Search

Myositis ossificans is characterized by heterotopic bone formation in skeletal muscle that may present as a tender, warm, palpable swelling, and mimicking soft tissue infection. We present the clinical and imaging evolution of the disease with a favorable outcome in a preterm baby with complicated postnatal course.

Aim To find early predictors for poor neurodevelopmental outcome after neonatal group B streptococcal meningitis. Methods We retrospectively analyzed clinical characteristics of 23 patients with neonatal group B streptococcal meningitis and their neurodevelopmental outcome at 18 months. Available group B Streptococcus strains were serotyped and their genomes characterized. Results We found several differences between patients with early- (n = 5) and late-onset (n = 18) disease. Nine children had neurologic abnormalities at 18 months and 4 had epilepsy, all of them after late-onset disease. Most important risk factors for poor outcome were impaired consciousness at admission, hemodynamic instability, seizures, or abnormal electroencephalogram during the acute illness and abnormal neurologic and ophthalmologic examination at the end of treatment, whereas abnormalities in laboratory and imaging studies were not predictive. Hypervirulent serotype III, multilocus sequence type 17 group B Streptococcus was the predominant pathogen. Conclusions Neurodevelopmental impairment after neonatal group B streptococcal meningitis is likelier in those with clinical and neurophysiological features indicating worse disease severity.

To identify the epidemiological and clinical features of acute viral lower respiratory tract infections (LRTI) caused by respiratory syncytial virus and other respiratory viruses, and to determine the risk factors for the severe disease among neonates.We retrospectively reviewed the records of neonates aged up to 44 postconceptional weeks who were hospitalized at a tertiary referral hospital due to confirmed viral LRTI between January 2015 and December 2020.Of 228 neonates with viral LRTI, one-third were born prematurely. A seasonal distribution of LRTIs from December to March was noticed, peaking in February. Forty-two percent of neonates were treated in the neonatal intensive care unit. One third of these presented with complications and needed mechanical ventilation. The most detected viruses were respiratory syncytial virus and rhinovirus. Prematurity was identified as a risk factor for worse clinical course and more complications, while rhinovirus infection was associated with an increased risk of apnea.The burden of respiratory syncytial virus LRTI in the neonatal period is high, although other respiratory viruses can also cause a severe respiratory disease. In preterm infants, rhinovirus infection presents an important risk factor for a severe course of LRTI with complications. Infection with two respiratory viruses leads to a more severe clinical course.

Carboxyhemoglobin (COHb) is an index of endogenous carbon monoxide formation during the hem degradation process and could be used to confirm hemolysis in neonates. The influence of other clinical factors on COHb values in neonates has not been fully investigated. We aimed to evaluate the influence of hemolysis, sepsis, respiratory distress, and postnatal age on COHb values. We retrospectively analyzed COHb measurements determined with a carbon monoxide-oximeter in 4 groups of term neonates: A-sepsis, B-respiratory distress, C-hemolysis, and D-healthy neonates. The mean COHb values were 1.41% (SD: 0.26), 1.32% (SD: 0.27), 2.5% (SD: 0.69), and 1.27% (SD: 0.19) (P

Purpose: To analyze clinical, laboratory, microbiologic, imaging and therapeutic data that contribute to outcome in newborn infants with osteoarticular (OSA) infection. Methods: Clinical course, imaging and follow-up data of 15 newborns with the diagnosis of OSA infection were retrospectively reviewed. Results: 15 newborns with 23 acute osteoarthritis foci were included: risk factors were identified in 73%, lower extremities were affected in 8 (53%) and more than half of the children had two-or multifocal involvement. The predominant causative agent was Staphylococcus aureus. While plain radiography showed osteolytic bone lesions in only 33%, scintigraphy was consistent with osteomyelitis in 74% of study infants. Magnetic resonance imaging revealed an inflammatory process even when other imaging modalities did not detect any OSA signs. All newborns underwent surgical and antibiotic treatment; the average time from admission to surgical treatment was 3.6 days. No bone and joint deformities or limb-length disturbances were found in the mean follow-up period of 8.5 years. Conclusion: Our study confirms that the most important prognostic factors in predicting a long-term favorable outcome are early diagnosis and therapy consisting of a combination of both surgical and appropriate antibiotic treatment.

