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Children form a specific group of patients, as there are significant differences between children and adults in both anatomy and physiology. Difficult airway may be unanticipated or anticipated. Difficulties encountered during intubation may cause hypoxia, hypoxic brain injury and, in extreme situations, may result in the patient’s death. There are few paediatric difficult-airway guidelines available in the current literature, and some of these have significant limitations. This position paper, intended for unanticipated difficult airway, was elaborated by the panel of specialists representing the Polish Society of Anaesthesiology and Intensive Care as well as the Polish Neonatal Society. It covers both elective intubation and emergency situations in children in all age groups. An integral part of the paper is an algorithm. The paper describes in detail all stages of the algorithm considering some modification in specific age groups, i.e. neonates.

AIM: To explore the appropriateness of applying a detailed assessment of general movements and characterize the relationship between global and detailed assessment.METHOD: The analysis was based on 783 video recordings of 233 infants (154 males, 79 females) who had been videoed from 27 to 45 weeks postmenstrual age. Apart from assessing the global general movement categories (normal, poor repertoire, cramped-synchronized, or chaotic general movements), we scored the amplitude, speed, spatial range, proximal and distal rotations, onset and offset, tremulous and cramped components of the upper and lower extremities. Applying the optimality concept, the maximum general movement optimality score of 42 indicates the optimal performance.RESULTS: General movement optimality scores (GMOS) differentiated between normal general movements (median 39 [25-75th centile 37-41]), poor repertoire general movements (median 25 [22-29]), and cramped-synchronized general movements (median 12 [10-14]; pINTERPRETATION: Further research might demonstrate that the GMOS provides a solid base for the prediction of improvement versus deterioration within an individual general movement trajectory.

Liver's development process includes growth and maturing. These changes in the structure and function have a major impact on the way drugs and other xenobiotics undergo the processes of biotransformation. Medications and their metabolic products may be toxic to the liver as well as other organs of the body. This article is a review of knowledge about the development of liver, dynamic changes in its structure and function and hepatic toxicity of xenobiotics. Particular attention was paid to reviewing substances toxic for the newborn. It was considered necessary to take into account aspects of the anatomical, physiological and developmental susceptibility of liver to xenobiotics.

Objectives The assessment of the appearance of local complications associated with the use of different non-invasive ventilation techniques in neonates. Materials and Methods The study was conducted in a group of 103 neonates, in whom non-invasive ventilation was administered using different techniques. In these subjects non-invasive respiratory CPAP (conventional system) support was used with single lumen nasopharyngeal cannula, double lumen Hudson type short cannula as well as the Baby Flow and the Infant Flow systems for administration of all modes of ventilation. Data were collected based on own observations and on medical records of the neonates treated in the Neonatal Intensive Care Department of the Medical University of Warsaw between 21.01.2008 and 06.05.2009. Results The average duration of the different non-invasive ventilation techniques was 7.77 days (min. 1 day, max. 32 days). Skin complications were mainly concerned with the nasal structures and were of varying intensity: from transient ischemia, erythema, dermal abrasion, bleeding, necrosis and narrowing of the lumen of the nasal passages (edema of the nasal mucosa). Complications associated with the use of the Baby Flow and Infant Flow systems were dependent upon the type of nasal tip. In cases when a mask was used, the most frequent type of complication concerned lesions of the base of the nose (34 cases) and lesions of the upper labial sulcus (13 cases). Complications involving the nasal septum (8 cases) were associated with the use of short double lumen nasal cannulae with the Baby Flow and Infant Flow systems as well as with Hudson type cannulae (2 cases). Necrosis of the nasal septum was associated with the use of Hudson type cannulae in two neonates. Conclusions The number of complications affecting the skin associated with the use of non-invasive ventilation is dependent on the maturity of the neonate, the body mass and the duration of ventilation. Complications affecting the skin are markedly more frequent in those cases when masks are used compared with the use of short double lumen cannulae, and they mainly affect the base of the nose. Undoubtedly, the majority of complications are transient in nature.

Preterm infants are very susceptible to infections. Immune response mechanisms in this group of patients and factors that influence cord blood mononuclear cell populations remain poorly understood and are considered insufficient. However, competent immune functions of the cord blood mononuclear cells are also described. The aim of this work was to evaluate the T-cell population (CD3+) with its subpopulations bearing T-cell receptor (TCR) αβ or TCR γδ in the cord blood of preterm infants born before 32 weeks of gestation by mothers with or without an intrauterine infection. Being a pilot study, it also aimed at feasibility check and assessment of an expected effect size. The cord blood samples of 46 infants age were subjected to direct immunofluorescent staining with monoclonal antibodies and then analyzed by flow cytometry. The percentage of CD3+ cells in neonates born by mothers with diagnosis of intrauterine infection was significantly lower than in neonates born by mothers without infection (p = 0.005; Mann–Whitney U test). The number of cells did not differ between groups. Infection present in the mother did not have an influence on the TCR αβ or TCR γδ subpopulations. Our study contributes to a better understanding of preterm infants’ immune mechanisms, and sets the stage for further investigations.

