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OBJECTIVE: The aim of the study is to examine the clinical significance of extreme leukocytosis (>40,000 cells/µL) at birth among neonates. STUDY DESIGN: Data were retrospectively collected on 208 infants with leukocytosis >40,000 cells/µL and on matched normal controls as determined in complete blood counts obtained on the first day of life. RESULTS: There were no significant group differences in birth weight, Apgar's score, timing of respiratory support, hospitalization in special care units or rehospitalization during the first month of life. All neonates with leukocytosis received antibiotics. The blood cultures of both groups were negative. A multivariate analysis showed that leukocytosis did not predict either the presence of symptoms associated with sepsis among neonates or hospitalization in a neonatal special care unit. CONCLUSION: Extreme leukocytosis on the first day of life is a poor predictor of infection. Clinicians should decide upon treatment according to risk factors and symptoms but not according to the degree of leukocytosis. KEY POINTS: · Extreme leukocytosis on the first day of life is a poor predictor of infection.. · Clinicians should decide upon treatment according to risk factors and symptoms.. · Leukocytosis was not predictive of a higher risk of morbidity in neonates..

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INTRODUCTION: Skin lesions seen after delivery are frequent and mostly shallow, without the need for special care or diagnosis challenge. In the following case, an infant was born at 35 weeks gestation, presented after the delivery with a well-demarcated, necrotic plaque over the right forearm with neurologic deficit. The differential diagnosis includes life-threatening reasons, therefore, emergent laboratory and imaging tests were held. Treatment was given after consulting a multidisciplinary team of experts, including antibiotic treatment, blood products and anticoagulation and physiotherapy treatment was started. Under this treatment, improvement was noticed but there was still a motor restriction. He was discharged home on his 24th day of life, with the working diagnosis of Congenital Volkmann Ischemic Contracture (CVIC). On his seventh week of life, he arrived to the emergency room with focal seizure resulting from an infarct seen on an MRI. He was diagnosed with cerebral palsy at the age of five months. In conclusion, Congenital Volkmann Ischemic Contracture is a rare diagnosis, however, awareness is of importance since fast treatment is crucial for future prognosis.

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INTRODUCTION: Necrotizing enterocolitis (NEC) is a major cause for morbidity and mortality among neonates, especially among low birth weight premature infants. Even though NEC has been highly investigated during the last few decades, understanding of the pathogenesis is still relatively poor. Throughout the years protective measures, as well as risk factors, were identified, but there is still no clear prevention strategy, and the percentage of neonates suffering of NEC was not changed. Moreover, the treatment approach is controversial in many circumstances other than a few clear surgical indications. The decision between conservative and surgical treatment in many situations is in the hands of the medical staff. Herein we present the story of a premature infant who suffered from feeding intolerance since birth, with major clinical deterioration after receiving packed red blood cells (PRBCs) transfusion. She was diagnosed with NEC and was treated conservatively, with clinical improvement and worsening alternately, until a colonic stricture was identified and treated surgically. We will provide a short review on risk factors, preventive measures, as well as the research regarding PRBCS transfusion and NEC development.

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Small for gestational age preterm are at increased risk for future metabolic syndrome. Early indication for the disrupted metabolism may be found in the perinatal period. We aimed to evaluate whether small for gestational age preterm infants are at increased risk for hypertriglyceridemia when treated with lipid emulsions, and to investigate the association between triglyceride levels and morbidity. Small for gestational age infants ≤ 34 weeks' gestation age born during 2013-2016 were matched and compared with appropriate for gestational age counterparts. Triglyceride concentration > 250 mg/dL during treatment with parenteral nutrition was considered high. The study included 71 pairs of preterm infants. Hypertriglyceridemia was documented among 22.5% of the small for gestational age infants vs. 5.6% of the appropriate for gestational age infants (p = 0.007). Mean triglyceride levels were 194.4 ± 192.3 mg/dL and 99.9 ± 82.8 mg/dL, respectively (p < 0.001). Small for gestational age was predictive of hypertriglyceridemia (OR = 6.41; 95% CI 1.8-22.9). No significant association was found between triglyceride levels and morbidities in multivariate analysis.Conclusion: Small for gestational age preterm infants receiving lipid emulsions might be at a higher risk for hypertriglyceridemia. Routine monitoring of triglyceride levels will enable identification of the necessity for a slower increase in lipid emulsion therapy. What is Known: • Moderate and very preterm infants are routinely treated with lipid emulsions. • Small for gestational age (SGA) infants may have different metabolism, as they demonstrate higher risk for metabolic syndrome. What is New: • • SGA infants had a higher mean triglyceride level and more commonly had early hypertriglyceridemia (triglycerides > 250 mg/dL) compared with appropriate for gestational age infants treated with the same intravenous lipid dose. Small for gestational age was predictive of hypertriglyceridemia. • No significant association was found between triglyceride levels and morbidities in multivariate analysis.

