ACUTE RENAL FAILURE IN THE NEWBORNS HOSPITALIZED AT THE INTENSIVE CARE UNIT, UNIVERSITY CLINICAL CENTRE TUZLA

Introduction: Reasons for acute renal failure in hospitalized infants were sepsis, hypovolemia, asphyxia, respiratory distress syndrome, surgical interventions and congenital heart defects. The aim of this study was to determine the frequency and and main etiologies, and early outcome of neonatal acute renal failure. Materials and Methods: At Intensive Care Unit, Clinical Center Tuzla, from 15. 01. 2013 to 15. 01. 2015 in 21 newborn was diagnosed renal failure, based on the amount of excreted urine and serum creatinine. Results: The prevalence of renal failure was 6.84%, with a higher incidence of female. 33.3% of infants were term neonates. Oliguria was diagnosed in 71.4% of newborns. Sepsis was the most common predisposing factor for the development of renal failure, associated with high mortality. Other causes of renal failure were perinatal hypoxia, RDS, surgical interventions and congenital heart defects. There was a positive correlation between the gestational age of the newborn and serum creatinine. Discussion: Early prevention of risk factors with rapid diagnosis and effective treatment, can affect further outcome of acute renal failure in infants

ELECTROLYTE AND ACID-BASE DISTURBANCES IN CRITICALLY ILL NEONATES

Prevalencija elektrolitnih i acidobaznih poremećaja u novorođenčadi nije dovoljno poznata, kao što još nisu dovoljno defi nirane normalne vrijednosti elektrolita i parametara acidobaznog statusa za zdravu i bolesnu novorođenčad u odnosu na gestacijsku i postnatalnu dob. Cilj rada bio je utvrditi učestalost elektrolitnih i acidobaznih poremećaja u bolesne novorođenčadi na intenzivnom tretmanu. Prospektivno su prikupljeni podatci za 100 konsekutivno zaprimljene novorođenčadi (45 rođenih u terminu i 55 prijevremeno rođenih) na intenzivno liječenje. Analizirani su anamnestički, klinički i laboratorijski podatci. U statističkoj obradi rezultata korištene su standardne metode deskriptivne statistike. Najčešći poremećaj bila je acidoza, metabolička (80%) i respiratorna (55%), dok je alkaloza bila rjeđa. U 63 novorođenčadi (63%) identifi cirani su miješani acidobazni poremećaji. Stupanj metaboličke i respiratorne acidoze korelirao je s težinom bolesti. Statistički značajna razlika u odnosu na gestacijsku dob nađena je za vrijednosti pH, baznog ekscesa, natrija, klorida, kalcija, ureje i albumina. Uz hipoalbuminemiju, najčešće su zabilježene hiponatremija, hipokloremija i hipokalcijemija. Zaključujemo da se velika zastupljenost metaboličkih poremećaja u našem istraživanju može donekle objasniti specifi čnostima fi ziologije naše populacije, a dodatni faktor rizika svakako je sam proces bolesti, ali i komplikacije primijenjene terapije. Pažljiv klinički nadzor i brza korekcija mogu pomoći u poboljšanju ishoda.The prevalence of electrolyte and acid-base disturbances in neonates are not suffi ciently known. In addition, normal electrolyte and acid-base status parameters in healthy and ill-affected neonates according to gestational and postnatal age have not yet been properly defi ned. The aim of the study was to determine the prevalence of electrolyte and acidbase disorders in critically ill neonates. We analyzed prospectively collected history, clinical and laboratory data, including electrolyte and acid-base parameters, on 100 consecutive neonates admitted to Department of Intensive Care, Clinical Department of Pediatrics, Tuzla University Clinical Center, from January 2017 to May 2017. On statistical analysis, standard methods of descriptive statistics were employed. The most common disorder was metabolic acidosis (80%), followed by respiratory acidosis, found in 55 (55%) patients, while alkalosis was less common: 18 and 4 critically ill newborns with respiratory and metabolic acidosis, respectively. Mixed acid-base disorders were recorded in 63 (63%) patients. Elevated anion gap was found in 16 (16%) and elevated corrected anion gap in 30 (30%) patients. The grade of metabolic and respiratory acidosis correlated with the disease severity. Statistically signifi cant differences according to gestational age were found for pH, base excess, sodium, chloride, calcium, urea and albumin. In addition to hypoalbuminemia, hyponatremia, hypochloremia and hypocalcemia were mostly reported. Fluid, electrolyte and acid-base balance are essential components in the treatment of neonates at a high risk. It is particularly important in low birth weight neonates. Premature infants usually require parenteral nutrition and fl uid, the quantity and composition of which may greatly vary. They also have important developmental restrictions in renal homeostatic mechanisms. Finally, prematurity makes them particularly vulnerable and susceptible to morbidity and mortality, which can be signifi cantly associated with fl uid, electrolyte and acid-basemimbalance. In conclusion, over-representation of metabolic disorders in our study may in part be explained by the specific physiology of this population, with the disease process itself or therapy related complications as additional risk factors. Careful clinical monitoring and rapid correction can help improve the outcomes

