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Porod in rojstvo otroka je občutljivo in ranljivo obdobje za žensko, novorojenčka in celotno družino. Rojstvo prvega otroka pomeni vzpostavitev družinskega sistema, v katerem se na sistemski, interpersonalni in intrapsihični ravni odzrcalijo koncepti in mehanizmi, s katerimi se ukvarja relacijska družinska terapija. Ta zmore z njimi poiskati pot razrešitve bolečih psihičnih vsebin in privesti do razbremenitve sistema. Ob prehodu v starševstvo prihajajo boleča afektivna občutja posebej do izraza, vendar je navadno v središču pozornosti zunanjega sveta rojstvo otroka, in ne počutje njegovih staršev ter vzdušje v družini. Središče raziskovalnega polja v doktorskem delu pa je prav ženska, ki s porodom kot točko prehoda stopi v svet nežnega, sočutnega in čustveno kompetentnega materinstva ali pa se v vrtincu različnih dejavnikov tveganja znajde v globini porodne travme, ki se kaže na različne načine disfunkcionalnega čutenja, odzivanja in vedenja. Porodni proces lahko pusti nezadovoljive občutke, ki pa kmalu izzvenijo, a se zgodi, da porod sproži tudi potlačene in nezavedne vsebine preteklosti, ki se ob intenzivni fizični in psihični preizkušnji poroda aktivirajo in vodijo v disfunkcionalne odnose. Doktorsko disertacijo z naslovom Doživljanje materinstva in podporni model terapevtske obravnave na prehodu v starševstvo pri ženskah z izkušnjo rojstva otroka s carskim rezom sestavljata teoretični in empirični del. V doktorskem delu je prikazan in kritično ovrednoten praktični preizkus celostne zdravstveno-terapevtske obravnave s PMTO. Iz celotne doktorske disertacije izhaja ugotovitev, da gre za inovativno obravnavo žensk in novorojenčkov po porodu, saj zajema dognanja in strategije več strokovnih področij oz. metod: zdravstvene obravnave, babištva, NBO ter relacijska družinska terapija. Dokazana je njena učinkovitost v primeru mater, ki so rodile s carskim rezom, in hkrati nakazana možnost za uporabo tudi pri drugih načinih poroda in prehoda v starševstvo. Njena uporaba v klinični in terapevtski praksi je prispevek h krepitvi duševnega zdravja nosečnic, porodnic in otročnic, njihovih novorojenih otrok ter družin. The birth of a child is a delicate and vulnerable time for the woman, the newborn and the whole family. The birth of the first child creates a family system in which the concepts and mechanisms that Relational Family Therapy deals with are reflected at the systemic, interpersonal, and intrapsychic levels. This therapy is used to help family members find a way to resolve painful psychological content and liberate the system. Painful affective emotions are especially pronounced during the transition to parenthood, but the attention of the outside world is usually focused on the birth of the child rather than on the well-being of the parents and the family atmosphere. The focus of the research field of this dissertation is the woman who enters the world of tender, compassionate, and emotionally competent motherhood with childbirth as a transition point or who finds herself in the depths of birth trauma in a vortex of various risk factors that manifests itself in various types of dysfunctional feelings, reactions, and behaviours. The birth process usually leaves unsatisfactory feelings and experiences that are temporary in nature, but it also happens that birth triggers repressed and unconscious contents of the past that are activated by the intense physical and psychological ordeal of birth and lead to dysfunctional relationships. The dissertation, entitled »Experience of Motherhood and a Supportive Therapeutic Model in the Transition Period to Parenthood in Women with the Experience of Giving Birth by Caesarean Section« consists of a theoretical and an empirical section. The dissertation presents and critically evaluates a practical test of integrated medical-therapeutic treatment with PMTO. The dissertation concludes that it is an innovative approach to the treatment of postpartum women and newborns because it integrates the knowledge and strategies of several professional fields or methods: Midwifery, NBO, and Relational Family Therapy. It has been shown to be effective with mothers who have delivered by caesarean section, but also demonstrates the possibility of using it with other delivery methods and in the transition to parenthood. Its use in clinical and therapeutic practice contributes to the mental health of pregnant and postnatal women, their newborn children, and families.

