Acute kidney injury in premature newborns-definition, etiology, and outcome.

BACKGROUND: Neonatal acute kidney injury (AKI) is common and is associated with poor outcomes. New criteria for the diagnosis of AKI were introduced based on the increase in serum creatinine (SCr) levels and/or reduction of urine output (UOP). Yet, there is no generally accepted opinion so far, which criteria (whether SCr, UOP, or their combination) are the most appropriate to diagnose neonatal AKI. METHODS: The retrospective study included 195 prematurely born neonates who fulfilled all inclusion criteria (with at least two SCr measurements). In all the neonates included in the study, AKI was diagnosed using three different definitions: (1) SCr criteria (an increase in SCr values of ≥0.3 mg/dl), (2) UOP criteria (UOP < 1.5 ml/kg/h), and (3) SCr + UOP criteria. RESULTS: Out of all of the patients the study included, 85 (44%) were diagnosed with AKI. The neonates who had AKI had a significantly lower gestational age, birth weight, and Apgar score, longer duration of mechanical ventilation, and a higher mortality rate. SCr + UOP criteria showed higher sensitivity for prediction of death compared to SCr or UOP alone (p = 0.0008, 95% CI 0.040-0.154, and p = 0.0038, 95% CI 0.024-0.125, respectively). If only SCr or only UOP criterion are used, they fail to identify AKI in 61 and 67%, respectively. AKI was an independent risk factor for death (OR 7.4875; CI 3.1887-17.5816). CONCLUSIONS: Similar to other studies, our data showed that neonates with AKI have worse outcome. Neonatal AKI defined based on SCr + UOP criteria is a better predictor of death than neonatal AKI defined based only on the SCr or UOP criteria. Also, by using SCr + UOP criteria for diagnosing neonatal AKI, more patients with AKI are recruited than when only one of those criteria is used.

ATYPICAL KAWASAKI DISEASE.

INTRODUCTION: Kawasaki disease is an acute vasculitis which occurs primarily in children under the age of 5. The etiology of the disease is still unknown. Diagnostic criteria for Kawasaki disease are fever and at least four of the five additional clinical signs. Incomplete Kawasaki disease should be taken into consideration in case of all children with unexplained fever for more than 5 days, associated with 2 or 3 of the main clinical findings of Kawasaki disease. The diagnosis of incomplete Kawasaki disease is based on echocardiographic findings indicating the involvement of the coronary arteries. Cardiac complications, mostly coronary artery aneurysm, can occur in 20% to 25% of untreated patients and in 4% of treated patients. CASE REPORT. In this report we present a case of atypical Kawasaki disease in a 3.5-month-old infant. As soon as the diagnosis was made, the patient received high doses of intravenous immunoglobulin, with the initial introduction of ibuprofen, then aspirin with a good clinical response. Due to the presence of aneurysm of coronary arteries, further therapy involved aspirin and clopidogrel over the following 3 months, and then only aspirin for 2 years. There was a gradual regression of the changes in the coronary blood vessels to the normalization of the echocardiographic findings after 2 years. CONCLUSION: Kawasaki disease is the second most common vasculitis of childhood, so it should be included in the differential diagnosis for any child with a prolonged unexplained fever. Atypical Kawasaki disease should be taken into consideration in cases when not all clinical criteria are present but coronary abnormalities are documented.

What kind of milk can prevent infant's sideropenic anemia--comparative study.

INTRODUCTION: The most common cause of sideropenic anemia in infants, during the period of their fast growth and development, is inadequate nutrition or insufficient intake of food rich in iron. The aim of this paper is to provide the insight into the problem of anemia and to emphasize nutrition as an important etiologic factor in the onset and prevention of anemia in infants. MATERIAL AND METHODS: Two retrospective studies were conducted at the Institute for Child and Youth Healthcare of Vojvodina. Department for Infant and Small Children's Pathology. The first study covered the period of eight years (1988-1995), and it included a total of 507 children, aged 1-24 months. The second study covered the period of two years (2010-2011) and a total of 290 children aged 1-12 months were included. The diagnosis of anemia was made according to clinical examination or after taking routine laboratory tests. According to the criteria of the World Health Organization, all children were divided into those with severe, moderate or mild anemia. RESULTS: Out of 507 children examined in the first study, 333 (65.68%) were breastfed, while 174 (34.32%) had never been breastfed. In the second study, 206 (71.03%) out of 290 children were breastfed, while 56 (19.31%) had never been breastfed. In both studies the highest percentage of children breastfed for the longest period was among children with mild form of anemia, while the children who were breastfed for the shortest period had severe anemia. In addition, the highest percentage of anemic children was supplementary fed with cow's milk in both studies. CONCLUSION: Short natural diet, early introduction of supplementation and choice of milk could be determining factors in the development and manifestation of anemia.