bluuebunny/crossref_metadata_2025 huggingface dataset:
Sheltered employment, sheltered lives: Family perspectives of conversion to community-based employment
Authors: Dague Bryan
Published: December 2019

This article examines selected aspects of one agency's conversion from a sheltered workshop facility to one providing community-based services for individuals with intellectual and developmental disabilities. Established in 1967 by parents as an alternative to institutionalization, this agency had remained entrenched in the sheltered workshop model for 35 years. A qualitative case study research design including semi-structured interviews, participant observation, and archival review was used to explore the families' perspectives and how they navigated the conversion process. Participants included a subgroup with a long history of sheltered work and a subgroup with no history of sheltered work. Conflicting issues emerged as families had different histories, culture, values, philosophies, and expectations of their children and their inclusion in community. While the initial transition was difficult, most families and participants were satisfied with the conversion process as long as they could maintain previous social networks and find acceptable employment in the community.
Coating carbon nanotubes with lead sulfide and bismuth sulfide
Authors: Jafry Huma R. , Tailor Ramesh C. , Ibbott Geoffrey , Barron Andrew R.
Published: December 2019

The filling of multi-walled carbon nanotubes (MWNTs) or vapor grown carbon fibers (VGCFs) with Pb2+ salts was investigated using two different methods. Using a two-step process, we were successful in filling VGCFs, but not MWNTs; nonetheless, there was no X-ray absorption from the tubes. In contrast, with an in-situ method, no filling of carbon nanotubes (CNTs) with metal or metal salts was observed; however, significant X-ray absorption was based on metal salts present on the outside of the CNTs. The presence of surface coating with good X-ray absorption led to the study of coating MWNTs, VGCFs, and single walled carbon nanotubes (SWNTs) with PbS or Bi2S3 using liquid phase deposition using the aid of surfactants and acid treated tubes. Acid treated tubes give a more even growth of the metal sulfide nanoparticles compared to the surfacted tubes. The PbS coated VGCFs show a comparable transmission of X-rays as commercially available 100% lead lined apron, but slightly lower attenuation per g/cm2 of material.
A novel polymeric metal halide extended network lead(II)-bromido complex, [(2-amino-5-methylpyridinium) (PbBr3)]n
Authors: Al-Far Rawhi , Ali Basem Fares , Haddad Salim F.
Published: December 2019

In [(2-amino-5-methylpyridinium) (PbBr3)]n the asymmetric unit comprises a cation (C6H9N2+) and half unit of the dimer anion hexabromodiplumbate (Pb2Br62−). The plumbate dianion forms a polymer, and together with the cation repeat symmetrically to form the extended [(2-amino-5-methylpyridinium) (PbBr3)]n structure. The polymeric anion [PbBr3]nn− possesses slightly distorted PbBr6 octahedral coordination and forms an infinite chain running along the a axis consisting of ... μ-Br2—Pb—μ-Br2—Pb—μ-Br2 ... that are interconnected with the next chain along the c axis via triply bridging Br1 atoms. In the crystal lattice, two intermolecular Br ... H—N—H ... Br and one (py)N—H ... Br hydrogen bonds tie the polymeric anionic chains to the cations, consolidating a three dimensional network.
Molecular interactions of triethylamine and 1-dodecanol binary liquid mixtures
Authors: Jeevaraj A. Kingson Solomon , Sankar U.
Published: December 2019

Solute – Solvent interactions of Triethylamine (TEA) and 1-Dodecanol binary mixture have been carried out for 11 concentrations at different temperatures using LCR(Inductance (L), Capacitance (C) and Resistance (R)) meter at a frequency of 1 KHz. The Kirkwood correlation factors and excess dielectric properties were determined and discussed to give information about the molecular interactions of the systems. The static dielectric constants for the mixture have been fitted with the modified Bruggeman model. The excess permittivities are found to be positive for all concentrations and temperatures, which represent solute and solvent interact in such a way the effective dipole moment increases.
The crystal structure of tris(4-aminophenylthio)arsine, As(SC6H4-4-NH2)3
Authors: Ioannou Panayiotis V. , Moushi Eleni E.
Published: December 2019

The reaction of a suspension of arsenic(III) oxide in deoxygenated methanol with redistilled 4-aminothiophenol at 25°C for 24 h afforded tris(4-aminophenylthio)arsine. Crystals suitable for X-ray analysis were obtained by recrystallization from chloroform. The compound is monoclinic [P21/n, 11.6427(2) Å, 9.3726(2) Å, 17.7788(4) Å, β = 99.854(2)°, Z = 4]. Its supramolecular organization is based on strong (N-H···N, N-H···S) and weak (C-H···S) intermolecular hydrogen bonding together with C-H···π interactions among the discrete molecular units. The crystal data of this and other As(III) trithiolates are compared and discussed in the light of probable operation of the α-effect in their nucleophilic reactions.
Synthesis of Pyridyloxycyclophosphazene and its Cu(I) Complex
Authors: Boncukçu Elvin , Elmali Fikriye Tuncel , Demirhan Nebahat
Published: December 2019

A new pyridyloxycyclophosphazene, called 2,2′-bis[2-oxy-6-methyl- pyridine]-4,4,6,6-bis[spiro(2′,2″-dioxy-1,1′-biphenyl)]cyclotriphosphazane (BB-CP) has been synthesized from the reaction of 2,2-dichloro-4,4,6,6-bis[spiro(2′,2″-dioxybiphenyl)] cyclotriphosphazane (2Cl-CP) and 2-hydroxy-6-methylpyridine (HMP). The Cu(I) complex of this ligand has been prepared. The new ligand and Cu(I) complex were characterized by FT-IR, 1 H NMR, 31P NMR, UV-vis, mass spectra, elemental and thermal analyses.
Synthesis, characterization of metal complexes of dehydroacetic-1,8-naphthaleimine. Study their effect on the larval mortality of Parasarcophaga aegyptiaca salem
Authors: El-Tabl Abdou S. , El-Bahnasawy Ramadan M. , Shakdofa Mohamad M.E. , El-Seidy Ahemd M.A. , Faramawy Mohamed F.
Published: December 2019

