[Posted 23/May/2023]

AUDIENCE: Nursing

KEY FINDINGS: Newborn survival can be improved through regular training of maternity health workers in evidence-based newborn care.

BACKGROUND: Under-5 mortality has declined globally; however, proportion of under-5 deaths occurring within the first 28 days after birth has increased significantly. This study aims to determine the impact of an educational intervention on neonatal care and survival rates in Nigeria.

DETAILS: This was a sequential exploratory mixed-methods design involving 21 health workers in the preintervention phase, while 15 health workers and 30 mother-baby dyads participated in the postintervention phase. Data were collected using semistructured interviews and nonparticipatory observation. Qualitative data were analyzed using thematic analysis, while quantitative data were analyzed using descriptive and inferential statistics. Healthy newborns were routinely separated from their mothers in the preintervention period. During this time, non-evidence-based practices, such as routine nasal and oral suctioning, were performed. Skin-to-skin contact and early initiation of breastfeeding were frequently interrupted. After the intervention, 80.6% were placed in skin-to-skin contact with their mothers, and 20 of these babies maintained contact with the mother until breastfeeding was established. There was decline in neonatal deaths post-intervention. Independent t-test analysis of the day of neonatal death demonstrates a significant difference in mean (P = .00, 95% confidence interval -5.629; -7.447 to -4.779).

Copyright © Wolters Kluwer Health, Inc. and/or its subsidiaries. All rights reserved.

Source: Emmanuel, Kain, V., and Forster, E. (2023). The Impact of an Educational Intervention on Neonatal Care and Survival. Journal of Perinatal and Neonatal Nursing. 2023; 37(2): 138-147. Published: April/June, 2023. DOI: 6655574.

Clinical Characteristics and Neurodevelopmental Outcomes in 30 Patients

[Posted 19/Jun/2026]

AUDIENCE: Neurology, Neonatology

KEY FINDINGS: KCNQ2-related neonatal epilepsy shows robust, topology-dependent genotype-phenotype correlations with prognostic utility: early EEG patterns flag risk; transmembrane missense variants are associated with DEE, whereas single-allele truncating/NMD variants are associated with SeL(F)NE. Apparent benefits of oxcarbazepine reflect associations in an observational cohort and should not be interpreted as causal; prospective, phenotype-stratified studies are warranted. Long-term developmental surveillance remains essential, particularly for individuals with DEE and those with severe early EEG patterns or variants in transmembrane/pore regions.

BACKGROUND: The aim of this study was to characterize clinical features, genetic architecture, treatment responses, and neurodevelopmental outcomes in neonatal epilepsy associated with KCNQ2 variants and to delineate genotype-phenotype correlations.

DETAILS: Authors conducted a retrospective, two-center study of 30 neonates from 2019 to 2024. All patients underwent whole-exome sequencing with Sanger confirmation and, at last follow-up, were classified, according to International League Against Epilepsy criteria as having self-limited (familial) neonatal epilepsy (SeL[F]NE) or developmental and epileptic encephalopathy (DEE). Primary outcomes were seizure freedom by 6 months and milestone-based three-level neurodevelopment (normal/mild/severe). Clinical/EEG/MRI features and variant class/topology were compared across phenotypes. Most infants presented in the first week of life (median 3 days), typically with focal tonic seizures. EEG abnormalities were common (90%); burst-suppression/profound discontinuity consistently signaled adverse neurodevelopment. MRI was often normal (53%) or nonspecific. Authors identified 29 distinct variants (32 occurrences) across 30 patients. Twenty-eight carried a single heterozygous variant, and 2 carried 2 heterozygous variants (phase not determined); missense variants predominated (21/30, 70%). Clear topology-phenotype patterns emerged: transmembrane missense variants—especially S5-pore-S6—were enriched in DEE, whereas C-terminal/nontransmembrane variants were associated with SeL(F)NE and benign outcomes. At the last follow-up, SeL(F)NE accounted for 63% and DEE 37%. Seizure freedom reached 93%. Oxcarbazepine was often associated with seizure control after phenobarbital nonresponse, but this observational signal should not be interpreted as causal. Neurodevelopment was normal in 63%; delays occurred only within the DEE cohort. All 5 single-allele truncating/NMD lesions (CNV deletion, canonical splice-site, 2 nonsense, 1 frameshift) aligned with SeL(F)NE, whereas the 2 individuals with 2 heterozygous variants were classified as DEE with marked impairment; however, phase was not determined and 1 recurrent variant (p.E515D) was classified as likely benign, precluding inference of 2 pathogenic alleles.

