EUROPEAN CONSENSUS GUIDELINES ON THE MANAGEMENT OF NEONATAL RESPIRATORY DISTRESS SYNDROME

Unatoč postignutom napretku u perinatalnom liječenju novorođenačkog sindroma respiratornog distresa (RDS), još uvijek postoje različiti stavovi. Europski tim stručnjaka neonatologa je, nakon kritičkog pregleda svih suvremenih dokaza, usuglasio smjernice 2007. godine. Postoje jaki dokazi o ulozi antenatalnih kortikosteroida u prevenciji RDS-a, ali nije sigurno je li višekratno davanje bez štetnih posljedica. Mnogi postupci u svrhu stabilizacije nedonoščeta po rođenju, kao primjena kisika te ventilacija pozitivnim tlakom, nisu zasnovani na dokazima i mogu ponekad biti štetni. Primjena egzogenog surfaktanta je od najveće važnosti u liječenju RDS-a, ali još uvijek nije jasno koji je preparat najbolji, koja je optimalna doza i vrijeme primjene za pojedinu dob trudnoće. Mehanička ventilacija može biti presudna za preživljenje, ali isto tako oštećuje pluća i stoga treba razviti protokole kako bi se izbjegla mehanička ventilacija, kada je to moguće, a primijenio kontinuirani pozitivni tlak preko nosa. Kako bi se novorođenčadi s RDS-om osigurao što bolji ishod, važne su potporne mjere kao što je održavanje tjelesne temperature, ravnoteža tekućina, adekvatna prehrana, liječenje arterijskog duktusa i potpora cirkulacije kako bi se krvni tlak održavao u normalnim granicama.Despite recent advances in the perinatal management of neonatal respiratory distress syndrome (RDS), controversies still exist. We report the recommendations of a European panel of expert neonatologists who developed consensus guidelines after critical examination of the most up-to-date evidence in 2007. Strong evidence exists for the role of antenatal steroids in RDS prevention, but it is not clear if repeated courses are safe. Many practices involved in preterm neonatal stabilization at birth are not evidence based, including oxygen administration and positive pressure lung inflation, and they may at times be harmful. Surfactant replacement therapy is crucial in management of RDS but the best preparation, optimal dose and timing of administration at different gestations is not always clear. Respiratory support in the form of mechanical ventilation may also be life saving but can cause lung injury, and protocols should be directed to avoiding mechanical ventilation where possible by using nasal continuous positive airways pressure. For babies with RDS to have the best outcome, it is essential that they have optimal supportive care, including maintenance of a normal body temperature, proper fluid management, good nutritional support, management of the ductus arteriosus and support of the circulation to maintain adequate blood pressure

Effect of Chorioamnionitis on Mortality, Early Onset Neonatal Sepsis and Bronchopulmonary Dysplasia in Preterm Neonates with Birth Weight of ≤1,500 Grams

The aim of the study was to investigate the effects of chorioamnionitis on mortality and early onset neonatal sepsis (EONS) and bronchopulmonary dysplasia (BPD) in preterm neonates with birth weight ≤1,500 g. The study included 395 preterm infants born at the Zagreb Clinical Hospital Center, from January 2001 to December 2005. All the placentas from preterm deliveries were sent for pathological examination. The patients were categorized into two groups: one including patients with chorioamnionitis at placental histology (47%) and the other control group without chorioamnionitis (53%). Neonates were distributed into 3 groups according to gestational age: the first group with 132 (33%) infants born at ≤28 weeks of gestation, the second with 202 (52%) infant born from 29 to 32 weeks of gestation and the third with 61 (15%) infants born at ≥33 weeks gestation. Chorioamnionitis was diagnosed significantly more often in the first gestational age group (91/132-69% of infants, χ2=51.307, p0.05). Lethal outcome ensued in 54/132 (41%) infants from the first gestational age group; 30/54 (55%) were born from pregnancies complicated by chorioamnionitis. In comparison with the control group, mortality was significantly higher in the group of premature infants with gestation ≤28 weeks whose placentas showed chorioamnionitis (χ2=7.645, p0.05). In conclusion, premature neonates from pregnancies complicated by chorioamnionitis are more often born at ≤28 weeks of gestation. Chorioamnionitis during pregnancy in neonates whose gestation is ≤28 weeks leads to a significantly higher rate of mortality than in neonates with a longer gestation period. A greater incidence of EONS was proven in the group of infants with chorioamnionitis. The difference between the incidence of BPD in preterm infants born from pregnancies complicated by chorioamnionitis and the control group was not significant

