Abstract
Neonatal head circumference (HC) not only represents the brain size of
Homo sapiens
, but is also an important health risk indicator. Addressing a lack of comparative studies on head size ...and its variability in term and preterm neonates from different populations, we aimed to examine neonatal HC by gestation according to a regional reference and a global standard. Retrospective analysis of data on neonatal HC obtained from the Lithuanian Medical Birth Register from 2001 to 2015 (423 999 newborns of 24–42 gestational weeks). The varying distribution by gestation and sex was estimated using GAMLSS, and the results were compared with the INTERGROWTH-21st standard. Mean HC increased with gestation in both sexes, while its fractional variability fell. The 3rd percentile matched that for INTERGROWTH-21st at all gestations, while the 50th and 97th percentiles were similar up to 27 weeks, but a full channel width higher than INTERGROWTH-21st at term. INTERGROWTH-21st facilitates the evaluation of neonatal HC in early gestations, while in later gestations, the specific features of neonatal HC of a particular population tend to be more precisely represented by regional references.
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2.
Pranas Šimulis (1926–2014) Basys, Vytautas
Acta medica Lituanica,
03/2015, Volume:
21, Issue:
4
Journal Article
Peer reviewed
Open access
Netekome garbaus žmogaus, žymaus vaikų gydytojo, patyrusio dėstytojo, profesoriaus habilituoto daktaro Prano Šimulio.
Šiltas ir malonus žmogus – toks jis buvo bendradarbiams, pacientų tėvams, ...studentams ir gydytojams tobulinimosi kursuose
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There is no global consensus as to which standards are the most appropriate for the assessment of birth weight and length. The study aimed to compare the applicability of regional and global ...standards to the Lithuanian newborn population by sex and gestational age, based on the prevalence of small or large for gestational age (SGA/LGA).
Analysis was performed on neonatal length and weight data obtained from the Lithuanian Medical Birth Register from 1995 to 2015 (618,235 newborns of 24-42 gestational weeks). Their distributions by gestation and sex were estimated using generalized additive models for location, scale, and shape (GAMLSS), and the results were compared with the INTERGROWTH-21st (IG-21) standard to evaluate the prevalence of SGA/LGA (10th/90th centile) at different gestational ages.
The difference in median length at term between the local reference and IG-21 was 3 cm-4 cm, while median weight at term differed by 200 g. The Lithuanian median weight at term was higher than in IG-21 by a full centile channel width, while the median length at term was higher by two channel widths. Based on the regional reference, the prevalence rates of SGA/LGA were 9.7%/10.1% for boys and 10.1%/9.9% for girls, close to the nominal 10%. Conversely, based on IG-21, the prevalence of SGA in boys/girls was less than half (4.1%/4.4%), while the prevalence of LGA was double (20.7%/19.1%).
Regional population-based neonatal references represent Lithuanian neonatal weight and length much more accurately than the global standard IG-21 which provides the prevalence rates for SGA/LGA that differ from the true values by a factor of two.
2015 m. sausio 24 d. – Lietuvos mokslų akademijos (LMA) tikrojo nario, profesoriaus, mokslų daktaro Prano MAŽYLIO 130 gimimo metų sukaktis. Ta proga išleistas proginis vokas, Lietuvos sveikatos ...mokslų universiteto Akušerijos ir ginekologijos klinika kartu su Kauno krašto akušerių ginekologų draugija Lietuvos medicinos ir farmacijos istorijos muziejuje 2015 m. vasario 5 d. organizavo mokslinę konferenciją „Gyvenimas kaip legenda. Akademikas Pranas Mažylis, 1885–1966“, atidarė parodą „Akademikas profesorius Pranas Mažylis – Lietuvos akušerijos ir ginekologijos mokyklos įkūrėjas, gimdymo pagalbos organizatorius, klinicistas, pedagogas“.
Straipsnyje pateikiami svarbiausieji Lietuvos mokslų akademijos akademiko Prano Mažylio gyvenimo etapai ir jo veikla dirbant Akademijos institutuose, komisijose, vadovavimas moksliniams tyrimams ir šių tyrimų svarbiausi rezultatai.