Spinalni disrafizmi so prirojene nepravilnosti hrbtenjače in spinalnega kanala, ki nastanejo zaradi motenj zapiranja nevralne cevi v zgodnjem embrionalnem razvoju. Glede na kožno kritje jih delimo na odprte in zaprte. Odprte disrafizme prepoznamo že s prenatalno diagnostiko, težja pa je prepoznava zaprtih (okultnih) stanj. Pri slednjih so nam pri diagnostiki v pomoč določeni kožni znaki nad hrbtenico, ki so prisotni pri več kot polovici bolnikov. Ultrazvočna preiskava spinalnega kanala je v prvih mesecih starosti, dokler hrbtenica ne zakosteni, metoda izbire v diagnostiki okultnih spinalnih disrafizmov. Sicer je najobčutljivejše diagnostično orodje magnetno resonančno slikanje, ki predstavlja tudi zlati standard predoperativne diagnostike. Zgodnja prepoznava je pomembna tudi v primerih asimptomatskih stanj, ker s tem omogočimo pravočasno kirurško zdravljenje otrok, pri katerih obstaja večje tveganje za nastanek nenadnih zapletov ali nepovratnih nevroloških posledic. V članku smo povzeli klinične in radiološke značilnosti posameznih disrafičnih stanj, ter oblikovali diagnostični algoritem, z namenom poenotenja zgodnje obravnave otrok s spinalnim disrafizmom.

Background: From the conception onward, certain parameters associated with maternal health may affect foetal body composition, growth and bone mineral content. The objective of the study was to determine the association between maternal vitamin D and adiponectin status with the anthropometrical measures of newborns, and bone health status measured by Quantitative Ultrasound (QUS) at birth. Methods: Circulating 25OHD and adiponectin concentration were measured in 73 pregnant women. Correlations with the anthropometrical measures and bone health status in their infants were studied. Bone health was evaluated using QUS with the measurements of speed of sound (SOS, in m/s) and Z score on the right tibia. Results: There was no significant association between maternal 25OHD and newborn’s anthropometrical measures at birth (weight p=0.35, length p=0.59 and head circumference p=0.47). There was a significant negative correlation between a maternal serum adiponectin and a) weight of infants at birth (R= -0.37, p=0.002); b) birth length (R= -0.31, p=0.008) and c) head circumference (R= -0.29, p=0.014). There was no significant correlation between maternal 25OHD blood levels during pregnancy and SOS in newborns (p=0.48). Additionally, a correlation between maternal adiponectin concentration during pregnancy and SOS in newborns was not significant (p=0.82). Conclusion: Although a high prevalence of low 25OHD level among pregnant women was found, maternal vitamin D status did not influence growth and bone health of their offspring at birth. Maternal adiponectin levels in plasma showed an inverse relationship with anthropometrical measures of infants at birth, while no correlation with the newborn’s bone health was found.

Objective - Small for gestational age (SGA) infants have an increased risk of developing metabolic syndrome (MS) later in life. The aim of our study was to analyze some of the potential MS biomarkers in SGA neonates and to find the most indicative neonatal biomarker associated with MS in SGA. Materials and Methods - Serum adiponectin, fasting glucose, insulin, total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, and triglycerides were evaluated in 43 small (SGA) and 25 appropriate for gestational age (AGA) neonates in the first month of life. Glucose/insulin (G/I) ratio and the homeostasis model assessment of insulin resistance index (HOMA-IR) were calculated. Results - Mean serum adiponectin in SGA was significantly lower than in AGA neonates (36.6 vs. 42.6 mg/L, P=0.021). In SGA infants a statistically insignificant higher fasting insulin levels (9.8 vs. 6.4 mIU/L), lower G/I ratio (1.9 vs. 3.0 mol/IU) and higher HOMA-IR (2.6 vs. 1.4) was observed. The mean serum triglyceride level in SGA neonates was significantly higher than in AGA neonates (1.7 vs. 1.4 mmol/L, P=0.031). Conclusion - SGA neonates demonstrated significantly reduced serum adiponectin and significantly increased serum triglyceride levels in comparison to AGA infants in the first month of life. Triglycerides appeared to be the most promising biomarker reflecting metabolic tendencies in SGA newborns and could possibly be used in predicting the future development of MS.

Objective - Bacterial infection of the scrotal appendages (scrotal pyocele) is a rare condition, especially in neonates. It is easy to confuse with other scrotal emergencies that require surgical intervention and orchiectomy. We present a case where pre- and intraoperative diagnosis was not clear and orchiectomy was performed; additionally, review of the literature, diagnostics, treatment options and lessons learned are discussed. Case report - A ten-day old full term neonate, born with bilateral hydroceles and glandular hypospadias, presented with a six day history of poor feeding and irritability; clinical examination revealed an enlarged, erythematous and tender right hemiscotum. Blood cultures, routine laboratory examinations and ultrasound (US) imaging was performed. Postnatal torsion with non-viable testicle, testicular malignancy and epididymo-orchitis were considered in the differential diagnosis. Upon surgical exploration, the testicle appeared non-viable due to severe inflammation and was removed. The patient was treated initially with ampicillin and gentamicin. After Streptococcus pneumoniae was cultured from specimens, treatment was continued with benzyl penicillin. Conclusion - Neonatal scrotal pyocele is an extremely rare condition. The main suggestive features are clinical presentation with signs of infection and an enlarged painful scrotum. US is the investigation of choice to differentiate from a surgical emergency. Free fluid in the scrotal cavity with septae, normal looking testicle on US and no signs of torsion at exploration are diagnostic signs. If diagnosed early, the first line of management is surgical aspiration or decompression, followed by broad-spectrum antibiotic treatment. With delay in diagnosis, the testicle may look non-viable and push surgeons for orchiectomy.

