Search

Background/Objectives: Our research aimed to assess if correlations could be found between items evaluated at the cerebral ultrasound performed at term-equivalent age (TEA) and neuro-motor outcomes evaluated at 12 and 24 months of corrected age in a group of preterm infants. Methods: The following were assessed: the Levine Index, the diagonals of the lateral ventricles, the size of the ventricular midbody, the sinocortical distance, the width of the basal ganglia, the cortical depth at the level of the cingular sulcus and the maturation of the gyral folding. The neurologic evaluation was performed at 12 and 24 months of corrected age, according to the Amiel Tison neurologic examination, and the items from the calendar of motor acquisitions were used as outcome measures of the study—gross and fine motor subsets. The comparisons between the different groups were performed using the FANOVA test, with a statistically significant association for a p < 0.05. Results: The abnormal gross motor acquisitions at 12 months were significantly associated with an increased size of the ventricular midbody (p < 0.009) and a significantly decreased diameter of the basal ganglia (p < 0.011) on the TEA cerebral ultrasound. At 24 months, a significant association was found with increased size of the ventricular midbody (>10.33 mm) (p < 0.001), a decreased diameter of the basal ganglia (p < 0.016), a decreased cortical depth (p < 0.021) and an immature gyral maturation pattern (p < 0.001). In the case of severely abnormal fine motor outcomes, at 12 months, there were statistically significant associations with an increased size of the ventricular midbody (p < 0.001) and an immature gyral folding pattern (p < 0.0180); at 24 months, significant associations were noted with the size of ventricular midbody (p < 0.001), a decreased diameter of the basal ganglia (p < 0.016), a decreased cortical depth (p < 0.021) and an immature gyration folding (p < 0.001). Conclusions: The abnormal gross and fine motor outcome in former premature infants at 12–24 months corrected age is significantly associated with abnormal findings in the head ultrasound examination performed at TEA reflecting both white matter (increased midbody distance) and grey matter (decreased diameter of the basal ganglia, decreased cortical depth and an immature gyration pattern) involvement.

It is documented that maternal diseases or treatments influence a newborn’s clinical status at birth. If a prenatal medical history is not available, or if signs or symptoms of a mother’s disease are revealed for the first time during pregnancy or postpartum, their effects on the newborn may be misattributed. Objective: The objective of this study is to emphasize the paramount importance of prenatal care, for both mothers and newborns, as a lack of maternal signs and symptoms during pregnancy does not exclude a potential severe neonatal condition. Materials and methods: We present a series of three cases of pregnant women who gave birth to very sick preterm newborns that required admission to the Neonatal Intensive Care Unit (NICU). The mothers were asymptomatic during pregnancy and unaware of their subclinical disease. The newborns’ complications, considered initially as consequences of prematurity or infection, subsequently revealed transient autoimmune disease in two of the cases (myasthenia gravis and hyperthyroidism) and a severe form of thrombophilia in the third case. Results: The newborns’ diagnosis preceded maternal diagnosis and contributed to the identification of the maternal pathology; adequate treatment was prescribed, with favorable short- and long-term outcomes. Conclusions: Prenatal exams and investigations throughout pregnancy are a good opportunity to detect subclinical diseases or predispositions. As newborns usually develop non-specific signs, one should have experience and pay attention to differentiating among etiologies. Our paper takes a reversed approach to the usual medical diagnosis pathway: from infant to mother instead of from mother to infant, proving that inter-specialty collaboration can work bi-directionally.

Aim: our study aimed to characterize the lung ultrasound (LUS) patterns noted immediately after delivery in term and near-term neonates, and to investigate whether the LUS scores or patterns observed at that point could anticipate the need for respiratory support in the sample of patients studied. Materials and methods: We performed two ultrasound examinations: one in the delivery room and the second at one hour of age. The anterior and lateral regions of both lungs were examined. We assessed the correlation between the LUS scores or patterns and the gestational age, umbilical arterial blood gases, the need for respiratory support (CPAP or mechanical ventilation), the presence of respiratory distress, and the need for the administration of oxygen. Results: LUS scores were significantly higher in the delivery room examination (8.05 ± 1.95) than at 1 h of age (6.4 ± 1.75) (p < 0.001). There were also statistically significant differences between the LUS patterns observed in different lung regions between the delivery room exam and the exam performed at 1 h of age (p values between 0.001 and 0.017). There were also differences noted regarding the LUS patterns between different lung regions at the exam in the delivery room (the right anterior region LUS patterns were significantly worse than the right lateral LUS patterns (p < 0.004), left anterior LUS patterns (p < 0.001), and left lateral LUS patterns (p < 0.001)). A statistically significant correlation was found between LUS scores and the gestational age of the patients (r = 0.568, p < 0.001—delivery room; r = 4.0443, p < 0.001—one hour of age). There were statistically significant associations between LUS scores, patterns at delivery (p < 0.001) and 1 h of age (p < 0.001), and the need for respiratory support (CPAP or mechanical ventilation). Conclusions: LUS in the delivery room offers important information regarding lung fluid elimination and aeration of the lungs, and early LUS features are significantly associated with the risk of respiratory distress and the need for respiratory support.

Childhood cancer survival rates are constantly improving due to treatment. Fertility research has focused on adult cancer patients, but studies among childhood cancer survivors who reach reproductive age are rare and mainly based on small numbers of patients. This is surprising as childhood cancer survivors constitute a distinct, ever-growing population that may have temporarily or permanently impaired fertility due to cancer treatment. Thus, the basic scientific concern specific to the pediatric population has focused on improving protection techniques and cryopreserved tissue transfer. Research on preservation techniques confirms the safety of surgical retrieval of gonadal (ovarian and testicular) tissue for cryopreservation. Outcomes may improve, but it is clear that large registries of long-term follow-up of patients are needed. Current research efforts imply the need to develop a national strategy in each country to ensure the education and information of pediatric patients undergoing gonadotoxic regimens and their families about fertility options and subsequent outcomes and give them the opportunity to join such programs.

Congenital chylothorax, the accumulation of lymph in the pleural space, is a rare and serious condition that can appear alone or accompany congenital anomalies. Ultrasonography and pleural fluid analysis can diagnose it early from the fetal period. Both prenatal and postnatal therapeutic interventions improve the fetal prognosis and decrease the rate of complications.

