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

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.

Intracranial haemorrhage (ICH) is the common name for periventricular and intraventricular haemorrhage. We analyzed patients diagnosed as ICH in period January 2001 till May 2002. In 29/323 (8.9%) pts was verified ICH, 16/29 (55.1%) were male sex. Birth weight under 1000 grams had 6/29 (20.6%), birth weight 1000-1499 grams was 10/29 (34.4%), than 1500 to 2499 grams 8/29 (27.5%) and over 2500 grams 5/29 (17.2%). APGAR score were under 7 in 20/29 (68.9%), and four of tham 4/20 (20%) had severe and 16/20 (80%) pts had modest and mild forms of perinatal asphyxia. According to Papile classification of ICH, we found: I degree ICH had 12.29 (41.3%) pts, II degree 8/29 (27.5%) pts, while severe forms III and IV degree of of ICH had 9/29 (31.2%) pts. In 3/29 (10.4%) pts, posthemoragic hydrocephalus were registrated. Risk-factors for development of ICH were low birth weight, small gestational age and perinatal asphyxia.