Apgar score and neonatal mortality in a hospital located in Transylvania, Romania

University of Medicine and Pharmacy of Targu Mures, RomaniaIntroduction. The Apgar score was developed in 1952 and used like a convenient method for reporting the status of the newborn infant immediately after birth. Despite the advent of modern technology, the Apgar score remains the best tool for the identification of newly born infants in need for cardiopulmonary resuscitation

Nou-născutul din mamă diabetică - o provocare în terapia intensivă neonatală

Universitatea de Medicină şi Farmacie Tîrgu-Mureş, Centrul Regional de Terapie Intensivă Neonatală UGON Tîrgu- Mureş, Români

Perinatal asphyxia: we can anticipate and ameliorate the effects?

Universitatea de Medicină şi Farmacie, Tîrgu-Mureş, Institutul de Boli Cardiovasculare şi Transplantm, Tîrgu-MureşIntroduction: Despite the progress in monitoring the fetus in utero and broadening knowledge of pathophysiology, asphyxia at birth remains a very topical issue due to the impact on the immediate and late outcome prognosis. Posthypoxic impairment of the brain is the most serious consequence of perinatal asphyxia, causing the clinical outline of hypoxic-ischemic encephalopathy, resulting in cerebral palsy. Case presentation: authors expose the cases of two-term newborns who presented birth asphyxia, who have received a similar treatment, but had a different short-term outcome. The first case was a newborn of the diabetic and hypertensive mother which subsequently developed multicystic encephalomalacia. The second case, which suffered acute asphyxia due to maternal intrapartum hypotension had a favorable outcome, with a normal neurological examination at discharge. Conclusion: anticipating the effects of perinatal asphyxia is difficult, but the presence of seizures, early and persistent pathological changes on electroencephalogram, cerebral edema detected by ultrasounds, and abnormal neurological examination at discharge can be considered poor prognostic factors.Introducere: În ciuda progreselor făcute în monitorizarea fătului in utero şi a lărgirii orizontului cunoaşterii fiziopatologiei, asfixia la naştere continuă să rămână o problemă de mare actualitate datorită răsunetului asupra prognosticului imediat şi îndepărtat. Afectarea posthipoxică a creierului este consecinţa cea mai gravă a asfixiei perinatale, determinând conturarea tabloului clinic de encefalopatie hipoxic-ischemică, având ca urmare paralizia cerebrală. Prezentări de caz: autorii expun cazurile a doi nou-născuţi la termen care au prezentat asfixie la naştere, care au beneficiat de o atitudine terapeutică similară, dar care au avut o evoluţie precoce diferită. Primul caz este al unui nounăscut din mamă diabetică şi hipertensivă care a dezvoltat ulterior encefalomalacie multichistică. Al doilea caz, care a suferit o asfixie acută pe fondul hipotensiunii materne postanestezie a avut o evoluţie favorabilă, examenul neurologic fiind normal la externare. Concluzii: anticiparea efectelor asfixiei perinatale este dificilă, dar prezenţa convulsiilor, a modificărilor EEG precoce şi persistente, a edemului cerebral detectat prin ETF, precum şi examenul neurologic anormal la externare pot fi consideraţi factori de prognostic nefavorabil

Comparative evaluation of echocardiography indices during the transition to extrauterine life between small and appropriate for gestational age infants

ObjectivesTo study changes in heart function and hemodynamics during the transitional period in small for gestational (SGA) infants and appropriate (AGA) healthier counterparts.DesignA hospital based prospective observational study was performed at a perinatal center. Echocardiograms were performed on the first postnatal day and again at 48 h age. Term SGA infants were compared with those AGA newborns matched for the GA and mode of delivery.ResultsEighteen SGA infants were compared with 18 AGA infants [gestation 38 ± 1.5 vs. 38 ± 1.2 weeks, p > 0.05 and birthweight 2331 ± 345 vs. 3332 ± 405 grams, p < 0.05, respectively]. Maternal weight and body mass index was higher among non-affected pregnancies, 61% infants were born vaginally, and no differences in cord blood pH at birth were noted. SGA infants had higher systolic and mean blood pressure at both time points, lower indices of right ventricular (RV) performance [TAPSE (tricuspid annular peak systolic excursion) 7.4 ± 2.8 vs. 9.3 ± 0.7 on day 1, 7.2 ± 2.8 vs. 9.2 ± 0.5 on day 2, p = 0.001], lower pulmonary acceleration time (PAAT) suggestive of elevated pulmonary vascular resistance [56.4 ± 10.5 vs. 65.7 ± 13.2 on day 1, 61.4 ± 12.5 vs. 71.5 ± 15.7 on day 2, p = 0.01] and higher left ventricular (LV) ejection fraction [62.1 ± 7.8 vs. 54.9 ± 5.5 on day 1, 61.9 ± 7.6 vs. 55.8 ± 4.9 on day 2, p = 0.003].ConclusionsSGA infants had evidence of higher pulmonary vascular resistance, and lower RV performance during the postnatal transition. The relevance and impact of these changes to hemodynamic disease states during the postnatal transition requires prospective investigation

