Zmiany w obrazie ultrasonograficznym i obrazie rezonansu magnetycznego mózgu u noworodków leczonych metodą selektywnej hipotermii

Introduction: Hypoxic ischemic insults during labor remain an important cause of brain injury in term and near-term neonates. Selective cerebral hypothermia is a potentially neuroprotective rescue therapy. Ultrasonography (US) andnmagnetic resonance imaging (MRI) are routinely used to visualize intracranial changes in neonatal hypoxic-ischemic injuries. Aim of the study: We attempted to describe all pathological findings on US and MRI in the brains of our patients following selective cerebral hypothermia. Materials and methods: Twenty-nine neonates with hypoxic-ischemic encephalopathy (HIE) following therapeutic cooling were assessed with cranial ultrasound (US) and magnetic resonance imaging (MRI). The findings were compared with the clinical outcome. Results: Over one-fourth (27.6%) of the examined infants had a normal brain on MRI (with only 17.2% on US). Involvement of the basal ganglia and thalami was one of the most frequent findings in our material (9/29 = 31% on MRI, and 7/29-24.1% on US). Cerebral parenchymal hemorrhage was detected on MRI in as many as 7 (24.1%) and cerebellar parenchymal hemorrhage in 4 (13.8%) infants. The loss in the gray-white matter differentiation (‘fuzzy brain’), usually transient on US, was observed in 79.3% of the neonates. Diffusion restriction in the callosal splenium (13.8%) and hyperechoic thalami and basal ganglia were strictly correlated to a significantly higher incidence of severe developmental delay. Conclusion: Abnormalities on MRI and US were observed in 75% of newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.Wstęp: Uraz niedotlenieniowo-niedokrwienny jest częstą przyczyną okołoporodowego uszkodzenia mózgu u noworodków, u których potencjalną, neuroprotekcyjną metodą leczenia jest selektywna hipotermia. Ultrasonografia (USG) i rezonans magnetyczny (MRI) są rutynowymi metodami obrazowania mózgu u noworodków ze zmianami niedotlenieniowo-niedokrwiennymi. Cel pracy: Podjęłyśmy próbę opisania wszystkich zmian patologicznych wykrytych w badaniu USG i MRI mózgu u noworodków, które leczone były metodą selektywnej hipotermii. Materiał i metoda: Przezciemiączkowe badanie ultrasonograficzne (USG) oraz badanie metodą rezonansu magnetycznego (MR) wykonano u 29 noworodków z encefalopatią niedotlenienieniowo-niedokrwienną (ENN) po zastosowaniu terapeutycznej hipotermii. Wyniki badań porównano z oceną kliniczną. Wyniki: U ponad jednej czwartej badanych dzieci (27,6%) badanie MR mózgu było prawidłowe (w badaniu USG tylko u 17,2%). Zajęcie jąder podstawy i wzgórz było jednym z najczęstszych znalezisk w naszym materiale (9/29= 31% w MR i 7/29 = 24.1% w USG). Krwawienie śródmózgowe wykryto w MR aż w 7 przypadkach (24,1%), a śródmóżdżkowe w 4 (13,8%). Brak zróżnicowaniu istoty szarej i białej (“fuzzy brain”), zwykle przemijające w obrazie USG, obserwowano u 79,3% noworodków. Restrykcja dyfuzji wody w płacie ciała modzelowatego (13,8%) oraz hiperechogeniczność wzgórz i jąder podstawy mózgu ściśle korelowały z istotnie częstszym występowaniem znacznego opóźnienia rozwoju. Wnioski: Nieprawidłowy obraz MRI i US występuje u 75% noworodków z encefalopatią niedotlenieniowoniedokrwienną leczonych metodą selektywnej hipotermii

Sequential sonographic features in neonatal renal vein thrombosis

Objectives: Renal vein thrombosis in newborns is a rare but serious and acute disease. Clinical representations of RVT can vary from discrete symptoms to life-threatening conditions. Therefore imaging, and in particular sonography, plays an important role in the diagnosis of RVT in neonates. Gray-scale, color and spectral/power Doppler ultrasound are all used in the diagnosis of RVT. Material and methods: We present retrospective sequential ultrasonic imaging of three patients (two term and one preterm infant) with findings characteristic of RVT. Results: Initial ultrasound diagnostic features include: renal enlargement, echogenic medullary streaks, lack of the flow pattern characteristic of arcuate vessels and subsequently loss of corticomedullary differentiation, reduced echogenicity around pyramids and echogenic band at the extreme apex of the pyramid. Higher resistance index or less pulsatile venous flow on the affected kidney are helpful Doppler signs. Conclusions: Knowledge and identification of specific features of each phase of the evolution of RTV seems essential to prompt diagnosis. We would like to highlight the evolution of specific sonographic features in each subsequent phase of RVT