The objective of the study was to assess cerebral mass, based on head circumfer- ence measurements in neonates exposed to tobacco smoke in utero, and to deter- mine the relative proportions of the cerebral and body mass. The study included 147 neonates born in the period 2003–2004 at the Princess Anna Mazowiecka University Hospita land admitted to the Neonatal and Intensive Care Department of the Medical University in Warsaw. Subjects were divided into three groups on the basis of maternal status as active, passive, or nonsmokers determined by materna lurinary cotinine concentration and a questionnaire. Neonates whose mothers were active smokers throughout the whole period of pregnancy had a lower head circumference and in consequence a lower cerebral mass significantly more frequently when compared with those whose mothers were nonsmokers, P=0.002. (Median difference in cerebral mass was 48.27 g.) The risk of lower cerebral mass was 3.9 (1.4–10.8, CI 95%) in the group of neonates whose mothers actively smoked cigarettes during pregnancy. A negative correlation was seen between cerebral mass and maternal urinary cotinine concentration (correlation coefficient r=−23, P=0.006). The ratio of the cerebral to body mass was similar for neonates in all three groups. Active smoking during pregnancy had a negative effect on the cerebral mass of theneonate, however no such effect was observed in neonates whose mothers were passive smokers. The deficiency in cerebral mass increased with greater smoking intensity. Active smoking by the mother during pregnancy inhibits the growth of the brain as well as that of the body mass of the neonate.

Streszczenie Odsetek porodow przedwczesnych w Polsce od kilku lat utrzymuje sie na stalym poziomie i wynosi okolo 6%. Noworodki urodzone przedwcześnie – miedzy 22. a 37. tygodniem ciązy, stanowią grupe ryzyka zwiekszonej zachorowalności miedzy innymi na choroby zakaźne, jak: blonica, odra, krztusiec, zapalenie pluc i grypa. Hospitalizacja tych dzieci wiąze sie czesto z 4–5 miesiecznym pobytem w oddziale noworodkowym i jest bardzo kosztowana. Problemy niestety nie konczą sie wraz ze zwolnieniem noworodka do domu. Jednym z zasadniczych jest znaczne opoźnienie w terminowym zaszczepieniu tych dzieci. Mimo zalecen Amerykanskiej Akademii Pediatrii, Polskiego Towarzystwa Neonatologicznego i Polskiego Towarzystwa Wakcynologicznego, dzieci te nie są szczepione przez lekarzy rodzinnych wedlug wieku chronologicznego. Istnieje aktualnie wiele badan dotyczących noworodkow z malą i ekstremalnie malą masą ciala potwierdzających skutecznośc, bezpieczenstwo i dobrą tolerancje podstawowych szczepien przeciwko blonicy, tezcowi, bezkomorkowej szczepionki przeciwkrztuścowej, pneumokokowej czy szczepionki przeciwko Haemophilus influenzae. W Klinice Neonatologii i I ntensywnej Terapii Noworodka WUM rozpoczeliśmy szczepienia w 2. miesiącu zycia noworodkow w dobrym stanie lub nieco poźniej po ustabilizowaniu stanu klinicznego, zwykle kilka dni przed wypisem. Wykonywanie szczepien podczas hospitalizacji zapewnia noworodkom maksymalne bezpieczenstwo i pozwala na dobrą ocene ewentualnych objawow niepoządanych (bezdechy, zaburzenia krązenia). Wdrozenie takiej procedury zwiekszy na pewno odsetek dzieci zaszczepionych, zmniejszy obawy lekarzy rodzinnych i rodzicow przed wykonywaniem kolejnych szczepien i przyczyni sie do skrupulatniejszego przestrzegania obowiązującego kalendarza szczepien.

