Publications (60)82.96 Total impact
- [Show abstract] [Hide abstract] ABSTRACT: Intraventricular hemorrhage (IVH) affects 15-20% of babies born before 32 weeks of pregnancy. Besides gestational age (below 32 weeks) there are a number of IVH risk factors. Increasing attention is being paid to genetic factors in the development of IVH. The authors discuss genetic factors (mutations of coagulation factors, gene polymorphisms in pro-inflammatory cytokines, mutation of type IV collagen gene, polymorphisms of genes responsible for the regulation of systemic blood pressure and cerebral blood flows) whose involvement in IVH pathogenesis has been confirmed in the highest number of reports and for which being a carrier plays an important role in their pathophysiology. The role of genetic factors in IVH remains unclear. Further analysis of the role of genetic factors in the pathophysiology of IVH will make it possible to determine the group of newborns who are specifically at risk of developing IVH in the perinatal period.
- [Show abstract] [Hide abstract] ABSTRACT: We report a case of a female neonate with an incomplete (Class II) pentalogy of Cantrell (PC) presenting: omphalocoele, thoracoabdominal type of partial ectopia cordis with ventricular septal defect and valvular pulmonary stenosis. The patient underwent a successful complete operation. We discuss associated anomalies that might occur with PC and the general overall prognosis for patients with PC. This report describes a very rare case of a patient with PC and coexisting partial ectopia cordis who survived.
- [Show abstract] [Hide abstract] ABSTRACT: The study aimed at investigating the impact of late prematurity (LPT) on neonatal outcome in twins and neonatal morbidity and mortality within LPT with regard to the completed weeks of gestation. The study was conducted in six tertiary obstetric departments from different provinces of Poland (Warsaw, Lublin, Poznan, Wroclaw, Bytom). It included 465 twin deliveries in the above centers in 2012. A comparative analysis of maternal factors, the course of pregnancy and delivery and neonatal outcome between LPT (34 + 0-36 + 6 weeks of gestation) and term groups (completed 37 weeks) was performed. The neonatal outcome included short-term morbidities. The analysis of neonatal complication rates according to completed gestational weeks was carried out. Out of 465 twin deliveries 213 (44.8%) were LPT and 156 (33.55%) were term. There were no neonatal deaths among LPT and term twins. One-third of LPT newborns suffered from respiratory disorders or required antibiotics, 40% had jaundice requiring phototherapy, and 30% were admitted to NICU. The analysis of neonatal morbidity with regard to each gestational week at delivery showed that most analyzed complications occurred less frequently with the advancing gestational age, especially respiratory disorders and NICU admissions. The only two factors with significant influence on neonatal morbidity rate were neonatal birth weight (OR = 0.43, 95% CI = 0.2-0.9, p = .02) and gestational age at delivery (OR = 0.62, 95% CI = 0.5-0.8, p < .01). LPT have a higher risk of neonatal morbidity than term twins. Gestational age and neonatal birth weight seem to play a crucial role in neonatal outcome in twins.
- [Show abstract] [Hide abstract] ABSTRACT: Abstract Adrenal diseases in pregnant women are diagnosed relatively rarely. The main cause of hypercortisolemia during pregnancy is Cushing's syndrome related to adrenal adenoma. It is important to diagnose Cushing's syndrome in pregnant women because it can lead to significant maternal and foetal complications and morbidity. However, due to physiological endocrine changes and symptoms in pregnant women the diagnosis of this disorder can be a challenge. One current case describes a 38-year-old pregnant woman with hypertension, oedema and an adrenal tumour. At the beginning, Conn syndrome was suspected, but after careful analysis Cushing's syndrome (with an adenoma of the right adrenal gland) was diagnosed. After delivery and 5 weeks of pharmacological treatment the patient underwent right side adrenalectomy by laparoscopy.
- [Show abstract] [Hide abstract] ABSTRACT: Neonatal myocardial infarction (MI) is a life-threatening condition rarely encountered in neonates. It has high mortality rate but early recognition and intensive care management can be successful. We describe the case of a full-term male neonate, born by caesarean section in general good condition. Soon after the delivery respiratory difficulties began and the neonate had a circulatory collapse due to myocardial infarction. His heart and coronary arteries were anatomically normal and a massive thrombotic occlusion of the left main coronary artery was believed to be the cause of MI. Myocardities caused by enterovirus was ruled out. Although the aggressive treatment with anticoagulant agents, catecholamines and diuretics the patient did not survive. All the attending neonatologists and paediatricians should take into account the possibility of MI when evaluating a neonate with an acute onset of collapse.
