This paper attempts to provide a preliminary report on neonatal medicine in prehistoric times in Anatolia. Skeletal findings in newborn babies are rare in the archeological record, and all interpretations are made based on artistic figures. A naked woman carved into a stone stab on the floor between God reliefs in Göbeklitepe which was erected by hunter-gatherers 12,000 years ago may suggest the center might have been for pregnant women to safe birth place or more likely an ideal location for blessed intercourse under the powerful god eyes. Çatalhöyük, the largest and best preserved Neolithic settlements dating from 7500 BC. The figurine of the "Mother-Goddess" in sitting position for child birth is the world's earliest known work of art which depicts a newborn head. A figurine of diencephalic (omphalopagus) twin which is thought to be a goddess is the earliest representation of a human with congenital anomalies. Newborn infant burials were probably used as vessels of communication to the gods.

Background: Therapeutic hypothermia provides up to 30% neuroprotection in moderate to severe hypoxic ischemic encephalopathy (HIE). Additional neuroprotection may be achieved by using concomitant pharmacologic neuroprotective agents. Aim: The aim was to evaluate the safety of concomitant neuroprotective therapy of therapeutic hypothermia and magnesium sulfate (MgSO ₄ ) in the management of moderate and severe HIE in term and near-term infants. Study Design: Multicenter double-blind randomized controlled trial. Methodology: Term and near-term newborn infants (≥35 weeks) with a clinical diagnosis of moderate or severe HIE were randomized to either Arm A (therapeutic hypothermia plus MgSO ₄ ) or Arm B (therapeutic hypothermia plus placebo) using a net-based randomization system. Both groups received, within 6 h of birth, standard hypothermia therapy (72 h of cooling to 33.5°C followed by slow rewarming over a period of 8 h) plus either MgSO ₄ (250 mg/kg/dose ×3 doses) or placebo (normal saline). The groups were compared for short-term predischarge adverse outcomes. Results: A total of 60 patients were randomized (29 in Arm A and 31 in Arm B). Both groups had similar baseline characteristics (P > 0.05) including severity of HIE. There were no differences in the short-term adverse outcomes (death, seizures, thrombocytopenia, coagulopathy, renal failure, elevated liver function test's, hypotension, intracranial hemorrhage, necrotizing enterocolitis, pulmonary hemorrhage, persistent pulmonary hypertension, and pulmonary air leak syndromes) between the two groups (P > 0.05). Conclusions: The combined use of therapeutic hypothermia and MgSO ₄ appears to be safe particularly with respect to maintaining normal blood pressure and coagulopathy. Long-term survival and neurodevelopmental outcomes remain to be evaluated.

Background: Early-onset sepsis is a significant cause of mortality and morbidity in neonates. Currently, there are no recommendations on how to manage a well-appearing co-twin if one twin meets the criteria for evaluation for sepsis. Objective: Review our experience on management of well-appearing co-twins when one twin (index case) is evaluated for sepsis. Methods: Retrospective review of twins born at ≥36 weeks gestation. Index cases were categorized into two groups: (1) Presence of clinical signs of sepsis and no risk factors (RFs), and (2) presence of clinical signs with RF. All co-twins were well-appearing. Clinical presentation, diagnosis, and management are presented for all twins. Results: The study included 33 twin pairs. Septic workup was performed in index cases due to the presence of clinical signs with no RF (66.7%) or clinical signs with RF (33.3%) and all received antibiotics. Septic workup was performed in 18.2% of co-twins when clinical signs but no RFs were present in the index cases and 36.4% of co-twins when clinical signs and RF were present. No cases of sepsis were identified in either twin. Conclusion: Variation in the management of a well-appearing co-twin exists when the other twin is evaluated due to clinical signs of sepsis with or without the presence of RF. Our small dataset suggests that it may be reasonable to defer a septic workup of the well-appearing co-twin; particularly in the absence of RF. A larger study is required to confirm this suggestion.

Objectives: The prevalence of cutaneous lesions in newborns varies among different sex, and race. There are limited reports of skin lesions among Egyptians neonates. This study was conducted to determine the prevalence of different cutaneous lesions in newborns and evaluates the association between age, gender, maturity, route of delivery, birth weight, maternal disease, and different skin lesion. Patients and Methods: All of the subjects were healthy newborn infants, who were born between April 2013 and March 2014. They were enrolled and examined for cutaneous lesions by pediatrician and dermatologists. All patients were examined within the first 7 days of birth. Results: A total of 177 neonates were included in this descriptive prospective cohort study. Skin disorders were found in 132 neonates out of 177 (74.6%) of cases and 45 (25.4%) of cases were free of any skin disorder. Benign transient lesions of newborn were the most common category of neonatal skin disorders that were seen in 54 neonates (41% of all cases), followed in frequency by birth marks that were noticed in 45 neonates (34% of all cases). Napkin dermatitis was considered the third common category of neonatal skin diseases 20 (15.2%). Genodermatoses were only noticed in 3% of cases. Other (6.8%) of cases were [epidermolysis bullosae (1.5%), cutis aplasia congenital (2.3%), histocytosis X (1.5%), Suckling blisters (1.5%)]. Conclusion: Benign transient lesions of the newborn were the most common category of neonatal skin disorders, followed in frequency by birth marks. The prevalence of different pathological skin lesion was not common. The prevalence of the skin lesions of newborns are different in this study, these could be due to environmental factors, race, the age of the infant and the period of observation of the studied subjects.

