Zita Gyurkovits

Assessment of respiratory mechanics with forced oscillations in healthy newborns

Lung function data in healthy newborn infants are scarce largely due to lack of suitable techniques, although data for developmental and prenatal exposure studies are much needed. We have modified the forced oscillation technique (FOT) for the measurement of respiratory mechanical impedance (Zrs) in unsedated sleeping infants in the first 3 days of life.

Adrenal haemorrhage in term neonates: a retrospective study from the period 2001–2013

Abstract Objective: To assess the incidence, risk factors and clinical presentations of neonatal adrenal haemorrhage (NAH) in uncomplicated, singleton and term deliveries. Methods: A retrospective analysis of 26 416 term neonates delivered between 2001 and 2013, and screened with abdominal ultrasonography. Results: Of the 26 416 neonates, 74 (0.28%) displayed NAH; the male/female ratio was 1.55:1. Vaginal delivery was significantly more frequent than caesarean section among them (71 versus 3; 95.9% versus 4.1%). Unilateral bleeding occurred on the right side in 36 (48.7%), and on the left in 34 (45.9%), without a significant difference; bilateral haematomas were found in four cases (5.4%). The most common risk factors were macrosomia (16, 21.6%) and fetal acidaemia (23, 31%), while four (5.4%) neonates exhibited pathological acidaemia. Clinical presentations included jaundice in 37 (50%), anaemia in six (8.1%) and an adrenal insufficiency in only one (1.3%) case. In three cases, neuroblastoma was diagnosed. Conclusions: Vaginal delivery, macrosomia and fetal acidaemia are the most important risk factors for NAH. The adrenal glands on both sides were similarly involved. In the healthy neonates with NAH, the clinical presentations were mild, with spontaneous regression. Differentiation of NAH from tumours is of considerable importance.

Comparison of oxidative stress markers in vaginal deliveries with or without epidural analgesia

Introduction Epidural analgesia (EA) is a widely accepted, safe, and reliable method of labour pain relief; it has proved to be beneficial to both mother and child. However, it can be associated with a longer second stage of labour, more frequent oxytocin augmentation, hypotension, and fever, due to changes in the maternal inflammatory reactions, and this may possibly affect the neonatal outcome. For the efficient production of energy, molecular oxygen (O2) is required as an electron acceptor in all living aerobic organisms. The cell-damaging effects of highly reactive oxygen species (ROS) such as superoxide (O2 ), hydrogen peroxide (H2O2), etc. are exerted via a variety of physiological and pathophysiological reactions and have been implicated in many diseases and the process of ageing. Most living organisms have developed well-integrated antioxidant defences to scavenge free radicals. These mechanisms include enzymes, e.g. superoxide dismutases (SODs), catalase (CAT), glutathione peroxidases (GPs), and molecules, e.g. glutathione (GSH), vitamins C and E, and betacarotene. Oxidative stress may arise when the balance between ROS and antioxidants is disturbed. The ROS can cause intracellular oxidative damage to proteins, nucleic acids, and lipid membranes through the peroxidation of unsaturated fatty acids. The ROS serve as important cell signalling molecules, but in excess they can contribute to the pathophysiology of various diseases associated with the low antioxidant capacity (such as retinopathy and bronchopulmonary dysplasia). The effects of different analgesia on oxidative balance have already been investigated in numerous articles. The literature seems to agree on the fact that local anaesthetics have potential antioxidant effect. The current study was designed to assess foetal oxidative stress indices in the cord blood of singleton, fullterm neonates of mothers who received EA on request as compared with normal vaginal deliveries without the administration of pain control. The level of GSH, the activities of the antioxidant enzymes SOD, CAT, and GP, and the extent of lipid peroxidation (LP) were determined.

Predictors of caesarean section – a cross-sectional study in Hungary

Abstract Purpose: The aim of this study was to analyse the factors associated with caesarean section (CS) at the Department of Obstetrics and Gynaecology, University of Szeged, Hungary. Study design: Data collection was based on self-administered questionnaire and medical records related to the deliveries in the year of 2014. Maternal age, education level, marital status, pre-gestational body mass index (BMI), infertility treatment, previous CS, gestational diabetes mellitus (GDM), pre-pregnancy hypertension and pregnancy-induced hypertension (HT/PIH) were examined. The participation rate was 67.3%, multiple pregnancies and questionnaires with missing data were excluded (n = 1493). Univariate and multivariate comparisons were performed. Results: There were 1125 (45.4%) CSs out of 2479 deliveries. CS rate: 40.0%. Underweight 109 (7.1%), normal 921 (60.2%), overweight 320 (20.9%) obese 181 (11.8%). HT/PIH: 7.6% (n = 117), GDM: 10.1% (n = 155). The odds of CS were significantly higher among obese mothers (OR: 1.81) compared with the normal weight group. Increasing maternal age (OR: 0.97) and being underweight (OR: 0.59) significantly decreased, previous CS (OR: 12.19), infertility treatment (OR: 1.91) and HT/PIH (OR: 1.87) significantly increased the probability of CS. Conclusions: Pre-gestational obesity, infertility treatment, previous CS and HT/PIH had significant effect on the mode of delivery.

