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Traditional views on neonatal pain neglected long neglected the neonates' capability of feeling pain. Newborn infants experience at least one painful procedure during their first days of life, but with a lower gestational age, invasive procedures become more frequent and invasive. The modulation of the autonomic nervous system (ANS) is significantly changed during painful procedures. The analysis of the heart rate variability is shown to be a reliable tool in analyzing the ANS. In this study, the dynamic of the system has been examined by applying the Poincaré plot analysis, a primer of nonlinear methods used in the analysis of the ANS. The aim of this study is to assess the occurrence of changes in linear heart rate variability parameters, to determine the changes in the Poincaré plot indices and to evaluate the correlation between their differences in healthy newborns. The results have shown a significant increase in the heart rate, a reduction of the duration of RR intervals, and the square root of the mean squared differences between successive RR intervals (RMSSD), as well as a decrease in the short-term variability (SD1) of the Poin-care plot. The results highlight the need for studying the application of nonlinear analyses of the HRV on the effects of pain on the ANS and its long-term effects on the infant. [ABSTRACT FROM AUTHOR]

Children's health is affected by the quality of indoor and outdoor environments. In order to prevent environmentally mediated diseases among children, the Member States of the World Health Organization (WHO) European Region adopted the Parma Declaration on Environment and Health in 2010, which includes commitments to provide children with access to safe water and sanitation, improve indoor air quality in children's facilities, and make schools tobacco- and smoke-free places. To measure progress towards these goals, WHO facilitated the development of a survey toolkit for national surveys. In preparation for a national school survey in Croatia, this toolkit was pilot tested in two high schools in the city of Osijek, Croatia, in spring 2012. The main problems detected in the survey were: 1) high prevalence of smoking, with 34% of pupils smoking inside or outside school during school hours; 2) poor ventilation, with pupils spending over 30% of their school time in classrooms with carbon dioxide concentrations exceeding 1,000 ppm; and 3) the presence of dampness in school premises. Sanitation facilities were generally satisfactory. Concentrations of formaldehyde, nitrogen dioxide, and benzene in classrooms were generally low. Smoking, poor ventilation, and dampness were the environmental risk factors identified in this survey in the two schools. [ABSTRACT FROM AUTHOR]

Respiratory distress (RD) is the commonest reason for admission in Neonatology intensive care units (NICU) and it is caused by respiratory and non-respiratory illnesses. The goal of the study is to find out most important causes of RD in preterm babies with 32 or more weeks of gestation, and to compare the etiology factors for RD in those preterm and in full term babies. Retrospective study in the NICU, Clinical Hospital Osijek, during the year 2016 was done. Almost 20% of admitted in NICU have RD, 34% of preterm babies of or older than 32 weeks, and 12% of terms babies. Among newborns with RD 61% were boys, and 39% girls. Among all live born 4% of boys and 2, 6% of girls had RD. Mother's illnesses as a cause of RD were found in 23, 2% and illnesses of the child in the other 60, 1%. Complications during delivery caused RD in the last 4% of newborns (some neonates have had more than one reason for RD). In 18, 9% of newborns the etiological factor was not found, and RD is probably genetically caused. The proportion of unknown causes is higher in preterm babies (22%). RD in term babies is mainly caused by illnesses of the child himself, and in pre-term by mother's illnesses. [ABSTRACT FROM AUTHOR]

The neonate must make a transition after birth from intrauterine continuous transplacental supply of oxygen and glucose to different extra uterine conditions. In healthy neonate the period of adaptation almost finished in the perinatal period and newborn can be safely discharged after this time. Retrospective study in the NICU, Clinical Hospital Osijek, during the year 2016 was done. Almost 26% of neonates were admitted in NICU because of the prolonged adaptation to extra uterine life. It was their main diagnosis. The majority of them have been polycytemic, had early jaundice and a part of them had bradycardia. Mother's illnesses as a possible cause of prolonged neonatal adaptation were found in 21.7%. About 58.3% of newborns with prolonged adaptation have had problems during mother's pregnancy and delivery. Hypertrophic as well as hypotrophic neonates were risk neonates for prolonged postnatal adaptation, as well as newborns gender. Mode of delivery takes a big role in the neonatal adaptation. Induction and augmentation of the labor acts as a possibly stress factor. Main symptoms among those newborns were: plethora, cyanotic crises, bradicardia, dystonia, irritability, jaundice and respiratory distress. Most of the investigated newborns need oxygen 6-10 days. The majority of them stay in the hospital up to 10 days. Prolonged adaptation has almost equally been found in the first, second and third pregnancy. [ABSTRACT FROM AUTHOR]

Estimated glomerular filtration rate (eGFR) is one of the best-performing methods in evaluating kidney function. There are limited data regarding the estimated glomerular filtration rate in children and young adults with hemophilia. The aim of this study was to determine the difference between three commonly used estimated glomerular filtration rate equations in the pediatric population in a cohort of patients with hemophilia. Our prospective study included 36 pediatric patients with moderate or severe hemophilia. eGFR was calculated for each patient using the original creatinine-based "bedside Schwartz" equation, the cystatin C-based equation and the creatinine-cystatin C-based equation. The difference between the equations, calculated using the one-way repeated ANOVA test, was statistically significant (p <0.001), and post hoc analysis found differences between each method. Correlation analysis showed the strongest positive correlation between the bedside Schwartz equation and creatinine-cystatin C-based equation (r=0.866) among the three methods examined. A correlation between the three eGFR methods was present, but with significant differences between them. Due to the observed differences between eGFR in pediatric patients with hemophilia, further research is needed to find the optimal measurement method for eGFR. Nevertheless, we recommend implementing eGFR equations in routine clinical monitoring of pediatric patients with hemophilia., Competing Interests: Conflict of interest: The authors declare no conflict of interest.

Aware that exposure to stuffy indoor air with high levels of carbon dioxide (CO2) is associated with higher absenteeism and reduced academic performance in school pupils, the World Health Organization (WHO) Regional Office for Europe initiated indoor air quality surveys in schools, including CO2 monitoring, to assess ventilation and exposure to stuffy air. Here we report the findings of the first such survey in Croatia. It was conducted in 60 classrooms of 20 urban and rural elementary schools throughout the country during the heating season. Measurements of CO2 levels showed that all 60 classrooms exceeded the international guidelines of 1938 mg/m3. Mean CO2 concentrations ranged from 2771 to 7763 mg/m3. The highest concentration measured in urban schools was 7763 mg/m3 and in rural schools 4771 mg/m3. Average CO2 levels were higher in continental schools (3683 mg/m3) than the coastal ones (3134 mg/m3), but all demonstrate poor ventilation during the heating season all over Croatia.