Key Points Question What is the current red blood cell (RBC) transfusion practice for preterm infants born before 32 weeks’ gestation in Europe? Findings This cohort study included 1143 infants from 64 neonatal intensive care units across 22 European countries. By day 28 of life, 36.5% of infants had received an RBC transfusion, and most transfusions based on hemoglobin threshold were given above restrictive thresholds tested in recent trials. Meaning These findings suggest that there is a need to address the gap between evidence and practice and to understand factors influencing ongoing variable practices of RBC transfusions among preterm infants.

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.

The psychophysical preparation program for pregnant women includes physical exercises and theoretical lectures aimed at preparing the pregnant woman for childbirth and that the benefits far outweigh the risks. Exercise is an essential element of pregnancy, and OB-GYNs and other obstetric care providers should encourage their patients to continue or begin exercise. The aim of this work is to understand the impact of psychophysical preparation of pregnant women on health during and after pregnancy, birth outcomes and postpartum recovery. Twenty scientific research papers/articles including 5517 respondents were reviewed, based on databases: Web of Science, EBSCO, Scopus, Medline, PubMed, ScienceDirect, Google Scholar, and others. Works published from 2017-2022 were reviewed. The results of this study show that pregnant women who attended the program of psychophysical preparation for childbirth had a chance to experience childbirth in a more beautiful light, to be prepared, so that they would go to the maternity hospital with less fear, how to use breathing techniques during childbirth, and how to have the easiest and most beautiful childbirth without the use of drugs and interventions. Pregnant women had significantly more positive outcomes of childbirth as well as postpartum recovery and mental health. Psychological support and education have positive outcomes on the mental health of pregnant women because they reduce fear of the unknown and reduce the risk of postpartum depression. Higher rates of intact perineum, reduction of episiotomy and less damage of perineal tears are recorded. The preparation itself significantly affects the outcome of the test subjects’ births, where vaginal births are much more common, and the rate of instrumental methods of birth and caesarean section is reduced. A positive outcome was recorded during postpartum recovery.

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: Ascaris lumbricoides is a widely spread helminthic infection, predominantly affecting children, making them the most commonly infected population group. The objective of this study is to assess the prevalence of Ascaris lumbricoides infestation in two municipalities, Tešanj and Maglaj, and to investigate the occurrence of Ascaris lumbricoides infections in the pediatric population, focusing particularly on preschool children. Materials and Methods: The study involved the collection of 1409 fecal samples from the Tešanj and Maglaj areas, gathered over a 6-month period, spanning from September 2018 to February 2019. The processing of these samples was conducted in the Microbiology Laboratory of Tešanj General Hospital. Results: Out of the total 1409 samples, 129 (9.16%) tested positive for Ascaris lumbricoides infestation. In Tešanj, where 1198 samples were collected, 106 (8.85%) tested positive, while in Maglaj, 211 samples were collected, with 23 (10.9%) testing positive. Notably, the majority of positive cases in both Tešanj and Maglaj were preschool-age children, accounting for 88.68% and 86.96%, respectively. The study did not identify any statistically significant correlation between age and gender distribution among those with positive test results in either Tešanj or Maglaj. Conclusion: Based on the study results, which have highlighted the infestation of preschool children with Ascaris lumbricoides in two municipalities in our country, it is imperative to implement preventive measures aimed at reducing the incidence of infection.

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.