Search Results (1,654)

Background/Objectives: Children born very preterm (VP) are at increased risk of later emotional and cognitive difficulties, including anxiety symptoms during childhood. Altered early brain development, particularly within subcortical circuits involved in emotional regulation, may contribute to this vulnerability. This study aimed to assess anxiety symptoms in preschool-aged children born VP, examine their relationship with cognitive performance, and determine whether neonatal brain volumes at term-equivalent age (TEA) were associated with later anxiety symptoms. We also explored whether cognition mediated the association between neonatal striatal volumes and anxiety. Methods: We conducted a longitudinal cohort study of infants born at ≤32 weeks of gestation and/or with a birth weight ≤1500 g admitted to a tertiary neonatal intensive care unit between 2018 and 2021. At 4–6 years of age, anxiety symptoms were assessed using the Child Behavior Checklist (CBCL) Anxiety Problems subscale, and cognitive performance was evaluated with the Wechsler Preschool and Primary Scale of Intelligence-IV (WPPSI-IV). Neonatal magnetic resonance imaging performed at TEA was used to obtain regional brain volumetric measures. Associations were analyzed using adjusted linear regression, interaction-based volumetric modeling, path analysis, and receiver operating characteristic analysis. Results: Ninety-five children were included, and 24 (25.3%) showed clinically relevant anxiety symptoms according to the CBCL Anxiety Problems subscale. Higher WPPSI-IV scores were associated with lower anxiety scores (β = −0.183; p = 0.042). The best-fitting MRI model included caudate volume, putamen volume, and their interaction, with a significant association between the putamen–caudate interaction and anxiety symptoms (β = −17.807; p < 0.001). In the path model, both cognition and the putamen–caudate interaction were directly associated with anxiety, whereas the indirect effect through cognition was not significant. The final MRI model showed acceptable discrimination for clinically relevant anxiety (AUC = 0.796). Conclusions: Anxiety symptoms were frequent in preschool-aged children born VP and were associated with lower cognitive performance. Neonatal striatal volumetric organization, particularly the interaction between the putamen and caudate volumes, was independently associated with later anxiety symptoms, suggesting that cognitive and early neural factors may contribute to anxiety risk through parallel rather than mediated pathways. Full article

Background: During the COVID pandemic increased rates of intensive care unit (ICU) admission, mechanical ventilation, caesarean delivery, and preterm birth among women with SARS-CoV-2 infection in pregnancy were recorded. Purpose: This study describes the clinical course and perinatal outcomes of pregnant women with COVID-19 across pre- and post-vaccination periods. Methods: This study included all pregnant women with confirmed SARS-CoV-2 infection who subsequently delivered at the University General Hospital of Larissa between March 2020 and May 2023. Demographics, comorbidities, gestational age at infection and at delivery, COVID-19 symptoms, need for hospitalization, obstetric complications, mode of delivery, and neonatal outcomes were documented. An assessment of ischemia-modified albumin (IMA) was performed in a subset of women. Results: A total of 327 women (including 14 twin gestations) were recorded. Most women experienced mild disease while a minority required hospital admission, or intensive care (1.8 and 0.3% for the studied population, respectively). Fever and upper respiratory symptoms predominated, while radiologic evidence of pneumonia was rare. Overall preterm birth (<37 weeks) occurred in 13% of pregnancies and caesarean section in about two thirds of deliveries. Neonatal outcomes were favorable, with low rates of neonatal intensive care unit (NICU) admission and no early neonatal deaths. IMA values were higher during acute infection and declined towards recovery. Conclusion: Pregnant women with COVID-19 in Central Greece had predominantly mild clinical courses and excellent perinatal outcomes. IMA may represent a biologically plausible marker of disease activity, but further studies are needed. Full article