Background: Umbilical venous catheter (UVC) is the most commonly used central venous line during neonatal resuscitation. Misplacement is responsible for potential serious complications. Aims: The aim was to find out the ability of bedside ultrasound to determine the UVC tip position (TP). Ultrasound may then be the new gold standard saving unnecessary radiographs thus decreasing the radiation dose received by neonates. Early detection of UVC misplacement will help in preventing complications as ultrasound is easy, readily available at the bedside. Settings and Design: Prospective blind comparison to a gold standard. Subjects and Methods: Our study included all neonates admitted to the neonatal intensive care unit from February 2013 to October 2013 who required insertion of UVC. Exclusion criteria included neonates with thoracic or abdominal congenital abnormalities, critically ill or very low birth neonates and withdrawal of parent consent. A portable chest-abdomen radiograph was obtained followed by bedside ultrasound examination by a senior radiologist blinded to the radiograph interpretation. The UVC TP determined by ultrasound was compared to chest-abdomen radiograph interpretation. Statistical Analysis: Sensitivity, specificity, accuracy positive and negative predictive values for ultrasound results were calculated. Results: Seventy-five catheter insertions for 74 neonates were included in our study. The sensitivity, specificity, and accuracy of ultrasound were 91.3%, 94.2%, and 93.3%, respectively, with a positive predictive value of 87.5% and a negative predictive value of 96.1%. Conclusion: Our results show that bedside ultrasound could replace thoracoabdominal radiograph in determining UVC TP therefore decreasing neonatal radiation dose and decreasing or preventing complications resulting from misplacement.

Background: Patent ductus arteriosus (PDA) is a common finding in premature infants, and there are conflicting studies about the indications and benefits for medical or surgical intervention. Near-infrared spectroscopy (NIRS) allows bedside, noninvasive monitoring of tissue perfusion or oxygenation of underlying organs. Objectives: The objective of this study was to investigate the impact of ibuprofen on regional tissue oxygenation in the cerebral and somatic circulation using NIRS in infants medically treated for an hemodynamically significant PDA. Materials and Methods: This was a prospective observational study in the Neonatal Intensive Care Unit of Rotunda Maternity Hospital from May 2011 to April 2012. All infants <34 weeks and <1500 g with a PDA confirmed on echocardiogram were enrolled in the study. NIRS sensor was applied at least 1 h pre-treatment and at least 9 h during treatment after the first dose of ibuprofen. Nontreatment patients were infants who met the above criteria, but did not receive ibuprofen. Results: There are a total of 20 recordings for 18 infants; 10 infants received ibuprofen and 10 infants who were not treated. In the treatment group, 1 infant received ibuprofen on two occasions. One infant was initially in the nontreatment group and later received ibuprofen therapy. The mean (standard deviation [SD]) cerebral regional oxygenation (CrO ₂ %) pretreatment was 68.1 (±6.28) % and during treatment was 68.56 (±6.43) %. The mean (SD) somatic regional oxygenation (SrO ₂ %) pretreatment was 40.9 (+/25.3) % and during treatment was 48.6 (±20.4) %. In the nontreatment group, the mean (SD) CrO ₂ was 66.8 (±8.75) % and SrO ₂ was 45.7 (23.75) %. Conclusion: This study highlights the equipoise and clinical dilemma surrounding managing preterm babies with PDAs. NIRS does not seem to be a helpful adjunct in stratifying those high-risk babies who may benefit from ductal closure, that is, babies where PDA is affecting tissue oxygenation. However, in the one baby who had a significant complication necrotizing enterocolitis, NIRS did identify early a significant change in the somatic oxygenation, 30% drop from baseline. Even when a PDA is considered hemodynamically significant by a Consultant Paediatric Cardiologist, it appears to have little or no effect on CrO ₂ and SrO ₂ saturation. In comparison to indomethacin, ibuprofen had little or no effect on CrO ₂ and SrO ₂ .

Objective: The objective was to compare the effects of early versus delayed cord clamping (ECC vs. DCC) on immediate neonatal adverse outcomes and delayed benefits. Methodology: Prospective randomized controlled trial in mother-infant pairs who were term, singleton with uneventful pregnancies and normal vaginal deliveries. Intervention: ECC done at 10 s after birth. DCC done at 180 s after complete delivery of the fetus. Results: A sample size of 86 mothers were included, but 10 infant blood samples were discarded because they were hemolyzed. Hence final analysis was done on 76 mother-infant pairs (ECC = 39; DCC = 37). Mean serum ferritin level was 299.7 ng/ml in the ECC group versus 399.9 ng/ml in the DCC group with no significant complications in either group. Multiple regression analysis confirmed a clear relationship between DCC and serum ferritin levels after accounting for the effect of secondary variables. Conclusion: DCC should become the standard of care in all low risk singleton pregnancies.

