bluuebunny/crossref_metadata_2025 huggingface dataset:
Product Cordial Labeling Of Scale Graph S_{1,r}\left(C_3\right) For r\geq3
Authors: Irene Yanne , Lestari Winda Ayu Mei , Mahmudi Mahmudi , Manaqib Muhammad , Elfiyanti Gustina
Published: December 2024

Graph theory plays a crucial role in various fields, including communication systems, computer networks, and integrated circuit design. One important aspect of this theory is product cordial labeling, which involves assigning labels to the vertices and edges of a graph in a specific way to achieve a balance. Despite extensive research, the product cordial labeling of scale graphs has not been thoroughly explored. This study aims to fill this gap by investigating whether the scale graph  can be labeled in a product cordial manner. To achieve this, we followed a three-step methodology: first, we identified the vertices and edge notations of the scale graph ; second, we assigned binary labels (0 and 1) to each vertex and edge to identify a pattern; and third, we proved that this pattern meets the criteria for product cordial labeling. Our findings reveal that the scale graph does indeed support product cordial labeling, thus confirming it as a product cordial graph. This research not only advances our understanding of graph labeling but also provides practical insights that can be applied to optimize network structures and address complex problems in science and engineering.Graph theory plays a crucial role in various fields, including communication systems, computer networks, and integrated circuit design. One important aspect of this theory is product cordial labeling, which involves assigning labels to the vertices and edges of a graph in a specific way to achieve a balance. Despite extensive research, the product cordial labeling of scale graphs has not been thoroughly explored. This study aims to fill this gap by investigating whether the scale graph  can be labeled in a product cordial manner. To achieve this, we followed a three-step methodology: first, we identified the vertices and edge notations of the scale graph ; second, we assigned binary labels (0 and 1) to each vertex and edge to identify a pattern; and third, we proved that this pattern meets the criteria for product cordial labeling. Our findings reveal that the scale graph does indeed support product cordial labeling, thus confirming it as a product cordial graph. This research not only advances our understanding of graph labeling but also provides practical insights that can be applied to optimize network structures and address complex problems in science and engineering.
The Impact of Macromedia Flash Utilization in Cone Material on Class IX Students' Conceptual Comprehension
Authors: Aswita Nova , Widiawati Widiawati , Widyaningrum Indah
Published: December 2024

This research seeks to ascertain the impact of Macromedia Flash on the conceptual comprehension of ninth-grade students at SMP Negeri 5 Pagaralam regarding cone content. This research employs an experimental design utilizing a Pre-test - Post-test control group methodology. The research utilized observation sheets and essay-format test question sheets as instruments. This study included 29 students who engaged with Macromedia Flash media and 30 students who received conventional instruction. Data gathering methods are conducted by observation and testing. The research findings demonstrate that students utilizing Macromedia Flash learning media exhibit a superior comprehension of topics compared to those engaged in traditional learning methods. The average percentage score for concept understanding indicators was 83.28 in the experimental class and 67.07 in the control class. The experimental class surpasses the control class. Consequently, the utilization of Macromedia Flash affects pupils' comprehension of topics.
Exploration Of Computational Thinking Skills Of Junior High School Student In Term Of FI And FD Cognitive Style
Authors: Hasanah Merrina Uswatun , Masduki Masduki
Published: December 2024

The purpose of this study is to investigate the computational thinking skills of junior high school students in terms of FI and FD cognitive styles on materials with numerical patterns. The type of research used is qualitative descriptive. The subjects of the study were 57 students from class VIII at one of the public junior high schools in Jepara. The data collection instruments used are computational thinking test questions, GEFT tests, and interviews. Researchers adopted three questions from the Pusmendik Kemdikbud class VIII to test students' computational thinking skills. All questions were validated by three mathematics education experts and tested on 5 grade VIII students before being used. In this study, four components of computational thinking: abstraction, pattern recognition, algorithmic thinking, and generalization were used to analyze students' computational thinking skills. This study focused on exploratory examination of pupils’ computational thinking with high categories, researchers selected 3 students on FI cognitive style and 2 students on FD cognitive style. The results showed that students with a FI cognitive style were able to meet all indicators of computational thinking namely abstraction, pattern recognition, algorithmic thinking, and decomposition. In contrast, students with FD cognitive styles are able to meet three indicators of computational thinking: abstraction, pattern recognition and generalization. Thus, it may be said that the ability to think computationally is related to the cognitive style of students.
Exploring Elementary School Student's Computational Thinking In Terms Of Cognitive Style
Authors: Suwarno Bambang Adi , Masduki Masduki
Published: December 2024

