CHILD- AND FAMILY-CENTERED CARE IN THE TREATMENT OF CHILDREN - KNOWLEDGE, ATTITUDES, PRACTICE

Despite the advances in medical technology, health care improvements have not always been accompanied by commensurate attention to the child\u27s well-being. Psychological and emotional status of children during hospital treatment is often underestimated. Namely, certain kind of institutional negligence is frequently present in everyday practice in children\u27s institutions. Many hospitals in Bosnia and Herzegovina (B&H) have become child-friendly during the implementation of the Project on Child-Friendly Hospitals supported by UNICEF and WHO. Apart from the introduction of child friendly environment, staff in hospitals was trained to provide a holistic approach. The program was closely linked to the Baby Friendly Hospital Initiative that supported breastfeeding. A few years thereafter, our focus is still on the physical treatment of sick children, whereas the attention to their anxieties, fears and suffering has failed. A more serious approach to this problem is needed and should begin at an educational level in medical school programs. Accordingly, our philosophy (mission) should change from a mechanical (techno-) medicine to holistic medicine

CHILD- AND FAMILY-CENTERED CARE IN THE TREATMENT OF CHILDREN - KNOWLEDGE, ATTITUDES, PRACTICE

Despite the advances in medical technology, health care improvements have not always been accompanied by commensurate attention to the child\u27s well-being. Psychological and emotional status of children during hospital treatment is often underestimated. Namely, certain kind of institutional negligence is frequently present in everyday practice in children\u27s institutions. Many hospitals in Bosnia and Herzegovina (B&H) have become child-friendly during the implementation of the Project on Child-Friendly Hospitals supported by UNICEF and WHO. Apart from the introduction of child friendly environment, staff in hospitals was trained to provide a holistic approach. The program was closely linked to the Baby Friendly Hospital Initiative that supported breastfeeding. A few years thereafter, our focus is still on the physical treatment of sick children, whereas the attention to their anxieties, fears and suffering has failed. A more serious approach to this problem is needed and should begin at an educational level in medical school programs. Accordingly, our philosophy (mission) should change from a mechanical (techno-) medicine to holistic medicine

Minor Malformations: Neonatal or Anthropological Story?

Minor malformations (mM) are mild physical deformities that with their incidence, number and evolution may be external indicators of hidden, more serious disorders. Most often these are recognized by the neonatologists. First studies done some forty years ago showed an average incidence of 15% in the general population of newborns and about 50% in children with major malformations (MM). A study done in Maternity Hospital Mostar covering a one-year cohort of the newborns and assessing 38 mM showed an average incidence 23.7% mM in children without MM. Twelve mM have had a frequency above 1%, many of them in the head region. The most frequent specific mM was a deep sacral dimple (4.6%). Eighteen mM malformations that appeared more often were re-evaluated three months later. A large part (50–80%) disappeared, but a small number (about 17%) were newly discovered. In the newborns with MM, the incidence of mM was 57.5%. 15 of 23 children with MM (65.2%) had more than three associated mM. The highest percentage was in the group of hypotrophic newborns. The connection of mM with MM and specificity of incidence of mM in one population are the reason why the search for mM in the neonatal period could be benefit also for children and whole population

Down sindrom u regiji zapadne Hercegovine u petogodišnjem razdoblju-dinamika incidencije

