Neonatal hyperglycemia is a common metabolic disorder seen in very low birth weight (VLBW) and critically ill newborns. Hyperglycemia is a recognized cause for mortality and morbidity in the neonatal period. Incidence in preterm infants is around 45%–80%. The mechanism of increased risk of hyperglycemia in preterm infants is not well understood, but different possible mechanisms have been reported. Plasma glucose values more than 180–200 mg/dl (10–11.1 mmol) are of concern as this can lead to complications. Hyperglycemia was found to predispose to severe intraventricular hemorrhage, retinopathy of prematurity, necrotizing enterocolitis, and increased mortality. It is important to recognize and manage this condition early to avoid serious complications. Multiple etiologies with different management strategies are mentioned in the literature. Here, we discuss a complete understanding on practical management of hyperglycemia and we propose a simplified practical approach for the diagnosis and management of neonatal hyperglycemia.

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Background: Neonatal bronchopulmonary dysplasia (BPD) is a chronic neonatal respiratory disease that is precipitated by prolonged oxygenation and mechanical ventilation (MV), leading to respiratory distress (RD). Aim of Study: The aim of the study is to assess the role of Vitamin D as adjuvant treatment in the prevention and management of BPD in neonates. Patients and Methods: Prospective randomized controlled trial with identification number TCTR20210622001 on 100 premature neonates who had RD and were put on MV. The examined neonates were classified into 2 groups: Group 1, which received Vitamin D (Vit D), and Group 2, which had placebo. Urinary β2-microglobulin (B2M) in addition to plasma Krebs von den Lungen-6 (KL-6) levels were measured on the 1^st and the 14^th day of hospitalization. Results: There was a decrease in urinary B2M and plasma KL-6 levels in Group 1, if compared with Group 2 neonates (P < 0.05). There was a decrease in hospitalization in Group 1 neonates (P < 0.05). Group 1 neonates showed a decrease of the developed BPD cases (P < 0.05). Conclusion: Vit D supplementation may help in the prevention of BPD in neonates, but further studies with larger number of neonates should be done. Recommendation: Routine Vit D supplementation in a dose of 800 IU to preterm who are susceptible to develop BPD.

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Background: Hypoglycemia is a serious problem in infants at risk and creates long-term consequences. Therefore, rapid and accurate measurement of blood glucose is of clinical importance. Objectives: The objective of this study was to evaluate the agreement of venous blood glucose measurements from hypoglycemic high-risk neonates, using blood gas analyzer (BGA), compared to central laboratory chemistry analyzer (CL). Methods: A prospective study of all high-risk neonates for hypoglycemia and neonatal intensive care units (NICUs) was enrolled. Point-of-care glucose was performed, and if <40 mg/dL, venous blood would be collected for CL and ABG. For analysis of the agreement of CL and BGA, Bland–Altman (BA) analysis, with multiple observations per individual, including limits of agreement (limits of agreement [LOA] ±1.96 standard deviation [SD]), was used. Results: One hundred and forty-five paired glucose values were analyzed. There were strong correlations between CL and BGA in all glucose measurements and hypoglycemic range (r = 0.81, P < 0.001, and 0.73, P < 0.01, respectively). A weak correlation was demonstrated in hyperglycemic ranges (r = 0.35, P = 0.15). For BA analysis of all glucose measurements and hypoglycemic ranges, LOA (±1.96 SD) of CL and BGA were −9.5 (±46.5) mg/dL and −11.1 (±10.9) mg/dL, respectively. The hyperglycemic range illustrated higher LOA, with LOA (±1.96 SD) of −32.9 (±124) mg/dL. Conclusions: In NICU settings where normoglycemic and hypoglycemic ranges are targeted, venous BGA glucose could be used as a reliable test instead of CL. No similar correlation was found in the hyperglycemic range.

