Background:
Neonatal hypocalcemia is either early onset (<3 days of age) or late onset (>3 days of age). Neonates with hypocalcemia can become asymptomatic, however in case of presenting the manifestations could be hypotonia, poor feeding, apnea, seizures or cardiac failure. Among the possible causes could be hypothyroidism, hypoparathyroidism (transient or primary). Diagnosis is based on the presence of hypocalcemia, hyperphosphatemia, and elevated PTH concentrations. Transient neonatal pseudohypoparathyroidism differs from other persistent type I and type II, because it is self-limited and has an adequate response to treatment.

Objective:
The case of a neonate is presented who had early onset seizure associated with hypocalcemia, hyperphosphatemia, and raised parathyroid hormone.

Methods:
We report a newborn with transient PHP who presented multifocal hypocalcemic seizures. We discuss this rare entity with reference to the recent literature.

Results:
The hypocalcemia was initially resistant to calcium therapy, but responded to vitamin D analog therapy. The diagnosis of 'neonatal pseudohypoparathyroidism' was entertained; the infant remained stable and seizure-free with normal serum biochemistry during the next months of follow-up.

Conclusion:
In conclusion, in case of late–onset neonatal seizure secondary to hyocalcemia, in relation with hyperphosphatemia and raised PTH, the diagnosis of transient pseudohypoparathyroidism should be considered. The diagnostic path must consider all the possible differential diagnoses in order to undertake a timely and correct course of treatment where calcium and vitamin D are the corner stone.

Background:
The high morbidity of necrotizing enterocolitis (NEC) in very low birth weight infants (<1500 grams) requires the search for prevention strategies that are more effective than treatment. Current evidence supports the use of probiotics as protective factors.
Objective:
To determine if probiotic supplementation in VLBW infants represents a preventive factor for the development of NEC.
Methods:
Retrospective cohort study conducted with 145 VLBW infants, where the presence of NEC was evaluated in populations supplemented with Limosilactobacillus reuteri, Bifidobacterium lactis or not supplemented. The comparison among groups was performed with the chi-square test for maximum likelihood-ratio.
Results:
Of 66 supplemented patients, 86.4% did not present NEC (RR 0.23 [95% Ci: 0.12-0.43]; p<0.0001) (Table 1). In those not supplemented, the incidence of NEC was 59.5%. An NNT of 1.7 to 3.1 was obtained.
Conclusion:
Despite the heterogeneity in clinical studies of probiotic supplementation, the evidence is strongly in favor of probiotic treatment for the prevention of NEC. This study found that supplementation from the first days of life with L. reuteri at doses of 600 million CFUs was more effective in preventing the presentation of NEC than higher doses.

The novel coronavirus disease 2019(COVID-19) pandemic has prompted the development of guidelines for diagnosis, management, infection control strategies and discharge planning.However, there is currently limited knowledge about neonatal COVID-19 and severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infections. While the number of pediatric COVID-19 cases appears to be low, the exact incidence and associated morbidities/mortality of SARS-CoV-2 infection in neonates are not clear. This report focuses on a preterm girl who was delivered by caesarean section at a postmenstrual age(PMA) of 31+6weeks (maternal eclampsia) with a birthweight of 1400g (P10-50). She was admitted to the Neonatal Intensive Care Unit(NICU) and discharged at day 31 of life(PMA 36+1w).
At 39weeks PMA(day 53), she developed episodes of bradycardia with desaturation and was transferred to the NICU on CPAP support. Due to frequent and severe apnoeas, she required endotracheal intubation. Within a few hours, reverse-transcription polymerase chain reaction (RT-PCR) for SARS-CoV-2 tested positive. The mother had mild symptoms and also tested positive. Due to ongoing clinical deterioration and laboratory findings indicating signs of secondary infection, she empirically started antibiotics and corticosteroid therapy. Chest X-rays showed right upper lobe atelectasis. The infant progressed well and was extubated to nCPAP after 4 days and discharged on day 64.
With this report, the authors would like to emphasize that, although rare, even newborns can experience severe COVID-19 that may require intensive care and invasive ventilatory support. In this case possible risk factors may have been high and repeated viral exposure, preterm birth, and immature regulation of breathing.

