Background: Ophthalmia neonatorum (ON) is an inflammation of the conjunctiva, manifested in the neonatal period. The most common factors contributing to the occurrence of ON are pathogens that are transmitted from mother to newborn through the birth canal, maternal infection during pregnancy, inadequate ocular prophylaxis, susceptibility to infection of the newborn eye and ocular trauma during labour. Aim: The aim of this study was to examine obstetric risk factors for developing ON. Methods: The study was prospective and included all newborns of gestational age of 24 to 42 weeks, both genders, born in the period from 1 October 2011 to 1 October 2012 at the University Clinical Centre Tuzla, with signs of ON. The obstetric risk factors affecting the occurrence of ON were analyzed. Results: During the study period 206 newborns out of 4180 developed ON, with an incidence of 4.93%. The most important risk factors for ON during pregnancy and labour were colpitis (p 18 hours (p 18 hours, mother’s comorbidity and Apgar score at 5 minutes <7. Newborns of mothers with the mentioned risks require a somewhat different prophylaxis and should be closely monitored during the first month of life.

Objectives. We examined association between incidence rate of low birth weight in liveborn infants and maternal sociodemographic status in Tuzla Canton during 1992–1995 war in Bosnia and Herzegovina. Methods. The present study covers a 22-year period (1988–2009), including the war period (1992–1995), and we retrospectively collected data on a total of 108 316 liveborn infants and their mothers from three different socioeconomic periods: before (1988–1991), during (1992–1995), and after the war (1996– 2009). Association between incidence rate of low birth weight in liveborn infants and maternal sociodemographic status were determined for each study period. Results. There were 23 194 live births in the prewar, 18 302 during the war, and 66 820 in the postwar period. Among the liveborn infants born during the war, 1373 (7.5%) had birth weight of <2500 g, which is significantly more in comparison with 851 (3.6%) liveborn infants in this birth weight group born before and 1864 (2.8%) after the war. We found the number of examinations during pregnancy was 1.8 per pregnant woman in the war period, which was low in comparison with the number of examinations before (4.6 per pregnant woman) and after (7.1 per pregnant woman) the war (P < .001 for both). Prewar perinatal mortality LBW infants of 6.2 per 1000 live births increased to 10.8 per 1000 live births during the war (P < .001), but after the war, perinatal mortality LBW infants (5.2‰) and early neonatal mortality (2.4‰) decreased. Conclusions. We found statistically significant association between low-birth-weight and maternal sociodemographic status in Tuzla Canton during 1992–1995 war in Bosnia and Herzegovina.

Introduction: Diabetic nephropathy is a chronic complication in patients with diabetes melli- tus typ 1, which leads to kidney disfunction. Aim: The aim of this study was to compare the metabolic control and albuminuria with ultrasound fin- dings of morphometric measurements and registration Doppler signals of kidneys between children and youth with diabetes mellitus type 1 according to the duration of illness. Material and Methods: The retrospective-pro- spective study included 69 patients of both genders, that got diabetes mellitus type 1 when they were in the age from 2. to 25. years. Patients were divided into two groups according to the length of diabetes mellitus type 1: the first group was those whose illness had la- sted for more than 10 years, and second group with du- ration of diabetes mellitus typ 1 less than 10 years. Results: No significant difference was registered between the groups regarding frequency of albuminu- ria, but the chance of it occurring are greater in patients with longer duration of diabetes mellitus type 1. Pati- ents with albuminuria and diabetes mellitus type 1 du- ration over 10 years had higher glycated hemoglobin A1C, blood pressure, body mass index followed by en- larged volume of both kidneys. Patients with albumi- nuria and diabetes mellitus type 1 for less than 10 years had a higher creatinine clearance. Conclusion: Ultrasound dimensions and volume of the kidneys in patients with metabolic control para- meters are useful for monitoring especially in the early