Introduction A blood exchange transfusion (BET) is most commonly performed to treat severe neonatal haemolytic disease. A distinct form of blood transfusion adverse reaction is transfusion-related immunomodulation. The purpose of our retrospective single-centre case-control cohort study was to investigate whether a blood exchange transfusion in the neonatal period provokes immunomodulation and affects humoral immune response to vaccination, morbidity and occurrence of autoantibodies. Methods Study subjects were 74 apparently healthy children, who were born at term as appropriate for gestational age and received four doses of diphtheria and tetanus toxoid vaccine. Forty-one received BET due to neonatal hemolytic disease and no other blood product afterwards, while 33 did not receive any blood products. Analysis of diphtheria, tetanus and autoimmune antibodies was performed and their medical records were analyzed for infectious, allergic, cancerous and autoimmune diseases. Results A clearly exaggerated immune response to diphtheria (1.016 IU/mL, 95% confidence interval (CI) 0.662–1.369 IU/mL vs. 0.515 IU/mL, 95% CI 0.363 to 0.626 IU/mL, P = 0.011) and slightly exaggerated immune response to tetanus vaccine (1.798 IU/mL, 95% CI 1.180–2.416 IU/mL vs. 1.036 IU/mL, 95% CI 0.398–1.673 IU/mL, P = non-specific) were observed in BET subjects. A propensity towards autoimmunity (25.8% vs. 12.5%, P = non-specific) was observed in BET subjects. However, BET in the neonatal period did not influence the occurrence of bacterial, childhood viral diseases with exception of varicella (43.9% vs. 21.2%, P = 0.040), autoimmune and cancer diseases. Conclusion BET impacted humoral immune response to diphtheria and tetanus vaccine and occurrence of autoimmune antibodies, but did not affect morbidity and the occurrence of autoimmune diseases. These effects could be related to massive antigenic load of BET and an accelerated priming of immune cells and consequent immunomodulation.

Fetalna in neonatalna aloimunska trombocitopenija (FNAIT) je posledica transplacentarnega prenosa in vezave aloimunskih protiteles na trombocitne antigene otroka, ki jih je podedoval od očeta. Do aloimunizacije matere proti trombocitnim antigenom lahko pride tekom nosečnosti, kot tudi ob transfuziji trombocitov. FNAIT je redka bolezen, ki lahko poteka popolnoma brez bolezenskih znakov ali pa ima otrok znake hemoraške diateze. Njen najhujši zaplet je znotrajlobanjska krvavitev, zato sta zgodnja diagnostika in v primeru indikacije ustrezno zdravljenje zelo pomembna. Po podatkih iz literature je ocenjena pojavnost FNAIT 1 na 1000-2000 živorojenih. Pojavnost FNAIT v Sloveniji ni znana. Namen opravljene retrospektivne raziskave je bil ugotoviti pojavnost in etiologijo FNAIT v Sloveniji ter klinično sliko bolnikov s FNAIT. Rezultati raziskave, v kateri smo analizirali izvide transfuzijskih preiskav za dokaz trombocitnih protiteles pri novorojenčkih ali materah, so pokazali veliko nižjo pojavnost. V obdobju od leta 1996 do leta 2016 je bilo v Sloveniji potrjenih 39 primerov FNAIT, povprečno 2 na leto, medtem ko je bilo prošenj za dokaz trombocitnih protiteles pri novorojenčku ali materi povprečno 9 na leto. Pojavnost FNAIT je torej v Sloveniji 1 na 10.000 živorojenih. Kljub temu, da je ocena pojavnosti zaradi retrospektivne analize najverjetneje podcenjena, menimo, da omenjeni rezultati potrjujejo naša klinična opažanja, da je FNAIT poddiagnosticirana. Prispevek zato, poleg rezultatov retrospektivne raziskave o pojavnosti, etiologiji in klinični sliki FNAIT v Sloveniji, predstavlja pregled trenutnega znanja o FNAIT, saj želimo, da se na omenjeno bolezen, ki je lahko življenje ogrožajoča, pogosteje pomisli in ustrezno ukrepa.

