CRIB II score versus gestational age and birth weight in preterm infant mortality prediction: who will win the bet?

Introduction. In neonatology, various illness severity scores have been developed to predict mortality and morbidity risk in neonates. The aim of our study was to validate the ability of the ‘Clinical Risk Index for Babies’ (CRIB) II score to predict mortality in neonates born before 32 weeks’ gestation in a level 3 neonatal intensive care unit (NICU), setting. Materials and Methods. Prospective birth cohort study including all live-born neonates of 32 weeks’ gestation or less. . CRIB II score was calculated and the predicted mortality was compared with the observed mortality. Discrimination (the ability of the score to correctly predict survival or death) was assessed by calculating the receiver operating characteristic curve (ROC curve) and its associated area under the curve (AUC). Results. The ROC curve analysis in our study showed that the AUC was 0.9008 suggesting that mortality prediction was 90% accurate for all infants. Sensitivity and specificity were 77% and 88% respectively. In our study population, the CRIB II score appears to be more accurate than gestational age and birth weight in predicting mortality. Conclusions. The CRIB II scoring system is a useful tool for predicting mortality and morbidity in NICUs, and also a useful tool for evaluating the variations in mortality and other outcomes seen between different NICUs

Postinfectious Glomerulonephritis and Epstein-Barr Virus Co-Infection

Contrary to group A b-hemolytic streptococcus as the most common cause of postinfectious glomerulonephritis (PIGN), Epstein-Barr virus (EBV) is only occasionally associated with acute renal involvement. We describe an 11-year-old boy who presented with clinical signs of infective mononucleosis and acute glomerulonephritis characterized by edema, hypertension and dark colored urine with diminished renal function. Serology tests confirmed streptococcal infection and acute EBV infection. Persistently depressed C3 complement and gross hematuria indicated renal biopsy which shows PIGN-type picture and, in addition, acute interstitial nephritis, both conclusive of streptococcal infection. We performed tissue DNA extraction by polymerase chain reaction (PCR) and demonstrated EBV-DNA from the kidney specimen supporting EBV involvement in renal tissue. This is the first reported case of PIGN with serologically-proven streptococcal and simultaneously, acute EBV co-infection. EBV-DNA extraction supported the EBV involvement in renal tissue suggesting that both etiologic agents might have contributed to renal inflammation. Adding serology evaluation for EBV in cases with typical clinical signs of infective mononucleosis and renal symptoms, EBV might be more commonly associated with PIGN than is currently appreciated

Pediatric Idiopathic Intracranial Hypertension: Clinical and Demographic Features

Idiopathic intracranial hypertension (IIH) is a clinical condition characterized by elevated intracranial pressure and absence of clinical, laboratory or radiographic evidence of central nervous system infection, vascular malformation, intracranial space occupying lesion or hydrocephalus. In the last years the raising understanding of pediatric IIH, especially concerning its demographics and epidemiology, has brought up to a redefinition of diagnostic criteria and reevaluation of pathogenesis and treatment. The authors reviewed the records of nineteen consecutive children with newly diagnosed IIH in order to compare demographic characteristics, clinical pictures and ophthalmologic aspects as optic disc evaluation and visual field evaluation, as well as treatment modalities and follow up. Beside obesity and female gender, potential alternative risk factors remains to be investigated, which need a good collaboration between neuroophthalmologists and pediatric neurologists

Mediastinal tube placement in a premature infant with cardiorespiratory derangement due to ventilator associated pneumomediastinum

While mediastinal free air in the ventilated newborn is usually benign, tension pneumomediastinum can lead to further cardiorespiratory compromise due to the compression of mediastinal structures, including the heart and large blood vessels. The authors present a case of life-threatening pneumomediastinum in a ventilated preterm leading to abrupt onset of cardiorespiratory failure. An 8 French (Fr) drainage catheter was placed in the anterior mediastinum using the 2nd right intercostal space as an insertion site, with prompt hemodynamic improvement. A brief description of the drainage technique and a literature review is presented

CRIB II score versus gestational age and birth weight in preterm infant mortality prediction: who will win the bet?

