The aim of the present study was to analyze complete blood count (CBC) and C-reactive protein (CRP) levels to create the predictive score for diagnosis of early-onset neonatal sepsis (EONS). All neonates treated for suspected EONS between January 2004 and December 2006 were evaluated from their case record. A diagnosis of EONS was made if either clinical findings consistent with sepsis developed within 72 hours of life, or if positive cultures were obtained. Evaluations for EONS were preformed in 341 neonates, and 199/341 (58.4%) developed EONS. Total white blood count, immature/total ratio, immature/ mature ratio, and CRP levels were found to be independent predictors of EONS, and the predictive score for EONS was created. An increase in the predictive score for EONS was directly correlated with possibility of EONS. Receiver operating characteristic (ROC) curve analysis determined a cut-off value of a predictive score for EONS > 0.503, with sensitivity of 73% and specificity of 89%. Correct prediction of EONS was found in 78% of all neonates, 80% for positive and 75% for negative outcome (p < 0.0001). In conclusion, for its high sensitivity and prediction rates, the predictive score for EONS is useful in diagnostic evaluation of neonates suspected for EONS.

UNLABELLED Each birth which has happened before gestation period of 37 weeks of gestation and which is not related to a degree of birth difficulty is called premature birth. Different researches pointed out that C-reactive protein (CRP) can be used as a possible marker of idiopathic preterm delivery. RESEARCH GOALS WERE To examine reliability of CRP in mothers serum as a marker of premature birth among pregnant women who had no of the known risks for premature birth. To determine critical value of CRP in pregnancies this ended up as a premature birth. To determine connection between value of CRP and low birth weight of the newborn. The research is done in a form of prospective study on 200 pregnant women. Research included pregnant women without known risks factors for premature birth with condition that those women had suitable antenatal protection. All pregnant women were divided in into two groups, experimental and control group. Experimental group is consisted of 150 pregnant women who were regularly controlled in ambulance. Control group consisted of 50 pregnant women who were hospitalized at the Department for Pathology of pregnancy due to threatening miscarriage symptoms of condition that tocolytic index were less than 4. The value of CRP in serum of all pregnant women was determined in period from 20 to 24th week of gestation. In further course of pregnancy we followed those pregnant women with more often premature birth and if premature birth occurred more often in pregnant women with increased value of CRP in relation to women who had normal values. As a critical value for CRP was taken > 2 median value. Besides descriptive statistic methods in evaluating data processing were used (see text for symbols) test, student's t-test, Fishers test and Mann-Whitney test. RESULTS Mean value of CRP in experimental group was 3.913 and in control group 14.92 (t = 4.72, p < 0.0001). Mean value of CRP was 18.17 in group of prematurely births and in women who gave birth on time 3.87 (t = 5.72, p < 0.0001). Value of CRP > 2 had 33 women who gave birth prematurely (16.5%). CONCLUSIONS CRP can be used as a reliable marker of idiopathic premature birth. CRP value which is connected with development of premature birth is 4 mg/l. There is connection between the value of CRP > 2 and low birth weight of the newborn.

