He L, Harold SF, Frydrysiak–Brzozowska A. Breastfeeding: The Natural, Nonpareil, and Nourishing Nexus between a Mother and Her Baby. Newborn 2025; 4(3):iv-x. DOI: 10.5005/newborn-4-3-iv.

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Jani PR, Maheshwari A. Kangaroo Care — Knowledge, Attitude, and Practices among Clinicians: International Perspective from a Cross-sectional Survey. Newborn 2025; 4(3):115–121. DOI: 10.5005/jp-journals-11002-0136.

 

Abstract:

Introduction: Kangaroo care (KC) is a low-cost, effective intervention offering many benefits to the infant, parents, health system, and society. Although knowledge, attitudes, and practices (KAP) regarding KC among clinicians have reported at a single-institution or local regional levels, concerns remain about information gaps related to national income levels. This study aimed to explore disparities in KAP on KC among clinicians across countries with different income levels.

Methods: A web-based survey was conducted between December 2024 and March 2025. Only one response per clinician was collected. Results: Responses from 134 clinicians across 32 countries revealed that while awareness and acceptance of KC were generally high among caregivers and parents, significant disparities existed based on country income levels. Most respondents (90%) reported acceptable knowledge levels, but formal training for caregivers was limited (36%), particularly in upper-middle-income countries (UMICs). Local guidelines were more commonly available in lower-middle-income countries (LMICs) than in UMICs. Attitudes toward KC were largely positive among both caregivers (84%) and parents (78%), with higher support observed in high-income countries (HICs). Mothers often preferred practicing KC with their partner present and generally felt comfortable during the process. In practice, KC was more widely implemented for both term and preterm infants in HICs, whereas LMICs focused more on preterm or low birth weight infants.
Conclusions: There is a need for more structured training and consistent guidelines to promote equitable and effective KC practices globally.

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​Key scientific associations: Attitude, Income level, Kangaroo care, Knowledge, Low-birth-weight infant, Practices, Preterm infant, Survey, Term infant. 

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Vereen R, Carr N, Puia-Dumitrescu M, Kaempf J, Krick J. Neonatologists’ Use of Social Media: A Survey Exploring Professional and Personal Practices. Newborn 2025; 4(2):122–126. DOI: 10.5005/jp-journals-11002-0131.

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Abstract:

Background: Limited data specifically describe how physicians utilize social media for professional purposes, with some studies suggesting differences based on specialty and demographics. This study explored how neonatologists use social media and its impact on their clinical practice, given the growing use of social media for health information.
Methods: An anonymous online survey was distributed to neonatologists through the American Academy of Pediatrics (AAP) Section on Neonatal and Perinatal Medicine.
Results: A total of 223 neonatologists participated in the survey. The majority reported that they “Never” or “Rarely” contribute to (74%), seek (68%), or scan (58%) social media for medical knowledge. Opinions on the impact of social media on clinical practice were mixed, with perceptions varying significantly by age (p-value < 0.01). Those who viewed social media positively highlighted its role in increasing awareness of recent publications and providing valuable parental insights. Conversely, the most common concern was the potential for misinformation, bias, and confusion stemming from social media content.
Conclusions: Although most neonatologists “Never/Rarely” use social media to contribute or seek medical information, a notable proportion are scanning social media platforms to stay informed about recent publications and potentially enhance the quality of care. Older neonatologists and those with more experience perceive social media as less valuable and less positively impacting clinical care. It is likely neonatologists are not using social media at the same rate as families, which could contribute to communication gaps as families increasingly use social media for information and support. Further research is needed to assess the effects of social media on healthcare quality and resource allocation and to develop strategies to mitigate misinformation and confusion.

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​​Key scientific associations: Newborn, NICU, infection, neonate, communication, education, clinical practice, physicians, professional organizations, healthcare journals, networking, education, organizational promotion, patient education, specialty, demographics, Tweetiatricians, X, Twitter, timely anticipatory media guidance, Committee on Medical Liability and Risk Management, Likert scale, information fabrication, full-time equivalents.

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Motojima Y, Namba F, Tan K, Malhotra A. Does Routine Intensive Care Provision at 22–23 Weeks’ Gestation Improve Outcomes of Infants Born between 24 and 27 Weeks? Newborn 2025;4(3):127–132. DOI: 10.5005/jp-journals-11002-0132. 

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Abstract:

Background: With the development of neonatal care, the number of weeks of gestational age at which intensive care is provided has decreased significantly, and there is much debate as to whether or not aggressive resuscitation should be performed in these extremely preterm infants. In this study, we examined whether there are differences in outcomes for extremely preterm infants between neonatal units in two countries (Australia and Japan) with differing neonatal care practices, especially in terms of resuscitation at 22–23 weeks of gestation.
Materials and methods: This was a retrospective observational study conducted in two level III NICUs [Monash Children’s Hospital (MCH) in Australia and Saitama Medical Center (SMC) in Japan]. Preterm infants born between 24 and 27 weeks of gestation between 2017 and 2021 were included, and neonatal outcomes to discharge were compared.
Results: Four hundred fifty-seven (308 in MCH, 149 in SMC) infants were included. Median (IQR) birth weight was 804 (648, 975) gm for MCH vs 810 (638, 964) gm for SMC infants. Neonatal morbidities compared (MCH vs SMC) included chronic lung disease (CLD) (70.9% vs 57.5%, p = 0.005), necrotizing enterocolitis (5.8% vs 0.0%, p = 0.003), early onset sepsis (2.6% vs 0.0%, p = 0.048), severe interventricular hemorrhage (10.7% vs 3.4%, p = 0.008), periventricular leukomalacia (4.9% vs 0.0%, p = 0.007), retinopathy of prematurity (ROP) (9.7% vs 30.1%, p < 0.001), and mortality (9.4% vs 2.7%, p = 0.009).
Conclusion: Most neonatal morbidities were less common in extremely preterm infants born at SMC, who routinely provide intensive care to infants born at 22 weeks’ gestation. Care of preterm infants at extremes of gestation (22 and 23 weeks) may have an impact on outcomes of extremely preterm infants born later in gestation.

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​​Key scientific associations: neonate, preterm infant, aggressive neonatal resuscitation, Monash, Saitama, surfactant, visual impairment, hearing impairment, cognitive and executive brain dysfunction, cerebral palsy, learning disabilities, Neonatal Research Network of Japan, Australia and New Zealand Neonatal Network, data dictionaries, delayed cord clamping, cord milking, Kaplan-Meier curves.

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Kumar AR, Kumar Saha SK, Choudhary M. Oral 10% Dextrose was More Effective than Expressed Breast Milk for Pain Relief in Neonates Receiving Their First Dose of Hepatitis B Vaccination. Newborn 2025;4(3):133–137. DOI: 10.5005/jp-journals-11002-0134. 

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Abstract:

Background: Pain management is often overlooked in neonates undergoing minor procedures. Other than traditional analgesics, several nonpharmacological methods, such as expressed breast milk (EBM) and oral sweet solutions like dextrose, have been tried, but the comparative efficacy remains debated.

Objective: To compare the analgesic effects of oral 10% dextrose vs EBM in neonates before they receive their first dose of hepatitis B vaccination.

Materials and methods: A single-center prospective observational study was conducted with 300 neonates randomly assigned into two groups of 150 each. Neonates received either 2 mL of EBM or 10% dextrose 2 minutes before vaccination. Pain was assessed using the Neonatal Infant Pain Scale (NIPS), duration of crying, and heart rate.

Results: Mean NIPS score was significantly lower in the 10% dextrose group (2.1 ± 1.9) compared to the EBM group (5.3 ± 2.7; p < 0.001). The cry time was also significantly lower in the dextrose group (14.67 ± 4.6 s) vs the EBM group (82.24 ± 26.57; p < 0.001). The groups did not differ in the changes in heart rate.

Conclusion: Oral 10% dextrose was more effective than EBM in reducing procedural pain in neonates before they received their first dose of hepatitis B vaccination

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​Key scientific associations: infant, neonatal pain, expressed breast milk, 10% dextrose, NIPS, non-pharmacological analgesia, Neonatal Infant Pain Scale, non-pharmacological pain relief, oral sweet solutions, duration of cry, opioids, non-steroidal medications, topical analgesics, pacifiers, breastfeeding, non-nutritive sucking, kangaroo maternal care, limiting environmental stimuli, swaddling, facilitated tuck, pre-structured proformas, alcohol-dipped cotton swabs, plastic neonatal brain, PIPP-R.

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Krizam G, Dongara AR, Khan NA, Derawi H, Raza SM5, Ali N, Vijayamadhavan V. Neonatal Tuberculosis in Preterm Infants Admitted to a Neonatal Intensive Care Unit in the United Arab Emirates. Newborn 2025;4(3):138–141. DOI: 10.5005/jp-journals-11002-0133. 

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Abstract:

Introduction: Congenital tuberculosis is a rare but serious form of tuberculosis that occurs due to intra- or perinatal transmission of Mycobacterium tuberculosis (M. tuberculosis) from an infected mother to the fetus/infant. We present cases of three premature infants treated at our unit.
Clinical features:
Case 1: A significantly ill mother delivered a female infant at 27 weeks, who tested negative in her initial screening for tuberculosis. However, she deteriorated on postnatal day 40, and the gastric aspirates showed acid-fast bacilli (AFB). There was a good clinical response to antituberculosis treatment.
Cases 2 and 3: Our second and third patients were dichorionic-diamniotic twins born at 26+5 weeks’ gestation.
Twin 2 was on minimal respiratory support until postnatal day 37, when he worsened despite antibiotic therapy; the cultures remained negative. Gastric aspirates for AFB were positive. Once the diagnosis of TB was confirmed in this twin, gastric aspirate samples from twin 1 were tested for AFB but showed inconclusive results. The infant developed progressively worsening respiratory distress on postnatal day 50; he showed a good clinical response to empiric antituberculosis treatment.
Conclusion: Congenital tuberculosis can present with a myriad of signs/symptoms that are often nonspecific. There can be important hints in maternal history and clinical deterioration despite conventional antibiotics. These infants then need to be evaluated specifically for mycobacterial infections.