Novel copper(II), nickel(II), cobalt(II), manganese(II), zinc(II) and cadmium(II) complexes of Schiff base ligand [H2L] (1), 3,3′-(naphthalene-1,8-diylbis(azanylylidene))bis(ethan-1-yl-1-ylid-ene))bis(2-hydroxy-6-methyl 4H-pyran-4-one) have been prepared and characterized using physio-chemical and spectroscopic techniques. The molar conductance data revealed that all complexes are non-electrolytic in nature. The IR data showed that the ligand behaved either as neutral or dibasic tetradentate bonded to the metal ion through the two azomethine groups and protonated or deprotonated hydroxyl groups. The electronic spectral data and magnetic measurements of the complexes indicated that the geometries are octahedral. The ESR spectra of the copper(II) complexes indicated an axial symmetry type of a d(x2-y2) ground state with considerably covalent environment. Complexes (6) and (7) have the best insecticidal activity.
Preparation and characterization of Nano spinel powder via co-precipitation and sol-gel techniques
Authors: Khalil N.M. , Hassan M.B. , Ali F.S. , Shakdofa M.M.E.
Published: December 2019

Different compositions of pure magnesium aluminate spinel, alumina-spinel and magnesia-spinel Nano ceramic materials were prepared using co-precipitation and sol-gel techniques. The powders prepared from different molecular compositions of the starting materials; 1 : 1, 1 : 4 and 4 : 1 of either magnesium nitrate and aluminum nitrate (co-precipitation) or magnesium chloride and aluminum hydroxide (sol-gel) were calcined at different firing temperatures; 900, 1100, 1300 and 1500°C. The solid phase compositions of the calcined samples were investigated using x-ray diffraction analysis (XRD). The crystal size of the fired powders was calculated from XRD patterns using Scherer's equation. The microstructure and solid phase analysis of some selected samples were investigated using scanning electron microscope attached with energy dispersed x-ray unit. Based on the mineralogical, crystal size and microstructure studies, it is concluded that different compositions of pure spinel, magnesia-spinel and alumina-spinel could be attained at different firing temperatures; 900°C, 1100°C, 1300°C and 1500°C via co-precipitation and sol-gel techniques. For economical reasons firing at 900°C is considered sufficient for obtaining pure spinel, magnesia-spinel and alumina-spinel Nano powders (<100 nm); particles prepared via sol-gel are relatively smaller compared with those prepared via co-precipitation.
Dielectric characterization and molecular interaction behaviour in binary mixture of 1,2-diaminopropane with 2-aminoethanol
Authors: Undre P.B. , Patil S.S. , Khirade P.W.
Published: December 2019

The dielectric dispersion ε′ and dielectric loss ε″ of binary mixture of 1,2–diaminopropane – 2-aminoethanol were measured by employing the Time Domain Reflectometry technique over a frequency range 10 MHz to 20 GHz at 15, 25, 35 and 45°C. To evaluate various dielectric parameters, the frequency dependents complex permittivity (ε* (ω) = ε′- jε″) data such as static permittivity (εs), relaxation time (τ) and permittivity at high frequency (ε∞) were fitted by the non-linear least-squares fit method to Debye expression. Temperature dependent εs, τ, Kirkwood correlation factor (g), free energy of activation (ΔG) and enthalpy of activation (ΔH) have been determined and discussed in terms of the effect of -NH2 and -CH3 side-group on molecular dynamics and intermolecular hydrogen bonds. It is appropriate to report the present work on the dielectric behavior of 1,2–diaminopropane and 2-aminoethanol liquid molecules, and also their conformations, because the dielectric behavior and molecular dynamics of the system under study can be explored more clearly only by comparing the dielectric data of the mixture system with the dielectric data of the individual molecules and their dynamics.
Synthesis, crystal structure and thermal properties of Cd(II) and Hg(II) terpyridine based compounds
Authors: Saghatforoush Lotfali , Pourmohsen Mehrdad , Asgari Parvin
Published: December 2019

Cd(II) and Hg(II) compounds of 4′-(4-methylphenyl)-2,2′:6′,2″-terpyridine (Mephtpy) have been synthesized and characterized by CHN elemental analysis, FT-IR, 1H and 13C NMR, thermal analysis and analyzed structurally by X-ray single-crystal diffraction. X-ray analysis showed that the coordination number in complexes were the same with N3I2 coordination sphere. Both metal ions adopt a distorted square-pyramidal geometry. The thermo gravimetric analyses showed that the complexes were stable up to 365 and 340°C, respectively.
A novel compound [Mn(H2O)6](AMTZ)2(PA)2 (AMTZ = 4-amino-3,5-dimethyl-1,2,4-triazole and PA = Picrate) with Extensive hydrogen bonds: Synthesis, structure and thermal characters
Authors: Bi Yan-Gang , Wu Bi-Dong , Xue Lin-jun , Zhou Zun-Ning , Yang Li , Zhang Jian-Guo , Zhang Tong-Lai
Published: December 2019