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Introduction: Computed tomography (CT) imaging should be employed judiciously, given its cost, use of intravenous contrast, and ionizing radiation. The aim of this study was to determine the clinical benefit of a CT scan in the evaluation of refractory puerperal fever and to identify the appropriate candidates for its use.Methods: This was a retrospective cohort study conducted in a single tertiary care center between January 2007 to April 2017. Indications for CT scan were refractory postpartum fever of ≥3 days and/or ultrasound findings suggesting complex abdominal fluid collection. Primary outcome was defined as a change in the mode of treatment due to the CT findings. In addition, a multivariate analysis of risk factors for puerperal fever was performed to identify patients who would benefit from the CT scan evaluation.Results: There were 520 women that underwent an abdominal and pelvic CT scan during the study period, 238 (45.7%) met inclusion criteria, 94 (39.5%) had a normal CT scan, and 144 (60.5%) had abnormal findings including 32 (13.4%) cases with pelvic thrombophlebitis and 112 (47%) cases with pelvic fluid collections. Results of the CT changed clinical management in 93 (39.0%) patients, including: switching antibiotics in 24 (10%) patients, adding low molecular weight heparin for 28 (11.8%) patients, and surgical intervention (laparotomy or drainage insertion) in 41 (17.2%) patients. In the regression model, we didn't find any significant risk factors associated with treatment change following the CT scan.Conclusions: Abdominal and pelvic CT scan in women with refractory puerperal fever has a high clinical yield and lead to a change in management in a substantial number of patients.

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BACKGROUND: The need for postnatal monitoring of infants exposed to intrauterine beta blockers (BBs) has not been clearly defined. OBJECTIVES: To evaluate infants exposed to intrauterine BBs in order to estimate the need for postnatal monitoring. METHODS: This retrospective case-control study comprised 153 term infants born to mothers who had been treated with BBs during pregnancy. Treatment indications included hypertension 76 mothers (49.7%), cardiac arrhythmias 48 (31.4%), rheumatic heart disease 14 (9.1%), cardiomyopathy 11 (7.2%) and migraine 4 (2.6%). The controls were infants of mothers with hypertension not exposed to BBs who were born at the same gestational age and born closest (before or after) to the matched infant in the study group. RESULTS: Compared to the control group, the infants in the study group had a higher prevalence of early asymptomatic hypoglycemia (study 30.7% vs. control 18.3%, P = 0.016), short symptomatic bradycardia events, other cardiac manifestations (P = 0.016), and longer hospitalization (P < 0.001). No life-threatening medical conditions were documented. The birth weight was significantly lower for the high-dose subgroup compared to the low-dose subgroup (P = 0.03), and the high-dose subgroup had a higher incidence of small-for-gestational-age (P = 0.02). CONCLUSIONS: No alarming or life-threatening medical conditions were observed among term infants born to BB treated mothers. These infants can be safely observed for 48 hours after birth close to their mothers in the maternity ward. Glucose follow-up is needed, especially in the first hours of life.

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OBJECTIVE: The aim of this study was to compare the pregnancy outcome of two different management strategies: outpatient versus inpatient in women with prenatal diagnosis of vasa previa. MATERIALS AND METHODS: This is a retrospective cohort study conducted at a single tertiary center. Women with a prenatally diagnosed vasa previa between January 2007 and June 2017 were included. Obstetric and neonatal outcomes were compared between two management strategies: elective admission at 34 weeks of gestation or outpatient management unless there were signs of labor or premature contractions. RESULTS: A total of 109 women met the inclusion criteria: 75 (68.8%) women in the inpatient group and 34 (31.2%) in the outpatient group. Women in the inpatient group were more likely to receive antenatal steroids (57.3 vs. 26.4%, p = 0.002) and were less likely to have an urgent cesarean section (34.6 vs. 58.8%, respectively, p < 0.001) compared with outpatient group. There was no difference in the rate of neonatal complications (inpatient: 64.6% vs. outpatient: 52.7%, p = 0.27) or neonatal anemia requiring transfusion (2.7 vs. 5.8%, respectively, p = 0.5) between the groups. CONCLUSION: The rate of elective cesarean section and exposure to antenatal steroids was higher in patients with vasa previa who were admitted electively at 34 weeks of gestation compared with patients who were managed as outpatient.

