[Socio-demographic characteristics and vitamin D status in women born before 32 weeks'].

UNLABELLED: Deficiency of vitamin D (25-OHD) is a health problem among prematurely born women and their newborns independently of the geographical location of the country. OBJECTIVES: To study serum levels of vitamin D in patients born before 32 weeks and their newborns at birth. To analyse the socio-demographic factors, complications of pregnancy and their relationship with vitamin D status of women. PATIENTS AND METHODS: The study has been carried out in the University hospital "Maichin dom" Sofia for the period August 2013-January 2014. 35 women who gave birth before 32 gestational week and their 41 newborns with birth weight < 1500g have been investigated. The serum level of vitamin D (25-OH D) in mother-infant pairs at birth and 8 weeks of age in infants has been investigated. The ECLIA method has been used. Serum levels of vit D (25-OHD) have been estimated as sufficient:(> 30 ng/ml), insufficient (21-29ng/ml) and deficient (< 20 ng/ml). RESULTS: At delivery according to their vit D (25- OHD) serum levels 63% of the mothers are defficient /12.61 ± 4.8 ng/ml/, 28.5% are insufficient/26.66 ± 2.59/and only 8.5%/40.4 ± 8.48/sufficient with normal levels of vitamin D. For newborns data are respectively 32%/ 20.08 ± 3.69/-deficient, 49%/27.39 ± 2.70/- insufficient and 19 %- sufficient/41.6 + 10/ There is a positive correlation between mother's and children's serum levels of vitamin D (25- OHD). Statistical significant differences are observed in the levels of vitamin D and the presence of infection and preeclampsia in the mothers. During the period of the study there were no seasonal variations in vit D (25-OHD) serum levels of mother-baby pairs. All newborns received Vit D3 1334 IU/daily from 20th day of age. At eight weeks of age sufficient levels of vitamin D have 70% of the children, but 30% of the newborns remains with inadequate supplementation/27.09 ng/ml/. CONCLUSION: 91.5% of mothers are with insufficient serum levels of vitamin D (25OHD) at birth, and a deficit is present in 63% of all women. Only in 8.5% of the women had normal values. This implies more effective monitoring and vitamin D prophylaxis during pregnancy.

[Respirtory distress in newborns of mothers with factor V-Leiden thrombophilia].

AIM: The main aim of the trial is to determine the frequency of respiratory distress syndrome / RDS/ and disorders of coagulation in infants of mothers with thrombophilia. MATERIALS AND METHODS: In 51 newborns of mothers with thrombophilia were evaluated the presence of respiratory distress and maternal-fetal infection /MFI/. The children were divided in two groups: Group I--16 newborns of mothers with thrombophilia and Group II--15 healthy children. We analyzed Hb, Ht, Er, Thr, prothrombin index /INR/, activated partial thromboplastin time /aPTT/ in both groups. RESULTS: The analysis of Hb, Ht, Er, Thr showed no evidence of anemia or coagulopathy with platelet consumption. In 64.7% of children was observed respiratory distress syndrome during the first days, 21.5% had severe respiratory distress /RD/, that required intubation and assisted ventilation. Only in 10/19.6%/ children with RDS there were data proving MFI/high CRP and positive microbiological samples/. There was no significant difference in the INR value in Group I/1.5 +/- 0.3/ and group II/1.6 +/- 0.1/. The children of mothers with thrombophilia had significantly more shortened aPTT/35, 1s +/- 4.2/ compared with the control group: aPTT/43.9 +/- 4,4/. CONCLUSION: The high incidence of RDS and shortened aPTT indicate that maternal thrombophilia is a risk factor for thrombosis in newborns. MFI that are accompanied with activated PAI also lead to thrombosis, especially in children in Neonatal Intensive Care Units. These results point out that there should be prevention of other risk factors for thrombosis such as dehydration and placement of central venous catheters.

[Frequency, severity and risk factors for bronchopulmonary dysplasia among very low birth weight premature infants admitted in the NICU of the University Obstetrics and Gynecology Hospital, Sofia].

