Predictors of adverse short-term outcomes in late preterm infants.

BACKGROUND: Infants born between 34 weeks and 36 weeks and 6 days of gestation are defined as late preterm infants (LPIs), and they account for approximately 74% of all premature births. Preterm birth (PB) remains the leading cause of infant mortality and morbidity worldwide. AIM: To analyse short-term morbidity and mortality and identify predictors of adverse outcomes in late preterm infants. PATIENTS AND METHODS: In this retrospective study, we evaluated adverse short-term outcomes of LPIs admitted to the Intensive Care Unit (ICU), Clinic for Children's Diseases, University Clinical Center Tuzla, between 01.01.2020 and 31.12.2022. The analysed data included sex, gestational age, parity, birth weight, Apgar score (i.e., assessment of vitality at birth in the first and fifth minutes after birth), and length of hospitalization in NICU, as well as short-term outcome data. Maternal risk factors we observed were: age of mother, parity, maternal morbidity during pregnancy, complications and treatment during pregnancy. LPIs with major anatomic malformations were excluded from the study. Logistic regression analysis was used to identify risk factors for neonatal morbidity among LPIs. RESULTS: We analysed data from 154 late preterm newborns, most of whom were male (60%), delivered by caesarean Sect. (68.2%) and from nulliparous mothers (63.6%). Respiratory complications were the most common outcome among all subgroups, followed by CNS morbidity, infections and jaundice requiring phototherapy. The rate of almost all of the complications in the late-preterm group decreased as gestational age increased from 34 to 36 weeks. Birth weight (OR: 1,2; 95% CI: 0,9 - 2,3; p = 0,0313) and male sex (OR: 2,5; 95% CI: 1,1-5,4; p = 0,0204) were significantly and independently associated with an increased risk for respiratory morbidity, and gestational weeks and male sex were associated with infectious morbidity. None of the risk factors analysed herein were predictors of CNS morbidity in LPIs. CONCLUSION: A younger gestational age at birth is associated with a greater risk of short-term complications among LPIs, thus highlighting the need for increased knowledge about the epidemiology of these late preterm births. Understanding the risks of late preterm birth is critical to optimizing clinical decision-making, enhancing the cost-effectiveness of endeavours to delay delivery during the late preterm period, and reducing neonatal morbidity.

Frequency of Urinary Tract Infection When Diagnosing Vesico Uretheral Reflux in Children in Tuzla Canton.

Background: Vesicoureteral reflux (VUR) represents the return of urine from the bladder into the ureter and the renal canal system. Reflux can occur only on one or both kidneys. VUR most often occurs due to an incompetent ureterovesical junction, which consequently leads to hydronephrosis and dysfunction of the lower parts of the urinary system. Objective: The aim of the study was to determine the frequency of urinary infection when diagnosing vesicouretheral reflux in children in the Tuzla Canton, in the five-year period from 01.01.2016 to 01.01.2021. Methods: Through a retrospective study, we analyzed data from 256 children with vesiocouretheral reflux (VUR), examined in the Nephrology Outpatient Clinic, Clinic for Children's Diseases, University Clinical Center Tuzla, in the period from 01.01.2016 to 01.01.2021, from early neonatal to 15 years of age. The age and gender of children, the most common symptoms of urinary tract infections during the detection of VUR, and the degree of VUR were analyzed. Results: From 256 children with VUR, 54% were male and 46% female. The highest prevalence of VUR was in the age group 0-2 years, and the lowest in the age of children > 15 years. There was no statistically significant difference between the groups of our respondents in relation to age groups, nor in relation to the gender of the children. Statistically significantly more children were without nonspecific symptoms and with asymptomatic bacteriuria in the group without UTI symptoms in children with VUR compared to the group with UTI symptoms in children with VUR. Pathological urine culture between the groups was without a statistically significant difference. Conclusion: Although urinary tract infection in children is common, the possibility of permanent consequences should always be kept in mind if VUR is not diagnosed and treated in time.

