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Background Preterm birth is a key factor contributing to haemorrhage incidence in neonates. This study focused on defining relevant parameters for the assessment of intraventricular and intraparenchymal haemorrhage risks in neonates. Methods Chi-square automatic interaction detection was used to analyse the Apgar score (AS), the Apgar max score, and the course of resuscitation documented according to the expanded AS in 696 infants born between 2009 and 2011 in the Neonatal and Intensive Care Department of the Medical University of Warsaw. Results Gestational age was the most relevant discriminating variable for the prediction of intraventricular and intraparenchymal haemorrhage incidences. Infants born before the 31st week of pregnancy made up 80% of the intraventricular or intraparenchymal haemorrhage cases. Additionally, a fraction of inspired oxygen > 0.8 at ten minutes after birth was a better discriminating variable in the youngest neonates than an Apgar max score ≤ 5, identifying 31.6% and 20.6% of infants with intraventricular and intraparenchymal haemorrhage, respectively. Conclusions Consideration of the oxygen concentration supplied during resuscitation significantly improves the prognosis of intraventricular and intraparenchymal haemorrhages in preemies compared to the use of the classical AS.

Necrotising enterocolitis (NEC) is one of the most common diseases in neonates and predominantly affects premature or very-low-birth-weight infants. Diagnosis is difficult and needed in hours since the first symptom onset for the best therapeutic effects. Artificial intelligence (AI) may play a significant role in NEC diagnosis. A literature search on the use of AI in the diagnosis of NEC was performed. Four databases (PubMed, Embase, arXiv, and IEEE Xplore) were searched with the appropriate MeSH terms. The search yielded 118 publications that were reduced to 8 after screening and checking for eligibility. Of the eight, five used classic machine learning (ML), and three were on the topic of deep ML. Most publications showed promising results. However, no publications with evident clinical benefits were found. Datasets used for training and testing AI systems were small and typically came from a single institution. The potential of AI to improve the diagnosis of NEC is evident. The body of literature on this topic is scarce, and more research in this area is needed, especially with a focus on clinical utility. Cross-institutional data for the training and testing of AI algorithms are required to make progress in this area. IMPACT: Only a few publications on the use of AI in NEC diagnosis are available although they offer some evidence that AI may be helpful in NEC diagnosis. AI requires large, multicentre, and multimodal datasets of high quality for model training and testing. Published results in the literature are based on data from single institutions and, as such, have limited generalisability. Large multicentre studies evaluating broad datasets are needed to evaluate the true potential of AI in diagnosing NEC in a clinical setting.

Very preterm infants are usually supported by parenteral nutrition delivered through central lines (CLs) while progressing with enteral intake, although the optimal time point for their removal is unclear. This study evaluated the impact of the CL discontinuation time on the short-term growth outcomes of preterm infants. A non-inferiority, parallel-group, randomized controlled trial was conducted in four neonatal intensive care units in Poland. Preterm infants with very low birth weight (VLBW) without congenital abnormalities were eligible. Patients were allocated to discontinue central access at an enteral feeding volume of 100 mL/kg/day (intervention group) or 140 mL/kg/day (control group). The study’s primary outcome was weight at 36 weeks’ postmenstrual age, with a non-inferiority margin of −210 g. Overall, 211 patients were allocated to the intervention or control groups between January 2019 and February 2021, of which 101 and 100 were eligible for intention-to-treat analysis, respectively. The mean weight was 2232 g and 2200 g at 36 weeks’ postmenstrual age in the intervention and control groups, respectively. The mean between-group difference was 32 g (95% confidence interval, −68 to 132; p = 0.531), which did not cross the specified margin of non-inferiority. No intervention-related adverse events were observed. Early CL removal was non-inferior to the standard type for short-term growth outcomes in VLBW infants.

Introduction. With the improvement in perinatal care management, the survival rate of very and extremely preterm infants increased, while the incidence of neonatal morbidity remained constant. The aim of the study was to analyse and compare two cohorts of Neonatal Intensive Care Unit-admitted preterm infants with gestational age

