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.

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.

DESACYLATED GHRELIN AND LEPTIN IN THE CORD BLOOD OF SMALL-FOR-GESTATIONAL-AGE NEWBORNS WITH INTRAUTERINE GROWTH RESTRICTION

Context

Ghrelin, in both its acylated and desacylated forms, and leptin can modulate fetal energy balance and development.

Objective

The aim of our study is to assess desacylated ghrelin (DAG) and leptin values and influence on intrauterine and postnatal growth in infants with intrauterine growth restriction.

Design subjects and methods

We performed a prospective study on 39 infants recruited over five months, 20 appropriate - for - gestational - age (AGA) infants and 19 small-for-gestational-age (SGA) infants, in which we measured DAG and leptin in the umbilical cord blood and we compared their respective values between the two groups, along with auxological parameters at birth and at 10 months of postnatal age.

Results

Our results show that both DAG and leptin have lower values in SGA infants and correlate with most of the anthropometrical parameters at birth. Both hormones correlate with weight at 10 months in SGA infants, but this correlation lacks in AGA infants. Whereas DAG in the cord blood can be considered a predictor for weight at 10 months (β=0.207, p=0.001), the same cannot be stated about leptin (β=0.078, p=0.195).

Conclusion

DAG and leptin are involved in both intrauterine and postnatal development, but the extent of their role is still to be determined.

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.

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.

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.

SUPRAVIEŢUIREA NOU-NĂSCUŢILOR PREMATURI ÎN FUNCŢIE DE NIVELUL DE ACORDARE A ASISTENŢEI MEDICALE

În întreaga lume, naştereа prematură este principala cauză a mortalităţii infantile şi o cauză semnificativă a pierderii potenţialului uman de prematuri supravieţuitori pentru următoarele etape de viaţă. Obiectiv. Determinarea ratei de supravieţuire a nou-născuţilor prematuri în funcţie de nivelul de acordare a asistenţei medicale şi factorii de risc principali implicaţi în decesul nou-născuţilor prematuri cu termenul de gestaţie mai mic de 34 de săptămâni. Material şi metodă. Au fost luaţi în studiu 750 de nou-născuţi prematuri repartizaţi în trei loturi astfel: lotul I – 476 de nou-născuţi prematuri din IMSP IMşiC Chişinău (maternitate de nivel III); lotul II – 240 de nou-născuţi prematuri transferaţi din maternităţi de nivel I şi II prin linia AVIASAN şi lotul III – 34 de nou-născuţi prematuri din IMSP IMşiC Chişinău cărora li s-a administrat surfactant prin metoda LISA (Less Invasive Surfactant Administration). S-a efectuat o analiză complexă privind factorii de risc pentru mortalitate şi impactul pozitiv al condiţiilor de îngrijire. Datele au fost analizate folosind soft-ul SPSS V.21. (IBM Statistical Package for the Social Sciences, Chicago, Illinois). Rezultate. Rata de supravieţuire la 78 de zile de viaţă fost semnificativ mai mare în cazul nou-născuţilor proveniţi din maternităţi de nivel III, care au urmat terapie LISA (93,3%), comparativ cu nou-născuţii din loturile I (78,2%) şi II (78,9%). Concluzii. Supravieţuirea nou-născuţilor prematuri este o problemă multifactorială. Factorul principal ce determină rata de deces a acestor nou-născuţi îl reprezintă sindromul de detresă respiratorie (SDR), fiind urmat de greutatea la naştere (GN), vârsta de gestaţie (VG), metoda de resuscitare, displazia bronhopulmonară (DBP) şi, nu în ultimul rând, nivelul maternităţii de provenienţă. Posibilităţile moderne de reanimare a prematurilor, din maternităţi de gradul III, cresc semnificativ speranţa de viaţă a prematurilor cu vârsta gestaţională mai mică de 34 de săptămâni.

