Browsing by Author "Martić, Jelena (19639196900)"

Introduction/Objective Vitamin K deficiency is common in newborn infants and without prophylaxis there is a risk of vitamin K deficiency bleeding (VKDB). The most frequent prophylactic approach is an intramuscular (IM) injection of vitamin K1 immediately after birth. Its efficiency to prevent late VKDB has been recently questioned by several reports. Based on our experience, we discuss the need for additional vitamin K1 supplementation after its IM administration at birth. Methods We present a retrospective review of 12 infants, 11 with confirmed and one with probable late VKDB despite IM prophylaxis at birth, who were treated in the two largest tertiary care pediatric hospitals in Serbia during the last 15 years. Results All the patients were exclusively breastfed. In 11 patients, daily weight gain was normal or increased, and one patient had failure to gain weight. Six infants were previously healthy, three infants received antibiotics prior to bleeding, and in two diarrhea and cholestasis, respectively, existed previously. An intracranial bleeding was documented in nine infants, four of whom died. Conclusion Low content of phytomenadione in human milk could occasionally be attributed to late VKDB despite postnatal IM injection of vitamin K1 in otherwise healthy, exclusively breastfed infants. This might be aggravated by transient disturbance of vitamin K turnover due to antibiotic use, acute diarrhea, or transient cholestasis. We suggest that an additional vitamin K1 supplementation after postnatal IM prophylaxis could be justified in exclusively breastfed infants. © 2017, Serbia Medical Society. All rights reserved.

Introduction. Fetomaternal hemorrhage (FMH) is a transfusion of fetal blood into the maternal circulation. A volume of transfused fetal blood required to cause severe, life-threatening fetal anemia, is not clearly defined. Some authors suggest volumes of 80 mL and 150 mL as a threshold which defines massive FMH. Therefore, a rate of massive FMH is 1: 1,000 and 1: 5,000 births, respectively. Fetal and neonatal anemia is one of the most serious complications of the FMH. Clinical manifestations of FMH are nonspecific, and mostly it presented as reduced fetal movements and changes in cardiotocography (CTG). The standard for diagnosing FMH is Kleihaurer-Betke test. Case report. A 34-year-old gravida (G) 1, para (P) 1 was hospitalized due to uterine contractions at 39 weeks of gestation. CTG monitoring revealed sinusoidal fetal heart rate and clinical examination showed complete cervical dilatation. Immediately after admission, the women delivered vaginally. Apgar scores were 1 and 2 at the first and fifth minute, respectively. Immediately baby was intubated and mechanical ventilation started. Initial analysis revealed pronounced acidosis and severe anemia. The patient received intravenous fluid therapy with sodium-bicarbonate as well as red cell transfusion. With all measures, the condition of the baby improved with normalization of hemoglobin level and blood pH. Kleihaurer-Betke test revealed the presence of fetal red cells in maternal circulation, equivalent to 531 mL blood loss. The level of maternal fetal hemoglobin (HbF) and elevated alpha fetoprotein also con-firmed the diagnosis of massive FMH. Conclusion. For the successful diagnosis and management of FMH direct communication between the obstetrician and the pediatrician is necessary as presented in this report. © 2016, Institut za Vojnomedicinske Naucne Informacije/Documentaciju. All rights reserved.

Neonatal encephalopathy is a manifestation of acute neurological disorder in newborn infants and is commonly presented with decreased level of consciousness (lethargy or comma) and seizures. Etiology of neonatal encephalopathy is versatile. The most common cause is hypoxic-ischemic encephalopathy which is a cause of more than 50% of cases of neonatal encephalopathy. Other causes include infections, inborn errors of metabolism, cerebrovascular infarcts, bilirubin induced neurological disfunction, va-rious neurodegenerative disorders and epileptic syndromes. Because of a wide spectrum of etiology, newborn with encephalopathy must be carefully examined and immediate laboratory analysis, electroencephalographic and neuroradiological investigation must be performed, as well as further specific investigation if needed. Management of newborn with acute neurological disorder consists of stabilization of vital parameters, symptomatic therapy which includes correction of hypoglycemia, electrolyte disturbances, aci-dosis and anemia and treatment of seizures. Specific therapy of neonatal encephalopathy depends on etiology, so multidisciplinary team of pediatric specialists is commonly involved in diagnostic and therapeutic procedures. In many cases of neonatal encephalo-pathy, prompt diagnosis can be life-saving. © 2021, Croatian Paediatric Society. All rights reserved.

SUMMARY. Perinatal stroke is defined as an acute neurological syndrome with chronic sequelae due to cerebral injury of vascular origin occuring between 20 weeks gestation and 28 postnatal days. Novel classification is based on neuroimaging and clinical features, and distinguishes two groups: acute, symptomatic perinatal stroke with occurrence from birth to 28 days and presumed perinatal stroke which clinical presentation involves a chronic, static, focal neurologic deficit or seizures. Advances in understanding the etiology of perinatal cerebral infarction may reduce the incidence of this entity, primarily through appropriate antenatal monitoring and postnatal treatment. Early recognition of clinical manifestations and risk factors would enable prompt diagnosis and referral of patients to centers with the possibility of specific neuroradiological diagnostics. Appropriate therapy would contribute to the preservation of brain functions and recovery of damaged structures. Anticoagulant therapy is indicated in specific cases of arterial ischemic infarction and sinovenous thrombosis. Physical therapy is necessary in order to improve the neurological outcome and prevent permanent neurological damage. © 2023, Croatian Medical Association. All rights reserved.