Birth marks and neonatal skin disorders. From angel kiss to epidermolysis bullosa

INTRODUCTION At present there are no exact epidemiologic data on the prevalence of neonatal skin disorders and birth marks in Hungary. AIM The aim of the authors was to investigate the prevalence of skin disorders in mature healthy neonates after birth. METHOD The survey was carried out in the Neonatal Care Unit at the Department of Obstetrics and Gynaecology at the University of Szeged between April, 2012 and May, 2013. RESULTS A total of 2289 newborn infants underwent whole-body screening skin examinations. At least one skin manifestation was found in 63% of the neonates. The major groups of skin disorders were transient benign cutaneous lesions, vascular lesions, pigmented lesions, traumatic, iatrogenic, congenital or acquired disorders with skin injuries, developmental abnormalities and benign skin tumours. The most frequent transient cutaneous lesions were erythema toxicum neonatorum, sebaceous hyperplasia and desquamation. The most common vascular lesions were naevus simplex, haemangioma and haemangioma precursor lesion, while the most frequently observed pigmented lesions were congenital melanocytic naevi and Mongolian spot. CONCLUSIONS In the vast majority of cases, special treatment was not necessary, but 5.27% of the neonates required local dermatologic therapy, and in 9.2% of neonates follow up was recommended.

Adverse perinatal outcome in teenage pregnancies: an analysis of a 5-year period in Southeastern Hungary

Abstract Objective: To determine the risks of adverse perinatal outcomes of teenage mothers. Material and methods: A retrospective analysis was performed on teenage mothers (under 20 years of age) who delivered in the period of 2010–2014 at the Department of Obstetrics and Gynecology, University of Szeged (study group). All mothers who delivered in Hungary during the same period were studied as a control group. The following parameters were analyzed: demographic data of the mothers, maternal complications, perinatal outcome and congenital malformations of the newborns. The binominal test, Student’s t-test and Poisson’s regression were applied using STATA 9.0 (StataCorp, College Station, TX, USA) statistical software (p < .05 was considered to be statistically significant). Results: During this 5-year period, 12,845 births were recorded at the Department, of these 274 (2.1%) were teenage pregnancies with 275 newborns. The offsprings of teenage mothers had significantly lower mean birth weight (3110.2 ± 564.03 g versus 3247 g), higher rate of congenital malformations (8.0 versus 5.0%) and higher admission to neonatal intensive care unit (12.4 versus 8.0%) than the infants in the control group. Conclusions: Younger maternal age was significantly associated with lower mean birth weight, higher risk of congenital malformations, and increased admission rate to neonatal intensive care unit.

Evaluation of placental vascularization indices in monochorionic diamniotic and dichorionic diamniotic twin pregnancies

OBJECTIVES We aimed to investigate and compare placental vascularization indices between monochorionic-diamniotic, dichorionic-diamniotic normal twin pregnancies, and normal singular pregnancies. We hypothesized that there is correlation between placental three-dimensional power Doppler vascularization indices and birth weight in case of twin pregnancies, and that normal singular pregnancies have higher placental vascularization indices than normal twin pregnancies. STUDY DESIGN Placental three-dimensional power Doppler vascularization indices, such as vascularization index, flow index, and vascularization-flow index were measured in monochorionic-diamniotic (N = 15) and dichorionic-diamniotic (N = 36) normal twin pregnancies, and in normal singular (N = 109) pregnancies. Correlations were analyzed between vascularization indices, and birth weight, APGAR score, umbilical pH, umbilical venous bicarbonate, lactate, and base excess. RESULTS Vascularization indices and birth weight were significantly (p < 0.01) higher in normal singular gestations (vascularization index = 10.36, flow index = 46.08, vascularization-flow index = 4.08, average birth weight = 3377 g at 38.2 weeks average gestational age) compared to monochorionic-diamniotic and dichorionic-diamniotic normal twin pregnancies. No significant differences were found in vascularization indices between monochorionic-diamniotic and dichorionic-diamniotic normal twins. There were no significant differences in APGAR score, umbilical pH, umbilical venous bicarbonate, lactate, and base excess between groups examined (p < 0.01). We found strong linear correlations between placental vascularization indices and birth weight in both twin groups. CONCLUSION Placental three-dimensional power Doppler vascularization indices seem appropriate for predicting birth weight in monochorionic-diamniotic and dichorionic-diamniotic normal twin pregnancies. Our pilot study revealed reference values for vascularization indices in case of twin pregnancies examined.

