Neonatal outcomes for women diagnosed with cancer during pregnancy - single-center study

Pregnancy complicated by cancer is one of the most serious challenges of modern perinatology. The increasing number of cancers diagnosed and treated during pregnancy requires a multidisciplinary approach to optimize the treatment of the person who is pregnant and deliver a healthy child. The aim of the study is to analyze the course of the neonatal period in children of mothers suffering from cancer during pregnancy, treated in a specialist hospital for women and children. Being diagnosed with cancer during pregnancy significantly increases the risk of premature delivery, prematurity and intrauterine growth restriction. Our own observations show no significant differences during the neonatal period in children of mothers suffering from a malignant tumor during pregnancy compared to children of healthy mothers. This applies to both full-term and premature babies. Modern treatment of malignant tumors during pregnancy seems to be safe for the fetus and newborn. It is optimal to conduct oncological, obstetric and neonatological treatment in one center. It seems advisable to conduct long-term follow-up observations in children of pregnant people with cancer. Since the described groups of patients and their newborns are small and heterogeneous, in order to develop appropriate standards, it is recommended to report these cases to central registers.

Implementation of the Reimbursement Cost of Human-Milk-Based Neonatal Therapy in Polish Health Care Service : Practical and Ethical Background

BACKGROUND

A human-milk-based diet is the best option for nutritional therapy for preterm and/or sick newborns.

RESEARCH AIM

The study aims were to restructure the reimbursement rates to hospitals in Poland for infants' tube feedings to favor the use of donor human milk over formula for newborns who required supplementation of expressed mother's milk and evaluate the results of the financing change during the first year of implementation (2018).

METHODS

Financial data from hospitals were collected (2015-2016) by the Human Milk Bank Foundation using a data sheet designed by the Agency for Health Technology Assessment and Tariff System. We used data to restructure the reimbursement rates to hospitals for infants' tube feedings and implemented the changes in late 2017. The National Health Fund was requested to share reported data in 2018 concerning tube feeding services.

RESULTS

More than half (61%) of NICUs introduced human milk tube feeding for newborns. It was provided to participants (N = 5,530), most frequently to seriously ill preterm infants (66.6%). Of these infants, 2,323 were fed donor human milk. Only 1,925 newborns received formula tube feeding. However, there were large differences in frequency of services reported among various parts of the country.

CONCLUSIONS

Based on our knowledge, Poland is the only European country where the reimbursement cost for human-milk-based nutritional therapy has been implemented in a manner intended to increase the quality of health care services for preterm newborns. Equal reimbursement for expressed mother's milk and donor milk did not appear to cause overuse of donor milk based on our analysis of the 2018 data.

Birth body length, birth body weight and birth head circumference in neonates born in a single centre between 2011 and 2016

OBJECTIVES

Access to updated and accurate standards for local populations is important for the interpretation of body measurements in neonates and may have an impact on the doctor's recommendations for monitoring early childhood development.

STUDY AIM

to present individual mean values for the most prevalent body measurements (i.e. birth body length (BBL), birth body weight (BBW) and birth head circumference (BHC)) in neonates and compare them to the duration of pregnancy.

MATERIAL AND METHODS

The measurements (BBL, BBW and BHC) were collected and analyzed from over 27,000 neonates born in a single center. All women with single pregnancies with gestation ranging from 33 to 42 weeks were included in the study.

RESULTS

Mean values and statistically significant standard deviation values from population standards of BBL, BBW, and BHC were evaluated for neonates that were born between the 33rd and 42nd week of gestation. Analysis was conducted for the lower limit (10th percentile), average (50th percentile) and upper limit (90th percentile).

CONCLUSIONS

This was the first time in Polish literature when population standards were presented for three body meas-urements of neonates. With the size of the cohort, these standards can be successfully implemented into routine clinical practice, especially for screening children with body size deficits.