Multiple brain abscesses caused by citrobacter koseri in a preterm neonate : case report

Background: Brain abscesses are very rarely diagnosed in neonates, but if present, they are associated with a high risk of severe complications and mortality. In neonates, brain abscesses can be detected on transfontanelle ultrasonography, in which they appear as hyperechogenic lesions surrounded by a hypoechogenic border. Case Report: We present a female neonate, born in the 28th week of gestation, with birth weight of 950 grams, who was born in an ambulance by spontaneous vaginal vertex delivery. No signs of infection were present until the 35th day of hospitalization, when a sudden and serious deterioration in the patient's condition was observed due to late-onset sepsis. Cranial US, performed on the 40th day of life, revealed hyperechogenic lesions with a hypoechogenic halo in the right frontal lobe, which could correspond to brain abscesses. These lesions were caused by Citrobacter koseri septicaemia, identified by transfontanelle ultrasonography, and confirmed on magnetic resonance imaging. The patient recovered and was discharged on the 91th day of life (39 PCA) with a recommendation of permanent neurological surveillance. Conclusions: Ultrasonography of the central nervous system can reveal inflammatory changes and developing brain abscesses. In neonates, magnetic resonance imaging should be performed as the method of choice for confirming brain abscesses

Doppler tissue imaging assessment of myocardial velocities and atrioventricular time intervals in term newborn infants during the neonatal period