- [Show abstract] [Hide abstract] ABSTRACT: We present two cases of twin-to-twin transfusion from two institutions. Laser photocoagulation was used to ablate the bridging aterio-venous shunts in one cases permitting resolution of early evidence of hydrops fetalis, while in the other prompt recognition of fetal cardiac failure after amniotic fluid reduction with cesarean section allowed for neonatal intensive with survival. We discuss the origins of twin-to-twin syndrome and it contemporary treatment, and fetal and neonatal complications that can arise in this monochorionic multi-fetal gestations and current medical management.
- [Show abstract] [Hide abstract] ABSTRACT: Background: Fetal tumors represent rare group of abnormalities however ovarian cysts are the most frequenttype of abdominal tumors in female newborns. The diagnosis has become more frequent due to the prenatalultrasonography monitoring. Due to the possible complications of such abnormalities it is important to be awareof the management and treatment options. The literature presents different management options from conserva-tive approach such as wait and see policy to more aggressive as intrauterine cyst aspiration or surgery. Casereport: We have presented the management and treatment of large complex fetal ovarian cyst diagnosed pre-natally. Towards the end of pregnancy the cyst changed its consistency; it contained fluid/debris levels which didshow some calcifications and possible hemorrhagic fluid suggesting torsion. The patient was delivered by a ce-sarean section and the neonate was referred for selective abdominal surgery. Conclusion: Fetal ovarian cysts arerare however they may cause serious complications. The decision regarding the management and treatment offetal ovarian cyst should depend on the size, appearance of the cyst and visible complications. Ultrasonographicmonitoring allows differentiation of the ovarian mass (simple/complex) and application of appropriate manage-ment. We think that simple ovarian cyst should be managed by wait and see policy and close postnatal follow-upand complex ovarian cysts should be managed by early surgery especially if symptomatic.
- [Show abstract] [Hide abstract] ABSTRACT: The incidence of multiple pregnancies has increased dramatically over the last few years in developed countries, largely attributed to delayed childbearing and the increasing use of assisted reproduction technologies and ovulation inducing hormones. Relatively few countries have population-based statistics covering birth statistics. Of those that do, the numbers of quintuplet pregnancies rose sharply in the nineties while, at the same time, their delivery rates decreased greatly because of the use of fetal reduction. Fetal reduction is not possible or legal in some countries, Poland being one of them, and therefore obstetricians are faced with the challenges of quintuplet deliveries. Conservative treatment and management is difficult, and outcomes often vary greatly. Despite this, expert care provided at tertiary care centers can positively influence outcomes. The objective of this article is to present different care options and their consequences in two illustrative cases, as well as to establish a set of obstetric care and management goals that would allow prolongation of the gestation time. Quintuplet pregnancy is rare but poses relevant clinical problems to both the obstetrician and the neonatologist. It should be managed with close cooperation between all concerned. Due to the extreme and invariable risk of premature delivery associated with quintuplet pregnancies, we recommend early diagnosis, adequate prenatal care at one tertiary medical center, routine hospitalization and bed rest, repeated ante partum ultrasound surveillance with tests of fetal well-being, tocolytic therapy at first signs of the risk of premature labor, and specialized neonatology care after delivery.
- [Show abstract] [Hide abstract] ABSTRACT: The aim of the study was to evaluate the pentoxifylline administration on the foetal-placental circulation and neonatal outcome in women with threatened preterm labour. Pentoxifylline was given as a supplement to standard tocolytic therapy in a group of 43 patients (pentoxifylline group) as an intravenous infusion and oral supplementation in a total dosage of 800 mg/day. The drug was administered within 3 weeks after admission. No pentoxifylline was given in the control group (53 patients). Doppler velocimetry of pulsatility indices (PI) of the umbilical (UA) and middle cerebral (MCA) arteries as well as cerebro-placental ratio (CPR) were calculated. Also, the neonatal outcome was estimated in both groups. From the second week of therapy with pentoxifylline, the PI decreased in umbilical artery and increased in the MCA, whereas in the control group, there were no changes. The value of PIUA, evaluated after the third week of pentoxifylline administration, was statistically significantly lower when compared to data obtained on admission (mean: 0.99 ± 0.22 versus 0.82 ± 0.12; p =0.016). Pentoxifylline significantly increased CPR values calculated after third week of drug administration, which were statistically significantly higher in the pentoxifylline group when compared with respective data in the control group (mean: 2.30 versus 1.61; p = 0.001). The risk of severe neonatal complications was significantly lower in the pentoxifylline group (p = 0.026). Pentoxifylline changed foetal-placental blood circulation in patients with threatened preterm labour and improved neonatal outcome.
