Search Results (1,301)

Neonatal infections remain a leading cause of morbidity and mortality worldwide, particularly among preterm and low-birth-weight infants and in low- and middle-income countries. This burden has intensified with the global increase in multidrug-resistant (MDR) bacteria, especially in neonatal intensive care units, where prolonged hospitalization, invasive interventions, and exposure to broad-spectrum antibiotics promote colonization, transmission, and invasive infection. In this narrative review, we explore the epidemiology and microbiological characteristics of MDR bacterial infections in newborns, alongside their associated risk factors, diagnostic challenges, treatment outcomes, and prevention strategies. Across different settings, Gram-negative pathogens, particularly Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii, account for a substantial proportion of severe neonatal infections, whereas methicillin-resistant Staphylococcus aureus remains important in selected units. The risk of MDR infection is driven by a complex interplay of factors, ranging from maternal and perinatal exposures to the inherent immunological vulnerability of newborns, hospital-based transmission, antibiotic selection pressure, and structural deficiencies in healthcare infrastructure. Diagnosis remains challenging because clinical presentations are nonspecific and culture-based methods are constrained by low blood volumes, prior antimicrobial exposure, and delayed turnaround times. Treatment is increasingly complicated due to resistance to standard empirical regimens, substantial regional variation in susceptibility profiles, and limited neonatal pharmacokinetic and safety data for reserve agents. Current evidence mainly supports surveillance-informed empirical therapy, susceptibility-guided treatment adjustment, antimicrobial stewardship, and strict infection prevention measures. Future progress will require neonatal-specific clinical trials, harmonized surveillance systems, stronger molecular epidemiology, and more equitable access to microbiological diagnostics and effective treatment. Full article

This study aimed to estimate life expectancy at birth and survival patterns within a multigenerational family from Romania (102 individuals), whose members lived across the period 1900–2024. Life expectancy was estimated using abridged synthetic cohort life tables, and the results were interpreted through survival curve analysis. Life expectancy at birth was estimated at approximately 84 years for females and 80 years for males, while the overall life expectancy for the total family population was 81 years, representing a weighted estimate derived from sex-specific life tables, with weights corresponding to the proportion of females and males in the studied population, rather than a simple arithmetic mean, following standard demographic practice. The resulting survival curves exhibited a clear Type I survival pattern, characterized by low mortality at younger ages and an increasing concentration of deaths at older ages. When contextualized using recent Eurostat data, the life expectancy estimated for the analyzed family exceeds current national-level values reported for Romania and is close to the European Union average, particularly for females. These findings indicate a favorable survival profile at the familial level and illustrate the usefulness of life tables for investigating longevity patterns in small populations. Full article

Background/Objectives: Early detection of postnatal growth failure (PGF) is essential for optimizing nutritional management in preterm infants, as PGF is associated with adverse neurodevelopmental outcomes. Early prediction remains difficult because postnatal growth is influenced by multiple clinical factors including gestation age, birth weight, nutritional status, and comorbidities. Machine-learning approaches have been proposed to predict complex neonatal outcomes. This study compared the predictive performance of neonatologists with that of a machine-learning model for predicting PGF. Methods: PGF was defined as a decrease in weight z-score greater than 1.28 at discharge compared with birth. A machine-learning model based on extreme gradient boosting (XGBoost) was trained using a dataset of 7954 very low birth weight (VLBW) infants. Nine neonatologists independently assessed 100 clinical cases through a questionnaire-based evaluation, including 50 patients with PGF. Predictive performance was evaluated using seven metrics: area under the receiver operating characteristic curve (AUROC), accuracy, error rate, positive predictive value (PPV), sensitivity, specificity, and F1 score. Results: The neonatologists had a median of 5 years (range: 4–10 years) of clinical experience. The median prediction score among the neonatologists was 52/100 (range, 44–60), whereas the XGBoost model achieved 79/100. The XGBoost model achieved an AUROC of 0.79, accuracy of 0.79, error rate of 0.21, sensitivity of 0.82, and an F1 score of 0.80, demonstrating superior overall performance compared to the neonatologists. In addition, the XGBoost model had a lower error rate than the neonatologists (0.21 vs. 0.49), whereas specificity (0.76 vs. 0.86) and PPV (0.77 vs. 0.53) did not differ significantly. Conclusions: The machine-learning model demonstrated superior or comparable predictive performance to that of neonatologists in detecting PGF. Machine-learning-based prediction models may support early risk stratification and targeted nutritional management in VLBW infants. Full article

