Publications by authors named "Dorota Pawlik"

40 Publications

Coagulase-Negative Staphylococci Contained in Gut Microbiota as a Primary Source of Sepsis in Low- and Very Low Birth Weight Neonates.

J Clin Med 2020 Aug 4;9(8). Epub 2020 Aug 4.

Jagiellonian University Medical College, 31-121 Cracow, Poland.

Background: There are only a few reports in the literature about translocation of coagulase-negative staphylococci (CoNS) as a primary cause of sepsis in neonates, although CoNS are among a short list of "translocating" bacteria when present in abundance.

Methods: 468 blood samples, 119 stool samples, and 8 catheter tips, from 311 neonates, were tested for presence of microorganisms. CoNS strains isolated from the blood and stool or from blood and catheter tip of the same newborn at approximately the same time were paired and typed with PFGE (Pulse-Field Gel Electrophoresis) method. The strains were then tested for the presence of adherence genes and biofilm formation.

Results: The strains with identical PFGE profiles in comparison to those with non-identical profiles differed in terms of the pattern of the virulence genes and showed a lack of the genes related to adherence, but more often presence of IS256, which is related to virulence. They also were phenotypically unable to adhere to intestinal Caco2 cells.

Conclusions: A considerable proportion of CoNS strains isolated from bloodstream of VLBW/LWB neonates was identical to the strains isolated from faeces of the same neonates at the same time. These observations may offer indirect evidence indicating that at least some CoNS can translocate from the gastrointestinal tract of the premature neonates into the bloodstream and thus cause generalized infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/jcm9082517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7464628PMC
August 2020

Contribution of a Novel Variant to Peters Plus Syndrome Discovered by a Combination of Next-Generation Sequencing and Automated Text Mining.

Int J Mol Sci 2019 Nov 28;20(23). Epub 2019 Nov 28.

Center for Medical Genomics-OMICRON, Jagiellonian University Medical College, ul. Kopernika 7c, 31-034 Krakow, Poland.

Anterior segment dysgenesis (ASD) encompasses a spectrum of ocular disorders affecting the structures of the anterior eye chamber. Mutations in several genes, involved in eye development, are implicated in this disorder. ASD is often accompanied by diverse multisystemic symptoms and another genetic cause, such as variants in genes encoding collagen type IV. Thus, a wide spectrum of phenotypes and underlying genetic diversity make fast and proper diagnosis challenging. Here, we used AMELIE, an automatic text mining tool that enriches data with the most up-to-date information from literature, and wANNOVAR, which is based on well-documented databases and incorporates variant filtering strategy to identify genetic variants responsible for severely-manifested ASD in a newborn child. This strategy, applied to trio sequencing data in compliance with ACMG 2015 guidelines, helped us find two compound heterozygous variants of the gene, of which c.660+1G>A (rs80338851) was previously associated with the phenotype of Peters plus syndrome (PPS), while the second, NM_194318.3:c.755delC (p.T252fs), in exon 9 of the same gene was noted for the first time. PPS, a very rare subtype of ASD, is a glycosylation disorder, where the dysfunctional gene product, O-fucose-specific β-1,3-glucosyltransferase, is ineffective in providing a noncanonical quality control system for proper protein folding in cells. Our study expands the mutation spectrum of the gene related to PPS. We suggest that the implementation of automatic text mining tools in combination with careful variant filtering could help translate sequencing results into diagnosis, thus, considerably accelerating the diagnostic process and, thereby, improving patient management.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/ijms20236006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6928627PMC
November 2019

L-citrulline supplementation in the treatment of pulmonary hypertension associated with bronchopulmonary dysplasia in preterm infant: A case report.

SAGE Open Med Case Rep 2018 22;6:2050313X18778730. Epub 2018 May 22.

Department of Neonatology, Hospital "Ujastki" Neo-medic Centre, Kraków, Poland.

Introduction: the aim of this case report is to present that oral L-citrulline supplementation may attenuate chronic pulmonary hypertension and reduce oxygen requirement in infants with severe bronchopulmonary dysplasia.

Important Clinical Findings: a boy, with a birth weight of 700 g, born by cesarean section after 25 weeks of pregnancy complicated with preeclampsia, was admitted to the neonatal intensive care unit. He was ventilatory dependent for the next 3 months with significantly increased oxygen requirements. A severe stage of bronchopulmonary dysplasia, complicated with increased pulmonary vascular resistance, was diagnosed. Treatment with inhaled nitric oxide and oral sildenafil was included in the therapy of chronic pulmonary hypertension. The results of screening echocardiograms and increased plasma brain natriuretic peptide concentrations, suggested right ventricle dysfunction.

The Main Intervention: at the beginning of the sixth month of hospitalization, oral supplementation of L-citrulline in a single dose of 150 mg/kg/day was introduced and continued for 70 days. During the first 3 weeks after L-citrulline was started, the patient was weaned from mechanical ventilation and he was never intubated again until he was discharged. Plasma brain natriuretic peptide concentrations decreased significantly during the first month of L-citrulline administration and became stable until the termination of L-citrulline supplementation. At discharge, the patient required 22%-25% concentration of oxygen supplemented intermittently, exclusively during feeding.

Conclusion: these results indicate that L-citrulline supplementation may deserve coverage as an additional, potentially beneficial alternative in the prophylaxis or therapy of chronic pulmonary hypertension in newborns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/2050313X18778730DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968659PMC
May 2018

Compatibility of intravenous pentoxifylline with other medications infused concurrently in preterm infants with late-onset sepsis.

Acta Paediatr 2018 07 30;107(7):1288-1289. Epub 2018 Mar 30.

Department of Neonatology, Jagiellonian University Medical College, Kraków, Poland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/apa.14312DOI Listing
July 2018

Device-associated pneumonia of very low birth weight infants in Polish Neonatal Intensive Care Units.

Adv Med Sci 2016 Mar 26;61(1):90-5. Epub 2015 Sep 26.

Institute of Nature Conservation, Polish Academy of Sciences, Krakow, Poland.

Purpose: Late-Onset Pneumonia (LO-PNEU) is still the most important complication associated with the hospitalization of infants with very low birth weight (<1501g). The purpose of this paper is to summarize the results of an ongoing surveillance program defining LO-PNEU as associated or not associated with respiratory support in the NICU and distribution of causative pathogens from the Polish Neonatology Surveillance Network (PNSN).

Materials And Methods: Surveillance of infections was conducted in the years 2009-2011 at six Polish NICUs.

Results: The incidence was 3.1/1000 NICU patient days (pds). The mean gestational age and birth weight among infants with LO-PNEU were significantly lower. The VAP incidence was of 18.2/1000 NICU pds for mechanically ventilated (MV) infants, while the rates for those receiving only CPAP were as low as 7.7/1000 NICU pds. MV significantly increased the risk of PNEU, but MV or CPAP for <10 days did not increase the risk of LO-PNEU. Significantly associated with LO-PNEU was the use of central or peripheral venous catheters and total parenteral nutrition for longer periods. Microorganisms isolated in cases of LO-PNEU were Gram-positive cocci (53.5%) and Gram-negative rods, with predominating E. coli. Non fermentative bacilli were significantly more frequent in cases of VAP than in other cases.

