BackgroundChikungunya virus (CHIKV) is an emerging arboviral infection with a global distribution and may cause fetal and neonatal infections after maternal CHIKV-infections during gestation.MethodologyWe performed a systematic review to evaluate the risk for: a) mother-to-child transmission (MTCT), b) antepartum fetal deaths (APFD), c) symptomatic neonatal disease, and d) neonatal deaths from maternal CHIKV-infections during gestation. We also recorded the neonatal clinical manifestations after such maternal infections (qualitative data synthesis). We searched PubMed (last search 3/2017) for articles, of any study design, with any of the above outcomes. We calculated the overall risk of MTCT, APFDs and risk of symptomatic neonatal disease by simple pooling. For endpoints with ≥5 events in more than one study, we also synthesized the data by random-effect-model (REM) meta-analysis.Principal findingsAmong 563 identified articles, 13 articles from 8 cohorts were included in the quantitative data synthesis and 33 articles in the qualitative data synthesis. Most cohorts reported data only on symptomatic rather than on all neonatal infections. By extrapolation also of these data, the overall pooled-MTCT-risk across cohorts was at least 15.5% (206/1331), (12.6% by REMs). The pooled APFD-risk was 1.7% (20/1203); while the risk of CHIKV-confirmed-APFDs was 0.3% (3/1203). Overall, the pooled-risk of symptomatic neonatal disease was 15.3% (203/1331), (11.9% by REMs). The pooled risk of symptomatic disease was 50.0% (23/46) among intrapartum vs 0% (0/712) among antepartum/peripartum maternal infections. Infected newborns, from maternal infections during gestation were either asymptomatic or presented within their first week of life, but not at birth, with fever, irritability, hyperalgesia, diffuse limb edema, rashes and occasionally sepsis-like illness and meningoencephalitis. The pooled-risk of neonatal death was 0.6% (5/832) among maternal infections and 2.8% (5/182) among neonatal infections; long-term neurodevelopmental delays occurred in 50% of symptomatic neonatal infections.Conclusions/SignificancePublished cohorts with data on the risk to the fetus and/or newborn from maternal CHIKV-infections during gestation were sparse compared to the number of recently reported CHIKV-infection outbreaks worldwide; however perinatal infections do occur, at high rates during intrapartum period, and can be related to neonatal death and long-term disabilities.

No abstract

Hypoglycemia in neonates is associated with long-term neurodevelopmental effects. Hyperinsulinemic hypoglycemia (HH) is the most common cause of persistent hypoglycemia in neonatal intensive care units. Diazoxide is the only medication that is currently recommended for treatment of HH in neonates. However, the use of diazoxide in neonates is associated with pulmonary hypertension as an adverse effect. In this article, we review the literature on the mechanism of action and adverse effects with the use of diazoxide in neonatal hyperinsulinism. We then present a case series of neonates treated with diazoxide in our neonatal intensive care unit over a 5-year period. Among 23 neonates who received diazoxide, 4 developed pulmonary hypertension and 1 died. All infants who developed pulmonary hypertension were born preterm at less than 36 weeks gestation and had pre-existing risk factors for pulmonary hypertension. HH in preterm neonates, with pre-existing pulmonary hypertension or with risk factors for pulmonary hypertension requires thoughtful management.

(1) Background: Timely and effective positive pressure ventilation (PPV) is the most important component of neonatal resuscitation. Emerging data supports the use of supraglottic airways such as the laryngeal mask airway (LMA) as a first-line interface for PPV during neonatal resuscitation. LMA use reduces the need for intubation compared to facemask use in systematic reviews, but there is no difference in the incidence of death or moderate-to-severe hypoxic ischemic encephalopathy (HIE). Time to effective ventilation during simulation with manikin models by providers with limited neonatal airway experience may add to the current evidence that compares the LMA to the neonatal facemask as the first-line ventilation interface during neonatal resuscitation.; (2) Methods: Thirty-two pre-clinical medical students were recruited and randomized to learning and performing ventilation with either the LMA or neonatal facemask on a neonatal manikin. Tidal volume was measured by breath-by-breath analysis to assess adequacy and consistency of PPV in 10 consecutive breaths. Perceived confidence was measured by pre- and post-intervention surveys that utilized a Likert scale from 1 to 5.; (3) Results: Median time to achieve effective ventilation was shorter with a neonatal facemask compared to the LMA (43 (30, 112) seconds vs. 82 (61, 264) seconds, p < 0.01). Participants reported higher perceived confidence post-intervention with use of a facemask when compared to use of the LMA (5 (4, 5) vs. 4 (4, 4), p = 0.03).; (4) Conclusions: Pre-clinical medical students demonstrated a shorter time to effective ventilation and reported higher confidence scores after learning and demonstrating PPV using the facemask when compared to LMA in a neonatal manikin. Further studies are warranted to evaluate the use of supraglottic airways in providers with limited experience with airway management of neonates, as well as in ways to better promote proficiency and confidence in the use of the LMA.