Background: Preterm birth, the leading cause of neonatal mortality, is associated with reduced nephron endowment and an increased risk of kidney disease in later life. In preterm infants, the interruption of nephrogenesis leads to a lower nephron number and structural abnormalities. Prenatal factors such as intrauterine growth restriction, and postnatal factors including nephrotoxic medications, patent ductus arteriosus, perinatal asphyxia, and infections contribute to this deficit. Ultrasound is a key tool for assessing renal volume at birth and can, when indexed to body weight, be used to estimate nephron endowment, which is known to vary widely among individuals. Methods: This study analyzed 52 preterm infants with birth weight < 1000 g, assessing combined renal volume (sum of right and left kidney volumes) indexed to body weight. Results: The mean combined kidney volume-to-body weight ratio was 12.12 (SD = 2.03). Values below the 10th percentile (9.46) or more than one standard deviation below the mean (10.11) may indicate nephron deficiency at birth. Conclusions: Standardized ultrasound-based parameters enable the early identification of neonates at risk for nephron deficit, supporting targeted preventive strategies. Long-term follow-up is essential to detect early renal functional impairment and reduce the risk of chronic kidney disease. Full article

Background: Adverse pregnancy outcomes such as preeclampsia (PE), preterm birth, low birth weight (LBW), small for gestational age (SGA), and stillbirth are major contributors to maternal and neonatal morbidity and mortality. Elevated maternal homocysteine (Hcy) levels, influenced by genetic, dietary, and lifestyle factors, have been increasingly associated with placental dysfunction and adverse pregnancy outcomes. This review aims to evaluate the link between hyperhomocysteinemia and pregnancy complications to inform clinical practice. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Central Library was conducted up to December 2024. Observational studies assessing maternal Hcy levels in relation to pregnancy complications were included. Heterogeneity was measured using the I² statistic, and a random-effects model using the DerSimonian–Laird method was applied to account for study variability. Effect sizes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). Results: Thirteen studies were included in this meta-analysis. Elevated maternal Hcy was significantly associated with: PE (OR: 2.49; 95% CI: 1.41–4.40; I² = 96.03%; n = 9), preterm birth (OR: 4.01; 95% CI: 1.84–8.72; I² = 91.08%; n = 6), fetal loss (OR: 1.76; 95% CI: 1.22–2.52; I² = 41.47%; n = 6), SGA (OR: 1.69; 95% CI: 1.35–2.11; I² = 0.00%; n = 3), and LBW (OR: 2.46; 95% CI: 1.37–4.43; I² = 77.71%; n = 3). Conclusions: This review highlights a significant association between elevated maternal Hcy levels and various pregnancy complications. However, given the substantial heterogeneity and reliance on observational evidence, these findings should be interpreted with caution. Future well-designed prospective cohort studies with standardized definitions of hyperhomocysteinemia, consistent timing of exposure assessment across pregnancy trimesters, and adjustment for key confounders are needed to better clarify these associations and underlying mechanisms. Full article

