Darjan Kardum

Histopathological placental inflammation provides objective evidence of intrauterine inflammatory exposure in preterm birth, but placental histopathology i

Introduction. Hypothermia has been widely regarded as a major contributor to neonatal mortality and morbidity. Chemical warming packs used during delivery room resuscitation are associated with decreased rates of hypothermia. The ideal thermal mattress should be inexpensive, electricity-free, reusable, and safe for use in low-resource settings. In this pilot study, we describe the characteristics of a novel, inexpensive chemical warmer developed by the authors. Methods. The novel neonatal chemical warmer consists of two main components. The first component is the chemical warmer bag which is designed for single use, while the other is the container in which the chemical warmer is placed upon activation is reusable. A total of 5 chemical heaters were activated and tested. The goal was to determine whether the temperatures measured on the surface of the warmer were in the optimal range of the chemical heaters available so far. The temperature was measured every 5 minutes at 5 places (corners of the heater and in the middle of the heater), and the maximum measured temperature will be recorded. Temperatures were recorded every 5 minutes as long as the surface temperature measured above 35.9 ºC. Results. By the 5 minutes after activation two and at the 10th minute, all five chemical warmers achieved the desired surface temperature > 36.0 °C (range 38.4 – 40.4 °C.). The length in which the chemical warmer provided the temperatures in the desired range (36.0 – 42.0 °C) varied between 35 to 60 minutes, and we observed that this is highly dependent on starting surface temperatures. Regarding the safety of the surface temperatures produced, no recorded temperatures were above 42.0 °C. The maximum recorded temperature was 40.4 °C in the warmer, with the highest starting temperature in the 10th minute. Conclusion. The novel neonatal chemical warmer performed well when the starting surface temperatures were higher, with the best-performing one being the one with the highest starting temperature of 33.0 °C.

Introduction: Even though adequate caloric intake is essential for the promotion of growth in extremely premature infants, this is rarely achieved. We investigated how total caloric intake in the first week of life and other events during the hospitalization impact head circumference and weight at 36 weeks of corrected age in extremely preterm infants. Patients and methods: The study sample consisted of extremely preterm infants treated at Osijek University Hospital Centre, born between January 2018 and December 2020. Records were collected regarding nutritional data, sex, gestational age, birth weight and head circumference, invasive respiratory support, bacterial infection, necrotizing enterocolitis, postnatal steroids, need for supplemental oxygen at 36 weeks gestation, day of introduction of enteral nutrition, duration of parenteral nutrition, length of stay, hemodynamically significant patent ductus arteriosus, cystic periventricular leukomalacia and retinopathy of prematurity. Results: The study cohort included 30 infants. At 36 weeks gestation for weight, median Z scores were -1.63 (IQR -2.34 to -1.15; 95% CI -2.09 to -1.52), and for head circumference were -1.32 (IQR 2.37 to - 0.81; 95% CI -1.75 to -0.91). Median energy intake on the first day of life was 33.42 kcal/kg, and 80.78 kcal/kg on day 7. Early caloric intake was not correlated with changes in Z scores for head circumference and weight at 36 weeks of gestation. Other factors influenced changes in head circumference and weight Z scores, namely: gestational age, respiratory support during the first week, need for additional O2 at 36 weeks, and retinopathy of prematurity requiring intervention. Conclusion: In our cohort of premature infants at 36 weeks corrected age other factors, not primarily total caloric intake influenced growth parameters.

To analyse placental changes in infants’ gestational age < 34 weeks and its correlation to short-term respiratory outcomes or death until hospital discharge. Information regarding all in-house born preterm infants born before 34 weeks gestation and born from January 2009 until December 2014 were collected and included among others, placental pathology and relevant data on demographics and outcomes of infants. Placental abnormalities was found in 157/253 (65.05%) cases. Acute placental inflammation was found to be the most common in both groups of premature neonates, followed by maternal vascular underperfusion. Maternal vascular underperfusion was significantly more common in GA ≤ 27 weeks compared to infants GA 28–33 weeks (35.2% vs. 13.7%; p = 0.018). Similarly, chronic placental inflammation was more common in infants GA ≤ 27 weeks compared to infants GA 28–33 weeks (14.3% vs. 3.3%; p = 0.014). Infants with placental pathology had a lower median birth weight (1460g vs. 1754g; p = 0.001, and were of shorter median GA at birth (31 vs. 32; p = 0.001). Infants with any placental disease had higher rates of death until hospital discharge (10.2% vs. 3.1%; p = 0.039) and higher rates of any stage of bronchopulmonary dysplasia (41.4% vs. 26.0%; p = 0.013). There were no significant differences in mechanical ventilation rates, duration of mechanical ventilation and duration of supplemental oxygen therapy. Identifiable placental abnormalities were found in most infants born < 34 weeks gestation. Placental pathology is associated with increased rates of bronchopulmonary dysplasia and death until hospital discharge.

