Functional gastrointestinal disorders in children: a single centre experience.

Functional gastrointestinal disorders in childhood (FGIDs) constitute a significant time-consuming clinical problem for healthcare practitioners, and they carry an important psychosocial burden for patients and their families. The aim of this study was to characterize etiology, clinical features, and interventions in a paediatric cohort of patients with FGIDs, who were referred to a tertiary care university-affiliated centre. Methods A retrospective study of children aged 1-15 years old referred to the Clinic for Children's Diseases, University Clinical Center Tuzla, from January 2022 to December 2022, who fulfilled criteria for FGIDs (n=209), were divided in three groups: 0-3, 4-10 and 11-15 years old. Demographic characteristics, number of examinations, duration of symptoms, initial diagnosis, hospital evaluation and outcomes of each child were collected. Results During the study period, 670 patients were referred to a gastroenterologist, out of whom 209 (31.2%) fulfilled the criteria for FGIDs, with median age of 8.0 years. Females were predominant in all groups (p=0.0369). Children aged 4 to 10 years were significantly more frequent (p<0.0001). A median duration of symptoms was one year. Functional constipation was the most common diagnosis, 99 (47.4%), followed by functional abdominal pain not otherwise specified, 67 (37.2%), and functional dyspepsia, 25 (12.0%). Fifty-two percent of patients did not require further follow-up by the gastroenterologist. Conclusion Although FGDIs are frequent, they are not well accepted neither among patients nor physicians. Extensive diagnostic procedures are often unnecessary and the cessation of specialized care follow-up is possible in a significant number of cases.

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.