MORTALITY OF NEWBORNS IN CROATIA IN 2005

Rani neonatalni mortalitet (RNM) je sastavnica perinatalnog mortaliteta, i zadnjih godina je manji od fetalnog mortaliteta. RNM je u 2005. g. u Hrvatskoj bio 71% za skupinu novorođenčadi porodne težine (PT) 500–749 g, 32% za novorođenčad PT 750–999 g, 16% za novorođenčad PT 1000–1249 g, i 9% za novorođenčad PT 1250–1499 g. Mortalitet do otpusta iz bolnice (MOB) je za skupine novorođenčadi iste porodne težine bio 84%, potom 48%, zatim 20% i 10%. U skupinama novorođenčadi veće porodne težine RNM i MOB bili su još niži. RNM sve novorođenčadi >500 g bio je 3,4‰, neonatalni mortalitet (NM) je bio 4,1‰ i MOB je bio 4,4‰. RNM novorođenčadi PT >1000 g bio je 2,2‰, NM je bio 2,6‰ i MOB je bio 2,9‰. RNM je za svu novorođenčad PT >500 g činio prosječno 76,7% smrtnosti (145/189), dok je ostalih 44 djece (23,3%) umrlo nakon prvog tjedna života. To ukazuje da RNM nije podcijenjen na račun visokog kasnijeg moraliteta, i da pedijatrijska-neonatalna služba ne ostvaruje smanjenje RNM na račun kasnijeg povišenja ¬mortaliteta ili MOB. U 2005. godini je kao i u 2003. i 2004. tri četvrtine novorođenčadi PT 500–1499 g rođeno u rodilištima III. razine. Za vjerodostojnu analizu podataka ishoda novorođenčadi i djece planirana je izrada novih obrazaca perinatalnih zbivanja, uz prikupljanje podataka o postnatalnom transportu novorođenčadi i mjestu liječenja novorođenčeta. Potrebno je nastaviti prikupljati detaljne podatke o vitalnim događajima do otpusta iz bolnice. Ti podatci predstavljat će osnovu za planiranje potreba neonatološke službe, izradu smjernica za prenatalno i postnatalno usmjeravanje novorođenčadi i za davanje vjerodostojnijih prognoza roditeljima novorođenčadi najnižih porodnih težina.Early neonatal mortality (ENM) is one of components of perinatal mortality. In recent years ENM is smaller than fetal mortality. ENM was in 2004 in Croatia 71% for newborns of birth-weight (BW) 500–749 g; 32% for those 750–999 g, 16% for those 1000–1249 g, and 9% for newborns of BW 1250–1499 g. Mortality to discharge from hospital (MDH) for newborns in these birth-weight groups was 84%, 48%, 20% and 10%, respectively. In groups of newborns with larger BW over 1500 g ENM and MDH were even lower. ENM for all newborns BW >500 g was 3,4‰, neonatal mortality (NM) was 4,1‰, and MDH was 4,4‰, respectively. ENM for newborns of BW > 1000 g was 2,2‰, NM was 2,6‰, and MDH was 2,9‰, respectively. ENM made 76,7% mortality of all newborns (BW >500 g) (145/189), while the rest of 44 newborns (23,3%) died after the first week of life. Therefore, ENM was not underestimated due to possible higher late neonatal mortality, pediatric-neonatal services didn\u27t reduce ENM on expenses of higher late neonatal mortality or MDH. In the year 2005, as in 2003 and 2004, three fourths of newborns of BW 500–1499 grams were born in maternities of 3rd level. Within the aims of the proper analysis of newborns’ outcome data, is creation of new certificates of vital events with details of postnatal transport and place of treatment of newborn. It is necessary to continue to follow survival or mortality of all newborns to discharge from the hospital. These data will give us benchmark for planning of neonatal resources, development of recommendations in perinatology-neonatology for prenatal and postnatal transfer, and for more exact prognoses of the smallest newborns in the process of decision making