THE SURVIVAL OF PREMATURE INFANTS DEPENDING ON THE LEVEL OF MEDICAL ASSISTANCE

Worldwide, premature birth is the main cause of infant mortality and a significant cause of human potential loss of premature survivors for the next stages of life. Purpose. To determine the rate of premature infants survival depending on the level of medical assistance and the main risk factors involved in the death of preterm infants with gestational age less than 34 weeks. Materials and methods. We included in the study 750 preterm newborns divided into three groups as follows: group 1 – 476 premature newborns born in IMSP IMsC, Chisinau (level III maternity); group 2 – 240 premature infants transferred by the AVIASAN service from level I and II maternities to the level III unit and group 3 – 34 premature babies from IMSP IMsC Chisinau that received surfactant administered by the LISA method (Less Invasive Surfactant Administration). We performed a complex analysis of the risk factors for death and the positive impact of highly specialised care on survival. The data was analysed using SPSS V.21 software (IBM Statistical Package for the Social Sciences, Chicago, Illinois). Results. The survival rate at 78 days of life was significantly higher in the newborns from the level III maternity that received LISA therapy (93.3%), compared to those in group 1 (78.2%) and group 2 (78.9%) respectively. Conclusions. The survival of premature infants is a multifactorial problem. The main factor that determines the rate of death for these infants is respiratory distress syndrome (RDS), followed by birth weight (BW), gestational age (GA), resuscitation method, bronchopulmonary dysplasia (BPD) and last but not least by the level of maternity where the infants were born. These factors might be considered predictive for death of preterm newborns with gestational age less than 34 weeks.

COMPARISON OF THE EFFICIENCY OF CAFFEINE VERSUS AMINOPHYLLINE FOR THE TREATMENT OF APNOEA OF PREMATURITY

Purpose. Comparison of the efficiency of caffeine and aminophylline for the treatment of apnoea in premature neonates. Material and method. We conducted a retrospective study on two lots of premature infants admitted in the Regional Centre of Neonatal Intensive Care Unit of the “Cuza-Vodă” Clinical Hospital of Obstetrics and Gynaecology of Iasi during June 2012 – June 2015. Results. Neonates treated with caffeine had significantly less apnoea on day 3 and 14 of treatment comparing with those who received aminophylline. Caffeine treatment was associated with less need for CPAP and mechanical ventilation comparing with aminophylline, but there was no statistical significance. Anemia, intraventricular hemorrhage, persistent ductus arteriosus and chronic lung disease were correlated with an increased duration of the treatment for apnoea of prematurity. Neonates from the caffeine group had more episodes of agitation, tachycardia and digestive intolerance, but at the same time a reduced incidence of necrotizing enterocolitis, weight loss and hypertension, compared to those from the aminophylline group. The hospital stay duration was reduced in the infants that received caffeine treatment compared to those that received aminophylline. Conclusion. The therapeutic advantages of caffeine are remarkable due to low incidence of significant adverse effects and its long-term cost/efficiency ratio, which recommend it as the best treatment for apnoea of prematurity. These facts justify the initiation of a multicenter national study including a higher number of premature neonates for the evaluation of the efficiency of caffeine therapy in all gestational age groups.

