Jurgelėnė, Valentina

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.

Background: Acute parvovirus-B19 affects 3.3–3.8% of pregnant women, with an 11% risk of fetal loss before 20 weeks. Neonatal outcomes depend on gestational age, maternal health, and early intervention, such as intrauterine transfusions and comprehensive neonatal care. This case demonstrates the challenges of managing severe persistent congenital parvovirus- B19 related complications in an extremely preterm neonate. Case Presentation Summary: At 22 weeks of gestation the fetus was diagnosed with hydrops fetalis, anemia that was treated twice with blood transfusions. The neonate was delivered at 24 weeks of gestation due maternal HELLP syndrome. At birth severe respiratory distress, generalized edema, hydropericardium, ascites and hepatomegaly were evident. Congenital parvovirus-B19 infection was confirmed by the presence of viral DNA in the blood. The ascites was drained twice and multiple erythrocytes, thrombocyte as well as 1 fresh plasma transfusions were required for persistent anemia and thrombocytopenia. Presence of parvovirus DNA in the blood was still found at 37 days of age and persistence of thrombocytopenia below 20 despite the transfusions lead to the decision of treatment with IVIG. A 6-day treatment course was administered resulting in stabilized platelet count. However, platelet count normalized only after additional IVIG doses were administered. Condition was complicated by cytomegalovirus infection, treated with valganciclovir. The infant also suffered other bacterial, fungal and viral infections but primary immunodeficiency was yet not confirmed. IVIG infusions were repeated every 3- 4 weeks and the infant was discharged after 120 days of hospitalization with normal cell counts. Learning Points/Discussion: Cytopenia caused by persistent congenital parvovirus-B19 infection might be difficult to manage. In the absence of specific antiviral treatment, IVIG therapy plays a critical role in improving clinical outcomes in patients with parvovirus-related complications.

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.

Introduction: Bronchiolitis is one of the most frequent causes of hospitalization in children under age of 2. Most evidence-based clinical bronchiolitis guidelines recommend minimal or no laboratory and instrumental tests and only supportive management. Aim: To evaluate treatment options and influencing factors of children referred to our university hospital pediatric emergency department (PED); to analyze hospitalization rate, and associated factors. Methods: Retrospective single center study was performed. Data of children < 2 years of age referred to PED from 2018 March to2019 June were included. Exclusion: lack of medical documentation, neonatal age. Demographic and clinical data, diagnostic and treatment options were evaluated. Results: In total, 268 children were included, 60% male. Majority were <6 months (n=181, 67.5%). 73 children had different risk factors, such as prematurity, cardiovascular diseases, etc. Most of the children complained of cough (n=240) without difference between the age or gender groups; wheezing was less frequent complaint on presentation (n=113). 50% of children had symptoms of RDS and younger children were more likely to present with RDS (39% from total; p<0.001). Obstruction was equally frequent in both age groups; however, crepitation was more commonly detected in younger children (121/181 versus 47/87; p=0.042). Most of the children were hospitalized and as expected, the majority were younger (138/181 as for <6 mo, 38/87 as for >6mo, p<0.001). None of the clinical factors except wheezing was associated with more frequent hospitalization rate (OR* 5.88, CI 95% 2.5-13.75 asfor wheezing; adjusted for age, gender, risk group, RDS). Most of the children received inhalations with salbutamol (n=182) and 63 of all were prescribed glucocorticoids on arrival. 32 received antibiotics. Younger children presenting with RDS were more likely to get salbutamol inhalations (p<0.001). Children less than 6mo of age were more likely to receive supplementary oxygen (81% versus 19% of >6mo; p<0.001). As expected, children receiving O2 were more likely to be hospitalized (OR 11.63, CI 95% 4.25-31.83). None of other treatment methods were associatedwith hospital admission. In a linear regression analysis, both supplementary O2 and antibiotics at ED were associated with longer LOS (OR 2.4 CI 95% 0.28-2.71 as for O2; OR 4.9 CI 95% 2.0-4.8 as for antibiotics). Conclusion: younger children with RDS were more likely to receive salbutamol inhalations. Children who presented with wheezing and those who received supplementary oxygen were more likely to be hospitalized. Receiving oxygen and antibiotics at ED was associated withlonger LOS.