Characteristics of the regional human milk bank in Poland - donors, recipients and nutritional value of human milk

BACKGROUND

In case of shortage of breast milk despite proper lactation care or the poor state of the mother’s health, breast milk from human milk bank is recommended for feeding preterm infants

OBJECTIVE

This study retrospectively evaluated the first year of the operation of the Regional Human Milk Bank

MATERIAL AND METHODS

Data concerning donors was collected in the human milk bank during the cooperation. The clinical characteristics of the recipients was made on the basis of medical documentation from the Holy Family Hospital in Warsaw, Poland. Analysis of nutritional value was performed with the human milk analyzer (MIRIS AB)

RESULTS

In the first year of activity, 45 voluntary donors established cooperation, donating from 650 to 32030 ml of human milk. The content of nutrients in milk provided by donors was variable - protein 0.4-1.5 g / 100 ml, fat 1.1-7.4 g / 100 ml, carbohydrates 6.3-7.9 g / 100 ml. The average length of using donated human milk was 4 days and the average volume of milk for one infant was 282 ml

CONCLUSIONS

The donor profiles have a significant impact on the milk composition form HMB. The nutritional value can be improved by recruitment donors from mothers that gave birth prematurely and by beginning donation at earlier stages of lactation as soon as lactation is stabilized. In case of shortage of mothers own milk the immediate implementation of donors milk as a short-term support can significantly reduce the food intolerance incidence in the group of prematurely born infants

[Shame of having a disabled child]

This work is devoted to the problem of shame linked to disability in children. It has been inspired by patients - disabled infants and their parents. The shame evidently experienced during meetings with parents learning about their child's condition leads to many difficult questions. Shame is not a simple, isolated emotion. It is a complicated feeling, closely connected to various shame-related emotions and experiences. Shame leads to a sense of guilt and self-blame. Shame linked to a child's disability is a shame of 'lacking' and low self-esteem. Additionally it is feeling of nakedness, vulnerability and despoilment of intimacy; it makes parents feel forced to put their interior world on display and to show their weakness caused by their child's condition. Sometimes shame is an experience of humiliation, or hurt dignity caused by the looks of other people. It is also the shame of one's own difficult thoughts, desire to escape responsibility. It is being ashamed of experiencing shame. It is an emotion of ultimate suffering, often returning during whole life. One solution to the 'discomfort of birth' could be a lonely island. The issue is not that simple, however, and philosophy helps in this respect. A being is good and it has to be good. One cannot be someone, one is not. This is the difference between a being and a desire. There is love and acceptance, but there is also shame - even on a lonely island.

Determinants of Postpartum Vitamin D Status in the Caucasian Mother-Offspring Pairs at a Latitude of 52°N: A Cross-Sectional Study

BACKGROUND

High prevalence of vitamin D deficiency in pregnancy is recorded.

AIM

To establish determinants of postpartum 25-hydroxyvitamin D (25(OH)D) levels on mothers and offspring.

METHODS

25(OH)D level was measured in cord blood and maternal blood collected ≤3 weeks postpartum. Maternal socioeconomic status, vitamin D intake, sun exposure during pregnancy and maternal and neonatal fat mass (FM; dual X-ray absorptiometry) were assessed within 3 weeks postpartum.

RESULTS

A total of 174 mother-offspring pairs were enrolled. Maternal 25(OH)D <20 ng/ml was seen in 32 (51%) of summer and 82 (74%) of winter deliveries. Women with 25(OH)D <20 ng/ml had a 2-fold lower percentage of vitamin D intake of ≥800 IU/day than women with 25(OH)D ≥20 ng/ml (p = 0.02). FM (%) was comparable between groups (p > 0.05). Multiple regression analysis revealed the delivery season, prenatal vitamin D intake ≥800 IU/day and duration of supplementation to be the determinants of maternal 25(OH)D level (R(2) = 0.26, p < 0.001). Maternal 25(OH)D level, season of birth and duration of maternal supplementation explained 83% of the variance in cord blood 25(OH)D level (R(2) = 0.83, p < 0.001).

