[Treatment of PPHN with iNO in an Infant with Trombophilia and Thrombus in PDA. Clinical Case.]

PPHN is common in 1-2/1000 newborn infants. The morbidity and mortality accompanying the disease are extremely high. The treatment is frequently ineffective. The therapy with iNO is the fir l strategy based therapy of PPHN. We present the clinical case of an infant with congenital pneumonia and secondary PPHN treated with iNO. During the clinical observation of the infant congenital trombophilia was diagnosed, due to the presence of a thrombus in PDA. The outcome was favorable.

[THE FETAL MIDDLE CEREBRAL ARTERY PEAK SYSTOLIC VELOCITY AS A PEDICTOR OF FETAL ANEMIA IN RH-ALLOIMMUNIZED PREGNANCY].

UNLABELLED: Rh-isoimmunization is a pathological condition in which the fetal red blood cells of a Rh (+) fetus are destroyed by the isoantibodies of a Rh (-) woman sensitized in a previous event. Despite of the wide spread implementation of anti D-gammaglobolin prophylaxis this is still the most common cause for fetal anemia. Recently, sonographic measurement of the fetal middle cerebral artery peak systolic velocity (MCA-PSV) has been shown to be an accurate non-invasive test to predict low fetal hemoglobin levels. We present a case report of Rh-alloimmunized pregnancy with moderate fetal anemia, followed-up by weekly MCA-PSV measurements. CASE REPORT: A 37-year-old Rh (-) negative gravida 3, para 1, without anti-D gammaglobolin prophylaxis in her previous pregnancies, presented at 27+0 weeks of gestation (w.g.) for a routine third trimester scan. Subsequent ultrasound measurements of MCA-PSV confirmed a progressive increase of the peak systolic velocities from 40 to 80 cm/sec, as well as a gradual rise in the anti-D titers. The evidence of developing fetal anemia necessitated elective Caesarean section performed at 35 wg. The neonate was admitted in the intensive care unit and required resuscitation, one exchange blood transfusion and several courses of phototherapy. The patient was discharged two weeks post partum. CONCLUSIONS: There is a strong correlation between the high peak systolic velocities in the middle cerebral artery (MCA-PSV) and the low levels of fetal hemoglobin. The high sensitivity and positive predictive value concerning the development of fetal anemia, as well as its good repeatability, makes this non-invasive test a valuable asset in the management of all pregnancies complicated by severe Rh-alloimmunization.

[Socio-demographic characteristics and vitamin D status in women born before 32 weeks'].

UNLABELLED: Deficiency of vitamin D (25-OHD) is a health problem among prematurely born women and their newborns independently of the geographical location of the country. OBJECTIVES: To study serum levels of vitamin D in patients born before 32 weeks and their newborns at birth. To analyse the socio-demographic factors, complications of pregnancy and their relationship with vitamin D status of women. PATIENTS AND METHODS: The study has been carried out in the University hospital "Maichin dom" Sofia for the period August 2013-January 2014. 35 women who gave birth before 32 gestational week and their 41 newborns with birth weight < 1500g have been investigated. The serum level of vitamin D (25-OH D) in mother-infant pairs at birth and 8 weeks of age in infants has been investigated. The ECLIA method has been used. Serum levels of vit D (25-OHD) have been estimated as sufficient:(> 30 ng/ml), insufficient (21-29ng/ml) and deficient (< 20 ng/ml). RESULTS: At delivery according to their vit D (25- OHD) serum levels 63% of the mothers are defficient /12.61 ± 4.8 ng/ml/, 28.5% are insufficient/26.66 ± 2.59/and only 8.5%/40.4 ± 8.48/sufficient with normal levels of vitamin D. For newborns data are respectively 32%/ 20.08 ± 3.69/-deficient, 49%/27.39 ± 2.70/- insufficient and 19 %- sufficient/41.6 + 10/ There is a positive correlation between mother's and children's serum levels of vitamin D (25- OHD). Statistical significant differences are observed in the levels of vitamin D and the presence of infection and preeclampsia in the mothers. During the period of the study there were no seasonal variations in vit D (25-OHD) serum levels of mother-baby pairs. All newborns received Vit D3 1334 IU/daily from 20th day of age. At eight weeks of age sufficient levels of vitamin D have 70% of the children, but 30% of the newborns remains with inadequate supplementation/27.09 ng/ml/. CONCLUSION: 91.5% of mothers are with insufficient serum levels of vitamin D (25OHD) at birth, and a deficit is present in 63% of all women. Only in 8.5% of the women had normal values. This implies more effective monitoring and vitamin D prophylaxis during pregnancy.

