School-age spirometry in survivors of chronic lung disease of prematurity in the surfactant era

Objective: To assess whether school-age spirometry and lung volume outcomes of preterm infants with history of moderate to severe respiratory distress syndrome (RDS), born in the surfactant era and treated with conventional mechanical ventilation (IMV) and discharged home with or without the diagnosis of BPD (hronic lung disease of prematurity), differ from those of term neonates (controls). Participants: The study included 148 Caucasian school-aged children (38 preterm infants without BPD, 20 preterm infants with BPD and 90 term infants). All infants were born at the Department of Pathology of Pregnancy and Labor, Pomeranian Medical University, Szczecin, Poland. Methods: Respiratory outcome in school-aged children was assessed using spirometry with the evaluation of flow and volume parameters, adjusted for age, weight and gender. The differences in spirometry were tested by the Wilcoxon or Mann-Whitney tests. Linear correlation and regression were also used. Results: No statistically significant differences between the spirometric parameters in preterm infants with and without BPD were found. All investigated parameters were significantly lower in both ventilated groups compared to term controls, with the exception of ERV%, which was significantly higher. Conclusions: The necessity to use assisted ventilation in preterm infants without neurological disorders most probably had an adverse effect on the lung function, assessed by spirometry at the age of 9-10 years, in the groups of children discharged home with or without BPD. Regardless of BPD, lung function parameters in prematurely born children with respiratory distress syndrome are always worse than in term controls

Pethidine for labor analgesia; monitoring of newborn heart rate, blood pressure and oxygen saturation during the first 24 hours after the delivery

Background: There is no information about an effect of pethidine labor analgesia on newborn vital signs in the first hours after the delivery. Objectives: The aim of the study was to assess changes in heart rate, blood pressure and oxygen saturation during the first 24 hours of life in neonates born after using pethidine for labor analgesia. Methods: 55 full-term neonates, 34 from intramuscular pethidine labor anesthesia in doses 50-100 mg and 21 born to mothers without any pharmacological form of anesthesia, were studied. Heart rate, oxygen saturation and blood pressure (SBP and DPB) were monitored using a Nellcor Oxi Max monitor N5500 (Tyco Healthcare), and recorded at 1, 6, 12 and 24 hours. Results: No significant differences in the heart rate (144; 139; 141; 142,5 versus 142; 140,5; 138; 141 beats/ minute), oxygen saturation (97%; 98%; 98%; 98,5%; versus 98%, 98%, 98%, 98%), SBP (66,5; 67; 66; 66,5 versus 68,5; 65; 64; 64,5 mmHg) and DBP (33,5; 35; 37; 40 versus 34; 32; 32; 38 mmHg) at 1, 6, 12 and 24 hours between pethidine and controls groups were found. Conclusions: Intramuscular pethidine analgesia during the first stage of labor in doses 50-100 mg does not significantly modify the oxygen saturation, heart rate and blood pressure in infants during the first 24 hours of their life

Ocena funkcji płuc u dzieci szkolnych leczonych metodą n-CPAP z powodu łagodnego lub średnio nasilonego noworodkowego zespołu zaburzeń oddychania

Objectives: The aim of our study was to evaluate whether mild to moderate infant respiratory distress syndrome (RDS) treated with nasal continuous positive airway pressure (NCPAP) might affect the pulmonary function in school-aged children. Material and methods: 50 children, aged 10.2}2.8 years, with a history of RDS and 90 controls without a neonatal history of lung diseases, matched for age and gestational age at birth, were studied. Pulmonary function was assessed by spirometry and oxygen saturation measured by pulse oximeter. Results: The incidence of respiratory tract infections within the first 6 years after discharge from the intensive care neonatal unit was higher in the RDS group than in controls (PStreszczenie Cel pracy: Celem pracy była ocena funkcji płuc u dzieci szkolnych leczonych w okresie noworodkowym metodą NCPAP z powodu łagodnych lub średnio nasilonych zaburzeń oddychania. Materiał i metody: Badaniami objęto 50 dzieci w wieku 10,2}2,8 lat z przebytą w okresie noworodkowym niewydolnością oddechową i 90 dzieci w podobnym wieku kalendarzowym i urodzonych w podobnym wieku ciążowym, ale bez objawów niewydolności oddechowej w okresie noworodkowym. Funkcje płuc oceniono poprzez zastosowanie badania spirometrycznego i oceny przezskórnego wysycenia tlenem hemoglobiny. Wyniki: W ciągu pierwszych 6 lat życia dzieci wymagające wsparcia oddechowego metodą NCPAP chorowały istotnie częściej na infekcje układu oddechowego (

