(1) Background: Every year, 2.5 million neonates die, mostly in low- and middle-income countries (LMIC), in total disregard of their fundamental human rights. Many of these deaths are preventable. For decades, the leading causes of neonatal mortality (prematurity, perinatal hypoxia, and infection) have been known, so why does neonatal mortality fail to diminish effectively? A bottom-up understanding of neonatal morbi-mortality and neonatal rights is essential to achieve adequate progress, and so is increased visibility. (2) Methods: We performed an overview on the leading causes of neonatal morbi-mortality and analyzed the key interventions to reduce it with a bottom-up approach: from the clinician in the field to the policy maker. (3) Results and Conclusions: Overall, more than half of neonatal deaths in LMIC are avoidable through established and well-known cost-effective interventions, good quality antenatal and intrapartum care, neonatal resuscitation, thermal care, nasal CPAP, infection control and prevention, and antibiotic stewardship. Implementing these requires education and training, particularly at the bottom of the healthcare pyramid, and advocacy at the highest levels of government for health policies supporting better newborn care. Moreover, to plan and follow interventions, better-quality data are paramount. For healthcare developments and improvement, neonates must be acknowledged as humans entitled to rights and freedoms, as stipulated by international law. Most importantly, they deserve more respectful care.

Aim: This study aimed to investigate the safety of transfusing red blood cell concentrates (RBCCs) through small [24 gauge (24G)] and extra-small [28 gauge [28G)] peripherally inserted central catheters (PICCs), according to guidelines of transfusion practice in Switzerland.Methods: We performed a non-inferiority in vitro study to assess the safety of transfusing RBCC for 4 h at a 4 ml/h speed through 24G silicone and 28G polyurethane PICC lines, compared with a peripheral 24G short catheter. The primary endpoint was hemolysis percentage. Secondary endpoints were catheter occlusion, inline pressure, and potassium and lactate values.Results: For the primary outcome, hemolysis values were not statistically different among catheter groups (0.06% variation, p = 0.95) or over time (2.75% variation, p = 0.72). The highest hemolysis values in both 24G and 28G PICCs were below the non-inferiority predefined margin. We did not observe catheter occlusion. Inline pressure varied between catheters but followed the same pattern of rapid increase followed by stabilization. Potassium and lactate measurements were not statistically different among tested catheters (0.139% variation, p = 0.98 for potassium and 0.062%, p = 0.96 for lactates).Conclusions: This study shows that RBCC transfusion performed in vitro through 24G silicone and 28G polyurethane PICC lines is feasible without detectable hemolysis or pressure concerns. Also, it adds that, concerning hemolysis, transfusion of RBCC in small and extra-small PICC lines is non-inferior to peripheral short 24G catheters. Clinical prospective assessment in preterm infants is needed to confirm these data further.

Infantile hemangioma (IH) is the most common vascular tumor in infancy, and its physiopathology is not fully understood. Nevertheless, a hypoxic insult may be an essential element for the formation of an IH. Herein, we describe a case of a 25-week premature newborn who developed an IH after a post-burn scar and its evolution.

Objective To explore the gaps in knowledge and practice in neonatal thermal care among healthcare workers in low-resource settings. Methods We conducted a 2-round, web-based survey of a purposive and snowball sample of healthcare workers in neonatal care in low-resource settings globally. The questionnaire was developed using themes of neonatal thermal care extracted from existing neonatal care guidelines, including WHO’s. The survey asked multiple-choice questions, supplemented by open-ended questions to capture first hand insights and information on neonatal thermal care. Results of the survey were analysed using Microsoft Excel. Data was collated and summarized using descriptive measures. Results Almost all participants acknowledged the importance of all the WHO warm chain elements, however, fewer participants responded positively regarding the practice of this warm chain. Only 56% of the participants acknowledged the usefulness of checking the peripheral temperature by hand-touch. The usefulness of the core temperature was valued higher than that of the peripheral temperature as an indicator of cold stress, with 70% and 58% agreement, respectively. Opinions diverged regarding the peripheral temperatures, including apparent inaccuracy compared to rectal or axillary temperature. Preferences on rewarming strategies widely differed among participants and so did the availability of warming equipment in their institutions. Conclusions We identified the general acknowledgment of the importance of the WHO warm chain but also its limited practice. We also identified that an inadequate understanding of cold stress underestimates the potential benefits of peripheral temperatures and leads to missed opportunities for timely prevention of hypothermia. Furthermore, lack of consistent guidance on equipment for rewarming hypothermic neonates hampers recovery.

