UNASSIGNED: The aim of this paper is to delve into the emotional and psychological challenges that fathers face as they navigate the complexities of having a preterm infant in the NICU and in an unprecedented sanitary context.
UNASSIGNED: We used three data collection methods such as interviews (narrative and the Clinical Interview for Parents of High-risk Infants- CLIP) and the Edinburgh Postnatal Depression Scale (EPDS) to gain a comprehensive understanding of the cases.
UNASSIGNED: The following analysis explores two individuals\' personal experiences of becoming a first-time father during the first wave of the COVID-19 pandemic through a close examination of two superordinate themes: \"A series of separations through the experienced COVID- 19 restrictions\" and \"Moments of connection.\" The transition to fatherhood is essentially with a medicalized form of connection with their newborn and the perceived paternal identity. In terms of temporality, these fathers experienced a combination of concerns about their infants\' long-term development and COVID-19 health concerns. Furthermore, they showed indications of phobic or hypochondriac tendencies using a psychoanalytic framework, along with an increased risk of postpartum depression.

Patent ductus arteriosus (PDA) is a frequently encountered defect in infants born extremely premature (≤26 weeks\' gestation). Historically, closure of the PDA was performed using cyclooxygenase inhibitor medications or by surgical ligations. However, the benefits of PDA closure using these therapies have never been demonstrated, albeit studies have previously not focused on the extremely premature infants. Therefore, there was a worldwide trend toward conservative management of the PDA. With improved survival of extremely premature infants, comorbidities associated with the PDA has increased, resulting in finding alternate treatments such as transcatheter patent ductus arteriosus closure (TCPC) for this population. Currently, there is a renewed interest toward selective treatment of the PDA in this high-risk cohort of small infants. This Comprehensive Review article inspects the globally changing trends in the management of the PDA in premature infants, with a special focus on the rising adoption of TCPC. Moreover, this article compiles data from several neonatal networks worldwide to help understand the problem at hand. Understanding the current management of premature infants and their outcomes is fundamentally essential if pediatric cardiologists are to offer TCPC as a viable therapeutic option for this population. This article aims to serve as a guide for pediatric cardiologists on this topic by compiling the results on landmark clinical trials on PDA management and the controversies that arise from these trials. Comparative outcomes from several countries are presented, including interpretations and opinions of the data from experts globally. This is a step toward coming to a global consensus in PDA management in premature infants.

UNASSIGNED: Restriction of PBF in infants born with CHD is often required to avoid pulmonary over-circulation prior to definitive intervention. The current standard is to surgically place pulmonary artery bands, but these have limitations and are associated with complications.
UNASSIGNED: The purpose of this study was to a single-center experience with a relatively novel technique to percutaneously restrict pulmonary blood flow (PBF) in select infants with congenital heart disease (CHD).
UNASSIGNED: Patients were selected to undergo this procedure either due to low birth weight or prematurity. All of them had CHD that would result in over-circulation without control of PBF. By a percutaneous method, modified vascular plug devices were placed in the bilateral branch pulmonary arteries.
UNASSIGNED: Seven neonates with CHD resulting in left-sided obstruction underwent this procedure. All patients demonstrated evidence of restricted PBF with a decrease in mean oxygen saturation from 95% to 84%. One patient required pulmonary artery band placement due to over-circulation 5 days after the procedure. All patients proceeded to full surgical intervention without device embolization or need for pulmonary arterioplasty. Hemodynamics demonstrated adequate limitation of PBF in 5 patients who underwent presurgical cardiac catheterization with a mean pulmonary vascular resistance of 1.52 WU × m2 and a mean transpulmonary gradient of 5.9 mm Hg.
UNASSIGNED: Percutaneous PBF restriction appears to be safe and a less invasive option to delay surgical intervention in a select population to allow for somatic growth and gestational maturation. It results in a decrease in the total number of sternotomies.

