Infant of a diabetic mother: clinical presentation, diagnosis and treatment.

An infant of a diabetic mother is defined as a newborn born to a mother who has diabetes during pregnancy. The term diabetic mother refers to pregnant women with diabetes diagnosed either before (type 1 or 2 diabetes) or during pregnancy (gestational diabetes). Rising incidence of type 1 and type 2 diabetes in young women and increasing maternal age at conception account for the higher risk of birth complications and adverse maternal and infant outcomes. Infants of diabetic mothers (IDMs) because of mother's diabetes are prone to developing complications and the most common include: large birth weight and complications resulting from it (i.e. birth injuries, perinatal asphyxia), cardiovascular and respiratory insufficiency (poor tolerance of labor stress), neonatal hypoglycemia and it's complications, delayed lung maturity (fetal hyperinsulinism and the opposite function of insulin to cortisol), cardiomegaly and hypertrophy of the intraventricular septum (functional narrowing of the outflow of the left ventricle and cardiac failure), congenital malformations (most often of the central nervous system and heart). Less common complications in IDMs are: persistent pulmonary hypertension, hyperbilirubinemia, renal vein thrombosis, small left colon syndrome, intrauterine death, polycythemia, and a predisposition to obesity, insulin resistance and diabetes later in life. This article presents current knowledge about pathological conditions and the recommended management for IDMs.

Fetal Third-Trimester Functional Cardiovascular Abnormalities and Neonatal Elevated Bilirubin Level.

BACKGROUND: The aim of the study was to analyze the neonatal outcomes of fetuses with diagnosed functional cardiovascular abnormalities, also considering the connection with neonatal hyperbilirubinemia. MATERIALS AND METHODS: It was an observational study of 100 neonates who had fetal echocardiography examinations in the third trimester (mean gestational age during the last echocardiography was 34 ± 3 weeks and mean birth weight was 3550 g). There were two groups: A: normal heart anatomy + no functional anomalies; group B: normal heart anatomy + functional abnormalities. Hyperbilirubinemia was defined as a bilirubin level of >10 mg%. RESULTS: In group A, there were 72 cases and only 5 cases despite having normal heart anatomy and normal heart study that presented additional problems. In group B (28 cases), the prenatal functional findings included tricuspid regurgitation (TR) (15 cases, 53%), pericardial effusion (4 cases, 14%), myocardial hypertrophy (4 cases, 14%), cardiomegaly (2 cases, 7%), abnormal bidirectional blood flow across the foramen ovale (3 cases, 11%), aneurysm of atrial septum (2 case, 7%), abnormal E/A ratio for mitral and tricuspid valve (1 case, 3%), bright spot (3 case, 11%), abnormal Doppler flow in ductus arteriosus compared to aortic arch (difference >60 cm/s) (1 case, 3%), supraventricular tachycardia (SVT) (1 case), and mitral regurgitation (1 case, 3%). In group A (n = 72 cases), bilirubin levels of >10 mg/dL were observed in 8% of newborns. In group B (n = 28), bilirubin levels of > 10 m/dL were observed in 46% of cases and TR was present in group B in 53% of cases (15/28 cases). The difference between group A and B in terms of elevated bilirubin levels was statistically significant (p < 0.001). CONCLUSIONS: In the case of fetal normal heart anatomy and normal heart study, a good neonatal outcome may be expected. When fetal cardiovascular functional abnormalities in normal heart anatomy are detected, with special attention paid to tricuspid valve regurgitation, a neonatal elevated bilirubin level (mean 11 mg/dL, range 10-15 mg/dL) may be expected.

Small prenatal diameter of the ascending aorta is associated with increased mortality risk in neonates with congenital diaphragmatic hernia.

