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Background and aim: The early identification of the former premature neonates at risk of neurologic sequelae could lead to early intervention and a better prognosis. This pilot study aimed to investigate whether the General Movement patterns observed at term-equivalent age in former premature infants could serve as predictors for guiding early intervention and improving prognosis. Materials and methods: In a population of 44 premature neonates (mean gestational age 33.59 weeks (+2.43 weeks)) examined at term-equivalent age, 10 neonates with a cramped–synchronized General Movements motor pattern were identified. These neonates were included in an early intervention program consisting of physiotherapy executed both by the therapist and by the parents at home. They were again examined at a corrected age of 12 weeks. The presence or absence of fidgety movements and the MOS-R (motor optimality score revised) was noted. The examinations were performed by certified specialists. Results: Normal fidgety movements and a MOS-R of 20–24 were presented in 9/10 of the former premature infants, with normal foot to foot contact present in 7/10, and normal hand to hand contact present in 5/10. The atypical patterns noted were side to side movements of the head in 5/10, a non-centered head in 9/10, asymmetric tonic neck reflex in 9/10 and jerky movements in 10/10. One patient presented with no fidgety movements and a MOS-R score of 9. Conclusion: Early intervention in our group of patients allowed for an improvement in the neurologic status, demonstrated by the presence of fidgety movements. We suggest that early intervention should be indicated in all premature infants that present with a cramped–synchronized GM pattern during examination at term-equivalent age. However, due to the small sample size, the absence of statistical analysis and a control group, and the limited follow-up period, the conclusions must be approached with caution. [ABSTRACT FROM AUTHOR]

Background and Objectives: Our quality management project aims to decrease by 20% the number of neonates with respiratory distress undergoing chest radiographs as part of their diagnosis and monitoring. Materials and Methods: This quality management project was developed at Life Memorial Hospital, Bucharest, between 2021 and 2023. Overall, 125 patients were included in the study. The project consisted of a training phase, then an implementation phase, and the final results were measured one year after the end of the implementation phase. The imaging protocol consisted of the performance of lung ultrasounds in all the patients on CPAP (continuous positive airway pressure) or mechanical ventilation (first ultrasound at about 90 min after delivery) and the performance of chest radiographs after endotracheal intubation in any case of deterioration of the status of the patient or if such a decision was taken by the clinician. The baseline characteristics of the population were noted and compared between years 2021, 2022, and 2023. The primary outcome measures were represented by the number of X-rays performed in ventilated patients per year (including the patients on CPAP, SIMV (synchronized intermittent mandatory ventilation), IPPV (intermittent positive pressure ventilation), HFOV (high-frequency oscillatory ventilation), the number of X-rays performed per patient on CPAP/year, the number of chest X-rays performed per mechanically ventilated patient/year and the mean radiation dose/patient/year. There was no randomization of the patients for the intervention. The results were compared between the year before the project was introduced and the 2 years across which the project was implemented. Results: The frequency of cases in which no chest X-ray was performed was significantly higher in 2023 compared to 2022 (58.1% vs. 35.8%; p = 0.03) or 2021 (58.1% vs. 34.5%; p = 0.05) (a decrease of 22.3% in 2023 compared with 2022 and of 23.6% in 2023 compared with 2021). The frequency of cases with one chest X-ray was significantly lower in 2023 compared to 2022 (16.3% vs. 35.8%; p = 0.032) or 2021 (16.3% vs. 44.8%; p = 0.008). The mean radiation dose decreased from 5.89 Gy × cm2 in 2021 to 3.76 Gy × cm2 in 2023 (36% reduction). However, there was an increase in the number of ventilated patients with more than one X-ray (11 in 2023 versus 6 in 2021). We also noted a slight annual increase in the mean number of X-rays per patient receiving CPAP followed by mechanical ventilation (from 1.80 in 2021 to 2.33 in 2022 and then 2.50 in 2023), and there was a similar trend in the patients that received only mechanical ventilation without a statistically significant difference in these cases. Conclusions: The quality management project accomplished its goal by obtaining a statistically significant increase in the number of ventilated patients in which chest radiographs were not performed and also resulted in a more than 30% decrease in the radiation dose per ventilated patient. This task was accomplished mainly by increasing the number of patients on CPAP and the use only of lung ultrasound in the patients on CPAP and simple cases. [ABSTRACT FROM AUTHOR]

