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This study is part of a European survey on delivery room practices endorsed by the Union of European Neonatal and Perinatal Societies (UENPS) and the Romanian Association of Neonatology (ANR). The aim of our study was to evaluate the current neonatal resuscitation practices in Romanian maternity hospitals and to compare the results between level III and level II centers.

Higher education institutions bears a great responsibility for the local, regional and national environment impacting them as well as the graduates and their future decisions. The concept of a sustainable university should comprise all three fields of sustainable development: a healthy environment, economic performance, and social cohesion. All things considered, the universities from Romania need to focus their attention on incorporating sustainability principles into everyday activities and structures: management performance (vision, mission, strategy), education and research (programmes, curricula, teaching methods), operations, forming networks and reporting to stakeholders (sustainability indicators). This research proposes a methodology to translate how the theoretical concept of a sustainable university is translated into practical tools for coordinating continuous improvement efforts put into sustainability. The methodology is based on the PDCA cycle. Moreover, this paper encourages universities from Romania to improve their strategic objectives through the integration of sustainable de velopment principles within their academic activities and strategies. Therefore, a new approach and tool for continuous improve ment and assessment of sustainability can be implemented in higher education, in Romania, in total compliance with the re quirements of European and international sustainability standards. In order to im prove the quality of Romanian higher education and administration, several conclusions and recommendations have been suggested for the implementation of this new approach. [ABSTRACT FROM AUTHOR]

This article makes a review of literature data on an extremely special category of infants - premature neonates with intrauterine growth restriction (IUGR). The antenatal recognition of a true fetal growth restriction helps prevent or decrease the mortality rate and neonatal morbidity. Prenatal and postnatal Doppler velocimetry has a great contribute to the differentiation of healthy SGA and real IUGR but also a challenge to predict which of the fetuses are at high risk for negative outcomes, and there are currently few understandable things about monitoring and treatment strategies most appropriate for preterm infants with RCIU. An international initiative to address these issues would be of great importance to improve the care of the group with IUGR. [ABSTRACT FROM AUTHOR]

Introduction. Neonatal intestinal ischemia is a frequent pathology, but unfortunately, often underdiagnosed. Current technique allows non-invasive investigation of splanchnic circulation, being capable of detecting early perfusion changes that occur at this level. Objectives. The aim of this study was to determine the clinical value of infrared spectroscopy (NIRS) in early detection of ischemic bowel modifications in newborns from neonatal intensive care unit. Material and methods. We performed a prospective observational study over a period of 18 months, on a group of 15 newborns with gestational age between 25-38 weeks. All infants included in the study had one or more clinical signs of digestive pathology. Starting non-invasive continuous monitoring by cerebral and abdominal NIRS was performed according to the appearance of the first digestive changes between day 3 and 21 of life. Oxygen saturation was measured in the cerebral and abdominal regions (rSO2-C and rSO2-A) and cerebro-splanchnic oxygenation ratio (CSOR) was carried out. Meanwhile infants were monitored by biological and hemodinamyc methods.The monitoring period was variable, being between 1-5 days, the period required for establish the causal diagnosis. Statistical significance was determined using statistical t-test. “p” was calculated for confidence interval of 95% (statistical significance p < 0.05). Also was evaluated the area under the receiver operating characteristic (ROC) curve to determine the suitability of this technique as a diagnostic tool. Results. The study group included: 3 neonates with congenital heart disease(CHD) with significant decrease in aortic blood fl ow, 4 neonates with necrotizing enterocolitis (NEC) stage II, 3 pacients with intrauterine growth retardation (IUGR) severe form, 1 newborn with intestinal atresia and secondary peritonitis, 1 newborn with Rh incompatibility anemia with placental anasarca and 3 pacients with sepsis and associated gastrointestinal pathology without NEC criteria. In all 15 patients, NIRS measurement values were significantly lower compared to the normal range, with different values depending on the severity of the condition. Mean rSO2-A value was 41.85 (interquartile range15-85) compared to an average value, considered normal. Also the average value of the CSOR ratio was significantly lower compared to the normal. The lowest values of rSO2-A at the beginning of simptoms has had the group of patients with CHD followed by those with NEC. The area under the ROC curve was 0.95 (95% CI 0.88 to 1.02) for the CSOR ratio. Considering a limit value of ROCS for prediction of intestinal ischemia < 0.75, this ratio proves to be an excellent indicator of changes in bowel circulation. Conclusion. NIRS method has the potential to detect the occurrence of alterations in intestinal oxygenation and perfusion, allowing early detection of bowel ischemia, just before the modification of other hemodynamic parameters. NIRS is a non-invasive, highly accurate method, to follow in evolution the changes in tissue perfusion under the treatment instituted, also being able to guide treatment, proving helpful in clinical practice. [ABSTRACT FROM AUTHOR]