Introduction/Objective Air leak syndrome is more frequent in neonatal period than at any other period of life. Its timely recognition and treatment is a medical emergency. We present results of a tertiary medical center in treatment of air leak syndrome in term and late preterm neonates. Methods Neonates born between 34th 0/7 and 41st 6/7 gestational weeks (g.w.) who were treated for air leak syndrome in the Neonatal Intensive Care Unit of Mother and Child Health Care Institute, from 2005 to 2015 were included in the study. Antropometric data, perinatal history, type of respiratory support prior to admission, chest radiography, type of pulmonary air leak syndrome and its management, underlying etiology, and final outcome were analyzed. Results Eighty-seven neonates of an average gestational age 38.1 ± 1.9 g.w. were included in the study. The average birth weight was 3182.5 ± 55.5 g. Fourty-seven (54%) were born by cesarean section and 40 (46%) were born by vaginal delivery. Prior to admission, 62.1% received supplemental oxygen, 4.6% were on nasal continuous positive airway pressure, and 21.8% were on conventional mechanical ventilation. Type of delivery did not significantly affect the appearance of pneumothorax, nor did the type of respiratory support received prior to admission (p > 0.05). The majority (93.1%) had pneumothorax, which was unilateral in 79%. The length of mechanical ventilation significantly affected the appearance of pneumothorax (p = 0.015). Low Apgar score in the first minute and the presence of pneumopericardium were significant factors predisposing for an unfavorable outcome. Conclusion Improving mechanical ventilation strategies and decreasing the rate of perinatal asphyxia in term and late preterm neonates could diminish the incidence of pulmonary air leak syndrome in this age group. © 2019, Serbia Medical Society. All rights reserved.

Purpose: The aim of this study was to evaluate the predictive value of the features of neonatal seizures for pharmacoresistant epilepsy in children. Method: This is a retrospective study that involved all children diagnosed as having epilepsy who had neonatal seizures and who were hospitalized at the Neurology Department of the Mother and Child Healthcare Institute in Belgrade from January the 1st 2017 until December 31st 2017. The following parameters and their impact on the outcome were investigated: perinatal data, the characteristics of epileptic seizures in the neonatal period, and the response to anticonvulsant treatment. The presence of pharmacoresistance was observed as an outcome parameter. Univariate and multivariate logistic regression analyses were used to define predictors of drug-resistant epilepsy. Results: The study involved 55 children, 35 (63.6%) male and 20 (36.4%) female. The average age of the children at the end of the observation period was 5.17 years (min: 0.25, max: 17.75, iqr (interquartile range): 6.92). Pharmacoresistant epilepsy was found in 36 (65.5%) children. The most common type of epilepsy was focal, which affected 30 patients (54.5%), than generalized, which affected 15 patients (27.3%), and combined generalized and focal, which affected 8 patients (14.5%). At the end of the observation period, 28 patients (50.9%) had no seizures, while 14 (25.5%) had daily seizures. It was found that the pharmacoresistant neonatal seizures and metabolic–genetic disorders were predictive factors of the occurrence of pharmacoresistant epilepsy. Conclusion: Patients prone to developing pharmacoresistant epilepsy might be identified as early as the neonatal and early infant period. High incidence of asphyxia cooccurring with established genetic–metabolic disease further emphasizes need for genetic testing in infants with neonatal seizures including in the presence of hypoxic–ischemic injury. © 2020 Elsevier Inc.

Purpose: The aim of this study was to evaluate the predictive value of the features of neonatal seizures for pharmacoresistant epilepsy in children. Method: This is a retrospective study that involved all children diagnosed as having epilepsy who had neonatal seizures and who were hospitalized at the Neurology Department of the Mother and Child Healthcare Institute in Belgrade from January the 1st 2017 until December 31st 2017. The following parameters and their impact on the outcome were investigated: perinatal data, the characteristics of epileptic seizures in the neonatal period, and the response to anticonvulsant treatment. The presence of pharmacoresistance was observed as an outcome parameter. Univariate and multivariate logistic regression analyses were used to define predictors of drug-resistant epilepsy. Results: The study involved 55 children, 35 (63.6%) male and 20 (36.4%) female. The average age of the children at the end of the observation period was 5.17 years (min: 0.25, max: 17.75, iqr (interquartile range): 6.92). Pharmacoresistant epilepsy was found in 36 (65.5%) children. The most common type of epilepsy was focal, which affected 30 patients (54.5%), than generalized, which affected 15 patients (27.3%), and combined generalized and focal, which affected 8 patients (14.5%). At the end of the observation period, 28 patients (50.9%) had no seizures, while 14 (25.5%) had daily seizures. It was found that the pharmacoresistant neonatal seizures and metabolic–genetic disorders were predictive factors of the occurrence of pharmacoresistant epilepsy. Conclusion: Patients prone to developing pharmacoresistant epilepsy might be identified as early as the neonatal and early infant period. High incidence of asphyxia cooccurring with established genetic–metabolic disease further emphasizes need for genetic testing in infants with neonatal seizures including in the presence of hypoxic–ischemic injury. © 2020 Elsevier Inc.