Ewa Gulczyńska

Publications of Ewa Gulczyńska

• [Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy].

  Authors: Ewa Gulczyńska, Janusz Gadzinowski

  Ginekologia polska. 03/2012; 83(3):214-8.

  Hypoxia-ischemia in the perinatal period is a serious condition affecting infants, which can result in death and cerebral palsy and associated disabilities. There has been significant researchHypoxia-ischemia in the perinatal period is a serious condition affecting infants, which can result in death and cerebral palsy and associated disabilities. There has been significant research progress in hypoxic-ischemic encephalopathy over the last 2 decades. Many new molecular mechanisms of asphyxia have been identified. Despite all these advances, therapeutic interventions in HIE remain to be limited. Recently it has been revealed that mild therapeutic hypothermia is the only modality shown to improve neurologic outcome. The authors present a summary of pathogenesis of HIE, animal studies of cooling for hypoxic and ischemic models, and first publications on human therapeutic hypothermia trials. The diagnosis of encephalopathy in full-term neonates and enrollment criteria for hypothermia are also discussed. The current data from randomized control trials of hypothermia as neuroprotection for full and near-term infants are presented along with the results of meta-analyses of these trials. Finally the status of ongoing neonatal hypothermia trials as well as status of therapeutic hypothermia in Poland is summarized.

• Polish mother and child cohort study--defining the problem, the aim of the study and methodological assumption.

  Authors: Kinga Polańska, Wojciech Hanke, Jolanta Gromadzińska, Danuta Ligocka, Ewa Gulczyńska, Wojciech Sobala, Wojciech Wásowicz

  International journal of occupational medicine and environmental health. 01/2009; 22(4):383-91.

  Exposures during prenatal period have implications for pregnancy outcome as well as for children's health, morbidity and mortality. Prospective cohort study design allows for the identification ofExposures during prenatal period have implications for pregnancy outcome as well as for children's health, morbidity and mortality. Prospective cohort study design allows for the identification of exposures that may influence pregnancy outcome and children's health, verification of such exposures by biomarker measurements and notification of any changes in exposure level. Polish Mother and Child Cohort Study (REPRO_PL) is multicenter prospective cohort study conducted in 8 different regions of Poland. The final cohort is intended to comprise 1300 mother-child pairs to be recruited within 4-year period (2007-2011). The recruitment and all scheduled visits are conducted in maternity units or clinics in the districts included in the study. The women are followed-up 3 times in pregnancy (once in each trimester) and after delivery for the notification of pregnancy outcome. During each visit, detailed questionnaire and biological samples are collected including saliva, urine, hair, maternal blood and cord blood. About 6 weeks postpartum, breast milk from part of the women is collected. The study concentrates on the identification and evaluation of the effects of prenatal environmental exposure on pregnancy outcome and children's health. Specific research hypotheses refer to the role of heavy metals, exposure to polycyclic aromatic hydrocarbons (PAHs) and environmental tobacco smoke (ETS) in the aetiology of small-for-gestational-age (SGA) and preterm delivery (PD). The role of oxidative stress putative mechanism and pregnant women nutritional status will be investigated. Based on questionnaire data, the impact of occupational exposures and stressful situations will be evaluated. The results of the study will become available within the next few years and will help to determine levels of child prenatal exposure in several areas of Poland and its impact on course and outcome of pregnancy.

• [Umbilical cord entanglement in monoamniotic twin preganacy--case presentation and literature review]

  Authors: Mariusz Grzesiak, Piotr Hincz, Adam Bielak, Ewa Gulczyńska, Jan Wilczyński

  Ginekologia polska. 10/2006; 77(9):720-5.

