Aim To determine an outcome of acute kidney injury (AKI) in critically ill children (CIC) who needed renal replacement therapy (RRT) and were admitted to the Paediatric and Neonatal Intensive Care Unit (PICU and NICU) at the Paediatric Clinic, University Clinical Centre Sarajevo (UCCS). Methods The research included 81 children with AKI. The Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI was used. Other laboratory findings and imaging tests were made depending on children's primary disease that led to the AKI. Results Among 81 children with AKI, 38 were girls and 43 boys. A total of 39 (48.1%) patients died; the death was due to the nature of the primary disease and multiple organ failure syndromes. Out of the total of 81 patients the highest mortality rate was found in children in the first year of life, 22 (56.4%), while 17 (43.6%) patients died after the first year of life. Conclusion Without an accurate diagnosis at the right time, due to the lack of adequate biomarkers for AKI screening, the heterogeneity of AKI, comorbidities often lead to unfavourable outcomes of the disease, among CIC, especially in infants with low birth weight and extreme immaturity. Some causes of AKI are preventable and can be reduced by a better organization of primary and secondary health care.

Objectives: Preterm newborns with patent ductus arteriosus (PDA) are at greater risk for bronchopulmonary dysplasia (BPD), decreased perfusion of vital organs and mortality. The aim of study was to determine relationship between the existence of PDA and the development of necrotizing enterocolitis (NEC) in preterm infants. Methods: The study included 51 preterm infants with necrotizing NEC, admitted to the neonatal intensive care unit (NICU) at the University Clinical Center Sarajevo. In patients with NEC, 30 patients were treated conservatively (NEC II group), while 21 patients were treated surgically (NEC III group). The control group consisted of 71 preterm infants without necrotizing enterocolitis. The PDA was diagnosed by the presence of bounding peripheral pulses, and confirmed by two-dimensional Doppler echocardiography. Results: A statistically significant difference in PDA frequency was observed between the NEC group of patients and control group (χ2=11.484; p=0.0007), between the NEC II and control group (χ2=11.033; p=0.0009) and between the NEC III group and control group (χ2=5.557; p=0.0184). Logistic regression analysis revealed that PDA is an independent risk factor for the development of NEC (OR=10.95; 95% CI: 2.10, 57.08). Conclusion: Our data suggest that PDA represents independent risk factor for the development of NEC in premature infants, probably due to the influence of PDA on compromising mesenteric perfusion. Keywords: patent ductus arteriosus, necrotizing enterocolitis, preterm infants

Studies are supporting neuroprotective benefi t of therapeutic hypothermia in term newborns with hypoxic-ischemic encephalopathy.We assessed survival and neurodevelopmental outcome of neonates subjected to the procedure and factors that may haveinfl uenced it. Newborns with gestational age of more than 36 weeks and less than 6 hours of age with moderate to severe asphyxialencephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. The outcomemeasures assessed were death and neurodevelopmental characteristics. Twenty-fi ve children were assessed during the period fromOctober 2010 to October 2013. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission tothe hospital 7.02. Four (16%) children died and two were lost for follow up. At the age of fi nal assessment, developmental categoriesof communication were normal in 68.4%, problem solving in 73.7%, personal-social in 68.4%, gross motor in 57.9%, and fi ne motorin 36.8% but with a high need of retesting in this area. Seven of 19 patients (36.8%) had completely normal results for all fi ve categories,while three (15.8%) had abnormal results for all categories. None of the 18 parameters that were correlated with neurodevelopmentaloutcome showed statistical signifi cance. Amplitude integrated electroencephalography was done in ten patients and themost prominent fi nding was discontinuous activity in eight patients. In conclusion, a relatively small number of patients and limitationsof this study design precluded any far-reaching conclusions, but we think that this method can provide better survival and lessneurologic sequels in hypoxic-ischemic encephalopathy patients.