Conclusions: Observed incidence rates associated with VAP and CPAP-PNEU, were higher than in other national surveillance systems and expressing the feasibility of lowering the risk of LO-PNEU and increasing patient safety. The incidence of pneumonia was found to be lower when using CPAP as compared to using MV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.advms.2015.09.002DOI Listing
March 2016

Vertical transmission of HPV in pregnancy. A prospective clinical study of HPV-positive pregnant women.

Ginekol Pol 2014 Sep;85(9):672-6

Introduction: Human papillomavirus (HPV) is the most common sexually transmitted infection. Data reporting vertical transmission of HPV from the mother to the fetus are inconsistent and scant. Vertical transmission may occur by hematogenic route (transplacental), or by ascending contamination, or through the birth canal, which may result in the dreaded and rare laryngeal papillomatosis. Infected sperm at fertilization is a potential route of infection, too.

Objective: The objective of the study was to evaluate the rate of vertical transmission of HPV in HPV-positive pregnant women to their newborn infants, as well as the risk factors of HPV vertical transmission.

Material And Methods: The clinical material was provided by 136 pregnant women, aged 18-45 years. Out of this group, 30 (22.05%) women with abnormal Pap test and positive DNA HPV test were prospectively observed Neonatal status, i.e. DNA HPV from the nasopharyngeal smear was recorded in all infants during the perinatal period. The conventional Pap test was performed with the cervix brush in all women. The Bethesda 2011 classification system was applied.

Results: An average C Reactive Protein (CRP) concentration in the studied pregnant women was 711.6083 (Std Dev--12.93). The most frequent cytological findings in the cervical smears from the examined women were ASCUS, n = 13 (43.3%), then--LSIL, n = 10 (33.3%), HSIL--n = 5 (16.7%) and AGC--n = 2 (6.7%). In the neonates, the presence of LR HPV DNA was detected in 9 cases (30.0%) and HR HPV DNA in 7 cases (23.3%). Fourteen neonates (46.7%) tested HPV DNA negative in the perinatal period.

Conclusions: HPV infection (incidental or chronic) is observed in approximately 22% of pregnant women from the Matopolska province. Neonatal HPV infection in HPV-positive women was observed in 53.3% of the subjects. CRP concentration > 10 mg/dl in the serum of pregnant women statistically significantly (p 0.001) reduces the risk of vertical transmission of HPV from the mother to the fetus.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2014

Vaccination of preterm infants by polyvalent vaccines: immunogenicity and safety- review of literature.

Dev Period Med 2014 Jul-Sep;18(3):360-6

Poradnia Chorób Zakaźnych, Wojewódzki Specjalistyczny Szpital Dziecięcy im. Św. Ludwika w Krakowie, ul. Strzelecka 2a, 31-503 Kraków, tel. (12) 61-98-615, e-mail:

The immunization of infants against infectious diseases still raises many controversies, not only with parents, but also among physicians. This refers particularly to preterm infants. Due to the increasing popularity of polyvalent vaccines, a number of studies has recently been conducted to verify their immunogenicity and safety in preterm infants. The aim of the present paper was to review the current literature dealing with the problem in question. The following recommendations regarding the use of polyvalent vaccines in preterm infants and neonates with low birth weight can be formulated on the basis of current evidence (1). Due to sufficient immunogenicity, polyvalent vaccines can be administered to preterm infants in accordance with their calendar age (2). Booster vaccination of preterm infants after completing 12 months of age is vital for achieving complete and persistent immunity against all vaccine antigens (3). In order to reduce the risk of adverse events after the administration of a polyvalent vaccine, it is essential to carefully consider the cardiorespiratory status of preterm infants during preimmunization examination, as well as their history of any cardiorespiratory dysfunctions. In such cases administering the first dose of the vaccine in a hospital setting is strongly advised.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2014

Late-onset bloodstream infections of Very-Low-Birth-Weight infants: data from the Polish Neonatology Surveillance Network in 2009-2011.

BMC Infect Dis 2014 Jun 18;14:339. Epub 2014 Jun 18.

Microbiology, Jagiellonian University Medical College, 18 Czysta Street, Krakow 31-121, Poland.

Background: Late-Onset Bloodstream Infections (LO-BSI) continue to be one of the most important complications associated with hospitalization of infants born with very low birth weight (VLBW). The aims of this study were to assess the epidemiology of LO-BSI together with the risk factors and the distribution of causative pathogens at six Polish neonatal intensive care units that participated in the Polish Neonatology Surveillance Network from January 1, 2009 to December 31, 2011.

Methods: The surveillance covered 1,695 infants whose birth weights were <1501 grams (VLBW) in whom LO-BSI was diagnosed >72 hours after delivery. Case LO-BSI patients were defined according to NeoKISS.

Results: Four hundred twenty seven episodes of LO-BSI were diagnosed with a frequency of 25.3% and an incidence density of 6.7/1000 patient-days (pds). Results of our multivariate analysis demonstrated that surgical procedures and lower gestational age were significantly associated with the risk of LO-BSI. Intravascular catheters were used in infants with LO-BSI significantly more frequently and/or for longer duration: Central venous cathters (CVC) (OR 1.29) and Peripheral venous catheters (PVC) (OR 2.8), as well as, the total duration of total parenteral nutrition (13 vs. 29 days; OR 1.81). Occurrence of LO-BSI was significantly associated with increased the length of mechanical ventilation (MV) (OR 2.65) or the continuous positive airway pressure (CPAP) (OR 2.51), as well as, the duration of antibiotic use (OR 2.98). The occurrence of more than one infection was observed frequently (OR 9.2) with VLBW with LO-BSI. Microorganisms isolated in infants with LO-BSI were dominated by Gram-positive cocci, and predominantly by coagulase-negative staphylococci (62.5%).

Conclusions: Independent risk factor for LO-BSI in VLBV infants are: low gestational age and requirement for surgery. The incidence rates of LO-BSI especially CVC-BSI were higher in the Polish NICUs surveillance than those of other national networks, similar to the central- and peripheral utilization ratio.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2334-14-339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4074408PMC
June 2014

Necrotising enterocolitis in preterm infants: epidemiology and antibiotic consumption in the Polish neonatology network neonatal intensive care units in 2009.

PLoS One 2014 21;9(3):e92865. Epub 2014 Mar 21.

Chair of Microbiology, Jagiellonian University Medical College, Kraków, Poland.

Unlabelled: The aim of this study was to describe the epidemiology of necrotising enterocolitis (NEC), antibiotic consumption and the usefulness of microbiological tests in very low birth weight (VLBW) Polish newborns.

Methods: Prospective surveillance was performed in the year 2009 by local infection control teams. The study covered 910 infants hospitalized in six Polish neonatal intensive care units. Two kinds of indicators were used for the description of antibiotic usage: the duration of treatment (days of treatment, DOTs) and the defined daily dose (DDD).

Results: NEC incidence was 8.7% and fatality rate was 19%. Chorioamnionitis, late gestational age and low birth weight were identified as risk factors for NEC. Catheterization, mechanical ventilation and other selected procedures were used considerably longer in newborns with NEC than in the remaining neonates. Total usage of antibiotics reached 2.9 DDDs or 1.437 days; the average use of drugs per case of NEC amounted to 0.47 DDD or 23.2 DOTs. The level of antibiotic usage was analysed with correlation to microbiological tests performed and it was non-significantly greater in the group of children with NEC in whom the tests were performed.

