[Effects of intravitreal pegaptanib or bevacizumab and laser in treatment of threshold retinopathy of prematurity in zone I and posterior zone II--four years results]. / Prínos intravitreální aplikace anti-VEGF preparátu v lécbe prahového stadia ROP 3+ v zóne I-II: výsledky ctyrleté studie.

PURPOSE: To evaluate efficacy and safety of intravitreal injection of pegaptanib or bevacizumab and laser photocoagulation for treatment of threshold stage 3+ retinopathy of prematurity (ROP) affecting zone I and posterior zone II, and to compare the results in terms of regression, development of peripheral retinal vessels with conventional laser photocoagulation or combined with cryotherapy. METHODS: In this prospective comparative study, 174 eyes of 87 premature babies, from January 2008 to December 2011, were included. All infants were diagnosed with stage 3+ ROP for zone I or posterior II. Patients were randomly assigned to receive intravitreal pegaptanib (0.3 mg) or bevacizumab (0.625 mg/0.025 ml of solution) with conventional diode laser photocoagulation (Group A, 92 eyes of 46 infants) or laser therapy combined with cryotherapy (Group 8, 82 eyes of 41 infants), bilaterally. The main evaluated outcomes include time of regression and decrease of plus signs and development of peripheral retinal vessels after treatment, final structural-anatomic outcomes compared in the both groups of patients. Risk factors and other characteristics of infants include birth weight, gestational age, Apgar score, duration of intubation and hospitalizations, postmenstrual age at treatment, sepsis, surgery for necrotizing enterocolitis, intraventricular hemorrhage. Primary outcome of treatment success was defined as absence of recurrence of stage 3+ ROP in one or both eyes (reccurrence rate = 0) by 55 weeks' postmenstrual age. Treatment failure was defined as the recurrence of neovascularization (reccurrence rate = 1 or 2) in one or both eyes requiring retreatment. The mean follow-up after treatment was 23.5 months (range 4 - 45 months) in the Group A, and 25.2 months in the Group B (range 3 - 48 months). RESULTS: Final favorable anatomic outcome and stable regression of ROP at last control examination have 90.2% of eyes after adjuvant intavitral pagaptanbib or bevacizumab in the Group A, and 62% of eyes after only conventional treatment in the Group B (P = 0.0214). Regression of plus disease and peripheral retinal vessels development appeared significantly more rapidly in Group A patients who received intravitreal VEGF inhibitors and laser. An absence of recurrence of neovascularization (stage 3+ ROP) was identified at 87% of patients in the Group A, and 53% of patients in the Group B. This difference between the both groups was statistically significant (P = 0.0183). ROP reccured in 7 from 92 eyes (7.6%) in the Group A, and 23 from 82 eyes (28%) in the group B (P = 0.0276). Significantly better treatment effect was found for adjuvant intravitreal pagaptanib or bevacizumab with laser compared with conventional therapy of ROP 3+ in zone I and posterior zone II. Perioperative retinal haemorrhages after laser photocoagulation occured in 8% of eyes in the Group A, and 11% of eyes in the group B (P = 0.358), in all eyes with spontaneous resorption. No systemic or significant ocular complications of intravitreal anti-VEGF injections, such as endophthalmitis or retinal detachment were found during follow-up period after operation. CONCLUSIONS: A combination of intravitreal pegaptanib or bevacizumab injection and laser photocoagulation showed to be a safe, well tolerated and effective therapy in patients with stage 3+ ROP in zone I and posterior zone II. Adjuvant intravitreal antiVEGF injection, as compared with conventional laser or cryotherapy, showed significant benefit in terms of better final anatomic outcome, induction of prompt regression, rapid development of peripheral retinal vascularization and decrease of recurrence rate of neovascularization. Results of this study support the administration of pegaptanib and bevacizumab as an alternative usefull therapy in the management of stage 3+ ROP.

[Incidence of infection of newborns of GBS positive mothers in relation to peripartal antibiotic prophylaxis or mode of delivery]. / Výskyt infekcie u novorodencov SAG pozitívnych matiek v závislosti na peripartálnej antibiotickej profylaxii a spôsobe pôrodu.

OBJECTIVE: To evaluate the effectiveness of antibiotic prophylaxis given to GBS positive women in time of delivery on incidence of infection of their newborns. To find whether is the infection of the newborn correlated with the mode of delivery or with the length of PROM. DESIGN: Prospective cohort study. STUDY SAMPLE: Of all 6415 live born newborns born in between May 2010 to April 2011 at Faculty hospital Brno we selected only those whose mothers had positive GBS vaginal cultivation at time of delivery, which meant 1115 newborns. METHODS: We compared the incidence of complications resulting from infection between the newborns divided into groups based on time of administration of antibiotic prophylaxis (adequate, inadequate, none) or by mode of delivery (vaginal, cesarean without PROM, cesarean with PROM). RESULTS: In our 1115 newborns peripartal antibiotic prophylaxis was given adequately in 355 (31.84%) cases, inadequately in 609 (54.62%) cases, none was given in 151 (13.54%) cases. Vaginal delivery was in 869 (77,94%) cases, cesarean delivery with PROM in 146 (13.09%) cases, cesarean delivery without PROM in 100 (8.97%) cases. Complications due to infection was seen in 14 (1.26%) newborns, cultivation confirmation as GBS was in 2 (0.18%) newborns. There were no deaths of newborns according to the infection caused by GBS. CONCLUSION: Due to small amount of cases with GBS infection within our group we could not statistically prove the effect of antibiotic prophylaxis, nor could we associate our results with specific mode of delivery. The results seen in our study show an incidence of early-onset sepsis (regardless of agent) 2.18/1000 live born; invasive GBS sepsis: 0.31/1000 live born; GBS colonization of pregnant women 17.4%.

