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Purpose: Long-term follow-up (LTFU) care is essential to optimise health outcomes in childhood cancer survivors (CCS). We aimed to assess the impact of the COVID-19 pandemic on LTFU services and providers. Methods: A COVID-19 working group within the International Late Effects of Childhood Cancer Guideline Harmonization Group (IGHG) distributed a questionnaire to LTFU service providers in 37 countries across Europe, Asia, North America, Central/South America, and Australia. The questionnaire assessed how care delivery methods changed during the pandemic and respondents' level of worry about the pandemic's impact on LTFU care delivery, their finances, their health, and that of their family and friends. Results: Among 226 institutions, providers from 178 (79%) responded. Shortly after the initial outbreak, 42% of LTFU clinics closed. Restrictions during the pandemic resulted in fewer in-person consultations and an increased use of telemedicine, telephone, and email consultations. The use of a risk assessment to prioritise the method of LTFU consultation for individual CCS increased from 12% to 47%. While respondents anticipated in-person consultations to remain the primary method for LTFU service delivery, they expected significantly increased use of telemedicine and telephone consultations after the pandemic. On average, respondents reported highest levels of worry about psychosocial well-being of survivors. Conclusions: The pandemic necessitated changes in LTFU service delivery, including greater use of virtual LTFU care and risk-stratification to identify CCS that need in-person evaluations., + ID der Publikation: unilu_56897 + Sprache: Englisch + Letzte Aktualisierung: 2022-01-24 15:04:24

Cilj istraživanja: Cilj ovog istraživanja bio je utvrditi razinu i odrednice kritičke zdravstvene pismenost roditelja predškolske djece. Materijali i metode: Koristeći validirani test, sastavljen u sklopu projekta Informed Health Choices, proveli smo prospektivnu presječnu studiju u deset pedijatrijskih ambulanti primarne zdravstvene zaštite na području grada Splita u razdoblju od 1. veljače 2023. do 31. ožujka 2023. Testom je analizirana sposobnost roditelja djece u dobi do 7 godina da kritički procjene tvrdnje o zdravlju i učincima zdravstvenih intervencija, a ispitanici su uspoređeni na temelju vlastitih karakteristika kao i karakteristika njihove djece. Višestrukom regresijskom analizom su utvrđeni najznačajniji parametri koji su povezani s vještinama kritičke procjene zdravstvenih tvrdnji Rezultati: U istraživanje su uključena 402 ispitanika s medijanom (IQR) dobi od 45 (25-51) godina. Od ukupnog broja ispitanika, 80,1% su bile osobe ženskog spola. Ispitanici su pokazali vrlo dobru zdravstvenu pismenost te je medijan (IQR) uspjeha na testu od 12 pitanja iznosio 83,3% (66,7%-91,7%) točno odgovorenih pitanja. Prosječna stopa točnih odgovora na pojedino pitanje iznosila je 73,8% (69,9%-84,3%). Pokazalo se da za razliku od očeva, majke bolje procjenjuju zdravstvene tvrdnje (10,0 (8,0-11,0) vs. 8,0 (6,0-10,0); P, Objectives: The aim of this study was to determine the level and determinants of critical health literacy among parents of preschool children. Materials and Methods: Using a validated test developed as part of the Informed Health Choices project, we conducted a prospective cross-sectional study in ten primary healthcare pediatric clinics in the city of Split, from February 1, 2023, to March 31, 2023. The test assessed the ability of parents of children aged up to 7 years to critically evaluate health claims and treatment effects. Participants were compared based on their own characteristics as well as the characteristics of their children. Multiple regression analysis was used to identify the most significant parameters associated with critical health literacy skills. Results: The study included 402 participants with a median (IQR) age of 45 (25-51) years, with 80.1% of them being female. Participants demonstrated a high level of health literacy, with a median (IQR) test score of 83.3% (66.7%-91.7%) correct answers out of 12 questions. The average rate of correct answers for each individual question was 73.8% (69.9%-84.3%). Mothers performed better than fathers in evaluating health claims (10.0 (8.0-11.0) vs. 8.0 (6.0-10.0); P

Pozadina istraživanja: Djeca s Down sindromom (DS) zaostaju za tipičnom djecom u stjecanju razvojnih motoričkih prekretnica. Ciljevi ovog istraživanja bili su: 1) utvrditi vrijeme i vjerojatnosti rizika (OD ratio) usvajanja temeljnih motoričkih prekretnica s obzirom na tip tjelesne (ne)proporcionalnosti utvrđene na temelju CI i izraditi model za predviđanje razvoja grubih motoričkih prekretnica specifičnih za djecu s DS s obzirom na tip tjelesne (ne)proporcionalnosti novorođenčeta s DS utvrđene na temelju CI. Metode: U ovoj 20-godišnjoj prospektivnoj longitudinalnoj kohortnoj studiji pratili smo 47 djece s DS-om u dobi od 3 mjeseca do 5 godina od 2000 do 2020. god. Novorođenčad smo grupirali s obzirom na omjer opsega glave i porođajne težine težine (OG/PTx100) ili cefalizacijski indeks (CI) u skupinu proporcionalne (CI, Background: Children with Down syndrome (DS) lag behind typical children in acquisition of developmental milestones, which could differ depending on body proportionality. We aimed to determine the difference in acquisition of developmental milestones in children with DS with disproportionate CI compared to proportionate CI. We created a motor development model that predicted milestone acquisition time. Methods: In this 20-year prospective cohort study, 47 children with DS aged 3 months to 5 years followed up to 2020 were grouped according to the ratio of head circumference and birth weight (HC/BW) or Cephalization Index (CI) into proportionate (CI

Uvod: Konzumacija alkohola, droga i duhana među mladima najčešći su oblici rizičnih ponašanja. Poznavanje obrazaca navedenih ponašanja u određenoj sredini dalo bi smjernice za izradu specifičnih preventivnih programa. Cilj: Utvrditi prevalenciju, okolnosti i rizične čimbenike konzumacije alkohola droga i duhana među učenicima završnih razreda srednjih škola u Splitsko-dalmatinskoj županiji (SDŽ), razlike među školama (strukovne vs. gimnazije i privatne škole) te razlike u ovisnosti o mjestu pohađanja škole (Split i okolica, dalmatinsko zaleđe, otoci), kao i promjene u konzumaciji alkohola za vrijeme lockdowna tijekom pandemije COVID-19. Ovim istraživanjem želimo utvrditi i učestalost i promjene učestalosti hospitalizacija zbog akutnih alkoholnih intoksikacija (AAI) među djecom u dobi od 0 do 18 godina u razdoblju od 2008. do 2015. te ih usporediti s rezultatima iz razdoblja od 2016. do 2021. godine, kao i okolnosti koje su dovele do intoksikacije. Metode: Anonimni anketni upitnik putem mrežne (online) poveznice proslijeđen je učenicima završnih razreda srednjih škola u SDŽ-u (N = 1030). Učenici su upitnik mogli popuniti od lipnja do srpnja te od listopada do kraja prosinca 2020. godine. Pretražena je i medicinska dokumentacija djece starosti od 0 do 18 godina liječene na Klinici za dječje bolesti KBC-a Split od 1. siječnja 2008. do 31. prosinca 2021. godine zbog AAI-a (N = 272 od 2008. do 2015. i N = 71 od 2016. do 2021.) Rezultati: Prevalencija je pušenja među učenicima u SDŽ-u 37,28 %, konzumacije droga 24,27 % te pijenja alkohola 84,66 %. Učenici koji pohađaju strukovne škole češće puše od učenika u gimnazijama i privatnim školama (P < 0,001), dok među učenicima navedenih škola nema razlike u konzumaciji alkohola (P = 0,751) i droga (P = 0,192). Dječaci češće konzumiraju droge nego djevojčice (P = 0,013), dok nema razlike u konzumaciji alkohola (P = 0,328) i duhana (P = 0,85) među spolovima. Pušenje je najčešće među učenicima iz dalmatinskoga zaleđa (P = 0,037), konzumacija alkohola najčešća je na otocima (P = 0,007), a droga u Splitu i okolici (P = 0,029). Alkohol se najčešće pije u noćnim klubovima i café barovima (54,36 %), s prijateljima (92,89 %). Učenici ga obično piju kako bi se bolje osjećali (34,86 %). Pritom se najčešće piju žestoka pića u kombinaciji s bezalkoholnim pićem (39,33 %). Najveći broj učenika bez problema samostalno nabavlja alkoholna pića (85,33 %), njih 69,03 % barem se jednom opilo. Visina džeparca, samostalno zarađivanje, učestalost izlazaka, depresivnost, muški spol, razvedenost roditelja i viši stupanj obrazovanja majke povezani su s većim rizikom za upuštanje u rizična ponašanja, dok je za religioznost, veću učestalost prakticiranja vjere, bavljenje sportom i bolji školski uspjeh pokazano suprotno. Tijekom lockdowna zbog pandemije COVID-19 došlo je do značajnoga pada konzumacije alkohola među učenicima završnih razreda srednjih škola u SDŽ-u (P < 0,001), posebno u društvu s prijateljima (P < 0,001), dok je porasla učestalost pijenja s članovima obitelji (P < 0,001), samostalnoga pijenja (P < 0,001) te pijenja u različitim socijalnim kontekstima (P = 0,002). Tijekom lockdowna najčešće se pilo iz dosade (39,05 %). Učestalost pijenja tijekom lockdowna bila je manja među 53,98 % učenika, dok je 15,63 % učenika povećalo učestalost konzumacije (P < 0,001). Među učenicima gimnazija i privatnih škola zabilježen je značajniji pad pijenja u odnosu na učenike strukovnih škola (P = 0,002), kao i među učenicima na otocima (P = 0,050). Mladići su tijekom lockdowna češće pili od djevojaka (P < 0,001). Značajno smanjenje AAI-a među djecom u dobi od 0 do 18 godina zabilježen je i u 2020. (razdoblje pandemije) u odnosu na 2019. godinu, koja je prethodila pandemiji (P = 0,025). U razdoblju od 2008. do 2015. godine 488 djece bilo je liječeno na Klinici za dječje bolesti KBC-a Split zbog akutnih intoksikacija, od čega njih 272 (55,74 %) zbog AAI-a, dok ih je u razdoblju od 2016. do 2021. bilo 218, među kojima je 71 dijete (32,57 %) liječeno zbog AAI-a. U obama ispitivanim razdobljima AAI je bio češći među dječacima (63,60 % od 2008. do 2015. te 70,42 % od 2016. do 2021.), najčešće među skupinom u dobi od 14 do 18 godina (P < 0,001), tijekom vikenda i blagdana (P < 0,001) te izvan kuće (P < 0,001). Prosječna je dob bila 15,95 ± 1,51 godinu u razdoblju 2008. – 2015., odnosno 16,17 ± 1,3 godine u razdoblju 2016. – 2021.; koncentracija alkohola 2,003 ± 0,585 ‰ u razdoblju 2008. – 2015., odnosno 2,15 ± 0,539 ‰ u razdoblju 2016. – 2021.; prisustvo ozljeda u 11,03 % slučajeva u razdoblju 2008. – 2015., odnosno 23,94 % u razdoblju 2016. – 2021.; u razdoblju 2008. – 2015. na droge je bilo pozitivno 6,25 %, a u razdoblju 2016. – 2021. 8,45 % djece. Udio hospitalizacija djece u dobi od 0 do 18 godina zbog AAI-a među svim hospitalizacijama u razdoblju od 2008. (1,33 %) do 2021. godine (0,23 %) značajno se smanjio, pri čemu se u svakoj sljedećoj godini očekuje pad za 21,26 %. Zaključak: Iako je učestalost AAI-a među djecom u SDŽ-u u padu, rezultati istraživanja pokazuju visoku prevalenciju konzumacije alkohola, droga i duhana među mladima u ovisnosti o vrsti škole i mjestu pohađanja škole. Stoga rezultati ovoga istraživanja mogu dati smjernice za izradu specifičnijih preventivnih programa među djecom i mladima. Smanjenje konzumacije alkohola među mladima za vrijeme lockdowna posljedica je smanjenoga druženja s prijateljima i ograničene dostupnosti alkohola u tome razdoblju te je pokazatelj da se smanjenjem dostupnosti opojnih tvari, kao i boljom organizacijom i ponudom aktivnosti namijenjenih mladima, može smanjiti incidencija upuštanja u rizična ponašanja., Background: Alcohol, drugs and tobacco consumption is the most common type of risky behaviors among adolescents. Determinating the speciffic patterns of these behaviors in a particular environment would provide guidelines for creating speciffic prevention programs. Aim: To determine the prevalence, circumstances and risky factors for alcohol, drugs and tobacco consumption among high school students in Split-Dalmatia County (SDC), differences between schools (vocational vs. gymnasiums and private schools) and differences depending on the place of school attendance (Split and surroundings, rural parts, islands), as well as changes in alcohol consumption during the COVID-19 pandemic lockdown. We also wanted to determine the frequency and changes in hospitalizations due to acute alcohol intoxications (AAI) among children aged 0-18 in the period from 2008 to 2015 and compare them with the results from 2016 to 2021, as well as changes in circumstances that led to intoxication. Methods: An anonymous questionnaire survey was distributed online to final grade high school students of all schools in SDC (N = 1030). Students were able to complete the questionnaire survey in a period from June to July and from October to the end of December 2020. The data of children aged 0 to 18 years who were hospitalized for AAI at Department of Pediatrics, University Hospital of Split in a period from January 1, 2008 to December 31, 2021 (N = 272 from 2008 to 2015 and N = 71 from 2016 to 2021) were collected retrospectively from hospital medical records. Results: The prevalence of smoking among students in SDC is 37.28 %, drugs consumption 24.27 %, and drinking 84.66 %. Students attending vocational schools smoke more often than students in gymnasiums and private schools (P < 0.001), while there is no difference in alcohol (P = 0.751) and drugs consumption (P = 0.192) between students depending on the school type. Boys consume drugs more often (P = 0.013) than girls, while there is no difference in alcohol (P = 0.328) and tobacco (P = 0.85) consumption depending on the gender. Smoking is most common among students from the rural parts of SDC (P = 0.037), alcohol consumption on islands (P = 0.007), and drugs in Split and the surrounding area (P = 0.029). Students most frequently drink in nightclubs and coffee bars (54.36 %), with friends (92.89 %), “to feel better” (34.86 %), where they often drink mixed drinks (39.33 %). Students most often buy alcoholic beverages without any problem (85.33 %) and 69.03 % had been drunk in lifetime. While the greater amount of pocket money, employment, frequency of going out, depression, male gender, higher level of maternal education and having divorced parents increase the risk of participating in risky behaviors, religiosity, higher frequency of religion practicing, sports participation, and higher school performance reduce it. During the COVID-19 pandemic lockdown, there was a significant decrease in alcohol consumption among high school students in SDC (P < 0.001), especially with friends (P < 0.001), while the frequency of drinking with family members (P < 0.001), drinking alone (P < 0.001) and in different social context (P = 0.002) increased. Students were most often drinking out of boredom (39.05 %) during the lockdown. There was a decrease in frequency of drinking during the lockdown among 53.98 % of students, while 15.63 % of them increased it (P < 0.001). The decrease in alcohol consumption was more signifficant among students in gymnasiums and private schools than among students from vocational schools (P = 0.002), as well as among students on islands (P = 0.050). Boys were drinking more often than girls (P < 0.001) during the lockdown period. A significant decrease in AAI among children aged 0-18 years was also recorded in 2020 (pandemic period) compared to 2019 (pre-pandemic period) (P = 0.025). In the period from 2008 to 2015, 488 children were hospitalized at Department of Pediatrics, University Hospital of Split for acute intoxications, 272 (55.74 %) of them due to AAI, while in the period from 2016 to 2021 there were 218 intoxicated children, 71 (32.57 %) of them hospitalized due to AAI. In both examined periods, AAIs were more frequent among boys (63.60 % from 2008 – 2015, and 70.42 % from 2016 – 2021), most often among children aged 14 to 18 years (P < 0.001), during weekends and holidays (P < 0.001), and in outside places (P < 0.001). The average age was 15.95 ± 1.51 (in a period 2008 – 2015) and 16.17 ± 1.30 (in a period 2016 – 2021); blood alcohol concentration 2.003 ± 0.585 ‰ (in a period 2008 – 2015) and 2.15 ± 0.539 ‰ (in a period 2016 – 2021); the presence of injuries was detected among 11.03 % (in a period 2008 – 2015) and 23.94 % (in a period 2016 – 2021) children; and 6.25 % (in a period 2008 – 2015) and 8.45 % (in a period 2016 – 2021) children were positive for drugs in urine samples. The proportion of hospitalizations of children aged 0-18 due to AAI among all hospitalizations has signifficantly decreased from 2008 (1.33 %) to 2021 (0.23 %), with an expected decrease of 21.26 % in every next year. Conclusion: Although the incidence of AAIs among children in SDC is declining, the results of this study show a high prevalence of alcohol, drug and tobacco consumption among adolescents, depending on the type and place of school attendance. Therefore the results of this study can provide guidelines for more specific prevention programms among children and adolescents. The decrease in alcohol consumption among adolescents during the lockdown is a consequence of reduced socializing with friends and limited availability of alcohol during this period, and an indication that reducing the availability of psychoactive substances and maybe with better organization and offer of activities where young people can socialize, the incidence of risky behaviors among them can be reduced.

Background: Down syndrome (DS) is the most common genetic disorder. To date, the scientific literature regarding micronutrient status in children and adolescents with DS has not been systematically reviewed. Therefore, our aim was to provide a systematic review and meta-analysis on this topic. Methods: We identified all relevant case-control studies published by 1 January 2022, by searching the PubMed and Scopus databases for original English-language articles analysing the micronutrient status of individuals with DS. Forty studies were included in the systematic review and 31 in the meta-analysis. Results: Statistically significant differences between individuals with DS (cases) and non-DS (controls) (P ≤ 0.05) were obtained for zinc, selenium, copper, vitamin B12, sodium and calcium. Serum, plasma and whole blood analyses showed lower zinc levels in cases than controls {standardised mean difference [SMD] serum [95% confidence interval (CI)] = -2.32 [-3.22, -1.41], P < 0.00001; SMD plasma [95% CI] = -1.29 [-2.26, -0.31], P < 0.01; SMD blood [95% CI] = -1.59 [-2.29, -0.89], P < 0.00001}. Similarly, plasma and blood selenium concentrations were significantly lower in cases than controls (SMD plasma [95% CI] = -1.39 [-2.26, -0.51], P = 0.002; SMD blood [95% CI] = -1.86 [-2.59, -1.13], P < 0.00001). Intraerythrocytic copper and serum B12 were higher in cases than controls (SMD Cu [95% CI] = 3.33 [2.19, 4.46], P < 0.00001; SMD B12 [95% CI] = 0.89 [0.01, 1.77], P = 0.048). Blood calcium was lower in cases than controls (SMD Ca [95% CI] = -0.77 [-1.34, -0.21], P = 0.007). Conclusions: This study provides the first systematic overview of micronutrient status in children and adolescents with DS and has shown that relatively little consistent research has been executed in this field. There is a clear need for more well-designed, clinical trials to study the micronutrient status and effects of dietary supplements in children and adolescents with DS.

