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2023 | January-March | Volume 2 | Issue 1

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Akhil Maheshwari, Kei Lui, Mario Motta


[Year:2023] [Month:January-March] [Volume:2] [Number:1] [Pages:4] [Pages No:iv - vii]

   DOI: 10.5005/newborn-2-1-iv  |  Open Access | 



Mario Motta, Salvatore Aversa, Morotti Francesco, Akhil Maheshwari, Cesare Tomasi, Francesco Maria Risso

Extrauterine Growth Restriction in Preterm Very Low Birth Weight Infants: The Use of a Web-based System Designed for Computerized Prescribing of Parenteral Nutrition in Neonatal Intensive Care

[Year:2023] [Month:January-March] [Volume:2] [Number:1] [Pages:10] [Pages No:1 - 10]

Keywords: Computerized prescribing, Extrauterine growth restriction, Newborn, Parenteral nutrition

   DOI: 10.5005/jp-journals-11002-0052  |  Open Access |  How to cite  | 


Aim: Extrauterine growth restriction (EUGR) is a multifactorial condition that may lead to long-term consequences for preterm infants. Providing adequate nutrition is one of the keys to ameliorating growth. Technology can help clinicians with powerful tools. We evaluate the impact of a web-based software specifically designed for neonatal parenteral nutrition (PN) prescription on EUGR in a cohort of very low birth weight (VLBW) infants. Materials and methods: We retrospectively analyzed anthropometric measurements (AMs) and comorbidities in a cohort of 119 VLBW infants treated with PN for at least 5 consecutive days. International Fetal and Newborn Growth Consortium for the 21st Century (INTERGROWTH-21st) standards were used to identify small for gestational age (SGA, birth weight < 10th centile) infants and to define EUGR. EUGR was defined as “cross-sectional” (AMs < 10th percentile at discharge) and “longitudinal” (loss in AMs Z-score from birth to discharge > 1 standard deviation [SD]). Results: Nutritional intakes were consistent with current available nutritional guidelines. There were significant differences in the measured incidence of EUGR depending on the adopted definition. The longitudinal definition appeared to be the most appropriate than the cross-sectional one for identifying postnatal growth failure in preterm infants. Lower lipid intake and longer durations of PN were risk factors for poor growth in weight and head circumference (HC). Metabolic disorders, such as cholestasis, hyperglycemia, and hypertriglyceridemia, had stronger links with lower AMs and longer PN needs than just the nutritional intakes. No relationships were observed between the most of comorbidities associated with prematurity and EUGR. Conclusion: A web-based system for the prescription of neonatal PN seems to be useful for ensuring adequate intakes in preterm infants. Further studies with larger sample sizes could be designed for evaluating the application of this software within a neonatal network and its effect on postnatal growth. Clinical significance: The use of an electronic prescribing system designed for neonatal care can help neonatologists in giving VLBW infants the correct intake of nutrients.



Manvi Tyagi, Brunetta Guaragni, Alvaro Dendi, Atnafu Mekonnen Tekleab, Mario Motta, Akhil Maheshwari

Use of Cryoprecipitate in Newborn Infants

[Year:2023] [Month:January-March] [Volume:2] [Number:1] [Pages:8] [Pages No:11 - 18]

Keywords: Cryoprecipitate, Cryoprecipitated antihemophilic factor, Factor I, Factor VIII, Factor XII, Fibrinogen, Newborn neonate infant, Transfusion product

   DOI: 10.5005/jp-journals-11002-0045  |  Open Access |  How to cite  | 


Cryoprecipitate is a transfusion blood product derived from fresh–frozen plasma (FFP), comprised mainly of the insoluble precipitate that gravitates to the bottom of the container when plasma is thawed and refrozen. It is highly enriched in coagulation factors I (fibrinogen), VIII, and XIII; von Willebrand factor (vWF); and fibronectin. In this article, we have reviewed currently available information on the preparation, properties, and clinical importance of cryoprecipitate in treating critically ill neonates. We have searched extensively in the databases PubMed, Embase, and Scopus after short-listing keywords to describe the current relevance of cryoprecipitate.



Ling He, Karl Johan Tronstad, Akhil Maheshwari

Mitochondrial Dynamics during Development

[Year:2023] [Month:January-March] [Volume:2] [Number:1] [Pages:26] [Pages No:19 - 44]

Keywords: Archezoan, Inner membrane, Intermembrane space, Matrix, Mitochondrial DNA, Mitophagy, Neonate, Ontogeny, Outer membrane, Parkin

   DOI: 10.5005/jp-journals-11002-0053  |  Open Access |  How to cite  | 


Mitochondria are dynamic membrane-bound organelles in eukaryotic cells. These are important for the generation of chemical energy needed to power various cellular functions and also support metabolic, energetic, and epigenetic regulation in various cells. These organelles are also important for communication with the nucleus and other cellular structures, to maintain developmental sequences and somatic homeostasis, and for cellular adaptation to stress. Increasing information shows mitochondrial defects as an important cause of inherited disorders in different organ systems. In this article, we provide an extensive review of ontogeny, ultrastructural morphology, biogenesis, functional dynamics, important clinical manifestations of mitochondrial dysfunction, and possibilities for clinical intervention. We present information from our own clinical and laboratory research in conjunction with information collected from an extensive search in the databases PubMed, EMBASE, and Scopus.



