Jurgaitė, Eglė

Background/Objectives: Early nutrition is crucial for postnatal growth and metabolic status in preterm very low birth weight (VLBW) infants; however, the optimal macronutrient proportions remain unclear. We aimed to investigate how early nutrition influences long-term outcomes in extremely preterm (EP) and very/moderately preterm (VP) infants. Methods: We included 120 preterm infants in the prospective follow-up study. Anthropometric and metabolic parameters (fasting glycemia, insulin, and IGF-1) were assessed at birth, on the 28th day after birth, and once a year until 3–4 years (N = 65). Total daily parenteral and enteral nutrient intake was calculated. Standard deviation scores (SDS) for anthropometric measurements were calculated using Swedish growth reference data. Results: Although there was no difference in weight-adjusted macronutrient intake, EP newborns grew more slowly in the first 28 days than VP newborns. At the age of 1 year, the central-to-peripheral subcutaneous fat ratio was higher in children born EP compared to children born VP. No other anthropometric differences were found between groups at 1 year of age, and later between both groups. On the 28th day after birth, infants born EP had higher glucose and insulin levels, HOMA-IR, and lower IGF-1 levels compared to infants born VP. No relation was found between macronutrient intake and increases in weight SDS and height SDS in VP newborns. In the EP subgroup, carbohydrate and protein intake during the first 28 days were directly related to central-to-peripheral subcutaneous fat at 1 and 3–4 years. Conclusions: Early nutrition affects children’s growth up to 1 year of age, while later on, other factors seem to interfere. Higher protein and carbohydrate intake does not have a positive effect on the growth of preterm infants but is related to more central adipose tissue distribution.

Aim Impaired postnatal growth is the most important issue in very low-birth-weight (VLBW) infants. Early nutrition is one of the modifiable factors and has the greatest influence on growth. Optimal nutrients intake in this population remain unknown. The aim of this study was to evaluate nutrients intake during the first 28 days of life and its impact on growth, metabolic and hormonal profile at this age. Methods 120 infants with birth weights below 1500 g and gestational ages below 35 weeks were included in the study. Nutrient intakes were assessed daily, and anthropometric measurements were checked weekly until 28th day postpartum. Glycaemia and hormonal levels were assessed on day 28th after birth before the meal. Results The mean birth weight SDS was -1.25G1.44 and length SDS was -1.69G1.62. The mean daily weight gain velocity in 28 days was 12.3G3.5 g/day. On 28th day after birth, mean weight SDS was -2.07G1.11; length SDS was -1.91G1.46; ponderal index was 22.5G2.3. Metabolic and hormonal parameters in 28th day were as follows (mean G SD): fasting glycaemia - 4.72G1.51 mmol/l; fasting insulin - 17.6G18.0 mU/l; HOMA-IR – 4.46G6.39; IGF-1 – 1.83G1.19 nmol/l; IGF-BP-3 – 8.80G3.20 ng/ml; IGF-1/IGF-BP-3 ratio 1,55G0.82. Cumulative total energy and fat intake in 28 days (g/kg) correlated directly with IGF-BP-3 level (rZ0.255, P Z 0.01 and rZ0.263, P Z 0.008, respectively). Cumulative carbohydrate intake tend to be related to IGF-1 level (rZ0.194, P Z 0.054). Cumulative fat intake was inversely related to HOMA-IR and glucose level on 28th day after birth (rZ0.210, P Z 0.036 and rZ-0.212, P Z 0.033, respectively) . Cumulative carbohydrates intake was inversely related to insulin level, HOMAIR and glucose level (rZ-0.230, P Z 0.020; rZ-0.275, P Z 0.006 and rZ-0.319, P Z 0.001, respectively). Cumulative protein intake was also inversely related to glucose levels (rZ-0.259, P Z 0.009). However, protein to total energy ratio was inversely related to IGF-BP-3 and directly to insulin levels and HOMA-IR (rZ0.249, P Z 0.013; rZ0.216, P Z 0.031 and rZ0.251, P Z 0.011, respectively). Length SDS at on 28th day after birth was not related to nutritional factors. Conclusion Total energy and higher carbohydrate intake lead to higher weight gain, but did not result in unfavorable carbohydrate metabolism. Protein-rich nutrition in VLBW infants was related to higher insulin resistance 4 weeks after birth. Ethics: Approval of the study was obtained at the Kaunas Regional Bioethics Committee (approval No. BE-2-12). The study was registered at ISRCTN Database (No. ISRCTN64647571). The written consent of both parents was obtained.