Pretilost u ranoj životnoj dobi je jedan od vodećih javno zdravstvenih problema u svijetu. Poznato je da pretilost u ranoj životnoj dobi većinom perzistira u odrasloj dobi, a što je važan čimbenik razvoja kardiovaskularnih komplikacija i metaboličkog sindroma (MS). Zbog svega navedenoga postoji stalna potreba za pronalaskom novih molekularnih biljega koji bi dodatno pomogli u praćenju napredovanja metaboličkog poremećaja. Katestatin je peptid koji proteolitičikim cijepanjem nastaje iz kromogranina A te ima široki spektar biološke aktivnosti, poput inhibicije otpuštanja katekolamina, smanjenja krvnog tlaka, poticanja oslobađanja histamina, smanjenja beta-adrenergičke stimulacije i regulacije oksidativnog stresa. Do sada je objavljeno nekoliko studija na odrasloj populaciji, a koje su pokazale da je katestatin značajan rizični faktor za hipertenziju, a koliko nam je poznato, ovo je prvo izvješće o serumskim koncentracijama katestatina u pretile djece i adolescenata. Također, manjkavost vitamina D povezana je s nizom različitih kronični bolesti uključujući pretilost. Uloga vitamina D u pretilosti nije u potpunosti razjašnjena, a potencijalni učinci uključuju regulaciju upalnog odgovora, ekspresiju gena koji reguliraju adipogenezu i adipocitnu apoptozu te utjecaj na lučenje leptina i adiponektina i regulaciju intenziteta metabolizma. Cilj ovoga istraživanja je bio usporediti serumske koncentracije katestatina i 25- hidroksi vitamin D (25(OH)D) s odrednicama MS-a i ostalim kardiovaskularnim rizičnim čimbenicima između pretilih ispitanika i odgovarajuće kontrolne skupine ispitanika. U studiju je uključeno 91 pretilo dijete i adolescent s ITM z vrijednosti >2 i kao kontrolna skupina 39 zdrave djece (ITM z vrijednosti, Childhood obesity is one of the leading public health problems in the world and it is well known that early childhood obesity persists most into adulthood, an important factor in the development of cardiovascular complications and metabolic syndrome (MS). There is a constant need for new molecular biomarkers that will help clinicians decipher the progression of the metabolic disorder. Catestatin is a peptide by proteolytic cleavage derived from chromogranin A and has a wide range of biological activities, such as inhibition of catecholamine release, reduction of blood pressure, stimulation of histamine release, reduction of beta-adrenergic stimulation and regulation of oxidative stress. So far, several studies have been published in the adult population that have shown that catestatin is a significant risk factor for hypertension, and to our knowledge, this is the first report of serum catestatin levels in obese children and adolescents. Also, vitamin D deficiency is associated with a number of different chronic diseases including obesity. The role of vitamin D in obese individuals has not been fully elucidated, but it is considered possible to regulate the inflammatory response, the expression of genes that regulate adipogenesis and adipocyte apoptosis and also affect leptin and adiponectin secretion and regulate energy metabolism. The aim of this study was to compare serum levels of catestatin and 25-hydroxy vitamin D (25 (OH) D) with components of MS and other cardiovascular risk factors among obese subjects, with control group. The study included 91 obese children and adolescents with BMI z score >2 and control group of 39 healthy children and adolescents (BMI z score

Djeca koja su bila izložena prenatalnim, perinatalnim i/ili postnatalnim faktorima rizika smatraju se neurorizičnom djecom. Smatra se da od ukupnog broja novorođene djece njih 1015% se rađa s neurološkim odstupanjima, dok se kod njih 50% može očekivati neurološka odstupanja blažeg ili težeg stupnja. Teška neurološka odstupanja klinički se manifestiraju već u dojenačkoj dobi, dok se blaža neurološka odstupanja manifestiraju iza prve godine pa do školske dobi u vremenskom redoslijedu: usporen razvoj motorike, nerazvijenost fine i grube motorike, smetnje u ponašanju, smetnje u razvoju govora, te smetnje u kognitivnom razvoju. U najugroženije skupine spadaju nedonoščad i djeca niže porođajne težine zbog nerazvijenosti tjelesnih sustava, a posebice živčanog sustava. Cilj ovog rada je prikazati najutjecajnije faktore rizika koji mogu izazvati odstupanja u prenatalnom, perinatalnom i postnatalnom periodu, te opisati koja se stanja javljaju kod nisko i visoko neurorizične djece. Također u radu će biti prikazane sestrinske intervencije, te kako pomoći djeci s neurološkim odstupanjima integraciju u društvo, kako se ne bi osjećali socijalno izoliranim. U radu će biti istaknuta važnost edukacije, kako zdravstvenih djelatnika, tako i roditelja oboljele djece. Children who were exposed to prenatal, perinatal and/or postnatal risk factors are considered neuro-risk children. It is believed that 10-15% of the total number of newborns are born with neurological abnormalities, while 50% can be expected to have mild or severe neurological abnormalities. Severe neurological deviations are clinically manifested already in infancy, while milder neurological deviations manifest after the first year and up to school age in chronological order: slow motor development, underdevelopment of fine and gross motor skills, behavioral disorders, speech development disorders, and disorders in cognitive development. The most vulnerable groups include premature babies and children of lower birth weight due to the underdevelopment of body systems, especially the nervous system. The aim of this paper is to show the most influential risk factors that can cause deviations in the prenatal, perinatal and postnatal period, and to describe which conditions occur in low and high neurorisk children. Nursing interventions will also be presented in the paper, and how to help children with neurological deviations integrate into society, so that they do not feel socially isolated. The paper will emphasize the importance of education, both of health workers and parents of sick children.

Treating complicated wounds in the pediatric population using traditional wet to moist wound dressing methods is not always appropriate due to the frequent need to change dressings daily or even a number of times a day, causing distress to the patient. Topical negative pressure is a method that allows for fewer dressings and provides localized benefits, thus accelerating wound healing. The merits of this therapy have been proven in studies on adults, but research on the pediatric population is scarce. Here we intend to present the results of negative pressure wound therapy (NPWT) on 34 pediatric patients (study group) and compare them with 24 patients (control group) treated with the traditional wet to moist dressing for complicated wounds. The results show that topical negative pressure wound therapy is a safe method that downgrades a wound from a complicated to a simple one and allows definitive coverage using a simpler technique with fewer wound dressings. The scars of the patients in the study group exhibited a better result on a visual scar scale. The patients in the control group had a shorter hospital stay. Based on the recorded results, we were able to make treatment recommendations.

Cilj: Prikazati klinički tijek dviju djevojčica s kongenitalnom crijevnom opstrukcijom uzrokovanom duodenalnom membranom, liječenih od ove rijetke anomalije u Kliničkom bolničkom centru Rijeka u razmaku od pet mjeseci. Prikaz slučaja: Kod prve je djevojčice sumnja na duodenalnu opstrukciju postavljena zbog prenatalnog ultrazvučnog nalaza, dok je kod druge sumnja na opstrukciju postavljena postnatalno jer od drugog dana života nije tolerirala oralni unos hrane. U sklopu inicijalnog zbrinjavanja u obje je djevojčice obustavljena enteralna i uvedena parenteralna prehrana, postavljena je nazogastrična sonda te uvedena parenteralna nadoknada volumena. Ultrazvuk abdomena, radiografija abdomena, pasaža crijeva i irigografija nisu pokazali znakove gastrointestinalne opstrukcije. Obje djevojčice ubrzo su počele sve bolje tolerirati enteralni unos. Međutim, prva djevojčica nije tolerirala obroke veće od 15 mL instant-formule, a druga nakon 15. dana života ponovno nije tolerirala enteralni unos hrane. Ponovljena je široka dijagnostička obrada koja u prve djevojčice nije dokazala duodenalnu opstrukciju. U druge je djevojčice ezofagogastroduodenoskopijom utvrđena duodenalna opstrukcija nepoznate etiologije. U 19., odnosno 25. danu života provedena je laparotomija. Intraoperativno, nakon duodenotomije, u oba je slučaja vizualizirana duodenalna membrana koja je potom ekscidirana. Poslijeoperacijski oporavak bio je uredan s manjim nekirurškim komplikacijama. Djevojčice su otpuštene iz bolnice 21., odnosno 36. poslijeoperacijskog dana. Zaključci: Postavljanje dijagnoze duodenalne membrane često je vrlo složeno zbog intermitentne prirode simptoma. Eksplorativna laparotomija katkad je nužna kako bi se postavila konačna dijagnoza., Aim: To report the clinical courses of two patients with intestinal obstruction caused by duodenal web, who were diagnosed with this rare congenital anomaly at Clinical Hospital Center Rijeka in a span of 5 months. Case report: One of the patients was prenatally suspected to have duodenal obstruction due to ultrasonographic findings, while the other showed signs of obstruction by not tolerating oral intake from the second day of life (DOL). Ceasing enteral feeding, placing a nasogastric tube and introducing intravenous hydration and parenteral nutrition was performed as initial management. Abdominal ultrasonography, abdominal radiography, upper gastrointestinal contrast study and contrast enema were performed but showed no signs of obstruction. Both patients showed improvement in tolerating oral intake over the next few days. However, the first patient did not tolerate meals exceeding 15 mL of infant formula, and the second patient again did not tolerate any oral intake from the 15th day of life. A broad diagnostic workup was repeated but did not show conclusive evidence of obstruction regarding the first patient. Esophagogastroduodenoscopy found duodenal obstruction of unknown origin regarding the second patient. Laparotomy was performed on the 19th and 25th DOL, respectively. Duodenal web was visualized and excised in both patients following duodenotomy. Postoperative recovery was orderly with minor nonsurgical complications. The patients were discharged from hospital on the 21st and 36th postoperative day, respectively. Conclusions: Diagnosing a perforated duodenal web is often challenging because of possible intermittent nature of its symptoms. Exploratory laparotomy is sometimes required to reach diagnosis.

Cilj: Prikazati slučaj pedijatrijske pacijentice sa sindromom gornjeg medijastinuma (SGM) kod koje je citološkom analizom pleuralnog i perikardijalnog izljeva postavljena preliminarna dijagnoza T-staničnog ne-Hodgkinovog limfoma (T-NHL) i zbog životne ugroženosti započeta kemoterapija s izvrsnim odgovorom. Prikaz slučaja: Pacijentica u dobi od 15 godina pregledana je u hitnoj pedijatrijskoj ambulanti zbog nespecificiranog gubitka svijesti. Pet dana pred prijam žalila se na šum u ušima, vrtoglavicu, noćno znojenje, difuzne bolove u trbuhu i povraćanje, uz suh kašalj na dan prijama. Zbog brzog pogoršanja kliničkog stanja s cijanozom i hipoksijom zaprimljena je u Jedinicu intenzivnog liječenja. Slikovne pretrage pokazale su uvećanu sjenu medijastinuma te obilan perikardijalni i pleuralni izljev. Uz intenzivne potporne mjere liječenja, učinjena je hitna perikardiocenteza i pleuralna drenaža. Citološkom analizom izljeva postavljena je dijagnoza T-NHL-a te je bez histološke potvrde uvedena kemoterapija prema EURO-LB 02 protokolu, s izvrsnim odgovorom. Pet godina nakon završetka liječenja pacijentica je u kontinuiranoj kompletnoj remisiji. Zaključak: SGM je hitno stanje u pedijatrijskoj onkologiji. Brz razvoj tipičnih simptoma i znakova SGM-a kod djeteta treba pobuditi kliničku sumnju na medijastinalni tumor. U ovakvim slučajevima životne ugroženosti, uz intenzivne mjere liječenja, potrebno je započeti antitumorsku terapiju na osnovi preliminarne dijagnoze bez histološke potvrde. Rano prepoznavanje i adekvatno zbrinjavanje SGM-a od presudne je važnosti za povoljan ishod., Aim: To present the case of a pediatric patient with superior mediastinal syndrome (SMS) in whom a preliminary diagnosis of T-cell non-Hodgkin lymphoma (T-NHL) was established by cytological analysis of pleural and pericardial effusion and due to the life-threatening condition, chemotherapy was initiated with an excellent response. Case report: A 15-year-old girl was examined in the emergency pediatric department due to unspecified loss of consciousness. Five days before the admission, she was complaining of tinnitus, dizziness, night sweats, diffuse abdominal pain and vomiting, and dry cough on the day of the admission. Her clinical condition worsened rapidly with cyanosis and hypoxia, and she was admitted to the Intensive Care Unit. Imaging studies demonstrated a mediastinal mass, and large pericardial and pleural effusion. Along with intensive supportive measures, pericardiocentesis and pleural drainage were performed. Cytological examination of fluids established a preliminary diagnosis of T-NHL, and chemotherapy according to EURO-LB 02 protocol was started without histological confirmation, with excellent response. Five years after the end of the treatment, the patient is in complete remission. Conclusion: SMS is an emergency in pediatric oncology. The rapid development of typical SMS signs and symptoms in a child should arouse clinical suspicion of a mediastinal tumor. In life-threatening cases, along with intensive care treatment, it is necessary to start anticancer therapy based on a preliminary diagnosis without histological confirmation. Early identification and adequate treatment of SMS are crucial for a favorable outcome.

Rano suzbijanje, prekidanje epileptičkih napadaja središnji je stup u strategiji njihova liječenja. Većina epileptičkih napadaja događa se izvan medicinske ustanove, najčešće u kućnom okruženju. Stoga smo izradili i predložili ovaj algoritam zbrinjavanja motoričkih/konvulzivnih epileptičkih napadaja u izvanbolničkom okruženju, prvenstveno s ciljem pružanja uniformne informacije i edukacije roditelja/skrbnika te za olakšavanje snalaženja liječnicima primarne zdravstvene zaštite i timovima hitne medicinske pomoći. Za potrebe pisanja ovog rada analizirali smo i sintetizirali postojeće smjernice u cilju preporuke jednostavnog, razumljivog i racionalnog terapijskog algoritma koji savjetujemo i primjenjujemo kao službeni algoritam preporuka naše ustanove. U njegovoj izradi usmjerili smo se na svjetske i nacionalne preporučene algoritme kao i dostupne studije koje su, koliko je to moguće, temeljene na dokazima. Prema našim saznanjima ovo je prvi pisani nacionalni algoritam takve vrste te do sada nisu postajale pisane smjernice/upute za liječenje epileptičkih napadaja, produljenih epileptičkih napadaja i epileptičkog statusa u izvanbolničkom okruženju uzimajući u obzir dostupnost, racionalnost i primjenjivost pojedinih lijekova u izvanbolničkim uvjetima, uvažavajući kliničku praksu u Republici Hrvatskoj. Sukladno navedenom, primjena benzodiazepina (BZD), vremenski jasno definirana, smatra se prvom linijom liječenja epileptičkog napadaja. Izvanbolnička primjena BZD-a, prvenstveno midazolama za orkomukuznu primjenu ili diazepama za rektalnu primjenu, povezana je s kraćim trajanjem generaliziranih konvulzivnih napadaja, smanjenjem vjerojatnosti ponavljajućih napadaja i smanjenjem broja posjeta hitnoj pomoći. Ukoliko napadaj potraje >3 minuta, svakako je potrebno žurno primijeniti jedan od BZD-a, pod pretpostavkom da ga se posjeduje (midazolam oromukozno – prednost! ili diazepam rektalno), te isto ponoviti u slučaju daljnjeg trajanja napadaja duljeg od pet minuta te pozvati/alarmirati sustav hitne medicinske pomoći. Uz provođenje mjera održavanja vitalnih funkcija potrebno je inzistirati na intravaskularnom pristupu za ponovljenu primjenu BZD-a, no doza BZD-a može se ponoviti intramuskularno. U rijetkim slučajevima može se primijeniti fenobarbiton intramuskularno, kao i levetiracetam intravenozno, a u slučaju izostanka njihova učinka započeti s primjenom midazolama u trajnoj infuziji. Dostupnost primjerenih oblika BZD-a, sukladno smjernicama, u izvanbolničkom okruženju kao i njihova pravilna uporaba – pravodobna primjena i odgovarajuće doziranje početkom napadaja – dva su ključna koraka prema poboljšanju cjelokupne zdravstvene skrbi u djece s visokim rizikom za pojavu epileptičkih napadaja i djece s epilepsijom. Navedeno ujedno predstavlja i pravovremeno suzbijanje produljenih epileptičkih napadaja i prevenciju epileptičkog statusa., Early suppression, termination of seizures is a central pillar in their treatment strategies. The majority of seizures occur outside of a medical facility, most often in the home environment. Therefore, we created and proposed this algorithm for the management of motor/convulsive seizures in an outpatient setting, primarily with the aim of providing uniform information and education to parents/caregivers, and to facilitate guidance for primary care physicians and emergency medical system (EMS). For the purposes of writing this paper, we analyzed and synthesized the existing guidelines in order to recommend a simple, understandable and rational therapeutic algorithm, which we advise and apply as the official recommendation algorithm of our institution. In creating it, we focused on world and national recommended algorithms as well as available studies that are, as far as possible, evidence based. According to our knowledge, this is the first written national algorithm of its kind, and until now there have been no written guidelines/instructions for the treatment of convulsive seizures, prolonged convulsive seizures, and status epilepticus in an outpatient setting, taking into account the availability, rationality and applicability of individual drugs in outpatient settings, respecting clinical practice in Republic Croatia. Accordingly, the use of benzodiazepines (BZD), clearly defined in time, is considered the first line of treatment for convulsive seizures. Outpatient administration of BZDs, primarily midazolam for oromucosal administration or diazepam for rectal administration, is associated with a shorter duration of generalized convulsive seizures, a reduction in the likelihood of recurrent seizures, and a reduction in the number of visits to the emergency room. If the seizure lasts >3 minutes, it is definitely necessary to urgently apply one of the BZD, assuming that it is available (oromucosal midazolam – an advantage! or diazepam rectally), and repeat the same in case the seizure continues for more than 5 minutes, and call/alert the EMS. Along with measures to maintain vital functions, it is necessary to insist on intravascular access for repeated BZD administration, but the dose of BZD can also be repeated intramuscularly. In rare cases, phenobarbital can be administered intramuscularly, as well as levetiracetam intravenously, and in the absence of the same effect, the administration of midazolam in continuous infusion can be started. The availability of appropriate forms of BZD, in accordance with the guidelines, in the outpatient setting as well as their correct use – timely application and appropriate dosage at the onset of seizures – are two key steps towards improving overall health care in children with high-risk for convulsive seizures and children with epilepsy. The above mentioned also presents the timely suppression of prolonged convulsive seizures and prevention of epileptic status.