Tetralogy of Fallot (TOF) is a common congenital heart disease but very heterogeneous in terms of detailed cardiac anatomy, associated malformations, and genetic anomalies, especially when assessed prenatally.We aimed to analyze the clinical spectrum of TOF in the prenatal period, including detailed cardiac morphology, coexisting anomalies, and their impact on short-term neonatal outcome. We also assessed changing trends in the prenatal diagnostic workup of TOF.A retrospective cohort study including fetuses diagnosed with TOF between 2002 and 2019 was conducted in a tertiary Fetal Cardiology Center. Medical records and echocardiographic examinations were reviewed to collect demographic, sonographic, and genetic data.Among 326 TOF fetuses, 237 (73%) had pulmonary stenosis (TOF-PS), 72 (22%) pulmonary atresia (TOF-PA), and 17 (5%) absent pulmonary valve (TOF-APV). The yearly number of diagnoses increased during the study period, with decreasing fetal age at the time of diagnosis. Extracardiac malformations were found in 172 (53%) fetuses, cardiovascular malformations in 159 (49%), and genetic anomalies in 99 (39% of the tested group). Hypoplastic thymus, right aortic arch, and polyhydramnios were sonographic markers of microdeletion 22q11. Left-to-right ductal flow was predictive of postnatal ductal dependency. The perinatal outcome was dependent on the presence of associated anomalies and disease subtype, with TOF-APV having the worst prognosis.Extracardiac and genetic anomalies are common in fetuses with TOF, and, together with disease subtype and ductal flow assessment, they impact the perinatal management and outcomes. Genetic testing with array comparative genomic hybridization should be offered in all cases.

IntroductionThyroid disorders are commonly concomitant with premature birth; however, indications to start therapy remain unclear due to lack of gestational age-specific reference ranges and thyroid ultrasound nomograms. We aim to evaluate the age-specific correlation between circulating free thyroxine (FT4) and thyrotropin stimulating hormone (TSH) levels and ultrasound thyroid volume to assist identify infants requiring thyroid hormone replacement therapy.Methods and analysisThis is an observational, prospective, single-centre study that will include 200 preterm infants born between 24 and 32 weeks of gestational age, without any congenital diseases or malformation that may affect thyroid function. Venous blood will be obtained in infants at 14–21 days of life, and at 32 and 36 weeks of postconceptional age (PCA) to measure FT4 and TSH concentrations. Thyroid ultrasound will be performed at 32 and 36 weeks of PCA. Relevant outcomes will include determination of FT4 and TSH values and ultrasound thyroid volume for preterm infants born at 24–28 weeks of gestation and 29–32 weeks of gestation. Correlations among circulating hormone concentrations and thyroid volumes with the head circumference and body mass will also be determined.Ethics and disseminationThe Ethics Committee of the Medical University of Warsaw has approved the study protocol prior to recruitment (KB44/2019). Informed consent will be obtained from caretakers of preterm infants at the time of enrolment. Consent for participation in the study can be withdrawn at any time, without consequences and without obligation to justify the decision. All data will be stored in a secure, password-protected Excel file that is only accessible to researchers involved in the study. Findings will be published in a peer-reviewed journal and disseminated at relevant national and international conferences.Trial registration numberNCT04208503.

BACKGROUND Both gestational and chronological age of the neonate may influence and impair the function of the delicate and immature myocardium. However, the transition from fetal to neonatal circulation in preterm neonates is poorly understood. AIMS This study aimed to compare left ventricular (LV) systolic and diastolic function between premature neonates at expected term and term neonates during the postnatal cardiovascular transitional period. METHODS Using echocardiography, we assessed systolic and diastolic function of the LV in 89 preterm neonates at week 40 of postconceptional age and 29 term neonates after closure of the patent ductus arteriosus (PDA) and on the 28th day of life. Based on M‑mode images, we measured myocardial thickness and fractional shortening (FS%). Using pulsed‑wave Doppler echocardiography, we estimated cardiac output, myocardial performance index (MPI), and LV diastolic function (E and A waves, E/A ratio). Systolic and diastolic function was also assessed by tissue Doppler imaging. RESULTS Compared with term neonates on the 28th day of life, preterm neonates had reduced myocardial thickness (P ≤0.04), FS% (P = 0.002), and cardiac output (P = 0.01). However, preterm neonates had a lower MPI than term neonates after PDA closure (P0.001) and on the 28th day of life (P = 0.02). The E/A ratio and S' wave values were similar in preterm and term neonates (P0.05). CONCLUSIONS Preterm neonates at 40 weeks of postconceptional age have preserved systolic and diastolic function of the LV.

Appropriate supplementation of vitamin D can affect infections, allergy, and mental and behavioral development. This study aimed to assess the effectiveness of monitored vitamin D supplementation in a population of preterm infants. 109 preterm infants (24 0/7–32 6/7 weeks of gestation) were randomized to receive 500 IU vitamin D standard therapy (n = 55, approximately 800–1000 IU from combined sources) or monitored therapy (n = 54, with an option of dose modification). 25-hydroxyvitamin D [25(OH)D] concentrations were measured at birth, 4 weeks of age, and 35, 40, and 52 ± 2 weeks of post-conceptional age (PCA). Vitamin D supplementation was discontinued in 23% of infants subjected to standard treatment due to increased potentially toxic 25(OH)D concentrations (&gt, 90 ng/mL) at 40 weeks of PCA. A significantly higher infants’ percentage in the monitored group had safe vitamin D levels (20–80 ng/mL) at 52 weeks of PCA (p = 0.017). We observed increased vitamin D levels and abnormal ultrasound findings in five infants. Biochemical markers of vitamin D toxicity were observed in two patients at 52 weeks of PCA in the control group. Inadequate and excessive amounts of vitamin D can lead to serious health problems. Supplementation with 800–1000 IU of vitamin D prevents deficiency and should be monitored to avoid overdose.

