[Birth marks and neonatal skin disorders. From angel kiss to epidermolysis bullosa]. / Születési jegyek, újszülöttkori borelváltozások. Az angyalcsóktól az epidermolysis bullosáig.

INTRODUCTION: At present there are no exact epidemiologic data on the prevalence of neonatal skin disorders and birth marks in Hungary. AIM: The aim of the authors was to investigate the prevalence of skin disorders in mature healthy neonates after birth. METHOD: The survey was carried out in the Neonatal Care Unit at the Department of Obstetrics and Gynaecology at the University of Szeged between April, 2012 and May, 2013. RESULTS: A total of 2289 newborn infants underwent whole-body screening skin examinations. At least one skin manifestation was found in 63% of the neonates. The major groups of skin disorders were transient benign cutaneous lesions, vascular lesions, pigmented lesions, traumatic, iatrogenic, congenital or acquired disorders with skin injuries, developmental abnormalities and benign skin tumours. The most frequent transient cutaneous lesions were erythema toxicum neonatorum, sebaceous hyperplasia and desquamation. The most common vascular lesions were naevus simplex, haemangioma and haemangioma precursor lesion, while the most frequently observed pigmented lesions were congenital melanocytic naevi and Mongolian spot. CONCLUSIONS: In the vast majority of cases, special treatment was not necessary, but 5.27% of the neonates required local dermatologic therapy, and in 9.2% of neonates follow up was recommended.

Use of antibiotics in suspected early-onset neonatal sepsis / Antibiotikumhasználat korai szepszis gyanúja esetén újszülöttkorban.