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OBJECTIVE: The aim of this study was to evaluate obstetric outcomes in relation to the extent of donor sperm exposure with and without egg donation. MATERIALS AND METHODS: This is a retrospective cohort study in a single tertiary care center. All women with a singleton pregnancy who conceived following sperm donation (SD) were included. Obstetrics and neonatal outcomes for pregnancies following single SD were compared with pregnancies following repeat SD from the same donor. In a secondary analysis, we compared pregnancy outcomes among three modes of assisted reproductive technology (intrauterine insemination [IUI-SD], in vitro fertilization [IVF-SD], and IVF sperm + egg donation [IVF-SD + ED]). RESULTS: A total of 706 pregnant women met the inclusion criteria, 243 (34.4%) following the first SD and 463 (65.6%) following repeat donations. Compared with repeat SDs, single donation was not associated with higher rates of preterm delivery (12.8 vs. 12.7%, respectively, p = 0.99), preeclampsia (7.0 vs. 6.9%, p = 0.999), and intrauterine growth restriction (4.1 vs. 3.9%, p = 0.88). Pregnancies following IVF-SD + ED had increased risk for preeclampsia (adjusted odds ratio [AOR], 3.1; 95% confidence interval [CI], 1.5-6.6), preterm labor (AOR, 2.4; 95% CI, 1.1-5.4), and cesarean section (AOR, 2.1; 95% CI, 1.0-4.3) compared with IUI-SD and IVF-SD. CONCLUSION: The extent of donor sperm exposure did not correlate with obstetrics complications, but double gamete donation was associated with increased risk for preeclampsia, preterm labor, and cesarean section.

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OBJECTIVE: To evaluate the impact of a quality improvement intervention during the first hour of life ("Golden Hour") on short-term preterm neonatal outcome. STUDY DESIGN: A comprehensive protocol designed for initial stabilization and treatment of preterm infants that included cord blood sampling, use of a dedicated resuscitation room and improved team communication using Crew Resource Management tools. The infants admitted before and after implementation of the protocol were retrospectively compared in a matched case-control design. RESULTS: There were 194 infants in the intervention group and 194 controls. Admission temperatures improved significantly from a mean of 35.26 °C to 36.26 °C (P < 0.001), and late-onset sepsis and bronchopulmonary dysplasia rates lowered significantly (P = 0.035 and P = 0.028, respectively) in the intervention group. There was trend towards reduction in early blood transfusion and ventilation duration. CONCLUSIONS: A "Golden Hour" quality improvement intervention was of significant benefit for preterm neonates. Further follow-up to assess long-term effects is warranted.

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INTRODUCTION: Advanced maternal age (AMA) is associated with increased risk for preeclampsia, however, a paucity of data exists regarding the characteristics of the disease in this age group. Our aim was to compare the characteristics and severity of preeclampsia in older and younger gravidas. MATERIALS & METHODS: A retrospective, small case control study of women diagnosed with preeclampsia in a single tertiary care center. Nulliparous women ≥40 years old with singleton pregnancies ≥ 24 0/7 weeks' gestation were matched (1:2 ratio) with young (20-34 years old) nulliparous women. RESULTS: The rate of severe preeclampsia (60.9 vs 69.6% respectively), HELLP, eclampsia or the need for magnesium treatment did not differ between the groups. However, the AMA group had an increased rate of postpartum presentation or exacerbation of preeclampsia compared to the control group (50.0 vs. 28.3% respectively, p = 0.01). In the AMA group, 93.5% of births were by cesarean section (CS) compared to 52.2% in the control group (p < 0.0001). There was no difference in birthweight, rate of small for gestational age or composite neonatal morbidity between the groups. CONCLUSIONS: Preeclampsia at an advanced maternal age carries a similar rate of severe preeclampsia and complications as in young women. However, women over 40 years old have an increased risk for presentation or exacerbation of preeclampsia in the postpartum period and an increased rate of CS compared to younger gravidas.

