Early neonatal complications in pregnant women with gestational diabetes mellitus and the effects of glycemic control on neonatal infection

BACKGROUND Gestational diabetes mellitus(GDM)has become increasingly prevalent globally.Glycemic control in pregnant women with GDM has a critical role in neonatal complications.AIM To analyze the early neonatal complications in GDM,and examine the effect of blood glucose control level on neonatal infection.METHODS The clinical data of 236 pregnant women with GDM and 240 healthy pregnant women and newborns during from March 2020 to December 2021 the same period were retrospectively analyzed,and the early complications in newborns in the two groups were compared.The patients were divided into the conforming glycemic control group(CGC group)and the non-conforming glycemic control group(NCGC group)based on whether glycemic control in the pregnant women with GDM conformed to standards.Baseline data,immune function,infectionrelated markers,and infection rates in neonates were compared between the two groups.RESULTS The incidence of neonatal complications in the 236 neonates in the GDM group was significantly higher than that in the control group(P<0.05).Pregnant women with GDM in the NCGC group(n=178)had significantly higher fasting plasma glucose,2 h postprandial blood glucose and glycated hemoglobin A1C levels than those in the CGC group(n=58)(P<0.05).There were no differences in baseline data between the two groups(P>0.05).Additionally,the NCGC group had significantly decreased peripheral blood CD3^(+),CD4^(+),CD8^(+)T cell ratios,CD4/CD8 ratios and immunoglobulin G in neonates compared with the CGC group(P<0.05),while white blood cells,serum procalcitonin and C-reactive protein levels increased significantly.The neonatal infection rate was also significantly increased in the NCGC group(P<0.05).CONCLUSION The risk of neonatal complications increased in pregnant women with GDM.Poor glycemic control decreased neonatal immune function,and increased the incidence of neonatal infections.

Late Neonatal Bacterial Infection at the Brazzaville Teaching Hospital

Background: Late Neonatal Bacterial Infection (LNNBI) is a clinical and biological manifestations related to penetration and growth of specific causative bacteria in bloodstream occurring on the 4th-28th day of life. LNNBI still represents an important cause of mortality and morbidity among infants. Objectives: To determine the frequency of late bacterial infections in newborns, to describe the clinical and biological profiles and to identify the main responsible germs. Methods: Descriptive study data collection, conducted over a period of 10 months at the Brazzaville Teaching Hospital, of interest to newborns admitted from the 4th day of life for suspicion of neonatal infection, and those admitted for any other pathology and having presented an infection 48 hours after hospitalization, and in whom a bacterial culture and/or an inflammatory assessment confirmed or suspected infection. Results: During the study period, 1682 newborns were hospitalized, and 86 were hospitalized for a late neonatal bacterial infection, i.e. a frequency of 5.1%. There were 67 (77.9%) community infections and 19 (22.1%) nosocomial infections. The frequency of nosocomial infection was 1.1%. The main signs were fever in 65 cases (75.6%), and respiratory distress in 37 cases (43%). The most frequent localizations were bacteremia 32 (37.2%), pulmonary 21 (24.4%), digestive and meningeal in 11 cases (12.8%) each. The most common germ Klebsiella in 10 (50%) newborns was resistant to the usual antibiotics. The evolution was favorable in 71 cases (82.5%), and death occurred in 12 cases (14%). Conclusion: Late neonatal bacterial infection is common. The main responsible germs are gram-negative bacilli, in particular Klebsiella multi-resistant.

Uropathogens of Urinary Tract Infection in Pregnancy and Maternal-Fetal Outcomes at the Douala Referral Hospital, Cameroon: A Case-Control Study

Background: Urinary tract infection (UTI) is common in pregnancy and accounts for a high burden of maternal and perinatal morbidity/mortality and health expenditure. The burden of this condition has been understudied in Cameroon. We aimed to determine the uropathogens of urinary tract infection in pregnancy, and the maternal-fetal outcomes of UTI at the Douala Referral Hospital. Methods: We conducted an analytic matched case-control study of 206 pregnant women with evidence of urinary tract infection (103 cases) and those without (103 controls) who underwent antenatal care and gave birth at the DRH from January 2019 to April 2019. Socio-demographic, laboratory and maternal-fetal outcome data were collected using a pre-tested structured questionnaire and analyzed with SPSS version 23. Statistical significance was set at p < 0.05. Results: Escherichia coli (51.5%), Proteus mirabilis (15.5%), Staphylococcus aureus (11.7%) and Klebsiella sp. (6.8%) were the predominant uropathogens of UTI. Maternal outcomes of UTI were puerperal pyelonephritis (AOR 3.1;95% CI: 1.11 - 3.55, p = 0.0023), preterm labor (AOR 4.4;95% CI: 1.0 - 2.7, p = 0.008) and preterm birth (AOR 4.6;95% CI 1.9 - 22.9, p = 0.05). Furthermore, low birth weight (AOR 2.1;95% CI: 0.8 - 5.6, p = 0.05), neonatal infection (AOR 13;95% CI: 0.9 - 191.6, p = 0.04) and neonatal intensive care unit admission (AOR 2.5;95% CI: 1.7 - 3.6, p = 0.003) were fetal outcomes of UTI. Conclusion: Escherichia coli was the main uropathogenic agent of UTI during pregnancy. Maternal outcomes of UTI were puerperal pyelonephritis, preterm labor and delivery while fetal outcomes include: low-birth weight, neonatal infection and neonatal intensive care admission. Prompt diagnosis of this condition is the cornerstone to avoid adverse outcomes.

