Publications by authors named "Milan Stanojevic"

49 Publications

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

J Perinat Med 2020 Dec 2;49(1):111-115. Epub 2020 Dec 2.

Department of Obstetrics and Gynaecology, Fetal Medicine Unit, Maternal and Child Health and Development Network, University Hospital 12 de Octubre, Complutense University of Madrid, Madrid, Spain.

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http://dx.doi.org/10.1515/jpm-2020-0539DOI Listing
December 2020

Risk factors associated with adverse fetal outcomes in pregnancies affected by Coronavirus disease 2019 (COVID-19): a secondary analysis of the WAPM study on COVID-19.

Authors:
Daniele Di Mascio Cihat Sen Gabriele Saccone Alberto Galindo Amos Grünebaum Jun Yoshimatsu Milan Stanojevic Asım Kurjak Frank Chervenak María José Rodríguez Suárez Zita Maria Gambacorti-Passerini María de Los Angeles Anaya Baz Esther Vanessa Aguilar Galán Yolanda Cuñarro López Juan Antonio De León Luis Ignacio Cueto Hernández Ignacio Herraiz Cecilia Villalain Roberta Venturella Giuseppe Rizzo Ilenia Mappa Giovanni Gerosolima Lars Hellmeyer Josefine Königbauer Giada Ameli Tiziana Frusca Nicola Volpe Giovanni Battista Luca Schera Stefania Fieni Eutalia Esposito Giuliana Simonazzi Gaetana Di Donna Aly Youssef Anna Nunzia Della Gatta Mariano Catello Di Donna Vito Chiantera Natalina Buono Giulio Sozzi Pantaleo Greco Danila Morano Beatrice Bianchi Maria Giulia Lombana Marino Federica Laraud Arianna Ramone Angelo Cagnacci Fabio Barra Claudio Gustavino Simone Ferrero Fabio Ghezzi Antonella Cromi Antonio Simone Laganà Valentina Laurita Longo Francesca Stollagli Angelo Sirico Antonio Lanzone Lorenza Driul Fabiana Cecchini D Serena Xodo Brian Rodriguez Felipe Mercado-Olivares Deena Elkafrawi Giovanni Sisti Rosanna Esposito Antonio Coviello Marco Cerbone Maddalena Morlando Antonio Schiattarella Nicola Colacurci Pasquale De Franciscis Ilaria Cataneo Marinella Lenzi Fabrizio Sandri Riccardo Buscemi Giorgia Gattei Francesca Della Sala Eleonora Valori Maria Cristina Rovellotti Elisa Done Gilles Faron Leonardo Gucciardo Valentina Esposito Flaminia Vena Antonella Giancotti Roberto Brunelli Ludovico Muzii Luigi Nappi Felice Sorrentino Lorenzo Vasciaveo Marco Liberati Danilo Buca Martina Leombroni Francesca Di Sebastiano Luciano Di Tizio Diego Gazzolo Massimo Franchi Quintino Cesare Ianniciello Simone Garzon Giuliano Petriglia Leonardo Borrello Albaro Josè Nieto-Calvache Juan Manuel Burgos-Luna Caroline Kadji Andrew Carlin Elisa Bevilacqua Marina Moucho Pedro Viana Pinto Rita Figueiredo José Morales Roselló Gabriela Loscalzo Alicia Martinez-Varea Vincente Diago Jesús S Jimenez Lopez Alicia Yeliz Aykanat Stefano Cosma Andrea Carosso Chiara Benedetto Amanda Bermejo Otto Henrique May Feuerschuette Ozlem Uyaniklar Sakine Rahimli Ocakouglu Zeliha Atak Reyhan Gündüz Esra Tustas Haberal Bernd Froessler Anupam Parange Peter Palm Igor Samardjiski Chiara Taccaliti Erhan Okuyan George Daskalakis Renato Augusto Moreira de Sa Alejandro Pittaro Maria Luisa Gonzalez-Duran Ana Concheiro Guisan Şerife Özlem Genç Blanka Zlatohlávková Anna Luengo Piqueras Dolores Esteban Oliva Aylin Pelin Cil Olus Api Panos Antsaklis Liana Ples Ioannis Kyvernitakis Holger Maul Marcel Malan Albert Lila Roberta Granese Alfredo Ercoli Giuseppe Zoccali Andrea Villasco Nicoletta Biglia Ciuhodaru Madalina Elena Costa Caroline Daelemans Axelle Pintiaux Elisa Cueto Eran Hadar Sarah Dollinger Noa A Brzezinski Sinai Erasmo Huertas Pedro Arango Amadeo Sanchez Javier Alfonso Schvartzman Liviu Cojocaru Sifa Turan Ozhan Turan Maria Carmela Di Dedda Rebeca Garrote Molpeceres Snezana Zdjelar Tanja Premru-Srsen Lilijana Kornhauser Cerar Mirjam Druškovič Valentina De Robertis Vedran Stefanovic Irmeli Nupponen Kaisa Nelskylä Zulfiya Khodjaeva Ksenia A Gorina Gennady T Sukhikh Giuseppe Maria Maruotti Silvia Visentin Erich Cosmi Jacopo Ferrari Alessandra Gatti Daniela Luvero Roberto Angioli Ludovica Puri Marco Palumbo Giusella D'Urso Francesco Colaleo Agnese Maria Chiara Rapisarda Ilma Floriana Carbone Antonio Mollo Giovanni Nazzaro Mariavittoria Locci Maurizio Guida Attilio Di Spiezio Sardo Pierluigi Benedetti Panici Vincenzo Berghella Maria Elena Flacco Lamberto Manzoli Giuseppe Bifulco Giovanni Scambia Fulvio Zullo Francesco D'Antonio

J Perinat Med 2020 11;48(9):950-958

Centre for High Risk Pregnancy and Fetal Care, University of Chieti, Department of Obstetrics and Gynaecology, Chieti, Italy.