Összefoglaló. Bevezetés: Az újszülöttkori szepszis ritka, de magas mortalitással járó állapot. Az Egészségügyi Szakmai Kollégium Neonatológiai Tagozata 2017-ben bevezette a korai szepszisrol szóló állásfoglalást, meghatározva a kezelés indikációját a túlzott mértéku antibiotikumadás elkerülése céljából. Célkituzés: Retrospektív analízissel vizsgáltuk az állásfoglalás elotti és utáni idoszak antibiotikumhasználatát klinikánk beteganyagán. Módszer: Az intézményünkben 2014. 01. 01. és 2018. 12. 31. között született, a 34. gestatiós hetet betöltött újszülöttek adatait vizsgáltuk a következo kimenetelekre koncentrálva: szepszisre utaló klinikai tünetek jelenléte, az antibiotikummal kezelt újszülöttek száma, koraiszepszis-incidencia, mortalitás. A statisztikai analízis az RStudio programmal történt (szignifikancia: p<0,05). Eredmények: A vizsgált 5 évben összesen 12 347 újszülött jött a világra, közülük antibiotikumot kapott 1502 (12,16%); évekre lebontva: 2014-ben 517 (21,10%), 2015-ben 401 (16,63%), 2016-ban 459 (17,96%), 2017-ben 61 (2,39%), 2018-ban 64 (2,69%). Az antibiotikumterápiában részesültek (n = 1502) közül 239 (15,91%) újszülöttnek volt fertozésre utaló tünete. A klinikai tüneteket mutató újszülöttek száma nem növekedett szignifikánsan (p = 0,285); 2014-ben 52 (2,12%), 2015-ben 42 (1,74%), 2016-ban 42 (1,64%), 2017-ben 46 (1,80%), 2018-ban 57 (2,40%). Hemokultúra-pozitív szepszis összesen: 4; koraiszepszis-incidencia: 0,324/1000. Szepszishez kötheto haláleset nem volt. Megbeszélés: A protokollváltást megelozoen az újszülöttek csupán rizikófaktorok alapján is részesültek antibiotikumterápiában, 2017 óta azonban elsosorban a fertozés klinikai tüneteit mutató újszülötteket kezeljük, ami az antibiotikumhasználat szignifikáns csökkenéséhez vezetett. A korábbi, rizikófaktorok alapján adott antibiotikumterápia megszüntetését követoen nem emelkedett a tünetet mutató szeptikus újszülöttek száma, sem a korai szepszis okozta mortalitás. Következtetés: A 34. gestatiós hetet betöltött újszülötteknél a korai szepszis gyanúja miatti antibiotikumhasználat biztonsággal csökkentheto volt, ezzel megelozve a felesleges antibiotikumkezelés rövid és hosszú távú mellékhatásait. Orv Hetil. 2022; 163(11): 431-437. INTRODUCTION: Early-onset neonatal sepsis is a rare, but life-threatening condition. In 2017, the Hungarian Neonatal Society issued a national guideline to rationalize the use of antibiotic use in neonatal sepsis. OBJECTIVE: To retrospectively determine the frequency of prescribed antibiotics before and after the introduction of national guidance. METHOD: Data of neonates (>34. gestational weeks) delivered in our hospital between 1st January 2014 and 31st December 2018 were analysed with focusing on signs of sepsis, number of neonates treated with antibiotics, incidence of early-onset neonatal sepsis, sepsis-related mortality. Statistical analysis was performed with RStudio software (significance: p<0.05). RESULTS: During the analysed time period, 12 347 neonates were born, 1502 (12.16%) neonates were given antibiotics, showing a significant decrease after 2017: 517 (21.10%) in 2014, 401 (16.63%) in 2015, 459 (17.96%) in 2016, 61 (2.39%) in 2017, 64 (2.69%) in 2018, respectively. Out of the group of neonates treated with antibiotics (n = 1502), only 239 (15.91%) neonates showed the clinical signs of sepsis. No significant change was observed in the number of symptomatic newborns during the study period: 52 (2.12%) in 2014, 42 (1.74%) in 2015, 42 (1.64%) in 2016, 46 (1.80%) in 2017, 57 (2.40%) in 2018, p = 0.285. Blood culture confirmed neonatal sepsis was observed in 4 babies, incidence of early-onset neonatal sepsis was 0.324/1000, sepsis-related mortality was zero. DISCUSSION: Before the introduction of the national guideline, most of the neonates were prescribed antibiotics based on risk factors. Since 2017, antibiotics have been mainly preserved for newborns with clinical signs of sepsis. Despite cessation of antiobiotic treatment indicated by risk factors, the number of symptomatic babies and sepsis-related mortality have not increased. CONCLUSION: The use of antibiotics for neonates >34th gestational week can be safely reduced, entailing a decrease in short- and long-term complications of early antibiotic use. Orv Hetil. 2022; 163(11): 431-437.

Respiratory Oscillometry in Newborn Infants: Conventional and Intra-Breath Approaches.

Background: Oscillometry has been employed widely as a non-invasive and standardized measurement of respiratory function in children and adults; however, limited information is available on infants. Aims: To establish the within-session variability of respiratory impedance (Zrs), to characterize the degree and profile of intra-breath changes in Zrs and to assess their impact on conventional oscillometry in newborns. Methods: 109 healthy newborns were enrolled in the study conducted in the first 5 postpartum days during natural sleep. A custom-made wave-tube oscillometry setup was used, with an 8-48 Hz pseudorandom and a 16 Hz sinusoidal signal used for spectral and intra-breath oscillometry, respectively. A resistance-compliance-inertance (R-C-L) model was fitted to average Zrs spectra obtained from successive 30-s recordings. Intra-breath measures, such as resistance (Rrs) and reactance (Xrs) at the end-expiratory, end-inspiratory and maximum-flow points were estimated from three 90-s recordings. All natural and artifact-free breaths were included in the analysis. Results: Within-session changes in the mean R, C and L values, respectively, were large (mean coefficients of variation: 10.3, 20.3, and 26.6%); the fluctuations of the intra-breath measures were of similar degree (20-24%). Intra-breath analysis also revealed large swings in Rrs and Xrs within the breathing cycle: the peak-to-peak changes amounted to 93% (range: 32-218%) and 41% (9-212%), respectively, of the zero-flow Zrs magnitude. Discussion: Intra-breath tracking of Zrs provides new insight into the determinants of the dynamics of respiratory system, and highlights the biasing effects of mechanical non-linearities on the average Zrs data obtained from the conventional spectral oscillometry.