Copyright © American Academy of Neurology. All Rights Reserved.

Source: Li, Y., Li, J., Li, L., et al. KCNQ2 Variants in Neonatal Epilepsy: Clinical Characteristics and Neurodevelopmental Outcomes in 30 Patients. Neuro Genetics. 2026; 12(3): e200380. Published: June, 2026. 12(3): e200380. DOI: 10.1212/NXG.0000000000200380.

ISUOG vs Delphi Diagnostic Criteria

[Posted 18/Jun/2026]

AUDIENCE: Ob/Gyn, Neonatology

KEY FINDINGS: While the detection rate of sFGR was higher using the Delphi criteria compared with the ISUOG criteria, the additional cases identified solely using the Delphi definition had significantly lower perinatal morbidity and mortality compared with those meeting the ISUOG definition for sFGR. Nonetheless, each constituent criterion within the Delphi definition was independently associated with adverse outcome in sFGR twin pregnancy. Further research is needed to elucidate the most appropriate tools for diagnosing and classifying MCDA twin pregnancies complicated by sFGR.

BACKGROUND: Purpose of this study is to evaluate the diagnostic performance of the Delphi consensus definition for selective fetal growth restriction (sFGR), compared with the traditional definition recommended by the International Society of Ultrasound in Obstetrics and Gynecology (ISUOG), in predicting adverse perinatal outcome in monochorionic diamniotic (MCDA) twin pregnancy.

DETAILS: This was a retrospective cohort study of MCDA twin pregnancies followed at a tertiary fetal medicine unit between January 2000 and January 2024. Cases diagnosed with twin-to-twin transfusion syndrome or twin anemia–polycythemia sequence before or at the time of sFGR diagnosis and those with fetal structural or genetic anomaly were excluded. Fetal growth was assessed using chorionicity-specific twin reference charts and sFGR was diagnosed using the ISUOG or Delphi definition. Logistic regression analysis was used to evaluate the performance of each constituent criterion of the Delphi definition in identifying cases at risk of adverse outcome. The diagnostic performance of the ISUOG and Delphi criteria was assessed using receiver-operating-characteristics (ROC)-curve analysis. The final analysis included 363 MCDA twin pregnancies, of which 110 (30.3%) were diagnosed with sFGR using the Delphi consensus definition. The ISUOG criteria identified only 53/363 (14.6%) cases as sFGR. The rate of intact survival of both twins was significantly lower among the 53 cases diagnosed using ISUOG criteria compared with the 57 cases diagnosed solely using Delphi criteria (26.4% vs 63.2%), with significantly lower neonatal morbidity in the latter group. Logistic regression analysis showed that each constituent criterion of the Delphi definition was associated independently with significantly reduced intact survival of both twins. All combinations of Delphi criteria showed low-to-moderate discriminative ability in predicting the demise of the smaller and/or larger twin (all areas under the ROC curve > 0.6). The Delphi criteria had slightly higher sensitivity (0.840 vs 0.789) but lower specificity (0.743 vs 0.877) compared with the ISUOG criteria for predicting the demise of the smaller twin. Similar results were obtained for the prediction of larger twin demise and double fetal demise.

Copyright © John Wiley & Sons, Inc. All rights reserved

Source: Sorrenti, S., Yaghi, O., Prasad, S., et al. Perinatal Outcome of Monochorionic Twin Pregnancy Complicated by Selective Fetal Growth Restriction: ISUOG vs Delphi Diagnostic Criteria. Ultrasound in Obstetrics and Gynecology. 2026; 67(6): 774-782. Published: June, 2026. DOI: 10.1002/uog.70239.

