AIM To estimate prevalence of respiratory distress syndrome in preterm twins compared to preterm singletons. METHODS This is a retrospective observational point prevalence study conducted at the level of three neonatal intensive care units. Medical records of all preterm newborns (<37 weeks of gestation) with respiratory distress syndrome treated in a two-year period were reviewed. The birth order of twins, gestational age and mortality were analysed. RESULTS Out of 809 preterm newborns, 104 (12.9%) were twins. Median gestational age at birth was 30.3 (IQR 31.4-34.2) weeks. Respiratory distress syndrome was diagnosed in 525 (64.9 %) preterm newborns, of which 441 singletons and 84 twins. Prevalence of respiratory distress syndrome in first-born twins was not significantly higher compared with singletons, 67.3% (35/52) vs. 62.6 % (441/705), respectively (p=0.06). Prevalence of respiratory distress syndrome in second-born twins was 94.2 % (49/52), which was significantly higher compared with both singletons and first-born twins (p<0.001). The mortality rate of preterm newborns was significantly higher in second-born twins compared with singletons and first-born twins, 15.4 % vs. 6.8 % (p<0.001) and 15.4 % vs. 5.5% (p<0.001), respectively. CONCLUSION There was a higher risk of respiratory distress syndrome and higher mortality rate in twins compared with singletons, but only in second-born twins the difference was statistically significant.

Introduction Inflammation can arise as a consequence of both extracorporeal shock wave lithotripsy (ESWL) and ureteroscopy (URS) treatments. Alterations in inflammatory parameters may serve as indicators of kidney injuries and the ensuing inflammation. This study aims to investigate the effects of ESWL and URS procedures on inflammatory parameters for proximal ureteral stone treatment. Materials and methods A prospective interventional study comprised 120 patients with confirmed stones measuring less than 10 mm in the upper half of the proximal ureter. These patients were randomly assigned to either the ESWL or URS treatment groups. Laboratory analyses encompassed interleukin-6 (IL-6), leukocyte count, fibrinogen levels, and erythrocyte sedimentation rate (ESR), which were assessed prior to the intervention, on the first postoperative day, and six months later. IL-6 levels in the serum were determined using a chemiluminescence immunoassay (CLIA). Results There was no significant difference in IL-6 levels between pre-intervention and the first post-intervention day in patients treated with ESWL (1.8 (1.4-2.59) pg/mL vs. 2.33 (1.22-3.19) pg/mL). However, for patients treated with URS, the pre-intervention IL-6 value was 2.9 (1.9-3.34) pg/mL, and it increased significantly to 7.1 (3.85-28.07) pg/mL on the first post-intervention day (p<0.001). On the first post-intervention day, levels of IL-6, CRP, leukocyte count, and ESR were significantly higher in patients treated with URS compared to ESWL (p<0.001; p<0.001; p=0.03; p=0.03, respectively). Conclusion Our research findings suggest that monitoring IL-6 levels can offer valuable insights into the degree of inflammation and tissue damage during and following observed procedures, particularly among patients undergoing URS, even within the initial days post-procedure.

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.

Introduction:The diagnosis of acute kidney injury (AKI) in preterm newborns with perinatal asphyxia based on increased serum creatinine (sCr) value and oliguria/anuria is usually delayed. The Aim of this paper is to evaluate serum cystatin C as an early predictor of AKI. Materials and methods:The study included 42 preterm newborns (24-37 weeks) with perinatal asphyxia (Apgar score (AS) ≤ 3 at 5 minutes of life or blood pH on admission ≤ 7.00). The sCr and sCysC levels were measured on the 1st, 3rd, and 7th day of life. According to KDIGO criteria, the newborns were classified into groups, and sCr and sCys-C values were compared. Results:The mean gestational age was 29.9 ± 3.0 weeks. AKI was diagnosed in 62.8 % of patients. Of these patients, 81.5% belonged to AKI 1 group, and 18.5 % to AKI 2 group.No newborns had the criteria for AKI 3. On day 7 the mean sCr values were significantly higher in AKI (65.4± 21.8) compared with the non-AKI group (168.4±38.2) (p<0.001), but not on day 1 and 3 (p = 0.322, 0.012, respectively). The sCys-C values were significantly higher in the AKI group on day 3 ( AKI vs. non-AKI group, 0.69 ±0.22 vs. 1.22 ±0.20; p <0.001) and day 7 (AKI vs. non-AKI group, 0.62 ±0.41 vs. 1.68 ±0.20; p <0.001). The sCys-C was also an earlier marker of a more severe stage of AKI than sCr. Conclusion:The sCys-C was elevated earlier than sCr, making it a valuable diagnostic tool for AKI in preterm newborns.