MORTALITY OF NEWBORNS IN REPUBLIC OF CROATIA IN THE YEAR 2008

Rani neonatalni mortalitet (RNM) je sastavnica perinatalnog mortaliteta, zadnjih godina je manji od fetalnog mortaliteta. RNM je u 2007. godini u Hrvatskoj bio 69% za skupinu novorođenčadi porodne težine (PT) 500–749 g, 30% za novorođenčad PT 750–999 g, dok je 2008. godine RNM za djecu PT ≤999 g bio 42%. Po 100-gramskim razredima RNM je bio za djecu PT <500 g 100%, za djecu PT 500–599 g 72,2%, za djecu PT 600–699 g 77,8%, za djecu PT 700–799 g 46,4%, za djecu PT 800–899 g 20% i za djecu PT 900–999 g RNM je bio 16,2%. Za novoro|enčad PT 1000–1249 g RNM je bio 9,6% i za novoro|enčad PT 1250–1499 g 2,4%. Mortalitet do otpusta iz bolnice (MOB) je za skupine novorođenčadi iste porodne težine bio: za djecu <500 g 100%, za djecu PT 500–599 g 94,4%, za djecu PT 600–699 g 77,8%, za djecu PT 700–799 g 57,1%, za djecu PT 800–899 g 42,9%, za djecu 900–999 g 21,6%, za djecu PT 1000–1249 g 12% i za djecu PT 1250–1499 g 2,4%. Sve su te vrijednosti niže od odgovarajućih za prethodno razdoblje. U skupinama novorođenčadi veće porodne težine RNM i MOB bili su još niži. RNM sve novorođenčadi bio je 2,7‰, neonatalni mortalitet (NM) je bio 3,1‰ i MOB je bio 3,5‰, što je tako|er manje nego prethodnih godina. RNM novorođenčadi PT ≥1000 g bio je 1,3‰, NM 1,5‰ i MOB 1,7‰, manje nego za 2007. godinu. RNM je za svu novorođ enčad činio prosječno 77,1% smrtnosti (118/153), dok je ostalih 35 djece (22,9%) umrlo nakon prvog tjedna života. To poka zuje da RNM nije podcijenjen na račun visokog kasnijeg mortaliteta, i da pedijatrijska-neonatalna služba ne ostvaruje smanjenje RNM na račun kasnijeg povišenja neonatalnog mortaliteta ili mortaliteta do otpusta iz bolnice. U razdoblju 2003.–2006. godine je tri četvrtine novorođenčadi PT 500–1499 g ro|eno u rodilištima III. razine. U 2007. godini su četiri petine ove djece rođene u rodilištima III. razine. U 2008. godini je 18,5% djece PT ≤1499 g rođeno u rodilištima izvan III. razine. Trend rađanja ove djece usmjeren je prema rodilištima III. razine, ali još ima mjesta povećanju broja poroda ove djece u rodilištima III. razine. Usporedbe RNM i NM s europskim zemljama ukazuju na postojanje daljnjih mogućnosti poboljšanja perinatalnih pokazatelja. Za vjerodostojnu analizu podataka ishoda novorođenčadi i djece planirana je izrada novih obrazaca perinatalnih zbivanja, uz prikupljanje podataka o postnatalnom transportu novorođenčadi i mjestu liječenja novorođenčeta. Potrebno je nastaviti prikupljati detaljne podatke o vitalnim događajima do otpusta iz bolnice. Ti podatci predstavljat će osnovu za planiranje potreba neonatološke službe, izradu smjernica za prenatalno i postnatalno usmjeravanje novorođenčadi i za davanje vjerodostojnijih prognoza roditeljima novorođenčadi najnižih porodnih težina.Early neonatal mortality (ENM) is one of components of perinatal mortality. In recent years ENM is smaller than fetal mortality. ENM was in 2008 in Croatia 69% for newborns of birth-weight (BW) 500–749 g; 30% for those 750–999 g, 16% for those 1000–1249 g, and 6% for newborns of BW 1250–1499 g. In newborns divided by 100-grams, ENM for infants BW <500 g was 100%, for those of BW 500–599 g was 72,2%, for infants BW PT 600–699 g 77,8%, for infants of BW 700–799 g 46,4%, for infants of BW 800–899 g 20% and for infants of BW 900–999 g ENM was 16,2%, respectively. For infants of BW 1000–1249 g ENM was 9,6% and for infants of BW 1250–1499 g was 2,4%, respectively. Mortality to discharge from hospital (MDH) for subgroups of infants of the same BW was 100% for infants of BW <500 g, for infants of BW 500–599 g 94,4%, for infants of BW 600–699 g 77,8%, for infants of BW 700–799 g 57,1%, for infants of BW 800–899 g 42,9%, for infants of BW 900–999 g 21,6%, for infants of BW 1000–1249 g 12%, and for infants of BW 1250–1499 g was 2,4%, respectively. All these values were lower than corresponding in previous period. In groups of infants of larger BW, ENM and MDH were lower. ENM of all newborns was 2,7‰, neonatal mortal-1,3‰, NM was 1,5‰, and MDH was 1,7‰, respectively, lower than in the year 2007. ENM was 77,1% (118/153) of all infants deaths, while the remained 35 infants (22,9%) died after the first week. Therefore, ENM was not underestimated instead of possible higher late neonatal mortality, pediatric-neonatal services didn’t reduce ENM on expenses of higher late neonatal mortality or MDH. In the years 2003–2006, three fourths of newborns of BW 500–1499 g were born in maternities of IIIrd level. In the year 2007 four fifths of these newborns were born in maternities of IIIrd level. In the year 2008 18,5% of infants of BW ≤1499 g were born in maternities outside of IIIrd level. Through the years the proportion of these infants born in maternities of IIIrd level is increasing, but that proportion can be even larger. Comparisons of ENM and NM with some European countries show the possibility of further improvement in perinatal markers. In the aim of the proper analysis of newborns’ outcome data, creation of new certificates of vital events is planned with details of postnatal transport and place of the treatment of newborn. It is necessary to continue to follow survival or mortality of all newborns up to discharge from hospital. These data will give us benchmark for planning of neonatal resources, development of recommendations in perinatology-neonatology for prenatal and postnatal transfer, and for more exact prognoses to parents of the smallest newborns