SHORT-TERM OUTCOME OF MASSIVE PULMONARY HEMORRHAGE IN PRETERM INFANTS IN TUZLA CANTON.

Massive pulmonary hemorrhage (MPH) in neonates is a severe condition followed by many complications and associated with a high mortality rate. The aim of this study was to present the incidence, possible risk factors, and short-term outcome of neonatal MPH in Tuzla Canton. We retrospectively analyzed data on neonates with MPH from January 2015 to December 2017. On statistical analysis, standard methods of descriptive statistics were used. During the three-year study period, 16 neonates developed MPH, 5 (31.25%) male and 11 (68.75%) female. Their mean gestational age was 29.48±2.21 weeks and mean birth weight 1276.69±387.65 grams. Seven (43.75%) neonates survived and 9 (56.25%) died. Significant differences between the two outcome groups (survivors/died) were found in gestational age, birth weight, birth length, 5-minute Apgar score, and length of treatment at the Neonatal Intensive Care Unit. In Tuzla Canton, MPH occurred mainly in preterm neonates requiring mechanical ventilation, with the incidence of 1.91% of total premature births. The short-term outcome was uncertain, with a high mortality rate of 56.25%. Lower gestational age, lower birth weight, lower birth length and lower 5-minute Apgar score were confirmed as risk factors for poor short-term outcome.

Epidemiology of neonatal sepsis caused by multidrug resistant pathogens in a neonatal intensive care unit level 3.

Aim Steady progress in intensive treatment worldwide has increased the survival of immature neonates, but with multiple invasive procedures, which have increased the risk of infection, thus the bacterial resistance to antibiotics. The aim of this study was to analyse the epidemiology of multidrug resistance pathogens as causative agents of neonatal sepsis in the neonatal intensive care unit. Methods A retrospective cohort study conducted at the Intensive care unit of the Paediatric Clinic of Tuzla over a three-year period (2016-2018) analysed epidemiology of neonatal sepsis caused by multidrug resistance pathogens. Statistical analysis applied standard methods, and the research was approved by the Ethics Committee of the institution. Results Of the total of 921 treated neonates, multidrug resistance (MDR) pathogens among causative agents of neonatal sepsis were found in 22 neonates (2.38%) with no gender difference. Prematurity and low birth weight were confirmed as the most significant risk factors. From the maternal risk factors a significant difference was found in the first birth and in vitro fertilization. Clinically, MDR sepsis manifested frequently as late onset sepsis, with longer hospital stay and higher mortality. The findings of leukopenia, thrombocytopenia and coagulation disorders were significant. Gram negative bacteria were frequently isolated, in particular Acinetobacter, which showed the greatest resistance to antibiotics. Conclusion Neonatal MDR sepsis is a threat to life, it complicates the treatment, increases costs and mortality. Outcomes can be improved by preventive strategies, earlier and more accurate diagnosis and rational use of antibiotics.

Risk Factors and Outcome of Neonatal Pneumothorax in Tuzla Canton.

AIM: The aim of this study was to analyze risk factors and outcome of neonatal pneumothorax in Tuzla Canton. METHODS: Neonates with chest X-ray confirmed pneumothorax in University Clinical Center of Tuzla, within a three-year period, from January 2015 to December 2017, were retrospectively studied. Participants were evaluated for baseline characteristics, predisposing factors of neonatal pneumothorax, accompanying disorders and mortality. RESULTS: During the observed three-year period 11425 neonates were born in Tuzla Canton, with 7.33 % of preterm births, and 604 neonates were treated in NICU, with 265 neonates who required mechanical ventilation. Neonatal pneumothorax (NP) was diagnosed in 22 patients (9 term, 13 preterm), 12 (54.5%) were male. The incidence was 0.20% of total births, respectively 3.64% of those treated in NICU. The mean gestational age were 35.1 ± 3.0 weeks and birth weight 2 506.8 ± 727.7 grams. NP was mostly unilateral (72.7%) and right-sided. The most commonly associated diseases were: respiratory distress syndrome, intracranial haemorrhage, pneumonia, transient tachypnea and sepsis. In 8 (36.4%) neonates, the underlying cause of NP could be mechanical ventilation (secondary), whereas in 14 (63.6%) NP was spontaneous, without previous mechanical ventilation, although 11 of them required mechanical ventilation after pneumothorax. CONCLUSION: All perinatal risk factors were investigate, and significant differences in two observed groups related to mechanical ventilation were found for birth weight, gestational age, Caesarean section, length of mechanical ventilation, surfactant replacement therapy and outcome. Three (13.64%) neonates with NP died, and among risk factors with poor outcome, significant was only Apgar score in the first minute ≤ 5.

