Tamelienė, Rasa

Background, Objectives: Neonates, especially preterm infants in the NICU, undergo numerous procedures that may cause discomfort or pain. There is limited research on factors influencing neonatal stress and pain responses. This study aimed to identify factors in newborns associated with increased neonatal pain. Methods: We conducted a prospective quantitative study at the Lithuanian University of Health Sciences Kaunas Clinics (Dec2020–Nov 2021). Term and preterm neonates admitted to the Neonatology Department/NICU were included. Exclusion criteria: endocrine, and CNS disorders, treatment with glucocorticoids or analgesics, and dehydration. Data collected: neonates’ vitals, demographics, PIPP score, physiological parameters. Salivary cortisol and melatonin were measured via ELISA be-fore and 30 minutes after venipuncture or heel prick. Statistical analysis performed with SPSS 29.0. p value < 0.05 considered significant. Results: In total 98 newborns were included in the study,63.3% were term, 30 – treated in NICU. 68.4% of birth – natural, 9.2% had congenital malformations. Preterm neonates had greater increases in heart and respiratory rates during procedures (p < 0.001, p = 0.005), higher pre-procedural PIPP scores (p < 0.001), it remained similar after procedure. Females tended to have lower SpO2 before and after the procedure(p = 0.059, p = 0.057). Higher RR before, after the procedure associated with congenital abnormalities (p = 0.016, p = 0.050).Cortisol was higher in premature newborns after venipuncture(p = 0.039), also they had higher cortisol difference after NICU procedure (p = 0.039). Females had higher cortisol before procedure in NICU (p = 0.009). Congenital abnormalities associated with greater cortisol difference during heel-lance (B = 29.583,p = 0.039), lower gestational age – with higher cortisol difference in NICU procedures(p = 0.041). Neonatal sepsis was negatively correlated with melatonin concentration (p = 0.025).Conclusion: We observed that prematurity, congenital conditions, and neonatal sepsis are associated with heightened physiological and hormonal stress and pain responses.

Background, Objectives: Studies have demonstrated that neo-nates exhibit cortical responses to noxious stimuli, express clear physiological stress reactions. Major challenge – effective pain assessment. There is lack of studies investigating maternal fac-tors influencing neonatal stress and pain responses. This study aimed to identify these factors. Methods: We conducted a prospective quantitative study at the Lithuanian University of Health Sciences Kaunas Clinics (Dec2020–Nov 2021). Term and preterm neonates admitted to the Neonatology Department/NICU were included. Exclusion criteria: neonate endocrine, CNS disorders, treatment with glucocorticoids or analgesics, and dehydration. Data collected: neonate's vitals, demographics, PIPP score, mothers’ medical history. Newborn salivary cortisol and melatonin were measured via ELISA before and 30 minutes after venipuncture or heel prick. Statistical analysis performed with SPSS 29.0. p value < 0.05 considered significant. Results: 98 newborns included in the study, 63.3% born on term. 68.4% of birth – natural. Half of women < 30 y.o. (median29 years, IQR26-33). 73.5% had pathology during pregnancy, 62.2% had medical anesthesia/pain management during labor. Higher melatonin in newborns born via CPO post NICU procedure(p = 0.028). Newborns from mothers who had any pathology during pregnancy were 12.6x more likely to have higher cortisol before heel-lance procedure (p = 0.021). The method of delivery negatively correlated with pre-procedure cortisol concentration(p = 0.035, p = 0.068). Maternal harmful habits increase melatonin concentration 6.319x after the heel-lance prick. Pain relief during labor and harmful maternal habits were associated with difference in melatonin concentration before and after the heel-lance procedure (p = 0.005, p = 0.002). Neonates born via CPO had higher melatonin after NICU procedure (p = 0.028). Conclusion: We observed that neonatal stress and pain responses are significantly influenced by maternal factors, including maternal health, delivery method, and maternal behaviors.

Objective. To investigate respiratory practices to prevent or treat evolving bronchopulmonary dysplasia (BPD) in neonatal intensive care units (NICUs) across Europe. Study design. Between March and July 2024, a web-based survey was sent to European NICUs caring for infants born preterm with gestational age (GA) <28 weeks. Results. We received replies from 447/721 (62%) NICUs across 24 European countries. Almost 16% of NICUs routinely intubate at birth, especially if the GA is <24 weeks. During transition most NICUs use continuous positive airway pressure ≥5 cmH2O and start with an FiO2 0.3. Volume-targeted ventilation is the primary ventilation mode in 60% of the NICUs. Permissive hypercapnia is a common practice. Higher SpO2 target limits have been adopted, although alarm settings vary across NICUs. Caffeine is routinely started (96%). Surfactant is used in all NICUs, mostly rescue (74%) via less invasive administration (81%). Prophylactic inhaled nitric oxide (iNO) is not used. Treatment of patent ductus arteriosus (PDA) varies; half of NICUs pharmacologically treat PDA early, based on echocardiographic findings. Ureaplasma screening is done in 22% of NICUs. Most (97%) NICUs use postnatal corticosteroids, with dexamethasone being the preferred drug (65%) and starting 2-3 weeks after birth. Only 5% use corticosteroids prophylactically. After 2-3 weeks, diuretics are used frequently, inhaled corticosteroids/bronchodilators to a much lesser extent. Conclusion. This large survey shows considerable practice variation in preventing and treating evolving BPD across Europe, especially for interventions with limited evidence.

