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 first 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.

Predictors and incidence of hospitalization due to respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRTI) in non-prophylaxed moderate-to-late preterm infants in Bosnia and Herzegovina.

Prematurity is a risk factor for respiratory syncytial virus (RSV)-associated lower respiratory tract infections (LRTIs), due to immature humoral and cell-mediated immune system in preterm newborns, as well as their incomplete lung development. Palivizumab, a humanized monoclonal antibody against the F glycoprotein of RSV, is licensed for the prevention of severe RSV LRTI in children at high risk for the disease. This study is a part of a larger observational, retrospective-prospective epidemiological study (PONI) conducted at 72 sites across 23 countries in the northern temperate zone. The aim of our non-interventional study was to identify common predictors and factors associated with RSV LRTI hospitalization in non-prophylaxed, moderate-to-late preterm infants, born between 33 weeks and 0 days and 35 weeks and 6 days of gestation, and less than 6 months prior to or during the RSV season in Bosnia and Herzegovina (B&H). A total of 160 moderate-to-late preterm infants were included from four sites in B&H (Sarajevo, Tuzla, Mostar, and Banja Luka). We identified several significant intrinsic and extrinsic factors to be associated with the risk of RSV LRTI hospitalization in the preterm infants, including: comorbidities after birth, shorter hospital stay, admission to NICU/PICU while in the maternity ward, household smoking, low maternal age, breast feeding, number of family members, and history of family/paternal atopy. Overall, our results indicated that the risk of RSV LRTI in preterm newborns can be associated with different environmental and social/cultural factors, and further research is needed to comprehensively evaluate these associations.

Predictors of Mortality in Neonates with Seizures; a Prospective Cohort Study.

OBJECTIVE: The aim of this study was to analyze prognostic indicators for mortality in neonates with seizures in a level III Neonatal Intensive Care Unit (NICU). PATIENTS AND METHODS: A cohort of 100 neonates with clinically manifested seizures hospitalized in the NICU during 4 years period was prospectively monitored for the first year of life. The cohort consisted of 33 preterm and 67 full-term babies with 60 male and 40 female infants. RESULTS: The mortality rate in the first year of life of infants with seizures in the neonatal period was 23%. The most common cause of seizures was birth asphyxia for full-term infants and intra-periventricular hemorrhage for preterm infants. Death was more common in pre-term than term infants (p <0,005). Simple regression demonstrated statistically significant associations between death in the first year of life and a cluster of highly associated variables: resuscitation (p<0, 01), mechanical ventilation (p<0,01) and asphyxia (p<0,05). This cluster of variables significantly correlates with: gestational age (p<0, 05), birth weight (p<0, 05) and intracranial hemorrhage (p<0, 05). CONCLUSION: In this cohort of neonates with seizures asphyxia requiring neonatal resuscitation was the primary risk factor for death.

CONTRIBUTING FACTORS FOR DEVELOPMENT OF NECROTIZING ENTEROCOLITIS IN PRETERM INFANTS IN THE NEONATAL INTENSIVE CARE UNIT.

BACKGROUND: necrotizing enterocolitis is a serious condition that affects mostly preterm infants, with high mortality rate. AIM: to estimate the influence of potentially contributing factors of this multifactorial disease. METHODS: the study group included 51 necrotizing enterocolitis infants who were less than 37 week gestation who were hospitalized in NICU during a five year period. The control group consisted of 71 patients with approximately the same gestational age and birth weight. Average gestational age in the study group was 30.2 weeks (SD 3.7), average birth weight 1502g (SD 781.5). Average postnatal age in the time of the presenting NEC was 18.2 days (SD 12.8). RESULTS: Logistic regression estimates the influence of risk factors, which in our study related to the treatment of preterm infants on the likelihood of NEC development. Our regression model consisted of seven independent variables (nosocomial infections, mechanical ventilation, nasal continuous positive pressure, morphine, inotropes, blood transfusions, and H2 blockers), which were shown to have a statistically significant impact, X2 (7, n=1222) = 49.522, p<0.0001; two independent variables (nosocomial infection and H2 blockers use) were statistically significant. Preterm infants with nosocomial infection had a three times greater chance of developing NEC, and infants who received H2 blockers had a 1.5 higher risk. CONCLUSIONS: Underlying pathology of very low birth weight infants and their treatment in NICU contribute to NEC development. Identifying risk factors can be crucial for the early diagnosis and outcome of disease. Awareness of risk factors should influence changes in practice to reduce the risk of NEC.