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AIM: To evaluate the perinatal and postnatal risk factors for various brain pathologies among preterm twins. METHODS: Retrospective data of 104 twin pairs of which one of the siblings had evidence of abnormal head ultrasound (HUS) and its co-twin with normal HUS served as control. RESULTS: Abnormal HUS consisted of periventricular echodensities among 69 infants, intraventricular hemorrhage among 28 infants, cystic periventricular leukomalacia among 10 infants, and other parenchymal brain pathologies among 5 infants. Perinatal and postnatal complications were similar between study and controls. Siblings with severe brain pathologies were ventilated for longer time over their co-twins. In 10 out of 11 cases of discordant twins (≥20%) with severe brain pathology, the severe pathology was recorded in the larger sibling. CONCLUSIONS: Our study results, which included matched preterm twin pairs for study/control groups to evaluate risk factors for the overall evidence of brain injury, could not determine specific risk factors for these brain pathologies. The finding that severe brain pathologies were more common among the larger co-twin requires further study of and attention to short- and long-term outcomes and the potential conflicts that may arise.

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OBJECTIVES: To determine the incidence, risk factors and outcomes associated with transient and/or persistent periventricular echodensities (PVED) among preterm infants. METHODS: Medical records of preterm infants born at ≤ 32 weeks gestational age (GA) with PVED and no other brain pathology were reviewed and compared to matched control infants in a case-controlled retrospective study. Neurodevelopmental outcomes at 8-24 months corrected age were documented. RESULTS: A 17.8% incidence of PVED was recorded, with the highest incidence of 30-40% recorded at 29-31 weeks GA. Study and control groups were similar for all maternal parameters and neonatal morbidities, except for a higher incidence of respiratory distress syndrome among the study group. PVED at one month of age was predicted by 5 min Apgar score < 7 [OR = 33.78 (CI 2.94-388.06, p = 0.005)]. PVED was not associated with long-term neurodevelopmental disability. CONCLUSIONS: No risk factors or specific associated morbidities were identified among preterm infants with transient PVED. PVED at one month of age was predicted by low 5 min Apgar scores, possibly suggesting different pathogenesis or timing between the groups. Long-term outcome studies are needed to determine PVED impact.

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Background Measuring fetal abdominal circumference (AC) prenatally is an effective tool for predicting neonatal weight and macrosomia. Data are lacking regarding the outcome of newborn infants with prenatal diagnosis of large AC. Aim The aim of this study was to evaluate early short-term neonatal outcome among term singleton newborn infants with prenatal diagnosis of large AC. Methods Retrospective data were collected on 501 term infants with prenatal diagnosis of large AC (≥ 360 mm) and on matched controls, including information on maternal condition and on infant perinatal complications. Results In compare with controls, the study group had higher incidence of macrosomia (188 [37.5%] vs. 18 [3.6%], p < 0.001), hypoglycemia (48 (9.6%) vs. 25 [5%], p = 0.007), and significant morbidity (49 [9.8%] vs. 28 [5.6%], p = 0.017) but without increased incidence of congenital malformations or other perinatal complications. Only among the macrosomic, study subgroup and their controls differences were recorded including hypoglycemia (17.6 vs. 4.8%, p < 0.001), need for oral glucose (11.2 vs. 2.7%, p = 0.002), significant morbidity (10.1 vs. 3.7%, p = 0.024), and hospitalization in special care unit (11.7 vs. 4.3%, p = 0.012). Conclusion Prelabor diagnosis of large AC mostly reflects the infant's high birth weight and macrosomia with the associated perinatal complications. Large AC by itself was not predictive of any congenital malformations or perinatal and postnatal complications.