Introduction: The aim of this study was to evaluate whether selected prenatal markers obtained from fetal echocardiography can predict postnatal outcome in congenital diaphragmatic hernia (CDH) patients. We also aimed to verify the prognostic value of lung-to-head ratio (LHR). Material and methods: The study group included 29 fetuses with CDH. We analyzed potentially prognostic parameters measured using fetal echocardiography and fetal ultrasound. The assessed parameters were compared between the group of patients with CDH who survived to discharge (n = 21) and the subset of patients who died before discharge from hospital (n = 8). Results: In survivors, mean z-score for ascending aorta (AAo) diameter was 0.23 ±0.98 vs. - 1.82 ±1.04 in patients who died (t-test, p = 0.0015). In survivors, the main pulmonary artery/ascending aorta ratio was 1.22 ±0.17 vs. 1.46 ±0.21 in patients who died (t-test, p = 0.017). In survivors, the LHR was 1.81 ±0.96 vs. 0.95 ±0.6 in patients who died (t-test, p = 0.019). In survivors, the observed to expected LHR was 57 ±30% vs 30 ±18% in patients who died (t-test, p = 0.018). Conclusions: Narrowing of the ascending aorta in CDH fetuses is a poor prognostic factor associated with increased mortality in neonates. Our study also confirmed the prognostic value of LHR.

The COVID-19 pandemic impact on the Polish medical personnel work: a survey and in-depth interviews study.

Objective: The objective of the study was to examine the impact of the COVID-19 pandemic on the work of medical personnel in terms of: task scope, preparation to perform medical tasks related to the pandemic, team collaboration, involvement in tasks performed, concerns about performing tasks related to the pandemic, stress levels. Methods: The mixed-method approach was applied to this cross-sectional study. The online questionnaire which included 40 questions was completed via Google among medical personnel in Poland. Eight semi-structured, in-depth interviews were conducted to deepen the data obtained with the questionnaires. Participants: The questionnaire was completed by 215 healthcare professionals, with the largest group being nurses (56.3%) followed by physicians (22.3%), midwives (11.6%) and other healthcare professionals (e.g., physiotherapists, paramedics, nutritionists - 9.8%). Among the respondents were people who worked in the hospital in the so-called "covid wards" (31.2%) and other hospital wards (60%) as well as people who were employed outside the hospital (8.8%). Results: The pandemic affected the nature and range of tasks performed by health professionals. Initially, respondents felt unprepared to work under pandemic conditions, but over time their ratings increased in all areas studied. More than half of respondents reported no change in interpersonal relationship within the team, but nearly 35% noted a worsening and only one in 10 claimed improvement. Study participants rated their own commitment to tasks slightly higher than that of their colleagues (mean 4.9 and 4.4 respectively) but the overall rating was high. The mean self-rating of work stress increased from 3.7 before the pandemic to 5.1 during the pandemic. Most of the respondents were afraid of transmission of the infection to their relatives. Other fears included the possibility of making a medical error, not being able to help the patient, not having enough personal protective equipment (PPE) and contracting SARS-CoV-2. Conclusion: The conducted study revealed that the organization of medical care in the initial period of the pandemic, especially the hospital care of patients infected with SARS-CoV-2, was quite chaotic. The most affected were the people who were transferred to work in the covid wards. Not all medical professionals were prepared to work with the COVID-19 patients, as they lacked experience working in such facilities, especially in intensive care units (ICU). Working under time pressure and under new conditions led mainly to an increase in perceived stress and conflicts between staff.

The prevalence of hypothyroxinemia in premature newborns.

