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Background: Intensive treatment in oncology often leads to severe complications, including infection and coagulation disturbances. Among the most serious are fungal infections which are often life-threatening, and difficult to recognize and treat. We present a patient with severe pneumonia and pleural effusion, that developed during treatment of a soft tissue sarcoma with pulmonary metastases., Case Report: A 16-year-old girl was admitted to the ITU because of marked dyspnoea, bilateral pneumonia and pleural effusion. She was intubated and placed on a ventilator, and bilateral pleural drains were inserted. She also required vigorous inotropic support (dopamine + noradrenaline). CRP was 12.5-19.8 mg dL(-1) and procalcitonin was below 1 ng mL(-1)). Lung metastases and tuberculosis were excluded and fungal infection suspected. Aspergillus DNA was detected in bronchoalveolar lavage, and in blood serum (PCR). Amphotericin B and voriconazole were instituted, but without evident success, The girl was severely distressed, required mechanical ventilation with an F1O2 of 0.6, while her CRP increased to 28.4 mg dL(-1). The amphotericin was stopped and replaced with caspofungin, resulting in rapid improvement in her clinical status. The girl was extubated after 21 days of ventilation, however due to a very severe opioid withdrawal syndrome with extreme agitation, she was re-intubated. After a further two weeks on methadone and sedatives, she was extubated again, this time successfully, One month later she was discharged from the hospital, still on oral voriconazole., Conclusion: Fungal infection should always be considered in immunocompromised patients with clinical signs of systemic infection. Recognition and treatment of pulmonary aspergillosis is difficult and may require multi drug therapy.

Purpose: The aim of the study was to evaluate some of the possible risk factors for retinopathy of prematurity (ROP) treated with laser photocoagulation or cryocoagulation., Material and Methods: The study comprised 71 preterm infants with ROP needing treatment and 118 prematures without ROP or with ROP requiring no treatment, as a control group. All infants were born with gestational age < or = 32 weeks and birth weight < or = 1500g. The perinatal variables, including some of clinical data, the length of mechanical ventilation as well as continous positive airway pressure (CPAP), duration of total parenteral nutrition and some of laboratory data were analyzed, to evaluate their correlation with the development of ROP., Results: Gestational age before 28 weeks (OR = 5.11), episodes of convulsiones (OR = 2.15), mechanical ventilation for more than 20 days (OR = 5.86) and > 30 days (OR = 7.47), CPAP for more than 5 days (OR = 4.15) and > 10 days (OR = 2.84), total parenteral nutrition for more than 10 days (OR = 7.84) and > 20 days (OR = 9.02) and elevated peak of alanine aminotransferase (AIAT) levels (OR = 3.17) were significant risk factors for ROP requiring treatment., Conclusions: The opthalmic examination for retinopathy of prematurity requiring laser photocoagulation or cryocoagulation should be obligatory for prematures born < or = 32 weeks of gestational age, with birth weight < or = 1500 g. The frequency of the consecutive ophthalmic examinations depends on the severity of prematurity and on the presence and intensification of the risk factors for ROP.