Wstęp i cel: Przy użyciu echokardiograficznej metody doplera tkankowego oceniono zmiany ruchu miokardium dla leweji prawej komory oraz czasy przewodzenia przedsionkowo-komorowego u noworodków donoszonych w pierwszym miesiącu życia.Metody: Badania wykonano u 20 zdrowych noworodków urodzonych miedzy 37.–41. tygodniem ciąży. Pomiar prędkości miokardium wykonywano w projekcji koniuszkowej, w osi długiej serca, jako obraz 4 jam serca kodowany kolorowym doplerem tkankowym. Odczytywano zapis cyklu serca przedstawionego za pomocą trzech fal: fala skurczowa (Sm; kiedy płatki zastawki wędrują w kierunku koniuszka serca), fala wczesnej fazy rozkurczowej (Em; kiedy pierścień zastawki oddala się od koniuszka serca) oraz fala związana z fazą skurczu przedsionków (Am). Ponadto wykonano pomiary następujących czasów: czas Am-IV (od początku fali Am do początku fali IV); czas Am-Sm (od początku fali Am do początku fali Sm); czas IV-Am (odpoczątku fali IV do początku kolejnej fali Am); czas Sm-Am (od początku fali Sm do początku następnej fali Am). Zmierzono też czas skurczu izowolumetrycznego (IVCT) i czas rozkurczu izowolumetrycznego (IVRT). Wszystkie pomiary wykonano u każdego noworodka 3-krotnie: 1. pomiar — bezpośrednio po urodzeniu w 1. dobie życia, 2. pomiar — w 3. dobie życia oraz 3. pomiar — na koniec okresu noworodkowego w 28. dobie życia.Wyniki: We wszystkich pomiarach wartości średniej prędkości ruchu miokardium w zakresie fal Em, Am i Sm były wyższedla komory prawej niż dla komory lewej. Zmianę istotną statystycznie odnotowano dla komory prawej w zakresie czasów: Am-IV i Am-Sm (między dobą 1. a 3.), p < 0,02; IV-Am (miedzy dobą 1. a 28.), p < 0,005; Sm-Am (miedzy dobą 1. a 28.), p < 0,01. Dla komory lewej zmianę istotną statycznie wykazano w zakresie czasów: Am-IV (między dobą 1. a 28.), p < 0,05 oraz Sm-Am (między dobą 1. a 28.) p < 0,01. Średnie wartości IVCT i IVRT pozostawały stałe we wszystkich pomiarach dla komory prawej. Natomiast dla komory lewej zarówno w zakresie IVCT i IVRT wykazano różnicę istotną statycznie między1. i 28. dobą życia (p < 0,01).Wnioski: Zaobserwowane różnice w średnich wartościach prędkości miokardium i w średnich wartościach czasów przewodzenia odzwierciedlają zmiany w hemodynamice układu sercowo-naczyniowego charakterystyczne dla okresu noworodkowego.Background: In both term and premature neonates, changes in the systolic and diastolic function of the left ventricle (LV) and right ventricle (RV) reflect the degree of neonatal myocardial immaturity and the co-existence of foetal circulation as wellas the presence of concurrent diseases.Aim: To evaluate the changes in values of systolic and diastolic LV and RV function using pulse tissue Doppler imaging (TDI) in 20 healthy term newborn infants from birth to the 28th day of life.Methods: Ventricular peak myocardial velocities were recorded during early diastole (Em wave), atrial contraction (Am wave), and systole (Sm wave). TDI derived atrioventricular (AV) intervals were measured as the period from atrial contraction (Am) to isovolumic contraction (IV), from Am to ventricular systole (Sm), from Sm to the following Am, and from IV to the following Am. The first measurements were taken as soon as possible after birth, the second on the third day, and the final one onthe 28th day of life.Results: The diastolic myocardial velocities recorded in the RV were higher than those in the LV. Statistically significant differences were observed for time intervals in the RV: Am-IV and Am-Sm (day 1–3), p < 0.02; IV-Am (day 1–28), p < 0.005; Sm-Am (day 1–28), p < 0.01. Statistically significant differences for time intervals were also evident in the LV: Am-IV (day1–28), p < 0.05; and for Sm-Am (day 1–28), p < 0.01. Mean isovolumetric contraction time (ICT) and isovolumetric relaxationtime (IRT) intervals remained stable for all measurements recorded in the RV. However, a statistically significant difference was evident for both ICT and IRT intervals in the LV between days 1 and 28 of life (p < 0.01).Conclusions: 1. Cardiac TDI is feasible in the neonate. 2. In neonates, the diastolic and systolic function recorded in the RVwas better than that in the LV. This may reflect the ‘persistent’ foetal status of this ventricle in the first day of life. 3. The differences observed in conduction times also reflect the haemodynamic changes which occur in the circulatory system of the neonate in the first month of life. 4. Further investigation of a larger population of neonates throughout the whole neonatal period is indicated

Regresja zmian torbielowatych w obrazie MR mózgu u dziecka z noworodkową encefalopatią niedotlenieniowo-niedokrwienną, poddanego hipotermii leczniczej

