Influence of refrigeration or freezing on human milk macronutrients and energy content in early lactation: Results from a tertiary centre survey.

BACKGROUND: Neonates with severe conditions that cannot be breastfed should receive fresh or preserved expressed human milk in addition to parenteral nutrition. OBJECTIVE: To identify the time during lactation when the macronutrients provide maximum energy and evaluate the effect of refrigeration and freezing. METHODS: We analyzed the composition of fresh milk, refrigerated at +4°C and frozen at -20°C, expressed by mothers of 60 preterm and 30 term infants from a level III maternity, in colostrum, transitional, and mature milk. RESULTS: In fresh milk, the protein level constantly decreases during lactation, with a significant difference after 3 weeks of lactation. Preterm milk of day 21 and day 30 had significantly lower protein than term milk (1.27 versus 1.43 g/dL, P=0.015 and 1.13 versus 1.28 g/dL, P=0.001). Refrigeration for 72 hours of term milk decreased protein content less than freezing. Preterm colostrum has significantly less protein after 48 hours of refrigeration or freezing. Preterm milk from day 60 lost carbohydrates if refrigerated 72 hours or frozen for 2 months. Lipids in preterm colostrum decrease after 8 weeks of freezing. Refrigeration for up to 72 hours did not change significantly the energy value of colostrum or transitional milk. Freezing preterm milk more than 2 weeks leads to significant loss of energy. CONCLUSIONS: Milk frozen for more than 2 weeks contains less protein and energy than milk refrigerated for up to 72 hours. In the absence of milk bank access, in common settings, short-term refrigeration is preferable to long-term freezing.

Physician attitudes in Romania toward withholding and withdrawal of intensive care for infants with very poor prognosis.

OBJECTIVE: The purpose of this study was to examine the attitudes of Romanian physicians toward withholding and withdrawing intensive care for infants whose prognosis is very poor. METHODS: A survey tool was developed by the authors and completed by participants in the annual meeting of the Neonatology Association of Romania. RESULTS: The majority of respondents attempt resuscitation of all live-born infants, have never stopped resuscitation at birth while the infant was still alive, and have never stopped respiratory support because of poor prognosis. Nearly all respondents were uncomfortable talking with parents about withholding or withdrawing intensive care, and they were also uncomfortable talking to the parents about the death of their infant. CONCLUSIONS: Romanian physicians are uniformly reluctant to withhold or withdraw intensive care for infants, even those with very poor prognosis. In addition, physicians are very uncomfortable talking with parents about limiting or stopping support and talking about the death of an infant. Educational programs targeting the communication of difficult topics with parents have the potential to decrease the discomfort experienced by physicians in conversing with parents about their child's poor prognosis or death.

High-dose phenobarbital or erythropoietin for the treatment of perinatal asphyxia in term newborns.

BACKGROUND: The aim of this study was to compare two neuroprotective strategies to supportive care in the treatment of perinatal asphyxia. METHODS: A total of 67 term newborns with perinatal asphyxia were included and randomized into three groups: one group received supportive treatment; another group received a single dose of 40 mg/kg phenobarbital; and the third received three daily doses of 1000 IU/kg erythropoietin. The following parameters were analyzed: gestational age, birthweight, Apgar scores, cord blood pH, total serum antioxidant status (TAS), superoxide dismutase (SOD), glutathione peroxidase (GPx) and malondialdehyde (MDA). The newborns were included in the follow-up program and examined up to 18 months of age. RESULTS: TAS was higher in the erythropoietin group than in the other groups. SOD and GPx were lower for infants treated with phenobarbital or erythropoietin compared to control infants. MDA was lower in the erythropoietin group compared to the other groups, although the difference was not statistically significant (P > 0.05). The mortality rate was lower in the phenobarbital and erythropoietin groups (both 4.6%) than in the control group (17.4%). Long-term neurologic follow up showed a high incidence of sequelae in the control group compared to the phenobarbital and erythropoietin groups. Follow-up results were better in the phenobarbital group than in the erythropoietin group for motor and cognitive function at 3 and 6 months and worse for expressive language. At 18 months, however, the differences between these two groups were not significant. CONCLUSION: High-dose phenobarbital or erythropoietin along with supportive treatment has a positive influence on the outcome of newborns with perinatal asphyxia. Phenobarbital has the advantage of low cost and simplicity.