The title compound 1, [Mn(H2O)6](AMTZ)2(PA)2, contains 4-animo-3,5-dimethyl-1,2,4-triazole (AMTZ) and picrate (PA) and was characterized by elemental analysis, FT-IR spectroscopy and Single-Crystal X-ray diffraction. The space group of compound 1 is triclinic P-1(2), with a = 6.797(2) Å, b = 9.800(3) Å, c = 13.197(4) Å, α=,β=,γ=. The central Mn2+ is octahedral and surrounded by two kinds of centrosymmetric molecules, AMTZ and PA. The compound has an extended 3-D supramolecular structure due to water molecules coordinated though hydrogen bonds to the nitrogen and oxygen atoms and the offset face-to-face π ··· π packing. The differential scanning calorimetry (DSC) analysis shows that two exothermic processes take place at 341.4°C and 473.9°C. The kinetic parameter of the first exothermic process was studied using Kissinger's method and Ozawa's method. This provided the enthalpy of formation (−3337.7 kJ·mol−1), critical temperature of thermal explosion (588.79 K). The entropy of activation (ΔS≠), enthalpy of activation (ΔH≠), and free energy of activation (ΔG≠) were, respectively, −209.78 J·K−1·mol−1, 155.50 kJ·mol−1 and 267.75 kJ·mol−1. A flame sensitivity test showed that the 50% firing height (h50) was 20 cm.
Synthesis, characterization and complexation properties of a novel Mg-porphyrazine with metal ions in acetonitrile-chloroform
Authors: Kabay Nilgün , Baygu Yasemin , Gök Yaşar , Başoğlu Aysel , Ocak Ümmühan
Published: December 2019

The synthesis and characterization of a novel metal derivative of a peripherally symmetrically tetra-substituted porphyrazine derived from 25,26-dioxa-6,7,9,10,15,16,18,19-octahydro-25H-1,24-methanodibenzo[q,t][1,4,13,16,17,10]tetraoxadithiacyclohenicosine-12,13-dicarbonitrile was carried out. The influence of metal cations such as Zn2+, Fe2+, Mn2+, Ni2+, Co2+, Hg2+ and Cu2+ on the spectroscopic properties of the ligands, the starting material dinitrile and MgPz were investigated in acetonitrile-chloroform solution (1/1) by means of absorption spectrometry. Absorption spectra showed isosbestic points in the spectrophotometric titration of Cu2+ and Hg2+ with MgPz ligand. The results of spectrophotometric titration experiments disclosed the complex stability constant of the novel ligand, MgPz with Cu2+ and Hg2+ cations.
A structural study of lithium m-terphenyl carboxylates
Authors: Lee Peter T.K. , McClintick Jessica , Robertson Katherine N. , Clyburne Jason A.C.
Published: December 2019

During large-scale preparations of 2,6-dimesitylbenzoic acid, Mes2ArCO2H (Mes = 2,4,6-trimethylphenyl), a highly insoluble by-product precipitated and was isolated. The material formed in modest yield but significantly impacted the preparation of Mes2ArCO2H. The isolated product could be dissolved, with difficulty, in acetone, THF or pyridine. Crystallization under the evaporating solvents resulted in the isolation of three new compounds in relatively low yield. From pyridine the compound [Mes2ArCO2Li(H2O)(py)]2 was recovered. Recrystallization from THF gave (Mes2ArCO2H)(Mes2ArCO2)Li(THF)2, which has been shown to contain both neutral (benzoic acid) and anionic (benzoate) ligands. Finally, crystals of [Mes2ArCO2(H2O)Li(μ-OH2)(μ-O2CMes2Ar)Li(H2O)]2·2H2O were isolated from the acetone solution. These new solids were characterized using single crystal X-ray structural determinations.
Synthesis of novel heterocycles containing Se-O/Se-N linkages: Role of intramolecular coordination
Authors: Selvakumar K. , Singh Vijay Pal , Shah Poonam , Singh Harkesh B.
Published: December 2019

The contrasting structure and reactivity of the mono ortho-coordinated aryl- and alkyl-selenium derivatives and 2,6-dibsubstituted aryl- and alkyl-selenium derivatives are described. The 2,6-disubstituted diaryl diselenides with Se$\ctdot$O intramolecular coordination and steric congestion around selenium undergo intramolecular cyclization to give the corresponding Se-O/Se-N heterocycles. The aliphatic analogue, 2-chlorocyclohex-1-ene-1,3-dicarbaldehyde (13), undergoes intramolecular cyclization upon reaction with disodium diselenide to form a resonance stabilized cyclic diselenide (15). However, 2-chlorocyclohex-1-enecarbaldehyde (16), with one coordinating formyl group, does not undergo an intramolecular cyclization under similar reaction conditions. Diselenides, 2,2′-bis(5-tert-butyl-benzene-1,3-dimethanol)diselenide (22) and bis(5-tert-butyl-isophthaladehyde) diselenide (23), with cissoid conformations are orange in color and show absorbances at longer wavelengths (368 and 380 nm respectively, n → σ*). The diselenides, bis(5-tert-butyl-isophthalic acid dimethyl ester)diselenide (24) and bis(5-tert-butyl-isophthalic acid diisopropyl ester)diselenide (25), with transoid conformations, are pale yellow in color with absorbances at shorter wavelengths (324 and 323 nm respectively, n → σ*). The intramolecularly stabilized arylselenenyl bromides with 2,6-disubstitution underwent interesting cyclization reactions to afford novel cyclic selenenate esters (with Se-O bond) and selenenamides and benzisoselenazoline (with Se-N bond) derivatives depending upon the orthofunctions.
Synthesis, spectral characterization and biological studies of quinoline based ligands and their transition metal complexes
Authors: Narayanachar  , Dhumwad Shreedhar D. , Suresh D.K.
Published: December 2019