Mathematics learning in the independent curriculum emphasizes the pedagogical dimension which aims to create active students so that they are able to develop their thinking patterns and get them used to finding solutions to their own problems. This study uses qualitative methods to investigate elementary school students' abilities through computational thinking, focusing on the cognitive styles of Field Independence (FI) and Field Dependence (FD). The subjects in this study amounted to 14 fifth grade students of public elementary schools in Klaten Regency, Central Java Province. Researchers used data collection instruments in the form of test, learning style questionnaires and interviews. The number of test compiled consisted of 5 items. Before use, the test were validated by 3 mathematics education experts and tested on 5 fifth grade students. After validation and testing, the test that can be used consist of 3 test.  Based on the results of tests and learning style questionnaires, research took one of the students' test results with a Field Independent learning style and 1 student with a Field Dependent learning style. The results of this study indicate that there are differences in the computational thinking process of the two subjects in solving problems. At the abstraction stage, FI students are able to answer important factors that need to be considered in making conclusions, FI students are also able to explain alternative solutions to the problems given appropriately. Meanwhile, FD students tend to work directly so they tend to experience errors at the pattern recognition, algorithm thinking and generalization stages. Thus, it can be concluded that students with a field independent cognitive style are more active in using computational thinking processes than students with a field dependent cognitive style.
Analysis of Contextual Problem Solving Ability of Three-Variable Linear Equation System Material Given Mathematical Disposition
Authors: Ismiranda Khoirina , Nurcahyo Adi , Utami Nida Sri
Published: December 2024

This research aims to analyze students' difficulties related to mathematical dispositions and measure students' abilities in solving problems related to three-variable linear equation systems based on mathematical dispositions. Descriptive analysis methods are used in this qualitative research. All X-G students were given a mathematical disposition survey as part of the data collection process for this research. Three students were selected from each mathematical disposition category to take a test of their contextual problem-solving skills. Based on the results of the research, there were three groups of students in class X-G SMAN 1 TOROH, namely 3 students with high mathematics dispositions, 14 students with medium mathematics dispositions, and 16 students with low mathematics dispositions. Based on the analysis of answers and discussions, students with strong mathematical skills have excellent problem-solving skills because they meet three problem-solving indicators, namely making a problem-solving plan, implementing a problem-solving plan, and evaluating problems. Students have difficulty in the indicator of understanding problems because they are not used to writing what they know and what is asked. Students with a moderate mathematical disposition meet two indicators of problem-solving, namely creating and implementing a problem-solving plan, so they are in the moderate category in terms of problem-solving. Students with moderate mathematical dispositions also have difficulty writing the conclusion of the problem. Because students with low mathematical dispositions only fulfill one indicator, namely evaluating the problem, these students have problem-solving skills in the low category. In addition, students with low mathematical dispositions had difficulty in applying the formula.
Development Of Mathematics Learning Media Smart Snakes and Ladder Statistics (UTAPTIK) In Primary School Statistics Materials
Authors: Heriyanti Lutfiah , Pranata Khavisa
Published: December 2024

Learning media is an important element in the learning process, functioning as a valuable instrument for transmitting knowledge. The learning media used in education must be appropriate to the needs and characteristics of students. In class 6 at SDN Pasirangin 05 the majority of students are actively involved in the learning process. Therefore, it is very appropriate to utilize learning media that fosters innovation, fun, and increases students' understanding of the subject matter. The objectives of this research are: (1) Designing and constructing UTAPTIK learning teaching materials. (2) What is the level of validity of the UTAPTIK media used in learning mathematical statistics concepts? (3) Knowing students' responses to UTAPTIK game media. Researchers used Research and Development methodology to conduct research. This research methodology uses the ADDIE development paradigm, namely the Analyze, Design, Development, Implement and Evaluate stages. This research uses data collection methodology such as filling out questionnaires, making observations, and documenting findings. This research resulted in the development of UTAPTIK learning media which consists of several components such as a game arena, dice, game guide book, and statistics cards. The results of this research are UTAPTIK products with product validation results showing very valid criteria determined by a score of 97% from material expert validators. In addition, the criteria were considered valid with a score of 76% from media expert validators. The validation results by material expert validators and media expert validators are classified as very valid so that the media can be tested. The student questionnaire obtained a score of 94% in the very valid category. The smart statistical snakes and ladders game media (UTAPTIK) is classified as very valid and worthy of being integrated into the learning process of class VI students.
Supervision in Inclusive Islamic Early Childhood Education: Strategies Approach for an Integrated Program
Authors: Awaludin Dandy Prasetyo , Sintya Tira Fitria Astrid Dhica , Purwanto Nurtanio Agus , Hermanto Hermanto
Published: December 2024