[Blood transfusions suppress erythropoiesis in anemia of prematurity].

UNLABELLED: AIM AND TASKS: The major gene regulating erythropoietin /EPO/ synthesis is hypoxia induced factor/HIF/. Proceeding from the assumption that the transfusions /HT/ remove hypoxia due to anemia and inactivate HIF, the aim of the study was to show the decreased activity of erythropoiesis after HT MATERIALS AND METHODS: PATIENTS: 40 premature infants <34 g.a. and birth weight < 1400 g with anemia of prematurity. We analyzed: Hb /g/I/, Ht%, Thrx 10(9)/I, Ret%, 24-48 hours and 7-10 days after HT The dynamics of changes of blood lactate /mmol/l/level after HT was used as an indirect index of relative hypoxia/activated HIF/. The changes of Hb /g/l/ and Ht% determined the need of haemotransfusions. RESULTS: After HT along with the increase of Hb from 89, 7+/-10,0 to 119+/-13,3, there was significant decrease in Ret % from 2,4+/-1,1 to 1,4+/-0,5 7-10 day after HT There was also a reduction of Thr from 391,5+/-131,5 to 250, 7+/-57,2 and blood lactate in mmol/l from 2,5+/-1,1 to 1,5+/-0,7. The study showed that 7-10 days after HT the values of Hb and Ht decreased to baseline levels, that required new transfusion. CONCLUSION: Transfusion of packed red blood cells in patients with anemia of prematurity suppresses erythropoiesis, which is demonstrated by the significant reduction in reticulocyte count. The decreased level of blood lactate after HT shows elimination of the relative hypoxia that is required for hypoxia- induced expression of HIF and erythropoietin synthesis.

[Congenital cystic lung lesions--review of the literature with three clinical cases].

Congenital cystic lung lesions are rare. Mainly affects the lower respiratory patishta.i are congenital cystic malformation and adematozna bronchopulmonary sequestration (BPS). The pathogenesis of the occurrence of these malformations is not clear but they have a common clinical course. In most cases, the anomaly is asymptomatic and occurs with infections of the lung during the first year of life. Currently congenital lung lesions were classified into five types and is considered by most authors. The anomaly is due to the abnormal proliferation of terminal bronchioles accompanied by inhibition of alveolar development between 7-17 weeks, obstructed airway dysplasia and metaplasia of normal lung tissue. Early diagnosis is vital in making a medical decision on how to treat CCAM. Associated with abnormalities of the urinary tract, cardiovascular system, gastrointestinal atresia, diaphragmatic hernia skeletal abnormalities. In pregnancies in which prenatal lung lesions weighs registered necessary series of ultrasound examinations to track finding and using the Doppler to assess how the blood supply of the fault. The clinical presentation of malformations is respiratory distress, respiratory infection, and dyspnea. The use of CT and MRA allows better visualization of the pulmonary lesions. With its combination with arteriography and bronchoscopy are used to differentiate CCAM and pulmonary sequestration. We present three cases with lung lesions were born in Neonatologia clinic at the University Hospital of Obstetrics and Gynecology "Maternity" Sofia for the period 2010-2012 three cases CCAMs type 1, operated by 5 meters after birth with a good final outcome without complications in the postoperative period and lack of pulmonary symptoms up to 1 year after birth.

[Respirtory distress in newborns of mothers with factor V-Leiden thrombophilia].