A series novel Schiff bases derived from 2-mercapto-3-formyl quinoline/2-hydroxy-3-formyl quinoline with 1,8-diaminonaphthalene (DAN) and its corresponding transition metal complexes of Co (II), Ni(II), Cu(II) and Zn (II) were synthesized, characterized by elemental analysis, spectral (IR, 1H-NMR, Mass, UV-Vis, Fluorescence, ESR, TGA) and magnetic studies. The results indicated that all the metal complexes possess octahedral geometry. The measured molar conductance in DMF indicates that the complexes are non-electrolytic in nature. These Schiff bases and metal complexes have been screened for antibacterial, antifungal activities by MIC method and further evaluated for anti-inflammatory and analgesic activity by carrageenan induced paw oedema and tail flick methods in rats.
Pneumothorax in neonates: Trends, predictors and outcomes
Authors: Duong H. Hanh , Mirea L. , Shah P.S. , Yang J. , Lee S.K. , Sankaran K.
Published: December 2019

OBJECTIVE: To examine rates, trends, predictive risk factors, and outcomes associated with pneumothorax in neonates. STUDY DESIGN: Retrospective analyses were used to estimate rates and assess trends in pneumothorax among early preterm (GA <32 weeks), moderate-late preterm (GA 32–36), and term (GA ≥37 weeks) neonates admitted to neonatal intensive care units (NICUs) participating in the Canadian Neonatal Network™ from 2005 to 2011. For each GA group, multivariable logistic regression models were derived to predict pneumothorax using risk factors with known clinical relevance. Additional logistic regression analyses assessed associations between pneumothorax and mortality, bronchopulmonary dysplasia, and intraventricular hemorrhage. RESULTS: The study included 71,237 neonates; of them 16,985 (24%) early preterm, 27,709 (39%) moderate-late preterm, and 26,543 (37%) term neonates. The overall rate of pneumothorax by GA was bimodal with estimates of 4.0%, 2.6%, and 6.7% respectively. No significant temporal trends were detected. Risk factors for pneumothorax included: a) for the overall lpopulation- Score for Neonatal Acute Physiology, version II >20, surfactant use, and respiratory distress syndrome; b) for early preterm infants-chorioamnionitis; c) for moderate-late preterm infants-higher birth weight, male sex, rupture of membranes >24 hours, and outborn status; and d) for term infants- male sex, outborn status, and meconium aspiration in term neonates. In early preterm neonates, pneumothorax was associated with mortality, bronchopulmonary dysplasia, severe intraventricular hemorrhage, and prolonged NICU stay. CONCLUSIONS: Pneumothorax rates were higher among term and early preterm neonates admitted to the NICU. Predictors of pneumothorax varied between GA groups. Pneumothorax-associated mortality and morbidity were significantly greater in early preterm infants.
Right-sided congenital diaphragmatic hernia: A tertiary centre's experience over 25 years
Authors: Jani P. , Bidarkar S.S. , Walker K. , Halliday R. , Badawi N. , Cohen R.C.
Published: December 2019

AIMS: To provide analysis on infants treated for right-sided congenital diaphragmatic hernia (RCDH) including mortality, neonatal morbidities, and associated congenital anomalies. METHODS: We reviewed records of infants admitted with RCDH from 1985 to 2010. RESULTS: A total of 160 infants with CDH were identified; of them 22 infants had RCDH, 14 (64%) were male and eight (36%) were female. Eleven of the 22 infants died (50%), of which seven (64%) were male, and four (36%) were female. Three infants (13.6%) were diagnosed prenatally, and 19 (86.4%) were diagnosed postnatally. A statistically significant association with mortality was observed for low five minute Apgar score (OR = 8; 95% CI: 1.24–51.5), and high alveolar-arterial gradient >400 (OR = 25.7; 95% CI: 2.2–298.5). Fourteen infants (64%) underwent surgical correction, three (21.4%) infants who underwent surgery died. Three infants were discharged with oxygen supplementation and tube feeding at home, and one on sildenafil. No statistical significance was observed between other variables and mortality/morbidity. We observed a change in practice in relation to timing of surgery allowing stabilisation of patient prior to surgery. Average in-patient stay for RCDH infants was 23.5 days (range: 0–112), compared with the total in-patient mean stay of 10.5 days. CONCLUSIONS: Low five minute Apgar score, and high alveolar-arterial gradient were significant predictors of mortality. RCDH is associated with high mortality (50%), prolonged length of stay and other anomalies. In recent years, we observed an improving trend for survival.
Predicting fetal karyotype in fetuses with omphalocele: The current role of ultrasound
Authors: Zork N.M. , Pierce S. , Zollinger T. , Kominiarek M.
Published: December 2019

