SpO2, heart rate, and arterial blood pressure during successful or failed application of non-invasive ventilation after delivery - a single-centre study.

INTRODUCTION: SpO2, heart rate, and systolic, diastolic, and mean arterial blood pressure are among the commonly applied and most frequently chosen indicators of well-being of newborns in intensive care units. Objective: to determine the relationship between the aforementioned parameters and the status of newborns depending on the outcome of the Infant Flow (I-F) therapy, and the development of complications in the form of pneumothorax. MATERIAL AND METHODS: A retrospective single-centre study covering the years 2009-2014. A total of 182 neonates, with mean gestational age 34.1 weeks and mean body weight 2226 g, were analysed. The minimum and maximum values of the evaluated parameters were analysed statistically according to the therapy outcome noted as success or failure. RESULTS: A successful outcome of I-F therapy (71.4%) was characterised by higher SpO2 (93.3 ±7.28 vs. 85.9 ±14.77 at P < 0.001; 99.95 ±0.31 vs. 98.6 ±3.30 at P < 0.0001), lower heart rate (122.5 ±12.37 vs. 135.9 ±14.97 at P < 0.0001), and higher max systolic blood pressure (79.05 ±12.49 vs. 69.78 ±13.73 mm Hg at P < 0.0001), max diastolic blood pressure (57.03 ±9.31 vs. 50.41 ±13.82 mm Hg; P < 0.0003), and max as well as min mean arterial blood pressure (46.8 ±10.13 vs. 41.39 ±15.46 mm Hg; P < 0.001) (27.88 ±5.71 vs. 26.14 ±7.35 mm Hg; P < 0.02). CONCLUSIONS: In newborns suffering from respiratory failure and treated with I-F, higher SpO2 values, lower heart rate, and higher arterial blood pressure coincide with success of the I-F therapy.

Ocular manifestation of congenital toxoplasmosis, clinical implication - case report.

The aim of this case report was to present extremely severe, ophthalmic complications in form of rare, congenital toxoplasmatic bilateral defect of eye-balls concomitant with advanced uveitis, microphthalmia and eye-multistructural developmental abnormalities leading to irreversible visual disability. The ocular diagnosis was confirmed in Ret-Cam II and ultrasonography and it was accompanied with congenital multiorgan lesions including hepato-splenomegaly, thrombocytopenia, leukomalacia, hydrocephalus and ventriculomegaly with neurological symptoms. Serology, PCR of cerebro-spinal fluid and cord blood confirmed the presence of congenital Toxoplasma gondii infection in the infant. The authors took the effort of insightful analysis for the causes of applied treatment failure in mother during pregnancy, analyzing the inefficacy of Spiromycin therapy in pregnant woman and evaluating false-negative result of amniocentesis for Toxoplasma gondii presence. Among many issues concerning anti-toxoplasmatic treatment in mother and infant presented in this article, the need for multiple repetition of toxoplasmatic tests should be underlined including amniotic fluid PCR and ultrasonography which can add much important data for correct diagnosis. The authors indicate that the lack of benefits from conservative therapy in case of suspected Toxopalsma gondii suggestion lead to dramatic multiorgan complications, especially ophthalmo-neurologic, leading to irreversible visual disability.

Remifentanil patient-controlled analgesia for labor - monitoring of newborn heart rate, blood pressure and oxygen saturation during the first 24 hours after delivery.