Congenital hypothyroidism diagnosed by TSH assessment in bloodspot screening may be overlooked in preterm newborns due to immaturity of the hypothalamus-pituitary-thyroid axis in them. The purpose of the study was to determine the prevalence and causes of hypothyroxinemia in preterm newborns, determined by TSH and FT4 serum concentration measurement, performed on the 3-5th day of life. We assessed TSH, FT4 and FT3 serum concentration on the 3-5th day of life in preterm children born at our centre within three consecutive years. We assessed the incidence of hypothyroxinemia, and its cause: primary hypothyroidism, secondary hypothyroidism or low FT4 syndrome - with normal TSH concentration, its dependence - among others - on gestational age (GA), birth body weight (BBW) and being SGA. A total of 525 preterm children were examined. FT4 concentration was decreased in 14.9% of preterm newborns. The most frequent cause of hypothyroxinemia was low FT4 syndrome (79.5%). More than 92% cases of hypothyroxinemia occurred in children born before the 32nd week and/or with BBW below 1500 g. Thus, every fourth child in these groups had a reduced FT4 concentration. Neonates with hypothyroxinemia were significantly lighter than those with normal FT4. In older and heavier neonates with hypothyroxinemia, serious congenital defects were observed. Neither IVH nor SGA nor twin pregnancies predispose children to hypothyroxinemia. Among newborns with untreated hypothyroxinemia in whom TSH and FT4 assessment was repeated within 2-5 weeks, a decreased FT4 concentration was confirmed in 56.1% of cases. As hypothyroxinemia affects 25% of newborns born before the 32nd week of gestation and those in whom BBW is less than 1500g, it seems that in this group of children the newborn screening should be extended to measure serum TSH and FT4 concentration between the 3-5th day of life. In older and heavier neonates, additional serum TSH and FT4 assessment should be limited to children with severe congenital abnormalities but not to all SGA or twins. Despite the fact that the most common form of preterm hypothyroxinemia is low FT4 syndrome, it should be emphasized that FT4 remains lowered on subsequent testing in more them 50% of cases.

Advantages of side-lying position. A comparative study of positioning during bottle-feeding in preterm infants (≤34 weeks GA).

BACKGROUND: The quality and safety of bottle-feeding in premature infants can be improved by optimal positioning. This study analysed the advantages of side-lying position (SLP) and semielevated position (SEP) during bottle-feeding in premature infants. MATERIAL AND METHODS: A total of 42 neonates (n=42) born ≤34 weeks of gestational age were included in the study. Four feeding sessions-two in SLP and two in SEP- were analysed for each newborn. The level of saturation (SpO2) and heart rate, which are the parameters assessing the physiological stability, were measured in the studied newborns. The other factors that were examined to determine the quality of feeding included the total time of decline of SpO2 to ≤85%, level of the newborn's alertness measured using the Neonatal Behavioral Assessment Scale, and the frequency of choking episodes. The proportion of milk consumed (volume of milk consumed relative to the volume expected) and the feeding duration as well as the total time of feeding session were recorded. RESULTS: SLP was safer in terms of the frequency of choking episodes. Choking episodes were more frequently observed with feeding in SEP (p<0.001). Moreover, the proportion of milk consumed by infants was statistically significantly higher in SLP (p<0.046) compared to SEP. No significant differences in the other tested parameters were noted in infants fed in SLP and infants fed in SEP. CONCLUSIONS: This study demonstrated that SLP is effective in reducing the number of choking episodes during feeding. The proportion of milk consumed was better when the neonates were fed in SLP.

The influence of the technique of surfactant administration (LISA vs INSURE) on the outcomes of respiratory distress syndrome treatment in preterm infants.

OBJECTIVE: Intratracheal administration of exogenous surfactant is a well-established therapy for respiratory distress syndrome in preterm infants. The two preferred methods for respiratory support in neonates that contribute to limiting the risk of lung damage associated with mechanical ventilation include nCPAP and non-invasive ventilation. The increasing popularity of surfactant administration techniques is due to the fact they reduce the time of mechanical ventilation until this medication is administered. In some cases a short period of mechanical ventilation follows (INSURE: INtubation-SURfactant-Extubation). There are also methods that make it possible to completely avoid intubation and help maintain spontaneous breathing during surfactant administration (LISA: Less Invasive Surfactant Administration, MIST: Minimal Invasive Surfactant Therapy). Aim: To analyze treatment outcomes in preterm infants who suffer from respiratory distress syndrome and require exogenous surfactant administration depending on the technique used: LISA vs INSURE. PATIENTS AND METHODS: Material and methods: The present retrospective analysis included 129 infants born at a gestational age of between 24 and 33 weeks who were hospitalized in the Neonatology Department in the years 2014-2016, were administered surfactant and remained on non-invasive ventilation. All the subjects received only proractant alfa. Both study groups: LISA (n=83) and INSURE (n=46) were analyzed in terms of respiratory distress treatment outcomes and the presence of complications of prematurity. RESULTS: Results: There were no significant differences in patient characteristics between the two study groups (LISA vs INSURE: mean birth body weight was 1210 g vs 1275 g, respectively; mean gestational age at birth was 30 weeks vs 29 6/7 weeks, respectively). The comparison of respiratory support method and FiO2 concentration within the first 72 hours after surfactant administration showed no significant differences between the groups. Similarly, respiratory outcomes did not significantly differ between the LISA and INSURE groups and were: the need for intubation ⎼ 42.2% vs 32.6%, p=0.201, duration of mechanical ventilation - median days 0 vs 0, p=0.377, duration of nCPAP - median days 5 vs 5, p=0.379, duration of oxygen supplementation - median days 1 vs 1, p=0.555, and the incidence of bronchopulmonary dysplasia - 28.9% vs 23.9%, p=0.506. Also, the incidence of complications was similar in both study groups. CONCLUSION: Conclusions: Our retrospective analysis of preliminary outcomes of surfactant administration involving the use of the LISA technique showed no statistically significant differences as compared with the INSURE method. The randomized, prospective study that is currently being conducted at our Neonatology Department and includes biochemical markers of lung damage, will bring more objective data on the safety and effectiveness of both surfactant administration techniques (LISA vs INSURE).