Background and aim: Our research aims to find correlations between the brain imaging performed at term-corrected age and the atypical general movement (GM) patterns noticed during the same visit a—cramped-synchronized (CS) or poor repertoire (PR)—in formerly premature neonates to provide evidence for the structures involved in the modulation of GM patterns that could be injured and result in the appearance of these patterns and further deficits. Materials and methods: A total of 44 preterm neonates ((mean GA, 33.59 weeks (+2.43 weeks)) were examined in the follow-up program at Life Memorial Hospital Bucharest at term-equivalent age (TEA). The GM and ultrasound examinations were performed by trained and certified specialists. Three GM pattens were noted (normal, PR, or CS), and the measurements of the following cerebral structures were conducted via head ultrasounds: ventricular index, the short and long axes of the lateral ventricles, the midbody distance of the lateral ventricle, the diagonal of the caudate nucleus, the width of the basal ganglia, the width of the interhemispheric fissure, the sinocortical width, the length and thickness of the callosal body, the anteroposterior diameter of the pons, the diameter of the vermis, and the transverse diameters of the cerebellum and vermis. The ultrasound measurements were compared between the groups in order to find statistically significant correlations by using the FANOVA test (significance p < 0.05). Results: The presence of the CS movement pattern was significantly associated with an increased ventricular index (mean 11.36 vs. 8.90; p = 0.032), increased midbody distance of the lateral ventricle–CS versus PR (8.31 vs. 3.73; p = 0.001); CS versus normal (8.31 vs. 3.34; p = 0.001), increased long and short axes of the lateral ventricles (p < 0.001), and decreased width of the basal ganglia–CS versus PR (11.07 vs. 15.69; p = 0.001); CS versus normal pattern (11.07 vs. 15.15; p = 0.0010). The PR movement pattern was significantly associated with an increased value of the sinocortical width when compared to the CS pattern (p < 0.001) and a decreased anteroposterior diameter of the pons when compared to both the CS (12.06 vs. 16.83; p = 0.001) and normal (12.06 vs. 16.78; p = 0.001) patterns. The same correlations were present when the subgroup of infants with a GA ≤ 32 weeks was analyzed. Conclusions: Our study demonstrated that there are correlations between atypical GM patterns (cramped-synchronized—CS and poor repertoire—PR) and abnormalities in the dimensions of the structures measured via ultrasound at the term-equivalent age. The correlations could provide information about the structures that are affected and could lead to a lack of modulation in the GM patterns. [ABSTRACT FROM AUTHOR]

Background. Cerebral venous sinus thrombosis (CVST) is considered a rare condition in neonates. We present the experience of our unit in the diagnosis and management of inborn patients with CVST, in order to increase awareness of this condition and the chances of early diagnosis and management. Material and method. We present three cases of patients born in our department between 2019-2022 with CVST. There are reviewed: the history, the symptomatology in the neonatal period, the imaging findings and the treatment in the hospital. In all the cases the diagnosis was suspected after an ultrasound examination and confirmed by MRI. After discharge from the hospital the patients were followed by the pediatric neurologist and were included in an early intervention program for motor and occupational therapy. There are also reviewed the motor, cognitive and language outcomes of the patients. Results. The first case is represented by the term neonate with seizures at 40 hours of age. The seizures were controlled by levetiracetam. The ultrasound and MRI showed lesions with a venous topography of different ages. The patient developed unilateral motor deficit delayed milestones, and cognitive and language impairment. The second case is an asymptomatic neonate diagnosed at 3 days of life by a routine ultrasound with right-sided intraparenchymal and interhemispheric hematomas and CSVT. The patient developed a head growth deficit and motor delay. The third case is a term LGA neonate with respiratory distress that was diagnosed with a white matter lesion and an old CVST. The patient presented with a mild motor deficit Conclusion. The diagnosis of CVST requires a high awareness about the risk factors, the presenting symptoms and ultrasound suggestive findings – this in turn leads to an appropriate indication for MRI confirmation of the lesions and a better prognosis because the appropriate treatment could be provided and the patient could be included in an early intervention program in order to decrease de incidence and severity of the long-term neuro-behavioral consequences. [ABSTRACT FROM AUTHOR]

Tethered cord is a congenital syndrome characterized by the spinal cord under tension, being extended and attached to caudal structures, usually being associated with dysraphic lesions. Tethered cord is an anomaly of the caudal cell mass and a secondary neurulation process with a deficit of regression of the caudal eminence. Advancements in ultrasonography allow the condition to be detected from the second or the third trimester, creating the necessary premises for a higher rate of successful treatment. Pain and neurological disfunctions, such as muscular weakness and sphincteric dysfunctions, represent the main symptoms of the condition. Left untreated, tethered cord will lead to progressive neurological decline and irreversible damage to the nerves. The main outcomes of the surgery are the reduction or stoppage of neurological function decline and the improvement of sphincteric control which represent a significant improvement in the quality of life of the patients. We present the case of a newborn with tethered cord diagnosed postnatally, with the aim to emphasize the importance of ultrasonographic use in the prenatal diagnosis of congenital anomalies. [ABSTRACT FROM AUTHOR]

