Analiza wpływu wybranych czynników anestezjologicznych na stan neurobehawioralny noworodka

Introduction. An increasing percentage of children are born through C-sections. Both mother and child are exposed to potential obstetric, anesthesia and neonatal complications. Hypoxia associated with obstetric or anesthetic complications can lead to fetal hypoxia, and induce adaptation difficulties in the postpartum period or permanent developmental disorders. Knowledge of issues related to the perioperative care of the mother and child will minimize complications and provide high-quality care.Aim. The aim of the study was to analyze the impact of opioids in analgesia and hypotension during C-section on neonatal neurobehavioral state.Material and Methods. The study involved 102 mothers and their babies born by C-section. The study was approved by the Bioethics Committee of PUM. The inclusion criterion was the lack of systemic diseases in the mother and the gestational age over 36 weeks. All mothers were subarachnoidally anesthetized for the labor. Newborns after two days of life were assessed by NBAS (Neonatal Behavioral Assessment Scale).Results. Neonatal reflexes in the study group were normal. Newborns of mothers who were added fentanyl to anesthesia, did not differ in behavior from the others (p>0.05). After adding Morphini Sulfas 0.1% Spinal to anesthesia there were observed statistically significant differences in the behavior of newborns, compared to infants whose mothers did not receive it, in terms of sound stimulus habituation (p=0.04) in favor of those whose mothers received MF Spinal intrathecally. Children of mothers anaesthetized without the addition of MF Spinal presented higher self-calming abilities than the others (p=0.03). The ability of calming down differed infants of mothers whose blood pressure declined during anesthesia (p=0.04).Conclusions. Subarachnoid anesthesia with opioid supplementation for C-section as well as an anesthesia-related decrease in blood pressure slightly affected neurobehavioral state of infants born by C-section comparing to those whose mothers had not received opioids intraspinally and had not experienced a blood pressure decrease. (JNNN 2016;5(3):92–98)Wstęp. Drogą cięcia cesarskiego rodzi się coraz większy odsetek dzieci. Niezależnie od przyczyn, z jakich zostało wykonane, zarówno matka, jak i dziecko narażeni są na potencjalne powikłania położnicze, anestezjologiczne, neonatologiczne. Niedotlenienie związane z powikłaniami położniczymi, czy anestezjologicznymi może prowadzić do niedotlenienia dziecka płodowego, a tym samym wpłynąć na trudności adaptacyjne w okresie poporodowym czy trwałe zaburzenia rozwojowe. Znajomość zagadnień związanych z opieką okołooperacyjną nad matką i dzieckiem pozwoli na minimalizację powikłań i zapewnienie wysokiej jakości opieki.Cel. Celem badań była analiza wpływu podaży opioidów w analgezji oraz obniżenia ciśnienia tętniczego podczas cięcia cesarskiego na stan neurobehawioralny noworodka.Materiał i metody. Badaniem objęto 102 pary noworodków i ich matek, które urodziły przez cięcie cesarskie. Na badanie uzyskano zgodę Komisji Bioetycznej PUM. Kryterium włączenia stanowił brak chorób układowych u matek oraz wiek ciążowy powyżej 36 tygodnia ciąży. Wszystkie matki znieczulane były do porodu podpajęczynówkowo. Szczegóły dotyczące znieczulenia uzyskano z karty znieczulenia. Noworodki po ukończeniu 2 doby życia zostały ocenione skalą NBAS (Neonatal Behavioural Assessment Scale) zgodnie z zasadami przeprowadzenia badania.Wyniki. Odruchy noworodkowe w badanej grupie były prawidłowe. Stan neurobehawioralny w większości badanych pozycji nie wykazywał różnic między badanymi. Noworodki matek, którym do leków znieczulenia dodano Fentanyl, nie różniły się zachowaniem od pozostałych (p>0,05). Po dodaniu Morphini Sulfas 0,1% Spinal do znieczulenia przewodowego zaobserwowano istotne statystycznie różnice w zachowaniu noworodków w porównaniu do dzieci, których matki jej nie otrzymały w zakresie habituacji bodźca dźwiękowego (p=0,04) na korzyść tych, których matki otrzymały dokanałowo MF Spinal. Dzieci matek znieczulanych bez dodatku MF Spinal prezentowały samouspokajanie się na wyższym poziomie od pozostałych (p=0,03). Umiejętność uspokajania się różniła noworodki matek, u których obniżyło się ciśnienie tętnicze podczas znieczulenia (p=0,04).Wnioski. Opieka nad matką i dzieckiem powinna być zindywidualizowana w oparciu o potrzeby matki i dziecka wynikające z samopoczucia matki i stanu neurobehawioralnego dziecka. (PNN 2016;5(3):92–98