Background:

Although recent advances in respiratory care improved the prognosis of newborns with severe respiratory failure, air-leak continues to be frequent. Pneumothorax is the most common subtype in the neonatal períod.
Objective: to characterize our neonatal population diagnosed with pneumothorax.

Methods:
We performed a retrospective study of the patients diagnosed in our Neonatal Intensive Care Unit, from January 2012 to December 2022. Statistical comparison was performed between preterm and full-term newborns using SPSS.

Results:
Seventy-three patients met the inclusion criteria, 67% of which were males. Thirty-eight percent were full-term and 27% late preterm.
Ninety-three percent presented with respiratory distress in the first 2 hours after birth; 84% of the pneumothoraxes occured in the first 2 days of life in both full-term and preterm groups.
Premature newborns demonstrated respiratory distress earlier (p=0.047), with an increased need for surfactant administration (p=0.017) and thoracotomy (p=0.008), and were more frequently diagnosed with hyaline membrane disease (p˂0.001). Transient tachypnea (p=0.001) was more frequent in full-term newborns. No statistical difference was found in the time of the chest tube.
Mortality rate was 4%, with two patients dying due to other causes and one due to pneumothorax, and no statistical difference was found between the two groups.

Conclusions:
Although respiratory distress occured earlier in premature newborns, pneumothorax appears to be more frequent in the first two days of life regardless of gestational age.
One in three patients required thoracotomy, with a significant higher risk in premature patients. Mortality rate from pneumothorax was low even in premature patients.

Background: Focal dermal hypoplasia (FDH) is a rare X-linked dominant disorder, caused by mutations in the PORCN gene and characterized by dermal hypoplasia/aplasia producing dermatologic, skeletal, ocular, dental and craniofacial defects.
Objectives: We present a female newborn with clinical features of FDH detected at birth: dermal hypoplasia (fig. 1B), cleft lip (fig. 1A), hyper and hypopigmentation areas following Blaschko lines distribution (fig. 1C) and syndactyly and anonychia on her feet.
Methods: It was performed a next generation sequencing panel for dermal hypoplasia based on whole exome sequencing. Parents underwent testing for the identified variant.
Results: The patient was the only child of healthy nonconsanguineous parents. Intrauterine growth restriction was detected in the second trimester of pregnancy. Delivery was at full-term, and the patient was adequate for her gestational age. We identified a de novo frameshift variant (c.95del p.(Leu32Profs*20) in the POCRN gene. This variant was not yet described in the literature nor is reported in genomic databases. Parents testing allowed to conclude a very likely de novo inherited variant and allowed to its reclassification as pathogenic.
Conclusions:
FDH usually occurs as de novo variants. Its phenotype varies widely from mild defects to severe forms. Given the possibility of various organs involvement, a multidisciplinary approach is advised.
Molecular diagnosis allows specific genetic counselling for the child but also for the parents, namely invasive prenatal molecular diagnosis in future pregnancies, considering the possibility of gonadal mosaicism.

Background: Wolman disease occurs as a result of the loss of enzymatic activity in lysosomal acid lipase, which is responsible for the hydrolysis of cholesterol esters and triglycerides. The disease is characterized by vomiting, diarrhea, decreased weight gain, and hepatomegaly, leading to death in early infancy.
Objective: The study aims to examine the clinical features of Wolman disease and evaluate treatment responses.
Methods: The case of a male patient who was diagnosed with wolman disease through enzyme analysis and died 68 days old was presented
Results: The patient was born to a healthy 24-year-old mother, without proper prenatal care, through cesarean delivery at 38 weeks of gestation, and the baby was a result of consanguineous marriage. On the third day after birth, the baby presented to the emergency department with complaints of abdominal distension. Physical examination revealed hepatosplenomegaly and jaundice, and laboratory tests showed increased liver enzyme levels and coagulation values, leading to admission to the neonatal intensive care unit. Etiological investigations included urine reducing substances, sugar chromatography, tandem mass spectrometry, plasma amino acids, urine organic acids, very long-chain fatty acids, alpha-1 antitrypsin, TORCH, and enzyme analysis for Wolman and Niemann-Pick disease type C. Additionally, a biliary ultrasound was performed to evaluate for biliary atresia. Based on the available test results, a presumptive diagnosis of Wolman disease was made.
Conclusion: In cases of diseases presenting with hepatosplenomegaly and cholestasis during the neonatal period, lipid metabolism disorders should be considered in the differential diagnosis.