Background: Cardiac tamponade (CT) is a rare but life-threatening medical emergency caused by fluid accumulation in the pericardial sac, impairing cardiac filling and reducing output. More than 20% of CT cases are iatrogenic. CT is a recognized complication of central venous catheter (CVC) placement, with mortality rates in pediatric patients reported to reach 50%. Clinical presentation is often nonspecific, and echocardiography remains the diagnostic gold standard. Case report: We present two pediatric cases of CT due to late CVC migration, managed in the pediatric intensive care unit (PICU). The first case involved a 25-day-old neonate with short bowel syndrome who received prolonged parenteral nutrition via CVC. Four days after catheter insertion, the patient developed sudden cardiocirculatory collapse. The second case featured a 2-year-old child with Leigh syndrome who required mechanical ventilation and multimodal pharmacological therapy. Six days after CVC placement, the patient developed acute hemodynamic deterioration. In both cases, echocardiography confirmed CT, while chest radiography suggested intracardiac positioning of the catheter tip. Management and outcome: Emergency pericardiocentesis and advanced cardiopulmonary resuscitation were performed. Despite transient hemodynamic stabilization, both patients developed multiorgan failure with fatal outcomes. Conclusion: CT is a critical complication in pediatric patients with CVCs. Accurate verification of catheter tip position is essential, and intracardiac placement should be avoided. Any sudden clinical deterioration in a patient with a CVC should raise suspicion of late catheter migration and requires immediate life-saving intervention. Full article

Micro- and nanoplastics (MNPs) are ubiquitous environmental contaminants detected in numerous human tissues, yet epidemiological evidence on MNPs exposure and neurodevelopmental outcomes in children has not been systematically evaluated. We aimed to systematically identify, appraise, and synthesize observational evidence on this association in children aged 0–18 years. Six databases were searched on 19 February 2026 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO: CRD420261328979). Risk of bias and certainty of evidence were assessed using Joanna Briggs Institute (JBI) checklists and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) framework. Three studies met the inclusion criteria (all published in 2025, China; n = 30–5670; two studies with probable population overlap), addressing behavioral, cognitive, and neurological outcome domains, encompassing 56 associations across 14 outcomes. Each study showed a uniform direction of association (higher MP exposure was associated with poorer outcomes); however, probable population overlap between Dong and Zheng precludes interpretation of this pattern as independent cross-study replication. All outcomes were rated Very Low certainty under GRADE; meta-analysis was not performed. Although experimental evidence supports biological plausibility, no causal inferences can be drawn in the absence of independent replication, and the field remains at the stage of hypothesis generation. Future studies should prioritize prospective longitudinal designs, spectroscopic exposure confirmation, and standardized neurodevelopmental outcomes. Full article

Background/Objectives: To evaluate the association between adjunct tendon vibration and changes over 12 months in dual-energy X-ray absorptiometry (DXA)-derived bone mineral density (BMD) T-score and bone turnover markers in older adults with osteoporosis receiving standard care in a non-randomised controlled cohort study. Methods: This 12-month prospective non-randomised controlled cohort study included 100 adults aged ≥60 years with DXA-confirmed osteoporosis recruited from orthopaedic clinics in the Greater Thessaloniki area. Fifty participants received adjunct tendon vibration therapy in addition to usual care, while 50 received usual care alone. Usual care consisted of calcium and vitamin D supplementation. The primary outcome was post-intervention BMD T-score, analysed using analysis of covariance (ANCOVA) adjusted for baseline T-score. Secondary outcomes included changes in bone turnover markers and calcium/phosphate metabolism. Sensitivity analysis was conducted using a linear mixed-effects model with repeated BMD measurements. Results: Baseline characteristics were comparable between groups. Over 12 months, the intervention group showed greater improvement in BMD T-score than controls (median change 0.90 [0.70–1.00] vs. −0.10 [−0.10–0.10], p < 0.001). The adjusted between-group difference was 0.871 (95% CI 0.773–0.968; p < 0.001). Results remained consistent after adjustment for age and sex. The mixed-effects model confirmed a significant group × time interaction (β = 0.922, 95% CI 0.806–1.038; p < 0.001). Bone resorption markers decreased more in the intervention group. The magnitude of the observed BMD improvement (~0.9 T-score units) is notable for a non-pharmacological intervention and should be interpreted cautiously. Conclusions: Adjunct tendon vibration was associated with a more favourable BMD trajectory and changes in bone turnover markers in older adults with osteoporosis receiving standard care. Given the non-randomised design and potential residual confounding, these findings should be interpreted as associative rather than causal. Full article