COMPARAREA EFICIENŢEI CAFEINEI VERSUS AMINOFILINĂ PENTRU TRATAMENTUL APNEEI DE PREMATURITATE

Scop. Evaluarea eficienţei cafeinei comparativ cu aminofilina în tratamentul apneei de prematuritate. Material şi metodă. Am realizat un studiu retrospectiv comparativ pe două loturi de nou-născuţi prematuri admişi în Centrul Regional de Terapie Intensivă Neonatală din cadrul Spitalului Clinic de Obstetrică şi Ginecologie „Cuza-Vodă“, Iaşi, în perioada iunie 2012 – iunie 2015. Rezultate. La nou-născuţii care au primit cafeină s-a înregistrat o reducere semnificativă statistic a numărului crizelor de apnee în ziua a 3-a, respectiv a 14-a de tratament comparativ cu cei care au fost trataţi cu aminofilină. Tratamentul cu cafeină s-a asociat o uşoară scădere a necesităţii instituirii CPAP şi a ventilaţiei mecanice comparativ cu aminofilina, dar diferenţele nu au fost semnificative statistic. Anemia, hemoragia intraventriculară, per sistenţa de canal arterial şi boala pulmonară cronică s-au corelat cu creşterea duratei tratamentului pentru apnee de prematuritate. Nou-născuţii din lotul cu cafeină au prezentat mai multe episoade de agitaţie, tahicardie şi intoleranţă digestivă, însă o incidenţă mai mică a enterocolitei ulcero-necrotice, a scăderii ponderale şi a HTA, faţă de cei care au primit aminofilină. Durata de spitalizare a fost mai redusă la nou-născuţii trataţi cu cafeină, comparativ cu cei din lotul cu aminofilină. Concluzii. Avantajele terapeutice ale cafeinei sunt remarcabile prin incidenţa scăzută a efectelor adverse semnificative şi raportul cost/beneficiu pe termen lung, pledând pentru recomandarea acesteia ca tratament de elecţie pentru apneea de prematuritate. Aceste aspecte justifică iniţierea unui studiu multicentric la nivel naţional care să includă un număr mult mai semnificativ de nou-născuţi prematuri pentru evaluarea eficienţei tratamentului cu cafeină la toate categoriile de vârstă gestaţională.

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.

ASPECTE ETICE PRIVIND RECOLTAREA SÂNGELUI DIN CORDONUL OMBILICAL ÎN SCOP DIAGNOSTIC

Aprofundarea studiilor privind mecanismele genetice şi epigenetice (determinate de mediu) ale atopiei a adus dezvăluiri privind debutul intrauterin al alergiei, dovedit de prezenţa IgE în sângele cordonului ombilical. Depistarea acestor nou-născuţi şi includerea lor într-un program de îngrijiri specifice reduc morbiditatea ulterioară din cadrul marşului alergic cu efecte incontestabile asupra calităţii vieţii şi a costurilor de îngrijire medicală. Creşterea dramatică a prevalenţei atopiei în ultimele decenii sugerează importanţa determinărilor IgE în cordonul ombilical. Utilizarea în scop diagnostic a sângelui cordonului ombilical impune însă legi şi reguli clare care fac obiectul dezbaterii din prezenta lucrare.

ETHICAL ASPECTS ABOUT INFORMED CONSENT IN CORD BLOOD COLLECTION FOR DIAGNOSTIC PURPOSES

Deepening the knowledge about genetic and epigenetic mechanisms studies (environmental caused) regarding atopy, brought revelations about intrauterine onset of allergies, proven by the presence of IgE in umbilical cord blood. Detection of these newborns and their inclusion in a specific care program further reduces the morbidity of allergic march with the undeniable effects on quality of life and healthcare costs. The dramatic increase in the prevalence of atopy in recent decades suggests the importance of IgE in umbilical cord determinations. The use of umbilical cord blood for diagnostic purposes requires clear laws and rules and this is the subject we suggest to debate in this paper.

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

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.

