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Objective Hypoxic-ischemic encephalopathy (HIE) affects millions of newborns annually, especially in low-resource settings. Real-time monitoring of hypoxic-ischemic brain damage is urgently needed for assessment of severity and management of neonates with birth asphyxia. Aim of the work is monitoring of near-infrared spectroscopy (NIRS)-measured cerebral regional oxygen saturation (cRSO2) and cerebral fractional tissue oxygen extraction (FTOE) in neonates after birth asphyxia in relation to their clinical course. Study Design Forty asphyxiated-term and near-term neonates with mild to severe HIE admitted at neonatal intensive care unit of Alexandria University Maternity Hospital from March to October 2019, received therapeutic hypothermia (TH) and had continuous NIRS monitoring of cRSO2 for 72 hours. Infants were categorized into HIE with seizing and nonseizing groups, and abnormal and normal magnetic resonance imaging (MRI) groups. Results Clinical seizures (CS) occurred in 15 (37.5%) of HIE neonates and 13.3% of them died (n = 2). In the current study, significantly higher cRSO2 and lower FTOE values were found in the seizing infants as compared with nonseizing group (p < 0.001). NIRS-measured day 2-cRSO2 and day 1-FTOE were associated with CS in newborns with HIE and day 1-cRSO2 and FTOE were associated with abnormal MRI at 1 month of age. cRSO2 values were found to correlate positively with initial Thompson score especially in days 1 and 2. Further, neonates with CS were more likely to have MRI abnormalities at follow-up. Conclusion NIRS measures may highlight differences between asphyxiated neonates who develop CS or later MRI abnormalities and those who do not. Key Points

Neonates admitted to neonatal intensive care units are at a risk of developing healthcare associated infections, leading to increased risk of mortality. This study aimed to identify organisms causing such late-onset infections in neonates and determine whether these isolates were genetically identical to those from the surrounding environmental surfaces and hands of healthcare workers (HCWs). A cross-sectional study was carried out over a period of four months in a University neonatal intensive care unit. Samples were collected from all neonates with symptoms of late-onset infections (n=180). Fingerprint samples of 21 healthcare workers as well as 330 random environmental samples were also taken from the unit. Isolates from neonates, environment and fingerprints were subjected to protein electrophoresis followed by sequencing to detect genetic similarities. Almost half of neonatal samples were culture-positive (91/180, 50.6%), out of which, 72% of bacterial isolates (49/ 68) were multi-drug resistant. Klebsiella pneumoniae (32.6%) and Candida spp. (28.4%) were the commonest neonatal isolates. A cluster of four homologous Klebsiella pneumoniae strains was isolated from two neonates as well as an examining bed and a portal incubator. Another cluster was isolated from hands and three neonatal samples. Both clusters were multi-drug resistant Klebsiella pneumoniae. A homologous pair of each of Candida tropicalis and Candida glabrata was isolated from the blood of two neonates, and one neonatal and a crash cart sample, respectively. Overall, 8.8% (8/91) of neonatal samples were found to be homologous to other neonatal /environmental/ hand isolates, denoting perpetuation of pathogens between neonates themselves and also other reservoirs of infections. Conclusion: Hands of healthcare providers as well as surfaces are reservoirs of multi-drug resistant pathogens in the neonatal intensive care unit.

Neonates admitted to neonatal intensive care units are at a risk of developing healthcare associated infections, leading to increased risk of mortality. This study aimed to identify organisms causing such late-onset infections in neonates and determine whether these isolates were genetically identical to those from the surrounding environmental surfaces and hands of healthcare workers (HCWs). A cross-sectional study was carried out over a period of four months in a University neonatal intensive care unit. Samples were collected from all neonates with symptoms of late-onset infections (n=180). Fingerprint samples of 21 healthcare workers as well as 330 random environmental samples were also taken from the unit. Isolates from neonates, environment and ngerprints were subjected to protein electrophoresis followed by sequencing to detect genetic similarities. Almost half of neonatal samples were culture-positive (91/180, 50.6%), out of which, 72% of bacterial isolates (49/ 68) were multi-drug resistant. Klebsiella pneumoniae (32.6%) and Candida spp. (28.4%) were the commonest neonatal isolates. A cluster of four homologous Klebsiella pneumoniae strains was isolated from two neonates as well as an examining bed and a portal incubator. Another cluster was isolated from hands and three neonatal samples. Both clusters were multi-drug resistant Klebsiella pneumoniae. A homologous pair of each of Candida tropicalis and Candida glabrata was isolated from the blood of two neonates, and one neonatal and a crash cart sample, respectively. Overall, 8.8% (8/91) of neonatal samples were found to be homologous to other neonatal /environmental/ hand isolates, denoting perpetuation of pathogens between neonates themselves and also other reservoirs of infections. Conclusion: Hands of healthcare providers as well as surfaces are reservoirs of multi-drug resistant pathogens in the neonatal intensive care unit. What Is KnownThe role of hands and the environment in transmission of infections to neonates is a subject of debate Genetic sequencing provides solid evidence for detecting homologous strains Antibiotic resistance is a growing concern for all physicians What Is New Klebsiella pneumoniae was the most commonly perpetuating pathogen among neonates, environment and hands.All homologous Klebsiella strains were multi-drug resistant Proven role of environment and hands in transmitting pathogens to neonates. Inter-neonatal transmission of pathogens also occurs.