Objectives To evaluate the strength of association between maternal and pregnancy characteristics and the risk of adverse perinatal outcomes in pregnancies with laboratory confirmed COVID-19. Methods Secondary analysis of a multinational, cohort study on all consecutive pregnant women with laboratory-confirmed COVID-19 from February 1, 2020 to April 30, 2020 from 73 centers from 22 different countries. A confirmed case of COVID-19 was defined as a positive result on real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) assay of nasal and pharyngeal swab specimens. The primary outcome was a composite adverse fetal outcome, defined as the presence of either abortion (pregnancy loss before 22 weeks of gestations), stillbirth (intrauterine fetal death after 22 weeks of gestation), neonatal death (death of a live-born infant within the first 28 days of life), and perinatal death (either stillbirth or neonatal death). Logistic regression analysis was performed to evaluate parameters independently associated with the primary outcome. Logistic regression was reported as odds ratio (OR) with 95% confidence interval (CI). Results Mean gestational age at diagnosis was 30.6±9.5 weeks, with 8.0% of women being diagnosed in the first, 22.2% in the second and 69.8% in the third trimester of pregnancy. There were six miscarriage (2.3%), six intrauterine device (IUD) (2.3) and 5 (2.0%) neonatal deaths, with an overall rate of perinatal death of 4.2% (11/265), thus resulting into 17 cases experiencing and 226 not experiencing composite adverse fetal outcome. Neither stillbirths nor neonatal deaths had congenital anomalies found at antenatal or postnatal evaluation. Furthermore, none of the cases experiencing IUD had signs of impending demise at arterial or venous Doppler. Neonatal deaths were all considered as prematurity-related adverse events. Of the 250 live-born neonates, one (0.4%) was found positive at RT-PCR pharyngeal swabs performed after delivery. The mother was tested positive during the third trimester of pregnancy. The newborn was asymptomatic and had negative RT-PCR test after 14 days of life. At logistic regression analysis, gestational age at diagnosis (OR: 0.85, 95% CI 0.8-0.9 per week increase; p<0.001), birthweight (OR: 1.17, 95% CI 1.09-1.12.7 per 100 g decrease; p=0.012) and maternal ventilatory support, including either need for oxygen or CPAP (OR: 4.12, 95% CI 2.3-7.9; p=0.001) were independently associated with composite adverse fetal outcome. Conclusions Early gestational age at infection, maternal ventilatory supports and low birthweight are the main determinants of adverse perinatal outcomes in fetuses with maternal COVID-19 infection. Conversely, the risk of vertical transmission seems negligible.
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http://dx.doi.org/10.1515/jpm-2020-0355DOI Listing
November 2020

Professionally responsible advocacy for women and children first during the COVID-19 pandemic: guidance from World Association of Perinatal Medicine and International Academy of Perinatal Medicine.

J Perinat Med 2020 Nov;48(9):867-873

Department of Obstetrics and Gynecology, University of Zagreb, Zagreb, Croatia.

The goal of perinatal medicine is to provide professionally responsible clinical management of the conditions and diagnoses of pregnant, fetal, and neonatal patients. The New York Declaration of the International Academy of Perinatal Medicine, "Women and children First - or Last?" was directed toward the ethical challenges of perinatal medicine in middle-income and low-income countries. The global COVID-19 pandemic presents common ethical challenges in all countries, independent of their national wealth. In this paper the World Association of Perinatal Medicine provides ethics-based guidance for professionally responsible advocacy for women and children first during the COVID-19 pandemic. We first present an ethical framework that explains ethical reasoning, clinically relevant ethical principles and professional virtues, and decision making with pregnant patients and parents. We then apply this ethical framework to evidence-based treatment and its improvement, planned home birth, ring-fencing obstetric services, attendance of spouse or partner at birth, and the responsible management of organizational resources. Perinatal physicians should focus on the mission of perinatal medicine to put women and children first and frame-shifting when necessary to put the lives and health of the population of patients served by a hospital first.
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http://dx.doi.org/10.1515/jpm-2020-0329DOI Listing
November 2020

Are Covid-19-positive mothers dangerous for their term and well newborn babies? Is there an answer?

J Perinat Med 2020 Jun;48(5):441-445

Department of Obstetrics and Gynecology Medical School University of Zagreb, Neonatal Unit, Sveti Duh University Hospital, Voćarska cesta 63/1, Zagreb 10000, Croatia.

Background The pandemic caused by the new coronavirus SARS-CoV-2 (Covid-19) is quite a challenging experience for the world. At the moment of birth, the fetus is prepared to face the challenge of labor and the exposure to the outside world, meaning that labor and birth represent the first extrauterine major exposure to a complex microbiota. The vagina, which is a canal for reproduction, is by evolution separated (but not far) from the anus and urethra. Passing through the birthing canal is a mechanism for intergenerational transmission of vaginal and gut microorganisms for the vertical transmission of microbiota not only from our mothers and grandmothers but also from earlier ancestors. Methods Many national and international instructions have been developed since the beginning of the Covid-19 outbreak in January 2020 in Wuhan in China. All of them pointed out hygiene measures, social distancing and avoidance of social contacts as the most important epidemiological preventive measures. Pregnancy and neonatal periods are considered as high risk for Covid-19 infection. Results The instructions defined the care for pregnant women in the delivery room, during a hospital stay and after discharge. The controversial procedures in the care of Covid-19-suspected or -positive asymptomatic women in labor were: mode of delivery, companion during birth and labor, skin-to-skin contact, breastfeeding, and visits during a hospital stay. Conclusion There is a hope that instruction on coping with the coronavirus (Covid-19) infection in pregnancy with all proposed interventions affecting mothers, babies and families, besides saving lives, are beneficial and efficient by exerting no harm.
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http://dx.doi.org/10.1515/jpm-2020-0186DOI Listing
June 2020

Multi-center results on the clinical use of KANET.

J Perinat Med 2019 Nov;47(9):897-909

Department of Perinatology and Gynecology, Kagawa University Graduate School of Medicine, Kagawa, Japan.

An extensive review of the literature on the diagnostic and clinical accuracy of Kurjak's antenatal neurodevelopmental test (KANET) and the summarized results of the multi-center study involving 10 centers revealed that four-dimensional ultrasonography (4D US) has become a powerful tool and KANET a valuable test that empowers the clinicians worldwide to evaluate the fetal behavior in a systematic way and contribute to the detection of fetuses that might be at high risk for neurological impairments and in particular cerebral palsy (CP). After 10 years of clinical use, many published papers and multi-center studies, hundreds of trained physicians and numerous tests performed all over the world, KANET has proven its value and has been showing encouraging results so far. The aim of this paper is to show the results from the studies done so far and to reveal the clinical value of the KANET. We expect that data from the larger ongoing collaborative study, the short- and long-term postnatal follow-up will continue to improve our knowledge. Ultimately, we all strive to prevent the CP disorders, autism spectrum disorder (ASD) and other neurological impairments and we are convinced that KANET might be helpful in the realization of this important aim.
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http://dx.doi.org/10.1515/jpm-2019-0281DOI Listing
November 2019

Is Four-Dimensional (4D) Ultrasound Entering a New Field of Fetal Psychiatry?