Therapeutic hypothermia in asphyxiated newborns: selective head cooling vs. whole body cooling - comparison of short term outcomes.

OBJECTIVES: Therapeutic hypothermia TH became broadly used in the management of the asphyxiated newborns. Although two cooling methods are used, so far the superiority of none of them has been established. The purpose of the study is to compare two cooling methods: selective head cooling (SHC) and whole body cooling (WBC) MATERIAL AND METHODS: We conducted a prospective observational study in newborns with HIE. The patients received one of methods: SHC or WBC. The eligibility criteria were similar to previous studies. Stability of cardio-respiratory parameters and short term outcomes were analyzed. RESULTS: 78 neonates with hypoxic-ischemic encephalopathy due to perinatal asphyxia were involved in this study. The SHC group consisted of 51 newborns, the WBC group consisted of 27 patients. Both study groups had similar baseline characteristics and condition at birth. There were no significant differences in hospital course, neurological status and adverse effects associated with cooling procedure between groups. Analyzing the rate of thrombocytopenia and the number of transfusions of blood components no statistically significant differences were found between the groups. CONCLUSIONS: Results of our study indicate that two compared methods of TH despite varied target core temperature ranges do not differ significantly according to clinical course and risk of adverse events. Further observations are conducted and we look forward to the results of the long neurodevelopmental care.

The level of extracellular superoxide dismutase in the first week of life in very and extremely low birth weight infants and the risk of developing bronchopulmonary dysplasia.

Background Antioxidant enzymes may play a significant role in the development of bronchopulmonary dysplasia (BPD). The aim of the study was to assess the relationship between the level of extracellular superoxide dismutase (SOD3) in the serum at days 1 and 7 of life and the risk of developing BPD. Methods The study comprised 103 neonates born before 32 weeks' gestation with a birth weight of ≤1500 g. Results In the investigated group, the median serum SOD3 level at day 1 of life was 4.01 ng/mL [interquartile range (IQR) 2.59-5.09 ng/mL] and at day 7 of life 3.13 ng/mL (IQR 2.49-4.34 ng/mL). A statistically significant decrease in the serum SOD3 level was found in the first week of life, P < 0.0001. No correlation was found between the serum SOD3 level at day 1 of life and gestational age R = 0.07, P = 0.4543 and birth weight R = 0.10, P = 0.3083. No statistically significant correlation was found between the dynamics of change in the SOD3 level in serum at days 1 and 7 of life and the risk of BPD development for the definition of BPD at day 28 of life, P = 0.8764 nor at 36 weeks' postmenstrual age, P = 0.6598. Conclusion The study revealed a statistically significant decrease in the serum SOD3 level in the first week of life in very and extremely low birth weight infants born before 32 weeks of gestation. In the clinical setting, no relationship was observed between the level of SOD3 in serum and the risk of developing BPD.

