Ductal dependent congenital heart diseases represent 14-20% of all congenital heart diseases. A primary goal of the treatment of these diseases is to retain ductus open until the final cardiosurgical treatment. Prostaglandins are presently the only medicaments, which have a capability to keep ductus open. By means of a retrospective study in a period from January, 2000 until December, 2002 at the Paediatric clinic of the Clinical centre of the University in Sarajevo, 14 patients (treated with prostaglandins) diagnosed with ductal dependent congenital heart diseases were analyzed. In our sample, there are 9/14 male patients (64.3%), 11/14 (78.6%) were full-term newborns, while 10/14 (71.4%) were eutrophic at birth. An average saturation increase, after the prostaglandin therapy, measured in blood from the capillaries is 29, and measured transcutanlly is 32 units. Duration of prostaglandin therapy in our study was on average 17.2 days. The most common cause of death was insufficientia cardiorespiratoria (4 out of 11), but sepsis/infection (3 out of 11) and insufficientia renalis were also common. 78.6% (11 out of 14) patients died partly because of the complexity of these diseases, but also because a cardiosurgical treatment is delayed. A goal of this study is evaluation of saturation with oxygen before and after the prostaglandin therapy.

We have analyzed 132 newborns with hyperbilirubinemia (BW < 2500 g, GW > 37 weeks) hospitalized in Neonatal Unit of Paediatric Hospital during 2001. In 78 out of 132 (59.1%) newborns, causal diagnosis were established. Rh isoimmunization caused hyperbilirubinaemia in 2.8% (3/132) cases, ABO isoimmunization in 15.95% (21/32), infections in 9.15% (12/32) and other (polycitaemia, kephalhaematoma, loss of weight > 8%, jaundice related to the brestafeeding) in 31.8% (42/132). Maximal serum bilirubin level was reached between fourth and seventh day of life. In 47/132 newborns (40.9%) non-specific hyperbilirubinaemia were diagnosed. All babies were successfully treated by fototherapy. Blood exchange transfusion was performed in only 2 cases. Rh isoimmunisation was not significant factor in etiology of hyperbilirubinemia because of global prevention of Rh negative mothers. Hyperbilirubinemia of "healthy full-term newborn" was most often seen in 40.9% cases. Diagnostic criteria for hyperbilirubinemia were revised, and fottherapy, as safe, non-invasive method, replaced blood exchange transfusion, as an expansive procedure with low but constant mortality.

Group B Streptococcus (GBS) is the main ethiological agent of neonatal sepsis in the developed countries. Because of high mortality rate American College of Obstetrics and Gynaecologists and Centers for Disease Control published recommendation for prevention of neonatal GBS infection. Program recommends screening of all pregnant women for anogenital GBS infection including intrapartum treatment of pregnant women at high risk, with penicillin or ampicillin. Clindamicin or erythromicin may be used for women allergic to penicillin. Since there is no detailed informations of early-onset neonatal GBS infection in our country, we investigated its incidence in Pediatric Clinic in Sarajevo, from December 1999 (when first case of early-onset GBS infection in last decade was diagnosed) to August 2002. During that period 7 neonates with early-onset GBS infection were identified (incidence 0.52 per 1000 livebirths). Four of seven sick newborns died, 2/7 survived with severe neurological sequelae and only one female newborn survived without deficits. In the same period we registered 36 (2.4%) GBS colonised neonates out of 1530 admitted neonates. The number probably is higher because of discharge GBS colonized asymptomatic neonates from Maternity as a healthy to home. Results of this study intend the necessity of implementation guidelines for GBS prevention since early onset GBS infection is becoming as an increasing problems in our population.

UNLABELLED The current trend in neonatal cardiology assumes the administration of prostaglandins. Prostaglandins are indicated as a palliative and not definitive therapeutic medicament in neonates with duct dependent congenital heart anomalies. The aim of this study is to evaluate the medicament Prostaglandin, first time administrated to neonatal cardiac patients, in Bosnia and Hercegovina. During December 1997 till June 2000. at the Neonatal department of Pediatric Clinic in Sarajevo 1162 pts were admitted, of which 17 (1.4%) with congenital heart disease have received prostaglandin therapy, with the mean age of 4.5 days (45 minutes till 20 days). 13/17 (76.5%) pts were boys and 4/17 (23.5%) girls, with mean body weight of 3.125 gr (range: 1.250 g to 4.100 g), mean gestational age 40 weeks (range 34 to 42). The patients were admitted for: cyanosis, breathing difficulties or fatigue. Central cyanosis was evident at admission in 15/17 pts, whose oxygen saturation at admission was from 21% up to 76%. The diagnosis of congenital cyanotic heart anomalies was made in 15/17 pts (88%) by clinical examination, X ray, ECG and ultrasound examination and acyanotic duct dependent on 2/17 (12%) pts. The administration of prostaglandin's was necessary and of vital importance for life maintenance of these pts till the surgical correction of these congenital heart anomalies. Prostaglandin E1 (PGE1) was administrated by infusion pump with the mean doses of maintenance: 0.023 mcg/kg/min in 11/17 (65%), and Prostaglandin E2 PGE2 in 6 (35%) pts, maintenance doses of 0.38 mcg/kg/hour. The duration of the prostaglandin application was from 7 hrs up to 30 days, mean 12 days. Five (29.5%) pts were intubatued during the application of this medicament. The side effects of this therapy were present in 13 pts (76.4%): hyperpyrexis in 8, apnea in 2 and apnea + hyperpyrexis in 3 pts. 8/17 (47%) pts were operated and corrected abroad, they are now in good condition, and 9/17 (53%) pts died. The death causes were a part of complex congenital heart disease: impossibility of performing the heart surgery in the country when needed, impossibility of pts evacuation to the foreign cardiosurgical center on time, sepsis or persistent pulmonary hypertension. CONCLUSION In pts with congenital heart disease whose survival is duct dependent, the availability is compulsory and the application of prostaglandins as a palliative medicament. The prostaglandins have made a revolution in saving children's lives in neonatal cardiology.

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.