BACKGROUND
Cardiovascular transition at birth is a complex physiological phenomenon driven by a drop in pulmonary vascular resistance within the first few breaths and an increase in systemic vascular resistance, secondary to the removal of the low-resistance placental circulation through cord clamping (CC).
OBJECTIVE
To implement our current understanding of the physiology of haemodynamic transition and the impact of CC on humans, as our current understanding is mainly based on animal studies.
METHODS
Targeted echocardiograms were performed before (T1) and immediately following (T2) cord clamping (CC) in 10 term vigorous infants born by vaginal delivery (VD). Variables were assumed as not normal given the sample size, and compared using Wilcoxon Signed-Rank Test.
RESULTS
Main results are showed in table 1. CC occurred at a median of 202.5 [180-227.5] seconds. The median heart rate was 175.7 [155.6 – 184.2] bpm at T1 and 169 [152.5 – 186-6] bpm at T2. Left ventricular output (LVO) significantly increased following CC (p=0.037), while there was a non-significant increase in right ventricular output (RVO) (p=0.14). Pulmonary acceleration time indexed to right ventricle ejection time (PAATi) remained stable before and after CC. Biventricular pulsed wave TDI-derived measurements (s’, a’, IVRT, IVCT, MPI) did not significantly change after cord clamping.
CONCLUSION
In spontaneously breathing term infants born by vaginal delivery, clamping of the cord at a median of 3 mins was not associated with changes in cardiac function, other than an increase in LVO. Therre was no impact on pulmonary vascular resistance.

Background:
The resuscitaire is a key apparatus used in the resuscitation of infants and neonates. It provides increased ambient warmth, lighting, monitoring, airway support and suction. Having a functional and correctly stocked resuscitaire is vital to improving the outcome of infant and neonatal care in our emergency department.

Objective:
To align the stock and functionality of the Emergency Department resuscitaire with international best practice.

Methods:
It was noted that the resuscitaire was not functioning or stocked as per international best practice. Steps were put in place to correct the functional elements. The care model and stocking patterns were taken from Cork University Maternity Hospital and the Neonatal Resuscitation Program.

Results:
The stocking list is set to be implemented on the resuscitaire and roles are to be agreed on how often it is restocked and quality checked to provide optimum care for neonates and infants in the Mercy University Hospital Emergency Department. This should be treated in parallel to similar quality checks to adult resuscitation trolleys.

Conclusion:
The care of a neonate or infant is often time-critical as they often present with:
1. “Cold shock” (peripheral vasoconstriction) requiring ambient warmth and fluid resuscitation.
2. Respiratory arrest, which is the most common form of paediatric arrest. Having readily available, functional and appropriate airway supports such as a “neopuff” or “T-Piece” circuits can assist in optimising neonatal and infant resuscitations.

These conditions can be optimised by appropriate use of a well maintained resuscitaire.

Objective:
To measure the success rate of attempts at peripheral vein cannulation in neonatology patients.
Background:
Peripheral venous cannulation is perhaps the most common procedure performed in neonatology. Multiple attempts increase the risk of blood stream infections and are associated with altered pain sensitivity in childhood.
Methods:
The study took place between 1st March and 30th April in a neonatal HDU caring mainly for newborns with complex congenital/surgical conditions. Venous cannulation on the unit is performed mainly by IV team nurses and neonatology/general paediatrics registrars. Each attempt was recorded prospectively.
Results:
57 attempts were recorded. 44 (77%) ended with a cannula in place. ¼ of attempts involved ≥3 pricks. The 1st prick success rate was 35% (19/55). The 2nd prick success rate was 56% (19/34). The overall success rate for any subsequent prick by the same operator was 22% (4 of 18)
The success rate per insertion technique was analysed. For the traditional method (inspection/palpation) the success rate per needle prick was success was 32% (26/81). With transillumination, the same rate was 50% (8/16). Ultrasound-guided insertion was sometimes available for rescue attempts. The per prick success rate with ultrasound was 80% (8/10).
Conclusion:
Patients in a neonatal HDU are at high risk of difficult IV access. After two unsuccessful pricks, subsequent attempts by the same operator are far less likely to be successful. Ultrasound-guided cannula insertion by trained operators is a promising technique for babies with difficult access.