Neurodevelopmental Follow Up After Therapeutic Hypothermia for Perinatal Asphyxia.

INTRODUCTION: Neuroprotective benefit of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy (HIE) was assessed by analyzing survival and neurodevelopmental outcome of neonates subjected to this procedure. MATERIAL AND METHODS: Newborns with gestational age > 36 weeks and < 6 hours of age with moderate to severe asphyxial encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. Outcome measures assessed were death and neurodevelopmental characteristics, which were compared at the different age using ASQ-3. Twenty-five children were assessed at age 3-6, 12-18 and 24-36 months. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died. RESULTS: At the first assessment developmental categories of communication were normal in 78.9%, problem solving in 63.2%, personal-social in 68.4%, gross motor in 68.4%, and fine motor in 42.1% with a high need of retesting in this area. Second assessment was done in 17 patients: developmental categories of communication normal in 58.8%, problem solving in 70.6%, personal-social in 64.7%, gross motor in 64.7%, and fine motor in 35.3%. Third evaluation was done in 14 patients: developmental categories of communication were normal in 64.3%, problem solving in 71.4%, personal-social in 57.1%, gross motor in 64.3%, and fine motor in 42.9%. CONCLUSION: There was no correlation between baseline parameters and outcome. Results of the study are showing that therapeutic hypothermia in term newborns can provide better survival and less neurologic sequels in HIE patients.

Relationship of nosocomial infections with the development of necrotizing enterocolitis in preterm infants.

OBJECTIVE: The aim of this study was to determine the association between the number of nosocomial infections prior to necrotizing enterocolitis (NEC) diagnosis as well as to evaluated how it contributed to development of NEC in premature infants. MATERIAL AND METHODS: The study included 51 preterm infants diagnosed with NEC and 71 preterm infants without NEC hospitalized in the neonatal intensive care unit (NICU) of Clinical Center University of Sarajevo. We evaluated the correlation of the number of nosocomial infections prior to NEC diagnosis with the development of NEC. RESULTS: There was a statistically significant association of the number of nosocomial infections prior NEC diagnosis with the development of NEC (odds ratio, 3.32; 95% confidence interval, 1.09-10.01). CONCLUSION: Increased number of nosocomial infections prior to NEC diagnosis is associated with increased risk of necrotizing enterocolitis.

Assessing mortality risk in very low birth weight infants.

INTRODUCTION: Preterm birth is the most important univariant risk factor of neonatal mortality. Assessment of risk factors affecting mortality in preterm infants with very low birth weight is important for the treatment of this highly vulnerable population. OBJECTIVE: Detection of risk factors for neonatal mortality in very low birth weight premature infants. METHODS: The current study was conducted in a tertiary research and educational hospital, NICU, Pediatric Clinic KCU Sarajevo, from January 2010 to December 2010. After admission CRIB score was determined to every hospitalized infant with birth weight < 1500 g, born before the full 31 weeks of gestation (30 weeks + 6 days). We also gathered information about the Apgar score in 5th minute, gender, presence of respiratory distress syndrome and hemodynamic stability. 67 infants fulfilled inclusion criteria. RESULTS: Mean birth weight was 1136.4 g +/- 250.9, range 550-1500 g. Mean gestational age was 27.29 weeks +/-1.97, range 22-30 weeks. Mean CRIB score was 3.22, range 0-18. Twenty VLBW infants out of 67 died (29.85%). There was significant difference between groups of survived and dead infants regarding gestational age, birth weight, Apgar score, Crib score, base excess, presence of respiratory distress syndrome and hemodynamic stability at the birth. CONCLUSION: CRIB score, birth weight, gestational age, base excess, Apgar score, respiratory distress syndrome and hemodynamic instability are valuable predictors for a neonatal mortality in population of preterm infants with very low birth weight.

The effects of antenatal corticosteroids and surfactant replacement on neonatal respiratory distress syndrome.

