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ObjectiveTo evaluate the effectiveness and safety of standard vs. high-dose ibuprofen for the treatment of hemodynamically significant patent ductus arteriosus(hs-PDA).Study designA retrospective study of preterm infants who received either standard (10–5–5 mg/kg/day) or high (postnatal age 1–3 days: 10–5–5 mg/kg/day; 3–5 days: 15–7.5–7.5 mg/kg/day; >5 days: 20–10–10 mg/kg/day) dose ibuprofen for hs-PDA was conducted.ResultSixty preterm infants with a mean birthweight of 898.2 (±262.6) g and mean gestational age of 26.3 (±0.6) weeks were included. High-dose ibuprofen was associated with a 21%(95% CI, −1.87 to 39.06%; p = 0.07) absolute reduction in PDA ligation compared to standard-dose ibuprofen. On adjusted analysis, receipt of standard-dose ibuprofen (OR 7.37, 95% CI, 1.2–45.27; p = 0.03) independently predicted increased PDA ligation risk. There were no differences in oliguria, NEC, or BPD between groups.ConclusionHigh-dose ibuprofen may significantly reduce PDA ligations. No difference in the safety profile with high-dose ibuprofen as compared to the standard-dose regimen was demonstrated.

Organic radical batteries (ORBs) represent a viable pathway to a more sustainable energy storage technology compared to conventional Li-ion batteries. For further materials and cell development towards competitive energy and power densities, a deeper understanding of electron transport and conductivity in organic radical polymer cathodes is required. Such electron transport is characterised by electron hopping processes, which depend on the presence of closely spaced hopping sites. Using a combination of electrochemical, electron paramagnetic resonance (EPR) spectroscopic, and theoretical molecular dynamics as well as density functional theory modelling techniques, we explored how compositional characteristics of cross-linked poly(2,2,6,6-tetramethyl-1-piperidinyloxy-4-yl methacrylate) (PTMA) polymers govern electron hopping and rationalise their impact on ORB performance. Electrochemistry and EPR spectroscopy not only show a correlation between capacity and the total number of radicals in an ORB using a PTMA cathode, but also indicates that the state-of-health degrades about twice as fast if the amount of radical is reduced by 15%. The presence of up to 3% free monomer radicals did not improve fast charging capabilities. Pulsed EPR indicated that these radicals readily dissolve into the electrolyte but a direct effect on battery degradation could not be shown. However, a qualitative impact cannot be excluded either. The work further illustrates that nitroxide units have a high affinity to the carbon black conductive additive, indicating the possibility of its participation in electron hopping. At the same time, the polymers attempt to adopt a compact conformation to increase radical–radical contact. Hence, a kinetic competition exists, which might gradually be altered towards a thermodynamically more stable configuration by repeated cycling, yet further investigations are required for its characterisation.

Social media use is associated with developing communities of practice that promote the rapid exchange of information across traditional institutional and geographical boundaries faster than previously possible. We aimed to describe and share our experience using #neoEBM (Neonatal Evidence Based Medicine) hashtag to organise and build a digital community of neonatal care practice. Analysis of #neoEBM Twitter data in the Symplur Signals database between 1 May 2018 to 9 January 2021. Data on tweets containing the #neoEBM hashtag were analysed using online analytical tools, including the total number of tweets and user engagement. Since its registration, a total of 3 228 distinct individual Twitter users used the hashtag with 23 939 tweets and 37 259 710 impressions generated. The two days with the greatest number of tweets containing #neoEBM were 8 May 2018 (n = 218) and 28 April 2019 (n = 340), coinciding with the annual Pediatric Academic Societies meeting. The majority of Twitter users made one tweet using #neoEBM (n = 1078), followed by two tweets (n = 411) and more than 10 tweets (n = 347). The number of individual impressions (views) of tweets containing #neoEBM was 37 259 710. Of the 23 939 tweets using #neoEBM, 17 817 (74%) were retweeted (shared), 15 643 (65%) included at least one link and 1 196 (5%) had at least one reply. As #neoEBM users increased over time, so did tweets containing #neoEBM, with each additional user of the hashtag associated with a mean increase in 7.8 (95% CI 7.7-8.0) tweets containing #neoEBM. Our findings support the observation that the #neoEBM community possesses many of the characteristics of a community of practice, and it may be an effective tool to disseminate research findings. By sharing our experiences, we hope to encourage others to engage with or build online digital communities of practice to share knowledge and build collaborative networks across disciplines, institutions and countries.