  Monoamniotic twins are at most increased risk of perinatal complications with perinatal mortality of 28-60 % reported in literature. The most specific complication to monoamniotic twins isMonoamniotic twins are at most increased risk of perinatal complications with perinatal mortality of 28-60 % reported in literature. The most specific complication to monoamniotic twins is entanglement and (or) knotting of the cords leading to intrauterine death of both (more often) or one twin. In first presented case 1, 23-year-old primigravida in 33wks of twin monoamniotic gestation was reffered to our Institute due to intrauterine death of one co-twin caused by umbilical cord entanglement. In second case, 26-year-old multigravida in monoamniotic twin gestation was admitted to our institution. A serious umbilical cord entanglement was observed and a presence of true knot of umbilical cord was suspected. Presented cases indicate that establishing a chorionicity and amniocity in twin pregnancy is an essential part of ultrasound examination. The diagnosis of cord entanglement in monoamniotic twin pregnancy enables a forecasting of possible complications. According to the established diagnosis future protocols of perinatal management could be proposed. Due to possible complications counseling and management of monoamniotic twins should be performed in tertiary medical centers.

• [Midazolam--how safe is it in sedation of newborn?]

  Authors: Ewa Gulczyńska

  Polski merkuriusz lekarski : organ Polskiego Towarzystwa Lekarskiego. 01/2006; 19(114):816-8.

  Since the nineties, while both pain and stress reactions in newborn were revealed, the period of opioid analgesia as well as benzodwuazepin sedation was initiated. Midazolam is the drug which isSince the nineties, while both pain and stress reactions in newborn were revealed, the period of opioid analgesia as well as benzodwuazepin sedation was initiated. Midazolam is the drug which is particularly willingly used in neonatal intensive care units. Although commonly accepted as a safe drug, midazolam produced adverse effects which could make early as well late treatment outcome worse. In this paper the results of pharmacokinetics studies and studies concerning the adverse effects of midazolam among low birth weight newborn are collected and the current opinion of experts dedicates regarding analgetic and sedative procedures in neonatal period are presented. On the basis of the results of the previous studies, it seems reasonable to be more critical of our sedation approach with midazolam and pay more attention to appropriate administration of midazolam in neonatal period.

• [Can we expect decreasing the incidence of patent ductus arteriosus (PDA) in the population of premature neonates who had received antenatal steroid therapy?]

  Authors: Marcin Kesiak, Marek Nowiczewski, Ewa Gulczyńska, Elzbieta Kasprzak, Jolanta Binikowska, Janusz Gadzinowski

  Ginekologia polska. 11/2005; 76(10):812-8.

  OBJECTIVES: The efficacy of antenatal steroid therapy (ANS--use with the recommendation from 1999; therapy repeated every 7-10 days; dexamethasone was used) on the incidence of RDS in neonates bornOBJECTIVES: The efficacy of antenatal steroid therapy (ANS--use with the recommendation from 1999; therapy repeated every 7-10 days; dexamethasone was used) on the incidence of RDS in neonates born before 34 weeks of gestation has been well documented in several studies. However, we know very little about the influence of ANS on patent ductus arteriosus (PDA). DESIGN: The purpose of this study was to assess the influence of ANS on the incidence of PDA in neonates born before 35 weeks of gestation. MATERIALS AND METHODS: The analysed population consisted of 425 newborns delivered at Research Institute Polish Mother's Memorial Hospital between 1996-1998. Patients were enrolled in three groups according to mode of ANS: Group I--complete ANS; Group II--partial ANS; Group III--without ANS (reference group, OR = 1). The complete ANS consisted of at least 24 mg of dexamethasone with a first dose given not earlier then 24 hours before delivery. The analysis was based on retrospective evaluation of patient's medical records. PDA was diagnosed during echocardiographic examination or during autopsy. The incidence and risk of significant PDA in enrolled groups were estimated. RESULTS: Use of complete ANS has no influence of the incidence of PDA. In the partial ANS group the risk of PDA (OR 1,89; p = 0,052 vs group III) was increased. Risk of PDA was also higher in patients born before 29 weeks of gestation, especially from the partial ANS group. CONCLUSIONS: The antenatal steroid therapy has influence of the incidence of PDA. We observed higher risk of PDA in the group of neonates born before 29 weeks of gestation and in the partial ANS group.

