Faculty of Medicine

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HYDROCEPHALUS WITH VENTRICULOPERITONEAL SHUNT IN INFANTS: OUR EXPERIENCES AND CLINICAL OUTCOMES
(Macedonian Association of Anatomists, 2022-12)
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Tamara Voinovska
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Mica Kimovska-Hristov
AbstractHydrocephalus is a condition resulting from disorder in absorption and circulation of the cerebrospinal fluid (CSF). It leads toaprogressive ventricular dilatation and need of ventriculoperitoneal shunt (VP)placement. The aim of our study wasto present our experience withinfantswith hydrocephalus,ventriculoperitoneal shunt placement, and earlypostoperative follow-up.A retrospective study was conducted comprising infantswith hydrocephalus born between January 2019-January 2022with ventriculoperitoneal shunt placement performedatthe University Clinic for Neurosurgery in Skopje,Macedonia. Demographic and clinical characteristics, complications and the need for ventriculoperitoneal shunt were documented.Of twenty-three infantswith hydrocephalus,14 (60.8%) were preterm infants (median birth weight 2120g; mean gestational age 33.1weeks), 9(39.1%) were term infants(mean birth weight 3600g; mean gestational age 38.4 weeks). The etiology of hydrocephalus was:congenital hydrocephalusin 5infants(21.7%),prematurityin 6 infants(26.08%), spina bifida in 2 infants(8.7%),systemic infection in 4 infants(17.3%), and intraventricular hemorrhage in 6 infants(26.08%).Ventriculoperitoneal shunt was placed inall 23infants, at the mean age of 33.5(30-43) days.Postoperative complicationsas a result of ventriculoperitoneal shuntplacement were:ventriculitismanifested in3 preterm (13%) infants,of which 2(8.6%) died;fiveterm infants(21.7%) had postoperativeseizures, of which2 infants(8.6%) died. Nineteeninfants(82.6%) were discharged and transferredto the neonatology department. Ventriculoperitoneal shunt placementis atreatment of choice for infantswith hydrocephalus, although postoperative complications in preterm infantsincrease the percentageof morbidity and mortality.
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THE ROLE OF RISK OF RENAL FAILURE, INJURY TO THE KIDNEY, FAILURE OF KIDNEY FUNCTION, LOSS OF KIDNEY FUNCTION AND ENDSTAGE RENAL FAILURE (RIFLE) CLASSIFICATION IN IDENTIFICATION AND PREDICTION SEVERITY OF THE KIDNEY INJURY IN NEWBORNS
(SHMSHM / AAMD, 2021)
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Olivera Jordanova
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Elizabeta Shuperliska
Objective: Acute kidney injury is a serious condition with various clinical manifestations ranging from minimal kidneys disordsers to kidney injury requiring substitution therapy. Because of need of timely diagnosis of kidney injury, RIFLE classification could be used. The aim of the study was to determine the role of RIFLE classification in detecting and follow up the progression of kidney injury in newborns. Methods: This study was realized at University Clinic of Pediatrics in Skopje from period of two years. It was analyzed the medical records of 80 newborns (40 with kidney injury and 40 without kidney injury) treated in intensive care unit. The severity of the disease was determined by RIFLE classification. Results: During the study period 6.25% of newborns have developed acute kidney injury acording standard clasification. Most of the newborns analyzed in the study were male (66 and 59%) and term (67% and 61%). RIFLE classification was applied in this study. We reported “risk” in 32%, “injury” in 57% and “failure” in 11% of newborns with AKI. Of these, 69% showed progression to “injury “and 15% to “failure”. In 17% of newborns with verified “injury” the condition progressed to “failure”. Conclusion: By using RIFLE classification we could not only identify kidney injury, but also detected the progression of the disease. Hence the significance of this classification as a solid tool in the diagnosis and follow-up of kidney injury in newborns.
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OSTEOMYELITIS OF FEMUR IN A DRUG ADDICTED CHILD
(Macedonian Association of Anatomists, 2021)
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One of the serious complicationsrelated to intravenous drug use is osteomyelitis. We report a13-year-old male child with a history of intravenous heroin abuse, who was admitted to the hospital complaining of abdominal pain and pain in the left leg. Anteroposterior roentgenogram and CT scan of the left thigh and femur,confirmed the diagnosis of osteomyelitis. Pus culture was positive for Staphylococcus aureus. Despite extensive antibiotic and anticoagulant therapy,the patient’sclinical status improved very slowly. Surgical procedure was not undertaken. Femoral osteomyelitis due to injection drug use in childhood is an extremely rare and uncommoncondition. Intravenous drug abuse, late-onset treatment, and secondary bacterial infection can lead to complications which occurred in the case presented.Itis an extremely difficult condition to treat and is a real challenge for physicians. The rapid response and participation of a multidisciplinary team of physiciansis of particularimportance
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INCIDENCE, RISK FACTORS AND OUTCOMES OF ACUTE KIDNEY INJURY IN PRETERM NEWBORNS
(Macedonian Association of Anatomists, 2021)
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Elizabeta Shuperliska
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Acute kidney injury is a sudden loss of renal function that results indeterioration ofthe renal’s ability to excrete urine in sufficient quantity and adequate composition. The aim of the study was to determine the incidence, risk factors and outcomes of acute kidney injury in pretermnewborns.The study was conducted at theUniversity Clinic of Pediatrics–Skopje.It was a clinical, epidemiological prospective study. In the period of two years, 40preterm newbornshospitalized at the Intensive Care Unit (ICU)with documentedkidney injury were analyzed. Medical data records of hospitalized preterm infants with kidney injury were processed. The material was statistically analyzed using methods of descriptive statistics. We evaluated 40 preterm newbornswith documented acute kidney injury,who at the period of 2 years were treated in the ICU. The prevalence of kidney injury was 6.9%. Most of the involved preterm newbornswere male(72%),and born at 32 to 37 weeks with low birth weight (58%). Prerenal injury was evaluated in 79.5% of the cases.The mortality rate was 36% and it was significantly higher in the group of preterm infants born under 28 weeks,with Extremely Low Birth Weight Newborns ELBW. (P=0.01). Acute kidney injury is a life threatening condition with a still high mortality rate. Appropriate treatment of kidney injury in newbornswith ELBW improves the outcomes and reduces the mortality of the disease.
