birth plan and greater pain intensity are associated with a poorer perception of control, whilst women’s active participation was associated with higher perceived control. These findings underscore the importance of personalised and respectful care to improve women’s childbirth experience, particularly perceived support, control and satisfaction. Full article

Background: Coping styles and general self-efficacy (GSE) are central to managing pregnancy challenges, yet evidence from lower-middle-income countries remains limited. This study aimed to identify coping styles during pregnancy and to assess their associations with GSE, social determinants, and pregnancy-related factors. Methods: A multicenter cross-sectional study was conducted among pregnant women aged 18–45 years attending antenatal clinics in Sousse, Tunisia, between July 2024 and March 2025. A multistage random sampling strategy recruited participants. Data was collected using validated Arabic versions of the Brief COPE Inventory and the General Self-Efficacy Scale (GSES). Results: Among 417 respondents, emotion-focused coping was the most frequently used coping strategy (mean = 31.83 ± 6.85). Mean GSE was 28.15 ± 6.01, with 12.2% reporting low GSE. There is a significant difference between GSE and problem-focused and emotion-focused coping styles (p = 0.011; p = 0.019, respectively). Unemployment was negatively associated with problem-focused coping (p = 0.012), while rural residence and divorce were negatively associated with emotion-focused coping (p = 0.037; p = 0.004, respectively). Avoidant coping style was determined by unemployment and multiparity (p =0.043; p = 0.049, respectively). Conclusions: These findings highlighted the need for comprehensive perinatal care strategies that incorporate psychosocial factors and address contextual vulnerabilities, particularly among rural, unemployed, and divorced pregnant women. Full article

Preeclampsia is a leading cause of maternal and perinatal morbidity and mortality worldwide. This significant burden necessitates effective early identification of pregnancies at high-risk for preeclampsia. Accurate prediction is essential in order to develop and optimize preventive strategies. The evolution of preeclampsia screening has progressed from a traditional checklist-based approach to individualized, multivariable models. The first-trimester triple test, which was developed by the Fetal Medicine Foundation (FMF), represents this advancement. It utilizes Bayes’ theorem to calculate patient-specific risks by integrating maternal factors, mean arterial pressure, uterine artery pulsatility index, and serum placental growth factor. This model, called “first trimester FMF triple test”, has undergone successful internal and external validation for the prediction of preterm preeclampsia. To ensure the reliability of biomarker measurements and achieve an optimal screening performance, it is essential to implement standardized measurement protocols and rigorous quality control processes in biomarker testing. The triple test could also be utilized in the 2nd and 3rd trimester, and the addition of biomarkers such as soluble fms-like tyrosine kinase-1 further improves risk stratification assessment and continued surveillance of high-risk pregnancies. Full article

Preterm birth is associated with a higher risk of neurodevelopmental adverse outcomes later in life. This increased risk is partly due to interrupted brain development during critical early periods. Early nutrition is a key factor that can influence both brain growth and the development of the gut microbiota, which plays an important role in overall health. Evidence shows that human milk, including fortified human milk, supports the growth of beneficial gut bacteria such as Bifidobacterium and Lactobacillus. These bacteria help protect the immature intestine, reduce inflammation, and support normal development. In contrast, formula feeding, frequent use of antibiotics, and perinatal stress, common conditions for preterm infants in neonatal intensive care units, can disturb the normal development of the gut microbiota. These factors may lead to dysbiosis, a state in which harmful bacteria become more dominant. Early changes in gut microbiota may affect brain development through the gut–brain axis. This communication system connects the gut and the brain through immune responses, metabolic products, and hormonal pathways. Disruption of this system during early life may have long-term effects on cognitive, motor, and behavioral development. Both clinical and experimental studies suggest that improving early nutrition may support better neurodevelopmental outcomes. Nutritional strategies such as optimizing protein and energy intake and using probiotics or prebiotics may help promote a healthier gut microbiota and support brain development. In conclusion, early nutrition in preterm infants plays a crucial role during a sensitive period of brain development. By supporting healthy gut microbiota formation, early nutritional interventions may help improve long-term neurodevelopmental outcomes in this vulnerable population. The aim of this narrative review is to explore the relationship between early nutrition, gut microbiota development, and later neurodevelopment in preterm neonates. Full article