- [Show abstract] [Hide abstract] ABSTRACT: A single course of antenatal corticosteroids (ACS) is associated with a reduction in respiratory distress syndrome and neonatal death. Multiple Courses of Antenatal Corticosteroids Study (MACS), a study involving 1858 women, was a multicentre randomized placebo-controlled trial of multiple courses of ACS, given every 14 days until 33+6 weeks or birth, whichever came first. The primary outcome of the study, a composite of neonatal mortality and morbidity, was similar for the multiple ACS and placebo groups (12.9% vs. 12.5%), but infants exposed to multiple courses of ACS weighed less, were shorter, and had smaller head circumferences. Thus for women who remain at increased risk of preterm birth, multiple courses of ACS (every 14 days) are not recommended. Chronic use of corticosteroids is associated with numerous side effects including weight gain and depression The aim of this postpartum assessment was to ascertain if multiple courses of ACS were associated with maternal side effects.
- [Show abstract] [Hide abstract] ABSTRACT: This is a case presentation of a newborn with a congenital genetic disorders, born on the third level of perinatal care. Until the final result of karyotype was revealed CHARGE syndrome was suspected. CHARGE (Coloboma of the eye structure, heart defect, atresia of chonae, retardation of growth, genital anomalies, ear anomalies) syndrome affects about 1 in 1000 children and may be difficult to diagnose. Originally, CHARGE syndrome was considered to be a nonrandom association of anomalies rather than a syndrome. It was until 2004 when Vissers and associates reported the presence of mutations in a chromodomain DNA binding protein that can be ordered . Gene test is unavailable to perform in Poland. It is an extremely complex syndrome, including extensive medical and physical difficulties that differ from child to child. Babies with CHARGE syndrome are often born with life-threatening borth defects such as heart defects and breathing problems. It is common that features of CHARGE syndrome overlap with those of other genetic disorders. In this case presentation we describe the baby who was observed due to the features as a CHARGE syndrome until the final cytogenic analysis of karyotypes of parents and baby was revealed.
- [Show abstract] [Hide abstract] ABSTRACT: A systemic fetal inflammatory response, reflected by histological funisitis is associated with pulmonary morbidity and increased mortality after premature birth. The receptor for advanced glycation end products (RAGE) is a membrane-bound multiligand receptor with a key role in inflammation. Soluble RAGE (sRAGE) is created by alternative mRNA splicing or shedding of the receptor's extracellular domain and can inhibit RAGE-activation. To assess the association of funisitis with airway and systemic concentrations of sRAGE in very premature infants. Forty-two ventilated infants (gestational age: 27.4 +/- 1.8weeks, birth weight: 1017 +/- 229 g [mean +/- SD]) were studied. sRAGE concentrations were measured in tracheobronchial aspirate fluid (TAF) on days of life 1, 3, 5, 7 and 10 and in umbilical cord serum of 28 infants by ELISA. The secretory component for IgA (SC) served as reference protein in TAF. Placental tissue, membranes and umbilical cords were examined microscopically to distinguish three groups: chorioamnionitis (n=9), funisitis (n=17) and controls (n=16). The funisitis group had lower sRAGE concentrations than both other groups in cord blood serum (median: 0.52 ng/ml [25th-75th centile: 0.32-0.91]; control, 1.72 [1.02-2.69]; chorioamnionitis, 1.44 [0.92-1.63], p<0.01) and TAF on day 1 (290 ng/ngSC [140-400]; control, 2750 [1470-28920]; chorioamnionitis, 2150 [1220-7140], p<0.01). sRAGE in TAF remained lower in the funisitis than in the chorioamnionitis group on days 3 and 10, p<0.01 respectively. Decreased sRAGE in airways and circulation after funisitis may contribute to an imbalance between pro- and anti-inflammatory factors priming very premature infants for pulmonary injury and increasing the risk of adverse outcome.