Conclusions: A high risk of developing NEC is closely associated with VLBW and with inflammation of the amnion during labour. We observed no relationship between the consumption of antibiotics in neonates with NEC and positive results of microbiological testing indicating sepsis accompanying NEC or gut colonization with pathogens.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0092865PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3962467PMC
November 2014

May the supplementation of lipid emulsion containing DHA in VLBW infants influence their psychological development evaluated at three years of age? Preliminary study.

Dev Period Med 2014 Oct-Dec;18(4):432-8

Instytut Psychologii, Uniwersytet Jagielloński, Al. Mickiewicza 3, 31-120 Kraków, Poland, tel. 519-516-453, e-mail:

Objectives: The aim of the study was to evaluate the possible influence of a lipid emulsion containing DHA (docosahexaenoic polyunsaturated fatty acid), parenterally administered from the first day of life, on the psychological development of 3-year-old children born with very low birth weight (VLBW). It was suspected that an increased amount of DHA in parenteral nutrition may be a variable that modifies the relation between other medical or social factors and their influence on the child's development.

Material And Methods: Two groups of three-year-old children with calendar age ranging from 29 to 51 months (mean value--38 months) were tested. The children in the study group (n=23) were parenterally nourished during the first weeks of life with a lipid emulsion containing DHA. The patients in the control group (n=13) were fed with a lipid emulsion without DHA.

Results: Using the General Linear Model (GLM) with the analysis of interaction effects, it was found that the supplementation of the lipid emulsion containing DHA in parenteral nutrition from the first day of life beneficially influenced the relation between immaturity associated with the children's health status at birth and emotional development evaluated at three years of age. It also modified the relation between emotional and linguistic development.

Conclusions: When administered after birth in prematurely born children, the lipid emulsion containing DHA may influence their development at the age of three years. It may either compensate the negative effects that immaturity associated with the health status at birth has on emotional development, or stimulate the language development in children whose emotional development is normal.
View Article and Find Full Text PDF

Download full-text PDF

Source
May 2015

[Epidemiology of infections in very low birth weight infants. Polish Neonatology Network research].

Med Wieku Rozwoj 2013 Jul-Sep;17(3):224-31

Klinika Neonatologii i Intensywnej Terapii, Kasprzaka 17a, 01-211 Warszawa,

Aim Of Study: 1. prospective record of infections; 2. prevention of nosocomial infections by providing current data about infections, which are significant for making therapeutic decisions.

Material And Methods: Recorded infections: early-onset sepsis (congenital), late-onset sepsis (acquired in hospital), necrotising enterocolitis (NEC), pneumonia. Infections were diagnosed and qualified on the basis of definitions of infections based on the National Nosocomial Infections Surveillance (NNIS) criteria, developed by CDC, USA, including modifications of German Neo-KISS programme. Infection control was realised as a part of common research project of "Polish Neonatology Network", appointed by the decision of the Minister of Science and Higher Education no. 669/E-215/BWSN- 0180/2008 dated 20.05.2008 r. The study was conducted by 6 Polish neonatology units, Microbiology Chair of Jagiellonian University Collegium Medicum and Institute of Theoretical and Applied Computer Science. Infants with birth weight lower than 1500 g were qualified for the study.

Results: Between 1.01.2009 and 31.12.2009, 910 patients were registered, i.e. 19.1% of VLBW infants born in that period. The conducted analysis showed significant differences between centres in gestational age, birth weight, hospitalisation, use of invasive procedures, antibiotics and parenteral feeding. Cumulative morbidity rate was 68.5% total. Blood infection (sepsis) was the most commonly observed type of infection: 268 cases - 43.1% of all recorded forms of infection. Pneumonia was diagnosed in 242 cases, 38.8% total. NEC constituted 12.7% studied infections (79 cases). Apart from NEC, the risk of other forms of infection differed between centres. Dominant etiologic factor of all infections were Gram-positive cocci, which constituted 565 isolated microorganisms. Among them coagulase-negative staphylococci (CNS) were the most common (41.7%), while Staphylococcus aureus was fourth most frequent etiologic factor of infections (6.3% total).

Conclusions: 1. Introduction of unified definition and criteria for diagnosing infections and the use of morbidity rates enables comparative analysis of epidemiology of infections in neonatal intensive care units. 2. Due to significant differences observed between prophylactic and therapeutic procedures in various units, it is essential to propose Polish recommendations regarding control over etiology of infections and use of invasive procedures, such as intravenous catheters and ventilation. 3. It is essential to undertake action leading to fully rational antibiotic therapy, because overuse of antibiotics leads to bacterial resistance and increases incidence of infections.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2014

Infections reported in newborns with very low birth weight who required surgical treatment. Data from the Polish Neonatology Surveillance Network.

Med Wieku Rozwoj 2013 Apr-Jun;17(2):143-50

Klinika Neonatologii i Intensywnej Terapii, Warszawa.

Aim: To determine the risk of various forms of infections appearing in very low birth weight newborns (VLBW) during the period of 30 days after surgical treatment in hospitals which have perinatal care departments with neonatal intensive care units that form the Polish Neonatology Surveillance Network (PNSN).

Material And Methods: Continuous prospective monitoring of infections was carried out from January 1st to December 31st 2009 in six neonatal intensive care units which form the Polish Neonatal Surveillance Network. (PNSN). 910 newborns with very low birth weight (VLBW) were included in the study programme. 91 (10%) of this group underwent 118 surgical interventions. 12 newborns needed two or more surgeries. The most common procedure was the closure of persistent ductus artesiosus (PDA) and photocoagulation of vascular damage in the eye fundus.

Results: In the period of 30 days after surgery the following were diagnosed: in 3 newborns - necrotizing enterocolitis (NEC), in 22 newborns - sepsis (BSI) and in 54 newborns - pneumonia (PNEU). Symptoms of BSI and PNEU were on average observed on the 10th day after surgical intervention, while in the case of NEC on the 17th day. The highest incidence of infection (148.4%) was observed after PDA closure and in connection with introducing a drain into the pleural cavity through the intercostal space. The incidence of PN EU (37.3%) was twice as high as the incidence of BSI (18.6%). Surgical procedure was a factor significantly increasing the risk of infection and morbidity (RR 2.1, P<001) In our investigations there was no case of the local infection of a surgical site. 11 newborns died (mortality was 12.1%). The most common bacterial strains found in our investigation were coagulase-negative Staphylococcus and Escherichia Coli.

Conclusions: Taking into consideration the fact that surgical procedure in VLBW-newborns significantly increases the risk of pneumonia and to a minor degree the risk of NEC and BSI, further detailed investigation in the field of perisurgical epidemiology is needed in order to elaborate a more deeply oriented and more effective strategy of infection prevention in the group of VLBW newborns.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2013

Fish-oil fat emulsion supplementation reduces the risk of retinopathy in very low birth weight infants: a prospective, randomized study.

JPEN J Parenter Enteral Nutr 2014 Aug 20;38(6):711-6. Epub 2013 Aug 20.

Division of Neonatology, Department of Child Health, University of Missouri School of Medicine, Columbia, Missouri.