Background: Minimal access surgeries are growing more common in neonatal care, but the risk of accidental injury to abdominal wall blood vessels remains a concern. This risk is increased by limited precise anatomical data specific to neonates. Therefore, this study aimed to quantitatively map the superficial and deep blood vessels of the neonatal anterior abdominal wall concerning important surgical landmarks to develop evidence-based recommendations for safer laparoscopic port placement. Methods: Thirty formalin-fixed low-birth-weight neonatal body donations (≤4 weeks old) were dissected. An anatomical grid based on palpable landmarks—including the umbilicus, xiphoid process, and anterior superior iliac spines—was utilised to measure distances to the nearest vessels via digital image analysis. In situ topography of the liver, stomach, and umbilical vessels was also documented. Results: A midline corridor of reduced vascular density was identified; minimum circumferential distances to deep vessels above the umbilicus averaged 6.84–6.88 mm. Conversely, lateral regions were highly vascular, particularly at or below the transumbilical plane, with distances to deep vessels as short as 1.08 ± 0.83 mm. The liver and stomach extended significantly below the costal margin (averaging 20.61 ± 8.29 mm and 34.18 ± 14.44 mm, respectively). Conclusions: The results establish an anatomical foundation for using the reduced vascular midline for port placement and highlight the importance of inserting secondary lateral ports under direct visualisation. Full article

Background and Objectives: The double burden of malnutrition (DBM), characterized by the coexistence of malnutrition and overweight within the same household, has become a significant public health concern in low- and middle-income countries. Tanzania is undergoing a nutritional transition marked by persistent child malnutrition alongside increasing maternal overweight. This study examined socio-demographic, maternal, and child-level factors associated with DBM among children under five years in Tanzania. Methods: This cross-sectional study used data from the 2022 Tanzania Demographic and Health Survey, including a weighted sample of 5744 children under five and their mothers aged 15–49 years. DBM was defined as the presence of child malnutrition, measured using the Composite Index of Anthropometric Failure (CIAF), in households where the mother was overweight or obese. Bivariate chi-square tests and binary logistic regression analyses were conducted in STATA 17. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were estimated to identify predictors of DBM. Results: DBM was more prevalent in rural areas. Significant predictors included birth order (AOR = 0.611, p = 0.030), child sex (AOR = 0.708, p = 0.011), perceived birth size (AOR = 0.270, p = 0.004), child age (AOR = 0.474, p < 0.001), maternal age (AOR = 0.599, p = 0.045), and maternal education (AOR = 0.604, p = 0.035). Higher maternal education reduced the likelihood of DBM, while firstborn male and small-sized children were at greater risk. Conclusions: DBM in Tanzania is influenced by both biological and socio-demographic factors. Integrated, multi-sectoral interventions targeting maternal education, prenatal care, and optimal maternal nutrition are essential to reduce DBM and achieve global malnutrition reduction targets. Full article

Necrotizing enterocolitis (NEC) and sepsis/late-onset sepsis (LOS) are significant contributors to preterm infant morbidity and mortality, with prematurity and low birth weight representing major risk factors for these interconnected conditions. Although the pathogenesis of NEC and LOS is not fully understood, there is a clear association with an immature intestinal mucosal barrier, which may enable bacterial invasion and translocation, resulting in an inflammatory cascade. Increasing recognition of the gut microbiome as a marker for health and disease has driven interest in probiotics, particularly Bifidobacterium spp. and Lactobacillus spp., as potential adjunctive agents for the prevention and management of NEC and LOS in preterm infants, which is the area of focus of this review. The focus of this paper was to analyze clinical studies using different probiotic strains, and compare single-strain versus multi-strain probiotic formulations. Several studies support that probiotic supplementation in preterm infants has the potential to decrease NEC incidence and, to a lesser extent, sepsis/LOS. Nonetheless, inconsistent results due to strain differences and clinical heterogeneity limit the widespread adoption of this mode of therapy, as do safety concerns in this vulnerable population. Further high-quality standardized studies are necessary to establish consistent guidelines for probiotic use in preterm infants. Full article