Triple atresia (TA), that is, esophageal atresia (EA), duodenal atresia (DA), and imperforate anus is very uncommon. We retrospectively analyzed five children who presented with TA from January 2007 to December 2012. High sigmoid colostomy was done in three and excision of pouch colon in two cases, as the first stage of surgery. Out of five cases, three cases underwent DA surgery as the third stage, and in two cases, the diagnosis was made later, and in one case the child was not stable during the tracheoesophageal fistula surgery, and hence, it was postponed. In case of the two cases where it was diagnosed at the time of admission, they directly underwent DA surgery as the first stage. A high index of suspicion for the detection of coexisting gastrointestinal anomalies is mandatory in the management EA patients, to avoid undue morbidity and mortality.

A 2 days old full term male neonate, born to unrelated parents, is presented with bilateral corneal opacity. With the presence of clinical features such as bilateral Peters' anomaly, short stature, cleft lip and palate, typical facial features (thin upper lip, round face, low set ears, small ear pinna, broad neck, and small palpebral fissures) and congenital heart defect, we established diagnosis of Peters plus syndrome-like phenotype due absence of mutation in beta 1,3-glucosyltransferase. We report this rare case and reviewed literature. All patients with bilateral Peters' anomaly should be screened for systemic malformations.

Acute urinary retention in infants secondary to extrinsic compression from a pelvic mass is rather a rare finding in neonates hence its diagnosis is often missed or delayed. We are reporting a case of a 5-day old neonate who presented with urinary retention missed at initial presentation and could have been prevented if taken in its full context with high index of suspicion.

We report the second case in English literature of limb ischemia related to umbilical venous catheter (UVC) use. This case was an extremely low birth weight preterm infant who otherwise remained stable during the first 8 days of life. On day 9, she developed intermittent ischemia of the distal phalanges of four fingers on the right hand. On day 11, the ischemia worsened during obtaining a blood for culture from the UVC. Blood cultures yielded cloxacillin-sensitive Staphylococcus aureus. On day 15, a large right atrial thrombus (RAT) was found after an echocardiogram (ECHO). Through consecutive ECHOs, we determined that the RAT was increasing in size. After administering a single dose of recombinant tissue plasminogen activator, size of the RAT decreased significantly, and no anticoagulants, it was deemed unnecessary. On day 147, the patient developed pulmonary hypertension (PH), which was attributed to severe bronchopulmonary dysplasia, and the patient died on day 168. After thorough analysis of the case, it is possible that PH might have been caused by a pulmonary embolism (PE). If a long-term anticoagulant was administered, or PE was considered and treated, the final patient outcome might have been different. In summary, a diagnosis of UVC-related ischemia requires a high index of suspicion. It may be of value to administer a long-term anticoagulant after successful treatment of RAT, and it would be prudent to consider a PE in a preterm infant who then develops PH.

Congenital nasal pyriform aperture stenosis is a lethal cause of neonatal respiratory distress due to narrowing of the pyriform aperture anteriorly. It is the most narrow part of the nasal airway, any decrease in the cross-sectional area will increase the airway resistance several times leading to complete airway obstruction. History and clinical examination give clue to the diagnosis, which should be confirmed by imaging (particularly by computed tomography scan). Based on the severity of obstruction, it is managed either conservatively or surgically.

Congenital malaria is among rare presentation of the disease. Neonatal malaria remains extremely rare both in endemic and non endemic areas. Herein, we report three cases of congenital malaria presenting with prolonged jaundice from a non endemic region of North-India. This may emphasize the need to consider congenital malaria as a differential diagnosis while evaluating the babies with atypical symptoms like prolonged conjugated hyperbilirubinemia.

Bilateral congenital diaphragmatic hernia is a major birth defect with poor prognosis. It is an unsuspecting neonatal emergency which poses formidable challenges in initial resuscitation and further management. We describe a case of bilateral congenital diaphragmatic hernia with severe respiratory distress with brief highlights of its management and difficulties encountered.

Nevus lipomatosus cutaneous superficialis (NLCS) is a rare developmental abnormality characterized by group of ectopic fat cells dispersed in collagen bundles of the papillary dermis. Herein we present a case of congeniatal solitary NLCS in the perianal region of a female neonate presented with features of pseudo hermaphrodism which was ruled out by routine investigation. Simple surgical exicision was done and histological examination was suggestive of NLCS.

Facial nerve palsy in the neonatal period can be result of few reasons including congenital, trauma at the time of birth, or developmental. The majority of infants (more than 90%) with congenital facial palsy usually recover by 3-6 months. The most important step in management is eye care as these infants have incomplete eye closure. If the weakness persistent beyond 3 months than plastic surgeon should be brought in picture.

After an uncomplicated pregnancy and parturition, a male neonate was born with a scrotal abnormality. On physical examination, a skin bulge was noted at the left side of the scrotum, sized about 2 by 2 cm. Both testicles were descended, and the bulge had no palpable content. The genitals, perineum, and anus were normal. The scrotal raphe was located normally. An accessory scrotum was diagnosed. It is important to pay attention to other urogenital anomalies, as well as to think of a possible VACTERL association. A solitary abnormality is harmless.