Background: The neonatal period involves rapid physiological adaptation and high vulnerability to painful stimuli, especially in NICU-admitted infants. Neonates have the neurophysiological capacity for nociception, and repeated pain exposure may impair neurodevelopment. Non-pharmacological interventions, particularly oral sucrose and breast milk, are widely used as first-line analgesic strategies due to their safety and efficacy. However, heterogeneity in existing studies requires evidence synthesis. Methods: A systematic review following PRISMA guidelines was conducted to assess the effectiveness of sucrose and breast milk in neonatal pain reduction. PubMed, Scopus, CINAHL, and Web of Science were searched for randomized controlled trials published between 2019 and 2024. Studies involving neonates undergoing painful procedures and receiving sucrose, breast milk, or both were included. Data extraction and risk of bias assessment were performed independently. Due to heterogeneity in interventions and outcomes, a narrative synthesis was conducted. Results: Thirteen randomized controlled trials were included. Both sucrose and breast milk consistently reduced neonatal pain scores and physiological indicators such as heart rate and oxygen saturation. Sucrose showed rapid, short-term analgesia mediated by endogenous opioid pathways, while breast milk provided additional sensory, nutritional, and emotional benefits that support mother–infant bonding. Multimodal approaches, including kangaroo care, non-nutritive sucking, and swaddling, enhanced analgesic effects. Heterogeneity in protocols and assessment tools limited comparability across studies. Conclusions: Sucrose and breast milk are safe and effective non-pharmacological interventions for neonatal pain management. Their incorporation into standardized multimodal protocols is recommended to optimize analgesia and promote humanized neonatal care. Further research is needed to standardize dosing and evaluate long-term outcomes. Full article

Objective: To evaluate and compare fetal arterial and venous Doppler parameters in early-onset (EO) and late-onset (LO) fetal growth restriction (FGR), and to assess their performance within the study cohort and their association with composite adverse neonatal outcome (CANO). Methods: This prospective observational cohort study included 184 singleton pregnancies between 24 and 37 weeks of gestation, comprising 91 FGR cases and 93 appropriate-for-gestational-age controls. FGR was defined according to Delphi consensus criteria and classified as EO-FGR (<32 weeks) or LO-FGR (≥32 weeks). All fetuses underwent standardized Doppler assessment of the umbilical artery (UA), middle cerebral artery (MCA), uterine artery (UtA), and ductus venosus (DV). The cerebroplacental ratio (CPR) was calculated. Multivariable logistic regression models were constructed separately for EO-FGR and LO-FGR. Classification performance was evaluated using receiver operating characteristic analysis. CANO was defined as at least one of the following: 5-min Apgar score <7, respiratory distress syndrome, neonatal intensive care unit admission, or preterm birth. Results: In both EO-FGR and LO-FGR, UA PI values were significantly higher, whereas MCA PI and CPR were significantly lower than in controls. CPR demonstrated the highest discriminative performance among arterial parameters in both subgroups. DV Doppler indices were not significantly different in EO-FGR. In LO-FGR, DV S-wave and v-wave velocities were independently associated with FGR. No significant associations were observed between Doppler parameters and CANO in subgroup analyses. Conclusions: Arterial Doppler parameters, particularly CPR, showed consistent alterations in both EO- and LO-FGR. The contribution of venous Doppler parameters differed according to clinical subtype, with additional value observed in LO-FGR. Full article

Background: Despite the growing literature demonstrating the psychological impact of a NICU admission on parents, the longer-term adjustment to a NICU experience following an infant’s discharge is largely unknown. This study aimed to explore the NICU experience and the psychosocial trajectories of NICU graduate families after discharge. Methods: Using a qualitative design, a select group of mothers participated in qualitative interviews after completion of a quantitative survey. Interviews were completed online over a secure video platform. Participants (n = 21) included three groups of mothers of NICU graduates aged 2–24. Interviews ranged from 45 to 90 min, depending on the number of NICU children. The NICU care experience was explored as well as the impact of the NICU experience on parental coping, relationships, overprotective parenting, and post-traumatic growth. Results: Participants reflected on their NICU care experience and offered concrete suggestions for improvements in care. Short-term symptoms of psychological distress immediately following the NICU admission were described; however, psychological adjustment and parenting issues resulting from a NICU experience appeared to be long-term. Common themes included: (a) Effect on the Family, (b) Grief and Loss, (c) Post-Traumatic Growth, and (d) Goals for Intervention. Conclusions: These findings expand our understanding of the complexity of the NICU family experience, demonstrate the prolonged effects of a NICU admission on the family over time, and offer areas for improvement in care across the continuum. Full article

