Aušrelė Kudrevičienė

The value of ultrasonography and Doppler sonography in prognosticating long-term outcomes among full-term newborns with perinatal asphyxia.

BACKGROUND AND OBJECTIVE The aim of the study was to determine the correlation of hypoxic-ischemic (HI) brain injury in full-term neonates detected via ultrasonography (USG) and blood flow parameters evaluated via Doppler sonography (DS) with long-term outcomes of mental and neuromotor development at the age of 1-year. MATERIALS AND METHODS In total, 125 full-term neonates (78 subjects of case group and 47 subjects of control group) were studied. During the first five days of life, the subjects daily underwent cerebral USG and DS. At the age of 1-year the neuromotor condition and mental development was evaluated. RESULTS The HI injury groups detected during USG significantly correlated with the mental development groups (r=0.3; P=0.01) and the neurological evaluation groups (r=0.3; P<0.001). In the presence of brain swelling (edema) and thalamus and/or basal ganglia (E/T/BG) injury, USG demonstrated high accuracy values when prognosticating spastic quadriparesis and severe mental development impairment in 1-year-old subjects: sensitivity - 100%, specificity - 93-100%, positive predictive value (PPV) - 60-100%, and NPV - 100%. In subjects with spastic quadriparesis, mean end-diastolic velocity (Vd) values were significantly higher (P≤0.05), and mean resistive index (RI) values were significantly lower (P<0.05) than those in subjects with normal neuromotor development. In subjects with severe mental retardation, mean Vd values in ACA were statistically significantly higher, and mean RI values in ACA and ACM were statistically significantly lower than those in subjects with normal mental development. CONCLUSIONS Hypoxic-ischemic brain changes detected during ultrasonography and cerebral blood flow parameters associated with long-term outcomes of mental and neuromotor development at the age of 1-year.

Early-onset neonatal infection in Lithuania

Aim: The aim of the study was to analyze the etiology of early-onset neonatal infection (EONI), the risk factors, the forms and the time of its manifestation, and the tactics and outcomes of antibacterial treatment. Methods: During the prospective investigation, cases of newborns with diagnosed EONI and initial treatment in 2011 were analyzed. Four in-patient departments of Lithuania took part in the investigation. Results: In total, 18,778 newborns were included in the investigation. During the studied period, 209 cases of EONI were diagnosed: unspecified EONI in 168 (80.4%) neonates, pneumonia in 20 (9.6%), and early-onset sepsis (EOS) in 21 (10%) neonates. Group B Streptococcus (GBS) was responsible for 40% of microbiologically confirmed cases of sepsis. A negative blood culture was found in 11 newborns (52.4%) treated for sepsis. In all the cases, EONI was empirically treated with penicillin and gentamycin. The duration of antibacterial treatment varied between in-patient departments in Lithuania. During the studied period, 51.7% of women were screened for GBS colonization during pregnancy, and 21% of them had a positive vaginal culture for GBS; 78% of GBS carriers received intrapartum prophylactic antibiotics. Conclusions: The incidence of culture-confirmed early neonatal sepsis in Lithuania is similar to that indicated in the scientific literature, and is decreasing. Routine antenatal screening for GBS vaginal carriage in pregnant women is not universally performed in Lithuania. The duration of antibacterial treatment for EONI should be standardized in Lithuania.