Childhood and Coress model of carcinogenesis.

INTRODUCTION: In the last fifty years the incidence of gastric cancer in developed countries is a constant trend, but mortality in all countries remains at the same level and ranks second behind lung cancer. In the case of gastric cancer has a far more important the role the early diagnosis compared to prevention. MATERIAL AND METHODS: The sample included 200 subjects aged 7-18 years treated at the Pediatric Clinic, University Clinic Tuzla and Pediatric Clinic and the Clinic for Child Surgery of Clinical Center of Sarajevo University who had endoscopic and histologically verified gastritis. The method of processing the tissue preparations of histologic sections of paraffin-fixed and paraffin tissue by hematoxylin-eosin method and Helicobacter pylori, using Giemsa. RESULTS AND DISCUSSION: Pathological analysis of the sample of patients with gastritis found that in 91% of patients had chronic superficial gastritis, while in 9% of patients were found atrophic changes, with or without intestinal metaplasia. Atrophic changes with or without intestinal metaplasia was found in 10.2% of H. pylori-positive patients with gastritis. The same analysis in a significant percentage of 5.7% of H. pylori-negative patients was atrophic changes, with or without intestinal metaplasia. Analysis of activity of the inflammatory process, we have found that the symptoms matched a statistically significant percentage (86.5%) with the active phase of the disease, which speaks against thinking that H. pylori infection is asymptomatic condition, which is often cited in the literature. CONCLUSION: Gastric mucosal lesion caused H. pylori infection is a reversible process and the eradication of this infection not only stops the activity of the inflammatory process, but also restores the mucous membranes. Eradication leads to a significant drop in the incidence of recurrence of gastritis and peptic ulcer disease, and can lead to prevention of malignant disease in 70-80% of cases, even, and perhaps more.

Early and correct diagnosis of celiac disease in the prevention of growth disorders and child development.

Coeliac, in ordinary people known as "flour allergy" and in medicine world known as gluten enteropathy which means enteric damage caused by gluten. Data about incidence of gluten enteropathy is different in different countries around the World and depend on is it or is it not the right diagnosis for enteric disorder. Sometimes, this disease is unrecognized because of unspecific clinical signs. This disease is happening in every moment of a lifetime, most common during the childhood when the children try to eat any food which contains gluten. Anyway, if children had no symptoms it doesn't¢t mean that disease not exists, and that¢is because we have to do diagnostic tests to confirm gluten enteropathy. Gluten intolerance is chronic disease and demand use of the specific non gluten food during the lifetime. Early diagnosis is right way to prevent unregularly growth. Aim of this study was to show the influence of early diagnostic about growth. For each patient we had a permission of parents and we showed our original results for three month we investigated.

[The lunar cycle and seizures in children]. / Lunarni ciklus i cerebralni napadi u djece.