The implementation of supervision in the field of education does not only focus on evaluation or assessment of weaknesses but rather on efforts to improve the quality of education. Supervision in early childhood education that implements inclusive programs needs to be continuously developed to adjust to the learning environment in schools. This study aims to describe the strategy for developing inclusive education supervision in integrated one-roof Islamic early childhood education institutions in Pati Regency. This study uses a qualitative method with a case study approach. The source of research data was obtained from informants of three school principals from each early childhood education service unit, namely TPA, KB, and TK. Data collection techniques include observation, interviews, and documentation. The data analysis process is carried out inductively by detailing empirical facts through direct activities in the field. The results of the study indicate that in integrated Islamic-based inclusive early childhood education institutions, educational supervision and coaching programs have been implemented by all teachers and school education personnel. The strategy for developing educational supervision that can be applied forms a solid foundation for optimizing inclusive learning practices. These strategies include an in-depth understanding of inclusion, teacher involvement and training, development of inclusive learning plans, utilization of resources, and continuous monitoring and evaluation. Overall, these findings continue to emphasize the inclusion program promoted by the institution.
Integrating Indigenous Traditions into Character Education: Insights from Primary School Teachers
Authors: Suparjan Suparjan , Tawakkal Tawakkal , Humairah Andi Eliyah , Harpina Harpina , Madjid Tahmid , Ismiyani Nining , Syarif Irman
Published: December 2024

This research aims to explore how primary school teachers integrate character education based on indigenous cultures and traditions in elementary school settings. Using a qualitative approach, the study involved collecting and analyzing data through semi-structured interviews with eight educators. The procedure included gathering information, reducing and presenting data, and drawing conclusions to understand how teachers incorporate local traditions and cultures from the Malay and Dayak tribes—such as Pengari, Saprahan, Beduruk, Robok-robok, Beroyong and Jagau Sungei—into their teaching practices. The findings reveal that teachers adapt these traditions to promote character development, focusing on values like cooperation, mutual assistance, responsibility, social care, and environmental consciousness. This study contributes novel insights into the practical application of indigenous cultural elements in character education and demonstrates how these practices can enhance student development and cultural awareness.
Teacher-Student Interaction: A Strong Foundation for Quality Character Education
Authors: Sari Dewi Purnama , Sutarto Sutarto
Published: December 2024

Character education is critical in developing students’ attitudes and personalities. One approach that can be used is through teacher interaction with students. This study aims to reveal teachers’ approach to interacting with students to develop good character values. This study is a qualitative study with a phenomenological approach. The research informants were eight teachers who intensively interacted with students for over a year. The data collection technique used in-depth interviews. The data analysis technique used was interpretative phenomenological analysis (AFI), which includes three stages: horizontalization, developing meaning units, and presenting the phenomenon’s essence. To obtain valid data, researchers conducted source triangulation. The study results showed that intensive teacher-student interaction, both classically and individually, can provide understanding and foster students’ awareness of having good character. Therefore, to build students’ character in a better direction, teachers are strongly advised to constantly interact with students intensively, both classically and individually, to foster sensitivity and students’ means of having good character.
Analysis of The Need for Using Geospatial Technology in Developing Electronic Student Worksheet
Authors: Nabil Ziyad Fadhlan , Efendi Ridwan , Novia Hera
Published: December 2024

This study aims to determine the need to develop student worksheets based on Geospatial Technology as a learning resource for physics students in high school. This study focuses on quantitative research using questionnaires that are analyzed using descriptive statistics. This study involved 23 respondents spread across several schools in Padang, West Sumatra and 32 students in one of the high schools in Padang City, West Sumatra. The instrument in this study uses a needs questionnaire with several statements addressed to teachers and students. Based on the teacher needs questionnaire, as many as 60.9% of the 23 teachers do not know this technology, so only 39.1% know it but only 8.7% apply it in learning. The results of the needs questionnaire analysis show that student worksheets developed with Geospatial Technology, especially on the topic of renewable energy sources, are needed and are expected to help students achieve their desired learning goals. Based on this, the use of technology as a learning resource is urgently needed by students, so it is necessary to conduct a needs analysis in developing student worksheets based on Geospatial Technology.
Application of Communication in The Metatah Traditional Ceremony in Bali
Authors: Nofrianti Mami , Alisa Della Nindia
Published: December 2024

Traditional ceremonies in Bali are an important part of the culture and identity of its people. Communication in this traditional ceremony involves various elements such as symbols, movements, music, and ritual language rich in meaning. This research explores the dynamics of communication in Balinese traditional ceremonies, focusing on the role of symbols and rituals in transmitting values, norms, and cultural identity to future generations. This research uses a literature study method with a qualitative approach to explore communication in Balinese traditional ceremonies. Through the analysis of various literature sources, including books, articles, and related publications, this research gains deep insights into the role of communication in the context of Balinese culture. By integrating communication theory, cultural anthropology, and traditional ceremony studies, this research aims to depict the complexity of ritual and symbolic communication in Balinese traditional ceremonies and its impact on the sustainability of local culture. The ultimate goal is to provide a more comprehensive understanding of how communication plays a key role in preserving and strengthening cultural heritage.
Students' Perceptions of The Instagram Account @Ubahstigma As A Mental Health Education Platform
Authors: Indiarma Verani , Aditia Rafinita , Manalu Primayanti
Published: December 2024