AIM: The main aim of the trial is to determine the frequency of respiratory distress syndrome / RDS/ and disorders of coagulation in infants of mothers with thrombophilia. MATERIALS AND METHODS: In 51 newborns of mothers with thrombophilia were evaluated the presence of respiratory distress and maternal-fetal infection /MFI/. The children were divided in two groups: Group I--16 newborns of mothers with thrombophilia and Group II--15 healthy children. We analyzed Hb, Ht, Er, Thr, prothrombin index /INR/, activated partial thromboplastin time /aPTT/ in both groups. RESULTS: The analysis of Hb, Ht, Er, Thr showed no evidence of anemia or coagulopathy with platelet consumption. In 64.7% of children was observed respiratory distress syndrome during the first days, 21.5% had severe respiratory distress /RD/, that required intubation and assisted ventilation. Only in 10/19.6%/ children with RDS there were data proving MFI/high CRP and positive microbiological samples/. There was no significant difference in the INR value in Group I/1.5 +/- 0.3/ and group II/1.6 +/- 0.1/. The children of mothers with thrombophilia had significantly more shortened aPTT/35, 1s +/- 4.2/ compared with the control group: aPTT/43.9 +/- 4,4/. CONCLUSION: The high incidence of RDS and shortened aPTT indicate that maternal thrombophilia is a risk factor for thrombosis in newborns. MFI that are accompanied with activated PAI also lead to thrombosis, especially in children in Neonatal Intensive Care Units. These results point out that there should be prevention of other risk factors for thrombosis such as dehydration and placement of central venous catheters.

["In vitro" babies--dreams, that turned real, but a lot of questions and unknown items].

UNLABELLED: In vitro babies bring happiness to a lot of families. Their development, health and social problems are being studied in details. OBJECTIVES: To establish the well being of babies, born at the University Maternity Hospital "Maichin dom" following assisted reproduction (AR), probable risk factors immediately after birth and afterwards. Aims of the study are to look for a correlation between AR and the incidence and importance of medical problems, arising during the neonatal period: multiple pregnancy; prematurity; intrauterine growth retardation; neonatal mortality; inborn malformations and chromosomal diseases; CNS impairment; duration of hospitalization. STUDY DESIGN: This is a retrospective study including all 440 babies born thanks to AR (according to the available medical records) during the period 2008-2010 at the University Maternity Hospital "Maichin dom". A correlation between the main items observed and the number of babies in each pregnancy was investigated for the period 01.01.2010-31.12.2010. RESULTS: During the period 2008-2010 there are 99 babies from single pregnancy, 15 (15%) admitted to the NICU; 384 twin pregnancies (186 of them after AR)--733 babies and 15 foetus mortus. 114 IVF couplets (31%) or 221 babies (7 foetus mortus) are admitted to physiological neonatal ward, while 72 (63%) couplets or 137 babies (7 foetus mortus) are admitted to the NICU. There are 48 triplet pregnancies or 141 babies (3 f. mortus), 40 being IVF (83%) or 117 babies, all 40 AR triplets are admitted to the NICU. 269 babies (61% of all AR babies) need intensive treatment--mostly (94%) babies from multiple pregnancies. Mean birth weight was established to be 2060 g; with babies, requiring intensive treatment is 1408 g. Gestational age at birth is from 25 to 39 g.w.; with NICU patients mean gestational age is 32 g.w. Mean maternal age is relatively high--34 years with a wide range (24-50 years). A high incidence of operative deliveries is established--mostly with couplets and triplets. CONCLUSIONS: Rules of good clinical practice should be introduced with AR, aiming at reducing the number of multiple pregnancies. This should be priority for all national programs for assisted reproduction.

[Osteopenia of prematurity--prophylaxis, diagnostics and treatment].

UNLABELLED: Osteopenia of prematurity is a metabolic bone disease of premature infants with birth weight < 1500 g and gestational age < 32 weeks. Sub-optimal bone matrix, poor skeletal support and an increased risk of fractures characterized the disease. Its importance is determined by relatively high frequency--between 30-70% of infants at risk, multifactorial etiology and impact on early and late morbidity of the newborns. The prevention and treatment of bone disorders are important aspects of the care of preterm babies. OBJECTIVE: To identify of the risk factors, to determine early diagnostic criteria and to create a prevention program for osteopenia in infants with very low and extremely low birth weight. MATERIALS AND METHODS: The prospective study includes 39 preterm babies with birth weight below 1500 gr. and < 32 g. w who were admitted to the NICU from September 2011-January 2012. Bone metabolism was monitored by calcium, phosphate and alkaline phosphatise at 2-weeks intervals. Vitamin D levels of the neonates were registered at birth, and at 8th week. PTH was measured at the second and the 8th weeks. RESULTS: The following biochemical abnormalities were found. Hypophosphatemia in two weeks (P < 1,6 mmol/l), a gradual increase in phosphorus levels and normalization at eight weeks of age. There was a significant positive correlation between 25OHD/phosphorus at eight weeks/r = 0.353/. Significantly elevated levels of parathyroid hormone in eight weeks, correlating with low levels of vitamin D (negative correlation between 25OHD/parathormone r = -0.581). Blood levels of calcium and alkaline phosphatase were in normal limits. IN CONCLUSION: Risk factors for osteopenia are: the low gestational age and low levels of vitamin D at birth. Biochemical markers of osteopenia are: changes in levels of parathyroid hormone, phosphorus and vitamin D at eight weeks of age. Prevention includes: early supplementation of vitamin D in the risk neonates with individual dose adjustment. Upon biochemical evidence of osteopenia treatment should begin in the second week of life with supplementation of phosphorus, and vitamin D 1320 IU/daily and appropriate physiotherapy.