AIM: To analyze the annual trend of hospitalization and potential influence of the lunar cycle of children treated for seizures METHODS: The data of the patients treated for seizures (convulsions, epileptic seizures, disturbance of consciousness and epileptic seizures in children with neurodevelopmental disability) in the Pediatrics Clinic of the University Clinical Center of Tuzla were retrospectively analyzed during 2008 in relation to seasonal distribution, admission time (month, week, admission moment, day in a week, time of the day) and the lunar cycle. RESULTS: Out f the total of 234 treated children, 55 (23,5%) were infants, 101 (43,1%) were under six years of age and 78 (33,3%) were of school age. The most common type of seizures were convulsions, 123 (42,6%). The seizures were numerous in the midst of the week, as opposed to weekends. The highest number of children was treated in January, February, July and August, that it, in the fourth, seventh, twenty-seventh and thirty-first week of the year. Seizures occured during the day in 149 patients (63,7%) and during the night in 84 (35,9%) patients (p < 0,0034). The number of treated patients was significantly larger in the third and fourth lunar phases (p < 0,018). CONCLUSIONS: The results suggested seasonal and weekly trends of hospitalization of patients with seizures and their relation with circadian and lunar cycles. There is a need for further prospective studies in order to get better understanding of the influence of the lunar cycle on health.

[Humoral immunity in children with immunodeficiency and immunosuppression]. / Humoralna imunost u djece sa imunodeficijencijama i imunosupresijom.

The objective of the study was to determine the immunological characteristics of immunodeficiency and immunosuppression in children and to estimate the type of disorder within the immunological system. In the prospective study with 90 patients included, all were separated into three groups (30 patients per group) of which the first group was formed of patients with immunodeficiency; the second group of patients who were receiving the immunosuppressive therapy for autoimmune diseases for more than 6 months; and the third group being the control group formed of patients with uncomplicated bacterial infections. The follow-up parameters were gathered using questionnaire on personal and family anamnesis of patients with immunological parameters: humoral unspecific immunities (CRP, C3, C4, IL1 and IL2), humoral specific immunities (IgG, IgM, IgA and IgE) and cellular specific immunity. Concentrations of medium values of CRP in patients with immunodeficiency and on immunosuppressive therapy, statistically are significantly lower than in patients from the control group (p < 0.05). Individually increased concentrations of CRP within the groups are the indicator of acute inflammatory process and of relapse of basic disease in patients with autoimmune diseases. The concentrations of IL1 are lower than standard values in the test. in 28 patients (93%) with immunodeficiency and in 26 (87%) patients with immunosuppression. Increased concentrations in 2 (7%) patients with immunodeficiency are sign of acute inflammatory process, and 4 (14%) patients with immunosuppression and increased concentrations have shown signs of inflammation and relapse of basic disease. Concentration of IL2 in 1 (3%) patient from immunosuppressed group was increased (iatrogenic immunosuppressant). There is no statistically significant difference in concentrations of medium values of C3 and C4 complements among the studied groups of patients (p > 0.05). Concentrations of IgG in group of patients with immunodeficiency are statistically and significantly lower at medium and individual values (p < 0.001), as well as the concentrations of IgM and IgA (p < 0.05) comparing to other studied groups. Concentrations of IgE above 4.500 IU/ml were found in 3 (10%) patients with Hyper IgE syndrome. Results of our study have shown the possibility of evaluation of the level and the scale of disorder of the immunological system in children.

[Brucellosis spondilitis in a ten year boy]. / Brucelozni spondilitis u desetogodisnjeg djecaka.