Respiratory Distress in Full and Post Term Neonates: Prevalence, Etiologies and Outcomes in a Tertiary Health Center in Yaoundé

Introduction: Respiratory pathologies are top listed amongst neonatal morbidities. Our objective was to describe the clinical features, causes and treatment of respiratory distress (RD) in full and post term neonates in a tertiary health center in Yaoundé, the Essos Hospital Centre (EHC). Patients and Method: This was a retrospective study. Full/post term neonates with RD from January 2017-December 2018 were included. Main parameters: incidence of RD, etiologies, risk factors for severity and mortality. Results: We included 186 neonates among 2312 newborn babies. The RD prevalence rate was 8%. Sex ratio of 2.15 was favoring male, median gestational age of 38 weeks. Clinical signs of RD were dominated by a Silverman score above 4/10 in 64%. Main etiologies were pneumonia (44%), followed by transient tachypnea (35.4). Perinatal asphyxia (OR = 9.412, P = 0.005) and cyanosis (OR = 6.509;P < 0.001) were worsening RD, while caesarian section was protective (OR = 0.412;P = 0.050). Mortality rate (MR) was 10.4%. Therapeutic measures briefly consisted in oxygen therapy for 98.9% of patients and probabilistic antibiotic therapy. Conclusion: Neonatal pneumonia was the preeminent etiology of RD in this population;the MR was high.

Coronavirus Infection during Pregnancy: A 1-Year Experience among Pregnant Egyptian Women

Objectives: This study aimed to investigate the effect of COVID-19 on fetal well-being and perinatal outcomes. Methods: Pregnant women with documented COVID-19 infection who visited the antenatal care clinic of El Shatby Maternity Hospital, Alexandria, Egypt, from May 2020 to May 2021 were selected and classified into three groups according to the illness severity: mild, moderate, and severe. Fetal well-being was examined using the umbilical and cerebral Doppler and nonstress test (NST). The estimated fetal weight and amniotic fluid volume were also evaluated. After delivery, the neonates were evaluated through Apgar scoring at 1 and 5 min, cord blood samples, and neonatal nasopharyngeal swabs. Results: Abnormal umbilical and cerebral Doppler findings, abnormal NST results, higher incidence of cesarean section (CS) and emergency CS, and poor perinatal outcomes were observed in severe cases. Moderate and mild maternal infections had neither an adverse perinatal outcome nor an effect on the mode of delivery. Conclusion: Severe COVID-19 infection can affect the perinatal outcome.

Profile of Newborns Hospitalized for Maternal Fetal Infection and Having a Positive CRP in the Pediatric Department of the Gabriel TouréCHU in Bamako, Mali

Objective: Early bacterial neonatal infection (INBP) or maternofetal infection (early neonatal sepsis) remains a concern of the pediatrician due to diagnostic difficulties and its increased morbidity and mortality. No study has been done in Mali on the profile of newborns admitted for INBP with positive CRP, hence the initiation of this work with the aim of studying the epidemiological, biological and bacteriological profile of newborns with a bacterial maternal-fetal infection. Method: Longitudinal study descriptive (from 27 June to 3 September 2016) which concerned all newborns aged from 0 to 72 hours of life hospitalized for confirmed early bacterial neonatal infection with a positive C-reactive protein (CRP) in the neonatal department of the CHU Gabriel Touré. INBP was defined by the presence of maternal and neonatal infectious risk factors, positivity of CRP with a germ in the blood culture. Results: During the study period we included 244 newborns for probable maternofetal infection and who benefited from the CRP assay, 43 had a positive CRP, i.e. a frequency of 17.62%. The sex ratio was 2.30. The majority had a low birth weight (<2500 g) in 69.8% of cases. Mothers were aged 18 to 35 in 93%. The majority were out of school (43.8%) and housewives in 74.4%. The main reasons for consultations were prematurity and/or low birth weight, respiratory distress and neonatal distress, i.e. 46.5%, 25.6% and 11.6% respectively. Among the 43 newborns with a positive CRP, the blood culture returned positive in 79.1% (n = 34). We deplore 2 deaths (4.7%). The main bacteria were gram-positive cocci (Staphylococcus aureus 53.01% and Streptococccus agalactiae 4.10%), gram-negative bacilli (GNB) type Enterobacteriaceae (Klebsiella pneumoniae 11.25% and E. coli at 5.70%) and non-fermentative GNBs (Pseudomonas aeruginosa 2.80% and Acinetobacter baumannii complex 2.24%). Conclusion: Maternal-fetal infection is a hospital pathology frequently encountered in the neonatal period. Its clinical presentation is dominated by respiratory distress, neurological disorders and low birth weight.