Cutaneous lesions and disorders in healthy neonates and their relationships with maternal-neonatal factors: a cross-sectional study

BackgroundCutaneous lesions are very common in neonates. Although a number of studies have reported on their incidence, very little is known about the factors that influence them. We set out to investigate a large population of neonates with the aims of achieving an overall picture of neonatal skin manifestations, and examining their relationships with various maternal, neonatal and perinatal factors.MethodsThis study was conducted on neonates born at the Department of Obstetrics and Gynaecology at the University of Szeged between June 2013 and July 2015. A total of 4658 consecutive infants underwent a whole-body skin examination within the first 72 hours of extrauterine life. The official neonatal medical charts were used to collect data on the history of the participating neonates and on maternal factors.Results74.35% of the neonates exhibited at least one skin manifestation. The major diagnosis groups were transient, benign cutaneous lesions; vascular lesions; traumatic, iatrogenic, congenital or acquired disorders with skin injuries; pigmented lesions; and developmental abnormalities or benign skin tumours. The relationships between the skin findings and six neonatal or maternal factors were examined: gender, gestational age and birth weight of the neonates; maternal age and the number of previous pregnancies of the mothers, and mode and circumstances of the delivery.ConclusionsWe found several significant correlations between the examined maternal/neonatal factors and the occurrence of birthmarks and neonatal skin disorders. Of course, further studies are required to confirm and better understand these associations.

A cross-sectional study of newborns over a 20-year period in Szeged, Hungary

Abstract Objective: Records of metric data of birth, serve not only the medical needs of the newborn baby, but are also indicators to assess the status of public health. Methods: This is a retrospective study of 4946 newborns (singleton: 2508 boys and 2365 girls) born in 1989 and in 2009 at the Department of Obstetrics and Gynaecology of the University of Szeged. We aimed as to compare and map the metrical changes over 20 years, and to describe the averages of four body parameters of the normal birth weight (2500–4000 g) subgroup (3993 singleton babies) in both years. Statistical analysis was performed with SPSS 17.0. Results: In 1989, the mean birth weight was 3223.770 ± 559.595 g, birth length 49.551 ± 2.729 cm, chest circumference 32.181 ± 2.231 cm, and head circumference 34.122 ± 1.688 cm. In 2009, the birth weight was 3309.673 ± 582.630 g, birth length 49.515 ± 2.658 cm, chest circumference 32.736 ± 2.392 cm and head circumference 33.854 ± 1.768 cm. The mean birth weight, chest circumference and the maximum value of birth weight have thus increased. The mean maternal age shifted to 30.21 ± 4.863 years, which is an increase of 3.57 years in 20 years. Conclusion: The body parameters of newborns changed significantly between 1989 and 2009. As underlying causes changes in eating habits and lifestyle of the mother are to be mentioned.

Születési jegyek, újszülöttkori bőrelváltozások.Az angyalcsóktól az epidermolysis bullosáig | Birth marks and neonatal skin disorders. From angel kiss to epidermolysis bullosa

INTRODUCTION At present there are no exact epidemiologic data on the prevalence of neonatal skin disorders and birth marks in Hungary. AIM The aim of the authors was to investigate the prevalence of skin disorders in mature healthy neonates after birth. METHOD The survey was carried out in the Neonatal Care Unit at the Department of Obstetrics and Gynaecology at the University of Szeged between April, 2012 and May, 2013. RESULTS A total of 2289 newborn infants underwent whole-body screening skin examinations. At least one skin manifestation was found in 63% of the neonates. The major groups of skin disorders were transient benign cutaneous lesions, vascular lesions, pigmented lesions, traumatic, iatrogenic, congenital or acquired disorders with skin injuries, developmental abnormalities and benign skin tumours. The most frequent transient cutaneous lesions were erythema toxicum neonatorum, sebaceous hyperplasia and desquamation. The most common vascular lesions were naevus simplex, haemangioma and haemangioma precursor lesion, while the most frequently observed pigmented lesions were congenital melanocytic naevi and Mongolian spot. CONCLUSIONS In the vast majority of cases, special treatment was not necessary, but 5.27% of the neonates required local dermatologic therapy, and in 9.2% of neonates follow up was recommended.