Šilkūnė, Ugnė

Background The esophagus and trachea develop very early in the fetus as the foregut tube divides. Failure of development can cause tracheoesophageal fistula and esophageal atresia. These congenital malformations of the trachea and esophagus include a wide assembly of anomalies with a broad spectrum of symptoms such as respiratory distress, choking, and failure to pass a nasogastric orendotracheal tube. Early diagnosis and treatment require interprofessional teamwork. Case report A preterm male infant was born to a healthy mother gravida 1 para 1 born via spontaneous vaginal delivery at 31 weeks of gestation, with a birth weight of 1470 grams. Esophageal atresia was suspected antenatally. The Apgar score was of 1– 1 at 1 and 5 minutes, respectively. The infant was born unresponsive and not breathing, the resuscitation was started. Positive pressure ventilation with a T-piece resuscitator was started at a rate of 60 breaths per minute, however, there were no chest wall movements and no breathing sounds were heard on auscultation. During laryngoscopy there was a visible obstacle beyond the vocal cords, the neonatologists were unable to insert an endotracheal tube of 2.5 and 3 cm diameter deeper than 6 cm into mouth. Tracheal obstacle made pulmonary ventilation impossible. Chest compressions were continued as long as neonatologists were sure that the airway was closed and there was no way to restore breathing. After 20 minutes of resuscitation, the infant died. The autopsy was performed. During the morphological examination, there was determined that the newborn had multiple congenital malformations including esophageal atresia with tracheoesophageal fistula, severe laryngeal stenosis, and horseshoe kidney. Conclusions This case report demonstrates that congenital tracheal and esophageal malformations may cause airway obstruction and may be a fatal condition in neonates.

Introduction Necrotizing enterocolitis (NEC) is a life-threatening illness and one of the most severe diseases of premature newborns. NEC has a mortality rate as high as 50% (1). Existing data suggest neonatal diet is a very important modifiable factor (2). Providing infants with breast milk has been the main way of nutritional therapy in NEC prevention and also shows positive outcomes for infants following surgery in stage III NEC(3). The disease is 6-10 times more common in exclusively formula-fed infants than in those fed only breast milk (4). A donor human milk bank (DHMB) was opened in Lithuanian University of Health Sciences (LUHS) Hospital, in December 2016 (5). Aim The aim of the study was to determine the impact of donor human milk on prevalence, features and surgical needs of necrotizing enterocolitis. Methods We performed a retrospective study of 135 patients’ data. Patients were treated in LUHS Hospital Neonatal intensive care unit in 2010-2021 yrs. Inclusion criteria: 1) gestational age (GA)≤32 weeks 2) diagnosis of NEC 3) no congenital anomalies of the digestive tract. Patients were divided into two groups - control group (n=73) – treated before DHM was available (2010 – 2016yrs.), intervention group (n=62) – after DHM became available (2017-2021 yrs.). Groups were compared considering stages and outcomes of disease, surgical needs, duration of parenteral feeding, and need of erythrocyte mass transfusions. Statistical analysis was performed using IBM SPSS Statistics 27.0. Results were considered significant where p<0,05. Results Patients diagnosed with NEC (n=73) composed 7,52% of all patients (n=971) ≤32 weeks GA before DHM was available and 6,51% (n=62) of all patients (n=843) after DHM became available. . We found 85,7% (n=18) of NEC-related deaths in the control group, respectively –60,86% (n=14) in the intervention group. The difference was not significant. NEC stages varied among groups, however, there was no significant difference. Average number of NEC-related surgical procedures (0,93±1,17 vs 0,52±0,80) was significantly lower in the intervention group (p=0.020). Duration of parenteral feeding (8,00±9,45 vs 8,29±5,35) and number of erythrocyte mass transfusions (3,60±3,38 vs 3,11±3,40) did not differ significantly among groups. Conclusions According to the statistics, the number of NEC-related surgical procedures was significantly lower once DHM became available. NEC prevalence and stages did not differ significantly among groups, as well as NEC-related deaths. Also, there were no significant differences in erythrocyte mass transfusion numbers and duration of parenteral feeding.