Streszczenie Wstep Syncytialny wirus oddechowy (RSV) wywoluje corocznie epidemie zakazen dolnych drog oddechowych i jest glowną przyczyną hospitalizacji dzieci Cel pracy Ocena czestości zakazen ukladu oddechowego u dzieci z dysplazją oskrzelowo-plucną (BPD) otrzymujących paliwizumab oraz tolerancji immunoprofilaktyki. Material i metody Wieloośrodkowe, retrospektywne, nieinterwencyjne badanie przeprowadzone w 25 ośrodkach w Polsce. Wlączono 577 dzieci (w wieku 4–102 tygodnie zycia; urodzone w 22.– 34. tygodniu ciązy) z BPD, ktorym podano przynajmniej jedną dawke leku. W specjalnie opracowanym formularzu odnotowano wszystkie epizody zakazen drog oddechowych i hospitalizacji. Określono dzialania niepoządane i tolerancje leku oraz liczbe i przyczyne zgonow. Wyniki Podano 2001 dawek leku oraz zaobserwowano 436 epizodow zakazen drog oddechowych. Odsetek pacjentow z co najmniej jednym epizodem zakazenia drog oddechowych zmniejszyl sie z 22,9% po pierwszej dawce paliwizumabu do 7,5% po piątej, ale redukcja nie osiągnela istotności statystycznej (p=0,0524). Zmniejszenie odsetka pacjentow z co najmniej jednym epizodem zakazenia drog oddechowych bylo spowodowane systematycznym, znamiennym statystycznie zmniejszeniem sie liczby epizodow zakazen z zajeciem dolnych drog oddechowych z 11,1% (62/557) po pierwszej dawce do 0% (0/93) po dawce piątej (p Wnioski 1. Po kolejnych dawkach paliwizumabu stwierdzono statystycznie istotne zmniejszenie liczby epizodow zakazen dolnych drog oddechowych i hospitalizacji z przyczyn oddechowych oraz czestośc podazy kortykosteroidow i bronchodylatatorow. 2. W zadnym przypadku przyczyną zgonu nie bylo zakazenie RSV. 3. Czestośc dzialan niepoządanych byla niska. 4. Profilaktyka paliwizumabem potwierdzila skutecznośc dzialania i celowośc wprowadzenia jako obowiązujący program.

Streszczenie Noworodki, zwlaszcza urodzone przedwcześnie, są szczegolnie narazone na infekcje w okresie okoloporodowym. Rozwij ający sie uklad odpornościowy podczas ciązy znajduje sie w stanie naturalnej supresji, gdyz jego nadmierna aktywacja moze skutkowac m.in. przedwczesną akcją porodową, a nawet obumarciem plodu. Znaczącą role w odporności noworodka przypisuje sie mechanizmom wrodzonym, czyli nieswoistym, mechanizmy swoiste wyksztalcają sie poźniej. Potrzeba czasu, by uklad immunologiczny podjąl swoją prawidlową funkcje, a okres przejściowy moze byc trudniejszy w przypadku wcześniakow.

Martwicze zapalenie jelit jest najczestszym stanem naglym dotyczącym przewodu pokarmowego wystepującym u wcześniakow oraz najczestszą przyczyną interwencji chirurgicznej na oddziale intensywnej terapii noworodka. W erze surfaktantu, wraz z zwiekszeniem przezywalności noworodkow z ekstremalnie malą masą ciala, wzrosla czestośc NEC. NEC prawie wylącznie wystepuje u noworodkow urodzonych przedwcześnie (>90%). Ponad 90% z tych noworodkow rodzi sie z masą ciala ponizej 2000 g. Wcześniactwo jest jedynym powtarzającym sie w badaniach kohortowych czynnikiem ryzyka wystąpienia NEC, a zachorowalnośc jest mala, w krajach, w ktorych odsetek wcześniactwa jest niski. NEC u noworodkow donoszonych charakteryzuje sie mniej nasilonym przebiegiem klinicznym. Obserwacje te sklaniają wielu badaczy do opinii, ze u noworodkow donoszonych wystepuje inna jednostka chorobowa niz NEC, choc o bardzo podobnym przebiegu. NEC wystepuje z czestością 1–3/1000 zywych urodzen (dane amerykanskie) i najcześciej dotyczy noworodkow urodzonych pomiedzy 30 a 32 tygodniem ciązy. Rozpoznanie jest najcześciej ustalane w drugim tygodniu zycia i wystepuje u noworodkow, u ktorych rozpoczeto zywienie enteralne. Śmiertelnośc z powodu NEC wynosi 10–50%. Do najczestszych powiklan martwiczego zapalenia jelit nalezą m.in. zespol krotkiego jelita oraz zaburzenia wchlaniania. W niniejszym artykule omowione zostaną patofizjologia martwiczego zapalenia jelit oraz mechanizmy obronne i reakcja zapalna zachodzące w trakcie trwanie tej choroby w organizmie noworodka przedwcześnie urodzonego.