Aim. The paper represents a review of the current state of knowledge regarding lenticulostriate vasculopathy (LSV) in premature and term neonates. Material and method. There are reviewed the definition, the history of this diagnosis, the epidemiology, the anatomy of the vessels the etiology and the methods of diagnosis. Results. LSV is defined as the bright hyperechoic blood vessels in the region of the thalamus and basal ganglia. It was first described in 1960. The incidence is 0.3-2% of live births. The etiology is infectious (congenital rubella, cytomegalovirus, toxoplasma, or other chronic intrauterine infections), hypoxic ischemic, and in many cases idiopathic (without a clear cause). The diagnosis is mainly done by ultrasonography – the are also proposed classification systems based on the number of vessels affected and/or the echogenicity of the vessels involved. Conclusion. LSV represents a pathology recognized for a long time, in the past, it was considered mainly associated with chronic intrauterine infections, at present, it is more and more seen as a consequence of perinatal hypoxic events. Further large follow-up studies are needed in order to better characterize the etiology and prognosis of this pathologic condition.

Congenital diaphragmatic hernia (CDH) is a structural birth defect that with varying degrees of severity that results in significant neonatal morbidity and mortality. CDH occurs in 1:2,500 live births, and despite the advances in prenatal diagnosis and neonatal intensive care, the mortality and morbidity rate in infants with CDH is significant. In this article, we tried to summarize the main modalities of diagnosis, prognosis and medical treatment in CDH cases, found in specialty literature.

Introduction. Chest X-ray (CXR) has been for decades the most practiced diagnostic tool in respiratory pathology, an available and sometimes life-saving investigation, but we must admit that it has also long-term risks. X-rays can destroy living tissues, affecting DNA and producing genetic mutations Objective. Reducing the exposure of the newborn to ionizing radiation Material and method. We have analyzed the diagnostic correlation between CXR and lung ultrasound (LUS) for newborns with respiratory pathology admitted to the Neonatal Intensive Care Unit (NICU) of Emergency University Hospital Bucharest. They required a chest X-ray, and we correlated the ultrasound appearance with the radiological one. Results. Acknowledging the normal appearance of LUS, multiple neonatal pathologies can be identified and monitored by pulmonary ultrasound, avoiding chest X-ray. Conclusions. Lung ultrasound proved to be a very useful tool, always handy, easy to perform, reproducible, provides the image promptly, and is immediately integrated clinically into the medical thinking at the patient’s bedside, therefore it should become standard of care.

Oligohydramnios is both a consequence of fetal malformations and of uteroplacental insufficiency. Its existence is associated with a high rate of both antepartum and intrapartum complications. It is vital that its occurrence is detected as early as possible so that we can manage it correctly. The main causes of its occurrence are identified and described in this review. The management of oligohydramnios is most often expectant, the timing of delivery also being determined by Doppler examination and changes in parameters measuring fetal growth and development.

Preterm birth is a leading cause of neonatal mortality and morbidity, affecting more than 15 million babies worldwide each year. Preterm infants also have higher rates of motor, functional, and cognitive deficits. Modern imaging has contributed significantly to a better understanding of the etiology of various forms of brain injury in neonates. The follow-up of premature newborns is essential to prevent and diminish neurological sequelae in time. A multi-disciplinary team is needed to adequately monitor this category of children, in which the family doctor has a significant role. The variety of adverse events that preterm infants can be exposed to before, during, and after birth poses significant obstacles to developing therapeutic interventions to prevent brain damage, including developmental vulnerability to injury during a particular gestational age. In addition, several procedures required for neonatal critical care, reduce mortality but increase the risk of brain injury. This review is aimed to update the reader about the complications of preterm birth, current therapeutic uses, imaging techniques, as well as present and future research on preterm birth.

Objective. We aim to evaluate the implications of cesarean delivery compared to natural birth by analyzing newborns’ systemic and cerebral oxygenation levels during the first 10 minutes of life. Design. This paper presents a 4-year prospective cohort study. Setting. Polizu Maternity, "Alessandrescu-Rusescu" National Institute for Mother and Child's Protection, Bucharest, Romania. Patients. Randomly selected pregnant women and their fetuses. Interventions. During the 10 min following umbilical cord clamping, regional cerebral oxygen saturation (rcSO2) was measured using the INVOS 5100 device and peripheral oxygen saturation (SpO2) was determined using the Masimo SET pulse oximeter in neonates from cesarean and natural deliveries. Main outcome measures. The cerebral fractional tissue oxygen extraction (cFTOE) in the first 10 minutes of life was calculated based on these values. Results. Newborns delivered vaginally showed higher rcSO2 levels at 1 minute of life than those born via C-section (40.5 ± 16.5% vs 33.7 ± 14.8%, AUC = 0.625; IC 95%: 0.506 - 0.743; p = 0.043). Neonatal cFTOE at 1 minute of life was significantly higher in caesarean-delivered newborns versus naturally born neonates (0.40 ± 0.25 vs 0.50 ± 0.19, p = 0.03; AUC = 0.638; IC 95%: 0.517-0.758; p = 0.023). Conclusions. Prelabor cesarean delivery seemingly plays a significant role in the process of fetal and neonatal cerebral oxygenation immediately postnatally, which is highlighted by lower rcSO2 and higher cFTOE values. Cerebral oxygen saturation monitoring in the delivery room allows the optimization of oxygen therapy in order to prevent the consequences of hypoxia or hyperoxia.

