Purpose: The purpose of this study is to identify the relationships between postpartum emotional manifestations and various neonatal variables, as well as variables within this category, in the context of hospitalization together after birth. Patients and Methods: Between 1 March 2020 and 1 September 2020, a cross-sectional research design was used including mother–child couples (112 mothers, 121 newborns - 13 twins/triplets). Results: Using a t-test for independent samples, we observed: a) the symptoms of depression were more severe in mothers of newborns hospitalized in neonatal intensive care units (NICUs) [t(110) = 4.334)], provided oxygen therapy [t(109.99) = 3.162], born prematurely [t(110) = 3.157], or with adjustment disorders [t(109) = − 2.947] (p < 0.01); b) a similar, for anxiety as a state [t(82.38) = 5.251], t(107.29) = 4.523, t(110) = 3.416, t(109) = − 3.268, p < 0.01], and as a trait was more common [t(80.79) = 4.501, t(108.790) = 4.669, t(109) = − 3.268, p < 0.001] compared to other mothers. Using Pearson’s test (p < 0.001), several very strong correlations were observed between neonatal variables, including number (no.) of days of hospitalization with birth weight (BW) (r = − 0.802), head circumference (HC) (r = − 0.822), and gestational age (GA) (r = − 0.800) and the mother’s postpartum anxiety as a state/trait (r = 0.770). Using Poisson regression, it was observed that anxiety as a state (Λ = 0.020, z = 4.029, p < 0.001) and as a trait (Λ = 0.800, z = 6.160, p < 0.001) stimulated the intensity of symptoms of postpartum depression (optimal models). Conclusion: Postpartum maternal psychological manifestations were associated with NICU hospitalization, pathology, and some neonatal therapies. We also noticed, that the duration of hospitalization, BW, HC, and GA, were correlated with maternal emotional disorders. Results will facilitate future optimization of birth management and postnatal care.

INTRODUCTION: This article reflects on the plight of patients with short bowel syndrome (SBS) in developing countries. SBS is life threatening, rare, complex and often not considered a priority by healthcare planners in the developing countries because of the high cost of treatment. Data was collected and analyzed from 3 different hospitals in two different countries (Romania and Austria) from November 2013 to February 2016 CASE PRESENTATION: The patient had an emergency surgery for volvulus as a result of an extensive ischemic necrosis, with just 80 cm of the bowel left and no ileocecal valve after enterectomy. Despite intensive care and surgeries for anastomotic joint ischemic necrosis and intestinal adhesion with just 70 cm of the intestine left after primary anastomosis, the patient remained in a catabolic state (metabolic acidosis, severe malabsorption and loss of nutrients, water and electrolytes through diarrhea) and was transferred overseas where two more surgeries (intestinal stomas) and good intensive care helped to achieve enteral autonomy at the optimal time. DISCUSSION: This immune-deficient patient was exposed to various types of bacteria ( Klebsiella pneumoniae , Pseudomonas aeruginosa ). Two years after surgery an acute enterocolitis with salmonella infection and resultant intestinal failure treated in patient’s country of origin failed to achieve enteral nutrition warranting a second overseas transfer. CONCLUSION: The lack of sufficient mucosal surface followed by long time intestinal adaptation process is crucial in determining bowel functional capacity. Long time hospital stay and cost was reduced through a parental home healthcare management training scheme. Highlights:

Background and objectives: The postpartum maternal physical and psychological state played a fundamental role in the mother–child relationship at the beginning of the COVID-19 pandemic. The aim of the study is to analyze the influence of maternal psychological manifestations on the mother–child couple through three objectives (briefly expressed): (I) Determination of the main acute and chronic conditions of newborns/infants. (II) Verification of the hypothesis of the existence of a link between the following neonatal variables: gestational age, birth weight, number of days of hospitalization, and specific neonatal therapies (oxygen, surfactant, and blood products’ transfusion). (III) Verification of the influence of postpartum maternal psychological status on the mother–child couple through three hypotheses. Materials and methods: This cross-sectional study was conducted in two hospitals in Timișoara, Romania, between 1 March and 1 September 2020, and included 165 mothers and their 175 newborns. Mothers answered the Edinburgh Postnatal Depression Scale, Spielberger’s Inventory of State-Trait Anxiety, and the Collins and Read Revised Adult Attachment Scale. Results: (I) The acute and chronic pathology of the infants in the study group was polymorphic. (II) Large correlations were identified between the following infant variables: gestational age with birth weight, and number of hospitalization days with birth weight, gestational age, and use of blood product transfusion (all p < 0.001). (III) (1) State anxiety was the only significant predictor of number of hospitalization days (p = 0.037), number of acute disorders (p = 0.028), and number of infant chronic diseases (p = 0.037). (2) Maternal depressive symptoms were the only predictor of postpartum maternal attachment (p = 0.018). (3) Depressive symptoms, state, and trait anxiety were non-significant in all models studied (all p > 0.05). Conclusions: Postpartum maternal physical and psychological state plays a fundamental role on the mother–child relationship in the new social and complex family conditions.

