[Blood lactate measurments as a diagnostic and prognostic tool after birth asphyxia in newborn infants with gestational age > or = 34 gestational weeks].

UNLABELLED: Blood lactate at birth as result of activated anaerobic glycolysis is a marker of perinatal asphyxia. AIM: To evaluate the dynamics of blood lactate, pH and base excess (BE) as a tool for assessing the severity of fetal hypoxia and predicting neonatal outcome. METHODS: 79 neonates (> or = 34 gestational weeks) were included and followed up until discharge: 43 with pathologic fetal hearth rate patterns and/or 1-minute Apgar score < 7 ("asphyxia group"); 36 without obstetric or clinical signs of asphyxia (control group). Samples from umbilical artery (u.a.), capillary blood at 2h and 12-24 h after birth were analyzed for blood lactate, pH and BE. RESULTS: Lactate value (u.a.) was significantly higher (5.3 +/- 3.4 mmol/l), pH and BE were lower (7.29 +/- 0.05 and -14.1 +/- 5.9 mmol/l) in the "asphyxia group" compared to the control group (2.7 +/- 1.2 mmol/l, 7.29 +/- 0.05 and -5.9 +/- 3.3 respectively). The 2 h lactate-values increased significantly in infants with asphyxia (6,.7 +/- 4.7) compared to the controls (3.2 +/- 1.1), the 12-24 h values were reduced in the main group (4.6 +/- 1.5) and without changes in the controls (3.2 +/- 0.88). Values of pH and BE at 2 h and 12-24 h increased progressively in both groups without significant differences between them. Hypoxic-ischemic encephalopathy (HIE) stage II-III was observed in infants with u.a. pH < 7.05, BE < -15 if u.a. lactate was high and progressively increased in next 2 h. CONCLUSIONS: High u.a. lactate values correlate with low pH and BE and is a reliable tool for assessing the severity of fetal asphyxia. Increasing lactate concentration after birth is better predictor of severe HIE.

[Maternal insulin-dependent diabetes and congenital malformations in the newborn]. / Maichin diabet i vrodeni malformatsii na novorodenoto.

Congenital malformations (CM) are one of the leading causes of perinatal morbidity and mortality in infants of insulin dependent diabetic mothers (IDM). The aim of the present study is to determinate the incidence and structure of CM in this high risk population. The study included 14,325 newborns born between 1997-2000. 157 of them were IDM. The incidence of CM in IDM is 4-8 times higher than in general newborn population. The most frequent CM are congenital heart disease and polimalformation syndrome. The duration of mothers insulin dependent diabetes and poor glycemic control before and during pregnancy increases the risk of CM.

[Retinopathy of prematurity--frequency and risk factors]. / Retinopatiia na nedonosenoto--chestota i riskovi faktori.

UNLABELLED: Retinopathy of prematurity (ROP) is a significant problem in very low birth weight (VLBW) newborns, patients of the neonatal intensive care units (NICU). The aim of the present investigation is to report the results of our ROP-screening program: 1. Current frequency of ROP and the need for retinal surgery; 2. Main risk factors and the prophylactic possibilities for ROP. STUDY DESIGN: This is a retrospective study for 3 years period: 08.'98-07.01. 188 survived premature newborn patients of NICU, "Majchin dom", Sofia, met the criteria for ROP screening. The first eye exam was performed at 3 weeks of age, followed by exams every 2 weeks until complete vascularisation of the retina. RESULTS: The incidence of ROP any stage was 11.2% (21 of 188) and 4.2% (8) for stage > or = 3. The mean birth weight of the ROP (+) group was 982 g, the mean gestational age (g.a.)--27.9 g.w., comparing with 1258 g and 30.9 g.w. respectively of the ROP(-) group (p < 0.05). ROP stage > or = 3 was diagnosed as a rule among the newborns with birth weight < 1000 g 14.6% (7 of 48) and g.a. < 28 g.w. (6 of 41). Seven children have undergone successful retinal surgery. The children of ROP(+) group needed significantly longer mechanical ventilation and supplemental O2, they developed more often bronchopulmonary dysplasia and severe grade III-IV IVH, the percent of neonatal sepsis and the need of blood transfusions in the first month was greater too. CONCLUSION: The frequency and severity of ROP in our study is relatively low and that depends on the strict monitoring of the intensive cares. Main risk factors are extremely low birth weight and gestational age; severe RDS with longer duration of mechanical ventilation and supplemental oxygen. Grade III-IV IVH and neonatal sepsis are often a parallel finding with severe ROP. Other risk factors are the greater number of blood transfusions and the developing of chronic lung disease.