Introduction. In neonatology, various illness severity scores have been developed to predict mortality and morbidity risk in neonates. The aim of our study was to validate the ability of the ‘Clinical Risk Index for Babies’ (CRIB) II score to predict mortality in neonates born before 32 weeks’ gestation in a level 3 neonatal intensive care unit (NICU), setting. Materials and Methods. Prospective birth cohort study including all live-born neonates of 32 weeks’ gestation or less. . CRIB II score was calculated and the predicted mortality was compared with the observed mortality. Discrimination (the ability of the score to correctly predict survival or death) was assessed by calculating the receiver operating characteristic curve (ROC curve) and its associated area under the curve (AUC). Results. The ROC curve analysis in our study showed that the AUC was 0.9008 suggesting that mortality prediction was 90% accurate for all infants. Sensitivity and specificity were 77% and 88% respectively. In our study population, the CRIB II score appears to be more accurate than gestational age and birth weight in predicting mortality. Conclusions. The CRIB II scoring system is a useful tool for predicting mortality and morbidity in NICUs, and also a useful tool for evaluating the variations in mortality and other outcomes seen between different NICUs

CRIB II score versus gestational age and birth weight in preterm infant mortality prediction: who will win the bet?

Introduction. In neonatology, various illness severity scores have been developed to predict mortality and morbidity risk in neonates. The aim of our study was to validate the ability of the ‘Clinical Risk Index for Babies’ (CRIB) II score to predict mortality in neonates born before 32 weeks’ gestation in a level 3 neonatal intensive care unit (NICU), setting. Materials and Methods. Prospective birth cohort study including all live-born neonates of 32 weeks’ gestation or less. . CRIB II score was calculated and the predicted mortality was compared with the observed mortality. Discrimination (the ability of the score to correctly predict survival or death) was assessed by calculating the receiver operating characteristic curve (ROC curve) and its associated area under the curve (AUC). Results. The ROC curve analysis in our study showed that the AUC was 0.9008 suggesting that mortality prediction was 90% accurate for all infants. Sensitivity and specificity were 77% and 88% respectively. In our study population, the CRIB II score appears to be more accurate than gestational age and birth weight in predicting mortality. Conclusions. The CRIB II scoring system is a useful tool for predicting mortality and morbidity in NICUs, and also a useful tool for evaluating the variations in mortality and other outcomes seen between different NICUs

Postinfectious Glomerulonephritis and Epstein-Barr Virus Co-Infection

Contrary to group A b-hemolytic streptococcus as the most common cause of postinfectious glomerulonephritis (PIGN), Epstein-Barr virus (EBV) is only occasionally associated with acute renal involvement. We describe an 11-year-old boy who presented with clinical signs of infective mononucleosis and acute glomerulonephritis characterized by edema, hypertension and dark colored urine with diminished renal function. Serology tests confirmed streptococcal infection and acute EBV infection. Persistently depressed C3 complement and gross hematuria indicated renal biopsy which shows PIGN-type picture and, in addition, acute interstitial nephritis, both conclusive of streptococcal infection. We performed tissue DNA extraction by polymerase chain reaction (PCR) and demonstrated EBV-DNA from the kidney specimen supporting EBV involvement in renal tissue. This is the first reported case of PIGN with serologically-proven streptococcal and simultaneously, acute EBV co-infection. EBV-DNA extraction supported the EBV involvement in renal tissue suggesting that both etiologic agents might have contributed to renal inflammation. Adding serology evaluation for EBV in cases with typical clinical signs of infective mononucleosis and renal symptoms, EBV might be more commonly associated with PIGN than is currently appreciated

Successful separation of xypho-omphalopagus conjoined twins with extrauterine twin-twin transfusion syndrome: a case report

Conjoined twining is a rare medical phenomenon, with an overall prevalence of 1.47 per 100 000 births. This report describes a successful separation of xypho-omphalopagus conjoined twins complicated by unbalanced blood shunting through the porto-systemic anastomoses within the shared liver parenchyma. Significant extrauterine twin-twin transfusion syndrome caused by unbalanced shunting is an extremely rare, and probably under-recognized, hemodynamic complication in conjoined twins necessitating urgent separation. Progressive deterioration with a poor outcome can be prevented if the condition is recognized in a timely manner

Report on the work of the Reference center for pediatric cardiology Ministry of Health of the Republic of Croatia

