True human tails, a rare and perplexing congenital phenomenon, continue to intrigue medical practitioners due to their complex aetiology. A male term neonate presented to our paediatric surgery department with a true tail arising from the left lumbosacral region. The antenatal period was uneventful, and the neonate exhibited normal development and vital parameters. Clinical examination revealed a tail-like structure covered by normal skin, devoid of spontaneous movements or bony elements. Neurological assessments and ultrasound examinations showed no associated abnormalities. The patient\'s family history included a sibling with hypospadias. This case adds to the limited literature on true tails and highlights the importance of thorough evaluation and management of such rare anomalies.

BACKGROUND: Sustained implementation of facility-level quality improvement (QI) processes, such as plan-do-study-act cycles, requires enabling meso-level environments and supportive macro-level policies and strategies. Although this is well recognised, there is little systematic empirical evidence on roles and capacities, especially at the immediate meso-level of the system, that sustain QI strategies at the frontline.
METHODS: In this paper we report on qualitative research to characterize the elements of a quality and outcome-oriented meso-level, focused on sub/district health systems (DHSs), conducted within a multi-level initiative to improve maternal-newborn health (MNH) in three provinces of South Africa. Drawing on the embedded experience and tacit knowledge of core project partners, obtained through in-depth interviews (39) and project documentation, we analysed thematically the roles, capacities and systems required at the meso-level for sustained QI, and experiences with strengthening the meso-level.
RESULTS: Meso-level QI roles identified included establishing and supporting QI systems and strengthening delivery networks. We propose three elements of system capacity as enabling these meso-level roles: (1) leadership stability and capacity, (2) the presence of formal mechanisms to coordinate service delivery processes at sub-district and district levels (including governance, referral and outreach systems), and (3) responsive district support systems (including quality oriented human resource, information, and emergency medical services [EMS] management), embedded within supportive relational eco-systems and appropriate decision-space. While respondents reported successes with system strengthening, overall, the meso-level was regarded as poorly oriented to and even disabling of quality at the frontline.
CONCLUSIONS: We argue for a more explicit orientation to quality and outcomes as an essential district and sub-district function (which we refer to as meso-level stewardship), requiring appropriate structures, processes, and capacities.

UNASSIGNED: There is increasing evidence that the COVID-19 pandemic has impacted adversely on the provision of essential health services globally. The Southeast Asia region (SEAR) has experienced extremely high rates of COVID-19 infection, with potential adverse impacts on provision of reproductive, maternal, neonatal, and child health (RMNCH) services.
UNASSIGNED: We conducted a systematic literature review of quantitative evidence to characterise the impact of COVID-19 on the provision of essential RMNCH services across the SEAR. Studies published between December 2019 and May 2022 were included in the study. The quality of studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist.
UNASSIGNED: We reviewed 1924 studies and analysed data from 20 peer-reviewed studies and three reports documenting quantitative pre-post estimates of RMNCH service disruption because of the COVID-19 pandemic. Eleven studies were of low methodological quality, in addition to seven and five studies of moderate and high methodological qualities respectively. Six countries in the region were represented in the included studies: India (11 studies), Bangladesh (4), Nepal (3), Sri Lanka (1), Bhutan (1) and Myanmar (1). These countries demonstrated a wide reduction in antenatal care services (-1.6% to -69.6%), facility-based deliveries (-2.3% to -52.4%), child immunisation provision (-13.5% to -87.7%), emergency obstetric care (+4.0% to -76.6%), and family planning services (-4.2% to -100%).
UNASSIGNED: There have been large COVID-19 pandemic related disruptions for a wide range of RMNCH essential health service indicators in several SEAR countries. Notably, we found a higher level of service disruption than the WHO PULSE survey estimates. If left unaddressed, such disruptions may set back hard-fought gains in RMNCH outcomes across the region. The absence of studies in five SEAR countries is a priority evidence gap that needs addressing to better inform policies for service protection.
UNASSIGNED: WHO Sri Lanka Country Office.