A Single-Centre, Open-Label, Phase 2 Trial

[Posted 16/Jun/2026]

AUDIENCE: Hematology, Oncology

KEY FINDINGS: Adverse events were few, probably due to organ sparing by total marrow and lymphoid irradiation. Total marrow and lymphoid irradiation 2000 cGy could be safely delivered in combination with high-dose etoposide and cyclophosphamide. The regimen was associated with encouraging 2-year progression-free survival rates.

BACKGROUND: Total marrow and lymphoid irradiation delivers augmented doses of radiation to the bone marrow and lymph nodes while maintaining low doses to vital organs. We aimed to assess the effectiveness of combining total marrow and lymphoid irradiation (2000 cGy to bone marrow and lymph nodes) with high-dose cyclophosphamide and etoposide as a conditioning regimen before allogeneic haematopoietic cell transplantation (HCT) in patients with relapsed or refractory acute leukaemia.

DETAILS: This single-centre, open-label, phase 2 trial with an initial six-patient safety lead-in, conducted in the USA, enrolled patients aged between 16 and 60 years with relapsed or refractory acute myeloid leukaemia or acute lymphoblastic leukaemia. Total marrow and lymphoid irradiation was given on days -9 to -5, etoposide 60 mg/kg on day -4, and cyclophosphamide 100 mg/kg on day -2. Bone marrow or peripheral blood stem cells from sibling or matched or one allele mismatched unrelated donors were infused on day 0. Graft versus host disease prophylaxis consisted of tacrolimus and sirolimus. The primary endpoint for the initial safety lead-in segment was toxicity and for the phase 2 study was 2-year progression-free survival. All patients who began treatment were included in the analysis. This trial is registered with ClinicalTrials.gov, NCT02094794, and is closed to accrual. Between May 9, 2014, and Mar 5, 2024, 107 patients were enrolled and screened for eligibility. One did not meet eligibility criteria (uncontrolled cytomegalovirus). 106 received conditioning radiation and HCT per protocol. Median follow-up was 1·8 years (IQR 0·6-3·0) for all patients and 3·1 years (2·1-4·9) for patients who were alive at last contact. None of the six patients in the safety lead-in experienced unacceptable toxicity. 49 (46%) of 106 patients were female and 57 (54%) were male. 72 (68%) of patients were White and 22 (21%) were Asian or Pacific Islander. The 2-year estimate of progression-free survival in all patients was 34% (95% CI 25-43%). The most common grade 3-4 adverse events were cytopenias 96 (91%), metabolic disorders 83 (78%), oral mucositis 45 (42%), diarrhoea 25 (24%), nausea 21 (20%), and palmar-plantar erythrodysesthesia syndrome 11 (10%). One patient died of sinusoidal obstruction syndrome attributed to the conditioning regimen.

Copyright © Elsevier Ltd. All rights reserved.

Source: Stein, A., Wang, Y., Malki, M., et al. Total Marrow and Lymphoid Irradiation in Combination With Cyclophosphamide and Etoposide Before Haematopoietic Cell Transplantation for Relapsed or Refractory Acute Leukaemia: A Single-Centre, Open-Label, Phase 2 Trial. The Lancet Haematology. 2026; 13: e365-e375. Published: May, 2026. DOI: 10.1016/S2352-3026(26)00014-1.

[Posted 15/Jun/2026]

AUDIENCE: Infectious Disease, Internal Medicine

KEY FINDINGS: Study results suggest that clinicians should initiate antiviral chemoprophylaxis for at least 70% of eligible NH residents within 2 days of outbreak detection to lower risk of hospitalization.

BACKGROUND: Influenza outbreaks in nursing homes (NHs) pose a substantial threat to older adults, often resulting in morbidity and mortality. The Centers for Disease Control and Prevention (CDC) and the Infectious Diseases Society of America (IDSA) recommend prompt postexposure prophylaxis, also termed chemoprophylaxis or prophylaxis with oseltamivir, for all residents who are not ill to limit influenza spread in NHs. Purpose of the study is to examine whether initiating antiviral chemoprophylaxis for 70% or more of eligible NH residents within 2 days of influenza outbreak detection is associated with lower all-cause mortality and hospitalization at 14 and 30 days.