Intraventricular hemorrhage in preterm infants of less than 28 weeks gestation with surfactant administration

Universitatea de Medicină şi Farmacie Tg. Mureş, Centrul Regional de Terapie Intensivă Neonatală Tg. MureşIntroducere: Hemoragia intraventriculară (IVH) la vârste gestaţionale (VG) foarte mici este o complicaţie ameninţătoare de viaţă, care necesită diagnostic precoce şi urmărire ecografică şi neurologică. Material şi metodă: În studiul retrospectiv desfăşurat în perioada 1 ianuarie 2016-31 decembrie 2017 am analizat factorii de risc pentru IVH la un lot de 79 prematuri cu vârsta gestaţională ≤ 28 săptămâni internaţi în Centrul Regional de Terapie Intensivă Neonatală Tg. Mureş. Rezultate: Din cei 79 prematuri incluşi în studiu, 52 (65,82%) au beneficiat de administrare de surfactant exogen (lotul 1), iar la 27 (34.18%) nu s-a administrat surfactant exogen (lotul 2). Prezenţa IVH s-a raportat la 38.46% în lotul 1 şi la 37,03% în lotul 2, nesemnificativ statistic (p=0.17;OR=0.14;95% IC=0.014-1.445). Pentru lotul 1, VG medie a fost de 25.71±1,69 SD, iar greutatea la naştere (GN) medie a fost de 846.9 g±212.1g, comparativ cu lotul 2 unde VG medie a fost de 26.29±1,54, SD, respectiv GN medie 965.9 g±206.8g (p<0,05). Administrarea de corticoterapie antenatală nu a influenţat dezvoltarea IVH (p=1; OR=1.071; 95%IC=0.706-1.626) la niciunul din loturi. 55% din lotul 1, respectiv 60% din lotul 2 au prezentat hemoragii de grad 3/4, hipotensiunea arterială fiind prezentă la 40%, respectiv 30% din cazurile cu IVH. Dezvoltarea IVH s-a corelat semnificativ cu necesitatea suportului ventilator invaziv (p=0,0013, OR = 0, 0915, 95% IC=0,01-0,46). Au decedat 13,46% dintre nou-născuţii din lotul 1, respectiv 3,70% din lotul 2. Concluzii: managementul corect al detresei respiratorii, limitarea ventilaţiei invazive, tratamentul hipotensiunii sunt condiţii esenţiale pentru limitarea HIV la prematurul extrem de mic cu sau fără administrare de surfactant.Introduction: Intraventricular hemorrhage (IVH) at very small gestational age (GA) is a life-threatening complication that requires early diagnosis and ultrasound and neurological follow-up. Material and methods: In this retrospective study conducted between 1 January 2016 and 31 December 2017, we analyzed the risk factors for IVH in a group of 79 preterm infants with gestational ages ≤ 28 weeks, admitted in the Regional Center of Neonatal Intensive Care Tg. Mures. Results: Of the 79 preterms included in the study, 52 (65.82%) received exogenous surfactant (lot 1), and 27 (34.17%) did not receive exogenous surfactant (group 2). The presence of IVH was 38.46% in lot 1 and 37.03% in group 2, which is not statistically significant (p = 0.17, OR = 0.14, 95% IC = 0.014-1.445). For group 1, mean GA was 25.71 ± 1.69 SD and mean birth weight (BW) was 846.9 g ± 212.1 g compared to group 2 where mean VG was 26.29 ± 1.54 SD, and the mean BW was 965.9 g ± 206.8 g (p <0.05). The administration of antenatal corticosteroids did not influence the development of IVH (p = 1; OR = 1.071; 95% IC = 0.706-1.626) in any of the groups. 55% of group 1 and 60% of group 2 experienced grade 3/4 hemorrhages, with hypotension presenting in 40% and 30% of IVH cases, respectively. IVH development significantly correlated with the need for invasive ventilator support (p = 0.0013, OR = 0, 0915, 95% IC = 0.01-0.46). 13.46% of newborns in group 1 and 3.70% of group 2 were deceased. Conclusions: Proper management of respiratory distress, limitation of invasive ventilation, treatment of hypotension are essential conditions for limiting IVH in extremely premature infants with or without surfactant administration

Auxological correlation between the maternal obesity, excessive weight gain during pregnancy, macrosomia, feeding practices and infant obesity

