Predictors and incidence of hospitalization due to respiratory syncytial virus (RSV)-associated lower respiratory tract infection (LRTI) in non-prophylaxed moderate-to-late preterm infants in Bosnia and Herzegovina.

Prematurity is a risk factor for respiratory syncytial virus (RSV)-associated lower respiratory tract infections (LRTIs), due to immature humoral and cell-mediated immune system in preterm newborns, as well as their incomplete lung development. Palivizumab, a humanized monoclonal antibody against the F glycoprotein of RSV, is licensed for the prevention of severe RSV LRTI in children at high risk for the disease. This study is a part of a larger observational, retrospective-prospective epidemiological study (PONI) conducted at 72 sites across 23 countries in the northern temperate zone. The aim of our non-interventional study was to identify common predictors and factors associated with RSV LRTI hospitalization in non-prophylaxed, moderate-to-late preterm infants, born between 33 weeks and 0 days and 35 weeks and 6 days of gestation, and less than 6 months prior to or during the RSV season in Bosnia and Herzegovina (B&H). A total of 160 moderate-to-late preterm infants were included from four sites in B&H (Sarajevo, Tuzla, Mostar, and Banja Luka). We identified several significant intrinsic and extrinsic factors to be associated with the risk of RSV LRTI hospitalization in the preterm infants, including: comorbidities after birth, shorter hospital stay, admission to NICU/PICU while in the maternity ward, household smoking, low maternal age, breast feeding, number of family members, and history of family/paternal atopy. Overall, our results indicated that the risk of RSV LRTI in preterm newborns can be associated with different environmental and social/cultural factors, and further research is needed to comprehensively evaluate these associations.

Limited survivability of unbalanced progeny of carriers of a unique t(4;19)(p15.32;p13.3): a study in multiple generations.

BACKGROUND: Carriership of a reciprocal chromosomal translocation (RCT) involving the short arm of chromosome 4 (4p) may result in birth of a child with Wolf-Hirschhorn syndrome (WHS) due to monosomy 4p, a priori modified by the impact of the partner chromosome imbalance. Familial transmission studies of RCT enable obtaining empirical risk figures that are essential for genetic counseling. In this study, pedigree data from carriers of a unique t(4;19)(p15.32;p13.3), ascertained by two children with WHS phenotype, were collected through five generations and empirical risk for different pregnancy outcomes was assessed. In addition, the phenotype-karyotype correlation was studied in two unbalanced children against the phenotypes of children (literature data) with pure monosomy 4p15.32 â†’ pter and pure trisomy 19p13.3 â†’ pter, accordingly. The phenotype analysis was conducted using the catalogue of traits according to the Munich Dysmorphology Database. Pedigree segregation analysis was conducted by the direct method according to Stengel- Rutkowski et al. RESULTS: A double segment imbalance, trisomy 19p13.3 â†’ pter with monosomy 4p15.32 â†’ pter, was diagnosed in WHS progeny at birth. No essential modification of WHS phenotype by the additional trisomy 19p was observed, except for a limited survivability (death in infancy). Pedigree segregation analysis covered 39 relatives showed the probability rate for liveborn with unbalanced karyotype of 3.7 ± 3.6% (1/27), for stillbirth/neonatal death at 7.4 ± 5.0% (2/27), for miscarriage at 22.2 ± 8.0% (6/27), for the chance of having a baby without unbalanced karyotype was estimated at 66.7 ± 9.1% (18/27). In addition, the value of 7.4% for genetic counseling for any carrier of RCT at risk for single segment 19p13.3 â†’ pter imbalance at birth was evaluated as such value have not been estimated so far. CONCLUSION: Carriership of a t(4;19)(p15.32;p13.3) is at low risk for an unbalanced child at birth and for stillbirth/neonatal death but high for miscarriages. The chance of having a baby without unbalanced karyotype was estimated to be high. Monosomy 4p15.32 â†’ pter together with trisomy 19p13.3 â†’ pter as a double segment imbalance in children with WHS may be connected with a limited survivability in infancy.