The impact of positioning on bottle-feeding in preterm infants (≤ 34 GA). A comparative study of the semi-elevated and the side-lying position - a pilot study.

OBJECTIVE: Objective: The aim of the study was to compare the advantages of semi-elevated and side-lying positioning during bottle-feeding of preterm infants ≤ 34 weeks gestational age (34+0/7). PATIENTS AND METHODS: Material and methods: The study included six neonates (n=6) born ≤ 34 weeks gestational age who reached the age ≥ 32 weeks of postmenstrual age on the day when the study began and were hospitalized in the neonatology ward. Four bottle-feeding sessions were tested in each of the newborns: two in the side-lying and two in the semi-elevated position. The position for the first test was chosen randomly. For each of the positions twelve feeding sessions were examined and each preterm infant had bottle-feeding sessions analyzed both in the semi-elevated and side-lying positions. The level of saturation and heart rate were measured as the parameters indicative of the newborn's physiological stability. The factors determining the qualitative aspect of feeding included the level of the newborn's alertness and the occurrence of choking episodes. The amount of food consumed and the duration of the feeding were also recorded. RESULTS: Results: The side-lying position was more effective with regard to the total amount of sustenance consumed as compared to the semi-elevated feeding position and the study result was statistically significant (p=0.007). The difference in the number of chokes between the study groups was not statistically significant, although a trend towards a reduced number of choking episodes was observed among infants fed in the side-lying position (p=0.090). There were no significant differences in oxygen saturation, heart rate and level of activity between the study groups. CONCLUSION: Conclusions: The effects of this pilot study demonstrate the efficacy of the side-lying feeding position regarding the final amount of milk intake. The side-lying position may also reduce the number of choking episodes during the feeding. The results suggest the need to extend the study in order to confirm the potential benefits of using the side-lying position.

[Biomarkers of intrauterine growth restriction].

Intrauterine growth restriction (IUGR) is a serious clinical problem affecting about 10% of all pregnancies, and even up to 15% of all monochorionic twin pregnancies. This disorder is accompanied by strongly increased perinatal mortality. IUGR has multiple causes including maternal, fetal, placental, and environmental factors. Importantly, IUGR is associated with a number of negative effects exerted just after the birth, as well as during the later years of life. Despite multiple clinical trials conducted for many years, there is no reliable algorithm to diagnose the disease at an early stage, and lack of efficient therapy increases the risk of abnormal fetus development. In this short review, we present recent progress on potential IUGR biomarkers that could be determined during pregnancy and in the umbilical blood after delivery to provide more accurate diagnosis, prophylaxis and efficient treatment.

The role of recombinant human CC10 in the prevention of chronic pulmonary insufficiency of prematurity.

BACKGROUND: Preterm neonates can develop chronic pulmonary insufficiency of prematurity (CPIP) later in infancy. Recombinant human CC10 protein (rhCC10) is an anti-inflammatory agent that could potentially prevent CPIP. METHODS: The safety and efficacy of a single intratracheal dose of rhCC10 in reducing CPIP at 12 months corrected gestational age (CGA) was evaluated in a Phase II double-blind, randomized, placebo-controlled, multisite clinical trial. Eighty-eight neonates were randomized: 22 to placebo and 22 to 1.5 mg/kg rhCC10 in the first cohort and 21 to placebo and 23 to 5 mg/kg rhCC10 in the second cohort. Neonates were followed to 12 months CGA. RESULTS: With CPIP defined as signs/symptoms, medical visits, hospital readmissions, and use of medications for respiratory complications at 12 months CGA, no significant differences were observed between rhCC10 or placebo groups. Only 5% of neonates had no evidence of CPIP at 12 months CGA. CONCLUSIONS: A single dose of rhCC10 was not effective in reducing CPIP at 12 CGA. Since most neonates had evidence of CPIP using these exploratory endpoints, it is essential to develop more robust outcome measures for clinical trials of respiratory medications in high-risk premature neonates.

Fraction of Inspired Oxygen as a Predictor of CPAP Failure in Preterm Infants with Respiratory Distress Syndrome: A Prospective Multicenter Study.

