Aleksejūnė, Vaida

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.

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.

Fetomaterninė transfuzija – tai vaisiaus kraujo patekimas į motinos kraujotaką bet kuriuo nėštumo laikotarpiu. Nedidelis vaisiaus kraujo patekimas – fiziologinis įvykis, bet, įvykus masyviai transfuzijai, vaisius gali žūti arba gimti kritiškai sunkios būklės. Ši būklė yra reta, tačiau 2022–2023 m. 2 sav. laikotarpiu Kauno klinikų Neonatologijos klinikoje gydyti trys labai sunkios būklės naujagimiai, patyrę fetomaterninę transfuziją.

Every year around 15 million premature neonates are born in the world, and this number is continuously increasing. The incidence of premature birth varies between 5% and 18% throughout the world. Despite advancements in medicine and technology and increased evidence-based diagnostic and treatment recommendations, prematurity is the most common cause of death among children under 5 years of age. The sequelae in the survivors of extreme prematurity are mental disability, cognitive impairment, cerebral palsy, blindness, deafness and chronic illness. Considering ethical and economic implications, neonatal survival and morbidity prognosis, resuscitation of neonates of borderline gestation differs in various countries and many international organisations do not recommend active resuscitation and treatment of newborns of up to 25 weeks of gestation. We present a case study of one of the smallest newborns in the world and the smallest newborn known to survive in Lithuania.

The 22 week gestation, 350 g (<3 ‰) an infant female born to a 29 year old Gravida 2, Para 1 mother. Vaginal delivery occurred after preterm labor and presumed chorioamnionitis. The mother didn’t receive dexamethasone. Apgar scores were six and seven at 1 and 5 minutes of delivery. The baby was resuscitated and mechanically ventilated for severe respiratory distress syndrome. The baby had three doses of surfactant administered but ventilation parameters increased and high frequency oscillatory ventilation (HFOV) was initiated. Early onset pulmonary interstitial emphysema was apparent by day 4 and later it deployed mediastinum (Figure 1), disturbed blood circulation. A thoracotomy and the lower lobe of the right lung with cystic derivatives were removed by day 27 (Figure 2). At that time, the infant weighed 495 g. At 44 days of life the newborn was extubated, oxygen therapy was extended in the nCPAP, and later reintubated during infections. Patent ductus arteriosus, stage I retinopathy of prematurity, grade I intraventricular hemorrhage, ventriculomegaly ex vacuo anemia, hypergly ce mia, two times sepsis, tree times pneumonia, pyelonephritis. CMV infection was diagnosed after 63 days of age. An increase in DNA copy number was observed after 8 weeks of treatment. After the mother was tested, a high titre of immunoglobulin G against CMV was found in the blood, so the newborn started to be fed wit h mother's pasteurized milk. Continuing the appointment treatment, the number of copies of DNA decreased.[...].

Objectives: To evaluate significance of gender, age, duration of T1D, degree of glycemic control and autoimmunity status for development of microvascular complications in Lithuanian pediatric population. Methods: Data of 289 T1D patients <18 years were analyzed. The degree of retinopathy was evaluated by digital fundus photography. 24 h urinary albumin concentration was measured for the screening of nephropathy. Michigan Neuropathy Screening Questionnaire and tests for vibration, pressure and temperature sensation were used for neuropathy screening. The autoimmunity status was evaluated by measuring GAD65, IA2, and IAA (RIA); ICA antibodies were measured by ELISA method. Results: Mean age of patients was 12.1 4 years. Distribution by age: 0–4 years 4.5%, 5–8 years 18%, 9–12 years 23.2%, 13–17 years 54.3%. 48.4% were males. Mean duration of T1D was 4.2 3.4 years, in 61.9% duration of disease was <5 years. Neuropathy, nephropathy and retinopathy were present in 9.3%, 4.7% and 1.8% of our patients, respectively. 2 patients had diabetic cataract. The average level of HbA1c was 8.1 1.78%. 43.6% of patients had HbA1c <7.5%. Adolescents (both genders, 13–17 years) and girls had the worst glycemic control (mean HbA1c 8.49 1.9 and 8.35 1.8%, respectively). Duration of T1D and glycemic control were significantly related to the presence of nephropathy and retinopathy (p = 0.03 and p < 0.001, respectively), but not to that of neuropathy. Anti-IA2 alone were found 56.4%, GAD65 - in 46.7%, both types of antibodies - in 31.1% of cases. IAAwere found in 91.8%, ICA - in 6.1% of cases. No significant associations between presence of any type of antibodies and microvascular complications were found. Conclusions: Adolescents, especially girls, have the worst glycemic control compared with other age groups. T1D duration ≥5 years and poor glycemic control have a major impact on the development of nephropathy and retinopathy. [...].

Objectives. To evaluate significance of gender, age, duration of type 1 diabetes (TID), degree of glycemic control and autoimmunity status for development of microvascular complications in Lithuanian pediatric population. Methods. Data of 289 TID patients < 18 yrs analyzed. The degree of retinopathy was evaluated by digital fundus photography. 24 h urinary albumin concentration was measured for the screening of nephropathy. Michigan Neuropathy Screening Questionnaire and tests for vibration, pressure sensation and temperature sensation were used for neuropathy screening. The autoimmunity status was evaluated by measuring GAD65, IA2, and insulin autoantibodies (RIA); ICA antibodies were measured by ELISA method. Results. Mean age of patients was 12.1±4 yrs. Distribution by age: 0-4 yrs 4.5%, 5-8 yrs 18%, 9-12 yrs 23.2%, 13-17 yrs 54.3%. 48.4% were males. Mean duration of TID was 4.2±3.4 years, in 61.9% duration of disease was < 5 yrs. [...].

Background: Diabetic ketoacidosis remains a serious condition in newly diagnosed type 1 diabetes (T1D) in children with a frequency varying from 25 to 70% in different countries. Objectives: To test if there is an association of diabetic ketosis at presentation with age, autoimmunity status and family history of diabetes in the Lithuanian pediatric population. Methods: Study sample consisted of 256 newly diagnosed T1D in children less than 18 yrs in Lithuania since 2007 in whom pancreatic antibodies tests were available. Results: At presentation, 22.8% of children were 0–4 years old, 28.3% - 5–9 years old, 42.9% - 10–14 years old and 5.9% older than 14 years. Frequency of ketosis at presentation was 67.2%. 24.2% of children had positive family history of diabetes among first, second or thirddegree relatives. Tyrosine phosphatase antibodies (IA2) alone were found in 20.7%, glutamic acid decarboxylase antibodies (GAD65) alone - in 19.3%; both types of antibodies - in 53.1% of cases; 6.9% of children were antibody-negative.No significant association between ketosis at the onset of disease and age groups was found (p=0.95). Ketosis at the diagnosis was present in 55% of patients without family history of diabetes and only in 12% in those with positive family history (p=0.02). Diabetic ketosis was found in 76.7% of children with positive IA2 antibodies, in 60.7% - with positive GAD65 antibodies, in 71,4% - with both types of antibodies, and in 30% in antibody-negative children (Fisher exact p=0.074). Conclusions: Ketosis in newly diagnosed diabetes cases in childhood in Lithuania was more frequent among children without family history of diabetes, but not related to age at presentation. A trend towards more frequent ketosis was found in children with positive pancreatic antibodies, especially IA2 and a combination of IA2 and GAD65.