The authors present the first case of regression of cystic lesions on brain MRI in a newborn after therapeutic hypothermia in Poland. Multicystic encephalopathy is the most severe form of hypoxic-ischemic encephalopathy and its regression is described very rarely in the literature. Magnetic resonance imaging is an accepted, optimal method of evaluation of the brain and establishing prognosis in children with HIE. After normal pregnancy an emergency cesarean section was performed at 37 weeks gestation due to the markers of intrauterine hypoxia on CTG. The condition of the newborn was serious: 3 ,5, 7, 8 points according to Apgar score in 1st, 3nd, 5th and 10th minute of life, respectively. The infant required resuscitation. The cooling procedure lasted 72 hours. The first MRI study was performed at the age of 3 weeks and revealed cavities in the frontal and parietal lobed. The Evans index was 0.33. The second MRI investigation was carried out at the age of 5 weeks. The cavitary appearance did not change, the Evans index decreased to 0.32. The child underwent third MRI at the age of 2 years 4 months. No cystic lesions were found. There were signs of gliosis in their place and focal corticalsubcortical atrophy. The Evans index was 0.28 (within the normal limits). The neuropsychological status of the child at the age of 2.5 years is normal and brain MRI reveals strikingly mild lesions as compared to cavitary injury reported at the age of 3 and 5 weeks. The presented case shows that severe hypoxic-ischemic lesions such as cavities in an infant after cooling procedure do not necessarily mean poor prognosis, as with time even such lesions may regress. Therefore, even after the MRI diagnosis of multicystic encephalopathy the prognosis should be made with care.Autorki przedstawiają pierwszy w Polsce przypadek regresji zmian torbielowatych w obrazie MR mózgu u noworodka poddanego hipotermii leczniczej. Encefalopatia wielotorbielowata jest najcięższą postacią zmian niedotlenieniowo-niedokrwiennych i ustąpienie zmian jest opisywane niezwykle rzadko. Rezonans magnetyczny jest uznaną, optymalną metodą oceny stanu mózgowia, prognozowania dalszego rozwoju dziecka z ENN i określania rokowania. Noworodek z prawidłowej ciąży I został urodzony cięciem cesarskim w 37 tygodniu ciąży ze wskazań nagłych wobec wykładników kardiotokograficznych niedotlenienia wewnątrzmacicznego. Stan dziecka był ciężki, punktacja wg Apgar 3 ,5, 7, 8 odpowiednio w 1., 3., 5. i 10. minucie życia. Noworodek wymagał resuscytacji. Był poddany procedurze chłodzenia przez 72 godz. Pierwsze badanie MR wykonano w 3. tygodniu życia i uwidoczniono jamy wypełnione płynem w płatach czołowych i ciemieniowych. Wskaźnik Evansa wynosił 0,33. Drugie badanie MR wykonano w wieku 5 tygodni. Obraz jam nie uległ zmianie, wskaźnik Evansa zmniejszył się do 0,32. Trzecie badanie MR wykonano w wieku 2 lat i 4/12 i nie uwidoczniono jam. W ich miejscu widoczna była glioza i odcinkowy zanik korowo-podkorowy. Wskaźnik Evansa wyniósł 0,28 (w granicach normy). Stan neuropsychologiczny dziecka w wieku 2,5 lat nie odbiega od normy, a obraz MR mózgu wykazuje uderzająco niewielkie zmiany w stosunku do stwierdzanych w wieku noworodkowym. Prezentowany przypadek pokazuje, że ciężkie zmiany niedotlenieniowo-niedokrwienne w postaci jam u dziecka po leczeniu hipotermią nie muszą rokować źle, ponieważ z upływem czasu nawet zmiany jamiste mogą ulec regresji. Zatem nawet po stwierdzeniu w obrazie MR cech encefalopatii wielotorbielowatej rokowanie odnośnie przeżycia i dalszego stanu neurorozwojowego dziecka powinno być stawiane ostrożnie

Antenatal corticosteroids and respiratory distress syndrome — the first Polish national survey

Objectives: Our retrospective study aimed to evaluate the rate and the appropriate use of antenatal corticosteroid therapy, and their effect on the incidence and treatment of respiratory distress syndrome (RDS) and its complications. Material and methods: A retrospective analysis of clinical practice in Poland was performed using standard investigating tools: a questionnaire on the frequency of using antennal corticosteroids in the selected centers, as well as neonatal data. A total of 987 newborns at ≤ 32 weeks of gestation, treated in 54 centers (including 42 tertiary and 12 secondary referral centers) over a period of 6 months in 2013, were deemed eligible. The study group consisted of 749 newborns whose mothers received antenatal steroids. The non-steroid group included 238 newborns. Results: Antenatal corticosteroids were administered to 75.89% of the neonates from the study group, with 79% and 21% receiving one and two courses, respectively. Children whose mothers received prenatal steroids presented with less extensive radiographic changes typical of RDS, and less often required surfactant therapy (70% vs. 78%; p = 0.0143). In the group of children undergoing antenatal steroid therapy, the percentage of BPD was lower (13.27% vs. 18.63%) (p = 0.0881). The mortality rates were 20.91% and 10.81% in controls and the study group, respectively (p = 0.0001). Conclusions: The percentage of antenatal steroid use in secondary and tertiary referral centers in Poland is unsatisfactorily low (76%). Antenatal corticosteroids demonstrated high efficacy in decreasing severe forms of RDS, less need for surfactant therapy, and reduced BPD and mortality rates.

