Background: Acinetobacter baumannii sepsis constitutes an extreme threat with a poor prognosis and is a difficult infection to control, especially in Asia. Moreover, a knowledge gap in the risk of mortality in neonatal A. baumannii sepsis still exists. Methods: This study aimed to identify the risk factors of mortality in neonates with A. baumannii sepsis in Thailand from 1996 to 2019. A multivariable logistic regression model was analyzed for nonsurvivors and survivors of neonatal A. baumannii sepsis. Results: In a 24-year period, 91 neonates with A. baumannii sepsis were reviewed. The median (interquartile range) gestational age and birth weight were 33 (28.5, 37.5) weeks and 1740 (987.5, 2730.0) g, respectively. The 30-day case fatality rate was 36.3% (33/91). In univariable analysis, nonsurvivors of neonatal A. baumannii sepsis was associated with smaller neonates, lower Apgar scores, septic shock, mechanical ventilation, umbilical catheterization, neutropenia, severe thrombocytopenia, carbapenem-resistant A. baumannii sepsis, inadequate empiric antimicrobial therapy, and acute kidney injury. In multivariable analysis, nonsurvivors of neonatal A. baumannii sepsis were associated with septic shock (adjusted odds ratio [OR] = 41.38; 95% confidence intervals [CI]: 3.42-501.13; P = 0.003), severe thrombocytopenia (adjusted OR = 33.70; 95% CI: 3.44-330.55; P = 0.002), and inadequate empiric antimicrobial therapy (adjusted OR = 10.05; 95% CI: 1.40-71.98; P = 0.02). Conclusion:In high multidrug-resistant areas, empiric treatment with broader spectrum antimicrobials should be considered in neonates with sepsis shock or severe thrombocytopenia.

Objectives The purpose of the study was to determine the clinical features of NLE and to compare the neonatal outcomes between newborns born to pregnant women with SLE and healthy pregnant women. Methods We conducted a retrospective cohort analysis between 2007 and 2019 in a tertiary referral hospital in Thailand. A total of 118 pregnant women with SLE with 132 neonates compared with 264 randomly selected healthy pregnant women. Results The median (interquartile range) gestational age and birth weight of 132 neonates born to women with SLE were 37 (35–38) weeks and 2687 g (2045–3160 g), respectively. The clinical features of NLE infants were hemolytic anemia (8%), thrombocytopenia (2.7%) and hyperbilirubinemia (5.3%). There was no neonate with a congenital complete heart block or skin lesion. Moreover, logistic regression analysis found that neonates born to women with SLE increased the risk of preterm birth [odd ratio (OR) 8.87, 95% confidence interval (95% CI) 4.32–18.21, p < 0.001], low birth weight (OR 10.35, 95% CI 5.08–21.08, p < 0.001), birth asphyxia (OR 2.91, 95% CI 1.26–6.73, p = 0.011) and NICU admission (OR 4.26, 95% CI 2.44–7.42, p < 0.001). SLE disease activity and corticosteroid and azathioprine usage were associated with preterm delivery in pregnant women with SLE. Conclusion The major clinical features of NLE patients were hematologic and hepatobiliary abnormalities in our study. Pregnancies with SLE dramatically increased the risk of preterm delivery and neonatal complications. Lay summary Neonatal lupus erythematosus (NLE) is the consequence of the transplacental passage of autoantibodies to newborns during pregnancy. The clinical features of NLE infants in our study were hemolytic anemia (8%), thrombocytopenia (2.7%) and hyperbilirubinemia (5.3%). There was no neonate with a congenital complete heart block or skin lesion. We also compared the neonatal outcomes between 118 pregnant women with SLE and 264 randomly selected healthy pregnant women. Our study found that the neonates born to women with SLE increased the risk of preterm birth, low birth weight, birth asphyxia and NICU admission. Moreover, SLE disease activity and corticosteroid and azathioprine usage were associated with preterm delivery in pregnant women with SLE.

Neonatal Hyperbilirubinemia, or jaundice, is a harmful disease found in newborns, a symptom of which is the yellowish discoloration of the skin. Visual examination is most frequently used for screening of Hyperbilirubinemia in neonates, however, blood specimen collection is the gold standard to identify the disease and its severity. We propose a Mobile Computer-Aided Diagnosis (mCADx) tool to identify the Neonatal Hyperbilirubinemia symptom using advanced digital image processing and data mining techniques. The mCADx was developed in a cross-platform environment. The mCADx works with smart devices run on either iOS or Android operating systems. With ethical committee approval, we collected and studied image data of 178 infant subjects with different jaundice severity levels. The severity of the disease was examined from blood test results, which were annotated by medical specialists. Data mining techniques included Decision Trees, k Nearest Neighbor, and the Conventional Neural Network was investigated in the dataset. An in-depth comparison between techniques was performed and discussed. The classification results in CNN gained the highest accuracy at 0.8099, 0.9251, 0.8086. This novel work can assist in identifying Neonatal Hyperbilirubinemia in newborns after discharging from the hospital. Reoccurring Neonatal Hyperbilirubinemia can be found with minimum awareness of parents. Limitations and future works were discussed in this work.

Objective: It remains unclear if changes in neonatal care have resulted in better outcomes for extremely preterm infants (EPTs). This study was to evaluate neonatal mortality and morbidity in EPTs.Material and Methods: A retrospective cohort study of EPTs at a gestational age (GA) ≤28 weeks, who were admitted to the neonatal intensive care unit between January 2004 and December 2018. The study was divided into 2 periods, from 2004-2010 and 2011-2018. The likelihood ratio test in Multiple Cox regression models were used to determine adjusted hazard ratios (aHR) for differences in mortality among the two periods.Results: A total of 188 EPTs were enrolled. The overall median (interquartile range), GA and birth weight of the enrolled infants were 26 (25, 27) weeks and 780 (667, 875) g, respectively. The mortality rate was 66/188 (35.1%). The mortality rate between 2004-2010 and 2011-2018 decreased from 44.6% to 32.8%, but was not statistically significant (p-value=0.170). Multiple Cox regression analysis of mortality rate demonstrated statistical significance with infants of 23-24 and 25-26 weeks GA VS 27-28 weeks GA [aHR 3.85, 95% confidence interval (CI) (1.95, 7.58), p-value<0.010] and [aHR 1.92, 95% CI (1.09, 3.35), p-value<0.010], respectively. Pregnancy complications [aHR 2.24, 95% CI (0.96, 5.24), p-value=0.040)] and EPTs intubated VS early CPAP at birth [aHR 2.41, 95% CI (1.36, 4.25), p-value<0.010] were statistically significant.Conclusion: The mortality rate of EPTs decreased with advancing GA. Prenatal care of pregnancy complications and improving care practices might reduce the mortality rate.

No abstract