Faculty of Medicine

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THE RISK FACTORS FOR POSTOPERATIVE OUTCOMES IN NEONATAL CARDIAC SURGERY
(Macedonian Association of Anatomists and Morphologists, 2020-12)
ABSTRACT Background: In the last three decades a neonatal cardiac surgery has improved the approach and methods for adequate treatment of complex congenital heart defects. Although we have advances in fetal cardiac imaging and improved perioperative cardiac procedures, the postoperative outcomes in neonatal care (neonates) are still present. Objective: To present our experience of operated neonates with congenital heart defects in a tertiary referral center, Neonatal Intensive Care Unit (NICU) in Skopje N. Macedonia. Materials and methods: We conducted a retrospective study including neonates who underwent surgical intervention between January 2013 and December 2015 at the University Clinic for Pediatric Diseases in Skopje. We analyzed perioperative and postoperative variables. The main outcomes were duration of cardiopulmonaly bypass (CPB), and x-cross of aorta, duration of mechanical ventilation, intensive care unit stay and postoperative complications. Fourteen (14) neonates were discharged from our Clinic. Results: Out of a total of 85 children, 15/85 (17.6 %) were neonates; males 12/15(80%) females 3/15 (20 %). The overall mortality was 1/15% (6.6%). There were 13/15 (86.6%) corrective procedures and 2/15 (13.3%) palliative ones. The mean duration of CPB was 46.6 min. (18±296 min.), the mean duration of x-cross of aorta was 17.5 min. (10±65 min.). The mean duration of mechanical ventilation was 3.4 days (1±15 days), duration of inotropic support was 4.2 days (1± 16 days) and ICU stay was 5.8 days (7.9 ± 14days). After the operation, 2/15 (13.3%) neonates required reintubation in the ICU. Postoperative complications were confirmed in 3 neonates (intracranial bleeding with seizures, block nodes AV and pneumonia). The incidence of all postoperative complications was 6.6%. Fourteen (14) patients were discharged from the Clinic. Conclusion: Due to adequate cardiac surgery, significant technological advances, devices and increasing experience in neonatal cardiac surgery we have improved postoperative outcomes.
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NEONATAL HYPOGLYCEMIA: A CONTINUING DEBATE IN DEFINITION AND MANAGEMENT
(Macedonian Academy of Sciences and Arts / Sciendo, 2015-12)
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Elizabeta Petkovska
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Snezana Jancevska
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Neonatal hypoglycemia (NH) is one of the most common abnormalities encountered in the newborn. Maintaining glucose homeostasis is one of the important physiological events during fetal-to-neonatal transition. Transient low blood glucose concentrations are frequently encountered in the majority of healthy newborns and are the reflections of normal metabolic adaptation processes. Nevertheless, there is a great concern that prolonged or recurrent low blood glucose levels may result in long-term neurological and developmental consequences. Strikingly, it was demonstrated that the incidence and timing of low glucose concentrations in the groups most at risk for asymptomatic neonatal hypoglycemia, did not find association between repetitive low glucose concentrations and poor neurodevelopmental outcomes. On the contrary, NH due to hyperinsulinism is strongly associated with brain injury. Fundamental issue of great professional controversy is concerning the best manner to manage asymptomatic newborns NH. Both, overtreating NH and undertreating NH are poles with significant potential disadvantages. Therefore, NH is one of the most important issues in the day-to-day practice. This article appraises the critical questions of definition (widely accepted blood glucose concentration: < 2.6 mmol/l or 47 mg/dl), follow-up ad management of NH
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ACUTE KIDNEY INJURY IN NEONATES AND NEUTOPHILIC GELATINOUS ASSOCIATED LIPOCALIN AS EARLY BIOMARKER
(Macedonian Association of Anatomists, 2019)
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Olivera Jordanova
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Objective: Acute kidney injury (AKI) is a serious problem in neonates in intensive care units. It is defined as a rapid decrease in glomerular filtration that leads to retention of creatinine and nitrogenous waste products and usually with a decrease in urine output. NGAL represents the most promising biomarker for early detection of kidney injury. It can detect the kidney injury in the first 2 to 3 hours of its occurrence, even before there is a decrease in urine output and an increase in sCr. The aim of the study was to determine the role of biomarker NGAL in early detection of kidney injury in neonates. Methods. The study evaluated the neonates suffering kidney injury who at the period of three years were treated at the University Children's Hospital in Skopje. All cases of neonates with kidney injury were analyzed according to gender, gestational age, birth weight and risk factors such as asphyxia, sepsis, prematurity, meconium plug syndrome and congenital heart diseases. NGAL was analyzed in urine samples collected on two occasions (day of admission and 2 days later) and the concentration of NGAL was determined using NGAL ELISA KIT (Bioporto). Medical data records of admitted neonates with AKI were analyzed. The material was statistically processed using methods of descriptive statistics. Results. The study was carried out at the neonatal intensive care unit at the University Children's Hospital Skopje in which neonates with documented acute kidney injury were evaluated. The whole study has been performed during the 3 year period. The estimated prevalence of AKI in neonates was 6.4%. Most of the involved neonates in the study were born at term (68%) with predominance of male neonates (64%). The analyzed results showed a higher values of urinary NGAL on the day of admission (373.8 ± 194.9) and a slight upward trend, with further increase in the third day after admission (439.4 ± 254, 7). There was a significant difference between the uNGAL values and sCr values on the day of admission of neonates in NICU, p<0,001. The mean urinary NGAL values in neonates with AKI with lethal outcome were 586.39 ± 182.3 while the mean values in neonates without lethal outcome was 254.22 ± 28.5. This difference was statistically significant (p<0,001). Conclusion: Early, biomarker based identification of neonates at risk of kidney injury is a fundamental step toward AKI prevention. NGAL has ability to predict AKI before clinical signs are evident and can facilitate implementation of appropriate preventive measures and improve resource utilization. Its use allows us to make the right clinical decisions at the right time, before the illness is clinically manifest and take appropriate measures to prevent renal function decline.