CONCLUSIONS

The key determinants of higher maternal vitamin D status were the summer-autumn season of delivery and prenatal use of ≥800 IU/day of vitamin D. The cord blood 25(OH)D level was mainly determined by maternal 25(OH)D level and season of birth.

Impact of vitamin D supplementation during lactation on vitamin D status and body composition of mother-infant pairs: a MAVID randomized controlled trial

OBJECTIVE

The optimal vitamin D intake for nursing women is controversial. Deterioration, at least in bone mass, is reported during lactation. This study evaluated whether vitamin D supplementation during lactation enhances the maternal and infant's vitamin D status, bone mass and body composition.

DESIGN AND METHODS

After term delivery, 174 healthy mothers were randomized to receive 1200 IU/d (800 IU/d+400 IU/d from multivitamins) or 400 IU/d (placebo+400 IU/d from multivitamins) of cholecalciferol for 6 months while breastfeeding. All infants received 400 IU/d of cholecalciferol. Serum 25-hydroxyvitamin D [25(OH)D], iPTH, calcium, urinary calcium, and densitometry were performed in mother-offspring pairs after delivery, and at 3 and 6 months later.

RESULTS

A total of 137 (79%) (n = 70; 1200 IU/d, n = 67; 400 IU/d) completed the study. 25(OH)D was similar in both groups at baseline (13.7 ng/ml vs. 16.1 ng/ml; P = 0.09) and at 3 months (25.7 ng/ml vs. 24.5 ng/ml; P = 0.09), but appeared higher in the 1200 IU/d group at 6 months of supplementation (25.6 ng/ml vs. 23.1 ng/ml; P = 0.009). The prevalence of 25(OH)D <20 ng/ml was comparable between groups at baseline (71% vs. 64%, P = 0.36) but lower in the 1200 IU/d group after 3 months (9% vs. 25%, P = 0.009) and 6 months (14% vs. 30%, P = 0.03). Maternal and infants' iPTH, calciuria, bone mass and body composition as well as infants' 25(OH)D levels were not significantly different between groups during the study. Significant negative correlations were noted between maternal 25(OH)D and fat mass (R =  -0.49, P = 0.00001), android fat mass (R = -0.53, P = 0.00001), and gynoid fat mass (R = -0.43, P = 0.00001) after 6 months of supplementation.

CONCLUSIONS

Vitamin D supplementation at a dose of 400 IU/d was not sufficient to maintain 25(OH)D >20 ng/ml in nursing women, while 1200 IU/d appeared more effective, but had no effect on breastfed offspring vitamin D status, or changes in the bone mass and the body composition observed in both during breastfeeding.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01506557.

[Frequency of hypotrophic births in the Warsaw population]

INTRODUCTION

Newborn's reduced body mass and length are regarded as an important symptom. The diagnosis requires careful observation of the individual's course of growth and metabolic condition. Various criteria are used to diagnose hypotrophy; 3rd, 5th or 10th percentile body mass are the most common, although others recommend using a value of -2.0 SDS body mass and length.

AIM OF THE STUDY

To define the frequency of body mass and length deficiency in newborns in the Warsaw population.

MATERIAL AND METHODS

4096 children born in single deliveries in 2009 at one Warsaw hospital. Body dimensions at birth were compared against the following standards, taking gestation period and sex into consideration: 1. Usher and McLean (UML). 2. A standard generally used in Warsaw maternity wards, drawn up by the Mother and Baby Institute (IMiD). 3. A standard drawn up in Wielkopolska (WLKP). Hypotrophy was diagnosed retrospectively on the basis of -2.0 SDS body mass and/or body length and 10th percentile body mass criterion.

RESULTS

Regardless of sex and the standard being applied, at least one of the analysed body dimensions fell at or below -2.0 SDS in approximately 1% of all children. In newborn boys hypotrophy was diagnosed significantly less frequently using the UML standard than using the national ones, while in newborn girls it was diagnosed less frequently using the IMiD standard than UML or WLKP. Birth mass below the 10th percentile was found in approximately 7% and in just over 3% of all newborns using the IMiD and WLKP standards respectively.

