Slobodan Spasojevic

A simultaneous comparison of four neonatal pain scales in clinical settings

Objective. To evaluate the usefulness of four neonatal pain scales (DAN, NIPS, PIPP, and NPAS) in describing newborns response to a painful event in clinical settings. Methods. Prospective observational study at university-affiliated neonatal unit. Three hundred-sixty newborns were observed during venepuncture and heel lancing as a part of routine blood workout. Values of pain scales were determined in three time frames (start of procedure – T0, maximal response – T1, end of procedure – T2). Results. In T0 versus T1 time frame, a sharp increase of percentage was observed in all pain scales independently of procedure with high statistical significance (P ∼ 0.00). NIPS showed the highest (venepuncture 742%; heel lancing 1472%) and PIPP the lowest increase (venepuncture 303%; heel lancing 510%). In T1 versus T2 time frame, for venepuncture NIPS showed the highest (49%) and PIPP the lowest (38%) percentage of decrease, whereas for heel lancing PIPP had the highest (28%) and NIPS the lowest (20%) one. All pain scales showed significant individual and overall variability (CV > 30%). PIPP had the lowest (42.7 + 14.3) and NIPS the highest (103.8 + 91.3) overall coefficient of variation. DANs confidence parameters were the most uniform ones (se 1.0, sp 0.93, ppv 0.93, npv 1.0), whereas PIPPs confidence parameters were the highest while measuring high intensity pain (se 0.94, sp 1.0, ppv 1.0, npv 0.94). Conclusion. DAN is a pain scale convenient for the use in clinical settings, especially if a fine distinction of magnitude of the present pain is not needed, whereas PIPP can be used if adequate equipment is available.

The influence of EPO and hypothermia on the kidneys of rats after perinatal asphyxia

The aim of this study was to determine the effects of erythropoietin (EPO), moderate hypothermia, and a combination thereof on the kidneys of newborn rats damaged during perinatal asphyxia. An animal model of perinatal asphyxia (Wistar rats) was used in which after birth, newborn rats were divided into four groups of 15 animals each: G1, rats exposed only to asphyxia; G2, rats exposed to asphyxia and hypothermia (rectal temperature 32°C) and which received EPO (darbepoetin alpha) intraperitoneally; G3, rats exposed to asphyxia and hypothermia; G4, rats exposed to asphyxia and which received EPO. The rats were sacrificed on the 7th day of life and histopathological evaluation of kidneys was performed. Damage to the proximal tubules was significantly higher in group G1 rats than in groups G2, G3, and G4 rats (p < 0.01). Damage to the distal tubules was found only in group G1 rats. Histological changes in the proximal tubules were more prominent than in the distal tubules (p < 0.01). The immature glomeruli zone was less expressed in group G4 rats than in groups G1, G2, and G3 rats (p < 0.01). Based on these results, we conclude that EPO and hypothermia, as well as the combination thereof, have a protective effect on rats’ kidneys damaged during perinatal asphyxia.

Neuroprotective effects of hypothermia and erythropoietin after perinatal asphyxia in newborn rats.

Abstract Objective: Evaluation of neuroprotective effects of hypothermia, erythropoietin and their simultaneous use after perinatal asphyxia in newborn rats. Method: Histerectomy was performed to Wistar female rats on the last day of gestation. Perinatal asphyxia was induced by submersion of uterus containing pups in saline for 15 min. After resuscitation, pups were randomized into 4 groups, 15 animals in each: G1 – asphyxia; G2 – asphyxia + hypothermia (rectal temperature 33 °C for 1 h); G3 – asphyxia + erythropoietin (Darbepoetin-α 2.5 μg, intraperitoneally) and G4 – asphyxia + erythropoietin + hypothermia. Pups were sacrificed on 7th day of life and histopathological analysis of hippocampus was performed. Results: Measure of damage to dorsal, ventral and entire hippocampus was significantly lower in groups G2, G3 and G4 than in group G1 (p ∼ 0.00; respectively). Measure of damage to hippocampus in group G4 was significantly lower than in group G2 (p = 0.029). Conclusions: This study demonstrates that simultaneous use of hypothermia and erythropoietin has more expressed neuroprotective effects than sole use of hypothermia after perinatal asphyxia in newborn rats.

Newborns from in vitro fertilization conceived pregnancies

Infertility, defined as ‘unsuccessful conception after 1 year of unprotected intercourse’ is an increasing problem in many countries. Demographic data in Serbia continue to show negative trend of depopulation. One-third of married couples in Serbia are childless and half of them cannot have offspring due to health problems. Analysis of morbidity and mortality of premature newborns IVT (in vitro fertilization) conceived and treated in two Department of Intensive Care, in Novi Sad and Belgrade, Serbia during 2 years. Significant number of IVF conceived newborns are treated at NICUs. Prematurity, low birth weight, perinatal asphyxia, systemic infection, as well as proper initial stabilization, especially prevention and early treatment of systemic hypotension are important factors contributing to morbidity of these patients.

Chronic Inflammatory Demyelinating Polyradiculoneuropathy, in an 8-Year-Old Girl, Complicated by Deafness and Kidney Fibrosis

Based on case history and clinical and electrophysiological examinations, the authors report on a case of an 8-year-old girl who was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy. The disease was complicated by deafness and kidney fibrosis. During treatment with methylprednisolone and intravenous immunoglobulin, followed by mycophenolate mofetil, prompt improvement of neurological findings occurred. The improvement of hearing was poor. Because the pathogenesis of chronic inflammatory demyelinating polyradiculoneuropathy has still not been clear, and on the grounds of several cases of chronic inflammatory demyelinating polyradiculoneuropathy conjoined with the kidney disease described in literature (glomerulopathy, interstitial nephritis), every patient with chronic inflammatory demyelinating polyradiculoneuropathy needs to undergo the urinalyses.

