Laura Suciu

Mortality and morbidity of very preterm infants in Romania: how are we doing?

Birth before 28 weeks of gestation is associated with high mortality and morbidity. The purpose of this study was to examine characteristics associated with in‐hospital mortality and morbidity among extremely low‐birthweight neonates admitted to three tertiary care centers in Romania.

Trends in outcomes of very preterm infants in Romania: A tale of three cities

Although survival of preterm infants has improved, prematurity remains the second most frequent cause of death before 5 years of age in Romania. Data on the changing mortality of Romanian preterm infants born before 29 weeks of gestation have not been available.

Congenital Heart Disease Requiring Maintenance of Ductus Arteriosus in Critically Ill Newborns Admitted at A Tertiary Neonatal Intensive Care Unit

Abstract Introduction: Congenital heart diseases (CHD) have been reported to be responsible for 30 to 50% of infant mortality caused by congenital disabilities. In critical cases, survival of newborns with CHD depends on the patency of the ductus arteriosus (PDA), for maintaining the systemic or pulmonary circulation. The aim of the study was to assess the efficacy and side effects of PGE (prostaglandin E) administration in newborns with critical congenital heart disease requiring maintenance of the ductus arteriosus. Material and method: All clinical and paraclinical data of 66 infants admitted to one referral tertiary level academic center and treated with Alprostadil were analyzed. Patients were divided into three groups: Group 1: PDA dependent pulmonary circulation (n=11) Group 2: PDA dependent systemic circulation (n=31) Group 3: PDA depending mixed circulation (n=24) Results: The mean age of starting PGE1 treatment was 2.06 days, 1.91 (+/−1.44) days for PDA depending pulmonary flow, 2.39 (+/−1.62) days for PDA depending systemic flow and 1.71 (+/1.12) for PDA depending mixing circulation. PEG1 initiation was commenced 48 hours after admission for 72%, between 48-72 hours for 6%, and after 72 to 120 hours for 21% of newborns detected with PDA dependent circulation. Before PEG1 initiation the mean initial SpO2 was 77.89 (+/− 9.2)% and mean initial oxygen pressure (PaO2) was 26.96(+/−6.45) mmHg. At the point when stable wide open PDA was achieved their mean SpO2increased to 89.73 (+/−8.4)%, and PaO2 rose to 49 (+/−7.2) mmHg. During PGE1 treatment, eleven infants (16.7%) had apnea attacks, five children (7.5%) had convulsions, 33 (50%) had fever, 47 (71.2%) had leukocytosis, 52 (78.8%) had edema, 25.8% had gastrointestinal intolerance, 45.5% had hypokalemia, and 63.6% had irritability. Conclusions: For those infants with severe cyanosis or shock caused by PDA dependent heart lesions, the initiation and maintenance of PGE1 infusion is imperative. The side effects of this beneficial therapy were transient and treatable.

Health Care Professional’s Attitude Towards the Effective Management of Pain in the Critically Ill Neonate

Abstract Introduction: Over the past 25 years, caregiver’s knowledge of pain in newborn infants has advanced from the beliefs that newborn infants do not feel pain, to the knowledge that preterm infants experience more pain compare to older children and adults. However, caregivers know that pain exists in this population and research has supported that pain continues to be untreated up to 65% of the time. Aim of the study: The purpose of this study was to investigate the attitude and knowledge of health care professionals from the area of Neonatology in Romania regarding procedural pain management in newborn infants. Material and methods: The sample consisted of 85 physicians and nurses (110 invited) working in five Neonatal Care Centres. Data were collected using a self-completion, 17 items questionnaire designed for this study. Results: With a response rate of 77.27% which was similar in nurses and physicians, respondents in our study were aware about the pain experience during procedural interventions, recognized the items of pain scales assessment, and are not comfortable with the parental presence during painful procedures. Twenty-five percent of nurses versus 9% of physicians reported rushed care as an important barrier of adequate non-pharmacological pain management (95% IC, 0.319-0.003) Conclusions: The use of pain protocols for an effective management of pain during neonatal period is required.

MANAGEMENT OF PRETERM INFANTS IN ROMANIA

Although significant improvements in Romania health indicators were made since 1990’s neonatal, post neonatal and infant mortality rates remain high in regional comparison and continue to give rise to concern. The chief aim of our project proposal “National Registry for premature neonates born before 32 gestational ages” is to maintain and improve the quality and safety of medical care. The goal is to build the research base in the areas of epidemiology/ health services research and Quality Improvement Science. We want to develop an Internet-based, real-time data entry, data management, and report-on-demand information system for: identify trends and variation in neonatal mortality and morbidity, to benchmark local trends, to monitor the effect of guidelines implementation. We want to collect a standardized, anonymous set of data from every child born at participating hospitals or transferred to a participating hospital from another hospital without intermediate discharge home. Data will be submitting to the Network electronically and will be used to provide comprehensive confidential reports to participating hospitals. De identified data will be transmitted and stored anonymously. The issue of confidentiality arises in the context of the intervention, and in the context of our research activities. The principles of confidentiality apply for individuals and for hospitals.