Physicians' Opinion and Practice of Vitamin K Administration at Birth in Romania.

(1) Background. Vitamin K is recommended worldwide as a standard of care for the prophylaxis of vitamin-K-deficiency bleeding (VKDB). This is also a standard practice in Romania, but due to the rising number of refusals by parents of basic interventions in the neonatal period, we aimed to assess the Romanian neonatologists' opinions and current practice regarding vitamin K administration at birth. (2) Methods. We designed and conducted an electronic survey addressed to 110 physicians working in Romanian hospitals. (3) Results. Half of respondents are accustomed to receiving refusals for vitamin K administration once or twice a year. When parents refuse vitamin K administration, they usually refuse other neonatal interventions, according to 90.9% of the responding physicians, and this situation has occurred more frequently during the last two years. The number of refusals and especially their increase are more frequent in level III hospitals (p = 0.0304, p = 0.0036, respectively). Only 22.7% of the physicians responded that they would recommend an oral preparation of vitamin K in the absence of intramuscular prophylaxis. (4) Conclusion. Efforts should be made to address parents' concerns and to have available alternatives to the intramuscular administration of vitamin K.

A Case of Inherited t(4;10)(q26;q26.2) Chromosomal Translocation Elucidated by Multiple Chromosomal and Molecular Analyses. Case Report and Review of the Literature.

We present a complex chromosomal anomaly identified using cytogenetic and molecular methods. The child was diagnosed during the neonatal period with a multiple congenital anomalies syndrome characterized by: flattened occipital region; slight turricephaly; tall and broad forehead; hypertelorism; deep-set eyes; down slanting and short palpebral fissures; epicanthic folds; prominent nose with wide root and bulbous tip; microstomia; micro-retrognathia, large, short philtrum with prominent reliefs; low set, prominent ears; and congenital heart disease. The GTG banding karyotype showed a 46,XY,der(10)(10pter→10q26.2::4q26→4qter) chromosomal formula and his mother presented an apparently balanced reciprocal translocation: 46,XX,t(4;10)(q26;q26.2). The chromosomal anomalies of the child were confirmed by MLPA, and supplementary investigation discovered a quadruplication of the 4q35.2 region. The mother has a triplication of the same chromosomal fragment (4q35.2). Using array-CGH, we described the anomalies completely. Thus, the boy has a 71,057 kb triplication of the 4q26-q35.2 region, a 562 kb microdeletion in the 10q26.3 region, and a 795 kb quadruplication of the 4q35.2 region, while the mother presents a 795 kb triplication of the 4q35.2 region. Analyzing these data, we consider that the boy's phenotype is influenced only by the 4q partial trisomy. We compare our case with similar cases, and we review the literature data.

Fatal neonatal persistent pulmonary hypertension caused by vegetations of infective endocarditis - case report and review of the literature.

Neonatal infective endocarditis is a rare condition and usually pertains to a specific class of immunologically depressed preterm infants, with a long history of invasive procedures in the Neonatal Intensive Care Unit. We report the case of an aggressive and fatal neonatal infective endocarditis in a full-term infant, who developed massive endocardial vegetations on the tricuspid valve, leading to persistent pulmonary hypertension of the newborn, unresponsive to nitric oxide ventilation. Post-mortem cardiac cultures were positive with Serratia marcescens, an unusual germ for an early-onset infection, which was absent in blood cultures.

Total antioxidant status in fresh and stored human milk from mothers of term and preterm neonates.