Background: Preliminary studies suggest that fish-oil lipid emulsion given parenterally to very preterm infants reduces the severity of retinopathy (ROP) and cholestasis.

Methods: Infants weighing <1250 g at birth were randomly allocated to 2 groups: an experimental group of 60 infants that received an intravenous (IV) soybean, olive oil, and fish oil emulsion, and a control group of 70 infants that was given a parenteral soybean and olive oil emulsion. Plasma and erythrocyte concentrations of docosahexaenoic acid (DHA) were determined using a high-performance liquid chromatography-mass spectrometry analysis.

Results: Nine infants in the fish oil group required laser therapy for ROP compared with 22 infants in the standard intralipid group (risk ratio [RR], 0.48; 95% confidence interval [CI], 0.24-0.96). Three infants in the fish oil group developed cholestasis compared with 20 infants in the standard intralipid group (RR, 0.18; 95% CI, 0.055-0.56). The mean plasma DHA concentrations in treated infants were 2.9-fold higher in the fish oil group than in control infants on the 7th and 14th days of life. The mean DHA content in erythrocytes of treated infants was 4.5-fold and 2.7-fold higher compared with controls at 7 and 14 days of age.

Conclusions: Premature infants receiving an IV fat emulsion containing fish oil had less ROP requiring laser treatment and less cholestasis than those receiving a standard lipid emulsion. These infants also had higher plasma and erythrocyte DHA levels at 7 and 14 days, suggesting potential long-term neurodevelopmental benefits.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1177/0148607113499373DOI Listing
August 2014

Distribution of cytomegalovirus gN variants and associated clinical sequelae in infants.

J Clin Virol 2013 Sep 25;58(1):271-5. Epub 2013 Jun 25.

Laboratory of Molecular Virology and Biological Chemistry, Institute of Medical Biology, Polish Academy of Sciences, Lodz, Poland.

Background: Human cytomegalovirus (HCMV) is the most widespread cause of congenital infection. The effects of various viral strains and viral loads on the infection outcome have been under debate.

Objectives: To determine the distribution of gN variants in HCMV strains isolated from children with congenital or postnatal infection and to establish the relationship between the viral genotype, the viral load, and the sequelae.

Study Design: The study population included congenitally HCMV-infected newborns and children with postnatal or unproven congenital HCMV infection. The genotyping was performed by RFLP analysis of PCR-amplified fragments, and the viral load was measured by quantitative real-time PCR.

Results: Our results demonstrated that the HCMV genotypes gN3b, gN4b, and gN4c were prevalent in the patients examined. There were no differences in the distributions of gN genotypes in the congenitally and postnatally infected children. Multiple HCMV strains were detected in both groups of children. A significant association between the HCMV gN4 genotype and the incidence of neurological disorders was observed (p=0.045). Our results suggest that the detection of the gN2 or the gN4 genotype may be indicative of serious manifestations in children. In contrast, the gN3b and the gN1 genotypes represent less pathogenic HCMV strains. The HCMV load in urine was significantly higher in children with congenital infection compared with children with postnatal infection. No correlation was found between the viral load and the genotype.

Conclusion: Our results suggest that the gN genotype may be a virological marker of symptomatic HCMV infection in newborns.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jcv.2013.05.024DOI Listing
September 2013

Enterobacteriaceae infections of very low birth weight infants in Polish neonatal intensive care units: resistance and cross-transmission.

Pediatr Infect Dis J 2013 Jun;32(6):594-8

Microbiology, Jagiellonian University Medical College, Krakow, Poland.

Background: The aims of our study were analysis of the occurrence of infections by members of the Enterobacteriaceae family in 6 Polish neonatal intensive care units in 2009, their drug resistance, the epidemiology of extended-spectrum β-lactamase (ESBL)-producing strains and the possibility of using modern tools of microbiology diagnosis in infection control, especially for the reduction of antimicrobial resistance.

Methods: A prospective surveillance covered 910 newborns. Case patients were defined as neonates with very low birth weight who had clinical signs of septicemia, pneumonia or necrotizing enterocolitis. Early-onset infection was defined as infection diagnosed within 3 days after delivery.

Results: The incidence of Enterobacteriaceae infections was 2.6/1000 patient-days. The risk of Enterobacteriaceae pneumonia increased with the length of hospitalization (P = 0.0356). The most common pathogen was Escherichia coli (12.4% of all strains, in early-onset infection 18.5%) and Klebsiella spp. (9.1% of all). The ESBL phenotype was found in 37% of isolates, of which 89.3% were producing CTX-M-type, 70.2% TEM-type and 8.5% SHV-type. Epidemic clones were detected in the 2 studied neonatal intensive care units: 6 of the 9 ESBL-positive Enterobacter cloacae and 16 of the 18 ESBL-positive Klebsiella pneumoniae strains were classified into 1 epidemic clone, which showed resistance to penicillin without inhibitors, amoxycillin/clavulanic acid, cephalosporins, aztreoname, aminoglycosides and trimethoprim/sulfamethoxazole.

Conclusions: Enterobacteriaceae bacilli are a significant problem in neonatal intensive care units, especially in early-onset infection and for long hospitalized very low birth weight infants. The observed high drug resistance was in large part related to the dominance of epidemic strains as a result of horizontal transmission. The best way to reduce drug resistance would be adequate procedures of isolation and hand hygiene.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/INF.0b013e318287fe2aDOI Listing
June 2013

[Congenital cytomegaly in one twin - a case report].

Med Wieku Rozwoj 2012 Jul-Sep;16(3):252-60

Klinika Chorób Dzieci Katedry Pediatrii, Uniwersytet Jagielloński, Collegium Medium w Krakowie, ul. Wielicka 265, 30-663 Kraków.

A report on dichorionic/diamniotic pregnancy in which only one, female, fetus was infected with cytomegalovirus and presented with severe congenital diseases at birth. Infection of the fetus occurred after recurrent maternal infection. The second, male, fetus did not have CMV infection. The cesarean section was performed at the 38th week of gestation. The birth weight of the infected girl was 1680g, the main symptoms, beside dystrophy, concerned the central nervous system: microcephaly, brain atrophy, hydrocephalus, corpus callosum agenesis. She also had Turner syndrome symptoms. The viral load was highest in the urine 81.2 x10^6/ml, in the cerebro-spinal fluid 15.4x10^6/ml and lower in blood 0.38 x10^5/ml. The concentration of specific IgG was 308 U/ml. Specific IgM was not detected. Throughout hospitalization, the infection maintained only one viral genotype gB2. Despite treatment with ganciclovir (10 weeks) and foscarnet (2 weeks), the girl died at the age of 8 months. Novel molecular diagnostic techniques (nested and real time PCR) confirmed the congenital infection and were helpful in the monitoring of the infection and treatment efficacy.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2013

[Intellectual and motor development of extremely low birth weight (≤1000 g) children in the 7th year of life; a multicenter, cross-sectional study of children born in the Malopolska voivodship between 2002 and 2004].

Med Wieku Rozwoj 2012 Jul-Sep;16(3):222-31

Klinika Chorób Dzieci Katedry Pediatrii WL UJ, ul. Wielicka 265, 30-663 Kraków.

