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Introduction Neonates born prematurely or small for gestational age (SGA) as a consequence of intrauterine growth restriction (IUGR) have a higher risk of neurological injury due to fetal hypoxia. Hypoxic ischemic encephalopathy (HIE) and intraventricular hemorrhage (IVH) are the main clinical forms of brain injury. The patterns and underlying mechanisms of neurological injury are interrelated. Aim of the study The purpose of the study was to evaluate the neurological outcome of SGA newborns versus neonates born preterm. Materials and methods A 3 year randomized case - control study was conducted between the 1st of January 2014 and the 31th of December 2016, at the Emergency County Hospital, Timisoara. 170 SGA newborns and 170 AGA newborns matched 1:1 for gestational age and birth month were included in the study. Patients were divided in 4 subgroups according to gestational age: 101 SGA newborns born at term (SGATerm) and 69 SGA newborns born preterm (SGA-Preterm), 101 AGA neonates born at term (AGA-Term) and 69 AGA neonates born preterm (AGA-Preterm). Results and discussions Preterm neonates had difficulties of early neonatal adaptation, as indicated by a low APGAR score. Preterm neonates irrespective of birth weight, had a higher incidence of both HIE (26.1% SGA Preterm versus 11.8% SGA Term and 11.5% AGA Preterm compared to 0.0% AGA Term) and IVH (20.3% SGA Preterm versus 7.9% SGA Term and 15.9% AGA Preterm compared to 0.0% AGA Term ). Conclusions Neonates born preterm have a poorer neurological outcome compared to term newborns, regardless of birth weight. SGA is an additional, aggravating factor for neurological injury. More extensive studies on the different subgroups of SGA newborns are required in order understand the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Introduction: In recent years' abdominal ultrasound has become a very useful and accessible method for exploring the pediatric gastrointestinal pathology. Study objective: Assessing the need to perform an abdominal ultrasound in the neonate and infant, as a screening procedure, in order to find evidence of malformative or tumoral pathology. Methods: Abdominal ultrasounds were performed on 769 patients hospitalized in our clinic during July 2013 - March 2015. The patients were aged between 0-1 years, with an average of 3 ± 2.5 months. Of these, 450 patients (58.51%) received a routine abdominal ultrasound without any clinical evidence to justify this investigation. Results: The most common pathology was that of the reno-urinary tract: renal malformations - 1 case (cystic renal dysplasia), Ist and IInd degree hydronephrosis - 75 cases (16.67%), IIIrd and IVth degree hydronephrosis - 18 cases (4%); other findings consisted in ovary cysts - 39 patients (8.6%), vascular portal malformations - 5 cases (1.1%), digestive malformations (midgut cyst) - 2 cases (0.04%), tumoral pathology - 10 cases (2.2%), congenital spleen cyst - 1 case. Discussions: The relatively high prevalence of abdominal pathology (75 cases, 28%) detected accidentally by performing routine abdominal echography in these patients has not changed the therapeutical approach in 92% of cases. 6 cases were subject to surgical referrals. 2 cases required immediate surgery (neuroblastoma and nephroblastoma), while other 2 cases would undergo surgery at a later stage. Conclusions: Abdominal ultrasound during the neonatal period and infancy is important in order to establish a complete diagnosis and subsequent monitoring of these cases. [ABSTRACT FROM AUTHOR]