BACKGROUND: Antioxidant defense of the body is assured by both endogenous and exogenous factors comprising several enzymes, vitamins, protein components and derivates and oligoelements. Breast milk has been proven to have important and essential antioxidant composition to prevent and protect against diseases in infancy. The objective of this study was to determine the total antioxidant status (TAS) of human milk and to evaluate the differences between premature milk and term milk at different moments of lactation (colostrum, transitional milk and mature milk). A second objective was to evaluate how TAS varies whether the human milk is refrigerated or frozen. METHODS: Pumped human milk samples of the third, seven and 30th day were collected from women who had term deliveries (30 cases) and preterm deliveries (60 cases). Samples were refrigerated (+4 °C) or frozen in domestic conditions (-20 °C) for various durations and TAS was determined using the ABTS® technique with Randox® reagents and compared for the two groups. RESULTS: Higher values were found in term versus preterm fresh milk at 30 days of lactation. A slight reduction in TAS was found after 72 h of refrigeration, while 1 week freezing produced significant decrease of total antioxidants. Freezing for 12 weeks reduced more than 50% of TAS in fresh milk. CONCLUSION: Breastfeeding provides the optimal antioxidant for neonates, regardless of gestational age. Fresh milk has the higher antioxidant power. When it is not available, refrigerated milk for 24 h is better than for 72 h and preferable than frozen milk. Freezing human milk for 3 months in household conditions markedly diminishes TAS.

The Role of Follow-up in Monitoring the Outcomes of Prematurity in a Cohort of Romanian Infants.

BACKGROUND: The rate of preterm births in Romania is one of the highest among European countries. However, there is little information regarding the ways in which premature birth affects the outcome in Romanian preterm infants. AIMS: To investigate the effects of early developmental intervention after discharge from the hospital on motor and cognitive development in preterm infants. STUDY DESIGN: Longitudinal observational study. METHODS: We performed the Amiel-Tison neurologic evaluation at discharge and the Bayley Scales of Infant Development from 3 to 24 months. Based on these evaluations, an outcome score was formulated. RESULTS: Between 2007 and 2010, 1157 of 2793 premature infants were included into the study. There was a negative correlation between the number of evaluations and the risk of developing neurologic sequelae (p<0.001). The correlation analysis demonstrated a significant association between the final category of risk at the end of the follow up program and the degree of compliance (p<0.01). At 24 months evaluation, there was a correlation between the low gestational age and the risk of developing severe neurologic sequelae (p<0.001). CONCLUSION: This study shows the importance of follow up program in decreasing the risk of developing neurologic sequelae in preterm infants.

Pulse Oximetry During the First 24 Hours as a Screening Tool for Congenital Heart Defects.

INTRODUCTION: Although screening for congenital heart defects (CHD) relies mainly on antenatal ultrasonography and clinical examination after birth, life-threatening cardiac malformations are often not diagnosed before the patient is discharged. AIM: To assess the use of routine pulse oximetry in the delivery room and at 24 hours postpartum, and to study its feasibility as a screening test for CHD. MATERIAL AND METHODS: In this prospective study, all infants born in "Cuza Voda" Maternity Hospital, Iasi, Romania, were enrolled over a thirteen-month period. Preductal oximetry was assessed during the first hour, and postductal oximetry was evaluated at twenty-four hours postpartum. Data were then analyzed to establish the sensitivity and specificity of pulse oximetry, as a screening test for CHD. RESULTS: 5406 infants were included in the study, with a mean gestational age of 38.2 weeks and a mean birth weight of 3175 grams. During the first minute, blood oxygen saturation varied between 40% and 90% and at 24 hours of life, it ranged between 90% and 100%. Following oximetry assessment, 14 infants with critical CHD were identified. Blood oxygen saturation values in infants with CHD were lower throughout the entire period of evaluation. Pulse oximetry had good sensitivity and specificity at 1 hour (Se=87.5%, Sp=95.5%) and 24 hours (Se=92.5%, Sp=97.4%) for the diagnosis of CHD. Blood oxygen saturation values at one minute, 1 hour and 24 hours are strong discriminative parameters for the early diagnosis of CHD. CONCLUSION: Routine pulse oximetry during the first 24 hours postpartum represents an early indicator of CHD to facilitate timely intervention. Pulse oximetry provides excellent sensitivity and specificity and has tremendous potential as a standard screening test for CHD during the first 24 hours of life.

Clinical, immunological and pathological profile of infants suffering from cow's milk protein allergy.