OBJECTIVE: To assess the ability of ultrasound in predicting abnormal karyotype in pregnancies with prenatally diagnosed omphaloceles and to compare its test characteristics to previously published studies. METHODS: A retrospective case-control study of omphaloceles diagnosed at one center was performed from 1995–2007. Cases were those with an abnormal karyotype and controls were those with a normal karyotype. Data collection included demographics, karyotype results, and ultrasound findings. The number and type of associated anomalies were compared between the cases and controls. The sensitivity, specificity, positive predictive value, and negative predictive value for predicting an abnormal karyotype were calculated from previously published studies. RESULTS: Of the 73 subjects, there were 12 cases and 61 controls. The majority of women were Caucasian and primigravida. The cases were less likely to have an isolated omphalocele [1 (8.3%) vs. 27 (42.6%), OR = 0.122; 95% CI: 0.02–0.08] but were more likely to have two or more major anomalies [8 (66.7%) vs. 17 (27.9%), OR = 5.18; 95% CI: 1.19–24.04)] compared to the controls. Cardiac anomalies and only one additional major anomaly were not different between the two groups, P > 0.05. The test characteristics for this study were similar to previously published studies. CONCLUSIONS: Isolated omphaloceles were more likely to have a normal karyotype; however fetuses with multiple anomalies were more likely to have an abnormal karyotype. Despite advances in ultrasound technology, its ability for predicting an abnormal karyotype in these fetuses has not improved.
In vitro measurement of flow rate variability in neonatal IV therapy with and without the use of check valves
Authors: van der Eijk A.C. , van der Plas A.J. , van der Palen C.J.N.M. , Dankelman J. , Smit B.J.
Published: December 2019

BACKGROUND: In multi-infusion IV therapy, the actual volume delivered to the neonate can vary over time. To reduce flow rate variability, check valves can be used. A check valve allows flow through the valve in only one direction. OBJECTIVE: To evaluate flow rate variability in a low flow dual-infusion setup with and without check valves. METHODS: The effect of changing the height of and adding syringes to the IV-administration set was tested with and without check valves in an in vitro dual-infusion setup with in-line flow meters. The pre-programmed flow rates were 2.5 and 0.1 ml/h. RESULTS: Twenty-four tests of 90 minutes were performed. Time to reach 75% of the pre-programmed 0.1 ml/h flow rate was >20 minutes. The highest total delivered volume during a test was (mean ± SD) 56 ± 8% of the expected delivery for tests without check valves, and diminished to 12 ± 24% of the expected delivery for check valves with a higher opening pressure. CONCLUSIONS: The actual flows and the total delivered volume in low flow dual-infusion setups are less than expected on the pre-programmed flow-rate. These findings emphasize the need for the development of more accurate delivery systems for drugs and fluids in neonatology. Caregivers should be aware of these findings, and optimise the delivery of IV substances by making use of check valves with low opening pressures and by minimising compliance and volume of the IV-administration set. Furthermore, changes in the relative height between pumps and catheter tip should be minimized.
Acute neonatal appendicitis: A diagnosis to consider in abdominal sepsis
Authors: Arias-Llorente R.P. , Flórez-Díez P. , Oviedo-Gutiérrez M. , Suárez-Rodríguez M. , Costa-Romero M. , Solís-Sánchez G. , García-López E.
Published: December 2019

Appendicitis in the neonatal period is extremely rare. Its low incidence together with non-specific clinical symptoms often mean the diagnosis is delayed, leading to increased rates of peritonitis and mortality. We report the case of a 33-week premature infant, small for gestational age (1180 g at birth), clinically stable and receiving exclusive enteral feeding, who presented clinical manifestations of necrotizing enterocolitis at 14 days of life. Acute phase reactants were elevated and abdominal radiography showed pneumoperitoneum. Laparotomy revealed acute perforated appendicitis without intestinal involvement and purulent fluid in the peritoneum, for which appendectomy was performed. Neonatal acute appendicitis should be considered in the differential diagnosis of abdominal sepsis since early diagnosis and treatment significantly reduce associated morbidity and mortality.
Methylmalonic acidemia presenting as persistent pulmonary hypertension of the newborn
Authors: Agarwal R. , Feldman G.L. , Poulik J. , Stockton D.W. , Sood B.G.
Published: December 2019

Persistent pulmonary hypertension of the newborn (PPHN) results from disruption of the normal fetal-neonatal circulatory transition and may be associated with meconium aspiration, group B streptococcal sepsis, pneumonia, respiratory distress syndrome, congenital diaphragmatic hernia and pulmonary hypoplasia. Seventeen percent of cases are considered idiopathic since there is no identifiable cause. Although it is recognized that acidosis and hypoxia from any cause in neonates may produce pulmonary vasoconstriction and maintain pulmonary hypertension, PPHN has not been reported in inborn errors of metabolism (IEM) associated with metabolic acidosis like methyl malonic acidemia (MMA). We report the first case in the literature of MMA presenting concomitantly with PPHN. Undiagnosed IEMs, like MMA, could represent a subset of idiopathic cases of PPHN. Infants and neonates have a limited repertoire with which to respond to an overwhelming illness. Because metabolic diseases are rare, they are considered only after excluding more common causes of neonatal distress. PPHN is therefore more likely to be attributed to meconium aspiration, sepsis, pneumonia or respiratory distress syndrome than to an IEM. The advent of expanded newborn screening has made pre-symptomatic diagnosis of several IEMs including MMA possible. However, not all IEMs are identified, and in some instances, an infant who has an IEM may become ill before the results of the newborn screen become available. Early diagnosis of IEM is crucial to prevent catastrophic consequences and the awareness of an association with PPHN would lead to an aggressive search of an underlying IEM and its management.
Cesarean section plus delayed cord clamping approach in the perinatal management of congenital high airway obstruction syndrome (CHAOS): A case report
Authors: Pivetti V. , Cavigioli F. , Lista G. , Napolitano M. , Rustico M. , Paganelli A. , Ferrazzi E.
Published: December 2019