Introduction: A better understanding of the developmental problems in extremely low birth weight (ELBW) preterm infants may enhance their chances of proper adaptation to their environment and make it possible to retrospectively assess perinatal and neonatal methods of treatment. The aim of the study was to evaluate the cognitive and motor development of ELBW children born from 2002 to 2004 in the 7th year of life. Based on these results and perinatal mortality data, it was established what chance the children have to live free of severe complications.

Material And Methods: Two hundred and four alive newborns with birth weight .1000 g were born in the Malopolska voivodship between 1.09.2002 and 31.08.2004. One hundred and fifteen children (56%) died in early infancy. The study included 81 (91%) children out of the 89 surviving ones. Their mean gestational age at birth was 27.3 weeks. (SD: 2.1 weeks) and their mean birth weight was 840g (SD: 130g). Neurosensory disturbances were assessed in all the children and their cognitive development was evaluated with the use of the WISC-R (Wechsler Intelligence Scale for Children . Revised) scale. The children were divided into 3 groups: group I . normal development (full motor capacity and IQ >84 points and no vision or hearing impairment), group II . mild or moderate impairment (cerebral palsy level I, II or III according to the Gross Motor Function Classification System [GMCS], or IQ 40-84 points, or abnormal vision or hearing, or signs of the hyperactivity syndrome), group III . severe impairment (cerebral palsy level IV, and/or IQ <40 points, or deafness/blindness).

Results: Forty-five (56%) children were included in group I, 25 (30%) in group II and 11 (14%) in group III. Moreover, other neurologic abnormalities, such as uneven development, problems with concentration, or abnormal grapho-motor ability were highly prevalent in the group of ELBW children. The incidence of cerebral palsy in the population studied was 16%, the incidence of deafness and severe hearing impairment was 11%, and blindness and severe vision impairment . 12%. In general, the chance of survival free of severe complications was merely 15% in children with birthweight .700 g, 28% in children with birth weight 701- 800 g, 45% in children with birth weight 801-900 g, and 62% in children with birth weight 901-1000 g.

Conclusions: 1. The data gathered in a regional study may yield valuable information useful in assessing the prognosis of the general health status of ELBW newborns. 2. Most of the children present uneven development, problems with concentration, or abnormal grapho-motor ability, which may be a cause of learning problems and abnormal relationships with peers. 3. A follow-up study up to adulthood is required for this group of ELBW newborns.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2013

[The effects of enteral administration of glutamine enriched solution in very low birth weight infants on reducing the symptoms of feeding intolerance. A prospective, randomized pilot study].

Med Wieku Rozwoj 2012 Jul-Sep;16(3):205-11

Ryszard Lauterbach, Klinika Neonatologii UJ CM, ul. Kopernika 23, 31-501 Kraków.

Background: Feeding intolerance frequently occurs during the first several weeks of life in very low birth weight infants and may require the reduction of oral feeding. When significantly expressed, it may lead to the development of necrotizing enterocolitis. Apart from breast milk, also the maintenance of normal peristalsis, enterocyte nourishment and keeping a low pH value in the stomach seem to be important points in the NEC prophylaxis.

Aim: The authors present the results of the randomized pilot study, performed in two, differently fed groups of VLBW newborns. The aim of the study was to compare the frequency of feeding intolerance, necrotizing enterocolitis, sepsis caused by Gram negative bacteria, intestinal perforation and the number of deaths between the study group and the control group of newborns.

Materials And Methods: 106 VLBW newborns were qualified for research. In the study group (50 newborns), apart from the mother's milk or preterm formula, infants were enteraly receiving a glutamine/ amino acid solution, the osmolality of which was comparable to amniotic fluid. The pH value of the solution was 5.5 so as to lower acidity of the stomach fluids. In the control group (56 newborns) infants were fed enteraly exclusively with the mother's milk or preterm formula. The patients in the two groups were comparable with regard to birth weight, gestational age, Apgar score and CRIB score, and the frequency of antenatal corticosteroid administration.

Results: There was a significantly lower risk of feeding intolerance in infants who were receiving the glutamine/amino acid solution (p=0.015). Also there was a lower risk of NEC (5 vs 10 cases), intestinal perforation (1 vs 4 cases), sepsis caused by Gram negative bacteria (1 vs 4 cases) and death (1 vs 3) in the study group. However, none of these differences reached statistical significance.

Conclusions: Enteral supplementation of glutamine/amino acid solution given simultaneously with enteral feeding is safe and may significantly reduce feeding intolerance in very low birth weight infants in their first days or weeks of life. The results of our research can be useful when attempting to work out the principles of NEC prophylaxis by means of maintaining normal peristalsis, enterocyte nourishment and keeping a low pH value in the stomach.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2013

[Antibiotic consumption and its costs of purchase in Polish neonatology networks units].

Przegl Epidemiol 2012 ;66(3):513-9

Katedra Mikrobiologii, Collegium Medicum Uniwersytet Jagielloński, Kraków.

Aim: The study presents the results of the analysis of antibiotic consumption and its direct costs in selected neonatal units.

Material And Methods: Data were collected retrospectively (the year 2007) in five hospitals, during the pilot phase of the Polish Neonatal Network . Antibiotic consumption was assessed using the Defined Daily Dose (DDD). The costs were assessed as the costs of purchase of one DDD.

Results: The study included 11 922 children hospitalized in the period from 1.01 to 31.12.2007. In this group, 731 infants have birth weight < 1500 grams (from 2.2% to 64.2% in individual units, median--7.3%). The mean consumption of antibacterial drugs was 48.52 DDD/1 000 person-days (P-D) of stay among the entire study population (median--42,52), and varied from 23.13 to 85.82 DDD/1,000 P-D. However, this difference has not been statistically significant. The most commonly used group of antibiotics were beta-lactams--in four out of five units the percentage of its usage ranged from 48.71% to 74.67%. Next group were aminoglicosides--in one unit its usage reached 56.97% and in other ranged from 5.01% to 22.53%. Glycopeptides and macrolides were also used in every unit of the studied group. The usage of glycopeptides ranged from 1.7% to 10.81% and of macrolides from 1.32% to 15.71%. Different kinds of antibiotics were used occasionally. The differences of costs of purchase of one DDD between hospitals were greater and varied from 17,64 PLN/ DDD to 84,58 PLN/ DDD (average costs). A considerable range of costs index values was also noted for different groups of antibiotics. The costs of purchase of one DDD of beta-lactams varied from 19.54 PLN/ DDD to 68.35 PLN/ DDD; for aminoglicosides the cost varied from 4.61 PLN/ DDD to 122.9 PLN/ DDD, for glycopeptides--from 31.40 PLN/ DDD to 283.13 PLN/ DDD and in case of macrolides: from 12.05 PLN/ DDD to 90.77 PLN/ DDD. This differentiation of the cost of purchasing a single defined daily dose, taking into account the specific groups of antibiotics, did not have the characteristics of statistical significance.

Conclusions: As expected, the antibiotic regimens in the studied wards were similar. This is due to a homogeneous population of hospitalized patients. However, the differences of costs of purchase of antibiotics observed in the study, indicate the considerable variety of the treatment patterns in Polish neonatology units and the need to develop and implement recommendations of effective pharmacotherapy for patients in intensive neonatal care units and the implementation of a unified model of infections surveillance.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2013

[Occurrence of the hypervirulent ST-17 clone of Streptococcus agalactiae in pregnant women and newborns].

