ANTHROPOMETRIC AND BIOCHEMICAL ASSESSMENT OF INTRAUTERINE GROWTH RESTRICTION IN TERM NEWBORNS

Cilj rada. Usporediti razlike između antropometrijskih i biokemijskih parametara intrauterinog rasta fetusa. Metode istraživanja. Prospektivna klinička studija uključuje dvije kohorte novorođenčadi rođenih u Klinici za ginekologiju i porodništvo KBC Rijeka, u odnosu na njihovu porodnu težinu: eutrofičnu i hipotrofičnu novorođenčad. Zabilježeni su biokemijski parametri iz krvi pupkovine, antropometrijske mjere djece te svi podaci važni za fetalni rast koji su nađeni u medicinskoj dokumentaciji za svaku pojedinu trudnoću. Rezultati. Značajna je razlika između dviju skupina u ponderalnom indeksu (PI) i omjeru opseg nadlaktice/opseg glavice (ON/OG), u korist eutrofične novorođenčadi. Uspoređujući biokemijske biljege obiju skupina, u krvi pupkovine hipotrofične novorođenčadi je nađena znakovito niža koncentracija glukoze i prealbumina, a povišena koncentracija esencijalnih aminokiselina cistina, histidina, glicina, treonina, triptofana, valina, fenilalanina, izoleucina i leucina. Zaključak. Suprotno očekivanjima, određene aminokiseline nađene su u krvi pupkovine u većoj koncentraciji u skupini hipotrofične novorođenčadi. Ponderalni indeks i omjer opseg nadlaktice/opseg glavice su indirektni pokazatelji, neovisni o konstruiranim krivuljama fetalnog rasta te time predstavljaju pravu poremetnju rasta.Objective. To assess difference between anthropometric and biochemical markers of adequacy of intra­uterine growth. Methods. Prospective clinical study is performed which included two cohorts of newborns according to their birth weight (AGA, SGA). The biochemical markers as well as data important to actual fetal growth from medical history in relation to each pregnancy were gathered. All newborns were subject to anthropometric measurement and cord blood biochemical analysis. Results. We underline significant difference for ponderal index (PI) and mid-arm/head circumference (MA/HC) ratio. Comparing biochemical markers between both groups, in cord blood significantly lower ­values of glucose and of prealbumine, whereas the higher mean values of essential amino acids cysteine, histidine, glycine, threonine, tryptophane, valine, phenylalanine, leucine and isoleucine were found. Conclusions. Contrary to our expectations, higher concentrations of certain amino acids in SGA group of newborns were found. Ponderal index and mid arm/head circumference ratio are indirect indices independent of constructed growth charts, herewith they represent true growth disturbance

Umbilical Vein Catheterization - When Complications Occur A Case Report

Although umbilical venous catheterization is a routine procedure in premature newborns, it is associated with various, potentially life threatening, complications. We present a case of a premature baby diagnosed with a hepatic parenchymal liquid collection as a complication of umbilical vein catheterization in our Neonatal Intensive Care Unit. The child was born in the 25th gestational week (GW) and was doing well until the12th day of life when his general condition deteriorated. He appeared anxious and his oxygen saturation (SaO2) decreased. There was slight abdominal distension and tenderness over the abdominal wall, with weak bowel movements, and a palpable liver. Abdominal ultrasound (US) showed an enlarged liver with a well-defined hypoechoic area, with inhomogeneous echogenicity. Such findings were suggestive of fluid extravasation to the liver through a malpositioned umbilical venous catheter. The umbilical catheter was withdrawn, antimicrobial treatment initiated, and eventual complete regression of the collection was seen eleven days after extravasation. Rapid, unexplained clinical deterioration of a newborn with an umbilical vein catheter should always raise the suspicion of a complication due to catheterization. Such a catheter should be carefully revised and, if there is any doubt, removed. Timely diagnosis and adequate treatment is essential, and potentially life-saving