Objectives: Proper infant classification, particularly a preterm infant, as small or large for gestational age, is crucial to undertake activities to improve postnatal outcomes. This study aimed to assess the usability of the Fenton preterm growth charts to evaluate the anthropometric parameters of Polish preterm neonates. Material and methods: In this single-center, retrospective study data extracted from the medical documentation of preterm neonates born 2002–2013 were analyzed. Body weight, body length, and head circumference were evaluated and used to develop growth charts, which were compared with the reference Fenton growth charts. Results: This study included 3,205 preterm neonates, of whom 937 were born before 30 weeks of pregnancy. Overall, 11.04%, 3.3%, and 5.2% of neonates were below the 10 th percentile on the Fenton charts for birth weight, body length, and head circumference, respectively. Only 26 (6.67%) of 390 analyzed anthropological parameters differed significantly between the study and the Fenton groups. Statistically significant differences between the study and the Fenton populations were found only in body length for both sexes, and in head circumference for female neonates. Conclusions: The growth charts developed in this study for a population of Polish preterm neonates corresponded to the Fenton charts in terms of birth weight but differed in terms of body length and head circumference. Our findings suggest the need to evaluate growth charts for Polish preterm newborns.

IntroductionNecrotising enterocolitis (NEC) is one of the most serious conditions in newborn infants, affecting up to 10% of very low birth weight (VLBW) infants. Mortality rates can rise as high as 60%.The suspected diagnosis is confirmed with typical findings on abdominal radiography (AR) such as pneumatosis intestinalis (PI), portal vein gas (PVG) and in extreme cases pneumoperitoneum. Abdominal ultrasound (AUS) can depict PI, PVG and pnuemoperitoneum (in some cases ahead of AR), but it also provides other crucial information such as bowel wall viability (thickness or thinning) and free abdominal fluid. These additional findings are helpful in diagnosing and managing NEC.Methods and analysisThe hypothesis being tested is that preforming an AR in patients with clinical symptoms of NEC, but inconclusive/normal AR will enhance detection rates, and expedite treatment in infants born at Ethics and disseminationThe Bioethical Committee of the Medical University of Warsaw has approved the study (KB 130/2017). We plan to submit our findings to international peer-reviewed journals. Abstract will be submitted to local and international conferences.Trial registration numberNCT03188380; Protocol version: V.2.08.2019; Pre-results.

The thyroid of the fetus of a mother with Graves’ disease (GD) is affected by the transplacental passage of both antithyroid drugs (ATDs) and thyroid-stimulating hormone receptor antibodies (TRAb). Thyroid hormone imbalances are harmful for the developing brain. This study aimed to evaluate the impact of the duration of antithyroid drug treatment in hyperthyroid pregnant women with GD on infants’ thyroid volume. Twenty-nine neonates born to mothers with GD were divided into two groups depending on the duration of ATDs treatment. The ultrasound thyroid volumes of the infants were measured within the first week of life. Thyroid-stimulating hormone, thyroxine, and TRAb values were recorded. There was no difference between groups in the thyroid hormones’ values. The median thyroid volume for the entire group of neonates with mothers with GD, for the groups of neonates of mothers with long- and short-treated GD, and for the control group were 1.539, 1.816, 1.347 and 1.014 mL, respectively. There were statistically significant differences in the thyroid volume between the GD group and the control group, as well as between the groups of neonates of mothers with long- and short-treated GD (p < 0.05). Studies have shown that the longer the duration of ATDs administration to mothers, the greater the thyroid volume of the neonate.

Objectives: Renal vein thrombosis in newborns is a rare but serious and acute disease. Clinical representations of RVT can vary from discrete symptoms to life-threatening conditions. Therefore imaging, and in particular sonography, plays an important role in the diagnosis of RVT in neonates. Gray-scale, color and spectral/power Doppler ultrasound are all used in the diagnosis of RVT. Material and methods: We present retrospective sequential ultrasonic imaging of three patients (two term and one preterm infant) with findings characteristic of RVT. Results: Initial ultrasound diagnostic features include: renal enlargement, echogenic medullary streaks, lack of the flow pattern characteristic of arcuate vessels and subsequently loss of corticomedullary differentiation, reduced echogenicity around pyramids and echogenic band at the extreme apex of the pyramid. Higher resistance index or less pulsatile venous flow on the affected kidney are helpful Doppler signs. Conclusions: Knowledge and identification of specific features of each phase of the evolution of RTV seems essential to prompt diagnosis. We would like to highlight the evolution of specific sonographic features in each subsequent phase of RVT.

