Human milk POPs and neonatal risk trend from 1982 to 2009 in the same geographic region in Serbia.

Three groups of POPs - DDT, HCH and PCBs were monitored in early human milk for 27 years (1982-2009), as a measure of environmental pollution in the same geographic region (South Backa, Voyvodina, Serbia). Measurements were performed using ECD GC Varian 3400. Concetrations of DDT and HCH had general decreasing trend from 1982 to 2009. However, the concentrations of both groups of compounds showed small rises in 1994. Concentrations of PCBs had general decreasing trend from 1982 to 2009 - smooth and steep only till 1994 and with two small peaks in 2003 and 2009. The latest estimated daily intake of DDT and HCH was well below the EU upper limit for pesticides in food intended for infants and small children. Although the estimated daily intake of PCBs was far below the upper limit for daily milk products in Serbia, its increase in 2003 and 2009 is a clear indication of environmental influx of these compounds after the 1994 measurements. The likely explanation for such POP profiles in South Backa could have been a series of negative environmental impacts escalating in 1999, after which four hot spots were identified in Serbia (Novi Sad, Pancevo, Bor and Kragujevac) by UNEP. The results of this monitoring showed that although a long standing environmental presence of POPs has a decreasing trend, their occasional output in the environment may cause bioaccumulation and biomagnification in human organisms which already start in the neonatal age through mother-child transfer via human milk.

Cutis marmorata telangiectatica congenita in a preterm newborn - Case report and literature review.

BACKGROUND: Cutis marmorata telangiectatica congenita (CMTC) is a sporadic congenital skin vascular abnormality. Significant number of patients has other congenital anomalies. CASE REPORT: We report a case of a preterm male newborn with cutis marmorata pattern presented on the skin of the face, right side of front of the trunk, whole back, glutei and both legs. Besides, microretrognatia and asymmetric, bad-formed, low-set ears were notable. Ophthalmologic findings showed visual impairment and pale optic nerve papilla. Monitoring of child showed mental underdevelopment and motor retardation. CONCLUSION: CMTC is a rare finding with good prognosis of skin malformations, with an obligation of dermatologist and paediatrician to investigate other associated congenital anomalies.

[Prenatal diagnosis of skeletal dysplasia: case report of a fetus with multiple anomalies]. / Problem antenatalne dijagnostike skeletnih displazija: prikaz slucaja fetusa sa multiplim anomalijama.