Clinical characteristics of Atopic Dermatitis (AD) in children were analyzed, and severity of illness was estimated using SCORAD point system index and Three Item Severity score (TIS) index. The research was done at the Clinic for Children Diseases in Tuzla. The inclusion criteria were: diagnosis of AD according to Hanifin and Rajka criterions, age up to 15. The exclusion criteria were: not meeting the criteria for an AD diagnosis, over 15 years of age, usage of anti-histamines in the last 5 days and/or usage of corticosteroids in the last 4 weeks, and diagnosis of other illnesses that do not have atopic foundation. The analysis included: clinical characteristics, parameters of both score systems and correlation of SCORAD and TIS indices. The conditions of research were met by 261 children (128 boys and 133 girls), with median age of 16.8 +/- 5.4 months. The early occurrence of AD changes (before the second year of life) were present in 51.3% of children, the positive anamnesis for AD was found in 17.2% of children, changes in AD typical localization in 96.6% of children, oversensitivity to food in 47.5% and airborne allergens in 12.3% of children. The values of SCORAD index were ranging from 14-92 (median 37.1 +/- 18.06) and a significant correlation of the parameter to the total value of SCORAD index (distribution p = 0.0002; intensity p = 0.001; subjective symptoms p < 0.0001). The values of TSI index were ranging from 1-8 (median 4.3842.03) with the significant correlation of parameter to the total value (for erythema p < 0.0001; for edema p < 0.0001; and for excoriation p = 0.0007). When comparing the SCORAD and TIS index values, we found significant correlation (r = 0.531; p < 0.0001). TIS index as a simplified SCORAD index is reliable for the quick estimate of illness in daily medical work, but in clinical research SCORAD index offers a much more detailed and reliable estimate.

Every year millions of children worldwide die because of potentially treatable diseases, and diseases that can be prevented. The largest number of lethal outcomes can be prevented by improving living conditions, by activities to improve public health, improving education and training of health care professionals for timely detection of serious diseases and the improvement of initial medical treatment. Treatment of a seriously ill child requires a structured approach. In particular, the anatomical and physiological features of the child and the way in which changes with age may affect emergency treatment activities. Early recognition of potential respiratory, circulatory or central neurological disorders in children may reduce mortality and morbidity. Pre-hospital effective implementation of emergency medical care is an important element in reducing mortality in childhood. Â

Early diagnosis and treatment of the neonate with suspected infection are essential to prevent severe and life-threatening complications. The aim of this retrospective study was to evaluate the validity of the hematologic scoring system in diagnosing earlyonset neonatal infection (EONI), according to Rodwell et al. We included 341 term singletons of both genders, gestational age of 37th to 42nd week, with risk factors for EONI and without visible anomalies. A diagnosis of EONI was based on clinical, laboratory and/or microbiological findings of EONI, without consideration of hematologic findings. Hematologic findings (white blood with differential count, and platelets count) were scored according to Rodwell et al. The cut-off score was 3. During the study period, there were 12 298 live births, 11 599 terms and 699 prematures. In the first 72 hours of life, 199/341 (58.4%) neonates were considered to have EONI, of which 52/199 (26.1%) neonates with proven and 73.9% probable EONI. The applied hematologic scoring systems in EONI had high specificity (92%) and positive predictive value (PPV) (88%), as same as in probable EONI with specificity of 92% and PPV of 84%. In proven EONI both specificity (92%) and negative predictive value PPV (82%) were high. The validity of the hematologic scoring system in diagnosing EONI among neonates with risk factors is acceptable. The use of the test is available even in the smallest delivery rooms, and the price is reasonable, not only for single but for repeated use.

Introduction: Sleep-disordered breathing is common in children.There is a large scale of symptoms, from plain harmless snoring to obstructive sleep apnea syndrome (OSAS). Obstructive sleep apnea in pediatric population is commonly caused by enlarged tonsils or adenoids and affects between 1% and 3% preschool and school aged population. The aim of this study was to examine quality of life in children before and after adenoidectomy, that did not have enlarged tonsils. Patients and Methods: Prospective study included 30 children with OSA symptoms both sexes from 3-12 years old consequtive admited to ENT Clinic Tuzla for adenoidectomy, without tonsillar hypertrophy,and it was carried out in the period from mid November 2005 to end of June 2006. Specific exclusion criteria were: no existing of OSA, neuromuscular disorders, constitutional maxillofacial anomalys, septal deviation, mental retardation, obesity (BMI>30). Hystory was taken from parents or caregiver, each child was examined from ENT specialist, paediatrician and anestesiologist. The adenoid size was estimated by palpation or/and X-ray examination of nasopharynx. By oropharyngoscopy was not found tonsillar hypertrophy. OSA -18 quality of life survey was used to estimate improvement of quality of life after adenoidectomy. The same parent completed OSA-18 servey before surgery and second OSA-18 servey 5 weeks after surgery. The children, that had asserted symptoms of OSA by OSA-18 quality life survey, were analysed by this survey 5 weeks after surgery.Results before and after surgery were compared. Adenoidectomy was done with standard operation technik at ENT departmant, witch includes complete removal of adenoids with uniform anestesiology protocol. Results: In 13 patients undergone adenoidectomy OSA had a small impact on quolity of life, at 13 patents had a moderate impact and at 4 patents had a large impact. Significant improovement of quality of life after adenoidectomy was found in all domains using QOL-OSA-18 test: sleep disturbance (P< .0001), physical suffering (P< .0001), emotional distress (P< .0001), daytime problems (P= .0055) and caregiver concerns (P< .0001). The mean OSA-18 –QOL total change score showed significant impruvment of quality of life in patients suffering from OSA who undergone adenoidectomy (P< .0001).