Uvod: Down sindrom (DS) je najčešća kromosomopatija koja se pojavljuje u novorođenačkoj populaciji djece u regiji zapadne Hercegovine (zH). Praćenjem incidencije kroz više desetljeća u ovoj regiji povećali smo razumijevanje i zdravstvenog i sociokulturnog standarda u pristupu djeci s ovim osobitim sindromom. Cilj ove analize petogodišnjeg razdoblja bio je dobiti uvid u osnovne epidemiološke karakteristike novorođenčadi sa SD u razdoblju od 2016. do 2020.g. Ispitanici i metode: Proveli smo retrospektivnu analizu bolničke dokumentacije na Klinici za dječje bolesti SKB Mostar. Ispitanici su bili djeca liječena zbog Down sindroma. Rezultati: U tom razdoblju bilo je 8851 živorođene novorođenčadi u regiji zH. Bilo je 15 živorođene djece s DS. Incidencija DS za to razdoblje iznosi 1,69/1000 novorođenih. Abortirani i mrtvorođenčad se nisu analizirali. Bilo je sedmero dječaka (47 %) i osam djevojčica (53 %). Sva djeca su citogenetski analizirana, svi su bili regularni tip trisomije 21. Devet majki (60 %) je bilo starije od 35 g. Major malformacije (MM) su nađene u sve novorođenčadi, najčešće su bile prisutne malformacije kardiovaskularnog sustava (67 %). Šestero (40 %) je imalo više od šest karakterističnih minor stigmi (mM). 80 % djece rođeno je nakon 37 tjedana gestacije. 87 % majki je imalo urednu trudnoće. U 93 % novorođenčadi s DS postnatalni ishod je bio uredan. Jedno novorođenče je imalo smrtni ishod. Zaključak: Prevalencija DS u regiji zapadne Hercegovine kroz zadnjih pet godina je neznatno niža od one u prijašnjem desetljeću. Nešto je viša od one u zapadnim regijama Europske unije. Bolja perinatalna zaštita i dobri ishodi djece s DS optimizirali su i humanizirali pristup novorođenčetu s DS

PREVALENCE OF INTELLECTUAL DISABILITIES AND EPILEPSY IN DIFFERENT FORMS OF SPASTIC CEREBRAL PALSY IN ADULTS

Background: Spastic cerebral palsy may be interconnected with other neurodevelopmental disorders such as intellectual disabilities, and epilepsy. Brain synaptic plasticity and successful restorative rehabilitation may also contribute to diminish neurological deficit of patients having cerebral palsy. The aim of this study was to investigate the prevalence of intellectual disabilities and epilepsy in adult patients with different forms of spastic cerebral palsy and to find out correlation between the severity level of intellectual disabilities and epilepsy. Subjects and methods: Adults diagnosed with different forms of spastic cerebral palsy were analyzed during a three-month period. The investigated features were: gender and age; form of cerebral palsy; the prevalence of intellectual disabilities and epilepsy. Intellectual disabilities were divided into 4 severity levels. The correlation between the severity level of intellectual disabilities and epilepsy was statistically analyzed. Results: Intellectual disability was present in 55% of patients diagnosed with spastic cerebral palsy. Epilepsy was present in 36% of such patients. It was recorded in 51.1% of quadriplegic, 21.9% of diplegic, and 19.2% of hemiplegic patients. Intellectual disability was present in 73.8% of quadriplegic, 31.3% of diplegic, and 53.8% of hemiplegic patients. The statistically significant correlation existed between the severe intellectual disability and epilepsy. Conclusions: Intellectual disabilities and epilepsy most frequently occurred in patients with most severe forms of spastic cerebral palsy. Epilepsy is strongly correlated to the severity level of intellectual disability. Such patients require additional special modes of treatment and restorative rehabilitation to improve the functional outcome

Down sindrom u regiji zapadne Hercegovine u petogodišnjem razdoblju-dinamika incidencije