Over the last 30 years, three new opioids of the piperidine family have been introduced to anaesthesia clinical practice: sufentanil, alfentanil and remifentanil. Alfentanil is a derivative of fentanyl, with quicker onset than that of fentanyl and with shorter duration and more intense vagomimetic properties than those of fentanyl and sufentanil. It may cause less intense respiratory depression than equianalgesic doses of fentanyl. Clinical trials indicate that alfentanil can be used effectively as an analgesic, as an analgesic supplement to anaesthesia, and as the major component of a general anaesthetic. Its short duration of effect makes it attractive as an analgesic supplement for short ambulatory surgical procedures. Sufentanil is a more potent and more lipophilic analgesic than fentanyl. It would appear to maintain haemodynamic stability during surgery better than other opioids. Epidural sufentanil produces a rapid onset and good quality of analgesia. In addition, low doses administered intravenously via a PCA pump seem to have a potential role for analgesia during labour. Remifentanil is an opioid analgesic that is rapidly metabolized by non-specific blood and tissue esterases. According to its unique pharmacokinetic profile, remifentanil-based anaesthesia combines high-dosage opioid analgesia intraoperatively with a rapid and predictable postoperative awakening, even after long procedures. Its vagomimetic properties are especially pronounced in small children, the elderly and hypovolaemic patients, and in these groups atropine should be always given before remifentanil administration. Remifentanil also minimises the adrenergic response to endotracheal intubation. Three mju agonist-antagonists have been used for pain treatment: nalbuphine, butorphanol and buprenorphine. They can be used in ambulatory settings. Nalbuphine can be used parenterally. It reverses morphine-induced respiratory depression while maintaining adequate analgesic effect. Buprenorphine can be given sublingually, percutanenously, epidurally and parenterally. It is a potent analgesic, recommended for strong postoperative pain. Butorphanol is a potent analgesic that increases heart rate, arterial and pulmonary blood pressures and cardiac output. It should be given carefully in patients with coronary disease.

Background: Ascites in neonates and infants is usually caused by cardiac failure and urinary or biliary tract obstruction. The objective of this study was to characterize our experience with ascites as a complication of sepsis., Methods: We retrospectively collected and analyzed data of patients treated in the intensive care unit (ICU) of the university-based children's hospital, in whom ascites developed during nosocomial sepsis. Ten infants admitted to the ICU in the first 2 days of life developed sepsis on the mean 31.5 (+/-21.9) postnatal day. Gram-negative bacteria were the causative organism in nine cases, and Staphylococcus hemolyticus in one. Because of sepsis, reintubation and mechanical ventilation were necessary. All patients received broad spectrum antibiotics (including meropenem and ciprofloxacin), blood transfusions, catecholamines and intravenous immunoglobulin preparations. Ascites was observed on the median 13.5 day of sepsis (range 3-36), and severely compromised gas exchange. Continuous peritoneal drainage was applied by means of an intravascular catheter placed in the right lower abdominal quadrant., Results: The mean drained fluid volume was 44.7 (+/-20.4) ml.kg(-1).day(-1), drainage was continued for a median of 5.5 (range 1-56) day, and enabled significant reduction of ventilator settings 24 h after its implementation. No severe complications related to drainage occurred; six of 10 babies survived., Conclusions: Ascites can develop in infants with sepsis and cause respiratory compromise. Continuous drainage of ascitic fluid by means of an intravenous catheter is relatively safe and can improve gas exchange.

Late form of vitamin K deficiency bleeding (VKDB) occurs in infants who received none, or inadequate vitamin K prophylaxis after birth. Exclusively breastfed infants are especially prone to development of this disease. We present 4 cases of late VKDB with different clinical picture and outcome. In two patients intracranial bleeding of variable magnitude was detected, in one, bleeding into pleural cavity and in the fourth severe bleeding from injection sites without internal haemorrhage. Diagnosis was based on the clinical picture with special emphasis on the child's past history and results of coagulation tests. Treatment consisted mainly of vitamin K administration and infusion of fresh frozen plasma. One patient developed severe and definite brain damage after intracranial bleeding, the second only a mild brain dysfunction, the remaining two infants recovered fully. These observations and literature data suggest that in exclusively breastfed infants who did not receive vitamin K after birth, late VKDB should be taken into account as a cause of haemorrhage with different localization and magnitude. There is a need for more emphasis on teaching of physicians about late VKDB and for parenteral vitamin K prophylaxis programme for all newborn infants.