Objectives. Congenital diaphragmatic hernia (CDH) represents a developmental defect of the diaphragm, which allows the protrusion of the abdominal viscera into the thoracic cavity. In view of the fact that herniation occurs during a critical period of lung development, the pathological effect is pulmonary hypoplasia in different degrees, usually more severe on the ipsilateral side of the hernia, and also may be present contralateral if the mediastinum is bulged, compressing the lung. Material and methods. We present the case of a patient hospitalized in the Neonatology Department of “St. Andrew” County Emergency Clinical Hospital of Constanta, diagnosed with left CDH at birth. Outcomes. Full-term male newborn, gestational age (GA) 39 weeks, birth weight (BW) 3300g, Apgar Score 6. The 35-year-old mother, Gravida-VI, Para-III, has a pregnancy with inadequate prenatal care, with no structural abnormalities of the fetus detected by the 3rd-semester ultrasound. At birth, the newborn needed neonatal resuscitation, initially with positive pressure ventilation (on mask and bag) and after that, intubated and mechanical ventilated. Chest X-Ray showed a left diaphragmatic hernia, and the pediatric surgery team was called for further therapeutic management. Approximately 48 hours postoperatively, the chest X-Ray identified right upper lobe pneumothorax, with complete remission in 24 hours, under mechanical ventilation. Conclusions. CDH represents a condition with a challenging diagnosis and management. In the best cases, newborns have a very good clinical outcome with neonatal care and surgical treatment after birth. The management of infants with congenital diaphragmatic hernia requires the services of an interprofessional team. After the diagnosis in the antenatal period, parents should be allowed to discuss with a team, including maternal-fetal medicine, pediatric surgery, neonatology, and social work as appropriate. Genetic evaluation and counseling are recommended to identify risks in future pregnancies. Following the repair in the postnatal period, a standardized and interdisciplinary follow-up to provide surveillance, screening, and clinical care is recommended to improve outcomes.

The paper presents the clinical, ultrasound and MRI appearances in the case of the closed spinal dysraphisms with a cutaneous/subcutaneous mass: lypomyelomeningocele, posterior meningocele and cervical meningocele. There is mentioned first the classification of these defects, then, for each type, a case example is presented, showing the clinical aspect of the lesion, the ultrasound features and the correlation of ultrasound with MRI images. The examples show a good correlation between ultrasound and MRI, entitling the ultrasound exam to be the first line of exploration in the case of this category of patients.

The fetal growth normally depends on sufficient delivery of oxygen and nutrients mainly via the placenta. Inadequate fetal nutrition may result in poor development and adaptation that permanently alter the fetus' metabolism and physiology. Intrauterine Growth Restriction is defined as a deviation on the fetal growth pattern. An estimated fetal weight (EFW) that is below the 10th percentile for gestational age is commonly used to describe fetal growth restriction. Usually obtained sonographically, there is evidence that ultrasound imaging of the uterine artery, middle cerebral artery, and fetal umbilical artery during the late third-trimester (approximately 35-37 weeks) significantly improves the detection and diagnosis of IUGR. In obstetrics, an increased risk of perinatal mortality and morbidity is associated with the diagnosis of IUGR.

Background and aim: The early identification of the former premature neonates at risk of neurologic sequelae could lead to early intervention and a better prognosis. This pilot study aimed to investigate whether the General Movement patterns observed at term-equivalent age in former premature infants could serve as predictors for guiding early intervention and improving prognosis. Materials and methods: In a population of 44 premature neonates (mean gestational age 33.59 weeks (+2.43 weeks)) examined at term-equivalent age, 10 neonates with a cramped–synchronized General Movements motor pattern were identified. These neonates were included in an early intervention program consisting of physiotherapy executed both by the therapist and by the parents at home. They were again examined at a corrected age of 12 weeks. The presence or absence of fidgety movements and the MOS-R (motor optimality score revised) was noted. The examinations were performed by certified specialists. Results: Normal fidgety movements and a MOS-R of 20–24 were presented in 9/10 of the former premature infants, with normal foot to foot contact present in 7/10, and normal hand to hand contact present in 5/10. The atypical patterns noted were side to side movements of the head in 5/10, a non-centered head in 9/10, asymmetric tonic neck reflex in 9/10 and jerky movements in 10/10. One patient presented with no fidgety movements and a MOS-R score of 9. Conclusion: Early intervention in our group of patients allowed for an improvement in the neurologic status, demonstrated by the presence of fidgety movements. We suggest that early intervention should be indicated in all premature infants that present with a cramped–synchronized GM pattern during examination at term-equivalent age. However, due to the small sample size, the absence of statistical analysis and a control group, and the limited follow-up period, the conclusions must be approached with caution.

Background and Objectives: Our quality management project aims to decrease by 20% the number of neonates with respiratory distress undergoing chest radiographs as part of their diagnosis and monitoring. Materials and Methods: This quality management project was developed at Life Memorial Hospital, Bucharest, between 2021 and 2023. Overall, 125 patients were included in the study. The project consisted of a training phase, then an implementation phase, and the final results were measured one year after the end of the implementation phase. The imaging protocol consisted of the performance of lung ultrasounds in all the patients on CPAP (continuous positive airway pressure) or mechanical ventilation (first ultrasound at about 90 min after delivery) and the performance of chest radiographs after endotracheal intubation in any case of deterioration of the status of the patient or if such a decision was taken by the clinician. The baseline characteristics of the population were noted and compared between years 2021, 2022, and 2023. The primary outcome measures were represented by the number of X-rays performed in ventilated patients per year (including the patients on CPAP, SIMV (synchronized intermittent mandatory ventilation), IPPV (intermittent positive pressure ventilation), HFOV (high-frequency oscillatory ventilation), the number of X-rays performed per patient on CPAP/year, the number of chest X-rays performed per mechanically ventilated patient/year and the mean radiation dose/patient/year. There was no randomization of the patients for the intervention. The results were compared between the year before the project was introduced and the 2 years across which the project was implemented. Results: The frequency of cases in which no chest X-ray was performed was significantly higher in 2023 compared to 2022 (58.1% vs. 35.8%; p = 0.03) or 2021 (58.1% vs. 34.5%; p = 0.05) (a decrease of 22.3% in 2023 compared with 2022 and of 23.6% in 2023 compared with 2021). The frequency of cases with one chest X-ray was significantly lower in 2023 compared to 2022 (16.3% vs. 35.8%; p = 0.032) or 2021 (16.3% vs. 44.8%; p = 0.008). The mean radiation dose decreased from 5.89 Gy × cm2 in 2021 to 3.76 Gy × cm2 in 2023 (36% reduction). However, there was an increase in the number of ventilated patients with more than one X-ray (11 in 2023 versus 6 in 2021). We also noted a slight annual increase in the mean number of X-rays per patient receiving CPAP followed by mechanical ventilation (from 1.80 in 2021 to 2.33 in 2022 and then 2.50 in 2023), and there was a similar trend in the patients that received only mechanical ventilation without a statistically significant difference in these cases. Conclusions: The quality management project accomplished its goal by obtaining a statistically significant increase in the number of ventilated patients in which chest radiographs were not performed and also resulted in a more than 30% decrease in the radiation dose per ventilated patient. This task was accomplished mainly by increasing the number of patients on CPAP and the use only of lung ultrasound in the patients on CPAP and simple cases.