- [Show abstract] [Hide abstract] ABSTRACT: A systemic fetal inflammatory response, reflected by chorioamnionitis with funisitis, is a risk factor for bronchopulmonary dysplasia. Clara cell secretory protein (CC10), a product of pulmonary Clara cells, has anti-inflammatory properties. Local down-regulation of CC10 has been associated with inflammatory lung disease. Increased serum levels of CC10 can indicate injury to alveolar-capillary integrity. We hypothesized that extremely premature infants with a systemic fetal inflammatory response would have decreased concentrations of CC10 in tracheobronchial aspirates and that CC10 concentrations in umbilical cord serum of these infants would be increased, reflecting alveolar epithelial damage. We measured CC10 concentrations in tracheobronchial aspirates of 42 ventilated extremely premature infants during their first week of life and in umbilical cord serum of 24 of them by ELISA. Standardized histological examination of the placenta, membranes and umbilical cord was used to identify infants with funisitis. Seventeen infants with funisitis had lower CC10 concentrations in tracheobronchial aspirates on days 1 (p < 0.01) and 3 (p < 0.05) than the remaining 25. Exogenous surfactant treatment was associated with higher CC10 concentrations on day 1 (p < 0.05). Initial leukocyte count correlated inversely with CC10 in tracheobronchial aspirates on days 1-5. Umbilical cord serum concentrations of CC10 did not differ between the infants with funisitis and the controls. Reduced anti-inflammatory CC10 concentrations in airways of extremely premature infants with a fetal inflammatory response might make their lungs susceptible for further postnatal injuries. Umbilical cord serum CC10 is not an indicator for a fetal systemic inflammatory reaction.
- [Show abstract] [Hide abstract] ABSTRACT: A systemic inflammatory response of the fetus, reflected by histologic funisitis, is a risk factor for bronchopulmonary dysplasia (BPD). Impaired pulmonary angiogenesis accompanied by simplification and rarification of alveoli is a histologic hallmark of BPD. Angiopoietin-1 mediates vascular development, maturation, and stabilization. Endostatin mainly acts as an angiostatic factor. We hypothesized that funisitis was associated with changes of endostatin and angiopoietin-1 concentrations in the airways and that an imbalance between the factors might be associated with BPD or death. We measured concentrations of angiopoietin-1 and endostatin by enzyme-linked immunosorbent assay in tracheobronchial aspirate fluid samples of 42 ventilated preterm infants during postnatal days 1 through 15. The secretory component for IgA served as reference protein. A standardized histologic examination was used to distinguish three groups: chorioamnionitis, funisitis, and controls without inflammation. Concentrations of the mediators steadily decreased. Funisitis was associated with lower concentrations of both proteins, which might impair their physiologic activities in pulmonary angiogenesis. An increase of the ratio angiopoietin-1/endostatin until day 7 of life indicated a shift of the mediators potentially favoring angiogenesis. However, infants, who developed BPD or died, had a decreased ratio on days 1, 3, and 15, suggesting an imbalance toward inhibition of pulmonary angiogenesis.
- [Show abstract] [Hide abstract] ABSTRACT: Macrophage migration inhibitory factor is a proinflammatory mediator of innate immunity, enhances cell growth, and plays a role in preterm delivery. We speculated that funisitis, reflecting fetal systemic inflammation, would be associated with higher concentrations of macrophage migration inhibitory factor in airways of extremely premature infants. We measured macrophage migration inhibitory factor by enzyme linked immunosorbent assay in tracheobronchial aspirate fluid of 35 ventilated infants less than 30 weeks' gestational age, throughout the first week of life. Three groups were distinguished histologically: chorioamnionitis, funisitis, and control. Unexpectedly, funisitis was associated with significantly decreased macrophage migration inhibitory factor in tracheobronchial aspirate fluid on day 1 (P < .01) and levels remained lower than in the chorioamnionitis group thereafter. For the 35 patients in total, macrophage migration inhibitory factor steadily declined. Decreased macrophage migration inhibitory factor concentrations in airways of extremely premature infants with systemic fetal inflammation early in life might predispose them to pulmonary infection and interfere with maturation of the lung, contributing to adverse pulmonary outcome.
Poznan University of Medical Sciences
Posen, Greater Poland Voivodeship, Poland
- Department of Neonatology
Università degli Studi di PerugiaPerugia, Umbria, Italy