Czy „późne wcześniaki” to znaczący problem neonatologiczny?

Abstract Background: The survival rate and quality of life of extremely low birthweight infants remain to be one of the main challenges of modern neonatology. Therefore, pre-term children born after 32 weeks of gestation with more normal birthweight, have become a relatively minor medical problem in comparison. Objectives: The aim of the following work was to compare the frequency of complications occurring in neonatal period in groups of late preterms and full-term neonates. Methods: A group of 725 late pre-term babies, born between 34-36 6/7 GA, constituted the study group and has been analyzed retrospectively. 5040 neonates born at term comprised the control group. The results were analyzed statistically using chi-square test. Results: Respiratory disturbances were diagnosed in 178 neonates in the study group (24.55%), while in the control group in 138 cases (2.74%), p=0.0000. Intrauterine infections were present in 92 neonates in the study group (12.69%) and in 327 infants in the control group (6.49%), p=0.0000. Hiperbilirubinemia developed in 520 neonates in the study group (71.72%), and in 1895 babies in the control group (37.60%), p=0.0000. Conclusions: 1. Respiratory disturbances, hiperbilirubinemia and intrauterine infections are more frequently observed in late preterms. 2. Increased morbidity in late preterm neonates prolongs the time of hospitalization.Wstęp: Wielkim wyzwaniem dla współczesnej neonatologii jest zwiększenie przeżywalności oraz poprawa jakości życia noworodków urodzonych z ekstremalnie małą masą ciała. Dlatego też stan zdrowia dzieci urodzonych po 32 tygodniu ciąży wydaje się mniejszym problemem medycznym. Cel: Celem pracy było porównanie występowania powikłań w okresie adaptacyjnym w grupie późnych wcześniaków i noworodków donoszonych. Metoda: Retrospektywnie przeanalizowano grupę 725 późnych wcześniaków urodzonych między 34-36 t c. 6/7 GA. Grupę kontrolną stanowiło 5040 noworodków urodzonych w terminie. Wyniki opracowano statystycznie przy użyciu testu chi2. Wyniki: Zaburzenia oddychania były zdiagnozowane u 178 noworodków w grupie badanej (24,55%) a w grupie kontrolnej u 138 (2,74%) p=0,0000. Zakażenie wewnątrzmaciczne rozpoznano u 92 (12,69%) późnych wcześniaków i u 432 (6,49%) noworodków urodzonych w terminie p=0,0000. Żółtaczka wystąpiła u 520 (71,72%) noworodków w grupie badanej i u 1895 (37,60%) w grupie kontrolnej p=0,0000. Wnioski: 1. W grupie późnych wcześniaków obserwujemy częściej zaburzenia oddychania, zakażenia wewnątrzmaciczne i żółtaczki 2. Wyższa zachorowalność w grupie późnych wcześniaków wydłuża czas hospitalizacji

Neonatal outcome after cesarean section

Cesarean section is the most commonly performed procedure all over the world. Both American and European data reveal constant and steady increase of pregnancies resolved by a cesarean section. The reasons include: growing number of medical indications or requests of the pregnant women. Regardless of the fact that elective cesarean section decreases the risk of intrauterine hypoxia, meconium aspiration and injury during labor, it remains a significant risk factor for respiratory failure in the course of transient tachypnea of the newborn, infant respiratory distress syndrome and pulmonary hypertension, both for term and late preterm infants. As a consequence, the infant requires a prolonged stay in the intensive care unit, together with advanced and often expensive medical procedures such as mechanical (often high-frequency) ventilation, nitric oxide therapy and extracorporeal membrane oxygenation. The American Association of Obstetricians and Gynecologists and the European Association of Perinatal Medicine recommend for a cesarean section due to medical indications to be performed after 39 weeks gestation, preferably after uterine contractions started, and elective cesarean section, particularly if there are indications to finish the pregnancy before 39 weeks gestation, after lung maturity has been assessed (in other case steroids ought to be administered prenatally to mature the lung muscles). That includes also cases of elective cesarean sections performed due to previous cesarean sections , which are the most frequent reasons for repeating procedure. The recommendations also restrict the indications for cesarean section in case of significant prematurity, what in turn is connected with more restricted indications for resuscitation of extremely premature infants and babies with extremely low birth weight