Flora bakteryjna przewodu pokarmowego odgrywa zasadniczą role w metabolicznych procesach immunologicznych i wykazuje naturalne wlaściwości obronne przeciwko bakteriom chorobotworczym. W momencie porodu przewod pokarmowy noworodka jest jalowy. Ksztaltowanie sie prawidlowej flory jelitowej zalezy od skladu mleka matki. Mleko matki ma unikatowe wlaściwości immunologiczne i odzywcze. Zawiera wiele bioaktywnych czynnikow, ktorych znaczenie w pierwszych dniach zycia wplywa w sposob zasadniczy na ksztaltowanie ekosystemu, jakim jest przewod pokarmowy noworodka. Sterylny pokarm naturalny bezpośrednio po porodzie staje sie szybko siedliskiem bakterii tych „dobrych”, ale niekiedy takze patogennych. W stolcu zdrowych karmionych piersią noworodkow urodzonych silami natury dominują bifidobakterie i bakterie z rodzaju Lactobacillus. U noworodkow urodzonych przedwcześnie obserwujemy opoźnioną kolonizacje tych bakterii. Źrodlem bakterii kwasu mlekowego w mleku kobiecym są: pozywienie matki, skora wokol gruczolu piersiowego, jama ustna, gardlo i nos noworodka. Flora bakteryjna przewodu pokarmowego noworodka zalezy od rodzaju porodu, kolonizacji szyjki macicy i pochwy, diety matki, antybiotykow.

Pokarm matki jest najlepszym pozywieniem dla noworodka w pierwszych 6 miesiącach zycia i stwarza optymalne warunki dla jego rozwoju. Istnieje tylko kilka chorob, w ktorych pokarm matki nie jest zalecany. Nalezą do nich: zakazenie matki wirusem HIV i ludzkim wirusem limfotropowym komorek T typu I i II, choroby matki wymagające zastosowania chemioterapii i radioterapii, narkomania u matki. Poza tymi, nie budzącymi zadnych wątpliwości, przeciwwskazaniami istnieje kilka innych, mniej bezwzglednych. Wiedza ich dotycząca jest szczegolnie istotna ze wzgledu na czeste pytania matek dotyczące bezpieczenstwa karmienia i ewentualnego zagrozenia dla dziecka wiązącego sie z ich pokarmem. W pracy omowiono wytyczne związane z karmieniem piersią w takich chorobach matki, jak zapalenie wątroby typu A, B, C, zakazenie wirusem ospy wietrznej, cytomegalii, opryszczki, grypy, gruźlica, cukrzyca, alergia.

Purpose We hypothesised that abnormal genital tract colonisation leading to an in utero inflammation/infection process, contributes to the risk of respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), intra ventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP) and necrotizing enterocolitis (NEC) in preterm infants. Methods 396 placentas and umbilical cords of neonates born at 22–32 weeks of gestation were evaluated. Genital tract and amniotic fluid swabs were cultured for aerobic and anaerobic bacteria. Results Chorioamnionitis significantly increases the risk for RDS (OR 1.74, 95% CI 1.14–2.65), NEC (OR 3.22, 95% CI 1.36–3.28) and ROP > 2 (OR 2.12, 95% CI 1.33–3.36). But the risk for IVH, PDA and BPD did not differ between the groups. Klebsiella pneumoniae (OR 5.33, 95% CI 1.06–26.79), Staphylococcus sp. (OR 18.39, 95% CI 2.32–145.2) and Enterococcus faecalis (OR 10.7, 95% CI 1.27–89.9) showed a significant relationship with intrauterine inflammation processes. E. faecalis increased the risk for NEC (OR 6.13, 95% CI 1.059–37.6). We did not note a link between ROP and genital tract colonisation. Interestingly PDA seems to be triggered by the presence of Pseudomonas aeruginosa (OR 2.38 95% CI 1.83–3.82). Conclusion Our results show a link between K. pneumoniae , Staphylococcus sp., E. faecalis and intrauterine infection. E. faecalis increases the risk for NEC, and suggests a direct link between gram + bacteria, chorioamnionitis and NEC.

The objective of this study was to determine neonatal anthropometric indices such as: birth weight, crown-heel length, head and chest circumference and ponderal index , in relation to the maternal smoker status (active and passive smoking). The study included 147 neonates born in 2003-2004 at the Princess Anna Mazowiecka University Hospital in Warsaw admitted to the Neonatal and Intensive Care Department of Warsaw Medical University. Neonates were assigned to one of three groups: babies of mothers who were active smokers, passive smokers and non-smokers based on a questionnaire concerning exposure to tobacco smoke and on the concentration of cotinine in maternal urine. The babies of mothers who were active smokers were born with lower birth weight (p=0.033), lower crown-heel length (p=0.026), lower head circumference (p=0.002) and lower chest circumference (p=0.021) significantly more often than babies of non-smoker mothers. Babies whose mothers were active smokers had an increased risk of lower head circumference or 3, 9 (1, 4-10, 7, CI 95%), and an increased risk of lower chest circumference OR 4, 0 (1, 5-10, 9, CI 95%). The babies of mothers who were passive smokers also had lower anthropometric indices, but the differences were not statistically significant. No effect on ponderal index was observed among the neonates whose mothers were active and passive smokers. Smoking during pregnancy causes symmetrical restriction of intrauterine growth.

