The Influence of Clinical and Anthropometric Parameters on the Serum Levels of the Endothelin-1 in Pregnant Women and their Newborns

Pregnancy induced hypertension (PIH) is major contributor to maternal death in developing countries. Endothelin-1 (ET-1) is the most potent vasoconstriction agent known and its serum levels are increased in PIH. Therefore it is important to elucidate maternal and neonatal factors which influence endothelin-1 serum levels. 100 pathological pregnancies and 88 controls were analyzed for blood endothelin-1 and their anthropometric and clinical data were collected. In maternal blood ET-1 levels were strongly predicted by diagnosis, therapy and BMI, while umbilical cord ET-1 levels were strongly predicted by gestational age, therapy and delivery termination. Positive correlation between BMI and ET-1 levels suggest that obese pregnant women have increased risk for cardiovascular diseases. Inverse relationship between Apgar and umbilical ET-1 indicates that ET-1 could be considered as a prognostic marker in cases of neonatal asphyxia

Pediatric Idiopathic Intracranial Hypertension: Clinical and Demographic Features

Idiopathic intracranial hypertension (IIH) is a clinical condition characterized by elevated intracranial pressure and absence of clinical, laboratory or radiographic evidence of central nervous system infection, vascular malformation, intracranial space occupying lesion or hydrocephalus. In the last years the raising understanding of pediatric IIH, especially concerning its demographics and epidemiology, has brought up to a redefinition of diagnostic criteria and reevaluation of pathogenesis and treatment. The authors reviewed the records of nineteen consecutive children with newly diagnosed IIH in order to compare demographic characteristics, clinical pictures and ophthalmologic aspects as optic disc evaluation and visual field evaluation, as well as treatment modalities and follow up. Beside obesity and female gender, potential alternative risk factors remains to be investigated, which need a good collaboration between neuroophthalmologists and pediatric neurologists

BIRTH WEIGHT AND LENGTH OF NEWBORNS AT UNIVERSITY HOSPITAL RIJEKA

Cilj rada. Izraditi tablice i analizirati standardne vrijednosti porodne težine i porodne duljine zdrave novorođenčadi. Ispitanici i metode. Retrospektivno su analizirani podatci o 19 996 novorođenčadi jednoplodnih trudnoća od 22. do 42. tjedna gestacije rođenih u Klinici za ginekologiju i porodništvo KBC Rijeka u razdoblju od deset godina. Iz analize su isključena novorođenčad s kongenitalnim malformacijama, mrtvorođeni, djeca majki s nesigurnim trajanjem trudnoće i majki s kroničnim bolestima. Rezultati su prikazani u tablicama i krivuljama centilnih vrijednosti prema navršenim tjednima trudnoće, paritetu majke i spolu novorođenčeta. Rezultati. Medijana vrijednost porodne težine u 40. tjednu trudnoće za analiziranu skupinu iznosila je 3580 g (c.10=3070 g; c.90=4140 g). Najnižu porodnu masu u 40. tjednu imala su ženska novorođenčad prvorotkinja, 3450 g (c.10=2980 g; c.90=3955 g). Slijede ženska djeca višerotkinja (3550 g) i muška djeca prvorotkinja (3590 g). Najteža su bila muška novorođenčad višerotkinja 3720 g. U 40. tjednu gestacije medijana vrijednost porodne duljine iznosila je 52 cm (c.10=49 cm; c.90=54 cm). Zaključak. Izrada antropometrijskih standarda na vlastitoj populaciji novorođenčadi preduvjet je za kvalitetnu skrb djeteta. Usporedba rezultata sa sličnim ¬studijama u zemlji otežena je zbog metodološki različitog pristupa u odabiru ispitanika. Zato je potrebno jedinstvenom metodologijom izraditi nacionalne standarde, kako bi se osigurao veći ispitivani uzorak, dobili objektivniji rezultati te omogućilo otkrivanje poremećaja fetalnog rasta.Aim. To present the obtained data as table records and to analyse standard values of birth weight and birth length in healthy newborns. Methods. Retrospective study of 19 996 singleton pregnancies\u27 neonates with a gestational age between 22 to 42 weeks born at the University Hospital Rijeka, Department of Obstetrics and Gynecology, over the ¬period of ten years. Statistical evaluation of the hospital records data. Newborns with congenital disorders, stillborn ¬children, neonates born to mothers with uncertain pregnancy duration and those born to mothers with chronic diseases that may influence fetal growth (malignant and endocrine diseases, hypertension) were excluded. Obtained results have been presented in tables of percentiles, according to gestational age, mother\u27s parity and neonatal gender. Results. Median birth weight value for the analysed group born at 40-th gestational week was 3580 gs (c10=3070 gs; c90=4140 gs). ¬Female neonates of primiparas, born at 40-th gestational week, had the lowest median birth weight, 3450 gs (c10=2980 gs; c90=3955 gs), followed by female neonates of multiparas (3550 gs) and male neonates of primiparas (3590 gs). Male newborns of multiparas had the greatest median birth weight, 3720 gs. Median birth length value at the 40-th gestational week for the analysed group was 52 cms (c10=49 cms; c90=54 cms). Conclusion. Construction of anthropometrical ¬standards in a certain population is essential condition for maintaining quality of antenatal and postnatal health care. ¬Eventual comparison of our results with similar studies in the country is difficult due to variant methodological ¬approaches considering the selection of examinees. It is essential to apply the unique methodology and create national standards, which would ensure greater examined sample and thus more objective results to enable further researches of fetal growth delays