Congenital epidermolysis bullosa – a case report

Bullous dermatitis in infants is a clinical term used for a number of disorders associated with primary neonatal pemphigus. The disease requires differentiation of autoimmune disorders such as pemphigus vulgaris, pemphigus foliaceus, and bullous pemphigoid. These diseases are the result of pemphigus IgG antibodies that pass from the mother to the fetus through the placenta. The level of antibody titers in the pregnant woman and her clinical condition are not the markers of the severity of the disease in children, but, in case of a high level, a miscarriage premature birth, or even stillbirth, may occur. Staphylococcal syndrome exfoliative dermatitis (staphylococcal scalded skin syndrome - SSSS), the etiological agents of which are type A or B exfoliative toxins of Staphylococcus aureus, is most frequently observed. These toxins can activate as superantigens and cause T-cell activation. They induce proteolysis and separation of the granular layer of epidermis through direct binding of these antigens. Symptoms of the disorder, regardless of the etiologic factors, are common: redness of the skin and formation of bubbles of various sizes filled with serous or serous-bloody content. Bursting bubbles patches peel off, leaving bare, sometimes oozing surface. Extensive damage to the skin is a gateway to infection and disturbs the function of regulating warmth and water-electrolyte balance. Early detection of the cause and appropriate general and local treatment effectively prevent the development of sepsis. The authors present a case of a full-term neonate (male, birthweight 3230 g, good overall condition, 5-min Apgar score: 10) born with dermatitis bullosa of unknown etiology. Physical examination immediately after birth revealed multiple blisters filled with serous and serous-bloody content on the skin all over the neonatal body, mostly in the area of both armpits, elbows, wrists, knees, ankles and fingers of both hands and feet. The course of pregnancy was uncomplicated. However, detailed family history revealed pemphigus skin in the mother (from infancy up to the age of puberty) but the mother was not able to offer details on the diagnosis and treatment of this disease. Symptoms in the mother disappeared after her first menstrual period. Both, typical clinical symptoms presenting in the newborn and maternal pemphigus in the past initially suggested an autoimmune disorder. However, the examination of the levels of IgG antibody and anti-IgA in neonatal serum, as well as tissue examination by the immunofluorescence (IF) method to detect the presence of these antibodies, were negative and consequently the autoimmune disease was excluded. Negative results of bacteriological tests did not confirm the staphylococcal syndrome. It seems that the cause of cutaneous pemphigus observed in the newborn could be an intrauterine infection or hidden, undiagnosed collagen disease in the mother

Method of analgesia for labor in relation to newborn condition, cord blood cortisol and interleukin-6 levels

Abstract Aim of the study: To assess the impact of various forms of intrapartum analgesia on birth condition of the newborn. Material: The study included 109 newborns, among them 23 from mothers who received intravenous patientcontrolled analgesia (PCA) using remifentanil (0.2μg/kg per dose), 31 infants from mothers treated with PCA epidural anesthesia with fentanyl and 0.125% bupivacaine, 34 newborns from mothers treated with pethidine analgesia given on an ad hoc basis at a dose of 50mg by intramuscular injection, and 21 newborns from mothers who did not use any form of anesthesia. Methods: The birth condition was evaluated in all infants by Apgar score and umbilical artery blood gases. In the blood from the umbilical vein the concentration of cortisol and interleukin-6 were evaluated. Results and conclusions: The use of epidural analgesia with bupivacaine as well as pethidine given intramuscularly did not impair the status of newborn evaluated on the basis of Apgar score, however, it adversely modifies the pH and umbilical artery blood pCO2. No additional beneficial effect of anesthesia using remifentanil intravenous PCA method on newborn status assessed on the basis of the value of Apgar score and acid-base balance of umbilical artery blood was found and it does not allow to recommend this form of anesthesia as surpassing the existing methods of intrapatum analgesia. The concentration of cortisol and interleukin-6 in umbilical cord blood is not related with the type of maternal intrapartum analgesia