Aim Echocardiographic evaluation of left ventricular function in preterm infants with and without bronchopulmonary dysplasia. Methods In 82 preterm infants (32 in no-bronchopulmonary-dysplasia group, 35 in mild-bronchopulmonary-dysplasia group, and 15 in severe-bronchopulmonary-dysplasia group), echocardiography was performed on the first day of life, at 28 days of life, and at 36 weeks postconceptional age. Results The mean E/A ratio at 36 PCA was 0.94±0.31 and 0.73±0.12 in the mild- and severe-bronchopulmonary-dysplasia groups, respectively (P=.037). The mean E′-wave velocity was 5.62±1.61 cm/s vs 4.32±1.11 cm/s at 1 day of life (P=.006) and 6.40±1.39 cm/s vs 5.34±1.37 cm/s at 28 days of life (P=.030) in the no-bronchopulmonary-dysplasia and mild-bronchopulmonary-dysplasia groups, respectively. This measure tended to be lower in the severe-bronchopulmonary-dysplasia group compared to the no-bronchopulmonary-dysplasia group (5.25±1.29 cm/s at 28 days of life; P=.081). The E/E′ ratio differed between the no-bronchopulmonary-dysplasia (7.21±1.85) and mild-bronchopulmonary-dysplasia groups (9.03±2.56; P=.019) at 1 day of life. The left ventricle myocardial performance index decreased between 1 day of life and 36 postconceptional age in infants without bronchopulmonary dysplasia and those with mild bronchopulmonary dysplasia, but not in those with severe bronchopulmonary dysplasia. Conclusion E/A and E/E′ ratios are the most sensitive indicators of impaired left ventricle diastolic function in preterm infants with bronchopulmonary dysplasia.

AIM This study evaluated whether practitioners from 70 countries used premedication for non-emergency neonatal intubation and identified attitudes and experience regarding the safety, side effects and efficiency of neonatal intubation. METHODS Invitations to take part in the survey were issued between December 18, 2018 and February 4, 2019 to the users of neonatal-based websites and Facebook groups, members of professional societies and the authors of relevant publications in the last five years. RESULTS We analysed 718 completed questionnaires from 40 European and 30 non-European countries. Most of the responses were from neonatologists (69.6%) and paediatric or neonatal trainees (10.3%). In units without a protocol (31.6%), more than half of the practitioners (60.4%) chose premedication according to personal preference and 37.0%-11.9% of the overall respondents did not use any drugs for non-emergency intubation. The most frequently reported drug combination was fentanyl, atropine and succinylcholine (6.8%). Most of the practitioners (78.5%) use the same drugs for term and preterm infants. Only 24.8% of the physicians were fully satisfied with their premedication practices. CONCLUSION Nearly 12% of the respondents did not use premedication for non-emergency neonatal intubation. The wide-ranging policies and practices found among the respondents highlight the need for international consensus guidelines.

We aimed to determine the volume of the thyroid gland in full-term neonates born to hypothyroid mothers as compared with full-term infants born to healthy mothers and to investigate the association between levothyroxine doses and the thyroid volume of neonates.This is single center prospective observational study of 245 full-term neonates (96 from hypothyroid and 149 from healthy mothers). Ultrasound examination in both longitudinal and transverse projections was used to calculate the thyroid volume applying the ellipsoid formula.Median (interquartile range) thyroid volume of newborns from hypothyroid mothers was significantly smaller compared to the control group with regard to the total thyroid volume and the left lobe (p 0.05). We found no statistically significant difference for the right lobe (p 0.05) and inverse correlation between the thyroid volume and levothyroxine doses taken by mothers.Results of the present study indicate that maternal thyroid hormone levels may interfere with the fetal hypothalamic-pituitary axis.