Background: Early rehabilitation after pediatric ischemic stroke may support neuroplasticity and improve long-term functional outcomes. However, rehabilitation practices remain heterogeneous, and evidence-based recommendations regarding the optimal timing and intensity of intervention are limited. Objectives: This scoping review aimed to evaluate the available evidence regarding early rehabilitation after pediatric ischemic stroke, identify prognostic factors associated with functional recovery, summarize current therapeutic approaches, and highlight gaps in the existing literature. Eligibility Criteria: Eligible studies included children and adolescents aged 0–18 years diagnosed with ischemic stroke and receiving rehabilitation or therapeutic intervention. Studies addressing the timing, intensity, and effects of physiotherapy, occupational therapy, speech and language therapy, neuropsychological intervention, neuromodulation, or multidisciplinary rehabilitation were considered for inclusion. Sources of Evidence: A structured literature search was conducted in PubMed/MEDLINE, Scopus, Web of Science, the Cochrane Library, and Google Scholar for studies published between 2000 and January 2025. Charting Methods: Data were extracted using a standardized charting form and synthesized narratively because of substantial heterogeneity in study design, populations, interventions, and outcome measures. Results: Twenty-one sources met the inclusion criteria. Direct evidence specifically addressing early rehabilitation after pediatric ischemic stroke was limited and consisted primarily of observational studies. A substantial proportion of the available evidence was indirect, originating from studies of perinatal stroke, unilateral brain injury, cerebral palsy, and related pediatric neurorehabilitation populations, as well as clinical guidelines and expert consensus documents. The available evidence suggests potential benefits across motor, cognitive, communication, and functional domains, although the strength and directness of evidence varied substantially. Several studies identified the early post-stroke period as a potentially important window for neuroplasticity, while family involvement, individualized treatment planning, and interdisciplinary care were consistently highlighted as important components of rehabilitation. Evidence supporting neuromodulation techniques remained preliminary and was largely limited to selected pediatric populations. Conclusions: The available evidence, although heterogeneous and largely indirect, suggests that early coordinated and multidisciplinary rehabilitation may be beneficial in pediatric ischemic stroke care. However, the current evidence base remains limited, and high-quality prospective studies are needed to establish standardized rehabilitation protocols and determine the optimal timing and intensity of therapeutic interventions. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is an increasingly prevalent condition in both adults and children. Dysregulated telomere maintenance has been proposed as a mechanism underlying disease progression, although pediatric evidence remains limited and controversial. This study aimed to investigate the relationship between telomere length (TL) and hepato-metabolic features in children with MASLD. A total of 212 pediatric patients with biopsy-proven MASLD and 40 controls were enrolled. Telomere length in leukocytes (LTL) and liver tissue (HTL) was measured using quantitative polymerase chain reaction, and telomerase reverse transcriptase (TERT) mRNA and protein expression were also evaluated. Associations between TL and clinical, metabolic, and perinatal variables were analyzed. Children with MASLD showed significantly shorter LTL and HTL compared to controls. Shorter LTL was observed in more advanced steatohepatitis (MASH) and was associated with fibrosis severity. TERT expression was reduced in patients. LTL was also associated with perinatal factors, including preterm birth and low birthweight. Multivariable analysis identified MASH, fibrosis, and small-for-gestational-age status as independently associated with shorter LTL. In conclusion, LTL is associated with disease severity in pediatric MASLD, particularly fibrosis. These findings support a potential role of telomere dynamics in disease progression, although causal relationships require confirmation in longitudinal studies. Full article