Srijan Singh, Astha Amrit, Sushant Mane, Gangajal Kasniya, Mohd Mozibur Rahman, Atnafu Mekonnen Tekleab, Akhil Maheshwari

Congenital Chikungunya Virus Infections

[Year:2023] [Month:January-March] [Volume:2] [Number:1] [Pages:15] [Pages No:45 - 59]

Keywords: Aedes aegypti, Aedes albopictus, Brownie nose, Chikungunya sign, Chikungunya virus encephalitis, Infant, Neonate, Newborn, Thrombocytopenia, Vertical transmission

   DOI: 10.5005/jp-journals-11002-0054  |  Open Access |  How to cite  | 


Structure: Chikungunya virus (CHIKV) is an arthropod-borne ribonucleic acid (RNA) virus, classified in the genus alphavirus in the family Togaviridae. Clinical presentation: Perinatal/neonatal infections are rare, but some infants can develop fever, thrombocytopenia, lymphopenia, pigmentary changes, and a maculopapular rash. The neurocognitive outcome of some infants with vertically transmitted mother-to-child perinatal infections and CHIKV neonatal encephalopathy can be poor. Diagnosis: The diagnosis of CHIKV infections can be confirmed by the detection of chikungunya viral RNA via real-time reverse-transcription polymerase chain reaction (RT-PCR) and/or specific immunoglobulin (Ig)M and IgG serology. Treatment: Currently, no specific antiviral treatment(s) are available for CHIKV, and management is limited to supportive care by maintaining adequate intravascular volume by intravenous fluids and oral rehydration. Infants exposed in utero or during the perinatal period need to be monitored for adverse neurocognitive outcomes.



Akhil Maheshwari

Innate Immune Memory in Macrophages

[Year:2023] [Month:January-March] [Volume:2] [Number:1] [Pages:20] [Pages No:60 - 79]

Keywords: Chromatin, Development, Fetus, Fumarate, Lipoprotein(a), MMP-2, MMP-9, Neonate, Newborn, Succinic acid, α-ketoglutaric acid

   DOI: 10.5005/jp-journals-11002-0058  |  Open Access |  How to cite  | 


Macrophages have been recognized as the primary mediators of innate immunity starting from embryonic/fetal development. Macrophage-mediated defenses may not be as antigen-specific as adaptive immunity, but increasing information suggests that these responses do strengthen with repeated immunological triggers. The concept of innate memory in macrophages has been described as “trained immunity” or “innate immune memory (IIM).” As currently understood, this cellular memory is rooted in epigenetic and metabolic reprogramming. The recognition of IIM may be particularly important in the fetus and the young neonate who are yet to develop protective levels of adaptive immunity, and could even be of preventive/therapeutic importance in many disorders. There may also be a possibility of therapeutic enhancement with targeted vaccination. This article presents a review of the properties, mechanisms, and possible clinical significance of macrophage-mediated IIM.



Arjun Verma, Abhishek Paul, Atnafu Mekonnen Tekleab, Abhay Lodha, Kei Lui, Akhil Maheshwari, Jan Klimek, Pradeep Suryawanshi

Lung Ultrasound in Neonates: An Emerging Tool for Monitoring Critically Ill Infants

[Year:2023] [Month:January-March] [Volume:2] [Number:1] [Pages:11] [Pages No:80 - 90]

Keywords: Bronchopulmonary dysplasia, Conventional lung ultrasound score, Modified lung ultrasound score, Pneumothorax, Point-of-care lung ultrasound, Respiratory distress syndrome, Transient tachypnea of newborn