Cow's milk protein allergy (CMPA) is the most frequently encountered form of food allergy in pediatric patients and occurs secondary to cow's milk proteins (CMP) ingestion. The aim of this study is to define the profile of children suffering from CMPA and to describe the associated pathological findings. The authors performed a retrospective case-control study on 160 infants that presented with CMPA symptoms at "Sf. Maria" Emergency Clinical Hospital for Children, Iassy, Romania, between January 2013 and January 2015. Fifty-five infants were diagnosed with CMPA (Group 1 - cases group) and 105 had no proven allergy (Group 2 - control group). Mean age of patients, gender distribution and prevalence of premature birth registered no statistically significant difference between the two groups. The prevalence of familial history of allergy was higher in case of patients with CMPA (36.36% versus 20% in control group). The delay between the introduction of CMP into alimentation and symptoms' onset was significantly shorter in Group 1 (12 days) compared to Group 2 (42 days) (p=0.0051), thus pleading for an earlier onset of symptoms in case of CMPA. CMPA usually manifested through an association of gastrointestinal (76.36%), cutaneous and mucosal symptoms (70.91%). Specific IgE were positive values in 49 patients with CMPA (89.09%) and 32 patients (30.48%) without CMPA (p<0.001). Endoscopic examinations with tissue sampling were performed in 26 infants with CMPA. Focal erythema, erosions and lymphoid nodular hyperplasia were signaled in 23 cases and eosinophilic infiltration was noticed in 15 cases. In conclusion, specific IgE and pathological changes offer highly reliable methods for CMPA diagnosis.

Early intrauterine development of mixed giant intracranial teratoma in newborn: a case report.

UNLABELLED: Teratoma is one of the most frequent fetal intracranial tumors, but it usually grows very quickly and the fetus is generally a stillborn. Rare cases have slow development or are located in areas that afford immediate surgery after birth with variable chances of survival. Even more rare cases survive days or weeks, but with no chance of surgical treatment and with prolonged palliative care. We present a 34 weeks premature infant, born by C-section with a giant intracranial tumor, whose origin could not be ascertained, occupied almost all-intracranial space and survived 25 days with supportive care. The histological examination established a G3 mixed teratoma, predominantly with immature cells from all three embryonic layers. The cerebellum was normal and infra-mesencephalic structures were present. The infant presented with severe anemia and mild respiratory distress, and was out of neurosurgical therapeutic resources. Antenatal examination was normal until 30 weeks, when fetal ultrasound described a degree of hydrocephalus, but no tumor was individualized. CONCLUSIONS: G3 type complex teratoma, even rare, can be localized at cerebral level and get giant development and growth only in the third trimester of pregnancy, ending with a neonate that has no chance of survival. Such cases cannot benefit of therapeutic interruption of pregnancy and generate serious difficulties for parents and clinicians.

Correlations Among Parental and Neonatal Anthropometric Parameters, Feeding Practices and Infant Obesity.

BACKGROUND AND AIMS: Infant and adult obesity is becoming a real public health concern in Romania, similar to other countries of the European Union. Maternal obesity and excessive weight gain during pregnancy are proven risk factors for the obesity of the child. The protective role of the breastfeeding against obesity has also been demonstrated. The most important issue is whether the choice of a milk formula with the right protein composition could or not protect the newborn from becoming a future obese infant and child. Our study aims to describe the characteristics of a group of macrosomic newborns, in relation to the mothers' weight gain during pregnancy, mode of delivery, birth weight, complications at birth, time of first feeding and type of feeding during maternity stay. PATIENTS AND METHODS: We conducted a retrospective study on 179 newborns with birth weights >4000 grams, born over a period of three months (March-May) in 6 large maternity hospitals in Romania. RESULTS: the newborns had a mean gestational age of 39.5 weeks and a mean birth weight of 4195 grams. Male newborns were prevalent (74%). More than half were born by Cesarian section and had Apgar scores with a median of 9. Macrosomes are prone to complications at birth and in our study those were mainly hypoglycemia and birth trauma. Time at first feeding was 95 minutes (mean), with a high percentage of formula/mixed feeding (68%). CONCLUSION: Macrosomia itself attracts the risk of birth by cesarean section (54% of study group), birth trauma and a low rate of exclusive breast milk feeding (32% of study group) at discharge.