Analysis of various factors influencing the development of birthmarks and cutaneous lesions in newborn infants / A születési jegyek és az újszülöttkori borgyógyászati elváltozások kialakulásában szerepet játszó tényezok vizsgálata.

Összefoglaló. Bevezetés: A szakirodalomban számos felmérés született az újszülöttkori borelváltozások elofordulási gyakoriságának vizsgálatára. Az epidemiológiai vizsgálatok eredményei azonban nem mindig adaptálhatók, hiszen jelentos különbségeket találunk az egyes népcsoportok bormanifesztációi között, emellett kevés és ellentmondásos adat áll rendelkezésre arról, hogy milyen tényezok befolyásolják ezen bortünetek kialakulását. Célkituzés: Prospektív kohorszvizsgálatunk fo célkituzése az volt, hogy felmérjük az alapvetoen egészséges, érett újszülöttek borgyógyászati elváltozásainak elofordulási gyakoriságát, illetve megvizsgáljuk az ezen elváltozások kialakulásában szerepet játszó tényezoket. Módszer: Vizsgálatunkat a Szegedi Tudományegyetem Szülészeti és Nogyógyászati Klinikájának Újszülött Osztályán végeztük 2014 áprilisa és 2015 áprilisa között. Az újszülöttek borgyógyászati vizsgálatát követoen az édesanyák 50 kérdést tartalmazó, standardizált kérdoívet töltöttek ki. Az újszülöttekre, illetve a szülés körülményeire vonatkozó adatokat a hivatalos betegdokumentáció adatainak felhasználásával elemeztük. Eredmények: A vizsgálatban összesen 1629, kaukázusi típusú újszülött vett részt. 88,15%-uknál diagnosztizáltunk legalább egyfajta borgyógyászati eltérést. Vizsgálatunkban számos esetben szignifikáns korrelációt találtunk az újszülöttek neme, gestatiós kora és súlya, valamint az újszülöttkori borelváltozások elofordulási gyakorisága között. Emellett a szociodemográfiai tényezok, a szülok fenotípusos jellegzetességei, az édesanya betegségei, gyógyszerszedési szokásai, káros szenvedélyei is hatást gyakorolhatnak a laesiók kialakulására. Következtetés: Az irodalmi adatok áttekintését követoen elmondhatjuk, hogy vizsgálatunk rendkívül átfogó, új adatokat szolgáltat a neonatalis bortünetek elofordulási gyakoriságáról és a kialakulásukban potenciálisan szerepet játszó tényezok kapcsolatáról hazánkban és világviszonylatban is. Orv Hetil. 2022; 163(13): 513-522. INTRODUCTION: Cutaneous lesions are very frequent in neonates. Despite the fact that the incidence of neonatal skin disorders has been reported in several studies, very few reports address the factors that influence the appearance of birthmarks. OBJECTIVE: In this cross-sectional study, we aimed to record cutaneous findings in essentially healthy, term and late preterm neonates, and to use this data to assess the associations between various factors and the appearance of birthmarks. METHOD: The study was conducted on consecutive neonates born between April 2014 and April 2015 at the Department of Obstetrics and Gynecology at the University of Szeged. After the whole-body skin examination, a standardized questionnaire consisting of 50 questions was completed by the mothers. Data relating to the neonatal history of the participating neonates were obtained from the official neonatal medical charts. RESULTS: A total of 1629 Caucasian neonates were included in the study. Of these, 88.15% exhibited at least one skin manifestation. Significant correlations were found between the newborn gender, gestational age and weight and the presence of many skin manifestations. Furthermore, sociodemographic factors, parental phenotypic characteristics, maternal diseases and medicine-taking habits also have impact on the development of certain cutaneous lesions. CONCLUSION: By examining a large number of newborns and by providing detailed analysis of several neonatal, perinatal and parental factors, our study contributes to a deeper understanding of the development of the examined cutaneous lesions. Orv Hetil. 2022; 163(13): 513-522.