Neonatalna hipoksično-ishemična encefalopatija (HIE) je posledica obporodnega pomanjkanja kisika v osrednjem živčevju ter je eden najbolj pogostih vzrokov za trajno nevrološko okvaro otrok. Pri nekaterih otrocih se kasneje razvije cerebralna paraliza (CP). Pri HIE pride do povečanega nastanka reaktivnih kisikovih spojin in aktivacije vnetnih procesov. Genetska variabilnost v teh poteh bi lahko vplivala na nastanek CP po HIE. V raziskavi smo se osredotočili na pogoste polimorfizme v ključnih genih, ki sodelujejo pri antioksidativni obrambi in pri vnetnem odgovoru po HIE. Vključili smo 90 otrok z zmerno in hudo HIE. S kompetitivnim alelno-specifičnim PCR smo določili polimorfizme v izbranih genih za antioksidativne encime (SOD2 rs4880, CAT rs1001179, GPX1 rs1050450) in provnetne dejavnike (NLRP3 rs35829419, CARD8 rs2043211, IL1B rs1143623, IL1B rs16944, IL1B rs1071671, TNF rs1800629). Pri otrocih, ki so bili zdravljeni s TH in so po rojstvu opravili MR slikanje glave, je bila stopnja možganske okvare opredeljena po klasifikaciji Rutheford. Povezanost polimorfizmov z razvojem CP po HIE in z izidom na MR smo analizirali z uporabo standardnih statističnih testov. Povezave med izbranimi polimorfizmi in nastankom CP nismo dokazali. V skupini otrok, ki ni bila zdravljena s TH, je bil polimorfen alel NLRP3 rs35829419 nominalno značilno povezan z večjim tveganjem za nastanek CP (p = 0,034). V skupini, zdravljeni s TH, pa preučevani polimorfizmi niso bili povezani s pojavom CP. V skupini, zdravljeni s TH, je bil polimorfni alel CARD8 rs2043211 nominalno značilno povezan z normalno/blago možgansko poškodbo na MR glave (p = 0,040), IL1B rs1143623 C alel pa je bil nominalno povezan z zmerno/hudo možgansko poškodbo na MR (p = 0,040). Hipoteze, da so polimorfizmi v izbranih genih povezani s pojavom CP po HIE, nismo potrdili. Vpliv polimorfizmov na izid po HIE je bil do sedaj slabo poznan, zato rezultati predstavljajo izhodišče za nadaljnja raziskovanja na tem področju z večjim številom preiskovancev. Neonatal hypoxic-ischemic encephalopathy (HIE) results from peripartum or intrapartum brain tissue hypoxia and ischemia and is a common cause of long-term neurologic sequelae, including cerebral palsy (CP). Hypoxic-ischemic (HI) insult results in oxidative stress and activation of inflammatory processes. Genetic variability in these pathways could influence the development of CP after HIE. The aim of our study was to evaluate the association of the selected single nucleotide polymorphisms (SNPs) in the genes involved in response to oxidative stress and inflammation with the development of CP after HIE. Ninety children with moderate and severe HIE were included in the study. Genotyping using competitive allele-specific PCR was performed for polymorphisms in genes encoding antioxidant enzymes (SOD2 rs4880, CAT rs1001179, GPX1 rs1050450) and proinflammatory factors (NLRP3 rs35829419, CARD8 rs2043211, IL1B rs1143623, IL1B rs16944, IL1B rs1071676, TNF rs1800629) that could contribute to the development of CP after HIE. In children treated with TH where MRI was performed, it was classified according to the Rutheford classification. Standard statistical tests were used to evaluate the association of selected SNPs with the development of CP. No association between the selected SNPs and the development of CP was found. Polymorphic NLRP3 rs35829419 allele was nominally significantly associated with the development of CP in children who were not treated with TH (p = 0.034). None of the SNPs were associated with CP in children treated with TH. Among children treated with TH polymorphic allele CARD8 rs2043211 was nominally significantly associated with normal/mild MRI overall findings (p = 0.040) and IL1B rs1143623 C allele was nominally significantly associated with moderate/severe MRI overall findings (p = 0.040). The association of genetic variability with the outcome after HIE has so far not been well established, therefore the results of our study represent foundations for future research in larger studies.

Pri novorojenčkih neredko prihaja do motenj srčnega ritma. Pojavljajo se lahko pri otrocih s strukturno normalnim srcem in pri otrocih s prirojenimi boleznimi srca. Najpogostejša tahikardna motnja srčnega ritma, ki jo pri novorojenčkih moramo zdraviti, je nadprekatna tahikardija, ki ji sledi atrijsko plapolanje. Mehanizma nastanka tahikardij sta povečana prevodnost preko krogotoka s ponovnim vstopom (angl. re-entry circuits) ali povečana avtomatičnost sprožilnega žarišča. Dejavniki tveganja za motnje srčnega ritma (pri-rojena srčna napaka, nedonošenost, elektrolitske motnje, zdravila, okužbe, povišana telesna temperatura) so prisotni le pri manjšini novorojenčkov. Klinično se tahikardija kaže z nespecifičnimi in pogosto diskretnimi znaki, kot so odklanjanje hranjenja, letargija, razdražljivost, tahipneja, bledica, cianoza, potenje in stokanje. Pri nekaterih lahko pride do hude cirkulatorne odpovedi. Aritmije so relativno pogos-te pri otrocih v enoti za intenzivno medicino v 24 urah po srčni operaciji. Zdravljenje vključuje vagalne manevre, intravensko dajanje adenozina, uporabo antiaritmičnih zdravil in elektrokonverzijo. V prispevku opisujemo posamezne vrste tahikardij in načela zdravljenja. Opisujemo klinična primera novorojenčkov s tahikardijo.

Izhodišča. Akutni bronhiolitis je eden glavnih vzrokov za hospitalizacijo otrok, mlajših od dveh let. Atelektaza, neujemanje ventilacije s perfuzijo in bakterijske superinfekcije so zapleti, ki zahtevajo neinvazivno ali invazivno predihavanje. Opredeliti smo želeli dejavnike, ki vplivali na pojavnost atelektaze pri novorojenčkih z akutnim bronhiolitisom. Bolniki in metode. V retrospektivno kohortno analizo smo vključili novorojenčke z akutnim bronhiolitisom, ki so bili od oktobra 2017 do marca 2018 hospitalizirani na Kliničnem oddelku za neonatologijo UKC Ljubljana. Razdelili smo jih v dve skupini: s pridruženo atelektazo ali brez. Skupini smo primerjali glede na anamnestične, klinične in laboratorijske dejavnike. Rezultati. Zdravili smo 29 novorojenčkov z akutnim bronhiolitisom, 8 s pridruženo atelektazo. Novorojenčki s pridruženo atelektazo so dlje potrebovali dodatek kisika v vdihanem zraku (p = 0,01) in so bili večkrat neinvazivno in invazivno predihavani (p = 0,017). Večkrat so bili zdravljeni z antibiotiki (p = 0,004) in imeli radiološke znake pljučnice (p = 0,008). Skupini se nista razlikovali v deležu nedono-šenosti, okužbe z respiratornim sincicijskim virusom (RSV), porodni teži in spolu. Zaključki. Novorojenčki z bronhiolitisom in atelektazo so imeli pogosteje bakterijsko superinfekcijo in pljučnico.