Algoritmas (lot. algorismus

Algoritmas (lot. algorismus

Įgimta antinksčių hiperplazija yra autosominiu būdu paveldima liga, kuri lemia sutrikusią kortizolio sintezę. Dėl šios sintezės sutrikimo organizme kaupiasi kortizolio prekursoriai, kurie paverčiami androgenais. Kortizolio trūkumas ir padidėjęs androgenų kiekis sukelia sveikatos sutrikimų tiek moterims, tiek vyrams. Dėl perteklinio androgenų kiekio mergaitės gimsta su virilizuotomis išorinėmis genitalijomis. Pacientėms būdingesnis berniukiškas elgesys, vyriškų profesijų ir pomėgių pasirinkimas, atsiranda psichologinių problemų, sutrinka jų santykiai su priešinga lytimi dėl savo kūno nepriėmimo ar seksualinės orientacijos. Moterys, sergančios įgimta antinksčių hiperplazija, rečiau siekia motinystės. Dauguma berniukų, sergančių įgimta antinksčių hiperplazija, išoriškai atrodo sveiki, tačiau jiems nustatoma seksualinės funkcijos bei vaisingumo sutrikimų. Pagrindinė vyrų, turinčių įgimtą antinksčių hiperplazija, sutrikusio nevaisingumo priežastis nurodoma antinksčių intarpai sėklidėse. Negydant pacientų šių intarpų gali daugėti ir tai gali sukelti nevaisingumą. Rekomenduojama vyrams, sergantiems antinksčių hiperplazija, siūlyti spermos užšaldymą. Šiame straipsnyje plačiau apžvelgta literatūra ir atlikti tyrimai, kuriuose analizuota įgimtos antinksčių hiperplazijos įtaka seksualinei funkcijai ir vaisingumui.

Background and aims. Subfebrile prolonged fever of unknown origin in children is a multicausal syndrome. Some children referred for pediatrician with prolonged fever are actually not having elevated temperatures, others have well-documented fevers associated with clinical, laboratory, or epidemiologic findings that should point to a specific diagnosis. Sometime the reasons of fever remain unknown. This study aimed to analyze the causes of subfebrile fever in children. Methods. A retrospective analysis of cases of subfebrile prolonged fever in children, consulted in Outpatient Department of Children of Kaunas Clinical Hospital in 2013. Children with daily fever ≤ 38,0°C lasting for ≥14 days were included into the study. Results. Medical records of 43 patients with subfebrile prolonged fever were analyzed. Patients age ranged from 5 months to17 years (mean 9.35±5.32y); 27 (62.8%, p>0.05) of them were >7 years old; 17 were boys and 26 were girls. Fever mean was 37.42°C and in average lasted for 82.5 days. Final diagnosis was reached in 37 children (86.05%). The most common cause (55.8%) of prolonged subfebrile fever was upper respiratory tract infection (tonsillitis, otitis, etmoiditis, adenoiditis), followed by latent tuberculosis infection (21%), lower respiratory tract infections 4.65% (bronchitis), mononucleosis 4.65%, one case of urinary tract infection and toxocariasis. Some patients had few infections. Conclusions. 1.The most common cause of prolonged subfebrile fever was upper respiratory tract infection and latent tuberculosis infection. In 13,95% of cases the causes remained unknown. 2. Prolonged subfebrile fever was more common between school age patients.

Aim. The aim of the study was to analyze changes in the prevalence of congenital developmental abnormalities (CDA) in Lithuania during 2002-2011. Methods. This was a survey that included data from the Lithuanian Neonatal Registry for the period of 2002-2011. The results were calculated by applying the ANOVA test, Bonferroni’s criterion, and the Z test. The results were considered to be statistically significant when p < 0.05. Results. The prevalence of CDA among liveborn neonates born during the period 2002-2011 ranged from 3.5% to 4.9% (p = 0.09). Of neonates born during the 22nd-27th weeks of gestation, 14.6% had CDA, of those born during the 28th-31st weeks of gestation – 13.8%, of those born during weeks 32-36 – 7.9%, and among those born ≥ 37th week of gestation – 3.8%. The diagnosis of CDA was significantly more frequent among neonates born during the 22nd-31st weeks of gestation than among those born during weeks 32-36 (p < 0.05). During the period 2002-2011, the predominant CDA were those of the musculoskeletal and the cardiovascular systems. In 2002, CDA of the musculoskeletal system comprised 40.9%, and those of the cardiovascular system – 21.6% of all CDA. In 2002, a statistically significant higher number of neonates were born with CDA of the musculoskeletal system than those with CDA of the cardiovascular system. In 2011, the prevalence of CDA of these two types was not statistically significantly different: CDA of the musculoskeletal system comprised 25%, and CDA of the cardiovascular system – 29.7% of all congenital anomalies. In 2002, the highest number of neonatal deaths was caused by CDA of the cardiovascular system (39%), other CDA and syndromes (25.4%), and CDA of the musculoskeletal system (13.6%). In 2011, the structure of mortality from CDA was not statistically significantly different: other CDA and syndromes as causes of death were diagnosed in 46.2% cases of all congenital anomalies, CDA of the musculoskeletal system

