COVID-19 TRIAGE AMONG HOSPITALIZED NEONATES IN TUZLA CANTON

Aim: To evaluate the incidence, characteristics, transmission, and outcomes of COVID-19 infection in hospitalized neonates in Tuzla Canton and to emphasize the importance of quality triage in the prevention and control of infection. Material and Methods: A retrospective cohort study, which included all consecutive neonates suspected of COVID-19 infection, and which required screening supervision in the triage department, from those who required hospital treatment at the Pediatric Clinic, University Clinical Center Tuzla for 12 months. (January 1 to December 31, 2020). Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution. Results: In the observed period, in the neonatal triage department, 111 neonates suspected to COVID-19 were treated, with no gender difference. Among them were 92 neonates of mothers suspected of COVID-19 (66 admitted immediately after birth, 26 readmitted after discharge home), and 19 neonates of mothers positive for COVID-19 (16 admitted immediately after birth, 3 readmitted). Cesarean delivery was a more common delivery option, and fever a more common symptom in COVID-19 positive mothers, but without statistical significance. The neonates from COVID-19 suspected mothers formed a heterogeneous group, with common perinatal problems, while neonates from COVID-19 positive mothers, hospitalized immediately after birth, were almost term neonates with appropriate birth weight, without need for a lot of treatment. All neonates hospitalized immediately after birth were negative for COVID-19. The only three COVID-19 positive neonates were readmitted after previous discharge home, and they had mild symptoms, mostly one-day fever, and they all recovered completely. All of these neonates are under further follow-up after discharge from the hospital, and all are, for now, in good general condition, and all have continued to breastfeed. Conclusion: Neonates born to mothers with positive COVID-19 infection generally have favorable outcomes, with no convincing case of vertical transmission. Neonatal COVID-19 is mostly asymptomatic, acquired postnatally, and associated with favorable outcomes. The importance of quality triage in the prevention and control of infection is crucial, with consistent implementation of safe practices including proper patient isolation and appropriate protective equipment

ACUTE RENAL FAILURE IN TERM NEWBORN FOLLOWING PERINATAL ASPHYXIA

Introduction: Perinatal asphyxia (PA) results in hypoxic damage to almost all organs, kidneys being most frequently (40%) affected. Objectives: was to determine the incidence of acute renal failure (ARF) in term neonates with PA and to correlate it with severity of hypoxic ischemic encephalopathy (HIE). Materials and methods: This prospective study of 54 term neonates with PA was performed in tertiary level neonatal intensive care unit at Pediatric Clinic Sarajevo from June 2014 to June 2016. The severe PA was defined as 5. minute Apgar score 1.5 mg/dl (>133 micromol/L) on 3rd day of life or urine output 6 hrs beyond 24 hrs of life. Results. Out of 54 neonates with PA, 22 (40.74 %) had ARF. Most of them (63.6%) had non-oliguric ARF with mean renal output of 2.2 ± 0.5 ml/kg/h. Eight neonates (36.4%) had oliguric ARF with mean renal output of 0.35 ± 0.6 ml/kg/h. Most of the neonates with oliguric ARF (63.4%) had severe PA while in those with non-oliguric ARF moderate PA was predominant. ARF was highest in the neonates with HIE III (85.71 %). (Figure 1.). This showed that as HIE stage progressed, more renal dysfunction was seen in asphyxiated babies and this difference in incidence was found statistically significant (p<0.05). Conclusions. Neonates with severe PA had more frequent ARF and the predominant type of renal involvement was non oliguric. Neonates with HIE stage II and III had significantly higher incidence of ARF