We have analyzed diagnostic value of interleukin 6 (IL-6) from the umbilical cord blood in recognition of early neonatal infection (ENI) of newborns whose mothers have obstetrical risks. The study included 120 newborns with birth weight <2500 gr., gestational age from 37 to 42 weeks, which mothers had some of the obstetrical risks. We established three groups: group A (newborns with microbiological proof of ENI), group B (clinical signs and hematological parameters of ENI) and group C (newborns without ENI). Median of IL-6 value in group A was 48.5 pg/ml with sensitivity, specificity and diagnostic value in recognition of ENI 78%, 81% and 80%. In group B median of IL-6 was 49 pg/ml with sensitivity, specificity and diagnostic value 65%, 80% and 77%. In group C median of IL-6 was 9.7 pg/ml. We noticed significant connection between value of IL-6 and mother's urinary tract infection; group A (p=0.023), group B (p = 0.007). Also there was a remarkable relationship between mother's colpitis and level of IL-6 in newborn with ENI in group A (p=0.011) and group B (p = 0.012). High levels of IL-6 in umbilical cord blood can help us in recognition of newborns that are endangered by infection and they are clearly connected with some of mother's obstetrical risks.

UNLABELLED Obstructive sleep apnea (OSA) caused by enlarged tonsils and adenoids is common in pediatric population. The prevalence of pediatric obstructive sleep apnea syndrome has been estimated to be between 1% and 3% in preschool and school-aged children. The aim of this study was to examine quality of life in children before and after adenotonsillectomy. SUBJECTS AND METHODS This study was prospective and it was carried out in the period from mid-November 2005 to end-June 2006. Specific exclusion criteria were: no existing of OSA, neuromuscular disorders, constitutional maxillofacial anomalies, septal deviation, mental retardation, obesity (BMI > 30). Anamnesis was taken from parents or caregiver, each child was examined from ENT specialist, Pediatar and Anestesiolog. The adenoid size was estimated by palpation or/and X-ray examination of nasopharynx. The tonsils size was estimated by Brodsky scala. OSA-18 quality of life survey was used to estimate improvement of quality of life after adenotonsillectomy. The children that had asserted symptoms of OSA by OSA-18 quality of life survey, were analyzed by this survey 5 weeks after surgery. The results before and after surgery were compared. The adenotonsillectomy was done with standard operation technique at our ENT department (cold dissection using termocauter), and comprehends removal palatinal tonsils and adenoids, that are removed by adenotom with uniform anestesiology protocol. RESULTS At 13 patients (43.3%) undergone adenotonsillectomy, OSA had a small impact on quality of life, at 11 (36.7) patients had a moderate impact and at 6 (20%) patients had large impact. Statistical significant improvement of quality of life after adenotonsillectomy was found in all domains using OSA-18-QOL survey: sleep disturbance (P < 0.0001), physical suffering (P < 0.0001), emotional distress (P < 0.0001), daytime problems (P = 0.0081) and caregiver concerns (P < 0.0001). The mean OSA-18-QOL total change score showed significant improvement of quality of life in patients suffering from OSA who undergone adenotonsillectomy. CONCLUSION Adenotonsillectomy improves quality of life in children suffering from OSA caused by adenotonsillar hypertrophy.