Aim To determine a prognostic value of cerebral blood flow parameters for the development of neurological sequelae in term neonates with hypoxic ischaemic encephalopathy (HIE). Methods We reviewed medical records of 47 term neonates with HIE who survived until the age of 12 months of life. According to the Sarnat and Sarnat clinical score, neonates were divided into 3 groups: mild HIE, moderate HIE and severe HIE. All included neonates had the colour Doppler brain sonography performed in the first 24 hours of life. The neurological assessment was done at the age of 12 months of life by using the Denver Developmental Screening Test (DDST). Logic regression analysis was performed using the colour doppler brain sonography parameters with the development of neurological impairment as the primary outcome. Results Out of 47 neonates, 19 (40.4%) were with mild, 17 (36.2%) with moderate and 11 (23.4%) with severe HIE. The values of cerebral blood flow parameters and resistance index (RI) significantly correlated with the neurological impairment at the age of 12 months of life (p<0.001). The limit value of RI indicating the poor neurodevelopmental outcome was 0.81, sensitivity 80%, specificity 85.3%, positive predictive value 52.2% and negative predictive value 95.2%. Conclusion The cerebral blood flow parameters measured with colour doppler brain sonography are good indicators of the severity of HIE and later neurodevelopmetal outcome.

Introduction: Brain MRI scans can predict neurodevelopmental outcomes in neonates treated with therapeutic hypothermia. It is a common clinical practice to perform brain MRI before discharge, but brain MRI scans performed at around four months of age have a better prognostic value for a long-term neurological outcome in asphyxiated neonates. Aim: To identify which of three selected clinical parameters (oral feeding ability, muscle tone, history of seizure) evaluated 10 days after therapeutic hypothermia could predict the primary outcome of an abnormal brain MRI. Methods: We reviewed the medical records of neonates ≥ 36 completed weeks of gestation consecutively treated with therapeutic hypothermia who underwent brain MRI. Clinical parameters on day 10 after therapeutic hypothermia were correlated with brain MRI findings in the first 7-14 days of life. Logic regression analysis was performed using all three covariates of the clinical status, with an abnormal MRI as the primary outcome. Results: Brain MRI was abnormal in 42 (51.85 %) neonates with the following distribution of brain injury patterns: abnormal signal in the basal nuclei in 6, an abnormal signal in the cortex in 16, an abnormal signal both in the cortex and basal nuclei in 20 neonates. Out of three analyzed clinical parameters, feeding difficulty (P < 0.001, OR 8.3, 95% CI 2.9 - 28.9) and a history of seizures (P < 0.001, OR 11.95, 95% CI 3 - 44.5) were significantly associated with an abnormal MRI.  Conclusion: Neonates who were capable of full oral feeding by day 10 after therapeutic hypothermia and had no history of seizures were unlikely to have an abnormal MRI. This may be used in selective planning of pre-discharge MRI in asphyxiated neonates.

Introduction: Newborn screening (NBS) is a system of organized search in the entire neonatal population for specific diseases. In Bosnia and Herzegovina, two diseases are included in NBS, congenital hypothyroidism (CH), and phenylketonuria. The screening for CH is based on determination of thyroid stimulating hormone (TSH) levels in blood obtained by heel prick method. The aim of this study is to evaluate the effectiveness of NBS program for CH based on TSH and establish the mean age of diagnosis of CH.Methods: TSH was measured by time-resolved fluoroimmunoassay (DELFIA Neonatal hTSH kit). The TSH cutoff value was 9 μU/mL. Neonates with TSH < 9 μU/mL had a negative NBS result. Neonates with TSH ≥ 9 μU/mL were recalled for a confirmation test and thyroid hormones were determined from venous blood to establish diagnosis of CH.Results: A total of 24,351 neonates were subjected to NBS in our institution. A total of 164 newborns with TSH ≥ 9 μU/ml were sent to additional testing (mean recall rate of 0.68%) at a mean age of 11.4 ± 0.5 days of life. In this group, diagnosis of CH was confirmed in 22 neonates (13.41%). The mean rate of false positive results of NBS was 0.59%. The incidence of CH in Sarajevo Canton ranged from 1/2477 in 2018 to 1/641 in 2020. The mean incidence of CH over a 5-year period was 1/1085, while the mean age at the time of diagnosis was 16.5 ± 1.2 days.Conclusion: The analysis of NBS on congenital hypothyroidism data showed the satisfactory recall and false positive rate and indicated well selected TSH cutoff value. The mean age at the time of diagnosis assures early treatment and good neurological outcome in neonates with CH.