Reduction-oxidation (redox) chemistry plays a vital role in human homeostasis. These reactions play critical roles in energy generation, as part of innate immunity, and in the generation of secondary messengers with various functions such as cell cycle progression or the release of neurotransmitters. Despite this cornerstone role, if left unchecked, the body can overproduce reactive oxygen species (ROS) or reactive nitrogen species (RNS). When these overwhelm endogenous antioxidant systems, oxidative stress (OS) occurs. In neonates, OS has been associated with retinopathy of prematurity (ROP), leukomalacia, and bronchopulmonary dysplasia (BPD). Given its broad spectrum of effects, research has started to examine whether OS plays a role in necrotizing enterocolitis (NEC). In this paper, we will discuss the basics of redox chemistry and how the human body keeps these in check. We will then discuss what happens when these go awry, focusing mostly on NEC in neonates.

Background/Objectives: Prematurity rates remain high and represent a challenge for the public health systems of any country, with a high impact on neonatal mortality. This study aimed to evaluate the frequency and environmental and maternal-fetal risk factors for premature birth in a cohort of parturient women, with their newborns monitored in a neonatal intensive care unit at a private reference hospital. Methods: A cohort was carried out between 2013 and 2018 among parturient women living in a capital city in the Northeast of Brazil whose newborns were admitted to the neonatal intensive care unit. This study was approved by the Research Ethics Committee of the University of Fortaleza. The information collected comprised data from both medical records and hydrosanitary data from maternal homes. Results: The prevalence of prematurity among live births (n = 9778) between 2013 and 2018 at this hospital was 23%. The frequency of prematurity among those eligible (n = 480) was 76.9%, and the frequency of eligible premature babies (n = 369) in relation to the total number of births in this period was 3.8%. In the multivariate analysis, the significant risk factors for prematurity were primigravida (RR = 1.104, 95%CI: 1.004-1.213) and hypertensive syndromes during pregnancy (RR = 1.262, 95%CI: 1.161-1.371), and the significant protective factor was the highest number of prenatal consultations (RR = 0.924, 95%CI: 0.901-0.947). Conclusions: This study contributes to providing greater visibility to prenatal care and the understanding of complications during pregnancy and childbirth care. These results indicate the need to implement public policies that promote improvements in the population\'s living conditions and care for pregnant women to reduce premature births and, consequently, neonatal and infant mortality.