Przegl Epidemiol 2012 ;66(3):395-401

Zakład Bakteriologii, Epidemiologii Drobnoustrojów i Parazytologii Uniwersytetu Jagiellońskiego Collegium Medicum, Kraków, Polska.

Unlabelled: OBJECTIVES. The ST-17 clone of Streptococcus agalactiae (Group B Streptococcus, GBS) identified by Multi Locus Sequence Typing (MLST) is recognized as a hypervirulent international clone mainly associated with invasive neonatal infections. There is no data on the occurrence of the ST-17 clone of GBS in pregnant women and newborns in Poland.

Methods: 169 strains of GBS, isolated from pregnant women's carriage, and 42 from newborns with invasive infection or asymptotic carriage, which were derived from the collection of the Chair of Microbiology Jagiellonian University Medical College, collected between 2006-2010, were genetically characterized. The PCR with specific primers ST17S and ST17AS was adopted to characterize the gbs2018 gene variant specific to ST-17 clone. All positive results in direction of ST-17 were confirmed by MLST. The genetic relatedness of the ST-17 clone was determined by PFGE.

Results: The hypervirulent ST-17 clone was detected in 2.4% of women with GBS asymptotic carriage, whereas it was detected in 18.2% newborns with invasive infection. No ST-17 was isolated from healthy neonates. Statistically significant correlation between the presence of ST-17 and neonatal GBS infection was showed, in comparison to healthy neonates colonized by GBS (p = 0.0398) and to GBS-positive pregnant women (p <0.00001). The ST-17 strains belonged to 2 clearly distinguishable PFGE type, but were closely related to one another at a level of 60% similarity. CONCLUSIONS. The results emphasize the necessity of a regular study of the ST-17 GBS clone occurrence among pregnant women and newborns in Poland.
View Article and Find Full Text PDF

Download full-text PDF

Source
January 2013

[Assessment of somatic development and body composition in the 7th year of life in children born as extremely low birth weight infants (≤1000g); a multi-centre cross-sectional study of a cohort born between 2002 and 2004 in the Malopolska voivodship].

Med Wieku Rozwoj 2012 Apr-Jun;16(2):81-8

Klinika Chorób Dzieci Katedry Pediatrii Polsko-Amerykańskiego Instytutu Pediatrii, Wydzia Wielickału Lekarskiego Uniwersytetu Jagiellońskiego, Kraków, Poland.

Unlabelled: Children born with extremely low birth weight often present delayed growth in the first years of their lives: they remain shorter and weigh less than their peers. Current reports published worldwide state that later in life these children are at an increased risk of cardiac and vascular diseases, diabetes and obesity. Abnormal distribution and the excess of fat tissue predispose them to develop the metabolic syndrome. THE AIM of the study was to evaluate the somatic development of seven-year-old children born with birth-weight ≤1000 g (ELBW) in the Malopolska voivodship and to estimate the content and distribution of fat tissue. Moreover, the risk factors of disturbed somatic development were evaluated.

Materials And Methods: Two hundred and four live newborns with birth weight ≤1000 g were born in the Malopolska voivodship between 1.09.2002 and 31.08.2004. One hundred and fifteen of these children (56%) died in early infancy. The study included 81 children in the 7th year of life out of the 89 surviving ones. Their mean gestational age at birth was 27.3 weeks. (SD: 2.1 weeks) and their mean birth-weight was 840 g (SD: 130 g). All the children underwent anthropometric measurements and the thickness of the skin fold over the triceps was measured. Body mass index (BMI) was calculated and the body composition was assessed by multifrequency bioimpedance. The control group consisted of 39 children born at term chosen randomly from the general population and matched with regard to age and sex.

Results: The ELBW children in the 7th year of life were shorter (z-score: -1.06±1.4 p<0.001), had lower body mass (z-score: -0.57±0.9; p=0.01), smaller head circumference (z-score: -1.2±1.3; p<0.001), lower BMI (z-score: -0.99±1.6; p<0.001) as compared to their peers. Fat tissue mass was lower in the ELBW group than in the control group (11% vs 16%; p<0.01). The most retarded somatic development was observed in the group of children suffering from cerebral palsy.

Conclusions: 1. Children born with ELBW, at 7 years of life, present significantly retarded somatic development as compared with their full-term peers. 2. The most important risk factor of somatic development disturbances is cerebral palsy. 3. Children born with low birth weight and ELBW, need long term follow up.
View Article and Find Full Text PDF

Download full-text PDF

Source
April 2013

Early-onset infections of very-low-birth-weight infants in Polish neonatal intensive care units.

Pediatr Infect Dis J 2012 Jul;31(7):691-5

Microbiology, Jagiellonian University Medical College, Krakow, Poland.

Aim: The objective of this study was to investigate the incidence, causes, the risk factors, etiologic agents and the outcomes of early-onset infections (EOIs) in very-low-birth-weight newborns in Polish neonatal intensive care units.

Methods: Continuous prospective infection surveillance conducted during 2009 at 6 Polish neonatal intensive care units and included 910 newborns whose birth weight was lower than 1500 g. Infections were defined according to the Gastmeier's criteria. EOIs were diagnosed <3 days after delivery.

Results: The frequency of early-onset septicemia (EOS) was 7.0% and of early-onset pneumonia (EO-pneumonia) 8.6%. The factors significantly increasing the risk of EOS were low gestational age, small birth weight, low score in the Clinical Risk Index for Babies and Apgar score as well as maternal chorioamnionitis. The perinatal prophylaxis did not have an influence on the occurrence of EOS. The factors considerably increasing the risk of EO-pneumonia were low scores in the Clinical Risk Index for Babies and Apgar scores, a low gestational age and bacterial vaginosis in the child's mother during pregnancy. The most important etiologic organisms were Gram-positive cocci (39.7% of all the infections, 47.8% in EOS), Streptococcus agalactiae (20% of the EOS), Gram-negative bacilli (33.3% isolates), yeast-like fungi (isolated in 7.9% of cases) and atypical bacteria (22% of the cases of EO-pneumonia).

Conclusions: The observed frequency of EOS did not differ from the one described in the literature, whereas the frequency of EO-pneumonia was higher. The bacterial etiologies suggest the vertical transmission of the pathogens and a close relationship between the observed EOIs with maternal environment. The applied perinatal antibiotic prophylaxis was ineffective.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/INF.0b013e3182567b74DOI Listing
July 2012

Docosahexaenoic acid (DHA) concentration in very low birth weight newborns receiving a fish-oil based fat emulsion from the first day of life. Preliminary clinical observation.

Med Wieku Rozwoj 2011 Jul-Sep;15(3):312-7

Department of Neonatology, Jagiellonian University, Collegium Medicum, Kraków, Poland.

Background: Preterm infants are at increased risk for DHA deficiency because from 26th weeks of pregnancy until term, 80% of the brain this acid accrues in the fetus. Moreover, the main sources of lipids for preterm newborns are fat emulsions which do not contain DHA.

Aim: 1) to investigate the plasma DHA concentration in prematurely delivered newborns who are receiving a fish-oil emulsion in amount equal to one third of total daily intravenous lipid intake or soybean/olive oil fat emulsion from the first day of life. 2) to compare plasma DHA concentration, evaluated immediately after birth in prematurely born infants, with the respective data obtained in full term newborns.