Psychiatr Danub 2019 Jun;31(2):133-140

Department of Obstetrics and Gynecology, Clinical Hospital "Sveti Duh", Medical School University of Zagreb, Zagreb, Croatia,

The aim of is to explore whether by observing the fetus by 4D US it is possible to enter fetal behavior, emotions, mental status, consciousness, awareness and other states connected with fetal mind and ability of self-regulation. It is well known that fetal motoric activity is enabling the development of central and peripheral nervous system and the muscles. It is 4D US which enabled to investigate fetal movement patterns from the first trimester of pregnancy throughout the whole pregnancy. Based on the evaluation of fetal spontaneous motor activity by 4D US, a prenatal neurologic scoring test named Kurjak Antenatal Neurodevelopmental Test (KANET) was created. This test has been used to assess almost 2000 fetuses and our results have indicated that KANET has an ability to recognize normal, borderline, and abnormal behavior in fetuses from normal and abnormal pregnancies. The fetus is able to process tactile, vestibular, taste, olfactory, auditory and visual sensations. The fetus responds to painful stimuli with a wide spectrum of reactions. Important external signs of emotion are facial expressions. The existence of a wide range of facial expressions, including grimacing, smiling, crying, similar to emotional expressions in adults, has been revealed by 4D sonography in the 2 and 3 trimesters of pregnancy. It is questionable if mental, emotional and behavioral conditions of the fetus were covered in this paper and whether we are able to perceive the fetus as the patient who may develop communication or some other psychiatric disorders which we will be hopefully able to recognize prenatally. Although it seems as the speculation from the point of view of our recent diagnostic possibilities, it is apparent that the day when this will be a reality is rapidly approaching.
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http://dx.doi.org/10.24869/psyd.2019.133DOI Listing
June 2019

Ki-67 labeling index and expression of p53 are non-predictive for invasiveness and tumor size in functional and nonfunctional pituitary adenomas.

Acta Neurochir (Wien) 2019 06 30;161(6):1149-1156. Epub 2019 Apr 30.

Department for Neurosurgery, University Hospital Tübingen, Hoppe-Seyler-Strasse 3, 72076, Tübingen, Germany.

Background: It is still controversial whether an increased proliferation index is correlated with the tumor invasiveness of pituitary adenomas. A homogeneous large monocentric series of pituitary adenomas was retrospectively analyzed. The correlation between the proliferation indices (Ki-67 and p53 expression levels) and invasiveness and size of pituitary adenomas was investigated in primary operated and recurrent adenomas.

Method: Four hundred thirty-nine patients after resection of pituitary adenomas were retrospectively included (43 recurrent tumors, 196 null cell adenomas, 86 somatotroph adenomas, 55 corticotroph adenomas, 55 prolactinomas, 4 thyreotroph adenomas). The maximum tumor diameter and tumor invasiveness in Knosp grading were assessed and Ki-67 and p53 immunostaining was performed. The role of invasiveness was evaluated using a cumulative odds ordinal logistic regression. For calculating the effect of tumor size, a one-way analysis of variance (ANOVA) was conducted.

Results: Overall and in the subgroups, no significant correlation between proliferation indices and mean tumor diameter was found. No significant predictive expression value of Ki-67 and p53 on tumor invasiveness and in recurrent tumors could be demonstrated. There was a tendency that Ki-67 LI and p53 LI are higher in recurrent corticotroph adenomas and lactotroph adenomas but values did not reach the significant level.

Conclusion: Invasive character of pituitary adenomas is neither correlated with increased Ki-67 LI nor with increased p53 expression. Proliferation parameters are independent from adenoma size at initial presentation. The partly elevated expression of Ki-67 in recurrent tumors underlines the clinical importance of the marker.
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http://dx.doi.org/10.1007/s00701-019-03879-4DOI Listing
June 2019

Spinal meningioma surgery in the elderly: who benefits?

J Neurosurg Sci 2018 Nov 21. Epub 2018 Nov 21.

Department of Neurosurgery, University Hospital of Tuebingen, Tuebingen, Germany.

Background: With increasing life expectancy and increasing demands on quality of life more spinal meningiomas will limit quality of life in elderly in the coming decades. We investigated whether elderly can improve neurologically and gain self-dependence postoperatively.

Methods: Medical records of consecutive spinal meningioma patients from 2004 - 2015 were retrospectively analyzed. Age, gender, preoperative duration and quality of symptoms, pre- and postoperative McCormick score, Karnofsky Performace Status (KPS), American Society of Anesthesiologists Physical Status (ASA), modified Clinical Scoring System (mCSS) and tumor characteristics were included. Elderly were defined by ≥ 70 years.

Results: 129 patients were included, of which 44 ≥ 70 years. Younger patients were significantly better preoperatively in McCormick, KPS, ASA and mCSS within the first postoperative year. Both younger and elderly patients improved significantly postoperatively in McCormick, KPS and mCSS. Surgical complication rate was similar for younger and elderly patients (5.9 vs. 6.8%, resp.). Systemic complication rate was higher in elderly (0 vs. 6.8%, resp.).

Conclusions: Surgery for spinal meningioma in elderly (KPS ≥ 40 and ASA ≤ 3) leads to a significant improvement of McCormick, KPS and mCSS postoperatively. This leads to a higher rate of self-dependency and thereby probably to an improvement of quality of life in elderly. However, special attention for systemic complications is necessary.
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http://dx.doi.org/10.23736/S0390-5616.18.04582-4DOI Listing
November 2018

Diagnosis of fetal syndromes by three- and four-dimensional ultrasound: is there any improvement?

