Background:The novel coronavirus disease 2019 (COVID-19) pandemic has causedboth physical and emotional stress throughout the population due to its worldwideimpact. The unknowns about the disease, social isolation, pregnant women’s concernsregarding exposure to the COVID-19, inaccessibility to necessary care, and thepossibility of harm to their fetus may cause increased psychological distress duringthe perinatal period.
Objective:We aimed to evaluate the association between perinatal anxiety,prenatal attachment, and maternal–infant attachment status among women with those who delivered their child in a tertiary-care center with rigid hospital restrictions.
Methods:Term pregnant women who experienced the last trimester of their pregnancy during COVID-19 curfews between December 2020 and May 2021 wereasked specifically about their concerns during the COVID-19 pandemic and they filled out the Perinatal Anxiety Screening Scale (PASS) and the Prenatal AttachmentInventory (PAI). Those who continued the follow-up within a month of period followingthe delivery were invited to fill out the Maternal Attachment Inventory (MAI).
Results: A total of 600 women completed the survey. While the evaluation of the relationship between participants’ mean PAI and MAI scores showed a statistically significant positive correlation between scales (r=0.124, p=0.002), mean PAI and PASS scores showed a statistically significant negative correlation between scale scores (r= 0.137, p=0.001).
Conclusion:Examining the factors, affecting the attachment process of pregnant and puerperal women, will guide the improvement of the quality of health services in the COVID-19 pandemic.

Aware that our diverse, highly skilled, multidisciplinary team had a wealth of knowledge at their disposal, we wanted to share this in an easily accessible format.

Aims:
- Create a collaborative learning network to promote shared learning from an interprofessional team in RJMS Belfast.
- Use technology to enhance learning through an easily accessible and inclusive format.
- Increase diversity and inclusion of clinical education midst the MDT.
- Enhance knowledge and understanding of other professional roles and aims in neonatal care.

Description:
With these shared aims an interprofessional, educational team; NeoSim was created. We wanted to create a bank of evidence based, peer reviewed educational videos. We began by surveying the team for desired topics, to ensure content was relevant. To ensure the content was easily accessible, a YouTube channel was created.

Discussion:
The educational videos are an informative resource that anyone can access at any time, from any location. Be it on the ward prior to preforming a procedure or in the comforts of your home. They have been used to aid regional teaching, courses, medical and inductions, with excellent feedback.

Over 30 videos have been created, with more in production and the list of future topics continuing to grow. The videos are easily created, reviewed, and published by our local MDT. Through helpful feedback and submission of ideas, future clips have been created using a PDSA cycle. Moving forward we plan to increase our collaboration of shared-learning regionally amongst trusts in NI and nationally in the UK.

Background: As the assisted reproductive technique (ART) rates are increasing worldwide so is the incidence of intrauterine growth retardation, multiple births, premature births, perinatal mortality, very low birth weight, and congenital anomalies has also increased
contributing to poor perinatal outcomes.
Objective:To know the morbidity and mortality in the neonates born of ART pregnancy and compare it with the neonates of spontaneously conceived pregnancies.
Study design:This was a prospective monocenteric study done in the Neonatology unit of the Pediatrics Department at Dayanand Medical College and Hospital Ludhiana.
Participants:100 consecutive IVF conceived neonates were compared with 100 non IVF conceived neonates over a period of one year.
Intervention: Clinical data was collected for all the enrolled neonates on a structured proforma and analysed statistically.
Results- In our study, the prematurity was significantly high among IVF conceived neonates. The LBW was significantly high among IVF conceived neonates. The morbidities like birth asphyxia , RDS (Surfactant administration, requirement of CPAP & ventilatory support), EOS, ROP , NNH , anemia of prematurity and PDA was significantly more among IVF conceived neonates as prematurity was more but when compared gestational wise no significant difference was observed. There was no significant difference in the mortality of IVF conceived & non IVF conceived neonates.
Conclusion- The prematurity, LBW & multiple births were more among IVF conceived when compared to non IVF conceived pregnancy. The morbidity and mortality outcomes were more dependent on gestational age at which neonates were born and not on mode of conception.