Perception is the process by which individuals interpret, organize, and assign meaning to stimuli derived from experiences and learning. This research aims to analyze the perceptions of Bengkulu University students toward the Instagram account @ubahstigma as an educational source for mental health information. The theory used in this study is Perception Theory, which focuses on the process of receiving information and the factors that influence individual perceptions of the research subject. The study employs a qualitative method with a phenomenological approach. Informants were selected using purposive sampling based on criteria set by the researcher. The findings indicate that informants' perceptions are influenced by both internal and external factors, such as experience, background, expectations, hopes, and social changes. This research is expected to encourage more stakeholders to actively support the enhancement of educational resources related to mental health
Gender Issues: a Critical Discourse on Articles in Online Media Magdalene. Co
Authors: Widiastuti Wahyu , Budiman Dwi Aji , Saragih Rasianna Br
Published: December 2024

This study aims to determine how the discourse formation of articles on the issue of violence against women in the online media Magdalene.co which appeared from June to December 2021. This research uses descriptive qualitative research methods, the research subject is the author of articles on violence against women in Magdalene.co media and the object of research is articles on violence against women. The data collection techniques used in the research are documentation and interviews with parties related to the research theme. The data analysis method uses the Van Dijk model which consists of three dimensions, namely Text, Social Congnition, and Social Context. The data validity test uses triangulation techniques. The results of the research at the text level show that the discourse in the article on violence against women in the online media Magdalene.co. in the content of the article emphasizes the condition of women as victims of violence and some sentences show how the perpetrators of violence behave. Judging from the level of social congnition, Magdalene.co journalists in their articles emphasize the condition of women as victims of violence. Judging from the level of social context, information about women's harassment will always be a taboo issue for society. This issue will continue to be discussed in the community considering the number of victims of violence against women is quite large, so this will continue to be an issue that will be published in the mass media.
Blood pressure correlates poorly with left ventricular output and	celiac artery blood flow in preterm infants in the first 48 hours of life
Authors: EL-Khuffash Afif F. , Walsh Kevin , Molloy Eleanor J.
Published: December 2024

Background: There is poor correlation between invasive blood pressure (BP), left and right ventricular outputs, and superior vena cava flow. Few data exists on the relationship between BP and celiac artery blood flow in preterm infants.

Objective: To assess the relationship between BP and left/right ventricular outputs (LVO and RVO), and celiac artery blood flow in preterm infants during the first 48 hours of life.

Study Design: Thirty infants with a median [inter quartile range (IQR)] age of 27.4 [25.8–29.3] weeks and median birth weight [IQR] of 1014 [0.720–1.260] g underwent 60 echocardiographic examinations at 12 and 48 hours of age. Simultaneous measurements of LVO, RVO, CAF and invasive BP were taken. Systemic vascular resistance (SVR) was calculated. Non parametric tests were used for analysis.

Results: BP correlated with RVO at 12 hours but not 48 hours. There was no correlation between BP and LVO or CAF at 12 or 48 hours. CAF correlated with LVO in the absence of a significant PDA (r=0.55). There was a negative correlation between CAF and SVR (r=0.90).

Conclusion: BP is not a reliable measure of CAF, LVO and RVO. CAF is mainly determined by LVO and possibly SVR. CAF may be used in conjunction with other echocardiographic markers to assess the haemodynamic status of preterm infants.
Spectral analysis of heart rate variability in premature	infants
Authors: Peesey Morarji , Anwar Mujahid , Rosen Harel , Craelius William , Hiatt Mark , Hegyi Thomas
Published: December 2024

We studied the effect of gestational age, birth weight, postmenstrual age and selected neonatal morbidities on the heart rate power spectra in preterm infants (birth weight 1075 [840, 1230] grams, gestational age 27 [26, 30] weeks). Age at testing was 6 (3, 11) days. Birth weight, gestational age and postmenstrual age were positively correlated with low frequency power (0.03–0.39 Hz) with correlation coefficients of 0.59, 0.54 and 0.53 respectively (p<0.05); high frequency power (0.4–1.0 Hz) [r-value 0.54, 0.58 and 0.50 respectively] (p<0.05); and total power [r-value 0.41, 0.38 and 0.41 (p<0.05) respectively]. No significant effect on heart rate power spectra was observed for intraventricular hemorrhage, mechanical ventilation or methylxanthine use. Our data indicates increased heart rate variability with maturation and no major effect of the neonatal morbidities studied at the time when infants were physiologically stable.
Management of neonatal upper airway obstruction: Decreased	morbidity by utilizing a decision tree model with mandibular distraction	osteogenesis
Authors: Vyas Raj M. , Dipple Katrina M. , Head Christian , Wald Samuel H. , Wasson Kristy L. , Gabbay Joubin S. , Tahernia Amir , Bradley James P.
Published: December 2024

Objective: Upper airway obstruction in a newborn with a craniofacial anomaly requires urgent management. While tracheostomy may be life saving in these circumstances, it may be associated with numerous morbidities. Distraction osteogenesis (DO) or lengthening of the mandible offers an alternative to tracheostomy with proper patient selection.