Cilj je ovog izvješća u proteklom trogodišnjem razdoblju (2019–2022) prikazati: 1) aktivnosti Referentnog centra, 2) postignute stručne rezultate i primjenu novih metoda, postupaka i unaprjeđenje struke, i 3) znanstvenu i stručnu suradnju s inozemnim ustanovama visoke razine. Rezultati: Referentni je centar jedino mjesto u Republici Hrvatskoj koje kontinuirano zbrinjava populaciju najugroženijih i najtežih bolesnika pedijatrijske dobi sa srčanom patologijom. Ima kontinuirano, 24 sata dostupnu kardiološku, kardiokiruršku, anesteziološku, neonatalnu i intenzivnu skrb za djecu sa složenim prirođenim i stečenim srčanim bolestima. Također su dostupne metode nadomještanja funkcije organa u zatajivanju (ECMO potpora, LVAD-BiVAD, Berlin-Heart pumpa, hemodijaliza, program transplantacije srca / drugih organa), a sve zahvaljujući timskom radu i suradnji tima nekoliko Zavoda. Izvode se složene kardiokirurške operacije u djece s prirođenim srčanim greškama uz jasan trend povećanja broja i složenosti operacija, te uz i dalje prihvatljivo nisku smrtnost. Danas smo u mogućnosti samostalno liječiti gotovo sve srčane bolesti u djece. Godišnje se izvede oko 200 kateterizacija srca u djece. Više od 40% čine intervencijske procedure, a više od 50% tih intervencija izvodi se u dojenačkom periodu. Tijekom protekle tri godine uvedeno je pet novih perkutanih intervencijskih metoda: liječenje nativne koarktacije i rekoarktacije umetanjem stenta, liječenje stenoze pulmonalnih grana umetanjem stenta, perkutano umetanje valvule na pulmonalnu poziciju, dilatacija postojećeg stenta te zatvaranje aortopulmonalnih kolaterala u djece s univentrikulskim srcem. Navedeni iskoraci učinjeni su kontinuiranim zalaganjem članova tima uz potporu i mentorstvo, odnosno kontinuiranu suradnju s inozemnim stručnjacima iz triju inozemnih ustanova (DeutschesHerzZentrum Muenchen, KinderherzZentrum Linz, Kids Heart Center Budapest). Zaključak: Naš centar stoji uz bok rijetkih centara u Europi koji su u mogućnosti izvesti navedene procedure. Navedene su aktivnosti rezultirale unaprjeđenjem kvalitete skrbi na razini RH i temelj su za daljnji planirani rast i razvoj struke u okvirima naše zemlje.The aim of this report is to show in the past three-year period (2019–2022): 1)activities of the Reference Center, 2)achieved professional results and the application of new methods, procedures, and improvement of the profession, and 3)scientific and professional cooperation with high-level foreign institutions. Results: The reference center is the only place in the Republic of Croatia that continuously cares for the population of the most vulnerable children with cardiac pathology. It has continuous, 24-hour cardiology, cardiac surgery, anesthesiology, neonatal and intensive care for children with complex congenital and acquired heart diseases. Organ function replacement are also available (ECMO support, LVAD-BiVAD, Berlin-Heart pump, hemodialysis, heart/other organ transplant program) thanks to the teamwork and cooperation of different Departments. Complex cardiac surgeries are performed in children with a clear trend of increasing the number and complexity of surgeries, with low mortality. Today, we can independently treat almost all congenital heart defects in children. About 200 cardiac catheterizations are performed in children annually. More than 40% are interventional procedures with more than 50% of these interventions performed in infancy. In the past three years, five new percutaneous intervention methods have been introduced: stent insertion in native coarctation and in recoarctation, stent insertion in stenosis of the pulmonary branches, percutaneous valve insertion in the pulmonary position, dilatation of the existing stent, and closure of aortopulmonary collaterals in children with a univentricular heart. The steps were made by the continuous efforts of team members with support, mentoring, and continuous cooperation with foreign experts from three foreign institutions (DeutschesHerzZentrum Muenchen, KinderherzZentrum Linz, KidsHeart- Center Budapest). Conclusion: Our center stands alongside the rare centers in Europe that can perform the abovementioned procedures. The activities resulted in the improvement of the quality of care and form the basis for further development of the profession within the framework of our country

Povezanost histološki dokazanih upalnih promjena posteljice i kronične plućne bolesti u nedonoščadi : doktorski rad