Purpose Retinopathy of prematurity (ROP) is a vision-threatening complication of a premature birth, in which the etiology still remains unclear. Importantly, the molecular processes that govern these effects can be investigated in a perturbed plasma proteome composition. Thus, plasma proteomics may add new insights into a better understanding of the pathogenesis of this disease. Methods The cord and peripheral blood of neonates (≤30 weeks gestational age) was drawn at birth and at the 36th postmenstrual week (PMA), respectively. Blood samples were retrospectively subdivided into ROP(+) and ROP(-) groups, according to the development of ROP. Results The quantitative analysis of plasma proteome at both time points revealed 30 protein abundance changes between ROP(+) and ROP(-) groups. After standardization to gestational age, children who developed ROP were characterized by an increased C3 complement component and fibrinogen level at both analyzed time points. Conclusions Higher levels of the complement C3 component and fibrinogen, present in the cord blood and persistent to 36 PMA, may indicate a chronic low-grade systemic inflammation and hypercoagulable state that may play a role in the development of ROP.

Objective: In the presented study, we aimed to systematically analyze plasma proteomes in cord blood samples from preterm infants stratified by their gestational age to identify proteins and related malfunctioning pathways at birth, possibly contributing to the complications observed among preterm infants. Study design: Preterm newborns were enrolled of three subgroups with different gestation age: newborns born ≤26 (group 1), between 27 and 28 (group 2) and between 29 and 30 (group 3) weeks of gestation, respectively, and compared to the control group of healthy, full-term newborns in respect to their plasma proteome composition. Result: Preterm delivery is associated with multiple protein abundance changes in plasma related to a plethora of processes, including inflammation and immunomodulation, coagulation, and complement activation as some key features. Conclusion: Plasma proteome analysis revealed numerous gestation-age-dependent protein abundance differences between term and preterm infants, which highlight key dysregulated pathways and potential new protein treatment targets.

In this study, we aimed to analyze time-resolved plasma proteome changes in preterm neonates stratified by their gestational age to detect malfunctioning pathways that derive from the systemic immaturity of the neonate and to highlight those that are differentially regulated during the early development. Preterm newborns were enrolled in three subgroups with different gestational ages: before 26 weeks of gestation (group 1), between 27 and 28 weeks of gestation (group 2), and between 29 and 30 (group 3) weeks of gestation. Plasma protein abundances were assessed at two time points (at preterm delivery and at the 36th week of post-menstrual age) by quantitative proteomics. The quantitative analysis of plasma proteome in preterm infants revealed a multitude of time-related differences in protein abundances between the studied groups. We report protein changes in several functional domains, including inflammatory domains, immunomodulatory factors, and coagulation regulators as key features, with important gestational age-dependent hemopexin induction. The global trend emerging from our data, which can collectively be interpreted as a progression toward recovery from the perinatal perturbations, highlights the profound impact of gestation duration on the ability to bridge the gap in systemic homeostasis after preterm labor.

An abnormal presentation of the central nervous system in a fetus during a screening examination is an indication for extended diagnosis, the aim of which is to explain the character of such an anomaly (a congenital defect, destructive effect of intrauterine infection or abnormality with reasons that are difficult to explain). Knowledge of normal development sequence of the fetal brain, which is discussed in this paper, is the basis for correct interpretation of imaging findings. Together with the increase in survival of preterm neonates, a high risk of early brain damage is still a problem in this extremely immature population. Therefore, imaging examinations become necessary. The paper presents intrauterine and postnatal risk factors of early brain damage as well as classification of such lesions, of hemorrhagic and hypoxic-ischemic etiology. The diagnosis of the cerebellum damage, which is currently believed to be a significant cause of autism, is emphasized. The evolution of lesions over time is also presented. Moreover, the elements of diagnosis important for prognosis are stressed. The standards of imaging examinations of the central nervous system include the schedule of ultrasound examinations and provide indications for extended diagnosis with the use of magnetic resonance imaging.

IntroductionUncertainty exists regarding the optimal time for removal of central lines used to provide parenteral nutrition in preterm infants. The aim of this study is to determine whether earlier central line removal is non-inferior to its removal after reaching full enteral intake, in respect to growth outcome of preterm infants.Methods and analysisVery low birthweight premature infants will be recruited. Eligible infants will be randomised in equal proportions between two groups. In the intervention group central lines will be removed when infants reach 100 mL/kg/day of enteral intake. In the control group central lines will be removed when infants reach 140 mL/kg/day of enteral intake (full enteral intake). The primary outcome measure will be the difference between the two groups in weight at 36 weeks’ postmenstrual age. Non-inferiority will be declared if the mean weight of children in the intervention group will be no worse than the mean weight of children from the control group, by a margin of −210 g.Ethics and disseminationThe Bioethics Committee of the Medical University of Warsaw approved the study protocol prior to recruitment. The findings of this trial will be submitted to a peer-reviewed journal (neonatology, paediatrics or nutrition). Abstracts will be submitted to relevant national and international conferences.Trial registration numberNCT03730883.Protocol versionVersion 3. 14.08.2019.