Značaj serumskih vrijednosti endotelina-1 i čimbenika rasta vaskularnog endotela u prognozi neonatalnog ishoda u trudnoćama s hipertenzivnim poremećajima i intrauterinim zastojem rasta : doktorski rad

Cilj istraživanja: Odrediti serumske vrijednosti endotelina (ET1) i čimbenika rasta vaskularnog endotela (VEGF) uključenih u patofiziološke mehanizme hipertenzivnih poremećaja trudnoće i intrauterinog zastoja rasta. Ovim istraživanjem nastojalo se utvrditi postoji li povezanost vazoaktivnih čimbenika (VEGFa i ET1) u serumu i posteljici s novorođenačkim ishodom. Ispitanici i metode: U istraživanje su bile uključene 43 trudnice s hipertenzivnim poremećajima trudnoće (HPT), 31 trudnica s poremećajem intrauterinog rasta (IUZR) i 36 trudnica s hipertenzivnim poremećajima i pridruženim intrauterinim zastojem rasta ploda (HPT+IUZR). Uključni kriteriji trudnica s HPT i HPT+IUZR bile su povišene vrijednosti krvnog tlaka više od 140/90 mmHg nakon 20.tjedna trudnoće sa ili bez proteinurije i kliničkih manifestacija navedenih poremećaja i IUZRa, te njihova novorođenčad. Kriteriji uključenja trudnica s IUZR bio je ustanovljen zastoj rasta ploda > 2SD ispod vrijednosti 10. percentile krivulje normalnog intrauterinog rasta i njihova novorođenčad nakon postnatalne potvrde dijagnoze zastoja rasta ploda. Prema porođajnoj težini (PT) novorođenčad je klasificirana u eutrofičnu (PT 10-90. percentile za gestacijsku dob), hipotrofičnu (PT 90 percentile za gestacijsku dob). Serumske razine VEGFa i ET1 mjerene su u 3. tromjesječju, u pupkovini i nakon poroda. Svim trudnicama su po porodu posteljice poslane na patohistološku analizu i imunohistokemijsku analizu ekspresije VEGFa i ET1. Novorođenački ishod klasificiran je u skupine zdrave, bolesne i umrle novorođenčadi, a dijagnoze pojedinih ispitivanih bolesti u novorođenčadi postavljene su prema standardima dobre kliničke prakse u neonatologiji. Rezultati: Od ispitivanih angiogenih čimbenika serumske vrijednosti ET1 trudnica s HPT+IUZR pokazale su se statistički značajno veće od ET1 u kontrolnoj skupini (P1,6). Potrebno je istaknuti da su vrijednosti ET1 izmjerene u 3. tromjesječju trudnica s IUZRa značajno povezane s neonatalnom asfiksijom (P<0,042). Serumske vrijednost ET1 3. tromjesječja u ispitivanoj skupini s HPT+IUZR značajno su povezane s neonatalnom infekcijom i simptomatskom hipoglikemijom novorođenčadi u odnosu na novorođenčad iz skupine IUZR, te kontrolnu skupinu (P<0,05). Zaključak: Rezultati ovog istraživanja pokazali su da su serumske vrijednosti ET1 i VEGFa povišene na svima razinama krvožilja uključenih u patofiziologiju hipertenzivnih poremećaja trudnoće i IUZRa. Pokazalo se da od ispitivanih čimbenika serumske vrijednosti ET1 imaju visoku prediktivnu vrijednost u procjeni ishoda novorođenčadi. Otkriven je potencijalno novi biokemijski čimbenik koji bi mogao omogućiti precizniju procjenu