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Retinopathy of prematurity (nROP) among extremely low gestational age newborns (ELGAN) in Slovenia has increased in recent years. At the same time mortality has further decreased and less invasive approaches for treatment of respiratory distress syndrome have been established. With the aim to study the possible association between the incidence of ROP and the duration of noninvasive ventilation, this retrospective study comprised ELGANs born during the first period (2010/2011), when invasive respiratory support was the prevalent method and in the second period (2015/2016), when noninvasive respiratory support was adopted. The results showed that the duration of noninvasive ventilation is a potential risk factor for ROP. Controlling for known risk factors for ROP and then adjusting for gestational age, number of transfusions and fraction of inspired oxygen (FiO2), the odds of ROP were 1.22 times greater (95% confidence interval, CI 1.01–1.48) with every additional week of noninvasive ventilation (p = 0.03).

Understanding the attitudes of a particular society on a “good death” is important when it comes to end-of-life decision-making and palliative care. In the Republic of Croatia no systematic research has been done on the attitudes of the general population about the concept of a “good death”. This cross sectional survey was conducted on a three-stage random sample, stratified by regions, counties and locations within those counties (N = 1203) during November and December, 2019. ANOVA, to determine differences, factor analysis and multiple regression analysis were used. The most important characteristics of a good death outlined by the respondents were: the absence of pain, the presence and unencumberedness of family and loved ones, the importance of a sense of fulfilment and meaning in life in this regard, reconciliation with God, the presence of awareness and sobriety, and the possibility of treatment.

Purpose. With this 11-year long retrospective study (2009–2019) we wanted to ascertain the incidence of respiratory tract colonisation of extremely low gestational age newborns (ELGANs) with Ureaplasma parvum and Ureaplasma urealyticum and if there is a difference in the severity of bronchopulmonary dysplasia (BPD) between preterm infants with proven respiratory tract colonisation with U. parvum and U. urealyticum and without colonisation, controlled for other risk factors for BPD. Methods. We reviewed the medical records of ELGANs 23 0/7–27 6/7 weeks of gestation, tested for U. parvum and U. urealyticum. The causative Ureaplasma species (spp.) were identified using Mycofast Screening Revolution assay based on liquid broth cultures or with the PCR method. Results. This study included 196 preterm newborns. Fifty (25.5%) newborns had Ureaplasma spp. respiratory tract colonisation, with U. parvum being the predominant species. The results showed a slightly growing incidence rate of respiratory tract colonisation with Ureaplasma spp. in the observed period. The incidence rate for 2019 was 16.2 per 100 infants. We also discovered a statistically significant correlation between the severity of BPD and the colonisation with Ureaplasma spp. (p=0.041). Controlling for other risk factors for BPD in the regression model, the preterm infants colonised with Ureaplasma spp. had 4.32-times (95% confidence interval, CI 1.20–15.49) higher odds for developing moderate to severe BPD. Conclusions. Our results suggest that U. parvum and U. urealyticum could be associated with the development of BPD in ELGANs.