Obesity in women of reproductive age is a major issue. It is associated with reduced fertility and an increased risk of obstetric and perinatal complications. Bariatric surgery is the most effective treatment for severe obesity, leading to substantial weight reduction, improvement of metabolic disorders, and enhanced fertility. Consequently, an increasing number of women are becoming pregnant after undergoing bariatric surgery. The aim of this paper is to review current recommendations and research data regarding the care of women after bariatric surgery in the periconceptional and perinatal periods, as well as throughout pregnancy, delivery, and the postpartum period. Research suggests that pregnancy after bariatric surgery is associated with a lower risk of gestational diabetes, hypertension, preeclampsia, and fetal macrosomia compared with pregnancies in women with similar baseline BMI (body mass index) who have not undergone surgical treatment. At the same time, an increased risk is observed for low birth weight, maternal micro- and macronutrient deficiencies, and complications characteristic of bariatric procedures, such as dumping syndrome or intra-abdominal hernias. Most scientific societies recommend postponing pregnancy planning for 12–18 months after surgery and using effective contraception, preferably methods that do not require gastrointestinal absorption. Regular monitoring of laboratory parameters, individually tailored supplementation, and interdisciplinary care are essential for the safe management of pregnancy after bariatric surgery. In particular, care should include achieving a stable body weight before conception, monitoring of nutritional status, verifying proper weight gain during pregnancy, and considering alternative methods for gestational diabetes screening (e.g., glycaemic monitoring instead of oral glucose tolerance testing) due to the risk of dumping syndrome. Appropriate preparation for pregnancy and proper management throughout its course allow for reducing the risk of perinatal complications. Bariatric surgery itself is not a contraindication to vaginal delivery. Full article

Objective: This retrospective observational four-year review (2019–2022) evaluated neonatal admissions to Malta’s NICU and their outcomes. Study Design: Data from neonates up to 28 days meeting NICU admission criteria with available EMRs were analyzed, focusing on demographic data such as gestation and birth weight, need for resuscitation at birth, admission reasons, and outcomes related to nutrition, respiratory support, congenital anomalies, prematurity-related complications, phototherapy, and infection. Results: Total admissions numbered 1303 (7.3% of total births), out of which 1234 had available electronic medical records and were included in the final analysis. The main reasons for admission were respiratory distress syndrome (27.7%), transient tachypnoea (16.3%), and sepsis (13.5%). Among preterm infants, conditions related to prematurity were observed at expected frequencies and are reported descriptively. Feeding practice resulted in delayed attainment of full enteral nutrition compared to international standards, with an exclusive breastfeeding rate below the EU average. Sepsis and CLABSI rates were low, indicative of robust infection prevention and control measures. Conclusions: This study provides a descriptive overview of NICU admissions and outcomes stratified by gestational age at a single tertiary center in Malta, and highlights areas for improvement. The findings highlight expected patterns of prematurity-related morbidity and differences in clinical management, particularly in nutritional and respiratory support. Future prospective studies incorporating standardized data collection and detailed maternal and demographic variables are needed to better inform neonatal care and service planning. Full article

Gestational weight gain (GWG) and birth weight (BW) have a multifactorial etiology, which makes identifying the most influential determinants difficult. The association between variants of the FTO and LEPR genes has been explored as contributing factors to obesity in various age groups; however, their role in GWG and BW in adolescent mothers and their offspring is uncertain. To determine whether the presence of polymorphisms rs9939609 (FTO) and rs1137101 (LEPR) is associated with gestational weight gain and newborn weight in a cohort of adolescent mothers. Methods: A prospective cohort study of 305 mother-child dyads was conducted between 2020 and 2024. Genotyping of the single nucleotide variants (SNVs) rs9939609 of the FTO gene and rs1137101 of the LEPR gene was performed using real-time PCR and high-resolution melting analysis (qPCR-HRM), using maternal peripheral blood and umbilical cord blood samples. GWG, BW, energy intake, and other perinatal data were recorded and classified. Genetic data from 305 mother–offspring dyads were analyzed. The median maternal age was 16 years, and 71.4% had a normal pre-pregnancy body mass index (BMI). The most frequent genotypes were TT for FTO rs9939609 and AG for LEPR rs1137101. In both groups, the genotypic distribution significantly deviated from Hardy–Weinberg equilibrium (p < 0.0001). The AA genotype of FTO was associated with a higher probability of excessive gestational weight gain (GWG) after adjustment for pre-pregnancy BMI and dietary and sociodemographic factors. High protein and lipid intake increased the risk of excessive GWG, whereas adequate intake of carbohydrates and legumes showed a protective effect. An initial significant association was identified between the LEPR rs1137101 variant (AA allele) and low birth weight (LBW); however, this association was lost after adjustment for confounding factors. The FTO rs9939609 variant was significantly associated with GWG. On the other hand, the LEPR rs1137101 variant in the offspring showed an association with BW categorized by percentiles (in crude analysis), while the FTO variant showed no relationship with birth weight. Full article

