Assessment of cardiac function in donor and recipient fetuses during a 7-day follow-up after selective laser photocoagulation of communicating vessels due to TTTS

Objectives: The aim of the study was to analyze the changes in cardiac function and myocardial contractility of donor and recipient fetuses with twin-to-twin transfusion syndrome (TTTS) subjected to selective laser photocoagulation of the communicating vessels (SLPCV), between and after the procedure. Finally, we verified if fetuses with Quintero’s stage I TTTS presented with early impairment of myocardial contractility.  Material and methods: We selected 77 consecutive women with twin pregnancies, whose both fetuses survived at least seven days post-SLPCV. Myocardial contractility of both fetuses was evaluated ultrasonographically, and their myocardial performance indices (Tei-Index values) and shortening fractions (SF) were determined.  Results: In donor fetuses, the Tei-Index values for both right and left ventricle remained within the respective reference ranges both before the procedure and during a 7-day follow-up. A significant change in shortening fraction values for the left ventricle in recipient fetuses and the right ventricle of in the donors was observed during a 7-day follow-up.  Conclusions: Comparison of the cardiac parameters of donors and recipients revealed significant differences in Tei-indices during the entire follow-up period.  The group with Quintero’s I stage TTTS included 74% of recipient fetuses with abnormal Tei-Index values for the right ventricle (mean 0.53).

Foetal macrosomia — incidence, determinants and neonatal outcomes: 10-years retrospective review, 2010–2019

Objectives: Prevalence of macrosomia differs worldwide according to studied population and has been variable over last few decades. The objective of the study was to determine the trends in incidence and clinical characteristics of infants with macrosomia born in two diverse Polish neonatal centres from 2010–2019. Material and methods: Trends in the incidence of macrosomia, maternal age, delivery mode and neonatal complications were analysed over a 10 year period based on birth medical records. Results: The total number of 43 165 term neonates were analysed with macrosomia incidence of 16.63% (n = 7179). The prevalence of macrosomia was stable from 2010–2019 irrespectively of referentiality and geographical area. Mean maternal age increased over the decade with higher age of mothers of macrosomic neonates. Recognizability of gestation diabetes among pregnant women increased from 9.61% in 2010 to 15.27% in 2019 and it was comparable in mothers of macrosomic infants. The percentage of caesarean sections was higher in macrosomic neonates and gradually increased over last decade. The highest percentage of birth injuries was observed in the first grade of macrosomia (4000–4499 g). The number of neonatal complications including lower Apgar score, respiratory and cardiology symptoms correlated with severity of macrosomia, with highest morbidity in children above 5000 g. Conclusions: The prevalence of macrosomia in the studied cohort remained invariable over the last decade. Macrosomia is associated with an increased rate of caesarean sections, higher maternal age and increased neonatal morbidity. A higher macrosomia grade is related to a worse neonatal outcome. Further studies on other risk factors of macrosomia are needed

Diagnostic performance of point-of-use ultrasound of resuscitation outcomes: A systematic review and meta-analysis of 3265 patients

Background: Echocardiography in the setting of resuscitation can provide information as to the cause of the cardiac arrest, as well as indicators of futility. This systematic review and meta-analysis were performed to determine the value of point-of-care ultrasonography (PoCUS) in the assessment of survival for adult patients with cardiac arrest. Methods: This meta-analysis was performed in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, EMBASE, Web of Science, Cochrane have been searched from databases inception until March 2nd 2021. The search was limited to adult patients with cardiac arrest and without publication dates or country restrictions. Papers were chosen if they met the required criteria relating to the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of this diagnostic technique concerning resuscitation outcomes. Results: This systematic review identified 20 studies. Overall, for survival to hospital discharge, PoCUS was 6.2% sensitivity (95% confidence interval [CI] 4.7% to 8.0%) and 2.1% specific (95% CI 0.8–4.2%). PoCUS sensitivity and specificity for return of spontaneous circulation were 23.8% (95% CI 21.4–26.4%) and 50.7% (95% CI 45.8–55.7%) respectively, and for survival to admission 13.8% (95% CI 12.2–15.5%) and 20.1% (95% CI 16.2–24.3%), respectively. Conclusions: The results do not allow unambiguous recommendation of PoCUS as a predictor of resuscitation outcomes and further studies based on a large number of patients with full standardization of operators, their training and procedures performed were necessary

The Impact of COVID-19 pandemic on children with pulmonary arterial hypertension. parental anxiety and attitudes. Follow-up Data from the Polish Registry of Pulmonary Hypertension (BNP-PL)

The COVID-19 pandemic has impacted healthcare systems worldwide. Little is known about the impact of the pandemic on medical and psycho-social aspects of children with rare diseases such as pulmonary arterial hypertension and their parents. The study is based on children registered in The Database of Pulmonary Hypertension in the Polish Population and a parent-reported survey deployed during the first 6 months of the pandemic. The questionnaire consisted of six question panels: demographic data, fear of COVID-19, General Anxiety Disorder-7 (GAD-7), social impact of pandemic, patients’ medical status, and alarming symptoms (appearance or exacerbation). Out of 80 children registered, we collected 58 responses (72.5% response rate). Responders (parents) were mostly female (n = 55; 94.8%) at a mean age of 40.6 ± 6.9 years. Patients (children) were both females (n = 32; 55%) and males with a mean age of 10.0 ± 5.1 years. Eleven (19%) children had symptoms of potential disease exacerbation. Eight parents (72.7%) decided for watchful waiting while others contacted their GPs or cardiologists (n = 6; 54.5%). Three children had to be hospitalized (27.3%). Most planned hospitalizations (27/48; 56.2%) and out-patient visits (20/35; 57.1%) were cancelled, delayed, or substituted by telehealth services. Among the participating parents, the study shows very high levels of anxiety (n = 20; 34.5%) and concern (n = 55; 94.8%) and the need for detailed information (52; 89.6%) regarding COVID-19 and medical service preparedness during the pandemic. The COVID-19 pandemic has influenced child healthcare and caused high levels of anxiety among parents