Congenital anomalies (CA) are any abnormality present at birth, either structural or functional, that may potentially affect an infant’s health, development, and/or survival. There is a paucity of studies on clinical characteristics and outcomes of CA in Bosnia and Herzegovina, mainly due to the lack of a nationwide congenital malformations monitoring system. A 5-year hospital-based study was conducted to determine the prevalence at birth and clinical characteristics of selected major CA in Sarajevo Canton, Bosnia and Herzegovina. Ninety-one CA were observed from 2012 to 2016 (the overall prevalence was 39.6 cases/10,000 live births). The mean age of neonates at diagnosis was 3 days. The gastrointestinal tract was the most commonly affected system (76.9%), with esophageal atresia (EA) being the most frequent (17.6% of all CA). Major CA were more prevalent among preterm infants than term infants (P = .001), particularly in males (61.5% vs. 38.5%; P = .028; M:F ratio was 1.59). Multiple CA were seen in 37.4% of neonates. The overall mortality rate of neonates was 11%, and the median length of hospital stay was 19.8 days. Our study revealed the distribution and clinical patterns of common major CA in the largest tertiary care facility in Bosnia and Herzegovina. It also confirmed a relatively high mortality rate, which requires further efforts to improve the quality of neonatal care in the country.

Aim To analyse biochemical markers as possible predictors of death before discharge in cooled newborns following perinatal asphyxia. Methods A total of 91 infants that underwent therapeutic hypothermia after perinatal asphyxia were included. Inclusion criteria for therapeutic hypothermia were Sarnat stage 2 or 3. Data were collected from medical histories regarding gender, gestational age, birth weight, Apgar and Sarnat score; additionally, gas analyses, liver and cardiac enzymes before, and in the first 12 hours after starting therapeutic hypothermia, were evaluated. The patients' characteristics were compared between two groups, survivors and non-survivors. Results Statistical difference was not found between groups regarding gender, gestational age, birth weight, delivery type, 1st and 5th minute Apgar score, seizures, alanine aminotransferase (ALT), creatine kinase (CK), troponin and fibrinogen level. Groups were significantly different regarding acid-base balance (p=0.012), base excess (BE) (p=0.025), lactate (p=0.002), aspartate aminotransferaze (AST), (p=0.011), lactate dehydrogenase (LDH) (p=0.006), activated partial thromboplastin clotting time (aPTT) (p=0.001) and international normalized ratio (INR) (p=0.001). Conclusion Acid-base balance, BE, lactate, AST, LDH, aPTT and INR were significantly higher in the group of cooled newborns after perinatal asphyxia (non-survivors), and can serve as predictors of death before discharge. Combining diagnostic modalities raises a chance for accurate prediction of outcomes of asphyxiated infants.

Lenticulostriate vasculopathy (LSV) is a relatively common fi nding in routine cranial ultrasound examination that has been associated with many infectious and non-infectious conditions. The aim of this review was to provide a better understanding of LSV ultrasound fi nding, as well as the need for further laboratory and imaging examinations in infants. The most of the published studies represented small series, with few prospective long-term studies involving the control groups. Authors have mostly found an association between LSV, especially higher-grade (although there is no universally accepted classifi cation) with congenital cytomegalovirus (CMV) infection, classifying those children as at risk for sensorineural hearing loss. In contrast, some authors pointed out that LSV could be found relatively often, and believe that isolated LSV, especially lower-grade, is not predictive for an unfavourable outcome and a long-term prognosis. Therefore, although 35 years have passed since the first publication of LSV, there is still no consensus among experts on the clinical signifi cance of isolated LSV, but caution is certainly needed given the fact that most infants with congenital CMV are asymptomatic.

Introduction: Adequate prenatal and postnatal care for preterm neonates not only affects the survival rate, but also the occurrence of chronic diseases, and in the future also affects the quality of life of that children. Aim: To examine the influence of independent predictors (weeks of gestation, body weight, sex) on the outcome of the disease and to analyze the influence of the applied ventilatory mode on the final outcome of treatment. Material and methods:  The study included neonates (n = 248) born prematurely who were treated in the neonatal intensive care unit for a period of one year due to immaturity-related difficulties. Results: The mean age of male neonates (n = 119) at birth was 31.13 ± 3.3 weeks of gestation (WG), and females (n = 129) 31.59 ± 3.2 WG. Weeks of gestation have a statistically significant effect on survival (p = 0.0001), for each more week of gestation, the chances of survival increase by 21%. There was no significant difference between birth weight and sex (p = 0.289), and the birth weight of the neonates had a statistically significant effect on survival (p = 0.0001). For every 10 grams of body weight, in our sample, the chance of survival increases by 2%. Ventilation mode showed a statistically significant effect on neonatal survival (p < 0.05), and intubation mode was used as an indicator. If neonates are switched from non-invasive to invasive ventilation mode, the chance of survival in our sample is reduced by 88%. Conclusion: Weeks of gestation, birth weight, and the use of a noninvasive mode of ventilation are predictors of a positive outcome for preterm neonates.