This study aimed to explore the correlations of nuclear factor erythroid 2-related factor-2 (NRF2) gene polymorphisms, prepregnancy body mass index (BMI) and the interaction between them with the risk of preeclampsia (PE). A case–control study was conducted in which pregnant women with PE (n = 198) and normotensive pregnant women (n = 396) were recruited as the case group and control group, respectively, from two tertiary hospitals in Hunan Province. Data collection was achieved through face-to-face interviews utilizing a standardized questionnaire, along with perinatal health care records. Blood samples were also collected, and genotyping of nine single-nucleotide polymorphisms (SNPs) in the NRF2 gene was subsequently performed using the MassArray platform. Both univariate and multivariate logistic regression analyses were employed to assess the associations of NRF2 gene polymorphisms with prepregnancy BMI and their interactions with the risk of PE. Multivariate logistic regression analyses revealed a significant association between prepregnancy BMI and PE susceptibility. Specifically, prepregnancy overweight/obesity (BMI ≥ 24.0 kg/m²) was associated with an elevated risk of PE (adjusted OR = 4.59, 95% CI: 2.82–7.45), whereas underweight status (BMI < 18.5 kg/m²) was correlated with a reduced PE risk (adjusted OR = 0.38, 95% CI: 0.18–0.78). The NRF2 polymorphism rs13005431 exhibited a protective effect against PE under the additive genetic model (adjusted OR = 0.59, 95% CI: 0.37–0.93). Furthermore, logistic regression analyses revealed a significant effect of the multiplicative interaction between prepregnancy overweight/obesity and polymorphisms rs35652124 (adjusted OR = 0.24, 95% CI: 0.06–0.89) and rs2627765 (adjusted OR = 3.62, 95% CI: 1.07–12.23) on susceptibility to PE. These findings collectively underscore the critical and independent roles of prepregnancy BMI, NRF2 polymorphisms, and their interactions in modulating PE susceptibility, suggesting that the combined effects of metabolic profiles and genetic determinants may act synergistically to shape PE risk. Full article

Aim: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. In this study, we evaluated the potential role of anemia and packed red blood cell (RBC) transfusions as risk factors in ROP development. Methods: A retrospective cohort study was conducted on premature infants who met the following inclusion criteria: infants with gestational age (GA) ≤ 32 weeks and very low birth weight (VLBW) who were admitted to the Neonatology-Preterm Department of Emergency Pediatric Hospital Cluj-Napoca during a two-year period (from 1 January 2023 to 31 December 2024). We investigated differences in the following perinatal characteristics between the two groups, those with ROP and those without: GA, birth weight (BW), severe respiratory distress syndrome, early-onset and late-onset sepsis, hemoglobin (Hb) levels, and RBC transfusions. We used the statistically significant variables to perform binary logistic regression. Results: A total of 124 newborns were recruited, with the following inclusion criteria: GA ≤ 32 weeks and BW ≤ 1500 g, of whom 79 received at least one RBC transfusion prior to 36 weeks corrected GA. Of them, 48 developed ROP with an incidence of 38.7%. In 20 cases, ROP required treatment. To adjust for clinical illness, a binary logistic regression model was created, including known risk factors for ROP and illness severity (GA, severe respiratory distress syndrome, and early- and late-onset sepsis) that were closely related to the risk of ROP development. For this regression model, Nagelkerke R-squared = 0.358, p < 0.001, and the AOR was 4.812 (95% CI: 1.374–16.847). Conclusions: RBC transfusions increased the risk of ROP. Full article

Background: Preterm premature rupture of membranes (PPROM) before 32 weeks of gestation with prolonged latency is associated with substantial neonatal morbidity, including Dry Lung Syndrome (DLS), pulmonary hypoplasia (PH), bronchopulmonary dysplasia (BPD), and death. Accurate individualized risk stratification remains elusive, as the interacting contributions of amniotic fluid dynamics, inflammatory status, and microbiological burden are inadequately captured by traditional statistical approaches. Methods: We performed a retrospective, exploratory–predictive analysis of 66 pregnancies complicated by second-trimester PPROM with latency exceeding 14 days. Elastic Net and Random Forest models were trained across six clinically defined predictor domains using a multi-stage block modelling strategy. To address the clinically relevant distinction between antenatal and postnatal information, results are reported separately for Model A—comprising exclusively antenatal predictors available during expectant management (gestational age at PPROM, latency, amniotic fluid trajectory, inflammatory status, vaginal microbiome at admission)—and Model B, which additionally incorporates postnatal variables and characterizes the full mechanistic perinatal risk trajectory. Binary and ordinal outcomes included DLS, PH, BPD, intraventricular hemorrhage (IVH), and neonatal death. Pairwise interaction models were additionally computed to identify cross-domain risk constellations. Results: Distinct predictor architectures emerged per outcome. Pulmonary hypoplasia was most strongly associated with temporal features of oligohydramnios—particularly the persistence and timing of SDP < 1 cm—rather than isolated measurements. For DLS, the antenatal model (Model A) achieved AUC 0.776, driven by gestational maturity and inflammatory status; surfactant administration—a postnatal variable reflecting therapeutic response rather than an antenatal risk factor—dominated only the mechanistic Model B. Neonatal death was driven by a combined profile of respiratory support burden, amniotic fluid persistence, and co-morbidity. IVH showed consistently high ordinal predictability (accuracy 0.863), with amniotic fluid dynamics and microbiological burden as leading contributors. BPD remained the least linearly separable endpoint across all configurations. Conclusions: Multi-domain machine learning reveals outcome-specific, cross-domain risk architectures following second-trimester PPROM that are invisible to conventional statistical models. Longitudinal amniotic fluid trajectory is the dominant antenatal determinant of structural pulmonary morbidity, while microbiological burden independently shapes neurological risk. These findings support prospective validation of integrated ML-based risk stratification tools for individualized antenatal counselling in this high-risk population. Full article