Background: The esophagus and trachea develop very early in the fetus as the foregut tube divides. Failure of development can cause tracheoesophageal fistula and esophageal atresia. These congenital malformations of the trachea and esophagus include a wide assembly of anomalies with a broad spectrum of symptoms such as respiratory distress, choking, and failure to pass a nasogastric or endotracheal tube. Early diagnosis and treatment require interprofessional teamwork. Case report: A preterm male infant was born to a healthy mother gravida 1 para 1 born via spontaneous vaginal delivery at 31 weeks of gestation, with a birth weight of 1470 grams. Esophageal atresia was suspected antenatally. The Apgar score was of 1– 1 at 1 and 5 minutes, respectively. The infant was born unresponsive and not breathing, the resuscitation was started. Positive pressure ventilation with a T-piece resuscitator was started at a rate of 60 breaths per minute, however, there were no chest wall movements and no breathing sounds were heard on auscultation. During laryngoscopy there was a visible obstacle beyond the vocal cords, the neonatologists were unable to insert an endotracheal tube of 2.5 and 3 cm diameter deeper than 6 cm into mouth. Tracheal obstacle made pulmonary ventilation impossible. Chest compressions were continued as long as neonatologists were sure that the airway was closed and there was no way to restore breathing. After 20 minutes of resuscitation, the infant died. The autopsy was performed. During the morphological examination, there was determined that the newborn had multiple congenital malformations including esophageal atresia with tracheoesophageal fistula, severe laryngeal stenosis, and horseshoe kidney. Conclusions: This case report demonstrates that congenital tracheal and esophageal malformations may cause airway obstruction and may be a fatal condition in neonates.

Introduction: Staphylococcal scalded skin syndrome (SSSS) is exfoliative skin disease that mostly affects newborns but can also occur in older children. This syndrome is caused by exotoxins produced by Staphylococcus aureus. The severity of the disease varies from being a localized skin lesion to amore extensive generalized condition, characterized by cutaneous erythema followed by desquamation of the epidermal layer of the skin. Prompt antibacterial treatment is essential for good prognosis. Case description: A six-day-old full-term newborn admitted to emergency room with erythematous scalded lesions allover the body which started around navel two days ago, without history of trauma or burns after birth. During the examination, painful scalded skin was observed on the torso, face, limbs and perineum. Body temperature was normal. Other body system examinations were normal. Blood tests showed elevated CRP and a left shift in leukogram. In case of severe condition and suspected SSSS the patient was hospitalized to Neonatal Intensive Care Unit. Blood and skin cultures were taken, empiric treatment with gentamicin and oxacillin was started. After skin culture came positive to oxacillin sensitive Staphylococcus aureus, treatment with gentamicin was stopped. Blood culture was negative. Symptomatic treatment included paracetamol, morphine, midazolam, intravenous fluids and enteral nutrition. Skin care with emollients for dry patches and chlorhexidine solution for moist areas was recommended by dermatologist. The treatment was effective and skin condition improved, weeping areas became dry, inflammatory markers decreased. Enteral nutrition was discontinued and breast milk was started. After 9 days, the newborn was transferred to the neonatal unit in stable condition, skin erythema kept decreasing, no new lesions were found. The erythroderma completely decreased after 16 days, and the newborn was discharged home. Conclusions: This case report demonstrates that SSSS maybe an emergency case in neonate. Early diagnosis and appropiate treatment can prevent mortality and complications.