Stroke is the second leading cause of death worldwide. The global incidence of stroke has increased in recent years, although low and middle-income countries have been heavily affected. Because of the complicated and diversified physical and emotional disruption, stroke survivors are likely to face a variety of difficulties in daily life activities. Because of the wide impact of a stroke on all body structures and functions, there is no gold standard instrument to evaluate impairment and all elements of recovery after a stroke, and there is no single scale that can capture all the effects of a stroke. The International Classification of Impairments, Disability, and Handicaps (ICIDH) categorized the consequences of the diseases into three categories: impairment, disability, and handicap. Using the biopsychosocial model in 2001 WHO defines and classifies disability by using International Classification of Functioning Disability and Health (ICF). The ICF divides the impairment into three categories: body function and structure, activity, and participation. This article aims to review the most important tools that are reliable and valid in assessing the disability left after a stroke: The National Institute of Health Stroke Scale (NIHSS), Barthel index (BI), The modified Rankin scale (mRS), Instrumental activities of daily living (IADL), Glasgow outcome scale (GOS), The Functional Independence Measure (FIM), The World Health Organization Disability Assessment Schedule (WHODAS 2.0). The WHODAS 2.0 questionnaire is validated in several countries and it would be useful to be validated, also, in our country.

Objectives. Percutaneously central catheters are typically used in neonatal intensive care units (NICU) to provide parenteral nutrition and drug therapy administration. Their use is associated with specific complications: occlusions, infections, thrombosis, rupture, and migration, including rare life-threatening conditions such as pericardial effusion and cardiac tamponade. Material and methods. We present the case of a patient hospitalized in the Neonatology Department of “St. Andrei” County Clinical Emergency Hospital of Constanta, diagnosed with cardiac tamponade at 18 days of life. Outcomes. Premature male newborn, gestational age (GA) of 33 weeks, birth weight (BW) 2380 g, Apgar score 5/7, issuing from pregnancy without prenatal care, admitted in NICU with Continuous Positive Airway Pressure (CPAP) respiratory support. He required intensive care during the neonatal period and presented with sudden cardiac instability 18 days after the insertion of a peripherally inserted central catheter (PIC-Line). The echocardiography demonstrated severe pericardial effusion with evidence of cardiac tamponade. Successful urgent subxiphoid pericardiocentesis was performed. Totally 20 ml of fluid was collected, consistent with the composition of the hyperosmolar solution infused. Conclusions. Despite the fact that it is a rare complication, cardiac tamponade should be considered in any newborn with a PIC-Line who presents with sudden suggestive deterioration (cardiorespiratory instability, bradycardia, cyanosis and metabolic acidosis), which does not respond to resuscitation maneuvers, when lines are considered to be placed correctly. Implementing a modern algorithm, who is easy to learn and quick to perform, with the help of ultrasonography, represents the key of success for detecting urgent neonatal complications leading to sudden deterioration.

The influence of the maternal vaginal microbiome in vaginal birth is an important factor in the pathogenesis of early-onset neonatal sepsis. The incidence of Sneathia infection is hard to assess due to the difficulty in its detection, as special culture conditions are required. The laboratory methods used in its detection are based on molecular analysis. This emergent, anaerobic agent, by ascending from the female genital tract, can colonize and infect the amniotic fluid, fetal membranes, and placenta. Chorioamnionitis, neonatal sepsis, stillbirth, spontaneous premature labor, and preterm prelabour rupture of the membrane are some of the adverse reactions that can be associated with the presence of Sneathia. In conclusion, Sneathia infection, although underestimated due to its virulence, represents an increased risk of maternal-fetal infections, with the risk of developing a series of neonatal complications. The detection and treatment of this infection will contribute to a decrease in neonatal morbidity and mortality.

COVID-19 infection is primarily a community-acquired airborne respiratory infection, making pediatric and neonatal populations extremely vulnerable to the disease. Since the beginning of the coronavirus pandemic, many questions regarding mother and infant health have arisen, one of the most discussed issues being the management of infants born to mothers with suspected or confirmed COVID-19. Is it advisable to separate the child from the positive mother immediately after birth? What are the recommendations for breastfeeding? Are there any short and long-term follow-up indications or are there any possible long-term complications that we should take into account in those children? And not lastly, what are the most respectful and ethical measures both for mother and infant? We aim to analyze and compare the existing guidelines regarding the management of infants born to mothers with suspected or confirmed COVID-19 and to discuss the similarities and discrepancies between the available protocols.

As obesity increases worldwide, so do the incidence of gestational diabetes mellitus (GDM) and the related perinatal complications. Pancreatic β-cell secretion is altered by hormonal changes during pregnancy. It appears, however, that patients who develop gestational diabetes have pre-existing insulin resistance. However, there are other risk factors to be considered, such as obesity, age, ethnicity, and polycystic ovary syndrome. Screening for gestational diabetes is very important to avoid maternal and fetal complications. For most pregnant women, glycemic control is achieved through dietary and lifestyle changes, although a small percentage requires pharmacological treatment.

Vitamin D is a standard vitamin supplementation for children in many countries, used mainly for preventing rickets. Many studies were published about the efficiency of vitamin D administration in children and adults for other pathologies besides rickets. Very often the results were contradictory, but nevertheless, more and more articles are published on this matter. There is no consensus for the effective vitamin D dosage nor for the vitamin D normal serum values. Both vitamin D deficiency and vitamin intoxication are dangerous for children. Recently some studies are showing controversial data that advise being more careful in prescribing vitamin D as a routine.

Multiple Sclerosis is a chronic autoimmune neurodegenerative disorder which affects brain, spinal cord and optic nerve. During last years the perception over the disease changed dramatically, now being considered a handleable disease. The particularity of this subject is that Multiple Sclerosis is a disease which affects mostly young women, many of them not having any children at the moment of diagnosis. This article highlights the fact that women diagnosed with Multiple Sclerosis are allowed to get pregnant, and, moreover, they are encouraged to live a normal life. In most cases, disease activity freezes during pregnancy, only a small percentage of women will continue to have clinically and radiologically active disease. For those women, IFN-β and Glatiramer Acetate are the first-choice therapies that should be given. In cases when the disease is not responding to common medication, refractory to treatment forms may be successfully treated with Natalizuab, during the first and the second trimester. Breastfeeding is also encouraged, as it has a protective effect on disease progression. The main purpose of this article is to make a literature review in which to summarize the updates regarding pregnancy and postpartum management, relapses management and, also, the impact of pregnancy on Multiple Sclerosis course. The analysis was limited to articles written in English and published between August 2019 - October 2022 on PubMed, NCBI and Medical Journals.