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Using Score for Neonatal Acute Physiology Perinatal Extension II (SNAPPE II) In Neonates with Acute Kidney Injury
(ID Design 2012/Scientific Foundation SPIROSKI, 2019)
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Olivera Jordanova
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Background: Acute kidney injury is a severe clinical condition. It is common in neonates in intensive care unit. It is defined as a sudden deterioration in kidney function resulting in derangements in fluid balance, electrolytes, and waste products. The score for neonatal acute physiology perinatal extension in critically sick neonates with kidney injury is a useful tool for assessing the severity of the disease. Aim: This study aimed to determine the incidence of AKI and the role of SNAPPE 2 score in predicting mortality and morbidity of kidney injury in neonates. Methods: The study was designed as a prospective clinical investigation performed in the period of three years, which included 100 neonates (50 with AKI and 50 without AKI) hospitalised in intensive care unit of University Clinic of Children Diseases in Skopje. The severity of the illness of hospitalised newborn infants was estimated with SNAPPE 2 score realised in the first 12 hours of admission to NICU. Medical data records of admitted neonates with AKI were analysed. The material was statistically processed using methods of descriptive statistics. Results: During the study period, 770 new born's were hospitalised in the intensive care unit due to various pathological conditions and 50 new born's were selected with AKI. The control group consisted of 50 neonates with comparable associated pathological conditions, but without kidney injury. The calculated prevalence of AKI in neonates was 6.4%. Most of the involved neonates in the study in both groups (AKI and non-AKI) were born at term (64% and 54%) with a predominance of male neonates (68% and 60%). The mortality rate was significantly higher in newborns with AKI than in the control group (36% vs 24%) (p < 0.01). The mean SNAPPE 2 score value in neonates with AKI was higher than in the control group (58.72 vs 40.0), and the difference was significant (p = 0.00001). Difficult score level predominated in half (50%) of newborn infants with AKI, while median score level predominated in control group (42%). There was a significant difference between the mean score value in neonates with AKI and lethal outcome compared to neonates with AKI without lethal outcome (70.73 ± 18.6 vs 40.2 ± 16.6) (p < 0.0001). Conclusion: Acute kidney injury is a life-threatening condition with still high mortality rate. The severity of the illness of hospitalised neonates in an intensive care unit is estimated by SNAPPE 2 score. Also, the risk of mortality is estimated too, taking into consideration the fact that higher values of the score are associated with higher mortality. Appropriate treatment of neonates with severe kidney injury improves the outcome and reduces the mortality of the disease.
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Physical birth outcomes in neonates prenatally exposed to buprenorphine – our first experiences
(2019-09-17)
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Introduction/Objective Buprenorphine appears generally similar to, and in some cases superior to, methadone in terms of maternal, fetal, and neonatal outcomes. The objective of the study was to assess some physical birth outcomes in neonates prenatally exposed to buprenorphine. Methods During a seven-year period, nine patients have been treated with buprenorphine during their pregnancy. All women underwent interview, clinical investigations, biochemical analysis, toxicological screening, viral markers for hepatitis B, C, HIV, with regular check-ups by an obstetrician and a psychiatrist. Newborn outcomes included: birth weight in grams, birth length in centimeters, physical anomalies, head/chest circumference in centimeters, Apgar score at 1 minute / 5 minutes, gestational age (weeks), newborn length of hospital stay in days, breast-feeding, the newborn’s need for pharmacologic treatment after delivery. Results The mean birth weight was 2,991.11 ± 37 g; birth length was 49.44 ± 2.29 cm; head circumference was 33.11 ± 0.78 cm; chest circumference was 32.33 ± 1 cm; first minute Apgar score was 8.22, fifth minute 9.22; age at delivery was 38.77 ± 1.09 weeks; hospitalization after delivery 4.44 ± 1.13 days. None of the newborns had physical anomalies. Six of the newborns were breastfed. Conclusion Buprenorphine is a safe and important part of a complete comprehensive treatment approach in pregnant women with opioid use disorder. Buprenorphine treatment of maternal opioid use disorder indicated a low risk of preterm birth, normal birth weight and length, head and chest circumference, Apgar score, short hospitalization after delivery.

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