UNLABELLED Early-onset neonatal sepsis (EONS) is one of the most common diagnostic challenges in neonatal population. Aims of this study was to analyse values of total white blood count (WBC) and differential count in neonates with EONS and to determine cut-off values with the highest accuracy in diagnosis of infection. PATIENTS AND METHODS In the retrospective-prospective research we include 341 neonates born from 37th to 42nd week of gestational age, with one or more obstetric risk factors for EONS, in single pregnancy, both genders and without visible anomalies. Capillary blood samples for analysed parameters levels were obtained in the first 72 hours of life. A diagnosis of EONS was based on microbiological findings, clinical signs and radiography of chest. RESULTS Obstetric risk for EONS at delivery had 341/12 298 (2.8%) neonates, and EONS occurred in 199/341 (58.4%) neonates. The mean total WBC count was 22.5 +/- 9.5 x 109/L, the mean absolute mature neutrophil count was 13.9 +/- 6.8 x 109/, while the mean total neutrophil count was 15.6 +/- 7.8 x 109/L. Neonates with EONS had medial of total immature neutrophil count of 1.2 x 109/L, immature to total neutrophil ratio (I:T ratio) of 0.09 and medial of immature to mature neutrophil ratio (I:M ratio) was 0.10. ROC curve analysis cut-off values of I:T (> 0.08) and I:M (> 0.09) ratio had acceptable accuracy in the diagnosis of EONS. The value of total WBC > 26.4 x 109/L, with accuracy of 88% predict EONS. High predictive value (82.9%) in EONS had total neutrophil count value of more than 17.6, and total immature neutrophil count value of more than 1.1 x l09/L predict presence of EONS with accuracy of 65.3%. Cut-off values of I:T (66.8%) and I:M (67.3%) ratio almost in the same percent predict EONS. In univariable predictive model, only cut-off value of mature neutrophil count was not significant in the detection of EONS, while cut-off values of other analysed parameters had significant predictive value (p < 0.05). CONCLUSION Total white blood count and differential count are changed in neonates with early-onset neonatal sepsis. The predictive value of analysed parameters cut-off values is important in everyday work of neonatology's to make difference among infected and non-infected neonates.

Objective – The aim of the study was to investigate the effectiveness of surfactant therapy usage for preterm newborns on the frequency, type and the time of occurrence of respiratory distress syndrome (RDS) complications and mortality.  Patients and methods – Over a four year period all newborns of gestational age 24 to 34 weeks and diagnosed with RDS, were reviewed retrospectively, that is 130 preterm newborns with therapy and they constituted the research group. The control group included preterm 147 newborns with the same characteristics, who were not given surfactant.  Results – Complications of RDS are divided into complications of the respiratory system, central nervous system (CNS) and sepsis. 64/130 (49.2%) were diagnosed with CNS complications, there were less respiratory system complications 40/130 (30.8%), and 26/130 (20%) preterm newborns with sepsis. In the first 3 days CNS complications occurred in 12/64 (18.7%) newborns, but they mostly occurred from the 4th to 7th day of life (50%). Respiratory system complication in the first 3 days was found in 22.5% newborns, but in the control group the number was higher (43.2%). Complications of the respiratory system were mostly from 4 to 7 days (50%), and in the control group 29.5%. Sepsis was diagnosed mostly after the 8th day, in 16/26 (61.5%) newborns, and in the control group the number was lower 6/18 (33.3%). The preterm newborns who were given surfactant had a higher chance of survival in comparison to preterm newborns who were not given surfactant (I‡Â² test = 2.77; P =0.095).  Conclusion – The usage of surfactants in any form reduces the incidence of RDS, the frequency of complications, the time of occurrence of the complication of CNS and respiratory system.