The incomplete ossification of the spinal processes allows the ultrasonographic evaluation of the spinal cord and the adjacent structures in neonates and small infants. The paper describes the ultrasonographic examination of the spinal structures and the normal appearance of the spinal cord, the structures within the spinal canal, and the bony and muscular adjacent structures. Sagittal and axial sections at cervical, thoracic, lumbar, and sacral levels are described. There are also mentioned findings in the M mode and Doppler examinations.

Transient neonatal myasthenia gravis (TNMG) is a distinct type of myasthenia gravis (MG), a temporary autoimmune condition due to the mother’s antibodies crossing over the placenta and affecting the baby. Studies suggest that 10 to 15% of infants born to mothers suffering from MG will develop TNMG. Undoubtedly, if not diagnosed and treated in time, TNMG can be a serious condition, even life-threatening. Almost 80% of newborns will present symptoms in the first 24 hours of life that will last up to 4 weeks and a complete recovery is expected by 2 months of age. Only 10% of the affected infants may still be symptomatic at 4 months.

Objectives. The aim of this study was to present and describe specific macroscopic and microscopic placental findings in patients with hypoxic-ischemic encephalopathy (HIE). Materials and methods. We conducted an observational prospective study which included 84 patients diagnosed with HIE and had available placental histopathological examination. HIE diagnosis was performed according to Sarnat Score. Both macroscopical and microscopical placental lesions were identified. Patients were divided into 2 groups according to the presence of placental lesions. Outcomes. Placental lesions were associated with HIE. Patients with both HIE and placental lesions had lower pH value (p

Posture, hyper-kyphosis or “the postural round back”, and balance are topics that have been extensively studied, although with some conflicting findings. Body position is representative of physical and mental health. Bad posture can lead to spinal complications (affects the muscular system, deforms the skeletal bone, and causes abnormal development) and the same can be said the other way around. As the standard of living increases, there is an increase in consumerism for technological devices, especially among teenagers. Identified as a public health problem, postural changes among children and adolescents have a high prevalence, emphasizing the need for prevention, diagnosis, and early initiation of treatment, especially from the growth and development phase of the body, because during this period teenagers are most vulnerable to live changes. Taking these elements into consideration, we conducted an extensive literature review of the subject, considering adolescence a key element for early diagnosticating and the institution of a complex rehabilitation program, with full functional restoration. Efforts to reduce the prevalence of bad posture will improve not only body posture but will also reduce the prevalence and the severity of spine deformities.

Background. Alkaline phosphatase (ALP) has been intensively studied and proved to be useful in Neonatology. The first condition studied in correlation with increased ALP values was osteopenia of prematurity. In recent years there was an increase interested in correlations between ALP and bilirubin levels. In this article, we want to review the literature to find other benefits of ALP dosing in neonatal patients. Methods. Clinical trials were searched and analyzed by a single individual (via dedicated search engines such as Google Scholar, PubMed, and Scopus). We have included clinical studies from the last 7 years that present statistically significant results regarding the role of ALP dosing in the screening or diagnosis of other neonatal pathologies (jaundice with hyperbilirubinemia, necrotizing enterocolitis, liver dysfunction, renal failure and oncological diseases). Results. After excluding the clinical trials that did not meet the eligibility criteria, 6 clinical trials remained (n = 859). Following the analysis of these studies, correlations were highlighted between high ALP values in the umbilical cord and the need for phototherapy. It was also shown that all newborns with elevated ALP values required treatment for hyperbilirubinemia, as well as being a good predictor of severe jaundice and helping to predict its onset. Also, evidence about the correlation between high values of ALP and prematurity osteopenia was reaffirmed in recent studies. Conclusions. ALP is an easily dosed biomarker that can be successfully used in Neonatology. The existing studies to date encourage the use of ALP as a biomarker especially for the detection of osteopenia of prematurity and for the early detection of newborns who will develop intense forms of jaundice. There are still differences regarding the serum ALP values considered as cut-offs for the diagnosis of various neonatal conditions, but performing multicenter studies on a large number of cases could establish a valid consensus in order to use the same ALP cut-off values in all Neonatology departments.

Background. Studies to date support the beneficial effect that therapeutic hypothermia (TH) has on neonates with hypoxic-ischemic encephalopathy. TH can be delivered in two ways: selective head cooling (SHC) or therapeutic whole-body cooling (WBC). The purpose of this review is to examine the literature to expose the advantages and disadvantages of the two methods of performing TH in neonates diagnosed with moderate or severe HIE and to investigate whether one method is superior to the other. Methods. We started from the data from the Cochrane review published in 2013 [1] and we want to bring new information from recent clinical studies comparing the two TH methods (SHC vs WBC). Clinical studies were searched and analyzed by a single individual (through dedicated search engines such as Google Scholar, PubMed, and Scopus). We have included clinical studies from the last 7 years comparing the two ways of performing TH (SHC vs. WBC). We selected only the articles that compared the two methods and excluded the articles describing only one method. Results. After excluding the clinical trials that did not meet the eligibility criteria, 5 clinical trials remained (n = 256 neonates). Analysis of these studies supports the idea that both modalities of therapeutic hypothermia cool central nervous system (CNS) structures and have a similar neurodevelopmental prognosis among surviving neonates. Also, there are no significant differences in terms of short-term neurological prognosis, as well as the adverse effects that may occur in neonates with moderate or severe HIE (hypoxic-ischemic encephalopathy) treated with SHC or WBC; although some studies note the presence of more severe, statistically significant lesions among patients treated with SHC compared to those treated with WBC. Conclusions. Prospective, randomized studies on a much larger scale are needed to track the adverse effects that the two HT methods may have on patients, as well as long-term neurological and cognitive prognosis. Until now, there is no clear evidence that one of these two methods is definitely safer or more reliable than the other.