In this case, we describe a newborn with prenatal diagnosis of congenital high airway obstruction syndrome (CHAOS), successfully managed with a cesarean section with delayed cord clamping 180 seconds. In case of prenatal diagnosis of CHAOS, prompt airway intervention at delivery allows survival of this otherwise fatal condition. Ex utero intrapartum treatment (EXIT) is considered the elective procedure to secure the fetal airway before the baby is completely separated from the maternal circulation. In cases where the EXIT procedure is not possible for maternal reasons (Ballantyne's syndrome), delayed cord clamping may serve as an alternative method to manage CHAOS.
Current trends and future challenges in neonatal parenteral nutrition
Authors: Adamkin D.H. , Radmacher P.G.
Published: December 2019

A number of adaptations in total parenteral nutrition (TPN) protocols and practices for preterm neonates have been realized in the past several years, resulting in better survival and developmental outcomes. The early provision of appropriate concentrations of amino acids and energy are now recommended in evidence-based guidelines. Standardized TPN formulations are now available for many patients and may be associated with cost savings and improved adherence to guidelines. Several advantages of these preparations, including promotion of safer administration, consistent adherence to guidelines, and overall best practices, have been well documented. However, careful monitoring is still required to optimize nutrition for individual patients and to support overall safety as TPN practices continue to change. Additional research is needed to develop new lipid formulations that are tailored for safe use by very low birth weight (VLBW) and extremely low birth weight (ELBW) infants. This review presents recent research and improvements to guidelines, as well as future product needs for VLBW and ELBW neonates.
Association between tracheal pepsin, a reliable marker of gastric aspiration, and head of bed elevation among ventilated neonates
Authors: Garland J.S. , Alex C.P. , Johnston N. , Yan J.C. , Werlin S.L.
Published: December 2019

OBJECTIVES: To determine the frequency of tracheal pepsin in ventilated neonates and whether the angle of head elevation was associated with tracheal pepsin. STUDY DESIGN: Serial trachael samples (at 3, 7, 14, 21 and 28 days of ventilation) were obtained from intubated, ventilated very low birth weight infants. Presence of tracheal pepsin was determined by Western blot analysis using a specific anti-human pepsin antibody. RESULTS: Tracheal pepsin was detected in 35/66 (53%) of the ventilated neonates (birthweight: 798 ± 268 grams [mean ± standard deviation]). Neonates whose head elevation was in the upper quartile (≥14 degrees) during the first sampling time (day 3) were less likely (4/16 vs 9/10, P = 0.0013) to have tracheal pepsin when compared to neonates whose head elevation was in the lowest quartile (≤8 degrees). CONCLUSIONS: Pepsin, a marker for gastric secretion aspiration, was detected in 53% of ventilated low birth weight neonates; early elevation of the head of the bed was associated with a lower rate of tracheal pepsin.
Successful treatment of neonatal hemochromatosis as gestational alloimmune liver disease with intravenous immunoglobulin
Authors: Jimenez-Rivera C. , Gupta A. , Feberova J. , de Nanassy J.A. , Boland M.P.
Published: December 2019

Neonatal hemochromatosis (NH) is a rare, often fatal disorder characterized by liver failure and hepatic and extrahepatic iron overload. Clinical manifestations can occur in utero or immediately after birth. Evidence suggests that most cases are due to a gestational disease with transplacental transfer of maternal IgG antibodies targeting the fetal liver resulting in immune injury. The alloimmune target is believed to be a fetal hepatocyte cell surface antigen, with subsequent complement activation resulting in severe loss of hepatocytes and fetal iron overload. This cascade of events leads to acute liver failure and neonatal death. With gestational alloimmune liver disease (GALD) being the mechanism of liver injury in most cases of NH, a new paradigm of treatment with intravenous immunoglobulin (IVIG) and exchange transfusion has been successfully used. We describe an extremely ill newborn with NH successfully treated with three doses of IVIG.
Effects of beractant and poractant administration on cerebral	hemodynamics
Authors: Fujii Alan M. , Bailey Jennifer , Doros Gheorghe , Sampat Kunal , Sikes N. Carol , Mason Melanie J. , Kaiser Jeffrey R.
Published: December 2019

Objective: To determine whether type and timing of surfactant preparation affect cerebral blood flow (CBF) hemodynamics differently.

Study design: Two sites monitoring cerebral hemodynamics during surfactant administration. Beractant (4.0 ml/kg) and poractant (2.5 ml/kg first dose, 1.25 ml/kg subsequent doses) were administered according to the manufacturer. CBF velocity (CBFv) was assessed before and after the first (Site A) and second (Site B) doses of beractant and poractant.

Results: At Site A, 10 infants (birth weight 690 ± 133 g) were studied. CBFv decreased 28.9 ± 5.1% following the first dose of surfactant; there were no differences between beractant and poractant. At Site B, 16 infants (birth weight 896 ± 311 g) were studied. CBFv increased 47.4 ± 35.7% after the second dose of beractant and did not change after the second dose of poractant.

Conclusion: This is a preliminary report of two related trials examining CBFv responses to beractant and poractant. CBFv decreased similarly after the first dose of beractant and poractant. CBFv increased after the second dose of beractant, but not after poractant. Cerebral hemodynamic responses between the first and second doses may be due to differences in quantities of airway fluid, while second dose differences between beractant and poractant may be due to differences in dose-volume.
Maternal serum selenium and low birth weight neonates
Authors: Mohammadzadeh A. , Farhat A.S. , Valaee L. , Khadem N. , Khajedaluee M. , Parizadeh S.M.R.
Published: December 2019

Introduction: Selenium is an essential element for the protection against oxidative stress in different biological materials. Excessive or insufficient intake of selenium can lead to clinically relevant disturbances in tissue functions. Selenium status is particularly important for neonates, and infants. Therefore, the aim of this prospective study was to examine the relationship between the concentration of serum selenium in pregnant women and the incidence of low birth weight (< 2500 g) in their newborns.