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AIM: The aim of the study is to examine whether baseline serum Mg concentration has an impact on short-term and long-term outcomes in preterm infants exposed antenatally to MgSO4. METHODS: Participants included all infants admitted to the neonatal intensive care unit at <32 weeks of gestational age. Infant serum Mg concentration (iMgC) was examined immediately after birth in those exposed to maternal MgSO4. Data for short-term outcomes were collected from the infants' computerised charts. Neurodevelopmental outcomes at 6-12 months corrected age were assessed using the Griffiths Mental Developmental Scales. RESULTS: Of 197 eligible infants, 145 were exposed to MgSO4. Baseline iMgC was available for 88 infants. Mean iMgC was 3.5 ± 0.88 mg/dL (1.6-5.7 mg/dL). Baseline iMgC was not associated with an increased risk for neither early morbidities nor adverse long-term outcome. However, iMgC above the mean (>3.5 mg/dL) was associated with significantly lower scores on locomotor (P = 0.016) and personal-social (0.041) scales in the first year of life. CONCLUSIONS: In a cohort of preterm infants antenatally exposed to MgSO4, elevated baseline iMgC (>3.5 mg/dL) was associated with lower locomotor scores. Further research is needed in order to study the relationship between supra-physiologic iMgC and its effect on the developing brain.

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BACKGROUND: Among term infants, ABO incompatibility is a leading cause of hemolytic disease and neonatal jaundice. With respect to preterm infants, data are lacking. OBJECTIVE: To evaluate the incidence and severity of ABO incompatibility hemolytic disease among preterm infants with respect to hemolytic and jaundice parameters. DESIGN: Clinical and laboratory data were collected retrospectively from the medical records of 118 ABO-incompatible preterms born at gestational age (GA) 29-34 weeks, as well as 118 controls matched for GA, birth weight, and multiplicity. All infants were born at the Sheba Medical Center Tel-Hashomer between 2009 and 2012. RESULTS: The study and control groups were similar on all maternal and neonatal outcome parameters. No differences between the groups were recorded throughout hospitalization regarding hematocrit levels or the need for blood transfusion. Bilirubin levels were higher among the study (ABO-incompatible) group during the first 10 days of life; however, no significant differences were found regarding the need for phototherapy. Upon evaluating subgroups divided by GA, we found no differences on any hematological and jaundice factors among preterms of 29-31 weeks, whereas among preterms of 32-34 weeks higher positive direct antiglobulin test (DAT) results (7% vs. 0% in the control, P = 0.014) as well as higher bilirubin levels were documented. CONCLUSIONS: Among ABO-incompatible preterm infants with GA 29-34 weeks, there is no evidence of significant hemolytic reaction derived from placental transfer of antibodies. With increasing GA, antibody transfer becomes more significant, resulting in more positive DAT results and greater incidence of neonatal jaundice.

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OBJECTIVE: To study the pattern of thyroid function testing in healthy newborns during the first year of life. STUDY DESIGN: We used the computerized database of a health management organization. Among the 18,507 infants insured by the Clalit Health Services born in the Sheba Medical Center between 2002 and 2007, 652 full-term healthy newborns with birth weight >2 kg and no significant perinatal morbidity underwent thyrotropin (TSH) determination as outpatients in their first year of life. The Clalit Health Services database provided demographic data, laboratory results, and dispensed medications for the newborns and their mothers. RESULTS: Initial serum TSH levels were within normal range (0.35-5.5 mIU/L) in 91.1%, elevated (> 5.5-≤ 10 mIU/L) in 8.3%, and highly elevated (>10 mIU/L) in 0.6% of the studied cohort. The 97.5 and 2.5 percentile values were 7.4 and 0.74 mIU/L, respectively. TSH measurements were repeated in 34.2%, 72.2%, and 100% of children with normal, elevated, and highly elevated initial levels, respectively; results were normal in 96%, 74%, and 50% of patients with initial normal, elevated, and highly elevated TSH, respectively; repeated TSH levels were > 97.5 percentile in 35% of patients with initial TSH > 97.5 percentile compared with 1% with first results < 97.5 percentile (P = .005). Only 4 (0.6%) of the 652 newborns included in the study received thyroxin treatment. CONCLUSION: The normal TSH levels found in most healthy infants with normal thyroid screening and the spontaneous normalization of TSH values below 7.4 mIU/liter, substantiate the reliability of the screening, reduce unnecessary work-up and unnecessary thyroxin treatment of neonates meeting these criteria.