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Perinatal CNS injuries are significant for the health of neonates and for child development at a later period. The aim of this study was to evaluate the dynamics of the frequency of perinatal CNS ...lesions (corresponding to ICD 10 code P91) over a 20-year period, using the data collected from the Lithuanian Medical Data of Births (Registry of Births).
In total, data of 559,164 newborns were analyzed.
During the period from 1997 to 2014, the frequency of term newborns with perinatal CNS injury decreased almost two times, from 20.4/1000 live births in 1997 to 15.5/1000 live births in 2014, or from 3.12% (95% CI 2.95; 3.31) to 1.46% (95% CI 1.32; 1.61). In 18 years, the rate of infant mortality from perinatal CNS injury decreased by more than four times and in 2014 it was 0.3/1000 births; it accounts for 11% of neonatal mortality (2.6/1000 live births). The largest decrease of CNS injury was seen after a caesarean birth (from 13.7% in 1999 to 1.7% in 2014) and breech delivery (from 9.7% in 1999 to 0.8% in 2014). Analysis of the dynamics of perinatal CNS injury in preterm births in selected groups did not identify a significant positive shift during the period. When evaluating the level of childbirth services in different-level maternity hospitals, CNS injury is undoubtedly diminished in 2B-level maternity hospitals (regional). Also, positive dynamics was observed in the data of 2A-level maternity hospitals, while in 3-level maternity hospitals (university hospitals), which deal with the most complicated obstetrical pathology and preterm newborns, positive dynamics was not observed. It is estimated that the frequency of hypoxic-ischemic encephalopathy was 0.63/1000 live births in Lithuania in 1993.
The frequency of perinatal CNS injury and its positive dynamics in over 18 years shows a progressive and scientifically-based perinatal health care organization in Lithuania.
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Trends in maternal health in Lithuania 1995-2014 Drąsutienė, Gražina Stanislava; Drazdienė, Nijolė; Arlauskienė, Audronė ...
Acta medica Lituanica,
01/2016, Volume:
23, Issue:
2
Journal Article
Peer reviewed
Open access
The Lithuanian Perinatology Program, orders issued by the Ministry of Health, regulating the care and treatment of mothers and their infants, and the well-running perinatal care system helped to ...improve the diagnostics and treatment of pregnancy pathology. Over the last 20 years, Lithuania has experienced significant improvements in the maternal and perinatal health.
Data was collected from the official statistics database, Medical Data of Births, provided by the Institute of Hygiene Health Information Centre, Vilnius University Faculty of Medicine, and the Vilnius University Centre of Neonatology in 1995-2014.
The average maternal age at delivery ranged from 25.8 years in 1995 to 28.8 years in 2014. The comparison of 2001 and 2014 data shows that the incidence of gestational diabetes increased by 6.7 times due to the improved diagnosis. The percentage of hypertensive disorders decreased from 6.1% in 1997 to 3.2% in 2014. Between 1995 and 2014, the prevalence of anemia among pregnant women declined by half. The marked decrease in respiratory, urinary, genital and other diseases was observed among pregnant women. From 1995 to 2014, in Lithuania there were 67 maternal deaths related to pregnancy and childbirth. Hemorrhage and infections during pregnancy, delivery and the postpartum period are considered the most common causes of maternal death.
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The aim of the study was to examine changes of total number of births and birth weight of Lithuanian newborns during the 1995–2013 in relation to the national and regional socio-economic welfare and ...governmental maternity support. The present results were based on Lithuanian Medical Data of Births Register. Only data of single newborns of identifiable sex, whose mothers were citizens of Lithuania, were included into the present analysis, and total number of analysed cases was N=597091. The total number of births dramatically decreased during the 1995-2002, slightly increased in the 2007-2009, and decreased again in the 2010-2013. Diminishing index was in line with increase of unemployment rate and decline of total Lithuanian population. Increase in number of births was estimated only in the 2007-2009, when maternity benefits were increased very evidently. The significant differences of mean birth weight by year were observed: the decrease in boys’ weight was detected in the 2001-2003, and the decrease in girls’ weight was detected in the 1995-1996 and in the 2001-2003 (p<0.05). However, the increase in weight of both sexes was observed in the 2008-2010 (right after raised maternal allowance). The prevalence of low and suboptimal birth weight was the highest in the 2002 and the lowest – in the 2008-2010 years. The obvious regional differences in changes of total number of births and birth weight were estimated.