Background: Although clinical evidence suggests that delayed cord clamping (DCC) prevents complications of haemodynamic instability, the cardiovascular consequences of DCC have not been investigated yet in humans.
Objective: To report the haemodynamic sequelae of cord clamping and unveil the factors that influence the ventricular transition from fetal to neonatal circulation.
Methods: In this cohort observational study, Echocardiography was performed before DCC, immediately after DCC, and at 5 minutes of life in 46 term vigorous infants born by elective cesarean section. Pulsed-wave Doppler-derived cardiac output and the pulmonary artery acceleration time indexed to the right ventricle ejection time were obtained. The myocardial performance indexes and the velocities of the tricuspid and mitral valve annuli were determined with tissue Doppler imaging, as markers of biventricular loading conditions. Heart rate was derived from Doppler imaging and obtained throughout the assessments.
Results: Left ventricular output increased throughout the first minutes of life, while right ventricular output decreased after DCC. Right ventricular afterload rose after DCC, decreasing in the following minutes. The tissue Doppler measurements showed that the loading conditions of both ventricles were transiently impaired by DCC, recovering at 5 minutes. The heart rate progressively decreased after birth, following a linear trend temporarily disrupted by DCC.
Conclusions: This study illustrates the cardiovascular consequences of DCC in term vigorous infants and offers insight into the haemodynamic transition from fetal to neonatal circulation in humans.

Background: Skin to skin contact in delivery suite is an early, vital part of family integrated care. Use of CPAP facilitates this with the very preterm infant. The benefits of humidification is respiratory support are well established. Humidification of gas using rPAP device facilitates longer ski to skin time while providing stable respiratory support.

Objective: To provide humidified gas for babies <34 weeks gestation who require initial stabilisation in delivery suite through the use of rPAP. At start of project, no baby was receiving humidified gas in delivery suite. Humidification began in December 2021.

Methods: Multi-directorate partnership between midwifery, neonatal and medical technical staff was required in order to acquire the necessary equipment. Staff education using written, pictorial and video materials was provided to all medical and nursing staff. Development of neonatal stabilisation protocol. 3 resuscitaire equipped with humidifier devices were assigned for eligible infants. One Stop Box with all equipment needed was developed.

Results: From December 2021 to present- 93% of babies that were eligible for rPAP received rPAP. 100% of these babies received humidified gases. Staff confidence was improved through simulation training and hands on experience when supervised by ANNP team.

Conclusion: Ongoing education and training to new staff is important to maintain best practice. Simulation offers an adjunct to learning within a controlled environment. The use of humidified rPAP at delivery can support effective stabilisation of the newborn and facilitate delivery room cuddles with a handsfree approach that ensures family integrated care model from birth.

Background: Delayed Cord Clamping (DCC) is an essential part of the stabilisation process for newborns on delivery. By facilitating a placental transfusion, the physiological transition from intrauterine to extrauterine life is supported. DCC has been shown to reduce mortality and morbidity in premature infants. Using the “LifeStart” trolley, a portable bed side resuscitaire, the rate of DCC for premature infants will improve.

Objectives: To increase the rate and documentation of DCC in preterm newborns >26/40 and <33+6/40, by using the “LifeStart” trolley. To facilitate resuscitation and stabilisation of newborns with an intact umbilical cord at delivery.

Methods: A quality improvement initiative was conducted from October 2022 to July 2023. Quality improvement processes of Plan, Do, Study and Act cycles were employed. A cohort of premature newborns born >26/40 and <33+6/40 gestation were eligible for using the “LifeStart” trolley to promote DCC provision.

Results: Using the “LifeStart” trolley the documentation of DCC rose from 39% to 85%. The rate - increase from 25% to 74%. Use of the trolley has gone from 0% to 32%.

Conclusion: Using the “LifeStart” trolley for DCC demonstrated a significant improvement in documentation practices and an increase in the rate who received DCC in this premature cohort. Using the “LifeStart” for DCC for all preterm babies requiring initial stabilisation and resuscitation steps recommended. The Rotunda is the first hospital in Ireland to introduce the “LifeStart” trolley via a quality improvement initiative.

Background
COVID-19 pandemic had a major impact on health system and practices globally and in India. Pregnant women and neonates were identified as a high risk group during pandemic. The guidelines from agencies like World Health Organization had recommended continuation of
breastfeeding and rooming in of neonates with their COVID-19 positive mothers. Due to lack of evidence, various practices were being followed. More evidence is needed on well- newborn care practices in relation to COVID-19 transmission to neonates.

Objectives
To describe the mode of delivery, feeding and well-baby care practices at tertiary centres in India and their association with COVID-19 positivity status of the newborn.

Methods
Present study was conducted across 20 centres. 768 neonates were included for analysis. Healthy neonates with complete information on neonatal characteristics, peripartum care variables, not requiring resuscitation at birth and with no medical indication for isolation were included. Data analyses was performed using SPSS version 20.

