Stonienė, Dalia

Introduction Congenital intestinal malrotation (CIM) is a gastrointestinal defect caused by abnormal rotation of the midgut during embryogenesis. Although it may remain asymptomatic, CIM can lead to intestinal obstruction which may result in acute or chronic intermittent gastrointestinal symptoms. Early diagnosis and treatment are essential to prevent severe complications, such as midgut volvulus and small bowel necrosis. [1] Case Presentation The patient was born via spontaneous vaginal delivery at 37 weeks of gestation, cried immediately after delivery and had a birth weight of 3530 g. Apgar scores were 9 and 9 at 1 and 5 minutes, respectively. The neonate passed meconium shortly after birth. During pregnancy, the mother received routine antenatal care, including ultrasonography examinations. The patient was the third child of three siblings. 10 minutes after birth, the newborn showed signs of respiratory insufficiency, which resolved after 5 hours of CPAP therapy. A 1-day-old neonate presented to the emergency department with complaints of vomiting, especially after breastfeeding. The emesis consisted of breast milk and was yellow-green in color. Congenital intestinal malrotation was suspected, prompting an abdominal X–ray, which revealed reduced bowel gas. An upper gastrointestinal (UGI) study with water-soluble contrast was performed, demonstrating intestinal obstruction. The patient underwent an urgent open Ladd‘s procedure, during which findings characteristic of CIM were observed. The postoperative course was uncomplicated, and the patient’s condition steadily improved. The neonate was discharged from the hospital after 12 days. Discussion Symptomatic intestinal malrotation in newborns is estimated to occur in approximately 1 in 6000 live births. Sudden onset of bilious vomiting is a key point in neonatal intestinal obstruction, and malrotation should always be suspected until proven otherwise. Bilious emesis should raise strong clinical suspicion for CIM, an UGI contrast study is the examination of choice and remains as gold standard for intestinal malrotation. [2] Conclusions This case underscores the importance of early recognition, timely surgical treatment and multidisciplinary care in ensuring favorable outcomes for neonate intestinal malrotation.

Our survey aimed to compare information on respiratory care in Neonatal Intensive Care Units (NICUs) in Italy and in the European and Mediterranean region.

Introduction Sacrococcygeal teratoma (SCT) is classified into four types based on tumor location. The most common types are Type I (predominantly external with minimal internal extension) and Type II (similar internal and external components)[1]. Approximately 25–50% of cases are detected prenatally via ultrasonography (USG). Standard treatment is surgical resection, with rare wound infections [2,3]. Case Presentation A newborn was delivered at 38 weeks via a planned Cesarean section (IV pregnancy, II delivery). The congenital anomaly of SCT was suspected at 13 gestation weeks based on USG and MRI. Postnatally, a 9.6 × 9.2 × 7.0 cm mass was observed in the sacrococcygeal region. The MRI confirmed the diagnosis of type II SCT with presacral and intrapelvic extension. The newborn was evaluated by a pediatric oncologist and a surgeon, who recommended radical resection. The mass was surgically removed. The infant was transferred to the neonatal intensive care unit, where cefazolin and metronidazole were initiated prophylactically, fentanyl infusion was administered for pain management and mechanical ventilation was utilized. On postoperative day 5, the surgical wound developed and it was decided to perform wound revision surgery. After the procedure the patient developed a fever, laboratory indicated Escherichia Coli growth and treatment was changed to meropenem. Following extubation, the infant exhibited stridor and increased respiratory effort. A neurosonogram revealed N. striatum vasculopathy. Testing for TORCH infections detected 1645 IU/mL of cytomegalovirus (CMV) DNA copies. As congenital infection couldn't be ruled out, valganciclovir was initiated. The 29-day-old patient was discharged for outpatient care under the primary care physician. Discussion SCT is a rare germ cell tumor with an estimated incidence of 1/35,000–40,000 live births [1,2,5]. The etiology remains unknown and there is no established association between SCT and CMV [4]. Conclusions The prognosis of SCT depends on diagnosis timing, complications, and surgery severity, with low mortality and ~20% long-term functional impairment [3,5,6].