Method: We conducted a case-control study on women who delivered low birth weight infants (Cases), and women with normal birth weight infants (Controls). We collected blood samples from all women within 24 hours of delivery, and assessed the concentration of selenium using electrothermal atomic absorption spectrometry. We compared serum concentration of selenium between the two groups. Multiple linear regression analysis was performed to control of potential confounding variables.

Results: A total of 123 mothers were studied, of them 70 Cases with low birth weight infants (1845 ± 472 g) and 53 Controls (birth weight = 3166 ± 435 g). Mothers in the Cases and Controls groups did not differ in age (24 ± 4 vs. 24.7 ± 5.4 years), body mass index (23.4 ± 3.4 vs. 22.9 ± 3.2), and socioeconomic or demographic factors. Maternal selenium concentration (μg/l) did not differ between Cases and Controls; 118.8 ± 24.5 μg/l vs. 122.5 ± 29.3 μg/l respectively. Maternal selenium did not differ between premature and full term deliveries. Small for gestational age and appropriate for gestational age newborns had similar maternal selenium concentrations.

Conclusion: In our study population, maternal selenium concentration had no impact on neonatal birth weights or premature deliveries.
Complication of emergency cesarean section: Open	metacarpophalangeal disarticulation and complete extensor tendon lacerations of	the hand in a neonate
Authors: Prazad Preetha , Puppala Bhagya L. , Baxamusa Taizoon H. , Mangurten Henry , Schweig Lorene
Published: December 2019

Accidental fetal injury is a serious but underreported complication during cesarean delivery, particularly after one that is emergent. The most commonly documented injury is skin laceration. Though the majority of reported lacerations are superficial, a few are deep and require surgical intervention. We report a case of severe multiple extensor tendon lacerations with open metacarpophalangeal joints sustained at the time of an emergency cesarean delivery that resulted in an excellent functional outcome following surgical repair.
Comparison of pigtail percutaneous versus traditional chest tube	thoracotomy for pneumothorax drainage in neonates
Authors: Molloy Eleanor J. , Walsh M.C.
Published: December 2019

Objective: Pigtail seldinger "over the wire" technique chest drains have been shown to be as effective and less invasive in adults than traditional chest tube thoracotomy. We aimed to compare conventional and pigtail chest tube management of pneumothorax in neonates.

Methods: Retrospective comparison of pigtail and conventional chest tubes in neonates with pneumothorax in a tertiary neonatal intensive care unit.

Results: 28 chest tubes were inserted in 18 neonates (23–39 weeks) including 12 conventional and 16 pigtail chest drains. Significantly increased analgesia was required while conventional chest drains were in situ compared to pigtail tubes. In addition 6 pneumothoraces were unresolved with conventional drains versus 1 following pigtail drain insertion.

Conclusion: Optimising management of acute pneumothorax would improve neonatal morbidity and mortality. The use of the smaller and more flexible pigtail thoracostomy may minimise lung injury during insertion and decrease analgesia requirements
Orogastric tube placement in extremely low birth weight	infants
Authors: Cordero Leandro , Nankervis Craig A. , Coley Brian D. , Giannone Peter J.
Published: December 2019

Background: Traditionally, orogastric tube (OGt) length of insertion is determined by nose-earlobe-xyphoid (NEX) measurement. Although radiography is the gold standard for verification of placement, scarce data are available for extremely low birth weight (ELBW) infants.

Objective: To correlate OGt placement in ELBW infants with its position in the gastrointestinal tract by radiography and to establish clinical correlates with gastrointestinal perforations.

Design/methods: Retrospective evaluation of 290 ELBW infants. The 1st (n=290) and 2nd (n=273) radiographs following OGt placement were evaluated. Diaphragm and OGt were referenced to the level of the 10{th} thoracic vertebra (T10). The lower esophageal sphincter (LES) was presumed to be at T9.

Results: Most (86%) OGt were placed during the first three days of life. OGt pores and the stomach were visible in 37% and 40% of the cases respectively. The diaphragm was noted to be at T8 (14%), T9 (43%), T10 (41%) & T11 (2%). On the first radiograph, OGt were in the esophagus (4%), in the duodenum (3%), straight in the stomach (8%) and diagonal in the stomach (85%). Of all 563 radiographs evaluated, 502 (89%) OGt were diagonal in the stomach, extending below the LES for a median 3 cm (0.7–4.9 cm). In the 225 radiographs where the stomach could be visualized, the median distance from T10 to the OGt tip was 2.8 cm (1–5) while that from T10 to the greater curvature was 3.1 cm (1–5).

Clinical correlates: There were 21 cases of necrotizing enterocolitis (15 of them with perforation) and 7 cases of spontaneous intestinal perforation. None of them were temporally or anatomically linked to OGt placement.

Conclusions: Radiological verification of OGt placement is possible. The unpredictable level of the diaphragm, the poor visibility of OGt pores and the often gasless stomach can make radiological verification difficult. Determining OGt insertion length in ELBW infants by the NEX method results in appropriate intragastric placement in 85% of the cases.
Laryngoscope bulb ingestion during delivery room	resuscitation
Authors: Al-Nemri AbdulRahman , Ignacio Lena C. , Al-Zamil Fahd
Published: December 2019

Resuscitation in the delivery room is a crucial part in management of a newborn. Endotracheal intubation remains an important step during neonatal resuscitation. It is a highly skilled procedure that is not without complication even if performed by highly experienced medical personnel. We report one rare complication of a laryngoscope bulb that was dislodged and ingested by the newborn patient.
Predictors of medical failure in the preterm patent ductus	arteriosus
Authors: Awad Sawsan M. , Khalid Omar , Suarez William
Published: December 2019

Background: The management of the patent ductus arteriosus in the preterm neonate continues to be a major factor affecting morbidity and mortality.