Introduction: Over recent decades, the study of the bacterial microbiome has gained increasing attention due to its vital role in human health. The development of the gut microbiome is especially critical during infancy, as it supports nutrient absorption, metabolic regulation, and immune system maturation. Several perinatal factors, including delivery mode, gestational age, and health status, have been shown to influence micro -biome establishment. Preterm and low-birth-weight infants, in particular, face heightened vulnerability to disruptions in microbiome development, which may contribute to adverse health outcomes. Aims & Methods: This study aimed to analyze the longitudinal development of the gut microbiome in preterm, low-birth-weight neonates over the first two months of life and to identify microbial patterns and alterations associated with delivery mode, gestational age, and clinical conditions. The study cohort included 115 low-birth-weight preterm infants and 99full-term, normal-weight controls. Stool samples from preterm infants were collected at multiple time points between day 1 and day 61 of life and grouped into six age categories for analysis. In total, 819 stool samples were examined. DNA was extracted and amplified targeting the V3–V4 region of the 16S rRNA gene, followed by sequencing on the Illumina MiSeq platform. Microbiome data were analyzed using bioinformatic and statistical tools to assess taxonomic composition, alpha diversity, and beta diversity. Results: Significant differences in microbiome profiles were associated with gestational age, mode of delivery, postnatal age, maternal medication, and the presence of necrotizing enterocolitis (NEC). Bacterial com-munities began to stabilize between days 26 and 35. A total of 56 bacterial genera — including Bifidobacterium, Clostridium, Escherichia-Shigella, Gemella, Klebsiella, Lactobacillus, and Streptococcus — showed a positive correlation with infants’ age in days, while 31 genera — including Bacillus, Cutibacterium, Flavobacterium, Macrococcus, Pseudomonas, and Staphylococcus — were negatively correlated. Eighteen bacterial genera were associated with the mode of delivery at various time points. Genera such as Fusobacterium, Bacteroides, Entero-coccus, Streptococcus, Gemella, and Corynebacterium were more commonly associated with vaginal birth, while Staphylococcus, Rahnella, Yokenella, Millisia, Negativicoccus, Finegoldia, Haemophilus, Acinetobacter, Conservatibacter, Serratia, Stenotrophomonas, and Peptoniphilus were associated with Caesarean section delivery. Moderate differences in early-life microbiome composition were also ob -served between low-birth-weight preterm and full-term infants. Conclusion: Gut microbiome development in preterm, low-birth-weight newborns is strongly influenced by clinical and perinatal factors, particularly during the first month of life. Mode of delivery, gestational maturity, and disease presence such as NEC contribute to microbial variability and delayed community stabilization. These findings highlight the importance of early-life monitoring and tailored interventions to support healthy microbiome development in vulnerable neonates.

Episodes of apnoea are common in extremely preterm infants (EPIs) and usually treated with caffeine and respiratory support. Understanding differences in apnoea definitions, monitoring practices, and use of respiratory stimulants is essential to improve future treatment.

Pastaraisiais dešimtmečiais priešlaikinių gimdymų pasaulyje daugėja, gerėja ir labai neišnešiotų mažesnio nei 28 sav. gestacinio amžiaus naujagimių išgyvenamumas. Tačiau, nustatyta, kad labai mažo gimimo svorio naujagimiams vis dar gresia didelė raidos sutrikimų rizika. Svarbu anksti nustatyti šiuos sutriki¬mus ir pritaikyti intervencines programas. Amplitudinė elektroencefalogramos (aEEG) kreivės pirmosios atspindi bet kokius naujagimio galvos smegenų ar bendrosios būklės pokyčius. Pasaulyje atliekami nauji tyrimai, kuriuose nagrinėjama dar viena aEEG panaudojimo sritis – remiantis pirmosiomis gyvenimo valandomis, paromis, savaitėmis neišnešiotiems nau¬ja¬gimiams registruotų aEEG rezultatais, galima prognozuoti raidos sutrikimo laipsnį kūdikystėje. Šio tyrimo tikslas - nustatyti amplitudine elektroencefalografija registruoto bioelektrinio smegenų aktyvumo prognozinę vertę numatant labai neišnešiotų naujagimių (< 32 sav. gestacinio amžiaus) neurologinę raidą sukakus 12 mėn. koreguo¬tam amžiui (KA). Visiems tiriamiesiems buvo užrašytos aEEG ir atliktos neurosonogramos iki vieno mėnesio amžiaus. Neurologinė raida vertinta kūdikiams sulaukus 12 mėn. KA. Tyrimo rezultatai parodė, kad pirmosios savaitės po gimimo bioelektrinis smegenų aktyvumas turėjo prognozinę vertę numatant 12 mėn. KA kūdikių motorinę raidą, o protinė raida nebuvo susijusi su bioelektriniu smegenų aktyvumu, bet nustatyta sąsaja su atviru arteriniu lataku.