UMF “Iuliu Haţieganu” Cluj, UMF “Gr. T. Popa” Iaşi, UMF “Carol Davila” Bucureşti, Fac. Medicină Oradea, UMF Târgu Mureș, SJU SibiuThe infant and adult obesity is becoming a real public health concern in Romania too. The mother's obesity and excessive weight gain during pregnancy are proven risk factors for the obesity of the child in the future. The protective role of breastfeeding against obesity is already demonstrated. The most important issue is whether the choice of a milk formula with the right protein composition could also protect or not the newborn from becoming future obese infants and children.Obezitatea copilului şi adultului are rate îngrijorătoare şi în Romania. Obezitatea mamei şi creşterea excesivă în greutate a gravidei constituie factori de risc pentru macrosomie şi pentru obezitatea ulterioară a copilului. Rolul protector al laptelui de mamă în prevenţia obezităţii infantile este deja demonstrat. Se pune întrebarea dacă alegerea unei formule de lapte cu conţinut adecvat de proteine protejează sau nu nou-născuţii care au deja greutate mare la naştere, pentru dezvoltarea obezităţii în perioada de sugar si copil mic

Drug Closure of a Patent Ductus Arteriosus in An Extremely Low Birth Weight Premature Newborn. A Case Report

Introduction: Patent ductus arteriosus involves maintaining the permeability of the vascular ductus located between the pulmonary artery and the descending aorta, due to the failure of transition from foetal to adult type circulation. This malformation is characteristic to premature newborns with extremely low birth weight. The main pathophysiological factors identified in this pathology are immaturity of the smooth muscles, presence of vasodilator mediators and persistent hypoxaemia. Ductal-dependent cardiac malformations require drug therapy for keeping the permeability of the ductus arteriosus until the time of corrective surgery

GATA4 rs61277615, rs73203482, and rs35813172 in Newborns with Transposition of the Great Arteries

Congenital heart disease is the most common malformative pathology in newborns, with a worldwide incidence at 0.4-5%. We investigated the possible relationship between variations in nucleotide sequences and specific cardiac malformations in the GATA-binding factor 4 (GATA4) exon 1 region by using Sanger sequencing. Forty-four newborns from a third-level neonatal intensive care unit who were diagnosed with nonsyndromic, ductal-dependent congenital heart disease (i.e., transposition of the great arteries or ductal-dependent coarctation of the aorta) were enrolled. Their DNA was extracted using commercial methods and tested using the multiplex ligation-dependent probe amplification (MLPA) technique. The Sanger sequencing for GATA4 exon 1 in the newborns’ DNA identified rs61277615, rs73203482, and rs35813172 variants not reported in the ClinVar archive of human variations in newborns previously diagnosed with transposition of the great arteries (n=5) and coarctation of the aorta (n=1). The identification of these novel variants in newborns with transposition of the great arteries or ductal-dependent coarctation of the aorta may be the first step in determining the variants’ contribution to the occurrence of congenital heart disease. However, these results may be inconclusive, since the observed variants within GATA4 gene were not previously reported

Comparative assessment of myocardial function between late premature newborns and term neonates using the 2D speckle tracking method

IntroductionAssessment of myocardial function through speckle tracking echocardiography (STE) can bring benefits to conventional echocardiography in premature newborns, a particular vulnerable group in terms of adaptation to extra-uterine life. Furthermore, it represents a non-invasive imagistic method which can guide therapeutic approach in the hemodynamically unstable newborn. This study aims to highlight the particularities of myocardial function in late premature newborns, by conducting a comparison with a group of healthy neonates, by using STE.MethodsConducted over a timespan of two years, this prospective study enrolled 64 term neonates and 21 premature newborns, with gestational ages ranging between 28 and 36 weeks, who prior to discharge underwent a cardiac ultrasound, involving two-dimensional image acquisitions of the apical four-chamber view of both ventricles. Afterwards, the images were offline analyzed, by using the autostrain function.ResultsAfter segmental strain analysis, no significant discrepancies between the two groups in terms of interventricular values were found. However, left ventricle and right ventricle strain measurements differed significantly (p &lt; 0.01), for each of the analyzed segments (basal, medial or apical). Moreover, a linear increase in interventricular (IV) basal strain with corrected gestational age progression was noted (p = 0.04). Peak global longitudinal strain (pGLS) and EF were similar between the two study groups. Premature newborns presented significantly more negative mean values of right ventricular free wall longitudinal strain (RVFWSL), (−24.19 ± 4.95 vs. −18.05 ± 5.88, p &lt; 0.01) and of right ventricle global four chamber longitudinal strain (RV4CSL), (−19.71 ± 3.62 vs. −15.46 ± 5.59, p &lt; 0.01), when compared to term neonates.ConclusionsThe 2D STE is a reliable method for cardiac assessment of late preterm newborns. The evaluation of two-dimensional global longitudinal LV and RV strains might represent a useful tool in clinical practice. A better response of the right ventricle to the longitudinal deformation within premature neonates was noted. Thus, this study facilitates the identification of accurate reference values for this particular population segment, which will enable the evaluation of ventricular function in premature newborns with concurring disorders. Future longitudinal studies, assessing the fetal heart, could provide more insight into the development of myocardial function