Wpływ modułu porodowego na triadę: matka–ojciec–dziecko

Introduction. Enabling a mother to have early contact with her baby regardless of a delivery module, and giving a father the opportunity to take care of baby and partner are important aspects of obstetric care, having effects on bonding. Aim of the study. Assess the influence of the delivery module on the interactions within the mother-father-newborn triad. Material and methods. Subjects were women (n = 200) and their babies born naturally (n = 92) and via c-section (n = 108). A research instrument was a questionnaire evaluating interactions within a triad. The analysis of the results was conducted using the Mann-Whitney U test and the Fisher test. The difference was regarded as statistically insignificant for p ≤ 0.05. Results. There were statistically significant differences in breastfeeding (p = 0.0001) and the way of talking to children (p = 0.04) depending on the delivery module. There were no statistically significant differences in other parameters (p > 0.05). Conclusions. Women after c-section had direct contact with their babies after delivery considerably less frequently, which had an impact on their attitudes and hindered the formation of dyadic bonds.Wstęp. Umożliwienie matce wczesnego kontaktu z dzieckiem oraz ojcom możliwości włączania się w opiekę nad noworodkiem i partnerką należy do ważnych aspektów opieki położniczej rzutujących na tworzenie się więzi w triadzie. Cel pracy. Ocena wpływu modułu porodowego na zachowania w triadzie. Materiał i metody. W badaniu udział wzięły położnice wraz dziećmi (n = 200) urodzonymi naturalnie (n = 92) oraz przez cięcie cesarskie (n = 108). Zastosowano kwestionariusz oceniający zachowania w triadzie. Analizę wyników przeprowadzono testem U Manna-Whitneya i Fishera. Za istotne przyjęto prawdopodobieństwo p ≤ 0,05. Wyniki. Zaobserwowano znamienne różnice między karmieniem piersią (p = 0,0001), sposobem mówienia do dziecka (p = 0,04), a modułem porodowym. W pozostałych z ocenianych parametrów nie zaobserwowano różnic (p > 0,05). Wnioski. Kobiety rodzące cięciem cesarskim częściej nie miały z dzieckiem bezpośredniego kontaktu po porodzie, wpływając na jakość postawy i utrudniając tworzenie więzi w diadzie

Mutations in the COL1A1 and COL1A2 genes associated with osteogenesis imperfecta (OI) types I or III

Although over 85% of osteogenesis imperfecta (OI) cases are associated with mutations in the procollagen type I genes (COL1A1 or COL1A2), no hot spots for the mutations were associated with particular clinical phenotypes. Eight patients that were studied here, diagnosed with OI by clinical standards, are from the Polish population with no ethnic background indicated. Previously unpublished mutations were found in six out of those eight patients. Genotypes for polymorphisms (Sp1 - rs1800012 and PvuII - rs412777), linked to bone formation and metabolism were determined. Mutations were found in exons 2, 22, 50 and in introns 13 and 51 of the COL1A1 gene. In COL1A2, one mutation was identified in exon 22. Deletion type mutations in COL1A1 that resulted in OI type I had no effect on collagen type I secretion, nor on its intracellular accumulation. Also, a single base substitution in I13 (c.904-9 G>T) was associated with the OI type I. The OI type III was associated with a single base change in I51 of COL1A1, possibly causing an exon skipping. Also, a missense mutation in COL1A2 changing Gly→Cys in the central part of the triple helical domain of the collagen type I molecule caused OI type III. It affected secretion of the heterotrimeric form of procollagen type I. However, no intracellular accumulation of procollagen chains could be detected. Mutation in COL1A2 affected its incorporation into procollagen type I. The results obtained shall help in genetic counseling of OI patients and provide a rational support for making informed, life important decisions by them and their families

A cohort of 17 patients with kyphoscoliotic Ehlers-Danlos syndrome caused by biallelic mutations in FKBP14: expansion of the clinical and mutational spectrum and description of the natural history.

PurposeIn 2012 we reported in six individuals a clinical condition almost indistinguishable from PLOD1-kyphoscoliotic Ehlers-Danlos syndrome (PLOD1-kEDS), caused by biallelic mutations in FKBP14, and characterized by progressive kyphoscoliosis, myopathy, and hearing loss in addition to connective tissue abnormalities such as joint hypermobility and hyperelastic skin. FKBP14 is an ER-resident protein belonging to the family of FK506-binding peptidyl-prolyl cis-trans isomerases (PPIases); it catalyzes the folding of type III collagen and interacts with type III, type VI, and type X collagens. Only nine affected individuals have been reported to date.MethodsWe report on a cohort of 17 individuals with FKBP14-kEDS and the follow-up of three previously reported patients, and provide an extensive overview of the disorder and its natural history based on clinical, biochemical, and molecular genetics data.ResultsBased on the frequency of the clinical features of 23 patients from the present and previous cohorts, we define major and minor features of FKBP14-kEDS. We show that myopathy is confirmed by histology and muscle imaging only in some patients, and that hearing impairment is predominantly sensorineural and may not be present in all individuals.ConclusionOur data further support the extensive clinical overlap with PLOD1-kEDS and show that vascular complications are rare manifestations of FKBP14-kEDS

Assessment of Accessibility of Public Transport by Using Temporal and Spatial Analysis

The development of sustainable transport is a priority in cities. It should aim to increase the number of trips made by public transport while minimizing social costs and the negative impact on the environment. The intensive development of cities from industrial to service-oriented and the phenomenon of suburbanization require changes in public transport services. However, often, operators do not change existing lines and stops or timetables justifying it with passenger habits. This approach may cause a discrepancy between the accessibility of public transport services and the demand for these services. Therefore, planning and improving the public transport system should be based on careful analyses. There are various approaches to this problem. The article presents a method to assess accessibility of public transport services using spatial and temporal analysis. The proposed method is based on dividing the area into basic fields and then, using appropriately selected measures, each field is assessed in terms of both the current level of accessibility of public transport services and the potential transport demand. A comparative analysis with the use of spatial tools indicates the degree of matching of these values and enables the identification of areas (basic fields) in which improvement of public transport services is required. For the proposed method, a case study was carried out for the city of Czeladź, located in Metropolis GZM in the southern part of Poland. The method can support decision making to improve the current public transport system