ObjectiveWe aimed to systematically review and analyse the outcomes of non-endotracheal suctioning (non-ETS) versus ETS in non-vigorous meconium-stained neonates.DesignWe conducted a systematic review of non-ETS and ETS in non-vigorous infants born through meconium-stained amniotic fluid (MSAF). We searched PubMed/Medline, Scopus, Clinical Trials.gov, Cumulative Index to Nursing and Allied Health, and Cochrane Library databases from inception to November 2019, using keywords and related terms. Only non-vigorous infants born through MSAF included in randomised controlled trials, were included. We calculated overall relative risks (RRs) and mean differences with 95% CIs using a random-effects model, to determine the impact of ETS in non-vigorous infants born through MSAF.Main outcome measuresThe primary outcome was the incidence of meconium aspiration syndrome (MAS). Secondary outcomes were respiratory outcome measures (pneumothorax, persistent pulmonary hypertension of the newborn, secondary pneumonia, need for respiratory support, duration of mechanical ventilation), initial resuscitation and others including shock, perinatal asphyxia, convulsions, neonatal mortality, blood culture-positive sepsis and duration of hospital stay.ResultsA total of 2085 articles were identified in the initial database search. Four studies, including 581 non-vigorous meconium-stained infants, fulfilled the inclusion criteria, comprising 292 infants in the non-ETS group and 289 in the ETS group. No statistically significant difference was found for MAS (RR 0.98; 95% CI 0.71 to 1.35).ConclusionsInitiating ETS soon after birth in non-vigorous meconium-stained infants may not alter their neonatal outcomes.

Objective: To compare the accuracy of pulse oximetry oxygen saturation (SpO 2 ) measured on the wrist compared with the ipsilateral palm, and SpO 2 measured on the ankle compared with the ipsilateral sole.Study Design: In this prospective observational study, neonates admitted to the neonatal intensive care unit were enrolled. We recorded SpO 2 (Masimo Radical-7 pulse oximeter) detected at the palm and ipsilateral wrist initially, then at 30 s, and at 1 min, and we repeated the same procedure over the sole and ipsilateral ankle. We recorded the time to obtain the SpO 2 readings from all these sites. Regression analysis was performed to determine the relationship between paired SpO 2 measurements. The mean difference (bias) and standard deviation of the paired SpO 2 differences (precision) were calculated (Bland-Altman plots).Result: A total of 150 patients (birth weight 2381±1020 g, gestational age 34.3 ± 4.3 weeks, median postnatal age 3.5 days (25th-75th percentile 1-16 days)) were enrolled. There was a good correlation between SpO 2 measured at the palm versus the wrist (r ¼ 0.95, P<0.001 (right); r ¼ 0.97, P< 0.001 (left)) and between SpO 2 measured at the sole versus the ankle (r ¼ 0.92, P<0.001 (right); r ¼ 0.91, P<0.001 (left)). There was also a good agreement between paired SpO 2 measurements from these sites. The bias and precision for SpO 2 at the right palm and right wrist was 0.08 ± 0.94% and for the left palm and left wrist 0.22 ± 0.87%. Similarly, the bias and precision for SpO 2 at the right sole and right ankle was À0.03 ± 0.93% and for the left sole and left ankle was À0.01 ± 0.93%. Conclusion:Our results show that the wrist and ankle can be used as alternative sites to measure SpO 2 in newborn infants in place of the routinely used palm or sole.

The CHO component in breast milk from mothers of SGA infants was significantly lower compared with the AGA and LGA groups, but with no clinical significance. Breast milk compositions of mothers of LGA infants were comparable to those of SGA and AGA infants. Therefore, fetal growth status does not significantly influence maternal breast milk nutrients.

Adolescents can develop a severe form of Coronavirus disease 2019 (COVID-19), especially with underlying comorbidities. No study has examined the efficacy or effectiveness of inactivated COVID-19 vaccines in adolescents. This single-center, prospective cohort study was performed to evaluate the safety and effectiveness of an inactivated COVID-19 vaccine in adolescents using the immunobridging approach at Chulabhorn Hospital. The key eligibility criterion was a healthy clinical condition or stable pre-existing comorbidity. The anti-receptor-binding domain (anti-RBD) antibody concentration at 4 weeks after dose 2 of the vaccine was compared between participants aged 12 to 17 years and those aged 18 to 30 years. Safety profiles included adverse events within 7 days after each dose of the vaccine and any adverse events through 1 month after dose 2 of the vaccine. In the adolescent and adult cohorts, the geometric mean concentration of anti-RBD antibody was 102.9 binding antibody unit (BAU)/mL (95% CI, 91.0–116.4) and 36.9 BAU/mL (95% CI, 30.9–44.0), respectively. The geometric mean ratio of the adolescent cohort was 2.79 (95% CI, 2.25–3.46, p < 0.0001) compared with the adult cohort, meeting the non-inferiority criterion. The reactogenicity was slightly lower in the adolescent than in the adult cohort. No serious adverse events occurred. The inactivated COVID-19 vaccine appears safe and effective in adolescents.