Introduction: Hypoxic ischemic insults during labor remain an important cause of brain injury in term and near-term neonates. Selective cerebral hypothermia is a potentially neuroprotective rescue therapy. Ultrasonography (US) andnmagnetic resonance imaging (MRI) are routinely used to visualize intracranial changes in neonatal hypoxic-ischemic injuries. Aim of the study: We attempted to describe all pathological findings on US and MRI in the brains of our patients following selective cerebral hypothermia. Materials and methods: Twenty-nine neonates with hypoxic-ischemic encephalopathy (HIE) following therapeutic cooling were assessed with cranial ultrasound (US) and magnetic resonance imaging (MRI). The findings were compared with the clinical outcome. Results: Over one-fourth (27.6%) of the examined infants had a normal brain on MRI (with only 17.2% on US). Involvement of the basal ganglia and thalami was one of the most frequent findings in our material (9/29 = 31% on MRI, and 7/29-24.1% on US). Cerebral parenchymal hemorrhage was detected on MRI in as many as 7 (24.1%) and cerebellar parenchymal hemorrhage in 4 (13.8%) infants. The loss in the gray-white matter differentiation (‘fuzzy brain’), usually transient on US, was observed in 79.3% of the neonates. Diffusion restriction in the callosal splenium (13.8%) and hyperechoic thalami and basal ganglia were strictly correlated to a significantly higher incidence of severe developmental delay. Conclusion: Abnormalities on MRI and US were observed in 75% of newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.

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.

Aim To evaluate right ventricular function in preterm infants with and without bronchopulmonary dysplasia. Methods Eighty-nine preterm infants (

Objectives: Evaluate the time dependent expression of genes in preterm neonates and verify the influence of ontogenic maturation and the environmental factors on the gene expression after birth. Material and methods: The study was carried out on 20 full-term newborns and 62 preterm newborns (mean birth weight = 1002 [g] (SD: 247), mean gestational age = 27.2 weeks (SD: 1.9)). Blood samples were drawn from all the study participants at birth and at the 36th week postmenstrual age from the preterm group to assess whole genome expression in umbilical cord blood and in peripheral blood leukocytes, respectively. (SurePrint G3 Human Gene Expression v3, 8x60K Microarrays (Agilent)). Results: A substantial number of genes was found to be expressed differentially at the time of birth and at 36 PMA in comparison to the term babies with more genes being down-regulated than up-regulated. However, the fold change in the majority of cases was < 2.0. Extremely preterm and very preterm infants were characterized by significantly down-regulated cytokine and chemokine related pathways. The number of down-regulated genes decreased and number of up-regulated genes increased at 36 PMA vs. cord blood. There were no specific gene expression pathway profiles found within the groups of different gestational ages. Conclusions: Preterm delivery is associated with a different gene expression profile in comparison to term delivery. The gene expression profile changes with the maturity of a newborn measured by the gestational age.

The objective of this study is to assess the cytological picture of the nasal mucosa of neonates born to mothers who are active smokers, passive smokers and non-smokers.A prospective study was conducted in a group of 86 neonates born between 23 and 41 weeks of gestation. The assignation of neonates to one of the three aforementioned groups was based on a questionnaire concerning exposure to tobacco smoke, and on the concentration of cotinine in maternal urine. A cytological examination was performed using exfoliative cytology with a semi-quantitative evaluation of the cells present in the specimens. Hematological summation equipment was used to assess the number of neutrophils, eosinophils, columnar, goblet, basal and squamous cells out of 500 cells counted. The number of specific cells was expressed as a percentage and a cytogram was created.The most common type of cytogram contained neutrophils, columnar cells, and squamous cells. No significant differences were observed between the subgroups. Similarly, there was no correlation between the median of each type of cell and the cotinine concentration in the mothers' urine.Active and passive smoking during pregnancy do not influence the cytological picture of the nasal mucosa of neonates.

Purpose The aim of this study was to determine brain oxygenation in full-term and preterm neonates using near infrared spectroscopy. Material and methods A total of 88 full-term and preterm newborn infants without hypoxic-ischaemic disorders admitted to the NICU were examined using NIRS on the first day of life and on day 28 of life. Additional measurements were taken at the end of the first week of life in the premature neonates group. Measurements of oxyhaemoglobin (HbO2), deoxyhaemoglobin (Hb), total haemoglobin (HbT) concentration and tissue oxygen saturation (Ox) were performed in 5 brain regions. Right and left frontal areas, the occipital area and right and left temporal areas were measured. Results In full-term healthy neonates a marked decrease in HbO, Hb and HbT values was observed on day 28 of life in all brain regions except the occipital area. In the neonatal period the greatest changes in brain oxygenation occurred in the right and left frontal regions of the brain. In preterm neonates constant values of HbO2 and Ox were observed in the first 28 days of life. In preterm newborn infants, as well as in full term newborn infants, similar Ox and HbO2 values were obtained on day 28 of life. Conclusions NIRS is a safe method and can be used to evaluate brain oxygenation in newborn infants. The results of these measurements are in accordance with changes in brain oxygenation in the first month of life, which are predicated on the basis of the neonate's physiology.