CONCLUSIONS

The absence of national standards for body length at birth makes the -2.0 SDS criterion difficult to use, while basing the diagnosis purely on evaluating body mass results in too few diagnoses of hypotrophy. Using the 10th percentile criterion allows for diagnosing hypotrophy in a few percent of newborns, while the Warsaw and Wielkopolska standards result in more diagnoses. Taking population trends into account, we postulate the need to prepare new national standards of body dimensions of newborns based on the gestation period.

Prematurity and protracted mechanical ventilation as risk factors for Pneumocystis jiroveci infection in HIV-negative neonates in an intensive care unit

This work was undertaken to elucidate some aspects of the epidemiology of Pneumocystis pneumonia (PP). We studied 42 mechanically ventilated, human immunodeficiency virus (HIV)-negative, severely ill neonates treated at an intensive care unit. The study group included 40 premature neonates and two mature neonates with lethal congenital defects. Progressive respiratory dysfunction in PP necessitated mechanical ventilation. Infection was usually noticeable on the 22nd day of life or after 12 days of ventilation. The usual manifestations included apnea, pallor, copious frothy sputum, seizures, and feeding difficulties. The diagnosis was established by detecting Pneumocystis jiroveci cysts in bronchial lavage fluid specimens (88.1% sensitivity). PP was managed with cotrimoxazole and pentamidine combination therapy administered over 14 days. No clinical improvement was noted in four neonates and three of them died during therapy. Prematurity and protracted mechanical ventilation are two risk factors for P. jiroveci infection in severely ill neonates in an intensive care unit.

[Pneumocystis pneumonia in newborns: a challenge in contemporary intensive care]

Pneumocystis jiroveci (P. jiroveci) is the etiological agent of pneumocystis pneumonia (PCP) in immunodeficient patients. The increased interest of clinicians in this particular pathogen during the past decade was prompted by rising numbers of patients with immunosuppression caused by AIDS, chemotherapy, or organ transplantation. Premature, seriously ill infants at intensive care units constitute a potential risk group for infection with P. jiroveci. Recent advances in medical sciences, owing mainly to developments in molecular biology, permitted the verification of the taxonomic position of pathogens and contributed to a better understanding of new aspects of pathophysiology and pathogenesis of PCP. It has been demonstrated that the genus Pneumocystis represents a heterogeneous group of opportunistic fungi exhibiting narrow host specificity. Pneumocystis jiroveci is the species which is specific for humans. The present paper outlines the clinical symptoms of PCP in infants, currently used diagnostic methods, and treatment procedures in PCP.

[Impact of delivery type on EGF and IGF-1 concentration in umbilical blood of newborns and their mothers' milk]

Peptide growth factors, including EGF and IGF-1, play a substantial role in child's growth and maturation processes. Growth factors found in mother's milk can modify development of the newborn and the infant, especially in the area of alimentary tract differentiation and maturation.

OBJECTIVES

Study was undertaken to evaluate impact of the delivery type on EGF and IGF-1 concentration in the umbilical blood of newborns and their mothers' milk.

MATERIAL AND METHODS

Sixty eight newborns and their mothers were examined. EGF and IGF-1 concentration was measured in serum of venous umbilical blood as well as in the mothers' milk collected on the first day of lactation. To measure EGF and IGF-1 concentration radioimmunoassay method (RIA) was applied.

RESULTS

No correlation was found between the concentration of the two growth factors in umbilical blood and the delivery type. Neither significant difference was found between EGF concentration in the milk of the mothers who had spontaneous labour and the factor concentration in the milk of the mothers who had a caesarean section. Contrary to EGF, IGF-1 concentration in the milk of the mothers who had a caesarean section was lower than in the milk of the mothers who had a spontaneous delivery. However, significant differences were observed only in a group of mothers of newborns born at term.

CONCLUSIONS

Caesarean section may disturb mechanisms of IGF-1 synthesis and release to mother's milk in the initial stage of lactation.