Study Design: A ten-year review of neonates with upper airway obstruction at two academic centers was performed (n=149). We compared conventionally treated neonates, receiving home monitoring or a tracheostomy on a case by case basis, to newborns managed by a new decision tree model (DTM), in which a specific pattern of diagnostic tests and specialist consultations were obtained to decide among home monitoring, tracheostomy, or distraction.

Results: Neonates managed with our DTM were significantly less likely to undergo a tracheostomy than those managed conventionally. In our DTM group, no deaths occurred and only one of 43 children who initially underwent DO required subsequent tracheostomy. In the conventionally managed children there were 3 deaths and significantly more hospital days, emergency department visits, respiratory infections, and gastrointestinal reflux. The DTM group had improved feeding, growth, and speech.

Conclusion: In treating newborns with micrognathia and upper airway obstruction, patient outcomes may be improved by utilizing a decision tree model with multidisciplinary specialists, timely studies, and an option for mandibular distraction osteogenesis.
Prevalence of bradyarrhythmias during transient episodes of	bradycardia among preterm infants
Authors: Mathew Oommen P. , Gamble Yvette D. , Zimowski Karen
Published: December 2024

Objective: The primary aim of this study was to determine the prevalence of transient bradyarrhythmias in preterm infants. The secondary aim was to characterize the non-sinus atrial rhythm.

Study design: Cardiorespiratory waveforms in preterm infants with gestational age ⩽ 32 weeks were acquired on a networked computer. Waveforms for 24 hours were screened for bradycardia utilizing Neoscan® software. Each bradycardia event was further reviewed for arrhythmia and classified as non-sinus atrial, junctional, ventricular, and others.

Results: Among the 58 preterm infants studied, 5 showed no transient bradycardia, 9 showed only sinus bradycardia and 44 exhibited both sinus and non-sinus bradyarrhythmias. Of the bradyarrhythmia episodes evaluated (n=546), the majority were classified as non-sinus atrial rhythm (54.2%); junctional (32.3%), ventricular (1.1%) and others (12.5%) constituted the remaining. Decreases in P-wave amplitude and PR interval were observed in the majority of non-sinus atrial bradycardia episodes. More than one type of arrhythmia was seen in most infants.

Conclusion: Non-sinus bradyarrhythmias occur frequently in preterm infants during transient bradycardia episodes.
Mild hydrops as a feature of Glycogen Storage Disease Type IV	(Andersen Disease) confirmed by biopsy and enzymatic activity
Authors: Shah Shetal , Hays Arthur , Yang Amy , Mccarthy Edith
Published: December 2024

Glycogen Storage Disease Type IV (Andersen Disease) is a rare autosomal recessive condition presenting with severe hypotonia and areflexia in all extremities [1]. Survival for this condition has been reported between 0 day and 5 weeks. Most reported cases are of slightly premature children (average gestational age 36 weeks) presenting with hypotonia and persistent dependence on mechanical ventilation [2,3]. The current standard of diagnosis is muscle biopsy which demonstrates PAS+ intracytoplasmic inclusions of polyglucosan bodies [4]. Hydropic features are not usually a constellation of this disorder, as there have been only 4 other internationally reported cases of such infants, only 1 preterm [5]. Here we report the first U.S.-based case of this disease presenting with hydropic features of soft tissue edema, mild pericardial effusion and bilateral pleural effusions in a preterm infant.
End-of-life decision making regarding infants of artificial	reproductive techniques and spontaneous conception
Authors: Hempel Bridget A. , Holzman Ian R.
Published: December 2024

Objective: Our goal was to determine if differences exist in the decisions made regarding dying infants based on method of conception. No studies have examined end-of-life decisions for infants regarding method of conception.

Study design: We reviewed the charts of infants who were born and died in our institution between January 1, 2001 through December 31, 2005. Method of conception, maternal age, marital status, level of education, religion, insurance, gestational age, cause of death and withdrawal of life-sustaining care were recorded. Statistical analysis was performed using Pearson Chi-squared tests of independence.

Results: Fifty-six mother/infant pairs were available for information. Artificial reproduction techniques (ART) were more likely to be utilized by women who were over 35 years old and married (p< 0.05). Withdrawal of care was not statistically significant regarding method of conception or gestational age (p> 0.05). Although not statistically significant, in this study it appears that single mothers may be less likely to withdraw support.