Aspiracija stranog tijela čak se 3 – 4 puta češće javlja u djece, poglavito u one mlađe od tri godine, nego u odraslih. Orašasti plodovi i razne vrste sjemenki najčešća su strana tijela koja aspiriraju manja djeca. Starija djeca češće aspiriraju sitne kućanske predmete ili sitne dijelove igračaka. Aspiracija stranog tijela može ugroziti život. U djeteta koje se zbog aspiracije guši i ne može kašljati niti govoriti treba odmah primijeniti Heimlichov manevar koji se ne smije koristiti u djece mlađe od godinu dana. U najvećem broju slučajeva nakon dramatične faze gušenja strano tijelo dospije u jedan od bronha kada nastupa prividno mirna faza. Ista se ne smije protumačiti tako da je s djetetom sve u redu, jer neprepoznato strano tijelo u donjim dišnim putovima može dovesti do teških komplikacija na plućima. Anamnestički podatak o naglom nastupu simptoma aspiracije ključan je element dijagnostičkog postupka. Nalaz fizikalnog pregleda i nalaz rendgenske snimke grudnih organa mogu biti normalni tako da je anamneza dovoljna za indiciranje bronhoskopskog pregleda kojim se definitivno postavlja dijagnoza stranog tijela u dišnom putu. Uklanjanje stranog tijela primarni je i obvezan cilj liječenja. Za bronhoskopsku evakuaciju stranog tijela iz dišnih putova djece definitivno se preporučuje koristiti kruta bronhoskopija. Mjere prevencije aspiracije stranih tijela u djece obuhvaćaju zakonodavstvo, provođenje stalnog nadzora sigurnosti proizvoda i edukaciju roditelja. Roditelje, odgajatelje i školske nastavnike treba poticati da pohađaju tečajeve osnovnog održavanja života i pružanja prve pomoći u slučaju nastupa gušenja., Foreign body aspiration occurs 3–4 times more often in children, especially in those younger than three years, than in adults. Nuts and seeds are the most common food items aspirated by infants and toddlers whereas nonfood items like small objects or toys are more commonly aspirated by older children. Foreign body aspiration can be life-threatening. In a child who is choking due to aspiration and is unable to speak or cough, the Heimlich maneuver should be attempted. This maneuver should not be used on children younger than one year. In the majority of cases dramatic acute phase of choking may be followed by a symptom-free period when a foreign body enters one of the bronchi. This must not be misinterpreted as a sign of resolution, since an unrecognized foreign body in lower airways can lead to serious lung complications. History of choking is the key element of the diagnostic procedure. Physical examination and chest x-ray may be normal. Thus, the history is sufficient to indicate a bronchoscopic examination which definitively establishes the diagnosis of airway foreign body. Removal of the foreign body is the primary objective of treatment. Rigid bronchoscopy is strongly recommended for evacuation of a foreign body from the airways of children. Preventive measures for foreign body aspiration in children include legislation, continued product safety vigilance and caregiver education. Parents, child care providers and teachers should be encouraged to take a course in basic life support and choking first aid.

Patološka stanja u prsištu u djece jesu pneumotoraks i pleuralni izljevi: parapneumonični izljev, hilotoraks, hematotoraks te maligni izljevi. Sva ova stanja zahtijevaju brzu dijagnostiku i liječenje. Najčešći patološki sadržaj u prsištu u djece jest pneumotoraks, a nastaje najčešće spontano, prodorom zraka između dva lista pleure. Parapneumonični izljev nastaje kao komplikacija upale pluća, a liječenje se sastoji od antibiotske terapije, ponekad od pleuralne drenaže i primjene intrapleuralne fibrinolitičke terapije. Hilozni izljev je rijedak u djece, a nastaje nakupljanjem hiloznog sadržaja u pleuralnom prostoru. Kod svih ovih stanja simptomi mogu varirati od suptilnih do životno ugrožavajućih., Pathological conditions in the chest in children are pneumothorax and pleural effusions: parapneumonic effusions, chylothorax, hematothorax and malignant effusions. All these conditions require prompt diagnosis and treatment. The most common pathological content in the chest in children is pneumothorax. It usually occurs spontaneously, due to the penetration of air between two layers of the pleura. Parapneumonic effusion occurs as a complication of pneumonia, and treatment consists of antibiotic therapy, sometimes pleural drainage and intrapleural fibrinolytic therapy. Chylous effusion is rare in children, and is caused by the accumulation of chylous content in the pleural cavity. In all these conditions, symptoms can range from subtle to life-threatening.

Febrilne konvulzije najčešći su konvulzivni poremećaj u djetinjstvu, zbog čega bi liječnici trebali biti upoznati s pravilnom procjenom i liječenjem ovoga uobičajenog stanja. Definira se kao bilo koji napadaj popraćen vrućicom, bez infekcije središnjega živčanog sustava, koji se javlja kod djece između šest mjeseci i pet godina. U upotrebi je pet kriterija prema kojima se klasificiraju kao jednostavne ili složene febrilne konvulzije. Ova klasifikacija nudi drugačije smjernice za kliničku praksu, poglavito odluku o provođenju lumbalne punkcije kako bi se isključila intrakranijalna infekcija. Hrvatsko društvo za dječju neurologiju izradilo je 2012. godine prve smjernice za racionalnu dijagnostiku i terapiju febrilnih konvulzija koje su trebale biti izvedive u svim bolničkim ustanovama u Republici Hrvatskoj. Iako su smjernice bile od velike pomoći mnogim kliničarima, dobivanjem novih medicinskih dokaza i razumijevanjem kliničkih entiteta koju se prezentiraju febrilnim konvulzijama, a variraju od samolimitirajućeg poremećaja bez dugoročnih posljedica preko samoograničavajućih i medikamentima kontroliranih entiteta pa sve do teških epileptičkih encefalopatija, nove smjernice pridonose postavljanju dijagnoze u hitnoj ambulanti, uključuju preporuke o hospitalizaciji, primjeni elektroencefalografije, neuroslikovnih pretraga, profilaksi diazepamom i antipireticima. Iako nove smjernice sadrže nove kliničke preporuke, ostavljaju neka neriješena pitanja na koja buduća klinička istraživanja trebaju ponuditi odgovore., Febrile seizures are the most common childhood convulsive disorder, which is why doctors should familiarize with the proper assessment and treatment of this common condition. It is defined as any seizure accompanied by fever, without central nervous system infection, occurring in children between 6 months and 5 years of age. Five criteria have been used to classify as simple or complex febrile seizures. This classification offers different guidelines for clinical practice, especially the decision to perform a lumbar puncture to rule out intracranial infection. In 2012, the Croatian Society for Pediatric Neurology created the first guidelines for the rational diagnosis and therapy of febrile convulsions, which were performed in all hospitals in Croatia. Although the guidelines have been of great help to many clinicians, new medical evidence and understanding the clinical entities that present with febrile seizures, which vary from a self-limiting disorder without long-term consequences, through self-limiting and drug-controlled entities to severe epileptic encephalopathies, the new guidelines contribute to setting diagnoses in the emergency clinic, include recommendations on hospitalization, use of electroencephalography, neuroimaging tests, prophylaxis with diazepam and antipyretics. Although the new guidelines contain new clinical recommendations, they leave some unresolved questions that future clinical research should offer.

Primarni megaureter uzrok je hidronefroze u gotovo četvrtine pedijatrijskih pacijenata. Primarni opstruktivni megaureter zapravo je funkcionalni poremećaj uretera karakteriziran dilatacijom njegovog lumena. S afirmacijom prenatalnog ultrazvuka kao standardom sve je veća incidencija prenatalno detektiranih megauretera. Bilo da je dijagnoza postavljena prenatalno ili postnatalno, po rođenju slijedi detaljna nefrološko-urološka evaluacija. Velik udio primarnih opstruktivnih uretera jest tranzitoran te dolazi do spontane rezolucije u čak 80% slučajeva. U onih u kojih je liječenje ipak potrebno, konvencionalno kirurško liječenje sve se više zamjenjuje minimalno invazivnom metodom – endoskopskom balon dilatacijom i postavljanjem JJ stenta. Iako su podatci o dugoročnim rezutatima oskudni, trenutni izvještaji potvrđuju balon dilataciju kao dobru metodu prvog izbora u liječenju primarnog opstruktivnog megauretera., Primary megaureter is the main cause of hydronephrosis in almost a quarter of patients. Primary obstructive megaureter is a functional disorder of the ureter characterized by dilation of its lumen. With the establishment of prenatal ultrasound as the gold standard, there is an increasing incidence of prenatally detected megaureters. Whether the diagnosis has been established prenatally, or postnatally, thorough nephrologicalurological evaluation should follow. Almost 80% of primary obstructive megaureters are transitory. In patients with no spontaneous resolution, conventional surgical treatment is recently often being replaced with a minimally invasive method – endoscopic baloon dilatation and JJ stenting. Even though currently deficient in long term results, current reports confirm baloon dilatation as a good method of first choice of treatment in patients with primary obstructive megaureter.

Anemija se pojavljuje u slučaju smanjene koncentracije hemoglobina ili eritrocita u krvi. Postoje dva tipa podjele anemija, a to su morfološki i kinetički pristup. Prema kinetičkoj podjeli postoje anemije koje nastaju zbog povećeg propadanja eritrocita, zbog gubitka eritrocita i zbog smanjenog stvaranja eritrocita. U morfološkoj podjeli anemije se dijele na mikrocitne, normocitne i makrocitne. Najčešća anemija u djece je sideropenična anemija, te ona nastaje zbog premale količine željeza u organizmu. Pojava sideropenične anemije u dječjoj dobi može uzrokovati kognitivna i motorička oštećenja. Manjak vitamina B12 i folne kiseline uzrokuje pojavu megaloblastične anemije. Ukoliko se djeca hrane kozjim mlijekom, a ne majčinim, slijedi nedostatak folne kiseline. Talasemija je vrsta hemolitičke anemije koju karakterizira poremećena sinteza beta globinskih lanaca inače normalne strukture. Talasemija ima nekoliko podvrsta, čije ime se temelji na vrsti lanca koji je zahvaćen. Kako se sama anemija pojavljuje kao podloga nekog drugog stanja, bitno je liječiti osnovnu bolest kako bi se i sama anemija mogla adekvatno izliječiti. Najvažnija je prehrana obogaćena željezom, u što spada meso, riba, školjke, jetra i perad. Što se tiče prevencije anemije, s njom je najvažnije započeti u trudnoći, a najviše je potrebna nedonoščadi, blizancima, novorođenčadi s niskom porođajnom težinom, novorođenčadi čije su majke oboljele od sideropenične anemije i djeca iz višeplodnih trudnoća. Medicinska sestra je osoba koja najviše vremena provodi s majkom, pa tako i s djetetom, i ona ima ključnu ulogu u prepoznavanju znakova i simptoma bolesti, zdravstvenoj njezi, edukaciji te pružanju potpore oboljelom i obitelji. Anemia occurs when the concentration of hemoglobin or erythrocytes in the blood is reduced. There are two types of anemia division, namely the morphological and the kinetic approach. According to the kinetic division, there are anemias that occur due to increased decay of erythrocytes, due to loss of erythrocytes and due to reduced formation of erythrocytes. In the morphological division, anemias are divided into microcytic, normocytic and macrocytic. The most common anemia in children is sideropenic anemia, which is caused by too little iron in the body. The appearance of sideropenic anemia in childhood can cause cognitive and motor impairments. Lack of vitamin B12 and folic acid causes megaloblastic anemia. If children are fed goat's milk and not mother's milk, folic acid deficiency follows. Thalassemia is a type of hemilitic anemia characterized by impaired synthesis of beta globin chains of otherwise normal structure. Thalassemia has several subtypes, whose name is based on the type of chain that is affected. As the anemia itself appears as the basis of another condition, it is important to treat the underlying disease so that the anemia itself can be adequately cured. The most important is a diet enriched with iron, which includes meat, fish, shellfish, liver and poultry. As for the prevention of anemia, it is most important to start with it during pregnancy, and it is most necessary for premature babies, twins, newborns with low birth weight, newborns whose mothers suffered from iron deficiency anemia and children from multiple pregnancies. The nurse is the person who spends the most time with the mother, including with the child, and she has a key role in recognizing the signs and symptoms of the disease, health care, education and providing support to the patient and the family.

Prijevremeno rođeno novorođenče (nedonošče) tek je porođeno dijete koje je nošeno kraće od punih 37 tjedana trudnoće, odnosno kraće od 259 dana, računajući od prvog dana posljednje menstruacije majke. Patofiziološke osobitosti prijevremeno rođenog novorođenčeta najvećim su dijelom odraz funkcijske nezrelosti organa i organskih sustava, koja stvara poteškoće u prilagodbi na izvanmaternični život. Komplikacije prematuriteta mogu biti uzrokovane samim prijevremenim porodom, nezrelošću organskih sustava i primjenom potrebne terapije, a rizik za njihov nastanak povećava se sa smanjenjem gestacijske dobi i porođajne mase. Dijelimo ih na kratkoročne i dugoročne. Od kratkoročnih komplikacija najizraženije i najčešće su respiratorni distres sindrom, bronhopulmonalna displazija, perzistirajući arterijski duktus, intraventrikularno krvarenje, periventrikularna leukomalacija, nekrotizirajući enterokolitis, poteškoće hranjenja, prematurna retinopatija i infekcije. Iz skupine dugoročnih komplikacija ističu se poremećaj rasta i razvoja (neurorazvojna odstupanja i kronične bolesti) te poteškoće u psihosocijalnom i emocionalnom funkcioniranju., Prematurity is defined as a birth that occurs before completed 37th gestational week. Immaturity of a preterm infant is the underlying reason for their adverse postnatal adaptation and specific pathophysiological characteristics. In preterm survivors there is a significant rate of short and long-term health complications. Risk of such complications increases with the decrease of gestational age at the time of delivery and the birth weight. Most common short-term complications that accompany preterm birth are respiratory distress syndrome, bronchopulmonary dysplasia, persistent arterial duct, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, feeding difficulties, premature retinopathy, and infections. Long term complications include growth impairment, neurodevelopmental disturbances, chronic health conditions, difficulties in psychosomatic and emotional functioning.

Background and Objectives: There are limited data regarding the incidence and risk factors for hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants. The aim of the present study was to determine the incidence and risk factors associated with neonatal hypoglycemia, hyperglycemia, and unstable glycemia in preterm infants during the first seven days of life. Materials and Methods: This prospective study included preterm infants

Objectives: With this study we tried to find an impact of the COVID-19 pandemic on the pediatric patients presenting at the pediatric emergency department with a diabetic ketoacidosis. For this we compared the patients presenting at the ED from the 11th of March 2020 until the 11th of March 2022, after the WHO declared a pandemic situation with those who presented between January 1st 2012 and December 31st 2019. Materials and Methods: This retrospective observational study was conducted with the available data from the pediatric ward in the REGIOMED hospital Coburg. The categorization for severity of diabetic ketoacidosis was done according to the current S3 guideline for the therapy of Diabetes Mellitus, valid in Germany at the time of the study. We compared the severity from 49 cases in group A and 12 cases in group B, after all necessary exclusions were performed. Apart from the severity we compared laboratory values for pH, bicarbonates, blood glucose and glycated hemoglobin A1c (HbA1c). The comparisons were performed for the whole groups, and between groups A and B divided for gender. Results: There was no statistically significant difference in severity of diabetic ketoacidosis between group A and group B (P=0.435). When comparing the severity between groups A and B according to gender, no difference could be found in the female subgroup (P=0.957), but a statistically significant change in the male subgroup (P=0.031) could be seen. There was no difference in the pH values (P=0.227), also not when divided according to gender (male P=0.146 and female P=0.521). This was again seen in the analysis of bicarbonate concentrations, no difference could be found (P=0.218), the male subgroup had a P-value of 0.082 and the female subgroup a P-value of 0.617. The blood glucose at admission in both groups was in the expected range with a mean value of 512.6 mg/dl in group A and 544.3 mg/dl in group B. With P=0.276 no difference could be found, this was also true after division into female (P=0.543) and male (P=0.150). Median HbA1c values were actually higher in group A (11.3%) than in group B (10.65%). We therefore failed to prove worse results (P=0.767). Looking only at the male patients we also had a mean reduction of HbA1c from 11.1% to 10.6% and had no worse outcome in group B (P=0.789). The female patients also had better HbA1c results, their median improving from 11.3% to 10.4%, therefore no worsened long term glycemic control was obvious (P=0.671). Conclusion: We could not prove a worse patient presentation with diabetic ketoacidosis during the COVID-19 pandemic in general. The only significant worse outcome was the severity in male patients., Ciljevi: Ovom smo studijom pokušali utvrditi utjecaj pandemije COVID-19 na pedijatrijske pacijente koji se javljaju na hitnu pedijatriju s dijabetičkom ketoacidozom. U tu svrhu usporedili smo pacijente koji su im se javili u razdoblju od 11. ožujka 2020 do 11. ožujka 2022, odnosno nakon što je WHO proglasio pandemijsku situaciju, s onima koji su se javili između 1. siječnja 2012 i 31. prosinca 2019. Materijali i metode: Ova retrospektivna opservacijska studija provedena je uz pomoć dostupnih podataka s pedijatrijskog odjela u bolnici REGIOMED Coburg. Kategorizacija prema ozbiljnosti dijabetičke ketoacidoze učinjena je prema trenutnim S3 smjernicama za terapiju dijabetes melitusa, a koje su bile na snazi u Njemačkoj i u vrijeme istraživanja. Usporedili smo tako težinu iz 49 slučajeva u skupini A i 12 slučajeva u skupini B, nakon što su izvršena sva potrebna isključenja. Osim težine, usporedili smo i laboratorijske vrijednosti za pH, bikarbonate, glukozu u krvi i glikirani hemoglobin A1c (HbA1c). Usporedbe su obavljene za cijele skupine te između skupina A i B podijeljenih prema spolu. Rezultati: Nije bilo statistički značajne razlike u težini dijabetičke ketoacidoze između skupine A i skupine B (P=0.435). Uspoređujući težinu između skupina A i B prema spolu, ustanovili smo da nije bilo razlike u ženskoj podskupini (P=0.957), ali se mogla vidjeti statistički značajna promjena u muškoj podskupini (P=0.031). Isto tako, nije bilo razlike ni u pH vrijednostima (P=0.227), čak ni onda kada bismo gledali s obzirom na spol (muški P=0.146 i ženski P=0.521). Nadalje, analizom koncentracija bikarbonata, opet smo utvrdili to da se nije mogla pronaći veća razlika (P=0.218), muška podskupina imala je P-vrijednost 0.082, a ženska podskupina P-vrijednost 0.617. Glukoza u krvi pri prijemu u obje skupine bila je u očekivanom rasponu sa srednjom vrijednošću od 512.6 mg/dl u skupini A i 544.3 mg/dl u skupini B. S P=0.276 nije se također mogla pronaći razlika, a isto to je vrijedilo i nakon podjele na žene (P=0.543) i muškarci (P=0.150). Srednje vrijednosti HbA1c bile su zapravo više u skupini A (11.3%) nego u skupini B (10.65%). Stoga nismo uspjeli dokazati lošije rezultate (P=0.767). Uzmemo li u obzir samo muške pacijente, isto smo imali prosječno smanjenje HbA1c s 11.1% na 10.6% te lošiji ishod nije bio zabilježen ni u skupini B (P=0.789). Pacijentice su također imale bolje rezultate HbA1c. Njihov medijan poboljšao se s 11.3% na 10.4%, stoga u vezi dugotrajne glikemijske kontrole nisu bila zabilježena značajnija pogoršanja (P=0.671). Zaključak: Općenito govoreći, nismo mogli dokazati lošiju prezentaciju pacijenata s dijabetičkom ketoacidozom tijekom pandemije COVID-19. Jedini značajno lošiji ishod bila je težina kod muških pacijenata.