J Perinat Med 2017 Aug;45(6):651-665

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With all of our present knowledge, high technology diagnostic equipment, electronic databases and other available supporting resources, detection of fetal syndromes is still a challenge for healthcare providers in prenatal as well as in the postnatal period. Prenatal diagnosis of fetal syndromes is not straightforward, and it is a difficult puzzle that needs to be assembled and solved. Detection of one anomaly should always raise a suspicion of the existence of more anomalies, and can be a trigger to investigate further and raise awareness of possible syndromes. Highly specialized software systems for three- and four-dimensional ultrasound (3D/4D US) enabled detailed depiction of fetal anatomy and assessment of the dynamics of fetal structural and functional development in real time. With recent advances in 3D/4D US technology, antenatal diagnosis of fetal anomalies and syndromes shifted from the 2nd to the 1st trimester of pregnancy. It is questionable what can and should be done after the prenatal diagnosis of fetal syndrome. The 3D and 4D US techniques improved detection accuracy of fetal abnormalities and syndromes from early pregnancy onwards. It is not easy to make prenatal diagnosis of fetal syndromes, so tools which help like online integrated databases are needed to increase diagnostic precision. The aim of this paper is to present the possibilities of different US techniques in the detection of some fetal syndromes prenatally.
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http://dx.doi.org/10.1515/jpm-2016-0416DOI Listing
August 2017

Multicentric studies of the fetal neurobehavior by KANET test.

J Perinat Med 2017 Aug;45(6):717-727

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Assessment of fetal neurobehavior and detection of neurological impairment prenatally has been a great challenge in perinatal medicine. The evolution of four-dimensional (4D) ultrasound not only enabled a better visualization of fetal anatomy but also allowed the study of fetal behavior in real time. Kurjak Antenatal Neurodevelopmental Test (KANET) was developed for the assessment of fetal neurobehavior and the detection of neurological disorders, based on the assessment of the fetus by application of 4D ultrasound in the same way that a neonate is assessed postnatally. KANET is a method that has been applied for the past 10 years and studies show that it is a strong diagnostic tool and can be introduced into everyday clinical practice. We present all data from studies performed up to now on KANET.
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http://dx.doi.org/10.1515/jpm-2016-0409DOI Listing
August 2017

A Multifaceted Approach to Revitalizing the Baby-Friendly Hospital Initiative in Croatia.

J Hum Lact 2016 Aug 27;32(3):568-73. Epub 2016 Apr 27.

Department of Obstetrics and Gynecology, Division of Neonatology, Medical School University of Zagreb, University Hospital "Sveti Duh" Zagreb, Zagreb, Croatia.

The Baby-Friendly Hospital Initiative (BFHI) was launched in Croatia in 1993. By 1998, 15 of 34 maternity facilities were designated "Baby-Friendly." Introduction of hospital bags, violating the International Code of the Marketing of Breastmilk Substitutes, led to a standstill in the BFHI. The aim of this article is to describe the successful reintroduction of the BFHI in Croatia between 2007 and 2015. After hospital bags were abolished in 2007, UNICEF Croatia undertook an assessment of BFHI implementation. All maternity facilities were invited by UNICEF and the Ministry of Health to join the renewed BFHI. UNICEF materials were translated and training for trainers, assessors, coordinators, and hospital staff held. By June 2015, 30 of 32 (94%) maternity facilities, providing care to 89% of newborns, were Baby-Friendly. Nine maternity hospitals have been renovated and 2 new hospitals have been built. Exclusive breastfeeding rates have risen 16% at 0 to 2 months (from 51% in 2007 to 67% in 2014) and 14% at 3 to 5 months (from 32% in 2007 to 46% in 2014). Fourteen "Breastfeeding-Friendly" primary care practices have been designated, 166 breastfeeding support groups are in operation, criteria for Mother-Friendly care are being piloted in 2 maternity facilities, and "Ten Steps in the Neonatal Intensive Care Unit" are being introduced. The BFHI provides an excellent opportunity for revitalizing breastfeeding protection, promotion, and support in all settings. Recognition and support of the BFHI by the Croatian government was crucial for implementing the BFHI, whereas the marketing practices of the breast milk substitutes industry are an ongoing challenge.
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http://dx.doi.org/10.1177/0890334415625872DOI Listing
August 2016

Fetal magnetic resonance imaging and ultrasound.

J Perinat Med 2016 Jul;44(5):533-42

Magnetic resonance imaging (MRI) has been increasingly adopted in obstetrics practice in the past three decades. MRI aids prenatal ultrasound and improves diagnostic accuracy for selected maternal and fetal conditions. However, it should be considered only when high-quality ultrasound cannot provide certain information that affects the counseling, prenatal intervention, pregnancy course, and delivery plan. Major indications of fetal MRI include, but are not restricted to, morbidly adherent placenta, selected cases of fetal brain anomalies, thoracic lesions (especially in severe congenital diaphragmatic hernia), and soft tissue tumors at head and neck regions of the fetus. For fetal anatomy assessment, a 1.5-Tesla machine with a fast T2-weighted single-shot technique is recommended for image requisition of common fetal abnormalities. Individual judgment needs to be applied when considering usage of a 3-Tesla machine. Gadolinium MRI contrast is not recommended during pregnancy. MRI should be avoided in the first half of pregnancy due to small fetal structures and motion artifacts. Assessment of fetal cerebral cortex can be achieved with MRI in the third trimester. MRI is a viable research tool for noninvasive interrogation of the fetus and the placenta.
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http://dx.doi.org/10.1515/jpm-2015-0226DOI Listing
July 2016

Epidemiology and Outcomes of Congenital Diaphragmatic Hernia in Croatia: A Population-Based Study.

Paediatr Perinat Epidemiol 2016 07 25;30(4):336-45. Epub 2016 Mar 25.

Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.

Background: Outcomes of neonates with congenital diaphragmatic hernia (CDH) are variable; reports are frequently limited to the experience of single tertiary care centres-a possible source of bias. Population-based studies decrease survivor bias and provide additional insight into this high-mortality condition. The objective of this study was to examine the incidence and outcomes of CDH in Croatia.

Methods: All cases of CDH in Croatia from 2001 through 2013 were ascertained from public health records. Overall and sex- and region-specific incidence rates were calculated, and characteristics associated with 1-year survival were assessed.

Results: We identified 145 cases of CDH during the study period, for an incidence of 2.67 per 10 000 total births. The incidence did not differ by calendar year (P = 0.38) or geographic region (P = 0.67). There was a slightly higher incidence among males (rate ratio, 1.37, 95% CI 0.99, 1.91). The 1-year survival rate was 33.1% for the entire cohort and 47.9% for liveborns who received any treatment at an intensive care unit. From multivariable analysis, survival was decreased in neonates with left CDH, liver up (odds ratio 0.1, 95% CI, 0.03, 0.4) and increased when treated in a centre with higher case volume (odds ratio 12.8, 95% CI, 2.2, 72.1).