INTRODUCTION: There is no available information about the effects of remifentanil labor analgesia on newborns' vital signs in the first hours after delivery. The aim of the study was to assess changes in the heart rate, blood pressure and oxygen saturation during the first 24 h of neonatal life after using remifentanil patient-controlled analgesia (PCA) for labor analgesia. MATERIAL AND METHODS: Forty-four full-term neonates, 23 from intravenous PCA remifentanil labor anesthesia 0.2 µg/kg, repeated not more frequently than every 2 min, and 21 born to mothers without any pharmacological forms of analgesia, were studied. Heart rate, oxygen saturation, and systolic (SBP) and diastolic blood pressure (DBP) were monitored using a Nellcor Oxi Max monitor N5500 (Tyco Healthcare), and recorded at 1 h, 6 h, 12 h and 24 h. RESULTS: No significant differences in heart rate (p = 0.54; p = 0.26; p = 0.60; p = 0.83), oxygen saturation (p = 0.21; p = 0.27; p = 0.61; p = 0.9) and DBP (p = 0.98; p = 0.31; p = 0.83; p = 0.58) between the groups at 1 h, 6 h, 12 h and 24 h. Newborns from the remifentanil group had lower SBP at 1 h of life (59 mm Hg vs. 68.5 mm Hg) but the difference was just on the borderline of statistical significance (p > 0.06). There were no significant differences in SBP between the groups at 6 h (p = 0.65), 12 h (p = 0.11), and 24 h (p = 0.89) of life. CONCLUSIONS: Remifentanil PCA analgesia during labor does not significantly modify the oxygen saturation, heart rate and blood pressure in infants during the first day of their life. Therefore, further studies are needed to explain the observed trend for arterial hypotension in the first hour of life in infants born to mothers treated with remifentanil.

School-age spirometry in survivors of chronic lung disease of prematurity in the surfactant era.

OBJECTIVE: To assess whether school-age spirometry and lung volume outcomes of preterm infants with history of moderate to severe respiratory distress syndrome (RDS), born in the surfactant era and treated with conventional mechanical ventilation (IMV) and discharged home with or without the diagnosis of BPD (chronic lung disease of prematurity), differ from those of term neonates (controls). PARTICIPANTS: The study included 148 Caucasian school-aged children (38 preterm infants without BPD, 20 preterm infants with BPD and 90 term infants). All infants were born at the Department of Pathology of Pregnancy and Labor, Pomeranian Medical University Szczecin, Poland. METHODS: Respiratory outcome in school-aged children was assessed using spirometry with the evaluation of flow and volume parameters, adjusted for age, weight and gender. The differences in spirometry were tested by the Wilcoxon or Mann-Whitney tests. Linear correlation and regression were also used. RESULTS: No statistically significant differences between the spirometric parameters in preterm infants with and without BPD were found. All investigated parameters were significantly lower in both ventilated groups compared to term controls, with the exception of ERV%, which was significantly higher CONCLUSIONS: The necessity to use assisted ventilation in preterm infants without neurological disorders most probably had an adverse effect on the lung function, assessed by spirometry at the age of 9-10 years, in the groups of children discharged home with or without BPD. Regardless of BPD, lung function parameters in prematurely born children with respiratory distress syndrome are always worse than in term controls.

[Pethidine for labor analgesia; monitoring of newborn heart rate, blood pressure and oxygen saturation during the first 24 hours after the delivery]. / Petydyna w analgezji porodu; monitorowanie czynnosci serca, cisnienia tetniczego i saturacji w ciagu pierwszych 24 godzin zycia noworodka.

BACKGROUND: There is no information about an effect of pethidine labor analgesia on newborn vital signs in the first hours after the delivery. OBJECTIVES: The aim of the study was to assess changes in heart rate, blood pressure and oxygen saturation during the first 24 hours of life in neonates born after using pethidine for labor analgesia. METHODS: 55 full-term neonates, 34 from intramuscular pethidine labor anesthesia in doses 50-100 mg and 21 born to mothers without any pharmacological form of anesthesia, were studied. Heart rate, oxygen saturation and blood pressure (SBP and DPB) were monitored using a Nellcor Oxi Max monitor N5500 (Tyco Healthcare), and recorded at 1, 6, 12 and 24 hours. RESULTS: No significant differences in the heart rate (144; 139; 141; 142,5 versus 142; 140,5; 138; 141 beats/minute), oxygen saturation (97%; 98%; 98%; 98,5%; versus 98%, 98%, 98%, 98%), SBP (66,5; 67; 66; 66,5 versus 68,5; 65; 64; 64,5 mmHg) and DBP (33,5; 35; 37; 40 versus 34; 32; 32; 38 mmHg) at 1, 6, 12 and 24 hours between pethidine and controls groups were found. CONCLUSIONS: Intramuscular pethidine analgesia during the first stage of labor in doses 50-100 mg does not significantly modify the oxygen saturation, heart rate and blood pressure in infants during the first 24 hours of their life.