Patient: Male, newborn Final Diagnosis: Hyperkalemia Symptoms: Respiratory distress • ventricular tachycardia Medication: — Clinical Procedure: Exchange transfusion Specialty: Pediatrics and Neonatology Objective: Unknown ethiology Background: Hyperkalemia is an important cause of arrhythmias and a medical emergency that requires urgent treatment. The etiology is usually multifactorial. It is most frequently caused by impaired potassium secretion, followed by transcellular potassium shifts and an increased potassium load. Case Report: A male newborn developed monomorphic ventricular tachycardia 2 hours after birth. He was born in the 35th week of gestation by urgent C-section following placental abruption. Laboratory results showed hemolytic anemia (Hb 99 g/L, Hct 0.31) with increased bilirubin levels and reticulocytosis, thrombocytopenia (39×109/L), hypoglycemia (0.8 mmol/L), and severe hyperkalemia (9.8 mmol/L). Umbilical artery blood gas analysis showed hypoxemia with acidosis (pO2 3.8 kPa, pH 7.21, pCO2 7.84 kPa, HCO3 23.3 mmol/L, BE –5 mmol/L). Creatinine (102 µmol/L) and urea (9.8 mmol/L) were mildly elevated. Inflammatory markers were also increased (CRP 26 mg/L, blood leukocyte count 24×109/L). Early-onset sepsis, caused by Candida albicans, was confirmed approximately 24 hours after birth. Non-invasive ventilation with 35–40% O2 was necessary due to transient tachypnea. The neonate received a transfusion of packed red blood cells, a 10% glucose infusion, and empirical antibiotic therapy. Hyperkalemia accompanied by arrhythmias was treated with calcium gluconate, insulin, Sorbisterit enema, and, finally, by exchange transfusion. Conclusions: We report a case of severe hyperkalemia in a newborn immediately after birth. Making a decision as early as possible regarding exchange transfusion is essential in patients with hyperkalemia with electrocardiogram changes and hemodynamic instability.

To survey university students on their views concerning the respect for autonomy of patients and the best interest of patients in relation to the withholding of resuscitation.A cross-sectional survey among university students of medicine, nursing, philosophy, law and theology of the first and the final study years at the University of Ljubljana and the University of Zagreb was conducted during the academic year of 2016/2017. A questionnaire constructed by Janiver et al. presenting clinical case vignettes was used.The survey response rates for students in Ljubljana and Zagreb were 45.4% (512 students) and 37.9% (812 students), respectively. The results of our research show statistically significant differences in do-not resuscitate decisions in different cases between medical and non-medical students in both countries. Male and religious students in both countries have lower odds of respecting relatives' wishes for the withholding of resuscitation (odds ratio 0.49-0.54; 95% confidence interval). All students agreed that they would first resuscitate children if they had to prioritize among patients.Our study clearly shows that gender, religious beliefs, and type of study are important factors associated with the decisions pertaining to the respect for autonomy, patient's best interest, and initiation or withholding of resuscitation.Preučiti mnenja študentov glede odločitev o avtonomiji pacientov in njihovi največji koristi z vidika odločati se za neoživljanje.Opravljena je bila presečna raziskava med študenti medicine, zdravstvene nege, filozofije, prava in teologije prvih in zadnjih letnikov študija univerz v Ljubljani in Zagrebu v akademskem letu 2016/2017. Vprašalnik je bil zasnovan na podlagi vprašalnika Janvier et al., ki so predstavili klinične primere v obliki vinjet.Na raziskavo se je odzvalo 45,4 % (512) študentov v Ljubljani in 37,9 % (812) v Zagrebu. Rezultati naše raziskave so pokazali statistično pomembne razlike pri odločitvah za neoživljanje v različnih primerih med študenti zdravstvenih in nezdravstvenih fakultet obeh držav. Študentje moškega spola in verni študentje obeh držav imajo nižje obete po upoštevanju želje svojcev za neoživljanje pacienta (razmerje verjetnosti 0,49– 0,54; 95-odstotni interval zaupanja). Vsi študentje so se strinjali, da bi pri oživljanju dali prednost otrokom, če bi morali izbirati med več pacienti hkrati.Študijska smer, spol in versko prepričanje so glavni dejavniki, ki vplivajo na odločitve študentov o oživljanju, upoštevanju želje svojcev glede oživljanja, pacientovi avtonomiji in največjih koristih za pacienta.