[A clinico-epidemiological study of neural tube defects in newborn infants]. / Kliniko-epidemiologichno prouchvane na defektite na nevralnata truba pri novorodeni detsa.

This is a retrospective study on the rate of inborn defects of neural tube in University Hospital of Obstetrics and Gynaecology--Sofia for two 5-years-long periods of time: from 1986 to 1990 and from 1993 to 1997. The results show an increasing rate of inborn NTD during the second period of time which can be partly explained by the fact that the hospital is National Perinatal Centre where high risk pregnancies and deliveries are concentrated. Most disturbing is the fact that more than half of life-born and still-born infants with NTD are at an age of gestation higher than 34 g.w. This is a result of late perinatal diagnosis of these defects and brings up serious psychological, social and economical problems.

[The duration and extent of intensive therapy for newborns]. / Produlzhitelnost i obem na intenzivnata terapiia pri novorodeni.

The aim of the study is to evaluate the duration, the extent and the complications of the intensive care of neonates, treated in the Neonatal Intensive Care Unit (NICU) of DUB "Maichin Dom" Sofia. Included retrospectively are all 383 neonates, admitted in the NICU for 1995, classified as mature--131, premature stage I--70, stage II--75, stage III--71 and stage IV--36 babies. The duration of the stay is increasing progressively according their weight: from 4 days for the mature children to 15.6 and 18.4 respectively for the newborns with very low and extremely low birth weight. The latter two groups have considerably higher need of ventilatory support (respectively 52.1% and 86.1% of them are ventilated) and higher mean duration of the ventilation--242 and 271 hours. Although they represent 28% of the patients in the NICU, the babies weighting below 1500 g accumulate 74% (17,347 hours) of the whole sum of ventilatory hours in the unit. They also develop more complications due to the immaturity and the assisted ventilation--pneumothorax, bronchopulmonary dysplasia etc. A conclusion is to be made, that the charge of a NICU is due mainly to the premature infants with very low and extremely low birth weight. These babies and the amount of ventilatory support in the unit (as total number of ventilatory hours and ventilated children) can serve as criteria for the extent of loading of the NICU.

[The early breast feeding of newborn infants]. / Ranno zakurmiane pri novorodenite.

Breast feeding was started at the age of 2 hours after birth, immediately after mother and baby were transported to the clinic for healthy term newborns. Our aim was to investigate the influence of the early start of breast feeding on the development of the newborns and on their mothers, as well as to compare the results with those, obtained when breast feeding had begun on the 6-th hour after birth. The results from our work show that the earlier the beginning of breast feeding, the earlier and the more effective the consolidation of the process. The physiological loss of weight with these babies shows a smaller percentage. The level of blood sugar varies in the normal limits. So far as mothers are concerned, the early beginning of breast feeding has a good impact on their after-birth period and helps the earlier initiation of the secretion of breast milk.

[Changes in the amount of free amino acids in infections due to Gram-negative agents]. / Promeni v kolichestvoto na svogodnite aminokiselini pri infektsii s Gram-otritsatelni prichiniteli.

Changes of free amino acid content in blood plasma from sheep and hens infected with S. abortus ovis and P. multocida or treated with purified lipopolysaccharides (endotoxins) of the respective agent, were studied. It was established that the infection reduced total free amino acid content by about 46% in sheep and by 36% in hens. The reduction in total free amino acid content did not affect to the same extent each individual amino acid. Treatment of sheep and hens only with purified lipopolysaccharides of respectively S. abortus ovis and P. multocida resulted also in reduced total free amino acid content equal to 33% in sheep and about 59% in hens. The reduced content of total free amino acids in this case also did not concern equally the individual amino acids. However, in all cases observed, when a given amino acid was reduced during the infection period the same reduction was evident following endotoxin treatment only. The conclusion is drawn that disturbances in cell metabolism arising under the influence of endotoxins let free by the respective agent are the main cause for the reduction both of total free amino acid content and of the individual free amino acid content.