BACKGROUND: The progress in the perinatology improved the survival rate of the infants with extremely low birth weight and gestational age. Among the most immature of them the frequency of bronchopulmonary dysplasia (BPD) remains high.. The use of different diagnostic criteria for BPD makes comparing the results difficult. AIM: To evaluate the frequency of BPD by birth weight and gestational age according to the new diagnostic criteria, and to identify the risk factors for development the disease. METHODS: 563 very low birth weight infants (<1500 g) were admitted to NICU from 01.01.2008 to 30.06.2010. 485 survived more than 28 days and were included in this study. BPD was diagnosed if supplemental 02 for the first 28 days was necessary. 02-requirements at 36 gestational weeks (gw) determine the severity level. RESULTS: 26,8% from the infants were with supplemental 02 in the first 28 d of life, but only the half of them 13,6% were with 02 > 21% at 36 gw (the classical diagnostic criteria for BPD). 10,9% were with moderate BPD, 2,7% - with severe BPD. The frequency of BPD decreased progressively from almost 100% at 23 gw or birth weight < 600 g to single cases after the 31 gw and birth weight > 1200 g. Mild or moderate BPD was more likely if gestational age was > 27 gw. The need for ventilatory support increased from 1,5 (+2,8) days (no-BPD group) to 50,2 (+/-20,1) days (severe BPD), p<0.05. Significant postnatal risk factors for developing BPD were patent ductus arteriosus - diagnosed in 25,4%; pneumothorax - in 3% of the BPD infants, compared with 1,7% and 0,5% among the infants without BPD respectively, p<0. 05. Sepsis and pulmonary hemorrhage were found slightly more frequently in the BPD group too (p>0, 05). The use of antenatal steroids was found to be a protective factor - 45% of the BPD infants had received antenatal steroids compared with 55% of those without BPD (p=0.05). CONCLUSION: According to the new diagnostic criteria, the frequency of BPD was about 2 times higher compared to the classical definition. Main risk factors were found to be ELBW, ELGA; additional risk carried the need for prolonged ventilatory support, patent ductus arteriosus and air leak syndrome.

[Osteopenia of prematurity--prophylaxis, diagnostics and treatment].

UNLABELLED: Osteopenia of prematurity is a metabolic bone disease of premature infants with birth weight < 1500 g and gestational age < 32 weeks. Sub-optimal bone matrix, poor skeletal support and an increased risk of fractures characterized the disease. Its importance is determined by relatively high frequency--between 30-70% of infants at risk, multifactorial etiology and impact on early and late morbidity of the newborns. The prevention and treatment of bone disorders are important aspects of the care of preterm babies. OBJECTIVE: To identify of the risk factors, to determine early diagnostic criteria and to create a prevention program for osteopenia in infants with very low and extremely low birth weight. MATERIALS AND METHODS: The prospective study includes 39 preterm babies with birth weight below 1500 gr. and < 32 g. w who were admitted to the NICU from September 2011-January 2012. Bone metabolism was monitored by calcium, phosphate and alkaline phosphatise at 2-weeks intervals. Vitamin D levels of the neonates were registered at birth, and at 8th week. PTH was measured at the second and the 8th weeks. RESULTS: The following biochemical abnormalities were found. Hypophosphatemia in two weeks (P < 1,6 mmol/l), a gradual increase in phosphorus levels and normalization at eight weeks of age. There was a significant positive correlation between 25OHD/phosphorus at eight weeks/r = 0.353/. Significantly elevated levels of parathyroid hormone in eight weeks, correlating with low levels of vitamin D (negative correlation between 25OHD/parathormone r = -0.581). Blood levels of calcium and alkaline phosphatase were in normal limits. IN CONCLUSION: Risk factors for osteopenia are: the low gestational age and low levels of vitamin D at birth. Biochemical markers of osteopenia are: changes in levels of parathyroid hormone, phosphorus and vitamin D at eight weeks of age. Prevention includes: early supplementation of vitamin D in the risk neonates with individual dose adjustment. Upon biochemical evidence of osteopenia treatment should begin in the second week of life with supplementation of phosphorus, and vitamin D 1320 IU/daily and appropriate physiotherapy.

