Lower heart rate variability (HRV) in a newborn might represent a risk factor for unfavourable outcome, a longer recovery after illness, and a sudden infant death. Our aim was to determine whether ...the newborn's sleeping position is associated with HRV.
We performed a prospective clinical study in 46 hospitalized cardiorespiratory stable term newborns. During sleeping, we measured the parameters of HRV in four body positions (supine, supine with tilt, prone, prone with tilt).
The TP (total power spectral density) was significantly higher when lying supine in comparison to prone (p = 0,048) and to prone with tilt (p = 0,046). The HF (high frequency of power spectral density) in the supine position without tilt tended to be higher compared to prone without tilt (p > 0,05). The LF (low frequency power) was significantly higher when lying supine compared to prone, both without tilt (p = 0,018). TP and HF showed a positive correlation with gestational but not postmenstrual age (p = 0.044 and p = 0.036, respectively).
In term newborns, sleeping position is associated with HRV. Higher TP and HF were found in the supine position, which might reflect better ANS stability. Gestational age positively correlated with TP and HF power, but only in supine position.
ISRCTN11702082, date of registration: March, 13th, 2020; retrospectively registered.
Prirojeni portosistemski venski obvodi (PPSVO) so redka skupina heterogenih razvojnih nepravilnosti portalnega in sis-temskega krvnega obtoka, zaradi katerih kri iz portalnega sistema preko različnih ...žilnih obvodov zaobide presnovo v jetrih in teče neposredno v sistemski krvni obtok. Razdelimo jih lahko v dve skupini − znotrajjetrne, med katere uvrščamo tudi perzistentni venozni duktus, in zunajjetrne obvode. Zaradi nepravilnega toka splanhnične krvi z nerazgrajenimi presnovki neposredno v sistemski krvni obtok lahko nastanejo hudi zapleti: neonatalna holestaza, benigni in maligni jetrni tumorji, hepato-pulmonalni sindrom, portopulmonalna hipertenzija in encefalopatija. Majhni znotrajjetrni obvodi se lahko v prvih dveh letih življenja spontano umaknejo. Druge, trajne znotrajjetrne in zunajjetrne obvode moramo zapreti v enem ali dveh korakih z maloinvazivnimi intervencijskimi radiološkimi zapiralnimi metodami ali s kirurškim posegom. Pri zunanjjetrnem obvodu tipa 1 je vedno potrebna presaditev jeter.
Zdravniški vestnik je odigral pomembno vlogo v razvoju sodobne slovenske medicine in slovenskega medicinskega jezika, zlasti terminologije. Namen članka je na kratko prikazati razvoj Zdravniškega ...vestnika od njegove ustanovitve 1929 do danes.
Neonatal apnoea can be treated with caffeine, which affects the central nervous and cardiovascular systems. Heart rate variability (HRV) reflects the activity of the autonomic nervous system (ANS) ...and might be used as a measure of ANS maturation in newborns. We aimed to establish the effect of caffeine on HRV in newborns and investigated the potential correlation between HRV and postmenstrual age (PMA). In 25 haemodynamically stable newborns hospitalized due to apnoea and treated with caffeine (2.5 mg/kg), we assessed breathing frequency, arterial oxygen saturation, body temperature, and the heart rate while they were sleeping. We assessed HRV by spectral analysis using fast Fourier transformation. The same protocol was reapplied 100 h after caffeine withdrawal to assess the control parameters. Caffeine increased breathing frequency (
= 0.023) but did not affect any other parameter assessed including HRV. We established a positive correlation between postmenstrual age and HRV during treatment with caffeine as well as after caffeine had been withdrawn (total power:
= 0.044; low-frequency band:
= 0.039). Apparently, the maintenance dose of caffeine is too low to affect the heart rate and HRV. A positive correlation between PMA and HRV might reflect maturation of the ANS, irrespective of caffeine treatment.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Group B Streptococcus (GBS) is the leading cause of invasive neonatal disease in the industrialized world. We aimed to genomically and phenotypically characterise invasive GBS isolates in Slovenia ...from 2001 to 2018 and contemporary colonising GBS isolates from screening cultures in 2018.
GBS isolates from 101 patients (invasive isolates) and 70 pregnant women (colonising isolates) were analysed. Basic clinical characteristics of the patients were collected from medical records. Antimicrobial susceptibility and phenotypic capsular serotype were determined. Whole-genome sequencing was performed to assign multilocus sequence types (STs), clonal complexes (CCs), pathogenicity/virulence factors, including capsular genotypes, and genome-based phylogeny.
Among invasive neonatal disease patients, 42.6% (n = 43) were females, 41.5% (n = 39/94) were from preterm deliveries (< 37 weeks gestation), and 41.6% (n = 42) had early-onset disease (EOD). All isolates were susceptible to benzylpenicillin with low minimum inhibitory concentrations (MICs; ≤0.125 mg/L). Overall, 7 serotypes were identified (Ia, Ib, II-V and VIII); serotype III being the most prevalent (59.6%). Twenty-eight MLST STs were detected that clustered into 6 CCs. CC-17 was the most common CC overall (53.2%), as well as among invasive (67.3%) and non-invasive (32.9%) isolates (p < 0.001). CC-17 was more common among patients with late-onset disease (LOD) (81.4%) compared to EOD (47.6%) (p < 0.001). The prevalence of other CCs was 12.9% (CC-23), 11.1% (CC-12), 10.5% (CC-1), 8.2% (CC-19), and 1.8% (CC-498). Of all isolates, 2.3% were singletons.