The goal of this study was to determine the effects of antenatal corticosteroids and surfactant replacement on the severity and frequency of Respiratory Distress Syndrome (RDS) in a cohort of premature infants born in Sarajevo, Bosnia and Herzegovina, from 2005 to 2007. The cohort consisted of 172 premature neonates with estimated gestational age between 26 and 34 weeks. Babies with IUGR, babies of diabetic mothers and babies with major congenital defects were excluded. Out of 172 neonates, 80 were treated antenatally with corticosteroids (single course of dexamethasone) and 92/172 were not. There was no statistical difference (p>0,5) in average gestational age (31,2 vs. 31,0 GW) and male/female ratio between investigated groups; there were significantly more male patients (p<0,05) in both groups. Frequency of RDS was significantly lower in the corticosteroid group (24/80) in relation to the control group (54/92) (p<0,001). Severe RDS was significantly (p<0,01) more frequent in the control group 34/53 (62,96%) then in the corticosteroid group 6/24 (25,0%). Bovine surfactant (Survanta) was given as a rescue therapy to 78 babies with clinical and radiological signs of RDS who required FiO2>0,40 and mechanical ventilation. Early surfactant administration within six hours after birth appeared to be effective at reducing mortality then later surfactant administration (p<0,005). In the group of babies requiring FiO2> or =0,6 at the time of surfactant replacement, the mortality rate was significantly higher (p<0,05). In conclusion, we confirm the efficacy of antenatal corticosteroid treatment and early surfactant treatment in a cohort of premature infants born in Sarajevo.

Th e goal of this study was to determine the eff ects of antenatal corticosteroids and surfactant re- placement on the severity and frequency of Respiratory Distress Syndrome (RDS) in a cohort of premature infants born in Sarajevo, Bosnia and Herzegovina, from  to . Th e cohort con- sisted of  premature neonates with estimated gestational age between  and  weeks. Babies with IUGR, babies of diabetic mothers and babies with major congenital defects were excluded. Out of  neonates,  were treated antenatally with corticosteroids (single course of dexam- ethasone) and / were not. Th ere was no statistical diff erence (p>,) in average gestational age (, vs. , GW) and male/female ratio between investigated groups; there were signifi cant- ly more male patients (p , and mechanical ventilation. Early surfactant administration within six hours after birth appeared to be eff ective at reducing mortal- ity then later surfactant administration (p<,). In the group of babies requiring FiO≥, at the time of surfactant replacement, the mortality rate was signifi cantly higher (p<,). In conclusion, we confi rm the effi cacy of antenatal corticosteroid treatment and early surfactant treatment in a cohort of premature infants born in Sarajevo.

Background. The significant advancement in the treatment of respiratory distress syndrome can be attributed to prenatal identification of high risk pregnancies, prevention of illness through antenatal care, prenatal administration of glucocorticoids, advancement in respiratory support and surfactant therapy. These measures resulted in the reduction of mortality and morbidity rates in preterm infants. Patients and methods. We analyzed data of 78 preterm babies with respiratory distress syndrome hospitalized in the NICU of the Pediatric Clinic, KCU Sarajevo. All children included in the study were mechanically ventilated and treated with one or more doses of bovine surfactant (Survanta) as rescue therapy. Surfactant was given to children with clinical and radiological signs of RDS, who required FiO2>0,40. We used the standard procedure of giving surfactant therapy to intubated children in sterile conditions, after we confirmed, by X-ray, correct tube placement. Results. We investigated the clinical efficacy of surfactant in relation to time of administration, O 2 requirement and necessity of one or more doses of surfactant. We found that early treatment with surfactant replacement- within 6 hours of birth- is more effective, and resulted in a significant reduction of mortality rate (p<0,01). Treatment with multiple doses is more effective in comparison to one dose, although there was not a significant difference (p<0,20) between the treated groups. There is a significant difference (p<0,01) between groups related to O 2 requirement. In the group of babies which required 60% or more O 2 concentration in inhaled air at the time of surfactant replacement, mortality rate was significantly higher (p<0,01). Conclusion. Our study confirmed the benefits of surfactant therapy in preterm babies with respiratory distress syndrome. We confirmed the advantages of early treatment vs. late treatment, but we could not confirm the obvious advantage of multiple over single doses. So, a reasonable recommendation is to treat the infants as soon as clinical signs of developing respiratory distress appear with an individual dose for each infant.

BACKGROUND Congenital lobar emphysema is characterized by overinflation of pulmonary lobe and is caused by localised bronchial obstruction. The disease may result in severe respiratory distress in early infancy. METHODS Records of children, with congenital lobar emphysema, who were treated at our department between 1997-2003, were reviewed. RESULTS Three males, aged 16 days till 1 year, were diagnosticed as congenital lobar emphysema. Presenting symptoms were dyspnea in 2 patients, cyanosis in 2 patients, wheesing in 2 patients, recurrent respiratory tract infection in 2 patients. Chest x rays and computerized tomography scans showed hyperinflation of the affected lobe in all patients. The affected sites were left upper lobe in 2 patients and right upper lobe in 1 patient. All patients underwent lobectomy. CONCLUSION It is necessary to suspect on this uncommon anomaly in early infancy. The diagnosis was established by chest x rays and CT scans. Intensive therapy and urgent lobectomy, in severe respiratory distress, are condition for successfully treatment.