Background: Breast milk is a critical element in developing a baby\'s immunity through immune transfer. Antibodies are an essential unit of immunity against infection with the SARS-CoV-2 virus. This paper explores antibodies in breast milk in postpartum women who have been vaccinated or exposed to coronavirus disease 2019 (COVID-19). Duration of antibody appearance was studied to determine the adequate time in transferring antibodies by breastfeeding. Methods: Three databases, PubMed, Google Scholar, and ScienceDirect, were used as sources of articles. Inclusion criteria applied in selecting articles were prospective observational study or experimental design study in English, evaluating antibodies in breast milk, and conducted between 2019-2021. Article quality and risk of bias were assessed with Critical Appraisal Skills Programme (CASP). The data found were synthesized in a narrative manner. Results: This systematic review included 20 articles. A total of 306 postpartum women who were infected with COVID-19, 20 postpartum women who had viral symptoms and 495 postpartum women who had been vaccinated were studied. Immunoglobulin A (IgA) and immunoglobulin G (IgG) antibodies were found in the breast milk of infected and vaccinated postpartum women. SARS CoV-2 infection is associated with the presence of IgA dominant, whereas vaccination is related to the presence of IgG dominant. Antibodies persisted from day 10 of onset to 10 months in infected postpartum women and started from three days to six weeks in vaccinated postpartum women. Meta-analysis could not be carried out due to the variety of articles. Conclusions: Antibodies found in breast milk in infected and vaccinated postpartum women have different dominant types. Further research needs to be done regarding the mechanism of antibody transfer in breast milk, longer research duration and studies that directly examine the comparison of antibodies in breast milk in vaccinated and infected postpartum women. Registration: PROSPERO ( CRD42022340859, 23 June 2022).

Background Most pregnancy-related complications and undesirable outcomes are preventable by effective interventions at a reasonable cost. These interventions are mainly deployed during the antenatal phase and are included under the umbrella of antenatal care (ANC). To our knowledge, no studies have been conducted to assess the adequacy of ANC in Saudi Arabia. This study aimed to measure and quantify the adequacy of ANC provided by the Ministry of Health (MoH) facilities in Jeddah and to determine potential factors influencing ANC. Methodology In this cross-sectional study, we used the Adequacy of Perinatal Care Utilization index to measure the adequacy of ANC. Data were collected from September 2023 to March 2024 in two randomly selected MoH hospitals by interviewing mothers and collecting data from medical records. Results A total of 303 mothers participated in this study. Mothers\' mean age was 31 years, and 50% of them had received higher school education. Prevalence of adequate ANC was 64.7%. There was a significant association between the adequacy of ANC and mothers\' level of education (p < 0.001), time taken to reach the nearest primary care center (p < 0.001), number of total pregnancies (p < 0.034), and the total number prenatal visits (p < 0.001). Conclusions This is the first study to shed light on the prevalence of adequacy of ANC in Saudi Arabia and its associated factors. This study would pave the way to investigate the adequacy of ANC on a national level and will aid policymakers in developing and implementing effective ANC preventive measures, hence helping improve women\'s health and their babies.

Pseudohypoaldosteronism type 1 is a rare congenital autosomal recessive disorder, characterised by failure of receptor response to aldosterone. It is caused by mutation in SCNN1A gene with clinical features like failure to thrive in infancy, hyponatraemia, hyperkalaemia and metabolic acidosis. We present a male infant with seizures, hyperkalaemia and with failure to thrive, diagnosed at day 6 of life. The baby required repeated correction for hyperkalaemia; hence, after ruling out treatable causes for hyperkalaemia, exonerated sequencing was done which showed pathogenic mutation for cystic fibrosis and recessive mutation for pseudohypoaldosteronism. But the child was clinically in favour of pseudohypoaldosteronism. Hence, features of pseudohypoaldosteronism predominate cystic fibrosis; they both may coexist.

Background: the benefits of water are significant during the birth process. Improved maternal experience of labor, less use of epidurals, better pain management, shorter labor, and a greater sense of control are observed during the birth process. Objective: This report aims to determine the benefits of hydrotherapy in clinical childbirth approaches and its applicability in pain control. Methods: A meta-analysis of randomized clinical trials selected from various databases with no publication date limits was conducted, comparing groups that did not use hydrotherapy with groups that did during labor. Results: Seven articles met the inclusion criteria, with five articles using hot water immersion and two using hot water shower as hydrotherapy treatments. This study identified 840 participants, with the intervention groups including 417 term pregnant women and the control groups including 423 pregnant women. The effect size of hydrotherapy on pain was calculated using the visual analog scale in five articles and analgesic use in the other two articles. Hydrotherapy significantly reduced pain during labor with a mean difference of -0.97 (95% CI: -1.91 to -0.03; I2 = 97.32%, p < 0.001). The duration of the first stage of labor was not significantly affected, with a mean difference of -0.17 h (95% CI: -0.55 to 0.21; I2 = 56.75%, p = 0.059). Additionally, hydrotherapy did not significantly impact the newborns\' Apgar scores at 5 min, with a mean difference of 0.18 (95% CI: -0.48 to 0.85; I2 = 2.15%, p = 0.939). Conclusions: Hydrotherapy is beneficial for pain control in the first stage of labor and does not increase its duration or negatively affect the Apgar score of newborns.