[Meningitis and chosen complications of neonatal period in preterm neonates born to single or multiple pregnancies]. / Neuroinfekcje a wybrane powiklania okresu noworodkowego u dzieci urodzonych przedwczesnie z ciaz pojedynczych i wieloplodowych.

UNLABELLED: The aim of this study was to determine the relationship between meningitis and neonatal period of complications such as massive intraventricular hemorrhage and into brain tissue, hypoxic-ischemic white matter injury retinopathy of prematurity 3-5 degrees and deafness in infants born prematurely from single and multiple pregnancies. MATERIAL: The retrospective study covered 460 preterm infants born to single pregnancies and 280 infants born prematurely with multiple pregnancies, hospitalized in the Clinic of Neonatology PUM in the years: 2005-2008. RESULTS: There were no statistically significant differences between the frequency of occurrence: peri/intraventricular hemorrhages (IVH) III degrees and IV degrees, hypoxic-ischemic injury in white matter, retinopathy of prematurity 3-5 degrees and hearing loss in newborns of both groups. Meningitis was diagnosed in 35 (7.92%) newborns from singleton pregnancy and in 9 (3.25%) with a multiple pregnancy. It was found that the risk of meningitis was significantly greater in infants with body weight less than 1000 grams (OR 4.18), and born under 28 weeks of gestation (OR = 5.07), regardless of group affiliation. We found a statistically significant correlation between the occurrence of meningitis and neonatal complications such as IVH III degrees and IV degrees (OR-5, 56), hypoxic-ischemic white matter injury (OR - 18.93) and retinopathy of prematurity (7.45) in newborns with both single and multiple pregnancies. There was no effect of meningitis on the incidence of hearing loss. CONCLUSION: There exists a significant association between the occurrence of meningitis and some neonatal complications such as massive intraventricular hemorrhage, hypoxic-ischemic changes in white matter of the brain and retinopathy of prematurity 3-5 degrees, leading to disturbances in the further development of the prematurely born child. The incidence of meningitis in newborn infants is inversely proportional to the duration of pregnancy.

[Congenital epidermolysis bullosa--a case report]. / Pecherzowe zapalenie skóry u noworodka--opis przypadku.

Bullous dermatitis in infants is a clinical term used for a number of disorders associated with primary neonatal pemphigus. The disease requires differentiation of autoimmune disorders such as pemphigus vulgaris, pemphigus foliaceus, and bullous pemphigoid. These diseases are the result of pemphigus IgG antibodies that pass from the mother to the fetus through the placenta. The level of antibody titers in the pregnant woman and her clinical condition are not the markers of the severity of the disease in children, but, in case of a high level, a miscarriage premature birth, or even stillbirth, may occur. Staphylococcal syndrome exfoliative dermatitis (staphylococcal scalded skin syndrome - SSSS), the etiological agents of which are type A or B exfoliative toxins of Staphylococcus aureus, is most frequently observed. These toxins can activate as superantigens and cause T-cell activation. They induce proteolysis and separation of the granular layer of epidermis through direct binding of these antigens. Symptoms of the disorder regardless of the etiologic factors, are common: redness of the skin and formation of bubbles of various sizes filed with serous or serous-bloody content. Bursting bubbles patches peel off, leaving bare, sometimes oozing surface. Extensive damage to the skin is a gateway to infection and disturbs the function of regulating warmth and water-electrolyte balance. Early detection of the cause and appropriate general and local treatment effectively prevent the development of sepsis. The authors present a case of a full-term neonate (male, birthweight 3230 g, good overall condition, 5-min Apgar score: 10) born with dermatitis bullosa of unknown etiology Physical examination immediately after birth revealed multiple blisters filled with serous and serous-bloody content on the skin all over the neonatal body mostly in the area of both armpits, elbows, wrists, knees, ankles and fingers of both hands and feet. The course of pregnancy was uncomplicated. However detailed family history revealed pemphigus skin in the mother (from infancy up to the age of puberty) but the mother was not able to offer details on the diagnosis and treatment of this disease. Symptoms in the mother disappeared after her first menstrual period. Both, typical clinical symptoms presenting in the newborn and maternal pemphigus in the past initially suggested an autoimmune disorder However the examination of the levels of IgG antibody and anti-IgA in neonatal serum, as well as tissue examination by the immunofluorescence (IF) method to detect the presence of these antibodies, were negative and consequently the autoimmune disease was excluded. Negative results of bacteriological tests did not confirm the staphylococcal syndrome. It seems that the cause of cutaneous pemphigus observed in the newborn could be an intrauterine infection or hidden, undiagnosed collagen disease in the mother.