[Procalcitonine--early marker of neonatal infection]. / Procalcitonina marker rapid al infectiei neonatale.

UNLABELLED: Neonatal infection represents the third most important cause of mortality in Neonatal Intensive Care Units (NICU), following perinatal asphyxia and respiratory distress syndrome. The incidence varies according to the level of care, between 5% in level II neonatal wards and 20% in the NICUs. The lack of specific early markers for infection could be partially responsible for the lack of antibiotic treatment or unnecessary treatment. In this context, many variables were examined as markers for sepsis. Large concentrations of C-reactive proteine (CRP) and procalcitonine (PCT) were positively correlated with the severity of the infection and generally indicated a poor outcome. AIM: The aim of this study is to demonstrate the utility of PCT as a fast, early and routinely used marker of neonatal infection, correlated with CRP, clinical symptoms and blood cultures. MATERIALS AND METHODS: this is a retrospective-prospective study on 2 lots of newborns from two neonatal wards of different levels of care (Lot I - 32 newborns from the Cuza-Voda NICU in Iasi, born in 2010, Lot II - 127 newborns from the Buna Vestire Maternity in Galati, born during 2008-2009). PCT was assessed before the beginning of the antibiotic treatment in newborns with high risk of sepsis or newborns with proven sepsis as corroborated with complete blood counts, CRP, fibrinogen, clinical symptoms and blood cultures. RESULTS: Among risk factors for neonatal infection, those found more often in newborns with proven sepsis are: ruptured membranes over 18 hours (p=0.043), Gram-negative bacilli colonization (p=0.003), respiratory distress syndrome (p=0.0008), abdominal distention (p=0.0042), oedema (p<<0.05) and necrotizing enterocolitis (p<<0.05). High values for PCT in premature newborns show the high risk for infection for this category of newborns, due to immunological imaturity and the presence of risk factors. High sensitivity and specificity of PCT (specificity =88.98%, sensitivity=87.5%) showed that the accuracy of PCT assessment in studied lots was 88.68% during the 24-72 hours of life time frame. CONCLUSION: High serum levels of PCT in studied lots plead for the usage of PCT for the fast and early diagnostis of neonatal infection. In those cases with positive PCT and negative blood cultures or positive CRP and clinical symptoms of infection, PCT would be a useful tool, aiding in the initiation or termination of antibiotic treatment, which would ultimately lead to lowering costs. PCT as a screening tool for cases with risk factors for infection is still to be analysed in terms of costs versus benefits and the longterm implications of neonatal sepsis and antibiotic treatment.

[Incidence of congenital malformations in the Iasi "Cuza Voda" Maternity Hospital]. / Cercetari privind incidenta malformatiilor congenitale în Spitalul Clinic "Cuza Voda" Iasi.

AIM: To update the data on the incidence of congenital malformations in our area and emphasize the importance of prenatal diagnosis. MATERIAL AND METHODS: The study was conducted over a period of ten years and included 2211 cases with congenital malformations. Such parameters as the incidence of malformations over these years, gestational age at the moment of diagnosis, and mortality from congenital malformations were followed. Statistical and graphical data were processed with the help of SPSS 16.0 and MS Excel software. RESULTS: The total prevalence of malformations was 3.52%, comparable with the data in the literature. Over this period a number of 262 cases (11.8%) ended in spontaneous miscarriage or termination of pregnancy for fetal abnormalities. A significant percentage of these pregnant women gave birth to their child, many of them dying shortafter. CONCLUSIONS: Congenital malformations remain the leading cause of mortality in neonates. In Romania, the advanced techniques of prenatal diagnosis being used only in specialized centers, and a large number of cases may escape early diagnosis. This study underlines the importance of a correct assessment of fetuses so that the discovery of fetal abnormalities at birth not to be a surprise.

[Effect of preoperative administration of prostaglandin E1 on cerebral blood flow in newborns with ductal-dependent congenital cardiac malformations]. / Efectele administrarii preoperatorii a prostaglandinei E1 asupra fluxului sanguin cerebral la nou-nascutul cu malformatie congenitala cardiaca ducto-dependenta.