• [Use of prenatal health care and risk of infants born small-for-gestational-age. Preliminary results of a case-control study in the Lódź voivodeship]

  Authors: Bogumiła Cieśla, Wojciech Hanke, Alicja Grodzicka, Ewa Gulczyńska, Barbara Pawłowska, Ewa Wasilewska-Wilk

  Przegla̧d epidemiologiczny. 02/2004; 58(3):537-46.

  It is well documented that small-for-gestational age (SGA) infants are at an increased risk of perinatal mortality and morbidity. In order to identify the major modifiable risk factors of SGA birth,It is well documented that small-for-gestational age (SGA) infants are at an increased risk of perinatal mortality and morbidity. In order to identify the major modifiable risk factors of SGA birth, a case-control study was launched in the area of Lódź voivodeship, Poland. The project was focused on the evaluation of the role of perinatal health services and avoidance of exposure to tobacco smoke in the prevention of SGA births. The study population consisted of mothers of 153 SGA infants (cases) and 93 mothers of control infants. SGA infants were identified as infants with body weight below 10th percentile for gestational age, using Ballarda scale. The controls were non-SGA infants delivered after 37 week of gestation. The infants from both groups were delivered in 26 maternity wards in the Lódź voivodeship within the period of June 1-November 1, 2003. One month after delivery, each mother of SGA and control infants was visited by an interviewer who collected information about her profile of use of perinatal health care and on active and passive exposure to tobacco smoke in pregnancy. Odds ratios and 95% confidence units (CU) were calculated using EpiInfo software developed by CDC, Atlanta, Georgia, US. Late booking for perinatal care (after 12 week of gestation) and less than 5 visits during pregnancy was found to be related to an increased risk of SGA, however, the OR values included unity. About 1/3 of mothers of SGA infants and "of the controls were served mainly by the private health sector. The use of private care was related to a lower risk of SGA: OR= 0.55 95% CI (0.31-0.96). This protective pattern was observed in the population of women aged 19-25 living in rural areas years and with only primary education. The preconception visits to obstetricians and contacts with health educators during pregnancy were also found to have some protective effect, however, the ORs were not statistically significant. The adverse effect of smoking during pregnancy was clearly confirmed in the study population, OR= 2.69 95%CI (1.37-5.33), while the role of passive smoking was difficult to assess due to the small number of nonsmoking women exposed to ETS. There are some indications that the poor use of perinatal health services may account for the elevated risk of SGA births in the Lódź voivodeship. The use of the private health sector is growing and seems to be related to a lower risk of SGA births. More effective tools to prevent maternal smoking have to be developed and implemented in routine perinatal care.

• [Neonatal outcome multiple pregnancies at the Neonatal Department of Research Institute of Polish Mother's Memorial Hospital]

  Authors: Ewa Gulczyńska, Agnieszka Zjawiona, Alicja Grodzicka, Marek Nowiczewski, Piotr Woźniak, Dorota Nowakowska, Jan Wilczyński, Janusz Gadzinowski

  Ginekologia polska. 11/2003; 74(10):1093-9.