lošeg neonatalnog ishoda. Uključivanjem serumskih biomarkera, posebno ET1 u antenatalnu dijagnostiku trećeg tromjesječja trudnoće mogla bi se predvidjeti hipoksična zbivanja u trudnice i nepovoljan ishod novorođenčadi.Aim: The goal was to determine serum values of endothelin (ET1) and vascular endothelial growth factor (VEGF) involved in patophisiology of hypertensive pregnancy disorders and intrauterine growth restriction. The conducted study aimed to determine whether vasoactive substances as VEGF and ET1 in serum and placenta are related to neonatal outcome. Patients and methods: The study included 43 pregnant woman with hypertensive disorders (HD), 31 pregnant woman with intrauterine growth restriction (IUGR) and 36 with concomitant both disorders (HD+IUGR). The inclusion criteria in HD and HD+IUGR were elevated blood preasure higher than 140/90 mmHg following 20.week of gestation with or without proteinuria clinically manifested and IUGR from their pregnancies. The inclusion criteria in IUGR were detected values above > 2SD under 10th percentile for normal distribution curve after postnatal confirmation of IUGR. According to birth weight (BW) they were classified in groups of eutrophic (BW) 10-90th percentile for gestation week), hipotrophic (PT 90th percentile for gestation week). Serum levels of VEGF and ET1 were measured in 3rd trimester, from umbilical cord and after the delivery. In all patients placentas were pathohistologicaly examined and immunohistochemically analysed for VEGF and ET1 expression. Neonatal outcome was classified as healthy group, ill and death while diagnoses of several pathological findings analysed were established according to good neonatal clinical practice. Results: When analysed angiogenic factors; serum values of ET1 in pregnancies with HD+IUGR measured at all three detection points showed statistically higher values compared to control group (P1,6). It needs to be point out that ET1 levels measured in 3rd trimester in IUGR group significantly correlates with neonatal asphyxia (P<0,042). Serum values of ET1 in 3rd trimester in HD+IUGR group correlated with the presence of neonatal infection and symptomatic neonatal hypoglycaemia when compared with IUGR and healthy control group (P<0,05). Conclusion: The results of conducted research study have shown that serum levels of ET1 and VEGF are increased and therefore involved in pathophisiology of HD and IUGR. It is shown that from all examined factors serum levels of ET1 has the highest predictive value in neonatal outcome evaluation. The potentially new biochemical marker for preselection and selection of group in hazard ratio for gestational pathology disorder has been introduced. Inclusion of serum biomarkers as non invasive antenatal diagnostic tool in 3rd trimester pregnancy can predict hypoxic states and poor neonatal outcome with high precision