UNLABELLED: Although the absolute number of congenital structural heart disease has not changed over the years, more and more infants undergo surgical interventions in the neonatal period, increasing the number of children and adults with post surgical status of cardiac disorders. Prostaglandin E1 (PGE1) is the first line drug to maintain or reopen the ductus arteriosus, until surgical intervention can be made. Cerebral blood flow (CBF) is regulated by multiple factors, like pO2, pCO2, pH, cardiac output and systemic blood pressure. The aim of the study was to determine how CBF changes after PGE1 administration in these newborns. MATERIALS AND METHODS: We studied the pO2, pCO2, mean systemic blood pressure, and cerebral blood flow velocities by colored and pulsed Doppler ultrasonography in 36 newborns with ductal dependent cardiac malformation before and after prostaglandin E1 administration, and correlated them to normal values for the age. RESULTS: We found that cerebral blood flow velocities followed the variations of blood pressure in restricted pulmonary circulation; improvement of oxygenation went parallel with decrease of cerebral diastolic velocities, and in aortic coarctation cerebral velocities decreased after introduction of PGE1. CONCLUSIONS: PGE1 administration improved cerebral blood flow velocities in all forms of cardiac malformations, due to reorganization of cardiac output and changes in oxemia. Key

[Germ circulation in neonatal units--risk factors for maternal-foetal infection]. / Circulatia germenilor in sectiile de nou-nascuti factori de risc pentru infectia materno-fetala.

UNLABELLED: Infections are the third most important cause of morbidity and mortality in neonatal units. Infection rates are 2-5% in I-II level units, 10% in IIIrd level units and 7-24% in NICUs. AIM: To identify risk factors contributing to maternal-foetal and hospital infections in neonatal units of different levels in two maternity hospitals in Romania: Buna Vestire Obstetrics and Gynaecology Hospital in Galati (Lot A) and Cuza-Voda Obstetrics and Gynaecology Hospital in Iasi (Lot B). MATERIAL AND METHODS: This is a retrospective and prospective study during four years in two neonatal units in maternity hospitals of different levels from Moldova: level II - Lot A and level III - Lot B. RESULTS: Neonatal infection rates were significantly higher in preemies compared to term newborns (5.91% - Lot A vs. 9.9% - Lot B). Predominant maternal colonization and infection bacteria were E. coli (16.12% - Lot A vs. 12.6% - Lot B) and S. aureus (1.3% - Lot A vs. 2.03% - Lot B). Personnel colonization, predominantly with MRSA, presented little hazard for neonatal infection (RR 0.9 - Lot A, RR 0.7 - Lot B). Hospital environment contamination also presented minor risk for neonatal infection (RR 1.7 - Lot A, RR 0.2 - Lot B). CONCLUSIONS: The main risk factors for neonatal infections were gestational age (premature infants have immunological underdevelopment) and maternal colonization. Personnel colonization and hospital contamination are of little importance in the development of neonatal infections.

[Research on the incidence and prevalence of congenital abnormalities in Iasi district and Iasi city, from 2001 to 2008]. / Cercetari pentru cunoasterea incidentei si prevalentei anomaliilor congenitale, în judetul si municipiul Iasi, in perioada 2001-2008.

UNLABELLED: Congenital abnormalities (CA) are deviations from the normal embryonic development that appear antenatal and they are characterized by the alteration of the morphology and function of an organ, system of organs or even of the entire body. MATERIAL AND METHOD: The study, on a period of eight years, included 1685 children with CA, from which 58% were males and 50% were from the country-side. RESULTS: It has been observed that 36% of the CA cases were premature births and 64% were normal term births. Also, 21% of the children with CA weighed less than 2700 grams at birth and 79% weighed more than 2700 grams at birth. The birth's APGAR score has been less than 7 in 30% of the cases and higher than 7 in 70% of the cases. 72% of the cases were natural births and 28% were caesarian births. 88% of the CA cases were singular congenital abnormalities and 12% were multiple congenital abnormalities. 24% of the CA were cardiac abnormalities and 21% were skeletal abnormalities. 3% of the subjects of the study have died, of which 69% died from cardiac abnormalities, 22% from hydrocephalus abnormalities, 7% from diaphragmatic hernia and 2% from renal congenital abnormalities.