Aim – Research was undertaken with the aim of evaluating the diagnostic value of the C-reactive protein (CRP) from umbilical blood in early neonatal infections (ENI) regarding clinical signs, haematology-laboratory parameters and microbiological results.  Examinees and methods – Prospective research at the Clinic for gynecology and obstetrics in Tuzla, in the period from March to December 2006, included 120 examined children of gestation period of 37 to 42 weeks, with birth mass below 2.500 grams. CRP values of umbilical blood, clinical symptoms of the disease, haematology-laboratory parameters and microbiological results were analyzed.  Results – Average CRP value of umbilical blood in the examined group was from 3.52±2.36 mg/l. 20/120 neonates had increased values of CRP. Sensitivity of CRP regarding clinical symptoms was found in 41%, regarding haematology-laboratory parameters in 53%, and only 21% regarding microbiological results. Specificity of CRP is especially high regarding haematology-laboratory parameters in 99%, as well as clinical symptoms in 92%, and slightly lower for microbiological results - 85%.  Conclusion – CRP from umbilical blood has limited value regarding clinical, haematology-laboratory and especially microbiological results. However, as a quick and easily available test it can serve for the recognition of healthy neonates and for the choice of neonates who require monitoring and treatment until microbiological results arrive.

Transport of newborns in mortal danger is usually interhospital (secondary) transport and it implies transport from one institution to another in cases when a regional hospital is not able to offer adequate treatment to a newborn in mortal danger. It can be antenatal »in utero« transport which offers transport of a high-risk pregnant woman and transport of a newborn. Transport of newborns in mortal danger is performed in two ways: from general hospitals »one-way transport«, or from tertiary institutions »two-way transport«. The system of interhospital transport consists of five components: organization, com­munication, staff, equipment in the ambulance and 24-hour availability. Efficient functioning of transport requires careful planning, detailed instructions and standards regarding the staff, procedures and the equipment necessary for the transport programme. Transport quality is assessed by a Scoring System which evaluates the status of the neonate in mortal danger before and after transport.

Aim – The aim of the study was to discover risk factors for delivery-plexus brachialis injury in newborns.  Methods – The data on plexus brachialis paralysis during the delivery of 45503 newborns were analyzed studying retrospectively babies who were delivered from 1 January 1996 to 31 December 2004 at Clin­ics for gynecology and obstetrics at the University-clinical centre in Tuzla. In the analyzed population we found 86 newborns with plexus brachialis injury which developed during delivery (examinees). The control group was formed of 86 newborns without plexus brachialis injury, chosen randomly as a sample from the same population (control group). The examinees and control group were compared regardless of gender, gestation period, delivery weight, presentation (occipital and pelvic) of the fetus during deliv­ery, as well as the Apgar score after the first and fifth minutes. The statistic significance of the results was evaluated with the I‡2 test.  Results – There were no differences in gender between the examinees and the control group. A signifi­cant difference in distribution of delivery weight was found between examinees and the control group: a frequency of delivery weight from 4000-4599 grams, and especially weight higher than 4500 grams, was significantly higher than in the control group. The discovered difference in incidence of occipital presentation during delivery in favor of the examinees was not statistically significant. Examinees had a significantly lower Apgar-score (≤7) - after both the first and fifth minutes. In 35 of 86 (42.5%) examinees we found combined clavicle fracture, plus in one humerus fracture and in one rib fracture.  Conclusion – The result of this research corresponds to findings from literature on risk factors for plexus brachialis injury: the most noticeable risk factors are delivery weight over 4000 grams and a low Apgar-score as a result of traumatic delivery, whereas in our research, contrary to other sources, the pelvic posi­tion of the foetus during delivery was not a statistically proven risk factor, at least in our case.