Objectives: To identify factors that may be important in determining which patients respond to medical therapy and which would suggest that surgical management is likely necessary.

Methods: A total of 117 patients' charts were retrospectively reviewed. Twenty-two were excluded due to incomplete data. Ninety-five patients were divided into medical responders (R) and non-responders (NR). Demographics and clinical data were compared using independent t-testing and ANOVA. A Ductal Response Score (DRS) was developed using factors known to be of significance for successful medical closure. This score was calculated on a subset of patients where all necessary data were present.

Results: Responders had higher gestational age (GA), body surface area (BSA) and left ventricular Z-score (LVZ-score). The interaction between groups showed significant difference between R and NR in LA/AO (P < 0.001), LV Z-score (P < 0.001), and BUN/Cr (P = 0.046), where NR had higher values compared to R. The effect of time on the DRS regardless of the group (10 patients) showed statistically insignificant difference (P= 0.263). Interaction between the groups (R = 6, NR = 4) showed significant worsening of the DRS in NR (P = 0.047). Extrapolation of data was performed. Independent t-test on DRS between groups, post-extrapolation (R = 19, NR = 9), showed statistically insignificant difference between the groups (P = 0.144).

Conclusion: The concept of determining a DRS may prove to be useful in evaluating response to medical therapy. However, further prospective study is needed.
Methemoglobinemia associated with Staphylococcus aureus sepsis in	a newborn
Authors: Mutlu Mehmet , Erduran Erol , Aksoy Ayşe , Aslan Yakup
Published: December 2019

Methemoglobinaemia is an infrequent cause of neonatal cyanosis. Methemoglobinaemia can be life threatening. Rapid diagnosis and early treatment of methemoglobinaemia are life-saving. Methemoglobinemia occurs following the intake of some drugs and some foods or water that contain high levels of nitrate, gastrointestinal infection and sepsis. We report a case of methemoglobinemia associated with Staphylococcus aureus sepsis in a newborn.
A simplified method for head cooling: Feasibility and safety
Authors: AlKharfy Turki M.
Published: December 2019

Objective: To study feasibility of a simplified method of head cooling using ice water filled rubber gloves in full term infants with moderate to severe hypoxic-ischemic encephalopathy and whether very early induced hypothermia would decrease mortality and incidence of convulsions in this group of infants.

Study Design: In this single center prospective cohort study, full term inborn infants were assigned to intervention cohort or control cohort based on the 24 hours on call staff physician preference. Patient selection was based on perinatal evidence of hypoxic-ischemic insult and clinical neurological findings on admission suggestive of moderate to severe hypoxic-ischemic encephalopathy. Hypothermia was passively initiated at delivery and was actively induced on admission. A simplified approach to induced head cooling was used by applying ice water filled rubber gloves. Combined selective head cooling and mild systemic hypothermia approach was applied. Cooling was continued for 72 hours. Short term outcomes of infants in the two cohorts were compared.

Results: 106 infants were enrolled, 54 infants in intervention cohort and 52 infants in control cohort. Active cooling was initiated in the intervention cohort at a median postnatal age of 57 minutes. The method of cooling was easy to learn and adopt by our unit members. The mortality rate was not significantly different between the two cohorts; 8/54 intervention cohort vs. 11/52 in the control cohort, p value 0.45. Infants in the intervention cohort had statistically significant reduction in the incidence of clinical convulsions, 14/54 vs. 25/52, p value 0.026. Fewer infants in the intervention group had abnormal electroencephalogram; 12/46 (26%) vs. 18/43 (42%) in the control group, however this did not reach statistical significance.

Conclusion: This simplified method of head cooling is feasible and might be helpful to treat newborn infants with hypoxic-ischemic encephalopathy in centers where sophisticated equipments are not available.
Neonatal necrotizing fasciitis and fungal infections in preterm infants
Authors: Al Tawil Khalil , Eldemerdash Alaa , Balkhy Hanan , Al Hathlol Khalid , Shaalan Mohammad
Published: December 2019

Necrotizing fasciitis (NF) in premature infants is a rare, yet life-threatening, soft tissue infection. We report four cases of NF that were encountered over a seven-year period. The onset of the disease was between four and twelve days of age. Predisposing factors were omphalitis in two infants and intestinal perforation in the other two infants, one of whom had necrotizing enterocolitis. Surgical biopsies from the affected sites showed mucormycosis in one infant and bipolaris fungi in another. One of these infants was treated with antifungal therapy in addition to broad spectrum antibiotics. This infant survived, even without surgical intervention while the other three died. We conclude that intestinal perforation and omphalitis are important predisposing factors of NF in premature infants. Fungal infection should be considered as one of the possible causes of NF in preterm infants. Early initiation of antifungal therapy, in addition to broad spectrum antibiotics, is justifiable in this disease entity.
Congenital parvovirus B19 infection associated with perinatal	stroke
Authors: Siebert Stephanie , Eis-Hübinger Anna Maria , Müller Andreas , Bartmann Peter , Heep Axel
Published: December 2019

We report a case of left hemispheric cerebral stroke and occlusion of right axillary artery in a newborn with fetal last trimester parvovirus B19 infection detected by polymerase chain reaction for viral DNA. Thromboembolic occlusion of cervical and cerebral arteries was demonstrated on MRI. Excluding vasculitis or prothrombotic condition, data suggest neonatal stroke arising from the congenital parvovirus B19 infection.