Značaj serumskih vrijednosti endotelina-1 i čimbenika rasta vaskularnog endotela u prognozi neonatalnog ishoda u trudnoćama s hipertenzivnim poremećajima i intrauterinim zastojem rasta : doktorski rad

Cilj istraživanja: Odrediti serumske vrijednosti endotelina (ET1) i čimbenika rasta vaskularnog endotela (VEGF) uključenih u patofiziološke mehanizme hipertenzivnih poremećaja trudnoće i intrauterinog zastoja rasta. Ovim istraživanjem nastojalo se utvrditi postoji li povezanost vazoaktivnih čimbenika (VEGFa i ET1) u serumu i posteljici s novorođenačkim ishodom. Ispitanici i metode: U istraživanje su bile uključene 43 trudnice s hipertenzivnim poremećajima trudnoće (HPT), 31 trudnica s poremećajem intrauterinog rasta (IUZR) i 36 trudnica s hipertenzivnim poremećajima i pridruženim intrauterinim zastojem rasta ploda (HPT+IUZR). Uključni kriteriji trudnica s HPT i HPT+IUZR bile su povišene vrijednosti krvnog tlaka više od 140/90 mmHg nakon 20.tjedna trudnoće sa ili bez proteinurije i kliničkih manifestacija navedenih poremećaja i IUZRa, te njihova novorođenčad. Kriteriji uključenja trudnica s IUZR bio je ustanovljen zastoj rasta ploda > 2SD ispod vrijednosti 10. percentile krivulje normalnog intrauterinog rasta i njihova novorođenčad nakon postnatalne potvrde dijagnoze zastoja rasta ploda. Prema porođajnoj težini (PT) novorođenčad je klasificirana u eutrofičnu (PT 10-90. percentile za gestacijsku dob), hipotrofičnu (PT 90 percentile za gestacijsku dob). Serumske razine VEGFa i ET1 mjerene su u 3. tromjesječju, u pupkovini i nakon poroda. Svim trudnicama su po porodu posteljice poslane na patohistološku analizu i imunohistokemijsku analizu ekspresije VEGFa i ET1. Novorođenački ishod klasificiran je u skupine zdrave, bolesne i umrle novorođenčadi, a dijagnoze pojedinih ispitivanih bolesti u novorođenčadi postavljene su prema standardima dobre kliničke prakse u neonatologiji. Rezultati: Od ispitivanih angiogenih čimbenika serumske vrijednosti ET1 trudnica s HPT+IUZR pokazale su se statistički značajno veće od ET1 u kontrolnoj skupini (P1,6). Potrebno je istaknuti da su vrijednosti ET1 izmjerene u 3. tromjesječju trudnica s IUZRa značajno povezane s neonatalnom asfiksijom (P<0,042). Serumske vrijednost ET1 3. tromjesječja u ispitivanoj skupini s HPT+IUZR značajno su povezane s neonatalnom infekcijom i simptomatskom hipoglikemijom novorođenčadi u odnosu na novorođenčad iz skupine IUZR, te kontrolnu skupinu (P<0,05). Zaključak: Rezultati ovog istraživanja pokazali su da su serumske vrijednosti ET1 i VEGFa povišene na svima razinama krvožilja uključenih u patofiziologiju hipertenzivnih poremećaja trudnoće i IUZRa. Pokazalo se da od ispitivanih čimbenika serumske vrijednosti ET1 imaju visoku prediktivnu vrijednost u procjeni ishoda novorođenčadi. Otkriven je potencijalno novi biokemijski čimbenik koji bi mogao omogućiti precizniju procjenu lošeg neonatalnog ishoda. Uključivanjem serumskih biomarkera, posebno ET1 u antenatalnu dijagnostiku trećeg tromjesječja trudnoće mogla bi se predvidjeti hipoksična zbivanja u trudnice i nepovoljan ishod novorođenčadi.Aim: The goal was to determine serum values of endothelin (ET1) and vascular endothelial growth factor (VEGF) involved in patophisiology of hypertensive pregnancy disorders and intrauterine growth restriction. The conducted study aimed to determine whether vasoactive substances as VEGF and ET1 in serum and placenta are related to neonatal outcome. Patients and methods: The study included 43 pregnant woman with hypertensive disorders (HD), 31 pregnant woman with intrauterine growth restriction (IUGR) and 36 with concomitant both disorders (HD+IUGR). The inclusion criteria in HD and HD+IUGR were elevated blood preasure higher than 140/90 mmHg following 20.week of gestation with or without proteinuria clinically manifested and IUGR from their pregnancies. The inclusion criteria in IUGR were detected values above > 2SD under 10th percentile for normal distribution curve after postnatal confirmation of IUGR. According to birth weight (BW) they were classified in groups of eutrophic (BW) 10-90th percentile for gestation week), hipotrophic (PT 90th percentile for gestation week). Serum levels of VEGF and ET1 were measured in 3rd trimester, from umbilical cord and after the delivery. In all patients placentas were pathohistologicaly examined and immunohistochemically analysed for VEGF and ET1 expression. Neonatal outcome was classified as healthy group, ill and death while diagnoses of several pathological findings analysed were established according to good neonatal clinical practice. Results: When analysed angiogenic factors; serum values of ET1 in pregnancies with HD+IUGR measured at all three detection points showed statistically higher values compared to control group (P1,6). It needs to be point out that ET1 levels measured in 3rd trimester in IUGR group significantly correlates with neonatal asphyxia (P<0,042). Serum values of ET1 in 3rd trimester in HD+IUGR group correlated with the presence of neonatal infection and symptomatic neonatal hypoglycaemia when compared with IUGR and healthy control group (P<0,05). Conclusion: The results of conducted research study have shown that serum levels of ET1 and VEGF are increased and therefore involved in pathophisiology of HD and IUGR. It is shown that from all examined factors serum levels of ET1 has the highest predictive value in neonatal outcome evaluation. The potentially new biochemical marker for preselection and selection of group in hazard ratio for gestational pathology disorder has been introduced. Inclusion of serum biomarkers as non invasive antenatal diagnostic tool in 3rd trimester pregnancy can predict hypoxic states and poor neonatal outcome with high precision