Using ultrasound-based radiomics technology to analyze fetal-lung texture, fetal lungs from pregnancies grouped according to whether they were affected by gestational diabetes mellitus (GDM) and/or pre-eclampsia (PE) could be distinguished from each other and from fetal lungs of normal pregnancies, and lungs from pregnancies at different gestational ages could be distinguished. What are the clinical implications of this work?These results support the possibility that this technology may be helpful in non-invasive fetal assessment and prediction of neonatal respiratory complications in women with PE, GDM or their combination.

Background Late preterm and term infants may develop respiratory issues with severe outcomes. Early identification of these diseases shortly after infants' birth can improve their management. Lung ultrasound (LUS) has been used to diagnose neonatal respiratory diseases. However, few LUS methods have been reported to predict the need for respiratory support, the basis of infant respiratory diseases management. Methods We conducted a prospective diagnostic accuracy study following the Standards for the Reporting of Diagnostic Accuracy Studies guidelines at a tertiary academic hospital between 2019 and 2020. A total of 310 late preterm and term infants with mild respiratory symptoms were enrolled. The LUS assessment was performed for each participant at one of the following times: 0.5, 1.0, 2.0, or 4.0 h after birth. Predictive reliability was tested by receiver operating characteristic curve analysis. The main outcome was the need for any respiratory support determined according to international guidelines. Results Seventy‐four infants needed respiratory support, and 236 were healthy according to a 3‐day follow‐up confirmation. Six LUS imaging patterns were found. Two “high‐risk” patterns were strongly correlated with respiratory support needs (area under the curve [AUC] = 0.95; 95% confidence interval [CI]: 0.92–0.98, p < .001). The optimal cut‐off value for “high‐risk” patterns was 2 (sensitivity = 87.8% and specificity = 91.1%). The predictive value of LUS was greater than that of a symptom‐based method (the Acute Care of at‐Risk Newborns assessment score) (AUCs' p < .01). Conclusions LUS can be used to predict the need for respiratory support in late preterm and term infants and is more reliable than tools based on respiratory symptoms.

Background Deep sleep, also known as slow-wave sleep (SWS), is essential for maintaining good health and is characterized by electroencephalographic (EEG) slow-wave activity (SWA). The use of phase-locked auditory stimulation (PLAS) to enhance SWA has emerged as a promising approach. However, the effectiveness of home-based PLAS has not yet been fully established. Method We used a newly developed wearable EEG device, called LANMAO, to record sleeping EEG signals and synchronize acoustic tones with SWA. We employed a within-subject design to investigate whether acoustic stimulation could increase SWA in a home setting using six subjects (mean age: 29 years, 3 males). Specifically, we applied acoustic stimulation (STIM) on odd-numbered slow waves and no stimulation (SHAM) on even-numbered slow waves. Results The PLAS significantly enhanced SWA, theta, alpha, fast spindle and slow spindle activity on STIM condition compare to SHAM condition across all subjects in home setting. Conclusion These results indicated that the capacity of PLAS, based on LANMAO device, could enhance the SWA in home setting. Our findings shed lights on the wide application of home-based deep sleep intervention.

Background Lungultarsound(LUS) is widely used to diagnose neonatal lung diseases, yet image patterns on intrauterine to extrauterine stage(right after birth), of which impairment is well related to lung disease, remains unclear. Objectives To identify these image patterns that can distinguish healthy infants from infants with lung disease.Methods This is a nested case-control study in a top-ranking obstetrics hospital in China, between 1 January 2020 to 1 April 2020. Infants transferred to the NICU after birth who had LUS obtained at 0.5, 1, 2, 4, 6 hours time intervals were enrolled. Confirmed by 3-day follow-up, case and control groups contains 22 patients and 473 healthy infants. Their GA ranges from 33.5 to 41.0 weeks. A newly designed protocol was used to capture the LUS image. The image patterns and their variations were shown and categorized as high and low-risk groups. The predictive value for healthy infants and patients were calculated. Rsults Low-risk patterns, accompanied with no high-risk ones, typically appeared in healthy infants (specificity=86.4%, PPV=99.0%), whereas four high-risk patterns could be seen in both healthy infants and patients (specificity=62.4%, PPV=9.6%). High-risk patterns were more likely to be pathological signs when appearing at the oxter and lower back and to be physiological signs when appearing at the prothorax. Conclusions LUS is valid to differentiate healthy infants from potential patients shortly after birth. Infants with low-risk patterns only are highly likely to be healthy, whereas infants with high-risk patterns have a risk for respiratory issues but need prolonged monitoring to confirm.

BACKGROUND Diabetes in pregnancy used to be considered associated with a higher risk of respiratory distress syndrome(RDS) in neonates. However, as antenatal examinations have improved, whether well-managed gestational diabetes remains an independent risk factor is unclear. This study was to determine the associations of well-managed gestational diabetes with morbidity and complications of RDS. Method This was a case-control study conducted at the Obstetrics & Gynecology Hospital of Fudan University, Shanghai, China. We collected data from 101 RDS infants and 101 RDS infants from among 1749 infants, through a standardized protocol with predefined inclusion and exclusion criteria. Assessment of diabetes management was based on HbA1c and random blood glucose measurements. Univariable and multivariable logistic regression was performed to calculate the odds ratio (OR). An intergroup analysis was conducted between RDS infants and those without RDS, and a subgroup analysis was conducted between RDS neonates born to women with gestational diabetes and those born to women without gestational diabetes. RESULTS The mean (±SD) gestational age of the RDS infants was 35.9 (1.9) weeks, which was similar to that of the non-RDS infants (35.7 (±1.3) weeks). The HbA1c levels at diabetes diagnosed, the HbA1c levels right before delivery and the RBG levels before delivery had no significant differences, and all of them were below a well-controlled level. In the intergroup analysis, the morbidity of gestational diabetes between the two groups showed no significant differences in the adjusted analyses (adjusted OR 1.40, 95% CI 0.59-3.36). However, the case group had significantly more placental abnormalities (adjusted OR 3.61, 95% CI 1.63-8.00), fetal distress (adjusted OR 4.20, 95% CI 1.87-9.46), and asphyxia (adjusted OR 3.74, 95% CI 1.59-8.81) than the control group. In the subgroup analysis, the total dose of the PS applications, incidence of complications, and need for respiratory support (total and separate) were not significantly different between the two groups. CONCLUSIONS Well managed gestational diabetes is no longer a significant risk factor for RDS, while acute or chronic ischemia factors are. With regards to most GDM, diet and exercise are sufficient for maintaining an HbA1c below 6.5%