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.

Background: The myocardial performance index (MPI) is a noninvasive method to measure global systolic and diastolic myocardial function. In both term and premature neonates, changes in the systolic and diastolic function of the left ventricle (LV) and right ventricle (RV) reflect the degree of neonatal myocardial immaturity and the co-existence of foetal circulation. Aim: To assess MPI (or Tei indices) of both ventricles in term and preterm newborns, and to observe MPI trends throughout the neonatal period. Methods: Heart ultrasound imaging was performed on the first day of life (DOL), after patent ductus arteriosus (PDA) closure, and on the 28th DOL, in 29 term and 29 preterm newborns. RVMPI and LVMPI were measured within the preterm group at 40 weeks of post-conception age (PCA). Results: A statistically significant reduction in RVMPI was observed in both term and preterm newborns. In term newborns, the RVMPI value on the first DOL was 0.42 ± 14, dropping to 0.29 ± 0.09 after PDA closure, and finally reaching 0.22 ± 0.09 on the 28th DOL. The respective RVMPI values for the preterm newborns were 0.44 ± 0.15, 0.30 ± 0.12, and 0.21 ± 0.08. Little variability in the mean values of LVMPI was observed in both groups throughout the neonatal period. The LVMPI for term neonates in successive measurements was 0.37 ± 0.10, 0.39 ± 0.07, and 0.37 ± 0.11, respectively, and for the preterm neonates it was 0.37 ± 0.10, 0.35 ± 0.09, and 0.36 ± 0.10, respectively. The MPI values from preterm newborns taken at 40 weeks PCA (RVMPI = 0.28 ± 0.09; LVMPI = 0.37 ± 0.05) were comparable to those measured in term newborns after PDA closure. Conclusions: Observed postnatal changes in RVMPI correspond to changes in ventricular function, reflecting the haemodynamic changes of the transitional circulation. The relatively small postnatal changes in LVMPI in term and preterm newborns may reflect an immature myocardium. The RVMPI and LVMPI values at 40 weeks PCA in preterm newborns correlate best with MPI values in term newborns just after PDA closure.

Objective This study aims to establish the reference ranges for normal thyroid gland (length, width, depth, and volume) in healthy term Polish neonates within the first week of life to aid in the comparative evaluation of infants with suspected thyroid disease. Study Design A total of 148 term neonates from mothers with normal thyroid function were examined during their first week of life. Ultrasound examination was performed in both longitudinal and transverse projections to create reference value percentile charts for thyroid volume in healthy term neonates. Results Median (range) width, depth, and length were 0.714 (range, 0.470–0.959), 0.677 (range, 0.527–0.960), 2.07 (range, 1.540–2.870) cm for the right lobe of the thyroid: and 0.720 (range, 0.535–1.010), 0.678 (range, 0.521–0.952), 2.015 (range, 1.620–2.730) cm for the left. Volumes for right lobe, left lobe, and both lobes combined were 0.502 (range, 0.228–0.931), 0.511 (range, 0.294–0.959), and 1.014 (range, 0.526–1.849) mL. Conclusion Diagnostic ultrasound examination of the thyroid in the neonate is a simple and useful method for assessment of thyroid gland disease and neonatal health. This study provides robust normative data for Polish newborns. Furthermore, we have found different values compared with other countries, particularly Scotland, which underlines the importance of establishing population-based data.