Conclusions: The incidence of CDH in Croatia is within the range of previous reports. Survival was substantially higher in neonates treated in a centre with higher case volume, which suggests that centralisation of medical care for CDH may be warranted in Croatia.
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http://dx.doi.org/10.1111/ppe.12289DOI Listing
July 2016

Controversial ultrasound findings in mid trimester pregnancy. Evidence based approach.

J Perinat Med 2016 Mar;44(2):131-7

Mid trimester fetal anatomy scan is a fundamental part of routine antenatal care. Some U/S soft markers or controversial U/S signs are seen during the scan and create some confusion regarding their relation to fetal chromosomal abnormalities. Example of these signs: echogenic focus in the heart, echogenic bowel, renal pyelectasis, ventriculomegaly, polydactely, club foot, choroid plexus cyst, single umbilical artery. We are presenting an evidence based approach from the literature for management of these controversial U/S signs.
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http://dx.doi.org/10.1515/jpm-2015-0223DOI Listing
March 2016

Petrosectomy and Topographical Anatomy in Traditional Kawase and Posterior Intradural Petrous Apicectomy (PIPA) Approach: An Anatomical Study.

World Neurosurg 2016 Feb 14;86:93-102. Epub 2015 Dec 14.

Neurochirurgie Uniklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany.

Objective: To compare the anatomical exposure and petrosectomy extent in the Kawase and posterior intradural petrous apicectomy (PIPA) approaches.

Methods: Kawase and PIPA approaches were performed on 4 fixed cadaveric heads (3 alcohol-fixed, 1 formaldehyde-fixed silicone-injected; 4 Kawase and 4 PIPA approaches). The microsurgical anatomy was examined by means of Zeiss Opmi CS/NC-4 microscopes. HD Karl Storz Endoscopes (AIDA system) were used to display intradural exposure. Petrosectomy volumes was assessed by comparing pre- and postoperative thin-slice computed tomography scans (Analyze 12.0; AnalyzeDirect Mayo Clinic).

Results: The Kawase approach exposed the rhomboid fossa with Meckel's cave extradurally, the upper half of the clivus, superior cerebellopontine angle, ventrolateral brainstem, the intrameatal region, basilar apex, and the preganglionic root of cranial nerve (CN) V, CN III-IV-VI intradurally. The PIPA approach exposed the cerebello-pontine angle with CN VI-XII, Meckel's cave, CN III-V, and the middle and lower clivus intradurally from a posterior view. The area of surgical exposure is wide in both approaches; however, the volume of petrosectomy, the working angle, and surgical corridor differ significantly.

Conclusions: The Kawase approach allows wide exposure of the middle cranial fossa (MCF) and posterior cranial fossa, requiring extradural temporal lobe retraction and an extradural petrosectomy with preservation of the internal acoustic meatus and cochlea. No temporal lobe retraction and direct control of neurovascular structures make the PIPA approach a valid alternative for lesions extending mostly in the Posterior cranial fossa with minor extension in the MCF. The longer surgical corridor, cerebellar retraction, and limited exposure of the anterior brainstem make this approach less indicated for lesions with major extension in the MCF and the anterior cavernous sinus.
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http://dx.doi.org/10.1016/j.wneu.2015.08.083DOI Listing
February 2016

Ultrasound in Africa: what can really be done?

J Perinat Med 2016 Mar;44(2):119-23

Today we are living in a globalized world in which information on what is happening in one part of the world is easily communicated to other parts of the world. This happens thanks to advancement in science and technology. One area where technology has made the greatest impact is heath care provision. Ultrasound technology is now playing a critical role in health care provision particularly in Obstetrics and Gynaecology. This has significantly assisted in provision of quality health care to pregnant women and their unborn infants and in reducing maternal and neonatal morbidity and mortality in the developed world. Africa the continent with greatest health care challenges and with the highest maternal and neonatal mortalities is yet to fully utilize this important technology. The need for this technology is great as the conditions requiring its application abound. The effective application of Ultrasound however faces serious challenges in Africa. To successfully entrench Ultrasound in quality Obstetrics and Gynaecology care various approaches must be adopted to overcome the challenges. The aim of this paper is to identify the benefits and the challenges inimical to the application Ultrasound in Obstetrics and Gynecology in Africa. It also examines what needs to be done to achieve better application of Ultrasound in Obstetrics and Gynecology.
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http://dx.doi.org/10.1515/jpm-2015-0224DOI Listing
March 2016

3D/4D sonography - any safety problem.

J Perinat Med 2016 Mar;44(2):125-9

Gray-scale image data are processed in 3D ultrasound by repeated scans of multiple planes within a few seconds to achieve one surface rendering image and three perpendicular plane images. The 4D image is achieved by repeating 3D images in short intervals, i.e. 3D and 4D ultrasound are based on simple B-mode images. During 3D/4D acquisition, a fetus in utero is exposed by ultrasound beam for only a few seconds, and it is as short as real-time B-mode scanning. Therefore, simple 3D imaging is as safe as a simple B-mode scan. The 4D ultrasound is also as safe as a simple B-mode scan, but the ultrasound exposure should be shorter than 30 min. The thermal index (TI) and mechanical index (MI) should both be lower than 1.0, and the ultrasound study is regulated by the Doppler ultrasound if it is combined with simple 3D or 4D ultrasound. Recently, some articles have reported the functional changes of animal fetal brain neuronal cells and liver cell apoptosis with Doppler ultrasound. We discuss cell apoptosis by ultrasound in this report. Diagnostic ultrasound safety is achieved by controlling the output pulse and continuous ultrasound waves using thermal and mechanical indices, which should be <1.0 in abdominal and transvaginal scan, pulsed Doppler, as well as 3D and 4D ultrasound. The lowest spatial peak temporal average (SPTA) intensity of the ultrasound to suppress cultured cell growth is 240 mW/cm2, below which no ultrasound effect has been reported. An ultrasound user must be trained to recognize the ultrasound bioeffects; thermal and mechanical indices, and how to reduce these when they are higher than 1.0 on the monitor display; and guide the proper use of the ultrasound under the ALARA principle, because the user is responsible for ensuring ultrasound safety.
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http://dx.doi.org/10.1515/jpm-2015-0225DOI Listing
March 2016

Is intrauterine surgery justified? Report from the working group on ultrasound in obstetrics of the World Association of Perinatal Medicine (WAPM).