The Incidence and Effects of Alloimmunization in Pregnancy During the Period 2000 - 2013.

INTRODUCTION: The objective of the analysis was to examine the epidemiological aspects of maternal alloimmunization and to determine the most common antibody specificities resulting in hemolytic disease of the newborn (HDN). MATERIALS AND METHODS: The retrospective epidemiological study encompasses all pregnant women who underwent immunohematological screening and the newborn treated for HDN in the period from 2000 to 2013 in the Herzegovina region. RESULTS: The indirect Coombs test (ICT) detected antibodies against antigens in 384 (2.4%) pregnant women of the 18 800 who were tested at the Department of Transfusion Medicine. The direct Coombs test (DCT) detected antibodies against antigens in 160 (0.8%) newborn treated for HDN. The results of our 13-year study, in which 60% of the pregnant women had non-RhD antibodies, confirms this finding. CONCLUSION: However, we have reached the 21st century and the burden of alloimmunisation in pregnancy is still on our backs. The problem of immunization and HDN is still present in our region, which is a neonatal and public health problem.

Prevalence of Intellectual Disabilities and Epilepsy in Different Forms of Spastic Cerebral Palsy in Adults.

BACKGROUND: Spastic cerebral palsy may be interconnected with other neurodevelopmental disorders such as intellectual disabilities, and epilepsy. Brain synaptic plasticity and successful restorative rehabilitation may also contribute to diminish neurological deficit of patients having cerebral palsy. The aim of this study was to investigate the prevalence of intellectual disabilities and epilepsy in adult patients with different forms of spastic cerebral palsy and to find out correlation between the severity level of intellectual disabilities and epilepsy. SUBJECTS AND METHODS: Adults diagnosed with different forms of spastic cerebral palsy were analyzed during a three-month period. The investigated features were: gender and age; form of cerebral palsy; the prevalence of intellectual disabilities and epilepsy. Intellectual disabilities were divided into 4 severity levels. The correlation between the severity level of intellectual disabilities and epilepsy was statistically analyzed. RESULTS: Intellectual disability was present in 55% of patients diagnosed with spastic cerebral palsy. Epilepsy was present in 36% of such patients. It was recorded in 51.1% of quadriplegic, 21.9% of diplegic, and 19.2% of hemiplegic patients. Intellectual disability was present in 73.8% of quadriplegic, 31.3% of diplegic, and 53.8% of hemiplegic patients. The statistically significant correlation existed between the severe intellectual disability and epilepsy. CONCLUSIONS: Intellectual disabilities and epilepsy most frequently occurred in patients with most severe forms of spastic cerebral palsy. Epilepsy is strongly correlated to the severity level of intellectual disability. Such patients require additional special modes of treatment and restorative rehabilitation to improve the functional outcome.

A comparison of blood and cerebrospinal fluid cytokines (IL-1ß, IL-6, IL-18, TNF-α) in neonates with perinatal hypoxia.

Perinatal hypoxia-ischemia is a specific and important pathological event in neonatal care practice. The data on relationship between the concentrations of cytokines in blood and cerebrospinal fluid (CSF) and perinatal brain injury are scarce. The aim of this study is to evaluate changes in interleukin (IL-1ß, IL-6, and IL-18) and tumor necrosis factor alpha (TNF-α) levels in newborns with perinatal hypoxia (PNH). CSF and serum samples of 35 term and near-term (35-40 weeks) newborns with PNH, at the age of 3-96 hours, were analyzed using enzyme-linked immunosorbent assay. Control group consisted of 25 non-asphyxic/non-hypoxic infants of the same age sampled for clinically suspected perinatal meningitis, but proven negative and healthy otherwise. The cytokine values in CSF and serum samples were determined in relation to initial hypoxic-ischemic encephalopathy (HIE) staged according the Sarnat/Sarnat method, and compared with neurological outcome at 12 months of age estimated using Amiel-Tison procedure. The concentrations of IL-6 and TNF-α in serum of PNH patients were significantly higher compared to control group (p = 0.0407 and p = 0.023, respectively). No significant difference between average values of cytokines in relation to the stage of HIE was observed. Significantly higher levels of IL-6 and IL-18 corresponded to a mildly abnormal neurological outcome, while higher levels of IL-6 and TNF-α corresponded to a severely abnormal neurological outcome, at 12 months of age. Elevated serum levels of IL-6 and TNF-α better corresponded with hypoxia/ischemia compared to CSF values, within 96 hours of birth. Also, higher serum levels of IL-6, TNF-α, and IL-18 corresponded better with abnormal neurological outcome at 12 months of age, compared to CSF values.