Cilj istraživanja: Cilj ovog istraživanja je ispitati pojavnost gastroshize i omfalokele u djece liječene u Zavodu za intenzivnu pedijatriju s postintenzivnom skrbi Klinike za dječje bolesti KBC-a Split, u razdoblju od 2002. do 2021. godine, te analizirati demografske, antropometrijske i kliničke karakteristike te ishode liječenja. Ujedno smo analizirali utjecaj rodne mase, gestacijske dobi i Apgar zbroja na nastanak komplikacija u naših ispitanika. Ispitanici i metode: Istraživanje je obuhvatilo 28 novorođenčadi s gastroshizom i omfalokelom liječene u Zavodu za intenzivnu pedijatriju s postintenzivnom skrbi Klinike za dječje bolesti KBC-a Split u razdoblju od 2002. do 2021. godine. Podaci potrebni za istraživanje su prikupljeni iz bolničke medicinske dokumentacije. Rezultati: Od ukupno 28 novorođenčadi s gastroshizom i omfalokelom 23 (82%) je imalo gastroshizu i 5 (18%) omfalokelu. Carskim rezom je porođeno 92% djece. Među njima je bilo 19 (68%) dječaka i 6 (32%) djevojčica. Medijan rodne mase bio je 2490 g (Q1 - Q3 1990-3027 g; min – maks 770-3490 g). Medijan gestacijske dobi bio je 36,5 tjedana (Q1 - Q3 35,3 - 38 tjedana; min – maks 25 - 41 tjedana). Medijan Apgar zbroja u 1. minuti bio je 8 (Q1 - Q3 6 -8,5; min - maks 1-10) i 8 (Q1 – Q3 7 - 8,5; min – maks 4-10) u 5. minuti. Najčešća perinatalna dijagnoza bila je mekonijska plodova voda, u 11 (42%) novorođenčadi. Kirurški je zbrinuto 27 (96%) djece, jedno dijete je umrlo prije kirurškog zbrinjavanja. Od njih je 19 (70%) zbrinuto primarnim kirurškim zahvatom, a 8 (30%) odgođenim. Najčešća metoda odgođenog zbrinjavanja je bila postavljanje vrećice. Sva djeca, koja su primarno kirurški zatvorena, zbrinuta su u 1. danu života. Medijan dana do definitivnog kirurškog zbrinjavanja u skupini odgođenog zatvaranja iznosio je 9,5 dana (min - maks 3 - 60 dana). Komplikacije je razvilo 22 (79%) djece, a najčešća postoperativna komplikacija bila je sepsa. Pridružene anomalije su bile prisutne u 16 (57%) ispitanika. Sva djeca s omfalokelom i polovina djece s gastroshizom su imala pridružene anomalije. Anomalije srca i krvnih žila su bile najčešće, imalo ih je 13 (46%) djece. Samo je jedno dijete imalo trisomiju 13. Od ukupno 28 novorođenčadi 25 (89%) je preživjelo, a 3 (11%) djece je umrlo zbog kardiopulmonalnog zatajenja. Zaključci: Pravovremeno postavljane dijagnoze ovih anomalija od velike je važnosti za planiranje postnatalne skrbi i okupljanje multidisciplinarnog tima. Napretkom prijeoperacijske skrbi, kirurških tehnika i poslijeoperacijskog zbrinjavanja smanjuje se udio komplikacija i poboljšava se preživljenje. Potrebno je provesti istraživanja koja obuhvaćaju širu populaciju ili prate duže vremensko razdoblje kako bi se donijeli precizniji zaključci., Objectives: The aim of this study was to examine the occurrence of gastroschisis and omphalocele in newborns treated in the Pediatric Intensive Care Unit in the period from 2002. to 2021. and to analyze the demographic, anthropometric and clinical characteristics and outcomes of treatment. We also analyzed the influence of birth weight, gestational age and Apgar score on the occurrence of complications in our subjects. Materials and methods: The study included 28 newborns with gastroschisis and omphalocele who were treated in the PICU, University Hospital of Split in the period from 2002. to 2021. Required information was obtained from hospital medical records. Results: Out of 28 newborns with gastroschisis and omphalocele 23 (83%) had gastroschisis and 5 (18%) had omphalocele. Caesarean section was used to deliver 92% of children. Among them 19 (68%) were male and 6 (32%) were female. The median birth weight was 2490 g (Q1 - Q3 1990-3027 g; min – max 770-3490 g). The median gestational age was 36,5 weeks (Q1 - Q3 35.3 - 38 weeks; min – max 25 - 41 weeks). The median for Apgar score was 8 (Q1 - Q3 6 -8.5; min - max 1-10) in first minute and 8 (Q1 – Q3 7 – 8.5; min – max 4-10) in fifth minute. The most common perinatal diagnosis, meconium-stained amniotic fluid, appeared in 11 (42%) of children. One child died before the surgical care, other 27 (96%) of children had surgery. Of them 19 (70%) were with primary closed and 8 (30%) had delayed closure. Most used method of staged reduction was silo bag. All the primarily closed children were taken care of within 1st day of life. The median of days until definitive surgical care for group of delayed closure was 9.5 days (min - max 3 - 60 days). Complications developed in 22 (79%) of children. Most common complication was sepsis. Associated anomalies were present in 16 (57%) of children. All children with omphalocele and half of the children with gastroschisis had associated anomalies. Cardiovascular anomalies were the most common, with 13 (46%) children having them. Only one child had a trisomy 13. Out of 28 newborns 25 (89%) survived and 3 (11%) of children died due to cardiopulmonary decompensation. Conclusion: Timely diagnoses are of great importance for planning of postnatal care and gathering a multidisciplinary team. Advances in preoperative and postoperative care, and surgical techniques reduce the number of complications and improve survival. For more precise conclusions on this topic research should include wilder population or have a loger time frame.

Prematuritet, odnosno rođenje prije 37. tjedna gestacije, nosi sa sobom čitav niz rizika i posljedica. Rizici rastu što je manja GA i rodna masa, te što je veće oštećenje mozga u trenutku poroda. Unatoč tome što se mortalitet takve djece godinama smanjuje, primarno napretkom jedinica intenzivnog liječenja u neonatalnoj skrbi, pokazalo se da velik broj prematurusa ima čitav niz kratkoročnih i dugoročnih komplikacija. Ovaj rad fokusirao se na mentalne poremećaje, poremećaje ponašanja i neurorazvojne poremećaje kako ih definira ICD-11 u skupini 06. Velikih broj studija koje se bave mentalnim ishodima prematuriteta utvrdile su korelaciju prematuriteta i povećanog rizika za određene poremećaje iz ove skupine. Budući da se neki od navedenih poremećaja katkad pojave tek u odrasloj dobi, studija, a pogotovo onih s velikim uzorkom, nažalost nema previše jer zahtijevaju dugotrajno praćenje i/ili uređene registre. Tu su vrlo korisne nacionalne studije kao npr. danska ili švedska koje su kroz duži vremenski period analizirale kompletnu populaciju prijevremeno rođene djece te promatrale učestalost mentalnih poremećaja u odrasloj životnoj dobi. Utvrđeno je da se rizik najčešće povećava za poremećaje intelektualnog razvoja, poremećaje učenja, poremećaje motoričke koordinacije, ASD, ADHD, a postoji i određeni rizik za depresiju, bipolarno afektivni poremećaj, psihozu i anksioznosti., Prematurity, being born before the 37th week of gestation, carries with it a whole series of risks and consequences. The risks increase the smaller the GA and birth weight, and the greater the brain damage at the time of birth. Despite the fact that the mortality of such children has been decreasing over the years, primarily due to the progress of intensive care units in neonatal care, it has been shown that a large number of premature babies have a whole series of short-term and long-term complications. This thesis is focused on mental disorders, behavioral disorders and neurodevelopmental disorders as defined by ICD-11 in group 06. A large number of studies dealing with the mental outcomes of prematurity determined the correlation of prematurity and increased risk for certain disorders from this group. Since some of the mentioned disorders sometimes appear only in adulthood, there are unfortunately not many studies, especially those with a large sample, as they require long-term follow-up and/or organized registries. There are very useful national studies, such as Denmark or Sweden, which over a long period of time analyzed the entire population of prematurely born children and observed the frequency of mental disorders in adulthood. It was found that the risk increases most often for disorders of intellectual development, learning disorders, motor coordination disorders, ASD, ADHD, and there is also a certain risk for depression, bipolar affective disorder, psychosis and anxiety.

U radu se govori o važnosti pravilne prehrane dojenčadi.

Chemotherapy used on pediatric patients especially those below 3 years of age causes disturbances in dental development. The aim of this case report was to present the late dental effects of chemotherapy in a patient treated for anaplastic ependymoma (WHO III) at an early age. Radiographic findings at the age of 9 years showed oligomicrodontia of six teeth, maxillary lateral incisors, and maxillary and mandibular first premolars. Pediatric cancer survivors after chemotherapy have an increased risk of one or more dental development disorders. To ensure proper dental care and to assess the long-term effects on oral health, tooth development, and occlusion, the involvement of a dentist is crucial. Adequate diagnosis and well-planned treatment of the dental defect can significantly improve patient oral health-related quality of life.

Sažetak. Cilj: Utvrditi metode liječenja bolesnika koji su zaprimljeni na Odjel intenzivnog liječenja djece (OILD) zbog patološkog sadržaja u prsištu. Cilj je također utvrditi indikacije za postavljanje pleuralne drenaže, tehnike postavljanja, analizirati dodatne specifične terapijske postupke koji su se provodili tijekom pleuralne drenaže, trajanje liječenja te komplikacije. Ispitanici i metode: Ispitanici su sva djeca od rođenja do 18. godine života zaprimljena zbog patološkog sadržaja u prsištu na OILD Kliničkog bolničkog centra Rijeka, u razdoblju od 1. siječnja 2014. do 31. prosinca 2018. Podatci su prikupljeni iz arhivirane medicinske dokumentacije, integriranog bolničkog informacijskog sustava i protokola za prijam bolesnika te zatim analizirani i statistički obrađeni. Rezultati: U ispitivanom su razdoblju na OILD zaprimljena 1044 djeteta – od toga je 114 bolesnika zaprimljeno zbog patološkog sadržaja u prsištu (10,9 %). Pleuralni dren postavljen je u 93 djeteta (95,6 %), 53 djevojčice i 40 dječaka. Indikacije za postavljanje pleuralnog drena bile su parapneumonični izljev (N=44, 47,3 %), pneumotoraks (N=37, 39,7 %), hilotoraks (N=11, 11,8 %) i maligni izljev (N=1, 1,1 %). Najčešća tehnika postavljanja pleuralnog drena u OILD-u bila je putem troakara, potom Seldingerova tehnika. U osmero djece s organiziranim izljevima provodila se fibrinolitička terapija. Nije bilo akutnih komplikacija tijekom postupka postavljanja pleuralnog drena. Najčešća kasnije utvrđena komplikacija, u 23 djeteta, bila je malpozicija drena. Zaključci: Većina djece zaprimljene na OILD zbog patološkog sadržaja u prsištu liječi se pleuralnom drenažom. Najčešća indikacija za postavljanje pleuralnog drena u našem je istraživanju parapneumonični izljev. Pleuralna je drenaža sigurna i učinkovita metoda liječenja patološkog sadržaja u prsištu djece, s niskim postotkom komplikacija., Objective: To determine the treatment methods and complications in children admitted to Pediatric Intensive Care Unit (PICU) due to pathological contents in the chest. The aim is also to determine the indications for pleural drainage placement, placement techniques, to analyze additional specific therapeutic procedures performed during pleural drainage, the duration of treatment and complications. Subjects and methods: Subjects are all children from birth to 18 years of age with pathological contents in the chest admitted to Pediatric Intensive Care Unit (PICU), Clinical Hospital Center Rijeka, in the period from January 1, 2014 – December 31, 2018. Data were collected and analyzed from archived medical records, integrated hospital information system, and patient admission protocols, and then statistically processed. Results: In the examined period, 1044 children were admitted to PICU; of these, 114 children had pathological contents in the chest (10.9%). The pleural drain was placed in 93 children (95.6%) 53 girls and 40 boys. Indications for pleural drainage were parapneumonic effusion (N = 44, 47.3%), pneumothorax (N = 37, 39.7%), chylothorax (N = 11, 11.8%) and malignant effusion (N = 1, 1.1%) The most common pleural drainage placement technique in the PICU was via the troacar, followed by Seldinger technique. Fibrinolytic therapy was given to eight children with loculated effusion. There were no acute complications during drain insertion. The most common later complication, in 23 children, was drain malposition. Conclusion: Most children admitted to PICU due to pathological contents in the chest are treated with pleural drainage The most common indication for pleural drainage placement in our institution was parapneumonic effusion. Pleural drainage is a safe and effective method for treating pathological contents in the chest in children, with a low percentage of complications.

Histiocitno-hemofagocitni sindrom podrazumijeva spektar različitih stanja koja imaju zajedničku patofiziologiju nastajanja, a to je prejak i nereguliran upalni odgovor na antigen. Patofiziologija HLH sindroma svodi se na poremećaj regulacije normalnih fizioloških imunoloških zbivanja i izostanak „down-regulacije“ istih. Javlja se u djece i odraslih. Može se podijeliti na primarni i sekundarni HLH. Sekundarni HLH je provociran infekcijama, malignitetima, reumatološki bolestima i imunomodificirajućim stanjima kao što je primjena kemoterapeutika i imunosupresiva. Najčešći infektivni uzrok je Epstein Barr virus. Klinička slika najčešće je nespecifična. Inicijalni simptomi mogu nalikovati infektivnim bolestima, prolongiranoj vrućici nepoznatog porijekla, hepatitisu, encefalitisu, različitim vaskulitisima i brojnim drugim stanjima. Rano prepoznavanje ovog stanja je krucijalno za dobar ishod iz razloga što se bolesnicima može vrlo lako i u kratkom periodu pogoršati klinička slika te rezultirati multiorganskim zatajenjem i smrti. Dijagnoza se temelji na kliničkim kriterijima bez ijednog patognomoničnog laboratorijskog testa ili kliničkog nalaza. Iako su kriteriji HLH 2004 i dalje najčešće korišteni za definiranje i dijagnosticiranje sindroma postoje i neka ograničenja, posebice u odraslih bolesnika. Liječenje HLH ovisi o temeljnom uzroku, stadiju bolesti te, ako postoje, okidaču ili okidačima. Glavni ciljevi su suzbijanje upale, kontrola, smirivanje i eliminacija svih identificiranih okidača. Primarni HLH se i danas liječi prateći smjernice HLH 2004, etoposidom i deksametazonom do transplantacije hematopoetskih matičnih stanica, a za sekundarni HLH još uvijek ne postoje dobro definirane smjernice, no ključ je identificirati i eliminirati okidač bolesti., Hemophagocytic lymphohistiocytosis involves a spectrum of different conditions that have a common pathophysiology of occurrence, which is a strong and unregulated inflammatory response to the antigen. Pathophysiology of HLH syndrome is a regulation disorder of normal physiological immune events with the absence of "down-regulation". It occurs in children and adults. It can be divided into primary and secondary HLH. Secondary HLH is triggered by infections, malignancies, rheumatic diseases and immunomodulatory conditions as associated with the administration of chemotherapeutics and immunosuppressants. The most common icause of infection is the Epstein Barr virus. The clinical picture is usually nonspecific. The initial symptoms can resemble infectious diseases, a prolonged fever of unknown origin, hepatitis, encephalitis, various vasculitis, and several other conditions. Early detection of this condition is crucial for a positive outcome because patients' clinical picture can easily and rapidly deteriorate rapidly resulting in multiorgan failure and death. The diagnosis is based on clinical criteria without any pathognomonic laboratory test or clinical finding. Although the 2004 HLH criteria are still the most common for defining and diagnosing the syndrome, there are some limitations, especially in adult patients. HLH treatment depends on the underlying cause, stage of the disease and, if apparent, its trigger/s . The main goals involve suppressing inflammation, and controlling, reducing and eliminating all identified triggers. Primary HLH is still being treated following the 2004 HLH guidelines, with etoposide and dexamethasone as a bridge to hematopoietic stem cell transplantation. There are still no well-defined guidelines for secondary HLH, but the key is to identify and eliminate the disease’s trigger.