Characteristics of fetal growth in the population of south-west Croatia

The aim of this work was to define nomograms and standards of fetal biometric parameters in the population of pregnant women in southwest region of Croatia. Study design and Methods. During the nine-year period from 1st January 2002 to 31st December 2010 ultrasound examination was performed on 1594 pregnant women with singleton uncomplicated pregnancy between 22nd and 41st gestation week. In total, 2728 ultrasound measurements were performed. Measurement were obtained for biparietal diameter, femur length, abdominal circumference and the transverse cerebellar diameter. The results were presented as mean values with standard deviations and percentiles. Results. Normal fetal biometry charts for own population of pregnant women in the southwest region of Croatia were constructed

Characteristics of fetal growth in the population of south-west Croatia

The aim of this work was to define nomograms and standards of fetal biometric parameters in the population of pregnant women in southwest region of Croatia. Study design and Methods. During the nine-year period from 1st January 2002 to 31st December 2010 ultrasound examination was performed on 1594 pregnant women with singleton uncomplicated pregnancy between 22nd and 41st gestation week. In total, 2728 ultrasound measurements were performed. Measurement were obtained for biparietal diameter, femur length, abdominal circumference and the transverse cerebellar diameter. The results were presented as mean values with standard deviations and percentiles. Results. Normal fetal biometry charts for own population of pregnant women in the southwest region of Croatia were constructed

Lamellar body count as a diagnostic test in predicting neonatal respiratory distress syndrome

Aim To determine the lamellar body count (LBC) cutoff value for fetal lung maturity and to evaluate the clinical usefulness of LBC in predicting the severity of neonatal respiratory distress syndrome (RDS). Methods A prospective study was conducted from 2002 until 2010. LBC was estimated in uncentrifugated amniotic fluid samples using Cell-Dyn 1800 analyzer. Amniotic fluid samples were obtained by amniocentesis or by puncturing embryonic membranes during cesarean section. The presence of mild, moderate, and severe RDS was assessed by neonatologist. Results A total of 313 patients with singleton pregnancies (24-41 weeks) were included in the study and 294 met the inclusion criteria. RDS was diagnosed in 28 neonates – mild in 8, moderate in 10, and severe in 10. In premature neonates (<37 gestational weeks), significant differences in LBC were only found between the subgroup without RDS and the group with moderate and the group with severe RDS (P < 0.001). In all neonates, significant differences were found between neonates without RDS and neonates with RDS. Using LBC cutoff value of ≥20,000/μL, sensitivity, specificity, and positive and negative predictive values of LBC in determining mature fetal lungs were 96%, 88%, 45.6%, and 99.5%, respectively. Conclusion This study suggests that LBC cutoff value of ≥20,000/μL can predict pulmonary maturity and reduce the risk of neonatal respiratory distress syndrome

HUMAN MILK FORTIFIERS IN NUTRITION OF PREMATURE INFANTS

Postnatalni rast praćen je povećanjem tjelesne mase kao i kompleksnim pojavama sazrijevanja funkcija organa, iza čega stoje složeni mehanizmi na organskoj i staničnoj razini. U biti rasta i razvoja stoje procesi maturacije i diferencijacije. Nedonščad ispod 2 kg ima posebne potrebe u tom pogledu jer ih možemo smatrati fetusima ex utero. Teoretski, njihova stopa rasta u tom bi slučaju trebala biti slična stopi rasta u fetusa. Majčino mlijeko pri prijevremenom porođaju ne zadovoljava u potpunosti povećane potrebe nedonoščeta za energijom, bjelančevinama i elektrolitima. Preporuča se majčinome mlijeku dodavati preparate koji povećavaju sadžaj tvari potrebnih za metabolizam. Time se postiže rast od 15 do 25 g/kg/dan, smanjuje se mogu}nost nastanka metaboličke bolesti kostiju, uz dobru podno{ljivost pripravka.The postnatal growth is followed by the body mass increase and complex phenomena of organ function maturation, behind which mechanisms on organic and cellular level can be recognized. Processes of maturation and differentiation are essential to the growth and development. Premature neonates below two kilograms, which can be recognized as fetuses ex utero, have specific needs in this regard. Theoretically, their growth rate should be similar to the fetal one. Human preterm milk is less than optimal to satisfy the preterm infant’s increased protein, energy and electrolyte requirements. Therefore, it is recommendable to fortify human milk to increase the metabolyte content. Herewith, the growth in wet weight of 15-25 g/kg/day has been achieved, the metabolic bone disease has been unlikely to emerge, and a fair preparation to tolerance has been recognized, too

Are you suffering from a large arterial occlusion? Please raise your arm!