The paper discusses the reliability of the Apgar score for evaluating newborns, particularly its usefulness in assessing the state of preterm or full term newborns born with hypoxia.The paper provides a sum-up of the opinions on usefulness and reliability of the Apgar score given by doctors from 255 NICUs.Data for the analysis were gathered by means of a questionnaire opinion poll sent to 158 primary referral centers, 71 secondary referral centers and 26 tertiary referral centers. Respondents answered questions about value of the Apgar score assessment (highly valuable, limited value, always reliable), as well as overrating and underrating children born in good overall condition and children born with clinical and biochemical indicators of hypoxia. In the group of prematurely born babies, the data concerning newborns with very low (VLBW) and extremely low birth weight (ELBW) were analyzed separately88.5% neonatologists claimed the use of the Apgar score in assessing newborn condition to be of little value and only 11.5% found this indicator useful and reliable.According to the majority of Polish neonatologists, Apgar score is not reliable in the assessment of term and preterm hypoxic newborns.

The survival rate and quality of life of extremely low birthweight infants remain to be one of the main challenges of modern neonatology. Therefore, pre-term children born after 32 weeks of gestation with more normal birthweight, have become a relatively minor medical problem in comparison.The aim of the following work was to compare the frequency of complications occurring in neonatal period in groups of late preterms and full-term neonates.A group of 725 late pre-term babies, born between 34-36 6/7 GA, constituted the study group and has been analyzed retrospectively 5040 neonates born at term comprised the control group. The results were analyzed statistically using chi-square test.Respiratory disturbances were diagnosed in 178 neonates in the study group (24.55%), while in the control group in 138 cases (2.74%), p = 0.0000. Intrauterine infections were present in 92 neonates in the study group (12.69%) and in 327 infants in the control group (6.49%), p = 0.0000. Hiperbilirubinemia developed in 520 neonates in the study group (71.72%), and in 1895 babies in the control group (37.60%), p = 0.0000.(1) Respiratory disturbances, hiperbilirubinemia and intrauterine infections are more frequently observed in late preterms. (2) Increased morbidity in late preterm neonates prolongs the time of hospitalization.

Although neonatal care has become more and more meticulous with significant changes in technology in the neonatal intensive care unit (NICU) in the past 50 years, iatrogenic cutaneous injuries continue to occur. Although the incidence of severe injuries is decreasing because the more difficult procedures are being replaced by improved techniques, skin injuries have not yet been completely eliminated. However, the nature and causes of cutaneous injuries have changed, and the injuries are frequent but generally minor. The major risk factors are low birth weight, gestational age, length of stay, a central venous line, mechanical ventilation, and support with continuous positive airway pressure. The rate of iatrogenic events is about 57% at gestational ages of 24-27 weeks, compared with 3% at term. There are no current comprehensive reviews of iatrogenic cutaneous injury. The purpose of this review is to describe the iatrogenic cutaneous injuries that may occur in the newborns as a consequence of perinatal and postnatal medical procedures. With increased survival of extremely-low-birth-weight (ELBW) infants and changing modes of management in the NICU, neonatologists must make every effort to recognize injuries and prevent their occurrence in the NICU.

The aim of this work was the assessment of the clinical condition, birth weight, frequency of premature birth and incidence of intrauterine growth restriction (IUGR) of the newborns whose mothers were active and passive smokers. This was a prospective study conducted in a group of 147 newborns born during the years 2003-2004 in the Princess Anna Mazowiecka Hospital, Warsaw, and hospitalized in the Neonatal and Intensive Care Department of Warsaw Medical University. Based on a questionnaire identifying the exposure to tobacco smoke and cotinine concentration in the mother's urine, the newborns were assigned to three groups: the newborns whose mothers were active smokers, the newborns whose mothers were passive smokers and the newborns of non-smoking mothers. There were no statistically significant differences in the Apgar score assessment at the 1st and 5th minute between the three groups of the newborns. Acid-base balance parameters (pH, BE) were also similar. The birth weight of the newborns of mothers who were active smokers was 325g lower than the birth weight of the newborns of non-smoking mothers. This difference was statistically significant p = 0.033. Maternal smoking in pregnancy was associated with an increased risk of deficit in birth weight 2.6 (1.0-6.9, CI 95%). In the group of the newborns whose mothers were active smokers, the incidence of lower birth weight (2500g) was also statistically significantly higher p = 0.01. There were no statistically significant differences in the incidence of premature birth and intrauterine growth restriction (IUGR).

Encephalopathy in a common neonatological sense is a term referring to a complex of clinical symptoms occurring in term infants in the first days of their life as a result of hypoxic-ischemic lesions. However, if we accept the encyclopedic definition of encephalopathy as a vast or multifocal brain lesions caused by a variety of factors, we may use the term to describe all patients with traumatic, hypoxic or toxic brain lesions, and therefore also newborns at different levels of maturity. Contrary to term newborns, in which case the hypoxic-ischemic encephalopathy are mostly intrauterine, for preterm infants there is a number of factors which destroy neural tissue postnatally The occurrence of those factors is often influenced by elements of essential intensive care. The article describes the most common biochemical disturbances and clinical causes.