Purpose: Romania is one of the European countries that has been hit the hardest by the severe acute respiratory syndrome caused by the new coronavirus SARS-CoV-2, with over 1.91 million reported cases and over 59,257 deaths. The aim of this study was to identify the main predictors of death in hospitalized patients. Patients and Methods: In the period from 1 March 2020 to 30 June 2021, an observational, retrospective, randomized, case-control study was conducted, which included a sample of 139 patients who died in hospital and another sample of 275 patients who had been discharged in an improved or healed condition. Confirmation of COVID-19 cases was performed by RT-PCR from nasopharyngeal and oropharyngeal exudates. Statistical data were analyzed by logistic regression, Cox regression and a comparison of survival curves by the log-rank (Mantel-Cox) test. Results: The most powerful logistic regression model identified the following independent predictors of death: history of coagulopathy HR = 30.73 [1.94– 487.09], p = 0.015; high percentage of neutrophils HR = 1.09 [1.01– 1.19], p = 0.027; and decreased blood-oxygenation HR = 53881.97 [1762.24– 1647489.44], p < 0.001. Cox regression identified the following factors that influenced the evolution of cases: history of coagulopathy HR = 2.44 [1.38– 4.35], p = 0.000; O₂ saturation HR = 0.98 [0.96– 0.99], p = 0.043; serum creatinine HR = 1.23 [1.08– 1.39], p = 0.001; dyspnea on admission HR = 2.99 [1.42– 6.30], p = 0.004; hospitalization directly in the ICU HR = 3.803 [1.97– 7.33], p < 0.001; heart damage HR = 16.76 [1.49– 188.56], p = 0.022; and decreased blood-oxygenation HR = 35.12 [5.92– 208.19], p < 0.001. Conclusion: Knowledge of the predictors of death in hospitalized patients allows for the future optimization of triage and therapeutic case management for COVID-19.

Hypoplastic left heart syndrome is a heterogeneous group of congenital cardiac malformations which associates hypoplastic/aplastic left ventricle, mitral and aortic valve, hypoplastic/atresia and severe aortic artery coarctation, and represents a medical‑surgical emergency. We present a case of a newborn hospitalised in three clinics (two clinics from Timisoara and one from Vienna), and operated for hypoplastic left heart syndrome, without aortic coarctation, using a mixed technique cardiovascular repair surgery. The initial therapeutic conduct included maintaining the permeability of the arterial canal with prostaglandin E1. At the Vienna General Hospital, at the age of 17 days, bilateral banding of the pulmonary artery was performed and, at the age of 20 days, during the cardiac catheterisation, the Rashkind procedure (balloon atrial septostomy) was performed, with two stents being implanted in the arterial canal. Postoperative complications were postcardiotomy syndrome, pneumonia with Enterococcus faecalis and Stenotrophomonas maltophilia, sepsis with methicillin‑resistant Staphylococcus aureus, coagulopathy, mixed anaemia, and metabolic acidosis. The patient died 1 month after the intervention due to cardiorespiratory arrest, bilateral congestive heart failure, left heart hypoplasia with shunt through the arterial canal and pulmonary artery banding, multiorgan failure, and severe secondary haemorrhagic disease. In conclusion, the initial cardiac surgical reconstruction consisted of a mixed technique, and anticoagulant medical treatment with heparin, antibiotics (bacterial endocarditis prophylaxis to be performed throughout life); postintervention hypoxic and infectious complications resulted in multiorgan failure and death.

Purpose: Matrix metalloproteinase-9 (MMP-9) takes part in uterine remodelling and inflammation, and glucocorticoids can restrain its release from neutrophils, yet the MMP-9-cortisol relationship has not been examined after delivery. We explored serum MMP-9 and cortisol in mother-newborn dyads on the first day after birth and their relation to neonatal adaptation and early maternal anxiety. Patients and Methods: In this single-centre prospective cohort, 40 dyads were enrolled in July 2022. Maternal serum MMP-9 (ELISA) and maternal and neonatal serum cortisol (chemiluminescence) were measured on day 1; maternal anxiety was assessed with the STAI-Y. Paired tests, Spearman correlations with bootstrap 95% confidence intervals (CIs), robust regression and false discovery rate (FDR) control were applied. Results: Data for both biomarkers were available for 38 dyads. Maternal cortisol exceeded neonatal cortisol (median 25.0 vs 11.7 μg/dL; median difference 11.2 μg/dL, 95% CI 7.4 to 14.8; p < 0.001), and the two were not correlated. Maternal MMP-9 was inversely associated with maternal cortisol (r_s = − 0.38, 95% CI − 0.64 to − 0.07; FDR q = 0.030), also after adjustment for age and delivery mode. Neonatal cortisol was inversely associated with the 1-min Apgar score (r_s = − 0.39, 95% CI − 0.63 to − 0.08; q = 0.030). Neither biomarker was associated with state or trait anxiety. Conclusion: In this small exploratory cohort, lower maternal MMP-9 accompanied higher maternal cortisol, and a less favourable Apgar score accompanied higher neonatal cortisol. These preliminary associations require confirmation in larger, adequately powered studies.