J Perinat Med 2016 Oct;44(7):737-743

Fetal surgery involves a large number of heterogeneous interventions that vary from simple and settled procedures to very sophisticated or still-in-development approaches. The overarching goal of fetal interventions is clear: to improve the health of children by intervening before birth to correct or treat prenatally diagnosed abnormalities. This article provides an overview of fetal interventions, ethical approaches in fetal surgery, and benefits obtained from antenatal surgeries.
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http://dx.doi.org/10.1515/jpm-2015-0132DOI Listing
October 2016

Favorable long-term outcomes of bilateral adrenalectomy in Cushing's disease.

Eur J Endocrinol 2014 Aug;171(2):209-15

Medizinische Klinik und Poliklinik IVLudwig-Maximilians-Universität München, Klinikum der Universität München, Ziemssenstraße 1, D-80336 Munich, GermanyDepartment of EndocrinologyMax Planck Institute of Psychiatry, München, GermanyDepartment of NeurosurgeryUniversity Hospital Tuebingen, Tübingen, GermanyIMSEKlinikum rechts der Isar der TU München, München, Germany andChirurgische Klinik und Poliklinik - InnenstadtKlinikum der Ludwig-Maximilians-Universität München, München, Germany

Objective: Bilateral adrenalectomy (BADX) is an important treatment option for patients with Cushing's syndrome (CS). Our aim is to analyze the long-term outcomes, surgical, biochemical, and clinical as well as morbidity and mortality, of patients who underwent BADX.

Design: A total of 50 patients who underwent BADX since 1990 in two German centers were identified. Of them, 34 patients had Cushing's disease (CD), nine ectopic CS (ECS), and seven ACTH-independent bilateral adrenal hyperplasia (BAH).

Methods: Standardized follow-up examination was performed in 36 patients with a minimum follow-up time of 6 months after BADX and a median follow-up time of 11 years.

Results: Surgical morbidity and mortality were 6 and 4% respectively. All patients were found to be in remission after BADX. Almost all Cushing's-specific comorbidities except for psychiatric diseases improved significantly. Health-related quality of life remained impaired in 45.0% of female and 16.7% of male patients compared with a healthy population. The median number of adrenal crises per 100 patient-years was four. Nelson tumor occurred in 24% of CD patients after a median time span of 51 months. Long-term mortality after 10 years was high in ECS (44%) compared with CD (3%) and BAH (14%).

Conclusions: BADX is an effective and relatively safe treatment option especially in patients with CD. The majority of patients experience considerable improvement of Cushing's symptoms.
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http://dx.doi.org/10.1530/EJE-14-0214DOI Listing
August 2014

Amnion protective cesarean section--method for gentle delivery of preterm and/or VLBW neonates.

J Matern Fetal Neonatal Med 2014 Mar 2;27(4):393-6. Epub 2013 Dec 2.

Department of Obstetrics and Gynecology, Medical School University of Zagreb , Clinical Hospital "Sv. Duh", Zagreb , Croatia.

Unlabelled: More than 50 percent of preterm neonates below 28 gestational weeks in our institution are delivered by cesarean section (CS).

Aim: To present advantages of less used method of delivery of premature and/or very low birth weight (VLBW) neonates by Amnion Protective Cesarean Section (APCS) when indicated and to review our experience with the method. It can be used in all deliveries by CS with unruptured amniotic membranes, at all gestational ages.

Materials And Methods: Including criteria were singleton pregnancies, gestation of 26 to 35 weeks and birth body weight between 700 to 1500 g. According to the criteria, during the studied period 10 neonates were delivered by APCS. We compared the outcomes of APCS neonates with ones delivered by coventional CS who matched them in mentioned criteria.

Results: Compared to CS cases, APCS neonates had statistically significant better first minute AS. Stay in NICU was shorter for APCS neonates but not statistically significant. From our experience APCS neonates had clinically better appearance (less bruises and hematomas).

Conclusion: APCS is promising method for delivery of preterm and/or VLBW neonates when indicated, although prospective studies are needed in order to prove its effectiveness compared to conventional CS.
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http://dx.doi.org/10.3109/14767058.2013.818119DOI Listing
March 2014

Assessment of motoric and hemodynamic parameters in growth restricted fetuses - case study.

J Matern Fetal Neonatal Med 2014 Feb 20;27(3):247-51. Epub 2013 Jun 20.

Department of Obstetrics and Gynecology, Clinical Hospital Sveti Duh, Medical School, University of Zagreb , Zagreb , Croatia .

Objective: In order to more accurately assess fetal neurological status in five fetuses with severe intrauterine growth restriction (IUGR), combined assessment of their hemodynamics and motor activity was undertaken in this study.

Method: Hemodynamic changes in the placental and fetal cerebral vessels were evaluated using the umbilical artery resistance index (URI), and the middle cerebral artery resistance index (CRI). The blood flow redistribution towards the fetal brain in response to fetal hypoxia was detected by the C/U (cerebro - umbilical) ratio, expressed as CRI/URI. Motoric parameters were assessed by new antenatal neurologic scoring test named Kurjak Antenatal Neurodevelopmental Test (KANET), based on evaluation of spontaneous motor activity using four-dimensional (4D) ultrasound.

Results: KANET has potential in recognizing pathologic and borderline behavior in IUGR fetuses with or without blood flow redistribution towards the fetal brain. Very low values of C/U ratio and abnormal KANET score have indicated adverse pregnancy outcome.

Conclusion: In some pregnancies complicated with IUGR, estimation of the risk of hypoxia versus prematurity can be extremely puzzling. Combined assessment of hemodynamic and motoric parameters in IUGR fetuses could allow construction of an algorithm, which would be helpful in the decision making process of pregnancy termination.
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http://dx.doi.org/10.3109/14767058.2013.807241DOI Listing
February 2014

The study of fetal neurobehavior in twins in all three trimesters of pregnancy.

J Matern Fetal Neonatal Med 2013 Aug 6;26(12):1186-95. Epub 2013 Mar 6.

Department of Obstetrics and Gynecology, Medical School University of Zagreb, Clinical Hospital Sveti Duh, Zagreb, Croatia.

Aim: The aim was to assess the onset and the frequencies of the first intertwin contacts by four-dimensional ultrasound (4D US) in the 1st trimester of pregnancy. In the second part of the study, fetal behavior and Kurjak Antenatal Neurodevelopmental Test (KANET) score of twins compared to singletons in the 2nd and the 3rd trimesters was assessed.