Epidemiological characteristics of children born with Down syndrome in western Herzegovina in the period of the last twenty years (1994-2013).

BACKGROUND: Children with Down syndrome (DS) are an everyday casuistry of pediatric clinical medicine. The prevalence of DS is dependent on socio-demographic and cultural conditions of a community. Antenatal screening is not carried out mainly due to religious views, and the prevalence of DS in our region is really considered a "natural phenomenon". The aim of the study was to analyze some epidemiological characteristics of infants with Down syndrome in the western region of Herzegovina in the period between year 1994-2013. SUBJECTS AND METHODS: We performed a retrospective analysis of hospital records of children who were supervised and treated at Children's Hospital through the twenty-year period. RESULTS: In this period there were 44,100 liveborn infants. Down syndrome was detected in 78 children (54 male and 24 female). The prevalence is estimated at 1.8/1,000 of live births. Aborted fetuses and stillbirths were not analyzed. 37 (47%) of the parent couples were over 35 years of age. Out of that 65 cytogenetic analysis, a regular type of trisomy 21 was found in 94% of cases, and the translocation in 6%. From major malformations (MM) heart failure was more often present (47%), then the anomaly of the gastrointestinal and genitourinary systems. Ten children (12%) died, most often in the early period of infancy due to complications of the cardiovascular system. CONCLUSION: The prevalence of DS throughout these two decades has been uniform in the region of western Herzegovina. Improvement in perinatal care in recent years caused higher survival and a better quality of life for the children with DS and thus their families. DS is less a desirable family tragedy, and increasingly a tolerable family fate.

Child- and family-centered care in the treatment of children - knowledge, attitudes, practice.

Despite the advances in medical technology, health care improvements have not always been accompanied by commensurate attention to the child's well-being. Psychological and emotional status of children during hospital treatment is often underestimated. Namely, certain kind of institutional negligence is frequently present in everyday practice in children's institutions. Many hospitals in Bosnia and Herzegovina (B&H) have become child-friendly during the implementation of the Project on Child-Friendly Hospitals supported by UNICEF and WHO. Apart from the introduction of child friendly environment, staff in hospitals was trained to provide a holistic approach. The program was closely linked to the Baby Friendly Hospital Initiative that supported breastfeeding. A few years thereafter, our focus is still on the physical treatment of sick children, whereas the attention to their anxieties, fears and suffering has failed. A more serious approach to this problem is needed and should begin at an educational level in medical school programs. Accordingly, our philosophy (mission) should change from a mechanical (techno-) medicine to holistic medicine.

Minor malformations: neonatal or anthropological story?

Minor malformations (mM) are mild physical deformities that with their incidence, number and evolution may be external indicators of hidden, more serious disorders. Most often these are recognized by the neonatologists. First studies done some forty years ago showed an average incidence of 15% in the general population of newborns and about 50% in children with major malformations (MM). A study done in Maternity Hospital Mostar covering a one-year cohort of the newborns and assessing 38 mM showed an average incidence 23.7% mM in children without MM. Twelve mM have had a frequency above 1%, many of them in the head region. The most frequent specific mM was a deep sacral dimple (4.6%). Eighteen mM malformations that appeared more often were re-evaluated three months later. A large part (50-80%) disappeared, but a small number (about 17%) were newly discovered. In the newborns with MM, the incidence of mM was 57.5%. 15 of 23 children with MM (65.2%) had more than three associated mM. The highest percentage was in the group of hypotrophic newborns. The connection of mM with MM and specificity of incidence of mM in one population are the reason why the search for mM in the neonatal period could be benefit also for children and whole population.