BackgroundNeonatal hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. The high prevalence of potentially preventable hypothermia today urges an investigation into why neonates still become hypothermic despite awareness of the problem and established thermal care guidelines. This study aimed to explore the gaps in knowledge and practices of neonatal thermal care among healthcare workers in low-resource settings.MethodsA cross-sectional, questionnaire-based survey was performed online among healthcare workers in low-resource settings. We applied a purposive and snowballing sampling method to recruit participants through a two-round international online survey. Questionnaires were developed using themes of neonatal thermal care extracted from existing neonatal care guidelines.Results55 neonatal care professionals participated in the first-round survey and 33 in the second. Almost all participants (n=44–54/55) acknowledged the importance of the WHO’s warm chain to keep a neonate warm. However, fewer participants (n=34–46/55) responded to practice them. When asked about cold stress, defined as a condition in which neonates are below optimum environmental temperature and using more oxygen and energy while maintaining normal body temperature, 15 out of 55 participants answered that checking extremity temperatures by hand touch was useless. Some participants reported concern about the extremity temperature’s inaccuracy compared with core temperature. Opinions and preferences for rewarming methods differed among participants, and so did the availability of warming equipment at their institutions.ConclusionAn inadequate understanding of cold stress underestimates the potential benefits of extremity temperatures and leads to missed opportunities for the timely prevention of hypothermia. The current thermal care guidelines fail to highlight the importance of monitoring cold stress and intervening before hypothermia occurs. Therefore, we urge introducing the concept of cold stress in any neonatal thermal care guidelines.

Background: Hypothermia has been widely regarded as a major contributory factor to neonatal mortality and morbidity in low-resource settings. Despite the recognition of the importance of thermal care for neonates a century ago and the established WHO guidelines, a high prevalence of neonatal hypothermia is still regularly reported. Hypothermia is avoidable in the majority of neonates because it is not a complication of prematurity but more the result of inadequate thermal care. The objective of this study was to explore the current gaps in knowledge and practice in neonatal thermal care among healthcare workers in low-resource settings.Methods: We conducted a 2-round, web-based survey of a purposive and snowball sample of healthcare workers in neonatal care in low-resource settings. The questionnaire was developed using themes of neonatal thermal care extracted from existing neonatal care guidelines, including WHO’s. The survey asked multiple-choice questions, supplemented by open-ended questions to capture first hand insights and information on neonatal thermal care. Results of the survey were analysed using Microsoft Excel. Data was collated and summarized using descriptive measures. Results: Almost all participants acknowledged the importance of all the WHO warm chain elements, however, fewer participants responded positively regarding the practice of this warm chain. Only 56% of the participants acknowledged the usefulness of checking the hand or foot temperature by hand-touch. The usefulness of the axillary or rectal temperature was valued higher than that of the hand or foot temperature as an indicator of cold stress. Opinions diverged regarding the hand or foot temperature, including apparent inaccuracy compared to axillary or rectal temperature. Preferences on rewarming strategies widely differed among participants and so did the availability of warming equipment in their institutions. Conclusions: We identified the general acknowledgment of the importance of the WHO warm chain but also its limited practice. We also identified that an inadequate understanding of cold stress underestimates the potential benefits of the hand or foot temperature and leads to missed opportunities for timely prevention of hypothermia. Furthermore, lack of consistent guidance on equipment for rewarming hypothermic neonates hampers recovery.

Review question / Objective: What is the prevalence of drug-resistant pathogens associated with neonatal Early Onset Sepsis (NEOS) in the African continent and their likelihood of resistance to commonly used antibiotics in the NEOS, and what is the trend through time? Condition being studied: There is no consensus on the definition of neonatal sepsis. Two main categories of neonatal sepsis are widely accepted: early-onset sepsis (EOS) defined as occurring in the first 72 hours of life, hence representing perinatal vertical infection; and late-onset sepsis (LOS), which occurs between 72 hours to 28 days and can be hospital or community-acquired. Information sources: Pubmed, EMBASE, Web of Science. All authors from papers with missing information were contacted before article exclusion.

Hypothermia occurs frequently among clinically unstable neonates who are not suitable to place in skin-to-skin care. This study aims to explore the existing evidence on the effectiveness, usability, and affordability of neonatal warming devices when skin-to-skin care is not feasible in low-resource settings. To explore existing data, we searched for (1) systematic reviews as well as randomised and quasi-randomised controlled trials comparing the effectiveness of radiant warmers, conductive warmers, or incubators among neonates, (2) neonatal thermal care guidelines for the use of warming devices in low-resource settings and (3) technical specification and resource requirement of warming devices which are available in the market and certified medical device by the US Food and Drug Administration or with a CE marking. Seven studies met the inclusion criteria, two were systematic reviews comparing radiant warmers vs. incubators and heated water-filled mattresses vs. incubators, and five were randomised controlled trials comparing conductive thermal mattresses with phase-change materials vs. radiant warmers and low-cost cardboard incubator vs. standard incubator. There was no significant difference in effectiveness between devices except radiant warmers caused a statistically significant increase in insensible water loss. Seven guidelines covering the use of neonatal warming devices show no consensus about the choice of warming methods for clinically unstable neonates. The main warming devices currently available and intended for low-resource settings are radiant warmers, incubators, and conductive warmers with advantages and limitations in terms of characteristics and resource requirements. Some devices require consumables which need to be considered when making a purchase decision. As effectiveness is comparable between devices, specific requirements according to patients' characteristics, technical specification, and context suitability must play a primary role in the selection and purchasing decision of warming devices. In the delivery room, a radiant warmer allows fast access during a short period and will benefit numerous neonates. In the neonatal unit, warming mattresses are low-cost, effective, and low-electricity consumption devices. Finally, incubators are required for very premature infants to control insensible water losses, mainly during the first one to two weeks of life, mostly in referral centres.