Objective: This study aimed to evaluate clinical characteristics and outcomes of complete uterine rupture during pregnancy and identify factors associated with adverse neonatal outcomes. Methods: This retrospective cohort study analyzed data from a single center between January 2008 and July 2024. Complete uterine rupture was defined as full-thickness myometrial and serosal rupture confirmed during surgery. Results: Among 50,185 deliveries, 22 cases of complete uterine rupture were identified (incidence: 0.044%). Most patients (86.4%) had a scarred uterus, exclusively due to previous myomectomy (n = 19). While abdominal pain was the primary symptom (72.7%), 22.7% of patients were asymptomatic. There were no cases of maternal mortality or peripartum hysterectomy. Of the 25 neonates, 12 (48%) experienced adverse outcomes, defined as NICU admission or perinatal death. Adverse neonatal outcomes were significantly associated with preterm delivery (p = 0.030), fetal heart rate abnormalities (p = 0.040), and a prolonged symptom-to-delivery interval (p = 0.032). Univariate analysis identified preterm delivery and abdominal pain as significant predictors of poor neonatal prognosis. Conclusions: Complete uterine rupture is a rare but critical obstetric emergency. Although maternal outcomes were favorable in this study, nearly half of the neonates experienced adverse outcomes. Preterm labor and abdominal pain serve as significant prognostic indicators. These findings emphasize that early clinical suspicion and minimizing the time from symptom detection to delivery are vital for optimizing neonatal survival and health. Full article

Umbilical cord mesenchymal stromal cells (UC-MSCs) are a key element of regenerative medicine due to their ability to secrete growth factors that stimulate proliferation and angiogenesis, and modulate the inflammatory response. Despite their widespread use, the influence of the perinatal microenvironment on their biological properties remains poorly understood. The aim of this study was to assess the influence of pH and blood gas parameters in umbilical cord blood on the global transcriptomic profile of UC-MSCs and to analyze the correlation between the metabolic status of the newborn and the expression of key trophic factors: EGF, FGF2, FGFR1, FGFR3, GDNF, HGF, IGF1, NES, NGF, and PGF. Methods: The study was conducted in two stages. In the first phase, transcriptomic screening was performed using Affymetrix HuGene 2.0 ST microarray on cells isolated from three environmental groups defined by cord blood pH: acidic (pH < 7.35), physiological (7.35–7.39), and alkaline (pH ≥ 7.4). In the second phase, the results were validated using qPCR on an expanded study group (N = 50). Gene expression levels (RQ) were related to blood gas parameters (pH, pCO₂, pO₂, cHCO₃) and the presence of clinical features of threatened neonatal asphyxia. Results: Microarray analysis revealed that environmental pH acts as a molecular phenotypic switch. Under low pH conditions (<7.35), a shift in cell profile from proliferative to structural–migratory was observed. Significant overexpression of genes responsible for extracellular matrix (ECM) organization and adhesion (e.g., COMP, DCN, LUM, FMOD) was observed, while pathways related to cell cycle and cell division (↓CDK1, AURKA, TOP2A) were downregulated. qPCR validation confirmed these observations, demonstrating a strong positive correlation between blood pH and the expression of regenerative mediators: FGFR1 (r = 0.28), EGF (r = 0.30), NGF (r = 0.39), and IGF1 (r = 0.30). A negative correlation was also found between carbon dioxide pressure (pCO₂) and the expression of NGF, FGFR1, and EGF. A significant clinical finding was that in newborns diagnosed with threatened asphyxia, EGF, FGFR1, and NGF gene expression was significantly reduced, indicating impaired trophic potential of the cells in response to metabolic stress. Conclusions: These results indicate that cord blood gas parameters are critical regulators of the genetic activity of UC-MSCs. Metabolic and respiratory acidosis not only inhibit the cells’ proliferative potential but also force them into a matrix remodeling mode, permanently modifying their transcriptomic profile. This suggests that the neonatal acid–base status may serve as an objective indicator of the “biological quality” of isolated stromal cells, which has significant implications for their future applications in cell therapies. Full article