The influence of prenatal exposure to tobacco smoke on neonatal body proportions

The objective of this study was to determine neonatal anthropometric indices such as: birth weight, crown-heel length, head and chest circumference and ponderal index , in relation to the maternal smoker status (active and passive smoking). The study included 147 neonates born in 2003-2004 at the Princess Anna Mazowiecka University Hospital in Warsaw admitted to the Neonatal and Intensive Care Department of Warsaw Medical University. Neonates were assigned to one of three groups: babies of mothers who were active smokers, passive smokers and non-smokers based on a questionnaire concerning exposure to tobacco smoke and on the concentration of cotinine in maternal urine. The babies of mothers who were active smokers were born with lower birth weight (p=0.033), lower crown-heel length (p=0.026), lower head circumference (p=0.002) and lower chest circumference (p=0.021) significantly more often than babies of non-smoker mothers. Babies whose mothers were active smokers had an increased risk of lower head circumference or 3, 9 (1, 4-10, 7, CI 95%), and an increased risk of lower chest circumference OR 4, 0 (1, 5-10, 9, CI 95%). The babies of mothers who were passive smokers also had lower anthropometric indices, but the differences were not statistically significant. No effect on ponderal index was observed among the neonates whose mothers were active and passive smokers. Smoking during pregnancy causes symmetrical restriction of intrauterine growth

Zmiany w obrazie ultrasonograficznym i obrazie rezonansu magnetycznego mózgu u noworodków leczonych metodą selektywnej hipotermii

Introduction: Hypoxic ischemic insults during labor remain an important cause of brain injury in term and near-term neonates. Selective cerebral hypothermia is a potentially neuroprotective rescue therapy. Ultrasonography (US) andnmagnetic resonance imaging (MRI) are routinely used to visualize intracranial changes in neonatal hypoxic-ischemic injuries. Aim of the study: We attempted to describe all pathological findings on US and MRI in the brains of our patients following selective cerebral hypothermia. Materials and methods: Twenty-nine neonates with hypoxic-ischemic encephalopathy (HIE) following therapeutic cooling were assessed with cranial ultrasound (US) and magnetic resonance imaging (MRI). The findings were compared with the clinical outcome. Results: Over one-fourth (27.6%) of the examined infants had a normal brain on MRI (with only 17.2% on US). Involvement of the basal ganglia and thalami was one of the most frequent findings in our material (9/29 = 31% on MRI, and 7/29-24.1% on US). Cerebral parenchymal hemorrhage was detected on MRI in as many as 7 (24.1%) and cerebellar parenchymal hemorrhage in 4 (13.8%) infants. The loss in the gray-white matter differentiation (‘fuzzy brain’), usually transient on US, was observed in 79.3% of the neonates. Diffusion restriction in the callosal splenium (13.8%) and hyperechoic thalami and basal ganglia were strictly correlated to a significantly higher incidence of severe developmental delay. Conclusion: Abnormalities on MRI and US were observed in 75% of newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.Wstęp: Uraz niedotlenieniowo-niedokrwienny jest częstą przyczyną okołoporodowego uszkodzenia mózgu u noworodków, u których potencjalną, neuroprotekcyjną metodą leczenia jest selektywna hipotermia. Ultrasonografia (USG) i rezonans magnetyczny (MRI) są rutynowymi metodami obrazowania mózgu u noworodków ze zmianami niedotlenieniowo-niedokrwiennymi. Cel pracy: Podjęłyśmy próbę opisania wszystkich zmian patologicznych wykrytych w badaniu USG i MRI mózgu u noworodków, które leczone były metodą selektywnej hipotermii. Materiał i metoda: Przezciemiączkowe badanie ultrasonograficzne (USG) oraz badanie metodą rezonansu magnetycznego (MR) wykonano u 29 noworodków z encefalopatią niedotlenienieniowo-niedokrwienną (ENN) po zastosowaniu terapeutycznej hipotermii. Wyniki badań porównano z oceną kliniczną. Wyniki: U ponad jednej czwartej badanych dzieci (27,6%) badanie MR mózgu było prawidłowe (w badaniu USG tylko u 17,2%). Zajęcie jąder podstawy i wzgórz było jednym z najczęstszych znalezisk w naszym materiale (9/29= 31% w MR i 7/29 = 24.1% w USG). Krwawienie śródmózgowe wykryto w MR aż w 7 przypadkach (24,1%), a śródmóżdżkowe w 4 (13,8%). Brak zróżnicowaniu istoty szarej i białej (“fuzzy brain”), zwykle przemijające w obrazie USG, obserwowano u 79,3% noworodków. Restrykcja dyfuzji wody w płacie ciała modzelowatego (13,8%) oraz hiperechogeniczność wzgórz i jąder podstawy mózgu ściśle korelowały z istotnie częstszym występowaniem znacznego opóźnienia rozwoju. Wnioski: Nieprawidłowy obraz MRI i US występuje u 75% noworodków z encefalopatią niedotlenieniowoniedokrwienną leczonych metodą selektywnej hipotermii

The impact of intrauterine tobacco exposure on the cerebral mass of the neonate based on the measurement of head circumference