Early detection of developmental dysplasia of hip by ultrasound.

OBJECTIVE: To assess the effectiveness of early universal ultrasound (US) screening of developmental dysplasia of the hip (DDH). STUDY DESIGN: A prospective study of universal hip screening of all mature neonates was conducted from 2012 to 2013, at the Department of Obstetrics and Gynaecology, University of Szeged; 1636 newborns (3272 hips) had clinical examinations and hip ultrasound by the Graf method within the1st 3 days of life. Prevalence of DDH, risk factors, sensitivity and specificity of clinical examinations were evaluated. RESULTS: At the 1st US, 70 of the examined 3272 hips (2.14%) were found to be positive. According to Graf categories, the following distribution was observed: type II C, 21 hips (30.0%); D, 24 hips (34.28%); III, 24 hips (34.28%); IV, 1 hip (1.44%). Regarding the risk factors, female gender, breech presentation and positive family history proved to be significant. Interestingly, 28 (50.90%) of the 55 newborns with DDH had neither positive physical signs nor any risk factors, except being female. The physical examination was calculated for sensitivity (20.0%) and specificity (98.34%). CONCLUSIONS: In our 1-year period study, 50.9% of the newborns with DDH had neither any positive physical signs nor any risk factors, except being a female. In contrast, early universal US screening of the hip facilitated to diagnose all cases with hip dysplasia. Hip sonography is an effective mode of prevention in orthopaedics, however further studies are needed to compare the rates of operative procedures in selective versus universal screening models.

Effect of nasal airway nonlinearities on oscillometric resistance measurements in infants.

Oscillometric measurements of respiratory system resistance (Rrs) in infants are usually made via the nasal pathways, which not only significantly contribute to overall Rrs but also introduce marked flow (V')-dependent changes. We employed intrabreath oscillometry in casts of the upper airways constructed from head CT images of 46 infants. We examined oscillometric nasal resistance (Rn) in upper airway casts with no respiratory flow (R0) and the effect of varying V' on Rn by simulating tidal breathing. A characteristic nonlinear relationship was found between Rn and V', exhibiting segmental linearity and a prominent breakpoint (V'bp) after log-log transformation. V'bp was linearly related to the preceding value of end-expiratory volume acceleration (V″eE; on average r2 = 0.96, P < 0.001). Rn depended on V', and R at end-expiration (ReE) showed a strong dependence on V″eE in every cast (r2 = 0.994, P < 001) with considerable interindividual variability. The intercept of the linear regression of ReE versus V″eE was found to be a close estimate of R0. These findings were utilized in reanalyzed Rrs data acquired in vivo in a small group of infants (n = 15). Using a graphical method to estimate R0 from ReE, we found a relative contribution of V'-dependent nonlinearity to total resistance of up to 33%. In conclusion, we propose a method for correcting the acceleration-dependent nonlinearity error in ReE. This correction can be adapted to estimate R0 from a single intrabreath oscillometric measurement, which would reduce the masking effects of the upper airways on the changes in the intrathoracic resistance.NEW & NOTEWORTHY Oscillometric measurements of respiratory system resistance (Rrs) in infants are usually made via the nasal pathways, which not only significantly contribute to overall Rrs but also introduce marked flow acceleration-dependent distortions. Here, we propose a method for correcting flow acceleration-dependent nonlinearity error based on in vitro measurements in 3D-printed upper airway casts of infants as well as in vivo measurements. This correction can be adapted to estimate Rrs from a single intrabreath oscillometric measurement.

Adverse perinatal outcome in teenage pregnancies: an analysis of a 5-year period in Southeastern Hungary.