The goal of this study was to determine the effects of antenatal corticosteroids and surfactant replacement on the severity and frequency of Respiratory Distress Syndrome (RDS) in a cohort of premature infants born in Sarajevo, Bosnia and Herzegovina, from 2005 to 2007. The cohort consisted of 172 premature neonates with estimated gestational age between 26 and 34 weeks. Babies with IUGR, babies of diabetic mothers and babies with major congenital defects were excluded. Out of 172 neonates, 80 were treated antenatally with corticosteroids (single course of dexamethasone) and 92/172 were not. There was no statistical difference (p>0,5) in average gestational age (31,2 vs. 31,0 GW) and male/female ratio between investigated groups; there were significantly more male patients (p<0,05) in both groups. Frequency of RDS was significantly lower in the corticosteroid group (24/80) in relation to the control group (54/92) (p<0,001). Severe RDS was significantly (p<0,01) more frequent in the control group 34/53 (62,96%) then in the corticosteroid group 6/24 (25,0%). Bovine surfactant (Survanta) was given as a rescue therapy to 78 babies with clinical and radiological signs of RDS who required FiO2>0,40 and mechanical ventilation. Early surfactant administration within six hours after birth appeared to be effective at reducing mortality then later surfactant administration (p<0,005). In the group of babies requiring FiO2> or =0,6 at the time of surfactant replacement, the mortality rate was significantly higher (p<0,05). In conclusion, we confirm the efficacy of antenatal corticosteroid treatment and early surfactant treatment in a cohort of premature infants born in Sarajevo.

[Antenatal corticosteroids in respiratory distress syndrome prevention: efficacy in relation to treatment--delivery interval]. / Antenatalni kortikosteroidi u prevenciji respiratornog distres sindroma: ucinkovitost u odnosu na tretman-porod interval.

Antenatal corticosteroids given to women, who are 24 to 34 weeks pregnant and may deliver within the next 24 hours to 7 days, are associated with significant reduction in rates of respiratory distress syndrome, intraventricular hemorrhage and mortality of pre-term babies. The aim of this study is assessment of antenatal corticosteroid effectiveness in reduction of RDS incidence in optimal delivery-treatment interval, in comparison to babies delivered before and after the optimal treatment interval has elapsed. This investigation included 80 pre-term babies between 26 and 34 gestational weeks whose mothers received corticosteroids before delivery. Control group consisted of 92 children of the same gestational age, whose mothers did not received corticosteroids antenatally. Babies of diabetic mothers, babies with IUGR and babies with congenital abnormalities were excluded. RDS was significantly less frequent in babies antenatally treated by corticosteroids (x2 31,473 p < 0.0001 coefficient contingency 0.366) then in babies whose mothers did not received corticosteroids before delivery. The majority of babies, 54.67% (p < 0.01) were born in optimal interval, 24 hours to 7 days from the beginning of the treatment, 32.0% (24/75) children were born within 24 hours and 13.3% (10/75) were born more then 7 days after the start of treatment. Comparing the incidence of RDS between groups of children born in optimal treatment-delivery interval (1 -7 days) and in the group of children born within 24 hours or after 7 days from the beginning of the treatment, no significant difference was found. The effect was clinically comparable, which suggests the possibility of reduction treatment-delivery interval in acute clinical conditions.

The effects of antenatal corticosteroid treatment on IVH-PVh of premature infants.

Intraventricular-periventricular hemorrhage (IVH-PVH) is the most frequent type of intracranial hemorrhage in premature infants and the major cause of neurodevelopmental disabilities in children too. The objective of this work is to evaluate the effects of prenatal corticosteroid treatment on the incidence of IVH-PVH in premature infants. The study enrolled 163 prematures of 26-34 weeks' gestation. They have been divided into two groups: the experimental group (80/163), who have been treated with corticosteroids prenatally and control group (83/163), who have not received such treatment. There is statistically significant difference in IVH-PVH incidence between the experimental group (18/80) and control group (32/83) (chi2 =5,616, p<0,05). There is no statistically significant difference in Apgar score after 5 minutes between the experimental group and control group of IVH-PVH prematures, t= 0,121. There is no statistically significant difference in mean gestation age between the experimental group (30,74 weeks) and control group (29,97 weeks) of IVH-PVH prematures, t= 1,299. There is no statistically significant difference in mean birth weight between the experimental group (1479,44 grams) and control group (1379,37 grams) of IVH-PVH prematures, t= 0,913. Antenatal corticosteroid treatment of premature infants reduced the incidence of IVH-PVH significantly. There is no statistically significant difference in Apgar score after 5 minutes, mean gestation age and mean birth weight between the experimental and control group of IVH PVH prematures.