INTRODUCTION: Skeletal anomalies are in the group of anomalies most difficult to be diagnosed antenatally. But, because of high lethality and morbidity rate as well as high possibility to be found again in the next pregnancy, they need to be systematically and actively looked for during every scan. CASE REPORT: A pregnant woman, aged 18, primigravida, was admitted to the Dept. of Obstetrics and Gynaecology because of polyhydramnios and suspected multiple fetal malformations. Fetal biparietal diameter and abdominal circumference were adequate for 33 weeks gestation, whereas all the long bones were short for the gestational age. A detailed ultrasound morphology check was impossible because of the excessive amount of amniotic fluid, but the skull, brain, lungs, spine and abdomen appeared normal. There was an impression of frontal bossing and left-sided cleft lip. A thoraco-abdominal disproportion was evident. All the extremities were short, feet were normal, and hands were not extended during the whole scan. The woman underwent an uneventful amino-drainage and three days after that she ruptured the membranes, giving birth to a live female, 2150 gr, 46 cm, Apgar score 6/7. The anomalies seen on ultrasound were confirmed after birth. After a series of dyspnea the neonate was transferred to the Dept. of Paediatrics where it underwent a series of further extensive diagnostic procedures and 37 days after birth it passed away. Postmortem examination led to the following diagnoses: Neonatus femininus eutrophicus temporis aetatis. Defectus partis memebranacei septi interventricularis. Ductus arteriosus Botalli persistence. Hypoplasia thymi. Cheliognathopalatoschisis. Low set ears. Extremitates breves. Atelectasis subtotalis pulmonis bilateralis. Foramen ovale apertum cum valvula competent. Oedema cerebri gradus maioris. DISCUSSION: Majority of fetal skeletal malformations can be relatively easily visualised during ultrasound scans and hence ultrasound is the most sensitive way of prenatal diagnosis of these anomalies. Maternal habitus, fetal position, alteration of amniotic fluid volume and gestational age can be factors that may aggravate check-ups. A prerogative for an early prenatal diagnosis of fetal skeletal anomalies is a well organized scan of each and every fetus that checks all bones, starting with the skull and finishing with hands and feet. Should an anomaly be found an extensive detailed scan by an expert should be performed, as well as karyotyping and a consultation with pediatrician/surgeon. In case of a lethal anomaly, an option of pregnancy termination should be considered and if the parents decide against it, the pregnancy should be closely monitored, with parents fully counseled about the prognosis for the child. In this case the anomaly was noted only after the 30th week of gestation and even then only because the patient came because she had some subjective difficulties because of the excessive amniotic fluid volume. On the other hand, some skeletal dysplasias can be diagnosed only in the late second, early third trimester and sometimes stay unnoticed until the end of pregnancy. This case could not be resolved definitely, for the anomalies were conclusive neither of a specific genetic syndrome, nor of an isolated skeletal dysplasia. Extensive further examination of parents as well as their families is needed in order to be able to give some information about the risks in the next pregnancy. CONCLUSION: Although skeletal anomalies are extremely difficult to diagnose antenatally, a detailed scan of a complete fetal anatomy between 20 and 32 gestational weeks with special attention given to the entire skeleton, gives certain assurance of excluding majority of major skeletal dysplasias or enables their diagnosis and further adequate plan for pregnancy management.

[Congenital leukemia--personal experience]. / Kongenitalna leukemija--nasa iskustva.

Congenital leukemia is a very rare form of acute leukemia and up to now more than 100 well documented cases have been published. Symptoms and signs of the disease may be faintly differentiated and be a differential diagnostic problem for a long period of time in comparison to other common diseases of the newborn. This is a case report on two newborns with congenital leukemia. It was an acute non-lymphoblastic leukemia in the first case, and acute lymphoblastic leukemia in the second. In both cases there were nonspecific manifestations of the disease (no weight gaining, hemorrhagic enterocolitis). In both cases polyhemotherapeutic protocols were performed. In the first case only partial remission occurred and death occurred during the hemathologic recidive of the disease. In the second case, 15 months after the diagnose of congenital leukemia has been established, complete remission is in course.

[Epidemiologic study of anemia in school children with special emphasis on hemoglobinopathies]. / Epidemioloska istrazivanja anemije u skolske dece s posebnim osvrtom na hemoglobinopatije.

A total of 746 schoolchildren of both sex (aged 7-15) were investigated in the community of Backa Palanka and Bac with the view to establishing reference hematologic values of the red lineage: Hemoglobin (Hgb) 135.3 +/- 20.4 g/l, erythrocytes (Er) 4.42 +/- 0.60 x 10(12)/L, hematocrit (HTC) 0.41 +/- 0.06, MCH: 30.5 +/- 2.7 pg, MCHC: 32.8 +/- 3.2 g/l, MCV: 93.2 +/- 5.4 fl. In only 7.3% of children hemoglobin values were below 114.8 g/l (1.5 SD) so that anemia did not represent a socio-medical problem in children aged 7-15 in the area investigated. With regard to the investigation of inherited abnormalities in the synthesis and structure of hemoglobin five children showed a persisting synthesis of fetal hemoglobin with the mildly augmented HbF values: 2.7%, 3.8%, 3.9%, 4.2% and 4.8% while the increase in HbA2 with the values for heterozygotic forms of thalassemia was found in four children thus accounting for 3.3%, 3.5%, 3.5% and 4.3%. It was concluded that although genetically induced anemias were rare they were nevertheless present in this region. They necessitated further epidemiologic studies which had been performed in the greater part of Yugoslavia but not in SAP of Vojvodina nor in the new location of SAP of Vojvodina.