Novorojenčki, rojeni kot veliki za gestacijsko starost, so novorojenčki, ki se rodijo s porodno težo in/ali porodno dolžino nad 90. percentilom za gestacijsko starost in spol. Neoptimalno znotrajmaternično okolje preko epigenetskih mehanizmov vpliva na fenotipske spremembe pre-snovnih in endokrinih poti pri plodu. Čezmerna rast ploda vodi v prenatalne in postnatalne zaplete, kot so prezgodnji porod, obporodna hipoksija, poškodbe, prehodne presnovne motnje, policitemija in zlatenica. Dolgoročno čezmerna rast ploda pomeni povečano tveganje za razvoj presnovnih in srčno-žilnih bolezni ter motenj delovanja osrednjega živčevja. Etiološko najpomembnejši vzrok makrosomije je nosečniška sladkorna bolezen. Če se pojavi po 28. tednu nosečnosti, lahko ostane neprepoznana, saj aktivno iskanje sladkorne bolezni pri nosečnicah poteka pred tem.

Izhodišče in namen: Prirojena dilatacija votlega sistema ledvic (angleško »urinary tract dilatation«, UTD) je ena najpogostejših napak, ugotovljenih z rutinsko ultrazvočno (UZ) preiskavo pri plodu. Včasih lahko UTD privede do ledvične okvare, ki je vodilni razlog za kronično ledvično bolezen pri otrocih, zato je potrebna zgodnja prepoznava in zdravljenje. Trenutno najbolj raziskan in obetaven biološki označevalec ledvične okvare je lipokalin, povezan z gelatinazo nevtrofilcev, določen v urinu (uNGAL), ki ima zaradi neinvazivnega odvzema vzorca urina še dodatno veliko prednost prav pri populaciji novorojenčkov. Želeli smo ovrednotiti njegovo vlogo pri novorojenčkih s prirojeno enostransko UTD. UZ-preiskava sečil ostaja prva in najvarnejša preiskava pri obravnavi ploda in novorojenčka s sumom na UTD. Ovrednotiti smo želeli UTD A (antenatalno) in P (postnatalno) klasifikacijski sistem, ki ga uporabljamo od leta 2014, glede porazdelitve specifičnih uropatij in določenih kliničnih izhodov. Preiskovanci in metode dela: V prospektivnem delu raziskave smo vključili 38 donošenih novorojenčkov s prirojeno enostransko UTD 38 zdravih, donošenih novorojenčkov pa je predstavljalo kontrolno skupino. Pri vseh smo opravili UZ sečil, z razvrstitvijo bolnikov po klasifikaciji UTD P in izmerili uNGAL s kemiluminiscenčno metodo. Pri nekaterih preiskovancih smo za postavitev končne etiološke diagnoze opravili dodatne preiskave (cistogram, scintigrafija ledvic). Novorojenčke v skupini preiskovancev smo razdelili v dve podskupini glede na obstrukcijo sečil, naknadno pa smo jih razdelili v dve podskupini tudi glede na obliko zdravljenja, ki je bilo kirurško ali konzervativno. V retrospektivnem delu raziskave smo vključili 126 novorojenčkov z enostransko in 40 novorojenčkov z obojestransko UTD. Zbrali smo podatke o stopnji UTD A in UTD P ter klinične podatke o specifičnih uropatijah, okužbah sečil in antibiotični zaščiti, potrebi po kirurški intervenciji, spontani resoluciji in času, ki je bil za to potreben, ter končnem izhodu glede ledvične funkcije ob koncu sledenja. Rezultati: V prospektivnem delu raziskave smo ugotovili statistično značilno višje vrednosti uNGAL-a v podskupini novorojenčkov z obstrukcijo sečil v primerjavi s skupino zdravih novorojenčkov (mediana 15,9 (IQR 6,4–25,0) in mediana 5,7 (IQR 3,6–11,1), Kruskal-Wallisov test, p = 0,016). Z ROC (angl. receiver operating curve) analizo smo določili diagnostični profil uNGAL-a za odkrivanje obstrukcije sečil in ugotovili, da je pri mejni vrednosti uNGAL-a 5,5 µg/L senzitivnost 89 % in specifičnost 51 %. AUC (angl. area under the curve) je bila 0,72 (95 % CI 0,59–0,85). V retrospektivnem delu raziskave smo dokazali statistično značilno povezavo med UTD A 2–3 in UTD P 2 ali 3 s senzitivnostjo 88 % in specifičnostjo 32 % (p < 0,005). Dokazali smo tudi statistično značilno povezanost stopnje UTD P s specifičnimi uropatijami (refluksna, obstrukcijska, idiopatska) (?2-test, p < 0,001), pojavnostjo okužbe sečil (?2-test, p = 0,003), potrebo po antibiotični zaščiti (?2-test, p < 0,001), potrebo po kirurškem zdravljenju (?2-test, p < 0,001), stopnjo spontane resolucije (?2-test, p < 0,001) in časom do le-te (Log-rank test, p = 0,011), medtem ko nismo dokazali povezanosti stopnje UTD P z ledvično funkcijo ob koncu sledenja vsi bolniki so imeli ob koncu sledenja (mediani čas spremljanja 24 mesecev (IQR – 12–48 mesecev)) normalno ledvično funkcijo. Sklepi: V prospektivnem delu raziskave smo dokazali možno uporabnost uNGAL-a iz enkratnega vzorca neinvazivno odvzetega urina v prvih dneh po rojstvu kot označevalca ledvične okvare pri novorojenčkih s prirojeno enostransko UTD. V drugem, retrospektivnem delu raziskave smo potrdili uporabnost in zanesljivost klasifikacijskega sistema UTD A/P pri napovedi različnih kliničnih izhodov pri novorojenčkih s prirojeno eno- ali obojestransko UTD. Background and purpose of the study: Urinary tract dilatation (UTD) is the most common genitourinary abnormality detected in routine prenatal ultrasound (US) examinations. Some UTDs can lead to kidney