Enterocolita ulcero-necrotică: date clinice şi posibilităţi de tratament

Obiective. Identificarea corelaţiilor între evoluţia clinică a nou-născuţilor cu enterocolita ulceronecrotică (EUN) şi stadiul de boală, factorii de risc asociaţi, respectiv tipul de tratament utilizat. Material şi metodă. S-a realizat un studiu retrospectiv pe o perioadă de 6 ani pe baza cazuisticii Centrului Regional de Terapie Intensivă Neonatală „Cuza Voda“ şi s-au identificat 205 cazuri de enterocolită ulceronecrotică dintr-un total de 6.183 de nou-născuţi îngrijiţi aici. Bolnavii au fost împărţiţi în loturi de studiu în funcţie de vârsta de gestaţie (VG), respectiv greutatea la naştere (GN). Protocolul de analiză s-a realizat pe baza unei fişe de lucru care a cuprins datele epidemiologice ale pacienţilor, factorii de risc, tipul alimentaţiei, vârsta în momentul diagnosticului, stadiul de boală conform clasificării Bell, modalitatea de tratament (medical, chirurgical sau mixt), complicaţiile înregistrate şi evoluţia pacienţilor. Prelucrarea statistică a datelor s-a făcut utilizând programul SPSS Statistics 20. Rezultate. Enterocolita ulceronecrotică a avut o frecvenţă de 3,3% în lotul studiat şi a fost diagnosticată la nou-născuţii prematuri în 75,6% dintre cazuri. VG medie în grupul de studiu a fost de 33 săptămâni. GN medie a fost de 1.896 g, cu 43% dintre cazuri în grupul cu greutate foarte mică la naştere (VLBW) şi 31,2% în grupul cu greutate mică la naştere (LBW). Incidenţa procentuală a factorilor de risc a fost următoarea în ordinea frecvenţei: persistenţa canalului arterial 19,5%, asfixia perinatală 13,7%, detresa respiratorie 100% dintre cazuri. 75,5% dintre cazuri au fost tratate şi externate din CRTIN, 16,6% dintre cazuri au fost transferate în Clinica de Chirurgie Pediatrică a Spitalului „Sf. Maria“ şi 3,9% au decedat la CRTIN. Din cele 34 de cazuri transferate, 19 cazuri au fost tratate chirurgical: 8 cazuri cu drenaj peritoneal (DP), 8 cazuri cu laparotomie primara (LAP) şi 3 cazuri cu LAP şi DP. Rata supravieţuirii în acest grup a fost 2,4%, iar pentru grupul cu tratament medical a fost 4,9%. Concluzii. Prematuritatea se corelează statistic cu stadii avansate de enterocolită în momentul diagnosticului. Modalitatea de tratament chirurgical aleasă (drenaj peritoneal sau laparotomie) nu influenţează rezultatele, iar alimentaţia enterală precoce cu formula de lapte este cel mai important factor de risc pentru apariţia EUN, urmat de vârsta de gestaţie şi greutatea foarte mică la naştere.

Neonatal necrotizing enterocolitis: Clinical data and treatment possibilities

Objectives. The aim of this paper is to identify the correlations between the clinical evolution of the neonates with necrotizing enterocolitis (NEC) and the stage of disease, associated risk factors and the type of treatment used. Material and methods. A 6 years retrospective study was performed based on reviewing the casuistry of the Regional Centre of Neonatal Intensive Care Unit (NICU) „Cuza Voda” and 205 cases of necrotizing enterocolitis were identified from a total number of 6183 neonates admitted there. Patients were divided in to study groups based on the gestational age (GA) and birth weight (BW). The analysis protocol was realized based on a working sheet that included the epidemiological data of the patients, the risk factors, type of nutrition, age at diagnosis, stage of disease according to Bell classification, type of treatment (medical, surgical or combined), complications and the general evolution. The statistical data processing was performed in SPSS Statistics 20 program. Results. NEC had a frequency of 3.3% is the study group and was diagnosed in premature newborns in 75.6% of cases. The mean GA for the study group was 33 weeks. The mean BW was 1896 g with 43% of the cases in very low birth weight (VLBW) group and 31.2% in low birth weight (LBW) group. The percentage incidence of the risk factors was as follows: persistence of ductus arteriosus 19.5%, perinatal asphyxia 13.7% and respiratory distress 100% of cases. 75.5% were treated and discharged from NICU, 16.6% were transferred to Pediatric Surgery Department „Sf. Maria” and 3.9% died in NICU. From the 34 cases transferred19 cases were surgically treated: 8 cases with peritoneal drainage (PD), 8 cases with primary laparotomy (LAP) and 3 cases with PD and LAP. The survival rate in this group was 2.4% and for the medically treated group was 4.9%. Conclusions. Prematurity is statistically correlated with encountering advanced stages of enterocolitis at the time of diagnosis. The option for surgical treatment (peritoneal drainage or laparotomy) does not influence the results and early enteral feeding with formula is the most important risk factor for NEC followed by age of gestation and very low birth weight.

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.

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.

[Incidence of congenital malformations in the Iaşi "Cuza Vodă" Maternity Hospital]

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.

[Clinical epidemiological retro prospective studies on the incidence and prevalence of cardiac congenital abnormalities in a group of 1570 children, born in Iaşi between 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.

