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Background Early mother–child skin-to-skin contact (SSC) in the first 2 h postpartum is highly beneficial for both mother and child. However, cases have been reported of newborns who have experienced apparently life-threatening events (ALTEs) or sudden death during this procedure. The causes of these events are unknown. Newborn’s prone position could influence the onset of these events but there is very little evidence to support any recommendation. We hypothesize that newborns’ breathing obstruction episodes increase as mothers lie more horizontally. The main objective of this study is to compare the occurrence of desaturation and bradycardia episodes as a function of mother’s bed incline. The study is designed as a randomized, controlled, assessor blind, multicenter, superiority trial with two parallel groups and 1:1 allocation ratio. Methods The study participants will be full-term healthy mother–newborn dyads from ten hospitals in Spain. Participants will be randomly assigned to one of two study arms defined by mother’s bed inclination (45° or 15°). The planned sample size is 5866. Centralized permuted blocks randomization and assessor blinding will be implemented. The newborns will be monitored remotely with pulse oximetry, from 10 min to 2 h after delivery. We established SO 2 and heart rate (HR) limit alarms, as well as an action protocol in the event of alarm activation. The primary outcome is the number of healthy newborns who undergo episodes of SO 2  ≤ 90%. Secondary outcomes are the mean SO 2 level, the number of newborns who experience episodes of SO 2  ≤ 85%, the time to SSC discontinuation due to abnormal SO 2 or HR, and episodes of HR < 111 beats per minute (bpm) or > 180 bpm. Subgroups and pooled analysis will be performed to identify if breast-feeding and mother and child positions favor the occurrence of desaturation or bradycardia episodes. Discussion A simple intervention such as modifying mother’s bed angle of inclination while in SSC with her child during the first 2 h postpartum could favor newborn’s hemodynamic and respiratory stabilization and thus contribute to reducing the onset of ALTEs. Trial registration ClinicalTrials.gov, NCT02585492 . Registered on 22nd October 2015. Protocol version 2 (30th June 2015).

BackgroundSkin antisepsis is one of the most important bundle measures to decrease central line-related bloodstream infections (CRBSIs). However, in the neonatal population, the use of alcoholic chlorhexidine is limited by the risk of skin lesions.ObjectiveWe hypothesised that skin antisepsis with alcohol-based 2% chlorhexidine instead of aqueous 2% chlorhexidine could reduce the incidence of CRBSI without increasing skin complications.DesignWe conducted a double cohort study comparing two periods of 3 years, first using aqueous and second using alcohol-based chlorhexidine, leaving a 1-year washout interval between them. In extremely preterm infants, aqueous chlorhexidine was used during the first week of life in both periods.ResultsA total of 1783 patients and 2493 episodes of central line catheter were analysed. There were no statistically significant differences in clinical and demographic data from infants in both periods. There was a significant reduction in the pooled incidence density of CRBSI in the second compared with the first period (4.03 vs 9.05 episodes/1000 central line days, OR 0.45 (95% CI 0.29 to 0.68)). The overall absolute risk reduction was 0.039 (95% CI 0.023 to 0.056) and the number needed to treat was 25. A similar but not significant reduction of the small number of CRBSI was observed in extremely preterm infants within the first week of life OR 0.43 (95% CI 0.134 to 1.379). No statistically significant differences in skin lesions were observed between periods, making erythema the most common injury(5.1% vs 4.2%).RelevanceAlcohol-based 2% chlorhexidine as a skin antiseptic could reduce the incidence of CRBSI in neonates without producing an increase in skin lesions.

ObjectiveWe hypothesized that the implementation of evidence-based interventions shaping a bundle approach could significantly reduce the incidence of ventilator-associated pneumonia (VAP) in the neonatal intensive care unit.Study designWe conducted a prospective observational cohort study including neonates undergoing mechanical ventilation >48 h. VAP rate and endotracheal intubation ratio were compared before (pre-period) and after (post-period) applying VAP prevention bundle strategies.ResultOne hundred seventy-four neonates were included in pre-period (30 months) and 106 in post-period (17 months). Demographic characteristics were comparable and device use ratios were similar. Twenty-eight VAP episodes were diagnosed, 25 in the first period and 3 after the implementation of prevention bundle. This represents a reduction in the incidence rate from 11.79 to 1.93 episodes/1000 ventilator days (p < 0.01).ConclusionThe implementation of an educational evidence-based program using a bundle approach to prevent VAP has shown a statistically significant reduction in its incidence density.