Objective – Outbreaks of sepsis caused by multidrug-resistant Acinetobacter baumannii in neonatal intensive care units have been reported, but rarely from our country. We describe such an outbreak in the Department of Paediatrics of the University Clinical Centre Tuzla in 2012 to investigate risk factors, the mode of transmission and to assess control measures. Setting – An 18 bed, level 3 neonatal intensive care unit in a university affiliated teaching hospital. Patients and methods – Seventeen neonates who developed multidrug-resistant Acinetobacter baumannii nosocomial infection were matched to 17 neonates who were admitted to the same unit without infections, during the outbreak period. Cases and controls were compared for possible risk factors (birth weight, gender, intubation, antibiotic use, etc.). Surveillance cultures were collected from health care personnel and the environment. Results – Six out of the 17 neonates (35.3%) died. Surveillance cultures were negative. Seventeen isolates from newborns had the same patterns of resistance. Multidrug-resistant Acinetobacter baumannii was brought into the unit by an infected infant who was transferred from the neurosurgery hospital. Risk factors significantly associated with the infection were: incubator care (OR 6.66; p =0.034), exposure to a central venous catheter (OR 13.75; p=0.004), mechanical ventilation (OR 5.25;p =0.031) and exposure to a patient with Acinetobacter baumannii infection (OR 38.40; p =0.02). Conclusion – Surveillance cultures for all newborns transferred from other hospitals and isolation measures are important to prevent nosocomial infections and outbreak. Negative environmental and health care worker cultures have to be meticulously analyzed. Cohorting of affected newborns and nursing staff, contact isolation, and environmental cleaning are crucial to control the outbreak.

Lung agenesis and gastric duplication cysts are both rare congenital anomalies. Gastric duplication cysts can present with nausea, vomiting, hematemesis, or vague abdominal pain. Unilateral pulmonary agenesis can present with respiratory distress which usually occurs due to retention of bronchial secretions and inflammations. We report the unique case of right pulmonary agenesis associated with gastric duplication cyst.

Background. Diabetic neuropathy is a clinical or sub-clinical disorder in type 1 diabetes mellitus (T1DM) in the absence of any other causes for peripheral neuropathy. Methods. This one-year study comprised 69 subjects, children and adolescents with T1DM. The metabolic control of the illness was assessed on the basis of the glycaemia, glycosylated haemoglobin, lipid status, blood pressure, body weight and height and body mass index of the subjects. The data from a questionnaire assessed the frequency of clinical signs of diabetic neuropathy. Results. The clinical manifestations of diabetic neuropathy were muscular weakness, cramps, paraesthesia, insensitivity to pain, vomiting, diarrhoea, urinary disorders. The subjects with neuropathy had glycaemia of 9.8±1.8 mmol/L and HbA1C 10.6 ± 2.2%, with statistically significantly increased triglyceride levels (t=1.8, p=0.04), systolic and diastolic blood pressure (t=5.4, p 10 years had significantly more frequent pathological findings of the back of the eye (X2=3,2, p=0,02), with no statistically significant difference in albumin/creatinine (urine). The ROC curve with an analysis of age at the beginning of neuropathy was 11.7 years, with 55% sensitivity and 82% specificity. Conclusion. Our analysis suggests that there is a significant connection between the metabolic condition and the duration of the illness and the increased frequency of neuropathy in children and adolescents with T1DM. Aim. To test the hypothesis that metabolic control and length of illness are connected with an increased frequency of neuropathy in children and adolescents with T1DM.

Atopic dermatitis (AD) is a chronically relapsing, inflammatory skin disease characterized by severe itch, rash and dry skin. Hypersensitivity to aeroallergens is found in 40%-50% of children with AD and it is the cause of intensive skin lesions. The aim of the study was to assess the presence of hypersensitivity to aeroallergens in AD children. The study included 114 children (56 boys and 58 girls), median age 27.5 months, who had been diagnosed with AD according to Hanifin and Rajka criteria. The severity of the disease was assessed by the SCORAD index. To recognize hypersensitivity to aeroallergens, the following parameters were analyzed: medical history, values of absolute eosinophil count, total IgE antibodies, specific IgE antibodies to aeroallergens, and results of the skin prick test for aeroallergens. A moderate form of the disease was present in 61.4% of study children, with a median SCORAD index score of 28.5 points; 12.3% of study children showed hypersensitivity to aeroallergens (history of hypersensitivity to aeroallergens in 27.2%, increased absolute eosinophil count in 53.5%, increased total IgE antibodies in 56.1%, positive skin prick test in 20.2%, and positive specific IgE antibodies to aeroallergens in 12.3% of children). The most common aeroallergens responsible were house dust in 6.1% and Dermatophagoides pteronyssinus in 3.5% of children with AD. Hypersensitivity to aeroallergens was recorded in the same number of children with mild and severe forms of the disease and in 5.7% of children with a moderate form. In conclusion, the presence of hypersensitivity to aeroallergens in children with AD is significant. By discovering and removing the aeroallergens responsible, it is possible to achieve reduction in the intensity of skin lesions and frequency of exacerbations.