Aim To assess the differences in the way how Slovenian and Croatian health care professionals (HCPs) confront ethical dilemmas and perceive the role of hospital ethics committees (HECs). ----- Methods This cross-sectional, survey-based study involved HCPs from three Slovenian and five Croatian university medical centers (UMC). The final sample sizes were 308 (244 or 79.2% women) for Slovenia and 485 (398 or 82.1% women) for Croatia. ----- Results Compared with Croatian physicians, Slovenian physicians reported a higher share of ethical dilemmas regarding waiting periods for diagnostics or treatment, suboptimal working conditions due to interpersonal relationships in the ward, and end-of-life treatment withdrawal, and a lower share regarding access to palliative care and patient information protection. Compared with Croatian nurses, Slovenian nurses reported a lower share of ethical dilemmas regarding the distribution of limited resources, recognizing the patient’s best interests, and access to palliative care. Compared with Croatian other HCPs, Slovenian other HCPs reported a lower burden of ethical dilemmas regarding waiting periods for diagnostics or treatment, distribution of limited resources, and access to palliative care. When encountering an ethical dilemma, all HCPs in both countries would first consult their colleagues. Slovenian and Croatian HCPs recognized the importance of the HECs to a similar extent, but viewed their role differently. ----- Conclusion Croatian and Slovenian HCPs are confronted with different ethical dilemmas and perceive the role of HECs differently

BACKGROUND Preterm infants born at less than 32 weeks of gestation are at higher risk of low total iron stores (iron deficiency). Serum ferritin is used as a valid total iron stores and iron deficiency biomarker, usually as a combination of ferritin and red blood cell counts. METHODS Serum hepcidin and ferritin values and red blood cell counts were obtained from 37 of 40 included premature infants born at less than 32 weeks of gestation at risk of iron deficiency. The first sample was obtained in the first week of life, and the second at transfer from the Neonatal intensive care unit to the maternity ward, when serum ferritin level below 25 μg/L has been defined as very low total iron stores (iron deficiency). RESULTS Ferritin median levels decreased from a median value of 152 μg/L at the first measurement to 54 μg/L at the second measurement. Hepcidin median levels also decreased from 30.1 μg/L to 2.1 μg/L. We found a positive and statistically significant correlation between levels of ferritin and hepcidin at both measurements (r = 0.57; p < 0.001 and r = 0.72; p < 0.001, respectively). Compared to serum hepcidin, ferritin at the first measurement has not statistically significant higher power in predicting children with iron deficiency before discharge from the hospital. CONCLUSIONS We found a correlation between ferritin and hepcidin levels. Nevertheless, hepcidin does not have a worse power in predicting children with iron deficiency compared to ferritin.

Retinopathy of prematurity (nROP) among extremely low gestational age newborns (ELGAN) in Slovenia has increased in recent years. At the same time mortality has further decreased and less invasive approaches for treatment of respiratory distress syndrome have been established. With the aim to study the possible association between the incidence of ROP and the duration of noninvasive ventilation, this retrospective study comprised ELGANs born during the first period (2010/2011), when invasive respiratory support was the prevalent method and in the second period (2015/2016), when noninvasive respiratory support was adopted. The results showed that the duration of noninvasive ventilation is a potential risk factor for ROP. Controlling for known risk factors for ROP and then adjusting for gestational age, number of transfusions and fraction of inspired oxygen (FiO

Background Group B Streptococcus (GBS) is the leading cause of invasive neonatal disease in the industrialized world. We aimed to genomically and phenotypically characterise invasive GBS isolates in Slovenia from 2001 to 2018 and contemporary colonising GBS isolates from screening cultures in 2018. Methods GBS isolates from 101 patients (invasive isolates) and 70 pregnant women (colonising isolates) were analysed. Basic clinical characteristics of the patients were collected from medical records. Antimicrobial susceptibility and phenotypic capsular serotype were determined. Whole-genome sequencing was performed to assign multilocus sequence types (STs), clonal complexes (CCs), pathogenicity/virulence factors, including capsular genotypes, and genome-based phylogeny. Results Among invasive neonatal disease patients, 42.6% (n = 43) were females, 41.5% (n = 39/94) were from preterm deliveries (n = 42) had early-onset disease (EOD). All isolates were susceptible to benzylpenicillin with low minimum inhibitory concentrations (MICs; ≤0.125 mg/L). Overall, 7 serotypes were identified (Ia, Ib, II-V and VIII); serotype III being the most prevalent (59.6%). Twenty-eight MLST STs were detected that clustered into 6 CCs. CC-17 was the most common CC overall (53.2%), as well as among invasive (67.3%) and non-invasive (32.9%) isolates (p p Conclusions A high prevalence of hypervirulent CC-17 isolates, with low genomic diversity and characteristic profile of pathogenicity/virulence factors, was detected among invasive neonatal and colonising GBS isolates from pregnant women in Slovenia. This is the first genomic characterisation of GBS isolates in Slovenia and provides valuable microbiological and genomic baseline data regarding the invasive and colonising GBS population nationally. Continuous genomic surveillance of GBS infections is crucial to analyse the impact of IND prevention strategies on the population structure of GBS locally, nationally, and internationally.

