[Diagnosis and prevention of neural tube defects--where are we? (Data based on the registry of congenital anomalies in the Pleven region)].

AIMS: to present some clinical and epidemiological data, concerning diagnosis and prevention of neural tube defects (NTDs), based on the registry of congenital anomalies (CAs) in the Pleven region; to analyse our data comparing with the data of other registries in Europe. MATERIALS AND METHODS: The source of the data was the regional population-based registry of Cas (in live births, stillbirths and terminations of pregnancy following prenatal diagnosis) using criteria according to EUROCAT recommendations. During the study period 1988-2006, 47 622 births were surveyed in the University hospital, City of Pleven. RESULTS: A total of 107 cases of NTDs were ascertained. About 20% of the cases with isolated NTDs were in terminations of pregnancy following prenatal diagnosis, in 80% of the case the diagnosis was ascertained in liveborn and stillborn fetus. The isolated NTDs were among the most common CAs, with a proportion of 8% of all registered cases and a prevalence of 2 per 1000 births. The genetic counseling revealed familial data (other affected child/pregnancy) in 7% of families with NTDs. Prenatal diagnosis was provided to the subsequent risk pregnancies in the affected families and NTDs were detected in 7% of the pregnancies. CONCLUSION: Neural tube defects are a common type of congenital defects that demonstrated a relatively high prevalence in the Pleven region. The data of the study indicates that there is a need to develop an official government policy regarding prevention of NTDs (pericoceptional folic acid supplementation and antenatal screening of CAs).

[Adrenal hemorrhage in a newborn with factor V Leiden--a clinical case].

Neonatal adrenal hemorrhage is frequently associated with birth trauma, perinatal asphyxia, septicemia, coagulation defects and thromboembolism. We report a case of bilateral adrenal hemorrhage in newborn baby with perinatal asphyxia. Ultrasound findings of subacute adrenal hemorrhage draw attention to its presumable antenatal genesis. DNA analysis for thrombophilic mutations identifies factor V Leiden.

[Prevention of anemia of prematurity].

Anemia of prematurity is seen in infants of less than 32 weeks' gestation. This anemia is due to low erythropoietin level and endogenous insufficiency of iron and vitamins. Administering of recombinant human erythropoietin, iron and vitamins in time is logic prevention alternative. The aim of our study is to examine the frequency of late haemotransfusions as an indicator of this prevention. We have investigated 181 children, who were born before the 32nd gestational week and who were distributed in two groups: group A (with prevention) and group B (without prevention). We found no significant difference in the frequency of the late transfusions between the two groups, but the results of the prevention in the most mature infants were better than those of the infants who were born before the 30th gestational week.

[Pentalogy of Cantrell--a case report].

Pentalogy of Cantrell is a rare congenital anomaly consisting of the following features: (1) midline supraumbilical abdominal wall defects (2) deficiency of the anterior diaphragm (3) defects in the diaphragmatic pericardium (4) defects of the lower sternum (5) congenital cardiac malformation We report a case of Cantrell's Pentalogy with rare cardiac malformation single ventricular chamber with two atria ventricular valves and pulmonary stenosis. The newbom had multiple congenital anomalies: omphalocele, thoracoabdominal ectopia cordis, diaphragmatic defect, short sternum/sternal defect and dysmorphic features--microcephaly, hypertelorism, down slanted palpebral fissures, micrognathia, low set ears.

[Our experience based on Omneo 1 /Nutrilon Comfort 1/ formula-fed of high-risk newborn babies].

OBJECTIVE: To investigate the acceptability and effect of Omneo 1/Nutrilon Comfort/milk formula of high-risk newborn babies. METHODS: Omneo 1 was given as food to 30 high-risk newborn babies. All of them were prematurely born of an average birth gestation age-33 gestation weeks and of average weight--1757,16 gr. None of the infants was ever fed mother's milk. The intake of Omneo 1 was applied to infants of stabilized health condition and post conceptual age no less than 38 gestation weeks /the average gestation weeks were 38,96/. The following parameters were closely observed: Body weight was measured once a week with the accuracy of +/- 5 gr.; The fecal pH was measured an 20 babies by means of multicolor indication paper Merck Eurolaba GmbH, Darmstadt, Germany; Stool characteristics-consistency and frequency, regurgitation and vomiting were recorded on the basis of mother's and personals interview. Methods used--clinical analysis, inquiry method, laboratory and anthropometric measuring. The survey is prospective. RESULTS: Weight gain was of 800 gr up to 1200 gr per month. Per day was achieved at an average weight gain - 37,60 gr. Decrease fecal pH was observed--at the beginning 7.1 (+/- 0.65) at the end of the study--5.1(+/-). The acidity of the excrements decreased which suppressed the development of pathogenic microorganisms. As regards the public inquiry, parents did not report cases an gastro-intestinal discomfort (regurgitation, constipation, colic). In two of the babies, blood in the excrements was macroscopically traced and "Allergy to cow's milk protein" was diagnosed. One of the infants was hospitalized with a generalized infection. The feeding with Omneo 1 was suspended in the case of these newborn, and they were excluded from the survey. CONCLUSION: Parents are positive about feeding Omneo 1 despite the higher price of the product. Omneo 1 milk contributes to adequate weight growth of high-risk newborn babies and its intake results in lower fecal pH as an indicator of positive bifidus effect.

[Our experience with linesolid usage in newborn children].