Over the past decades, bacterial microbiome studies have become increasingly important. The development of the gut microbiome has been shown to play an essential role in human health, and to be especially decisive in infants [1]. It influences nutrient absorption, metabolism regulation, and immune system development. Various factors have been proposed to modulate the development of the microbiome and therefore shape the growth and health of newborns [2]. Premature babies are often lowweight and even more sensitive to health issues. This study aims to analyse the development of the microbiome in preterm neonates over the first two months of life and look for patterns and alterations associated with several factors, like delivery mode, gestation time and necrotizing enterocolitis (NEC). A total of 78 preterm newborns were included in the study, with stool samples being taken at several timepoints from each baby. In total 515 samples were collected. The timepoints varied between ages of one and 61 days and were grouped in six age groups during the analysis. Genomic DNA was extracted from stool samples, and the bacterial V3–V4 hypervariable region of the 16S rRNA gene was amplified and sequenced on the Illumina MiSeq platform. The data were processed using bioinformatical tools and analysed bioinformatically and statistically to access microbiome composition, abundancies, alpha- and beta-diversities. The analysis revealed significant differences in the bacterial profiles across different timepoints, gestational ages, delivery modes, and in relation to the development of NEC. Alpha diversity indices increased over time; however, fewer or no significant differences were observed between the later timepoints. Consistent patterns emerged from both PCoA and PERMANOVA analyses. Notably, NEC was associated with distinct bacterial. Additionally, the abundance of several bacterial taxa correlated with gestational age. The bacterial profile of premature, low-birth-weight newborns varies according to factors such as age, delivery mode, gestational age, and the presence of disease. Comparing these microbiome dynamics in low-birth-weight infants with those in full-term newborns could provide valuable insights into the development of neonatal diseases such as necrotizing enterocolitis.

Vaikai ir jaunuoliai sudaro penktadalį Lietuvos populiacijos ir 100 procentų Lietuvos ateities. Jie - būsimoji mūsų šalies darbo jėga ir ateinančių kartų tėvai. Jų sveikata bus svarbus veiksnys, lemiantis šalies klestėjimą ir gyventojų ilgaamžiškumą. Šalys, kurios investuoja į vaikų sveikatą, gauna įspūdingą ekonominį atlygį, nes kiekvienas vaiko sveikatos labui išleistas euras per gyvenimą grįžta dešimteriopa nauda visuomenei. Lietuvoje vaikų sveikata tapo prioritetinė tik politiniuose dokumentuose. Realiame gyvenime valstybės rūpestį vaikų sveikata dažnai užgožia politinės intrigos ir asmeninės ambicijos, o labiausiai kvalifikuotas šios srities specialistas - vaikų ligų gydytojas, išstumiamas iš pirminės vaikų sveikatos priežiūros. Norėdami padėti visiems gydytojams, kurie savo praktikoje susiduria su vaikų sveikatos priežiūra, vedantieji Lietuvos vaikų ligų specialistai parengė trumpus dažniausių vaikų susirgimų ir būklių diagnostikos ir gydymo algoritmus. Tikimės, kad jie padės šeimos gydytojams, skubios pagalbos gydytojams ir pirminėje sveikatos priežiūros grandyje dirbantiems vaikų ligų gydytojams greičiau ir efektyviau įtarti, diagnozuoti ir pradėti gydyti įvairius vaikų susirgimus. Taip pat gydytojams bus lengviau nuspręsti, kur siųsti pacientą, įtariant sudėtingesnę patologiją; su kokiais specialistais ir kokiuose centruose konsultuotis dėl tolimesnio paciento ištyrimo bei ilgalaikio gydymo ir priežiūros. Šia knyga vaikų ligų gydytojai siekia prisidėti prie vaikų sveikatos priežiūros kokybės bei efektyvių paslaugų prieinamumo gerinimo mūsų šalyje ir padėti užtikrinti Vaikų teisių konvencijoje deklaruojamą vaiko teisę į geriausią įmanomą sveikatos priežiūrą.

In clinical practice, it is crucial to identify diagnostic methods that can forecast the neurodevelopmental outcomes of very preterm neonates. Our study aimed to assess the predictive significance of amplitude-integrated electroencephalography (aEEG) for the neurodevelopmental outcomes of preterm infants at 12 months corrected age and to establish the cut-off score that could indicate potential neurodevelopmental impairments.