ACUTE RENAL FAILURE IN TERM NEWBORN FOLLOWING PERINATAL ASPHYXIA

Introduction: Perinatal asphyxia (PA) results in hypoxic damage to almost all organs, kidneys being most frequently (40%) affected. Objectives: was to determine the incidence of acute renal failure (ARF) in term neonates with PA and to correlate it with severity of hypoxic ischemic encephalopathy (HIE). Materials and methods: This prospective study of 54 term neonates with PA was performed in tertiary level neonatal intensive care unit at Pediatric Clinic Sarajevo from June 2014 to June 2016. The severe PA was defined as 5. minute Apgar score 1.5 mg/dl (>133 micromol/L) on 3rd day of life or urine output 6 hrs beyond 24 hrs of life. Results. Out of 54 neonates with PA, 22 (40.74 %) had ARF. Most of them (63.6%) had non-oliguric ARF with mean renal output of 2.2 ± 0.5 ml/kg/h. Eight neonates (36.4%) had oliguric ARF with mean renal output of 0.35 ± 0.6 ml/kg/h. Most of the neonates with oliguric ARF (63.4%) had severe PA while in those with non-oliguric ARF moderate PA was predominant. ARF was highest in the neonates with HIE III (85.71 %). (Figure 1.). This showed that as HIE stage progressed, more renal dysfunction was seen in asphyxiated babies and this difference in incidence was found statistically significant (p<0.05). Conclusions. Neonates with severe PA had more frequent ARF and the predominant type of renal involvement was non oliguric. Neonates with HIE stage II and III had significantly higher incidence of ARF

Early signs of diabetic nephropathy and ultrasound characteristics of kidneys in children and youth with diabetes mellitus type 1

Introduction: Diabetic nephropathy is a chronic complication in patients with diabetes mellitus typ 1, which leads to kidney disfunction. Aim: The aim of this study was to compare the metabolic control and albuminuria with ultrasound findings of morphometric measurements and registration Doppler signals of kidneys between children and youth with diabetes mellitus type 1 according to the duration of illness. Material and Methods: The retrospective-prospective study included 69 patients of both genders, that got diabetes mellitus type 1 when they were in the age from 2. to 25. years. Patients were divided into two groups according to the length of diabetes mellitus type 1: the first group was those whose illness had lasted for more than 10 years, and second group with duration of diabetes mellitus typ 1 less than 10 years. Results: No significant difference was registered between the groups regarding frequency of albuminuria, but the chance of it occurring are greater in patients with longer duration of diabetes mellitus type 1. Patients with albuminuria and diabetes mellitus type 1 duration over 10 years had higher glycated hemoglobin A1C, blood pressure, body mass index followed by enlarged volume of both kidneys. Patients with albuminuria and diabetes mellitus type 1 for less than 10 years had a higher creatinine clearance. Conclusion: Ultrasound dimensions and volume of the kidneys in patients with metabolic control parameters are useful for monitoring especially in the early stages of diabetic nephropathy

Palivizumab prophylaxis of RSV infections in Bosnia and Herzegovina

Background: Palivizumab is indicated for respiratory syncytial virus (RSV) prophylaxis in high-risk children. Methods: Observational study, based on 4 sites in Bosnia and Herzegovina (B&H), with institutional reports of infants at high risk for RSV who received at least 1 dose of palivizumab during the 2008-2013 RSV seasons. Results: Across 6 RSV seasons, from 2008/9 to 2013/14, 589 infants were enrolled (0.29% of livebirths population). Of all infants, 290 (49.2%) were enrolled for prematurity only, 82 (13.9%) for bronchopulmonary dysplasia/chronic lung disease (BPD/CLD), 201 (34.1%) for congenital heart disease (CHD), and 13 (2.2%) for other reasons; 365 (61.9%) infants in total were born before 33 weeks. Average gestational age of preterm infants enrolled for prematurity only was 30.2 ± 3.2 weeks; for preterm infants with BPD/CLD it was 28.3 ± 3.7 weeks. Overall average of palivizumab injections was 4.1 ± 1.0. Hospitalization rate related to severe lower respiratory infections (LRI) during the period of protection by palivizumab was 1.2%. Respiratory infections which deserved medical attention were observed in 3.7% infants included in palivizumab prophylaxis. Conclusion: RSV prophylaxis in B&H is provided systematically and successfully, following the national guidance established in 2009, with the aim of achieving a good cost-benefit ratio, with very low hospitalization rate for severe LRI in prophylaxed infants. New randomized controlled trials (RCTs) and American Academy of Pediatrics (AAP) guidance revised in 2014 will be taken into account in establishing a new national recommendation