Background: Foreign citizenship and low socioeconomic status are key determinants of health inequalities and may influence maternal and neonatal outcomes. This study aimed to assess maternal health during pregnancy and the main adverse maternal and neonatal outcomes related to labour and childbirth among women living in Trentino (Northern Italy), comparing women with Italian and foreign citizenship. Methods: A retrospective epidemiological study was conducted using data from the Birth Assistance Certificate (CedAP) database of the Autonomous Province of Trento. This study included all women who gave birth in Trentino between 2012 and 2016. Associations between citizenship and adverse outcomes were assessed using multivariable logistic regression models adjusted for potential confounders. Results: The analysis included 23,165 women, of whom 25.9% had foreign citizenship. Women with foreign citizenship showed a significantly higher risk of gestational diabetes mellitus compared with Italian women and an increased risk of extremely preterm birth (<28 weeks of gestation), particularly among women from Central and South America, Asia and Eastern Europe. Regarding labour and mode of delivery, women with foreign citizenship had a higher risk of caesarean section, especially among women from Central and South America and Africa. In terms of neonatal outcomes, infants born to women with foreign citizenship showed a higher likelihood of requiring phototherapy and admission to the neonatal intensive care unit. Conclusions: Significant differences were observed between immigrant and Italian women in both social determinants and maternal and neonatal perinatal outcomes. Identifying factors associated with adverse outcomes during pregnancy may help improve targeted maternal care and reduce health inequalities for both mothers and newborns. Full article

Background and Objectives: Intrapartum clinical chorioamnionitis at term is a complication associated with adverse maternal and neonatal outcomes. We aimed to identify factors independently associated with severe histological chorioamnionitis in women with clinical chorioamnionitis at term and with severe histological chorioamnionitis accompanied by neonatal intensive care unit (NICU) admission, considered the most severe end of the spectrum. Materials and Methods: We retrospectively identified all women with a diagnosis of clinical chorioamnionitis during labor at term between 2017 and 2022. Maternal characteristics and maternal and neonatal outcomes were extracted from medical records. The study population was stratified by the presence or absence of histological chorioamnionitis. Results: Out of 12,332 women, 171 (1.4%) singleton pregnant women had an intrapartum diagnosis of clinical chorioamnionitis at term. A total of 96 (56.1%) were confirmed with severe histological chorioamnionitis. Thick meconium-stained amniotic fluid (MSAF) (OR = 5.88; 95% CI 1.12–30.86, p = 0.035) and advanced maternal age (OR = 1.14, 95% CI 1.01–1.29, p = 0.024) were independently associated with severe histologic chorioamnionitis. In women with severe acute histological chorioamnionitis, we observed a higher prevalence of neonatal NICU admission and longer NICU stay. Factors independently associated with severe histologic chorioamnionitis accompanied by adverse neonatal course (NICU admission) were maternal age, fetal tachycardia and thick meconium-stained amniotic fluid. Conclusions: The diagnosis of clinical chorioamnionitis has a low positive predictive value for intra-amniotic infection or inflammation. Factors such as maternal age, thick meconium-stained amniotic fluid and fetal tachycardia may help identify patients with underlying intra-amniotic infection and those at risk of worse perinatal outcomes. Improved identification may help avoid both over- and undertreatment and guide interventions aimed at preventing adverse neonatal outcomes. Full article