Barley malt-based composition as a galactagogue — a randomized, controlled trial in preterm mothers

Objectives: Delayed or insufficient breast milk production, as well as low milk supply, is still a challenging problem toovercome, particularly in the case of preterm delivery. Herbal galactagogues might be a good way to increase milk supply,however, there is a lack of clinical studies confirming their efficacy and safety.The aim of this study was to verify the safety and effectiveness as a galactagogue of the unique galactagogue compositionbased on barley malt with β -glucan and lemon balm.Material and methods: The study included 117 mothers of preterm infants randomly divided into the GalactagogueGroup given galactagogue and the Placebo Group. A complete data set was obtained for 80 participants, divided equallybetween two groups.Volume of milk expressed by mothers during the first two weeks after delivery was the primary outcome and safetyof the product was the secondary outcome.Results: Volume of milk recorded on participants’ last visit in the Galactagogue Group was significantly higher than in thePlacebo Group (95 mL vs 62.5 mL, p = 0.049). The total expressed milk volume during the study was 4209 ± 335 mLin the Placebo Group vs 6036 ± 498 mL (p = 0.003) in the Galactagogue Group.Conclusions: Supplementation with unique Galactagogue composition was safe and increased milk output which allowedachieving target minimal volume of 500 mL per day in first week of lactation in preterm mothers

Comparative two time-point proteome analysis of the plasma from preterm infants with and without bronchopulmonary dysplasia

Background: In this study, we aimed to analyze differences in plasma protein abundances between infants with and without bronchopulmonary dysplasia (BPD), to add new insights into a better understanding of the pathogenesis of this disease. Methods: Cord and peripheral blood of neonates (≤ 30 weeks gestational age) was drawn at birth and at the 36th postmenstrual week (36 PMA), respectively. Blood samples were retrospectively subdivided into BPD(+) and BPD(−) groups, according to the development of BPD. Results: Children with BPD were characterized by decreased afamin, gelsolin and carboxypeptidase N subunit 2 levels in cord blood, and decreased galectin-3 binding protein and hemoglobin subunit gamma-1 levels, as well as an increased serotransferrin abundance in plasma at the 36 PMA. Conclusions: BPD development is associated with the plasma proteome changes in preterm infants, adding further evidence for the possible involvement of disturbances in vitamin E availability and impaired immunological processes in the progression of prematurity pulmonary complications. Moreover, it also points to the differences in proteins related to infection resistance and maintaining an adequate level of hematocrit in infants diagnosed with BPD

New Achievements in High-Pressure Processing to Preserve Human Milk Bioactivity

High-pressure processing (HPP) is a non-thermal technology that is being increasingly applied in food industries worldwide. It was proposed that this method could be used as an alternative to holder pasteurization (HoP; 62.5°C, 30 min) in milk banks but its impact on the immunologic, enzymatic and hormonal components of human milk has not yet been evaluated in detail. The aim of our study was to compare the effects of HPP in variants: (1) 600 MPa, 10 min (2) 100 MPa, 10 min, interval 10 min, 600 MPa, 10 min (3) 200 MPa, 10 min, interval 10 min, 400 MPa, 10 min (4) 200 MPa, 10 min, interval 10 min, 600 MPa, 10 min in temperature range 19–21°C and HoP on the leptin, adiponectin, insulin, hepatocyte growth factor (HGF), lactoferrin and IgG contents in human milk. HoP was done at the Regional Human Milk Bank in Warsaw at the Holy Family Hospital on S90 Eco pasteurizer (Sterifeed, Medicare Colgate Ltd). Apparatus U4000/65 (Unipress Equipment, Poland) was used for pascalization. Milk samples were obtained from women during 2–6 weeks of lactation. Post-treatment culture showed no endogenous bacterial contamination in any tested option. Concentrations of selected components were determined using ELISA tests. The level of all analyzed components were significantly decreased by HoP: leptin 77.86%, adiponectin 32.79%, insulin 32.40%, HGF 88.72%, lactoferrin 60.31@.%, IgG 49.04%. All HPP variants caused an increase in leptin concentration, respectively (1) 81.79% (2) 90.01% (3) 86.12% (4) 47.96%. Retention of insulin after HPP was (1) 88.20% (2) 81.98% (3) 94.76% (4) 90.31% HGF (1) 36.15% (2) 38.81% 97.15% (3) 97.15% (4) 43.02%, lactoferrin (1) 55.78% (2) 57.63% (3) 78.77% (4) 64.75%. Moreover, HPP variant as 200 + 400 MPa preserved IgG (82.24%) better than HoP and resulted not statistically significant change of adiponectin level (38.55%) compare to raw milk. Our results showed that HPP leads to preservation of adipokines, growth factor, and lactoferrin, IgG much better or comparable with HoP