Meningitis and encephalitis are a group of neuroinfectious diseases that require both correct and early diagnosis and etiopathogenic treatment, because their potential for severe evolution, is often being associated with sequelae. In addition to the detailed anamnesis and clinical examination, it is important to know the specific neurological manifestations at the beginning in order to decide properly the indication to perform the lumbar puncture for identifying an etiopathogenic agent in order to administer a targeted treatment. We present the approach both in terms of diagnosis and treatment, in case of an elderly patient with a favourable evolution, towards healing, without associating neurological sequelae. At the same time, we present a synthesis of the novelties of diagnostic and treatment methods in infectious meningitis and encephalitis.

The COVID-19 pandemic raised an unexpected challenge for the medicine and pharmaceutical industry. The primary goal in a short timeframe was to fight the spreading of SARS-CoV-2 by any means, starting from social distancing, wearing face masks, and, in the end, finding a vaccine as effective as possible in preventing the virus spread. Studies were published from the first months of the pandemic, trying to show the way that this virus attacks the host and how it is transmitted in communities. Some data were contradictory, but one fact became obvious – children have a lower risk of infection with SARS-CoV-2. Data collected from many studies showed that some vaccines that were already in use before the COVID-19 pandemics are efficient in preventing SARS-CoV-2 infection. In this paper, we tried to summarize the nonspecific effects of preexisting vaccines against SARS-CoV-2 infection.

The composition of the intestinal microbiota plays an important role in the occurrence of allergies. Based on the immunomodulating capabilities of bacteria, various studies have investigated the potential role of probiotics in the prevention of eczema and atopic dermatitis in children. Atopic dermatitis (AD) is one of the first manifestations in the evolution of allergies, with a continuously increasing incidence worldwide. In the literature, various risk factors are described to play a role in the occurrence of DA, but the actual cause of the disease is still unknown. The intestinal flora seems to be involved in the development of AD, as patients with AD show quantitative, qualitative and functional changes. An imbalance of the human gut microbiota in the first years of life is a possible risk factor for immune-mediated disorders such as allergies. With the aim of modulating the gut microbiota, probiotic supplementation in the first months of life has been used to prevent allergic diseases in infants, with variable success. However, not much is known about the long-term consequences of the use of probiotics in the newborn on the composition of the gut microbiota. The aim of this paper is to highlight the positive links between the use of probiotics and the prevention or cure of eczema and atopic dermatitis.

Immature sacrococcygeal teratoma represents a histological form with rapid tumor growth, a risk of premature birth, an enhanced rate of complications, an increased risk of recurrence, and a higher mortality rate than the mature type. Thus, prenatal diagnosis of immature forms would significantly improve the prognosis of these cases. To this end, we performed an extensive literature review on the diagnosis, therapeutic management, and follow-up of immature teratomas. Regarding this medical conduct, we also presented our case. In conclusion, the early identification of immature sacrococcygeal teratomas with or without other associated structural abnormalities and their correct therapeutic approach are basic principles for a favorable evolution of these cases.

Background and aim: Our research aims to find correlations between the brain imaging performed at term-corrected age and the atypical general movement (GM) patterns noticed during the same visit a—cramped-synchronized (CS) or poor repertoire (PR)—in formerly premature neonates to provide evidence for the structures involved in the modulation of GM patterns that could be injured and result in the appearance of these patterns and further deficits. Materials and methods: A total of 44 preterm neonates ((mean GA, 33.59 weeks (+2.43 weeks)) were examined in the follow-up program at Life Memorial Hospital Bucharest at term-equivalent age (TEA). The GM and ultrasound examinations were performed by trained and certified specialists. Three GM pattens were noted (normal, PR, or CS), and the measurements of the following cerebral structures were conducted via head ultrasounds: ventricular index, the short and long axes of the lateral ventricles, the midbody distance of the lateral ventricle, the diagonal of the caudate nucleus, the width of the basal ganglia, the width of the interhemispheric fissure, the sinocortical width, the length and thickness of the callosal body, the anteroposterior diameter of the pons, the diameter of the vermis, and the transverse diameters of the cerebellum and vermis. The ultrasound measurements were compared between the groups in order to find statistically significant correlations by using the FANOVA test (significance p < 0.05). Results: The presence of the CS movement pattern was significantly associated with an increased ventricular index (mean 11.36 vs. 8.90; p = 0.032), increased midbody distance of the lateral ventricle–CS versus PR (8.31 vs. 3.73; p = 0.001); CS versus normal (8.31 vs. 3.34; p = 0.001), increased long and short axes of the lateral ventricles (p < 0.001), and decreased width of the basal ganglia–CS versus PR (11.07 vs. 15.69; p = 0.001); CS versus normal pattern (11.07 vs. 15.15; p = 0.0010). The PR movement pattern was significantly associated with an increased value of the sinocortical width when compared to the CS pattern (p < 0.001) and a decreased anteroposterior diameter of the pons when compared to both the CS (12.06 vs. 16.83; p = 0.001) and normal (12.06 vs. 16.78; p = 0.001) patterns. The same correlations were present when the subgroup of infants with a GA ≤ 32 weeks was analyzed. Conclusions: Our study demonstrated that there are correlations between atypical GM patterns (cramped-synchronized—CS and poor repertoire—PR) and abnormalities in the dimensions of the structures measured via ultrasound at the term-equivalent age. The correlations could provide information about the structures that are affected and could lead to a lack of modulation in the GM patterns.

Cord insertion during pregnancy may take and arise different series of characteristics. Intrapartum fetal assessment depends in a significant matter on the umbilical cord, amniotic fluid and placenta. It is also obvious that the umbilical cord may cause problems that can influence labor and pregnancy altogether. There are many concerns about umbilical cord pathology in the past few years, now more than ever because of high morbidity and mortality in both mother and fetus. This high rate of such concern is because of the fetal hypoxia, neonatal asphyxia and hypoxic-ischemic injury at birth. Modern approach and justified interventions are skills required by any young obstetrician and physician who works in Ob-gyn field. The faster the diagnostic and the proper care are embedded, the quicker and better the outcome of the newborn will be, under the circumstances. Multiple gestation involve some risks and they need to be recognized; preterm birth, growth restriction, fetal demise and perinatal mortality nowadays are associated with unfavorable results and traumatized or touching events. The labor and delivery anomalies which might occur is the only clear objective about studying the umbilical cord pathologies and make sure of improving the perinatal outcomes.