Pregnancy-induced hypertensive disorders (PIH) complicate up to 10% of all pregnancies and represent one of the leading causes of both maternal and fetal morbidity and mortality. Decreased blood flow to the placenta translates into chronic fetal hypoxia and fetal malnutrition, resulting in intrauterine growth restriction (IUGR), small for gestational age (SGA) newborns, prematurity, and even death. Aim of the study: The aim of the study was to determine the impact of maternal PIH on fetal growth and development by determining the prevalence of maternal PIH among newborns and identifying the incidence of preterm birth and SGA neonates born to mothers with PIH. Materials and methods: A retrospective observational study was conducted over a 3-year period (January 2014 -December 2016), at the Clinic of Obstetrics, Gynecology and Neonatology of the Emergency County Hospital Timisoara. Results and discussions: A total of 6108 newborns were included in the study. Patients were divided in 8 subgroups according to the presence or absence of maternal PIH (2 groups), term or premature birth (4 groups) and birth weight for gestational age (8 subgroups). From the total 6108 included newborns, 58 were born to mothers with PIH, representing an incidence of 0.94%. SGA criteria were met by 170 (2.7%) of the total patients and 289 (4.7%) patients were born preterm. The incidence of preterm birth was significantly higher among newborns with maternal PIH than mothers without PIH (62.1% and 4.2, respectively). SGA was more frequent in the preterm study groups compared to the term neonates [41.6% (preterm-PIH) and 24.5% (preterm) compared to 13.6% (term-PIH) and 1.5% (term)], and there was also a significantly higher prevalence of SGA in the term PIH group compared to term newborns without maternal PIH (13.6% compared to 1.5%). Conclusions: The prevalence of both premature birth and SGA was significantly higher in newborns with maternal PIH. Therefore, it can be concluded that maternal PIH exerts a negative effect on fetal growth and development. Intrauterine fetal monitoring of women with PIH and individual therapeutic managementof both mother and newborn are of paramount importance in improving the short and long-term outcome. [ABSTRACT FROM AUTHOR]

Introduction: Common causes of goiter in children include autoimmune disease and iodine deficiency. Purpose: The current study aims to frame goiter according to etiology in the pediatric population. Methods: A retrospective study was conducted over a period of 1 year and 6 months (January 2013-August 2014) in the Emergency Hospital for Children "Louis Țurcanu" Timisoara. The study group included a total of 36 patients aged between 4 to 18 years with a mean age of 12.3 years. Thyroid volume (Vt) was determined by ultrasound measurements and the diagnosis of goiter was established based on Vt> 97th percentile using diagrams adapted for age, gender. Results and Discussion: We found a high prevalence of Hashimoto thyroiditis, 21 patients (representing 58.33% of total). Of these, 14 patients (66.7%) associated type 1 diabetes, thyroiditis being the second autoimmune disease. Basedow's disease was diagnosed in 2 patients (5.55%), and one showed a solitary thyroid nodule. The other 14 patients (38.9%) with goiter had negative serology for autoimmunity, thus being labeled as diffuse nonimune goiter. The mean age of these patients was 12.2 years with the limits 4.9-18 years, 75% of whom were girls. All patients from this category had euthyroid; most (62%) came from Timisoara. In 5 patients (38%) coming from endemic areas, thyroglobulin was determined. All patients had normal levels of thyroglobulin and iodine deficiency could not be demonstrated. Urine iodine was not determined in the patients included in the present study. Conclusions: The autoimmune pathology is the most common cause of goiter in children. Nonimmune diffuse goiter was found at pubertal age, mostly in girls. Children with goiter, regardless of its etiology, require treatment with thyroxine during puberty even if they are euthyroid. Studies are needed on urine iodine in the West of Romania in the pediatric population. [ABSTRACT FROM AUTHOR]

Without claiming to achieve an integrated monitoring or intensive activities for the quality of surface water in the investigated area, this paper aims to assess the quality of water from Bega and Timiş rivers with regard to nitrites, nitrates and chlorides. This is part of a larger study on the quality of water sources in the region, with regard to the anionic and cationic pollutants. The study follows the impact of the drinking water on the human health, especially children and pregnant women. The considered parameters were below the admitted value, therefore no pollution problems were found. [ABSTRACT FROM AUTHOR]