Wstep i cel: Przy uzyciu echokardiograficznej metody doplera tkankowego oceniono zmiany ruchu miokardium dla leweji prawej komory oraz czasy przewodzenia przedsionkowo-komorowego u noworodkow donoszonych w pierwszym miesiącu zycia. Metody: Badania wykonano u 20 zdrowych noworodkow urodzonych miedzy 37.–41. tygodniem ciązy. Pomiar predkości miokardium wykonywano w projekcji koniuszkowej, w osi dlugiej serca, jako obraz 4 jam serca kodowany kolorowym doplerem tkankowym. Odczytywano zapis cyklu serca przedstawionego za pomocą trzech fal: fala skurczowa (Sm; kiedy platki zastawki wedrują w kierunku koniuszka serca), fala wczesnej fazy rozkurczowej (Em; kiedy pierścien zastawki oddala sie od koniuszka serca) oraz fala związana z fazą skurczu przedsionkow (Am). Ponadto wykonano pomiary nastepujących czasow: czas Am-IV (od początku fali Am do początku fali IV); czas Am-Sm (od początku fali Am do początku fali Sm); czas IV-Am (odpoczątku fali IV do początku kolejnej fali Am); czas Sm-Am (od początku fali Sm do początku nastepnej fali Am). Zmierzono tez czas skurczu izowolumetrycznego (IVCT) i czas rozkurczu izowolumetrycznego (IVRT). Wszystkie pomiary wykonano u kazdego noworodka 3-krotnie: 1. pomiar — bezpośrednio po urodzeniu w 1. dobie zycia, 2. pomiar — w 3. dobie zycia oraz 3. pomiar — na koniec okresu noworodkowego w 28. dobie zycia. Wyniki: We wszystkich pomiarach wartości średniej predkości ruchu miokardium w zakresie fal Em, Am i Sm byly wyzszedla komory prawej niz dla komory lewej. Zmiane istotną statystycznie odnotowano dla komory prawej w zakresie czasow: Am-IV i Am-Sm (miedzy dobą 1. a 3.), p < 0,02; IV-Am (miedzy dobą 1. a 28.), p < 0,005; Sm-Am (miedzy dobą 1. a 28.), p < 0,01. Dla komory lewej zmiane istotną statycznie wykazano w zakresie czasow: Am-IV (miedzy dobą 1. a 28.), p < 0,05 oraz Sm-Am (miedzy dobą 1. a 28.) p < 0,01. Średnie wartości IVCT i IVRT pozostawaly stale we wszystkich pomiarach dla komory prawej. Natomiast dla komory lewej zarowno w zakresie IVCT i IVRT wykazano roznice istotną statycznie miedzy1. i 28. dobą zycia (p < 0,01). Wnioski: Zaobserwowane roznice w średnich wartościach predkości miokardium i w średnich wartościach czasow przewodzenia odzwierciedlają zmiany w hemodynamice ukladu sercowo-naczyniowego charakterystyczne dla okresu noworodkowego.

An abnormal presentation of the central nervous system in a fetus during a screening examination is an indication for extended diagnosis, the aim of which is to explain the character of such an anomaly (a congenital defect, destructive effect of intrauterine infection or abnormality with reasons that are difficult to explain). Knowledge of normal development sequence of the fetal brain, which is discussed in this paper, is the basis for correct interpretation of imaging findings. Together with the increase in survival of preterm neonates, a high risk of early brain damage is still a problem in this extremely immature population. Therefore, imaging examinations become necessary. The paper presents intrauterine and postnatal risk factors of early brain damage as well as classification of such lesions, of hemorrhagic and hypoxic-ischemic etiology. The diagnosis of the cerebellum damage, which is currently believed to be a significant cause of autism, is emphasized. The evolution of lesions over time is also presented. Moreover, the elements of diagnosis important for prognosis are stressed. The standards of imaging examinations of the central nervous system include the schedule of ultrasound examinations and provide indications for extended diagnosis with the use of magnetic resonance imaging.Nieprawidłowy obraz ośrodkowego układu nerwowego płodu w badaniu przesiewowym jest wskazaniem do poszerzenia diagnostyki prenatalnej celem ustalenia charakteru tej nieprawidłowości (wada rozwojowa, efekt destrukcyjny zakażenia wewnątrzmacicznego czy też nieprawidłowość o trudnym do ustalenia pochodzeniu). Znajomość prawidłowej sekwencji rozwojowej mózgu płodu, omówiona w pracy, jest podstawą właściwej interpretacji badań obrazowych. Wraz ze stale zwiększającą się przeżywalnością noworodków urodzonych przedwcześnie problemem pozostaje wysokie ryzyko wczesnego uszkodzenia mózgu w tej skrajnie niedojrzałej populacji, co powoduje konieczność jego oceny w badaniach obrazowych. W pracy omówiono wewnątrzmaciczne i pourodzeniowe czynniki ryzyka wczesnych uszkodzeń mózgu oraz klasyfikację tych zmian, o etiologii krwotocznej i niedokrwienno-niedotlenieniowej. Zwrócono uwagę na diagnostykę uszkodzeń móżdżku, które obecnie są uważane za istotną przyczynę autyzmu. Przedstawiono ocenę ewolucji zmian w czasie. Zwrócono uwagę na te elementy diagnostyki, które są ważne ze względu na ustalanie rokowania dla dziecka. W standardzie badań obrazowych ośrodkowego układu nerwowego u noworodków zaprezentowano harmonogram badań ultrasonograficznych oraz wskazania do rozszerzenia diagnostyki o badanie metodą rezonansu magnetycznego.

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 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.