[Morbidity and mortality of premature neonates after introduction of national in vitro fertilisation programme--our experience].

INTRODUCTION Infertility occurs in approximately 10% of couples and in vitro fertilisation (IVF) is its most efficient treatment method. The National IVF Programme started in October 1st, 2006. OBJECTIVE Examination of morbidity and mortality of premature neonates conceived by IVF after initiation of the National IVF Programme. METHODS Retrospective analysis of history charts of IVF premature neonates treated at the Neonatal Intensive Care Unit (NICU) of the Institute of Child and Youth Healthcare of Vojvodina, Novi Sad, Serbia, from March 1st, 2007 to March 1st, 2008. RESULTS Of 189 treated premature neonates, 25 (13.23%) were IVF conceived, with mean gestational age (GA) of 29.46 +/- 3.28 gestational weeks (GW), one-minute Apgar score 5.44 +/- 2.45, five-minute Apgar score 7.16 +/- 1.92 and birth weight (BW) 1299 +/- 484.35 g; from singleton 12 (48%), twin 10 (40%), and trigeminal 3 (12%) gestations. The largest number of neonates were of GA between 29 and 31.9 GW (12; 48%) and BW between 1500 and 2499 g (9; 36%). All of them were treated due to respiratory distress syndrome, complicated in 2 (8%) with air leak syndromes and in 4 (16%) with pulmonary haemorrhage. Congenital anomalies were detected in 2 (8%) and intracranial haemorrhage developed subsequently in 21 (84%) neonates. Lethal outcome occurred in 7 (28%) neonates, in all cases in lower gestation groups (<29 GW). Variable analysis showed significantly higher incidence of chorioamnionitis (p = 0.0004) and lower GA (p approximately 0.00), BW (p approximately 0.00), one-minute Apgar score (p = 0.0007) as well as significant difference in prophylactic surfactant application (p approximately 0.00) and mean arterial pressure on admission (p = 0.002). CONCLUSION Morbidity and mortality of IVF premature neonates does not differ significantly from that of other premature neonates treated at NICU. Prematurity and low BW are important factors in pathology of these neonates and final outcome is influenced by perinatal asphyxia, risk of systemic infection, prophylactic surfactant application and arterial hypotension.

Prenatal urinary ascites due to the idiopathic bladder rupture

The case of intrauterine idiopathic bladder rupture with consecutive urinary ascites is presented. Conservative management resulted in complete resolution of the lesion.

Etiology and Outcome of Severe Apparent Life-Threatening Events in Infants.

Introduction An apparent life-threatening event (ALTE) is defined as “an episode that is frightening to the observer and is characterized by some combination of apnea, color change, marked change of muscle tone, choking, or gagging.” Objective The aims of this study were to determine etiology and outcome of severe ALTE (requiring resuscitation measures) and to review diagnostic approaches in infants hospitalized after such an episode of ALTE. Methods Retrospective analysis included patients hospitalized at the Intensive Care Unit, Institute of Child and Youth Healthcare of Vojvodina, after an episode of severe ALTE over a 4-year period. Results The study included 23 infants, 18 male (78.3%), and 5 female (21.7%). The average age at presentation was 78 days (1 day to 11 months). In 8 infants (34.7%), ALTE resulted in death. The most frequent conditions after diagnostic evaluation were lower respiratory tract infections (39.1%), intracranial and extracranial hemorrhages (13.0%), and central nervous system infections (8.6%). The cause remained unknown in 8.7% of cases. Initial investigations included complete blood cell count, C-reactive protein or procalcitonin, blood gasses, lactate, electrolytes, glucose, blood culture, urinalysis, and chest x-ray. Conclusions Apparent life-threatening event represents a diverse disorder. Lower respiratory tract infections and neurological disorders were the most common established etiology. Prematurity and congenital heart diseases stood out as important risk factors. Diagnostic evaluation varied according to suspected cause and trigger factors.

RISK FACTORS ASSOCIATED WITH FAILURE OF EXTUBATION IN VERY-LOW-BIRTH-WEIGHT NEWBORNS.

Abstract Aim: To identify risk factors associated with the failure of extubation of mechanically ventilated very-low-birth-weight newborns. Study design: Prospective observational study. Assessment of the occurrence of extubation failure in relation to demographic and ventilation parameters, the SpO2/FiO2 ratio, the spontaneous breathing test (SBT) and values of the Silverman–Andersen score (SAS). Extubation failure was defined as the need for reintubation for any reason within 72 h after extubation. Results: Extubation failed in 14/50 (28%) patients. Tidal volume applied at the moment of extubation (p = 0.030), the values of the SpO2/FiO2 ratio (p = 0.006), SBT (p = 0.034) and SAS measured for 60 min after extubation and later (p = 0.010, p = 0.000001, p∼0.000, respectively) showed a significant association with reintubation. Conclusions: Measured TV, SpO2/FiO2 ratio, SBT at the moment of extubation and values of SAS starting 1 h after extubation might be valuable parameters in identifying those VLBW newborns in the risk to fail extubation.

Sudden death in children

Milena BJELICA Institute of Child and Youth Health Care of Vojvodina Hajduk Veljkova 1