BACKGROUND: Escherichia coli and Klebsiella pneumoniae rank among the primary bacterial culprits in neonatal infections and fatalities in sub-Saharan Africa. This study characterized the phenotypic and genotypic features of E coli and K pneumoniae in a labor ward in Yaoundé, Cameroon.
METHODS: A prospective and cross-sectional study spanning 5months, from February 21, 2022 to June 30, 2022. Rectovaginal swabs were obtained from expectant mothers, and nasopharyngeal swabs were collected from their babies. Hand swabs of health care workers and environmental samples were also collected. The samples were cultured on eosin methylene blue agar. Extended-spectrum ß-lactamase (ESBL) production was assessed using CHROMAgar ESBL and the double-disk synergy test. A polymerase chain reaction was employed to detect ß-lactamase genes.
RESULTS: A total of 93 mothers and 90 neonates were collected. Almost all pregnant women (90%) were colonized by one or more multidrug-resistant (MDR) isolates with 58% being concomitantly ESBL producers. Altogether, 14 of 22 (64%) neonates were colonized by MDR isolates, while out of the 5 workers positive to Enterobacterales, all were colonized by MDR isolates. E coli predominated in pregnant women (55%) and neonates (73%), while K pneumoniae (83%) predominated in health care workers. The blaCTX-M (75%) was the leading ß-lactamase gene detected.
CONCLUSIONS: Our study suggests that drug-resistant E coli and K pneumoniae are circulating at high prevalence in the labor ward in Yaoundé and emphasizes the necessity for effective infection prevention and control along with antimicrobial stewardship measures.