damage, which is the primary cause of chronic renal disease in children, so a timely diagnosis and treatment are mandatory. The currently most investigated and promising biomarker is neutrophil gelatinase-associated lipocalin in urine (uNGAL), which is of special importance in the neonatal population due to its non-invasive urine collection. The aim of our study was to evaluate its role in newborns with congenital unilateral UTD. US of the urinary tract, though, remains the first and safest investigation needed for the evaluation of fetuses and newborns with suspected UTD. We evaluated the ultrasound UTD A (antenatal)/P (postnatal) classification system, which has been in use since 2014, and its association with specific uropathies and different clinical outcomes. Patients and methods: In the first, prospective part of the study, we enrolled 38 term newborns with congenital unilateral UTD, while 38 healthy term newborns represented the control group. US of the urinary tract was done according to the UTD P classification system, and the uNGAL concentration was measured by chemiluminescence analysis. Some of the newborns needed additional workup to define the etiology of the congenital kidney disease (cystograms, scintigraphies, urography). The newborns in the study group were further divided into 2 subgroups regarding the urinary tract obstruction, and subsequently according to the need for surgical or conservative treatment. In the retrospective part of our study, we enrolled 126 newborns with unilateral UTD and 40 newborns with bilateral UTD. Data was obtained on UTD A and UTD P grades, as well as clinical events such as specific uropathies, urinary tract infections, the need for prophylactic antibiotic therapy or surgical intervention, the rate and timing of spontaneous resolution, and renal function outcome at the end of follow-up. Results: Our prospective study showed significantly higher uNGAL values in the study subgroup with urinary tract obstruction compared to the control group (median 15.9 (IQR 6.4-25.0) vs median 5.7 (IQR 3.6-11.1), Kruskal-Wallis test, p = 0.016). A receiver operating curve (ROC) analysis was performed to determine the diagnostic profile of uNGAL to detect newborns with urinary tract obstruction. The analysis showed sensitivity to be 89 % and specificity 51 % at the cut-off point of uNGAL 5.5 μg/L. The area under the curve (AUC) was 0.72 (95 % CI 0.59⠒0.85). Our retrospective study showed a statistically significant association of UTD A 2-3 with UTD P 2 or 3 (sensitivity 88 %, specificity 32 %, p < 0.005). We have also proven a statistically significant association between different UTD P grades and specific clinical outcomes: specific uropathies (reflux, obstructive, idiopathic) (χ2 test, p < 0.001), urinary tract infections rate (χ2 test, p = 0.003), antibiotic prophylactic treatment (χ2 test, p < 0.001), the need for surgical procedure (χ2 test, p < 0.001), spontaneous resolution rate (χ2 test, p < 0.001), and time to spontaneous resolution (log-rank test, p = 0.011). We did not find any association with renal function at the end of follow-up, as all our patients had normal renal function at the end of follow-up (the median follow-up time was 24 months (IQR 12⠒48)). Conclusions: The prospective part of our study confirmed the potential usefulness of uNGAL from a single urine sample in the first few days of life as a non-invasive marker of kidney injury in newborns with congenital unilateral UTD. In the second, retrospective part of our study, we confirmed the validity and utility of the UTD A/P classification system in predicting different clinical outcomes in newborns with congenital unilateral or bilateral UTD.

Inflammation and oxidative stress are recognized as important contributors of brain injury in newborns due to a perinatal hypoxic-ischemic (HI) insult. Genetic variability in these pathways could influence the response to HI and the outcome of brain injury. The aim of our study was to evaluate the impact of common single-nucleotide polymorphisms in the genes involved in inflammation and response to oxidative stress on brain injury in newborns after perinatal HI insult based on the severity and pattern of magnetic resonance imaging (MRI) findings. The DNA of 44 subjects was isolated from buccal swabs. Genotyping was performed for NLRP3 rs35829419, CARD8 rs2043211, IL1B rs16944, IL1B rs1143623, IL1B rs1071676, TNF rs1800629, CAT rs1001179, SOD2 rs4880, and GPX1 rs1050450. Polymorphism in CARD8 was found to be protective against HI brain injury detected by MRI overall findings. Polymorphisms in IL1B were associated with posterior limb of internal capsule, basal ganglia, and white matter brain patterns determined by MRI. Our results suggest a possible association between genetic variability in inflammation- and antioxidant-related pathways and the severity of brain injury after HI insult in newborns.