Fetal alcohol spectrum disorders (FASD) are preventable conditions secondary to the mother’s consume of alcohol during pregnancy, and include fetal alcohol syndrome, partial fetal alcohol syndrome, alcohol-related birth defects and alcohol-related neurodevelopmental disorder. Their prevalence is not exactly known, due to a lack of knowledge regarding the correct diagnosis and due to the pregnant women’s alcohol consumption concealment, but the estimation is that one in ten pregnant women continue to drink during pregnancy. The importance of this group of disorders is represented by the involvement of the development and functioning of the central nervous system and due to predisposition of the product of conception to alcohol dependence in adulthood. FASD management involves prevention and treatment which are important to be initiated as early as possible. Prevention recommendations include cessation of alcohol consumption, nutritional supplementation and complications’ treatment, such as “secondary disabilities”, that include inappropriate sexual behavior, disrupted school experience, trouble with the law and incarceration, homelessness, unemployment, and chronic mental health problems. By offering an early diagnosis, a stable and nurturing living environment, along with the absence of exposure to physical, sexual or other types of violence, the eligibility for social and educational services is essential. Thus, prevention is the main key in the FASD management, alongside the screening to identify the high-risk pregnant females and their referral to appropriate programs. [ABSTRACT FROM AUTHOR]

Objective. To investigate if the unilateral ventricular dilatation detected by fetal and neonatal ultrasound is associated with neurological abnormalities during the first two years of life. Materials and method. A number of 1319 neonates were examined by head ultrasound on the first and third days of life. Prenatal histories and ultrasound were collected in all cases. There were selected the cases with unilateral ventricular dilatation that were examined by head ultrasound at one, two, four and six months and by clinical and neurologic examination and, if needed, using specific imaging and neurologic investigations at one, two, four, six, twelve months and at two years. Results. There were detected the dilatation of the left ventricle (18 cases), posterior horn of the left ventricle (88 cases), and posterior horn of the right ventricle (12 cases). All these cases were asymptomatic during the neonatal period and only six out 88 cases with left posterior horn dilatation and one of the 12 the cases with right posterior horn dilatation developed neurologic abnormalities. All these cases were identified before delivery by fetal ultrasound. The abnormalities identified were: tonus abnormalities – hypotonic at 4 and 6 months with normalization at 12 months in three out of 88 cases with left posterior horn dilatation and one out of 12 cases with dilatation of the posterior horn of the right ventricle. There were delays in the fine motor skills in all the six symptomatic cases with left ventricular dilation and in one out of 12 cases with right ventricular dilation. Conclusions. Unilateral ventricular dilatation detected by neonatal ultrasound is usually asymptomatic. The symptomatic cases are characterized by transient tonus abnormalities and abnormalities in the fine motor skills. [ABSTRACT FROM AUTHOR]

The increase in the number of microorganisms that cause maternal-fetal infections has led to the need to update the acronym TORCH (Toxoplasma, Others, Rubella, Cytomegalovirus, Herpes) to SCRATVHEZ (Syphilis, Cytomegalovirus, Rubella, AIDS, Tuberculosis, Varicella, Herpes, Enterovirus, Zika). The multiple routes of transmission (transplacental, intrapartum, breast milk or posttransfusion), the multitude of microorganisms generating various and complex complications – from quasi-asymptomatic diseases to intrauterine growth restriction, neurological sequelae and to fetal death, the treatment that varies from case to case, between symptomatic and etiological and the possibility of preventing infections, outline their complexity and importance. A complete and correct early diagnosis involves clinical, biological and serological evaluation from the prenatal period, in order to prevent the evolution of infections, especially in the case of those in which there is an etiological treatment. The importance of knowing these infections and the effort to prevent their transmission, in order to limit the development of the consequences they can cause, are key elements in the optimal management of a pregnancy. [ABSTRACT FROM AUTHOR]