Recurrent myocarditis is rare with only few reports having been published for paediatric cases. Repeated use of extracorporeal membrane oxygenation is also uncommon. In this paper we will present a very rare case of a 7-year old girl with recurrent fulminant myocarditis with heart failure requiring cardiopulmonary resuscitation and mechanical circulatory support with extracorporeal membrane oxygenation. Both episodes were precipitated by a viral upper respiratory tract infection, and in both cases the cardiac function eventually completely recovered. The second episode of fulminant myocarditis was particularly complex with markedly elevated markers of myocardiocytolysis, multiorgan dysfunction and the need for prolonged mechanical circulatory support. Nevertheless, the patient made a remarkable recovery. A comprehensive diagnostic workup pointed towards an aberrant immune response as the likely cause of the girl’s susceptibility for fulminant myocarditis.

SUMMARY Delirium is a clinical syndrome often underestimated in the intensive care units (ICU). The aim of this study was to determine the prevalence and factors that influence the onset of delirium. A questionnaire was sent to intensivists in Slovenian ICUs, who estimated the prevalence of delirious patients. The questionnaire consisted of demographic data, type of ICU, diagnosis, reason for admission to the ICU, type of anesthesia and surgery, clinical condition, type of supportive therapy, presence of delirium, data on discharge, transfers between departments or patient outcome on day 30. Patient consciousness was assessed by the Richmond Agitation-Sedation Scale (RASS) and the presence of delirium by the validated delirium-screening Confusion Assessment Method for the ICU (CAM-ICU). Replies received from intensivists included data on 103 patients. According to RASS ≥-3, the prevalence of delirium was 9.5% (7 out of 74 patients). There was no difference in the prevalence of delirium between surgical and medical ICU patients (p=0.388). Delirious patients had longer hospital stay (p=0.002) and ICU stay (p=0.032) compared to patients without delirium. All delirious patients survived until day 30, whereas 19 patients without delirium died (p=0.092). Logistic regression analysis dismissed any association of delirium with patient mortality (p=0.998). Age, gender, anesthesia, mechanical ventilation, and type of surgical procedure could not be evaluated as risk factors for delirium. In Slovenian ICUs, a lower proportion of delirium was observed, as reported from similar studies. Risk factors such as gender, age, mechanical ventilation, sedation, anesthesia, or department could not predict delirium. However, prolonged hospitalization of ICU patients could predict the onset of delirium, but the presence of delirium did not increase patient mortality.

Aim Study's objective was to identify risk factors associated with bronchiolitis severity. Methods A retrospective chart review of all children 24 hours. Conclusions Respiratory syncytial virus, hRV and hBoV were the most frequently detected viruses. The majority of patients admitted to the PICU had only one virus detected. Younger age and the use of antibiotics were associated with bronchiolitis severity.

Objectives To describe the process of development of "Slovenian Ethical Recommendations for Decision-Making on Treatment and Palliative Care of Patients at the End of Life in Intensive Care Medicine" and its final outcomes. Data sources Personal experience and reflection, complemented by published data. Study selection Not applicable. Data extraction Not applicable. Data synthesis Narrative, experiential reflection, literature review. Conclusions Slovenian ethical recommendations bring a small piece to a long tradition of ethical practice in a small European country. Despite the availability of informative international guiding documents on the issue, there are several specific good reasons for a small country or a region to develop its own unique guidelines (i.e., lack of local directives and legislation, unique cultural and political situation, need for development of professional expertise and terminology, and to educate healthcare providers). The authors strongly believe that our recommendations positively impact practice and will support best possible integrated palliative and end-of-life quality care with the ICU.