First-trimester screening is focused on both markers of aneuploidies and structural abnormalities detection. In the past ten years, clinicians have been increasingly interested in using Doppler ultrasound in the first trimester of pregnancy. Doppler examination can help estimate the risk of aneuploidy and early diagnose severe fetal malformations. The purpose of this article is to highlight the importance of color Doppler ultrasound examination of the fetus in the first trimester. Color Doppler examination also has a great significance in studying maternal-fetal circulation. According to the ISUOG guidelines, several vascular territories should be covered: uterine arteries, umbilical artery, and ductus venosus. The nowadays first trimester Doppler examination not only identifies specific ultrasonographic markers for aneuploidy but also aids in the identification and analysis of many anatomical structures.

Stem cells are precursor cells capable of self-renew and of generating numerous mature cell types. As the field of human embryonic stem cells harvesting has been put under questionable ethic issues, other sources are under investigation and present tremendous potential: tissue specific progenitor stem cells, mesenchymal stem cells, umbilical cord cells, bone marrow stem cells, and induced pluripotent stem cells. Stem cells interest different departments of regenerative medicine as well as conservative wildlife. Stem cells might be a viable option for the treatment of pathologies such as spinal injuries, cardiovascular disease, diabetes, liver injuries or even osteoarthritis. Scientists are looking forward to developing molecules that can activate tissue specific stem cells, promote stem cells to migrate to the side of tissue injury, and promote their differentiation to tissue specific cells, so that many health issues could have an alternative and efficient treatment and or even be cured.

Diabetes during pregnancy is more and more frequent worldwide because of the rising incidence of its known risk factors, such as high body mass index, sedentary lifestyle, and hypercaloric diets. It can be either a preexisting condition, or it can be first diagnosed during pregnancy, usually between the 24th and the 28th week of gestation, when it receives the name of gestational diabetes mellitus. Both preexisting diabetes mellitus and gestational diabetes mellitus may have severe maternal and newborn consequences, especially if there is insufficient control of the maternal glycemic levels and progression of diabetes complications, such as microvascular disease and nephropathy. Infants of diabetic mothers may experience excessive birth weight or, on the contrary, low birth weight, trauma at birth, cardiomyopathy, respiratory distress syndrome, hypoglycemia, hypocalcemia, jaundice, or polycythemia. This study’s aim is to gather and synthesize available information about maternal diabetes and its impact on fetal development and newborn outcome.

Iodine deficiency in pregnant women can lead to abortion, dysgravidy, intrauterine growth restriction, premature birth, low birth weight, which places the pregnant woman in a group with increased vulnerability to the lack of adequate amounts of iodine. Iodine deficiency in pregnancy can lead to increased perinatal and infant mortality and the prevalence of congenital anomalies. All these aspects shed new light on the many side effects of iodine deficiency during pregnancy. The present paper aligns with the general trend of assessing the maternal-fetal thyroid hormone status and establishing the most accurate indicators for its quantification and taking into account the degree of iodine deficiency and prematurity.

Aim. Because the COVID-19 pandemic is a topic of interest in the literature due to its information dynamics and, also, to its impact on the population health status; we wanted to highlight the connection between pandemic and lifestyle, with an emphasis on eating habits. Material and methods. A questionnaire with 20 items about sociodemographic data and information about eating habits was distributed. Results. Data collected reflected how COVID-19 pandemic influenced the employment status, level of income, smoker status, consumption of fruits, vegetable, candies, sweets, chocolate and fast-food of the respondents. The reported dietary changes were reflected both positively by more regular meals, a slight increase in the consumption of fruits and vegetables, lower consumption of fast food and higher cooked food, and negatively by a higher intake of sweets, candies and chocolate and as a result of an increasing in the habit of compulsive eating. Conclusion. The trait that easily weighed on all the activities of this period is the perceived level of stress and anxiety.

Ocular toxoplasmosis is a retinochoroiditis caused by Toxoplasma gondii infection, the most common cause of posterior infectious uveitis worldwide. Main features: it is a unilateral recurrent focal retinochoroiditis infection, with early manifestation after primary systemic infection, or with late manifestation after reactivation of intraretinal infectious cysts. The diagnosis is mainly clinical, being supported paraclinically by laboratory tests. Associated features: the most common is a unilateral focal ocular pathology, with multiple and bilateral active lesions occurring in a recently acquired infection or in immunocompromised patients. Ocular toxoplasmosis is characterized by posterior, intermediate, and anterior ocular damage; is a retinochoroiditis infection with significant involvement of the vitreous, with increased inflammation, retinal vasculitis, optic disc edema and anterior uveitis. Therapeutic management includes antiparasitic medication and corticosteroid therapy. Regarding pregnancy, it is essential to screen and capture the moment of maternal acute infection during pregnancy in patients with negative IgGs in order to treat the infection, to minimize or even prevent transplacental passage.

Gastroschisis is a congenital anterior abdominal wall defect that occurs in 4 to 5 in 10,000 births, consisting in the evisceration of bowel in the amniotic cavity without a membranous covering. Gastroschisis cases can be detected during the first trimester using ultrasonography or at the beginning of the second trimester with a detection rate of 100%. Although an isolated condition in most of the cases, further complications such as malrotation, atresia, stenosis, perforation or volvulus can be associated. Periodic monitoring is required to assess the progress of the pregnancy with measurements of the level of amniotic fluid, fetal biometry and bowel diameters at every ultrasound examination. Gastroschisis is most frequently associated with oligohydramnios, intrauterine fetal growth restriction, increased bowel wall thickness and bowel dilatation. The outcome of the disease is favourable with a survival rate of around 90% for born infants. The long time on ventilator and multiple intestinal surgeries that delay the moment of oral feeding with a long-term use of total parental nutrition and short bowel syndrome are the most important comorbidities. Delivery is recommended at 38 weeks of gestation, preserving caesarean delivery for complicated gastroschisis. Although a complex pathology, gastroschisis is associated with normal intellectual development and few to none long-term complications.

