Lenticulostriate vasculopathy in routine brain ultrasonography in infants: next step?

Lenticulostriate vasculopathy (LSV) is a relatively common fi nding in routine cranial ultrasound examination that has been associated with many infectious and non-infectious conditions. The aim of this review was to provide a better understanding of LSV ultrasound fi nding, as well as the need for further laboratory and imaging examinations in infants. The most of the published studies represented small series, with few prospective long-term studies involving the control groups. Authors have mostly found an association between LSV, especially higher-grade (although there is no universally accepted classifi cation) with congenital cytomegalovirus (CMV) infection, classifying those children as at risk for sensorineural hearing loss. In contrast, some authors pointed out that LSV could be found relatively often, and believe that isolated LSV, especially lower-grade, is not predictive for an unfavourable outcome and a long-term prognosis. Therefore, although 35 years have passed since the fi rst publication of LSV, there is still no consensus among experts on the clinical signifi cance of isolated LSV, but caution is certainly needed given the fact that most infants with congenital CMV are asymptomatic

Surfactant administration in premature infants with RDS

Background. The significant advancement in the treatment of respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancement in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants. Patients and methods. We analyzed data of 78 preterm babies with respiratory distress syndrome hospitalized in the NICU of the Pediatric Clinic, KCU Sarajevo. All children included in the study were mechanically ventilated and treated with one or more doses of bovine surfactant (Survanta) as rescue therapy. Surfactant was given to children with clinical and radiological signs of RDS, who required FiO2>0,40. We used the standard procedure of giving surfactant therapy to intubated children in sterile conditions, after we confirmed, by X-ray, correct tube placement. Results. We investigated the clinical efficacy of surfactant in relation to time of administration, O2 requirement and necessity of one or more doses of surfactant. We found that early treatment with surfactant replacement- within 6 hours of birth- is more effective, and resulted in a significant reduction of mortality rate (p<0,01). Treatment with multiple doses is more effective in comparison to one dose, although there was not a significant difference (p<0,20) between the treated groups. There is a significant difference (p<0,01) between groups related to O2 requirement. In the group of babies which required 60% or more O2 concentration in inhaled air at the time of surfactant replacement, mortality rate was significantly higher (p<0,01). Conclusion. Our study confirmed the benefits of surfactant therapy in preterm babies with respiratory distress syndrome. We confirmed the advantages of early treatment vs. late treatment, but we could not confirm the obvious advantage of multiple over single doses. So, a reasonable recommendation is to treat the infants as soon as clinical signs of developing respiratory distress appear with an individual dose for each infant

Surfactant administration in premature infants with RDS

Background. The significant advancement in the treatment of respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancement in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants. Patients and methods. We analyzed data of 78 preterm babies with respiratory distress syndrome hospitalized in the NICU of the Pediatric Clinic, KCU Sarajevo. All children included in the study were mechanically ventilated and treated with one or more doses of bovine surfactant (Survanta) as rescue therapy. Surfactant was given to children with clinical and radiological signs of RDS, who required FiO2>0,40. We used the standard procedure of giving surfactant therapy to intubated children in sterile conditions, after we confirmed, by X-ray, correct tube placement. Results. We investigated the clinical efficacy of surfactant in relation to time of administration, O2 requirement and necessity of one or more doses of surfactant. We found that early treatment with surfactant replacement- within 6 hours of birth- is more effective, and resulted in a significant reduction of mortality rate (p<0,01). Treatment with multiple doses is more effective in comparison to one dose, although there was not a significant difference (p<0,20) between the treated groups. There is a significant difference (p<0,01) between groups related to O2 requirement. In the group of babies which required 60% or more O2 concentration in inhaled air at the time of surfactant replacement, mortality rate was significantly higher (p<0,01). Conclusion. Our study confirmed the benefits of surfactant therapy in preterm babies with respiratory distress syndrome. We confirmed the advantages of early treatment vs. late treatment, but we could not confirm the obvious advantage of multiple over single doses. So, a reasonable recommendation is to treat the infants as soon as clinical signs of developing respiratory distress appear with an individual dose for each infant

Pneumothorax in premature infants with respiratory distress syndrome: focus on risk factors

Introduction: Pneumothorax is a life threatening condition, more often seen in immature infants receiving mechanical ventilation. It carries a significant risk of death and impaired outcome. Objective: To determine predictive factors for the occurrence of pneumothorax in preterm infants with respiratory distress syndrome (RDS). Patients and methods: The present study was conducted in a tertiary research and educational hospital, NICU, Pediatric Clinic UKC Sarajevo, from January 2010 to December 2013. All infants had chest X-ray at admission, and were treated due to RDS with nasal continuous positive airway pressure (CPAP), mechanical ventilation, or high frequency oscillatory ventilation. At admission we registered data regarding birth weight, gestational age, Apgar score, prenatally given steroids. Inclusion criteria were fulfilled by 417 infants. Data about timing, circumstances, side and treatment of pneumothorax were gathered from medical records. Results: Mean birth weight was 1,477 g, mean gestational age 29.6 weeks. We report 98 infants who did not survive. We also report incidence of pneumothorax in 5% of the infants with RDS. In this study pneumothorax and non-pneumothorax groups didn’t differ regarding sex, gestational age (median 29 and 30) nor birth weight (p = 0.818). Apgar score at the 1st and 5th minute of life had no influence in genesis of pulmonary air leak, neither prenatally given steroids (p = 0.639), nor surfactant administration. There was a low coverage of preterm infants with prenatal steroids (overall 28.29%). We found that FiO2 ≥ 0.4 in the first 12 hours of life, and need for mechanical ventilation are predicting factors for developing pneumothorax (p < 0.05). Conclusion: Together with mechanical ventilation, inspired fraction of oxygen higher than 40%, needed to provide adequate oxygenation in the first 12 hours of life in preterm infants, could be a predictive factor in selecting the highest risk babies for development of neonatal pneumothorax

Palivizumab prophylaxis of RSV infections in Bosnia and Herzegovina

Background: Palivizumab is indicated for respiratory syncytial virus (RSV) prophylaxis in high-risk children. Methods: Observational study, based on 4 sites in Bosnia and Herzegovina (B&H), with institutional reports of infants at high risk for RSV who received at least 1 dose of palivizumab during the 2008-2013 RSV seasons. Results: Across 6 RSV seasons, from 2008/9 to 2013/14, 589 infants were enrolled (0.29% of livebirths population). Of all infants, 290 (49.2%) were enrolled for prematurity only, 82 (13.9%) for bronchopulmonary dysplasia/chronic lung disease (BPD/CLD), 201 (34.1%) for congenital heart disease (CHD), and 13 (2.2%) for other reasons; 365 (61.9%) infants in total were born before 33 weeks. Average gestational age of preterm infants enrolled for prematurity only was 30.2 ± 3.2 weeks; for preterm infants with BPD/CLD it was 28.3 ± 3.7 weeks. Overall average of palivizumab injections was 4.1 ± 1.0. Hospitalization rate related to severe lower respiratory infections (LRI) during the period of protection by palivizumab was 1.2%. Respiratory infections which deserved medical attention were observed in 3.7% infants included in palivizumab prophylaxis. Conclusion: RSV prophylaxis in B&H is provided systematically and successfully, following the national guidance established in 2009, with the aim of achieving a good cost-benefit ratio, with very low hospitalization rate for severe LRI in prophylaxed infants. New randomized controlled trials (RCTs) and American Academy of Pediatrics (AAP) guidance revised in 2014 will be taken into account in establishing a new national recommendation