UNASSIGNED: Preeclampsia is a potentially life-threatening hypertensive pregnancy disorder that carries an acute risk of an unfavorable outcome of the pregnancy but also has consequences for the long-term health of the mother. Women who develop the early form of pre-eclampsia before the 32nd week of pregnancy have the highest risk and are also the most difficult to treat. The severity of pre-eclampsia is not characterized uniformly in Germany, so that the indication for delivery is rather individualized. The aim of this study was to reach a consensus on parameters that could serve as criteria for describing the severity of pre-eclampsia based on the urgency of delivery. To this end, a Delphi procedure was used to present a scenario in which a woman was admitted for preeclampsia before 32 gestational weeks and after completion of antenatal steroid therapy.
UNASSIGNED: Clinicians specialized in maternal-fetal medicine from German-speaking countries completed five rounds of a modified Delphi questionnaire. Presented parameters were selected by the section \"Hypertensive Pregnancy Diseases and Fetal Growth Restriction\" of the German Society of Gynecology and Obstetrics after reviewing the literature. These included objectifiable laboratory or clinical parameters as well as subjective symptoms of the patient. In addition, nine fetal parameters were taken into account. The clinicians were asked to rate presented parameters as an indication for delivery on a Likert scale from 0 to 4 (no indication to absolute indication without delay). For each item, the predefined cut-off for group consensus was ≥ 70% agreement.
UNASSIGNED: A total of 126 experts were approached. Sixty-nine experts (54.8%) took part in the first round; of those 50 completed the entire Delphi procedure. A consensus was reached on 14 parameters to be considered rapid preparation for delivery without delay (4 points on the Likert scale). These were among others hepatic hematoma or liver capsule rupture, acute liver failure with fulminant coagulation disorder or disseminated intravascular coagulation, eclampsia, pathologic findings in imaging (e.g. cMRI) or electrocardiogram arranged for new onset of headache or retrosternal pain, respectively. Twenty-six parameters were rated as factors that should be considered in the decision without being absolute (1 to 3 points), and 13 parameters should have no influence on the decision to deliver (0 points). No consensus on severe hypertension as an indication for delivery could be reached for blood pressure values below 220/140 mmHg.
UNASSIGNED: A consensus was reached on whether to deliver in preeclampsia typic clinical findings and symptoms. The results can serve as guidance for current clinical practice and for the definition of clinical endpoints in intervention studies. Nevertheless, the isolated criteria are a theoretical construction since the combined deterioration or summation of several factors rather than a single factor most likely influences the decision to deliver and reflect the severity of preeclampsia. Moreover, the degree of hypertension as an indication for delivery remains controversial, unless the patient suffers additionally from complaints. Future research should be enforced to incorporate long-term risks for the mother into a decision aid.
UNASSIGNED: Präeklampsie stellt eine potenziell lebensbedrohende hypertensive Schwangerschaftserkrankung dar, die mit einem akuten Risiko für ein ungünstiges Schwangerschaftsoutcome und mit Konsequenzen für die langfristige Gesundheit der Mutter verbunden ist. Das höchste Risiko haben Frauen, welche die Frühform von Präeklampsie vor der 32. Schwangerschaftswoche entwickeln, und die Behandlung dieser Frauen ist auch am schwierigsten. Der Schweregrad der Präeklampsie wird in Deutschland nicht einheitlich eingestuft. Das bedeutet, dass die Indikation zur Entbindung eher individuell erfolgt. Ziel dieser Studie war es, einen Konsens hinsichtlich der Parameter zu erreichen, die, basierend auf der Dringlichkeit der Entbindung, als Kriterien zur Beschreibung des Schweregrads der Präeklampsie dienen könnten. Es wurde dazu eine Delphi-Studie durchgeführt, die ein Szenario beschreiben sollte, bei der eine Frau wegen Präeklampsie vor der 32. Schwangerschaftswoche und nach Abschluss einer antenatalen Steroidtherapie stationär aufgenommen wird.
UNASSIGNED: Fachärzte und -ärztinnen für mütterliche-fetale Medizin aus deutschsprachigen Ländern nahmen an 5 Runden einer modifizierten Delphi-Befragung teil. Die vorgestellten Parameter wurden von der Sektion Hypertensive Schwangerschaftserkrankungen und fetale Wachstumsrestriktion der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe nach Durchsicht der Literatur ausgewählt. Die Liste der Parameter umfasste objektivierbare Laborparameter und klinische Parameter sowie subjektive Symptome von Patientinnen. Es wurden auch 9 fetale Parameter berücksichtigt. Die Fachärzte und -ärztinnen wurden gebeten, die vorgestellten Parameter als Indikation für eine Entbindung auf einer Likert-Skala von 0 bis 4 (keine Indikation bis absolute Indikation ohne Verzug) zu bewerten. Für jeden Punkt war der vorgegebene kritische Wert für ein Gruppenkonsens eine Zustimmung ≥ 70%.
UNASSIGNED: Insgesamt wurden 126 Fachärzte und -ärztinnen angeschrieben. Es nahmen 69 Fachärzte und -ärztinnen (54,8%) an der 1. Runde teil; davon haben 50 den gesamten Delphi-Prozess abgeschlossen. Ein Konsens wurde für 14 Parameter erreicht, die als Hinweise für eine schnelle Entbindung eingestuft wurden (4 Punkte auf der Likert-Skala). Dazu zählten u. a. Leberhämatom bzw. Leberkapselruptur, akutes Leberversagen mit fulminanter Gerinnungsstörung oder disseminierter intravasaler Gerinnung, Eklampsie, pathologische Befunde in der Bildgebung (z. B. cMRI) oder beim Elektrokardiogramm, das wegen erneutem Auftreten von Kopfschmerzen bzw. Brustbeinschmerzen durchgeführt wurde. 26 Parameter wurden als Faktoren eingestuft, die bei einer Entscheidung zur Entbindung berücksichtigt werden sollten, ohne dass sie absolut eine Entbindung erfordern (1 bis 3 Punkte); bei 13 Parametern war der Konsens, dass diese keinen Einfluss auf die Entscheidung zur Entbindung haben sollten (0 Punkte). Hinsichtlich des Punktes „schwerer Bluthochdruck als Indikation für eine Entbindung“ konnte kein Konsens erreicht werden, wenn die Blutdruckwerte unter 220/140 mmHg lagen.
UNASSIGNED: Es wurde ein Konsens hinsichtlich der typischen klinischen Befunde und Symptome für eine dringliche Entbindung erreicht. Die Ergebnisse können als Anleitung für die aktuelle klinische Praxis und bei der Definition von klinischen Endpunkten in Interventionsstudien dienen. Dennoch stellen diese isolierten Kriterien ein theoretisches Konstrukt dar, da in der Praxis die Entscheidung zur Entbindung auf einer kombinierten Verschlechterung bzw. auf der Summierung mehrerer Faktoren anstelle eines einzigen Faktors beruht, da diese Konstellation eher den Schweregrad der Präeklampsie reflektiert. Hinzu kommt noch, dass die Schwere der Hypertonie als Indikation für eine Entbindung immer noch kontrovers diskutiert wird, es sei denn, dass die Patientin auch unter anderen Beschwerden leidet. Die zukünftige Forschung sollte auch mütterliche Langzeitrisiken in die Entscheidungshilfe integrieren.