Bronhopulmonalna displazija (kronična plućna bolest) je multifakorijalna plućna bolest novorođenčadi koja pretežno pogađa prematuruse < 32 tjedna gestacije i rodne mase manje od 1250 g. Patogeneza joj se temelji na primarno nedovoljno zrelim plućima i plućnoj ozljedi koja može nastati zbog mehaničke distenzije dišnih puteva, toksičnog djelovanja kisika, infekcije i drugih uzroka. Klinička slika može biti vrlo varijabilna, ali najčešće uključuje pojavu tahipnoičnog disanja i inspiratornih retrakcija te kod težih oblika bolesti razvoj hipoksije i hiperkapnije. Većina pacijenata oporavi se u potpunosti kroz 2-4 mjeseca, no u pojedinim slučajevima klinički tijek se komplicira te je potrebna potpora dodatnim kisikom duže od šest mjeseci. Dugoročna poslijedica BPD je smanjena plućna funkcija i povećana sklonost razvoja težih kliničkih slika infektivnih respiratornih bolesti. Prevencija BPD može obuhvatiti antenatalne i postnatalne terapijske metode. U ovome istraživanju sudjelovalo je 29 pacijenata GD, Bronchopulmonary dypslasia (chronic lung disease) is a lung disorder that affects preterm infants, particularly those born before the 32nd week of gestation and those with a birth weight below 1250g. BPD is primarily caused by a lack of lung maturation at birth and pulmonary tissue damage which can be caused by mechanical trauma, oxygen poisoning and infection. Clincal findings differ between patients. Most patients present with tachypnea and respiratory retractions while hypoxia and hyperkapnia is present in severe cases. Most patients make a complete recovery in about 2-4 months, however complicated and severe cases may require oxygen supplementation >6 months after birth. Long-term consequences of BPD include a decreased pulmonary function and frequent complicated pulmonary infections. BPD prevention includes antenatal and postnatal methods. In this study 29 patients with a gestational age below 31 weeks and weight at birth below 1400g were treated with corticosteroids (DART, Pulmicort or both) for BPD prevention. Differences in hospital stay and therapy side effects were observed. A pattern was noted in which the patients treated with Pulmicort had the shortest hospital stay (49 days), followed by the patients treated with DART (60 days) and the longest stay was noted in those treated with both (92), however no statistically significant differences were found between the 3 groups. 71% of patients treated with the DART protocol that had a regular initial ultrasound had an abnormal ultrasound after therapy was completed. Postnatal corticosteriod use requires more studies in which their effectiveness and side effects should be properly assessed. It is currently administered in patients whose benefit should be higher than the possible side effects.

Bronhopulmonalna displazija je kronična, multifaktorijalna respiratorna bolest nedonoščadi koja zahvaća različite plućne strukture te time ima razičite kliničke prezentacije i ishode. Radi se o bolesti u čiju su etiopatogenezu uključeni razni antenatalni i postnatalni rizični čimbenici koji dovode do ozljede nezrelih pluća. S obzirom na navedeno, ne postoji jedinstvena terapijska strategija temeljena na samoj etiopatogenezi bolesti. Naglasak se stavlja na prevenciju samog nastanka BPD-a, a u tu svrhu se primjenjuju različite intervencije od kojih su najučinkovitije: antenatalna primjena kortikosteroida, postnatalna primjena surfaktanta i odabir optimalnih postavki mehaničke ventilacije te adekvatna nutritivna potpora. Najnovija istraživanja ukazuju na potencijalnu korist primjene terapije matičnim i progenitornim stanicama, no potrebna su daljnja istraživanja. BPD može imati dugoročne posljedice koje zahtijevaju stalno praćenje i terapiju takvih bolesnika. Potrebno je stoga, staviti naglasak na otkrivanje prediktivnih BPD biomarkera te ranu prevenciju bolesti, s ciljem smanjenja morbiditeta i mortaliteta od BPD-a., Bronchopulmonary dysplasia is a chronic, multifactorial respiratory disease of preterm infants that affects different lung structures and thus has different clinical presentations and outcomes. It is a disease whose etiopathogenesis involves various antenatal and postnatal risk factors, leading to injury to the immature lungs. Given the above, there is no single therapeutic strategy based on the etiopathogenesis of the disease itself. Emphasis is placed on the prevention of BPD, and for this purpose various interventions are used, the most effective of which are: antenatal administration of corticosteroids, postnatal administration of surfactant and selection of optimal mechanical ventilation settings and adequate nutritional support. Recent research indicates the potential benefit of stem cell and progenitor cell therapy, but further research is needed. BPD can have long-term consequences that require constant monitoring and therapy of such patients. Therefore, emphasis should be placed on the detection of predictive BPD biomarkers and early disease prevention, with the aim of reducing morbidity and mortality from BPD.

Epileptički status je hitno kliničko stanje u pedijatriji koje se može javiti kod djece bilo koje dobi. Javlja se u omjeru 16-61/100,000 djece, a pojavnost dominantno ovisi o dobi, spolu, socioekonomskim čimbenicima, te osobnim faktorima kao što su urođena stanja i bolesti. Češća je kod djece nego kod odraslih zbog povećane podražljivosti mozga kao posljedice nezrelosti moždanih struktura i sinapsi. Etiologija je šarolika i ovisi dominantno o dobi, a razvoj epileptičkog statusa može biti posljedica urođenih malformacija mozga, traume, infekcije središnjeg živčanog sustava, elektrolitnih disbalansa, ali i visokog febriliteta. Epileptičke statuse dijelimo na konvulzivne i ne-konvulzivne, od kojih se svaki dijeli još na žarišne i generalizirane epileptičke statuse. Za postavljanje konačne dijagnoze, osobito kod ne-konvulzivnih epileptičkih statusa potrebno je učiniti EEG. Terapija epileptičkih statusa uključuje suportivne mjere, liječenje podliježećih uzroka kada oni postoje, te specifično antikonvulzivno liječenje. Antikonvulzivna terapija primjenjuje se u četiri koraka, ovisno o trajanju epileptičkog napadaja, a osnovu liječenja čine benzodiazepini i dugodjelujući antikonvulzivni lijekovi. Produljeni epileptički napadaji i epileptički status mogu imati trajne neželjene posljedice jer uzrokuju smrt i oštećenje neurona, zbog čega je nužno na vrijeme liječiti i prekinuti epileptički status. U rjeđim slučajevima, dolazi i do smrti bolesnika., Status epilepticus is a pediatric emergency that can appear at any age. It appears in 16–61/100,000 children, which mainly depends on a child's age, sex, socioeconomic status, and personal factors, which include congenital malformations and other conditions. Status epilepticus is more common in children than in adults due to excessive hyperexcitation of the brain, resulting from the immaturity of the brain and synapsis. There are different causes of status epilepticus, and they depend mainly on a child's age. It can be a result of congenital malformations, infections, trauma, metabolic disorders, but also high fever. This condition can be divided into convulsive and non-convulsive status epilepticus, and each of them can be further divided into focal and generalized status epilepticus. An EEG result is needed to make a final diagnosis in both. Treatment includes four levels, depending on the duration of the seizure. Benzodiazepines are the basis of treatment, along with long-acting anticonvulsive medication. Status epilepticus can lead to neuronal death and damage and can therefore cause permanent consequences. The probability increases with the duration of the seizure, and therefore medications need to be started as soon as possible. In rare cases, status epilepticus can lead to the patient's death.

Akutno zatajenje jetre u djece je rijetki brzoprogresivni sindrom koji dovodi do oštećenja jetre, a može dovesti do oštećenja i drugih organa. Incidencija iznosi deset slučajeva na milijun. Etiologija varira ovisno o dobi, a uzroke dijelimo na infektivne, metaboličke i imunološke, povezane s lijekovima i toksinima te ostale poput hipoperfuzije ili maligne bolesti. U većini slučajeva uzrok ostaje nedefiniran. Simptomi su većinom nespecifični. Lijekovi su česti uzročnici AZJ kao i nasljedne metaboličke bolesti. Zarazne bolesti mogu, također prethoditi teškom oštećenju jetre. Od autoimunih bolesti koje mogu uzrokovati AZJ najčešći je autoimuni hepatitis. Paracetamol je dobro podnošljiv lijek kada se koristi unutar svoje uske terapijske širine. Hepatotoksičnom dozom smatra se 100 mg/kg, a hepatotoksični metabolit je N acetilpara-amino benzokinon imin (NAPQI). Simptomi trovanja su nespecifični. Antidot N-acetilcistein je učinkovit ako se primjenjuje brzo nakon primjene lijeka. Wilsonova bolest, nasljedni poremećaj metabolizma bakra, karakterizira se nakupljanjem bakra u jetri, ali i drugim organima. Uočavaju se simptomi i znakovi oštećenja jetre, ali i neurološki i psihijatrijski simptomi. Kod deficita α 1-atitripsina, najčešćeg uzroka metaboličke bolesti jetre u djece, dolazi do nakupljanja abnormalnog α 1-antitripsina i oštećenja u jetri te do oštećenja pluća zbog smanjenja zaštitnog učinka. Dijagnostika je klinička, radiološka i laboratorijska. Usprkos cijepljenju, hepatitis B najčešći je infektivni uzročnik AZJ. Spektar kliničkih simptoma i znakova najviše ovisi o imunološkom sustavu domaćina, a dijagnostika je pretežno laboratorijska. Akutno zatajenje jetre u djece zahtijeva hitno liječenje i multidisciplinarni tim. Često je u bolesnika s AZJ transplantacija jedina opcija preživljenja., Acute liver failure in children is a rare rapidly progressive syndrome that leads to liver damage and can lead to damage to other organs as well. The incidence is ten cases per million. The etiology varies with age, and the causes are divided into infectious, metabolic and immune, related to drugs and toxins and others such as hypoperfusion or malignancy. In most cases, the cause remains undefined. The symptoms are mostly nonspecific. Medications are common causes of ASD as well as hereditary metabolic diseases. Infectious diseases can also precede severe liver damage. Of the autoimmune diseases that can cause ASD, autoimmune hepatitis is the most common. Paracetamol is a well-tolerated drug when used within its narrow therapeutic range. The hepatotoxic dose is considered to be 100 mg / kg and the hepatotoxic metabolite is N acetylpara-amino benzoquinone imine (NAPQI). The symptoms of poisoning are nonspecific. The antidote N-acetylcysteine is effective if administered soon after drug administration. Wilson's disease, an inherited disorder of copper metabolism, is characterized by the accumulation of copper in the liver but also in other organs. Symptoms and signs of liver damage are observed, as well as neurological and psychiatric symptoms. Deficiency of α 1-atitrypsin, the most common cause of metabolic liver disease in children, leads to the accumulation of abnormal α 1-antitrypsin and liver damage, as well as lung damage due to reduced protective effect. Diagnosis is clinical, radiological and laboratory. Despite vaccination, hepatitis B is the most common infectious agent of AZJ. The spectrum of clinical symptoms and signs depends mostly on the host's immune system, and the diagnosis is predominantly laboratory. Acute liver failure in children requires urgent treatment and a multidisciplinary team. Transplantation is often the only survival option in patients with ASD.

Anemija je česta u nedonoščadi zbog slabijeg lučenja endogenog eritropoetina s posljedičnom slabijom eritropoezom, češćih flebotomija (uzimanje uzoraka krvi za laboratorijske pretrage) i kraćeg životnog vijeka eritrocita. Klinička slika može varirati od asimptomatske, preko bljedoće i slabog prirasta tjelesne mase, do kardiorespiratornih simptoma i metaboličkih komplikacija. Osnova liječenja je korekcija anemije. Transfuzijsko liječenje se zadnjih desetljeća sve više zamjenjuje primjenom rekombinantnog eritropoetina. Cilj ovog rada bio je ispitati ulogu rekombinantnog eritropoetina u korekciji anemije i smanjenju potreba za transfuzijom u nedonoščadi s anemijom. U istraživanje je uključeno petero pacijenata s AOP liječenih rekombinantnim eritropoetinom na Klinici za pedijatriju KBC-a Rijeka. Primjena rekombinantnog eritropoetina rezultirala je u svih pacijenata značajnim povećanjem broja retikulocita nakon jednog tjedna te značajnim povećanjem broja eritrocita i koncentracije hemoglobina nakon jedan mjesec liječenja. U svih pacijenata zamijećen je značajan prirast tjelesne mase. Komplikacije eritropoetina nisu zabilježene, a niti jedan pacijent nije primio transfuziju eritrocita. Naši rezultati potvrđuju opravdanost primjene eritropoetina u AOP., Anemia is a frequent finding in preterm infants due to decreased endogenous erythropoietin production with subsequent supression of erythropoiesis, frequent phlebotomies (blood sampling for laboratory testing), and the shorter lifespan of erythrocites. Clinical presentation can vary from asymptomatic or mild symptoms such as palor and growth retardation, to cardiopulmonary symptoms and metabolic complications. The main treatment is the correction of anemia. During the last several decades, red blood cell transfusions are being being replaced by application of subcutaneous recombinant erythropoietin. The aim of this study was to examine the role of recombinant erythropoietin in the correction of anemia and reduction of transfusions in preterm infants with anemia. The study included five patients with AOP treated with recombinant erythropoietin at the Department of Pediatrics, Clinical Hospital Center Rijeka. Administration of recombinant erythropoietin resulted in a significant increase in reticulocyte counts after one week in all patients and a significant increase in red blood cell count and hemoglobin concentration after one month of the treatment. Significant weight gain was observed in all patients. No complications were reported, and no patient received transfusion. Our results confirm the relevance of the use of erythropoietin in AOP.

Cilj studije bio je istražiti je li COVID-19 pandemija uzrokovala povećanu incidenciju kompliciranog apendicitisa zbog kasne prezentacije u bolnicu u usporedbi s razdobljem prije COVID-19 pandemije. Akutni apendicitis jedan je od najčešćih hitnih kirurških stanja. Tijekom COVID-19 pandemije došlo je do prijava zakašnjelog dolaska u bolnicu nekih hitnoća. Ukupno 266 pedijatrijskih pacijenata je u KBC Rijeka bilo podvrgnuto kirurškom liječenju zbog sumnje na akutni appendicitis od ožujka 2018. do ožujka 2022. Pacijenti su bili podijeljeni u dvije skupine: prvu skupinu činili su pacijenti koji su bili operirani prije početka pandemije COVID-19 (n=154), dok su drugu skupinu činili oni koji su išli na operaciju tijekom COVID-19 pandemije (n= 112). Primarna svrha ovog rada bila je usporedba incidencije perforacije crvuljka prije i tijekom pojave COVID-19 infekcije. Ukupno su dijagnosticirana 58 bolesnika (21,8%) sa perforacijom apendiksa. Pronađena je slaba značajnost u stopi perforiranog apendicitisa između razdoblja prije COVID- 19 (22,1%) i COVID-19 ere (21,4%). Nije uočena nikakva značajna razlika u komplikacijama akutnog apendicitisa prije i tijekom COVID-19 pandemije u KBC Rijeka., This study looks into the impact of the Covid-19 pandemic on the incidence of complicated appendicitis. This was perfomed by comparing the treatment and the hospitalization characteristics in the period before and during the Covid-19 pandemic. Acute appendicitis is one of the most common surgical conditions. In the period between March 2018 and March 2022, 266 pediatric patients have received surgical treatment due to suspicion of acute appendicitis. In this study two groups of patients were observed. One group included the data of patients who underwent surgery before the onset of the COVID-19 pandemic (n = 154), the second group consisted of those who underwent surgery during the COVID-19 pandemic (n = 112). The results show that 58 patients (21.8%) have developed and were diagnosed with the perforation. No significant difference has been noticed in the rate of perforated appendicitis between the period before COVID-19 (22.1%) and COVID-19 era (21.4%). Furthermore, no significant contrast was noticed in other complications of acute appendicitis before and during the COVID-19 pandemic at the Rijeka Clinical Hospital

Dijagnoza akutnog pankreatitisa temelji se na kliničkim nalazima, biokemijskim testovima i slikovnim pretragama. Upale gušterače u djece čine široki klinički spektar i mogu se prezentirati kao akutni pankreatitis, akutni rekurentni pankreatitis i kronični pankreatitis.Iako se smatralo da je riječ o rijetkom entitetu u dječjoj populaciji, bilježi se značajan porast incidencije u zadnja dva desetljeća. Među uzročnicima AP dječje dobi nalazimo infekcije, abdominalnu traumu, lijekove, kolelitijazu, strukturalne bolesti bilijarnog sustava ili pankreasa, metaboličke sistemske bolesti i dr. Dva glavna simptoma su abdominalna bol, povraćanje i mučnina.. Povišene serumske vrijednosti amilaze ili lipaze barem trostruko veće iznad gornje granice normale jedan su od kriterija potrebnih za dijagnozu. Iako je kompjutorizirana tomografija (CT) abdomena zlatni standard u slikovnoj obradi i dijagnozi, kao prvu liniju ipak koristimo ultrazvuk zbog svoje dostupnosti i sigurnosti. Komplikacije AP-a mogu biti lokalne (pseudocista, nekroza gušterače, apsces) ili sistemske (GIT krvarenje, šok, hiperglikemija, DIK, perikradni izljev, plearalni izljev, akutna tubularna nekroza, hipoglikemija, diseminirana intravskularna koagulacija itd.) Obzirom na težinu kliničke slike bolesti, AP se može klasificirati u blagi, srednje teški i teški pankreatitis. Djeca s nekompliciranim blagim pankreatitisom će se oporaviti u roku 5 do 8 dana. U slučaju težeg oblika bolesti prognoza ovisi o komplikacijama i komorbiditetima., Diagnosis of acute pancreatitis in children is based on clinical findings, biochemical tests and imaging. Inflammation of the pancreas in children is a wide clinical spectar and can present as acute pancreatitis, acute recurrent pancreatitis and chronih pancreatitis. Although previously thought to be a rare entity in pediatric population, in the last two decades there is a significant increase in the incidence. The common causes of AP in children are infections, abdominal trauma, medications, cholelithiasis, structural biliary/ pancreatic disease, metabolic, systemic diseases. The two classic symptoms of AP are abdominal pain and nausea/vomiting. Elevated serum amylase and/or lipase (>3 times upper limit of normal) are the two important elements of AP. The complications of AP may be either local or systemic. Local complications are pseudocyst, pancreatic necrosis and abscess, splenic infarct, intestinal obstruction/ perforation, acute respiratory distress syndrome, pleural effusion, pericardial effusion, shock, myocardial dysfunction, acute tubular necrosis, hyperglycemia, hypocalcemia, disseminated intravascular coagulation, pancreatic encephalopathy and fat necrosis. Based on the severity, AP is classified as mild AP, moderately severe AP and severe AP. In majority of children, the course is mild without complication and will recover in 5 to 8 days.