From the very beginning of life, biological events in the intrauterine environment influence the developing child, its growth, maturation and adaptation. The aim of this study was to assess the impact of maternal vitamin D and adiponectin status on offspring growth, general and bone health.162 healthy pregnant women were included in the study, with their vitaminD and adiponectin levels measured in the 32 nd week of pregnancy. Body weight and bone mineral density measurements of their offspring were performed at birth and at the age of three, six, nine and twelve months. Information on children's infectious, allergic and chronic disease was collected from their medical records.Vitamin D insufficiency/deficiency was present in 44% of pregnant women. There was no significant association between maternal vitamin D during pregnancy and offspring body weight at birth or later, as well as between maternal vitamin D and newborn bone mineral density. Additionally, there was no significant association between maternal vitamin D and infectious, allergic or other chronic diseases in offspring. A negative correlation between maternal adiponectin and offspring's body weight at birth was observed (r = - 0.37, p = 0.002), while association with bone mineral density in newborns was not significant.Despite the significant prevalence of vitamin D insufficiency among pregnant women, it did not influence growth or health of their offspring in this study. Maternal adiponectin levels showed an inverse relationship with birth weight of the infants, which may highlight the important link between maternal health and the offspring's growth.

Objective The aim of this study was to analyse clinical characteristics of newborns with genetic-cellular epilepsy (GCE) to compare them to those of newborns with seizures with other aetiologies and elucidate clues to the diagnosis of GCE. Methods This retrospective single-centre study analysed data from an 8-year cohort of newborns with seizures from 2010-2017. Clinical, neurophysiological, laboratory, and imaging data and outcomes of children with GCE were compared to those of newborns with seizures with other aetiologies. Results A total of 112 newborns (N = 68; 61% boys) were included. Hypoxic-ischaemic encephalopathy (N = 42; 29%) was the most common seizure aetiology; GCE (with pathogenic variants KCNQ2, KCNQ3, SCN2A, TBC1D24, CHD2, and STXBP) was diagnosed in 9 (6%). The group of newborns with GCE significantly differed from the group with seizures with other aetiologies in terms of family history of epilepsy (p = 0.000), neonatal epileptic status (NES) (p = 0.007), normal imaging studies (p = 0.000), and outcomes (p = 0.034), but did not differ regarding the type and age of seizure onset, number of antiepileptic drugs administered, and EEG results. Positive family history of epilepsy (p = 0.027), presence of NES (p = 0.041), and normal imaging studies (p = 0.002) were most indicative of the diagnosis of GCE. Probability of GCE with this combination was 0.92. Conclusion In a heterogenous group of newborns with seizures, a positive family history of epilepsy, presence of NES, and normal imaging studies were most indicative of the diagnosis of GCE.

We commonly use chloral hydrate sedation in newborns, though its cardiorespiratory side effects have not yet been fully investigated. Our study aimed to analyze the impact of chloral hydrate on cardiorespiratory parameters in term newborns. We performed a prospective, pre-post single-arm interventional study in 42 term, respiratorily and hemodynamically stable newborns. Oxygen saturation (SpO2), end-tidal CO2 (ETCO2), the apnea-hypopnea index and the respiratory and heart rates were recorded by polygraphy, starting 0.5-1 hour before oral administration of chloral hydrate at a dose of 40 mg/kg and ceasing 4 hours post-administration. After administration of chloral hydrate, the mean basal SpO2 dropped by 2.0% (from 97.1% to 95.1%; p < 0.001) and the mean basal ETCO2 increased by 3.9 mmHg (25.6 to 29.5 mmHg; p < 0.001). We found a significant decrease in the minimal SpO2 values (p < 0.001) and an increase in the percentage of time spent with SpO2 < 95% and < 90% (p < 0.001). The mean increase in the estimated apnea-hypopnea index was 3.5 events per hour (p < 0.001). The mean respiratory and heart rates were significantly lower 150 min after the administration of chloral hydrate when compared with pre-sedation values (51/min and 127/min versus 61/min and 138/min respectively; p < 0.001). A considerable number of patients exhibited changes in cardiorespiratory parameters that differed considerably from the normal ranges. In conclusion, SpO2, ETCO2, the estimated apnea-hypopnea index and the respiratory and heart rates changed after the administration of chloral hydrate. They remained within normal limits in most newborns, but the inter-individual variability was high in the studied population.