Introduction. Early diagnosis and aggressive treatment is fundamental in the management of patients with ventilator-associated pneumonia (VAP). Aim. The aim of this study was to determine the incidence of VAP among mechanically ventilated children and to identify the main risk factors and nosocomial germs for development of VAP in a critically ill PICU population. Material and methods. A retrospective, observational study was conducted over a period of 2 years (January 2011 - December 2012) in the Fist Pediatric Intensive Care Unit (PICU) of Emergency Hospital for Children "Louis Turcanu" Timisoara and included all mechanically ventilated children ⩾ 48 hours aged 0-18 years. Results. Of all 51 mechanically ventilated patients, who met the inclusion criteria, 43.13% developed VAP. Patients with VAP needed a greater number of days of mechanical ventilation (mean 23.59 vs. 5.68 days) and a longer duration of hospitalization (mean 42.18 vs. 20.27 days) than those without VAP. Multiple regression analysis identified 4 factors associated with VAP (p < 0.05): previously use of an antibiotic (t-statistics (t-stat) = 2.33, p = 0.036), previously use of more than one antibiotic (t-stat = 2.89, p < 0.01), previously use of an antifungal drug (t-stat = 2.00, p = 0.05), and reintubation (t-stat = 2.71, p < 0.01). Organisms identified by culture, involved in the etiology of VAP were: gram-negative bacteria 88.8%, fungi 6.6%, and gram-positive bacteria 4.4%. Conclusions. The incidence of VAP was higher (43%) in our study. Children on previously use of antibiotics or antifungal drugs, or experienced reintubation, developed VAP and had a longer period of mechanical ventilation and hospitalization. Pseudomonas aeruginosa was the most common Gram-negative bacteria associated with VAP. [ABSTRACT FROM AUTHOR]

Background: Malignant infantile osteopetrosis (MIOP) is a rare autosomal recessive bone disease, characterized by reduced or dysregulated osteoclastic activity and increased bone mass. Major consequences include bone marrow failure and nerve compression. Chronic anemia, feeding problems caused by bulbar nerve involvement and recurrent infections as well as bone growth in diameter and not length leads to failure to thrive (delayed growth, weight gain, and development), seen in many osteopetrotic children. The pericentric inversion of chromosome 9 is the most frequently found in general population and has a role in abnormal phenotype development. Material and methods: Case report of a 6 months old boy with 3 admissions, first at the age of three months for hypocalcemic seizures. Based on the dysmorphic phenotype,presence of anemia, severe hypocalcemia, hepatosplenomegaly, failure to thrive, mental retardation, ventriculomegaly, optic nerve atrophy and the typical radiological images diagnose of MIOP complicated by rickets was established. Failure to thrive was defined based on persistent weight and waist below the 5th percentile. Genetic evaluation for chromosome abnormalities revealed apericentric inversion of chromosome 9. Conclusions: MIOP is a rare disease which can present with nonspecific symptoms; therefore it has to be considered in case of craniofacial bones abnormalities, severe hypocalcemia, anemia and early onset failure to thrive. The association of osteopetrosis complicated by rickets and chromosome 9 inversion led in our case to severe dysmorphic features and severe growth restriction. [ABSTRACT FROM AUTHOR]

Introduction: Rapid increase in weight during early childhood, "catch-up growth" phenomenon, in children born small for gestational age (SGA) has been strongly linked with insulin resistance (IR), which may be a risk factor for type 2 diabetes mellitus and cardiovascular disease. IR occurred in the prenatal period has a protective role, that of intrauterine survival in conditions of malnutrition. In the postnatal period, early onset IR becomes a risk factor for metabolic syndrome and its components correlated with normal (or excessive) nutritional intake. Material and methods: A retrospective observational study was carried out on long-term metabolic complications in children born SGA, which were admitted to our hospital over a 5 year period from 2007 to 2011. 517 patients (mean age 12 years±0.6, aged between 6 - 18 years) were divided in two study groups, following the statistical processing of data sheets, as follows: 410 obese patients that were born appropriate for gestational age (AGA) (79,30 %) and 107 obese patients that were born SGA (29,69 %). Baseline glucose and insulin levels of the patients were measured and IR index was assessed by homeostasis model assessment (HOMA). A cut-off HOMA level of >2.5 in the prepubertal period and of > 3.5 for adolescents was used to identify an IR status. Results: IR was found in 20% of obese AGA children and 25,3% of obese SGA. Rate of IR in patients born SGA was greater compared to obese children born AGA and had a significant statistical difference (P = 0.03, mean 2,95229 AGA versus 3,72778 SGA group and SD 1,7 versus 2,6).Conclusion: Increased prevalence of IR patients born SGA compared to AGA indicates that being born SGA appears to be an additional risk factor in the developement of IR. IR met in a high percentage among obese patients born SGA, allows us to affirm that the cardiovascular risk in these patients as well as the risk of developing type 2 diabetes is higher. Monitoring, periodic evaluation and appropriate dietary therapy in the case of obese children born SGA is crucial in preventing early onset cardiovascular disease. [ABSTRACT FROM AUTHOR]