Cilj istraţivanja: PosljednjihgodinamnogobrojnimsekliničkimieksperimentalnimispitivanjimapokušavarasvijetlitiodnosizmeĎuupaleposteljice i fetalnogupalnog sindroma s jedne, te kratkoročnogidugoročnogishodaprijevremenogporoda s druge strane.Nedonošče čestoideususretnizukroničnihzdravstvenihtegoba, meĎu kojima se po svojoj teţini i značajnosti utjecaja na kvalitetu ţivota, posebno ističukronične bolesti dišnog sustava. Pokronologijinjihovepojavnostimoţemoihpodijelitiuraneoblike, kao što je kronična plućna bolest nedonoščeta, te kasne oblike, kaoštosu bronhoopstruktivni sindrom ranog djetinjstva i simptomi astme. Nameće se potreba istraţivanja onih stanja koja najviše ugroţavaju čedo tijekom trudnoće, poroda i rane novoroĎenačke dobi te potreba intenzivnog praćenja i rane detekcije smetnji u razvoju, ali i pravovremenog predviĎanja kroničnih ne-neuroloških zdravstvenih problemanedonoščeta. Ispitanici i metode; Ovo istraţivanje je povijesna kohortna studija kojajeudesetogodišnjemrazdoblju, od1998. do 2008. godine uključila262 nedonoščadi gestacijskedobi≤ 32.tjedanatrudnoće, roĎeneuKlinici za ginekologiji i porodništvo, KBC Rijeka. Grupiranjeispitanikaunutarispitivaneskupineprovedeno je premanačelu„nestedcasecontrolstudy“. Unutarispitivaneskupineprovedenajeanalizaprenatalnihineonatalnihčimbenikarizikatemajčinih čimbenikarizikazanastanakkroničnihrespiratornihteškoća. Odčimbenikarizikaispitivanisu patohistološkinalazposteljice, gestacijskadob, spol, rodnamasa, načinporoda, prijevremeno prsnućeplodovih ovojnica, infekcijaplodovevode, Apgarocjena, terapijaegzogenimsurfaktantom, mehaničkaventilacija, teprisustvootvorenog arterijskogduktusainovoroĎenačkesepse. VIMeĎu majčinim čimbenicimarizikaispitivanajestručnasprema, dob, pušenjeutrudnoći, antimikrobnaterapijautrudnoćiteprisustvokroničnihrespiratornihsimptomaiatopije. Postupnik patomorfološke analize posteljice predviĎao je mikroskopskuanalizuminimalnodevetuzoraka, adefinicijapatohistološkognalazatemeljilasenabrojuleukocitaunutarpoljazasvakiuzoraktkiva. Rezultati: MeĎu našim ispitanicima u 40%(105/262) je patohistološki nalaz posteljice i plodovih ovoja dokazao korioamnionitis, a u 17%(45/262) dokazan je fetalni upalni odgovor. Kronična plućna bolest nedonoščeta dijagnosticirana je u 24% (62/262) ispitanika, 26% (68/262) nedonoščadi razvilo jebronhoopstruktivni sindrom rane dječje dobi, a 23% (59/262) razvilo je simptome astme dječje dobi. Prisustvo fetalnog upalnog odgovora značajan je čimbenik prijevremenog poroda. Njegova prisutnost značajno povećava omjer vjerojatnosti za gestaciju kraću od tjedana (OR 5.87), rodnu masu manju od 1000 grama (OR 3.84), APGAR indeks <6 u 5.minuti (OR 2.47), otvoreni arterijski duktus (OR 4.66), potrebu mehaničke ventilacije (OR 3.20), kronične plućne bolesti nedonoščeta (OR 17.8) i bronhoopstruktivnog sindroma rane dječje dobi (OR 4.49). Logističkom regresijom kao nezavisni čimbenici rizika za nastanak kronične plućne bolesti nedonoščeta pokazali su se rodna masa < 1000 grama (OR 4.10), mehanička ventilacija (OR 5.24) i prisustvo fetalnog upalnog odgovora (OR 18.83). Path-analiza ukazala je na izraziti direktni učinak majčine atopije na nastanak astme (0.60), fetalnog upalnog odgovora na kroničnu plućnu bolest nedonoščeta (0.59), mehaničke ventilacije na kroničnu plućnu bolest nedonoščeta (0.45) i kronične plućne bolesti na nastanak bronhoopstruktivnog sindroma (0.54). Neposredni utjecaj gestacijske dobi na nastanak kronične plućne bolesti je minimalan i zanemariv (0.04). VIIZaključak: KliničkadogaĎanjaunajranijojţivotnojdobi, aionaprijesamogroĎenja, odogromnesuvaţnostisobziromnapatogenezupromjenaudišnimputevima, uskopovezanusarazvojnimetapamasustavazadisanje. Sadašnja saznanja, u koja su se naši rezultati u potpunosti uklopili, naglašavaju ulogu prenatalne upale i fetalnog upalnog sindroma kao vodećih čimbenika rizika za prijevremeni poroĎaj te njihov temeljni značaj za postnatalni respiratorni morbiditet. Posljednjih godina učinjeno je mnogo pokušaja s ciljem definiranja o gestaciji neovisne uloge korioamnionitisa na novoroĎenački i postnatalni ishod. Rezultati naše path-analize dodatno rasvjetljavaju taj patogenetski prijepor