Ultrazvočna preiskava (UZ) možganov je zanesljivo in neinvazivno orodje za odkrivanje najpogostejših prirojenih in pridobljenih nenormalnosti osrednjega živčevja (OŽ) pri nedonošenih novorojenčkih. Ustrezna oprema z namenskim ultrasonografskim aparatom in ustrezno velikimi sondami, posebnimi ultrasonografskimi nastavitvami za novorojenčke ter obsežnimi izkušnjami ultrasonografista so potrebni za pridobitev optimalne kakovosti ultrazvočne slike. Uporaba dodatnega akustičnega okna, kadar je to potrebno, in serijska ultrazvočna preiskava OŽ v času obravnave nedonošenčka omogočata, da prepoznamo večino poškodb in pridobimo podatke o času pojava in njihovem razvoju. Za bolj natančno določitev mesta in obsega poškodb in za odkrivanje tistih, ki so umeščene zunaj področja ultrazvočnega prikaza ter za prikaz mielinacije, pa ima dodano diagnostično vrednost časovno primerno izbrano magnetnoresonančno slikanje.

Background The quality of general movements (GMs) has proven to have predictive value for the developmental outcome, but this has not yet been studied in twins. Aims Our aim was to analyse the quality of GMs and neurological and developmental outcome in relation to the gestational age (GA), mode of conception and other perinatal risk factors in a group of twins. Study design The documentation of twins referred for follow-up in the period from 1998 to 2016 was studied retrospectively. Data concerning the quality of GMs, perinatal risk factors and developmental outcome were analysed. Subjects Eighty-nine twin pairs, GA from 24 to 38 weeks (median 35.0; IQR 3), birth weight 670 g–3820 g (median 2323; IQR 645) were included. Outcome measures Results of neurological, psychological and speech/language development and school outcome were analysed. Results GMs at term age and at three to four months postterm age did not differ with regard to the mode of conception. Preterm birth was significantly related to GMs at three to four months postterm age. At term age, GMs were significantly related to neurological outcome, while at three to four months postterm age, GMs were related to both the neurological and psychological outcome. Difficulties in speech/language development were diagnosed in almost half of the children, more frequently in boys and children with lower Apgar scores. Conclusion The study highlights the value of GMs for predicting the developmental outcome in twins and indicates the importance of developmental, especially speech/language, follow-up in twins.

Aim To compare regional tissue oxygenation (rSO2) in the brain, intestine, and kidney between newborns with and without congenital heart defects (CHD). Methods This observational case-control study was conducted at the Neonatal Deparetment of Children's Hospital Ljubljana between December 2012 and April 2014. It included 35 newborns with CHD and 30 healthy age- and sex-matched controls. CHD were assessed echocardiographically and divided into acyanotic and cyanotic group. RSO2 in the brain, intestine, and kidney was measured using near-infrared spectroscopy (NIRS). Simultaneously, heart rate (HR), breathing frequency (BF), mean arterial blood pressure (MAP), and arterial oxygen saturation (Sao2) were recorded. Results Newborns with CHD had significantly lower rSO2 in the left brain hemisphere (67 ± 11% vs 76 ± 8%, P = 0.004), right brain hemisphere (68 ± 11% vs 77 ± 8%, P

The focus of this paper is to review the data on the classic and nonclassic role of VD with regards to pregnancy and the newborn period. Over the past decade, new evidence has shown that vitamin D (VD) deficiency, in addition to its classical role in calcium metabolism and bone homeostasis, may contribute to the risk of developing a wide range of chronic diseases. VD may produce a wide array of favourable biological effects via genomic, non-genomic or intracrine mechanisms, and therefore contributes to the improvement of human health. Some of these effects may be even more important during pregnancy. Data from animal and human studies implicate maternal VD deficiency as a significant risk factor for several adverse outcomes affecting maternal, foetal and child health. In the newborn period, these comprise bone health, growth and immune response. Conclusion − Recent evidence supports the fact that low maternal vitamin D status is associated with an increased risk of adverse pregnancy outcomes. This paper investigates the effects of vitamin D on the placento-foetal unit and the mother, in terms of calcium metabolism and non-calcium effects.

