39 research outputs found
ANTHROPOMETRIC AND BIOCHEMICAL ASSESSMENT OF INTRAUTERINE GROWTH RESTRICTION IN TERM NEWBORNS
Cilj rada. Usporediti razlike izmeÄu antropometrijskih i biokemijskih parametara intrauterinog rasta fetusa. Metode istraživanja. Prospektivna kliniÄka studija ukljuÄuje dvije kohorte novoroÄenÄadi roÄenih u Klinici za ginekologiju i porodniÅ”tvo KBC Rijeka, u odnosu na njihovu porodnu težinu: eutrofiÄnu i hipotrofiÄnu novoroÄenÄad. Zabilježeni su biokemijski parametri iz krvi pupkovine, antropometrijske mjere djece te svi podaci važni za fetalni rast koji su naÄeni u medicinskoj dokumentaciji za svaku pojedinu trudnoÄu. Rezultati. ZnaÄajna je razlika izmeÄu dviju skupina u ponderalnom indeksu (PI) i omjeru opseg nadlaktice/opseg glavice (ON/OG), u korist eutrofiÄne novoroÄenÄadi. UsporeÄujuÄi biokemijske biljege obiju skupina, u krvi pupkovine hipotrofiÄne novoroÄenÄadi je naÄena znakovito niža koncentracija glukoze i prealbumina, a poviÅ”ena koncentracija esencijalnih aminokiselina cistina, histidina, glicina, treonina, triptofana, valina, fenilalanina, izoleucina i leucina. ZakljuÄak. Suprotno oÄekivanjima, odreÄene aminokiseline naÄene su u krvi pupkovine u veÄoj koncentraciji u skupini hipotrofiÄne novoroÄenÄadi. 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 intraĀuterine growth. Methods. Prospective clinical study is performed which included two cohorts of newborns according toĀ 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 Āvalues 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
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 ā
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 ā„20,000/Ī¼L, 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
ā„20,000/Ī¼L can predict pulmonary maturity and reduce
the risk of neonatal respiratory distress syndrome
HUMAN MILK FORTIFIERS IN NUTRITION OF PREMATURE INFANTS
Postnatalni rast praÄen je poveÄanjem tjelesne mase kao i kompleksnim pojavama sazrijevanja funkcija organa, iza Äega stoje složeni mehanizmi na organskoj i staniÄnoj razini. U biti rasta i razvoja stoje procesi maturacije i diferencijacije. NedonÅ”Äad ispod 2 kg ima posebne potrebe u tom pogledu jer ih možemo smatrati fetusima ex utero. Teoretski, njihova stopa rasta u tom bi sluÄaju trebala biti sliÄna stopi rasta u fetusa. MajÄino mlijeko pri prijevremenom poroÄaju ne zadovoljava u potpunosti poveÄane potrebe nedonoÅ”Äeta za energijom, bjelanÄevinama i elektrolitima. PreporuÄa se majÄinome mlijeku dodavati preparate koji poveÄavaju sadžaj tvari potrebnih za metabolizam. Time se postiže rast od 15 do 25 g/kg/dan, smanjuje se mogu}nost nastanka metaboliÄke 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 infantās 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 Ā· THE ROLE OF HUMAN RECOMBINANT ERYTHOROPOIETIN
Anemija u nedonoÅ”Äadi je patoloÅ”ko stanje koje u pravilu pogaĆ°a novoroĆ°enÄad vrlo niske rodne mase. Uzrok anemije je nedovoljno stvaranje eritropoetina. Osnova lijeÄenja su transfuzije koje bolesnika izlaƦu mnogim nepoželjnim uÄincima. Pojava sintetskih rekombinantnih humanih eritropoetina (rHuEPO) pružila je moguÄnost poticanja vlastite eritropoeze i time smanjila potrebu za transfuzijama. Primjena rekombinantnoga humanog eritropoetina ne dovodi do supresije vlastite proizvodnje eritropoetina u nedonoÅ”Äadi. Nuspojave koje se javljaju tijekom ili nakon lijeÄenja anemije, rijetko su zamijeÄene. Primjena rHuEPO u nedonoÅ”Äadi ne utjeÄe na rast. U lijeÄenju anemije zbog nedonoÅ”enosti, uz rHuEPO potrebno je osigurati primjeren unos željeza, vitamina i bjelanÄevina. Racionalna primjena eritropoetina u prevenciji i lijeÄenju anemije zbog nedonoÅ”enosti, svakako znaÄi napredak u cjelokupnoj skrbi za prijevremeno roĆ°enu 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