Using alternative energy sources for animal feed, such as hybrid corn varieties rather than genetically modified ones, is important. Therefore, the objective of this work was to assess the effects of supplementation at the end of gestation with Mexican Puma hybrid corn grain on productive and behavioral parameters in sheep. Twenty Columbia multiparous ewes were used; along with their diet, they were provided 600 g/animal/day of cracked corn during the last 20 days of pregnancy and the first week of lactation. The animals were divided into two groups: one fed commercial cracked corn (n = 11) and the other Mexican Tlaoli Puma hybrid cracked corn (n = 9). The productive parameters evaluated in the mother were: body weight, body condition score (BCS), feed intake, weight change, glucose, and ketone body levels, as well as the estimated quality of milk using Brix refractometer values on days 15 and 30 of lactation. In lambs, their rectal and external temperature was measured 2 h after birth, while their weight was measured 2 h after birth and every week until week 6 postpartum. Behavioral parameters were measured in the first two hours postpartum, including the maternal latency of cleaning the offspring, duration of the first cleaning episode, the lamb’s latencies of standing and nursing, and vocalizations in mother and lamb. Weight, BCS and weight change were not affected by the group but were affected by time; these parameters increased at the end of gestation and decreased significantly after delivery (p < 0.05). Ketone body levels were not affected by group or time (p > 0.05) and remained at low values. Glucose levels were not affected by the group but were affected by time; they increased significantly after birth (p < 0.05). Feed intake was similar in both groups (p > 0.05) and decreased as parturition approached (p < 0.05). The estimated milk quality was not affected by the group, nor by the time (p > 0.05). Mothers in both groups began cleaning their offspring within the first three minutes after giving birth and emitted a similar frequency of vocalizations (p > 0.05). However, mothers in the commercial maize group had a longer cleaning episode than those in the hybrid maize group (p < 0.05). The lambs in both groups stood up within the first half hour of birth, suckled before one hour after birth and emitted a similar number of vocalizations (p > 0.05). Temperatures and lamb weight were similar in both groups (p > 0.05); however, lamb weight increased as they aged (p < 0.05). It is concluded that supplementing sheep at the end of gestation with Puma hybrid Mexican corn grain can yield similar productive and behavioral benefits as supplementing with commercial grain. Full article

Background and Clinical Significant: Patent ductus arteriosus (PDA) is a common cardiovascular disorder in extremely low-birth-weight (ELBW) infants, for which surgical ligation is indicated when pharmacologic closure fails. Sudden increases in afterload combined with immature myocardial contractility can lead to post-ligation cardiac syndrome (PLCS), which usually occurs within hours after surgery. However, acute intraoperative hemodynamic collapse during PDA ligation has rarely been described. Case Presentation: A preterm infant born at 24 weeks and 3 days of gestation with a birth weight of 890 g underwent emergency PDA ligation for a hemodynamically significant PDA (hs-PDA) refractory to pharmacological treatment. Fifteen minutes after skin incision, the infant developed desaturation, bradycardia, and non-measurable noninvasive blood pressure, which required immediate hemodynamic resuscitation with manual ventilation, fluid administration, and dopamine and dobutamine infusions. Hemodynamics gradually recovered after completion of ductal ligation, whereas oxygen saturation did not fully recover. Postoperative chest radiography revealed a left-sided pneumothorax, and oxygen saturation stabilized after pleural air aspiration. The subsequent clinical course was uneventful, and typical PLCS did not develop. Conclusions: This case suggests that intraoperative hemodynamic collapse during PDA ligation may share pathophysiologic features with PLCS, and that concomitant pneumothorax can further aggravate hemodynamic instability by worsening hypoxemia and reducing venous return. Full article