[Vitamin D levels in maternal--VLBW infants pairs].

UNLABELLED: Normal foetal growth depends on sufficient mother's vit D intake. Premature birth interrupts vit D and mineral mother-to-foetus transfer and leads to vit D deficiency and disturbs newborn mineral bone metabolism. OBJECTIVES: To determine vit. D plasma levels in mothers and their very low birth weight- (VLBW) newborns and the prevalence of vit D deficiency in this population, to investigate seasonal variation and analyse babies' vit D levels from birth to the 8 postnatal week. PATIENTS AND METHODS: The study has been carried out in the University hospital "Maichin dom" Sofia for the period 09.2011-01.2012 and there have been investigated 32 women and their 39 VLBW infants as a target group. 25-OHD level has been measured in maternal and newborn cord blood samples. The ECLIA method has been used. 25-OHD level has been tested second time at eight weeks of age in 34 infants. According to the maternal vit D levels the patients have been divided into 3 groups: Group. 1--vit D reference range level (> 30 ng/ml); Group. 2--vit D insufficiency (21-29 ng/ml), Group. 3--vit D deficiency (< 20 ng/ml). RESULTS: Low Vit. D levels have been estimated in 62.5% of mothers' group. Nevertheless, only 38.6% of all babies have been Vit. D deficient. In 61.4% of them vit D has been in normal range (32.4-35.7 ng/ml). A significant positive correlation between maternal and infants' vit D level at birth has been established (r = 0.516; p = 0.002). There have been found a significant seasonal dependence of vit D level at birth in the group too: vit D plasma levels have been estimated higher in September-October group compared to those in November-January group. Most of the blood samples in winter months showed lower vit. D levels than the autumn group. At 8 weeks of age 67.6% of the babies have been with vit D insufficiency. There has been a significant positive correlation between 25-OHD levels at birth and at weeks (r = 0.425; p = 0.012). CONCLUSION: Vit. D insufficiency has been found in 62.5% of the mothers at birth. Maternal vit. D deficiency is a significant risk factor for neonatal vit D deficiency. There is a clear seasonal dependency with a significantly lower 25-OHD level in the mothers and their VLBW babies in winter months.

[Protocol - indications for transfusion in newborns with low and extremely low birght weight].

OBJECTIVES: Hyporegenerative anaemia of prematurity is the cause of frequent transfusions of packed red blood cells. Wellknown is the effect of inhibiting the erythropoiesis after blood transfusions as well as the risk of transmissive infections. Therefore the main purpose of this study was to work out a protocol - indications for blood transfusions in order to achieve maximal reduction in their incidence with premature babies during their stay in ICU. STUDY DESIGN: The study includes 57 newborn babies - birth weight < or = 1400 g, gestational age < or = 34 g.w. The changes in blood count values (Hb, Ht, Er,) from day 1 until day 60-70 were followed and analyzed. The effect of blood transfusions on oxygen needs reduction was analyzed by monitoring acid-base status in 30 infants with anaemia of prematurity with different degree of oxygen dependency. RESULTS: Mean Hb and Ht at birth were 163 +/- 20,4 g/l and 48.6 +/- 6, 3%. At day 15-20 Hb was 111,02 +/- 10,9 and Ht 32,65 +/- 3,46. A significant decrease in blood count values is observed until the end of the first month /p <0.05/. Afterwards they remain relatively constant, fairly close to those at day 25-30/Hb 101,45 +/- 10,24 g/l; Ht% 29,78 +/- 3,42/. The study showed that transfusions of packed red blood cells reduce oxygen requirements by aproximately 30% in premature babies on mechanical ventilation with high oxygen concentrations\FiO2 > or = 50%/. In premature babies with good overall condition and on low concentration oxygen therapy - < 50%, no effect was observed in reducing oxygen requirements after RBC transfusion. CONCLUSION: The leading indications for RBC-transfusions are not only Hb, Ht, postnatal age, but also the clinical condition and oxygen requirements. Severely ill premature babies on mechanical ventilation with FiO2 > or = 50% require blood transfusion at higher Hb values/<120 g/l/regardless of postnatal age.