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Background: Preterm infants frequently have hemodynamically significant patent ductus arteriosus (PDA). Persistent ductal shunting may result in pulmonary hyper circulation, increasing the risk of mortality and morbidity. The effectiveness of active management, as well as the timing and modality of PDA treatment, is still debatable. Aim: The purpose of this study was to determine whether there was a difference in mortality and morbidity between conservative and pharmacological treatment of clinically significant PDA in preterm infants at <34 weeks. Design: Retrospective study. Setting: Comprised of two neonatal intensive care units (NICUs). Materials and Methods: NICUs medical records from 2017 to 2020. Statistical Analysis: Logistic regression analysis. Results: A total of 1059 medical records were screened for the study, with 106 preterm (PT) infants included. The mean gestational age was 29.2 ± 3.2 weeks, the mean birth weight (BW) was 1267 ± 485 g, and the mean length of stay in the hospital was 30 ± 20 days. Twenty patients (18.8%) received paracetamol, six patients (5.6%) received ibuprofen, one patient (0.9%) received surgical ligation, and one patient (0.9%) received indomethacin. Five patients (4.7%) received multiple courses of PDA medication. Nineteen patients (17.9%) received diuretics. [Table 1] also contains additional data characteristics. After adjusting the confounding variables, intraventricular hemorrhage (IVH) (odds ratio [OR]: 5 P: 0.04) and BW were found to increase mortality (OR: 0.87 P: 0.034). Conservative treatment (OR: 1.4, P = 0.38), paracetamol (OR: 0.87, P = 0.22), and ibuprofen (OR 1.2, P = 0.12) had no effect on mortality. None of the treatment modalities (conservative, paracetamol, or ibuprofen) has a significant effect on morbidities (IVH, bronchopulmonary dysplasia, retinopathy of prematurity, late onset sepsis, pulmonary hemorrhage, or necrotizing enterocolitis). Conclusion: In PT 34 weeks, there was no difference in mortality or morbidity between conservative and pharmacological treatment of hemodynamically significant PDA.

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Surfactant replacement therapy is a major cornerstone in the successful management of neonates with respiratory distress syndrome. Until recently, the INtubate, SURfactant, Extubate protocol was the best a trade-off achieved to deliver the surfactant to the air exchanging respiratory epithelium against the barotrauma of prolonged intubation and ventilation. Minimal or Less Invasive Surfactant Therapy (MIST or LISA) was adapted in clinical practice as a gentler and a gentler way of delivering surfactant. LISA or MIST is associated with a significant reduction in the oxygen days and chronic lung disease, intraventricular hemorrhage of grade 2 or above, retinopathy of prematurity and other key neonatal outcomes. This translates into shortened neonatal intensive care unit stay and a significant reduction in the stress levels of neonatal nurses, parents, and caregivers. This procedure needs to be performed by skilled professionals with appropriate training to achieve the desired results.

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Newborns, especially preterms, have a higher risk of developing pneumothorax. We report a 33-week preemie who presented with recurrent, persistent right pneumothorax, which failed to resolve with standard treatment. The child underwent surgical removal of a suspect nonexpanding upper lobe of the right lung with clinical improvement. Histopathology was atypical but nearly consistent with congenital pulmonary airway malformation (CPAM). This report highlights the clinicopathological discordance noted and aims to draw an embryological explanation toward the atypical histomorphology of CPAM in preemies.

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Objective: We aimed to measure the joint angles of major joints in newborn babies to explore their association with gestational age (GA). Materials and Methods: This observational study was conducted to evaluate joint angles in healthy newborn infants, born between 28 and 41 completed weeks of gestation. Healthy and hemodynamically stable babies were selected by purposive sampling up to the 2^nd day of life. Six major joints of upper and lower limbs (shoulder, elbow, wrist, hip, knee, and ankle) were assessed on either side. The joint angles and range of motion (ROM) achieved through predefined passive movements were measured by a single observer using a manual acrylic goniometer. The positioning of the joints during measurement was standardized. Results: A total of 433 newborn babies, belonging to different GA, were evaluated. The joint angles and ROM did not show any significant differences between right and left sides and between male and female babies. The ROM of flexion-extension and adduction-abduction movement at shoulder, angle of palmer-flexion at wrist, and angle of dorsiflexion at ankle, were observed to correlate strongly with GA (correlation coefficient r of –0.75, –0.74, –0.73, and –0.73, respectively). The relationships were inverse. A mathematical model based upon multiple regression analysis is proposed to predict GA from these four measurements. Conclusions: Structured clinical assessment of major joint angles in newborn babies has the potential to provide relatively precise estimation of GA, which may be used to add accuracy to modified New Ballard Score.

