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Free fluid in the abdomen in newborns is a relatively common finding. A big problem is to establish the exact origin of ascites. We present the case of a newborn who had ascites of unknown origin suspected to be a ruptured ovarian cyst. Female newborn in the first day of life with US registered ascites and the assumption that the origin was a ruptured ovarian cyst. Prepartum cyst is not registered.The puncture was performed in order to relieve and reduce the amount of ascites due to respiratory distress. A pediatric gynecologist was consulted, who suggested the following approach. The analyzed serum estradiol values were below 27 IU. A puncture of the ascites fluid was performed and it was established that the values of estradiol in the puncture were over 1000 IJ, which clearly indicated that the ascites fluid originated from a ruptured ovarian cyst. If there is an assumption that the origin of ascites in a newborn is caused by the rupture of an ovarian cyst, a simple comparison of estradiol values in serum and punctate can establish a clear diagnosis (values in punctate are several times higher compared to serum). The study was approved by the Clinical Research Committee of the Mother and Child Health Institute of Serbia. [ABSTRACT FROM AUTHOR]

Objective -- To compare the effectiveness and safety of wound instillation with levobupivacaine with a placebo, in children who underwent inguinal hernia repair, for pain relief. The secondary objective was to examine the frequency of postoperative analgesic mixture (paracetamol/ibuprofen) use. Methods -- Single center randomized placebo-controlled trial. Paediatric teaching hospital in Belgrade, Serbia. This study included 100 children who underwent elective surgery for unilateral inguinal hernia. Children were randomized by simple randomization into two groups (N=50 in the experimental group, N=50 in the control group). A solution of 0.5% levobupivacaine, 0.5 mg/kg (0.1 ml/kg) was instilled into the wounds of children in the experimental group before suturing the abdominal fascia. The same amount of 0.9% saline was administered to the children in the control group. The primary outcome was the level of postoperative pain after coming round from general anesthesia (t0) and at 2h, 6h, 12h, 18h and 24h after surgery. The FLACC (Face, Legs, Activity, Cry, Consolability) scale was used to assess the level of pain. The secondary outcome was the frequency of paracetamol/ibuprofen use for pain relief after surgery. Results -- Out of the total number of children (100), 70% were boys (70) and 30% were girls (30), and their average age was 3.5±1.9 years. The average duration of surgical intervention in both groups was 31.6±4.2 minutes. Significantly fewer children in the experimental group reported pain (FLACC ≥1) at 2h (P=0.032) and 6h (P=0.001) after surgery, compared to the children in the control group (8 vs. 17 at 2h after surgery; 4 vs. 14 at 6h after surgery). Significantly fewer children in the control group reported sensations of pain that required administration of analgesics 6h after surgery (FLACC >3) compared to the control group (P=0.001) (1 vs. 14). Overall, significantly fewer children in the experimental group received a paracetamol/ibuprofen mixture for pain relief after surgery, compared to the children in the control group (P<0.001) (4 vs. 50). The average daily amount of acetaminophen in the experimental group was 28±127 mg/kg/day and ibuprofen 5.6±1.8 mg/kg/day, while in control group, acytaminophen 42.5±7.7 mg/kg/day and ibprofen 11.5±4 mg/kg/day. The total amount of analgesics was highly statistically significantly lower in the experimental group (P<0.001). Conclusion -- Instillation of levobupivacaine before wound suturing in children who had undergone elective inguinal hernia surgery repair was effective in postoperative pain relief. Children who received levobupivacaine also received less of the paracetamol/ibuprofen mixture to relieve their pain over 24 hours after surgery. [ABSTRACT FROM AUTHOR]