The intima media thickness of the common carotid artery (CIMT) is a well-known marker of subclinical atherosclerosis. The "catch-up growth" phenomenon in children born small for gestational age (SGA) has been linked to early onset obesity with the subsequent emergence of metabolic syndrome (MetS). Aim: to determine the association between being born SGA and CIMT, a measure of atherogenesis and to establish cut off values for CIMT in obese children. Material and methods. A prospective study was carried out over a 1 year period (Jul 2012-June 2013). We analyzed 122 obese patients, 96 patients appropriate for gestational age (AGA) and 26 patients SGA. Both groups were matched for age, sex and BMI. CIMT was measured in all the patients. Using ROC curve, cut off values have been obtained for both groups. Results. CIMT in obese children born SGA was significantly increased as compared with obese children born AGA similar age, sex and BMI (p = 0.0035). A CIMT cut off value of 0.049 cm has been obtained with a high sensitivity and specificity. Conclusion. Being born SGA increases the atherogenic risk. CIMT is a well-known marker of subclinical atherosclerosis and is a noninvasive and inexpensive method for detecting development of subclinical atherosclerosis. Further population studies regarding reference values for CIMT in obese children born SGA and AGA are necessary. [ABSTRACT FROM AUTHOR]

Introduction: Multiple familiary exostoses is a rare hereditary bone disease that can affect both genders characterized by the growth of bone tumors (exostosis or osteochondomas) mainly at the extremities of the long bones. The onset may be from the infant period and up to the young adult. Aim: Presenting the case of a patient how was addmited with pain on her left thigh, discussing the diagnostic and therapeutic palette. Case Report: We present the case of an 8-year and 5-month-old female patient, from rural area who was admitted to the I st Pediatric Clinic of the Emergency Clinical Hospital for Children "Louis Turcanu", Timisoara for left thigh pain, accentuated by mobilization. The pacient had a thigh injury by falling in the parc. The clinical examination reveals a minimal echinosis (post-traumatic) in the mentioned area and a tumor at the level of the upper right arm. The patient has a positiv family history (the father) for multiple exostosis disease. This condition is suspected and investigated in our patient. Imaging investigations confirm this suspicion. Conclusion: Multiple familiary exostoses should be suspected in all patients who have parents with this condition. Disease management is complex: pediatrician, physical therapist, geneticist, surgeon. There is a need for a national registry of rare diseases to quantify them at national level. [ABSTRACT FROM AUTHOR]

The "catch-up growth" phenomenon in children born small for gestational age (SGA) has been linked to early onset obesity with the subsequent emergence of metabolic syndrome (MetS). The intima media thickness of the common carotid artery (CIMT) is a well-known marker of subclinical atherosclerosis. Aim: to determine the association between being born SGA and CIMT, a measure of atherogenesis and to investigate metabolic risk factors which impact on CIMT in obese children. Material and methods: A prospective study was carried out over a 1 year period (July 2012-June 2013). We analyzed 122 obese patients, 96 patients appropriate for gestational age (AGA) and 26 patients SGA. Both groups were matched for age, sex and BMI. Blood pressure, lipids and glucose were determined. Oral glucose tolerance tests (oGTT) were performed. Insulin resistance (IR) was assessed by homeostasis model assessment (HOMA). CIMT was measured in all the patients. Results: CIMT in obese children born SGA was significantly increased as compared with obese children born AGA similar age, sex and BMI (p=0.0035). We demonstrated a strong correlation between CIMT and all other metabolic factors (r=0.98). In both groups, mean CIMT of was significantly related to diastolic blood pressure, triglycerides and HOMA. CIMT was not significantly related to systolic blood pressure and baseline glucose. Conclusion: High triglycerides levels and low HDL-cholesterol levels, IR and diastolic blood pressure, which are all components of MetS are strong predictors of increased CIMT in obese children. Being born SGA increases the atherogenic risk. [ABSTRACT FROM AUTHOR]