Congenital malformations of the central nervous system: clinical approach.

Central nervous system (CNS) malformations represent important factor of morbidity and mortality in children. The aim of the study was to determine the incidence, type and clinical features of CNS malformations in children who were admitted at the Neonatal and Child Neurology Department, Neonatal Intensive Care Unit and Paediatric Intensive Care Unit of Paediatric Clinic, University of Sarajevo Clinics Centre, from January 1st, 2002 to December 31st, 2006. There were total of 16520 admissions at the Paediatric Clinic over the studied period. CNS malformations, solitary or multiple, have been diagnosed in 100 patients (0,61%). The total number of various CNS malformations was 127. Lethal outcome was established in 9/100 cases (9%). The most frequent CNS malformations were neural tube defects 49/127 (38,6%). Hydrocephalus was seen in 34/127 (26,8%), microcephaly in 24/127 (18,9%), agenesis of corpus callosum in 10/127 (7,9%), Dandy Walker malformation in 6/127 (4,7%) and other CNS malformations in 4/127 (3,1%). In 20/100 of patients neural tube defect was associated with hydrocephalus (20%). CNS malformations were prenatally diagnosed in 13/100 of patients (13%). Primary prevention of CNS malformations can be improved in our country by better implementation of preconceptional folic acid therapy for all women of childbearing age. Secondary prevention by prenatal diagnosis requires advanced technical equipment and adequate education of physicians in the field of foetal ultrasonography. In our circumstances, prenatal diagnostics of CNS malformations is still not developed enough.

[Stroke in newborn infants]. / Mozdani udar u novorodenackoj dobi.

PURPOSE: Stroke is related to many different cerebrovascular events, with different ethiology and pathogenesis which are not clear enough. Frequency of the stroke in newborn infants is 1:4000 live births. Term infants are affected more frequently; clinical presentation typicaly is manifested by multifocal seisures between 1st and 4th day of life. Laboratory tests include analyses of prothrombotic factors which increase risk of thromboembolism. WORK METHOD: We descriptively showed a term newborn with of middle cerebral arthery infarction. CASE REPORT: A firstborn female neonate was received in intensive Care Unit because of meconial aspiration syndrome (MAS). In 3rd day of life the child had generalised seizure. Routine brain ultrasonography raised a high suspicion of middle certebral arthery infarction. The diagnosis was confirmed by CT, MRI and MR angiography. Child had not disturbances in coagulation status or other possible risk factors related to occurance of the stroke. CONCLUSION: In case of seizures between 1st and 4th day of life ,especially in term infants, cerebrovasular insult is one of possibilities, and adequate laboratory and neuroradiologic diagnostics should be done. Suspicion on middle cerebral arthery infarction can be made on the basis of brain ultrasonography, but for a definite diagnosis CT, MRI and AR angiografy are needed.

[Fryns syndrome]. / Fryns-ov syndrom.

Fryns syndrome is an extremely rare developmental disorder associated with deletion of long arm of chromosome 16. Characteristics of the Fyns syndrome are: craniofacial dysmorfism, diaphragmatic defects with lung hypoplasia, distal digital hypoplasia, brain and urogenital abnormalities and other developmental disturbances. After the first description in two stillborn sisters by Fryns (1971), new reports appeared with descriptions included disorders which have not described previously. We described a case of female live born with deletion of long arm of chromosome 16. Our patient had a typical craniofacial dysmorfism, brain abnormalities (Dandy Walker malformation), cardiac defects (artial septal defect and persistent ductus arteriosus), renal hypoplasia, gastrointestinal problems, hypotonia and feeding difficulties. Our patient had no diaphragmatic hernia and he survived neonatal period with severe neurological impairment.

[Pena-Shokeir phenotype (fetal akinesia/hypokinesia sequence)]. / Pena-shokeirov fenotip (sekvenca fetalne akinezije/hipokinezije).