Effect of chorioamnionitis on mortality, early onset neonatal sepsis and bronchopulmonary dysplasia in preterm neonates with birth weight of ≤ 1,500 grams [Utjecaj korioamnionitisa na mortalitet, ranu sepsu i bronhopulmonalnu displaziju u nedonoščadi porodne težine ≤1,500 grama ]

The aim of the study was to investigate the effects of chorioamnionitis on mortality and early onset neonatal sepsis (EONS) and bronchopulmonary dysplasia (BPD) in preterm neonates with birth weight or = 33 weeks gestation. Chorioamnionitis was diagnosed significantly more often in the first gestational age group (91/132-69% of infants, chi2 = 51.307, p 0.05). Lethal outcome ensued in 54/132 (41%) infants from the first gestational age group; 30/54 (55%) were born from pregnancies complicated by chorioamnionitis. In comparison with the control group, mortality was significantly higher in the group of premature infants with gestation 0.05). In conclusion, premature neonates from pregnancies complicated by chorioamnionitis are more often born at < or = 28 weeks of gestation. Chorioamnionitis in neonates whose gestation is < or = 28 weeks leads to a significantly higher rate of mortality than in neonates with a longer gestation period. A greater incidence of EONS was proven in the group of infants with chorioamnionitis. The difference between the incidence of BPD in preterm infants born from pregnancies complicated by chorioamnionitis and the control group was not significant