Perinatal mental illness affects up to 20% of new mothers worldwide, yet despite a growing research interest over the past decade, the etiology is still not fully understood, and clinical treatment guidelines remain inconsistent across countries and services. In this review, recent findings on neurobiological processes and evolutionary mechanisms, as they occur during the menstrual cycle, pregnancy, birth, postpartum and breastfeeding, are discussed. The intention is to raise awareness of physiological changes in pregnancy that might be relevant to the differential diagnosis and clinical treatment of perinatal psychiatric disorders such as depression, anxiety, PTSD after childbirth, bipolar relapse, postpartum psychosis, obsessive-compulsive symptoms, substance-use disorders, and suicidality. Areas addressed include the activities of the immune system, thyroid gland, cortisol, sleep and individual sensitivity to ovarian hormone fluctuations. Evolutionary biological mechanisms intended to sustain pregnancy and to ensure the survival of the newborn are assumed to have potent effects on the maternal brain. These non-pathological adaptations could provide grounds for a better understanding of risk factors and the etiology of perinatal mental illness. Full article

Purpose: To review the long-term cardiovascular risks associated with three common perinatal endocrine disorders—gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), and thyroid dysfunction (including postpartum thyroiditis)—and to identify opportunities for early risk stratification and prevention. Materials and Methods: We conducted a structured literature search of PubMed and Web of Science for peer-reviewed articles published between January 2000 and December 2025. Search terms included combinations related to GDM, HDP, thyroid dysfunction, and cardiovascular disease (CVD). We prioritized prospective cohort studies, meta-analyses, systematic reviews, and major clinical guidelines. Key findings were synthesized thematically. Results: GDM is associated with a 1.6- to 2-fold increased risk of future CVD, HDP with a 1.8-fold increase, and subclinical hypothyroidism with a two-fold increase. These risks persist for decades, are independent of traditional risk factors, and are amplified by obesity, recurrence, and social determinants of health. Converging pathophysiological mechanisms include persistent insulin resistance, chronic low-grade inflammation, endothelial dysfunction, autonomic dysregulation, epigenetic modifications, and subclinical myocardial remodeling. The placenta serves as a central endocrine–cardiovascular interface, releasing anti-angiogenic factors, pro-inflammatory cytokines, and exosomal microRNAs. Despite this evidence, postpartum screening uptake remains below 50%, care is fragmented, and pregnancy history is not incorporated into CVD risk calculators. Conclusion: A life-course approach integrating structured postpartum screening (6–12 weeks and annually), lifestyle interventions, targeted pharmacotherapy, and multidisciplinary cardio-obstetrics programs is urgently needed to reduce the global burden of premature heart disease, stroke, and heart failure in women. Full article

Background/Objectives: This study evaluates the prognostic utility of placental insufficiency biomarkers in late-onset fetal growth restriction occurring after 32 weeks of gestation. These markers were assessed both independently and in conjunction with ultrasound and Doppler indices to predict adverse perinatal outcomes. Given the clinical integration of maternal angiogenic factor assessment, it is imperative to determine whether these markers—specifically the sFlt-1/PlGF ratio—can effectively mitigate fetal and neonatal morbidity and mortality. Methods: This review is registered with PROSPERO and encompasses the literature from the last decade. The present analysis incorporated prospective observational cohort studies. Four comprehensive databases were queried, resulting in the evaluation of fifty-one relevant records. Thirty-six full-text articles were assessed for eligibility, resulting in the inclusion of six relevant manuscripts. The total sample size was 14.499 patients. Detection rates for growth restricted fetuses demonstrated significant variability, ranging from 15% to 88.5%. Conclusions: The clinical utility of angiogenic biomarkers for the prediction of fetal growth restriction remains unresolved; moreover, the empirical evidence synthesized within this review exhibits a significant degree of heterogeneity. Full article