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Objective: The objective of this study is aimed at investigating and evaluating respiratory patterns between infants hospitalized with brief resolved unexplained event (BRUE) and the control group. Methods: A convenient sampling method was used to select 52 patients presented at an urban, tertiary, and teaching pediatric hospital fitting the American Academy of Pediatrics' criteria of a lower-risk BRUE from December 2019 to December 2020. A random probability sampling method was used to select 52 patients as a control group. A NINIX apnea monitoring device was used to record respiratory time patterns and analyzed with SPSS 25. Results: A total of 104 participants participated in the study. Our study found that inspiration time (0.31 ± 0.04), expiratory time (0.93 ± 0.14), respiratory rate (38.48 ± 4.38), body temperature (37.11 ± 0.20), and heart rate (137.90 ± 6.60) were not statistically different between both groups. Mean birth weight in the control group and BRUE were respectively (3.43 ± 0.39, 3.23 ± 0.35). Mean gestational age in the control and BRUE groups were respectively (38.94 ± 1.01, 39.0 ± 1.04). Mean postnatal age in the control and BRUE groups were respectively (17.19 ± 6.07, 17.32 ± 7.35). Birth weight (P = 0.08) was statistically significant between both groups. In one patient, we recorded breath arrest for more than 20 s. Conclusion: There were no significant differences in respiratory patterns between infants hospitalized with BRUE and the control group. Low birth weight and low APGAR score are possible risk factors for infants experiencing BRUE, and more investigations are required to establish underlying causes.

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Introduction: The World Health Organization recommends early initiation of breastfeeding (EIBF). This is because breastfeeding is important for the child's development and has maternal benefits. Current literature has focused on sociodemographic factors, and the evidence supporting antenatal, peripartum, and neonatal variables is limited and contradicting. The main aim of this study is to report the rates of early breastfeeding initiation and their antenatal, peripartum, and neonatal correlates. Materials and Methods: A prospective observational study of pregnant women who attended the labor ward of the Specialty Hospital in Amman, Jordan between September 1, 2019, and June 1, 2020, was conducted. Inclusion criteria required women to be 18 years of age or more. Demographic, antenatal, peripartum, and neonatal data were collected. The timing of breastfeeding initiation was recorded in the 1^st h and between 1 and 24 h and then data were analyzed. Results: A total of 300 women were recruited with mean age of 29.5 years and mean gestational age being 38.6 weeks. In addition, breastfeeding initiation rates were 26.3% and 65.5% within the 1^st h and between 1 and 24 h, respectively. Antenatal, peripartum, and neonatal variables that were associated with lower rates of EIBF (P < 0.05) include antenatal obstetrics complications, induction of labor, assisted vaginal delivery, caesarean section (CS), CS performed on maternal request, CS under general anesthesia, surgical site pain, mother's perception of inadequate pain management, preterm delivery, low Apgar scores, low birth weight, neonatal intensive care unit admission, and less frequent rooming-in. Conclusion: Rates of breastfeeding initiation within the first hour and between 1 and 24 h of delivery were 26.3% and 65.5%, respectively. Compared to antenatal variables, the peripartum and neonatal variables are more likely to have significant effects on EIBF. Therefore, more obstetric attention should focus on these factors to improve rates of initiating breastfeeding early.

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Umbilical cord with two umbilical veins is a rarely reported anomaly. Four-vessel cord is known to be associated with other congenital anomalies. Second umbilical vein is usually due to persistence of right umbilical vein. We report two cases of two umbilical veins; one newborn with four-vessel umbilical cord with two umbilical veins, who presented with severe pulmonary arterial hypertension, and another newborn with three-vessel umbilical cord with two umbilical veins, diagnosed to have transposition of great arteries. The presence of two umbilical veins mandates comprehensive workup to rule out other congenital anomalies. However, as highlighted by our first case, the presence of two umbilical veins is not always an ominous sign but could be seen in otherwise normal baby.

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Instrumental delivery is the most common cause of skull fracture in neonates. We report a depressed fracture with massive intracranial hemorrhage in a term female infant born by unassisted cesarean section after unremarkable pregnancy.

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A newborn with microcephaly presented hemorrhagic bullous purpura triggered by heat in the 1^st h of life. Doppler arterial and venous ultrasound excluded vascular complications. Cytomegalovirus was detected in blood, urine, and serum of the lesions. The final diagnosis was cytomegalovirus congenital infection due to reactivation in an immune mother, with associated purpuric rash, confirmed by cerebral magnetic resonance imaging.

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