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.

The goal of this study was to determine the effects of antenatal corticosteroids and surfactant replacement on the severity and frequency of Respiratory Distress Syndrome (RDS) in a cohort of premature infants born in Sarajevo, Bosnia and Herzegovina, from 2005 to 2007. The cohort consisted of 172 premature neonates with estimated gestational age between 26 and 34 weeks. Babies with IUGR, babies of diabetic mothers and babies with major congenital defects were excluded. Out of 172 neonates, 80 were treated antenatally with corticosteroids (single course of dexamethasone) and 92/172 were not. There was no statistical difference (p>0,5) in average gestational age (31,2 vs. 31,0 GW) and male/female ratio between investigated groups; there were significantly more male patients (p<0,05) in both groups. Frequency of RDS was significantly lower in the corticosteroid group (24/80) in relation to the control group (54/92) (p<0,001). Severe RDS was significantly (p<0,01) more frequent in the control group 34/53 (62,96%) then in the corticosteroid group 6/24 (25,0%). Bovine surfactant (Survanta) was given as a rescue therapy to 78 babies with clinical and radiological signs of RDS who required FiO2>0,40 and mechanical ventilation. Early surfactant administration within six hours after birth appeared to be effective at reducing mortality then later surfactant administration (p<0,005). In the group of babies requiring FiO2> or =0,6 at the time of surfactant replacement, the mortality rate was significantly higher (p<0,05). In conclusion, we confirm the efficacy of antenatal corticosteroid treatment and early surfactant treatment in a cohort of premature infants born in Sarajevo.

Th e goal of this study was to determine the eff ects of antenatal corticosteroids and surfactant re- placement on the severity and frequency of Respiratory Distress Syndrome (RDS) in a cohort of premature infants born in Sarajevo, Bosnia and Herzegovina, from  to . Th e cohort con- sisted of  premature neonates with estimated gestational age between  and  weeks. Babies with IUGR, babies of diabetic mothers and babies with major congenital defects were excluded. Out of  neonates,  were treated antenatally with corticosteroids (single course of dexam- ethasone) and / were not. Th ere was no statistical diff erence (p>,) in average gestational age (, vs. , GW) and male/female ratio between investigated groups; there were signifi cant- ly more male patients (p , and mechanical ventilation. Early surfactant administration within six hours after birth appeared to be eff ective at reducing mortal- ity then later surfactant administration (p<,). In the group of babies requiring FiO≥, at the time of surfactant replacement, the mortality rate was signifi cantly higher (p<,). In conclusion, we confi rm the effi cacy of antenatal corticosteroid treatment and early surfactant treatment in a cohort of premature infants born in Sarajevo.

Using a new concept of terminology for sepsis syndrome, septic shock and multiorgan dysfunction/failure syndrome (MODS/MOSF) as a framework, we have evaluated 21 cases of severe sepsis of new admitted newborns in Neonatology Department of Pediatric clinic of Clinical center University of Sarajevo during last 2 years. We found that the most common etiologic agents were gram negative organisms (Klebsiella pn. and E. coli) and staphylococci. We did not observed any streptococcus group B sepsis despite of high incidence of these infections in developed countries. In 12 (60%) of 21 patients with severe sepsis MODS was developed, involving at least two organ systems, 3 of them also had the other acute insult (emergency surgery and asphyxia) as a possible trigger for MODS. The incidence of specific organ failure was: CNS (58%), respiratory (50%), cardiovascular (41%), the other systems were less involved. The overall mortality rate of patients with sepsis was 28%, whereas the overall mortality rate of MODS/MOSF was 50%.

We investigated 185 newborns with hyperbilirubinemia hospitalised in Neonatal Unit of Pediatric clinic during 1997. We identified an apparent cause for the jaundice in 76 newborns (41.0%), but in 109 newborns (58.8%) no cause for the jaundice was found. Contributing factors for this jaundice were: male sex, preterm bith, breast feeding, considerable weight loss, instrumental or induced delivery as well as genetic factors. Exchange transfusion was done in only 2 cases (1.08%) with Rh isoimmunisation and positive Coombs test, which is according to attitude that blood exchange transfusion as an expensive procedure with high mortality and morbidity has largely been replaced by phototherapy because of its relative freedom from complications together with its non-invasive nature. The average duration of hospitalisation of hyperbilirubinemic newborns lasted 4.8 days. We consider to make all efforts to short duration of hospitalisation time, because separation of newborn from the mother during phototherapy has a negative impact on early mother-infant social and emotional interaction.