Purpose The aim of the present study was to develop a population pharmacokinetic model of midazolam, and to evaluate the influence of maturation process and other variability factors in critically ill children with severe acute bronchiolitis, who received a long-term intravenous infusion of midazolam. Methods In the study were included 49 critically ill children of both genders (from 0 to 130 weeks of age) with severe acute bronchiolitis hospitalised in intensive care units. Nonlinear mixed effects modelling approach was applied for data analyses and simulations. Results The final model is a two-compartment model that includes the effects of body weight using allometric scaling with fixed exponents and maturation of clearance. For a typical subject, scaled to the adult body weight of 70 kg, population pharmacokinetic values were estimated at 8.52 L/h for clearance (when maturation function was 1), 25.5 L/h for intercompartmental clearance, and 5.71 L and 39.8 L for the volume of the central and peripheral compartment, respectively. Based on the final model, maturation reaches 50% of the adult clearance in 45.9 weeks of postmenstrual age. The influence of gender, ABCB1 genotype and biochemical parameters on midazolam clearance was not detected. Results of simulations indicate the need for reduced dosing in certain groups of patients in order to maintain plasma concentrations of midazolam within recommended values. Conclusions The developed population pharmacokinetic model can contribute to the dosing optimisation of midazolam, especially in critically ill children as it includes the influence of size and maturation of clearance, which are important parameters for achieving the desired plasma concentrations of midazolam.

Supplementary Table 1. Number of births in Slovenia during the years 2002–2018 and calculated representativeness of the sample based on the estimated incidence of invasive neonatal disease (IND) of 0.7/1000 births from reference 3. Supplementary Table 2. Antimicrobial susceptibility of Slovenian invasive neonatal and colonising pregnant women isolates of group B Streptococcus from early (2001–2011) and late (2012–2018) period (n = 171). Supplementary Table 3. Pairwise comparison of conventional phenotypic serotyping and molecular ‘serotyping’ results among invasive and non-invasive isolates of group B Streptococcus from early (2001–2011) and late (2012–2018) period (n = 171). Supplementary Table 4. Distribution of multilocus sequence typing (MLST) sequence types (STs) and clonal complexes (CCs) among Slovenian group B Streptococcus isolates overall and among isolates from infants with invasive neonatal disease (2001–2018) and pregnant woman with colonisation (2018. Supplementary Table 5. Distribution of multilocus sequence typing (MLST) and clonal complexes (CCs) among Slovenian group B Streptococcus isolates overall and among isolates from patients with invasive neonatal disease (2001–2018) and pregnant woman with colonisation (2018). Supplementary Table 6. Distribution of multilocus sequence typing (MLST) and clonal complexes (CCs) among invasive neonatal group B Streptococcus isolates from Slovenia within two groups based on disease onset. Supplementary Table 7. Distribution of multilocus sequence typing (MLST) and clonal complexes (CCs) among invasive neonatal group B Streptococcus isolates from Slovenia within two groups based on time period of disease. Supplementary Fig. 1. Distribution of invasive group B Streptococcus isolates (n = 114) from different laboratories in Slovenia from 2001 to 2018. Unfortunately, during 2001–2010, isolates from the largest laboratory (in Ljubljana) were not preserved so whole genome sequencing of those could not be performed. LJ: Ljubljana; MB: Maribor; CE: Celje; KP: Koper. Supplementary Fig. 2. eBURST analysis of 28 multilocus sequence typing (MLST) sequence types (STs) identifying six clonal complexes (CCs) and four singletons, among Slovenian group B Streptococcus isolates from infants with invasive neonatal disease (2001–2018) and pregnant woman with colonisation (2018).