As a result of a national survey we have proposed guidelines and recommendations for techniques of central veins catheterization in newborns. This procedure is widely used in every day clinical practice in neonatal intensive care units. Standards, which are being introduced, should make management of sick newborns uniform, especially in LBW and ELBW infants.

Parenteral nutrition is essential for premature infants during their first days of extrauterine life, when enteral feeding is not tolerated. Lipid emulsions are an integral part of parenteral nutrition. The aim of the study was to compare the effects of two lipid emulsions, based on olive-oil and soybean oil, used in parenteral nutrition of premature infants on: plasma lipid concentrations and hyperbilirubinemia based on plasma bilirubin levels and phototherapy times.Forty-four premature infants aged less than 32 weeks of gestation and with birth weight below 1500 g were randomized within first 48 hours of life, to receive in double-blind manner olive oil based (ClinOleic) or soybean oil based (Ivelip) emulsions. Plasma lipid concentration and bilirubin level were determined at 7(th) day of life.Thirty-eight infants completed the study, 18 in the olive oil group (27+/-2 GW, 936+/-218 g) and 20 in the soybean oil group (27+/-2 GW, 924+/-221 g). Both lipid emulsions were well tolerated and plasma lipid concentration were within a normal range, however in olive-oil group plasma cholesterol concentration (159+/-19.89 mg% vs. 128+/-8.85 mg%, p0.0126) and plasma LDL concentration (103.36+/-8.85 mg% vs. 78.87+/-7.59 mg%, p0.0342) were significantly higher. Plasma bilirubin levels and phototherapy times did not differ among the groups.Both lipid emulsions were well tolerated, maintained normal plasma lipid concentration and did not increase plasma bilirubin level.

Determination of xenobiotics in hair has become common in evaluation of exposure to drugs. It can be used to assess the drug intake among adults and exposure to these substances in prenatal period. The aim of this study was the nicotine determination in hair of newborns' whose mothers were smoking during pregnancy. Also the relationship between concentration of cotinine--the main metabolite of nicotine in the urine of mothers and nicotine concentration in their infants' hair has been evaluated. The group of 15 women who had been smoking during pregnancy and 10 non-smoking and not exposed to ETS women and their newborns were the subject of the study. The cotinine levels in maternal urine samples was measured by the high performance liquid chromatography (HPLC) with a spectrometric detection, with the use of norephedryne as an internal standard, after a prior extraction with the use of liquid-liquid technique. Nicotine assess in infants' hair was carried out by means of gas chromatography coupled with mass spectrometry, with the use of ketamine as an interior standard, after the prior extraction with the use of liquid-liquid technique. The mean cotinine concentration in the group of smoking women amounted to 1132.5+/-1236.3 ng/mg creatinine and the level of nicotine in hair of children amounted to 1.9+/-3.2 ng/mg of hair. In the group of non-smoking women the urine cotinine test showed that two patients were exposed to the tobacco smoke. Nicotine in their children's hair was below the detection limit. The demonstrated correlation between the nicotine concentration in infants' hair and the cotinine levels in mothers' urine shows that the source of fetal exposure to tobacco smoke constituents is smoking during pregnancy. The applied gas chromatography method/mass spectrometry method allows to evaluate the level of nicotine in hair of the newborns, whose mothers were smoking during pregnancy, however it seems that in the case of exposure to ETS a more sensitive method, such as gas or liquid chromatography coupled with tandem mass spectrometry has to be applied.