Uvod in namen raziskave: Izmenjalna transfuzija krvi (IT) predstavlja pomembno obliko zdravljenja novorojenčkov s hemolitično boleznijo ploda in novorojenčka (HBPN). Ena izmed možnih neželenih transfuzijskih reakcij je s transfuzijo povezana imunomodulacija (STPI), ki preko še ne povsem pojasnjenih mediatorjev in mehanizmov lahko povzroči številne pozitivne in negativne klinične učinke oz. vpliva na kasnejšo obolevnost prejemnikov krvi. Namen raziskave je raziskati vpliv IT v obdobju novorojenčka na imunsko odzivnost in obolevnost oz. ugotoviti, ali IT povzroča STPI. Raziskovalna metodologija: Prvi del raziskave temelji na prospektivni analizi celičnega imunskega odziva, ki smo jo izvedli na kohorti 86 preiskovancev. Od teh je 30 otrok eksperimentalne skupine v starosti nekaj dni zaradi HBPN prejelo IT, 56 zdravih otrok kontrolne skupine pa ni prejelo nobene krvne komponente. V starosti šest tednov in 13 mesecev smo vsem otrokom določili krvno koncentracijo levkocitov, limfocitov in limfocitnih populacij ter serumsko koncentracijo vnetnih in regulatornih citokinov. Drugi del raziskave temelji na retrospektivni analizi specifičnega protitelesnega imunskega odziva na toksoidno cepivo proti davici in tetanusu, serumskih avtoprotiteles in pojavnosti bakterijskih in virusnih okužb, alergijskih, avtoimunskih in rakavih bolezni, ki smo jo izvedli na kohorti 74 preiskovancev. Od teh je 41 otrok eksperimentalne skupine v starosti nekaj dni zaradi HBPN prejelo IT, 33 zdravih otrok kontrolne skupine pa ni prejelo nobene krvne komponente. Rezultati in razprava: Šest tednov po IT so imeli prejemniki IT v primerjavi z zdravimi dojenčki znake imunske izčrpanosti, saj so imeli pomembno nižjo krvno koncentracijo aktiviranih monocitov, aktiviranih celic T pomagalk, regulatornih celic T pomagalk in naivnih ter tranzicijskih limfocitov B. Trinajst mesecev po IT je imunska izčrpanost izzvenela, saj razlike v koncentraciji teh celic ni bilo več, a je razlika med prejemniki IT in zdravimi otroci vseeno ostala, saj so imeli prejemniki IT zmanjšano variabilnost koncentracije imunskih celic in citokinov. Po štirih odmerkih toksoidnega cepiva proti davici in tetanusu so imeli prejemniki IT izrazito močan in pomembno boljši protitelesni imunski proti davičnemu toksoidu. Prejemniki IT so pogosteje obolevali zaradi okužbe z varičela zoster virusom glede pojavnosti drugih virusnih in bakterijskih okužb, alergijskih, avtoimunskih in rakavih bolezni ter serumskih avtoprotiteles pa se niso razlikovali od zdravih otrok. Zaključki: IT v obdobju novorojenčka povzroča STPI, saj vpliva na delovanje specifičnega celičnega in protitelesnega imunskega odziva. Povzroči kratkoročno in prehodno imunsko izčrpanost, ki izzveni do 13. meseca starosti. Dolgoročno izboljša protitelesni imunski odziv na toksoidno cepivo proti davici in vpliva na pojavnost okužbe z varičela zoster virusom. Možen mehanizem nastanka STPI bi bila lahko masivna antigenska obremenitev, ki kratkoročno povzroči prehodno imunsko izčrpanost, dolgoročno pa pospešeno, a slabše uglašeno zorenje imunskega sistema. Protitelesni imunski odziv na cepljenje s toksoidnim cepivom proti davici in tetanusu je pri prejemnikih IT vsaj primerljiv z učinkovitostjo cepiva pri zdravih otrocih, zato naj bodo prejemniki IT s tema dvema cepivoma cepljeni po uradnemu cepilnemu programu za zdrave otroke. Introduction and objective: Exchange transfusion (ET) is an important treatment method of newborns with hemolytic disease of the fetus and newborn (HDFN). One of the possible adverse effects of transfusion is transfusion-related immunomodulation (TRIM), which can through still unexplained mediators and mechanisms lead to a number of positive and negative clinical outcomes and affects the subsequent morbidity of blood recipients. The objective of the study is to investigate the impact of ET in the neonatal period on immune response and morbidity and to determine whether ET triggers TRIM. Methods: The first part of the study is a prospective cohort analysis of the cellular immune response of 86 subjects. Thirty children of the experimental group received ET due to HDFN at the age of a few days and 56 healthy children in the control group did not receive any blood component. Blood concentrations of leukocytes, lymphocytes, lymphocyte populations and serum concentrations of inflammatory and regulatory cytokines were determined in all children at the age of six weeks and 13 months. The second part of the study is a retrospective cohort analysis of the specific humoral immune response to toxoid diphtheria and tetanus vaccine, serum autoantibodies and the incidence of bacterial and viral infections, allergic, autoimmune and cancer diseases of 74 subjects. Forty-one children of the experimental group received ET due to HDFN at the age of a few days and 33 healthy children in the control group did not receive any blood component. Results and discussion: At the age of six weeks ET recipients presented with signs of immune exhaustion as they had significantly lower blood concentrations of activated monocytes, activated helper T cells, regulatory helper T cells, naive and transitional B lymphocytes compared to healthy infants. Thirteen months after ET immune exhaustion disappeared as the difference in the concentration of these cells was no longer present, but the difference between ET recipients and healthy children remained as ET recipients exhibited reduced variability of immune cells and cytokines concentration. After four doses of diphtheria and tetanus toxoid vaccine ET recipients showed effective and significantly better humoral immune response to diphtheria toxoid. ET recipients were more likely to develop varicella zoster virus infection however, the incidence of other viral and bacterial infections, allergic, autoimmune, cancerous diseases and serum autoantibodies did not differ from healthy children. Conclusions: ET in the neonatal period triggers TRIM as it affects specific cellular and humoral immune response. It causes short-term and transient immune exhaustion that resolves by 13 months of age. It improves the long-term humoral immune response to diphtheria toxoid vaccine and affects the incidence of varicella zoster virus infection. A possible mechanism of TRIM development could be a massive antigenic load, which in short term causes transient immune exhaustion and in long term an accelerated but less attuned maturation of the immune system. The humoral immune response to diphtheria and tetanus toxoid vaccine in ET recipients is at least comparable to the efficacy of the vaccine in healthy children, so ET recipients should be vaccinated with these two vaccines according to the official immunization schedule for healthy children.