Introduction Cytomegalovirus (CMV) is a common virus and usually is harmless. [RB1] In people with weakened immune system, like very low birth weight (<1500 g, VLBW) infants, CMV can manifest with more serious symptoms affecting the eyes, lungs, liver, digestive tract, in some cases disease may be fatal CMV can be congenital (cCMV) and acquired (aCMV). In systematic review conducted in 2014, thirty-seven studies were included. The prevalence of cCMV in developed countries is 0.58%. Among these newborns 12.6% will experience hearing loss: 1 out of 3 symptomatic children and 1 out of 10 are asymptomatic children (1). The prevalence of aCMV among VLBW infants was estimated 19%, a sepsis-like syndrome occurs in approximately 15% and is associated with hepatosplenomegaly, hepatitis, and abnormalities of blood counts (lymphopenia, neutropenia, and/or thrombocytopenia) (2). aCMV is transmitted by direct contact with breast milk. The incidence of congenital and acquired CMV infection among very low birth weight infants in Lithuania is not known. Aim The aim of this study was to determine the incidence of congenital and acquired CMV infection in very low birth weight infants. Methods The study was conducted in LUHS Kauno klinikos, Department of Neonatology. 48 VLBW infants born <32 weeks were included into the prospective observational study. Blood samples for CMV PCR were drawn at two time points during hospitalisation. For congenital virus it was drawn before day 21 after birth, for acquired CMV – at 6–8 weeks or at any time CMV was suspected. Blood tests and clinical symptoms were assessed ±2 days when samples for CMVPCR were taken. Patients were compared for gestation age, sex, clinical status, and changes incomplete blood count (leukopenia, leukocytosis, thrombocytopenia) regarding development of cytomegalovirus infection. Statistical analysis was performed. Nonparametric tests were used for analysis because of the small sample size and absence of the normal distribution of the variables. Results Median gestational age of included infants was 27 weeks (IQR 26; 28), median birth weight was901 grams (IQR 804–1068). Out of 48 VLBW infants 56,25% were males, 43,75% were females. Blood tests for congenital CMV PCR were drawn at a time of 14 days (IQR 10–18). Zero infants were tested positive for cCMV. At the time of the blood draw for cCMV 83.3% infants showed no clinical symptoms, 3 infants (6.3%) had fever and 5 infants had sepsis-like symptoms (10.4%). 28 (58.3%) VLBW infants showed no changes in complete blood count when tested for cCMV. Second blood test for acquired CMV PCR was drawn at a median time of 44 days (IQR 41–47).12 (25%) infants were tested positive for acquired CMV, 25 (52,1% ) were tested negative and11 (22.9%) infants were not tested for aCMV. Thus, 12 out of 37 (32.4%) infants were found positive for aCMV. The median amount of CMV copies were 312 (IQR 161–2309). Out of 37VLBW infants tested for acquired CMV 75.7% showed no clinical symptoms, 5.4% had necrotizing enterocolitis (NEC) and were CMV negative, 2.7% had fever and were CMV positive.2.7% infants were diagnosed with NEC and had sepsis-like symptoms, however, were CMV negative, 4 (10.8%) VLBW infants had sepsis-like symptoms and 2 of them were CMV positive,1 (2.7%) CMV positive infant had seizures. Conclusions No cCMV infection was found in VLBW infants. aCMV was found in 32.4% of tested infants. aCMV may manifest with fever, sepsis-like symptoms, seizures. aCMV infection should not be overlooked immunocompromised patients such as VLBW infants.

INTRODUCTION The esophagus and trachea develop very early in the fetus as the foregut tube divides. Failure of development can cause tracheoesophageal fistula and esophageal atresia. These congenital malformations of the trachea and esophagus include a wide assembly of anomalies with a broad spectrum of symptoms such as respiratory distress, choking, and failure to pass a nasogastric or endotracheal tube. Early diagnosis and treatment require interprofessional teamwork. CASE PRESENTATION A preterm male infant was born to a healthy mother gravida 1 para 1born via spontaneous vaginal delivery at 31 weeks of gestation, with a birth weight of 1470 grams. Esophageal atresia was suspected antenatally. The Apgar score was of 1 - 1 at 1 and 5 minutes, respectively. The infant was born unresponsive and not breathing, the resuscitation was started. Positive pressure ventilation with a T-piece resuscitator was started at a rate of 60 breaths per minute, however, there were no chest wall movements and no breathing sounds were heard on auscultation. During laryngoscopy there was a visible obstacle beyond the vocal cords, the neonatologists were unable to insert an endotracheal tube of 2.5 and 3 cm diameter deeper than 6 cm into mouth. Tracheal obstacle made pulmonary ventilation impossible. Chest compressions were continued as long as neonatologists were sure that the airway was closed and there was no way to restore breathing. After 20 minutes of resuscitation, the infant died. The autopsy was performed. During the morphological examination, there was determined that the newborn had multiple congenital malformations including esophageal atresia with tracheoesophageal fistula, severe laryngeal stenosis, and horseshoe kidney. DISCUSSIONS This case report demonstrates that congenital tracheal and esophageal malformations may cause airway obstruction and may be a fatal condition in neonates.

Objectives and methods To evaluate if prevalence and features of necrotizing enterocolitis (NEC) changed after opening a donor human milk bank (DHMB) in the hospital of Lithuanian University of Health Sciences. A retrospective study of 117 patients’ data was performed. Inclusion criteria: 1) gestational age (GA) ≤32 weeks 2) diagnosis of NEC 3) no congenital anomalies of the digestive tract. Patients were divided into two groups - control group (n=73) – treated for NEC before DHM was available (2010 – 2016 yrs.), intervention group (n=44) – after DHM became available (2017-2020 yrs.). Groups were compared considering stages and outcomes of disease, surgical needs, duration of parenteral feeding, and need of erythrocyte mass transfusions. NEC stages varied among groups, however, there was no significant difference. [...]. Conclusions Number of NEC associated deaths decreased significantly once DHM became available. There was no significant difference in prevalence of NEC, distribution of NEC stages, number of surgical procedures, erythrocyte mass transfusions, and duration of parenteral feeding among the groups.