Background: Infants discharged home from a neonatal intensive care unit (NICU) often have multiple ongoing medical needs. The Coached, Coordinated, Enhanced Neonatal Transition (CCENT) program provides nurse navigator-led support for caregivers of high-risk infants through their first year after transitioning from the NICU to home. The objective was to compare health care resource use and costs between CCENT and standard care control groups post-discharge. Methods: Resource use and costs were collected at 4 months and 12 months post-discharge from families enrolled in the CCENT randomized controlled trial across Canada. Infant healthcare utilization and parent mental health service use and costs were analyzed from public health care system and family payer perspectives and were compared statistically between groups and within groups over time. Results: A total of 97 and 105 infants were randomized to the intervention and control groups, respectively. Significant reductions in use of medications and equipment were observed over time in both groups while use of allied health professionals decreased and emergency department (ED) visits increased for CCENT. Annual total healthcare costs per child to the public payer were $4135 (95% CI $2825, $5709) for the CCENT group and $4578 (95% CI $2246, $8356) for controls. The cost of delivering CCENT was $669 per family (SD $362). The average annual out-of-pocket cost per family was $724 (95% CI $467, $1024) for CCENT and $728 (95% CI $479, $1007) for controls. Conclusions: This study indicates the importance of considering patterns of healthcare utilization, program costs and costs to families when implementing NICU to home care interventions. Excluding the cost of a nurse navigator, costs to the healthcare system were not increased in the intervention group. Such a program may help families access appropriate care. Full article

Background: Antimicrobial stewardship in Neonatal (NICU) and Pediatric Intensive Care Units (PICUs) is complicated by rapid physiological maturation and the high vulnerability of the developing gut microbiome. Traditional metrics fails to capture the true utilization density of antibiotics in these settings. This study evaluated antimicrobial consumption patterns and alignment with the WHO AWaRe framework in two Indonesian hospitals and its impact towards patients’ length of stay. Methods: A retrospective multicenter study was conducted at a public hospital (Haji Hospital) and a private university hospital (HU Hospital) across 2024–2025. The study population includes all admitted patients (n = 315 in NICU and n = 12 in PICU) to calculate utilization density. Consumption was quantified using Defined Daily Dose (DDD)/100 bed-days, and qualitative assessment was performed using the WHO AWaRe classification. Results: Generalized linear modeling revealed that appropriate antibiotic therapy was significantly associated with a 17% reduction in hospital length of stay (β = −0.187, p = 0.035). At HU Hospital, PICU exhibited a seven-fold higher antimicrobial density (37.56 DDD/100) compared to NICU (5.22 DDD/100). At Haji Hospital, NICU density was 4.95 DDD/100 bed-days. Weight-normalized simulations revealed weight-based dosing disparity with low absolute DDD values in neonates mask a significant biological burden and intense selection pressure on the gut resistome due to immature renal clearance. While Haji Hospital maintained high “Access” category adherence (92.21%), HU Hospital’s PICU showed a high reliance on “Watch” agents (71.27%), specifically Ceftriaxone and Meropenem, which are known drivers of multidrug resistance. Conclusions: Low absolute dosing in neonates does not equate to low therapeutic density or reduced environmental pressure. The heavy use of broad-spectrum agents in the PICU acts as a primary driver for microbiome disruption. To mitigate the emergence of multidrug-resistant organisms, stewardship must transition from adult-indexed metrics (DDD) to more precise measures like Days of Therapy (DOT) and prioritize “Access” protocols to preserve microbiome integrity. Full article

Background: Exposure of pregnant women to stress and endocrine-disrupting chemicals (EDCs) during pregnancy can have a substantial impact on mother and infant health. We investigated the concentrations of EDCs, such as parabens (PBs) and triclosan (TCS), as well as stress hormones (cortisone and cortisol), across pregnancy trimesters and examined their associations with maternal average telomere length (TL). Methods: Hair samples from 49 postpartum women were analyzed using liquid chromatography–mass spectrometry (LC-MS) to quantify EDCs and stress hormone concentrations. Results: The mean methyl paraben concentrations in the hair of postpartum women were prevalent across all pregnancy trimesters, while butyl paraben was detected at the lowest levels. The mean concentration of PBs followed the order methyl > propyl > ethyl > benzyl > butyl paraben across pregnancy trimesters. We found that ethyl paraben and triclosan were each positively and significantly associated with cortisol levels in postpartum women’s hair. Consistent with this, the mean cortisone concentration gradually increased from the first to the third pregnancy trimester, whereas cortisol reached the highest mean concentration at the second trimester. A significant positive association between cortisol and cortisone levels was observed. Further analyses revealed that mothers’ average TL was positively associated with ethylparaben and triclosan levels and inversely associated with benzylparaben levels. Last but not least, we found that cortisol/cortisone levels were positively associated with postpartum women’s TL in a statistically significant manner. Conclusions: In the present study, prenatal exposure to stress hormones and EDCs appears to exert a statistically significant impact on maternal TL dynamics. Full article

