Objective: To assess predictive value of blood lactate measurements in infants during therapeutic hypothermia due to moderate to severe asphyxia in relation to early outcome. Patients and methods: We retrospectively evaluated records of 47 full-term newborns that underwent therapeutic hypothermia after moderate to severe perinatal asphyxia from January 2011 to December 2015. Criteria for whole body cooling were established according to Bristol Cooling Protocol UK, including clinical signs of HIE using Sarnat&Sarnat scale and aEEG. Blood samples were taken from venous catheter in recommended intervals (3, 6, 12, 24, 48, 72 hours). Early outcome is evaluated on the base of survival rate, neurologic status at discharge and presence of post hypoxic lesions confirmed with brain MRI. All investigated infants were categorized into 3 groups 1) Infants with normal brain MRI finding and normal neurologic examination at the discharge; 2) Infants with abnormal brain MRI finding at the discharge (with 2 subgroups depending of neurological status at the discharge); 3) Newborns with lethal outcome. Results: Mean value of blood lactate at admission for all subjects was 11.87 ± 5.41 (3.224.0), without statistical difference between groups. Three hours after beginning of cooling mean value was 8.36 ± 3.70 (2.2-17.0) with statistical difference between all groups of survived infants compared to infants who died. After 6 and 12 hours mean values were 6.311 ± 3.69 and 6.269 ± 3.37 respectively with statistical difference between neurologically asymptomatic infants (including those with MRI finding interpreted as a mild lesion) compared to infants with abnormal neurological examination at the discharge and infants who died. Values of blood lactate after 24h, 48h and 72 h were 4.46 ± 2.00 (1.0–11.7), 3.60 ± 1.36 (1.6–6.9), 3.36 ± 1.93 (1.29.3) respectively. After 24 h we did not find statistical difference between groups. Conclusion: Serial measurements of blood lactate during therapeutic hypothermia in asphyxiated infants are important. Initial value of lactate is not proved to be predictive, but prompt decreasing of lactate values within 24 hours of cooling is associated with better early outcome. *Correspondence to: Suada Heljić, MD, PhD, NICU, Pediatric Clinic, Clinical University Center Sarajevo, Bosnia and Herzegovina, Tel: +387 61 865 285 (M), +38733566439 (W); E-mail: heljicsuada@hotmail.com

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 have infl uenced it. Newborns with gestational age of more than 36 weeks and less than 6 hours of age with moderate to severe asphyxi al encephalopathy underwent cooling protocol at a temperature of 33.5 °C for 72 hours and rewarming period of 6 hours. The outcome measures assessed were death and neurodevelopmental characteristics. Twenty-fi ve children were assessed during the period from October 2010 to October 2013. Median gestational age was 40 weeks, birth weight 3470 g, Apgar score 2/4 and pH on admission to the hospital 7.02. Four (16%) children died and two were lost for follow up. At the age of fi nal assessment, developmental cate gories of communication were normal in 68.4%, problem solving in 73.7%, personal-social in 68.4%, gross motor in 57.9%, and fimotor in 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 e categories, while three (15.8%) had abnormal results for all categories. None of the 18 parameters that were correlated with neurodevelopmental outcome showed statistical signifi cance. Amplitude integrated electroencephalography was done in ten patients and the most prominent fiwas discontinuous activity in eight patients. In conclusion, a relatively small number of patients and l imitations of this study design precluded any far-reaching conclusions, but we think that this method can provide better survival and less neurologic sequels in hypoxic-ischemic encephalopathy patients.

Background: Although the mortality rate for preterm infants and the gestational age-specific mortality rate have dramatically improved over the last 3 to 4 decades, infants born preterm remain vulnerable to many complications, including respiratory distress syndrome, chronic lung disease, necrotizing enterocolitis, a compromised immune system, cardiovascular disorders, hearing and vision problems, and brain lesions. The aim is to determine mortality and morbidity rates and selected outcome variables for preterm infant’s grade 3 IVH or PVL) 16.6%, NEC Bell stages II or III 9.8%, BPD 25/72 (33.3%) of infants who survived to 36 weeks postmenstrual age. In 38 (37.2%) infants, episodes of infections were noticed (one or more episodes in 25 infants), half of them were caused by Gram positive bacteria, most frequent coagulasa negative staphylococci. Klebsiella pneumoniae was the most frequent organism among Gram negative bacteria. One patient had invasive candidiasis caused by Candida albicans. In 5 infants (4.9%) early onset of sepsis was documented. Conclusion: Very preterm infants remain very vulnerable group of population, and interventions to reduce the morbidity and mortality of preterm babies include tertiary interventions such as regionalized care, transportation in uterus, and treatment with antenatal steroids.