Background: Hypothermia during the newborn period is widely regarded as a major contributory cause of significant morbidity and mortality of newborn infants. Thermoprotective behaviours such as skin-to-skin care (SSC) or the use of appropriate devices have been recommended as simple tools for the avoidance of neonatal hypothermia. We examined the relation between the duration of skin-to-skin care and infant temperature change after birth in suboptimal delivery room temperatures. Methods: We reviewed the medical charts of all vaginally born infants of gestational age ≥ 35 weeks born January-July 2018 and admitted to the well-baby nursery. After SSC was discontinued, the infant’s rectal temperature was measured to determine the frequency and severity of hypothermia. Results: The charts of 688 vaginally born infants were examined. Our mean delivery room temperature was 21.7 (SD 2.2) °C, well below the WHO recommendation of 25 °C. After SSC 347 (50.4%) infants were normothermic (temperature 36.5–37.5 °C), 262 (38.0%) were mildly hypothermic (36.0-36.4 °C), and 79 (11.4%) were moderately hypothermic (32.0-35.9 °C). The mean skin-to-skin time in infants was 63.9 (SD 20.9) minutes. SSC duration was associated with increase in rectal temperature for patients of gestational ages ≥ 38 weeks and with decrease in rectal temperature in patients of gestational age < 38 weeks. Conclusion: SSC is effective, even at suboptimal delivery room temperatures, for promoting normothermia in infants of ≥ 38 weeks’ gestation but may not provide adequate warmth for infants of < 38 weeks.

Fetal hydrops is an accumulation of fluid in more than one extravascular space. Congenital chylothorax is a rare cause of non-immune fetal hydrops, and the prognosis is generally very poor. There is no consensus on the optional treatment of congenital chylothorax. Conservative treatments (low-fat high-protein diets with medium-chain triglycerides, total parenteral nutrition) and surgical interventions are performed. There is mounting evidence for the use of octreotide (a somatostatin analog) in cases nonresponsive to conservative treatment, but no specific recommendation as to the dose and the length of therapy exist so far. We report a male, late preterm newborn, with a birth weight of 3600 grams, born to a Caucasian 28-year-old secundigravida via cesarean section because of poor fetal biometric markers at 35 3/7 week gestation. Neonate was born with congenital chylothorax and severe non-immune hydrops. After the therapeutic failure of enteral low long-chain triglyceride formula and full parenteral nutrition in reducing chyle leak, the patient was treated with octreotide and shown rapid improvement. We conclude that octreotide treatment is a plausible therapeutic option before surgical treatment in patients with congenital chylothorax.

Aim: A myriad of myths surround pregnancy, especially regarding the prediction of the sex of the infant. Some of these myths and old wives' tales are, to this day, widespread among expectant parents. The objective of this study was to examine whether common pregnancy-related statements regarding foetal sex prediction vary between mothers of female and male infants. Methods: The questionnaire-based study was conducted from September 2017 to September 2018 at a well-baby nursery. Participants were mothers of infants (n = 350) admitted to the well-baby nursery with a singleton pregnancy and at > 36 weeks of gestation at birth. Results: We investigated a number of statements regarding foetal sex prediction. With the exception of one statement, there were no other differences between mothers of male and female infants. Pregnancy with a male foetus is associated with glossier hair during pregnancy. Women with female newborns reported glossier hair during pregnancy in 39.1% of cases, while women with male newborns reported the same in 45.0% of cases (P = 0.04). Conclusion: Old wives' tales regarding sex prediction of the infant during pregnancy remain myths for a reason, with the possible exception of one statement regarding glossier hair and pregnancy with a male foetus.