PERINATAL PREDICTORS OF NEURODEVELOPMENTAL OUTCOMES IN HIGH-RISK NEONATES

Background: Thanks to advancements in neonatal medicine, perinatal morbidity has been significantly reduced, but the number of high-risk neonates continues to rise. Efforts to predict neurodevelopmental outcomes at an early age remain limited. The aim of this study was to analyze perinatal predictors of neurodevelopmental outcomes in high-risk neonates. Methods: A prospective, longitudinal two-year study was conducted at the Pediatric Clinic of the University Clinical Center in Tuzla. The study included 151 neonates, with 99 in the test group (with known perinatal risk factors) and 52 in the control group (without risk factors). Early neurodevelopment was assessed using the Alberta Infant Motor Scale (AIMS). Standard statistical methods were applied for data processing. The study was approved by the Institutional Ethics Committee. Results: Of the 151 neonates observed, 108 (71.5%) had normal neurodevelopment at 18 months, 29 (19.2%) had mild disorders, and 14 (9.3%) had developmental delays. In the group with suboptimal neurodevelopment, significantly more twin pregnancies, health problems during pregnancy, unnatural births, artificial fertilization, and pregnancy complications were recorded. In neonates, there were significantly more premature births, hypoxic-ischemic encephalopathy, and intracranial hemorrhages. Significant correlations were found between the mother’s age and parity and delayed neurodevelopment. Additionally, correlations were found between birth weight, gestational age, Apgar score, length of hospitalization, and NICU stay with neurodevelopmental delay. Gestational age and the Apgar score at 1 minute showed significant negative predictive value for neurodevelopmental delay. Conclusion: Prematurity and perinatal asphyxia remain the greatest risks for adverse neurodevelopmental outcomes in neonates. These factors should be the focus of continued medical research and clinical practice. Neonates at the highest risk of developmental delay and their families should be prioritized for early identification, long-term follow-up, and timely interventions

OXYGEN SATURATION INDEX FOR ASSESSMENT OF RESPIRATORY FAILURE IN NEONATES

Introduction: Acute respiratory failure (ARF) is the most common problem seen in the preterm and term infants admitted to neonatal intensive care units. Etiology is not uniform, and mostly depend on gestational age. For adequate treatment is certainly important to recognize and treat underlying disease, but at the same time, we have to supply adequate respiratory support, tissue perfusion and oxygen deliveries. For a good outcome we need reliable estimation method for functional state of respiratory system, as well as monitoring the effects of treatment. Current assessment ARF is with blood gas, chest X-ray and Oxygenation index (OI). OI is quite aggressive assessment method for neonates, because it involves arterial blood sampling. Promoted in recent studies, Oxygen saturation index (OSI) measured by pulse oximetry, attempts to objectively score respiratory disease with parameters available non-invasively. The aim of our research is to evaluate correlation between OSI and OI in neonates with ARF requiring mechanical ventilation. Material and methods: In a retrospective cohort study 101 neonates were selected, treated at the Department of intensive therapy and care, Pediatric clinic of Tuzla, due to ARF requiring mechanical ventilation. We reviewed data such as gestational age, birth weight, gender, Apgar scores, values of Score for Neonatal Acute Physiology-Perinatal Extension, all the parameters from the arterial blood gas analysis, pulse oximetry values, Oxygenation Index and Oxygenation Saturation Index, that were calculated by the formulas. OSI and OI were calculated and correlated. Mean values of OSI and OI correlated with Pearson's coefficient of 0.76; p<0.0001 (95%CI=0.66-0.83). OSI correlated with SNAP-PE with Pearson's coefficient of 0.52; p<0.0001 (95%CI=0.36-0.65). Comparing the values of OSI between patients who died and those who survived, we found that OSI correlated with the outcome with Spearman's coefficient of -0.47; p<0.0001 (95%CI= -0.16 - -0.31). Bland-Altman plot confirmed correlation between OSI and OI in mean values, identifying discrepancy between two indices for extreme values. In conclusion, OSI correlates significantly with OI in infants with respiratory failure. This noninvasive method of oxygenation assessment, utilizing pulse oximetry, can be used to assess the severity of ARF and mortality risk in neonates