Patients And Methods: Transvaginal 4D assessment was performed in 20 women in the 1st trimester between 56 and 69 postmenstrual days (PMD), while trans-abdominal approach was performed from 70 PMD onwards and at weekly intervals until 112 PMD. Fetal behavior was assessed by 4D UD US between 28 and 36 gestational weeks in 49 twin pregnancies.

Results: The first intertwin contacts appeared at 61 PMD, while complex body movements appeared at 68 PMD. The complexity of intertwin contacts increased from 84 PMD. With increasing gestational age, a higher frequency of movements was observed. The number of abnormal, borderline, and normal KANET scores between singletons and twins was not statistically significant. Scores for isolated eye blinking, mouthing, grimacing, hand to head movement, finger movements, Gestalt perception and general movements differed significantly in twins and singletons.

Conclusions: Two types of activities were observed: spontaneous and reactive. Although twins showed less activity and different behavioral pattern than singletons, a considerable proportion of overall motility was due to intertwin contacts.
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http://dx.doi.org/10.3109/14767058.2013.773306DOI Listing
August 2013

Comparison between antenatal neurodevelopmental test and fetal Doppler in the assessment of fetal well being.

J Perinat Med 2013 Jan;41(1):107-14

Department of Obstetrics and Gynecology, Medical School University Zagreb, Zagreb, Croatia.

Aims: The primary aim of this study was to compare circulatory changes in the fetal brain under certain pathological conditions with alterations in fetal behavior.

Patients And Methods: A prospective longitudinal cohort study on fetal behavior of fetuses from singleton pregnancies between the 28th and 38th gestational week in the period from March 2009 to October 2011 was undertaken. There were 596 fetuses in the high-risk group and 273 fetuses in the low-risk group. Elevated umbilical artery Doppler pulsatility index and reduced middle cerebral artery pulsatility index obtained in the absence of fetal movements were considered abnormal. The Kurjak Antenatal Neurodevelopmental Test (KANET) was used to assess fetal behavior.

Results: Statistically significant differences in the distribution of normal, abnormal, and borderline KANET scores between low-risk and high-risk groups were found. Furthermore, 596 fetuses from the high-risk group were subdivided into subgroups according to the risk factor. The largest proportion of abnormal KANET scores (23.9%) was in the subgroup of fetuses whose mothers had an offspring diagnosed with cerebral palsy (23.9%), followed by the proportion of borderline KANET scores in the subgroup of fetuses from febrile mothers (12.7%). Fetal behavior was significantly different between the normal group and the following subgroups of fetuses: fetal growth restriction (FGR), gestational diabetes mellitus, threatened preterm birth, antepartal hemorrhage, maternal fever, sibling with cerebral palsy, and polyhydramnios.

Conclusions: A new clinical application of the KANET test in early identification of fetuses at risk for adverse neurological outcome was demonstrated.
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http://dx.doi.org/10.1515/jpm-2012-0018DOI Listing
January 2013

Psychometric assessment of the croatian version of the breastfeeding self-efficacy scale-short form.

J Hum Lact 2012 Nov 6;28(4):565-9. Epub 2012 Sep 6.

University Hospital Sveti Duh Zagreb, Croatia.

Background: Many mothers find it difficult to breastfeed exclusively for the recommended 6 months postpartum. The Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) was developed to measure breastfeeding self-efficacy, an important predictor of breastfeeding outcomes.

Objective: To translate and psychometrically assess the BSES-SF among women in Croatia.

Methods: A convenience sample of 190 breastfeeding mothers was recruited from a Baby-Friendly hospital in Zagreb, Croatia. In-hospital mothers completed questionnaires that included the translated BSES-SF, Sense of Coherence Scale (SOC-13), and a demographic questionnaire. The follow-up questionnaires were administered to mothers at 1 and 6 months postpartum to determine their infant feeding method.

Results: The mean total score of the Croatian version of the BSES-SF was 55 ± 7. The Cronbach α coefficient for internal consistency was 0.86, suggesting good reliability. In-hospital BSES-SF scores significantly predicted breastfeeding duration and exclusivity at 1 and 6 months postpartum, providing support for predictive validity. The BSES-SF scores were significantly correlated with the total SOC scores (r = 0.32, P < .001) and the SOC subscales of comprehensibility (r = 0.35, P < .001), manageability (r = 0.26, P < .001), and meaningfulness (r = 0.20, P = .005), providing support for construct validity.

Conclusion: This study provides evidence that the translated version of the BSES-SF may be a valid and reliable measure of breastfeeding self-efficacy among postpartum women in Croatia.
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http://dx.doi.org/10.1177/0890334412456240DOI Listing
November 2012

Continuity between fetal and neonatal neurobehavior.

Semin Fetal Neonatal Med 2012 Dec 17;17(6):324-9. Epub 2012 Jul 17.

Division of Neonatology, Department of Obstetrics and Gynecology, University Hospital Sveti Duh, School of Medicine, University of Zagreb, Zagreb, Croatia.

The human brain is very sensitive to environmental changes affecting its growth and development. Environmental changes influence neonatal behavior after birth, enabling continuity between prenatal and postnatal behavior, but postnatal adaptation could be considered as discontinuity. Thus there is the question of environmental discontinuity between intrauterine conditions characterized by existence of microgravity and extrauterine life with gravity as a developmental condition sine qua non. Four-dimensional ultrasound is currently being assessed as a functional prenatal screening test for detection of neurological impairment in utero. The Kurjak Antenatal Neurodevelopmental Test (KANET) combines the assessment of fetal behavior, general movements, and three out of four signs that have been postnatally considered as symptoms of possible neurodevelopmental impairment (neurological thumb, overlapping sutures and small head circumference). Although the KANET has been tested on normal and high-risk pregnancies, the significance of the test for detection and prevention of neurodevelopmental disability is still questionable.
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http://dx.doi.org/10.1016/j.siny.2012.06.006DOI Listing
December 2012

Neurologic parameters in the perinatal period in children with neurodevelopmental disorders.

J Matern Fetal Neonatal Med 2012 Oct 27;25(10):2088-92. Epub 2012 Mar 27.

Department of Neurology, University Hospital Sveti Duh, Medical School, University of Zagreb, Sveti Duh 64, 10000 Zagreb, Croatia.