Materials And Methods: Twenty one preterm infants in the two groups: the study group n=12 (newborns fed parenterally with a partially replaced a soybean/olive oil emulsion with a fish-oil emulsion); the control group n=9 (newborn fed parenterally with a soybean/olive oil emulsion) comparable with regard to demographic and clinical characteristics. Determination of plasma and erythrocytes DHA concentrations in newborns was made using a high-performance liquid chromatography-mass spectrometry (LC-ESI/MS) method. Detection of parent ions with negative ionization mode, m/z 327,5 amu. Method validation was according to the ICH and FDA requirements.

Results: The mean values of plasma DHA level measured on the 7th, 14th, 21st, 28th day of life, were statistically significantly lower in the control group when compared with respective data obtained in the study group (7th day: 7.98 vs 42.4 ěmol/L, p=0.0002; 14th day: 6.8 vs 21.14 ěmol/l, p=0.000001; 21st day: 11.56 vs 19.1 ěmol/L, p=0.035; 28th day: 11.4 vs 25.4 ěmol/L, p=0.0004). The mean value of plasma DHA level in full-term newborns measured in the first hours of life was 164.7 ěmol/L whereas in preterm neonates it reached 15.9 ěmol/L (p=0.000001).

Conclusions: The administration of fish-oil-based fat emulsion as a component of total parenteral nutrition from the first day of life may alleviate a marked decrease in plasma DHA level observed in preterm infants within the first weeks after birth. Established method allows for routine determination of DNA concentrations in plasma erythrocytes of newborns.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2012

The efficacy of fish-oil based fat emulsion administered from the first day of life in very low birth weight newborns.

Med Wieku Rozwoj 2011 Jul-Sep;15(3):306-11

Department of Neonatology, Collegium Medicum, Jagiellonian University, Kraków, Poland.

Background: DHA has been shown to be important for foetal brain development, optimal development for motor skills and visual acuity in infants. Newborns born prematurely are at increased risk for DHA (docosahexaenoic acid) insufficiency because they may not have benefited from a full trimester of the mother's lipid stores and have very limited ability to synthesize DHA. Moreover, within the first 2-3 weeks of life, the main sources of lipids for most prematurely delivered infants are soyabean/safflower/olive oil emulsions which are rich in n-6 fatty acids and do not contain DHA.

Aim: To perform a retrospective analysis, which compares the safety and efficacy outcomes of an intravenous fat emulsion based on fish-oil (containing docosahexaenoic acid- DHA), and is administered from the first day of life in very low birth weight newborns, with data obtained in preterm neonates with birthweight below 1500 g, receiving soyabean/olive oil emulsion, which do not contain DHA.

Materials And Methods: Infants from the two groups (the study group n=152; the control group n=185) were comparable with regard to demographic and clinical characteristics and were subjected to the same conventional therapy. Determination of plasma and erythrocytes DHA concentrations in newborns was made using a high-performance liquid chromatography-mass spectrometry (LC-ESI/MS) method. Detection of parent ions with negative ionization mode, m/z 327.5 amu. Method validation was according to the ICH and FDA requirements.

Results: There was a significantly lower risk of cholestasis in infants, who were receiving the soyabean/ olive oil/fish-oil emulsion (p=0.025). Also, there was a markedly lower risk of laser therapy in infants, who were receiving a fish-oil emulsion however, the difference did not reach statistical significance.

Conclusions: Fish-oil-based fat emulsion administered as a component of total parenteral nutrition from the first day of life is safe in the prophylaxis of cholestasis and severe retinopathy of prematurity. Further clinical investigations are needed.
View Article and Find Full Text PDF

Download full-text PDF

Source
March 2012

Effect of pentoxifylline, administered in preterm labour, on the foetal-placental circulation and neonatal outcome: a randomized, prospective pilot study.

Basic Clin Pharmacol Toxicol 2012 Apr 4;110(4):342-6. Epub 2011 Nov 4.

Department of Neonatology, Jagiellonian University Medical College Kraków, Kraków, Poland.

The aim of the study was to evaluate the pentoxifylline administration on the foetal-placental circulation and neonatal outcome in women with threatened preterm labour. Pentoxifylline was given as a supplement to standard tocolytic therapy in a group of 43 patients (pentoxifylline group) as an intravenous infusion and oral supplementation in a total dosage of 800 mg/day. The drug was administered within 3 weeks after admission. No pentoxifylline was given in the control group (53 patients). Doppler velocimetry of pulsatility indices (PI) of the umbilical (UA) and middle cerebral (MCA) arteries as well as cerebro-placental ratio (CPR) were calculated. Also, the neonatal outcome was estimated in both groups. From the second week of therapy with pentoxifylline, the PI decreased in umbilical artery and increased in the MCA, whereas in the control group, there were no changes. The value of PIUA, evaluated after the third week of pentoxifylline administration, was statistically significantly lower when compared to data obtained on admission (mean: 0.99 ± 0.22 versus 0.82 ± 0.12; p =0.016). Pentoxifylline significantly increased CPR values calculated after third week of drug administration, which were statistically significantly higher in the pentoxifylline group when compared with respective data in the control group (mean: 2.30 versus 1.61; p = 0.001). The risk of severe neonatal complications was significantly lower in the pentoxifylline group (p = 0.026). Pentoxifylline changed foetal-placental blood circulation in patients with threatened preterm labour and improved neonatal outcome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1742-7843.2011.00809.xDOI Listing
April 2012

A multicenter randomized controlled trial comparing effectiveness of two nasal continuous positive airway pressure devices in very-low-birth-weight infants.

Pediatr Crit Care Med 2012 Mar;13(2):191-6

Neonatal Intensive Care Unit, Medical University of Silesia, Hospital No. 2, Bytom, Poland.

Objective: Many studies suggest nasal continuous positive airway pressure is an effective and relatively complication-free means of respiratory support in premature infants. However, only limited data exist regarding the practical aspects of nasal continuous positive airway pressure delivery, including the best way to provide the positive airway pressure.

Design: Our aim was to compare the results of treatment using two different nasal continuous positive airway pressure devices: variable flow Infant Flow and constant flow nasal continuous positive airway pressure in two different groups of very-low-birth-weight infants in a multicenter randomized controlled trial. The indication groups were elective to avoid intubation and weaning from mechanical ventilation.

Setting: Twelve leading tertiary care neonatal centers in Poland.

Patients: Among 276 infants (weighing between 750-1500g, with a gestational age ≤32 wks) enrolled, 51% were randomized to receive Infant Flow and 49% to receive constant flow nasal continuous positive airway pressure.

Measurements And Main Results: Treatment success (i.e., no need for intubation/reintubation) occurred in 75% of our patients with a nonstatistically significant advantage seen with Infant Flow. The incidence of severe nasal complications and necrotizing enterocolitis were statistically significantly lower in the infants treated with Infant Flow. In our study, factors associated with elective nasal continuous positive airway pressure failure were birth weight ≤1000 g, gestational age ≤28 wks, clinical risk index for babies score >1, and PaO(2)/FIO(2) ratio of <150. Only birth weight ≤1000 g was associated with weaning failure.