Tuberkuloza je kronična infektivna bolest koju karakterizira granulomatizni tip upale. Može se javiti kao latentna infekcija, LTBI ili aktivna bolest, TBC. Najčešće zahvaća pluća, ali može zahvatiti sve organe u tijelu. Diseminiranoj infekciji posebno su sklona djeca ispod 12 mjeseci starosti te imunokompromitirana djeca. U pedijatrijskoj dobi česti su paucibacilarni oblici zbog čega dijagnostika tuberkuloze u djece predstavlja dijagnostički izazov. U dijagnostici važni su anamneza, fizikalni pregled, tuberkulinski test, IGRA testovi, konvencionalna bakteriološka dijagnostika, novije molekularne metode poput Xpert MTB/RIF testa te radiološke slikovne metode. Kod djece često tuberkuloza ne može biti potvrđena bakteriološki, bilo konvencionalnim ili molekularnim metodama, već se radi o kliničkoj dijagnozi temeljenoj na anamnestičkim podatcima, fizikalnom pregledu te radiološkim nalazima. Pravovremena dijagnostika tuberkuloze važna je zbog prevencije komplikacija, dieseminacije bolesti te radi mogućnosti pravovremenog i ciljanog liječenja., Tuberculosis is a chronic infectious disease characterized by a granulomatous type of inflammation. It can occur either as a latent infection, LTBI or active disease, TB. It most commonly affects the lungs but can affect all organs in the body. Children under 12 months of age and immunocompromised children are particularly prone to disseminated infection. Paucibacillary forms are common at paediatric age, which is why the diagnosis of tuberculosis in children is a diagnostic challenge. Anamnesis, physical examination, tuberculin test, IGRA tests, conventional bacteriological diagnostics, newer molecular methods such as Xpert MTB / RIF test and radiological imaging methods are important in diagnostics. In children, tuberculosis often cannot be confirmed bacteriologically, either conventionally or molecularly, but is a clinical diagnosis based on anamnestic data, physical examination, and radiological findings. Timely diagnosis of tuberculosis is important for the prevention of complications, dissemination of the disease and for the possibility of timely and targeted treatment.

Hemolitičko-uremijski sindrom klinički je sindrom okarakteriziran istovremenom pojavom mikroangiopatske hemolitičke anemije, trombocitopenije i akutne bubrežne ozljede. HUS je glavni uzrok akutne bubrežne ozljede u djece. Značajnu ulogu u patogenezi ima pretjerana aktivacija sustava komplementa. Prema najnovijoj klasifikaciji razlikujemo nasljedni i stečeni HUS. 90% slučajeva HUS-a uzrokuje STEC, a otprilike polovicu ostalih slučajeva uzrokuju mutacije gena za regulatorne proteine i komponente sustava komplementa. Streptococcus pneumoniae povezan je s 5-15% slučajeva HUS-a. Pojava nasljednog HUS-a može biti povezana s mutacijama drugih gena kao što su DGKE, PLG i THBD gen ili s poremećajem metabolizma kobalamina C. U skupinu stečenog HUS-a posredovanog infekcijom spadaju STEC-HUS te HUS uzrokovan brojnim drugim mikroorganizmima poput Shigellae dysenteriae, Streptococcusa pneumoniae, HIV-a te influenza virusa. Neinfektivni uzroci stečenog HUS-a mogu biti protutijela na komponente komplementa, neželjene posljedice uzimanja lijekova i specifična stanja (autoimune bolesti, stanje po transplantaciji tkiva i organa te maligne bolesti). Iako HUS dominantno pogađa bubreg, i ostali organski sustavi mogu biti zahvaćeni. Dijagnoza HUS-a obično je klinička, a potvrđuje se laboratorijskim pretragama. Po postavljanju dijagnoze treba odrediti etiologiju koja je dovela do pojave HUS-a. Najveći dio terapijskih postupaka koji se provode prilikom liječenja HUS-a čine suportivne mjere. U liječenju HUS-a posredovanog poremećajima komplementa koriste se infuzije svježe smrznute plazme, plazmafereza, ekulizumab, transplantacija bubrega i istovremena transplantacija jetre i bubrega. Ekulizumab je rekombinantno, humano monoklonsko protutijelo na C5 komponentu komplementa, a doveo je do poboljšanja u liječenju HUS-a. Njegova primjena kod drugih oblika HUS-a još se istražuje., Hemolytic uremic syndrome is a clinical syndrome characterized by simultaneous occurrence of microangiopathic hemolytic anemia, thrombocytopenia and acute renal injury. HUS is a major cause of acute renal injury in children. Excessive activation of the complement system plays a significant role in the pathogenesis. According to the latest classification there are two main groups of HUS – hereditary and acquired. 90% of HUS cases are caused by STEC, about half of the other cases are caused by mutations of genes for regulatory proteins and components of the complement system. S. pneumoniae is associated with 5-15% cases of HUS. The occurrence of atypical HUS may be associated with mutations of other genes such as DGKE, PLG and THBD gene or with a cobalamin C metabolism disorder. Acquired HUS can be caused by STEC, and several other microorganisms such as Shigella dysenteriae, Streptococcus pneumoniae, HIV and influenza virus. Non-infectious causes of acquired HUS are antibodies to complement components, adverse effects of medication and specific conditions (autoimmune diseases, tissue and organ transplantation, and malignancies). Although HUS predominantly affects the kidney, other organ systems can be affected. The diagnosis of HUS is usually clinical, and it is confirmed by laboratory tests. When the diagnosis is made, the etiology must be determined. Most of the therapeutic procedures are supportive measures. Fresh frozen plasma infusions, plasmapheresis, eculizumab, kidney transplantation, and combined liver-renal transplantation are used to treat complement-mediated HUS. Eculizumab is a recombinant, human monoclonal antibody to the C5 component of complement, and has led to a positive shift in the treatment of HUS. Its role in other forms of HUS is still being investigated.

Provedeno je retrospektivno istraživanje infektivnih komplikacija u pacijenata oboljelih od akutne limfatične leukemije (ALL), liječenih prema ALL IC-BFM protokolu od 2016. do 2020. godine na Zavodu za hematologiju, onkologiju i kliničku genetiku Kliničkog bolničkog centra Rijeka. U istraživanje je bilo uključeno 23 djece (16 dječaka i 7 djevojčica) s ALL-om, 20 intermedijarnog rizika i 3 visokog rizika. Prosječna dob bila je 5,9 godina (raspon 1,2 – 12,2 godine). Svi su pacijenti imali ugrađen centralni venski kateter i svi su primali oralni trimetoprim/sulfametoksazol za profilaksu Pneumocystis jiroveci pneumonije. Obrađene su 104 infektivne epizode (IE): 1 pacijent je imao 1 IE, 3 pacijenta 2 IE, a 19 pacijenata je imalo ≥ 3 IE (prosječno 4,5 IE po pacijentu). IE su najčešće bile dokumentirane tijekom faze rane intenzifikacije. Neutropenija je bila prisutna u 48 IE (46,15%), s trajanjem duljim od 7 dana u 28 epizoda (58,33%). Respiratorni trakt je bio najčešće sijelo infekcije (48,08%), a slijedi ga gastrointestinalni trakt (8,65%). Identificirano je bilo 49 izolata bakterija (47,12%), 4 virusna (3,85%), 4 gljivična (3,85%), 10 miješanih (9,6%), a u 37 IE (35,6%) patogen nije bio identificiran. Glavni uzročnici bakterijemije bili su koagulaza-negativni stafilokoki. Najčešća empirijska terapija bili su cefalosporini treće i četvrte generacije, a slijedi piperacilin/tazobaktam. Modifikacija prve linije antimikrobne terapije bila je potrebna u 58 IE (56,9%). Granulocitni čimbenik rasta bio je primijenjen u 56 IE (53,85%), a intravenski imunoglobulini u 65 IE (62,5%). Jedan pacijent je zahtijevao prijem na jedinicu intenzivnog liječenja. Nije zabilježena smrtnost povezana s infekcijom., This is a retrospective study of infectious complications in patients with acute lymphoblastic leukemia (ALL) treated in ALL IC-BFM protocol from 2016 to 2020 at the Division of Hematology and Oncology, Department of Pediatrics, Clinical Hospital Centre Rijeka. Twenty-three children (16 boys and 7 girls) with ALL (20 intermediate risk and 3 high risk-ALL) were included in the study. The median age was 5.9 years (range 1.2 – 12.2 years). All patients had implanted central venous catheters and were receiving oral trimethoprim/sulfametoxazole for Pneumocystis jiroveci pneumonia prophylaxis. We verified 104 infectious episodes (IE): 1 patient had 1 IE, 3 patients had 2 IE, and 19 patients had ≥3 IE (average 4.5 IE/patient). IE were mostly observed during the early intensification phase. Neutropenia was present in 48 IE (46.15%), with duration longer than 7 days in 28 episodes (58.33%). Respiratory tract was the most common site of infection (48.08%), followed by gastrointestinal tract (8.65%). There were 49 bacterial isolates (47.12%), 4 viral (3.85%), 4 fungal (3.85%), 10 mixed (9.6%), and in 37 IE (35.6%) associated pathogen was not identified. The main cause of bacteriemia were coagulase-negative staphylococci. The most common empiric therapy was third- and fourth-generation cephalosporins, followed by piperacillin/tazobactam. Modification of first-line antimicrobial therapy was required in 58 IE (56.9%). Granulocyte colony stimulating factor was administered in 56 IE (53.85%), and intravenous immunoglobulins in 65 IE (62.5%). One patient required admission to the intensive care unit. No infection-related death was observed.

Prema svjetskoj zdravstvenoj organizaciji (SZO) prijevremeni je porod definiran dovršenjem trudnoće prije navršenog 37. gestacijskog tjedna (GT) (trudnoća koja traje kraće od 259 dana od prvog dana posljednje menstruacije žene). Stopa mortaliteta prijevremeno rođene novorođenčadi ovisi o čimbenicima kao što su stupanj nedonošenosti, određen gestacijskom dobi i porođajnom masom, spol, rasa, postojanje kongenitalnih anomalija te razina neonatalne skrbi. Ovo retrospektivno istrazivanje rađeno je radi analize dijagnostičkih i terapijskih metoda na Klinici za pedijatriju, Odjela za intenzivno liječenje novorođenčadi u Rijeci, u usporedbi s neonatološkim odjelom Sveučilišne bolnice Priština, Kosovo. Testirana je hipoteza da prijevremeno rođeno novorođenče gestacijske dobi, World Health Organization (WHO) defines premature birth as the completion of a pregnancy before the 37th gestational week (GT) (pregnancy lasting less than 259 days from the first day of a woman's last menstrual period). The mortality rate of premature infants depends on factors such as the degree of prematurity, determined by gestational age and birth weight, sex, race, congenital anomalies and the level of neonatal care. This retrospective study was conducted to analyze diagnostic and therapeutic methods at the Clinic of Pediatrics, Department of Neonatal Intensive Care in Rijeka, compared to the neonatology department of the University Hospital Prishtina, Kosovo. The hypothesis was tested that premature newborns of gestational age

Dva najčešća uzroka niskog rasta su obiteljski nizak rast i konstitucionalno usporen rast sa zakašnjelim pubertetom, koji su normalne varijante rasta. Patološki uzroci niskog rasta su intrauterini zaostatak rasta, pothranjenost, endokrinološki uzroci, genetičke i sistemske bolesti. Povećan rast može se javiti kao jedan od simptoma u nizu bolesti dječje dobi, ali mogu biti i normalna varijanta rasta kao u slučaju konstitucionalno visokog rasta. Patološki uzroci visokog rasta su Klinefelterov, Jacobsov, Beckwith Wiedemann, Sotosov, Marfanov i Loeys Dietzov sindrom. Prekomjeran rast vidljiv je i kod pojačane sekrecije hormona rasta, homocistinurije i estrogenske rezistencije., The two most common causes of low growth are familial short stature and onstitutional delay of growth and puberty, which are normal growth variants. Pathological causes of short stature are intrauterine growth restriction, malnutrition, endocrine causes, genetic and systemic diseases. Increased growth can occur as one of the symptoms in a number of childhood diseases, but it can also be a normal variant of growth as in the case of constitutional tall stature. Pathological causes of high growth are Klinefelter, Jacobs, Beckwith Wiedemann, Sotos, Marfan and Loeys Dietz syndrome. Excessive growth is also seen in increased secretion of growth hormone, homocystinuria and estrogen resistance.

Cilj: Cilj ovog rada je prikazati tijek liječenja pacijenata s dijagnozom nekrotizirajućeg enterokolitisa (NEC) na Klinici za dječju kirurgiju Kliničkog bolničkog centra Rijeka te utvrditi kako određeni čimbenici utječu na ishod bolesti. Ispitanici i postupci: Retrospektivnim istraživanjem obuhvaćeni su kirurški liječeni pacijenti sa sumnjom ili dijagnozom NEC-a u razdoblju od siječnja 2011. do prosinca 2020. godine. Podaci su prikupljeni iz integriranog bolničkog informatičkog sustava te grafički i statistički obrađeni u programu MS Excel. Rezultati: Ispitivani uzorak čini 10 pacijenta. Svi ispitanici su nedonoščad, Aim: The aim of this paper is to present the course of treatment of patients diagnosed with necrotizing enterocolitis (NEC) at the Clinic for Pediatric Surgery of the Clinical Hospital Center Rijeka and determine how certain factors affect the outcome of the disease. Subjects and Procedures: The retrospective study included surgically treated patients with suspected or diagnosed NEC between January 2011 and December 2020. Data were collected from the integrated hospital information system. They were graphically and statistically processed in MS Excel. Results: The examined sample consisted of 10 patients. All subjects were preterm infants

Nekrotizirajući enterokolitis je najčešće gastroenterološko, životno ugrožavajuće stanje koje se javlja kod novorođenčadi, pretežno nedonoščadi. Točna patofiziologija bolesti nije poznata, međutim utvrđeno je da se radi o interakciji više faktora pri čemu se nedonošenost smatra najbitnijim, a bitnu ulogu imaju imunološka nezrelost, mikrobna disbioza i hiperreaktivnost crijeva. Sve navedeno dovodi do teške upale i ishemijske nekroze crijevne stijenke. U prosjeku klinički znakovi i simptomi javljaju se u drugom tjednu života i obuhvaćaju širok spektar kliničkih manifestacija poput netolerancija na hranu, abdominalne nadutost, povraćanja, prisutnosti krvi u stolici i nespecifičnih sistemskih znakova. S obzirom na nespecifičnost simptoma u postavljaju dijagnoze bitnu ulogu ima radiološki prikaz intestinalne pneumatoze, pneumoperitoneuma i prisutnost zraka u portalnom prostoru. Razlikujemo tri stadija bolesti prema Bellu s obzirom na kliničku sliku i radiološke nalaze. Određivanje stadija bolesti od iznimne je važnosti prilikom izbora terapije. Konzervativna terapija prva je metoda izbora u gotovo svim situacijama te uključuje praćenje vitalnih funkcija, otklanjanje potencijalnih štetnih čimbenika koji mogu utjecati na ishod bolesti, kontinuirano laboratorijsko i radioško praćenje te ovisno o prisutstvu infekcije, antimikrobno liječenje. Ukoliko konzervativne metode ne poluče rezultate ili dođe do crijevne perforacije preporuča se kirurško liječenje. Kirurško liječenje se pokušava izbjeći zbog većeg broja dugotrajnih i ozbiljnih posljedica od kojih je najčešća sindrom kratkog crijeva, a bitnu ulogu u kvaliteti života imaju dugoročne neurorazvojne posljedice koje se češće javljaju nakon kirurškog liječenja., Necrotizing enterocolitis is the most common gastroenterological life-threatening condition that occurs in newborns, mostly premature infants. The exact pathophysiology of the disease is unknown, but it is considered that it is multifactorial etiology, where prematurity is considered the most important. Also, underdeveloped immunity, microbial dysbiosis and intestinal hyperreactivity play an important role. All the reasons above lead to severe inflammation and ischemic necrosis of the intestinal wall. On average, clinical signs and symptoms occur in the second week of life and include a wide range of clinical manifestations such as food intolerance, abdominal bloating, vomiting, presence of blood in the stool, and nonspecific systemic signs. Given the non-specificity of symptoms, the radiological presentation of intestinal pneumatosis, pneumoperitoneum and the presence of air in the portal area, we distinguish three stages of the disease according to Bell based on the clinical picture and radiological findings. Determining the stage of the disease is extremely important when choosing a therapy. Conservative therapy is the first method of choice in almost all situations and includes monitoring of vital functions, elimination of potential harmful factors that may affect the outcome of the disease, continuous laboratory and radiological monitoring and depending on the presence of infection, antimicrobial treatment. If conservative methods do not work or intestinal perforation occurs, surgical treatment is recommended. Surgical treatment should be the last line of treatment due to several long-term and serious consequences- the most common of which is short bowel syndrome. It is important to mention the neurodevelopmental consequences that determine the quality of life after recovery.