INTRODUCTION: There are limited data available regarding the fraction of inspired oxygen (FiO2) predictive of the failure of continuous positive airway pressure (CPAP) in preterm infants with respiratory distress syndrome (RDS). Therefore, we investigated factors predictive of CPAP failure in the first 72 h of life, with special attention to the prognostic role of FiO2. METHODS: This multicenter, prospective study enrolled infants <30 weeks gestation in whom CPAP was initiated within the first 15 min after birth. In the univariate and multivariate logistic regression models, demographic, perinatal, and respiratory parameters were analyzed. The FiO2 threshold was determined with ROC curve analysis. RESULTS: Of 389 recruited newborns, CPAP failure occurred in 108 infants (27.8%). In the univariate model, each gestational week reduced the odds of CPAP failure by 19%, and each 100 g of birth weight reduced the odds by 16% (both p < 0.05). The risk was increased by 4.2 and 7.5% for each 0.01 increase in FiO2in the first and second hours of life, respectively. In the final multivariate model, birth weight and FiO2 in the second hour of life were the predictive measures. The prognostic threshold was FiO2 = 0.29 in the second hour of life (AUC 0.7; p < 0.0001), with a sensitivity of 73% and a specificity of 57%. CPAP failure implied a more than 20-fold higher risk of death and pneumothorax and a 2- to 5-fold higher risk of typical complications of prematurity, including bronchopulmonary dysplasia and severe intraventricular hemorrhage. CONCLUSION: FiO2 in the second hour of life is a significantpredictor of CPAP failure. The threshold of 0.29 best discriminates the CPAP outcome. Nonresponders to CPAP have a remarkably higher incidence of complications and a higher mortality rate.

Five-country manikin study found that neonatologists preferred using the LISAcath rather than the Angiocath for less invasive surfactant administration.

AIM: Less invasive surfactant administration (LISA) has been shown to decrease the risk of death and bronchopulmonary dysplasia in preterm neonates. The LISAcath is the first catheter to be specifically developed for LISA, and we compared the clinical impressions of neonatologists using the LISAcath and the commonly used Angiocath in a simulated setting. METHODS: This was a multinational, multicentre study, conducted in October 2016, which involved 39 neonatologists who were recruited by employees of the sponsor from large, well-recognised neonatal intensive care units across Europe. LISA was not the standard of care in these units in Austria, Belgium, Poland, Spain and the United Kingdom at the time of the study. After training, participants simulated LISA on a neonatal manikin, once with the LISAcath and once with Angiocath, then answered a 10-item questionnaire. RESULTS: The responses to nine of 10 questions showed that 67-95% of the respondents preferred the LISAcath to the Angiocath, with most of the remainder indicating no preference. The only exception was the luer connection question, with two-thirds expressing no preference. The LISAcath was considered potentially safer by 33 of 39 participants, with no votes for the Angiocath. CONCLUSION: Overall, neonatologists preferred using the LISAcath rather than the Angiocath on a neonatal manikin.

What is the impact of gestational diabetes mellitus on frequency of structural chromosome aberrations in pregnant women and their offspring?

Gestational diabetes mellitus (GDM) is defined as carbohydrate intolerance which results in hyperglycemia first diagnosed during pregnancy. It is associated with an increased levels of oxidative stress due to overproduction of reactive oxygen species (ROS). Overproduction of ROS induces protein oxidation, lipid peroxidation and different types of DNA damage. The objective of this study was to determine the frequencies of structural chromosome aberrations (CA) in peripheral blood of pregnant women (mothers) with GDM and in cord blood of their newborns. Peripheral blood lymphocytes were collected from 35 GDM mothers and cord blood lymphocytes from their 35 newborns. The control group included 30 pregnant mothers without diabetes mellitus (DM) and their 30 newborns. CA were evaluated with in vitro chromosome aberration assays. We observed a moderate increase of the mean numbers of structural CA between GDM mothers and their newborns, GDM mothers and mothers without DM, GDM mothers' offspring and the offspring of mothers without DM, mothers without DM and their newborns, but this effect did not reach statistical significance (p>0.1).