Background. The aim of our study was to evaluate the damaging impact of characteristics of the central venous catheters (CVCs) on red blood cells. Methods. CVCs from three different manufacturers were analyzed, including the presence of coating, tunnel geometry, length, lumen diameter, and number of lumens with two respective flow rates (33 mL/min and 500 mL/min). Blood cell damage was defined by analyzing microparticle (MP) and hematologic analysis. MPs were isolated by ultracentrifugation of erythrocyte concentrate and analyzed on a flow cytometer. Results. Characteristics of catheters were not associated with blood cell damage at a low flow rate but showed an effect with a high flow rate. CVCs with a polyhexanide methacrylate coating have caused statistically less blood cell damage than noncoated CVCs. The length of lumens, diameter, and geometry of the tunnel showed no differences in blood cell damage. Meanwhile, the number of lumens was predicted to have a greater effect on the erythrocyte damage, which was revealed with the formation of MPs and hematological parameters. CVCs with five lumens caused significantly less damage to the blood cells than CVCs with a single lumen. Moreover, a high flow rate of 500 mL/min caused less damage to the blood cells than a low rate of 33 mL/min. Conclusion. Properties of CVCs are an important factor for quality patient care, especially when transfusing blood with high flow rates, as we want to provide a patient with high-quality blood with as few damaged cells as possible.

Objectives: To evaluate effects of parental pain management educational interventions on postoperative pain assessment, intensity and duration of small children after a one-day-pediatric surgery. Methods: We conducted a prospective randomized, observational study of parental and nurse’s pain assessments in children. The Parents’ Postoperative Pain Management rating scale (PPPM), Wong-Baker FACES Pain Rating Scale (W-B) or the Numerical Rating Scale (NRS) was used. The children’s pain was assessed by parents who were or were not (intervention vs. control groups) preoperatively educated about pain management postoperatively in the hospital and the first three days at home. Nurses who cared for the children postoperatively in the hospital, independently from the parents, assessed the children’s postoperative pain with W-B and NRS. Results: One hundred and fifty-two parents and their children were included in the study. Complete data were available for 142 parents and their children, with one parent, usually the mother (108 (76.1 %)), being involved at all stages of the study. No differences in children’s postoperative pain scores and analgesic use at home were found between the two parental groups (intervention and control groups). Parental pain scores after surgery was strongly positively correlated with pain duration, and analgesic use by their children at home. Pain intensity scores assessed by nurses in the hospital were lower compared to parental pain intensity scores. There was high inter-rater reliability between the PPPM, Wong-Baker, and NRS scales. Conclusions: No differences in postoperative pain in children were found between the intervention and control groups of parents. Parents gave higher scores of pain intensity in children than nurses did.

The majority of children with febrile seizures have viral infections and viruses were detected in 22% to 63% of children in published studies. Using molecular methods, viruses were also detected in asymptomatic persons. A prospective study was conducted to detect respiratory and enteric viruses in 192 children with febrile seizures and compare the detection rates to those found in 156 healthy age-matched controls. A respiratory or enteric virus was detected in 72.9% of children with febrile seizures and in 51.4% of healthy controls. The viruses most strongly associated with febrile seizures were influenza, respiratory syncytial virus, parainfluenza, human coronavirus, and rotavirus. Compared to healthy controls, the age-adjusted odds ratios for nasopharynx virus positivity in febrile seizure patients were 79.4, 2.8, 7.2, and 4.9 for influenza virus, parainfluenza virus, respiratory syncytial virus, and human coronavirus, respectively, and 22.0 for rotavirus in stool. The detected virus did not influence clinical features of febrile seizure.