[Our experience with management of inherited thrombophilia during pregnancy. Preliminary report].

UNLABELLED: It has become clear in the recent years that inherited thrombophilias (IT) are associated with serious abnormalities during pregnancy. This includes miscarriage, still birth, placental abruption, praeclamcspia and intrauterine fetal growth restriction. The aim of this study is to share our experience in the field. MATERIALS AND METHODS: 38 patients with medical history of abnormal pregnancies (miscarriage, still birth, placental abruption, praeclamcspia and intrauterine fetal growth reastriction). They were all tested for the following gene alterations: V Laidon-R506Q/phiVL-R506Q/, protrombin G/A 20210 /Pi pG/A20210/, Plasminogen activator inhibitor- PAI- 4G/4G/PAI 4G/5G/). IT were diagnosed in 24 patients. They were all treated by: Aspirin 75 mg form prior to conception and low molecular Heparin after detection of fetal heart movement. Due to the observed NRDS in some of the newborns, the low molecular heparin intake was discontinued 30 days prior to expected delivery. RESULTS: keeping up to the therapeutic scheme, 70% (17) of women with IT gave birth to a term baby, and 30% (7)-to a preterm one, all pregnancies were successful. Amongst the patients with medical history of miscarriage, 72% were diagnosed with IT and 87.5% of them gave birth to a term newborn as a result of the anticoagulant treatment. CONCLUSIONS: Undiagnosed IT is a common cause of adverse pregnancy outcome. Uninterrupted anticoagulant treatment of these patients is very successful. The whole pregnancy should be followed up closely. Due to the higher risk of respiratory complications in the infants, delivery should be performed in a specialized hospital with neonatology department, capable of newborn resuscitation.

[Our experience with management of inherited thrombophilia during pregnancy. Preliminary report].

UNLABELLED: The physiologic mechanism that results in the occurrence of premenstrual syndrome (PMS) is not well understood. OBJECTIVE: Effective treatment in premenstrual syndrome with vitex agnus castus--femicur N in adolescent girls. [corrected]. MATERIAL AND METHODS: We have investigated 45 adolescent girls 14-16 years old for a 3 years period from march 2009 to march 2011. The first group of 23 girls were prescribed Femicur N 4 mg once daily for 3 month--90 capsules per course. The second group of 22 girls were given 40 mg of the study drug (Femicur N) twice a day, from the 19th day of the first day of the cycle for 10 days 3 month as the dose is 60 capsules per course. RESULTS: Our investigation showed that therapy with VAC-Femicur N in adolescents suffering from PMS was effective and the results were good. From 45 girls 20 girls (44.4%) were without any complaints and 13 girls (28.8%) had reduction of all premenstrual symptoms. In both groups premenstrual mastodynia in 13 girls (28.8%) has disappeard and with 4 girls (8.8%) complaints were redused.

[Our experience with management of inherited thrombophilia during pregnancy: preliminary report].