Background The aim of the study was to explore the correlation between clinical signs and confirmatory tests for cow's milk allergy (CMA) in the neonatal period and their relation to family history and the occurrence of food allergies in the postneonatal period. Methods The medical documentation of 361 newborns with suspected CMA and exclusion of other comorbidities was analyzed. The correlations between clinical signs and methods to confirm CMA [elevated levels of total immunoglobulin E (IgE) and/or specific IgE for cow's milk, improvement after the introduction of a cow's milk-free diet and positive challenge procedure] were studied. In 90 children, the data were additionally analyzed in relation to outcome (at the age of 1–11 years), evaluated by questionnaires, which inquired about signs and symptoms of food allergy, methods of CMA confirmation, and the presence of other food allergies. Results There was a positive correlation between exanthema and confirmed CMA in the neonatal period ( R = 0.184; p = n = 361), and hematochezia and confirmed CMA in the neonatal ( R = 0.203; p n = 361) and postneonatal period ( R = 0.215; p = 0.042; n = 90). Additional food allergies in the postneonatal period were positively correlated with neonatal CMA ( R = 0.275; p = 0.009; n = 90). No correlation was found between a positive family history of food allergies and CMA in the neonatal ( R = −0.66; p = 0.398; n = 165) and postneonatal periods ( R = 0.00; p = 1.000; n = 116). Conclusion Neonatal exanthema and hematochezia were the predominant clinical signs in neonates with CMA. Allergies to other food allergens appeared more frequently in children with CMA in the neonatal period. Neonatal CMA did not occur more frequently in families with food allergies.

Neonatal cyanosis is rarely due to hemoglobin variants with low oxygen affinity. We describe the clinical course and results of molecular genetic analysis of a boy who presented after birth with severe cyanosis. Arterial blood-gas analysis demonstrated a pronounced shift of the oxygen-hemoglobin dissociation curve to the right and molecular genetic analysis revealed a γ-globin variant, Hb F-Sarajevo. The patient presented is the second reported case of neonatal cyanosis due to this mutation, which was first described in 2012 by Zimmermann-Baer and coauthors. With the introduction of universal screening for congenital heart disease, the finding of low oxygen saturation will uncover more neonates with hemoglobinopathies with low oxygen affinity.

O bjective – To describe the clinical course of enteroviral meningitis in neonates in a tertiary neonatal unit. M aterials and M ethods – We analysed maternal and perinatal history, clinical and laboratory data, therapy and short-term outcomes in neonates who had enterovirus detected in the cerebrospinal fluid (CSF) and compared the group of neonates with early-onset (≤7 day of life (DOL)) meningitis to the group of neonates with late-onset (>7 DOL) meningitis. R esults – A total of 30 term neonates were included (63% male). Majority (73%) presented during the summer and autumn months, 57% were in contact with siblings who had signs of viral disease, 10% of mothers had signs of viral disease at delivery or shortly after. Neonates presented with irritability (97%), fever (83%), feeding intolerance (66%), diarrhoea (56%), nonspecific rash (23%), seizures (10%). Both the C-reactive protein (CRP) and pro-calcitonin (PCT) were elevated in 23% of patients; only CRP was elevated in 57%, only PCT in 37%. Twelve (40%) had elevated leukocyte count in the CSF. Antibiotics were initiated in 80% (median treatment 1.5 days). Majority of the neonates with early-onset meningitis had jaundice, higher urea and creatinine serum concentration, and lower thrombocyte numbers. Conclusion – Enteroviruses are an important cause of meningitis in neonates during summer and autumn months. Neonates in close contact with ill family members or carers are particularly at risk. Neonates present with fever, irritability, feeding intolerance, diarrhoea, normal or mildly elevated CRP and/or PCT values. Neonates with early-onset meningitis had a similar grade of infection and outcome as did the neonates with late-onset disease. Our findings confirm that enteroviral meningitis car- ries a good prognosis in the majority of neonates.

Objective: Because of the restraints on conducting studies on pharmaceutical use in sick newborns, many drugs are used off-label in this population. Moreover, industrially manufactured pharmaceuticals may contain different excipients, which may be either untested or not licensed for use in neonates. The aim of our study was to determine the prevalence and pattern of pharmaceutical and excipient exposure in newborns hospitalized at the Department of Neonatology, Ljubljana, Slovenia. Methods: A longitudinal prospective cross-sectional study was performed during a one-month period and included all hospitalized neonates. Route of administration, site of action, type of manufacture, licensing status, type and concentrations of excipients for all pharmaceuticals given to the neonates were determined. Results: Twenty seven different pharmaceutical preparations were prescribed to a total of 48 hospitalized newborns. In most cases, newborns were prescribed various pharmaceuticals that were not approved for use in this population. Newborns were exposed to 60 different excipients in industrially manufactured pharmaceutical preparations. More than half of the received pharmaceuticals contained potentially harmful and harmful excipients. Conclusions: Two-thirds of pharmaceutical preparations for neonates were used off-label. Newborns receive more auxiliary substances, which may be unsuitable for this age group and may even be toxic to them, via industrially manufactured pharmaceuticals.