[Germ circulation in neonatal units--risk factors for maternal-foetal infection]

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 Iaşi district and Iaşi city, from 2001 to 2008]

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.

[Effect of preoperative administration of prostaglandin E1 on cerebral blood flow in newborns with ductal-dependent congenital cardiac malformations]

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

[Disorders of the acid-basic balance in the post-hypoxic suffering at newborn babies]

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 Galaţi, 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]

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.

[Clinical and developmental aspects of cardiac involvement in infant of diabetic mother]

The authors evaluated the main clinical and evolutive aspects of heart involvement in the newborn of diabetic mother (IDM). We studied the files of 35 IDM in a 4 years period; they were investigated the first week of life and at 6-12 months (18 cases). Most of the patients were asymptomatic/signs of extracardiac suffering; 15 had a systolic murmur. ECG: left ventricle (LV) hypertrophy (8) and LV repolarization disturbances (19 cases). Chest X-ray: cardiomegaly (9 cases). Echocardiography: hypertrophic cardiomyopathy (HCM), especially septal (25 cases, 71%); LV diastolic dysfunction (19-35) and normal systolic function; pulmonary hypertension (3), other congenital heart diseases (8 cases). The control revealed the alleviation of the LV walls size and LV diastolic function. The high incidence of the cardiac manifestations in IDM and the risk of occurrence of some severe problems, require a complete cardiological exam from the first few days of life and a follow-up schedule until the normalization of the cardiac parameters.

[Antenatal corticosteroid therapy and the effects on complications of prematurity]

The respiratory distress syndrome (RDS) in the preterm neonates is the most frequent cause of morbidity and mortality in neonatal units. Corticosteroids were shown to have multiple beneficial effects in maturing fetal surfactant and in decreasing the incidence and severity of RDS, intraventricular hemorrhage and necrotizing enterocolitis.

MATERIAL AND METHODS

The authors studied 65 premies treated antenatally with corticosteroids versus 68 preterm neonates that didn't benefit from this therapy. All cases presented life threatening distress by various causes. There were evaluated the incidence of hyaline membrane disease, incidence related with gender, gestational age, the severity of respiratory distress (Silverman score), influence of the therapy on Apgar score, onset of symptomes and haematologic status, necessity of assisted ventilation and neonatal mortality.

RESULTS

We found a significant decrease in the incidence of RDS (40%), severity of vital life-threatening distress and neonatal mortality (60%). There were no significant side effects for the babies treated versus untreated.

CONCLUSIONS

Antenatal steroids given to the mother in imminence of premature birth are for real benefit in reducing neonatal mortality, increasing the number of survivors among small prematures and improving their quality of life. Even life threatening distress from other causes seem to be less severe, and even an incomplete course therapy conduces to decrease of distress severity.

[The presence in pregnant women of the risk factor of serum antibodies against 9 viruses with significance in materno-infantile pathology and the transfer of these antibodies to the newborns]

Indirect enzyme immunoassay, performed with Labsystems (Helsinki) kits, in 30 mothers and their newborns, revealed that 100% of parturient women present IgG antibody to hepatitis A (HAV), herpes simplex 1, and measles viruses, constantly transferring these antibodies to their newborns. 78.6% of the women had IgG to rubella (German measles) virus, passively transmitting them to their offsprings. Serological markers (HBsAg and anti-HBc) of hepatitis B virus infection were present in 42% of the investigated women, anti-HBc being also present in the serum of the newborns. Between the identified risk factors (in the past obstetrical history, current pregnancy, labor and early postnatal period) and the spectrum of IgG antibodies present in mothers no significant correlations were revealed. The same obvious lack of correlation between IgG antibodies and risk factors in the neonate (prematurity, low birth weight, malformations) was also found. However, the presence of IgG anti-measles (2 case), IgM anti-rubella (1 case) and IgM and HAV (4 cases) was associated, in the same order, with interstitial pneumonia, hepatosplenomegaly and death, icterus neonatorum, cardiovascular and neurologic malformations. Neither mothers nor their offsprings presented anti-HIV antibodies, suggesting that in the investigated patients no perinatal transmission had occurred.