UNASSIGNED: Studies have shown short-term and long-term positive effects of family-centred care interventions on neonatal and maternal health, and developmental outcomes in neonatal intensive care units. However, some challenges and barriers limit implementation of family-centred care.
UNASSIGNED: To investigate parental barriers to implementing family-centred care in a neonatal intensive care unit in Islamic Republic of Iran.
UNASSIGNED: A conventional content analysis was conducted at a neonatal intensive care unit in Tehran, Islamic Republic of Iran from 2020 to 2021. Twenty semi-structured interviews and 9 field notes were conducted. The interview data were analysed using the Graneheim and Lundman method and the demographic data were analysed using SPSS version 21.
UNASSIGNED: Two themes emerged from the data analysis. The first theme was \"inefficiency of playing the parental role\", with 2 main categories of \"face unpleasant feelings\" and \"inappropriate presence and participation\". The second theme was \"ineffective involvement of parents in the care\", with 3 main categories of \"lack of effective communication with personnel\", \"interference of parents in the treatment process\", and \"given insufficient information by parents\".
UNASSIGNED: Parental barriers to the provision of family-centred care featured prominently in the study. Therefore, to improve neonatal and family health, there is a need for involvement, coordination and effective communication between the medical teams and parents to create a supportive and friendly environment in neonatal intensive care units.
عوائق متعلقة بالوالدين تحول دون تنفيذ الرعاية التي ترتكز على الأسرة في وحدات الرعاية المركزة لحديثي الولادة في جمهورية إيران الإسلامية.
زهرة جعفري، سيما محمد خان كرمانشاهي، زهرة فنكي، زيبا مسيبي.
UNASSIGNED: أظهرت الدراسات أنَّ لتدخلات الرعاية التي تركِّز على الأسرة آثارً إيجابية قصيرة المدى وطويلة المدى على صحة حديثي الولادة وصحة الأم، وعلى مخرجات النمو في وحدات الرعاية المركزة لحديثي الولادة. ولكن بعض التحديات والعقبات يحدُّ من تنفيذ الرعاية التي تركِّز على الأسرة.
UNASSIGNED: هدفت هذه الدراسة الى استقصاء العوائق المتعلقة بالوالدين التي تحول دون تنفيذ الرعاية التي ترتكز على الأسرة في وحدات الرعاية المركزة لحديثي الولادة في جمهورية إيران الإسلامية.
UNASSIGNED: أُجريَ تحليل تقليدي للمحتوى في وحدة للرعاية المركزة لحديثي الولادة في طهران بجمهورية إيران الإسلامية، في الفترة - 2020 2021. وأُجريَت 20 مقابلة شبه منظمة و9 ملاحظات ميدانية. ثم خضعت بيانات المقابلات للتحليل باستخدام طريقة جرانيهايم ولوندمان، وخضعت البيانات السكانية للتحليل باستخدام برنامج SPSS، الإصدار 21.
UNASSIGNED: انبثق من تحليل البيانات موضوعان. الموضوع الأول كان \"التقصير في أداء دور الوالدين\"، وله فئتان رئيسيتان: \"مواجهة مشاعر غير سارة\" و\"عدم ملاءمة الحضور والمشاركة\". أمَّا الموضوع الثاني، فكان \"عدم فعالية إشراك الوالدين في الرعاية\"، وله 3 فئات رئيسية: \"غياب التواصل الفعال مع العاملين\"، و\"تدخل الوالدين في عملية العلاج\"، و\"نقص المعلومات التي يقدمها الوالدان\".
UNASSIGNED: برزت بوضوح في هذه الدراسة العوائق المتعلقة بالوالدين التي تحول دون توفير الرعاية التي تركِّز على الأسرة. ولذلك، فإن تحسين صحة حديثي الولادة والأسرة يتطلب مشاركة وتنسيقًا وتواصلًًا فعالًًا بين الفرق الطبية والوالدين، لتهيئة بيئة داعمة وملائمة في وحدات الرعاية المركزة لحديثي الولادة.
Obstacles parentaux à la mise en œuvre de soins centrés sur la famille dans une unité de soins intensifs néonatals en République islamique d\'Iran.
UNASSIGNED: Des études ont montré les effets positifs à court et à long terme des interventions de soins centrées sur la famille sur la santé néonatale et maternelle, et les résultats de développement dans les unités de soins intensifs néonatals. Toutefois, certains défis et obstacles entravent la mise en œuvre des soins centrés sur la famille.
UNASSIGNED: Étudier les obstacles parentaux à la mise en œuvre de soins centrés sur la famille dans une unité de soins intensifs néonatals en République islamique d\'Iran.
UNASSIGNED: Une analyse de contenu classique a été réalisée dans une unité de soins intensifs néonatals à Téhéran (République islamique d\'Iran) en 2020-2021. Vingt entretiens semi-structurés ont été réalisés et neuf notes de terrain ont été établies. L\'analyse des données des entretiens et celles des données démographiques ont été réalisée à l\'aide de la méthode de Graneheim et de Lundman et au moyen du logiciel SPSS version 21 respectivement.
UNASSIGNED: Deux thèmes sont ressortis de l\'analyse des données. Le premier thème était « L\'inefficacité dans le jeu de rôle des parents », avec deux catégories principales : « Faire face aux sentiments désagréables » et « Présence et participation inappropriées ». Le second thème était « L\'implication inefficace des parents dans les soins », avec trois catégories principales : « Manque de communication efficace avec le personnel », « Interférence des parents dans le processus de traitement » et « Informations insuffisantes données par les parents ».
UNASSIGNED: Les obstacles parentaux à la prestation de soins centrés sur la famille se reflétaient clairement dans l\'étude. Par conséquent, pour améliorer la santé néonatale et familiale, une participation, une coordination et une communication efficace sont nécessaires entre les équipes médicales et les parents afin de créer un environnement favorable et convivial dans les unités de soins intensifs néonatals.

Neonatal adrenal haemorrhage (NAH) is more frequently described in neonates due to their relatively larger size and increased vascularity. While most are asymptomatic, they can present with anaemia, jaundice, abdominal mass, scrotal haematoma or more severe complications such as shock and adrenal insufficiency. Scrotal haematoma seen with NAH may be mistaken for other more serious conditions causing acute scrotum. Prompt sonographic examination that includes the bilateral adrenal glands may help to detect NAH early and to avoid unnecessary interventions. Cases of NAH causing ipsilateral inguinal ecchymosis and scrotal haematoma have been reported, but contralateral haematomas are very rare. In this report, we present a unique case of a neonate with an antenatally acquired adrenal haematoma complicated with an acute peripartum rebleeding manifesting as a contralateral scrotal haematoma and inguinal ecchymosis. The NAH was treated conservatively and resolved on follow-up imaging.