Background. Bronchiolitis is most frequent cause of hospitalization in children <2years. Most evidence-based clinical bronchiolitis guidelines recommend minimal/ no laboratory/instrumental tests and only supportive management. Aims To evaluate treatment of children referred to pediatric emergency department (PED) with bronchiolitis and hospitalized into Pediatric Department (PD); to compare dominant diagnostic and treatment practices in our hospital. Methods. Retrospective single-center study. Data of children<2y hospitalized to PD 2018 March-2019 June were included. Exclusion:lack of medical documentation, neonatal age. Diagnostics, treatment use were evaluated. Results. 115 patients referred to PED due to bronchiolitis were later hospitalized. Only 99 (86.1%) met inclusion criteria and were analyzed. Median age–3mo (min 1mo, max 12mo);59.6% (n=59) were male. Most frequent symptoms in PED–subfebrile T°C(n=69, 69.7%), cough (n=89, 89.9%), dyspnea (n=57, 57.6%), ARDS (n=70, 70.7%). Mean SpO2–92.4±5.72%; RR–45.2±13.2bpm, auscultation findings–crackles (75.8%), wheezing (81.2%). Routine blood test performed for 29.3%(n=29) in PED and for 41.4%(n=41) in PD, eight–tested twice (in PED and PD).59 (59.6%) received chest X-ray.69 children required oxygen therapy.57.6% of patients received salbutamol in PED and 79.8%(n=79) in PD(average duration 4.7±3.5d). Glucocorticoids (GC) were administered in 20.2%(n=20) in PED vs 31.3%(n=31) in PD.11 patients were prescribed antibiotics. Mean length of stay (LOS)–4.9±3.9d. LOS was longer when children received oxygen or GC(5.67±4.4d and 7.1±5.8d respectively).

Introduction. Supposedly full-term neonates, born at 37-41+6 weeks of gestation are less susceptible to get ill in comparison with neonates born at less than 37 weeks of gestation. However according to data, outcomes of full-term neonates, particularly outcomes of respiratory tract diseases depend on the gestation week. In accordance with reviewed articles, neonates born at 37-38+6 weeks of gestation had a tendency to be ill more often than neonates born at ≥ 39 weeks of gestation. METHODS A retrospective study of morbidity trends in 2,655 full-term neonates born at the Hospital of the Lithuanian University of Health Sciences Kaunas Clinic in 2016 was carried out. The study did not involve neonates transferred from other hospitals. Data was collected from medical records. Subjects were divided into two groups according to gestational age: neonates born at 37-38+6 weeks of gestation and neonates born at ≥ 39 weeks of gestation. RESULTS The most common neonatal diseases were: hyperbilirubinemia (5.54%), birth trauma (2.64%) and hypoglycaemia (2.41%). Neonates born at 37-38+6 weeks of gestation suffered from the diseases significantly more often than neonates born at ≥ 39 weeks of gestation (38.1% and 23.7%, respectively; p < 0.05); moreover, hyperbilirubinemia (12.46% and 3.14%, respectively; p < 0.05), hypoglycaemia (5.43% and 1.37%, respectively; p < 0.05) and respiratory distress syndrome (0.7% and 0.0%, respectively; p < 0.05) were significantly more prevalent amongst them (Tab. 1). Infants born at 37-38+6 weeks of gestation received treatment more frequently in the intensive care unit (2.49% and 0.76%, respectively; p < 0.05) and had longer hospital stays (4 days [1-36 d.], and 3 days [1-29 d.]; p < 0.05).[...].

Introduction In Lithuania there is a widespread view that vaccination against influenza is not necessary. However, people in Lithuania are at high risk to get an upper respiratory tract infection due to the cold season. Especially medical students from 4-6 courses. They have close contact with patients in hospitals and can be infected or transfer the infection to them. Both ways the outcome is undesirable. We decided to determine the morbidity of upper respiratory tract infection and rate the immunization against influenza among students. Aim To evaluate the rate of vaccination against influenza among Lithuanian’s University of Health and Science, Medicine Academy, Medicine Faculty, students (LSMU MA MF) from 4 to 5 courses and the impact of the vaccine on upper respiratory tract infections (URTI). Objectives 1. To determine the rate of vaccination against influenza among LSMU MA MF students’ from 4-5 courses. 2. To compare morbidity of URTI between vaccinated and non-vaccinated students. 3. To compare the development of complications between vaccinated and non-vaccinated students after URTI. 4. To set the influence of lifestyle on URTI morbidity. Methods An internet survey of LSMU MA MF medical students from 4 to 5 courses was carried out. People had to answer anonymously to 12 questions of the created questionnaire. The sample size was 388 students. Two groups were concluded: respondents with URTI - 221 (57.3%) and respondents with no history of URTI- 167 (42.7%). Also we distinguished one major group of non-vaccinated students - 367 (94.5%) and one minor group of vaccinated students – 21 (5.5%) Vaccinations and sickness rates were evaluated in 2014 -09 -01 - 2015-02-28 period. Aspects that were assessed: vaccination rate, morbidity of URTI, development of complications after URTI (students expressed their condition after their illness in the internet survey), lifestyle influence (smoking, physical acti[...].