Lietuvoje pastebėta 2013 m. sergamumo virusiniu meningitu padidėjimas. Tyrimo tikslas – įvertinti vaikų, gydytų Kauno klinikinėje ligoninėje 2013 m. virusinio meningito savitumus (retrospektyvinė 204 ligos istorijų analizė). Vaikų amžiaus vidurkis – 9,9±4,4 metų, dažniau sirgo berniukai – 61,3 proc. Visi pacientai skundėsi galvos skausmu, pykinimu ar vėmimu ir karščiavo (aukščiausios temperatūros vidurkis – 38,15±0,7˚C). Meninginiai simptomai pasireiškė visiems pacientams: sprando raumenų rigidiškumas – 88 proc., teigiamas Kernigo simptomas – 32,8 proc., Brudzinskio simptomas – 24,5 proc. tirtų pacientų. Juosmeninė punkcija atlikta vidutiniškai – 2,8±1,6 dieną nuo ligos pradžios. Pokyčiai smegenų skystyje: leukocitų vidutiniškai 143,63±146,4X10⁶ /l, dominuojant limfocitams – 64,1±27,4 proc., baltymo vidutiniškai – 0,31±0,21 g/l), gliukozės vidutiniškai – 2,97±0,43 mmol/l. Jie nepriklausė nuo juosmeninės punkcijos atlikimo dienos. Nustatėme ryšį tarp didesnės CRB reikšmės (vidutiniškai buvo 9,3±10,5 mg/l), aukštesnės temperatūros ir didesnio leukocitų skaičiaus smegenų skystyje. Ligos sukėlėjas patvirtintas Echovirusas 30(5 atvejai iš 6). Visi atvejai buvo nesunkūs, būdingos eigos, komplikacijų nenustatyta.

Background. Enteroviruses are the most common cause of viral meningitis in children. Aim of the study was to analyze peculiarities of viral meningitis during the outbreak in 2013y. Method. A retrospective analyzes of viral meningitis cases in children, hospitalized in Kaunas Clinical Hospital in June – October, 2013y. Results. 204 cases of viral meningitis (63,3% of all registered cases in Lithuania in mentioned period) were analyzed. Children aged 2 - 17 years (9,9±4,4y); mostly boys - 61,3% (n=125). They were admitted to the hospital from the first to 10th day of the disease (mean 2.45±1.4d). All patients suffered from headache and fever 38.15±0.7ºC, lasting in average for 1.87±1.2d. 88% of patients had nuchal rigidity, 24,5% - Brudzinski’s and 32,8% Kernig’s sign. Focal findings were seen in 16,3% of cases. Lumbar puncture was done on average 2.8±1.6d of the disease to all patients. CSF findings include pleocytosis from 5 to 1080x106/l (mean 143.63±146.4x106/l) predominant mononuclears 64,1%, protein from 0.1 to 1.28 g/l (mean 0.31±0.21 g/l), normal or slightly low glucose (mean 2.97±0.43 mmol/l). CSF findings did not depend statistically significant on the day of LP. Low correlation between higher fever and number of cells (Spearman’s Rho=0,198, p=0,005), higher CRP and number of cells (Spearman’s Rho=0,202, p=0,005) were found. Mean CRP value was 9,3±10,6 mg/l. The mean duration of hospitalization was 5.5±1.7d. Prognosis for all children was good. Echovirus 30 serotype was identified (5 cases from 6 verified). Conclusions. Cases of children viral meningitis were typical and without complications. Echovirus serotype 30 was identified.