Uvod: Down sindrom (DS) je najčešća kromosomopatija koja se pojavljuje u novorođenačkoj populaciji djece u regiji zapadne Hercegovine (zH). Praćenjem incidencije kroz više desetljeća u ovoj regiji povećali smo razumijevanje i zdravstvenog i sociokulturnog standarda u pristupu djeci s ovim osobitim sindromom. Cilj ove analize petogodišnjeg razdoblja bio je dobiti uvid u osnovne epidemiološke karakteristike novorođenčadi sa SD u razdoblju od 2016. do 2020.g. Ispitanici i metode: Proveli smo retrospektivnu analizu bolničke dokumentacije na Klinici za dječje bolesti SKB Mostar. Ispitanici su bili djeca liječena zbog Down sindroma. Rezultati: U tom razdoblju bilo je 8851 živorođene novorođenčadi u regiji zH. Bilo je 15 živorođene djece s DS. Incidencija DS za to razdoblje iznosi 1,69/1000 novorođenih. Abortirani i mrtvorođenčad se nisu analizirali. Bilo je sedmero dječaka (47 %) i osam djevojčica (53 %). Sva djeca su citogenetski analizirana, svi su bili regularni tip trisomije 21. Devet majki (60 %) je bilo starije od 35 g. Major malformacije (MM) su nađene u sve novorođenčadi, najčešće su bile prisutne malformacije kardiovaskularnog sustava (67 %). Šestero (40 %) je imalo više od šest karakterističnih minor stigmi (mM). 80 % djece rođeno je nakon 37 tjedana gestacije. 87 % majki je imalo urednu trudnoće. U 93 % novorođenčadi s DS postnatalni ishod je bio uredan. Jedno novorođenče je imalo smrtni ishod. Zaključak: Prevalencija DS u regiji zapadne Hercegovine kroz zadnjih pet godina je neznatno niža od one u prijašnjem desetljeću. Nešto je viša od one u zapadnim regijama Europske unije. Bolja perinatalna zaštita i dobri ishodi djece s DS optimizirali su i humanizirali pristup novorođenčetu s DS

EPIDEMIOLOGICAL CHARACTERISTICS OF CHILDREN BORN ITH DOWN SYNDROME IN WESTERN HERZEGOVINA IN THE PERIOD OF THE LAST TWENTY YEARS (1994-2013)

Background: Children with Down syndrome (DS) are an everyday casuistry of pediatric clinical medicine. The prevalence of DS is dependent on socio-demographic and cultural conditions of a community. Antenatal screening is not carried out mainly due to religious views, and the prevalence of DS in our region is really considered a "natural phenomenon“. The aim of the study was to analyze some epidemiological characteristics of infants with Down syndrome in the western region of Herzegovina in the period between year 1994-2013. Subjects and methods: We performed a retrospective analysis of hospital records of children who were supervised and treated at Children\u27s Hospital through the twenty-year period. Results: In this period there were 44,100 liveborn infants. Down syndrome was detected in 78 children (54 male and 24 female). The prevalence is estimated at 1.8/1,000 of live births. Aborted fetuses and stillbirths were not analyzed. 37 (47%) of the parent couples were over 35 years of age. Out of that 65 cytogenetic analysis, a regular type of trisomy 21 was found in 94% of cases, and the translocation in 6%. From major malformations (MM) heart failure was more often present (47%), then the anomaly of the gastrointestinal and genitourinary systems. Ten children (12%) died, most often in the early period of infancy due to complications of the cardiovascular system. Conclusion: The prevalence of DS throughout these two decades has been uniform in the region of western Herzegovina. Improvement in perinatal care in recent years caused higher survival and a better quality of life for the children with DS and thus their families. DS is less a desirable family tragedy, and increasingly a tolerable family fate

Vasodilatory Prostaglandins in Perinatal Hypoxic Brain Damage

Prostaglandin (PGE2 and PGI2) synthesis was determined in the cerebrospinal fluid (CSF) and serum of 19 hypoxic neonates at the age of 5–96 hours by using Enzyme Linked Immunosorbent Assay (ELISA) method. Control group consisted of 8 children of the same age whose samples were taken due to initial suspicion of neonatal meningitis. The prostaglandin concentrations in CSF were correlated with initial hypoxic-ischemic encephalopathy (HIE) stage and neurological findings of patients at the age of 12 months. The values of PGE2 and PGI2 in the CSF of children with perinatal hypoxia (PNH) were significantly higher than in the children from the control group. The values of PGI2 in serum were significantly higher than in »CSF« of patients with PNH. Although average values of PGE2 and PGI2 in the liquor were higher in children with advanced stage of HIE, the differences between different stages were not statistically significant. We did not find any significant correlation between average concentrations of prostaglandins and neurological findings of the 12-month-old children