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AIM: This study evaluated mothers with diabetes to determine whether prepregnancy body mass index (BMI), BMI on delivery or gestational weight gain (GWG) had the greatest impact on maternal and neonatal outcomes. METHODS: We retrospectively examined the medical charts of 634 full-term infants born to mothers with gestational diabetes mellitus not requiring insulin (n = 476), gestational diabetes mellitus requiring insulin (n = 140) and insulin-dependent diabetes mellitus (n = 18). Data regarding maternal BMI before pregnancy and on delivery were recorded, as well as maternal and neonatal complications. RESULTS: Infants born to women who gained more than the recommended weight during pregnancy had higher birthweights, higher rates of meconium-stained amniotic fluid and neonatal hypoglycaemia. Using logistic regression, Caesarean section delivery was predicted by gestational diabetes requiring insulin, with an odds ratio (OR) of 1.76, maternal hypertension (OR 2.4), infants born large for gestational age (OR 2.78) and maternal BMI ≥ 30 on delivery (OR 1.06). Neonatal complications were predicted by maternal insulin-dependent diabetes (OR 5.21), lower gestational age (OR 0.8) and GWG above the recommended amount (OR 1.56). CONCLUSION: Women with diabetes should be made aware that higher GWG can lead to Caesarean section delivery, infant macrosomia and other neonatal complications.

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Decreased bone density has been found among infants of diabetic mothers and among large-for-gestational-age newborns. To evaluate which etiologies (physical or metabolic effect) have the greatest impact on neonatal bone density. A case-control study was conducted that included two study groups: one comprising 20 appropriate-for-gestational-age (AGA) infants of gestational diabetic mothers (IGDM) and matched controls, and the other comprising 20 macrosomic infants (birth weight > 4 kg) and matched controls. Bone density was examined along the tibia bone using quantitative ultrasound that measured speed of sound. Bone density among the group of macrosomic infants was significantly lower than among the control group (2,976 vs. 3,120 m/s respectively, p < 0.005). No differences in bone density were found between infants of diabetic mothers and their controls (3,005 vs. 3,043 m/s respectively, p = 0.286). Low bone density was predicted only by birth weight (for every increase of 100 g) (OR 1.148 [CI 1.014-1.299], p = 0.003). Bone density was found to be low among macrosomic newborn infants, whereas among AGA-IGDM infants bone density was similar to that of the control group. These findings strengthen the hypothesis that reduced fetal movements secondary to fetal macrosomia constitute the mechanism for reduced bone density.

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OBJECTIVE: To evaluate the effect of duration of early breastfeeding in the delivery room on blood glucose levels among term neonates of diabetic mothers. METHODS: Mothers with gestational diabetes were encouraged to breastfeed their infants immediately after birth in the delivery room. The breastfeeding duration was recorded by the midwife. RESULTS: The longer duration of breastfeeding subgroup (n = 39) demonstrated a lower rate of hypoglycaemia in the first 8 hours of life (< 40 mg/dl) compared to the shorter duration subgroup (n = 40), but this difference did not reach statistical significance (2.6% vs. 17.5% respectively, p = 0.057). Hypoglycaemia was mainly predicted by lower cord glucose for each decrease of 10 mg/dl (OR 2.11 [CI 1.1-4.03] p = 0.024. CONCLUSION: Longer duration of delivery room breastfeeding did not reduce the rate of hypoglycaemia, which was mainly influenced by lower cord blood glucose level.

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BACKGROUND: Serotonin reuptake inhibitor (SRI) medications are commonly in use during pregnancy. OBJECTIVES: To evaluate short-term neonatal clinical signs among infants exposed to intrauterine SRI medications, in order to estimate the need for postnatal monitoring and observation. METHODS: Retrospective review of clinical data in medical files of term infants born to mothers who reported treatment with SRIs during pregnancy. RESULTS: Out of 401 infants in the study group, 165 (41%) were reported to have at least 1 clinical symptom, including respiratory distress, jitteriness, restlessness, feeding difficulties, regurgitations, fever ≥38°C, a short cyanotic event and convulsions. In the symptomatic group, 70% exhibited mild symptoms, among them restlessness, jitteriness or feeding difficulties, while around 30% exhibited significant symptoms. Overall, 12% of the total cohort, mostly males (70%), presented significant clinical symptoms, but none had an urgent or life-threatening condition. Infants in the study group were shorter in length and had a higher rate of Apgar score <7 at 1 min, meconium-stained amniotic fluid and respiratory distress. CONCLUSIONS: Despite the high incidence of clinical signs among infants born to SRI-treated mothers, most of their symptoms were mild and self-limited. These infants should be observed while they are close to their mothers on the maternity ward for 48 h after birth.

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