UNLABELLED: It has become clear in the recent years that inherited thrombophilias (IT) are associated with serious abnormalities during pregnancy. This includes miscarriage, still birth, placental abruption, praeclamcspia and intrauterine fetal growth restriction. The aim of this study is to share our experience in the field. MATERIALS AND METHODS: 38 patients with medical history of abnormal pregnancies (miscarriage, still birth, placental abruption, praeclamcspia and intrauterine fetal growth reastriction). They were all tested for the following gene alterations: V Laidon- R506Q/phiVL-R506Q/, protrombin G/A 20210/pG/A20210/, Plasminogen activator inhibitor- PAI- 4G/4G /PAI 4G/5G/). IT were diagnosed in 24 patients. They were all treated by: Aspirin 75mg form prior to conception and low molecular Heparin after detection of fetal heart movement. Due to the observed NRDS in some of the newborns, the low molecular heparin intake was discontinued 30 days prior to expected delivery. RESULTS: keeping up to the therapeutic scheme, 70% (17) of women with IT gave birth to a term baby, and 30% (7)- to a preterm one, all pregnancies were successful. Amongst the patients with medical history of miscarriage, 72% were diagnosed with IT and 87.5% of them gave birth to a term newborn as a result of the anticoagulant treatment. CONCLUSIONS: Undiagnosed IT is a common cause of adverse pregnancy outcome. Uninterrupted anticoagulant treatment of these patients is very successful. The whole pregnancy should be followed up closely. Due to the higher risk of respiratory complications in the infants, delivery should be performed in a specialized hospital with neonatology department, capable of newborn resuscitation.

[Early diagnosis of Turner syndrome in a newborn].

The Turner syndrome, karyotype 45,X0 in the classical form, often remains undiagnosed until significant growth retardation is presented and sexual maturation at the puberty fails to occur. The girls are as a rule with normal IQ. We report a case of an infant of a 24 years mother after two spontaneous abortions and one birth of a normal boy. The newborn girl is with IUGR, after birth we establish edema of the feet, prominent ears and systolic murmur. The echocardiography diagnoses cardiac malformation--bicuspid aortic valve and sub aortic obstruction. The chromosomal analysis shows karyotype 45,X0. We discuss the methods for prenatal and early postnatal diagnosis. In utero and in the neonatal period there are symptoms that make the diagnosis Turner syndrome probable so that chromosomal analysis should be made to confirm it. Looking for other malformations (heart, kidney, endocrine) is necessary. The early diagnosis makes possible the beginning of appropriate hormonal treatment to achieve normal growth and to induce puberty.

[Does human recombinant erythropoetin /R-HU-EPO/ treatment for anemia of prematurity have any effect on reducing the number of blood transfusions?].

OBJECTIVES: The aim of the study is to establish the influence of r-hu-EPO treatment for anemia of prematurity on changes in blood count values and the number of inevitable blood transfusions in premature infants. STUDY DESIGN: The study includes 148 newborn babies--birth weight < or =1400 g, gestational age < or =34 g.w. They were divided in 2 groups: group I--treated with r-hu-EPO 1000 E/kg/week and Fe++ 3-6 mg/kg/day from week 3 after birth; group II--controls, treated only with transfusions of red blood cells. The changes in blood count values (Hb, Ht, Ery, Ret) from day 15-25 until day 60-70 were followed and analyzed, as well as the number of inevitable blood transfusions. RESULTS: A significant increase in Hb and Ht values was established with r-hu-EPO treated babies. At day 60-70 mean values of Hb are: in r-hu-EPO group 111.1 +/- 11.06 g/l; in control group 99.20 +/- 10.77 g/l (p < 0.001). At the end of the period Ht is 32.02 +/- 3.28% in babies treated with r-hu EPO versus 29.10 +/- 2.87% with controls (p < 0.005). Ret count is significantly higher from day 25-30 in r-hu-EPO group (5.16 +/- 3.23%) versus controls (2.75 +/- 1.33%). Mean number of inevitable blood transfusions in r-hu-EPO treated group is significantly lower (2.06 +/- 1.62) versus controls--3.75 +/- 1.95 (p < 0.001). CONCLUSION: r-hu EPO treatment has effect on changes in Hb, Ht, Ret and reduces the number of inevitable blood transfusions for anaemia of prematurity.

[Guidelines for parenteral nutrition in high risk newborn babies].

High risk newborn babies, admitted and treated at the Intensive care units often have to be started on intravenous nutrition--total or partial. The guidelines which we propose are adapted to the specific needs of the various groups of critically ill newborns--daily intake of liquids and essential nutritional substances according the day of life and the birth weight, as well their variations depending on the clinical condition and the morbidity of the baby.

[Treatment of anaemia of prematurity with SS-R-Hu-erythropoietin and significance of hypoxia-inducible factor].

