Necrotizing enterocolitis (NEC) has emerged over the past 25 years as the most common gastrointestinal emergency in neonatal intensive care units (NICUs) worldwide. Despite significant improvements in survival among premature and low-birth-weight (LBW) neonates due to advances in neonatal intensive care, the incidence of NEC remains persistently high, largely because of the physiological vulnerability associated with LBW and prematurity. The purpose of this study was to assess the incidence and identify predictors of NEC among LBW newborns in South Ethiopia. A hospital-based prospective cohort study was conducted among 627 LBW neonates in public hospitals in southern Ethiopia from December 2, 2020, to December 1, 2021. Data were coded and entered into Epi-data version 4.4.2.1 and exported to STATA version 17 for analysis. Weibull regression analysis was employed after assessing model fitness. Adjusted hazard ratio (AHR) with 95% confidence interval (CI) was calculated, and variables with a P value < .05 were considered statistically significant. The incidence rate of NEC among LBW neonates was 11.7 per 1000 child-day observations (95% CI: 8.95-15.26). Maternal age (25-35 years) (AHR = 2.45 [95% CI: 1.16-5.15]) and advanced maternal age (>35 years) (AHR = 3.68 [95% CI: 1.33-10.19]) were significantly associated with an increased risk of NEC. Other independent predictors of NEC included preeclampsia (AHR = 2.49 [95% CI: 1.18-5.31]), oligohydramnios (AHR = 9.80 [95% CI: 1.11-86.89]), intraventricular hemorrhage (IVH) (AHR = 7.56 [95% CI: 1.58-36.21]), neonatal jaundice (AHR = 2.03 [95% CI: 1.09-3.81]), dehydration (DHN) (AHR = 10.75 [95% CI: 2.33-49.63]), formula feeding (AHR = 4.71 [95% CI: 1.86-11.95]) and not initiated feeding early (AHR = 9.36 [95% CI: 4.17-20.98]]). This study revealed a high incidence rate of NEC among LBW neonates. To mitigate the burden of NEC among LBW neonates, targeted interventions aimed at preventing and effectively managing pregnancy-related complications, particularly preeclampsia and oligohydramnios, should be strengthened. In addition, early diagnosis and prompt treatment of neonatal conditions, including intraventricular hemorrhage, jaundice, and dehydration, are critical to decrease NEC. Promoting breastfeeding and encouraging early initiation of feeding are also key strategies for the effective prevention of NEC.

Fasting or restricting oral intake during labor may adversely affect maternal and neonatal outcomes. Although several interventions regarding oral intake during labor have been proposed, the optimal strategy for clinical practice remains controversial. This study aims to conduct a network meta-analysis to identify the most effective intervention for managing maternal oral intake during labor.

Bovine anaplasmosis and babesiosis are important tick-borne diseases associated with significant economic losses, although fetal infection and abortion are rarely described. This study reports a bovine abortion associated with co-infection by Anaplasma marginale, Babesia bovis and Babesia bigemina. in the Midwestern region of Brazil. Fetal necropsy was performed, followed by cytological, histopathological, immunohistochemical, and molecular analyses. Gross findings included jaundice, splenomegaly, hepatomegaly, and renal discoloration, consistent with severe hemolytic disease. Blood smear evaluation revealed intraerythrocytic inclusions compatible with (A) marginale and Babesia-like merozoites, and PCR confirmed (B) bovis and B. bigemina, and Anaplasma spp. infection was confirmed by sequencing. Histologically, lesions consisted of erythrophagocytosis, hemosiderosis, hemoglobin casts, and marked intravascular leukocytostasis in multiple organs. Immunohistochemistry demonstrated accumulation of macrophages and T lymphocytes, suggesting activation of a fetal inflammatory response. These findings emphasize the importance of including hemoparasitic infections in the differential diagnosis of bovine abortion and support a role for fetal immune responses in lesion development.

Acute fatty liver of pregnancy (AFLP) is a rare but serious hepatic disorder associated with significant maternal morbidity and mortality. While hepatic encephalopathy and multiorgan failure are recognized complications, the occurrence of transfusion-related acute lung injury (TRALI) and abdominal compartment syndrome (ACS) in the context of AFLP is rarely reported. We present a case of AFLP complicated by fulminant hepatic failure, hepatic encephalopathy, TRALI, ACS, and multiorgan dysfunction. A young primigravida at 36 weeks of gestation presented to the emergency department with nausea, vomiting, and jaundice. An immediate lower uterine segment caesarean delivery was performed, resulting in the birth of a live male infant. Postoperatively, the patient exhibited progressive deterioration in neurological status, worsening hepatic function, and acute kidney injury, necessitating admission to the surgical intensive care unit. Infectious and metabolic causes of hepatic failure were excluded, and viral hepatitis serologies were negative. She received intensive resuscitation with blood products, intravenous dextrose, and N-acetylcysteine. Abdominal haemorrhage, TRALI, and ACS complicated her clinical course. She progressed to fulminant hepatic failure with associated hypoglycaemia, hypoproteinaemia, hepatic encephalopathy, and ultimately brain herniation. AFLP remains a potentially life-threatening obstetrical emergency. Our patient had two risk factors for AFLP as a primigravida and carrying a male foetus. She had multiple organ failures in addition to TRALI and ACS, leading to a fatal outcome.