The most frequent eating disorders are anorexia nervosa, binge eating and bulimia nervosa. They are frequently aggravated during pregnancy or postpartum and because they impair the general health and psychosocial functioning of the patients, it is fundamental to be carefully managing these pathologies in a multidisciplinary team. The common association with menstrual irregularities, even with secondary amenorrhea, lead to unplanned pregnancy following the patients’ belief that they are infertile, and this represents a risk factor for both mother and fetus. Carefully attention should be paid in the patients’ assessment due to the concealment behaviors adopted in order to hide the maladaptive patterns or the eventual use of certain potential drugs that are thought to prevent weight gain or an excessive appetite and, moreover, in the postpartum period patient should be carefully investigated for an eventual anxiety or depression syndrome that may arise as a result of the postpartum body shape or weight gain from the pregnancy period.

Fluoride represents an essential element in dental development and safety. Fluoride deficiency is associated with dental cavities. The main dietary source of fluoride is in water, followed by fluoridated toothpaste, tea, seafood, canned sardines or shells as well as medicinal supplements. The adequate intake ranges from 0.7 mg/day for toddlers, to 3 mg/day for adult females and 4 mg/day for adult males. The fluoride intake can present a difficulty in assessment, especially during pregnancy, so the question remains: is fluoride supplementation recommended during pregnancy to prevent dental cavities in the offspring? The correct answer is ‘No’. Fluoride supplementation during pregnancy does not reduce the incidence of caries in offspring. Centers for Disease Control and Prevention (CDC) does not recommend fluoride supplementation due to its action mechanism; fluoride has beneficial effects only after the tooth eruption takes place through a topical mechanism. Fluorosis (fluoride toxicity) in offspring has not been described secondary to excessive ingestion of fluoride of the mother during pregnancy, but there are studies correlating neurotoxic effects in the infants from mothers who received fluoride supplementation.

It is estimated that 2% of pregnant women develop gallstones during pregnancy. Symptoms of biliary lithiasis may vary during pregnancy, from a slight added digestive discomfort to biliary colic of varying intensity, acute cholecystitis, or acute pancreatitis. Ultrasonography is the gold standard for diagnosis of sludge and gallstones, being both highly sensitive and specific. Initial management overlaps with the out-of-pregnancy management, initiating conservative, supportive care, as well as an adequate diet. Laparoscopic cholecystectomy is considered a safe intervention in pregnancy, being the second most common surgery after appendicectomy. If open laparoscopy is preferred, the major risk - perforation of the uterus - is avoided. Important complications of gallstones in pregnancy, jaundice and acute pancreatitis can be resolved safely and quickly by cholangiopancreatography (ERCP) techniques, with stone removal, sphincterotomy or stent mounting. After remission of pancreatic symptoms, laparoscopic cholecystectomy can be performed. Recent scientific data and current practice suggest an increase of biliopancreatic emergencies during pregnancy (probably due to rising incidence of obesity, age of gravida, prolonged use of oral combined contraceptives, dyslipidemia, etc.). Surgeons, as well as obstetricians, should be aware of the prompt modern management of these cases.

Cesarean scar defect, niche or isthmocele represents a poor healing in the anterior uterine wall after performing a cesarean section. The cesarean scar defect can be asymptomatic, or the patient could present abnormal uterine bleeding, chronic pelvic pain, dysmenorrhea, dyspareunia, cesarean scar pregnancy or abnormal placenta. Abnormal uterine bleeding caused by cesarean scar defect presents as a postmenstrual spotting and has become more and more common among women with a history of minimum one cesarean section delivery. The most studied risk factors are: multiple cesarean section deliveries, single layer suture, locked suture, retroflexed uterus and cesarean section delivery performed during active labor with a cervical dilatation of 5 cm. There have been described several surgical approaches: hysteroscopic, laparoscopic or vaginal. From our experience, we have treated successfully symptomatic patients with cesarean scar defect with the levonorgestrel-releasing intrauterine system. Although the therapeutic indications do not include this specific use, we have obtained significant improvement of abnormal uterine bleeding due to cesarean scar defect in our patients. Our results sustain the necessity of extensive interventional studies.

Preterm infants are a special category of patients known for high rates of associated morbidities. This morbidities range from breathing problems to motor and neurologic impairments. The survival rates are improving along with better neonatal care, but the effects of preterm birth can still be seen in this category in patients. Even though dental health problems are not a largely debated subject, one should take into consideration that teeth, like other tissues are influenced by prematurity, and preterm babies are more likely to develop dental problems.

At menopause, a woman's body undergoes radical hormonal changes, which predisposes to damage of the oral cavity. The onset of menopause is a series of morpho functional physiological adaptive changes with systemic and oral action in women. Oral health is closely related to dental hygiene, a major concern in menopause. The addressability of women to dental services tends to increase due to perimenopausal changes that occur in the gums and teeth and the oral microbiome. These changes have a hormonal substrate that significantly influences the evolution of oral health. The purpose of this review is to understand the occurrence and evolution of oro-dental complications in menopause and the systematization of therapeutic regimens. The PubMed and Web Of Science databases searched identified approximately 21 eligible articles. Periodontal damage is the most common, followed by dryness and burning sensation in the mouth. The role of hormone replacement therapy is controversial in terms of prophylaxis or the obvious therapeutic aspect of menopausal women with oral symptoms. The lack of extensive research, at least for the time being, does not establish clear therapeutic protocols to resolve these dental conditions.

Prenatal ultrasound examination should take place between 18 and 20 week of gestation and is important for early detection of fetal anomalies such as the facial malformations. One important anatomic element is the palate that raises echographic technical difficulties such as the shadowing by facial bones and, especially, by the superior alveolar ridge, the fetal prone position and its localization, respectively, profoundly, inside of fetal head or anatomic obstacles such as the fetal tongue, so new echographic examination techniques are being under evaluation. The prenatal detection rate of fetal cleft palate remains low, so various methods of examination are being proposed. The ultrasound assessment of the fetal face is made by 2D ultrasound, technique completed by 3D ultrasound, which includes the evaluation in both axial and coronal planes, with the uvula being analyzed in two types of section, transversal and sagittal. In the latter to epiglottis is a landmark that confirms the identification of the uvula and a normal uvula has a typical and resembling echographic pattern to the equal sign. Even though prenatal diagnosis of soft palate cleft is a real challenge, with low detection rate due to difficulty of its visualization during routine examination, and even if suspected, diagnostic accuracy is low.