UNLABELLED: The main cause of anaemia of prematurity is low erythropoietin levels. A few years ago hypoxia-inducible factor/HIF/gene transcriptor was established, regulating not only the synthesis of erythropoietin /EPO/, but also other growth factors as well as enzymes of anaerobic glycolysis, activated by hypoxia. OBJECTIVES: The aim of the study is to establish in clinical practice the role of hypoxia, respectively, activated HIF during treatment with erythropoietin by analyzing variations in hematological values; to examine blood lactate levels as an indicator of activated HIF and anaerobic glycolysis with Hb values 110-120 g/l; to analyze the number and impact of red blood cells transfusions on different categories of babies. STUDY DESIGN; The study includes 112 premature infants born before 34 weeks of gestation and below 1400 g. 90 babies, treated with EPO (700-1000 E/kg weekly dose in 2-3 applications, for 2-4 weeks), values of Hb g/l, Ht%, Ret%, Platelets 109/l were followed and compared. Treated babies were divided in two groups: group I--treatment (starting at Hb below 106 g/l, Ht less than 31%); group II--late prophylaxis (starting at Hb > or = 106 g/l, Ht > or = 31%). Blood lactate was examined in 22 non oxygen dependent premature babies without EPO treatment, with Hb 110-120 g/l, Ht 29-32%. RESULTS: We found that in group II during the first 7-10 days Hb decreases to 105.6 (+/- 9.4) g/l, rising up afterwards to 113.5 (+/-11.0) g/l at day 25-30. Ret reach maximal values at day 15-20 when Hb drops below 110 g/l and Ht below 31%. In group I at day 25-30 of treatment is observed a rise in Hb up to 117.3 (+/-11.3) and of Ht up to 32.7% (+/- 2.6) and no decrease of Hb and Ht values during the first 7-10 days, while Ret rise up to maximal values 6.5% (+/- 3.6) at day 7-10. With Hb levels of 116.4 (+/- 4.6) g/l we found an increase in blood lactate levels up to 2.6 (+/- 0.7) mmol/l as an indicator of relative hypoxia and activated HIF. Mean number of blood transfusions in group I is 3.01(+/- 1.7), versus 2.15 (+/- 1.7) in group II (statistically non-significant). In 29 infants in group II treatment was started at Hb 110-120 g/l and the mean number of red blood cell transfusion is 1.8 (1.5)--statistically significant difference with group I. In 32% from the treated infants we found platelets count rising above 500 x 109/l. CONCLUSIONS: The presence of hypoxia at low levels of Hb and Ht leads to more rapid activation of erythropoiesis. Nevertheless, these babies need more red blood cell transfusions due to clinical symptoms of hypoxia. Normoxia after red blood cell transfusion leads to decrease of reticulocytes count by 30% and platelets by 35% in spite of treatment. The presence of relative hypoxia with Hb 110-120 g/l u Ht 31-32% is optimal for starting treatment with EPO--levels, low enough for activation of HIF and high enough to avoid blood transfusions.

[Early parenteral nutrition with very low and extremely low birth weight infants--practical approach].

UNLABELLED: Newborn infants with birth weight 1500 g and less (VLBW/ELBW) have higher nutritional needs, but enteral feeding is often insufficient or impossible. Parenteral nutrition (PN) as an important component of intensive care with them minimizes the risk of nutritional deficiency. OBJECTIVE: To evaluate the safety and efficacy of early PN administration in VLBW/ELBW infants. STUDY DESIGN: The prospective study includes 23 newborn babies with birthweight below 1500 g who were admitted to the NICU from 01.03. to 20.04. 2009. With all babies a PN was started from the first day of life with dextrose and amino acid solutions, adding lipid solutions in gradually increasing quantity on the second day. During the first 20 days of life for each baby were calculated on a daily basis the exact quantities of energy and the essential nutritional substances as well as the balance among them. All babies were followed up for weight gain, presence or absence of complications, related with parenteral nutrition as well as for: blood sugar, acid-base status, total serum protein, electrolytes, urea, triglycerides, billirubin, alkaline phosphatase, ASAT ALAT RESULTS: We found that due to the small infusion volumes during the first days, the minimal daily needed nutrition levels are reached at day 4-5. Nutritional intake at day 7-10 in most children is enough for growth. A positive mean weight gain for the whole group 6.6 g/kg/d (SD 6.2) is observed. Negative weight gain during the first 20 days is observed only with two critically ill babies with substantial reduction of infusion volume. In 9 babies a transient increase in urea levels was observed during the first week, 5 babies had an increase in triglycerides as a symptom of bad lipid tolerance. In 7 babies on prolonged total PN an increase in alkaline phosphatase is observed. Conclusions. Early and sufficient PN in newborn babies below 1500 g guarantees the daily intake of energy and essential nutritive substances for adequate growth and is a basic component of intensive therapy. It should be corresponding to the nutritional needs as well as to the clinical condition; matching the severity of complications and carried under strict laboratory control.