[Vitamin D levels in maternal--VLBW infants pairs].

UNLABELLED: Normal foetal growth depends on sufficient mother's vit D intake. Premature birth interrupts vit D and mineral mother-to-foetus transfer and leads to vit D deficiency and disturbs newborn mineral bone metabolism. OBJECTIVES: To determine vit. D plasma levels in mothers and their very low birth weight- (VLBW) newborns and the prevalence of vit D deficiency in this population, to investigate seasonal variation and analyse babies' vit D levels from birth to the 8 postnatal week. PATIENTS AND METHODS: The study has been carried out in the University hospital "Maichin dom" Sofia for the period 09.2011-01.2012 and there have been investigated 32 women and their 39 VLBW infants as a target group. 25-OHD level has been measured in maternal and newborn cord blood samples. The ECLIA method has been used. 25-OHD level has been tested second time at eight weeks of age in 34 infants. According to the maternal vit D levels the patients have been divided into 3 groups: Group. 1--vit D reference range level (> 30 ng/ml); Group. 2--vit D insufficiency (21-29 ng/ml), Group. 3--vit D deficiency (< 20 ng/ml). RESULTS: Low Vit. D levels have been estimated in 62.5% of mothers' group. Nevertheless, only 38.6% of all babies have been Vit. D deficient. In 61.4% of them vit D has been in normal range (32.4-35.7 ng/ml). A significant positive correlation between maternal and infants' vit D level at birth has been established (r = 0.516; p = 0.002). There have been found a significant seasonal dependence of vit D level at birth in the group too: vit D plasma levels have been estimated higher in September-October group compared to those in November-January group. Most of the blood samples in winter months showed lower vit. D levels than the autumn group. At 8 weeks of age 67.6% of the babies have been with vit D insufficiency. There has been a significant positive correlation between 25-OHD levels at birth and at weeks (r = 0.425; p = 0.012). CONCLUSION: Vit. D insufficiency has been found in 62.5% of the mothers at birth. Maternal vit. D deficiency is a significant risk factor for neonatal vit D deficiency. There is a clear seasonal dependency with a significantly lower 25-OHD level in the mothers and their VLBW babies in winter months.

[Short term outcome after active obstetric management of very low birthweight infants].

UNLABELLED: Increased survival in infants weighing less than 1500g (VLBW) in recent decades is largely due to active perinatal management and intensive neonatal care. AIMS: To analyze the relationship between antenatal corticosteroid (ACS) administration, mode of delivery and the short term outcome in VLBW infants. METHODS: A total of 563 neonates weighing < 1500 g was studied between 01.01.2008 and 30.06.2010, distributed according the outcome into 3 groups: 330 healthy, 150 with chronic morbidities (bronchopulmonary dysplasia - supplemental O2 at 28 days, intraventricular hemorrhage gr.Ill-IV or cystic periventricular leucomalacia, retinopathy of prematurity gr.llI-V), 83 died. Mode of delivery, ACS and their influence on the outcome were evaluated by multinomial logistic regression analysis and the relative risk was calculated for each of them (OR). The ACS course was taken for completed if applicated in the 7 days before delivery. RESULTS: Lack of ACS significantly increased the risk of severe morbidities or death compared to the complete course: OR 2.6 and 4.9 respectively (p < 0.001). A higher risk was found comparing incomplete to complete course too: morbidities OR 2,3 (p = 0.01), death OR 3,1 (p = 0.01). Incomplete ACS did not improved outcome significantly. Mode of delivery didn't affected significantly the risk of morbidities. The relative risk of death was lower in neonates delivered by cesarean section compared with vaginal breech delivery (OR 0.2, p = 0.005) but higher compared with vaginal vertex delivery (OR 2.1, p = 0,004). In this study we didn't analyze the indications for cesarean section, some of which were due to fetal distress and could influence the outcome. CONCLUSION: The active obstetric management for VLBW infants reduces the risk of death and survival with morbidities. The main protective factor is the complete ACS course.