Background: The SCORAD index is most often used to assess the severity of atopic dermatitis (AD). Hypersensitivity to food allergens is found in up to 60% of children with moderate to severe forms of the disorder and it is a significant cause of intensification of skin changes. Aim: The study was to assess the severity of AD and the presence of hypersensitivity to food allergen. Methods: The study comprised 114 children (56 boys and 58 girls) aged from 1.5 months to 14.9 years, with diagnosed AD according to Hanifin and Rajka’s criteria. The severity of the illness was assessed by the SCORAD index and the following were analysed to recognize hypersensitivity to food allergens: anamnesis data, total IgE antibodies, specific IgE antibodies and the results of the skin prick test (SPT) for food allergens. Results: 61.4% of children had a moderate form of the illness, the median SCORAD index was 28.5 points. There was a significant correlation with the total SCORAD index values for: spread (p< 0.0001), intensity (p<0.0001) and subjective signs (p<0.0001), as well as a correlation between the parameters: spread and intensity of changes (p < 0.0001); spread and subjective signs (p< 0.0001); intensity and subjective signs (p < 0.0001). Hypersensitivity to food allergens was found in 28% of children tested (history of hypersensitivity to food 47.5%, high total IgE antibodies 56.1%, SPT positive 32.4%, specific IgE antibodies to food allergens 28%), and the most frequent allergens responsible were cow’s milk, 12.3% and eggs in 5.3% children. Conclusion: The most common was the moderate form of illness, and hypersensitivity to food allergens was significantly present. By removal of the responsible allergen, we can contribute to a reduction in the intensity of changes.

Background: In University Clinical Center, Department of Obstetrics and Gynaecology is using reference data from 1974 developed for the infants born in Belgrade (Serbia). It estimates the standards of term infants for neonatal weight, length and head circumference. Aim: This study was create to develop charts for birth weight, lenght and head circumference specific to gestational age, gender and parity for term singleton infants in Tuzla Canton. Methods: The study was conducted at University Clinical Center Tuzla, Department of Obstetrics and Gynecology, a primary obstetrical care facility for residents of Tuzla Canton over the one-year period. During the one year study period, 01.01.- 31.12.2009, there were 4106 infants born at 37th to 41th weeks of gestation (GW), 2168 (52.8 %) males and 1938 (47.2%) females. We analysed gestational age, birth weights, body length and head circumference. Results: Females infants of primiparae, born at 40th gestational week, had the lowest median birth weight, 3500 g, followed by female infants of multiparae, 3640 g, and male infants of primiparae, 3650 g. The greatest median birth weight, 3730 g, had male infants of multiparae. Median birth length value at the 40th gestational week for male infants of primiparae and multiparae, as well as female infants of multiparae is the same, 55 cm, while is lower in female infants of primiparae (54 cm). There is no difference in median head circumference at the 40th gestational week between female infants of primiparae and multiparae, and male infants of primiparae (35 cm). Mean birth weight and length of liveborn infants at 37. to 41. gestational week differed significantly between certain parities (F=8,723, Df=2, p<0,001; F=3,292, Df=2, p=0,037, respectively). No significant difference was found for head circumference (F=0,983, Df=2, p=0,374). Conclusion: The average birth weight of infants within Tuzla Canton is bigger in comparison with the centile that have been used so far.

Background. Transfusion therapy represents a rational model of therapy which is frequently used in neonatal period. Aim.to investigate predictive role of blood group, Rh factor and gestational age in transfusions reaction in neonates. Patients and methods. we evaluated 95 neonates gestational age between 28 and 42 weeks treated with blood components. All neonates were treated in the Unit of Neonatology at Department of Gynecology and Obstetrics at University Clinical Center Tuzla in the period of 01.01.2006.-31.12.2008. Results. During the period of investigation there were 12 526 born neonates gestational age from 28 to 42 weeks. Incidence of transfusion reaction was 0, 37%. The median of gestational age in the complete sample was 38 weeks, with interquartile range from 35 to 39 weeks, with 28 weeks minimum and 40 weeks maximum. The incidence of transfusion reaction in relation with the blood group was most evident in recipients in blood group type A, but there were no statistically significant differences in incidence of transfusion reactions between four blood groups (X2=6.352; df=3; p=0.097). There was no statistically significant difference in incidence of transfusion reaction according to the Rh factor (X2=0.755; df=1; p=0.385). Investigation of transfusion reaction according to the blood group and Rh factor showed no statistically significant difference (X2=8.063; df=7; p=0.327). The logistic regressional analyses showed that the gestational age is significant predictor of appearance of transfusion reaction (OR=0.867; %95 CI=0.756 do 0.993; p=0.04). Conclusion. Transfusion reactions in neonates are not rare. The blood group and Rh factor are not valid in prediction of transfusion reaction while the gestational age is good predictor in appearance of transfusion reaction.