Introduction Gastroschisis is a congenital abdominal wall defect that has become increasingly common in the last 20 years [1]. We present a case of a newborn with antenatally diagnosed gastroschisis complicated by the late-onset sepsis and pneumonia. Case Presentation Fetus was diagnosed with gastroschisis antenatally in the 15th gestational week. Newborn was delivered naturally at 35 weeks. On the first day of life, the initial stage of surgical repair was performed, involving the placement of the intestines into a SILO bag. On the third day, the abdominal wall defect was successfully closed. On the ninth day, sepsis was suspected due to worsening respiratory failure and elevated C-reactive protein levels. Culture identified Staphylococcus haemolyticus in the bloodstream and Candida albicans in both the urine and surgical wound. A chest X-ray revealed pneumonia. During sepsis treatment, bowel obstruction was suspected, further diagnostic evaluation confirmed hydronephrosis and a patent foramen ovale. Discussion Gastroschisis is diagnosed antenatally in the first trimester of pregnancy [2]. There is no particular pathophysiological mechanism of gastroschisis and a couple options have been suggested [3]. The average prevalence of this disease in the EU is 1/6000 births and increasing [2], therefore it is necessary to acquire the knowledge of possible complications and how to manage them. Close fetal monitoring after diagnosis is mandatory due to high risk of fetal death [4]. Although the patient in this case initially had a high prognostic grade for gastroschisis and an uncomplicated presentation, the development of a severe complication of sepsis underscores the challenges of managing such cases. Conclusions We present the case of a newborn with gastroschisis complicated by pneumonia, sepsis, and candidiasis. Early antenatal diagnostics and multidisciplinary care during the gestational period led to good outcome despite complications.

Introduction Sarcomas are representing in less than 1% of adult malignancies and approximately 10% of pediatric cancers [1]. Synovial sarcoma (SS) is often affecting limbs and joints and is usually associated with a specific genetic translocation, t(X:18)(p11.2;q11.2) [2]. However, in this case SS has formed on a newborn’s forehead and specific t(X:18)(p11.2;q11.2) translocation was not found. For this reason, clinical knowledge of this condition is limited. Case Presentation A full-term newborn presented with a 4.5 x 4.5 cm mass on the right forehead, initially resembling an encephalocele. The mass was firm, mobile, and had altered skin overlying it. Neurosonography revealed a non-homogeneous, echogenic mass, which was not connected to the skull. Magnetic resonance imaging showed a well-defined soft tissue tumor, not involving the bone. Consultation with genetics, pediatrics, and oncology was initiated. The tumor was surgically removed and histologically tested. Histological analysis confirmed SS (most probably monophasic type): spindle-shaped cells with oval nucleus, multiple mitoses, positive CD99, TLE-1 marks. No spreading of disease was found. Genetic testing did not reveal SS18-SSX translocation. 3 months after tumor resection surgery, local recurrence of tumorous growth was clinically and radiographically confirmed. Patient has a treatment planed with 6 rounds of chemotherapy with Vincristine and Dactinomycine. Discussion Synovial sarcoma often affects the limbs, particularly around large joints [3]. Although the genetic test did not confirm the common SS18-SSX translocation, the histological features were consistent with SS. This case highlights the challenges in diagnosing SS in neonates, as well as the importance of considering a multidisciplinary approach for both diagnosis and treatment. The standard treatment involves surgery, with chemotherapy considered for highrisk cases [4]. Conclusions Synovial sarcoma, though rare, should be considered in cases of soft tissue tumors, even in neonates. Early surgical resection is crucial, but the risk of recurrence and metastasis requires ongoing monitoring and adjuvant treatment [4]. Further research is necessary to understand the genetic variations in SS and their impact on prognosis and treatment response.

Laryngeal mask airway (LMA) use in neonatal resuscitation is limited despite existing evidence and recommendations. This survey investigated the knowledge and experience of healthcare providers on the use of the LMA and explored barriers and solutions for implementation.

Background. Neonatal hyperbilirubinemia is a common condition in newborns. In term newborns, the frequency of occurrence reaches 60%, and in premature babies, it is even higher. If not diagnosed and treated in time, neurotoxic complications may occur. However, not only timely diagnosis and treatment are important, but also proper identification of risk factors. Aim. To analyse the relationship between neonatal hyperbilirubinemia in late-preterm infants and the most important neonatal risk factors. Methods. A retrospective study was conducted at the LUHS KC Neonatology Clinic. Medical histories of all late premature newborns (34–36 weeks) born between October 1, 2022, and October 1, 2023, were selected for the study. 110 newborns were included in the study. Statistical analysis was performed with IBM SPSS Statistics 26.0 and MS Excel 2016 programmes. A difference was considered statistically significant when p ≤ 0.05. Results. Hyperbilirubinemia was observed in 61 neonates (55%), while 49 (45%) did not develop hyperbilirubinemia. Newborns with a gestational age of 34 weeks (compared to newborns of 35 and 36 weeks) had jaundice more often than not (p = 0.016). Jaundice occurred in 76% of newborns with a gestational age of 34 weeks. The study found that newborns with hyperbilirubinemia had a lower birth weight (p = 0.005). Important data showed that the time of onset of jaundice is affected by the method of delivery. Newborns who were born vaginally developed jaundice earlier than those born by caesarean section (p < 0.001). ROC analysis showed 69 hours, AUC = 0.791. In vaginal births, 85% of newborns developed jaundice within 69 hours and 15% after 69 hours, while in caesarean births, jaundice developed in 35% of newborns before 69 hours and 65% after 69 hours. It should also be mentioned that jaundice appeared earlier in newborns who had hematomas (p = 0.042). ROC analysis showed 43 hours, AUC = 0.748. 86% of neonates who had hematomas developed jaundice within 43 hours, and 14% of subjects developed jaundice after 43 hours. In the other group that did not have hematomas, jaundice developed within 43 hours in 40% of patients and after 43 hours in 60% of patients. Conclusion. Gestational age and birth weight are significant factors in the development of jaundice. Jaundice also develops earlier in the case of vaginal delivery or hematomas.