Cantrell’s pentalogy – a case report

Pentalogy of Cantrell is a rare multiple congenital malformation syndrome characterized by a combination of features: a midline supraumbilical abdominal wall defect, a defect of the lower sternum, a defect of the diaphragmatic pericardium, deficiency of the anterior diaphragm, and congenital cardiac anomalies. This congenital defects could be diagnosed as early as in the first trimester of pregnancy. The complexity of this anomaly, especially coexistent heart defects, determines the way and order of surgical treatment and commonly is a prognostic factor. A case of male newborn with prenatal diagnosed omphalocele and diaphragmatic hernia is reported in the present work. The child was operated within two hours after birth. Intraoperativelly a significant defect of diaphragmatic pericardium and heart surrounded by a small bowel were discovered. The defect of diaphragm was sutured and a drainage of left pericardial cavity was put in place. Afterwards, the abdominal wall defect was sutured after transferring organs into a peritoneal cavity. Six days after the procedure cardiac sonography was performed and it indicated the presence of hemodynamically insignificant congenital intracardiac defect – atrial septal defect. Up-to-date psychomotor development of the boy, currently five months old, is correct. Prenatal diagnosis of the complexity of congenital defects and possibility of fetus condition monitoring allows to plan precisely the time and way of the delivery, as well as to decide the treatment method of the newborn. Due to the absence of hemodynamic disorders and in spite of the present cardiac defect, an early surgical treatment of our patient was possible

Maternal active or passive smoking in relation to some neonatal morphological parameters and complications

Abstract Objective: To determine the relationship between maternal active and passive smoking and neonatal morphological parameters, as well as some neonatal complications in full-term newborns. Methods: 150 women with uncomplicated, singleton pregnancies were assessed by means of a patient questionnaire. Neonates were divided into 3 groups according to obtained information on maternal smoking status - active smoking: n=51, passive smoking: n=49, non-smoking: n=50. Immediately after birth morphological parameters such as: birthweight, body length, head and chest circumference were assessed. Results: Values of birthweight, body length, head and chest circumference in newborns born to active smoking mothers were significantly lower than in newborns of passive smoking and non-smoking mothers. No significant differences in values of RBC, WBC, PLT, Hemoglobin and Hematocrit between the studied groups have been detected. Oxygen hood was applied significantly more often in case of newborns from active smoking mothers than in the control subjects. In groups of newborns from active and passive smoking mothers, hyperbilirubinemia and signs of early onset infection were diagnosed significantly more frequently than in the control subjects. Conclusions: Active maternal smoking, as opposed to passive maternal smoking, leads to decreased birthweight, body length, head and chest circumference. Full-term newborns born to active smoking mothers often need to be treated with oxygen hood during the first hours after birth. Maternal smoking, both active and passive, leads to an increased risk of hyperbilirubinemia and early onset infection in neonates

Two histologically different tumours in a neonate born from an assisted reproductive technology pregnancy

The first case of a female neonate born from an in vitro fertilization with embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI) (IVF-ET (ICSI) with two histologically different tumours (craniopharyngioma and hepatoblastoma) is described. Anti-neoplasmatic therapy was abandoned due to the significant extent of the disease (craniopharyngioma, 15×12 cm in diameter with active internal hydrocephalus; and right liver lobe hepatoblastoma, 5 cm in diameter) and the severely impaired general condition of the neonate. The neonate died on the 30th day of life due to cerebellar and brainstem herniation, followed by circulatory and respiratory failure

Analysis of risk factors for nosocomial infections in the Neonatal Intensive Care Unit of the Pomeranian Medical University in Szczecin in the years 2005-2008

Summary The aim of the study was to assess the significance of some perinatal risk factors and neonatal complications in occurrence of nosocomial infections in the population of NICU patients. Material and methods: Analysis of risk factors was performed in all patients treated in the years 2005-2008 in NICU Department of the Pomeranian Medical University in Szczecin, Poland. Five hundred and seventeen neonates divided into groups with and without occurrence of nosocomial infection were included into the study. Results: Seventy nine (15.28%) neonates developed nosocomial infection. Among them pneumonia (56.96%) and sepsis (21.5%) were the most common. The proportion of Gram-positive and Gram negative organisms were 44.3% and 50.6% respectively. The main risk factor for nosocomial infection was colonization (sensitivity - 100% and specificity – 94.75%). Univariate analysis showed that premature rupture of fetal membrane, GA< 32 hbd, birthweigh

Assessment of relationship between cord blood cotinine levels and some factors of perinatal hypoxia

Abstract Objective: To determine the relationship between cord blood cotinine levels and some markers of perinatal hypoxia such as cord blood erythropoietin levels, parameters of umbilical arterial blood gas analysis and Apgar scores. Methods: 150 women with uncomplicated, healthy singleton pregnancies were assessed by means of a patient questionnaire. Neonates born by the examined pregnant women were divided into 3 groups according to recorded maternal smoking status – active smoking: n=51, passive smoking: n=49, non smoking: n=50. Immediately after birth umbilical venous (for cotinine and erythropoietin levels) and arterial blood (for pH, pO2, pCO2, BE) were collected. Results: Cotinine levels were significantly higher (