Unlabelled: Cerebral palsy (CP) is a term encompassing a group of nonprogressive, noncontagious conditions causing mild, moderate or severe disorders of neurodevelopment.

Objective: Objective of this study was to analyze the possible prenatal etiological factors for the emergence of neurodevelopmental disorders (NDs) and CP from the medical records of 100 children with neuromotor disabilities who were treated in Special Hospital for Children with Neuro-developmental and Movement Disorders, Goljak, Croatia.

Results: ND and CP were more often diagnosed in children with birth weight below 2500 g which was statistically proved at the level of significance reaching 0.05, although significant correlation was low for both parameters reaching 0.21. There are both statistically significant differences and the statistically significant correlation between the three gestational age categories within ND and CP. There were more children with the birth weight below 2500 g in the CP than in the ND group and the difference was statistically significant. In the CP group, there were more children with the lower gestational age than in the ND group, which was statistically highly significant. This difference, together with correlation is significant at the level of 0.01.

Conclusion: Further studies on the etiology of NDs are needed, with particular focus on the intrauterine risk factors.
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http://dx.doi.org/10.3109/14767058.2012.667179DOI Listing
October 2012

Intrauterine growth restriction and cerebral palsy.

Acta Inform Med 2012 Jan 1;18(2):64-82. Epub 2012 Jan 1.

Welcare Hospital, Dubai, Uae.

Intrauterine growth restriction (IUGR) can be described as condition in which fetus fails to reach his potential growth. It is common diagnosis in obstetrics, and carries an increased risk of perinatal mortality and morbidity. Moreover, IUGR has lifelong implications on health, especially on neurological outcome. There is a need for additional neurological assessment during monitoring of fetal well-being, in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Studies have revealed that the behavior of the fetus reflects the maturational processes of the central nervous system (CNS). Hence, ultrasound investigation of the fetal behavior can give us insight into the integrity and functioning of the fetal CNS. Furthermore, investigations carried out using modern method, four-dimensional (4D) sonography, have produced invaluable details of fetal behavior and its development, opening the door to a better understanding of the prenatal functional development of the CNS. Based on previous observations and several years of investigation, our reaserch group has proposed a new scoring system for the assessment of fetal neurological status by 4D sonography named Kurjak antenatal neurodevelopmental test (KANET). The value of KANET in distinguishing fetal brain and neurodevelopmental alterations due to the early brain impairment in utero is yet to be assessed in large population studies. However, preliminary results are very encouraging.
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http://dx.doi.org/10.5455/aim.2010.18.64-82DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232345PMC
January 2012

The assessment of fetal brain function in fetuses with ventrikulomegaly: the role of the KANET test.

J Matern Fetal Neonatal Med 2012 Aug 28;25(8):1267-72. Epub 2011 Nov 28.

Department of Obstetrics and Gynecology, University of Medical Sciences and Technology, Academy Charity Hospital, Khartoum, Sudan.

Objective: To assess differences in fetal behavior in both normal fetuses and fetuses with cerebral ventriculomegaly (VM).

Methods: In a period of eighteen months, in a longitudinal prospective cohort study, Kurjak Antenatal NeuorogicalTest (KANET) was applied to assess fetal behavior in both normal pregnancies and pregnancies with cerebral VM using four-dimensional ultrasound (4D US). According to the degree of enlargement of the ventricles, VM was divided into three groups: mild, moderate and severe. Moreover fetuses with isolated VM were separated from those with additional abnormalities. According to the KANET, fetuses with scores ≥ 14 were considered normal, those with scores 6-13 borderline and abnormal if the score was ≤ 5. Differences between two groups were examined by Fisher's exact test. Differences within the subgroups were examined by Kruskal-Wallis test and contingency table test.

Results: KANET scores in normal pregnancies and pregnancies with VM showed statistically significant differences. Most of the abnormal KANET scores as well as most of the borderline-scores were found among the fetuses with severe VM associated with additional abnormalities. There were no statistically significant differences between the control group and the groups with isolated and mild and /or moderate VM.

Conclusion: Evaluation of the fetal behavior in fetuses with cerebral VM using KANET test has the potential to detect fetuses with abnormal behavior, and to add the dimension of CNS function to the morphological criteria of VM. Long-term postnatal neurodevelopmental follow-up should confirm the data from prenatal investigation of fetal behavior.
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http://dx.doi.org/10.3109/14767058.2011.634463DOI Listing
August 2012

Reversal of thrombocytopenia and bleeding tendency in a preterm neonate with recombinant activated factor VII: case report.

Acta Clin Croat 2010 Sep;49(3):309-13

Department of Anesthesiology, Resuscitation and Intensive Therapy, Zagreb Children's Hospital, Zagreb, Croatia.

A male neonate, born at 26 weeks of postmenstrual age, with intracranial hemorrhage grade IV and thoracic drainage for artificial tension pneumothorax on day 6 of his life is presented. Despite prior transfusions, the preprocedural hemogram showed marked anemia and thrombocytopenia. To reverse thrombocytopenia and to avoid volume overload, the patient was administered 110 microg kg(-1) of recombinant activated factor VII (rFVIIa) and drainage of the pneumothorax was performed uneventfully.
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September 2010

Neurobehavioral continuity from fetus to neonate.

J Perinat Med 2011 03 10;39(2):171-7. Epub 2011 Feb 10.

Department of Obstetrics and Gynecology, Medical School University of Zagreb, Sveti Duh Cinical Hospital, Zagreb, Croatia.

Neurobehavior represents development of the central nervous system (CNS). Fetuses and newborns exhibit a large number of endogenously generated motor patterns, among which general movements are often investigated pre- and post-natally. Spontaneous activity is probably a more sensitive indicator of brain dysfunction than reactivity to sensory stimuli while testing reflexes. Nutritional stress at critical times during fetal development can have persistent and potentially irreversible effects particularly on brain growth and function. Unfavorable intrauterine environment can affect adversely brain growth. All endogenously generated movement patterns from un-stimulated CNS might be observed as early as from the seven to eight weeks' gestation, with a rich repertoire of movements within the next two or three weeks, continuing for five to six months postnatally. It is still uncertain whether a new scoring system for prenatal neurological assessment will be adequate for the distinction between normal and abnormal fetuses in low-risk pregnancies. The continuity of behavioral patterns from prenatal to postnatal life might answer these intriguing questions.
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http://dx.doi.org/10.1515/jpm.2011.004DOI Listing
March 2011