[Criteria for diagnosis and therapy of hyporegeneratory anemia in premature newborns below 33 week of gestation and body weight below 1500 grams].

AIM: The aim of the present study is to define criteria for erythropoietin therapy of hyporegeneratory anemia in premature newborns according to hemoglobin (Hb) and hematocrit (Hct) concentration, and reticulocyte count (Ret). MATERIALS AND METHODS: The prospective study includes two groups of 20 newborns with anemia of prematurity, body weight at birth below 1500 grams and gestation age below 33 gestation week. The newborns in the first group have been treated with beta-erythropoietin for four weeks--750-1000 E/kg weekly dose, divided q48h. Hb, Hct and Ret have been monitored and compared with that of control group newborns. The therapy of newborns in the control group consisted of blood transfusions. RESULTS: The hematological parameters in the newborns from the first group have been increased permanently after the first week of therapy, with Ret being most sensitive to the therapy. In the second group of newborns, due to blood transfusions, transient increase of Hb and Hct, and decrease of Ret have been observed in next days after the blood transfusions. CONCLUSIONS: The erythropoietin therapy of hyporegeneratory anemia in preterm newborns leads to rise in Hb, Hct and Ret. The therapy with blood transfusions suppresses erythropoiesis. This leads to decrease in Ret and transient rise in Hb, Hct and erythrocytes. That's why each blood transfusion leads to another one.

[Use of aminoglycoside antibiotic gentamycin in extremely premature infants--administration schedule and suggested dosage based on pharmacokinetic studies in plasma].

The pharmacokinetics of Gentamycin administered to 22 infants intravenously at currently recommended doses (2-2.5 mg every 24 h for infants less than 7 days of life and 28 g.a. and 12 h for infants 32 g.a). The results showed a statistically significant relation between half-life and postconsiptional age and direct correlation between total body clearance and postconsiptional age. These pharmacokinetics data were used to calculate a new dosage schedule for preterm infants. Ondoing therapeutic drug monitoring is essential to tailor the dosage to the individual patient. Gentamycin.

[Inborn bacterial infections during neonatal period].

Considering the high mortality and serios morbilidy associatent with neonatal infections. A competent diagnostic marker also needs to have reasonably high specificity. Good evidence exists to support the use of CRP measurements in conjunction with other established diagnostic tests (such as a white blood cell (WBC) count with differential and blood culture) to establish or exclude the diagnosis of sepsis in full-term or near-term infants. Sepsis was suspected within the first 3 days after birth in. There were 20% early-onset and 53% late-onset episodes of proven sepsis. CRP had sensitivities of 39.4% and 64.6% for proven or probable sepsis and 35.0% and 61.5% for proven sepsis in early-onset and late-onset episodes, respectively. To compare the clinical informative value of and C-reactive protein (CRP) plasma concentrations in the detection of infection and sepsis and in the assessment of severity of sepsis. PCT is a better marker of sepsis than CRP. The course of PCT shows a closer correlation than that of CRP with the severity of infection and organ dysfunction. Diagnostic markers are useful indicators of neonatal bacterial infections C-reactive protein (CRP), procalcitonin (PCT) Intralevcin 6, 8 are early sensitive markers of infection.

[Upper extremity gangrene in an infant of a diabetic mother, presenting at birth].

In utero gangrene of an extremity because of an arterial thrombosis is rare. More than 20% of the reported cases concern infants of diabetic mothers (IDM) with poor control of diabetes. Changes in coagulation related to deviation of clotting factors and low plasminogen activity may be the cause. We report a case of an IDM who presented at birth with upper extremity gangrene. The Dopplersonography has shown missing pulsations and thrombosis of a.brachialis sin, which was confirmed after amputation of the arm on the 5th day. The postoperative period was complicated by septicaemia, necrotising enterocolitis and disseminated intravasal coagulation resulting in the baby's death 10 days after birth.