i mogu biti jedan od putokaza u odreĎivanju smjera slijedećih istraţivanja.Objectives: In the last years, a huge number of clinical and experimental studies trying to elucidate the relationship between inflammation of the placenta and fetal inflammatory syndrome with short-term and long-term outcome of preterm delivery. Premature babies often have the burden of chronic health problems that could have a significant impact on quality of life, like long-lasting chronic respiratory disease. According to the chronology of their appearance it can be divided into early form, the chronic lung disease of prematurity, and late forms, such as wheezing in early childhood and early childhood asthma. The need for research of conditions that could threat the infants duringpregnancy, childbirth and early neonatal age is mandatory, as well as it is the need for intensive monitoring and early detection of chronic non-neurological medical problems of the prematurely born infant.PatientsandMethods: This study is a historical cohort study, with 262 preterm infants of gestational age ≤ 32 weeks, recruited in a ten-years period, born at the Department of Gynecology and Obstetrics, University Hospital Rijeka. Grouping of subjects within the study groups was carried out according to the "nested case control study." An analysis of maternal, prenatal and neonatal risk factors was carried out: pathohistological findings of the placenta, gestational age, sex, birth weight, mode of delivery, premature rupture of membranes, characteristics of the amniotic fluid, Apgar score, exogenous surfactant therapy, mechanical ventilation, presence of patent ductus arteriosus, and neonatal sepsis. Among the maternal risk factors we analyzed the education level, age, smoking during pregnancy, antimicrobial therapy during pregnancy and the presence of chronic IXrespiratory symptoms and atopy. The pathomorphological examination of the placenta includes microscopic analysis of at least nine samples, a definition of pathohistological findings based on the number of leukocytes in the fields for each tissue sample.Results:In our study 40%(105/262) of newborns had chorioamnionitis, whether 17% (45/262) had FIRS. 24% (62/262) of infants developed chronic lung disease of prematurity, 26% (68/262) had earlychildhood wheezing, and 23% (59/262) developed symptoms of early childhood asthma. The presence of FIRS had a significant impact on the gestational age less than 28 weeks(OR 5.87), birthweight less than 1000 grams (OR 3.84), APGAR score lower than 6 in the fifth minute of life (OR 2.47), presence of patent ductus arteriosus (OR 4.66), need for mechanical ventilation (OR 3.20), and presence of chronic lung disease of prematurity (OR 17.8) as well as early childhood wheezing (OR 4.49). With logistic regression analysis the birtweight < 1000 grams (OR 4.10), mechanical ventilation (OR 5.24) and FIRS-a (OR 18.83) showed up as indipendent risk factors for chronic lung disease. The path-analysis disclosed a strong direct impact of mother atopy on development ofearly childhood asthma (0.60), and strong impact of FIRS on chronic lung disease (0.59), as well as mechanical ventilation on chronic lung disease (0.45). Chronic lung disease had a strong direct influence on development of early childhood wheezing (0.54). The direct influence of gestational age on chronic lung disease is week and negligible (0.04).Conclusion: Clinical events in the early neonatal and, as we proved, in the prenatal period are of paramount importance with regard to the pathogenesis of changes in the airways, closely related to the developmental phases of the respiratory system. Our results are contributing to emphasize the importance ofprenatal infection and fetal inflammatory Xsyndrome as the leading risk factors for preterm delivery, and their fundamental importance for postnatal respiratory morbidity. In recent years a lot of attempts has be done to define the independent role of chorioamnionitis on neonatal and postnatal outcome. The results of our path-analysis sheds new light on the pathogenetic dispute and may be one of the clues in determining the direction of research in the future