Background and purpose: Triage tools to identify candidates for thrombectomy are of utmost importance in acute stroke. No prognostic tool has yet gained any widespread use. We compared the predictive value of various models based on National Institutes of Health Stroke Scale (NIHSS) subitems, ranging from simple to more complex models, for predicting large artery occlusion (LAO) in anterior circulation stroke. Methods: Patients registered in the SITS international Stroke Register with available NIHSS and radiological arterial occlusion data were analysed. We compared 2042 patients harbouring an LAO with 2881 patients having no/distal occlusions. Using binary logistic regression, we developed models ranging from simple 1 NIHSS-subitem to full NIHSS-subitems models. Sensitivities and specificities of the models for predicting LAO were examined. Results: The model with highest predictive value included all NIHSS subitems for predicting LAO (area under the curve (AUC) 0.77), yielding a sensitivity and specificity of 69% and 76%, respectively. The second most predictive model (AUC 0.76) included 4-NIHSS-subitems (level of consciousness commands, gaze, facial and arm motor function) yielding a sensitivity and specificity of 67% and 75%, respectively. The simplest model included only deficits in arm motor-function (AUC 0.72) for predicting LAO, yielding a sensitivity and specificity of 67% and 72%, respectively. Conclusions: Although increasingly more complex models yield a higher discriminative performance for predicting LAO, differences between models are not large. Assessing grade of arm dysfunction along with an established stroke-diagnosis model may serve as a surrogate measure of arterial occlusion-status, thereby assisting in triage decisions

ANEMIA IN PREMATURITY · THE ROLE OF HUMAN RECOMBINANT ERYTHOROPOIETIN

Anemija u nedonoščadi je patološko stanje koje u pravilu pogaða novoroðenčad vrlo niske rodne mase. Uzrok anemije je nedovoljno stvaranje eritropoetina. Osnova liječenja su transfuzije koje bolesnika izlaæu mnogim nepoželjnim učincima. Pojava sintetskih rekombinantnih humanih eritropoetina (rHuEPO) pružila je mogućnost poticanja vlastite eritropoeze i time smanjila potrebu za transfuzijama. Primjena rekombinantnoga humanog eritropoetina ne dovodi do supresije vlastite proizvodnje eritropoetina u nedonoščadi. Nuspojave koje se javljaju tijekom ili nakon liječenja anemije, rijetko su zamijećene. Primjena rHuEPO u nedonoščadi ne utječe na rast. U liječenju anemije zbog nedonošenosti, uz rHuEPO potrebno je osigurati primjeren unos željeza, vitamina i bjelančevina. Racionalna primjena eritropoetina u prevenciji i liječenju anemije zbog nedonošenosti, svakako znači napredak u cjelokupnoj skrbi za prijevremeno roðenu djecu.Anemia in prematures is a pathological state usually present in neonates with low birth weight. The cause of anemia is insufficient erythropoietin secretion. The principal treatment previously were blood transfusions which exposed the patients to many adverse effects. Discovery of synthetic recombinant human erythropoietins (rHuEPO) has given the opportunity to induce patient's erythropoiesis and reduce the need for blood transfusions. The use of rHuEPO in such condition doesn't suppress patient's own erythropoiesis, with low incidence of adverse events during and after the treatment. At the same time, rHuEPO doesn't influence patient's growth. Treatment of anemia in prematurity, beside the use of rHuEPO, also must include adequate iron, vitamins and proteins intake. The introduction and rational use of rHuEPO in the prevention and treatment of anemia in prematures certainly represents the significant progress in total medical care for such premature born children