[Nosocomial infections in a neonatology department, 1995-2002]

Nosocomial infections in newborns department are common due to number of invasive diagnostic and therapeutic procedures, prolonged hospitalization and development antibiotic resistance culture. Sepsis achieved 1 to 8 newborn infants for 1000 live births. This is still unresolved very important medical, organization, ethical and medical problem. The aim of this study was the estimation on the number, etiology and clinical form of nosocomial infection in Neonatology Department as well as the way of spread. We analyzed nosocomial infection in 8770 newborn infants in Neonatology Department with Intensive Therapy Chair and Clinic Obstetric and Perinatology Pomeranian University of Medicine from 1995 to 2002. For this retrospective study we used data from Commission for Nosocomial Infection. In analyzed period total percentage of newborn infants with nosocomial infection was under 1%, but in NICU was over 11%. Inborn vertical infection was 26.8% and horizontal strictly nosocomial infection was diagnosed in 73.2%. Etiology was mainly due to Gram negative bacterial infection. Clinically sepsis, pneumonia and meningitis was diagnosed. Clinical manifestation and laboratory tests like CRP, PCT, blood count, leukocyte index and microbiological culture was used for diagnosis. The most often positive bacterial culture was obtained from cock, washstand, bath and medical staff. Nosocomial infections in neonatology department are significant medical problem which need continuous monitoring, systemic prevention and in case of infection early intervention.

[Bigeminal pregnancy complicated with twin-to-twin transfusion]

Twin-to-twin transfusion syndrome is one of the complications during bigeminal pregnancy usually seen between 17 and 31 weeks of gestation. The most typical symptoms of twin-to-twin transfusion are ascites, hydropericardium and generalized hydrops of donors fetus. Characteristic is also difference of body weight over 15% and hemoglobin level more than 5 g/dl between twins. The mortality rate of donors is very high approaching 50%. In this case report we found some features of twin-to-twin transfusion: time of delivery--33 weeks of gestation, mode of delivery--cesarean section, generalized hydrops of the donor. The clinical status of donors was critical--Apgar score 1-1-1. The hemoglobin level was extremely low--3.2 g/dl. The rescue treatment was not successful and donors twin died. Clinical problems of second twin was also common: polycythaemia, hypoglycaemia and hyperbilirubinaemia.

Umbilical cord blood serum procalcitonin concentration in the diagnosis of early neonatal infection

OBJECTIVE

To evaluate serum procalcitonin concentration in umbilical cord blood for diagnosis of intrauterine bacterial infection.

MATERIALS AND METHODS

A prospective study was conducted between 2000 and 2001. Serum procalcitonin concentrations were evaluated in 187 umbilical cord blood samples. Five groups have been defined: controls A (n=37), full-term noninfected B1 (n=80) and infected neonates B2 (n=8), preterm noninfected C1 (n=38) and infected C2 (n=24) newborns. An immunoluminometric assay was used to determine procalcitonin concentration. The Mann-Whitney U-test and Spearman's correlation ratio were applied. The sensitivity and specificity, the positive and negative predictive values, and the area under receiver operating characteristic curves were calculated.

RESULTS

A statistically higher serum procalcitonin concentration was found in the preterm infected group (p<0.005; C2 vs A and C1).

CONCLUSION

Serum procalcitonin concentration in umbilical cord blood may be a useful parameter in the diagnosis of early neonatal infection.

[Complications during the neonatal period in newborns of adolescent mothers]

In 1990-1992 64 female and male newborns born by adolescent mothers were examined in Obstetrics Clinic of Pomeranian Medical Academy in Szczecin. There were analysed such factors as sex, gestational age, birth weight, clinical condition of newborns after birth, Apgar scores, frequency of perinatal trauma. It was observed that the percentage of prematurity, complications in neonatal adaptation, perinatal trauma and infections were significantly higher in the examined group. It was found that newborns from adolescent mothers formed a high risk group with neonatal complications. In consequence a great number of disorders can be expected in the postnatal development of newborns.