To evaluate the importance of maternal socio-economic factors on the risk of low birth weight in Lithuania.
The case-control study involved 851 newborns with low birth weight (<2500 g) (cases) and ...851 newborns with normal weight (controls). Study was accomplished from 1st February, 2001 until 31st October, 2002 in six main maternity hospitals in Lithuania. Mothers of infants were interviewed on the first day after delivery using the structured questionnaire. The database was processed by the application of statistical package "SPSS for Windows v.10.0".
Young (<20 years) and older (35 years and older) maternal age, primary or basic education, being single, divorced or widowed, low income, living in rural area and unemployment before pregnancy and during pregnancy increased the risk to deliver low birth weight baby in univariate analysis. In logistic multivariable regression analysis, low education, low income and unemployment during pregnancy significantly increased risk of low birth weight--OR - 2.0, 1.7 and 1.6 respectively. Interaction between several unfavorable risk factors increased risk of low birth weight by 3.4-7.8 times, being the highest among mothers with low education, unstable marital status and low income.
Maternal unfavorable socio-economic factors increased the risk to deliver low birth weight baby.
alpha-1-proteinase inhibitor (alpha-1-PI) might appear to be actively involved in atherogenesis as an important regulator protecting elastic tissue from damage by proteinases as well as lipid ...accumulation in arterial wall.
alpha-1-PI genetic variants were examined in 156 male coronary atherosclerosis patients (mean age 49+/-9 years). The frequency of alpha-1-PI phenotypes was determined in 1577 healthy individuals. Also, 108 long-survivors (mean age 92.7+/-4.3 years) were investigated for alpha-1-PI phenotype. The serum level of alpha-1-PI was examined in 43 coronary atherosclerosis patients (mean of age 49.6+/-8.1 years) and in different age groups of healthy males. A correlations between seruma-1-PI concentration and apoB, and apoA-1 were calculated. Relationship between serum alpha-1-PI and apolipoprotein B/apolipoprotein A-1 (apoB/apoA-1) ratio was determined. Isoelectric focusing of alpha-1-PI phenotypes was performed on thick polyacrylamide gels with ampholytes pH 3.5-5.0, 4.5-6.5 and 4.2-5.0. A quantitative assessment of alpha-1-PI, apoB and apoA-1 was performed by ELISA method using antibodies against human alpha-1-PI, apoB and apoA-1.
The phenotype PI ZZ of alpha-1-PI associated with a severe congenital deficiency of alpha-1-PI in patients and long-lived subjects was not found. In population this phenotype (0.06%) as well as PI SS phenotype (0.06%) was detected once. No significant difference was found in the frequency of PI*M, PI*S and PI*Z genes in the coronary atherosclerosis group and population. The PI*Z gene was significantly more frequent in patients with coronary atherosclerosis than in long-survivors (P<0.01). The correlation between blood serum (-1-PI concentration and age in the control group of males was significant (r=-0.83, P<0.01). The alpha-1-PI concentration was found significantly higher in coronary atherosclerosis patients compared with control (2.14+/-0.6 and 1.68+/-0.3 g/l respectively, P<0.05). The alpha-1-PI concentration was found to dependent on the apoB/apoA-1 ratio: it was higher in patients having apoB/apoA-1>1.0 than in patients with apoB/apoA-1<1.0 (2.4+/-0.6 and 2.04+/-0.5 g/l respectively, P<0.05). There was a significant correlation between alpha-1-PI concentration and apoB/apoA-1 ratio in blood serum of patients suffering from coronary atherosclerosis (r=0.25, P<0.05).
Derangements in the homeostasis of proteinase-antiproteinase system could be involved in destruction of the arterial wall connective tissue. The local as well as systemic inactivation of alpha-1-PI in atherosclerosis process could be related with hyperlipidemia. Investigation of long-survivors support the suggestion that they are important antiatherogenic control group for evaluating the role of genetic determinants in atherogenesis. Congenital (alpha-1-PI deficiency, hyperlipidemia) and acquired (related to smoking, aging) imbalance of proteinase-antiproteinase system is considered to one of the atherogenic factors. Authors discuss the possible mechanisms of atherogenesis related with imbalance of proteinase-antiproteinase system.
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