Pena-Shokeir syndrome is a rare lethal disorder which clinical phenotype is the result of a deformation sequence caused by fetal akinesia/hypokinesia. In approximately 50 % cases an autosomal recessive mode of inheritance were documented. Main clinical characteristics of Pena-Shokeir syndrome are: multiple ankylosis, pulmonary hypoplasia and facial dysmorphism. We have described female newborn with pulmonary hypoplasia, distal joint contractures and facial characteristics of Pena Shokeir syndrome. Our patient had hip and knee ankyloses, ulnar deviation of the hands, aberrant hand position--similar to that of trisomy 18, absent dermal ridges on the palms, talipes valgus and facial dysmorphism (prominent eyes, micrognathia, poorly folded and posteriorly rotated ears). During pregnancy polyhidramnion was documented. Among CNS abnormalities, agenesis of corpus callosum was found. Because of eventration of right hemidiaphragm, weakness of intercostal muskles and pulmonary hypoplasia, child was artificially ventilated from the birth, and died due to pulmonary complication in the second month of the life. Although the majority of those live-borne with Pena Shokeir syndrome die within the first month of life, postnatal recognition requires genetic counseling of parents and obtaining early prenatal diagnosis in next pregnancy.

[Fungal colonization of newborn in neonatal intensive care unit: a prospective study]. / Gljivicna kolonizacija novorodencadi u jedinici neonatalne intenzivne njege: prospektivna studija.

Invasive candidiasis in neonates has become an increasing problem over the past decade in Neonatal Intensive Care Units (NICUs) in the world; it is a relatively common cause of late onset sepsis associated with a high mortality. Prior colonization is the major risk factor for candidemia. To determine the rate of colonization, risk factors and the possible modes of acquisition of Candida spp. in neonates in NICU of Pediatric University Hospital, Sarajevo, during 3 months. Samples (mucocutaneous swabs, urine, stool, blood) were obtained weekly until the time of discharge or death (one infant enrolled in the study exited). Care health worker hands were cultured weekly (55 samples). Candida spp. from various body sites samples were isolated in 7 patients (rate of colonisation 14,8%) while 7 samples of haelth workers hands were positive for C. spp (14,5%). Patients colonizated or infected by Candida spp. in our study were or very preterm newborns (3/7) or compromised term newboms (4/7), with congenital abnormalities (2/7) or gastrointestinal surgical interventions (2/7). Two very preterm neonates were colonized early from the birth, which indicates possible vertical transmission. In other 5 patients, colonization occurred more lately, after at laest 15 days stay in NICU, which indicates nosocomial transmission as a predominant mode of acquisition. Among 10 positive patterns from different body sites, Candida albicans was isolated in 6 cases; other 4 cases were C. glabrata (2/10), C. krusei (1/10) and C. famata (1/10). Rather than focusing on methods of identifying of pregnant women with vaginal Candida colonization, attention should be directed to high risk neonates and infection control maesures including hands washing by health care workers.

[Wolf-Hirschhorn syndrome]. / Wolf-Hirschhornov sindrom.

Wolf-Hirschhorn syndrome (WHS) is a rare developmental disorder associated with hemizygous deletion of short arm of chromosome 4. Main phenotype characteristics of WHS are: intrauterine growth retardation, mental retardation, typical facial dysmorphism ("Greek warrior helmet"), microcephaly and midline fusion defects (cleft lip or palate, cardiac septal defects). Other abnormalities, like agenesis of corpus callosum, dysplastic kidneys, coloboma iris, skeletal abnormalities have been described occasionally. We described female newborn baby with 4p deletion, who had most of the phenotype characteristics of Wolf-Hirschhorn syndrome: intrauterine growth retardation, microcephaly, facial dysmorphism, congenital hypotonia and seizures in neonatal period. Other abnormalities included: hypoplastic cervical vertebra C4-C5, renal cyst and partial agenesis of corpus callosum. Patient had not cardiac septal defect. Due to a broad spectrum of possible morphologic abnormalities followed by mental retardation, prenatal diagnosis is very important. Postnatal recognition of the syndrome requires genetic counseling of parents and supportive multidisciplinary treatment.

[Intraventricular hemorrhage in premature neonates: etiopathogenesis, detection and prevention]. / Intraventrikularna hemoragija kod nedonoscadi; etiopatogeneza, detekcija i prevencija.