Hemolitična bolezen ploda in novorojenčka (HBPN) nastane zaradi vezave aloimunskih protiteles na otrokove eritrocitne antigene, kar povzroči razpad eritrocitov ter nastanek hiperbilirubinemije in anemije novorojenčka. Aloimunska protitelesa, ki prehajajo preko posteljice iz materinega v plodov krvni obtok, so lahko naravno prisotna protitelesa anti-A in anti-B ali pa redkeje prisotna protitelesa, ki nastanejo po izosenzibilizaciji matere na tuje eritrocitne antigene, kot so protitelesa anti-D. Do izosenzibilizacije matere lahko pride ob transfuziji eritrocitov ali med nosečnostjo. HBPN zaradi protiteles anti-A in anti-B (HBPN AB0) lahko poteka z blago hiperbilirubinemijo in anemijo ali pa huje, z visoko hiperbilirubinemijo in izrazito anemijo, tako da je potrebna izmenjalna transfuzija krvi novorojenčka. HBPN zaradi protiteles anti-D je zaradi učinkovitega programa zaščite RhD negativnih nosečnic z imunoglobulini anti-D danes redka bolezen, njen potek pa v primerjavi s HBPN AB0 hujši.V prvem delu prispevka opišemo patofiziologijo, klinično sliko, diagnosticiranje, zdravljenje in preventivo HBPN. V drugem delu prispevka predstavljamo rezultate kohortne retrospektivne analize 109 bolnikov s HBPN, hospitaliziranih na Kliničnem oddelku za neonatologijo med januarjem 2007 in decembrom 2016. V 84,4 % so HBPN povzročila protitelesa anti-A ali anti-B, v 9,2 % protitelesa anti-D in v 6,4 % ostala, redkejša protitelesa. Bolniki s HBPN, povzročeno z različnimi protitelesi, se v rezultatih hematoloških preiskav niso statistično značilno razlikovali. Pozitiven direktni Coombsov test so imeli vsi novorojenčki s HBPN RhD in le 64 % novorojenčkov s HBPN AB0. Vsi bolniki s HBPN RhD so potrebovali izmenjalno transfuzijo ali znotrajmaternično transfuzijo.

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.

Uvod: Nosečnost je fiziološko stanje, prepleteno s številnimi telesnimi in duševnimi spremembami, ki lahko včasih pri nosečnicah povzročajo nelagodje. Za zmanjševanje bolečin v hrbtu in kolkih, telesnih napestosti in za optimalno pozicioniranje ploda lahko uporabimo kraniosakralno terapijo. Namen: Namen diplomskega dela je pregled literature o kraniosakralni terapiji v nosečnosti in poporodnem obdobju. Metode dela: Pri diplomskem delu je bila uporabljena opisna metoda dela s pregledom znanstvene in strokovne literature na temo kraniosakralne terapije v nosečnosti in poporodnem obdobju. Avtorica je literaturo pridobila s pomočjo mednarodnih iskalnih baz PubMed, Cochrane Library, Medline, Cinahl, Science Direct, preko digitalne knjižnice Univerze v Ljubljani DiKUL, kooperativnega online bibliografskega sistema in servisa COBISS.si ter s pomočjo spletnih brskalnikov. Izbranih je bilo 87 raziskav, od katerih je bilo po dodatnem kritičnem vsebinskem pregledu uporabljenih 56. Avtorica je za namene diplomske naloge vključila literaturo, staro do 20 let. Rezultati: Raziskav na danem področju ni veliko in večina vsebuje pomanjkljive podatke za kritično interpretacijo rezultatov. Izvedene raziskave kažejo, da je kraniosakralna terapija od 81% do 95% uspešna pri reševanju težav pri nosečnicah z bolečinami v križu in/ali bolečinami v medeničnem obroču ter pri odkrivanju in zdravljenju različnih psiholoških in fizioloških motenj pri otrocih. Razprava in zaključek: V slovenskem prostoru bi bilo potrebno terapijo predstaviti širši javnosti. Potrebna bi bila obsežna longitudinalna raziskava, s katero bi lahko dokazali pozitivne in negativne učinke terapije. Introduction: Pregnancy is a physiological state which is intertwined with various physical and emotional changes. These often cause discomfort. To minimise the pain in the back and hips, physical tension and to encourage the optimum position of the foetus the craniosacral therapy can be used. Purpose: The purpose of this bachelor thesis is to examine the literature about the craniosacral therapy during pregnancy and postnatal period literature. Methods: The descriptive method of work was used in the making of this thesis, together with a systematic overview of the scientific writings and literature on the subject of the craniosacral therapy during pregnancy and postnatal period literature. The author has gathered the literature by looking into the international search base PubMed, Cochrane Library, Medline, Cinahl, Science Direct, via the digital library of the University of Ljubljana DiKUL, cooperative online bibliographic system and service COBISS.si, as well as other web browsers. 87 researches were chosen. Out of which 56 researches were used after an additional thorough examination. Literature not older than 20 years was used for the selection of articles and researches included in this examination. Results: There are not a lot of researches on the given topic and the majority lacks enough data for a critical interpretation of results. However, the carried out researches suggest that the craniosacral therapy is 81% - 95% efficient not only in solving problems of pregnant women with back pain and/or pelvic pain, but also in discovering and treating of various dysfunctions with children. Discussion and conclusion: This therapy should be presented to a wider Slovenian audience and introduced to our daily life. The frequency of its use ought to be researched and a longitudinal study should be made, which would prove its positive and negative impact.

