The role of antibiotic prophylaxis in preterm premature rupture of membranes.

Preterm premature rupture of membranes (PPROM) occurs in 3 percent of all pregnancies and is responsible for, or associated with, approximately one-third of preterm births causing significant perinatal morbidity and fetal death. Preterm infants are very vulnerable to respiratory distress syndrome (RDS), intraventricular hemorrhage (IVH), periventricular leucomalacia (PVL), other neurological sequelae, infection and necrotizing enterocolitis (NEC). Chorioamnionitis based on clinical criteria occurs in approximately 3-30% of all PPROM pregnancies. The aim of this study was to analyze the role of antibiotic prophylaxis in delivery delay on neonatal outcome (body weight, Apgar scores, pulmonary complications, neurological complications--abnormal cerebral ultrasound scan prior to hospital discharge, perinatal infections) and to determine the possibility of an optimal antibiotic regimen. Therefore we retrospectively analyzed last 5 years of data from patients treated in our center and provided a coherent overview of the clinical course and outcome of patients with PPROM treated with prophylactic antibiotics and antenatal corticosteroids. There were 324 preterm newborns which fulfilled the inclusion criteria for our study; 190 in Study group (received empiric i.v. antibiotics) and 134 in Control group (without antibiotic). We found significant difference in gestational age (p < 0.0001), birth weight (p < 0.0001), Apgar scores (p < 0.0001) maternal C-reactive protein level (p < 0.0001) and latency period (5.54 days vs. 11.33 days, p = 0.001) between the groups. Histologic chorioamnionitis was significantly more frequent in s Study group (14.2% vs. 36.3%, p < 0.0001). We found significant difference in neonatal outcome according the different antibiotic treatment. Antenatal antibiotics and corticosteroid therapies have clear benefits and should be offered to all women without contraindications.

Nucleated red blood cells count as first prognostic marker for adverse neonatal outcome in severe preeclamptic pregnancies.

The purpose of this study was to determine acceptability of the nucleated red blood cells counts (NRBC) as early prognostic parameter for adverse outcome in preterm neonates born from pregnancies complicated with severe preeclampsia. We analysed 77 premature newborns who were born from pregnancies with severe preeclampsia during eight years (2004-2011) in our tertiary center. Women with other pregnancy complications were excluded from the study, as well as newborns with malformations and chromosomal anomalies. Newborns were compared according to the count of nucleated red blood cells (NRBC) on the first day of life. Cut off of NRBC was determined at 40 per 100 white blood cells. We analyzed and compared birth weight, gestational age, Apgar scores in 1st and 5th minute, hypoglycemia in first day of life, need for respiratory support, neonatal infection and brain ultrasound findings at the day of discharge between the groups of newborns. We found significantly lower birth weight, gestational age and Apgar scores in case group (NRB C > 40) and significantly higher rate of infections, need for respiratory support, abnormal brain ultrasound findings, morbidity rate and adverse neonatal outcome compared to control newborns group. Increased count of nucleated red blood cells (NRBC) in preterm newborns born from pregnancies with severe preeclampsia seems to be the first significant marker for detecting adverse neonatal outcome.

[Surgical and radiotherapy in treatment of postauricular keloids--case report]. / Kirurska i iradijacijska terapija u lijecenju postaurikularnih keloida.

Treatment of keloid remains a great challenge for clinicians, in spite of numerous therapeutic regimens reported in the literature to date. Earlobe or postauricular regions are predominant locations for postoperative keloids due to the treatment of lop ears. There are several treatments that include intralesional steroid injections, surgical excision, cryotherapy, laser therapy, radiotherapy and pharmacotherapy. A case is presented with fourth recurrence of keloids after surgical treatment of lop ears with final satisfactory outcome after combined therapy that included surgical excision, skin flap transposition and radiotherapy. It is concluded that interdisciplinary approach that includes a combination of surgery and radiotherapy results in a satisfactory outcome of keloid treatment.