  OBJECTIVES: The purpose of this study was to analyze the course of neonatal period among babies born from truly higher-order multiple pregnancies (> or = 3). DESIGN: The retrospective analysisOBJECTIVES: The purpose of this study was to analyze the course of neonatal period among babies born from truly higher-order multiple pregnancies (> or = 3). DESIGN: The retrospective analysis included 81 infants born from multiple pregnancies (> or = 3), hospitalized in Neonatal Department of Research Institute of Polish Mother's Memorial Hospital between 1995-2001. MATERIALS AND METHODS: Studied population contained 63 babies delivered from 21 triplet pregnancies, 8 newborns from 2 quadruplet pregnancies and ten quintuplets. The groups were analyzed according to gestational age, birth weight, ventilation and hospitalization time as well as early and late consequences of prematurity. RESULTS: Among the multiples (> or = 3) the mean birth weight of triplets, quadruplets and quintuplets was respectively: 1656 g vs 1166 g vs 725 g, the diminished gestational age was also noticed: 32.4 vs 30 vs 26.5 GA. The cesarean section ratio in triplet deliveries was 95%, while quadruplets and quintuplets pregnancies were always delivered by operative interventions. The increase in number of fetuses was significantly associated with prolonged ventilation time (mean 9.5 vs 22.2 vs 57.5 days) as well as the hospitalization (mean 29.1 vs 64.1 s 79.6 days). The differences between mentioned above values reached statistical significance (p < 0.001). One out of three neonates born from triplet pregnancy required ventilatory support (36.6%), whereas in quadruplets and quintuplets this ratio reached 100%. The respiratory distress syndrome treated with surfactant was diagnosed in 7.9% (5/63) of triplets, 37.5% (3/8) quadruplets and 100% of quintuplets among whom 8 babies needed more than one dose of surfactant. The increased risk of unfavorable prematurity outcome (PDA, ROP, BPD, IVH) and neonatal death was highly related to plurality of pregnancy. CONCLUSIONS: Multiple pregnancies resulting from infertility treatment cause many medical problems. Undesirable outcome among neonates delivered from higher-order multiple pregnancies (> or = 3 fetuses) predestine to more judicious approach in the application of assisted reproductive techniques and multiple pregnancies prophylaxis.

• [Influence of antenatal steroid therapy on newborn nervous system]

  Authors: Marcin Kesiak, Ewa Gulczyńska, Dorota Nowakowska, Jan Wilczyński

  Ginekologia polska. 09/2002; 73(8):709-18.

  OBJECTIVES: Analysis of the impact of prenatal glucocorticoids on the neurological outcome of a newborn. DESIGN: The authors reviewed the most current reports concerning the influence of antenatalOBJECTIVES: Analysis of the impact of prenatal glucocorticoids on the neurological outcome of a newborn. DESIGN: The authors reviewed the most current reports concerning the influence of antenatal steroid therapy (used to accelerate of fetal lung maturation) on neonates. In the study we discussed the influence of steroid therapy on growth and development of the brain, as well as the occurrence rate of the most common neurological abnormalities, such as: intraventricular haemorrhage and periventricular leukomalacia. MATERIALS AND METHODS: Recent literature review. RESULTS: We believe that use of antenatal corticosteroids remains a major factor in reducing neonatal mortality. Treatment with one course of betamethasone, as we know at the present time, is completely safe for a newborn's nervous system. Many courses of antenatal steroids may decrease fetal brain growth. Antenatal steroid therapy reduced the incidence of intraventricular haemorrhage in preterm infants. Use of betamethasone, but probably not dexamethasone, in antenatal therapy reduced the incidence of periventricular leukomalacia in extremely low weight infants. CONCLUSIONS: According to recent studies regarding probable unfavourable role of dexamethasone in neonatal neurological development we are of opinion that dexamethasone should be replaced by betamethasone in therapy of imminent preterm labour.

• [Single nasal prong versus infant flow driver in very low birth weight infants: clinical efficacy of two modes of nasal continuous positive airway pressure (CPAP)]

  Authors: Ewa Gulczyńska, Agnieszka Zjawiona, Barbara Sobolewska, Janusz Gadzinowski

  Przegla̧d lekarski. 02/2002; 59 Suppl 1:54-6.

  The authors compared efficacy of two different NCPAP techniques in VLBW newborn with respiratory insufficiency. Among the patients with IFD support the higher weaning rate and the lower supplementalThe authors compared efficacy of two different NCPAP techniques in VLBW newborn with respiratory insufficiency. Among the patients with IFD support the higher weaning rate and the lower supplemental oxygen requirement as well as secondary infections incidents was observed.