Birth of an ill or premature infant and early separation from the mother on behalf of admission to a neonatal intensive care unit was found to be one of the most important predictors of postpartum depression. The goals of the study were to examine the postpartum depression symptoms frequency in the group of mothers of infants in the neonatal intensive care unit (NICU) at Pediatric Clinic of Ljubljana, and to examine the clinical use of the Neonatal Behavioral Assessment Scale (NBAS) to support the mother-infant bonding and to promote parental competencies. 63 mothers of infants in NICU participated in the study about postpartum depression symptoms frequency and 26 infants and their parents participated in the assessment of the neonatal behavior (12 mothers participated in both parts of the study). The results showed that early hospitalization of the newborn increases the risk of postnatal depression in mothers. The percent of mothers who scored 10 or more points on the Edinburgh Postnatal Depression Scale (EPDS) was higher than the incidence of postpartum depression in Slovenia. Results support the need of a postpartum depression screening tool for mothers of infants at NICU and show that the use of NBAS is a potentially useful tool to promote parent-infant interaction.

Background Neonatal seizures may cause irreversible changes to the immature brain and. A scoring system for early prognostic information could be a useful clinical tool. The aim of the study was to analyze risk factors for epilepsy after neonatal seizures, to validate Garfinkle's scoring system, and to analyze whether a new scoring system is feasible. Methods A retrospective study of 176 newborns (59.1% boys, 40.9% girls, 70.5% term, 29.5% preterm; mean birth weight 2820 g), admitted to the Department of Neonatology, Division of Pediatrics, University Medical Centre, Ljubljana, because of neonatal seizures (clinical and/or neurophysiological), was performed. Epilepsy rate between 2 and 12 years of follow-up was 18.1%. Five independent predictors from Garfinkle's study and other known predictors were entered into hierarchical binary logistic regression models and analyzed through four steps to identify independent predictors of epilepsy. We tested whether any of the predictors was an effect modifier. Results Of five potential predictors from Garfinkle's score, electroencephalograph background findings and etiology were predictive. Etiologies, gestation, mode of delivery, duration of seizures, and other risk factors at birth were found to be independent predictors. Duration of seizures has a different effect on prognosis depending on the gestational age. Conclusion Gestational age determines the association between duration of seizures and epilepsy. Scoring systems to predict development of epilepsy after neonatal seizures need to limit interaction between important predictor variables.

Noonan syndrome is a relatively common and heterogeneous genetic disorder, including congenital heart defect in more than half of the cases. If the defect is not large, life expectancy is normal. Here we report on a case of an infant with Noonan syndrome and rapidly progressive hypertrophic cardiomyopathy with lethal outcome, in whom we identified a novel mutation in the KRAS gene. This heterozygous unclassified missense variant in exon 3: c.179G>T (p.Gly60Val) might be associated with a lethal form of Noonan syndrome. The malignant clinical course of the disease and the lethal outcome in an infant only a few months old might be connected to RAS-mitogen- activated protein kinase pathway hyperactivation, consequently promoting cell growth and proliferation, leading to rapidly progressive hypertrophic cardiomyopathy. Further biochemical and functional studies are needed to confirm this hypothesis.

AIM: To report on the neurological presentation and neuroimaging findings in newborn infants with incontinentia pigmenti. METHOD: The clinical and neurological course including neuroimaging and follow-up data of eight newborn infants with the neurological phenotype of incontinentia pigmenti were retrospectively reviewed. RESULTS: While the clinical picture was polymorphic, the neurological manifestations were defined as encephalopathic and comprised lethargy and seizures in all but one of the infants. Magnetic resonance imaging (MRI) abnormalities were predominantly in the white matter. Diffusion-weighted imaging (DWI) was obtained during the acute phase in seven of the eight infants, showing restricted diffusion in the deep and subcortical white matter but also in the corpus callosum, basal ganglia, thalami, cerebellum, and cerebral peduncles. Susceptibility-weighted imaging (SWI), performed in five infants, showed a variable amount of signal loss, mainly in the white matter, within areas of restricted diffusion. Extensive MRI abnormalities in newborn infants were followed by abnormal neurodevelopment, with significant motor, cognitive, and/or visual problems. INTERPRETATION: To assess the extent of central nervous system involvement, MRI is recommended in the clinical evaluation of infants with incontinentia pigmenti. They have a characteristic pattern of brain lesions seen on MRI, best recognized using DWI and SWI in the acute neonatal phase, which allow the identification of and distinction between ischaemic and haemorrhagic lesions.