Two histologically different tumours in a neonate born from an assisted reproductive technology pregnancy.

The first case of a female neonate born from an in vitro fertilization with embryo transfer (IVF-ET) and intracytoplasmic sperm injection (ICSI) (IVF-ET (ICSI) with two histologically different tumours (craniopharyngioma and hepatoblastoma) is described. Anti-neoplasmatic therapy was abandoned due to the significant extent of the disease (craniopharyngioma, 15 x 12 cm in diameter with active internal hydrocephalus; and right liver lobe hepatoblastoma, 5 cm in diameter) and the severely impaired general condition of the neonate. The neonate died on the 30th day of life due to cerebellar and brainstem herniation, followed by circulatory and respiratory failure.

[Method of analgesia for labor in relation to newborn condition, cord blood cortisol and interleukin-6 levels]. / Sposób znieczulenia rodzacej a stan urodzeniowy, stezenie kortyzolu i interleukiny-6 we krwi pepowinowej.

AIM OF THE STUDY: To assess the impact of various forms of intrapartum analgesia on birth condition of the newborn. MATERIAL: The study included 109 newborns, among them 23 from mothers who received intravenous patient-controlled analgesia (PCA) using remifentanil (0.2 microg/kg per dose), 31 infants from mothers treated with PCA epidural anesthesia with fentanyl and 0.125% bupivacaine, 34 newborns from mothers treated with pethidine analgesia given on an ad hoc basis at a dose of 50 mg by intramuscular injection, and 21 newborns from mothers who did not use any form of anesthesia. METHODS: The birth condition was evaluated in all infants by Apgar score and umbilical artery blood gases. In the blood from the umbilical vein the concentration of cortisol and interleukin-6 were evaluated. RESULTS AND CONCLUSIONS: The use of epidural analgesia with bupivacaine as well as pethidine given intramuscularly did not impair the status of newborn evaluated on the basis of Apgar score, however, it adversely modifies the pH and umbilical artery blood pCO2. No additional beneficial effect of anesthesia using remifentanil intravenous PCA method on newborn status assessed on the basis of the value of Apgar score and acid-base balance of umbilical artery blood was found and it does not allow to recommend this form of anesthesia as surpassing the existing methods of intrapatum analgesia. The concentration of cortisol and interleukin-6 in umbilical cord blood is not related with the type of maternal intrapartum analgesia.

Pulmonary function in school-aged children with mild to moderate infant respiratory distress syndrome requiring nasal continuous positive airway pressure.

OBJECTIVES: The aim of our study was to evaluate whether mild to moderate infant respiratory distress syndrome (RDS) treated with nasal continuous positive airway pressure (NCPAP) might affect the pulmonary function in school-aged children. MATERIAL AND METHODS: 50 children, aged 10.2 +/- 2.8 years, with a history of RDS and 90 controls without a neonatal history of lung diseases, matched for age and gestational age at birth, were studied. Pulmonary function was assessed by spirometry and oxygen saturation measured by pulse oximeter RESULTS: The incidence of respiratory tract infections within the first 6 years after discharge from the intensive care neonatal unit was higher in the RDS group than in controls (P < 0.05). Spirometric parameters of the pulmonary function were comparable in both groups. Oxygen saturation was significantly lower in the RDS group (96.2 +/- 7 vs. 97.3 +/- 7%; P < 0.05). A significant negative correlation between spirometric parameters and the duration of NCPAP application and the duration of oxygen supplementation has been found. CONCLUSIONS: Pulmonary function assessed by spirometry was normal in school-aged children with infant RDS. However; spirometric parameters were negatively correlated with the duration of NCPAP and the duration of oxygen supplementation. In comparison with the controls, children with infant RDS had a higher incidence of respiratory tract infections (laryngitis, acute bronchitis and pneumonia) within the first 6 years of life, as well as lower oxygen saturation.

