OBJECTIVE We aimed to evaluate whether electrophysiological auditory thresholds (EATs) before 3 month of age, as assessed by the auditory brainstem responses (ABR) test and the auditory steady state responses (ASSR) test, can predict hearing outcome at 3 years of age among children born with congenital cytomegalovirus (cCMV) infection. STUDY DESIGN Audiological assessment was performed before 3 months of age, and every 6 months thereafter until 3 years of age, in a population of 63 children (126 ears). EATs before 3 months of age and at 3 years of age were compared. RESULT No ear with an EAT of ≤30 dBHL (i.e. normal hearing) before 3 months of age showed worsening EATs at 3 years of age. CONCLUSION An EAT of ≤30 dBHL obtained by ABR and ASSR tests before 3 months of age is predictive of a normal hearing at 3 years of age in children born with cCMV.OBJECTIVE To compare the length of stay (LOS) against the expected date of delivery (EDD) and to describe mortality and LOS outcomes by gestational age (GA) categories over the years. STUDY DESIGN Healthcare Cost and Utilization Project Kids' Inpatient database discharge records for years 2003, 2006, 2009, 2012, and 2016 were analyzed. For premature infants after inclusion-exclusion, actual, and calculated LOS were compared. Mortality and LOS outcomes were analyzed by GA and years. RESULTS The majority (99%) of infants >28 weeks were discharged by EDD while, for neonate ≤28 weeks, about three-quarters (75%) of infants were discharged by calculated EDD. LOS is increasing while mortality is decreasing by GA categories in recent years. CONCLUSIONS This is the largest study of mortality and LOS in the United States. Our study provides evidence-based numbers comparing actual LOS against EDD, which can be used in perinatal settings to counsel parents.OBJECTIVE No single test can accurately identify neonatal late-onset sepsis (LOS). Our aim was to use clinical evaluation with laboratory tests to rapidly assess sepsis risk. STUDY DESIGN A retrospective case-control study was performed in a tertiary Neonatal Center during the years 2016-2019. Infants with bacteriologically confirmed LOS were compared with control infants. A clinical health evaluation score was assigned to each infant. A prediction model was developed and validated by multivariable analysis. RESULTS The study included 145 infants, 48 with sepsis, and 97 controls. LOS was independently associated with sick appearance (OR 5.7, 95% CI 1.1-29.1), C-reactive protein > 0.75 (OR 5.4, 95% CI 1.1-26.3), and neutrophil-to-lymphocyte ratio > 1.5 (OR 6.7, 95% CI 1.2-38.5). Our model had an area under the receiver operating characteristic curve of 0.92 (95% CI 0.86-0.97). CONCLUSIONS Clinical evaluation with neutrophil-to-lymphocyte ratio and C-reactive protein can rapidly identify LOS enabling decreased health costs and antibiotic use.OBJECTIVE Determine whether management of neonatal hyperbilirubinemia differs if one used end-tidal carbon monoxide (CO) corrected for ambient CO (ETCOc) measurements instead of direct antiglobulin test (DAT) results to assess the severity of hemolysis. STUDY DESIGN Retrospective chart review of infants with total bilirubin and ETCOc levels measured from July 2016 to August 2018. The reported treatment is the hypothetical management infants might have received had there been strict adherence to American Academy of Pediatrics guidelines, rather than the actual management they received. RESULT Only 27.2% of 191 DAT(+) infants were hemolyzing based on ETCOc, while 29.1% of DAT (-) infants were hemolyzing based on ETCOc. Management of 18 (9.4%) infants differed depending if ETCOc or DAT were used to determine hemolysis. Eight fewer infants would have received phototherapy if ETCOc was used. CONCLUSIONS ETCOc is a more accurate determinant of hemolysis in the newborn, and its use can lead to less phototherapy.OBJECTIVE To compare the prognostic accuracy of six neonatal illness severity scores (CRIB, CRIB II, SNAP, SNAP II, SNAP-PE, and SNAP-PE II), birthweight (BW), and gestational age (GA) for predicting pre-discharge mortality among very low birth weight (VLBW) infants ( less then 1500 g) and very preterm infants ( less then 32 weeks' gestational age). STUDY DESIGN PubMed, EMBASE, and Scopus were the data sources searched for studies published before January 2019. Data were extracted, pooled, and analyzed using random-effects models and reported as AUC with 95% confidence intervals (CI). RESULTS Of 1659 screened studies, 24 met inclusion criteria. CRIB was the most discriminate for predicting pre-discharge mortality [AUC 0.88 (0.86-0.90)]. GA was the least discriminate [AUC 0.76 (0.72-0.80)]. CONCLUSIONS Although the original CRIB score was the most accurate predictor of pre-discharge mortality, significant heterogeneity between studies lowers confidence in this pooled estimate. A more precise illness severity score to predict pre-discharge mortality is still needed.OBJECTIVES Hospital closures promote latent factors putting patients at risk for medical errors. Our goal was to maintain safe patient care in our Neonatal Intensive Care Unit (NICU) by preventing any increase in neonatal mortality or hospital-based complications prior to hospital closure. METHODS Interventions included expanding TeamSTEPPS huddles and Leadership WalkRoundsTM. Measurements of safety domains were conducted using the Safety Attitudes Questionnaire. A run chart tracked neonatal mortality. We compared hospital-based complications for all neonatal admissions in 2019 with our own past outcomes and Vermont Oxford Network (VON) benchmarks. RESULTS Teamwork climate scores increased from an average score of 24.6-28.3 (maximum score 30, P  less then  0.05, CI 6.7-0.9). Quarterly neonatal mortality and neonatal outcomes did not worsen. The frequency of transfer did not increase. CONCLUSIONS A strong teamwork climate with resilient leadership may mitigate safety concerns under calamitous circumstances.E6 oncoprotein derived from high-risk human papillomavirus (HPV) drives the development of cervical cancer through p53 degradation. Because cervical cancer therapies to inactivate HPV or E6 protein are not available, alternative strategies are required. Here, we show that HPV-mediated nuclear export of human heterochromatin protein 1γ (HP1γ) reduces the stability of p53 through UBE2L3-mediated p53 polyubiquitination during cervical cancer progression. In general, HP1 plays a key role in heterochromatin formation and transcription in the nucleus.  https://www.selleckchem.com/products/chir-98014.html  However, our immunostaining data showed that the majority of HP1γ is localized in the cytoplasm in HPV-mediated cervical cancer. We found that HPV E6 protein drives unusual nuclear export of HP1γ through the interaction between the NES sequence of HP1γ and exportin-1. The mutation of the NES sequence in HP1γ led to nuclear retention of HP1γ and reduced cervical cancer cell growth and tumor generation. We further discovered that HP1γ directly suppresses the expression of UBE2L3 which drives E6-mediated proteasomal degradation of p53 in cervical cancer.