Prenatal and postnatal peculiarities and consequences of intestinal loop patency disorder with expansive giant cystic abdominal mass in a preterm newborn.

AIM: To analyse the findings in a newborn (36 gestational weeks, birth weight: 4,030 grams, birth length: 48 cm, Apgar score 7/8/8 points) with prenatal suspicion of intestinal obstruction at the duodenum/jejunum level. The patient required urgent surgery on the first day of life. RESULTS: Examination of the abdominal cavity confirmed the presence of a cystic mass with a volume of approximately 800 ml, which was located at the site of jejunal atresia. As part of the surgical solution, the cystic formation and the atretic segment of the intestine were resected with subsequent end-to-end jejuno-jejunal anastomosis and Bishop‒Koop ileostomy. The histological examination of 3 samples collected confirmed the presence of mucous membrane and smooth muscle. CONCLUSION: The cyst anatomically communicated with the aboral section of the jejunum, but the lumen of the jejunum was functionally obturated by solid whitish masses. The histological examination confirmed the diagnostic features of a cyst of intestinal origin. The ileum and colon were patent throughout, but of smaller diameter, so a Bishop-Koop relieving anastomosis was indicated. The condition of the child at the age of 9 months was stabilised and surgical closure of the stoma was carried out (Tab. 1, Fig. 8, Ref. 21). Text in PDF www.elis.sk Keywords: newborn, jejunal atresia, intestinal cyst.

Congenital cytomegalovirus infection ‒ a problem of past, present and future.

AIM: To analyse prenatal and postnatal characteristics, clinical and laboratory findings, results of investigations in the group of 11 newborns with congenital CMV infection, who were hospitalized at Neonatal Department of Intensive Medicine between January 1st 2012 and March 31st, 2022 were included. RESULTS: Prenatal foetal sonography revealed in patients 5 and 8, positive calcifications in the brain; in patients 6, 9 and 11, isolated ventriculomegaly was found. Neurological examination was clinically negative in patients 1 and 10, changes of muscular tonicity and spontaneous activity were confirmed in the rest of the group. In patients 5 and 10, one-sided positivity of otoacoustic emissions was confirmed. Chorioretinitis with bilateral negative otoacoustic emissions was confirmed in patient 5. Clinical status of patient 11 was complicated by pneumonitis. Three patients were treated with antiviral drugs orally, and 11 newborns had a combination of intravenous and oral form of treatment. CONCLUSION: The results of analysis will contribute to a society-wide solution of prevention. Monitoring of the frequency of CMV infection in the population with education of the population can decrease the number of affected newborns (Tab. 4, Ref. 29).

Noninvasive positive pressure ventilation in critically ill children with cardiac disease.

Noninvasive ventilation is effective in respiratory failure from various etiologies. This study aimed to analyze the efficacy of noninvasive positive pressure ventilation (NPPV) in pediatric cardiac patients. NPPV was used (1) as an alternative means of respiratory support in patients with hypoxemic or hypercarbic respiratory failure or with signs of respiratory distress that were considered to require intubation; or (2) as a preventive measure in patients with high risk for extubation failure. Between 2008 and 2011, there were 107 episodes of NPPV use in 82 patients. Their median age was 57 days (range 1 day to 18 years), and weight was 4.1 kg (range 1.7-68). Within the first hour of NPPV, partial pressure of carbon dioxide/fraction of inspired oxygen (PaO2/FiO2) was significantly increased, and arterial pCO2, and respiratory rate were decreased. This decrease in respiratory rate and increase in PaO 2/FiO2 continued during the first 24 h of therapy, and pCO2 was decreased during the first 6 h. In 59.8% of cases, NPPV was successfully used without the need for tracheal intubation. The Aristotle Basic Complexity score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour were independent predictors of NPPV failure. We conclude that NPPV improved oxygenation and decreased respiratory effort in pediatric cardiac patients, 59.8% of whom eventually did not receive intubation. A high-complexity surgical score, presence of infection, residual cardiac defect, and pH <7.36 in the first hour are predictors of NPPV failure, which occurs in most patients >24 h after the onset of therapy.

Amiodarone as a first-line therapy for postoperative junctional ectopic tachycardia.

BACKGROUND: Postoperative junctional ectopic tachycardia is a potentially life-threatening arrhythmia that is often resistant to conventional antiarrhythmic drugs. Amiodarone was suggested to be an adequate treatment; however, data regarding its efficacy and safety are limited. This study evaluated the efficacy of amiodarone in the first-line treatment of postoperative junctional ectopic tachycardia and assessed factors associated with failure of amiodarone therapy. METHODS: The study included 40 pediatric cardiosurgical patients with postoperative junctional ectopic tachycardia. Intravenous amiodarone in 2-mg/kg boluses and, if necessary, as continuous infusion (10 to 15 mug/kg/min), were used as the first-line therapy. Restoration of sinus rhythm or slowing of junctional ectopic tachycardia to a rate that allowed atrial or atrioventricular sequential pacing was considered as efficacy of therapy. RESULTS: Amiodarone was effective in 18 patients (45%). Sinus rhythm was achieved in 7, and heart rate decreased in 11 patients from 180 (range, 173 to 200) to 142 (range, 133-155) beats/min (p < 0.0001) and allowed effective pacing with atrioventricular synchrony. Higher arteriovenous oxygen saturation difference (p = 0.007) and lower body temperature (p = 0.02) were associated with failure of amiodarone therapy. CONCLUSIONS: Amiodarone as the first-line treatment was effective in almost half of the patients with postoperative junctional ectopic tachycardia. Higher arteriovenous oxygen saturation difference and lower body temperature were associated with failure of amiodarone therapy, and their presence may suggest more aggressive initial approach consisting of amiodarone combined with hypothermia.

Non-invasive positive pressure ventilation for bilateral diaphragm paralysis after pediatric cardiac surgery.

We present the case histories of two children having respiratory failure due to bilateral diaphragm paralysis after cardiac surgery. In both children non-invasive positive pressure ventilation alleviated respiratory distress, improved gas exchange, and prevented the need for endotracheal intubation. Following unilateral recovery of diaphragmatic function both children were successfully weaned from non-invasive positive pressure ventilation.