Interventions of Health Visitors in Making a Decision About Breastfeeding

Aim: The aim of this paper was to establish a link between the promotion of breastfeeding and the interventions of the visiting nurse. Methods: The study was conducted in 2012 in the city of Đakovo and the surrounding area. The questionnaire was filled out by mothers after leaving the maternity ward, during the first visit of the community health nurse within the first seven days after the labor. Results: From a total of 154 parturient women who filled in a survey after they had left the hospital, the decision about breastfeeding before the pregnancy was made by 58.4% of examinees. Primiparas from the city were older than primiparas from the surrounding rural area (p<0.001). Mothers received the majority of information about the proper placement of the child on the chest after birth from nurses in the maternity hospital (56.3% of the examinees). The study showed that 57.9% of the examinees had the support of their husband during lactation. The visiting nurses’ first visit was within seven days after delivery at the home of 121 (78.6%) examinees, showing good awareness and collaboration between secondary and primary health care. Conclusion: This research has confirmed that breastfeeding promotion and nursing interventions have a major impact on breastfeeding

Impact of early rehabilitation on the outcome of a chronic disease in children

Djecu rođenu s neurorizicima i djecu koja se ne razvijaju po očekivanim psihosocijalnim i neuromotornim obrascima treba uključiti u ranu intervenciju i rehabilitaciju. Nakon otpusta iz rodilišta djece s neurorizicima, neonatolog upoznaje roditelje s mogućnostima rane intervencije i rehabilitacije u mjestu stanovanja ili najbližem rehabilitacijskom centru. U Republici Hrvatskoj ne postoje standardizirani instrumenti i protokoli probira za odstupanja u psihosocijalnom i neuromotornom razvoju djece, što uvelike otežava rad pedijatrima u primarnoj zdravstvenoj zaštiti. Pedijatrijskim praćenjem psihosocijalnoga i neuromotornoga razvoja djece trebalo bi otkriti djecu koja se ne razvijaju po očekivanim obrascima. Djecu s neujednačenim neuromotornim i psihosocijalnim razvojem treba uključiti u ranu intervenciju i rehabilitaciju. U Udruzi za pomoć osobama s mentalnom retardacijom Đakovo (Udruga) koristimo razvojne probire prema Münchener Funktionelle Entwicklungsdiagnostik (MFED) i Guide for Monitoring Child Development (GMCD). Oba probira provode se do kraja treće godine života djeteta. Udruga provodi razvojnu neuromotornu rehabilitaciju po Vojti i Bobathu. Za ranu intervenciju i psihosocijalnu rehabilitaciju postoje educirani timovi. Timovi za psihosocijalnu rehabilitaciju i ranu intervenciju rade s djecom i njihovim roditeljima u kući i individualno u prostorima Udruge. Uz pomoć razvojnih probira MFED-a i GMCD-a te razgovorom s roditeljima kontrolira se napredak djece u neuromotornom i psihosocijalnom razvoju.Children born with neurorisks and children who do not develop according to the expected psychosocial and neuromotor patterns should be included in an early intervention and rehabilitation scheme. As soon as babies at neurological risk are discharged from a maternity hospital, a neonatologist informs the parents about the possibilities of early intervention and rehabilitation in their place of living or the nearest rehabilitation center. In the Republic of Croatia there are no standard instruments or screening protocols for deviations in the psychosocial and neuromotor development of children, which greatly affects and complicates the work of pediatricians in primary health care. Monitoring the psychosocial and neuromotor development of children, pediatricians should detect children who show deviations from the expected patterns. Children who show inconsistent and uneven neuromotor and psychosocial development should be included in early intervention and rehabilitation. In the Association for Assistance to Mentally Disabled in Đakovo (hereinafter referred to as the “Association”) the following developmental diagnostic procedures are used: the Münchener Funktionelle Entwicklungsdiagnostik (MFED) and the Guide for Monitoring Child Development (GMCD). Both diagnostic procedures are being carried out until the child turns three. The Association offers and provides developmental neuromotor rehabilitation using the Bobath and the Vojta method. There are trained teams that are responsible for early intervention and providing psychosocial rehabilitation. Those teams work with children and their parents at their homes and individually at the premises of the Association. Correspondingly, by using the developmental diagnostic procedures MFED and GMCD, and by communicating with parents, the children’s progress in their neuromotor and psychosocial development is being successfully monitored