Objective: Systemic lupus erythematosus (SLE), Sjögren syndrome (SS) and antiphospholipid syndrome (APS) are common autoimmune conditions in child-bearing aged women, but their influence on pregnancy and assisted reproductive outcomes remain controversial. We aimed to perform an umbrella review to summarize the current evidence to provide a reference for clinicians and future research. Methods: PubMed, Embase (Ovid) and Cochrane database were searched (inception to April 2025) for relevant publications. Study selection, data extraction, quality evaluation, evidence grading and data synthesis were completed independently by two authors. Odds ratio, relative risk or standardized mean difference with 95% confidence intervals were calculated. Results: Fourteen articles (51 meta-analyses) were included, to report the associations of SLE, primary SS (pSS), antiphospholipud antibodies (aPLs), primary APS (pAPS) and 6 maternal/8 fetal/5 assisted reproductive outcomes. SLE and pAPS significantly increased the risks of spontaneous abortion, total fetal loss, pregnancy-induced hypertension, premature delivery, small for gestational age, neonatal death and neonatal intensive care unit. SLE also decreased anti-Müllerian hormone level and significantly increased the risks of pre-eclampsia (PE), stillbirth, low birth weight (LBW) and neonatal one minute Apgar < 7. pSS significantly increased spontaneous abortion and LBW risks. Positive aPLs significantly increased the risk of miscarriage rate in assisted reproductive techenology (ART) and were also associated with total fetal loss, PE, intrauterine growth retardation and placental abruption. Conclusions: This review offers a thorough overview of the current evidence linking SLE, SS and APS to pregnancy and assisted reproductive outcomes. It identifies existing gaps and proposes future research directions. Full article

Background: Genetic causes of growth failure should be suspected in patients born small for gestational age (SGA) who fail to show postnatal catch-up growth, present with severe short stature (SS), and exhibit a poor or absent response to growth hormone (rhGH) therapy. Mutations in the insulin-like growth factor 1 receptor (IGF1R) gene are associated with impaired growth, intrauterine growth restriction (IUGR), low birth weight and/or length, and postnatal SS. Case Description: A 9-year-old boy, born SGA for birth length, was evaluated for severe SS. Common causes of SS were excluded. At 9 years and 7 months of age, his height was 112.6 cm (−3.99 SDS), weight 18 kg (−3.79 SDS), and BMI 14.2 kg/m² (−1.8 SDS); pubertal development was Tanner stage 1. The target height was 158 cm (−2.62 SDS). Bone age was delayed by approximately one year compared with chronological age. Serum IGF-1 levels were within the upper-normal range for age. GH therapy (0.035 mg/kg/day) was initiated due to the lack of catch-up growth in an SGA subject. After three years of treatment, the height gain was only 0.5 SDS. IGF-1 levels showed a transient treatment-related increase, followed by persistent normalization during ongoing therapy. Next-generation sequencing (NGS) analysis identified novel heterozygous paternal nonsense variant in the IGF1R gene: c.3498C>G (p.Tyr1166Ter). At 12 years of age, impaired fasting glucose and reduced glucose tolerance were detected; consequently, it was decided to discontinue rhGH therapy, also in light of the IGF1R mutation and the lack of height recovery. Conclusions: This case underlines the critical role of genetic testing in the evaluation of patients born SGA. The coexistence of SGA status and an IGF1R gene mutation may provide a clear explanation for both the poor response to rhGH therapy and the increased risk of alterations in glucose metabolism. An extensive narrative review of the literature on growth outcomes and glucose metabolism abnormalities during GH treatment in SGA patients carrying IGF1R variants was also performed. Full article