BACKGROUND: Human milk banks are essential facilities to provide donated human milk (DHM) to preterm and term infants with health complications. Little is known regarding milk bank donors and how their characteristics may influence the particularities of the donation process. The present study aims to assess characteristics of donors and their newborns to identify associations with the amount of DHM and initiation and donation time, during the first and second year of the milk bank operation in Córdoba, Spain.
METHODS: This cross-sectional study was conducted in three periods: pre-opening of the milk bank (PRE) including all women who gave birth to a newborn between January - May 2017 and were hospital users; donors in the first year after the opening (Period 1 (P1): April 2019 - March 2020); and in the second year (P2: April 2020 - March 2021). For P1 and P2, DHM data were recorded. The relationships between donor and newborn characteristics and the donation process were examined using univariable and regression models.
RESULTS: From 391 women interviewed in the PRE period, 55 (14%) showed intention to donate. In P1 and P2, there were 51 and 25 human milk (HM) donors, respectively. Age, gestational age (GA) and parity were similar between periods. In P2, a higher proportion of donors had higher education (P1: 46%; P2: 70.8%, p = 0.045). Around 40% of donors in both periods were on maternity leave. In P1, donors who had low birth weight infants (< 2500 g) donated more HM than those with infants weighing ≥ 2500 g (p = 0.020). In P2, women whose GA was < 37 weeks donated a higher volume vs. those with ≥ 37 weeks (p = 0.002). Maternity leave was linked to a shorter initiation time for donations in both periods (P1: p = 0.002; P2: p < 0.001).
CONCLUSIONS: Data obtained from a Spanish human milk bank indicate that prematurity and low birth weight appear to influence the amounts of DHM. Employment status might be a decisive factor in initiating HM donation. Additional efforts are required to identify shared donor characteristics that influence the initiation and volume of donation.