[Diagnostic importance of the cytologic examination of tracheal lavage fluid in high-risk newborn infants].

UNLABELLED: Aim of the study is to find out early diagnostic markers of chronic lung disease (CLD) in the tracheal lavage fluid (TLF) of high-risk neonates using the cytologic examination. MATERIAL AND METHODS: TLF from forty newborn infants treated by conventional ventilation (CV) and oxygen were studied. The infants were divided into three groups: I--12 term and 11 premature infants without signs of CLD on the 28th day of birth; II group--15 premature infants with persistent respiratory distress and oxygen dependence till the 28th day of life without signs of CLD after 36 weeks of gestation and III group--5 premature infants treated by CV more than 14 days with signs of CLD after 36 weeks of gestation. The diagnostic tracheal lavage (TL) was performed between the 4th and 10th day from the beginning of CV. A standart method for TL of neonates was used. The cytologic samples were prepared from filtrated TLF and examined by light microscopy. The percentage count of blood cell elements and the ratio between normal and metaplastic bronchoepithelial cells were determined and compared between the three groups. RESULTS: We found similar mean values of the cellular elements and the ratioes of the term and the preterm babies from I group: alveolar macrophages (AM)--75.8 +/- 11.35%; neutrophils (Neu)--22.78 +/-10.8%; lymphocytes (Ly)--1.1 +/- 0.32% and ratio between normal and metaplastic (N/M ratio) epithelial cells = 3,17:1. In the II group the mean value of Neu was 31.57 +/- 9.2%, which is higher than the Neu mean value of the I group, but the difference is not significant (p = 0.2). The mean value of AM was 65.7 +/- 9.8% and the of as well as between I and II group (p < 0,05) and between II and III group (p < 0.05). CONCLUSION: The percentage of the metaplastic respiratory cells in TLF has an early diagnostic value for CLD in high-risk newborn infants: metaplasia in less than 40% of the epithelial cells can be accepted as transitional, since it is reversible; mataplasia between 40% and 80% of the cells is associated with a risk of broncho-obstructive syndrome in early infancy. Squamous metaplasia of more than 80% of the cells in TLF has a diagnostic importance for CLD.

[Effect from surfactant therapy in extremely low birth weight infants depending on the method of delivery].

OBJECTIVES: To look for a correlation between way of delivery and the effect from surfactant therapy with extremely low birth weight infants. METHODS: The is a retrospective study and includes babies < or = 1000 g, < or = 28 g.w., born in University Maternity Hospital Maichin dom during the period 2001-2005. Babies were treated with surfactant because of RDS. Babies with severe inborn malformations and those, who died before 28-th day due to severe IVH were excluded from the study. All babies were treated and monitored according to the protocols for surfactant and intensive care therapy. Babies were divided in two groups: group N--33 babies; born by normal delivery, group S--27, born by Cesarean Section. RESULTS: There are no significant differences between the groups according birth weight, gestational age, gender; severity of RDS, incidence of IUGR; kind of surfactant, timing and number of doses. In both groups there is a slight prevalence of female sex. Incidence of full course corticosteroid prophylactics and of inborn infections is definitely higher in gr. N. Babies were followed for: duration of mechanical ventilation (8 days in gr. S vs 20 in gr. N); duration of O2 therapy (34 days in gr. S vs 55 in gr. N); incidence of IVH: gr. S 74% are IVH grade I-II, 11% are grade III-IV; while in gr. N IVH I-II cm. are 38%, IVH grade III-IV are 56%; incidence of BPD--gr. S 14%, vs gr. N --30%; incidence of rethinopathy--23% in gr. S vs 56% in gr. N; incidence of anaemia--100% in both groups. CONCLUSIONS: With ELBWI treated with surfactant chosing the least traumatic way of delivery is important, ensuring smaller duration of mechanical ventilation and O2 therapy, less severe IVH, BPD and ROP.