THROMBOCYTOPENIA AS ONE OF THE REASONS OF PROLONGED STAY IN THE NEONATAL INTENSIVE CARE UNIT

The aim of this paper was to present the occurrence and severity of thrombocytopenia, with intracranial and another bleeding in neonates with sepsis, analyze the risk factors for the development of thrombocytopenia and compare it with the length of hospitalization in the Neonatal Intensive Care Unit (NICU). Thrombocytopenia is a platelet count <150x109 / L and is common in newborns during hospitalization in the NICU. In the early days of life, the most common causes of thrombocytopenia in newborns are conditions that lead to fetal hypoxia, intrauterine growth failure, maternal hypertension, and sepsis. In this study were included all newborns with thrombocytopenia, who were hospitalized in NICU, Children's Disease Clinic, University Clinical Centre in Tuzla, from 01.01.2014 to 01.01.2019. In our results, 379 newborns had severe, 337 moderate, and 127 milder forms of thrombocytopenia, without a statistically significant difference in the incidence of thrombocytopenia between groups of neonates born <37 GW and ≥ 37 GW. Sepsis was the most common cause of thrombocytopenia, 300 children had early sepsis and 190 late. We found the statistically significant difference in intracranial hemorrhage of the second degree and pulmonary hemorrhage among neonates born <37 GW in relation to newborns born ≥ 37GW. A statistically significant effect of length of stay of our neonates in the Department of Neonatal Intensive Therapy and morbidity was shown in relation to the lower gestational age and lower platelet counts. Conclusion: Timely diagnosis of the cause and development of thrombocytopenia with adequate and effective treatment can reduce the mortality and morbidity of newborns with perinatal risk for neonatal thrombocytopenia

PRIMARY IMMUNODEFICIENCY IN CHILDREN IN TUZLA COUNTY

Introduction: The aim of the present study was to indicate importance of early detection of primary immunodeficiency in children, to determine the type of disorders and apply profilaxis and therapy. Material and Methods: The study was retrospective- prospective, during the period from 01.01.1997 to 31.12.2007 at Pediatric clinik, University Clinical Centre Tuzla. Results and Discussion: There were 53 patients both genders, age 1 month to 12.7 years (average age 3.0±3.4). In 33 (62.4%) patients diagnosis of primary immunodeficinecy was estimated until 3. years of life, cellular imunodeficinency disorders was diagnosed in 1 (1.9%), humoral 47 (88.8%) and C3 complement deficit in 5 (9.3%) of our patients. Since 2004 we registrated in crease new diagnosed, which point we started with screening among patients with repeated infections. Therapy and prophilaxy was administrated according usualy guidelines for these disorders of imunity. Therapy result was different according to type disorders, child age, and previous infections. After treatment, 37 (70%) patients recovered, as same as in 9 (17%), the worse condition in 2 (4%), and death in 5 (9%). Conclusion: According to accepted incidence in generall population presented number of immunodefitienti patients in our region is not adekvate and intensive detection in future period is neccessary.</jats:p

Early and Correct Diagnosis of Celiac Disease in the Prevention of Growth Disorders and Child Development

Coeliac, in ordinary people known as “flour allergy” and in medicine world known as gluten enteropathy which means enteric damage caused by gluten. Data about incidence of gluten enteropathy is different in different countries around the World and depend on is it or is it not the right diagnosis for enteric disorder. Sometimes, this disease is unrecognized because of unspecific clinical signs. This disease is happening in every moment of a lifetime, most common during the childhood when the children try to eat any food which contains gluten. Anyway, if children had no symptoms it doesn’t¢t mean that disease not exists, and that¢is because we have to do diagnostic tests to confirm gluten enteropathy. Gluten intolerance is chronic disease and demand use of the specific non gluten food during the lifetime. Early diagnosis is right way to prevent unregularly growth. Aim of this study was to show the influence of early diagnostic about growth. For each patient we had a permission of parents and we showed our original results for three month we investigated