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The study aimed to identify certain factors related to family history, pathological conditions, or exposure-type that are significantly correlated with recurrent wheezing and/or asthma in children. One hundred nine children with recurrent wheezing and 44 children with asthma were studied in order to identify the degree of correlation of these conditions with familial history of asthma or atopy, child's age group, gender, premature birth, perinatal asphyxia, neonatal infection, and antibiotic treatment during the neonatal period, history of atopy and obesity and histamine intolerance, nasopharyngeal bacterial colonization, pneumonia with bronchospasm. The clinical picture of these two diseases was also compared regarding the severity of exacerbations and their response to controller therapy. The medium age of children diagnosed with recurrent wheezing was significantly lower than those diagnosed with asthma (5.64 vs. 9.01 years; p<0.001). Inside the recurrent wheezing group, age distribution differed significantly from the asthma group (p-value <0.001). Atopy was the only pathological condition significantly associated with asthma (56.0%) when compared with the recurrent wheezing group (30.2%) with a relative risk value of 1.34 (p<0.004). For patients colonized with Staphylococcus aureus, the medium number of wheezing exacerbations was significantly higher (p<0.049). Approximately 91% of patients in the recurrent wheezing group and 71% from the asthma group responded to appropriate controller treatment. Our study showed a significant association between asthma and atopy, justifying the need to monitor asthma risk in a child with wheezing and atopy. Nasal carriage of Staphylococcus aureus proved to be significantly associated with the recurrence of wheezing in children. [ABSTRACT FROM AUTHOR]

The research aims to identify the respiratory pathology during the first two years of life in premature infants with gestational ages between 30-34 weeks and the risk factors for these conditions (familial, prenatal, and neonatal). There were investigated 31 premature infants with gestational ages between 30-34 weeks and the incidence of bronchopulmonary dysplasia, infections with the respiratory syncytial virus, or other viral infections requiring hospitalization, recurrent wheezing, and nasal colonization with pathogenic bacteria were noted. Also, regression models for each type of respiratory pathology as a function of the antenatal (smoking in the family, atopy, mother's age) and neonatal (gestational age, respiratory distress syndrome, duration of the treatment with antibiotics, use of the reserve antibiotics) factors were elaborated. Respiratory distress syndrome was present in 20 premature infants, and 19 infants received respiratory support. Two former premature infants presented with bronchopulmonary dysplasia, 3 with severe respiratory syncytial virus infections, 7 with recurrent wheezing, and 16 with viral infections requiring hospitalization. Respiratory distress syndrome and severe viral infections were more frequently found in families of smokers. Low gestational age and familial atopy were identified as good predictors of severe respiratory syncytial virus infections (p< 0.03) Premature infants with gestational ages between 30-34 weeks present with the risk of appearance of respiratory diseases during the first two years of life, especially disorders of the airways. Familial atopy and low gestational age represent independent risk factors for severe respiratory syncytial virus infections. [ABSTRACT FROM AUTHOR]

Consanguineous marriages between close biological relatives, most frequently first or second cousins, observed in up to 10% of the world’s population, are a manifest of historical and religious pride and prejudice. The offspring of consanguineous unions are more often homozygous for particular allele and, therefore, leads to autosomal recessive disorders which may be lethal or debilitating, but also with inborn errors of metabolism, with high rates of abortion, miscarriage, stillbirths, death in the first month and up to 10 years of life. This is a case report of a 19-yearold patient, OGIP, who was referred to our department at 23 weeks of gestation. Detailed ultrasound scan revealed mild ventriculomegaly and asymmetry of anterior horns of lateral ventricles with signs of intraventricular hemorrhage. Fetal MRI confirmed the ultrasound diagnosis. At series ultrasound scans, the fetus developed progressive, symmetrical intrauterine growth restriction, polyhydramnios, and signs of cervical insufficiency. The aim of this lecture is to provide for these couples a screening protocol with the best possible genetic counseling, antenatal and postnatal care, sympathetically and nonjudgmentally, as the best achievable results can be obtained. [ABSTRACT FROM AUTHOR]

The paper presents a study of the electric arc furnace who using Carbon-Jet and Oxygen-Jet to reduce specific consumption of energy. Electric arc furnaces (EAF) play an important and increasing role in modern steel work concepts. The ability to precisely control the temperature and chemistry of the batch make EAF an ideal choice for producing high-grade steel for the recycling of scrap. Of the steel made today 36% is produced by the EAF route and this share will increase to 50 by 2030. The EAF has been studied for many years, but it is still difficult to complete representation. [ABSTRACT FROM AUTHOR]