ObjectiveTo assess the rate, location, risk factors, management, and outcomes of neonatal thrombosis (NT).DesignA retrospective study investigating infants admitted to NICUs in Canadian Neonatal Network between January 2014 and December 2016 and diagnosed with NT. Each infant with NT was matched with an infant without NT.ResultsOf 39,971 infants, 587 (1.5%) were diagnosed with NT: 440 (75%) venous, 112 (19%) arterial, 29 (5%) both. NT rate was 1.4% in full-term and 1.7% in preterm infants. Venous thrombi occurred most commonly in the portal vein and arterial thrombi in the cerebral artery. Conservative management and low molecular weight heparin were the most common treatment modalities. Hospital stay was longer (p < 0.001) in the NT patients, but mortality was similar.ConclusionsNT was diagnosed in ~15/1000 NICU admissions and most commonly in the portal vein and cerebral arteries. Management varied based on the type and location of thrombi. Large multicenter trials are needed to address the best management strategies.

Circulatory transition after birth presents a critical period whereby the pulmonary vascular bed and right ventricle must adapt to rapidly changing loading conditions. Failure of postnatal transition may present as hypoxemic respiratory failure, with disordered pulmonary and systemic blood flow. In this review, we present the biological and clinical contributors to pathophysiology and present a management framework.

ObjectiveTo evaluate the effect of prophylactic probiotic (PP) administration on rates of necrotizing enterocolitis (NEC), late-onset sepsis (LOS), and mortality in preterm infants.Study designWe conducted a retrospective cohort study of infants < 29 weeks’ gestation, admitted to neonatal intensive care units participating in the Canadian Neonatal Network between 1 January 2014 and 31 December 2015. Infants in the exposure group received PP. A multiple logistic regression model with generalized estimation equation was used.ResultsA total of 3093 infants were included, 652 infants (21%) received PP. The adjusted odds ratios (aOR) of NEC (aOR 0.64, 95% confidence interval [CI] 0.410, 0.996), mortality (aOR 0.41, 95% CI 0.26, 0.63), and a composite of NEC or mortality were significantly lower in the PP group. There was no significant difference in the aOR of LOS.ConclusionProphylactic probiotic administration is associated with a reduction in NEC and mortality in preterm infants.

IntroductionPatent ductus arteriosus (PDA) is the most common cardiovascular problem that develops in extremely preterm infants and is associated with poor clinical outcomes. Uncertainty exists on whether early pharmacotherapeutic treatment of a clinically symptomatic and echocardiography-confirmed haemodynamically significant PDA in extremely preterm infants improves outcomes. Given the wide variation in the approach to PDA treatment in this gestational age (GA) group, a randomised trial design is essential to address the question. Before embarking on a large RCT in this vulnerable population, it is important to establish the feasibility of such a trial.Methods and analysis Design: a multi-centre, open-labelled, parallel-designed pilot randomised controlled trial. Participants: preterm infants born <26 weeks of gestation with a PDA diagnosed within 72 hours after birth. Intervention (selective early medical treatment (SMART) strategy): selective early pharmacological treatment of a moderate-severe PDA shunt (identified based on pre-defined clinical signs and routine screening echocardiography) within the first 72 postnatal hours with provision for repeat treatment if moderate-severe shunt persists. Comparison (early conservative management strategy): no treatment of PDA in the first postnatal week. Primary outcomes: (1) proportion of eligible infants recruited during the study period; (2) proportion of randomised infants treated outside of protocol-mandated therapy. Sites and sample size: the study is being conducted in seven neonatal intensive care units across Canada and the USA with a target of 100 randomised infants. Analysis: the primary feasibility outcomes will be expressed as proportions. A pre-planned Bayesian analysis will be conducted for secondary clinical outcomes such as mortality, severe intraventricular haemorrhage, procedural PDA closure and chronic lung disease to aid stakeholders including parent representatives decide on the appropriateness of enrolling this vulnerable population in a larger trial if the feasibility of recruitment in the pilot trial is established.Ethics and disseminationThe study has been approved by the IWK Research Ethics Board (#1027298) and six additional participating sites. On the completion of the study, results will be presented at national and international meetings, published in peer-reviewed journals and incorporated into existing systematic reviews.Trial registration number NCT05011149 (WHO Trial Registration Data Set in Appendix A).Protocol versionVer 7.2 (dated July 19, 2023).

