Gaidamavičienė, Gabija

Objectives Congenital epulis (CE) is a rare benign tumour typically arising from the alveolar ridge and more frequently observed in female neonates. The report highlights its potential impact on neonatal breathing and feeding, emphasizing the importance of early recognition and management.

Case presentation We present a case of a female neonate with a giant CE detected on prenatal ultrasound. After the birth the lesion interfered with feeding, while respiratory function remained unaffected. Three masses were surgically dissected from the maxillary mucosa and the neonate successfully transitioned to oral feeding within the first week. Histopathological examination revealed a granular cell tumour with negative immunoreactivity for S100.

Conclusions The case underlines the significance of prenatal diagnosis, collaborative multidisciplinary planning, and, when indicated, the application of the EXIT procedure for congenital orofacial tumours with potential airway obstruction. Early recognition and integrated care can substantially improve neonatal prognosis.

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.

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.

Tyrimo tikslas. Nustatyti motinos socialinius, psichologinius, biomedicininius ir naujagimio veiksnius, kurie turi įtakos maitinimo motinos pienu (MP) trukmei. Tyrimo metodai. Atliktas anketinis tyrimas. 282 pacientės, gimdžiusios Lietuvos sveikatos mokslų universiteto ligoninės Kauno klinikų (toliau - Kauno klinikų) Akušerijos ir ginekologijos klinikoje buvo apklaustos iškart po gimdymo bei praėjus 12 ir 29 mėn. po gimdymo. Atlikta statistinė duomenų analizė. Rezultatai. Vidutinė žindymo trukmė buvo 11,24±8,74 mėn. Neigiama įtaką žindymo trukmei turi jaunesnis moters amžius, žemesnis išsilavinimas, pirmas kūdikis, nelankyti žindymo kursai, sveikatos sutrikimai nėštumo laikotarpiu, analgezija gimdymo metu, mažesnis naujagimio gimimo svoris, mažesni APGAR balai, mažesnis gestacinis amžius, neatliktas oda-oda kontaktas bent 30 min., neinicijuotas žindymas per pirmas 2 val., motinos ir naujagimio buvimas atskirai ligoninėje. Žindukas, duotas kūdikiui per pirmus 6 gyvenimo mėnesius, taip pat daro neigiamą įtaką žindymo trukmei. Tarp tiriamųjų dažniausia žindymo nutraukimo priežastis buvo „pieno nebuvimas" bei moters apsisprendimas, jog jau „užtenka žindyti". Išvados. Moterys, turinčios aukščiau išvardytus rizikos veiksnius, turi didesnę riziką nutraukti žindymą anksčiau nei rekomenduojama.

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.

Donorinis motinos pienas turėtų būti pirmojo pasirinkimo alternatyva sergantiems arba neišnešiotiems naujagimiams, kai maitinimas motinos pienu negalimas. Maitinimas motinos pienu gali padėti sumažinti sunkių arba mirtinų ligų (sepsis, nekrozinis enterokolitas (NEK), lėtinė plaučių liga, neišnešiotų naujagimių retinopatija) dažnį. Dėl šių priežasčių donorinio motinos pieno bankai kuriasi visame pasaulyje. Pirmasis Lietuvos donorinio motinos pieno bankas (DMPB) įsikūrė Lietuvos sveikatos mokslų universitetinėje ligoninėje Kauno klinikose (toliau - Kauno klinikos). Nuo DMPB įkūrimo vėlyvais 2016 m. iki 2019 m. pabaigos buvo surinktas 1901 litras donorinio pieno ir juo maitinti 1548 naujagimiai. Pradėjus naujagimius maitinti donoriniu motinos pienu, stebimos NEK dažnio ir sunkių ligos stadijų mažėjimo tendencijos.

Tikslas – atlikti literatūros vaikų patiriamo ūminio skausmo nemedikamentinio malšinimo ir su skausmu susijusio nerimo gydymo tema paiešką ir analizę. Aprašyti nemedikamentinius skausmo mažinimo būdus ir su skausmu susijusio nerimo malšinimo priemones. Tyrimo objektas ir metodai. Tyrimo objektas – mokslinėse duomenų bazėse rastos publikacijos. Literatūros paieška buvo atliekama Medline (Pubmed), Google Scholar. Paieškai naudoti raktiniai žodžiai, atitinkantys tyrimo tikslą. Atlikus pradinę paiešką iš viso buvo rastos 206 publikacijos, susiaurinus paiešką įtraukiant papildomus kriterijus – straipsniai anglų kalba, žmogaus tyrimai, tik nemokami straipsniai, ne senesni nei 10 metų straipsniai – liko 7 straipsniai. Apibendrinimas. Skausmas yra viena dažniausių kreipimosi į vaikų priėmimo skyrių priežasčių. Daugeliui pacientų reikalingos įvairios procedūros, kurios gali būti netikėtos ir skausmingos, kelti nerimą bei nežinomybę, taip dar sustiprindamos skausmo pojūtį. Patiriama būklė ir negatyvi patirtis gali sukelti ne tik ūmias vaiko emocines reakcijas, bet ir turi pasekmių vėlesniam jo vystymuisi. Visuomenėje esantys su skausmu susiję prietarai dažnai trukdo suteikti adekvačią pagalbą ir pasirinkti geriausią skausmo malšinimo strategiją. Sveikatos specialistai yra atsakingi už tinkamą skausmo, baimės ir nerimo mažinimą. Nemedikamentiniai skausmo malšinimo metodai – esminė skausmo mažinimo dalis. Tinkamai parinktos ir naudojamos priemonės gali padėti įveikti su procedūromis susijusį pacientų patiriamą stresą ir nerimą, sumažinti skausmui malšinti reikalingų medikamentų dozes, taip pat dažnai padeda išvengti medikamentinio nerimo šalinimo.