The objective of the study was to assess cerebral mass, based on head circumfer- ence measurements in neonates exposed to tobacco smoke in utero, and to deter- mine the relative proportions of the cerebral and body mass. The study included 147 neonates born in the period 2003–2004 at the Princess Anna Mazowiecka University Hospita land admitted to the Neonatal and Intensive Care Department of the Medical University in Warsaw. Subjects were divided into three groups on the basis of maternal status as active, passive, or nonsmokers determined by materna lurinary cotinine concentration and a questionnaire. Neonates whose mothers were active smokers throughout the whole period of pregnancy had a lower head circumference and in consequence a lower cerebral mass significantly more frequently when compared with those whose mothers were nonsmokers, P=0.002. (Median difference in cerebral mass was 48.27 g.) The risk of lower cerebral mass was 3.9 (1.4–10.8, CI 95%) in the group of neonates whose mothers actively smoked cigarettes during pregnancy. A negative correlation was seen between cerebral mass and maternal urinary cotinine concentration (correlation coefficient r=−23, P=0.006). The ratio of the cerebral to body mass was similar for neonates in all three groups. Active smoking during pregnancy had a negative effect on the cerebral mass of theneonate, however no such effect was observed in neonates whose mothers were passive smokers. The deficiency in cerebral mass increased with greater smoking intensity. Active smoking by the mother during pregnancy inhibits the growth of the brain as well as that of the body mass of the neonate

Risk factors for preterm encephalopathy

Summary Encephalopathy in a common neonatological sense is a term referring to a complex of clinical symptoms occurring in term infants in the first days of their life as a result of hypoxic-ischemic lesions. However, if we accept the encyclopedic definition of encephalopathy as a vast or multifocal brain lesions caused by a variety of factors, we may use the term to describe all patients with traumatic, hypoxic or toxic brain lesions, and therefore also newborns at different levels of maturity. Contrary to term newborns, in which case the hypoxic-ischemic encephalopathy are mostly intrauterine, for preterm infants there is a number of factors which destroy neural tissue postnatally. The occurrence of those factors is often influenced by elements of essential intensive care. The article describes the most common biochemical disturbances and clinical causes

Sequential sonographic features in neonatal renal vein thrombosis

Objectives: Renal vein thrombosis in newborns is a rare but serious and acute disease. Clinical representations of RVT can vary from discrete symptoms to life-threatening conditions. Therefore imaging, and in particular sonography, plays an important role in the diagnosis of RVT in neonates. Gray-scale, color and spectral/power Doppler ultrasound are all used in the diagnosis of RVT. Material and methods: We present retrospective sequential ultrasonic imaging of three patients (two term and one preterm infant) with findings characteristic of RVT. Results: Initial ultrasound diagnostic features include: renal enlargement, echogenic medullary streaks, lack of the flow pattern characteristic of arcuate vessels and subsequently loss of corticomedullary differentiation, reduced echogenicity around pyramids and echogenic band at the extreme apex of the pyramid. Higher resistance index or less pulsatile venous flow on the affected kidney are helpful Doppler signs. Conclusions: Knowledge and identification of specific features of each phase of the evolution of RTV seems essential to prompt diagnosis. We would like to highlight the evolution of specific sonographic features in each subsequent phase of RVT

Multiple brain abscesses caused by citrobacter koseri in a preterm neonate : case report

Background: Brain abscesses are very rarely diagnosed in neonates, but if present, they are associated with a high risk of severe complications and mortality. In neonates, brain abscesses can be detected on transfontanelle ultrasonography, in which they appear as hyperechogenic lesions surrounded by a hypoechogenic border. Case Report: We present a female neonate, born in the 28th week of gestation, with birth weight of 950 grams, who was born in an ambulance by spontaneous vaginal vertex delivery. No signs of infection were present until the 35th day of hospitalization, when a sudden and serious deterioration in the patient's condition was observed due to late-onset sepsis. Cranial US, performed on the 40th day of life, revealed hyperechogenic lesions with a hypoechogenic halo in the right frontal lobe, which could correspond to brain abscesses. These lesions were caused by Citrobacter koseri septicaemia, identified by transfontanelle ultrasonography, and confirmed on magnetic resonance imaging. The patient recovered and was discharged on the 91th day of life (39 PCA) with a recommendation of permanent neurological surveillance. Conclusions: Ultrasonography of the central nervous system can reveal inflammatory changes and developing brain abscesses. In neonates, magnetic resonance imaging should be performed as the method of choice for confirming brain abscesses

The incidence of alpha-1-antitrypsin (A1AT) deficiency alleles in population of Central Poland — preliminary results from newborn screening