Neutropenija jest čest nalaz u pedijatrijskoj praksi. Cilj je ovoga rada ispitati demografske značajke, tijek i ishod neutropenije u 57 djece (30 dječaka i 27 djevojčica) liječene na Klinici za pedijatriju Kliničkog bolničkog centra Rijeka, tijekom desetogodišnjeg razdoblja (2012.-2021. godine). Onkološki su pacijenti s febrilnom neutropenijom isključeni iz istraživanja. Prosječna dob je bila 20,2 mjeseca (raspon 15 dana – 12,5 godina). Prosječno vrijeme od pojave neutropenije do upućivanja u bolnicu je bio 1,5 mjesec (raspon 1 dan – 9 mjeseci). Četrdeset (70,1%) pacijenata je imalo tešku neutropeniju, 14 (24,6%) umjerenu i 3 (5,3%) blagu. Prosječni apsolutni broj neutrofila (ABN) kod prijema je bio 507/μL (raspon 0 – 1410/μL). Kroničnu neutropeniju je imalo 50 (87,7%) pacijenata. Osamnaest (31,6%) pacijenata imalo je autoimunu neutropeniju, 9 (15,8%) postinfekcijsku, po 1 (1,8%) neonatalnu aloimunu, neonatalnu autoimunu i kongenitalnu neutropeniju, a u 27 (47,4%) pacijenata nije postavljena specifična dijagnoza. Tijekom neutropenije infekcije su zabilježene kod 20 (35,1%) djece od kojih je 12 (21,1%) bilo sklono ponovnim infekcijama. Granulocitni faktor rasta (G-CSF) primijenjen je kod 17 (29,8%) bolesnika s teškom neutropenijom. Niti jedno dijete nije profilaktički liječeno G-CSF ili antibioticima. Četrdeset i osam (84,2%) pacijenata se u potpunosti oporavilo. Srednje vrijeme do remisije je bilo 13 mjeseci (raspon 2 tjedna – 46 mjeseci). Medijan praćenja bio je 22,4 mjeseca (raspon 1 – 64 mjeseca). Iako većina djece s neutropenijom ima benigni tijek bolesti te ne zahtijeva liječničku intervenciju, preporuča se redovito praćenje svih pacijenata sve do postizanja remisije., Neutropenia is frequently observed in pediatric practice. Aim of the study was to characterize demographic features, course and outcome of neutropenia in 57 children (30 boys and 27 girls) treated at the Pediatrics Clinic of the Clinical Hospital Center Rijeka, over a ten-year period (2012-2021). Oncology patients with febrile neutropenia were excluded from the study. The median age was 20.2 months (range 15 days - 12.5 years). The median time from the first evidence of neutropenia to the admission was 1.5 months (range 1 day – 9 months). Three (5.3%) patients were categorized as having mild neutropenia, 14 (24.6%) patients had moderate neutropenia, and 40 (70.1%) patients had severe neutropenia. The mean ANC at admission was 507/μL (range 0 – 1410/ μL). Chronic neutropenia was present in 50 (87.7%) patients. Eighteen (31.6%) patients had autoimmune neutropenia, 9 (15.8%) postinfectious, 1 (1.8%) neonatal alloimmune, 1 (1,8%) neonatal autoimmune, and 1 (1,8%) congenital neutropenia. A specific diagnosis was not established in 27 (47,4%) children. Infections was recorded in 20 (35,1%) children during neutropenia, among whom 12 (21,1%) were prone to recurrent infections. Granulocyte-colony stimulating factor (G-CSF) was administered to 17 (29.8%) patients with severe neutropenia. No children were prophylactically treated with G-CSF or antibiotics. Forty-eight (84,2%) patients fully recovered. The median time to resolution was 13 months (range 2 weeks – 46 months). The median follow-up was 22.4 months (range 1 – 64 months). Although majority of children with neutropenia have benign course of the disease thus not requiring medical intervention, we suggest monitoring of all patients until the resolution of the disease.

Hipotireoza i hipertireoza predstavljaju poremećaje rada štitne žlijezde koji se očituju smanjenom ili povećanom proizvodnjom hormona štitnjače. Dva su glavna hormona koje sintetizira štitnjača: trijodtironin (T3) i tetrajodtironin (T4), a njihova sekrecija regulirana je razinom tireotropnog hormona (TSH) kojeg luči hipofiza. Tireoidni hormoni snažno potiču sve metaboličke procese i imaju ključnu ulogu u rastu i razvoju djeteta. Poremećaji rada štitne žlijezde najčešće su endokrinopatije dječje dobi. Češći su poremećaji koji uzorkuju hipotireozu, a mogu se klasificirati kao primarni ili sekundarni i kao kongenitalni ili stečeni hipotireoidizam. Kongenitalni hipotireoidizam je najčešći, izlječivi uzrok mentalne zaostalosti. U razvijenim državama svijeta uveden je novorođenački probir na kongenitalnu hipotireozu kako bi se spriječili neurorazvojni poremećaji. Stečena hipotireoza je najčešći poremećaj tireoidne funkcije u djece i adolescenata. Najčešće je uzrokovana autoimunim tireoiditisom (Hashimotov tireoiditis). Usporen rast u djeteta obično je prvi znak hipotireoze te je potrebno započeti liječenje levotiroksinom. Hipertireoidizam je u dječjoj dobi rijedak ali vrlo ozbiljan poremećaj. Gravesova bolest je najčešća hipertireoza dječje dobi. Autoimunosni je poremećaj u kojem dolazi do stimulacije tireotropinskih receptora antitijelima. Moguće terapijske opcije kod liječenja hipertireoze su antitireoidni lijekovi, liječenje radioaktivnim jodom i tireoidektomija., Hypothyroidism and hyperthyroidism are disorders of the thyroid gland that are characterized by decreased or increased production of thyroid hormones. There are two main hormones synthesized by the thyroid gland: triiodothyronine (T3) and tetraiodothyronine (T4). Their secretion is regulated by the level of thyrotropic hormone (TSH) secreted by the pituitary gland. Thyroid hormones strongly stimulate all metabolic processes and play a key role in the growth and development of the child. Thyroid disorders are the most common endocrinopathies in childhood. Disorders that cause hypothyroidism are more common and can be classified as primary or secondary and as congenital or acquired hypothyroidism. Congenital hypothyroidism is the most common, curable cause of mental retardation. In the developed world, neonatal screening for congenital hypothyroidism has been introduced to prevent neurodevelopmental disorders. Acquired hypothyroidism is the most common thyroid dysfunction in children and adolescents. It is most often caused by autoimmune thyroiditis (Hashimoto's thyroiditis). Slow growth in a child is usually the first sign of hypothyroidism and levothyroxine treatment should be started. Hyperthyroidism is a rare but very serious disorder in childhood. Graves' disease is the most common cause of hyperthyroidism in childhood. It is an autoimmune disorder in which thyrotropin receptors are stimulated by antibodies. Possible options in the treatment of hyperthyroidism are antithyroid drugs, radioactive iodine treatment and thyroidectomy.

Uvod: Duboka venska tromboza (DVT) sve se češće dijagnosticira u djece s malignim bolestima. Etiologija je multifaktorijalna, a uključuje kongenitalne i stečene protrombotičke čimbenike. Cilj: Cilj rada bio je istražiti čimbenike rizika za trombozu, lokalizaciju DVT-a, terapijski pristup i komplikacije DVT-a i antitrombotičke terapije u djece s malignim bolestima te usporediti dobivene rezultate s dostupnom literaturom. Metode: U istraživanje je bilo uključeno osmero djece (5 dječaka i 3 djevojčice) s DVT-om koji su liječeni od malignih bolesti na Klinici za pedijatriju KBC-a Rijeka od 1. siječnja 2006. do 31. prosinca 2021. godine. Svim pacijentima bili su ugrađeni centralni venski kateteri (CVK). Rezultati: Prosječna dob pacijenata bila je 10.4 godine (raspon 3 mjeseca – 17.5 godina). DVT je bila najčešća u djece s akutnom limfoblastičnom leukemijom. Dva pacijenta imala su DVT gornjih ekstremiteta, dva donjih ekstremiteta i dva desnog atrija, jedan trombozu cerebralnog venskog sinusa, a jedan pacijent je imao trombozu portalne vene. Četiri (50%) pacijenta imala su CVK-udruženu trombozu. Prirođena trombofilija uočena je u 5 (62.5%) pacijenata (MTHFR homozigotnost u 3 pacijenata i mutacija faktora V Leiden u 2 pacijenta). Najčešći čimbenici rizika za DVT bili su prisutnost CVK (100%), krvna grupa A i/ili B (75%), prirođena trombofilija (62.5%), istodobna primjena više protrombotičkih lijekova (62.5%) i dob iznad 10 godina (50%). Terapija izbora bio je niskomolekularni heparin (LMWH), s postignutom potpunom rekanalizacijom u 75% pacijenata. U 2 slučaja terapijskog neuspjeha učinjena je mehanička trombektomija. Dva pacijenta imala su posttrombotički sindrom i dvoje ponovnu trombozu. Zaključak: Unatoč malom broju pacijenata, naši rezultati vezani uz liječenje, komplikacije liječenja i posttrombotičke komplikacije su u skladu s objavljenim podacima. S obzirom na povećani rizik i multifaktorijalnu etiologiju DVT-a u djece s malignim bolestima, neophodna je individualna i pažljiva procjena čimbenika rizika, te pravovremena dijagnoza i terapijska intervencija., Introduction: Deep venous thrombosis (DVT) is increasingly being diagnosed in children with malignancies. The etiology is multifactorial, and includes congenital and acquired prothrombotic factors. Aim: The aim of the study was to investigate risk factors for thrombosis, localization of DVT, therapeutic approach, and complications of DVT and antithrombotic therapy in children with malignant diseases, and to compare the obtained results with available literature. Methods: Eight children (5 boys and 3 girls) with DVT treated for malignant diseases at the Department of Pediatrics, Clinical Hospital Center Rijeka, Croatia, between January 1, 2006, and December 31, 2021 were included in the study. All patients had implanted central venous catheters (CVC). Results: The mean age was 10.4 years (range 3 months – 17.5 years). DVT was the most frequent in children with acute lymphoblastic leukemia. Two patients had DVT of the upper extremities, lower extremities and right atrium respectively, one patient had cerebral venous sinus thrombosis, and one patient had portal vein thrombosis. Four (50%) patients had CVK-related thrombosis. Congenital thrombophilia was observed in 5 (62.5%) patients (MTHFR homosigosity in 3 patients and Factor V Leiden in 2 patients). The most common risk factors for DVT were the presence of CVC (100%), blood group A and/or B (75%), congenital thrombophilia (62.5%), concomitant use of multiple prothrombotic drugs (62.5%) and age over 10 years (50%). The therapy of choice was low molecular weight heparin (LMWH), with achieved complete venous recanalization in 75% of patients. In 2 cases of therapeutic failure, mechanical thrombectomy was performed. Two patients had postthrombotic syndrome, and recurrent thrombosis was observed in 2 patients. Conclusion: Despite a limited number of patients, our treatment-related outcomes, treatment adverse affects, and postthrombotic complications are consistent with published data. Given an increased risk and the multifactorial etiology of DVT in children with malignant diseases, individual and careful assessment for risk factors, and timely diagnosis and therapeutic intervention are essential.

Multisistemski inflamatorni sindrom u djece (MIS-C) hiperupalni je poremećaj nastao kao posljedica zaraze teškim akutnim respiratornim sindromom koronavirusa-2 (SARS-CoV-2). Obično zahvaća pedijatrijsku populaciju s najvećom prevalencijom u djece između tri i 12 godina, a najčešći komorbiditeti su pretilost i astma. MIS-C se razvija četiri do šest tjedana nakon infekcije SARS-CoV-2 te se u većini slučajeva prisutnost SARS-CoV-2 ne može otkriti PCR metodom. Sindrom karakteriziraju vrućica, upala i multiorganska disfunkcija te brojne sličnosti s drugim upalnim i autoimunim stanjima. Najistaknutije manifestacije MIS-C-a su simptomi kardiovaskularnog sustava, a uključuju miokarditis i srčano zatajenje. Zbog visoke incidencije kardiovaskularnih komplikacija, ehokardiografija ima veliku vrijednost u dijagnostici i praćenju tijeka bolesti te procjeni ozbiljnosti kardiovaskularne zahvaćenosti. MIS-C karakterizira hiperinflamatorno stanje i nastup citokinske oluje, što se može dokazati laboratorijskim markerima upale. Povišene vrijednosti specifičnog srčanog markera troponina ukazuju na izravnu ozljedu stanica miokarda, a značajna povišenja BNP-a i srodnih peptida ukazaju na pogoršanje intersticijalnog edema miokarda i nastalu vaskulopatiju. Uobičajeni su i laboratorijski nalazi anemije, leukopenije, limfopenije, trombocitopenije i hipoalbuminemije. Teški slučajevi MIS-C-a dovode do razvoja vazodilatacijskog ili kardiogenog šoka koji zahtijeva urgentnu hospitalizaciju u jedinicu intenzivne skrbi. Intravenski imunoglobulin (IVIG), glukokortikoidi i biološki agensi predstavljaju glavne terapijske modalitete za liječenje MIS-C-a. Primjena IVIG-a i visokih doza kortikosteroida indicirana je kao prva linija terapije liječenja MIS-C-a. U drugu liniju terapije spadaju antiagregacijski lijekovi i biološki lijekovi kao što su anakinra, tocilizumab ili infiksimab, posebice u slučaju bolesti refraktorne na primjenu prve linije terapije., Multisystem Inflammatory Syndrome in Children (MIS-C) is a hyperinflammatory disorder resulting from infection with severe acute coronavirus-2 respiratory syndrome (SARS-CoV-2). It usually affects the pediatric population with the highest prevalence in children between the ages of three and 12, and the most common comorbidities are obesity and asthma. MIS-C develops four to six weeks after SARS-CoV-2 infection, and in most cases the presence of SARS-CoV-2 cannot be detected by PCR. The syndrome is characterized by fever, inflammation and multiorgan dysfunction and numerous similarities with other inflammatory and autoimmune conditions. The most prominent manifestations of MIS-C are symptoms of the cardiovascular system, and include myocarditis and heart failure. Due to the high incidence of cardiovascular complications, echocardiography is of great value in diagnosing and monitoring the course of the disease and assessing the severity of cardiovascular involvement. MIS-C is characterized by a hyperinflammatory condition and the onset of a cytokine storm, which can be demonstrated by laboratory markers of inflammation. Elevated values of the specific cardiac marker troponin indicate direct injury to myocardial cells, and significant increases in BNP and related peptides indicate exacerbation of interstitial myocardial edema and resulting vasculopathy. Laboratory findings of anemia, leukopenia, lymphopenia, thrombocytopenia and hypoalbuminemia are also common. Severe cases of MIS-C lead to the development of vasodilatory or cardiogenic shock requiring urgent hospitalization in the intensive care unit. Intravenous immunoglobulin (IVIG), glucocorticoids and biological agents are the main therapeutic modalities for the treatment of MIS-C. The use of IVIG and high doses of corticosteroids is indicated as first-line therapy for the treatment of MIS-C. The second line of therapy includes antiplatelet drugs and biologics such as anakinra, tocilizumab or infiximab, especially in the case of refractory diseases on the application of the first line of therapy.

Klinički pristup i evaluacija boli u djece obuhvaćaju sljedeće: određivanje tipa i karaktera boli, izvora, lokalizacije i uz njih pratećih/povezanih znakova i simptoma te procjenu intenziteta boli. Osim navedenog, potrebno je utvrditi točan period u kojem se bol pojavila te odrediti njezino trajanje. Bol prema tipu može biti nociceptivna, neuropatska ili nociplastična, a svaki tip boli povezuje se s određenim karakterom: oštra, tupa, stiskajuća, probadajuća, grčevita, žareća, pulsirajuća i slično. Izvor i lokalizacija boli pomažu u određivanju njezine etiologije a prateći/povezani simptomi sužavaju diferencijalnu dijagnozu i ukazuju na onu najvjerojatniju. Samoprocjena intenziteta boli u djece ovisi o životnoj dobi djeteta odnosno o njegovoj kognitivnoj sposobnosti. Za procjenu se koriste: metoda samoprocjene, koja podrazumijeva dobno prilagođene ljestvice i upitnike o boli, namjenjena za djecu koja su sposobna razumjeti bol, kvantificirati ju i vizualizirati, te bihevioralno opservacijska metoda, gdje se promatraju fiziološki parametri i ponašanje djetata, namjenjena za djecu koja nisu sposobna sama procijeniti bol i nemaju sposobnost verbalizacije. Liječenje boli u djece uključuje nefarmakološke i farmakološke mjere. Nefarmakološko liječenje podrazumijeva fizikalne, bihevioralne i kognitivne metode. Farmakološko liječenje najčešće se provodi prema trostupanjskoj analgetičkoj ljestvici Svjetske zdravstvene organizacije, i obuhvaća sljedeće skupine lijekova: neopioidni analgetici (paracetamol i NSAID), opioidni analgetici (slabi i jaki) te adjuvantnu terapiju. Za olakšavanje proceduralne boli u novorođenčadi i dojenčadi mogu se koristiti oralna glukoza ili saharoza, a osim toga u sve djece za proceduralnu bol koriste se topikalne i injektibilne formulacije lokalnih anestetika., Clinical approach and evaluation of pain in children includes the following: determining the type and character of pain, determining the source, location, associated signs and symptoms and severity assessment. Moreover, it is necessary to determine the onset of pain and its duration. Pain can be classified by the type as: nociceptive, neuropathic and nociplastic. Every type of pain is associated with a specific character: sharp, dull, squeezing, stabbing, cramping, burning, throbbing etc. Source and location of pain can help to determine its aetiology while associated signs and symptoms can narrow down the differential diagnose and indicate the most likely one. Severity assessment depends upon the child's age and cognitive ability. Two methods are used for severity assessment: First, self-reporting, which include age-appropriate pain scales and questionnaires, adequate for children who are able to understand, quantify and visualise pain. Second, the behavioural-observation method, which observes physiological parameters and behaviour of the child, which is adequate for children who cannot self-report and nonverbal children. Treatment of pain includes both, nonpharmacological and pharmacological methods. Nonpharmacological treatment consists of physical, behavioural and cognitive methods. Pharmacological treatment is most often performed according to the World Health Organisation Analgesic Ladder. It includes the following agents: nonopioid analgesics (paracetamol and NSAID), opioid analgesics (weak and strong) and adjuvant therapy. Procedural pain in newborns and infants can be relieved with oral glucose or sucrose, but topical and injectable formulations of local anaesthetics are indicated in all children.