Conclusions: Neither method of conception nor gestation age is a determinant factor in withdrawal of life-sustaining care. Marital status may be an important factor and further investigation is necessary to determine the reason.
Immediate pro-inflammatory cytokine response associated with	asphyxia and volume infusions in a neonatal piglet model
Authors: Chalak Lina F. , Laptook Abbot R. , Perlman Jeffrey M. , Garcia Damian , Ramilo Octavio , Wyckoff Myra H.
Published: December 2024

A neonatal piglet model was used to determine IL6, IL8 and CRP responses to asphyxia and subsequent volume infusion. Mechanically ventilated swine (n=37, age: 8 ± 2 days, weight: 2.2 ± 0.7 kg) were progressively asphyxiated by changing the ventilator gases until heart rate < 100 bpm and mean arterial blood pressure < 20 mmHg. After 5 minutes of ventilatory resuscitation, piglets were randomized to receive volume infusion with either 5% Albumin (ALB), Normal Saline (NS), or no volume (SHAM). IL6, IL8 and CRP were measured at baseline, at the end of asphyxia (ASPYHXIA), and 2 hrs after resuscitation (RESUSCITATION). IL6 (median and [25–75 percentiles] pg/ml) increased from 163 [55,193] at baseline, to 263 [196,393] at ASPHYXIA, and 441 [309,875] at RESUSCITATION (p<0.001). Both IL8 and CRP were similar to baseline at all time intervals. Animals randomized to volume (ALB and NS) vs. SHAM had higher IL6 levels following RESUSCITATION (749 [383,1163] vs. 303 [204,465], p<0.02). In this model of severe neonatal asphyxia, serum IL-6 was elevated following volume infusion. The lack of change in IL8 and CRP suggests selectivity in the immediate inflammatory responses following asphyxia and volume resuscitation.
Systemic organ and core temperatures during deep hypothermia:	Comparison of whole-body and selective head cooling for perinatal	hypoxic-ischemic encephalopathy
Authors: Khilfeh Manhal , Raju Tonse N.K. , Navale Shankararao
Published: December 2024

Objectives: Mild hypothermia has been shown to be neuroprotective for newborn infants with hypoxic ischemic encephalopathy (HIE). In this study, we examined the effects of deep hypothermia on systemic and brain temperature changes during whole-body or selective head cooling in an animal model of perinatal HIE.

Methods: Twelve piglets were studied under anesthesia and artificial ventilation. Five ultra-sensitive, flexible, titanium, thermocouple probes were used for continuous temperature recording from five brain regions, two kidney regions; the thoracic aorta, the wall of the small intestine, and the rectal lumen using single sensor probes for each. Changes in temperatures from the 10 sites were recorded continuously during baseline, 20 minutes of hypoxic-ischemic injury; 60 minutes whole-body cooling (n=6) or selectively the head cooling (n=6); and 60 minutes of re-warming.

Results: Deep hypothermia with whole-body cooling led to uniform drops in temperature in the five brain regions, maintaining a constant gradient across the superficial and deep brain regions. Deep hypothermia with selective head cooling led to larger drops in superficial than in the deep brain temperatures. Deep whole-body hypothermia led to sharp drops in core body, kidney and small intestinal temperatures; the latter dropping to −11.27°C ± 3.72°C below baseline compared to −3.32°C ± 1.52°C below the baseline with deep hypothermia for selective head cooling (P<0.001).

Conclusions: Deep hypothermia with whole-body cooling can lead to severe core hypothermia especially of the kidney and small intestines, which get cooled far in excess of the aortic blood. Reduced kidney and small intestinal blood flow, and a direct cooling effect from lying on the cooling mattress may be responsible for rapid cooling of the kidney and the intestines. These findings underscore the need to target the core temperatures to strict ranges, as specified in the published hypothermia trials, especially during the transportation of infants to centers providing therapeutic hypothermia.
Does armed conflict impact maternal heath? A report from rural Haiti
Authors: Small Maria , Magee Edward , Colimon IveCarm , Frederic Rikerdy , Williams Keith P. , Kershaw Trace
Published: December 2024

Objectives: Few works address the impact of armed conflict on obstetric outcomes, largely secondary to limitations in measurement of these outcomes. In settings where hospitalized data is routinely and consistently obtained, these sources may provide rapidly accessible and valuable information on the status of women.

The objective of this work was to determine the impact of the armed conflict of February, 2004 on maternal health in rural Haiti.

Methods: Study of data from the Hospital Albert Schweitzer perinatal database from the time of conflict in February, 2004 was compared to baseline indices from the preceding year, 2003. Primary outcome measures included: maternal mortality, eclampsia, and stillbirth.

Results: In 2003, maternal deaths occurred in 0.8% of women at baseline, compared to 4% during the conflict. (p=0.03) The baseline eclampsia rates were 0.5% and rose to 14% during the 2004 conflict. (p=0.06) Surrounding hospital closures resulted in a marginally significant increase in patients from outside the hospital catchement area.

Conclusions: In areas of poverty, access to care is one of the most significant determinants of health. Peaks in maternal mortality may reflect obstructions in access to care during times of acute instability. These data may serve as markers for the social status of women, the function of the local health care system, and the international response to conflict, as experienced, by the most vulnerable members of the population.
Soluble vascular endothelial growth factor receptor-1 and hypoxic	ischemic encephalopathy
Authors: Mohamed Maha H. , Basset Fatma E. Abdel , Gad Ghada I. , Atef Shereen H. , Mohamed Ehab A.
Published: December 2024

Background: Vascular endothelial growth factor (VEGF) is a known mediator of angiogenesis. It has been shown to induce vascular proliferation and permeability via nitric-oxide-mediated mechanism during hypoxia. VEGF exerts its effects by binding to two receptors; VEGFR-1 and VEGFR-2.

