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Infants younger than 1 month are at risk for meningitis and may not present with classic signs such as seizures or a bulging fontanelle. Thus, a lumbar puncture should be considered during an evaluation for sepsis in newborns in specific scenarios. While the presence of bacteremia increases the likelihood of meningitis in infants, approximately one-third of cases of meningitis occur in the setting of negative blood cultures. AbstractMeningitis is a devastating infection in infants and is linked to adverse longterm outcomes. The prevalence of meningitis is variable and depends on gestational age, postnatal age, and clinical setting. Early diagnosis and treatment with appropriate antibiotics are crucial to decrease the risk of morbidity and mortality. Lumbar punctures are essential for the diagnosis of meningitis, but clinicians may defer lumbar puncture if the risk for meningitis is low or if there are substantial concerns regarding the risk associated with the procedure. Awareness of the epidemiology and microbiology of meningitis in infants, as well as valid contraindications to performing a lumbar puncture, is necessary to avoid missed diagnoses and procedurerelated adverse effects.Objectives After completing this article, readers should be able to:1. Incorporate current evidence to identify infants in the NICU and the outpatient setting who should undergo a lumbar puncture in the evaluation for suspected sepsis.2. Review the risks and contraindications associated with performing a lumbar puncture in infants.3. Discuss challenges in the interpretation of cerebrospinal fluid parameters in the setting of absent or uninterpretable cerebrospinal fluid cultures.

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IMPORTANCE Pulmonary rehabilitation (PR) after exacerbation of chronic obstructive pulmonary disease (COPD) is effective in reducing COPD hospitalizations and mortality while improving healthrelated quality of life, yet use of PR remains low. Estimates of the cost-effectiveness of PR in this setting could inform policies to improve uptake. OBJECTIVE To estimate the cost-effectiveness of participation in PR after hospitalization for COPD. DESIGN, SETTING, AND PARTICIPANTSThis economic evaluation estimated the costeffectiveness of participation in PR compared with no PR after COPD hospitalization in the US using a societal perspective analysis. A Markov microsimulation model was developed to estimate the costeffectiveness in the US health care system with a lifetime horizon, 1-year cycle length, and a discounted rate of 3% per year for both costs and outcomes. Data sources included published

: Melasma is a common dermatosis, presenting as ill-defined light to dark brown pigmentation of photo-exposed areas, most commonly the face. Its exact prevalence is unknown, but it is commoner in intermediate skin phototypes and women of reproductive age. Its treatment and monitoring have significance due to its chronic recalcitrant history and psychosocial impact. Various indices and tools like the Melasma Area and Severity Index (MASI), Melasma Severity Index (MSI), and Melasma Quality of Life Scale (MELASQoL) have been formulated for measuring severity and treatment response. In this review, particular emphasis has been laid on melasma's epidemiological and clinical aspects and its assessment and scoring.

Bronchopulmonary dysplasia (BPD) is a common morbidity affecting preterm infants and is associated with substantial long-term disabilities. There has been no change in the incidence of BPD over the past 20 years, despite improvements in survival and other outcomes. The preterm lung is vulnerable to injuries occurring as a result of invasive ventilation, hyperoxia, and infections that contribute to the development of BPD. Clinicians caring for infants in the neonatal intensive care unit use multiple therapies for the prevention and management of BPD. Non-invasive ventilation strategies and surfactant administration via thin catheters are treatment approaches that aim to avoid volutrauma and barotrauma to the preterm developing lung. Identifying high-risk infants to receive postnatal corticosteroids and undergo patent ductus arteriosus closure may help to individualize care and promote improved lung outcomes. In infants with established BPD, outpatient management is complex and requires coordination from several specialists and therapists. However, most current therapies used to prevent and manage BPD lack solid evidence to support their effectiveness. Further research is needed with appropriately defined outcomes to develop effective therapies and impact the incidence of BPD.

Background: There has been a 291% relative increase in congenital syphilis (CS) cases in the United States from 2015 to 2019. Although the majority of affected fetuses/infants are stillborn or are asymptomatic, a subset is born with severe clinical illness. We describe a series of severe CS cases in the neonatal intensive care unit. Methods: Retrospective review of infants with CS, admitted to the Duke Intensive Care Nursery from June 2016 to February 2020. We recorded birthweight, gestational age, medications, procedures, diagnoses, laboratory data and outcomes. Severe symptoms included: birth depression, hypoxic ischemic encephalopathy (HIE), disseminated intravascular coagulopathy and/or persistent pulmonary hypertension (PPHN). Results: Seven infants with CS were identified and 5 with severe presentations were included. Median gestational age was 35.1 weeks (range: 29-37 weeks, median: 35 weeks). All infants required intubation at birth, 2 required chest compressions and epinephrine in the delivery room. One had hydrops fetalis and died in the delivery room. All 4 surviving infants had HIE, severe PPHN, hepatitis and seizures. All infants had a positive rapid plasma reagin, and were treated with penicillin G. Maternal rapid plasma reagin was pending for 3 of 5 infants at delivery, and later returned positive; 2 were positive during pregnancy but not treated. Other infectious work-up was negative. Three infants survived to discharge. Conclusion: CS can be associated with HIE, PPHN and disseminated intravascular coagulopathy in affected infants. Clinicians should have a high index of suspicion and include CS in their differential diagnoses. This study also highlights the importance of adequate treatment of identified cases and screening during the third trimester and at delivery.