[Upper extremity gangrene in an infant of a diabetic mother, presenting at birth].

In utero gangrene of an extremity because of an arterial thrombosis is rare. More than 20% of the reported cases concern infants of diabetic mothers (IDM) with poor control of diabetes. Changes in coagulation related to deviation of clotting factors and low plasminogen activity may be the cause. We report a case of an IDM who presented at birth with upper extremity gangrene. The Dopplersonography has shown missing pulsations and thrombosis of a. brachialis sin, which was confirmed after amputation of the arm on the 5th day. The postoperative period was complicated by septicaemia, necrotising enterocolitis and disseminated intravasal coagulation resulting in the baby's death 10 days after birth.

[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.

[Resuscitation in very low birth weight and extremely low birth weight newborns in the delivery room]. / Sustoianie pri razhdaneto, spetsifika i obem na reanimatsiiata v rodilna zala pri novorodeni s mnogo nisko i ekstremno nisko teglo.

THE AIM: Of the study is to discuss the need of delivery room cardio-pulmonal resuscitation (DR-CPR) in VLBW and ELBW infants and intensity, to determine its prognostic significance for the neonatal outcomes, and the influence of some perinatal criteria. MATERIALS AND METHODS: A retrospective study is performed in University Maternity Hospital: Maichin Dom", for the years 1998-1999 including: 61 ELBW (500-999 g) and 122 VLBW (1000-1499 g). Excluded are infants with great malformations. RESULTS: There were 54% survivors in the ELBW and 86.1% in the VLBW group. 1-st min Apgar scores were significantly lower in the ELBW-group 3.5 +/- 1.9 in comparison to the VLBW: 4.9 +/- 1.9 = pH from umbilical artery were lower too: 7.19 +/- 0.16 and 7.24 +/- 0.14 respectively. From 12 ELBW babies with cord arterial pH < 7.1 survived only 3, but all 3 with pH < 7.0 died; 8 from 10 VLBW babies with pH < 7.1 survived. Intubation rates were as followed: ELBW group--82%, 70% in the first 5 min; VLBW group--57% and 34% respectively. Adrenalin and/or chest compression received 6 ELBW infants, 5 of who died and 4 had severe IVH. The same resuscitation received 8 VLBW babies, 4 of who died and 2 survivors had 3-4 grade IVH. Any grade of IVH occurred in 65% of ELBW and in 44% of VLBW infants. Severe IVH was seen in 37% and 16% respectively. Overall, survivors with grade 3-4 IVH were 15% among the ELBW group and 7.6% among the VLBW. CONCLUSIONS: Birth weight and gestational age are the most important factors, determining the intensity of DR-CPR and the prognosis in newborns of < 1500 g. Low Apgar scores, cord arterial pH < 7.10, the need of Adrenaline application and/or chest compression by DR-CPR are reliable prognostic criteria for death and poor nevrodevelopmental outcome.

[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.

[Administration of exogenous surfactant in premature very low birth weight infants with RDS]. / Prilagane na ekzogenen surfaktant pri nedonoseni detsa s mnogo nisko teglo i NRDS.

A retrospective study is carried out with the aim of establishing the effect from surfactant therapy on pulmonary function, survival and complication from intensive therapy on VLBWI with RDS. 67 premature infants below 1500 grams are included in the study divided in 3 groups: I gr.--27 babies treated with Corosurf; II gr.--16 babies treated with Exosurf; III gr.--24 control babies without surfactant. The results show that in spite of relatively lower gestational age and higher incidence of inborn infection in group I, Curosurf treated babies spend shortest time on mechanical ventilation and oxygen therapy showing lower incidence of BPD, IVH and mortality rate.

[Problems and outcome in very low birth weight infants, with three cases of babies under 700 grams]. / Problemi i izkhod pri novorodeni s ekstremno nisko teglo pod 700 grama s primer na tri sluchaia.