Background: Acute kidney injury (AKI) is the result of various causes and is associated with significant morbidity and mortality as well as long-term renal sequelae in pediatric patients. Objectives: The aim of the study is to determine the causes of AKI in pediatric patients who needed renal replacement therapy (RRT) and were admitted to the Pediatric and Neonatal Intensive Care Unit (PICU and NICU) at the Pediatric Clinic, University Clinical Center Sarajevo (UCCS). Methods: Our research included 81 children with AKI who needed RRT. We used the Kidney Disease: Improving Global Outcomes (KDIGO) criteria to define AKI. Severe acute kidney injury was defined as stage 2 or 3 of AKI when plasma creatinine level ≥2 times the baseline level or urine output <0.5 ml per kilogram of body weight per hour for ≥12 hours. Other laboratory findings and imaging tests were made depending on their primary disease that led to the AKI and its complications. Results: Our research analyzed 81 children with AKI who needed RRT 38 girls and 43 boys ages from birth to 18 years. Mean age of presentation was 6.28 years. Male female ratio in this study was 1.1:1. Non-olyguric AKI was diagnosed in 12 (14.8%) of children with AKI, while the rest 69 (85.2%) had the olyguric type. Patients with AKI were analyzed after a rough division on prerenal in 57 (70.4%) children, intrarenal in 23 (28.4%) and post-renal in 1 (1.2%) patient. Conclusion: As the AKI plays a key role in the mortality and morbidity in pediatric patients, especially in infants, it is important to recognise and treatment on time different etiologies of this serious condition. Some causes of AKI in our country can be prevented by better organization of primary and secondary health care, which would also reduce mortality and morbidity from AKI.

Abstract Background Brain abscesses are possible but very uncommon complications of bacterial sepsis and meningitis in neonates. We report a case of multiple brain abscesses in a preterm neonate as a complication of Serratia marcescens sepsis. Case The female preterm weighing 1990 g was delivered by cesarean section at 32 weeks of gestation. Apart from moderate respiratory distress syndrome (RDS), the baby was in a good condition with no indicators of perinatal infection. On the 3rd day of life, the clinical status deteriorated and the sepsis screen was positive. The baby was intubated and, along with other intensive measures, treated with high doses of vancomycin and imipenem. Serattia marcescens was isolated in hemoculture. The baby clinicaly improved in the following days, but the cranial ultrasound revealed multiple hypoechoic lesions in parietal lobes bilaterally. Magnetic resonance imaging (MRI) of the brain showed multiple (five) hypodense lesions with the peripheral enhancement suggestive of intra-parenchymal abscesses. The neurosurgical consilium suggested conservative treatment with antibiotics and weekly neuroimiging follow-up. The antibiotic treatment was conducted for a total of 8 weeks. The final MRI showed a total regresion of previous abscesses with the formation of small cavitations. The clinical and neurological examination of the baby was normal as was the EEG. The baby was discharged with a recommendation of neurological follow-up. Conclusion A multidisciplinary team approach, including neurosurgeons, neonatologists and infectious disease specialists, is needed for a decision on treatment of brain abscesses in neonates. Serial imaging is important in the assessment of the efficacy of treatment.

Introduction: Perinatal asphyxia (PA) results in hypoxic damage to almost all organs, kidneys being most frequently (40%) affected. Objectives: was to determine the incidence of acute renal failure (ARF) in term neonates with PA and to correlate it with severity of hypoxic ischemic encephalopathy (HIE). Materials and methods: This prospective study of 54 term neonates with PA was performed in tertiary level neonatal intensive care unit at Pediatric Clinic Sarajevo from June 2014 to June 2016. The severe PA was defined as 5. minute Apgar score < 3 and moderate PA as 5. minute Apgar score 4-6. Criteria adopted for ARF were serum creatinine > 1.5 mg/dl (> 133 micromol/L) on 3rd day of life or urine output < 0.5 ml/kg/hr for > 6 hrs beyond 24 hrs of life. Results. Out of 54 neonates with PA, 22 (40.74%) had ARF. Most of them (63.6%) had non-oliguric ARF with mean renal output of 2.2 ± 0.5 ml/kg/h. Eight neonates (36.4%) had oliguric ARF with mean renal output of 0.35 ± 0.6 ml/kg/h. Most of the neonates with oliguric ARF (63.4%) had severe PAwhile in those with non-oliguric ARF moderate PA was predominant. ARF was highest in the neonates with HIE III (85.71 %) (Figure 1). This showed that as HIE stage progressed, more renal dysfunction was seen in asphyxiated babies and this difference in incidence was found statistically significant (p < 0.05). Conclusions. Neonates with severe PA had more frequent ARF and the predominant type of renal involvement was non oliguric. Neonates with HIE stage II and III had significantly higher incidence of ARF.