Retinopathy of Prematurity (ROP) represents a major health issue in the modern society, being the main cause for blinding in children all over the world. We analyzed the results of a retrospective study performed on a 6-year period (2009-2014), within the Neonatal Unit of the County Emergency Hospital from Timisoara. We assessed 1948 premature infants with GA < 35 weeks and BW < 1500 grams (GA = gestational age; BW = birth weight). Incidence of retinopathy in the study group was 48.55% (945 infants). Laser therapy was applied to 155 of these (7.95%). The disease evolution was favourable in 143 infants (86.5%). The unfavourable evolution in one eye, yet favourable in the other eye, was noticed in 14 of the assessed children (9%), and the severe loss of the visual acuity / blindness was noted in 7 cases (4.5%). The screening of ROP is essential for a timely diagnosis, allowing the application of a therapy at the right moment. The examination is performed by the ophthalmologist, upon request from the neonatologist. Finding an alternative screening method (telemedicine, the study of genetic polymorphisms), which is much easier to perform, would allow a more efficient selection of infants at a risk for severe ROP. [ABSTRACT FROM AUTHOR]

Introduction: Necrotising enterocolitis (NEC) is an acquired gastrointestinal disease associated with significant morbidity and mortality in preterm newborns. Taking into account the catastrophic development of this disease, it is necessary to focus research on prevention strategies and identify predictive risk factors for its occurrence. Aim: The aim of this study was to determine the incidence of NEC and to identify the main risk factors associated with NEC in preterm infants with gestational age(GA) ≤32 weeks admitted to neonatal intensive care units(NICUs) in Romania. Material and methods: This was a retrospective study based on the data collected in a standardised format for all preterm infants with GA ≤32 weeks born over a period of 2 years (January 2010-december 2011) and admitted to 12 tertiary-level NICUs in Romania. It was used data registered in the National Registry of Neonatal Respiratory Distress (NRNRD). A diagnosis of NEC was made based on clinical, radiological and/or histopatological evidence of stage II or III, acording to Bell's criteria. Logistic regression analysis was performed to determine the significant risk factors associated with NEC. Results: There were 1696 neonates under 32 weeks of gestation that met inclusion criteria; 1605 did not have NEC, while 91(5,3%) met criterion for NEC. Lenght of hospital stay and mortality were higher in neonates with NEC than those without NEC. Logistic regression analysis showed that smal for gestational age(SGA) and nosocomial infections were the most important risk factors for NEC. Other factors that were associated with an increased risk of NEC were bronchopulmonary displasia (BPD), use of nasal continuos positive airway pressure (CPAP), sepsis, apnea of prematurity, the lack of antenatal glucocorticoids and outborn pacients. Male gender and PDA were not statistical significantly correlated with NEC (borderline statistical significance). Conclusions: The incidence of NEC was higher in this study (5,3%). Low birth weight, nosocomial infections, BPD, CPAP, apnea and lack of antenatal glucocorticoids were associated with an increased risk of NEC in Romanian preterm infants under 32 weeks of gestation. Male gender and PDA were not statistical significantly correlated with NEC (at the limit of statistical significance). [ABSTRACT FROM AUTHOR]

Congenital heart disease is a major risk factor for the development of necrotising enterocolitis (NEC), although its pathophysiology remains incompletely understood. NEC is a multifactorial disease that occurs in a high risk newborn. NEC incidence is inversely proportional to gestational age, only 10% of term infants develop disease. We present the case of a term newborn with intrauterine growth restriction and complex congenital heart disease (CHD), who developed in the underlying disease, enterocolitis at 10 days of life. Early diagnosis was established using near-infrared spectroscopy (NIRS) which showed significant mesenteric oxygen desaturation secondary to significant decrease in aortic blood flow. The standard treatment of NEC with antibiotics, enteral feeding cessation and cardio-circulatory support did not work in this newborn due to decreased mesenteric blood flow and significant ischemia. CHD that caused extremely low blood flow in mesenteric territory and which could not be surgically corrected caused child's death. NIRS is a noninvasive diagnostic method that monitors highly accurate regional tissue oxygenation and could detect mesenteric ischemia in early stages. The authors want to emphasize through this rare case of CHD, that any heart disease with decreased aortic flow lead to impaired mesenteric oxygen delivery beeing a risk factor for NEC. Tissue hypoxia secondary to decreases in mesenteric blood flow is the central pathophysiological cause of NEC in this term infant. We also want to highlight the usefulness of NIRS for noninvasive measurement of tissue perfusion in all high risk neonates. [ABSTRACT FROM AUTHOR]