Recent advances in neonatal medicine made reality the survival of newborn babies of extremely low weight and gestational age. This often provokes ethical problems in relation to high death rate, morbidity and neuro-developmental seguels. On the other hand it is usually impossible at birth to predict the presence and severity of future problems. We present the cases of three babies, where in spite of the most unfavourable factors connected to mother's condition, foetus and newborn, three healthy children were raised up. Their characteristics at birth are: 650 g--30 gestational weeks; 560 g--29 gestational weeks; 600 g--29 gestational weeks. In all of them intensive resuscitation and mechanical ventilation are started immediately after birth, two of them received prophylactic surfactant. Little by little, the problems arising from extremely low birth weight, faded away. All babies had grade I-II IVH which were totally resorbed. The first baby is three years old at the moment with were totally resorbed. The first baby is three years old at the moment with adequate for her age mental and neurologic development. The other two babies, resp. 9 and 3 months of age, are also developing normally. In conclusion, the possibilities for survival and raising up of babies of extremely low weight and gestational age are definitely increasing, requiring high qualification staff, modern technics and very large funds for diagnostics, monitoring and treatment.

[Morbidity in twins with a weight up to 1500 g and a gestational age up to 32 g. w]. / Zabolevaemost pri bliznatsi s teglo do 1500 g i gestatsionna vuzrast do 32 g. s.

Seventy-five newborns from multiple pregnancies with very low and extremely low birth weight are studied. 94% of the infants under 1000 g and 66% of those above 1000 g are born by vaginal way. Intrapartal asphyxia develop most often the second twins with birth weight under 1000 g--64.7%. These are the infants with higher morbidity: RDS--56.5%, IVH--100%. The survival rate of the twins of this group is notably lower than that of the infants from singleton pregnancies with equal weight and gestational age: 12.1% under 1000 g and 69% above 1000 g, against 38.3% and 77.9% respectively.

[Adaptational problems and diseases in twins with a gestational age over 32 weeks]. / Adaptatsionni problemi i zaboliavaniia pri bliznatsi s gestatsionna vuzrast nad 32 gestatsionna sedmitsa.

This retrospective study is carried out at the State University Hospital "Maichin dom" for the period 1991-1995, including 207 newborns from multiple pregnancies. Babies are divided in two groups according to gestational age: I group--32-37 gestational weeks (123 babies) and II group--over 37 gestational week (84 babies). The majority of babies are born by a normal mechanism, followed by those, delivered by cesarean section and in a small number of cases in the second group, the first twin is born by vacuum extraction, while the second one-by a normal mechanism. Having in mind the Apgar score and pH from umbilical artery, the condition of the newborn depends mostly upon the degree of maturity and less on the way of delivery. Twins in the second group show a definite tendency of intrauterine growth retardation (mean weight below the 10th percentile according to the intrauterine growth charts). A significant part of the neonatal period problems comprise in relative immaturity and intrauterine growth retardation. The analysis of neonatal morbidity shows a prevalence of lung pathology in the 32-37 gest. weeks group, followed by foeto-maternal infection (mostly in the first twin), metabolic and haematological disorders. In the group of twins over 37 weeks of gestation highest is the frequency of adaptation problems, followed by inborn infections. The conclusion is made that newborns from multiple pregnancies are of higher risk for increased morbidity and adaptation problems during the neonatal period.

[The structure of the morbidity in very low birth weight premature infants]. / Struktura na zabolevaemostta pri novorodeni nedonoseni detsa s mnogo nisko teglo.

It is a retrospective study, enrolling 255 liveborn premature infants, born up to 32 gestational weeks and below 1500 grams, who were admitted to the Intensive Care Unit of our hospital from 1993 to 1996. The aim of the study is to establish the most common disorders inside this group of high risk newborns. Among survivors is obvious the prevalence of pulmonary pathology (81.8%) and intraventricular hemorrhage (61.9%). The incidence of chronic lung disease is 15.4% being due to prematurity and intensive respiratory resuscitation. Inside this group of premature babies, the fact is observed that asphyxia intra partum does not play the leading role for the outcome, because many factors influence mortality rate there. The higher incidence of survival of babies below 1000 g is related to development of modern intensive care.