Vasodilatory prostaglandins in perinatal hypoxic brain damage.

Prostaglandin (PGE2 and PGI2) synthesis was determined in the cerebrospinal fluid (CSF) and serum of 19 hypoxic neonates at the age of 5-96 hours by using Enzyme Linked Immunosorbent Assay (ELISA) method. Control group consisted of 8 children of the same age whose samples were taken due to initial suspicion of neonatal meningitis. The prostaglandin concentrations in CSF were correlated with initial hypoxic-ischemic encephalopathy (HIE) stage and neurological findings of patients at the age of 12 months. The values of PGE2 and PGI2 in the CSF of children with perinatal hypoxia (PNH) were significantly higher than in the children from the control group. The values of PGI2 in serum were significantly higher than in "CSF" of patients with PNH. Although average values of PGE2 and PGI2 in the liquor were higher in children with advanced stage of HIE, the differences between different stages were not statistically significant. We did not find any significant correlation between average concentrations ofprostaglandins and neurological findings of the 12-month-old children.

Breastfeeding practices in Mostar, Bosnia and Herzegovina: cross-sectional self-report study.

AIM: To investigate breastfeeding practices among mothers of infants in the city of Mostar, Bosnia and Herzegovina. METHODS: The cross-sectional self-report study was conducted among 326 mothers of infants visiting the Advisory Center for Infants at the Medical Center in Mostar and at the Children's Department of Mostar University Hospital between January and May 2003. The data were collected from mothers by trained interviewers using a structured interview. In addition to demographic data, mothers were inquired about the frequency of breastfeeding, use of commercial infant food products, and the reasons for the termination of breastfeeding. RESULTS: According to mothers' statements, 85%, 70%, 44%, and 8% infants were breastfed at the age of 1, 3, 6, and 12 months, respectively. Significantly more infants aged < or =3 months were breast feed than not. Infant formula was given to 31%, 43%, 85%, and 62% of infants aged 1, 3, 6, and 12 months, respectively. Cow milk was given to 19% of 6-month-old infants, and the proportion of infants fed with cow milk increased with age. Tea and water were often added to the infant diet. The most frequently stated reason for the termination of breastfeeding was the lack of breast milk. Decision whether to breast feed or not was made by the mothers themselves, in 85% of cases before the delivery. Only 27% of mothers received advice on breastfeeding from the medical personnel. CONCLUSION: The number of breastfed infants decreased with their age, especially after 3 months of age. Infant formulas and cow milk were introduced into infant diet very early. The reasons stated for the termination of breastfeeding reflected unawareness of the indications for ablactation and advantages of breastfeeding. Young mothers should be better educated on breastfeeding.

Incidence of major congenital malformations in a region of Bosnia and Herzegovina allegedly polluted with depleted uranium.

OBJECTIVES: To determine the prevalence of major congenital malformations in West Herzegovina, a part of Bosnia and Herzegovina, immediately and five years after 1991-1995 military activities, which allegedly included the use of weapons with depleted uranium. METHODS: The study included all live-born and stillborn neonates and excluded all aborted fetuses in two one-year cohorts (1995 and 2000) of neonates in the Maternity Ward of the Mostar University Hospital. Malformations were recorded according to the recommendations of the EUROCAT protocol. RESULTS: Major malformations were found in 40 (2.16%) out of 1,853 neonates in 1995 (95% confidence interval [CI], 1.49-2.82%) and in 33 (2.26%) out of 1,463 neonates five years later (95% CI, 1.50-3.01%), ie, at comparable prevalence. In both cohorts, anomalies of the musculoskeletal system were the most common, followed by anomalies of the digestive system (in 1995) and the cardiovascular system (in 2000). The prevalence of malformations and the organ systems involved were essentially comparable with those in other populations not affected by military activities. CONCLUSION: Despite alleged environmental pollution in some regions of the former Yugoslavia, which was attributed to military activities and the presence of depleted uranium (the "Balkan syndrome"), there was no significant postwar increase in the prevalence of congenital malformations.