Background
There is an increasing prevalence of pregestational and gestational diabetes(GDM) in pregnancy.Little data exists on gestation specific neonatal outcomes, dependent on the type of maternal diabetes and treatment, which would aid prenatal counselling in relation to likelihood and duration of admission.Our aim is to define neonatal outcomes including admission rate to the NICU by gestational age for neonates born to mothers with pregestational and GDM.This information will provide up-to-date, local data to support health care professionals when counselling patients with diabetes in pregnancy.

Methods
A retrospective observational study identified 192 infants born to mothers with pregestational or gestational diabetes requiring admission to an Irish tertiary NICU from Jan – Dec 2018.Gestational age, birth weight, mode of delivery, APGARs, reason for admission, length of stay, need for respiratory and fluid support, hypoglycaemia and mortality were collected.Maternal factors accounted for included age, smoking, high BMI, pre-eclampsia/pregnancy-induced hypertension, and use of antenatal steroids.

Results
The statistical test used was ANOVA.There was no significant difference in birth weight between the groups (p=0.61).However, infants of mothers with T1DM were born earlier than those with GDM or MODY, but not with T2DM(Fig.1).The most common indication for admission was respiratory distress, followed by hypoglycaemia, feeding issues and jaundice.There was no significant difference in length of NICU stay (p=0.16).

Conclusion
Infants of mothers with T1DM are born significantly earlier than those with GDM or MODY, but not T2DM.Despite being born earlier, these infants have a similar birth weight to their peers.

Hypoglycaemia is a significant contributor to morbidity and mortality in neonates. Asymptomatic high risk neonates require screening as this is a preventable cause of neurological sequelae.

Our aim was to review the use of neonatal hypoglycaemia guidelines in the management of asymptomatic infants born to diabetic mothers, and to note if all asymptomatic neonates born to diabetic mothers were having blood sugar levels tested.

This was a retrospective audit of the babies born between January 2023 to April 2023 at Wexford General Hospital (WGH). The total number of births were 406 and a total of 85 babies were identified as infants of diabetic mothers (IDM) in that duration. Chart review of 50 patients were done, who met the criteria as of asymptomatic to assess the documentation of hypoglycaemia and adherence to the guidelines.

Among 50 patients who were included in this audit, (27) 54% were male and (23) 46% were female. All of them were under 48 hours of age. In (43) 86% of these babies’ blood glucose levels were regularly monitored and documented in the charts as per the guidelines. The remaining (7)14% of these at-risk neonates had no documentation of blood sugar levels

Most of the at-risk neonates had their blood sugar levels monitored, however, up to 14% had no clear documentation of this monitoring.
This audit demonstrated that the management of asymptomatic neonates born to diabetic mothers could be improved by highlighting the risk involved with hypoglycaemia and making guidelines readily available

Objective
Prenatal alcohol and drug exposure affects many different aspects of brain development.Children with FAS and NAS may exhibit deficits in neurodevelopment, central nervous system impairment, but also academic, behavioral, and psychosocial problems. The disrupted development can cause secondary disabilities such as behavior problems, school failure or low academic achievement, and mental health issues. The combination of trauma experiences in case off abuse and neglect in children with FAS and/or NAS is specific as the assessments focus.

Methods
In a clinical sample of 82 children diagnosed FAS and/or NAS (62 boys, 20 girls, 4-16y.o.); referred to our Center 2015-2022 with suspicion of emotional, sexual or phisical abuse and neglect. We examined their cognitive development, fine motor, visuospatial and attenton domain and academic achievement in school children, as well as EEG.

Results
In our sample, cognitive development delay was found in 40 children, in 63 fine motor skills were below the average, in 66 visuospatial development was delayes, 52 had attention difficulties, in 27 children EEG was dysritmic. In school children, 19 had severe academic difficulties. Children exposed to abuse, neglect and FAS and/or NAS had difficulties in multiple areas of functioning.

Conclusion
Children with both traumatization and prenatal alcohol and drug exposure had greater delays in neurodevelopment. Our data suggests that all child protective services identified children, especially children with cumulative lifetime malteratment experiences should be comprehensively examined for the integrity of their neuropsychological functioning, in order to make an effective social policies and intervention programs.