Introduction: Neonatal hyperthyroidism occurs în infants from mothers with Graves Basedow, with an incidence of 1:70. Purpose: Highlighting the risks and complications that may appear în infants of mothers with Graves' disease. Method: The cases of three newborns resulted from risk pregnancies (mothers known with Graves' disease) diagnosed with neonatal hyperthyroidism, are addressed. Admission status and evolution of each case were different, depending on the mother's compliance regarding the treatment and on the mothers (TSI) antibody levels. în the first case, admitted at the age of one day with thyrotoxicosis, the mother interrupted treatment throughout pregnancy. In the two cases which followed treatment during pregnancy, mothers TSI level during pregnancy was different: the patient with high TSI levels originally developed subclinical hypothyroidism due to transplacental passage of oral antithyroid medication, subsequently developing clinical symptoms of hyperthyroidism (agitation, tachycardia, growth retardation). In the third case, the mother's hard to control, persistent, thyrotoxicosis, throughout the whole pregnancy, affected the intrauterine development (gestational week 33 weeks). He presented with a mild form of hyperthyroidism caused by low amounts TSI antibodies during the pregnancy. The evolution was favorable with the normalization of the thyroid function; at the age of 3 months, no maternal antibodies have been detected in infants. Discussion: The risk of newborn thyrotoxicosis represents an emergency, antithyroid treatment followed by the mother has an essential role; high doses increase the risk of perinatal hypothyroidism. The severity of the symptoms depends on the antibody (TSI) levels which cross the placenta. Conclusions: Monitoring the newborn from mothers with Graves' disease is essential; it should begin from the intrauterine period and continued until at the age of 3-6 months. Reaching euthyroidism în both mother and the newborn is difficult to obtain and requires interdisciplinary collaboration [ABSTRACT FROM AUTHOR]

Introducere: hipertiroidismul neonatal apare la nou-născuţii din mamă cu Graves Basedow, frecvenţa bolii fiind de 1:70. Scopul lucrării: sublinierea complicaţiilor ce pot să apară la nou-născuţii proveniţi din aceste mame. Material şi metodă: prezentarea a trei nou-născuţi provenind din sarcini cu risc (mame cunoscute cu Graves) diagnosticaţi cu hipertiroidism neonatal. Starea la internare şi evoluţia cazurilor au fost diferite, în funcţie de tratamentul urmat/sau nu şi de titrul de anticorpi (TSI) al mamei pe parcursul sarcinii. La primul caz, internat la vârsta de o zi cu tireotoxicoză, mama a întrerupt tratamentul pe parcursul sarcinii. La cazurile cu tratament urmat, TSI-ul mamei pe parcursul sarcinii a fost diferit: nou-născutul provenind din mamă cu TSI mare a dezvoltat iniţal hipotiroidism subclinic datorită pasajului transplacentar de antitiroidiene orale, ulterior dezvoltând simptomatologie clinică de hipertiroidism (agitaţie, tahicardie, curbă ponderală staţionară). Tireotoxicoza mamei greu controlabilă medicamentos la cazul trei a infl uenţat dezvoltarea intrauterină a fătului (vârsta gestaţională = 33 săptămâni). TSI-ul relativ mic pe tot parcursul sarcinii a determinat o formă uşoară de hipertiroidism la aces nou-născut. Evoluţia a fost favorabilă cu normalizarea funcţiei tiroidiene; la vârsta de 3 luni anticorpii materni nu au mai fost detectaţi la sugari. Discuţii: Tireotoxicoza la nou-născut constituie o urgenţă; tratamentul antitiroidian la mamă are un rol esenţial; dozele mari cresc riscul hipotiroidismului perinatal. Gravitatea simptomatologiei este dată de titrul de anticorpi (TSI) ce traversează placenta. Concluzii: Monitorizarea nou-născutului provenit din mamă cu boala Graves este esenţială; ea trebuie începută din perioada intrauterină şi continuată până la vârsta de 3-6 luni. Menţinerea eutiroidiei atât la mamă, cât şi la nou-născut este dificil de obţinut şi necesită o colaborare interdisciplinară. [ABSTRACT FROM AUTHOR]