The first laboratory-confirmed neonatal Mpox infection in Sri Lanka

In 2022-2023,a global outbreak of Mpox was reported especially in nonendemic countries.We report the first laboratory-confirmed neonatal case of Mpox infection complicated by bronchopneumonia in Sri Lanka.

Neonatal immune activation during early and late postnatal brain development differently influences depression-related behaviors in adolescent and adult C57BL/6 mice

Aim:Immune challenge during early and late neonatal periods can induce robust alterations in physiological and behavioral functions,resulting in greater risk for the development of neuropsychiatric disorders,such as anxiety and depression,later in life.In addition,previous studies concluded that increasing age correlates with increased depression behaviors in humans and rodents.This study aimed to investigate for the first time whether immune challenge with a viral mimic,synthetic double-stranded ribonucleic acid(Poly I:C)during different neonatal periods can differently affect depression-related behaviors in adolescent and adult mice.Methods:Male C57BL/6 mice were treated with either saline or Poly I:C(1 mg/kg and 4 mg/kg)on postnatal days(PND)3-5(early neonatal phase)or PND 14-16(late neonatal phase),and then subjected to behavioral tests,including tail suspension test and forced swimming test,during adolescence(PND 35 or 40)and adulthood(PND 85 or 90).Results:The results demonstrated that early neonatal immune activation increases depression-related behaviors in both adolescent and adult mice,but late neonatal immune activation only increases depression in adult mice.In other words,these findings indicated that the nature of the offspring’s neuropathology can depend on the severity of the insult,the pup’s age at the time of the insult,and offspring age at the time of behavioral testing.Conclusion:These findings suggest that dose and timing of neonatal insult and offspring age may be important factors for evaluating neuropsychiatric disorders in adults who experienced early life infection.

Impact of probiotics supplement on the gut microbiota in neonates with antibiotic exposure: an open-label single-center randomized parallel controlled study

Background Antibiotics,a common strategy used for neonatal infection,show consistent effect on the gut microbiota of neonates.Supplementation with probiotics has become increasingly popular in mitigating the loss of the gut microbiota.However,no clear consensus recommending the use of probiotics in the infection of neonates currently exists.This study examined the effects of probiotics on the gut microbiota of infectious neonates when used concurrently with or during the recovery period following antibiotic therapy.Methods Fifty-five full-term neonates diagnosed with neonatal infections were divided into the following groups:NI(no intervention,antibiotic therapy only),PCA(probiotics used concurrently with antibiotics),and PAA(probiotics used after antibiotics).The NI group received antibiotic treatment(piperacillin–tazobactam)for 1 week and the PCA group received antibiotic treatment together with probiotics(Bifidobacterium longum,Lactobacillus acidophilus,and Enterococcus faecalis)for 1 week.The PAA group received antibiotic treatment for 1 week followed by probiotics for 1 week.Fecal samples were collected at four time nodes:newborn,1 week,2 weeks,and 42 days after birth.The composition of the gut microbiota was determined by the high-throughput sequencing of 16S rRNA amplicons.Results Antibiotic exposure was found to dramatically alter gut microbiota,with a significant decrease of Bifidobacterium and Lactobacillus.The use of probiotics did not restore the overall diversity of the gut microbiota.However,using probiotics simultaneously with the antibiotics was found to be beneficial for the gut microbiota as compared to delaying the use of probiotics to follow treatment with antibiotics,particularly in promoting the abundance of Bifidobacterium.Conclusions These results suggest that the early use of probiotics may have a potential ability to remodel the gut microbiota during recovery from antibiotic treatment.However,further study is required to fully understand the long-term effects including the clinical benefits.