Utjecaj korioamnionitisa na mortalitet, ranu sepsu i bronhopulmonalnu displaziju u nedonoščadi porodne težine ≤1,500 grama

The aim of the study was to investigate the effects of chorioamnionitis on mortality and early onset neonatal sepsis (EONS) and bronchopulmonary dysplasia (BPD) in preterm neonates with birth weight or = 33 weeks gestation. Chorioamnionitis was diagnosed significantly more often in the first gestational age group (91/132-69% of infants, chi2 = 51.307, p 0.05). Lethal outcome ensued in 54/132 (41%) infants from the first gestational age group; 30/54 (55%) were born from pregnancies complicated by chorioamnionitis. In comparison with the control group, mortality was significantly higher in the group of premature infants with gestation 0.05). In conclusion, premature neonates from pregnancies complicated by chorioamnionitis are more often born at < or = 28 weeks of gestation. Chorioamnionitis in neonates whose gestation is < or = 28 weeks leads to a significantly higher rate of mortality than in neonates with a longer gestation period. A greater incidence of EONS was proven in the group of infants with chorioamnionitis. The difference between the incidence of BPD in preterm infants born from pregnancies complicated by chorioamnionitis and the control group was not significant.Cilj ove retrospektivne studije je istražiti utjecaj korioamnionitisa na mortalitet, ranu novorođenačku sepsu (EONS) i bronhopulmonarnu displaziju (BPD) u nedonoščadi porodne težine ≤1,500 g. U studiju je uključeno 395 nedonoščadi rođenih u Kliničkom bolničkom centru Zagreb, u periodu od siječnja 2001. do prosinca 2005. Ispitanici su podijeljeni u 2 skupine prema nalazu patohistološkog pregleda posteljice, plodovih ovoja i pupkovine: u skupinu čija je trudnoća komplicirana korioamnionitisom i kontrolnu skupinu bez korioamnionitisa. Korioamnionitis je potvrđen u 184 (47%) ispitanih posteljica. Nedonoščad je podijeljena prema gestacijskoj dobi: bilo je 132 (33%) gestacije ≤28 tjedana, 202 (52%) gestacije 29 do 32 tjedna i 61 (15%) gestacije ≥33tjedna. U skupini nedonoščadi s gestacijom ≤28 tjedana bilo je 91/132 (69%) nedonošče rođeno iz trudnoće komplicirane korioamnionitisom (chi2=51,307, p<0,05). Smrtni ishod je uslijedio u 67 (17%) ispitanika, a 37/67 (55%) je bilo u skupini s korioamnionitisom (chi2=2,421, p>0,05). U skupini nedonoščadi čija je gestacija ≤28 tjedana umrlo je 54/132 (41%) ispitanika, a 30/54 (55%) je rođeno iz trudnoće komplicirane korioamnionitisom. Utvrđen je statistički značajno viši mortalitet u skupini nedonoščadi gestacije ≤28 tjedana koja je u trudnoći bila izložena korioamnionitisu (chi2=7,645, p<0,01). EONS je utvrđen u 100 (25%) ispitanika, a 66/100 (66%) je bilo iz skupine čija trudnoća je opterećena korioamnionitisom, što je pokazalo statistički značajnu razliku u odnosu na kontrolnu skupinu (chi2=22,396, p<0.01). BPD je razvijen u 25 (6%) ispitanika, a 12/25 (48%) je pripadalo skupini koja je u trudnoći izložena korioamnionitisu (chi2=0,022, p>0,05). Trudnoće komplicirane korioamnionitisom statistički značajno češće završavaju porodom ≤28 tjedana gestacije. Utvrđen je statistički značajno veći mortalitet u nedonoščadi gestacije ≤28 tjedana ukoliko su bila izložena korioamnionitisu. U skupini nedonoščadi rođenih iz trudnoće s korioamnionitisom je statistički značajno češća pojava EONS-a. Nedonoščad čije su majke u trudnoći imale korioamnionitis nema statistički značajno češću pojavnost BPD-a