Twenty-five percent to 50% of acute gastroenteritis (AGE) cases remain etiologically undiagnosed. Our main aim was to determine the most appropriate list of enteric pathogens to be included in the daily diagnostics scheme of AGE, ensuring the lowest possible diagnostic gap.Two hundred ninety seven children ≤6 years of age, admitted to hospital in Slovenia, October 2011 to October 2012, with AGE, and 88 ≤6 years old healthy children were included in the study. A broad spectrum of enteric pathogens was targeted with molecular methods, including 8 viruses, 6 bacteria and 2 parasites.At least one enteric pathogen was detected in 91.2% of cases with AGE and 27.3% of controls. Viruses were the most prevalent (82.5% and 15.9%), followed by bacteria (27.3% and 10.2%) and parasites (3.0% and 1.1%) in cases and controls, respectively. A high proportion (41.8%) of mixed infections was observed in the cases. For cases with undetermined etiology (8.8%), stool samples were analyzed with next generation sequencing, and a potential viral pathogen was detected in 17 additional samples (5.8%).Our study suggests that tests for rotaviruses, noroviruses genogroup II, adenoviruses 40/41, astroviruses, Campylobacter spp. and Salmonella sp. should be included in the initial diagnostic algorithm, which revealed the etiology in 83.5% of children tested. The use of molecular methods in diagnostics of gastroenteritis is preferable because of their high sensitivity, specificity, fast performance and the possibility of establishing the concentration of the target. The latter may be valuable for assessing the clinical significance of the detected enteric, particularly viral pathogens.

Delirium is a clinical syndrome often underestimated in the intensive care units (ICU). The aim of this study was to determine the prevalence and factors that influence the onset of delirium. A questionnaire was sent to intensivists in Slovenian ICUs, who estimated the prevalence of delirious patients. The questionnaire consisted of demographic data, type of ICU, diagnosis, reason for admission to the ICU, type of anesthesia and surgery, clinical condition, type of supportive therapy, presence of delirium, data on discharge, transfers between departments or patient outcome on day 30. Patient consciousness was assessed by the Richmond Agitation-Sedation Scale (RASS) and the presence of delirium by the validated delirium-screening Confusion Assessment Method for the ICU (CAM-ICU). Replies received from intensivists included data on 103 patients. According to RASS ≥-3, the prevalence of delirium was 9.5% (7 out of 74 patients). There was no difference in the prevalence of delirium between surgical and medical ICU patients (p=0.388). Delirious patients had longer hospital stay (p=0.002) and ICU stay (p=0.032) compared to patients without delirium. All delirious patients survived until day 30, whereas 19 patients without delirium died (p=0.092). Logistic regression analysis dismissed any association of delirium with patient mortality (p=0.998). Age, gender, anesthesia, mechanical ventilation, and type of surgical procedure could not be evaluated as risk factors for delirium. In Slovenian ICUs, a lower proportion of delirium was observed, as reported from similar studies. Risk factors such as gender, age, mechanical ventilation, sedation, anesthesia, or department could not predict delirium. However, prolonged hospitalization of ICU patients could predict the onset of delirium, but the presence of delirium did not increase patient mortality., Delirij je klinički sindrom koji se često podcjenjuje u jedinicama intenzivnog liječenja (JIL ). Cilj ovog istraživanja bio je utvrditi učestalost i čimbenike koji utječu na pojavu delirija. Upitnik je poslan intenzivistima u slovenskim jedinicama za intenzivno liječenje, koji su procijenili učestalost bolesnika s delirijem. Upitnik se sastojao od demografskih podataka, vrste intenzivnog liječenja, dijagnoze, razloga za prijam u JIL , vrste anestezije i operacije, kliničkog stanja, vrste potporne terapije, prisutnosti delirija, podataka o iscjedku, prijenosa između odjela ili ishoda bolesnika 30. dana. Svijest bolesnika je procijenjena pomoću Richmondove ljestvice za agitaciju-sedaciju (RASS), a prisutnost delirija pomoću validirane metode za procjenu konfuzije za primjenu u JIL (CAM-ICU). Odgovori dobiveni od intenzivista uključivali su podatke za 103 bolesnika. Prema RASS ≥-3, učestalost delirija bila je 9,5% (7 od 74 bolesnika). Nije bilo razlike u učestalosti delirija između kirurških i medicinskih bolesnika u intenzivnim odjelima (p=0,388). Bolesnici s delirijem imali su duži boravak u bolnici (p=0,002) i boravak u JIL (p=0,032) u usporedbi s bolesnicima bez delirija. Svi bolesnici s delirijem preživjeli su do 30. dana, dok je 19 bolesnika bez delirija umrlo (p=0,092). Logistička regresijska analiza odbacila je bilo kakvu povezanost delirija sa smrtnošću bolesnika (p=0,998). Dob, spol, anestezija, mehanička ventilacija i vrsta kirurškog zahvata nisu se mogli procijeniti kao čimbenici rizika za delirij. U slovenskim JIL zabilježen je manji udio delirija u usporedbi sa sličnim studijama. Čimbenici rizika kao što su spol, dob, mehanička ventilacija, sedacija, anestezija ili odjel ne mogu predvidjeti delirij. Međutim, dugotrajna hospitalizacija bolesnika u JIL mogla je predvidjeti početak delirija, ali prisutnost delirija nije povećala smrtnost bolesnika.