Acute fatty liver of pregnancy (AFLP) is a rare pregnancy-related liver disorder that can rapidly progress to multiorgan failure, including disseminated intravascular coagulation (DIC) and renal dysfunction. It is potentially fatal if not promptly recognized and treated; however, the diagnostic role of imaging modalities remains poorly defined. We report a case of a 29-year-old primigravida who presented with progressive jaundice, liver dysfunction, coagulopathy, and renal impairment at 33 weeks of gestation. Abdominal computed tomography (CT) demonstrated decreased hepatic attenuation, with a CT value of 23.0 Hounsfield units, suggestive of fatty deposition. Based on fulfillment of 7 of the 14 Swansea criteria and the presence of fetal distress, an emergency cesarean section was performed. On postoperative day 18, the controlled attenuation parameter (CAP) obtained by vibration-controlled transient elastography indicated a steatosis grade of S0, with a CAP value of 196 dB/m, whereas ultrasound-guided liver biopsy revealed microvesicular steatosis on histological examination, confirmed by adipophilin immunostaining. Electron microscopy further demonstrated numerous microvesicular lipid droplets and dilatation of the rough endoplasmic reticulum, leading to a definitive diagnosis of AFLP. This case suggests that CAP may underestimate hepatic fat accumulation when steatosis is predominantly microvesicular, as in AFLP, and that detailed pathological and ultrastructural evaluation may be valuable for diagnostic confirmation and improved understanding of disease pathophysiology.

Acute fatty liver of pregnancy (AFLP) is a rare but potentially life-threatening complication of late gestation that often presents with nonspecific features and significant overlap with other obstetric conditions, posing a diagnostic challenge. We report a case of a 28-year-old multigravida at 34 weeks of gestation who presented with progressive jaundice, encephalopathy, and multiorgan dysfunction, including disseminated intravascular coagulation (DIC) and acute kidney injury (AKI) requiring renal replacement therapy. Laboratory evaluation revealed severe hypoglycemia, hyperammonemia, marked transaminase elevation, and profound coagulopathy, supporting the diagnosis of AFLP based on the Swansea criteria. The clinical picture was initially confounded by overlapping features with hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome; however, key biochemical markers facilitated diagnostic clarification. The patient underwent prompt multidisciplinary management, including metabolic stabilization, correction of coagulopathy, and emergency cesarean delivery, followed by intensive care support. Significant clinical and biochemical improvement was observed following delivery, with progressive recovery of hepatic and renal function. This case highlights the importance of early recognition, differentiation from mimicking conditions, and timely intervention in AFLP, particularly in severe presentations with multiorgan involvement. It further emphasizes the role of hypoglycemia and metabolic dysfunction as critical diagnostic indicators and supports the principle that prompt delivery remains the definitive treatment in preventing maternal morbidity and mortality.

Background/Objectives: While satisfactory glycaemic control is possible with specialist care from a diabetologist and modern therapies, women with type 1 diabetes are still subject to poorer obstetric outcomes, even with optimal management. Methods: The analysis comprised a cohort of 55 pregnant patients with type 1 diabetes who attended the Diabetology Outpatient Clinic between 2018 and 2023; all were recruited no later than the first trimester. Qualified patients underwent medical interviews and physical examinations. Insulin pump, continuous glucose monitoring (CGM) system, and postpartum data were collected. Results: The median glycated haemoglobin (HbA1c) at the beginning of pregnancy was 6.1%, with means of 5.9% and 6.0% in the following trimesters. Only 1/3 of the women achieved the recommended HbA1c value throughout pregnancy. The average/median time in range (TIR) in each trimester was ≤70%. Among the women who achieved the recommended TIR target, the infants tended to have lower birth weights but a higher likelihood of jaundice. Almost half of the newborns were large for gestational age (LGA), and a third were macrosomic. The strongest predictor of LGA was a mean blood glucose level > 124 mg/dL in the third trimester, which increased the risk of LGA by almost 12 times. Conclusions: Good diabetes control does not prevent LGA/macrosomia. TIR appears to be a better predictor of obstetric complications, including LGA. A mean glucose level ≥ 124 mg/dL in the third trimester greatly increases the risk of LGA.