Abstract Rationale: Pentalogy of Cantrell (POC) is an extremely rare syndrome with an estimated incidence of 1:65,000 to 200,000 live births. Its complete form includes a midline epigastric abdominal wall defect, defects affecting the lower sternum, anterior diaphragm, diaphragmatic pericardium, and various intracardiac defects. Patient concerns: We report a case of complete POC affecting only the first-born of a set of premature dizygotic twins. Diagnosis: A giant omphalocele with an eviscerated liver and bowel on prenatal, obstetric ultrasonography at 24 gestational weeks was observed. At birth, physical examination confirmed a massive (10 × 8 cm) epigastric omphalocele in which a significant part of the liver was seen. A postnatal echocardiogram revealed the presence of an ostium secundum atrial septal defect, perimembranous ventricular septal defect, and moderate pulmonary stenosis. X-ray showed an abnormal intrathoracic positioned stomach, which was confirmed with a plain x-ray of the upper intestinal tract with hydrosoluble contrast. Computed tomography (CT) scan revealed the sternum's absence and a close connection between the pericardial sac and the stomach wall. Interventions: The patient underwent surgical intervention at 18 days of age. Outcomes: Despite adequate and appropriate postoperative treatment, the baby rapidly deteriorated and died 72 hours after surgery. Lessons: POC is a complex, high-mortality syndrome whose management requires a multidisciplinary approach and meticulous planning. Despite all efforts, POC carries a poor prognosis, particularly in patients affected by its complete form.

INTRODUCTION Gastric acidity plays an important role in the protection of infants against various pathogens from the environment. The histamine-2 receptor blockers (H2-blockers) are off-labeled drugs that are frequently prescribed in preterm neonates to prevent stress ulcers. The impact of the H2-blockers on the development of the necrotizing enterocolitis (NEC) in preterm infants is still controversial, particularly in the developing world. MATERIALS AND METHODS One hundred twenty-two preterm infants were enrolled in the study. The multivariate logistic regression model was used to identify potential postnatal risk factors associated with NEC. RESULTS Preterm infants (n = 51) with total NEC, medical NEC, and surgical NEC had the highest rate of receiving ranitidine compared with controls (n = 71) (39.2%, 19.6%, and 47.6%, p < 0.05). Logistic regression analysis revealed that ranitidine use and nosocomial infections were significantly associated with NEC development (odds ratios 1.55 and 3.3). CONCLUSIONS We confirm that ranitidine administration was associated with an increased risk of NEC in preterm infants. H2-blockers use should be only administered in very strictly selected cases after careful consideration of the risk-benefit ratio.

Zvizdic Z, Milisic E, Jonuzi A, Terzic S, Zvizdic D. The contribution of morphine sulfate to the development of necrotizing enterocolitis in preterm infants: a matched case-control study. Turk J Pediatr 2019; 61: 513-519. The aim of the study was to determine whether morphine sulfate administration is associated with an increased risk of necrotizing enterocolitis (NEC) in preterm infants supported by mechanical ventilation due to respiratory failure. The matched case-control retrospective study was carried out at the Neonatal Intensive Care Unit (NICU) of the University Clinical Center Sarajevo, on 122 preterm infants classified into total NEC group and control group. The total NEC group was further divided into medical NEC and surgical NEC subgroups. The association between the use and duration of morphine sulfate infusion and the development of NEC was evaluated in both unadjusted and adjusted analysis. Preterm infants who developed NEC were on mechanical ventilation more frequently compared to premature infants without signs of NEC (Mann- Whitney U test; p=0.0031). A positive correlation between the frequency of receiving morphine sulfate and the development of NEC was observed (Chi square test of independence; p=0.0001). The risk of NEC in preterm infants was increased by the use of morphine sulfate. Validation of this observation in other populations is warranted.

Background Acute pain is one of the most common adverse stimuli experienced by preterm infants. Those infants undergoing painful procedures in the neonatal intensive care unit (NICU) need help in having their pain reduced. 24% oral sucrose solution is a mild analgesic which is effective in decreasing short-term pain and distress during minor procedures such as heelsticks and venipunctures. Purpose The aim of the study was to prove the efficacy of 24% oral sucrose solution as pain relief in preterm infants undergoing painful procedures. Material and methods The sample comprised 58 preterm and low birthweight neonates who were hospitalised in the NICU of the Paediatric Clinic. The neonates received 0.5 ml 24% oral sucrose. The sucrose solution was prepared in our clinical pharmacy. The sample was divided into two groups: group A (GA) of 29 preterm infants, 25 to 32 weeks’ gestational age, birthweight from 950 to 1670 grams who received oral sucrose directly into the mouth 2 min before the painful procedures, and group B (GB) of 29 preterm infants, 28 to 33 weeks’ gestational age, birthweight from 1300 to 1730 grams who received pacifier dipped in the same amount of sucrose. The parameters that we observed were pulse, oxygen saturation and respiration before and after the procedure, and an evaluation was done using a premature infant pain profile (PIPP) scale. Results MedCalc version 12.6.1.0 statistical software was used. There were no statistically significant differences between groups A and B with regard to the following variables: sex (p=0.96), gestational age (p=0.062), birthweight (p=0.78), using the Mann–Whitney test. No statistically significant differences were found in oxygen saturation levels (GA p<0.0001 and GB p<0.0001) and respiratory rates (GA p=0.019 and GB p=0.055) inside the same group before and after the procedures or between the groups. The only difference was with regard to the pulse (GA p=0.0074 and GB p=0.0001) which can be explained with a smaller sample. Conclusion The study has demonstrated that the administration of 24% oral sucrose solution is effective as a simple and safe method of pain relief for preterm infants during painful procedures from single events such as heelsticks and venipuncture. No conflict of interest

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