Results
2.9% neonates were COVID-19 positive. 57% deliveries were through LSCS. Skin to skin contact was practiced among 64% of the dyads at birth. 30.5% well-neonates were isolated from
mothers. 61.3% of the mothers initiated breastfeeding within 1 hour of birth and 67.4% neonates were directly breastfed. There was no significant difference in COVID-19 positivity rate among newborns who received breastfeeding/ care close to mother compared to isolated neonates. Mode of delivery had no effect on COVID-19 positivity status of newborn.

Conclusion
The study findings support rooming in and continued breastfeeding of neonates born to COVID-19 positive mothers.

BACKGROUND:
The role of echocardiography in the neonatal intensive care unit (NICU) has rapidly evolved over the last two decades and there are now guidelines to direct Neonatologist Performed Echocardiography (NPE). More than 50% of newborns with congenital heart disease (CHD) are unrecognized at birth; however, the use of echocardiogram (Echo) for diagnosing CHD in newborns has made early intervention possible.

OBJECTIVE: To find out the prevalence of cardiac structural or functional abnormality in sick neonates by echocardiography.

METHODS
This study was conducted in the Neonatology unit, Department of Pediatrics, in JNMC, Sawangi Meghe. All neonates in the NICU were subjected to echocardiography as per inclusion and exclusion criteria. Indications for echocardiography, echocardiographic findings, and any changes in clinical management were determined.

RESULT
To evaluate the influence of echocardiographic examination in the clinical management of the sick neonate, 65 patients, admitted to the neonatal intensive care unit of a tertiary referral center. Worsening respiratory distress (45%) followed by birth asphyxia (10%) were the most common clinical indications for requesting an echocardiogram. C Thirty-four percent of neonates had normal heart anatomy. This investigation changed the clinical management in at least 66% of newborns scanned, including emergency surgical intervention for 7%, medical treatment for 22%, and routine cardiologic follow-up for 37% of patients.

CONCLUSION
Echocardiography on the neonatal unit has a high yield for the diagnosis of structural and functional cardiac abnormalities, often results in a change in clinical management, and can be a reliable tool in the hands of neonatologists.

Background:
One of the most common congenital heart diseases among preterm newborns is PDA. There is a higher incidence of PDA with lower birth weights and gestational ages.

Objectives:
To investigate the incidence of PDA in premature infants by using echocardiography.

Methods:
Preterm newborns delivered between January 2021 and December 2022 were included in this study. All preterm newborns had their first echocardiogram at 3 days of age. Echocardiography was repeated at the chronological age of 7 days if PDA was detected.

Results:
During the study period, eighty-seven preterm neonates participated in this study and underwent echocardiography. In the first echocardiogram, the incidence rate of PDA was 38 (43.67%). At gestational age of less than 28 weeks, 12 of 18 newborns had PDA. Of 24 newborns with birth weights of more than 1000 grams and less than 2500 grams, 14 had PDA. Newborns with birth weight of more than 2500 grams(n=45), 12 had PDA. On the second echocardiography, the incidence rate of PDA was 18% and was mostly found in neonates at the gestational age of less than 28 weeks and in those with a birth weight of less than 1000 grams.

Conclusion:
Preterm neonates had an 18% incidence rate of PDA. Those who are born with a low birth weight are more likely to suffer from PDA.

Background Transient hypothyroxinemia of prematurity (THoP) is defined as a free thyroxine level below the reference values despite normal TSH in preterm. Clinicians experience contradictions in management of THoP due to the lack of long-term data.This study aimed to evaluate the neurodevelopmental outcome of infants with THoP.
Methods Prospective study including infants born at 28-36 weeks of gestation (GW). Newborns with maternal thyroid disease, severe intracranial problems or congenital anomalies were excluded. Study group consisted of infants with THoP. Controls were infants without THoP. Neonatal demographics, replacement status, and morbidities including RDS, BPD and NEC were evaluated. Ages and Stages Questionnaire (ASQ) and Ages and Stages Questionary-Social-Emotional (ASQ:SE) developmental screening tests were administered at 2y corrected age.
Results 70 newborn infants were included, including 40 patients and 30 controls. Mean GW was 34,4±3,8wk in cases vs. 37,2±2,3w in controls (p=0,69). Mean birth weight was 1640±428g. Levothyroxine (L-T4) replacement was started in 12 infants (30%).Groups didn’t differ in terms of demographic characteristics. BPD, ROP were higher in L-T4 group (p=0,01). No group difference was found for ASQ and ASQ:SE results (p=0,75), also not between those with THoP who received and did not receive L-T4 (p=0,14).
Conclusion This study showed that L-T4 replacement was associated with higher rates of BPD and ROP, but not with differences in long-term neurological outcomes in THoP. Prospective controlled studies with larger sample sizes are needed to clarify the role of L-T4 replacement in THoP.