DETAILS: Retrospective cohort study using a sequential cluster-randomized target trial emulation and randomize-censor-weight approach for influenza outbreaks (September 1, 2018-May 31, 2022) in 12 US NH corporations. Eligibility criteria were age 18 years or older, present on the outbreak-detection day, no antiviral use in the preceding 7 days, no influenza in the past 14 days, and complete baseline data. Residents were followed up until hospitalization or death, an NH discharge to a nonacute-care location, or the end of follow-up. Data were analyzed from February 2023 to January 2026.

Exposures: Intensive antiviral chemoprophylaxis with oseltamivir (>=70% of eligible residents within 2 days of outbreak detection) or nonintensive antiviral chemoprophylaxis (0% to <70% of eligible residents).

Outcomes were all-cause death and hospitalizations within 14 and 30 days of outbreak detection. Discrete-time hazard models with pooled logistic regression were applied to estimate weighted risks, risk differences (RDs), and risk ratios (RRs).

Among 404 outbreaks in 318 NHs, 35,086 resident-trial observations (29,683 residents; median age 78 [IQR, 68- 86] years; 60% women; 81% White; 76% vaccinated) met eligibility criteria. Intensive oseltamivir prophylaxis was randomized to 17,155 observations; 17,931 were randomized to nonintensive care. At 14 days, intensive prophylaxis vs nonintensive yielded an RD of -0.06% (95% CI, -0.73% to 0.93%) and an RR of 0.96 (95% CI, 0.56-1.57) for death, and an RD of -0.96% (95% CI, -1.78% to -0.19%) and an RR of 0.79 (95% CI, 0.64-0.96) for hospitalization. At 30 days, the hospitalization differences persisted but were less precise and there continued to be no difference in death.

Copyright © American Medical Association. All Rights Reserved.

Source: Silva, J. B. B., Hsieh, H. T., Howe, C. J., et al. Prompt and Intensive Antiviral Chemoprophylaxis in Nursing Home Influenza Outbreaks. JAMA Internal Medicine.. 2026; 186(6): 714-722. Published: June, 2026. DOI: 10.1001/jamainternmed.2026.0401

A Nationwide Analysis

[Posted 12/Jun/2026]

AUDIENCE: Hospice & Palliative Nursing, Oncology

KEY FINDINGS: Hospice involvement was associated with lower use and reduced exposure to broad-spectrum antibiotics among patients with cancer near the end of life. These findings support the alignment of end-of-life treatment decisions with the comfort-oriented goals of hospice care.

BACKGROUND: Authors aimed to compare broad-spectrum antibiotic use between hospice and non-hospice patients with cancer at the end of life using nationwide data from Korea.

DETAILS: In this retrospective cohort study, authors analyzed the Korean National Health Insurance Service data of adult patients with cancer who died between 2018 and 2021. Hospice users were defined as patients who received inpatient, home-based, or consultation-based hospice care before death. Authors applied propensity score matching (1:2) to balance the baseline characteristics of the hospice and non-hospice groups. Broad-spectrum antibiotic use, including anti-pseudomonal penicillins, anti-pseudomonal cephalosporins, carbapenems, and glycopeptides, was assessed during the last 3 months of life using prescription proportions and days of therapy per 1,000 patient-days. After matching, 38,102 hospice and 75,736 non-hospice users were analyzed. During the last 3 months of life, 74.6% of hospice and 79.0% of non-hospice users received at least one broad-spectrum antibiotic (P<0.001). The proportion of patients receiving broad-spectrum antibiotics was generally lower among hospice users across all time intervals (P<0.001), and the number of days of therapy was also lower, with the largest differences observed during the final week and last 3 days of life. Subgroup analyses showed the highest antibiotic exposure among patients with hematologic and pancreatobiliary cancers, particularly in the non-hospice group.

Copyright © Journal of Hospice and Palliative Care. All rights reserved.

Source: Jeung, Y. S., Kim, G. J., Yu, J., et al. Comparison of Broad-Spectrum Antibiotic Use According to Hospice Utilization Among Patients with Cancer at the End of Life in South Korea: A Nationwide Analysis. v. 2026; 29(2): 41-50. Published: June, 2026. DOI: 10.14475/jhpc.2026.29.2.41