Unlabelled: It is often pointed that hospitalizations of premature infants generate high costs. It is particularly bothering with reference to neonatal intensive care units (NICU)., Objective: Since there is lack of desirable data in Poland, a study was launched in the city of Lódź in order to estimate exact costs of intensive care of premature infants., Methods: The study consisted in collecting data cocerning all resources (drugs, materials, medical equipment etc.) used during the hospitalizations of the neonates. It was constructed in a retrospective way, which means that data was collected from the first day of each patient's hospitalization till his or her discharge. The study lasted from 03.10.2004 to 06.04.2005. The study population were neonates borned before 37 week of gestation, who were treated in the Intensive Care Unit of Paediatric University Hospital, Medical University of Lodz. The population consisted of 30 patients borned between 23-36 week of gestation and birthweight between 600g and 3300g., Results: The structure of costs shows that the most expensive was medical care which constituted 51% of total costs. 90% of neonates costed no more than 30,000 zł and the average cost was 17,633,76 PLN., Conclusions: Total cost of hospitalization depends mainly on the length of stay. Among recovered patients hospitalizations lasted from 6 to 125 days. The longest stay costed 90,780 PLN. Detailed analysis is needed to consider if there is feasible possibility to limit time of hospitalizations in order to decrease costs.

The aim of the study was to determine the prognostic value of some pathologies related to prematurity in the development of stage 3 ROP in children with extremely low birth-weight. The group of 35 prematures with diagnosed 3rd stage ROP and 64 prematures without ROP was examined. The presence of the respiratory distress syndrome (RDS), persistent ductus arteriosus (PDA), necrotizing enterocolitis (NEC) and intraventricular haemorrhages (IVH) were analyzed. RDS was more frequent in prematures with 3rd stage ROP (p=0.005, OR=3.59). There was significant difference between the frequency of IVH in both groups (p = 0.03), but the odds ratio was significantly high only in the children with the 3rd stage IVH (OR=2.42). PDA was diagnosed more frequently in children with 3rd stage ROP but the difference was not statistically significant (p= 0.1 52, OR=1.80). There was significant difference between the groups when comparing the incidence of NEC (p=0.03, OR=3.34). The pathologies of the prematurity such as RDS, NEC and grade III IVH are the predictive factors for the development of stage 3 ROP (p=0.03, OR=3.34).

Although advanced neonatal care technology has contributed to significant decline in mortality of premature infants, it has also resulted in rising costs of hospitalization. Premature infants constitute 4% to 6% of all newborns treated annually in Neonatal Intensive Care Units (NICUs) and that is why the cost of prematurity determines considerable financial burden on health care in each country. In Poland research concerning costs of neonatal intensive care have not been conducted so far. The object of this paper is to review world-wide literature on that subject, particularly taking into consideration methods of estimating costs and economic analysis, such as cost-benefit analysis, cost-effect analysis and cost-utility analysis. The results of studies undertaken in the United States of America, Canada and Australia have been presented. Results of review indicate the strong relationship between high costs and small gestational age or low birth-weight of newborns. As no research in this area has been conducted in Poland so far, it seems to be crucial to estimate costs of neonatal intensive care of premature infants in Poland. Precise analysis of main factors determining high costs may be helpful in searching for significant savings. It would be a useful decision-making tool both for the NICU and the hospital managers.

Objectives: Sensitive, reliable and early parameters of bacterial infection are extremely valuable in diagnosis of nosocomial infections in neonatal intensive care unit. In this study procalcitonin (PCT) and C-reactive protein (CRP) were evaluated for their diagnostic relevance in neonatal late onset sepsis., Design: Clinical study, Materials and Methods: We analysed inflammatory parameters in 48 newborn infants admitted to the Intensive Care Unit of Institute of Paediatrics in Lodz who suffered from nosocomial sepsis. They were sampled for PCT and CRP levels at the time of the onset of signs and 24 hours later. CRP was determined by an nephelometric method and PCT was determined by an immunoluminometric assay., Results: At the onset of Gram negative sepsis 14 from 17 contaminated newborns had significantly increased CRP levels and 15 of them had increased levels of PCT After 24 hours 100% of them had elevated PCT and CRP levels. At the onset of Gram positive sepsis only 18 from 31 neonates with positive blood culture had increased CRP levels and 28 of them had elevated concentrations of PCT. This difference was statistically significant. After 24 hours 26 of them had elevated CRP and 100% had increased PCT concentrations--this difference was not significant., Conclusion: Measurement of procalcitonin concentrations may be useful for early diagnosis of late onset sepsis in neonates.