Impact of early rehabilitation on the outcome of a chronic disease in children

Djecu rođenu s neurorizicima i djecu koja se ne razvijaju po očekivanim psihosocijalnim i neuromotornim obrascima treba uključiti u ranu intervenciju i rehabilitaciju. Nakon otpusta iz rodilišta djece s neurorizicima, neonatolog upoznaje roditelje s mogućnostima rane intervencije i rehabilitacije u mjestu stanovanja ili najbližem rehabilitacijskom centru. U Republici Hrvatskoj ne postoje standardizirani instrumenti i protokoli probira za odstupanja u psihosocijalnom i neuromotornom razvoju djece, što uvelike otežava rad pedijatrima u primarnoj zdravstvenoj zaštiti. Pedijatrijskim praćenjem psihosocijalnoga i neuromotornoga razvoja djece trebalo bi otkriti djecu koja se ne razvijaju po očekivanim obrascima. Djecu s neujednačenim neuromotornim i psihosocijalnim razvojem treba uključiti u ranu intervenciju i rehabilitaciju. U Udruzi za pomoć osobama s mentalnom retardacijom Đakovo (Udruga) koristimo razvojne probire prema Münchener Funktionelle Entwicklungsdiagnostik (MFED) i Guide for Monitoring Child Development (GMCD). Oba probira provode se do kraja treće godine života djeteta. Udruga provodi razvojnu neuromotornu rehabilitaciju po Vojti i Bobathu. Za ranu intervenciju i psihosocijalnu rehabilitaciju postoje educirani timovi. Timovi za psihosocijalnu rehabilitaciju i ranu intervenciju rade s djecom i njihovim roditeljima u kući i individualno u prostorima Udruge. Uz pomoć razvojnih probira MFED-a i GMCD-a te razgovorom s roditeljima kontrolira se napredak djece u neuromotornom i psihosocijalnom razvoju.Children born with neurorisks and children who do not develop according to the expected psychosocial and neuromotor patterns should be included in an early intervention and rehabilitation scheme. As soon as babies at neurological risk are discharged from a maternity hospital, a neonatologist informs the parents about the possibilities of early intervention and rehabilitation in their place of living or the nearest rehabilitation center. In the Republic of Croatia there are no standard instruments or screening protocols for deviations in the psychosocial and neuromotor development of children, which greatly affects and complicates the work of pediatricians in primary health care. Monitoring the psychosocial and neuromotor development of children, pediatricians should detect children who show deviations from the expected patterns. Children who show inconsistent and uneven neuromotor and psychosocial development should be included in early intervention and rehabilitation. In the Association for Assistance to Mentally Disabled in Đakovo (hereinafter referred to as the “Association”) the following developmental diagnostic procedures are used: the Münchener Funktionelle Entwicklungsdiagnostik (MFED) and the Guide for Monitoring Child Development (GMCD). Both diagnostic procedures are being carried out until the child turns three. The Association offers and provides developmental neuromotor rehabilitation using the Bobath and the Vojta method. There are trained teams that are responsible for early intervention and providing psychosocial rehabilitation. Those teams work with children and their parents at their homes and individually at the premises of the Association. Correspondingly, by using the developmental diagnostic procedures MFED and GMCD, and by communicating with parents, the children’s progress in their neuromotor and psychosocial development is being successfully monitored