Objectives: To test the hypothesis that serum concentration of the soluble receptor sVEGF-R1 is increased in infants with hypoxic ischemic encephalopathy (HIE); and such an increase correlates with the severity of encephalopathy.

Study design: Serum samples of 30 full term newborns diagnosed with HIE and 20 controls were obtained within the first 6 hours of life and kept at −70°C. Concentrations of sVEGFR-1 were measured by the enzyme-linked immunosorbent assay double sandwich method. Values were correlated with the severity of HIE at birth and with outcomes measured at 4 weeks of age.

Results: The concentrations of sVEGFR-1 in HIE patients were increased when compared to control subjects. Patients with the least Apgar scores had the most increase in sVEGFR-1. sVEGFR-1 at a cut off 11.0 ng/ml had 100% sensitivity & 100% specificity for detection of HIE. The concentrations of sVEGFR-1 did not differ among patients with different degrees of HIE nor in patients with different short term clinical outcomes. Two stepwise regression analyses showed that both degree and outcome of HIE depend upon Apgar score and the liver enzyme alanine transaminase.

Conclusion: sVEGFR1 is upregulated early in neonates with HIE. It does not correlate with the severity of encephalopathy or the short term outcomes.
A case of superior vena cava syndrome in a newborn: Importance of	point of care echocardiography
Authors: Sehgal Arvind , Skidmore Martin
Published: December 2024

Central vascular catheterization for nutrition and monitoring is common in the current era of increasing survival of ever smaller preterm infants and their complex nutritional needs. Any foreign body in blood vessels, whether venous catheters or transvenous pacing catheters (implanted frequently in children with rhythm disorders) could put them at risk of progressive venous obstruction. Although obstruction of SVC leading to "SVC syndrome" has been widely reported in adults, it is very uncommon in children and may be associated with previous congenital heart surgery. In this case study we present SVC obstruction in a newborn infant as a complication of a central catheter. This was diagnosed by combination of clinical suspicion and typical Doppler characteristics as elucidated by application of echocardiographic skills by in-house neonatal staff.
Revisiting the effect of casein and whey on gastric emptying: Do	differences in protein source really matter?
Authors: Woodley Frederick W. , Mousa Hayat
Published: December 2024

Background: Despite a dearth of well-controlled studies comparing the gastric emptying (GE) of casein- and whey-based formulas in humans and lack of clear evidence suggesting that such a difference influences patient symptoms, prevailing opinion among healthcare professionals continues to purport that a clinically meaningful difference exists between the two.

Aim: To review the literature related to the influence of casein and whey on GE in humans.

Methods: A PubMed literature search was executed using a combination of the following search terms: gastric emptying, human, casein, and whey. Our primary interest was experimental design strategies with respect to established physiologic factors controlling GE.

Results: Our search resulted in 11 citations; 5 directly compared GE rates of casein- and whey-based formulas and 3 of the 5 suggested a difference. Critical review of these studies revealed numerous experimental design weaknesses that included: 1) lack of control over osmolality, caloric density, feeding volume and macronutrients (protein, fat, and carbohydrate), 2) small sample sizes, and 3) use of heterogeneous subjects with respect to age, symptom types, symptom severity, and general health status.

Conclusion: No convincing evidence exists to support the prevailing notion that casein- and whey-predominant formulas differently influence GE rates.
Analyzing EEG maturation in preterm infants: The value of a	quantitative approach
Authors: Niemarkt H.J. , Andriessen P. , Pasman J. , Vles J.S. , Zimmermann L.J. , Oetomo S. Bambang
Published: December 2024

Despite increase in survival of very low birth weight infants, the number of infants who experience neuromotor or neurocognitive problems later in life is still high.

Therefore, accurate documentation of the brain development in these infants is indicated. Electroencephalography (EEG) may be a valuable tool to monitor brain development during the intensive care period. However, our knowledge on EEG maturation is based on visually determined patterns. Since there are no exact reference values, conclusions on EEG maturation are difficult to establish and may vary between investigators. Also, most knowledge concerning EEG maturation is derived from relatively old studies in the "pre-digital" era.

New digital EEG recorders provide the opportunity towards a quantitative approach of EEG maturation. This approach may lead to a more objective and uniform description of EEG maturation. In this article we review the most important aspects of EEG maturation, i.e. changes in discontinuity, development of age specific waveforms, inter-hemispheric synchrony/correlation and the development of sleep-wake cycles, and qualitative or semi-quantitative studies concerning EEG maturation and outcome. We discuss the concept of an EEG analyzing algorithm and propose several quantitative analyzing techniques which may be incorporated in such an algorithm.
Referral for early intervention services in late premature infants	with a NICU experience
Authors: Needelman Howard , Jackson Barbara J. , McMorris Carol , Roberts Holly
Published: December 2024

Objective: This study investigated the likelihood of referral for early intervention services in premature infants of 34–35 weeks gestation.