The Gram-positive infections are a problem with increasing significance in the newborn period. LINEZOLID is the first member of the new group antibiotics--oxazolidinones. The most Gram-positive infections, including the resistant of vancomycin, influence by LINEZOLID. We treated twenty newborn babies with LINEZOLID during the period from April 2005 to April 2006. Initial empiric antibiotic therapy appointed all those children. Various Gram-positive cocci were isolated from different biological materials. Five assays were sterile, but the clinical signs were suspect for Gram-positive infection. The treatment with LINEZOLID initialized immediately after the identification of the microbiological agent or when was suspect the resistant of initial antibiotics gram-positive infection. Duration of therapy was determined by the elimination of the microbiological agent or by the involution of the clinical signs, which we observed in the all cases of the treatment with LINEZOLID. Our results received up to date demonstrate the effectiveness and the safety of the LINEZOLID treatment in the newborn period.

[Sectio caesarea in extremely low birth weight newborn babies--modern tendency or objective necessity].

UNLABELLED: Obstetrician-gynecologists in a team with neonatologists contributed to saving of many children with extremely low birth weight /ELBW/, increasing many times SC frequency, considering it to be a sparing method for successful delivery, favorably influencing the outcome for the newborn. Many authors put emphasis on the better results however others point out reasons for a certain level of skepticism, assuming that survivability should not be the only criteria. Thus our objective was to find out the role of the abdominal delivery on the favorable outcome for ELBW newborn babies. MATERIAL AND METHODS: The study is retrospective, including 40 deliveries of children weighing from 500 to 999 g, at the Clinic in Obstetrics at Dr. Georgi Stranski University Hospital--Pleven, for a period of 5 years /2000-2004/. The newborn babies were divided into two groups depending on the method of delivery: I group--per vias naturales /PN/--31 cases--77.5% II group--per SC--9 cases--22.5%. RESULTS AND DISCUSSION: Attention was paid in our study to the most frequently asked question about the survivability of the newborn babies until their discharge, neonatal diseases and mortality rate, respectively. Survivability rate in the first group was 32.2% compared to 66.6% for the newborn babies per SC. The main reasons for mortality in the newborn babies are massive brain hemorrhages--70% of the cases, respiratory insufficiency--25% and extreme immaturity--5%. CONCLUSIONS: 1. Operative delivery is an objective necessity as a method improving the final favorable outcome for ELBW newborn babies. 2. The intensive neonatal cares accompanied by precise application of surfactant sharply increase the survivability rate and reduce diseases and mortal rate of ELBW newborn babies. 3. The preventive cares in the maternity consultation rooms could become a landmark for reducing the number of pre-term deliveries.

[Active screening for genetic pathology in newborns. I. Registration of congenital abnormalities]. / Aktiven skrining za genetichna patologiia sred novorodeni. I. Registratsiia na vrodeni anomalii.

Active screening for genetic pathology over a period of 12 years (1990-2001) involved examination of 29,629 newborns at the Clinic of Obstetrics and Gynaecology. Congenital anomalies were detected in 1244 cases (live-, stillbirths and terminated pregnancies) which gives an average incidence rate of 42.0 per 1000 among the studied population. Congenital cardiac anomalies and CA of the central nervous system were the most common types of isolated CA. They provided frequencies of 7.76 per 1000 and 6.85 per 1000 cases respectively. The incidence of the neural tube defects (NTD), particularly, varied throughout the years (t = 2.69; p < 0.01) but stated high--on average 2.12 per 1000 with the highest rate of 3.89 per 1000 in 1993. A reduction in the incidence of NTD is possible with a recommendation of periconceptional folic acid supplementation. Registration of CA is a strategy for identifying families at risk to give births of child with CA. This approach enabled us to provide more accurate genetic counselling and prenatal diagnosis for genetic pathology. Active screening of newborn population is likely to be an effective and necessary service.

[Congenital anomalies among live-birth infants and their place in the structure of neonatal mortality--the Higher Medical Institute, Pleven (1993-97)]. / Vrodeni anomalii sred zhivorodenite i miastoto im v strukturata na neonatalnata smurtnost--VMI, Pleven (l993-97).

The aim of the study was to determine the frequency of the congenital anomalies (CA) among the live-born (LB), the structure of the neonatal mortality (NM) and the impact of congenital anomalies on it. Congenital anomalies were found in 171 (2.71%) of 11,902 infants born and hospitalized at the Clinics of Neonatology--Pleven between 1993 and 1997. 171 (14.4% o) of all LB died in 28 day after delivery. Noninfectious lung pathology and CA were responsible for respectively 28.7% and 27.5% of these deaths and were the main causes of NM. Multiple congenital anomalies and CA of cardio-vascular system were the most frequent CA that caused these deaths. The major part of the CA with genetic basis (64%) emphasizes the importance of the registration of CA and the genetic counselling for declining the NM rate.

[Nosocomial enterobacter - sepsis in neonatal intensive care unit in Pleven]. / Nozokomialen enterobacter - sepsis v neonatalogichno intenzivno otdelenie - Pleven.

At the recent years considerably increased the role of Enterobacter spp as causes of nosocomial sepsis in different intensive units. It is determined of their possibilities to change quick antibiotic resistance especially to third generation cephalosporins and wide insemination of the environment. During the period from 29.10.1997 to 30.12.1997 in Neonatal intensive care unit--Pleven have been registered 9 cases of nosocomial sepsis caused by Enterobacter aerogenes. The clinic picture run with shock, temperature instability, hyperbilirubinemia, mottling respiratory insufficiency, I/T ratio > 0.2. Thrombocytopenia. Detection of the pathogen organisms present wide antibiotics resistance to cephalosporins. The microbiological control of the environment have been isolated Enterobacter spp from neonatal intensive unit, delivery room, unit for healthy newborn. The persistence of Enterobacter infections is a result of low supply of household linen, detergents, single-used products and widely used of cephalosporins, insufficient staff and overpopulation with patients.