Background and Aim. This study aims to identify factors associated with successful breastfeeding in late preterm infants (LPIs) and explore the initiation of solid food feeding in the first year. The goal is to promote optimal development and mitigate risks associated with prematurity. Methods. A prospective cohort study was conducted of all infants born at 34+0 to 36+6 weeks gestational age in Lithuanian University of Health Sciences hospital Kaunas Clinics during 2020–2021. Families were followed up until the infants reached 12 months of age. Participants were divided into 3 sub-groups according to gestational age: 34+0+6, 35+0+6, 36+0+6. Average breastfeeding initial time, average breastfeeding duration time, average solid foods feeding initiation time and prevalence of breastfeeding at 1, 3, 6 and 12 months were examined. The correlation among factors that might affect breastfeeding rates was calculated using the chi-square test (p < 0.05). Results. 222 participants were eligible for analysis. The average breastfeeding initiation time was: 34+0+6 – 5.76 days (SD 4.36), 35+0+6 – 2.39 days (SD 2.15), 36+0+6 – 1.57 days (SD 2.08). Breastfeeding initiation of 34+0+6 group was statistically significantly delayed (p < 0.001). The rates of exclusive or partial breastfeeding were: 34+0+6 – 93.4% (n = 57), 35+0+6 – 86.1% (n = 53) and 36+0+6 – 88.7% (n = 94) at discharge, respectively. Group 36+0+6 had a statistically significant higher exclusive breastfeeding rate (p < 0.001). The rates of exclusive and partial breastfeeding at 1, 3, 6 and 12 months were: 34+0+6 – 83% (n = 48), 62.7% (n = 36), 49.2% (n = 28) and 27.6% (n = 16), 35+0+6 – 85.7% (n = 51), 76.8% (n = 46), 56.4% (n = 35) and 35.9% (n = 19), 36+0+6 – 83.5% (n = 88), 65.1% (n = 69), 50.5% (n = 54) and 33% (n = 36), respectively. The average duration of breastfeeding was: 34+0+6 – 5.89 months (SD 4.72), 35+0+6 – 6.87 months (SD 4.55), 36+0+6 – 6.51 months (SD 4.91). No correlation was found between the duration of exclusive breastfeeding rate and gestational age. The average time of solid food introduction was 5.48 months (SD 0.84) with vegetables being introduced as the first solid meal. No statistically significant difference between groups was observed. Conclusions. Vaginal delivery, skin-to-skin contact after birth, early rooming-in, breastfeeding within 2 hours after birth and successful prior breastfeeding statistically significant cause earlier breastfeeding initiation and longer duration of breastfeeding in LPIs. All infants began solid food feeding at an average age of 5 months, with vegetables being the primary food choice.

Background: The aim of this study is to identify factors associated with successful breastfeeding in late preterm infants (LPIs) and explore the initiation of complementary feeding; Methods: Prospective cohort study was conducted of infants born at 34+0 to 36+6 weeks gestational age in the Hospital of the Lithuanian University of Health Sciences Kaunas Clinics during 2020–2021. Families were followed up until the infants reached 12 months of age. Average breastfeeding initial time, average breastfeeding duration time, prevalence of exclusive breastfeeding and average solid-food feeding initiation time were examined. The correlations among factors that might affect breastfeeding rates were calculated using the chi-square test (p < 0.05); Results: In our study with 222 eligible participants, we observed a statistically significant delay in breastfeeding initiation only in the 34+0+6 gestational age group (p < 0.001). At discharge, the 36+0+6 group exhibited a significantly higher exclusive breastfeeding rate (p < 0.001). Over the first year, breastfeeding rates varied, with no correlation found between duration of exclusive breastfeeding and gestational age. Initial solid-food feeding times were similar across groups, and all infants were introduced to vegetables first; Conclusions: Vaginal delivery, skin-to-skin contact after birth, early rooming-in, and breastfeeding within 2 h after birth statistically significantly causes earlier breastfeeding initiation and longer duration of breastfeeding in LPIs. All infants began solid-food feeding at an average age of 5 months, with vegetables being the primary food choice.

An excessive weight loss (EWL) of >10% after birth is associated with serious health outcomes. The aim of this study was to determine factors that can reduce weight loss in full-term, exclusively breastfed infants after birth.