[Developmental impairment of children with very low and extremely low birth weight at 24 months corrected age, born in the Czech Republic in 2000-2009]. / Postizení vývoje detí s nízkou porodní hmotnostíve 24 mesících korigovaného veku, narozených v Ceské republice v letech 2000-2009.

OBJECTIVE: To evaluate the incidence of neonatal morbidity (NM), and developmental impairments (DIs) of very low (VLBW) and extremely low birth weight (ELBW) infants born in 2000-2009. DESIGN: Epidemiological study. SETTING: Outpatient clinics for children with perinatal risk at the regional neonatal centers. METHODS: Data on live born, specific neonatal mortality (SNM) and NM data were taken from the database the database of Institute of Health Information and Statistics of Czech Republic (IHIS CR). The incidence of DIs (cerebral palsy - CP, developmental delay - DD, growth retardation and sensory impairment) was evaluated at 24 months corrected age. Each cohort included newborn infants born always in the two-year periods.. Comparison of the incidence of DIs according to the birth-weight or to gestational age was performed in children born in 2009. RESULTS: 1. NM - in VLBW newborns, CNS morbidity and early indecisions decreased slightly (i.e. by 7 and 5%), other forms remained unchanged. In ELBW infants, CNS morbidity declined by 13.9% (p<0.05), early infections only by 5% (NS). - 2. DIs: - in VLBW infants, cerebral morbidity and early infections were reduced slightly (i.e. by 7 and 5% resp.). In ELBW category, CP decreased by 12%, and visual impairment by 9% (p<0.05). - 3. The occurrence of DIs by birth weight or gestational age did not differ, only in children <1000 g, in comparison with the group of <28 wks, was delayed growth increased by 6% (NS). - 4. In 2000-2007, SNM rate and also number of disabled children declined continuously. During period 2008-2009, in contrast to the previous 8 years, incidence of impaired children in both categories increased slightly (by 3%, and 1%, resp., NS). CONCLUSION: During the study period, SNM declined continuously, especially in the ELBW category. We managed to partially reduce NM (CNS and early infection), the problem remained late infection. In the period 2000-2007, incidence of DIs decreased, significantly in case of CP and visual impairment in ELBW children. Surprisingly in the last two years 2008-2009, there appeared in both categories an increase in the proportion of children with disabilities. It is a worrying finding, which should be re-evaluated.

[Changes in the developmental outcome of very low and extremely low birth weight infants at 24 months' corrected age born in 1997-2007]. / Zmeny incidence postizení vývoje u detí s velmi nízkou a extrémne nízkou porodní hmotností ve 24 mesících sicich korigovaného veku, narozených v letech 1997-2007.

OBJECTIVE: To describe the incidence of developmental impairments (DI) among very low birth weight (VLBW) infants at 24 months' corrected age, born in perinatal centers in 1997-2007, and evaluate their changing prognosis of intact development. DESIGN: Prospective epidemiological study. SETTING: Follow-up clinics of neonatal centers level III. METHODS: Live birth rate, in-hospital mortality, neonatal morbidity, DI and quality of survival were assessed. Neonatal morbidity was analyzed in periods 2000/2, 2003/5, and 2006/7 by the data of Institute of Health Informatics and Statistics. DI and quality of survival were evaluated in cohorts of VLBW infants born in 1997/9 (period I), 2000/2 (period II), 2003/5 (period III) and 2006/7 (period IV). RESULTS: Live birth rate of VLBW newborns in 1997-2007 increased in total of 39.5%, in-hospital mortality decreased, significantly in 1997-9 (fall of 10%). Neonatal morbidity, except infections, also declined. Significant decrease in DI-CP and visual impairment, was observed after period II, in category 1000-1499 g of 7/1.5%, in infants <1000 g of 8/7% resp. After period II, the prevalence of impaired children 1000-1499 g decreased of 5%, whereas in category < 1000 g only small decrease of 2% occurred in period III. Number of children without impairment increased gradually in both categories. CONCLUSIONS: The study showed significant increase in surviving VLBW infants, especially in category <1000 g. Increased survival rate at concurrent fall in severe neonatal morbidity (except infections) was not accompanied with worsened prognosis of an intact development.

[Prenatal induction of lung maturation in the fetus. Betamethasone versus betamethasone+thyrotropin-releasing hormone]. / Antenatální indukce plicní zralosti plodu. Betametazon versus betametazon+tyrotropin releasing hormon.

During the period from May 1, 1994 till December 31, 1997 at the First and Second Departments of Gynaecology and Obstetrics Masaryk University Brno 311 neonates with birthweights from 500 to 2000 g were born. A retrospective study was made comparing neonatal results of three methods of prenatal induction of maturing of surfactant in premature neonates. The first group was without treatment, in the second group only betamethasone was administered and in the third group betamethasone and thyrotropin releasing hormone (TRH). The neonates were divided into three body weight groups: 500-999 g, 1000-1499 g and 1500 g and more. The most favourable results with administration of betamethasone and TRH were obtained in the group weighing 500-999 g. This pertained to the smaller number of post-partum administration of surfactant, reduction of the oxygenation index and period of artificial pulmonary ventilation. IVth grade RDS and other complications in the child. In the group of neonates weighing 1000-1499 g administration of betamethasone and TRH had a positive effect only on the oxygenation index and grade of RDS. In the group of neonates with weights above 1500 there were no statistically significant differences between the described three groups. It may be concluded that the greatest effectiveness was achieved by a combination of betamethasone and TRH in neonates weighing 500-999 g, this combination was less effective in the group weighing 1000-1499 g and without effect in those weighing 1500 g or more.