Introduction Ventilator-associated pneumonia (VAP) constitutes a serious nosocomial infection. Our aim was to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in bronchoalveolar lavage fluid (BALF) and tracheal aspirates (TA) as early biomarkers of VAP in preterm infants. Methods Two cohorts were enrolled, one to select candidates and the other for validation. In both, we included preterms with suspected VAP, according to BALF culture, they were classified into confirmed VAP and no VAP. Concentration of 16 cytokines and 8 oxidative stress/inflammation biomarkers in BALF and TA was determined in all patients. Results In the first batch, IL-17A and TNF-α in BALF, and in the second one IL-10, IL-6, and TNF-α in BALF were significantly higher in VAP patients. BALF TNF-α AUC in both cohorts was 0.86 (sensitivity 0.83, specificity 0.88). No cytokine was shown to be predictive of VAP in TA. A statistically significant increase in the VAP group was found for glutathione sulfonamide (GSA) in BALF and TA. Conclusions TNF-α in BALF and GSA in BALF and TA were associated with VAP in preterm newborns; thus, they could be used as early biomarkers of VAP. Further studies with an increased number of patients are needed to confirm these results. Impact We found that TNF-α BALF and GSA in both BALF and TA are capable of discriminating preterm infants with VAP from those with pulmonary pathology without infection. This is the first study in preterm infants aiming to evaluate the reliability of cytokines and oxidative stress/inflammation biomarkers in BALF and TA as early diagnostic markers of VAP. We have validated these results in two independent cohorts of patients. Previously studies have focused on full-term neonates and toddlers and determined biomarkers mostly in TA, but none was exclusively conducted in preterm infants.

Therapeutic hypothermia (TH) initiated within 6 h from birth is the most effective therapeutic approach for moderate to severe hypoxic-ischemic encephalopathy (HIE). However, underlying mechanisms and effects on the human metabolism are not yet fully understood. This work aims at studying the evolution of several energy related key metabolites in newborns with HIE undergoing TH employing gas chromatography – mass spectrometry. The method was validated following stringent FDA requirements and applied to 194 samples from a subgroup of newborns with HIE (N = 61) enrolled in a multicenter clinical trial (HYPOTOP) for the determination of lactate, pyruvate, ketone bodies and several Krebs cycle metabolites at different sampling time points. The analysis of plasma samples from newborns with HIE revealed a decrease of lactate, pyruvate and β-hydroxybutyrate concentrations, whereas rising malate concentrations were observed. In healthy control newborns (N = 19) significantly lower levels of pyruvate and lactate were found in comparison to age-matched newborns with HIE undergoing TH, whereas acetoacetate and β-hydroxybutyrate levels were clearly increased. Access to a validated analytical method and a controlled cohort of newborns with HIE undergoing hypothermia treatment for the first time allowed the in-depth study of the evolution of key metabolites of metabolic junctions in this special population.

Background: Own mother’s milk (OMM) is the optimal nutrition for preterm infants. However, pasteurized donor human milk (DHM) is a valid alternative. We explored the differences of the transcriptome in exfoliated epithelial intestinal cells (EEIC) of preterm infants receiving full feed with OMM or DHM. Methods: The prospective observational study included preterm infants ≤ 32 weeks’ gestation and/or ≤1500 g birthweight. Total RNA from EEIC were processed for genome-wide expression analysis. Results: Principal component analysis and unsupervised hierarchical clustering analysis revealed two clustered groups corresponding to the OMM and DHM groups that showed differences in the gene expression profile in 1629 transcripts. The OMM group overexpressed lactalbumin alpha gene (LALBA), Cytochrome C oxidase subunit I gene (COX1) and caseins kappa gene (CSN3), beta gene (CSN2) and alpha gene (CSN1S1) and underexpressed Neutrophil Cytosolic Factor 1 gene (NCF1) compared to the DHM group. Conclusions: The transcriptomic analysis of EEIC showed that OMM induced a differential expression of specific genes that may contribute to a more efficient response to a pro-oxidant challenge early in the postnatal period when preterm infants are at a higher risk of oxidative stress. The use of OMM should be strongly promoted in preterm infants.

The death of the parasite usually leads to deflation of the cyst, wall necrosis and calcification. 2 Learning points Considering the patient's background including recent travels, birthplace and its epidemiological situation can point to the right direction in the diagnosis of a child attending an emergency care unit.