Najranjivije skupine s kojima se zdravstveni djelatnici susreću su trudnice, novorođenčad i nedonoščad. Trudnoća je razdoblje u kojem se u ženinom organizmu događaju različite prilagodbe. Te prilagodbe su popraćene različitim fiziološkim promjenama pa tako i promjenama u stvaranju hormona. U trudnoći, posteljica proizvodi hormone koji pomažu plodu da raste i razvija se, ali isto tako hormoni tijekom trudnoće blokiraju djelovanje ženskog inzulina. To se zove inzulinska rezistencija. Zbog te inzulinske rezistencije, potreba za inzulinom u trudnoći je dva do tri puta veća od normalne te manjak inzulina povećava razinu glukoze i dolazi do tako zvanog gestacijskog dijabetesa. U radu će biti definiran gestacijski dijabetes, biti će navedene sestrinske dijagnoze te će biti prikazana analiza podataka dobivenih iz povijesti bolesti pacijenata. Tijekom izrade završnog rada provedeno je istraživanje u KB Sv. Duh (odobreno od strane Etičkog povjerenstva pod Ur. brojem: 01-03-285/1), na Klinici za ginekologiju i porodništvo KB „Sveti Duh“. U istraživanju je sudjelovalo 45 trudnica i 45 novorođenčadi. Cilj istraživanja bio je kroz nekoliko čimbenika dokazati koliko gestacijski dijabetes kao rizični faktor majke utječe na APGAR ljestvicu djeteta. Analiza podataka je izvršena kvalitativnom i kvantitativnom metodom, uspoređujući podatke vezane uz težinu majke, godine majke, gestacijski dijabetes u odnosu na težinu djeteta pri rođenju i APGAR ljestvicu. The most vulnerable groups with whom health professional meet are pregnant women, newborns and premature infants. Pregnancy is a period in which various adjustments occur in women’s body. In pregnancy, the placenta produces hormones that help the fetus to grow and develop, but they also block the activity of woman’s insuline. Because of insulin resistance, the need for insulin in pregnancy is two to three times higher than normal and insulin deficiency increases glucose levels and leads to so-called gestational diabetes. This paper will provide the definition of gestational diabetes, list similar diagnoses and present an analysis of data obtained from patient’s medical history. Throughout the preparation of the final paper, research was conducted in Clinical Hospital Sveti Duh (approved by the Ethics Committee 03- 285/1), at the Clinic for Gynecology and Obstetrics at Clinical Hospital Sveti Duh. The study involved forty-five pregnant women and forty-five newborn children. The aim of the study was to prove, through several factors, how much gestational diabetes, as a risk factor for the mother, affects the child’s APGAR scale. Data analysis was performed by qualitative and quantitative method, comparing data related to maternal weight and age, gestational diabetes in relation to child weight at birth and APGAR scale.

Pneumotoraks označava nakupinu zraka u pleuralnom prostoru. Zrak u pleuralni prostor može ući putem dva mehanizma: traumom u slučaju ozljede torakalne stijenke, bronha ili traheje ili spontano, perforacijom pleure. Rizični faktori za razvoj pneumotoraksa su muški spol, visoki i mršavi habitus, adolescencija, mlađa odrasla dob, KOPB i pušenje. Simptomi se u većini slučajeva jave u mirovanju. Najčešće se prezentira iznenadnom pojavom dispneje i pleuritične prsne boli. Dijagnoza pneumotoraksa obično se potvrđuje metodama slikovne dijagnostike. U dijagnostici se najčešće koristi standarni PA snimak prsnog koša u uspravnom položaju. Za procjenu veličine pneumotoraksa najtočnija metoda je CT, međutim najčešće se RTG grudnih organa koristi u izračunu veličine pneumotoraksa. Kod manje djece, pneumotoraks se smatra malim ako zahvaća manje od 30% hemitoraksa i velikim ako zahvaća više od tog postotka. Zbrinjavanje pneumotoraksa u djece temeljeno je na smjernicama za odraslu populaciju. U djece s prvom epizodom PSP-a koji zahvaća manje od 30% hemitoraksa, preporuča se opservacija u bolnici. Torakalna drenaža izvodi se u bolesnika u kojih torakocenteza nije bila uspješna, u bolesnika sa rekurentnim pneumotoraksom te u većine bolesnika sa SSP. Metode kirurškog liječenja su torakotomija i VATS. Torakotomija je ostala metoda liječenja s najnižom stopom recidiva, no negativne strane metode su što dovodi do većeg gubitka krvi, veće postoperativne boli i duljeg ostanka u bolnici u odnosu na VATS., Pneumothorax refers to the accumulation of air in the pleural cavity. Air can enter the pleural space through two mechanisms: trauma in the case of injury to the thoracic wall, bronchi or trachea, or spontaneously, perforation of the pleura. Male sex, tall and thin habitus, adolescence, young adulthood, COPD and smoking are considered risk factors for the development of pneumothorax. Symptoms occur in most cases at rest. They are most often presented by the sudden onset of dyspnea and pleuritic chest pain. The diagnosis of pneumothorax is usually confirmed by imaging methods. The standard PA chest X-ray in the upright position is most often used in diagnostics. The most accurate method for estimating pneumothorax size is CT, however, chest X-rays are most commonly used to calculate pneumothorax size. In smaller children, pneumothorax is considered small if it affects less than 30% of hemitorax and large if it affects more than that percentage. The management of pneumothorax in children is based on guidelines for the adult population. In children with the first episode of PSP involving less than 30% of hemitorax, hospital observation is recommended. Thoracic drainage is performed in patients in whom thoracentesis was not successful, in patients with recurrent pneumothorax and in most patients with SSP. Methods of surgical treatment are thoracotomy and VATS. Thoracotomy remained the treatment method with the lowest recurrence rate, but the downsides are that it leads to greater blood loss, greater postoperative pain, and longer hospital stays compared to VATS.

Background and Objectives: Working in pediatric and neonatal intensive care units (ICUs) can be challenging and differs from work in adult ICUs. This study investigated for the first time the perceptions, experiences and challenges that healthcare professionals face when dealing with end-of-life decisions in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) in Croatia. Materials and Methods: This qualitative study with focus groups was conducted among physicians and nurses working in NICUs and PICUs in five healthcare institutions (three pediatric intensive care units (PICUs) and five neonatal intensive care units (NICUs)) at the tertiary level of healthcare in the Republic of Croatia, in Zagreb, Rijeka and Split. A total of 20 physicians and 21 nurses participated in eight focus groups. The questions concerned everyday practices in end-of-life decision-making and their connection with interpersonal relationships between physicians, nurses, patients and their families. The constant comparative analysis method was used in the analysis of the data. Results: The analysis revealed two main themes that were the same among the professional groups as well as in both NICU and PICU units. The theme “critical illness” consisted of the following subthemes: the child, the family, myself and other professionals. The theme “end-of-life procedures” consisted of the following subthemes: breaking point, decision-making, end-of-life procedures, “spill-over” and the four walls of the ICU. The perceptions and experiences of end-of-life issues among nurses and physicians working in NICUs and PICUs share multiple common characteristics. The high variability in end-of-life procedures applied and various difficulties experienced during shared decision-making processes were observed. Conclusions: There is a need for further research in order to develop clinical and professional guidelines that will inform end-of-life decision-making, including the specific perspectives of everyone involved, and the need to influence policymakers.

Perkutana biopsija bubrega izvodi se u KBC-u Split kontinuirano od 1994. Stroge indikacije za invazivni zahvat obuhvaćaju poznate bubrežne sindrome. Bubrežno tkivo se nakon postavljanja dijagnoze može naknadno analizirati radi novih biljega, važnih u patogenezi bubrežnih bolesti. Bubreg je mjesto aktivacije vitamina D koji ima pleiotropni povoljni učinak na organizam. Zbog bubrežne bolesti kompleksni mehanizam regulacije vitamina D može biti poremećen. Istražili smo izražaj receptora za vitamin D (VDR) te enzima aktivacje (1α-OHaza) i razgradnje (CYP24A1) vitamina D u bioptatima bubrega bolesnika s IgA nefropatijom (IgAN) i usporedili s kontrolnim tkivima. Za epidemiološku analizu prikupljeni su klinički i patološki padaci o 54 bolesnika bioptirana na Klinici za dječje bolesti od 2008. do 2017. Za eksperimentalnu analizu prikupljeni su arhivirani parafinski blokovi bubrežnog tkiva 12 bolesnika s IgAN-om (šestero djece i šestero odraslih). Izrezani su preparati debljine 5 µm, standardno priređeni za indirektno imunohistokemijsko bojenje protutijelima na VDR, 1α-OHazu i CYP24A1, analizirani na imunofluoroscencijskom mikroskopu, fotografirani i kvantificirani uporabom ImageJ računalnog programa. U statističkoj analizi je značajnim smatran P < 0,05. U epidemiološkoj analizi, od 54 ispitanika, 29 je bilo muškog i 25 ženskog spola, srednja dob 9,84 ± 5,4 godine. Polovina indikacija za biopsiju otpada na nefrotski sindrom (NS; 25,93%) i ne-nefrotsku proteinuriju s hematurijom (22,22%). Najčešće je dijagnosticirana IgAN, a potom bolest minimalnih promjena (MCD), Henoch-Schönlein nefritis (HSPN), fokalna segmentalna glomeruloskleroza (FSGS) i Alportov sindrom (AS). Spektar dijagnoza se promijenio u odnosu na prethodno analizirano razdoblje 1995 – 2005. jer je mali postotak prethodno često dijagnosticiranog mezangioproliferativnog glomerulonefritisa (MesPGN). Na promjene u indikacijama i veći broj bioptiranih s IH-om i ne-nefrotskom proteinurijom s hematurijom utjecale su nove klasifikacije i mogućnost boljeg dijagnosticiranja hereditarnih bolesti glomerularne bazalne membrane (GBM). U eksperimentalnoj analizi, izražaj VDR-a u bubrežnom tkivu je značajno veći u bolesnika s IgAN-om nego u kontroli (P = 0,037), a izražaj 1α-OHaze značajno manji nego u kontroli (P < 0,001). Izražaj CYP24A1 i postotak jezgara imunoreaktivnih na CYP24A1 u glomerulima i epitelu distalnih kanalića je značajno veći u bolesnika s IgAN-om nego u kontrolnim tkivima 67 (P < 0,001). Postotak nuklearnog izražaja CYP24A1 u epitelu proksimalnih kanalića pokazuje negativnu korelaciju s eGFR (P = 0,034). Raspodjela indikacija i patoloških nalaza slična je podacima iz većine drugih studija. Razlika u izražaju VDR-a i enzima povezanih s aktivacijom i degradacijom vitamina D upućuje na smanjenu proizvodnju kalcitriola i povećanu razgradnju vitamina D u bubregu bolesnika s IgAN-om., Percutaneous kidney biopsy has been performed at University Hospital of Split continuously since 1994. Strict indications for invasive procedure include well- known renal syndromes. After diagnosis, renal tissue can be subsequently analyzed for new markers, important in the pathogenesis of renal disease. The kidney is the site of activation of vitamin D, which has a pleiotropic beneficial effect on the body. Due to kidney disease, the complex mechanism of vitamin D regulation can be disrupted. We investigated the expression of vitamin D receptor (VDR) and the enzymes of activation (1α-OHase) and degradation (CYP24A1) of vitamin D in kidney biopsies of patients with IgA nephropathy (IgAN) and compared it with control. For epidemiological analysis, clinical and pathological data were collected on 54 patients biopsied in the Clinic for Children´s Diseases from 2008 to 2017. For experimental analysis, archived paraffin blocks of renal tissue of 12 patients with IgAN (6 children and 6 adults) were collected. Five µm thick slides, standardly prepared for indirect immunohistochemical staining with antibodies to VDR, 1α-OHase and CYP24A1, were analyzed on an immunofluorescence microscope, photographed and quantified using an Image J computer program. In the statistical analysis, P < 0.05 was considered significant. In the epidemiological analysis, out of the 54 patients, 29 were male and 25 female; mean age 9.84 ± 5.4 years. Half of the biopsyindications are nephrotic syndrome (NS; 25.93%) and non-nephrotic proteinuria with hematuria, 22.22%. IgAN was most commonly diagnosed, followed by minimal change disease (MCD), Henoch-Schönlein purpura nephritis (HSPN), focal segmental glomerulosclerosis (FSGS), and Alport syndrome (AS). The spectrum of diagnoses changed compared to the previously analyzed period 1995 – 2005 because a small percentage of previously frequently diagnosed mesangioproliferative glomerulonephritis (MesPGN). Changes in indications were influenced by new classifications and the possibility of better diagnosis of hereditary disease of the glomerular basement membrane (GBM). In the experimental analysis, the expression of VDR in renal tissue was higher in patients with IgAN (P = 0.037), and the expression of 1α-OHase was significantly lower than in control (P

Uvod i cilj: Dijagnoza kronične upalne bolesti crijeva, u svakog četvrtog oboljelog postavlja se u dječjoj dobi, tj. prije navršene osamnaeste godine života. Svjedoci smo značajnog porasta incidencije posljednjeg desetljeća, odnosno danas se ubraja među najčešće kronične gastroenterološke bolesti dječje dobi. Nedavno je određena incidencija i u našoj državi, koja je potvrdila da je ukupna incidencija 7,05/100,000 djece do navršene 18. godine života, što je slično ostalim razvijenim zemljama svijeta. Metode: S ciljem ranog otkrivanja te kako bi se olakšalo liječenje kronične upalne bolesti crijeva u svjetlu dostupnih novih terapija, Hrvatsko društvo za pedijatrijsku gastroenterologiju, hepatologiju i prehranu Hrvatskog liječničkog zbora izradilo je smjernice za dijagnostiku i konzervativno liječenje ovih bolesti. Prilikom kreiranja smjernica pretražena je dostupna znanstvena i stručna literatura, uključujući i smjernice relevantnih europskih društava. Rezultati: U detalje su razrađene smjernice za dijagnostiku i liječenje Crohnove bolesti i ulceroznog kolitisa sa predloženim algoritmima, praktičnim savjetima o dozama lijekova te mogućim nuspojavama. Zaključci: Pravovremena dijagnoza te odgovarajuća terapija smanjuju komplikacije bolesti te omogućuju adekvatan rast i razvoj djece oboljele od IBD-a., Introduction and aim: In every fourth person with inflammatory bowel disease (IBD), the diagnosis is made in childhood, before the age of eighteen. We are witnessing a significant increase in the incidence in the last decade and today IBD is one of the most common chronic gastrointestinal diseases of childhood. Recently, incidence in Croatia has been determined (7.05/100,000 children below 18 years), confirming that the incidence resembles those in developed countries. Material and methods: With the aim to enable early diagnosis and assure adequate treatment with currently emerging new therapies, the Croatian Society of Pediatric Gastroenterology, Hepatology and Nutrition of the Croatian Medical Association has developed guidelines for the diagnosis and pharmacological treatment of IBD in children, taking into account relevant European guidelines, scientific literature and expert opinions of members of this society who are providing long-term care of these patients. Results: These guidelines represent detailed recommendation for the diagnosis and treatment of Crohn’s disease and ulcerative colitis with proposed diagnostic and therapeutic algorithms, medication dosing regimens and possible side effects. Conclusion: Early diagnosis and personally tailored therapy are key factors in preventing disease complication and for and for assuring normal growth and development in children with IBD.

Cilj: Cilj istraživanja bio je utvrditi pojavnost, kliničke karakteristike te ishod prijevremeno rođene dojenčadi, liječene na Odjelu intenzivnog liječenja djece Klinike za pedijatriju Kliničkog bolničkog centra Rijeka, u razdoblju 2014. – 2018. godine. Ispitanici i metode: Ispitanici su sva prijevremeno rođena dojenčad liječena na Odjelu intenzivnog liječenja djece Klinike za pedijatriju Kliničkog bolničkog centra Rijeka, u razdoblju 2014.-2018. Ispitanici su prema gestacijskoj dobi podijeljeni u četiri skupine (ekstremno prijevremeno rođena, vrlo prijevremeno rođena, umjereno prijevremeno rođena, kasno prijevremeno rođena djeca) te su navedene skupine uspoređivane s obzirom na pojedine kliničke karakteristike. Rezultati: Ispitivanje je obuhvatilo ukupno 176-ero prijevremeno rođene dojenčadi. U skupini ispitane ekstremno prijevremeno rođene dojenčadi razlozi hospitalizacija u 90,3 % slučajeva bile su komplikacije prijevremenog rođenja, u skupini vrlo prijevremeno rođene dojenčadi komplikacije prijevremenog rođenja bile su razlogom hospitalizacija u 62,1 %, u 35 % slučajeva dojenčadi umjerenog, a u skupini dojenčadi kasnog prijevremenog rođenja 22,4 %. Od ukupnog broja ispitivane prijevremeno rođene dojenčadi, njih 79 (44,9 %) imalo je 1-2 komplikacije, 35 (19,9 %) ih je imalo 3-4 komplikacije, a 15-ero (8,5 %) prematurne dojenčadi imalo je pet ili više komplikacija prijevremenog rođenja. Od ukupno 176-ero ispitivane prijevremeno rođene dojenčadi u navedenom periodu, 14-ero (8 %) ih je umrlo tijekom hospitalizacije. Zaključci: Budući da su prema literaturi najčešći razlozi hospitalizacija prijevremeno rođene dojenčadi infekcije, nerijetko izravno povezane s komplikacijama prijevremenog rođenja, pokušaji smanjenja navedenog broja hospitalizacija trebali bi biti usmjereni upravo prema smanjenju broja infekcija. Uz navedeno bi, vjerojatno, poželjan učinak imala i dodatna koordinacija skrbi i praćenja., Aim: The study aimed to determine the incidence, clinical characteristics, and outcomes of the preterm infants treated at the Paediatric Intensive Care Unit of the Paediatric Clinic, Clinical Hospital Centre Rijeka, from 2014 to 2018. Patients and methods: Respondents were all preterm infants treated in the Paediatric Intensive Care Unit of the Paediatric Clinic, Clinical Hospital Centre Rijeka, from 2014 to 2018. Observed preterm infants were divided into four groups based on their gestational age (extremely prematurely born, very prematurely born, moderately prematurely born, late prematurely born). These groups were observed and compared with their individual clinical characteristics. Results: The study included a total of 176 premature infants. In the group of extremely premature infants, the reasons for hospitalization in 90.3% of cases were complications of premature birth, which caused hospitalizations in the group of very premature infants by 62.1%, among moderate infants by 35%, and in the group of late preterm infants by 22.4%. Of the total number of observed hospitalized preterm infants, 79 of them (44.9%) had 1-2 complications, 35 (19.9%) had 3-4 complications, and 15 of them (8.5%) had five or more complications. Out of the total of 176 observed preterm infants in this period, 14 (8%) died during the hospitalization. Conclusions: Based on literature sources, the most common reasons for hospitalization of preterm infants are infections – often directly related to complications of premature birth – the attempts to reduce the number of hospitalizations should focus on the reduction of infections. Besides that, more coordination between care and monitoring would probably ensure more positive outcomes.