COVID-19 TRIAGE AMONG HOSPITALIZED NEONATES IN TUZLA CANTON

Aim: To evaluate the incidence, characteristics, transmission, and outcomes of COVID-19 infection in hospitalized neonates in Tuzla Canton and to emphasize the importance of quality triage in the prevention and control of infection. Material and Methods: A retrospective cohort study, which included all consecutive neonates suspected of COVID-19 infection, and which required screening supervision in the triage department, from those who required hospital treatment at the Pediatric Clinic, University Clinical Center Tuzla for 12 months. (January 1 to December 31, 2020). Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution. Results: In the observed period, in the neonatal triage department, 111 neonates suspected to COVID-19 were treated, with no gender difference. Among them were 92 neonates of mothers suspected of COVID-19 (66 admitted immediately after birth, 26 readmitted after discharge home), and 19 neonates of mothers positive for COVID-19 (16 admitted immediately after birth, 3 readmitted). Cesarean delivery was a more common delivery option, and fever a more common symptom in COVID-19 positive mothers, but without statistical significance. The neonates from COVID-19 suspected mothers formed a heterogeneous group, with common perinatal problems, while neonates from COVID-19 positive mothers, hospitalized immediately after birth, were almost term neonates with appropriate birth weight, without need for a lot of treatment. All neonates hospitalized immediately after birth were negative for COVID-19. The only three COVID-19 positive neonates were readmitted after previous discharge home, and they had mild symptoms, mostly one-day fever, and they all recovered completely. All of these neonates are under further follow-up after discharge from the hospital, and all are, for now, in good general condition, and all have continued to breastfeed. Conclusion: Neonates born to mothers with positive COVID-19 infection generally have favorable outcomes, with no convincing case of vertical transmission. Neonatal COVID-19 is mostly asymptomatic, acquired postnatally, and associated with favorable outcomes. The importance of quality triage in the prevention and control of infection is crucial, with consistent implementation of safe practices including proper patient isolation and appropriate protective equipment

EFFECT OF URINE SAMPLE COLLECTION METHOD ON CONTAMINATION RATE OF URINE CULTURE

Introduction: Urine sample for biochemical analysis must fulfill certain criterions. The sample collection must be done by following established standards so that the results of analysis are reliable. In children of various age, especially during serious disease, adequate consideration must be devoted to this procedure.Aims: To evaluate contamination rate of the urine sample according to the methods of obtaining samples and collecting specimens in seriously sick children of various age during their intensive treatment.Methods: Urine culture findings in children treated in Intensive Care Unit (ICU) of Children’s Hospital in Tuzla in period from January 2007 to the end of December 2007 were included in retrospective analysis according to the method of collecting (bag collection, urethral catheterization, clean catch). In all of the three groups the percentage of positive findings and percentage of contaminated specimens as well as sex related distribution was analyzed. The urine sample was obtained from urethral catheter only in patients with indication for urethral catheterization. Kruskal-Wallis test and regression model were used in statistical analysis. Results: A total of 662 children were treated in ICU during the observed period. The urine sample for routine biochemical tests was obtained from all patients. In 107 patients (16.2 %) urine culture examination was indicated. In 48 (44.9%) patients urine sample was obtained by bag collection, in 41 (38.3%) by clean catch, and 18 (16.8%) by urethral catheterization. In 7 patients or 6.5% urine was contaminated. The majority of contaminated specimens were collected by bag (12.5%). In 20 (18.7%) patients urine culture was positive with significant number of etiologic agents and 80 (74.8%) specimens were negative. Difference in results in three monitored groups was statistically significant which was confirmed by Kruskal-Wallis test and stepwise regression model.Conclusion: Obtaining urine sample by bag collection brings the highest risk for contamination.</jats:p

PEDIATRIC EMERGENCY OF UNEXPECTED CAUSE: INFANTILE FIBROMATOSIS-CASE REPORT

Introduction:Infantile fibromatosis (IF) is a rare benign mesenchymal tumor of early childhood, located solitarily or multicentrically in the skin, soft tissues, muscles, bones, or visceral organs. The cause is unknown, and some cases are linked to mutations in two different genes. Rapid growth is typical, and while there are reports of spontaneous regression, relapses have also been recorded. Treatment depends on the location of the lesions, with surgery being the main treatment option. Case report: This paper presents an unusual emergency presentation of infantile fibromatosis in a 16-month-old girl, initially manifested as acute laryngitis. The rapid development of respiratory failure necessitated immediate life-saving treatment. Emergency diagnostics revealed a large mass deep within the neck structures, causing significant compression and endangering the airways. The child’s condition was critical, and the multidisciplinary team thoroughly discussed available treatment options. Eventually, after careful preparations, the tumormass was surgically removed on the sixth day. The postoperative course was challenging, but the outcome was positive. Pathohistological diagnosis confirmed infantile fibromatosis, and the treatment was successfully completed. Conclusion: Despite its rarity, infantile fibromatosis must be considered a potential cause of urgent, life-threatening conditions in children. Treatment requires individual adaptation and collaboration with a multidisciplinary team