Therapeutic hypothermia is a method of treatment in newborns with hypoxic ischemic encephalopathy. Hypothermia should be initiated no later than 6 h after birth. The purpose of this study was to evaluate the quality of the passive therapeutic cooling during neonatal transport. The study aims to evaluate the efficiency of our transport in maintenance of target body temperature during transport. We conducted a 10-year retrospective study in neonates, transported by helicopter or ambulance, who received therapeutic passive-induced hypothermia during transport to the Department of Pediatric Surgery and Intensive Therapy at the University Medical Centre Ljubljana between September 1, 2006, and December 31, 2016. Out of 68 transported newborns, 57 met the criteria for therapeutic induced hypothermia. Eight out of 51 (15.7%) were within therapeutic temperature zone before start of transport while 30 out of 57 (52.6%) were within therapeutic temperature zone at the end of transport. There was a negative correlation between the duration of transport and temperature at the admission (ρ = − 0.306; p = 0.026). A positive correlation was found between the body temperature before and at the end of transport (ρ = 0.410; p = 0,003). A positive correlation between axillary and rectal temperature on admission was found (ρ = 0,832; p

Conjoined twining is a rare medical phenomenon, with an overall prevalence of 1.47 per 100 000 births. This report describes a successful separation of xypho-omphalopagus conjoined twins complicated by unbalanced blood shunting through the porto-systemic anastomoses within the shared liver parenchyma. Significant extrauterine twin-twin transfusion syndrome caused by unbalanced shunting is an extremely rare, and probably under-recognized, hemodynamic complication in conjoined twins necessitating urgent separation. Progressive deterioration with a poor outcome can be prevented if the condition is recognized in a timely manner.

Background With the shortening length of stay of newborns in hospitals after birth, concerns have been raised about the possible rise in readmission rates. In Slovenia, where the normal length of stay is 3 days, no data on readmissions were available. We sought to determine the frequency and causes for readmissions. Methods We conducted a retrospective study on all newborns readmitted to Slovenian children's hospitals and wards in June 2012 and November 2012. We obtained basic demographic data for newborns and mothers, analyzed the frequency of diagnoses, and compared the duration of treatment between summer months and autumn months. Results The proportion of readmissions in June 2012 and November 2012 was 6% and 5.9%, respectively. Around 10% more boys were readmitted in June 2012 and November 2012. In June 2012, the mean age was 12.2 days, and the mean birth weight was 3444 g. In November, the mean age was 10.5 days, and the mean birth weight was 3271 g. Around 50% of mothers were primiparous, and their mean age was around 31 years. Most received > 10 prenatal check-ups and participated in a prenatal class. The most common diagnosis in June 2012 and November 2012 was jaundice. The duration of treatment did not statistically significantly differ between summer months and autumn months, but it was associated with the admission diagnosis and infants' characteristics. Conclusion Our study showed that the readmission rate in Slovenia was much higher than in some other developed countries. Prospective studies are needed to further confirm the findings and highlight the possible causes for this observation.