Necrotizing enterocolitis (NEC) is an inflammatory bowel disease that mainly affects low birth weight preterm infants. Because the etiology and pathogenesis of NEC are still incompletely understood, therapeutic options, morbidity and mortality were not significantly improved in the last decade of time. Taking into account the catastrophic development of this disease, it is necessary to focus research on prevention strategies and identify predictive risk factors for its occurrence. Many preventive measures have been tried and accepted in clinical practice, one of these is represented by probiotics supplementation. This article is a review of the literature regarding the efficacy of probiotics as a preventive strategy for NEC in premature infants with low birth weight. [ABSTRACT FROM AUTHOR]

Necrotizing enterocolitis (NEC) is an inflammatory bowel disease that mainly affects low birth weight preterm infants. Because the etiology and pathogenesis of NEC are still incompletely understood, therapeutic options, morbidity and mortality were not significantly improved in the last decade of time. Taking into account the catastrophic development of this disease, it is necessary to focus research on prevention strategies and identify predictive risk factors for its occurrence. Many preventive measures have been tried and accepted in clinical practice, one of these is represented by probiotics supplementation. This article is a review of the literature regarding the efficacy of probiotics as a preventive strategy for NEC in premature infants with low birth weight. [ABSTRACT FROM AUTHOR]

Ventilation associated pneumonia (VAP) is a nosocomial pneumonia occurring after 48 hours of mechanical ventilation. VAP incidence is between 5-40%. We aimed to identify the risk factors associated with VAP in premature infants below 32 weeks gestation and to implement a project to improve medical care. The study was conducted over a period of 20 months in a NICU and included 105 newborns. Diagnostic criteria were clinical, bacteriological and radiological. The incidence of VAP in 2009 was 30% and 23% in 2010. There were 6 deaths in 2009 and 2 deaths in 2010. The need for another intubation was the most important risk factor for VAP. The most common organism isolated in cultures from the endotracheal tube was Klebsiella spp. The new preventive strategies reduced the incidence and morbidity of VAP. Prospective studies are needed to confirm these results. [ABSTRACT FROM AUTHOR]

Ventilation associated pneumonia (VAP) is a nosocomial pneumonia occurring after 48 hours of mechanical ventilation. VAP incidence is between 5-40%. We aimed to identify the risk factors associated with VAP in premature infants below 32 weeks gestation and to implement a project to improve medical care. The study was conducted over a period of 20 months in a NICU and included 105 newborns. Diagnostic criteria were clinical, bacteriological and radiological. The incidence of VAP in 2009 was 30% and 23% in 2010. There were 6 deaths in 2009 and 2 deaths in 2010. The need for another intubation was the most important risk factor for VAP. The most common organism isolated in cultures from the endotracheal tube was Klebsiella spp. The new preventive strategies reduced the incidence and morbidity of VAP. Prospective studies are needed to confirm these results [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to assess the functional outcomes registered in patients from the Western part of Romania, who have been treated for retinopathy of prematurity, using a laser diode (810mn). Material and Methods: In the current study 52 premature infants with gestational age<34 weeks and a birth weight <2000 grams, 96 eyes in total were included. The functional outcomes were assessed by determining the best corrected visual acuity and refractive error. Statistical analysis used: The data were analysed using the IBM SPSS 20 software. Pearson Correlation was used to assess the strength of the relation between different parameters. Outcomes: For the eyes with the best visual function (BCVA between 0.8 and 1.0), mean gestational age was 29,452 weeks (SD = 1.958), mean weight at birth was 1363.38 grams (SD = 304.655), the mean energy used during treatment was 370.73 mW (SD = 95.972), and the mean number of burns applied was 1470.44 (SD = 581.960). The spherical equivalent ranged between -24.6 D and +3.4 D. High astigmatism (>3.0 D) was found in 26 eyes (27.08%) and anisometropia in 29 patients (55.77%). There is a strong positive correlation, statistically significant (P<0.001) between best corrected visual acuity and spherical equivalent, and a negative correlation, statistically significant (P=0.001), between best corrected visual acuity and the number of impacts during laser treatment. Conclusions: A long term follow-up is necessary in order to obtain an improvement in the quality of life and visual function of the patients who received laser treatment for retinopathy of prematurity. [ABSTRACT FROM AUTHOR]