Background Transition immediately after birth is a complex physiological process. The neonate has to establish sufficient ventilation to ensure significant changes from intra-uterine to extra-uterine circulation. If hypoxia or bradycardia or both occur, as commonly happens during immediate transition in preterm neonates, cerebral hypoxia–ischemia may cause perinatal brain injury. The primary objective of the COSGOD phase III trial is to investigate whether it is possible to increase survival without cerebral injury in preterm neonates of less than 32 weeks of gestation by targeting cerebral tissue oxygen saturation (crSO 2 ) using specified clinical treatment guidelines during the immediate transition period after birth (the first 15 min) in addition to the routine monitoring of arterial oxygen saturation (SpO 2 ) and heart rate (HR). Methods/Design COSGOD III is an investigator-initiated, randomized, multi-center, multi-national, phase III clinical trial. Inclusion criteria are neonates of less than 32 weeks of gestation, decision to provide full life support, and parental informed consent. Exclusion criteria are severe congenital malformations of brain, heart, lung, or prenatal cerebral injury or a combination of these. The premature infants will be randomly assigned to study or control groups. Both groups will have a near-infrared spectroscopy (NIRS) device (left frontal), pulse oximeter (right palm/wrist), and electrocardiogram placed immediately after birth. In the study group, the crSO 2 , SpO 2 , and HR readings are visible, and the infant will receive treatment in accordance with defined treatment guidelines. In the control group, only SpO 2 and HR will be visible, and the infant will receive routine treatment. The intervention period will last for the first 15 min after birth during the immediate transition period and resuscitation. Thereafter, each neonate will be followed up for primary outcome to term date or discharge. The primary outcome is mortality or cerebral injury (or both) defined as any intra-ventricular bleeding or cystic periventricular leukomalacia (or both). Secondary outcomes are neonatal morbidities. Discussion crSO 2 monitoring during immediate transition has been proven to be feasible and improve cerebral oxygenation during immediate transition. The additional monitoring of crSO 2 with dedicated interventions may improve outcome of preterm neonates as evidenced by increased survival without cerebral injury. Trial registration ClinicalTrials.gov Identifier: NCT03166722 . Registered March 5, 2017.

Chemical investigation of Anisothecium spirale (Mitt.) Broth. (Family Dicranaceae), an epiphytic moss from the Darjeeling district hill region of the Eastern Himalayas was performed for the first time. Analysis of neutral lipid and phospholipid classes as well as their respective fatty acids revealed the presence of a significantly high content of octadeca-6-yn-9,12,15-trienoic acid, an acetylenic fatty acid commonly known as dicranin. Dicranin and a less abundant acetylenic fatty acid were detected in neutral lipids. The unique nature of the fatty acid signature supports the view of considering dicranin as chemotaxonomic marker for Dicranaceae members.

Abstract Inhaled nitric oxide (iNO), a selective pulmonary vasodilator, is used as a therapeutic modality in infants with hypoxemic respiratory failure (HRF) associated with persistent pulmonary hypertension of the newborn (PPHN). iNO should ideally be initiated following echocardiographic confirmation of PPHN. Use of iNO is recommended in late preterm and term infants who develop HRF despite optimal oxygenation and ventilation strategies. However, routine iNO use in preterm infants on respiratory support is not recommended. iNO may be considered as a rescue modality in preterm infants with early-onset HRF when associated with prolonged rupture of membranes or oligohydramnios, or late-onset HRF in the context of bronchopulmonary dysplasia-associated pulmonary hypertension (PH) with severe right ventricular failure. A trial of iNO may also be considered for infants with congenital diaphragmatic hernia with persistent HRF despite optimal lung recruitment, and with echocardiographic evidence of supra-systemic PH and adequate left ventricular function.