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Key scientific associations: newborn, neonate, Mycobacterium tuberculosis, gastric aspirates, dichorionic-diamniotic twins, health burden, South-East Asia, Africa, respiratory viral panel, interferon-gamma release assay, lymph node biopsies, cerebrospinal fluid, Tuberculin skin test, TB Polymerase chain reaction, Cantwell guidelines, Beitzke guidelines, congenital tuberculosis, miliary tuberculosis.

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Singh S, Maheshwari A. Transgenerational Epigenetics. Newborn 2025;4(3):142–152. DOI: 10.5005/jp-journals-11002-0137.

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Abstract: Transgenerational epigenetic inheritance is the transmission of epigenetic modifications and markers from one generation to at least two subsequent generations of offspring without altering the primary structure of DNA. It differs from intergenerational transmission of epigenetic marks due to continued exposure of gametes or embryos to environmental factors. The best-studied epigenetic marks include DNA methylation, histone modifications, non-coding RNAs, and chromatin structural changes. Records from the Överkalix cohort in northern Sweden and the Dutch Hunger Winter have provided multigenerational demographic and health data with strong evidence for intergenerational epigenetic effects. In rodent studies, endocrine disruptors, pesticides, and nutritional deficiencies associate ancestral exposures to altered metabolism, fertility, and disease risk in unexposed descendants across generations. Transgenerational epigenetics is a rapidly evolving field that challenges traditional views of inheritance by suggesting that environmentally induced epigenetic information can persist beyond direct exposure and influence phenotypes across generations. However, even though there is compelling evidence from animal models for germline transmission of epigenetic marks, human clinical data are still limited and are often confounded by intergenerational effects and environmental continuity.

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Key scientific associations: neonate, infant, Across indirect epigenetics (AIE), Agouti viable yellow (Avy/a) mouse, Bisphenol A (BPA), chemical tags, direct epigenetics, DNA methylation, Dutch Hunger Winter study, epigenetics, gene expression, heritable, Infant, inherited, intergenerational inheritance, metabolic reprogramming, metastable epialleles, molar or top down epigenetics, molecular or bottom-up epigenetics, paramutation, polymorphisms, polyphenisms, post-translational modification, RNA silencing, soft inheritance, transgenerational epigenetic variation, transgenerational inheritance, Vinclozolin, within-indirect epigenetics (WIE).

 

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More K, Sahni M, Maheshwari A. Systemized Systemic Sono-screening (S4) Protocol: Initial Findings. Newborn 2025;4(3):153–155. DOI: 10.5005/jp-journals-11002-0135.

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Abstract: ​The authors are developing a systemized protocol for major-system sonographic screening, an extended physical examination in critically-ill infants. This program includes a brief examination of the brain, heart, lungs, intestine, and genitals. We also check the central line catheters for correct positioning and complications such as thrombi. This protocol gives more information than the traditional point-of-care ultrasound (POCUS) developed over the past two decades. In our recent screening of medical records, we have noted a high incidence of intracardiac thrombi in the right cardiac chambers. Some of these thrombi could well result from the longer durations for which umbilical venous catheters (UVCs) were used, but not every patient had undergone umbilical venous catheterization. The perception of lower blood flow velocities on the right side as a causative factor may also not be entirely correct; the hemodynamic measurements may vary at specific location(s) within the vessels/chambers, at various time-points in the cardiac cycle, and with physiological conditions such as ventricular hypertrophy. The high frequency of clots in the right heart chambers needs evaluation in larger, carefully designed studies.

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Key scientific associations: neonate, infant, Baby, echocardiography, intra-cardiac thrombi, Point-of-Care Ultrasound (POCUS), sonographic screening, subcostal views, systemized protocol, umbilical venous catheters, umbilical arterial catheters, central line catheters, blood flow velocities, ventricular hypertrophy.

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Rao AG, Maheshwari A. Clinical Illustration: Autosomal Recessive Polycystic Kidney Disease. Newborn 2025;4(3):156–158. DOI: 10.5005/jp-journals-11002-0138.

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Abstract: This article presents illustrative images suggestive of autosomal recessive polycystic kidney disease (ARPKD) from a young child born at full-term gestational age. She had a prior history of repeated episodes of fevers, and during her systemic evaluation, she was noted to have abnormal plasma renal function indices. Renal ultrasound showed enlarged kidneys with increased echogenicity, multiple cysts of varying sizes, and loss of normal corticomedullary differentiation. Sonographic images of the liver showed two anechoic cystic areas, possibly representing a combination of von Meyenburg complexes (biliary hamartomas) and focal intrahepatic biliary dilation, indicating Caroli disease.

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Key scientific associations: Neonate, Baby, Autosomal recessive polycystic kidney disease, Biliary hamartomas, Caroli disease, Caroli syndrome, Congenital hepatic fibrosis, Focal intrahepatic biliary dilation, Infant, Oligohydramnios, Polycystic kidney and hepatic disease 1, Renal tubular ectasia, von Meyenburg complexes.