Rani ishod masivnog plućnog krvarenja kod nedonoščadi u Tuzlanskom kantonu

Massive pulmonary hemorrhage (MPH) in neonates is a severe condition followed by many complications and associated with a high mortality rate. The aim of this study was to present the incidence, possible risk factors, and short-term outcome of neonatal MPH in Tuzla Canton. We retrospectively analyzed data on neonates with MPH from January 2015 to December 2017. On statistical analysis, standard methods of descriptive statistics were used. During the three-year study period, 16 neonates developed MPH, 5 (31.25%) male and 11 (68.75%) female. Their mean gestational age was 29.48±2.21 weeks and mean birth weight 1276.69±387.65 grams. Seven (43.75%) neonates survived and 9 (56.25%) died. Significant differences between the two outcome groups (survivors/ died) were found in gestational age, birth weight, birth length, 5-minute Apgar score, and length of treatment at the Neonatal Intensive Care Unit. In Tuzla Canton, MPH occurred mainly in preterm neonates requiring mechanical ventilation, with the incidence of 1.91% of total premature births. The short-term outcome was uncertain, with a high mortality rate of 56.25%. Lower gestational age, lower birth weight, lower birth length and lower 5-minute Apgar score were confirmed as risk factors for poor short-term outcome.Masivna plućna hemoragija (MPH) u novorođenčadi je teško stanje koje prati mnoštvo komplikacija i visoka stopa smrtnosti. Cilj ovoga istraživanja bio je utvrditi incidenciju, moguće čimbenike rizika i kratkoročni ishod neonatalne MPH u Tuzlanskom kantonu. Retrospektivno smo analizirali podatke o novorođenčadi s MPH od siječnja 2015. do prosinca 2017. godine. U statističkoj obradi primijenjene su standardne metode deskriptivne statistike.Tijekom promatranog trogodišnjeg razdoblja MPH se razvila u 16 novorođenčadi, 5 dječaka (31,25%) dječaka i 11 (68,75%) djevojčica. Srednja gestacijska dob bila je 29,48±2,21 tjedana, a srednja porođajna težina 1276,69±387,65 grama. Svih 16 bili su neonoščad niske porođajne težine od kojih je 7 (43,75%) preživjelo, a 9 (56,25%) umrlo. Značajne razlike među dvjema skupinama ishoda nađene su za gestacijsku dob, porođajnu težinu, porođajnu duljinu, Apgar indeks u petoj minuti i dužinu intenzivnog liječenja. U zaključku, u Tuzlanskom kantonu neonatalna MPH javljala se kod nedonoščadi koja su zahtijevala mehaničku ventilaciju, s incidencijom od 1,91% od ukupnog broja prijevremeno rođenih. Kratkoročni ishod bio je neizvjestan, s visokom stopom smrtnosti od 56,25%. Kraća gestacijska dob, niža porođajna težina, niža porođajna duljina i niži Apgar indeks u petoj minuti potvrđeni su kao čimbenici rizika za loš kratkoročni ishod

CARACTERISTICS OF PNEUMONIA HOSPITALIZATIONS AT PEDIATRIC CLINIC TUZLA

Introduction: Pneumonia is the most serious inflammatory disease of the lower respiratory system caused by various microorganisms. It occurs in all age groups, more often in children aged 5 years and below, in children with chronic diseases and impairments of the immune status. The aim of this study was to present the epidemiological, etiological and clinical characteristics of pneumonia in hospitalized children. Patients and methods:Â We analyzed the epidemiological, etiological and clinical characteristics of pneumonia in 224 children hospitalized at the Pediatric hospital Tuzla during one year period with radiologically proven pneumonia. Results: Almost half of children with pneumonia (46.4%) were infants, and 82.1% of patients were under five years of age. The boys were leading in all age groups. A significant number of children had one or more predisposing risk factors. Clinical signs, gas analyses and pulse oximetry well correlated with hypoxemic type of respiratory failure. The most frequently isolated pathogens were Staphylococcus aureus, Klebsiella sp. and Pseudomonas aeruginosa. The average length of intensive treatment was 2.8 days and the average total length of treatment was 9.5 days. Conclusion: Pneumonia hospitalizations of children at the Pediatric Clinic Tuzla, showed the usual age and gender distribution. A significant number of children had underlying chronic diseases. Etiological characteristics emphasizing severity of disease and immune status of children. The management of pneumonia in children has to follow general pediatric principles, and special attention should be given to risk categories