A high prevalence of hypervirulent CC-17 isolates, with low genomic diversity and characteristic profile of pathogenicity/virulence factors, was detected among invasive neonatal and colonising GBS isolates from pregnant women in Slovenia. This is the first genomic characterisation of GBS isolates in Slovenia and provides valuable microbiological and genomic baseline data regarding the invasive and colonising GBS population nationally. Continuous genomic surveillance of GBS infections is crucial to analyse the impact of IND prevention strategies on the population structure of GBS locally, nationally, and internationally.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Anemijo standardno laboratorijsko ugotavljamo kot zmanjšanje koncentracije hemoglobina in zmanjšanje števila eritrocitov in/ali hematokrita v volumski enoti krvi za več kot dva standardna odklona pod ...povprečno vrednostjo za starost. Za ugotavljanje vzroka anemije in uspešno zdravljenje je pomembno poznavanje fiziologije eritropoeze ter normalnih vrednosti laboratorijskih kazalnikov pri donošenem in nedonošenem novorojenčku. V preglednem prispevku najprej opišemo fiziologijo eritropoeze in nato pojasnimo osnovne laboratorijske hematološke parametre. Sledi poglavje o manj pogostih laboratorijskih kazalnikih za vrednotenje aktivnosti kostnega mozga, ki bi jih lahko večkrat uporabljali v vsakdanji praksi in se tako izognili obširnemu jemanju krvi. Predstavljamo klinični pristop k novorojenčku z anemijo. Zadnje poglavje posvečamo anemiji nedonošenčka, ki se v mnogočem razlikuje od anemije donošenega novorojenčka.
Objective: Because of the restraints on conducting studies on pharmaceutical use in sick newborns, many drugs are used off-label in this population. Moreover, industrially manufactured ...pharmaceuticals may contain different excipients, which may be either untested or not licensed for use in neonates. The aim of our study was to determine the prevalence and pattern of pharmaceutical and excipient exposure in newborns hospitalized at the Department of Neonatology, Ljubljana, Slovenia.
Methods: A longitudinal prospective cross-sectional study was performed during a one-month period and included all hospitalized neonates. Route of administration, site of action, type of manufacture, licensing status, type and concentrations of excipients for all pharmaceuticals given to the neonates were determined.
Results: Twenty seven different pharmaceutical preparations were prescribed to a total of 48 hospitalized newborns. In most cases, newborns were prescribed various pharmaceuticals that were not approved for use in this population. Newborns were exposed to 60 different excipients in industrially manufactured pharmaceutical preparations. More than half of the received pharmaceuticals contained potentially harmful and harmful excipients.
Conclusions: Two-thirds of pharmaceutical preparations for neonates were used off-label. Newborns receive more auxiliary substances, which may be unsuitable for this age group and may even be toxic to them, via industrially manufactured pharmaceuticals.
Odkar izvajamo zaščito RhD-negativnih nosečnic z anti-D protitelesi, je najpogostejši vzrok za hemolitično bolezen novorojenčka neskladje ABO krvnih skupin matere in ploda oz. novorojenčka. Hemolizo ...povzročajo protitelesa, ki so posledica izoimunizacije matere, in prehajajo preko posteljice v plod, kjer uničujejo plodove in novorojenčkove eritrocite. Bolezen se kaže s hemolitično anemijo, težko zgodnjo zlatenico in splenomegalijo. Ker so antigeni ABO prisotni tudi na trombocitih in drugih tkivih, lahko protitelesa anti-A ali anti-B v redkih primerih povzročijo tudi trombocitopenijo, saj se protitelesa odzivajo z istimi antigeni, prisotnimi tudi na trombocitih. V članku predstavljamo donošeno novorojenko s krvno skupino (KS) A, RhD pozitivno, po Kellu negativno, ki smo jo obravnavali zaradi hemolitične anemije in trombocitopenije. Materi so med nosečnostjo določili KS O, da je RhD pozitivna in po Kellu negativna. Ob sprejemu je bila deklica subikterična. Laboratorijski izvidi v starosti 100 ur so bili: hemoglobin 152 g/L, trombociti 44 × 109/L, celokupni bilirubin 254 μmol/L in direktni bilirubin 10,6 μmol/L. Direktni Coombsov test (DCT) pri deklici je bil pozitiven, imela je prisotna protitelesa anti-A IgG. Ob fototerapiji so vrednosti bilirubina ustrezno upadle. Zaradi trombocitopenije pri novorojenki smo analizirali materin hemogram, ki je pokazal normalno koncentracijo trombocitov v periferni krvi ter nato opravili genotipizacijo HPA pri materi in novorojenki, ki ni pokazala neskladja. Opravili smo tudi direktni test trombocitnih protiteles, ki je bil negativen. Za trombocite specifičnih protiteles (HPA in HLA) nismo uspeli potrditi. Število trombocitov se je spontano zvišalo. Ob zadnjem pregledu je v hemogramu izstopala nevtropenija, ki je spontano izzvenela do starosti 4 mesecev in pol.
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