[Maternal active or passive smoking in relation to some neonatal morphological parameters and complications]. / Palenie czynne lub bierne w okresie ciazy a wybrane parametry morfologiczne i powiklanma okresu noworodkowego.

OBJECTIVE: To determine the relationship between maternal active and passive smoking and neonatal morphological parameters, as well as some neonatal complications in full-term newborns. METHODS: 150 women with uncomplicated, singleton pregnancies were assessed by means of a patient questionnaire. Neonates were divided into 3 groups according to obtained information on maternal smoking status--active smoking: n=51, passive smoking: n=49, non-smoking: n=50. Immediately after birth morphological parameters such as: birthweight, body length, head and chest circumference were assessed. RESULTS: Values of birthweight, body length, head and chest circumference in newborns born to active smoking mothers were significantly lower than in newborns of passive smoking and non-smoking mothers. No significant differences in values of RBC, WBC, PLT Hemoglobin and Hematocrit between the studied groups have been detected. Oxygen hood was applied significantly more often in case of newborns from active smoking mothers than in the control subjects. In groups of newborns from active and passive smoking mothers, hyperbilirubinemia and signs of early onset infection were diagnosed significantly more frequently than in the control subjects. CONCLUSIONS: Active maternal smoking, as opposed to passive maternal smoking, leads to decreased birthweight, body length, head and chest circumference. Full-term newborns born to active smoking mothers often need to be treated with oxygen hood during the first hours after birth. Maternal smoking, both active and passive, leads to an increased risk of hyperbilirubinemia and early onset infection in neonates.

[Assessment of relationship between cord blood cotinine levels and some factors of perinatal hypoxia]. / Ocena zaleznosci miedzy stezeniem kotyniny we krwi pepowinowej a wybranymi wskaznikami niedotlenienia okoloporodowego.

OBJECTIVE: To determine the relationship between cord blood cotinine levels and some markers of perinatal hypoxia such as cord blood erythropoietin levels, parameters of umbilical arterial blood gas analysis and Apgar scores. METHODS: 150 women with uncomplicated, healthy singleton pregnancies were assessed by means of a patient questionnaire. Neonates born by the examined pregnant women were divided into 3 groups according to recorded maternal smoking status--active smoking: n = 51, passive smoking: n = 49, non smoking: n = 50. Immediately after birth umbilical venous (for cotinine and erythropoietin levels) and arterial blood (for pH, pO2, pCO2, BE) were collected. RESULTS: Cotinine levels were significantly higher (p < 0.00001) in active smoking group (Me = 19.3 ng/ml) than in passive smoking (Me = 0.75 ng/ml) and non smoking (Me = 0.72 ng/ml) ones. Cord blood erythropoietin, pH values and 1, 3 and 5-minute Apgar scores did not differ significantly between the study groups. No significant correlation between cotinine and erythropoietin, pH and Apgar scores results in all study material and in the compared groups was found. CONCLUSION: No correlation between cord blood cotinine and erythropoietin levels was detected. Cord blood cotinine concentration does not influence the condition of the newborn assessed by Apgar scores and umbilical arterial blood gas analysis.

Maternal adipose tissue, maternal and cord blood essential fatty acids and their long-chain polyunsaturated derivatives composition after elective caesarean section.