Bronchopulmonary dysplasia in very and extremely low birth weight infants - analysis of selected risk factors.

AIM: The aim of the study was to analyze the role of specific risk factors affecting the development and clinical course of BPD in infants born before 32 weeks of gestation with a birth weight ≤ 1500g. MATERIALS AND METHODS: The study included 222 infants born and hospitalized at the Department of Neonatology, Polish Mother's Memorial Hospital-Research Institute. At their 28-th day of life, the patients were divided into two groups: with and without BPD. The grade of BPD severity was determined at 36 weeks of postmenstrual age. RESULTS: BPD was diagnosed in 117 (52.7%) of infants, 65 (55,6%) of them developed its mild, 29 (24,8%) moderate and 23 (19,7%) severe form. Infants with BPD had significantly lower gestational age than those without BPD: 27.0 weeks (IQR 26.0-28.3 weeks) vs. 30.0 weeks (IQR 29.3-31.0 weeks), and lower birth weight: 900g (IQR 740.0-1050.0g) vs. 1290g (IQR 1100.0-1370.0g). A significantly lower gestational age R=-0.70, p < 0.0001 and birth weight R=-0.66, p<0.0001 were observed in correspondence with the increase of BPD severity. In BPD group there were 72 (61.5%) male infants, whereas in that without BPD 54 (51.4%) of them, p=0.1290. In the group with mild form of BPD, there were 29 (44.6%) males, with moderate 23 (79.3%) and severe 20 (87.0%), p=0.0002. A statistically significant difference was found for: respiratory distress syndrome 116 (99.2%) vs. 83 (79.1%), p<0.0001, congenital infection 70 (59.8%) vs. 40 (38.1%), p=0.0012, patent ductus arteriosus 61 (52.1) vs. 28 (26.7), p=0.0001, complete prenatal steroid therapy 77 (65.8%) vs. 85 (81.0%), p=0.0112 and Apgar score of 1 min., p<0.0001 and 5 min., p<0.0001. In the group with BPD significantly more frequent were: intraventricular hemorrhage 87 (74.4%) vs. 37 (35.2%), p<0.0001, periventricular leukomalacia 11 (9.4%) vs. 0 (0.0%) p=0.0009 and retinopathy of prematurity 47 (40.2%) vs. 6 (5.7%), p<0.0001. No statistical significance was found for: premature rupture of membranes, the route of delivery, Ureaplasma spp. infection and necrotizing enterocolitis. Independent factors affecting the risk of BPD are: gestational age (OR 0.3213, p<0.0001), birth weight (OR 0.9968, p=0.0036), and respiratory distress syndrome (OR 3.9388; p=0.0142). CONCLUSIONS: Lower gestational age, low birth weight, respiratory distress syndrome, Apgar score, congenital infection, lack of prenatal steroid therapy, patent ductus arteriosus and male gender are the risk factors for the development of BPD.

Intraventricular hemorrhage in premature infants with Respiratory Distress Syndrome treated with surfactant: incidence and risk factors in the prospective cohort study.