Tema magistrske naloge je vezana na večen problem novopečenih staršev – otrokovo spanje. Ideja mojega izdelka je zato nastala z namenom premagati to težavo in s tem omogočiti spanec tako staršem kot otroku. Starševstvo se je skozi čas vsekakor spremenilo in z novimi generacijami se vse bolj povečuje zanimanje za otroške izdelke in tehnologije, povezane z njimi, ki novopečenim staršem olajšajo vsakdanja opravila, skrajšajo čas dela in povečajo njihovo učinkovitost. V magistrski nalogi je zajet celoten razvoj izdelka po metodi »Design thinking«, ki je znana metodologija kreativnega reševanja problemov. Po raziskavi trga, analizi zbranih podatkov, podanih s strani bodočih in že obstoječih mamic, analizi vplivov zvoka na dojenčke in analizi strogih standardov v industriji otroških izdelkov sem prišla do razvoja različnih idej forme, mehanizmov, vključitve tehnologije, pa tudi stvari povezanih z blagovno znamko. Končni izdelek je rezultat vključitve uporabnikovih potreb in želja ter, kar je najpomembnejše, predstavlja rešitev in v procesu ustvarja edinstveno zgodbo. The topic of the Master's thesis is related to the eternal problem of newly born parents - the child's sleep. The idea behind my product therefore came about in order to overcome this problem and thus enable sleep for both parents and children. Parenting has definitely changed over time, and with new generations there is an increasing interest in baby products and related technologies that make it easier for new parents to do their daily chores, shorten their work time and efficiency. The Master's thesis covers the entire development of the product by the method »Design thinking«, which is a known methodology for creative problem solving. After researching the market, analyzing the data collected by prospective and existing moms, the effects of sound on babies and analyzing strict standards in the baby products industry, I came up with different ideas of form, mechanisms, technology integration, as well as brand-related things. The final product is the result of integrating the user's needs and desires and most importantly presents a solution and creates a unique story in the process.

Uvod: Zloraba drog v nosečnosti je škodljiva za nosečnico in plod. Posledice so sicer odvisne od vrste, količine in kombinacije drog, ki jih nosečnica uživa, a so vselej negativne. Novorojenčki se pogosto rodijo prezgodaj, s prenizko porodno težo, s številnimi zdravstvenimi zapleti, višjo stopnjo mrtvorojenosti. Tudi kasneje imajo pogosto težave pri fizičnem in kognitivnem razvoju ter živijo v okolju, kjer so izpostavljeni številnim dejavnikom, ki že sami vplivajo na negativen razvoj posameznika. Namen: Namen diplomskega dela je predstaviti kratkoročne in dolgoročne posledice jemanja nedovoljenih drog v nosečnosti za plod, novorojenčka oz. otroka, ter opisati odnos med otročnico, ki je odvisna od drog, in njenim novorojenčkom oz. otrokom. Metode dela: V diplomskem delu je uporabljena deskriptivna metoda dela. Opravljen je bil sistematičen pregled znanstvene in strokovne literature, napisane v slovenskem in angleškem jeziku. Iskanje literature je potekalo od maja 2018 do aprila 2019. Iskali smo v bazah podatkov CINAHL, PUBMED in MEDLINE ter prek sistema COBISS+. Rezultati: Kratkoročna posledica jemanja opioidov v nosečnosti je pojav neonatalnega abstinenčnega sindroma, ki vključuje širok spekter simptomov in se začne kazati v roku 72 ur po rojstvu ter lahko traja do 6 mesecev po porodu. Neonatalni abstinenčni sindrom se razvije tudi v primeru, da se nosečnica zdravi z nadomestnim zdravljenjem z metadonom. Potrebno ga je zdraviti, cilj zdravljenja pa je ob čim manjši sedaciji pomiriti novorojenčka. Novorojenček ima težave pri uravnavanju svojega notranjega okolja z zunanjim in doživlja hud stres. Dolgoročne posledice se pogosto kažejo kot zmanjšane kognitivne sposobnosti, težave pri samoobvladovanju in vedenjske težave, težave s spominom, težave z motoriko, večja nagnjenost k nasilju, težave pri navezovanju stikov in večja verjetnost, da bodo tudi sami uživali droge. Zloraba drog vpliva tudi na odnos med materjo in otrokom, matere odvisnice so pogosto nezainteresirane za skrb za svojega otroka, izkazujejo manj empatije in materinstvo zaznavajo kot zelo zahtevno nalogo. Otroke pogosto vzgajajo v neoptimalnem okolju. Razprava in zaključek: Raziskovanje obravnavanega področja je težavno, zato se tudi rezultati raziskav pogosto razlikujejo med sabo. Težko je namreč natančno določiti, kateri izmed mnogih dejavnikov je vplival na posameznika. Na potek in razplet zdravljenja pogosto vplivajo tudi zdravstveni delavci s svojim vedenjem, ki je pogosto odklonilno in obsojajoče, saj imajo pri tem nemajhno vlogo predsodki in pomanjkanje znanja. Vsi, ki se pri svojem delu soočajo z nosečnicami in otročnicami, ki so odvisne od drog, bi potrebovali dodatna izobraževanja, da bi jih bolje razumeli in jim znali pomagati. Introduction: The drug abuse during pregnancy is equally harmful to a woman as it is to a fetus. The consequences however depend on the type, quantity and combination of drugs the pregnant woman is taking. Nevertheless, the effect of drugs is always negative. The newborns are often born prematurely, underweight, with numerous health problems. Furthermore, the drug abuse also increases the chances of stillbirth. Even later on in life, the children have many problems in physical and cognitive developement that are emphasized also because of the environment they live in where they are exposed to many factors that have a negative impact on the individual's development. Purpose: The purpose of the following diploma work is to present short-term and long-term consequences the drug abuse during pregnancy has on the fetus, newborn/child and to describe the relationship between the drug addicted puerpera and her newborn. Methods: In the following diploma, the descriptive method of work is used. A systematic overview of