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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    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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    NEONATAL ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT
    (2017)
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    M Kimovska Hristova
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    R. Muratovska
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    T. Voinovska
    Objective: Acute kidney injury (AKI) is serious clinical problem in newborns in the neonatal intensive care unit (NICU). Predisposing factors for AKI in neonatal age are: certain clinical conditions (asphyxia, prematurity, sepsis, and meconium plug syndrome), therapeutic interventions and other nephrotoxic drugs.The aim of the study were to present the epidemiological and clinical characteristics of neonatal acute kidney injury in intensive care unit. Subjects and Methods: The study was designed as a prospective, clinical, epidemiological investigation conducted in the period of 3 years, which included 100 newborns hospitalized in NICU of University Children’s Hospital. (50 with AKI and 50 without AKI). Мedical data records of admitted neonates with AKI were analyzed. The material was statistically processed using methods of descriptive statistics. Results: The estimated prevalence of AKI in neonates was 6.4%, according to the standard definition, while the prevalence of neonatal AKI according to RIFLE classification was 8.7%. According to pathogenetic mechanisms that lead to kidney injury, prerenal AKI prevailed and it was registered in 78% of male newborns with neoliguric type of AKI. Perinatal asphyxia was a common predisposing factor associated to neonatal kidney injury and it was found in 30% of the examined newborns, being predominant in male infants and born with a low Apgar score in the fifth minute of their life. There was a significant association between the occurrence of AKI and mechanical ventilation and aminoglycoside therapy. The mortality rate was 32% and was significantly higher in the group of newborns with congenital heart diseases. Conclusion: Acute kidney injury is a life threatening condition. It is an independent contributor to mortality. Early diagnosis and appropriate treatment of acute kidney injury in critically ill newborns, improves the outcome and prognosis.
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    NEONATAL ACUTE KIDNEY INJURY ASSOCIATED WITH COMORBID CONDITIONS
    (Medical Faculty, Ss. Cyril and Methodius University in Skopje, 2015)
    Acute kidney injury (AKI) is a common clinical problem in neonatal intensive care units. Predisposing factors are perinatal asphyxia, prematurity, sepsis, and congestive heart failure. The aim of this study was to determine the contributung conditions associated with neonatal acute kidney injury.Materials and methods. In a clinical prospective sudy we evaluated neonates with acute kidney injury who had been hospitalized in the NICU at University Childrens Hospitals in Skopje, Republic of Macedonia. We studied medical records of neonates with a diagnosis of acute kidney injury in the period 2013-2014. Results. Out of 450 hospitalized neonates, 29(6.4%) with a documented acute kudney injury were analyzed in the study. The male to female ratio was 2.6:1. Most of the neonates involved in the study were term neonates (66%). Prerenal AKI was evaluated in 80% of cases. Perinatal asphyxia was the most common predisposing factor for kidney injury in our study and was evaluated in 56% cases with predomination of term infants and male. Sepsis was present in 44% of cases, prematurity in 34%, and congenital malformations in 27% of cases. Mortality rate was 26% and it was significantly higher in patients with assisted ventilation and sepsis (p<0.05). Conslusion. Early recognition of risk factors and rapid effective tratment of contributing conditions will reduce acute kudney injury in neonatal period.