Aim.Goal of the study was to assess the frequency of birth and mortality of low birth weight infants based on the level of neonatal institution where they were born and/or treated according to gestational age, in the Federation of Bosnia and Herzegovina. Methods. Through the prospective study over one-year period from 01.01. to 31.12.2009, the infants were analysed (stillborn and liveborn) of both genders, gestational age 24-42 weeks and birth weight below 2500 grams. Results. During the assessment period, 22897 infants were born, 669 with low birth weight, so that the incidence was 2.9 %. Gender breakdown is proportional. Most of the infants were born in two largest Cantons, Sarajevo and Tuzla. In the first level neonatal institutions 29 infants were born, 286 in the neonatal institutions of the second level, and 354 low birth weight infants were born in the neonatal institutions of third level. There is statistically significant discrepancy in frequency of low birth weight infants' births between neonatal institutions of first and second level (χ2=272.1; P<0.0001), as well as second and third level (χ2=13.4; P<0.0002). Of 29 low birth weight infants born in neonatal institutions of first level, 26 were referred to other institutions, while 3 died in the institution where they were born. Neonatal institution of second level kept 127 infants at treatment, 53 of whom died. There was no statistically significant discrepancy in mortality of low birth weight infants between the institutions of first and second level (χ2=0.71; P=0.398), with relative risk [ RR=0.507 (95% CI 0.148- 1.738) ]. In third level neonatal institutions, 513 infants were treated and 461 survived, while 52 died. Statistically significant discrepancy was found in the mortality rate of low birth weight infants between the institutions of second and third level ( χ2=71.8; P<0.0001), with high relative risk [ RR=6.349 (95% CI 4.030-10.003) ]. Conclusion: Survival of low birth weight infants born in the maternity hospitals with neonatal institutions of third level is statistically higher than the survival rate of infants born in the maternity hospital with neonatal institutions of first and second level.

Objectives. We examined association between incidence rate of low birth weight in liveborn infants and maternal sociodemographic status in Tuzla Canton during 1992–1995 war in Bosnia and Herzegovina. Methods. The present study covers a 22-year period (1988–2009), including the war period (1992–1995), and we retrospectively collected data on a total of 108 316 liveborn infants and their mothers from three different socioeconomic periods: before (1988–1991), during (1992–1995), and after the war (1996–2009). Association between incidence rate of low birth weight in liveborn infants and maternal sociodemographic status were determined for each study period. Results. There were 23 194 live births in the prewar, 18 302 during the war, and 66 820 in the postwar period. Among the liveborn infants born during the war, 1373 (7.5%) had birth weight of <2500 g, which is significantly more in comparison with 851 (3.6%) liveborn infants in this birth weight group born before and 1864 (2.8%) after the war. We found the number of examinations during pregnancy was 1.8 per pregnant woman in the war period, which was low in comparison with the number of examinations before (4.6 per pregnant woman) and after (7.1 per pregnant woman) the war (P<.001 for both). Prewar perinatal mortality LBW infants of 6.2 per 1000 live births increased to 10.8 per 1000 live births during the war (P<.001), but after the war, perinatal mortality LBW infants (5.2‰) and early neonatal mortality (2.4‰) decreased. Conclusions. We found statistically significant association between low-birth-weight and maternal sociodemographic status in Tuzla Canton during 1992–1995 war in Bosnia and Herzegovina.

Abdominoscrtoal hydrocele is unusual condition with large scrotal hydrocele, which communicates through narrow inguinal channel with abdominal component. Abdominoscrotal hydrocele is not a benign condition, because complications such as acute appendicitis, testicular dismorphism, ureterohydronephrosis, paratesticular malignity have been described earlier. This case study describes one year old boy with both-sided abdominoscrotal hydrocele. Abdominal masses connected with hydrocele need to induce a suspicion of this condition. Early diagnosis and existing surgical techniques for treatment of this disorder are the key factors in prevention of complications associated to this disorder.