BACKGROUND: Intraventricular hemorrhage (IVH) is a common pathology in preterm infants with extremely and very low birth weight. It is particularly often seen in newborns with Respiratory Distress Syndrome (RDS). AIM: To assess the incidence of IVH in preterm newborns with RDS treated with surfactant, and to identify factors that might reduce the risk of IVH in this population. MATERIAL AND METHODS: This multicenter, prospective cohort study is part of the "Neo-pro" study project. The investigations were carried out in 936 newborns, including 652 survivors. We enrolled a consecutive sample of infants born before 32 weeks' gestation. IVH was diagnosed with trans-fontanel ultrasonography, performed according to the approved standards and classified according to Papile's grading system. RESULTS: Intraventricular hemorrhage was diagnosed in 462/936 infants (49.4%), and in 43.3% of the survivors. Grade 3 and 4 IVH occurred in 14.8% and 13.8% of the infants, respectively, and in 10.6% and 5.7% of the survivors. Lack of antenatal application in mothers of corticosteroids increased the incidence rate of severe IVH from 14.2% to 22.1% (p=0.0087). The risk of IVH was reduced with early (from the first day of life) initiation of caffeine citrate (OR: 0.63, 95% CI: 0.45-0.88), delivery by cesarean section (OR: 0.50, 95% CI: 0.36-0.69), and the risk of severe IVH - from treatment with antenatal corticosteroids (OR: 0.58, 95% CI: 0.39-0.87). The most significant factor which increased the risk of hemorrhage was invasive mechanical ventilation (OR: 2.90, 95% CI: 2.07-4.07). The risk was further increased if the duration of mechanical ventilation was greater than seven days (OR: 3.02, 95% CI: 2.21-4.12). CONCLUSIONS: The incidence of IVH in newborns with RDS is significant and the risk of IVH is increased by mechanical ventilation. Antenatal exposure to corticosteroids and delivery by cesarean section have a protective effect, and the former also reduces the risk of the most severe manifestations of IVH. Caffeine citrate initiated from the first day of life is another protective strategy.

Thoracoamniotic Shunts in Macrocystic Lung Lesions: Case Series and Review of the Literature.

OBJECTIVE: To evaluate the efficiency of thoracoamniotic shunts for drainage of macrocystic-type congenital cystic adenomatoid malformation (CCAM). SUBJECTS AND METHODS: This was a retrospective study of 12 fetuses with a large thoracic cyst treated with thoracoamniotic shunting between 2004 and 2014 in a tertiary fetal therapy center. Medline was searched to identify cases of CCAM treated with thoracoamniotic shunting. RESULTS: In all cases the thoracic cyst was associated with major mediastinal shift, the CCAM volume ratio (CVR) was >1.6, and in eight cases there was associated hydrops. Shunt insertion was successfully carried out in all cases at a median gestational age of 24 weeks (range 18-34). In 10 cases there was live birth at a median age of 38 weeks (range 35-41), but in two hydropic fetuses there was intrauterine death. A literature search identified a total of 98 fetuses with CCAM treated with thoracoamniotic shunting between 1987 and 2016. In the combined data from the previous and the current study, the survival rate was 77% (53 of 69) for hydropic and 90% (37 of 41) for nonhydropic fetuses. CONCLUSIONS: The role of thoracoamniotic shunting in macrocystic lung lesions associated with hydrops is well accepted. Intrauterine intervention is also likely to be beneficial in the subgroup of nonhydropic fetuses with a CVR >1.6.

Antenatal corticosteroids and respiratory distress syndrome - the first Polish national survey.

OBJECTIVES: Our retrospective study aimed to evaluate the rate and the appropriate use of antenatal corticosteroid therapy, and their effect on the incidence and treatment of respiratory distress syndrome (RDS) and its complications. MATERIAL AND METHODS: A retrospective analysis of clinical practice in Poland was performed using standard investigating tools: a questionnaire on the frequency of using antennal corticosteroids in the selected centers, as well as neonatal data. A total of 987 newborns at ≤ 32 weeks of gestation, treated in 54 centers (including 42 tertiary and 12 secondary referral centers) over a period of 6 months in 2013, were deemed eligible. The study group consisted of 749 newborns whose mothers received antenatal steroids. The non-steroid group included 238 newborns. RESULTS: Antenatal corticosteroids were administered to 75.89% of the neonates from the study group, with 79% and 21% receiving one and two courses, respectively. Children whose mothers received prenatal steroids presented with less extensive radiographic changes typical of RDS, and less often required surfactant therapy (70% vs. 78%; p = 0.0143). In the group of children undergoing antenatal steroid therapy, the percentage of BPD was lower (13.27% vs. 18.63%) (p = 0.0881). The mortality rates were 20.91% and 10.81% in controls and the study group, respectively (p = 0.0001). CONCLUSIONS: The percentage of antenatal steroid use in secondary and tertiary referral centers in Poland is unsatisfactorily low (76%). Antenatal corticosteroids demonstrated high efficacy in decreasing severe forms of RDS, less need for surfactant therapy, and reduced BPD and mortality rates.