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RELATIONSHIP OF SERUM PROCALCITONIN LEVELS AND C-REACTIVE PROTEIN LEVELS IN NEWBORNS WITH SEPSIS IN DIFFERENT TYPES OF RESPIRATORY SUPPORT IN INTENSIVE CARE UNIT
(Institute of Public Health of the Republic of North Macedonia, 2021)
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Elizabeta Shuperliska
Sepsis in newborns with RDSy and asphyxia is essential; it is a life-threatening condition and still represents an important cause of mortality and morbidity. The aim of this study was to evaluate the predictive values of procalcitonin (PCT) as an early diagnostic and prognostic biochemical marker for sepsis in newborns with RDS and asphyxia. Material and methods: The study was designed as prospective and we examined 110 newborns with proven sepsis admitted in the Intensive Care Unit at the University Clinic of Pediatrics – Skopje in the period between December 2018 and Јanuary 2021. Procalcitonin levels were measured by using the immunoassay system Vidas based on the ELFA principles. The newborns with proven sepsis were divided into two groups. The first group comprised 55 newborns with RDS and proven sepsis and the second group included 55 newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values of PCT in the analyzed time period in first group of newborns with RDS and proven sepsis, p<0.001. The highest average values (40.37±53.79) were measured on admission with a high level of peak compared to the second group of newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values of PCT in the analyzed time period in the first group of newborns with RDS and proven sepsis with mechanical ventilation (MV) and bubble continuous positive airway pressure (BCPAP) compared to the second group of newborns with asphyxia and proven sepsis, p<0.001. PCT is a promising sepsis marker in newborns with RDSy, capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection at the time of ICU admission.
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PROMISING DIAGNSOTIC MARKER AT NICU AND PICU-NEW APPROACHES FOR DIAGNOSTIC AND TREATMENT
(Macedonian Association of Anatomists, 2019)
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Mica Kimovska-Hristova
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Tamara Voinovska
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The aim of this study is evaluate the initial PCT levels on the outcome of patients in pediatric intensive care units and find out if these biomarker can be used to predict sepsis. The study was designed as a prospective, clinical, investigation conducted in the period sixth months, which included 45 (M:F=25:20) newborns with two or three clinical signs of sepsis hospitalized in the Intensive Care Unit at the PHI University Clinic for Children Diseases. The patient have been divided into two groups: I group included 31 septic newborns with negative blood culture and II group - 14 septic newborns with positive blood cultures. Results of blood count (WBC), CRP and PCT, were recorded. Procalcitonin PCT levels at first 24 hours of the admission were increased in all 45 newborns (≥2 ng/mL). The values of C-reactive protein gradually increase after 12-36 hours at admission. The second measurement, after 3 days usage of an adequate antibiotic treatment, the levels of PCT is decreased,regardless of whether blood culture is positive or negative, except 5 patients develop severe sepsis, and three patients develop septic shock. After the third measurement the levels of PCT and CRP is decreased. NIV was used in 39.8% patients and Invasive MV was used in 29.8% patients.Sensitivity of procalcitonin 83.5%, Specificity of procalcitonin 81.3%. Procalcitonin value is a early prognostic factor for sepsis and it is a reliable parameter whether an appropriate antibiotic for the treatment is used,thus increasing newborns safety,and reducing costs .
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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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DIAGNOSTIC VALUES OF BIOCHEMICAL MARKERSIN ASPHYXED NEWBORNS WITH PROVEN SEPSIS
(Macedonian Association of Anatomists, 2020)
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Elizabeta Shuperliska
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Olivera Jordanova
Introduction: The aim of this study was to investigate the predictive values of biochemical parameters, including Procalcitonin (PCT), as an early diagnostic and prognostic marker for sepsis in asphyxed newborns with proven sepsis. Materials and Methods: This study was designed as a prospective study, where we included 110 (M:F=67:43) newborns with proven sepsis hospitalized in the Intensive Care Unit at the PHI University Children’s Hospital – Skopje.PCT and CRP,WBC one serum blood sample was obtained from each patient at the 24h at admission, as well asday 3 and day 7. Procalcitoninlevels were measured by using an immunoassay system Vidas, based on the Enzyme Linked Fluorescent Assay (ELFA) principles. Results: The newborns with proven sepsis have been divided into two groups. The first group included 50 proven septicpreterm newborns with a positive blood culture and the second group included 50 proven sepsis full-term newborns.We isolated forty two that had two or three bacteria at the same time. The identified bacteria included Staphylococcus aureus (n=56) mecA,Streptococcus (n=6), Acinetobacter baumannii (n=18), Serratia marcescens (n=9) and Entrobacteriaceae (n=31), Candida albicans(n= 1), Candida parapsilosis(n=1).Statistical analysis confirmed significantly different values of PCT in the analyzed time period in preterm newborns with proven sepsis p<0.001.Statistical analysis confirmed significantly different values of PCT in the analyzed time period in newborns with proven sepsis with asphyxia p<0.001. Conclusion: The levels of PCT have important clinical significance in predicting the prognosis of asphyxed newborns with sepsis, to prevent the development of severe sepsis and septic shock.

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