OBJECTIVE: To determine the risks of adverse perinatal outcomes of teenage mothers. MATERIAL AND METHODS: A retrospective analysis was performed on teenage mothers (under 20 years of age) who delivered in the period of 2010-2014 at the Department of Obstetrics and Gynecology, University of Szeged (study group). All mothers who delivered in Hungary during the same period were studied as a control group. The following parameters were analyzed: demographic data of the mothers, maternal complications, perinatal outcome and congenital malformations of the newborns. The binominal test, Student's t-test and Poisson's regression were applied using STATA 9.0 (StataCorp, College Station, TX, USA) statistical software (p < .05 was considered to be statistically significant). RESULTS: During this 5-year period, 12,845 births were recorded at the Department, of these 274 (2.1%) were teenage pregnancies with 275 newborns. The offsprings of teenage mothers had significantly lower mean birth weight (3110.2 ± 564.03 g versus 3247 g), higher rate of congenital malformations (8.0 versus 5.0%) and higher admission to neonatal intensive care unit (12.4 versus 8.0%) than the infants in the control group. CONCLUSIONS: Younger maternal age was significantly associated with lower mean birth weight, higher risk of congenital malformations, and increased admission rate to neonatal intensive care unit.

Evaluation of placental vascularization indices in monochorionic diamniotic and dichorionic diamniotic twin pregnancies.

OBJECTIVES: We aimed to investigate and compare placental vascularization indices between monochorionic-diamniotic, dichorionic-diamniotic normal twin pregnancies, and normal singular pregnancies. We hypothesized that there is correlation between placental three-dimensional power Doppler vascularization indices and birth weight in case of twin pregnancies, and that normal singular pregnancies have higher placental vascularization indices than normal twin pregnancies. STUDY DESIGN: Placental three-dimensional power Doppler vascularization indices, such as vascularization index, flow index, and vascularization-flow index were measured in monochorionic-diamniotic (N = 15) and dichorionic-diamniotic (N = 36) normal twin pregnancies, and in normal singular (N = 109) pregnancies. Correlations were analyzed between vascularization indices, and birth weight, APGAR score, umbilical pH, umbilical venous bicarbonate, lactate, and base excess. RESULTS: Vascularization indices and birth weight were significantly (p < 0.01) higher in normal singular gestations (vascularization index = 10.36, flow index = 46.08, vascularization-flow index = 4.08, average birth weight = 3377 g at 38.2 weeks average gestational age) compared to monochorionic-diamniotic and dichorionic-diamniotic normal twin pregnancies. No significant differences were found in vascularization indices between monochorionic-diamniotic and dichorionic-diamniotic normal twins. There were no significant differences in APGAR score, umbilical pH, umbilical venous bicarbonate, lactate, and base excess between groups examined (p < 0.01). We found strong linear correlations between placental vascularization indices and birth weight in both twin groups. CONCLUSION: Placental three-dimensional power Doppler vascularization indices seem appropriate for predicting birth weight in monochorionic-diamniotic and dichorionic-diamniotic normal twin pregnancies. Our pilot study revealed reference values for vascularization indices in case of twin pregnancies examined.

Predictors of caesarean section - a cross-sectional study in Hungary.

PURPOSE: The aim of this study was to analyse the factors associated with caesarean section (CS) at the Department of Obstetrics and Gynaecology, University of Szeged, Hungary. STUDY DESIGN: Data collection was based on self-administered questionnaire and medical records related to the deliveries in the year of 2014. Maternal age, education level, marital status, pre-gestational body mass index (BMI), infertility treatment, previous CS, gestational diabetes mellitus (GDM), pre-pregnancy hypertension and pregnancy-induced hypertension (HT/PIH) were examined. The participation rate was 67.3%, multiple pregnancies and questionnaires with missing data were excluded (n = 1493). Univariate and multivariate comparisons were performed. RESULTS: There were 1125 (45.4%) CSs out of 2479 deliveries. CS rate: 40.0%. Underweight 109 (7.1%), normal 921 (60.2%), overweight 320 (20.9%) obese 181 (11.8%). HT/PIH: 7.6% (n = 117), GDM: 10.1% (n = 155). The odds of CS were significantly higher among obese mothers (OR: 1.81) compared with the normal weight group. Increasing maternal age (OR: 0.97) and being underweight (OR: 0.59) significantly decreased, previous CS (OR: 12.19), infertility treatment (OR: 1.91) and HT/PIH (OR: 1.87) significantly increased the probability of CS. CONCLUSIONS: Pre-gestational obesity, infertility treatment, previous CS and HT/PIH had significant effect on the mode of delivery.