Background/Objectives: Vancomycin dosing in neonates is challenging due to high pharmacokinetic variability and immature renal function. This study evaluated current therapeutic drug monitoring (TDM) practices, the association between vancomycin concentration and clinical outcomes, and the predictive performance of a locally developed population pharmacokinetic (popPK) model compared to the published models. Methods: This was a retrospective cohort study of neonates admitted to a tertiary neonatal intensive care unit (NICU). We assessed the persistent positive culture, infection recurrence, mortality and acute kidney injury (AKI) stratified by initial vancomycin trough concentrations (<10 mg/L, 10–15 mg/L, >15 mg/L). The locally developed popPK model was externally validated and compared with 32 other published neonatal vancomycin popPK models (with a total of 33 models evaluated). Results: A total of 366 neonates were included (mean postmenstrual age of 28.9 ± 3.81 weeks; 191 received at least 5 days of vancomycin). Only 28% of neonates achieved initial vancomycin trough concentrations within the 10–15 mg/L using standard vancomycin dosing. Higher vancomycin trough concentrations (>15 mg/L) were not associated with improved efficacy but were significantly associated with a higher incidence of AKI. The locally derived popPK model demonstrated superior predictive accuracy, meeting all predefined performance criteria, whereas none of the 32 other published models met all the criteria. Conclusions: Current vancomycin dosing strategies often result in suboptimal exposure and increased nephrotoxicity without added efficacy. Model-informed precision dosing using the locally developed popPK model may offer a safer, more effective approach for neonatal vancomycin therapy. Full article

Background/Objectives: Neonatal sepsis remains a major contributor to neonatal morbidity and mortality worldwide, yet diagnostic uncertainty and heterogeneous clinical presentation continue to challenge early recognition and management. Early-onset sepsis (EOS), typically arising within the first 72 h of life, is strongly influenced by maternal and perinatal factors. Limited data exist on the temporal evolution of clinical system involvement during the first week of life. This study aimed to identify the predominant clinical systems involved in preterm and term neonates with suspected or confirmed sepsis and to determine maternal and neonatal risk factors associated with early disease severity, persistent sepsis, and adverse outcomes. Methods: A total of 297 neonates met the inclusion criteria. Most infants (99.3%) were admitted before 72 h of life. Clinical system involvement was recorded daily, and maternal–neonatal risk factors were analyzed to identify predictors of advanced sepsis at presentation, persistent sepsis at Day 7, and mortality. Results: Respiratory involvement was the predominant clinical system affected on Day 1 (57.2%) and remained common through Day 3. CNS, gastrointestinal, and skin involvement were infrequent. Lower gestational age (p = 0.035) and prolonged rupture of membranes >18 h (p = 0.043) independently predicted sepsis at Day 1. Advanced sepsis at admission was associated with lower birth weight, lower gestational age, older maternal age, and absence of intrapartum antibiotics (all p ≤ 0.001). Persistent sepsis at Day 7 was linked to prematurity (p = 0.008), higher mortality (p < 0.001), and prolonged hospitalization (p = 0.001). Conclusions: Respiratory involvement was the most common clinical system affected in neonates with EOS. Prematurity, low birth weight, prolonged rupture of membranes, and maternal intrapartum infection significantly increased the risk of severe disease. Understanding the evolution of clinical system involvement during the first days of life may support more precise risk stratification and reduce unnecessary antibiotic exposure. Full article