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BackgroundBrain is the most important organ in resuscitation. NIRS-measured cerebral oxygenation is evolving brain monitoring tool for neonatal resuscitation.MethodWe undertook a prospective observational study for monitoring of cerebral oxygenation and peripheral preductal saturation at 1 , 5 and 10 minutes after birth to establish centile chart normative for monitoring of full term neonates during transition. Fractional tissue oxygen extraction was calculated as well. In addition to studying factors affecting cerebral oxygenation at those points in time.Results 60 healthy term neonates were enrolled to define reference ranges and centile charts of cerebral oxygenation at 1, 5, and 10 minutes after birth. The strongest correlations between cerebral oxygenation metrics and peripheral preductal saturation were at 5 minutes after birth. The most significant factor affecting NIRS-measured crSO2 in healthy full term neonates was mode of delivery. This work was registered in the cinicaltrial.gov NCT05158881.Conclusions Normal references of cerebral oxygenation metrics can be used to guide intervention during neonatal resuscitation. Caesarean section is the most significant factor affecting cerebral oxygenation during the transition of healthy full term neonates.

Poor brain growth is major health concern for preterm babies. Nevertheless, there is still existing gap in usage of transcranial sonography to prevent poor brain growth. Pons belly size (basal pons) as new measurement is highly accurate than anterior-posterior diameter of pons which is used to assess pons growth. Corpus callosum-fastigium length may well foretell the growth of cerebellar vermis. Continuous monitoring weight and head circumference during neonatal period are good indicators of brain growth. Long duration on oxygen supplementation predispose preterm babies to have poor brain growth specifically pons, considering that being on mechanical ventilation is risk factor to spend more time on oxygen supplementation, and having low APGAR score requiring resuscitation with positive ventilation, predispose to have poor brain growth. Brain biometry measurements in the first month of life were not evident to predict retinopathy of prematurity, however further study could explore more. Cerebral blood flow increase with postnatal age, and the brain growth during neonatal period. Preterm babies who took surfactant are prone to have a decrease of peak systolic velocity which predispose them to have brain injury. Cerebral blood flow on day 1 didn't predict brain growth. This study indicate there is a high need to prevent poor brain growth before birth, while admitted, and after discharge.

Background Brain is one of the most sensitive organs to hypoxia during resuscitation. NIRS-measured cerebral oxygenation is an evolving brain monitoring tool for neonatal resuscitation. Methods We undertook a prospective observational study for monitoring of cerebral oxygenation and peripheral preductal saturation at 1, 5, and 10 min after birth. Fractional tissue oxygen extraction was calculated as well. In addition to studying factors affecting cerebral oxygenation at those points in time. For the current cohort, cerebral oxygenation centile charts were provided at those time points. This work was registered in the cinicaltrial.gov NCT05158881. Results Sixty healthy term neonates were enrolled to define reference ranges and centile charts of cerebral oxygenation at 1, 5, and 10 min after birth. The strongest correlations between cerebral oxygenation metrics and peripheral preductal saturation were at 5 min after birth with r value = 0.628. Using logistic regression analysis to determine the most significant factors affecting NIRS-measured crSO2 in healthy full-term neonates, we found that the mode of delivery was the most significant factor with OR = 4.000 (1.367–11.703) at 5 min and 8.726 (2.517–30.25) at 10 min. Conclusions Normal values for NIRS may help to identify infants with cerebral oxygenation below a certain value indicating regional hypoxia at certain time points and can guide neonatal resuscitation interventions. Caesarean section is the most significant factor affecting cerebral oxygenation during the transition of healthy full-term neonates.