[Clinical epidemiological retro prospective studies on the incidence and prevalence of cardiac congenital abnormalities in a group of 1570 children, born in Iasi between 2000-2009]. / Evaluari clinico-epidemiologice, retro-prospective asupra incidentei si prevalentei unor malformatii congenitale de cord, pe un lot de 1570 de copii, nascuti in judetul si in municipiul Iasi, in perioada 2000-2009.

MATERIAL AND METHOD: The study has been conducted on a period of ten years and it included 1570 children with congenital abnormalities (CA), of which 371 (24%) were cardiac abnormalities, 312 (20%) were skeletal abnormalities, 55 (3%) were Down Syndrome and 832 (53%) were other pathologies. RESULTS: 48% of the 371 children that were diagnosed with cardiac CA were males, while 52% were females; 52% of the children were from the city, while 48% were from the country-side; 42% of the children have been born prematurely, while 58% of them have been born at normal term. 38% of the children had an APGAR score lower than 7 and 62% of them had an APGAR score higher than 7. Of the total number of births, 72% were caesarian births and 28% were natural births. The different types of Cardiac CA that have been encountered in the study were atrioventricular canal (56%), transposition of the great vessels (18%), common arterial trunk (10%), atrial septal defect (8%), ventricular septal defect (5%) and tetralogy of Fallot (3%). 66% of the total number of deaths were represented by those with cardiac pathology, 21% were caused by hydrocephalus, 7% were caused by diaphragmatic hernia, 4% had renal CA, while 2% were caused by other pathologies.

[Disorders of the acid-basic balance in the post-hypoxic suffering at newborn babies]. / Perturbari ale echilibrului acido bazic in suferinta posthipoxicu la nou-nascut.

UNLABELLED: The study aims to asses the acid-basic disorders and the blood gasses in the blood of the umbilical cord and their correlation with the evolution of the newborn baby in the maternity hospital. MATERIAL AND METHOD: 157 newborns with perinatal asphyxia hospitalized (2002-2005) in the Maternity of "Sf. Apostol Andrei" Clinical Emergency Hospital of Galati, following-up the gestation age, the Apgar score, the risk factors of perinatal asphyxia, the pH in the cord and the evolution of the blood gasses in the cord, the start and evolution of neurologic disorders. RESULTS: The main risk factors for the asphyxia production: prematurity (64% of the cases and 25% of the cases with gestation age below 30 weeks), HTA induced in pregnancy, IUGR 39.4%. The Apgar score at one minute: values between 0-3 (40.8% cases), progressively decreasing to 20 minutes in 1.3%. 50% of the new born babies showed severe acidosis in the cord: pH > 6, 9, hypoxia in the cord blood was of 75%. The neurologic disorders started from the birth in all cases, with evolution to decease in 25.5% of the cases, higher incidence in prematures and a significant correlation with the pH in the cord.

[Aspects of practical diagnosis in perinatal post-hypoxic cardiomiopathy]. / Aspecte practice de diagnostic in cardiomiopatia posthipoxica perinatala.

UNLABELLED: Retrospectively the Perinatal Post-Hypoxic Cardiac disorder, was researched in 32 newborn (ages 0-14 days), having a normal weight, with hypoxia at birth, Apgar score 3-7, requiring resuscitation at birth. The patients did not show signs of major cardiac suffering, except a systolic murmur, the neurologic manifestations prevailing. RESULTS: The investigations showed: cardiomegaly (46.9%); ECG: repolarization disorders of the left ventricle (LV) (43.5%); echocardiographic modifications in 67.2% of cases, mainly hypertrophic cardiomyopathy with septal predominance (59.3%) and LV diastolic dysfunction. The treatment with spironolactone generated the significant decrease of the septal myocardial hypertrophy and of the tricuspidien insufficiency, with the normalization of the LV diastolic function. CONCLUSION: The echocardiographic examination, as the main method of diagnosis and follow up of the cardiomiopathy induced by the perinatal hypoxia has to be performed right in the 1st week of life and later on up to the cure of the morphologic and functional cardiac modifications.