   DOI: 10.5005/jp-journals-11002-0057  |  Open Access |  How to cite  | 


Context: Neonatal lung ultrasound is emerging as a useful clinical tool for the assessment of lung anatomy and management of various lung pathologies. In this review, we summarize normal lung ultrasound (LUS) findings and specific features of various lung morbidities. Evidence acquisition: A comprehensive literature search was conducted across multiple sources with relevant keywords with an additional filter of the age-group between 0 and 28 days. Findings: Apart from the description of normal newborn lungs, clinical and radiological features of a variety of lung pathologies were evaluated and incorporated in the review. Bedside LUS has evolved to be an important point-of-care imaging modality that can help in day-to-day clinical decision-making. It can be used in differentiating respiratory distress syndrome from transient tachypnea on the newborns, in the detection of pneumothorax, and in diagnosing pneumonia, pulmonary hemorrhage, and pleural effusion. Evidence supports the use of LUS scores to decide on the need for early rescue surfactant therapy with high sensitivity and specificity. Lung ultrasound scores obtained during the first 2 weeks after birth can help predict the likelihood of chronic lung disease/bronchopulmonary dysplasia. Once validated, it could be valuable for guiding early intervention and evaluation of new treatments. Conclusion: Neonatal lung ultrasound is emerging as a vital monitoring tool in critically ill infants with lung disease. It will be valuable in the early diagnosis, management, and prognosis of these patients.



Yahya Ethawi, Gangajal Kasniya, Nibras Al Baiti, Rehab Mohammed, FatimaElzahara Taha Mohammad, Roya Arif Huseynova

Congenital Zika Virus Infections

[Year:2023] [Month:January-March] [Volume:2] [Number:1] [Pages:11] [Pages No:91 - 101]

Keywords: Congenital Zika syndrome, Newborn, Real-time reverse transcription-polymerase chain reaction, Magnetic resonance imaging, Zika virus infection

   DOI: 10.5005/jp-journals-11002-0055  |  Open Access |  How to cite  | 


Zika virus (ZIKV) is an arthropod-borne flavivirus transmitted through bites of the Aedes mosquitoes. Infected mothers can vertically transmit ZIKV to their fetuses, particularly during the first and second trimesters. Infections beginning during early gestation can cause congenital Zika virus syndrome (CZS), which may be marked by arrested development and/or altered healing in the nervous system. There can be microcephaly, craniosynostosis, intracranial calcifications, ventriculomegaly, low brain volume and/or cortical atrophy, and hypoplasia/altered myelination in the corpus callosum, cerebellum, and brainstem. There may also be altered development with polymicrogyria, pachygyria, and lissencephaly. Clinically, infants with CZS may show facial dysmorphism, pulmonary hypoplasia, altered growth and development, hypertonia, hyperreflexia, limb contractures, and arthrogryposis multiplex. Perinatal infections can present with irritability, seizures, eye involvement, and sensorineural hearing loss (SNHL). Congenital zika virus syn and perinatal infections contrast with those acquired after birth, which usually have a relatively milder course. Overall, the mortality rate can reach 4–6%. Laboratory evaluation can include polymerase chain reactions on serum, cerebrospinal fluid, and urine; testing for immunoglobulin M (IgM); and plaque reduction neutralization tests (PRNTs) to confirm the specificity of these Zika virus IgM (ZIKV IgM) antibodies. Unfortunately, no specific treatment is available; most measures are largely supportive.



Prabhdeep Kaur, Pradeep K Dudeja

Pathophysiology of Enteropathogenic Escherichia coli-induced Diarrhea

[Year:2023] [Month:January-March] [Volume:2] [Number:1] [Pages:12] [Pages No:102 - 113]

Keywords: Attaching and effacing lesion (A/E), Epidemiology, Ion transporters, LEE pathogenicity island, Type III secretion system (T3SS), Tight junctions

   DOI: 10.5005/jp-journals-11002-0056  |  Open Access |  How to cite  | 


Enteropathogenic Escherichia coli (EPEC) are important diarrheal pathogens of infants and young children. Since the availability of molecular diagnosis methods, we now have new insights into the incidence and prevalence of these infections. Recent epidemiological studies indicate that atypical EPEC (aEPEC) are seen more frequently than typical EPEC (tEPEC) worldwide, including in both endemic diarrhea and diarrhea outbreaks. Therefore, it is important to further characterize the pathogenicity of these emerging strains. The virulence mechanisms and pathophysiology of the attaching and effacing lesion (A/E) and the type-three-secretion-system (T3SS) are complex but well-studied. A/E strains use their pool of locus of enterocyte effacement (LEE)-encoded and non-LEE-encoded effector proteins to subvert and modulate cellular and barrier properties of the host. However, the exact mechanisms of diarrhea in EPEC infection are not completely understood. From the clinical perspective, there is a need for fast, easy, and inexpensive diagnostic methods to define optimal treatment and prevention for children in endemic areas. In this article, we present a review of the classification of EPEC, epidemiology, pathogenesis of the disease caused by these bacteria, determinants of virulence, alterations in signaling, determinants of colonization vs. those of disease, and the limited information we have on the pathophysiology of EPEC-induced diarrhea. This article combines peer-reviewed evidence from our own studies and the results of an extensive literature search in the databases PubMed, EMBASE, and Scopus.


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