BACKGROUND: The essential fatty acids and their long-chain polyunsaturated derivatives (LC PUFAs) are important for the growth and maturation of the fetal organism. OBJECTIVE: The aim of a study was to assess the profile of the essential fatty acids and their LC PUFAs in the blood and adipose tissue of pregnant women and in the cord blood after elective caesarean section. DESIGN: The study group comprised 36 women and 38 their full-term babies born after elective caesarean section. In maternal adipose tissue, maternal blood (separately in plasma and erythrocytes) and cord blood (separately arterial and venous) composition of the fatty acids in total lipids was estimated with gas chromatography. RESULTS: In the maternal plasma and erythrocytes the weight percent content of linoleic acid and alfalinolenic acid was higher and of LC PUFAs was lower than in plasma and erythrocytes from the umbilical vein with the exception of EPA and DPA. In the maternal subcutaneous adipose tissue the content of alfalinolenic acid was higher and of linoleic acid and of LC PUFAs were lower than in maternal plasma and erythrocytes. There was no significant difference in the weight percent content of estimated acids between the venous and arterial umbilical blood. In the maternal plasma the weight percent content of linoleic acid, alfalinolenic acid and LC PUFAs was lower than in the maternal erythrocytes. CONCLUSION: Differences between maternal and cord blood essential fatty acids and their metabolites indicate that preferential placental transfer of n-6 and n-3 fatty acid metabolites or faster metabolic turnover of linolenic and arachidonic acids in the fetus than in mother is possible.

[Chorioamnionitis in relation to cord blood sICAM-1 and CRP levels of newborns with and without markers of early onset infection]. / Zapalenie blon plodowych a stezenie sICAM-1 i CRP we krwi pepowinowej noworodków z obecnymi i nieobecnymi wskaznikami zakazenia wczesnego.

UNLABELLED: THE AIM of the study was an evaluation of the relationship between histological chorioamnionitis and cord blood soluble intercellular adhesion molecule-1 (sICAM-1) and CRP levels. MATERIAL AND METHODS: in the group of 152 neonates observed for early onset infection (clinical and laboratory signs) the relationship between histological chorioamnionitis and cord blood sICAM-1 (ELISA) and CRP (turbidimetric method) levels was assessed. All these newborns were born in the years 2002-2004 to mothers with risk factors of perinatal infection. RESULTS: histological chorioamnionitis (ChA) was found in 50 cases, while early onset infection signs occurred in 112 neonates. The percentage of ill and healthy newborns in group with ChA and without ChA was similar. There were significantly higher sICAM-1 (p<0.001) levels in neonates from pregnancy complicated with ChA than without ChA (179 +/- 68.7 v. 147 +/- 30.8 ng/ml). There was not such difference in the CRP levels. There was also a significant positive correlation between cord blood sICAM-1 and ChA in the whole analyzed group of patients (r=0.26; p<0.001) and in the group of ill neonates (r=0.37; p<0.0001). There was a significant difference (p<0.001) in sICAM-1 levels between ill and healthy neonates from the group with ChA (191,8 +/- 73.9 v. 143,4 +/- 31.9 ng/ml) but not without ChA. No difference was found in sICAM-1 levels between groups of healthy neonates born after pregnancy complicated and not complicated with ChA. CONCLUSIONS: coexistence of ChA and early onset infection in neonates enhanced the cord blood sICAM-1 levels. Healthy newborns born from pregnancy complicated by ChA do not react by increasing cord blood sICAM-1 levels. It is not possible to exclude early onset infection in neonates on the basis of normal cord blood sICAM-1 levels, because ill newborns born after pregnancy not complicated with ChA also do not react with increasing sICAM-1 production at birth.

[Secundum atrial septal defect in newborns of diabetic mothers]. / Ubytek przegrody miedzyprzedsionkowej typu II u noworodków matek chorych na cukrzyce.