scientific and technical literature, written in Slovene and English, was performed. The literature search took place from April 2018 to May 2018. We searched through CINAHL, PUBMED and MEDLINE databases, and through the COBISS + system. Results: The short-term effects of taking opioids in pregnancy are the reason behind neonatal abstinence syndrome, which includes a wide range of symptoms and begins to show within 72 hours after birth and can last up to 6 months after delivery. Neonatal abstinence syndrome also occurs when the pregnant woman is treated with methadone replacement therapy. The treatement is neccesary as its main goal is to calm the newborn down with minimal sedation. The newborn has difficulties with regulating his inner environment with the outside while experiencing a severe stress. Long-term consequences are often seen as reduced cognitive abilities, problems with self-control and behavioral problems, memory problems, motor problems, increased propensity for violence, difficulties in making contact, children are also more likely to use drugs themselves. Drug abuse also affects the relationship between the mother and the child, the addicted mothers are oftentimes disinterested in taking care of their child, they display less empathy, and maternity is perceived as a very demanding task. Children are often raised in a sub-optimal environment. Discussion and conclusion: Researching on the subject area is difficult, therefor the results of researches often differ from one another. It is difficult to precisely determine which of many factors has affected the individual. Healthcare workers are often influenced by their own prejudices and condemnation that combined with the lack of knowledge can result in the subpar treatment of the patient. All those who work with pregnant women and puerperae who are dependent on drugs would need/should undergo additional training in order to understand these women better and to help them accordingly when needed.

Uvod: Natančno merjenje temperature je osnova za kakovostno zdravstveno nego novorojenčkov in dojenčkov. Pri tem mora medicinska sestra upoštevati stanje in starost pacientov ter okolje. Poznanih je več različnih načinov merjenja telesne temperature, vendar pa niso vsi enako zanesljivi in natančni. Namen: Namen diplomskega dela je predstaviti najnovejše študije na področju merjenja telesne temperature pri novorojenčku in dojenčku. Metode dela: Uporabljena je deskriptivna metoda dela in pregled strokovne in znanstvene literature s področja zdravstva in merjenja telesne temperature pri novorojenčku in dojenčku. Rezultati: Analiziranih je bilo 13 relevantnih člankov, ki so opisovali več različnih vrst merjenja telesne temperature. Avtorji štirih člankov bi aksilarno merjenje temperature vsaj potencialno priporočili, medtem ko so v enem članku to prakso pri nestabilnih novorojenčkih odsvetovali. Brezkontaktni infrardeči termometer, ki meri temperaturo na sredini čela, so obravnavali raziskovalci v štirih člankih, od katerih sta ta način priporočila le dva. V enem članku so merjenje na koži abdomna označili kot boljšo prakso od kože na sredini prsnega koša, drugi pa bi namesto kože abdomna raje priporočili kožo hrbta. Merjenje telesne temperature na temporalni arteriji so v določenih primerih priporočili v treh člankih, timpaničen način pa so raziskovalci obravnavali le v enem članku in ga tudi odsvetovali. Razprava in sklep: Zelo dobri načini merjenja telesne temperature so aksilarno merjenje, merjenje na temporalni arteriji in merjenje na koži hrbta, vendar se je potrebno zavedati prednosti in pomanjkljivosti teh metod. Večinoma morajo biti novorojenčki zdravi in stabilni ter bivati na sobni temperaturi in ne v ogrevanih okoljih. Timpanično merjenje telesne temperature se je izkazalo za nezanesljivo, prav tako tudi brezkontaktni infrardeči termometer, pri katerem smo dobili tudi nekoliko nasprotujoče si rezultate. Introduction: Accurate temperature measurement is basic for correct nursing of neonates and infants. Nurse has to take into account the condition of patients, ambient, age and adjust her procedures to her set goal. Many different ways of measuring body temperatureare are known, but not all of them are equally reliable and accurate. Purpose: The purpose of this thesis is to present the newest studies in the field of body temperature measuring in neonates and infants. Methods: We used descriptive method of work and review of professional and scientific literature from the field of nursing and body temperature measuring in neoates and infants Results: We analysed 13 relevant articles that were describing different ways of body temperature measuring. Authors of four articles would at least potentially recomend axillary temperature measuring, while in one article they didn’t advise it with unstable neonates. Four articles discused non-contact infrared thermometer, which measures temperature in the middle of forehead, and in only two of them researchers would recomend it. In one article, measuring on the skin of the abdomen was assesed as a good practise, instead of the skin in the middle of the chest, in anotherone they would rather use skin on the back instead of the skin on the abdomen. Measuring body temperature on the temporal artery was in special cases recomended based on three articles, tympanic way was however discussed only in one article and was also not recomended in it. Discussion and conclusion: Very good way of body temperature measuring is axillary thermometry, temporal artery measuring and measuring on the skin of the back, but we have to be aware of all the advantages and dissadvantages of these methods. Most of the times newborns have to be healthy and stable and be on room temperature care and not in heated environments. Tympanic body temperature measuring turned out to be unreliable, as well as non-contact infrared thermometer, that also got us some conflicting results.