Atelektaza pluća i infekcije donjih dišnih puteva u djece na odjelu za intenzivno liječenje

Cilj rada Prikazati etiološke, kliničke i radiološke karakteristikeatelektaze pluća kod djece na intenzivnom tretmanu u Odjeljenjuintenzivne njege i terapije Klinike za dječije bolesti Tuzla ujednogodišnjem periodu.Metode Uzorak je obuhvatio 31 dijete sa infekcijom donjih dišnihputeva i atelektazom pluća. Prosječna dob djece iznosila je 3,6 ±3,9 g. Analizirane su etiološke, kliničke i radiološke karakteristikeatelektaze pluća kod djece sa infekcijom donjih dišnih puteva.Rezultati U promatranom jednogodišnjem periodu zbog infekcijadonjih dišnih puteva, bronhitisa i pneumonije, liječeno je ukupno332 pacijenta, od čega 208 dječaka (62,7%) i 124 djevojčice(37,3%). Kod 224 (67,5%) pacijenta radiološki nalaz je pokazaopneumoniju, dok je kod 31 (9,3%), uz pneumoniju, opisanai atelektaza pluća. Najčešća je bila desnostrana atelektaza (20 ili64,5%), dok je u 10 ili 32,3% registrovana lijevostrana, a kodjednog pacijenta (3,2%) obostrana. Općenito osnovno oboljenjebila je infekcija donjih dišnih puteva (30 ili 96,8%), dok je kodsamo jednog pacijenta to bio medijastinalni ekspanzivni proces.Klinički znaci, nalazi gasnih analiza i pulsne oksimetrije, bili su ukorelaciji i u smislu hipoksemijskog tipa respiratorne insuficijencije.Najčešći uzrok atelektazi pluća bila je staza gustog sekreta,koja je dovela do smetnji ventilacije. Kontinuiranu oksigenoterapijuzahtijevalo je svih 31 pacijenata, najmanje 24 sata, dok jemonitoring vitalnih parametara kod 12 ili 38,7% pacijenata biopotreban duže od 24 sata. Prosječna dužina intenzivnog liječenjabila je 4,3 ± 2,7 dana (od 1 do 15 dana).Zaključak Atelektaze pluća kod djece sa infekcijama donjihdišnih puteva u odjeljenju intenzivne njege nisu rijetke. One predstavljajudodatni faktor rizika za ozbiljne poremećaje plućne ventilacije,naročito u dojenačkoj dobi

PERINATAL OUTCOME OF PRETERM INFANTS IN FEDERATION OF BOSNIA AND HERZEGOVINA

Introduction: Despite growing progress of perinatal medicine and perinatal care, between 9-19% of preterm infants are born each year. Improvement in survival of infants and the reduction in infant mortality rates is a key role of perinatal quality healthcare. The Aim: To evaluate the perinatal outcome of preterm infants in maternity wards of the Federation of Bosnia and Herzegovina for a period of one year. Material and methods: Of 22 897 live newborns, the research criteria matched 669 (2.9%) preterm infants with complete medical records in ten cantons of the Federation Bosnia and Herzegovina. We analyzed data from maternity wards documentation and discharge letters from tertiary health care centers. Results: Most deliveries were in the Tuzla and Sarajevo Canton with 42.5% of preterm infants. The mean gestational age of preterm infants was 31.4 weeks, with SD ± 5.34, and the mean birth weight 1295 grams, SD ± 234.2. The mean Apgar score was 4.6 ± 2.1, and in the fifth minute 6.6 ± 1.9.Of 669 examinees, there were 345 (51.56%) males and 324 (48.44%) females (51.56 vs 48.44; χ 2 = 1.19; P = 0.27). By analyzing the frequency of preterm infant birth rate according to weight categories, we found a significant difference in some levels of perinatal health institution, between the 1st and 2nd institutions levels (1.76% vs 3.01%; P< 0.0001), also between 2nd and 3rd institutions levels (3.01% vs 3.03%; P < 0.0002), and between 1st and 3rd institutions levels (1.76% vs 3.03%; P < 0.0001). A significant statistical difference in survival of tested newborns was found in institutions of 3rd level χ 2 = 49.25; P < 0.0001 with a low risk for unfavorable outcome [OR = 0.436; 95%CI (0.346-0.550)]. Conclusion: Perinatal outcome of preterm infants in the Federation Bosnia and Herzegovina significantly depends on the level of perinatal health care. Survival rate of infants born in the institutions of the 3rd level was statistically much higher than the survival rate of infants who were born in the 1st and the 2nd level institutions