Cutaneous lesions and disorders in healthy neonates and their relationships with maternal-neonatal factors: a cross-sectional study.

BACKGROUND: Cutaneous lesions are very common in neonates. Although a number of studies have reported on their incidence, very little is known about the factors that influence them. We set out to investigate a large population of neonates with the aims of achieving an overall picture of neonatal skin manifestations, and examining their relationships with various maternal, neonatal and perinatal factors. METHODS: This study was conducted on neonates born at the Department of Obstetrics and Gynaecology at the University of Szeged between June 2013 and July 2015. A total of 4658 consecutive infants underwent a whole-body skin examination within the first 72 hours of extrauterine life. The official neonatal medical charts were used to collect data on the history of the participating neonates and on maternal factors. RESULTS: 74.35% of the neonates exhibited at least one skin manifestation. The major diagnosis groups were transient, benign cutaneous lesions; vascular lesions; traumatic, iatrogenic, congenital or acquired disorders with skin injuries; pigmented lesions; and developmental abnormalities or benign skin tumours. The relationships between the skin findings and six neonatal or maternal factors were examined: gender, gestational age and birth weight of the neonates; maternal age and the number of previous pregnancies of the mothers, and mode and circumstances of the delivery. CONCLUSIONS: We found several significant correlations between the examined maternal/neonatal factors and the occurrence of birthmarks and neonatal skin disorders. Of course, further studies are required to confirm and better understand these associations.

A cross-sectional study of newborns over a 20-year period in Szeged, Hungary.

OBJECTIVE: Records of metric data of birth, serve not only the medical needs of the newborn baby, but are also indicators to assess the status of public health. METHODS: This is a retrospective study of 4946 newborns (singleton: 2508 boys and 2365 girls) born in 1989 and in 2009 at the Department of Obstetrics and Gynaecology of the University of Szeged. We aimed as to compare and map the metrical changes over 20 years, and to describe the averages of four body parameters of the normal birth weight (2500-4000 g) subgroup (3993 singleton babies) in both years. Statistical analysis was performed with SPSS 17.0. RESULTS: In 1989, the mean birth weight was 3223.770 ± 559.595 g, birth length 49.551 ± 2.729 cm, chest circumference 32.181 ± 2.231 cm, and head circumference 34.122 ± 1.688 cm. In 2009, the birth weight was 3309.673 ± 582.630 g, birth length 49.515 ± 2.658 cm, chest circumference 32.736 ± 2.392 cm and head circumference 33.854 ± 1.768 cm. The mean birth weight, chest circumference and the maximum value of birth weight have thus increased. The mean maternal age shifted to 30.21 ± 4.863 years, which is an increase of 3.57 years in 20 years. CONCLUSION: The body parameters of newborns changed significantly between 1989 and 2009. As underlying causes changes in eating habits and lifestyle of the mother are to be mentioned.

Adrenal haemorrhage in term neonates: a retrospective study from the period 2001-2013.