Study design: All infants 34–35 weeks gestation enrolled in a statewide follow-up program were identified. Referral for evaluation for early intervention was noted and risk factors for this outcome were examined.

Results: One-quarter of the infants were referred in the first two years of life. Males and infants with certain congenital anomalies were more likely to be referred. Approximately three quarters of those referred for evaluation for services were found to qualify for services. Over 30% of the infants were lost to follow up.

Conclusion: Premature infants delivered at 34–35 weeks have a significant risk for delay mandating evaluation for early intervention services.
Standardizing perinatal consults to improve trainee physician	competency and decrease maternal anxiety
Authors: Sobczak-Hoeft Susan M. , Finer Neil
Published: December 2024

Objective: To improve trainee physician competency by scripting perinatal consults while concurrently decreasing maternal anxiety and increasing recall.

Design: Physicians in neonatal fellowship consulted mothers with impending preterm deliveries between the gestational ages of 22 and 27 weeks using a scripted approach while videotaping the interaction. Mothers were assessed for anxiety before and after the consult as well as after the delivery. Maternal recall was also assessed after the consult. Videotapes were reviewed for the competency of the consulting physician.

Results: 14 mothers signed consent for videotaping. Physician competency improved after performing the consult at least once. Maternal anxiety based on an anxiety rating scale test (STAI) decreased in all women after the consult. Recall concerning survival and person performing the consult was highest, and recall concerning modalities of breathing devices and skills needed by a premature infant to go home was lowest.

Conclusion: A standardized approach to speaking with mothers with an impending preterm delivery increases the competency of trainees, as well as improves parent-physician communication by increasing recall and decreasing maternal anxiety prior to giving birth.
Severe clinical deterioration in a preterm twin following	discordant transmission of cytomegalovirus via breast milk
Authors: Hans Deborah M. , Sharon Bazak , Choi K. Yeon , Bendel Catherine M. , Schleiss Mark R.
Published: December 2024

There is clear evidence that transmission of cytomegalovirus (CMV) to infants occurs via breast milk. The precise risk for development of symptomatic CMV disease in very low birth weight (VLBW; <1500 grams at birth) premature infants following transmission from maternal breast milk is not clear, though severe disease has been described in this setting. We describe discordant transmission of CMV to VLBW twins, with severe clinical deterioration in the affected infant.
Trisomy 21 in one of extremely low birth weight twins
Authors: Solomon Benjamin D. , Balachandar Divya , Perry Karen , Carrillo-Carrasco Nuria , Markello Thomas C. , Rais-Bahrami Khodayar
Published: December 2024

Prematurity is frequently seen in the neonatal intensive care unit, and trisomy 21 is an often diagnosed neonatal disorder. We report a unique case of extremely premature twins, one of whom was ultimately diagnosed with trisomy 21. We were able to examine the neonatal courses and outcomes of these twins, which were similar despite the presence of trisomy 21 in one twin. This is the first report comparing the neonatal course of an infant with trisomy 21 to an unaffected twin in patients born so prematurely, and demonstrates the difficulty of making the diagnosis of trisomy 21 based solely on physical examination in premature infants.
Bacteremia and septicemia due to anaerobic bacteria in	newborns
Authors: Brook Itzhak
Published: December 2024

The awareness of the role of anaerobic bacteria in neonatal bacteremia and sepsis has increased in recent years. The incidence of recovery of anaerobes in neonatal bacteremia varies between 1.8% and 12.5%. Of the 179 cases reported in the literature, 73 were due to Bacteroides spp. (69 were the Bacteroides fragilis group), 57 Clostridium spp. (mostly Clostridium perfringens), 35 Peptostreptococus spp., 5 Propionibacterium acnes, 3 Veillonella spp., 3 Fusobacterium spp, and 2 Eubacterium spp. Predisposing factors were perinatal maternal complications (especially premature rupture of membranes and chorioamnionitis), scalp abscess, prematurity, and necrotizing enterocolitis. Organisms similar to those isolated in blood were concomitantly recovered in lung aspirates and cerebrospinal and peritoneal fluids. The overall mortality noted is 26% and is highest with B. fragilis group (34%). Inappropriate choice of antimicrobial therapy was often a contributory factor to mortality. Correction of underlying pathology, surgical drainage, and the use of proper antimicrobials are critical to successful resolution of the infection. Penicillin G is the drug of choice for anaerobic infection other than one due to beta-lactamase-producing anaerobic Gram negative bacilli. Antimicrobials useful for therapy these organisms include clindamycin, metronidazole, chloramphenicol, a carbapenem, and the combination of a penicillin plus a beta-lactamase inhibitor.