Wrodzony niedobór alfa-1 antytrypsyny, jest jedną z trzech najczęstszych chorób genetycznych rasy kaukaskiej, wiąże się z istotnie wyższym ryzykiem rozwoju postępujących chorób płuc, zwłaszcza przewlekłej obturacyjnej choroby płuc. Dane na temat częstości występowania tego niedoboru w populacji polskiej są niepełne, brakuje badań wykonanych w dostatecznie dużych i przekrojowych grupach populacyjnych. W pracy zaprezentowano wstępne wyniki badania przesiewowego realizowanego w populacji noworodków z Mazowsza. Analizę genotypu metodą real-time PCR i stężenia alfa-1 antytrypsyny metodą nefelometryczną we krwi pobranej na bibułę (DBS) wykonano w grupie 658 noworodków. Allele zmutowane PI*Z i PI*S wykryto u 28 dzieci, odpowiednio 2,8% i 1,5%. Ich obecność korespondowała z istotnie niższym stężeniem białka A1AT we krwi. Szacowana częstość występowania alleli niedoborowych wynosi dla PI*Z — 13,7/1000 (95% CI 5,8–21,5), dla PI*S — 7,6/1000 (95% CI 1,7–13,5), natomiast częstość występowania głównego genotypu deficytowego ZZ 1/5345. Badanie jest kontynuowane.Inherited alpha-1 antitrypsin deficiency (A1ATD) is listed among the three most common genetic disorders in Caucasians. It considerably increases the risk of progressive obstructive lung diseases, mostly chronic obstructive pulmonary disease. Data on the A1ATD prevalence in Poland are scarce, no studies with large enough groups representative for whole Polish population have been performed. Here, we present the preliminary data on the incidence of A1AT main deficiency alleles from the newborn screening in Mazovia (Central Poland) region. Real-time PCR genotyping and A1AT blood concentration measurement by nephelometry were performed from the dry blood spots (DBS) samples of 658 newborns. Deficiency alleles PI*Z i PI*S were present in 28 children, respectively in 2.8% and 1.5%. Their existence corresponded with significantly lower A1AT blood concentration. Estimated incidence of deficiency alleles was 13,7/1000 (95% CI 5.8–21.5) for PI∗Z and 7.6/1000 (95% CI 1.7– 13.5) for PI∗S. The calculated prevalence for the main deficiency genotype ZZ was 1/5345. The study is on-going

Ocena przydatności skali Apgar: ogólnopolska ankieta dotycząca oddziałów noworodkowych

Abstract Introduction: The paper discusses the reliability of the Apgar score for evaluating newborns, particularly its usefulness in assessing the state of preterm or full term newborns born with hypoxia. Aim: The paper provides a sum-up of the opinions on usefulness and reliability of the Apgar score given by doctors from 255 NICUs. Material and methods: Data for the analysis were gathered by means of a questionnaire opinion poll sent to 158 primary referral centers, 71 secondary referral centers and 26 tertiary referral centers. Respondents answered questions about value of the Apgar score assessment (highly valuable, limited value, always reliable), as well as overrating and underrating children born in good overall condition and children born with clinical and biochemical indicators of hypoxia. In the group of prematurely born babies, the data concerning newborns with very low (VLBW) and extremely low birth weight (ELBW) were analyzed separately. Results: 88,5% neonatologists claimed the use of the Apgar score in assessing newborn condition to be of little value and only 11,5% found this indicator useful and reliable. Conclusions: According to the majority of Polish neonatologists, Apgar score is not reliable in the assessment of term and preterm hypoxic newborns.Streszczenie Ocena noworodków według skali Apgar wydaje się być coraz mniej przydatna w ocenie noworodka niedotlenionego. Cel pracy: Celem pracy była sumaryczna opinia neonatologów zatrudnionych w 255 oddziałach noworodkowych dotyczącą przydatności i wiarygodności skali Apgar w ocenie stanu ogólnego noworodków. Materiał i metody: Badania oparto na ankietach przesłanych do 158 oddziałów I stopnia referencyjności,71 oddziałów II stopnia referencyjności i 26 oddziałów III stopnia referencyjności. Neonatolodzy przedstawili swoje opinie dotyczące wiarygodności skali Apgar w ocenie donoszonych i przedwcześnie urodzonych noworodków z objawami niedotlenienia wewnątrzmacicznego. Respondenci udzielali odpowiedzi oceniając wartość skali Apgar jako bardzo wiarygodną, o ograniczonej wiarygodności lub zawsze miarodajną, a także jako niedoszacowaną lub przeszacowaną w stosunku do biochemicznych i klinicznych wykładników niedotlenienia. W grupie noworodków przedwcześnie urodzonych opinie dotyczyły zarówno oceny noworodków z bardzo małą jak i ekstremalnie małą masą ciała. Wyniki: 88,5% neonatologów podkreśla ograniczoną wartość skali Apgar w ocenie stanu ogólnego noworodków, a tylko 11,5% uważa ją stale za przydatną i wiarygodną. Wnioski: Według większości polskich neonatologów ocena według skali Apgar noworodków niedotlenionych tak donoszonych jak i przedwcześnie urodzonych nie jest wiarygodna