OBJECTIVE: To assess the incidence, risk factors and clinical presentations of neonatal adrenal haemorrhage (NAH) in uncomplicated, singleton and term deliveries. METHODS: A retrospective analysis of 26,416 term neonates delivered between 2001 and 2013, and screened with abdominal ultrasonography. RESULTS: Of the 26,416 neonates, 74 (0.28%) displayed NAH; the male/female ratio was 1.55:1. Vaginal delivery was significantly more frequent than caesarean section among them (71 versus 3; 95.9% versus 4.1%). Unilateral bleeding occurred on the right side in 36 (48.7%), and on the left in 34 (45.9%), without a significant difference; bilateral haematomas were found in four cases (5.4%). The most common risk factors were macrosomia (16, 21.6%) and fetal acidaemia (23, 31%), while four (5.4%) neonates exhibited pathological acidaemia. Clinical presentations included jaundice in 37 (50%), anaemia in six (8.1%) and an adrenal insufficiency in only one (1.3%) case. In three cases, neuroblastoma was diagnosed. CONCLUSIONS: Vaginal delivery, macrosomia and fetal acidaemia are the most important risk factors for NAH. The adrenal glands on both sides were similarly involved. In the healthy neonates with NAH, the clinical presentations were mild, with spontaneous regression. Differentiation of NAH from tumours is of considerable importance.

Assessment of respiratory mechanics with forced oscillations in healthy newborns.

BACKGROUND: Lung function data in healthy newborn infants are scarce largely due to lack of suitable techniques, although data for developmental and prenatal exposure studies are much needed. We have modified the forced oscillation technique (FOT) for the measurement of respiratory mechanical impedance (Zrs) in unsedated sleeping infants in the first 3 days of life. METHODS: Zrs was measured during 30-s epochs of quiet sleep in term neonates born via spontaneous vaginal delivery with a non-invasive FOT between 8 and 48 Hz. Total respiratory resistance (R), compliance (C) and inertance (I) were obtained by fitting Zrs spectra. Cluster analysis was used to determine a set of minimal Zrs spectra representing optimal respiratory mechanics for each infant. RESULTS: Successful measurements were obtained in each of the first 3 days in 30/38 (78.9%) neonates. Group mean (± SD) values of R, C, I, and resonant frequency pooled for the 3 days were 45.9 ± 16.6 hPa s L(-1), 0.97 ± 0.21 ml hPa(-1), 0.082 ± 0.031 hPa s(2) L(-1) and 19.2 ± 3.2 Hz, respectively. Within-session variability represented by coefficient of variation was 5.34 ± 3.18% for R and 13.80 ± 8.57% for C. Greater between-session variability was observed for the individual infants; however, the only statistically significant change over time was a 13% increase in R from day 1 to day 2. Parameter interdependence was significant (r(2) = 0.63) between R and I reflecting the large contribution of the upper airways to the total Zrs. CONCLUSIONS: Noninvasive measurement of Zrs can be made in neonates during natural sleep with a high success rate, even in the first hours of life.

Neonatal outcome of macrosomic infants: an analysis of a two-year period.

OBJECTIVE: To assess the neonatal outcome of macrosomic neonates in uncomplicated, singleton, term deliveries. STUDY DESIGN: A retrospective analysis was performed on 5738 live-born term neonates born in the period 2008-2009. The neonatal outcomes were compared between two birth weight (BW) groups: the macrosomic neonates born with BW≥4000g and a control group: 2500-3999g. There were 410 (7.1%) neonates in the macrosomic group, 4757 (82.9%) in the control group, while 571 (10.0%) were less than 2500g at birth. A correlation analysis of two subgroups of the macrosomic neonates (4000-4499g vs. ≥4500g) was also carried out. RESULTS: The rate of caesarean section (CS) was significantly higher in the macrosomic group as compared with the control group (49.3% vs. 39.9%), as were the prevalences of hypoglycaemia (6.1% vs. 2.9%), adrenal haemorrhage (0.98% vs. 0.15%) and the male to female ratio (2.15 vs. 0.95). The rate of icterus was significantly higher in the control group (30.4% vs. 18.5%). The macrosomic subgroups were similar in many aspects, but we found significantly more neonates in the higher weight subgroup as regards a low Apgar score, clavicle fracture and the need for intensive care. CONCLUSIONS: The macrosomic infants were born in good general condition, although those with BW ≥4500g more frequently had an adverse outcome. The macrosomic and control groups' data revealed significant differences in the rate of CS, the male to female ratio, hypoglycaemia and adrenal haemorrhage.