Conclusions: We found fewer severe nasal complications but no statistically significant advantage in treatment success in infants assigned to Infant Flow nasal continuous positive airway pressure compared with those assigned to constant flow nasal continuous positive airway pressure treatment. Significant risk factors of treatment failure include small size, maturity, and severity of respiratory distress syndrome.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/PCC.0b013e3182231882DOI Listing
March 2012

Fish-oil fat emulsion supplementation may reduce the risk of severe retinopathy in VLBW infants.

Pediatrics 2011 Feb 3;127(2):223-8. Epub 2011 Jan 3.

Department of Neonatology, Jagiellonian University Medical College, Kraków, Kopernika, Poland.

Objective: The retina contains rods and cones that have membranes highly enriched with docosahexaenoic acid (DHA). Infants born prematurely are at risk of DHA insufficiency, because they may not have benefited from a full third trimester of the mother's lipid stores. Moreover, within the first 2 to 3 weeks of life, the main sources of lipids for premature infants are fat emulsions, which do not contain DHA.

Patients And Methods: This observational study was designed to compare the safety and efficacy outcomes of an intravenous fat emulsion that consists of fish-oil emulsion (contains DHA) with soybean and olive oil, administered from the first day of life to 40 infants who weighed <1250 g; results were obtained from a historical cohort of 44 preterm neonates who were given an emulsion of soybean and olive oil. The primary study outcomes were the occurrence of retinopathy and need for laser therapy and cholestasis. Infants in the 2 groups were comparable with regard to demographic and clinical characteristics and were subjected to the same conventional therapy.

Results: There was a significantly lower risk of laser therapy for infants who received an emulsion of soybean, olive oil, and fish oil (P = .023). No significant differences were found in acuity and latency of visual evoked potentials between infants in the 2 groups. There was no infant with cholestasis among those who received fish-oil emulsion, and there were 5 subjects with cholestasis in the historical group (P = .056).

Conclusion: Fish-oil-based fat emulsion administered from the first day of life may be effective in the prophylaxis of severe retinopathy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1542/peds.2010-2427DOI Listing
February 2011

[The influence of MRI examination on prenatal guidance and therapeutic decisions in fetuses with central nervous system defects].

Przegl Lek 2010 ;67(4):262-7

Kameda Radiologii CMUJ w Krakowie Zakład Diagnostyki Obrazowej Szpitala Uniwersyteckiego w Krakowie.

Purpose: The aim of this study was the evaluation of diagnostic and prognostic value of prenatal US and MRI in fetuses with central nervous system abnormalities, and of the influence of incorporating MRI to diagnostic algorithm on the therapeutic decisions.

Materials And Methods: 123 pregnant women (16-40 weeks' gestation) underwent MRI due to abnormal appearance of fetal central nervous system in US (using Voluson-Kretz 730PRO). MRI has been performed on a 1.5-T Excite (GE), using a phased-array body coil, with T2-weighted sequences (SSFSET2) and orthogonal scans. The MRI findings have been compared to those from prenatal US. The influence of MRI examination in prenatal diagnostic on decisions concerning termination of pregnancy, method of delivery and neurosurgical intervention after birth was assessed.

Results: Among 123 fetuses with central nervous system abnormalities, 11 neonates died after birth (in 6 cases pathologic examination was performed), in 67 cases the MR findings were correlated with the results of the neonatal evaluation, all other cases have not been verified. Almost in 70% of the cases, MRI findings complemented the US diagnosis, in 22 cases changed it with respect to central nervous system defects, and in 18 cases--with respect to other system/organ abnormalities. In a few cases US failed to provide a correct diagnosis. In 3 cases, the MRI findings have not been confirmed with postnatal evaluation.

Conclusions: Prenatal MRI in congenital central nervous system defects allows to obtain much more important therapeutic data and complement or correct the fetal sonographic diagnosis. Prenatal MRI allows to plan gynaecological, neonatal, neurosurgical treatment, and to predict neurological defects. It also improves prenatal guidance.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2010

[A case of sepsis in ILBW infant caused by Bacillus cereus].

Med Wieku Rozwoj 2009 Jan-Mar;13(1):40-4

Klinika Neonatologii UJ CM, ul. Kopernika 23, 31-501 Kraków.

Bacillus cereus is an aerobic or facultative anaerobic Gram-positive rod which is ubiquitous in the environment. The incidence of neonatal infections is very low. The clinical course is serious, usually life- threatening or permanently damaging the central nervous system. The immature immune system, subjected to invasive procedures, increases the morbidity risk in this age group, especially in extremely low birth weight infants. Diagnostic difficulties and insusceptibility to ''first- line'' antibiotics can delay effective therapy and increase the risk of its failure. We report a 730 g preterm neonate, delivered at 27 weeks gestation with late- onset sepsis due to Bacillus cereus. The disease course was complicated by development of brain abscesses. We describe the clinical course of infection, diagnostic difficulties and the treatment. After the 140 days of hospitalization and relatively long period of therapy with different antibiotics, the patient was discharged from hospital in good condition. Despite of transmission of infection to the central nervous system, the introduced therapy prevented severe neurological disabilities as confirmed during the evaluation according to the Bayley Scale of Infant Development, performed at 29 months of life.
View Article and Find Full Text PDF

Download full-text PDF

Source
October 2009

[Prevalence and risk factors of bronchopulmonary dysplasia among extremely low birth weight newborns of regional birth cohort of south-east Poland].

Przegl Lek 2009 ;66(1-2):14-20

Klinika Chorób Dzieci Katedry Pediatrii, Uniwersytet Jagielloński Collegium Medium w Krakowie.

Background: Advances in intensive health care within the last 30 years have resulted in increased survival of most immature neonates. The results of epidemiological studies indicate, however, that late complications of prematurity, including bronchopulmonary dysplasia (BPD), have become more frequent since the late 1990s. The identification of risk factors predisposing to severe BPD might help in developing treatment methods directed at the group of children with high risk of developing the disease.

Aim: Analysis of prevalence and risk factors of bronchopulmonary dysplasia among extremely low birth weight newborns of regional birth cohort of south-east Poland.

Methods: The study included newborns of birth weight < or = 1000g born in south-east district of Poland within one calendar year. The data assessed were: the need of oxygen therapy of at least 28 days' duration and the need of oxygen therapy at 36 weeks of postmenstrual age (PMA).

Results: During the study period 109 newborns with birth weight < or = 1000g) were hospitalized in three third-level departments of neonatology in south-east Poland. The final assessment for BPD included 56 children (51%), whose mean birth weight was 839g (SD: 128) and mean gestational age was 27.3 weeks (SD: 2.2). Thirty-nine children (70%) required oxygen therapy for at least 28 days, and 27 children (48%) required oxygen therapy at 36 weeks of PMA. Gestational age of the newborn, the need of respiratory support at birth, and the need of surgical treatment of PDA were found to be independent risk factors of oxygen therapy lasting for at least 28 days. Only the need of respiratory support at 7 days of life and the need for surgical treatment of PDA were found to be independent risk factors of oxygen therapy at the 36 weeks of PMA.

Conclusion: The analysis of several risk factors of BPD in children with birth weight < or =1000g revealed that the need for respiratory support at seven days of life is a major risk factor of developing chronic respiratory disease. The risk of BPD may be significantly reduced by adequate care aimed at shortening the time of conventional respiratory support and at limiting the persistence of ductus arteriosus.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2009