[Selected ethical problems in neonatology -- opinions of physicians and nurses based on questionnaire study]. / Wybrane problemy etyczne w neonatologii -- poglady lekarzy i pielegniarek na podstawie badan ankietowych.

UNLABELLED: AIM OF THIS PAPER: To present the opinions of doctors and nurses on the limitations of resuscitation and treatment of extremely premature newborns. MATERIAL AND METHODS: Anonymous questionnaire studies were carried out in 342 doctors and 1194 nurses from 6 provinces of Poland. The authors compared the answers of doctors and nurses as well as the answers form different provinces. The results were processed using the Chi2 test, with the significance level p<0.05. RESULTS: The will to resuscitate the neonate, regardless of its birth weight was declared by 29% of the physicians and 49% of the nurses, regardless of the gestational age - by 21% of the physicians and 47% of the nurses. Resuscitation of an extremely immature, asphyctic newborn was declared by 71% of the physicians and 59% of the nurses. Limitation of therapy after diagnosing severe intracranial hemorrhage is declared by 67% of the physicians and 45% of the nurses. 37% of the doctors and 30% of the nurses would comply with parents' will when deciding about resuscitation. 44% of the physicians and 31% of the nurses declare taking parents' decision into account in the matter of abandoning resuscitation. CONCLUSIONS: 1. There is a higher percentage of persons convinced about the necessity of resuscitation of every newborn, regardless of its maturity, among the nurses than among the doctors. 2. Among the nurses there are more persons, who are sceptical about saving the extremely premature newborns born with asphyxia, whereas among the doctors there are more persons inclined to stop therapy in case of a severe intracranial hemorrhage. 3. The most controversial are problems concerning the consideration of parents' will in decision about whether to continue or abandon resuscitation, but physicians are more apt to regard parents' will in resuscitation in some situations. 4. The analysis of the questionnaire points to the need for deeper knowledge of the present mortality rates of the extremely immature newborns and further development of the surviving ones among the physicians and nurses.

[Newborn of a mother with HELLP syndrome]. / Noworodek matki z zespolem HELLP.

HELLP syndrome is a serious complication of pregnancy with characteristic appearances between 22 to 26 weeks of gestation. Clinical classification in three groups, is based on platelet count. Early diagnosis and appropriate management allow women to achieve a mortality rate below 1%. Neonatal complications are strongly associated with a newborn's immaturity and class of HELLP syndrome. In both presented cases despite identical maternal treatment (steroids because of I st class of HELLP syndrome) neonatal clinical courses were different due to the differences in gestational age. However, appropriate prenatal and neonatal care in tertiary centers was successful.

[Tissue and blood oxygenation in newborns < 1250g and incidence of ROP]. / Stopien utlenowania krwi noworodków z masa ciala < 1250 g a czestosc retinopatii.

AIM: The aim of this study was to analyze correlations between the onset and severity of retinopathy and premature birth. MATERIAL AND METHODS: In the three groups of 30 newborns < 1250 g we have analyzed blood saturation, tissue oxygenation and blood transfusion. To estimate tissue oxygenation we used following formulas; 1. TVCE = [formula: see text] V-blood volume = 8% of body weight 2. Oxygen availability = (0.54 + 0.005 x gestational age) x Hb (g/dL) Additionally we investigated incidence of BPD, PDA, severe IVH, and sepsis. RESULTS: We have found statistically significant influence of drops of SaO2 < 85% and lower mean values of SaO2 on development of severe retinopathy. We have not seen any statistical differences in the other parameters of oxygenation between the groups. CONCLUSIONS: Fluctuation as well as instability of oxygen blood saturation seem to be the most important risk factors of retinopathy. Limitation of early blood transfusions can decrease incidence of ROP. We do not have adequate methods for the estimation of tissue oxygenation which can be used to verify indications for blood transfusion. We should use very restrictive recommendations for blood transfusion in ELBW babies.