AIM: To evaluate in own material the incidence of secundum atrial septal defect type fossa ovalis (ASD II) with signs of cardio-respiratory maladaptation in infants of diabetic mothers (IDM) during the first 48 hours of life, and subsequent echocardiography follow-up of babies with ASD II during the first year of life. MATERIAL AND METHODS: In the period from September 2002 to March 2003 a total of 502 neonates were born and 62 number them were from diabetic mothers. Echocardiography scanning was performed in a group of 49 neonates (42 IDM and 7 full-term infants of healthy mothers) with signs of cardio-respiratory maladaptation during the first 48 hours of life. Six neonates were born from pregestational diabetes mothers and 36 from gestational diabetes mothers (G1-17, G2-19), Birth weight of the newborns were in the range from 1370 to 4450 g, and gestational age was in the range between 30 to 41, mean 38.6 weeks. Apgar score was > 7 in 91.8% of neonates. In the whole study besides laboratory tests in direction of early onset infection, brain ultrasound and echocardiography scanning were performed. M-mode, 2-D presentation and Doppler blood flow velocity were done 4 times during the first year of life (in 2nd, 4th and 12th month). RESULTS: ASD II with 2 to 9 mm diameter was diagnosed in 20 (40.8%) of the examined neonates. Among them 16 were IDM and 4 from healthy mothers. There was no statistically significant difference in the frequency of ASD II recognition in accordance with type of maternal diabetes. During subsequent echocardiography scanning, spontaneous closure of ASD II was found in 11 (55.0%) babies at the age of 12 months. In the remaining 9 (45.0%) infants a decrease in ASD II was notices in 6 (30.0%) cases and the same diameter of arterial defect was left in 3 (15.0%). CONCLUSION: In 38.1% of neonates born to diabetic mothers, cardio-respiratory disturbances during the first 48 hours of life were accompanied by secundum atrial septal defect. During 12 months follow-up with echocardiography evaluation, decrease in diameter or spontaneous closure o ASD II occurred in most of our patients.

[Evaluation of diagnostic usefulness of the cord blood TNF-alpha levels as a marker of early onset neonatal infection]. / Ocena przydatnosci diagnostycznej okreslania stezenia TNF-alpha we krwi pepowinowej jako markera zakazenia wczesnego u noworodka.

OBJECTIVE: The aim of the study was to assess whether cord blood TNF-alpha levels can be useful as a marker of early onset neonatal infection. DESIGN: A prospective survey of a group of 110 newborns performed during the first 3 days of life. METHODS: The study was performed on a group of 110 newborns. In all the examined babies, cord blood TNF-alpha levels was evaluated by RIA. In addition CRP levels, and WBC, RBC, PLT were determined during the first two hours of life. On the basis of clinical symptoms and results of the known laboratory markers of infection the examined babies were divided into two subgroups. 74 of them were a study group and the other 36 -control group. RESULTS: It was found that cord blood TNF-alpha levels were significantly higher (p < 0.05) in the study than in the control group [Me = 31.15 pg/ml (5.0-311.0) versus Me = 21.4 pg/ml (5.0-74.8)]. The differentiation level of the TNF-alpha between study and control group was assessed on the level of 15 pg/ml. It was found that the sensitivity of this test as a marker of early onset infection is 78.0% and specificity is only 41.2%; odds ratio--3.2. Furthermore we did not find a significant correlation between TNF-alpha levels and CRP, as well as WBC, RBC ant PLT count. CONCLUSION: Newborns developing early onset infection are born with higher TNF-alpha levels than healthy subjects are. Low specificity of this test despite high sensitivity is a reason, which can cause a limitation in using this test in clinical practice.

[Immaturity or hypotrophy? The cord blood leptin levels in preterm and small-for-gestational age neonates]. / Niedojrzalosc czy niedozywienie? Poziom leptyny we krwi pepowinowej noworodków urodzonych przedwczesnie i z hipotrofia wewnatrzmaciczna.

OBJECTIVES: To assess cord blood leptin levels in preterm and small-for-gestational age neonates and determine whether fetal leptin levels correlate with selected clinical parameters associated with prematurity and undernutrition at birth. DESIGN: Study of preterm newborns (p-AGA; n = 31) and small-for-gestational age (t-SGA; n = 23) cases in a population of neonates born in Szczecin between September 2001 and June 2002. METHODS: Fetal cord blood was sampled after delivery. Leptin levels were measured by RIA. Anthropometric data (birth weight, birth length, head and chest circumferences, body mass index, Ponderal index) were also recorded. RESULTS: Cord blood leptin levels did not differ significantly between p-AGA and t-SGA neonates with similar birthweight. Among the two groups of newborns the correlations between fetal leptin and anthropometric data were only observed in p-AGAs, but not in t-SGA group. CONCLUSIONS: We suggest that cord blood leptin level depends on body mass rather than maturity of newborn. It is also hypothesized that leptin level in SGA neonates is determined by other than anthropometric parameters used in this study.