Current Issue : October-December Volume : 2026 Issue Number : 4 Articles : 6 Articles
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....
Advances in prenatal diagnosis have improved the perinatal management of congenital heart disease (CHD). However postnatal comorbidities still persist due to multifactorial causes, which limits prenatal prediction of individual outcomes. Oxidative stress (OS), particularly lipid peroxidation, has been suggested to play a role in the development and progression of CHD, with 8-iso-prostaglandin F2α (8-iso-PGF2α) serving as a biomarker of oxidative injury. This prospective case–control study aimed to evaluate OS in fetuses with isolated major CHD by comparing amniotic fluid (AF) 8-iso-PGF2α concentrations with controls. A total of 123 fetuses (83 CHD, 40 controls) were included at a tertiary CHD referral center. CHD cases were subclassified according to anatomical type and expected fetal brain perfusion under placental circulation. Controls were gestational agematched pregnancies undergoing amniocentesis for indications unlikely to affect OS. All pregnant women underwent standardized fetal biometry, Doppler assessment, and detailed echocardiography. AF samples were obtained by amniocentesis and analyzed for free 8- iso-PGF2α using a competitive ELISA, with values normalized to creatinine. Clinical, obstetric, and Doppler characteristics were comparable between groups. CHD fetuses showed significantly higher AF 8-iso-PGF2α concentrations than controls (2849 ± 1377 vs. 2088 ± 1087 ng/mg Cr, p = < 0.001), and remained significant after adjustment for GA, smoking status, diabetes and maternal age and body mass index (BMI). No consistent differences were observed across anatomical or hemodynamic CHD subgroups. These findings provide the first intrauterine evidence of increased lipid peroxidation in fetuses with CHD as reflected by elevated amniotic fluid 8-iso-PGF2α concentrations....
There is a need to better understand the indications and safety profiles for therapeutic plasma exchange (TPE) in children. We aimed to assess pediatric TPE practice at a large academic center by retrospective chart review from 2011 to 2022. Patient demographics and clinical information including American Society for Apheresis (ASFA) category were analyzed. The cohort consisted of 438 patients, 52.1% female with a median age of 11.4 years, who underwent 3385 TPE procedures. The adverse reaction rate was 6.8%, with hypotension being most common. Tandem circuits were used in 3.9% of procedures, and the adverse reaction rate was significantly higher, 16.1% (p = < 0.05). Cryoprecipitate transfusion occurred in 29.0% of procedures for hypofibrinogenemia (median treatment number 3) and 19.1% of procedures required an RBC prime. Our findings highlight contemporary practical considerations for running a pediatric apheresis service, provide insight into managing tandem procedures, and may provide guidance for future research endeavors and clinical practice....
Neonatal vitamin B12 (B12) deficiency can cause neurodevelopmental harm, and newborn screening (NBS) may enable early detection and treatment. We conducted a multicenter pilot project in four Prague university hospitals between 1 June 2022 and 30 June 2025. Algorithms included the determination of propionylcarnitine-derived primary markers using flow-injection tandem mass spectrometry and second-tier methylmalonic acid (MMA), with total homocysteine measured only when MMA was increased. Of 34,302 screened newborns with consent, 1365 (3.98%) triggered second-tier testing; 9 had MMA >2.5 μmol/L, of which 8 met the case definition after confirmatory testing, giving a birth frequency of 1:4228 (95% CI 1:2176–1:9931). Positive predictive value was 0.59% (95% CI 0.25–1.15%) and 88.89% (95% CI 51.75–99.72%) for the primary test and second-tier MMA, respectively, with a false positive rate of 0.00292% (95% CI 0.000074–0.01625%). All affected infants were treated orally with cyanocobalamin. Maternal work-up identified confirmed B12 deficiency in four of eight mothers and premalignant gastric changes in two of four positive women. These data support the feasibility, low cost, and clinical utility of incorporating B12 deficiency into Czech NBS, with benefits extending beyond newborn health....
Background: Preterm birth rates may have been affected during the COVID- 19 pandemic but the impact of this on perinatal morbidity is unknown. Aim: To review the impact of the COVID- 19 pandemic on rates of preterm birth and perinatal mortality. Methods: Medline, Embase, and online pre- prints were searched from Jan 2020 to Oct 2022. Case–control, cohort studies and reports comparing rates of preterm birth, stillbirth and neonatal death before and during the COVID- 19 pandemic period were included. The pooled odds ratio (OR) for preterm birth, stillbirth and neonatal death was calculated using a random effects model. The primary outcome was the rate of preterm birth, stillbirth and neonatal death in the pre- pandemic and pandemic periods. Results: 100 studies were included. Compared with pre- pandemic periods, there was a decrease in preterm births during the pandemic period: OR 0.95 (95% CI 0.94–0.97) I2 = 0.93, with the greatest reduction for births < 28 weeks' gestation in high- income countries: OR 0.92 (95% CI 0.88–0.96), I2 = 0.46. There was a reduction in neonatal deaths in high- income countries: OR 0.78 (95% CI 0.64–0.95), I2 = 0.4. In low- and middle- income countries the stillbirth rate increased during the pandemic compared with the pre- pandemic period: OR 1.18 (95% CI 1.02–1.36), I2 = 0.86. Conclusion: The COVID- 19 pandemic was associated with a reduction in preterm births and neonatal deaths. Further research is needed to investigate the mechanisms underlying these findings. Stillbirth rates increased in low- and middleincome countries where access to healthcare may have been restricted and strategies to address this in future pandemics are warranted....
agnostically challenging condition in which hypokinetic–rigid features most commonly result from defects in neurotransmitter biosynthesis or metabolism rather than the primary dopaminergic neurodegeneration observed in adults. Impairments in dopamine and serotonin pathways lead to monoamine deficiency, clinically manifesting as dystonia, oculogyric crises, and bradykinesia [1]. This condition is broadly classified into developmental and degenerative forms. The former results from impaired maturation of dopaminergic circuitry, whereas the latter is characterized by progressive nigrostriatal degeneration and may occur as part of complex multisystem neurodevelopmental disorders WW domain- containing oxidoreductase (WWOX) is a key regulator of neural development, synaptic homeostasis, and cortical organization. However, its role in monoamine pathways remains not well defined. Experimental studies suggest that WWOX modulates the vulnerability of dopaminergic neurons through interactions with JNK1 (stress- related kinase), particularly, which is involved in neurodegenerative signaling cascades [2]. Furthermore, genome- wide association studies have identified variants at the WWOX locus as genetic modifiers associated with accelerated progression to dementia in Parkinson's disease, suggesting a modulatory role in dopaminergic resilience rather than primary neurodegeneration Pathogenic WWOX variants are well- established causes of severe neurodevelopmental disorders including SCAR12 and WOREE (WWOX- related epileptic encephalopathy). However, a parkinsonian phenotype has not been reported in humans to date. Here, we describe the first case of neonatal–infantile parkinsonism associated with a pathogenic WWOX variant, clinically mimicking a primary monoamine neurotransmitter synthesis defect....
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