Demands for increased steel production and rules for network disturbances have, together with increasing cost of energy, made reactive power compensation a profitable solution in the steel industry. A modern and cost efficient steel melting process demands a stable and steady voltage support for the Electric Arc Furnace. With dynamic reactive power compensation, the random voltage variations characterized by an arc furnace are minimized. The minimized voltage variations are achieved by continuously compensating the reactive power consumption from the arc furnace. [ABSTRACT FROM AUTHOR]

This paper presents a study of electric arc furnace with an new powerful electric transformer. Electric arc furnaces type UHP requires large electrical power so they are modified from conventional ovens. In this case melting and refining are done with a single oxidant slag. Deoxidizing and alloying are done outside the electric arc furnace in the ladle furnace. This technology greatly increases productivity and lowers furnace specific materials and energy consumption. Increasing power transformer requires many changes. With increasing electric arc furnace productivity increased and extreme fluctuation of voltage, flicker, harmonics and imbalance between phases. [ABSTRACT FROM AUTHOR]

Childhood cancer survival rates are constantly improving due to treatment. Fertility research has focused on adult cancer patients, but studies among childhood cancer survivors who reach reproductive age are rare and mainly based on small numbers of patients. This is surprising as childhood cancer survivors constitute a distinct, ever-growing population that may have temporarily or permanently impaired fertility due to cancer treatment. Thus, the basic scientific concern specific to the pediatric population has focused on improving protection techniques and cryopreserved tissue transfer. Research on preservation techniques confirms the safety of surgical retrieval of gonadal (ovarian and testicular) tissue for cryopreservation. Outcomes may improve, but it is clear that large registries of long-term follow-up of patients are needed. Current research efforts imply the need to develop a national strategy in each country to ensure the education and information of pediatric patients undergoing gonadotoxic regimens and their families about fertility options and subsequent outcomes and give them the opportunity to join such programs. [ABSTRACT FROM AUTHOR]

This is a retrospective study in collaboration with the neonatal unit of Life Memorial Hospital. Ventriculomegaly is an ultrasound feature, not a diagnosis. Once objectified, it can be a normal variant, but most frequently it is associated with cranian or extracranian of chromosomal or nonchromosomal abnormalities. First-line confirmation is transfontanellar ultrasound exam, where typical sections are different than the intrauterine one. All fetal images have the parental agreement to be used in educational purpose. [ABSTRACT FROM AUTHOR]

Aim. The paper represents a review of the current state of knowledge regarding lenticulostriate vasculopathy (LSV) in premature and term neonates. Material and method. There are reviewed the definition, the history of this diagnosis, the epidemiology, the anatomy of the vessels the etiology and the methods of diagnosis. Results. LSV is defined as the bright hyperechoic blood vessels in the region of the thalamus and basal ganglia. It was first described in 1960. The incidence is 0.3-2% of live births. The etiology is infectious (congenital rubella, cytomegalovirus, toxoplasma, or other chronic intrauterine infections), hypoxic-ischemic, and in many cases idiopathic (without a clear cause). The diagnosis is mainly done by ultrasonography – the are also proposed classification systems based on the number of vessels affected and/or the echogenicity of the vessels involved. Conclusion. LSV represents a pathology recognized for a long time, in the past, it was considered mainly associated with chronic intrauterine infections, at present, it is more and more seen as a consequence of perinatal hypoxic events. Further large follow-up studies are needed in order to better characterize the etiology and prognosis of this pathologic condition. [ABSTRACT FROM AUTHOR]

Background. The incidence of multiple pregnancies is increasing in the last 10 years, along with the associated complications. Brain injuries and neurological complications associated with single fetal intrauterine death (sIUFD) are the most serious and have a negative impact on the surviving twin. Methods. This review was performed by a single individual who searched via Google Scholar and Pubmed clinical studies which included sIUFD in monochorionic (MC) twin pregnancies. This research included studies from the last 10 years and the keywords used were: “single intrauterine fetal death”, “monochorionic”, “fetal brain lesions”, and “twin pregnancies”. Results. After analyzing the clinical studies according to the keywords, only 15 studies (462 pregnancies) met the inclusion criteria. These included: monochorionic pregnancies and sIUF that occurred after 14 weeks. The results of these trials showed a strong statistical association between single fetal intrauterine death and co-twin fetal brain lesions and neonatal death. Also, many of these recent studies mentioned the relationship between monochorionic city and preterm delivery, fetal growth restriction and twin–twin transfusion syndrome (TTTS). Conclusion. Analyzing all these clinical studies, we can conclude that the intrauterine death of a twin in monochorionic pregnancies after the age of 14 weeks of gestation significantly affects the neurological development of the surviving twin. [ABSTRACT FROM AUTHOR]