INTRODUCTION: Brucellosis is acute infectious disease classified as zoonosis, which can leave humans with chronic damages and disability. It can appear as sporadic cases or a smaller epidemic anywhere in the world but it is more common in some areas and there it presents significant public health issue. Clinical picture is very variegated. A long period of latency is possible, unnoticed asymptomatic start or forms with mild clinical picture up to the forms with per acute septic-toxic shock and possible lethal outcome. Symptoms of general infectious syndrome, wave like (undulating) temperature, profuse night sweat, muscle, bone and joint pain can be considered to be characteristic. Diagnosis is made based on epidemiological data, clinical findings, microbiological and serological tests. Differentially diagnostic all long-lasting febrile diseases may be considered and disease with neuralgic and arthralgic syndromes. Therapy includes antibiotics and prevention implies sanitary veterinary control, food control and measures of professional protection. METHODS: This paper descriptively describes clinical course of the disease in ten year old boy with brucellosis spondylitis. CASE REPORT: Ten year old boy was hospitalized for febrile condition and acute pain in back and abdomen of unknown etiology. We did diagnostic and therapeutic treatment with multidisciplinary approach and due to information on previous cases of brucellosis in family we also added tests to brucellosis. Diagnosis of brucellosis spondylitis is made based on MRI of lumbosacral spine and is confirmed with positive serological tests and positive blood cultures to Brucella melitensis. The boy had no other localized foci of the disease in other organs or systems. Etiological treatment was done in accordance to recommended antimicrobic scheme. A complete recovery was achieved with further need for observation of condition and Elisa titer to this agent. CONCLUSION: Osteoarticular form of brucellosis is relatively common focal form of the disease in adult patients but not so common in children. Syndrome of acute lumbosacral pain in children is of unknown etiology and diagnostic procedures must include infectious diseases with possible osteo-articular symptoms including brucellosis.

[Characteristics of broncho-obstruction in childhood]. / Karakteristike bronhoopstrukcije u djecijoj dobi.

INTRODUCTION: The prevalence of broncho-obstruction in children is in permanent increase at any age and in global. According to many studies, about 50% of children have at least one episode of broncho-obstruction in the first six years of life. Risk factors for broncho-obstruction in children include not only intrinsic, but a lot of extrinsic factors which could accelerate beginning of early symptoms. Globally, there is increase in first hospitalization with broncho-obstruction and many authors described decrease in rehospitalizations, thanks to therapy improvements. There is evidence of seasonal distribution of children treated for broncho-obstruction. Depending on country and author, different periods of year are related to increased number of patients, which could be explained by seasonal agents. Many studies described geographic variation in incidence and prevalence of respiratory diseases, which could also be explained by seasonal agents. PURPOSE: The aim of this paper is to establish frequency of broncho-obstructive syndrome, comparing the age, gender, place of inhabitance and seasonal agents in children treated at the Department of Intensive care at the Pediatrics Clinic in Tuzla trough analysis of their personal histories, clinical, radiography and laboratory findings. METHODS: Analysis was based on population of patients treated at the Department for Intensive care of Pediatrics Clinic in Tuzla with broncho-obstructive syndrome, from January 1st to 31st December 2006. All selected patients were from Tuzla Canton. Source of the data for research were Admission protocol for Pediatric Clinics, Intensive care unit protocol and personal histories of children treated. Method of work was retrospective study which analyzed anamnesis' data, clinical, radiography and laboratory findings, therapeutic procedures and length of hospitalization at the Intensive care unit and outcome of the treatment. RESULTS AND DISCUSSION: Total number of 767 children were treated during the investigated period at the Intensive care unit. Out of this number 332 children (43,3%) were treated for syndrome of broncho-obstruction. The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was most common at nursing age (40,0%) and 76,5% patients were under age of five. Boys dominated at all age groups except for repeated admissions of school age where this relation was equal. Spatial distribution demonstrated that the highest number of children treated for broncho-obstruction was from Tuzla, Lukavac and Zivinice. The incidence of patients from these municipalities was significantly above the participation of these municipalities in total population. Season distribution demonstrated that the highest numbers of children were treated in December, and lowest in July and August. Number of treated children was statistically significant higher during winter months. Broncho-obstructive syndrome in 67,5% patients was with radiography confirmed pneumonia and in 13,8% with lung athelectasis. The most common isolated agents were Staphylococcus, Klebsiella and Pseudomonas. CONCLUSION: The frequency of broncho-obstructive syndrome in children was different regarding age, gender, place of inhabitance and year season. Broncho-obstructive syndrome was found in 67,5% patients with radiography confirmed pneumonia.