CEREBRAL PALSY IN CHILDREN WITH CONGENITAL CYTOMEGALOVIRUS INFECTION

Kongenitalna infekcija humanim citomegalovirusom (CMV) najčešća je transplacentarno prenesena virusna infekcija. Zahvaća 1% živorođene novorođenčadi, ali simptomatska je u u samo 10%. Može uzrokovati širok spektar neurorazvojnih poremećaja, kako u skupini simptomatske tako i u skupini asimptomatske novorođenčadi: zamjedbenu gluhoću, cerebralnu paralizu (CP), mentalnu retardaciju (MR) i epilepsiju. Prikazujemo šestero djece sa cerebralnom paralizom i njihove nalaze magnetske rezonancije/računalne tomografije mozga u ispitivanoj skupini od ukupno 39-ero djece s dokazanom kongenitalnom CMV infekcijom. Od 39-ero djece, 14-ero ih je bilo simptomatskih u novorođenačkoj dobi. Ostalo 25-ero asimptomatske dojenčadi upućeno je na dijagnostičku obradu nakon novorođenačke dobi (1,5-18 mjeseci), zbog neuroloških odstupanja praćenih mikrocefalijom i/ili gastrointestinalnih poremećaja. Dvoje djece upućeno je na dijagnostičku obradu zbog zamjedbene gluhoće. U sve djece infekcija CMV-om dokazana je specifičnim serološkim testovima, CMV DNA PCR i/ili izolacijom virusa u urinu. Neurorazvojni ishod u sve 39-ero djece praćen je tijekom 2-11 godina s ponavljanim neurološkim pregledima, ispitivanjem sluha, oftalmološkim pregledima, procjenom mentalnog razvoja, uključujući razvoj govora i ponašanja. CP je klasificiran prema prijedlogu SCPE-a (Surveillance of Cerebral Palsy in Europe), uključujući funkcionalno stupnjevanje: grubih, GMFCS-a (Gross Motor Functional Clasisfication System) i finih BFMF-a (Bimanual Fine Motor Function) motoričkih funkcija. Od 14-ero simptomatske djece, njih petero sa CP-om imalo je višestruka teža odstupanja i mikrocefaliju, a od asimptomatske samo jedno. Od šestero djece sa cerebralnom paralizom četvero je imalo diskinetski CP, dvoje V. stupanj i dvoje IV. stupanj prema GMFCS-u i BFMF-u. Dvoje je imalo bilateralno spastični CP III. stupanj prema GMFCS-u i BFMF-u. CT/MRI pokazali su kompleksne malformacije mozga: u dvoje djece polimikrogiriju, hipoplastični cerebelum i korpus kalozuma. Drugo dvoje djece imalo je multifokalnu leukoencefalopatiju s temporalnim cistama. CT mozga jednog djeteta pokazao je pahigiriju, leukoencefalopatiju, paraventrikularnu cistu, kalcifikacije i hipoplastičan cerebelum. U jednog asimptomatskog djeteta MRI je pokazao atrofiju mozga, hipomijelinizaciju i hipoplaziju korpus kalozuma. Zaključak: 6/39-ero ispitivane djece s kongenitalnom CMV infekcijom ima CP i pridružena teška i višestruka neurorazvojna odstupanja. Petero od 39-ero djece sa CP-om pripadalo je skupini simptomatske kongenitalne CMV infekcije. MRI i CT mozga pokazali su složene razvojne anomalije mozga: troje djece je imalo tešku kortikalnu disgenezu, hipoplaziju cerebeluma i korpus kalozuma, dvoje multifokalnu leukoencefalopatiju s temporalnim cistama, a jedno difuznu atrofiju mozga. Vrsta i opseg razvojnih anomalija u djece sa CP-om i kongenitalnom CMV infekcijom povezani su s vremenom nastanka kongenitalne CMV infekcije.Congenital cytomegalovirus (CMV) infection is the most common transplacentary transmitted viral infection, affecting 1% live born neonates but clinically symptomatic in only 10%. Both symptomatic and asymptomatic infected neonates may develop a wide range of neurodevelopmental disorders, the most severe being sensorineuronal hearing loss, cerebral palsy (CP), mental retardation (MR) and epilepsy. We present 6 children suffering cerebral palsy and their magnetic resonance/computer tomography findings in the examined group of 39 children in total with proven congenital CMV infection.Out of these 39 children, 14 were symptomatic at neonatal age. The remaining 25 asymptomatic infants were referred after neonatal age (1,5-18 months), for deviant neurological signs, accompanied by microcephaly and/or gastrointestinal problems.Two children were sent due to deafness. In all children examined CMV infection was proven by specific serology, PCR for CMV DNA and /or isolation of virus in the urine. All 39 children had prospective neurodevelopmental follow up for 2-11 years, undergoing repeated neurological, hearing tests, ophthalmologic, developmental assessment including speech and behaviour. Classification of CP was done according to the Surveillance of Cerebral Palsy in Europe (SCPE) proposal, including functional grading: the gross motor function classification system (GMFCS) and bimanual fine motor function (BFMF) criteria. Out of 14 symptomatic children, 5 were multihandicapped . All of them were microcephalic. One out of 25 asymptomatic children with CP was multihandicapped and microcephalic. Out of 6 children with cerebral palsy 4 have dyskinetic CP, two of them GMFCS and BFMF grade V, and two GMFCS IV and BFMF IV. Two children have bilateral spastic CP, GMFCS III and BFMF III. Cranial MRI/CT was performed in all 6 children with CP. In two multicandicaped children MRI demonstrated complex brain malformations: polymicrogyria, hypoplastic cerebellum, callosal hypoplasia. The other two multihandicapped children have multifocal leukoencephalopathy with temporal cysts. One multihandicapped child underwent cranial CT showing pacygyria, paraventricular cyst and calcification. In one asymptomatic multihandicapped child repeated MRI demonstrated brain atrophy, hypomyelination and calosal hypoplasia. Conclusion: 6/39 children examined with congenital CMV infection have CP accompanied by additional severe neurodevelopmental disorders. 5/39 children with CP had symptomatic CMV infection. Cranial MRI and CT demonstrated various brain abnormalities: two children have complex brain malformations (severe cortical dysgenesis, cerebellar hypoplasia, callosal hypoplasia), two widespread leukoencephalopathy with temporal cysts, and one diffuse brain atrophy. The spectrum of brain abnormalities in children with CP is related to the onset of congenital infection