Although the incidence of intra-periventricular hemorrhage has reduced in recent years, the increasing survival rates for the very low birth babies indicates that the lesion remains to be a big problem. Neuropathologic base of IVH-PVH is subependimal bleeding into germinal matrix, with consecutive dilatation of lateral ventricles and possible development of germinal matrix destruction, posthemorrhagic hydrocephalus and periventricular hemorrhagic infarction. Pathogenesis of IVH-PVH is multifactorial with participation of intravascular, vascular and extravascular factors. Detection of IVH-PVH and its neuropathologic consequences has been facilitated greatly by the introduction of real-time cranial ultrasonography. Long-time prognosis relates to the mechanisms of brain injury, i.e. presence of hypoxic-ischemic injury, posthemorrhagic hydrocephalus and periventricular hemorrhagic infarction. Extensive parenchymal lesions are associated with frequent subsequent motor, less frequent cognitive deficits. Prevention of IVH-PVH remains the most important goal. That includes prenatal interventions, such as prevention of premature birth, transportation of the premature infant "in utero", prenatal administration of phenobarbital and K-vitamin and optimal management of labor and delivery. Postnatal interventions include careful newborn resuscitation, correction of fluctuating cerebral blood velocity, correction of hemodynamic disturbances and pharmacologic interventions. Postnatal administration of different medicaments (phenobarbital, indomethacin, ethamsylate and vitamin E), have showed inconsistent results in reduction of IVH-PVH, thus there is no pharmacologic agent yet to be recommended for routine use in premature infants.

[Neural tube dysraphism: meningomyelocele and related disorders]. / Disrafizam neuralne cijevi: meningomijelokele i srodni poremecaji.

Neural tube disorders develop as a result of failure of neural tube closure between 3rd and 5th gestational weeks. This failure can cause soft structure anomalies (spina bifida, lumbal meningocela) or possible can contain neural tissue (meningomyeloccla, encephaloccla). Etiology of this disorder is not clear enough, and probably has multifactorial roots. Besides genetic factors, there are impact of some nutritional causes like folic acid. 28 cases with neural tube dysraphism hospitalized during period August 1999 till August 2002. at the Pediatric Clinic KCU Sarajevo were analyzed through retrospective study. 19/28 (67.8%) of newborn were from controlled pregnancy but without folic acid supplementation, 4 of them (14.2%) had prenatal diagnosis. Dysraphic disorder was the most often accompanied by paraplegia 16/28 (57.1%), hydrocephalus 17/28 (60.7%), from which 6/17 (35.2%) with Arnold Chiary malformation. 13/28 (46.4%) had skeletal deformities. Active preoperative treatment was conducted in 20/28 (71.4%) cases, and the rest of them were treated with home palliative care because of parent's rejection of surgery or major accompanied anomalies presence. In order to decrease the incidence of dysraphic disorders it is necessary to conduct periconceptional folic acid prevention, and provide early prenatal diagnosis. Long term treatment of children with meningomyclocele requires multidisciplinary approach that includes surgeons, orthopedists, pediatricians, physical therapists, in order to improve life quality of survived children.

[Neonatal hyperbilirubinemia: evaluation and treatment]. / Neonatalna hiperbilirubinemija: evaluacija i tretman.

We have analyzed 132 newborns with hyperbilirubinemia (BW < 2500 g, GW > 37 weeks) hospitalized in Neonatal Unit of Paediatric Hospital during 2001. In 78 out of 132 (59.1%) newborns, causal diagnosis were established. Rh isoimmunization caused hyperbilirubinaemia in 2.8% (3/132) cases, ABO isoimmunization in 15.95% (21/32), infections in 9.15% (12/32) and other (polycitaemia, kephalhaematoma, loss of weight > 8%, jaundice related to the brestafeeding) in 31.8% (42/132). Maximal serum bilirubin level was reached between fourth and seventh day of life. In 47/132 newborns (40.9%) non-specific hyperbilirubinaemia were diagnosed. All babies were successfully treated by fototherapy. Blood exchange transfusion was performed in only 2 cases. Rh isoimmunisation was not significant factor in etiology of hyperbilirubinemia because of global prevention of Rh negative mothers. Hyperbilirubinemia of "healthy full-term newborn" was most often seen in 40.9% cases. Diagnostic criteria for hyperbilirubinemia were revised, and fottherapy, as safe, non-invasive method, replaced blood exchange transfusion, as an expansive procedure with low but constant mortality.