Skausmas yra viena dažniausių kreipimosi į vaikų skubios pagalbos skyrių priežasčių. Dauguma vaikų patiria skausmingas diagnostikos procedūras, kurios kelia baimę, skausmą ir nerimą. Vaiko patiriamas skausmas dažnai neužtektinai pripažįstamas, netiksliai nustatomas jo stiprumas, todėl neužtikrinamas adekvatus nuskausminimas. Tikslas – nustatyti vaikų skausmo pojūčio skirtumus nuo suaugusiųjų, pristatyti skausmo vertinimo skales, padedančias atpažinti ir tiksliau įvertinti vaikų patiriamą skausmą, siekiant adekvataus nuskausminimo. Tyrimo objektas ir metodika. Atlikta sisteminė literatūros apžvalga vaikų patiriamo ūminio skausmo tema, naudojantis paieškos sistema Pubmed ir Google Scholar duomenų bazėse. Rasta 427 publikacijos. Analizei atrinkti 9 straipsniai, aprėpiantys 2010-2019 metų laikotarpį. Rezultatai. Sisteminėje literatūros apžvalgoje išnagrinėti 9 straipsniai. Įtraukti straipsniai nagrinėjantys kūdykių ir vaikų skauso neurofiziologinius ypatumus. Aptartos įvairaus amžiaus vaikams taikomos skausmo vertinimo skalės. Išvados. Vaikų skausmo neurofiziologiniai ypatumai labai skiriasi nuo suaugusiųjų. Nepakankamas nuskausminimas gali lemti ilgalaikius skausmo suvokimo pokyčius ir sukelti specifines su tuo susijusio elgesio išraiškas. Pastaraisiais metais daugėja duomenų, nurodančių kūdikių-vaikų-paauglių skausmo efektyvesnio įvertinimo bei gydymo poreikį. Nepaisant turimų priemonių bei specifinių skalių, nepakankamai adekvatus skausmo vertinimas lemia nepakankamą ar netinkamą nuskausminimą. Geresnei skausmo kontrolei užtikrinti svarbu mokyti medicinos personalą bei vaikų artimuosius, kaip laiku ir kuo tiksliau atpažinti vaiko jaučiamą skausmą bei jo stiprumą.

Necrotizing enterocolitis (NEC) is one of the most dangerous diseases for newborns with high rates of mortality and serious outcomes. It is also one of diseases whose risk can be reduced by feeding human milk (HM) exclusively. However, mothers of premature newborns are not always able to provide as much milk as the infant needs. To ensure exclusive human milk diet for newborns, donor human milk banks are establishing all over the world. One of them was opened in Lithuanian University of Health Sciences (LUHS) Hospital, Department of Neonatology in December 2016. Even though donor human milk (DHM) should not replace mother’s own milk (MOM), clinical studies suggest using it instead of formula since it lowers rates of NEC, modifies course of disease and improves feeding tolerance. The authorization of bioethics was received (LUHS Bioethics committee, No. BEC – MF - 21). We performed a retrospective study of 81 patients’ data. All patients were treated in LUHS Hospital department of neonatology, neonatal intensive care unit in 2010-2017 years. Inclusion criteria: 1) gestational age 32 weeks and lower 2) diagnosis of NEC 3) no congenital anomalies of digestive tract. Patients were assigned in two groups according to date of birth - control group (73 patients) – treated before donor human milk was available (2010 – 2016), intervention group (8 patients) – treated once donor human milk became available (late 2016, 2017 years). Groups were compared with the respect to ways of feeding (before the onset of NEC), demand of parenteral feeding, erythrocyte mass transfusion and outcomes of NEC. Chi-square and Man-Whitney U tests were used to identify differences between groups. The data was processed with MS Excel and SPSS/w 17.0. Results were considered significant where p<0.05. 1. Prevalence of NEC decreased significantly once donor human milk bank was established in LUHS Hospital, department of neonatology [...].