Regulatory T cells (Treg) play a prominent role in utero tolerating non-inherited maternal antigens and in regulating immune responses against pathogens at birth. This study investigates Treg immunity in newborns in West Africa, where sepsis remains a major public health problem. Treg phenotypes on neonates subgroups with early-onset sepsis (EOS), presumed sepsis, and healthy newborn with and without prenatal risk factors were evaluated. Treg phenotypes varied according to prenatal conditions, with increase in Treg frequency and Foxp3 expression in healthy newborns with prenatal risk factors compared to those with none risk. Compared to healthy newborns with prenatal risk factors, EOS neonates had a significantly reduced frequency of Treg and Foxp3 expression. In the Treg pool, higher frequency of activated Treg was observed in EOS neonates, suggesting an in-utero activation upstream of the sepsis onset. Their migration to the infection site may explain the reduced frequency of circulating Integrin α4β1+ Treg suggestive of homing to the endothelial tissue. EOS neonates show increases expression of CTLA-4, PD-1 and CD39 on Treg, which negatively regulate the activation of effector T cells (Teff) corroborating by the lower frequency of Teff in EOS neonates. The higher frequency of CD39+ Treg and the lower frequency of integrinα4β1+ Treg in EOS non-survivor suggests that Treg exhaustement and endothelial homing are associated with outcome severity. Neonates developing EOS are born with an altered Treg phenotypic profile. Treg expression of CTLA-4, PD-1, CD39, and integrinα4β1 cell markers can be considered as early warning or diagnostic markers of EOS.

UNASSIGNED: Delayed cord clamping (DCC) occurs in most preterm births.
UNASSIGNED: Evaluate the association of DCC with acute kidney injury (AKI) and two-year kidney outcomes.
UNASSIGNED: Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial of neonates born 240/7 to 276/7 weeks\' gestation. AKI and two year kidney outcomes were compared in neonates with DCC (≥30 seconds after delivery) to those with early cord clamping (ECC) (<30 seconds after delivery).
UNASSIGNED: The incidence and severity of AKI did not differ between the DCC and ECC groups (aOR 1.17 [95%CI 0.76-1.80]). At two years corrected age, DCC was associated with a 4.5-fold times increased adjusted odds of eGFR <90 mL/min/1.73m2. No significant associations were noted between DCC and albuminuria or elevated BP.
UNASSIGNED: DCC was not associated with decreased neonatal AKI, but was associated with higher adjusted odds of eGFR <90 mL/min/1.73m2 at two years.

UNASSIGNED: Ethno-racial inequalities are critical determinants of health outcomes. We quantified ethnic-racial inequalities on adverse birth outcomes and early neonatal mortality in Brazil.
UNASSIGNED: We conducted a cohort study in Brazil using administrative linked data between 2012 and 2019. Estimated the attributable fractions for the entire population (PAF) and specific groups (AF), as the proportion of each adverse outcome that would have been avoided if all women had the same baseline conditions as White women, both unadjusted and adjusted for socioeconomics and maternal risk factors. AF was also calculated by comparing women from each maternal race/skin colour group in different groups of mothers\' schooling, with White women with 8 or more years of education as the reference group and by year.
UNASSIGNED: 21,261,936 newborns were studied. If all women experienced the same rate as White women, 1.7% of preterm births, 7.2% of low birth weight (LBW), 10.8% of small for gestational age (SGA) and 11.8% of early neonatal deaths would have been prevented. Percentages preventable were higher among Indigenous (22.2% of preterm births, 17.9% of LBW, 20.5% of SGA and 19.6% of early neonatal deaths) and Black women (6% of preterm births, 21.4% of LBW, 22.8% of SGA births and 20.1% of early neonatal deaths). AF was higher in groups with fewer years of education among Indigenous, Black and Parda for all outcomes. AF increased over time, especially among Indigenous populations.
UNASSIGNED: A considerable portion of adverse birth outcomes and neonatal deaths could be avoided if ethnic-racial inequalities were non-existent in Brazil. Acting on the causes of these inequalities must be central in maternal and child health policies.
UNASSIGNED: Bill & Melinda Gates Foundation and Wellcome Trust.