An important problem, particularly from the point of view of the medicine, is active tobacco smoking and passive exposure to tobacco smoke of pregnant women and unfavourable health aftermath for the foetus and a newborns resulting from this. The aim of this study was to evaluate the exposure of smoking mothers to tobacco-specific N-nitrosamines, through the measurement of 4-(metylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL) in urine. The evaluation of tobacco smoking was performed on the basis of questionnaire studies and determination of cotinine in urine. The questionnaire studies that have been carried out, allowed the patients to be divided into two groups: women who do not smoke and are not exposed to ETS (17 women), and the ones who smoke (14 women). The women who smoked 11-15 cigarettes a day and more than 16 cigarettes constituted the largest percentage. The conformance of the declaration with the real exposure to tobacco smoke within the group of non-smoking women was 88%. Within the group of non-smoking women, the level of cotinine in 15 cases was 0 ng/ mg of creatinine, whereas in two cases, it amounted to 19.4 and 215.4 ng/mg of creatinine respectively. Among the persons, who were smoking, there were 4 cases, where the biomarker's level was 0 ng/mg of creatinine, and in 10 cases, the mean concentration of cotinine was 169.1 +/- 121.8 ng/mg of creatinine. The measurement of the content of tobacco-specific N-nitrosamines (NNAL- metabolite of NNK) in the urine of pregnant woman was carried out by means of the liquid chromatography/tandem mass spectrometry (LC/MS/MS). The analysis of obtained results showed that the mean concentration of NNAL in urine of smoking women was 59.2 +/- 40.2 pg/ ml. In the case of two patients, who declared to be non-smokers, and in the case of whom, the presence of cotinine was detected (19.4 and 215.4 ng/mg of and 88.4 pg/ml. The presence of 4-(metylnitrosamino)-1-(3-pyridyl)-1-butanol in the mother's urine, speaks volumes for the possible risk of exposure of a foetus to the cancerogenic components of tobacco smoke. The applied LC/MS/ MS method of determination of NNAL in urine, which allows the quantity of several pg/ml of the smoker's urine to be determined, can be used to mark the biomarker of exposure to the tobacco-specific N-nitrosamines. The lack of correlation between cotinine and NNAL concentration in urine, and the number of smoked cigarettes, speaks volumes for the lapse of quite a long time from the moment of cigarette smoking to the moment of collection of the biological material for research and the possible incredible declaration as to the number of smoked cigarettes. Only a slight tendency for the increase in the concentration of NNAL as well as the increase in the cotinine level could be caused by the difference in pharmacokinetic parameters of marked metabolites at the moment of smoking cessation.

One possible mechanism of lowering of the birth weight by tobacco smoke is disturbance in zinc transfer trough placenta caused by accumulation of cadmium in placenta. The aim of the study was determination of cadmium and zinc in placenta of smoking women and correlation its with cotinine concentration and birth weight The study shown that concentration of cotinine in urine of smoking woman was 859+/-1234 ng/mg creatinine. Cadmium and zinc concentrations in smokers were higher (Cd 0.095+/-0.041 microg/g; Zn 46.7+/-8.3307 microg! g) than in non smokers (Cd 0.067 +/-0.022 microg/g; Zn 41.0+/-5.54 microg/g). Concentration of cadmium in placenta shown week correlation with concentration of cotinine in urine. The birth weight of newborn of smoking women (2935.7+/-836.83 g) was statistically lower than non smokers (3288.9 +/-744.47 g), however it was not correlated with placenta cadmium and zinc concentration. The high variability of the ratio of zinc to cadmium concentration caused that was not statistical differences between studied groups. The performed research shown the influence of cigarette smoking of birth weight and cadmium concentration in placenta, however did not proved the hypotheses that accumulation of cadmium and zinc in placenta influence on birth weight.

Background and Objective. Evidence sug- gests that synthetic surfactants consisting solely of phos- pholipids can be improved through the addition of pep- tides, such as sinapultide, that mimic the action of hu- man surfactant protein-B (SP-B). A synthetic surfactant containing a mimic of SP-B may also reduce the potential risks associated with the use of animal-derived products. Our objective was to compare the efficacy and safety of a novel synthetic surfactant containing a functional SP-B mimic (lucinactant; Discovery Laboratories, Doylestown, PA) with those of a non-protein-containing synthetic surfactant (colfosceril palmitate; GlaxoSmithKline, Brentford, United Kingdom) and a bovine-derived sur- factant (beractant; Abbott Laboratories, Abbott Park, IL) in the prevention of neonatal respiratory distress syn- drome (RDS) and RDS-related death. Methods. We assigned randomly (double-masked) 1294 very preterm infants, weighing 600 to 1250 g and of

The aim of the studies was evaluation smoking habit by delivering woman using objective method--determination of cotinine in urine and placenta. In the study participated 93 woman delivering in Gynaecological-Obstetric Clinical Hospital of Medical University at Warsaw. Evaluation of tobacco smoking and exposure to ETS performed on the base of questionnaire and level of cotinine in urine. In the group of non smoking woman cotinine was not detected any in urine any in placenta. In the second group (19 patients), woman exposure to ETS concentration of cotinine in urine was 28.9 +/- 14.9 ng/mg of creatinine and only in two placentas was detected a low level of cotinine. In smoking delivering woman the urine concentration was 837.0 +/- 1324.5 ng/mg of creatinine and 21.3 +/- 7.5 ng/g placenta calculated from all results and 67.0 +/- 3.5 ng/g calculated only from positive results. A weak relation between concentration of cotinine in placenta and urine of smoking woman was shown.