The basic principle of umbilical cord (UC) care is to keep it clean and dry, as this provides the fastest and safest UC healing.To evaluate Slovenian UC care practice and compare its consistency with current international recommendations.A questionnaire covering UC care from birth to complete healing of the umbilical wound was sent to all Slovenian primary-, secondary- and tertiary-level pediatric centers. Three different clinical conditions of the newborn's umbilicus were defined: healthy umbilicus (HU), umbilicus at risk (UR) and unhealthy umbilicus (UU).The study revealed a correlation between the clinical condition of the umbilicus, the frequency of UC care and the antiseptic usage in both the outpatient and inpatient UC care groups. HU was treated less frequently than UR and significantly less than UU. In both groups, these two conditions were also indications for UC care with antiseptic. The frequency of antiseptic usage for HU care was significantly lower in the outpatient care group.Slovenian UC care follows the general international recommendations. Based on these and our experience, we formulated recommendations for adjustments to UC care, depending on the clinical condition of the umbilicus, in order to prevent important complications.

Background The criteria for identification of children with high risk of cerebral palsy are well documented, but the early identification of children at highest risk of minor motor deficits remains less clear. Aim To analyze the correlation between the quality of general movements (GMs) from term to twenty weeks postterm age and the motor competence between 5 and 6 years of age. Methods In the group of 45 preterm infants, the quality of GMs was assessed using Prechtl's method. The Movement Assessment Battery for Children (M-ABC) was used to test motor competence between 5 and 6 years of age. The correlations between GMs and M-ABC results were analyzed. Results During writhing period, the sensitivity of GMs to identify children with definite motor problem was 0.86 for total impairment, 0.67 for manual dexterity, 0.89 for ball skills and 0.92 for balance. During fidgety period, the sensitivity was higher than during the writhing period: 1.00 for total impairment, 1.00 for manual dexterity, 1.00 for ball skills and 0.83 for balance, respectively. The specificity was low at both ages (total scoring 0.24 at term and 0.21 at 3 months corrected age). Conclusion The sensitivity of GMs to identify children with definite motor problems is higher at the fidgety than at the writhing period. The specificity of GMs at the term and fidgety age to predict later motor abilities is low.

Neonatal electroencephalography (EEG) presents a challenge due to its difficult interpretation that differs significantly from interpretation in older children and adolescents. Also, from the technological point of view, it is more difficult to perform and is not a standard procedure in all neonatal intensive care units (NICUs). During recent years, long-term cerebral function monitoring by the means of amplitude-integrated EEG (aEEG) has become popular in NICUs because it is easy to apply, allows real-time interpretation by the neonatologist treating the newborn, and has predictive value for outcome. On the other side, to record conventional EEG (cEEG), which is still considered the gold standard of neonatal EEG, the EEG technician should not only be well trained in performing neonatal EEG but also has to adapt to suboptimal working conditions. These issues need to be understood when approaching the neonatal cEEG in NICU and the main structure of the article is dedicated to this technique. The authors discuss the benefits of the digitalization and its positive effects on the improvement of NICU recording. The technical aspects as well as the standards for cEEG recording are described, and a section is dedicated to possible artifacts. Thereafter, alternative and concomitant use of aEEG and its benefits are briefly discussed. At the end there is a section that presents a review of our own cEEG and aEEG recordings that were chosen as the most frequently encountered patterns according to Consensus statement on the use of EEG in the intensive care unit.

Clonidine has been shown effective in reducing sympathetic hyperactivity in neonatal abstinence syndrome (NAS). The aim of this study was to analyze clinical and laboratory characteristics of a group of newborns treated with clonidine for NAS due to maternal drug addiction and due to withdrawal from opioid analgesic therapy. Only one full–term newborn presented with metabolic acidosis and hyperkalemia; in others no clinical or laboratory adverse effects were detected. This report emphasizes the importance of alertness to potential adverse effects of clonidine therapy, and discusses possible pathophysiological aspects of hyperkalemia and metabolic acidosis during treatment for NAS.

The impairment of brachial plexus (IBP) in the neonate and infant remains an important problem. Risk factors for IBP are well known, but the mechanisms of impairment are not yet fully understood. It is important to identify early signs of IBP and to evaluate the hand function. In the guidelines we propose to use the Toronto scale for evaluation of hand function. The newborn with IBP should be referred to physiotherapy, and then regularly followed-up once a month. If the arm and hand function, especially flexion of the elbow, is not improving at the age of two months, the infant should be referred to the tertiary level rehabilitation centre and to department for plastic surgery at the University Medical Centre in Ljubljana. When necessary, the reconstructive procedure should be done by the age of three to six months. After reconstruction of brachial plexus, the child needs a comprehensive therapy program, which involves passive stretching, sensory stimulation, exercises to promote the development of active voluntary movements, bimanual activities, and symmetrical posture and movement patterns.