Tobacco smoke contain few thousands of chemical compounds, among them heavy metals. From toxicological point of view most important are lead, cadmium and radioactive polonium 210. The aim of the study was determination of cadmium in urine of tobacco smoking pregnant woman and checking if there is a correlation between the concentration of cadmium and cotinine, the most frequently used tobacco smoke biomarker. The study showed that concentration of cotinine in urine of smoking women was 702.5 +/- 1131.4 ng/mg creatinine and ranged from 50 to more than 6000 ng/mg creatinine. Cadmium concentration in smokers was 1.6 +/- 2.6 ng/ml and ranged from 0 to 11.5 ng/ml. In urine of woman who do not smoke and are not exposure to ETS was 1.1 +/- 2.2 ng/ml in the range 0-2.5 ng/ml and was not statistically different from concentration of cadmium in urine of smoking pregnant woman. In any one non-smoking woman, concentration of cadmium was not higher than 5 ng/ml, but in 11.8% of smoking women this level was exceeded. Calculations showed a weak correlation between concentration of cadmium and cotinine in urine of smoking pregnant women.

Neonatal sepsis is frequently associated with pathological activation of the coagulation system, leading to multiple organ dysfunction. Activated protein C has been shown to prevent thrombin generation during this process and improve microcirculation.We present the case of a full term septic neonate admitted for tertiary intensive care with multiple organ failure, including ARDS with severe pulmonary hypertension, renal failure, and disseminated intravascular coagulation. After initial resuscitation with volume expansion, catecholamines, pentoxifylline and nitric oxide, a diagnosis of severe systemic enteroccocal sepsis was made and vancomycin-meropenem therapy was started. Because available standard treatment, including platelet transfusion, did not improve the coagulation status, it was decided to give recombinant human activated protein C (drotrecogin alpha Xigris, Elli Lilly, USA - rhAPC) in 24 mcg kg(-1) h(-1) continuous four-day infusion. Six hours after the start of infusion all coagulation parameters returned to normal. No side effects were observed. Renal function was restored after 36-hr hemofiltration. Treatment success was due to several factors, including resuscitation from cardiogenic shock, effective antibiotic therapy, hemofiltration, and combined rhAPC-pentoxifylline therapyThe positive outcome of this case indicates that rhAPC can be safely used in infants. A large-scale study of the effectiveness of drotrecogin alpha in pediatric population is indicated.

The aim of our study was to assess frequency of ROP in VLBW and ELBW treated with rhEPO in preventing anemia. In 36 newborns with birth weight 480 to 1490 g (median 1032 g) and 24 to 32 weeks of gestational age (median 28.0 weeks) we have estimated concentration of cord erythropoietin. According this concentration we have divided our material into two groups. In first group of 22 newborns with cord concentration of EPO10 mU/ml we started early erythropoietin (rhEPO) therapy which was continued by 6 weeks. Second group of 14 no early usage newborns had cord EPO concentration10 mU/ml. In second group the control level of serum EPO was measured in 15th day of life. In newborns from second group in which the EPO concentration during two weeks decreased below 10 mU/ml we started to use rhEPO as a late usage. First oculistic consultation took place in the 5th week of life according to the screening performed in our country. In the first group (n = 22) with early EPO treatment retinopathy was recognized in 15 preterm newborns (68.2%). Eight of them (53.3%) had advanced form of retinopathy ROP (III lub III+) and were undergone a laserotherapy. In the group of late usage of rhEPO (n = 14) 8 newborns (57.1%) had signs of retinopathy, but only 3 of them (37.5%) required laserotherapy because of advanced form of ROP (III lub III+).

The aim of this preliminary study was the estimation of renal blood flow in 16 premature newborns from twin pregnancies with mean body weight 1270 g and mean gestational age 29 weeks.In control group we have 16 singleton newborns with mean gestational age 29 weeks and mean birth weight 1240 g. In both intervention and control group we have the similar clinical symptoms. The renal blood flow was carried out in the first day of life with the Acuson 128 XP Colour Doppler using the 6 and 7 MHz linear transducer. The renal blood flow parameters-PI, RI, Vmax, Vmin Vmean were measured in right and left renal arteries in theirs courses from the aorta to the renal hilus, by color sinal. In the investigation group the mean value of RI in right and left renal artery was 0,88. Mean PI in right vessel was 1,67 and in left 1,56. Mean V min in right and in left artery was 0,03 and mean V max in right artery was 0,34 and in left 0,33. Mean value of mean velocity in right vessels was 0,18 and in left 0,19.In control group we observed in right artery mean value of PI 1,74 and in left 1,6. Mean RI was 0,86 and 0,86 in right vessel in left vessel. Mean V min was 0,05 in right and 0,04 in left artery. Mean V max was 0,37 in right and 0,34 in left artery. Mean value of V mean was 0,19 in right artery and 0,18 in left artery.Using the student, Mann-Whitney and Shapiro-Wilk tests we have not observed statistically significant difference of Doppler parameters between control and investigation group and between the left and right artery. Although in newborns with broad PDA we noted significant higher value of RI (0,97, 0,98) than in newborns without PDA (0,78, 0,81).