Ivanauskienė, Vilma

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: 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.

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.

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.

Pulmonary hypoplasia is a rare condition characterized by incomplete development of lung tissue with a reduction of the bronchial segment, the alveoli and the lungs themselves. Respiratory movements of the fetus and sufficient amount of amniotic fluid are essential for the normal development of lung tissue. As a result long latency period with severe oligohydramnios after premature rupture of membranes impairs fetal development and increases the risk of pulmonary hypoplasia. We report a successful pulmonary hypoplasia clinical case after a latency period of 44 days. A 24-year-old woman attended the emergency room of our hospital at 22 weeks of gestation complaining of watery vaginal discharge. There were no clinical signs of intrauterine infection. During ultrasound examination severe oligohydramnios was observed with AFI of 35 mm. After a prolongation of pregnancy was chosen the antibiotic therapy and corticosteroids were prescribed. During further hospitalization, the condition of the patient and the fetus remained stable. At 28 weeks of gestation the vaginal delivery was induced and a live male newborn weighing 1398 g with Apgar Scores of 2/4/6 was born. Duration of latency period before birth – 1037 h 41 min or 44 days. Instantly after birth the newborn underwent initial resuscitation. He was intubated and mechanical ventilation was initiated. Anyway, hypoxemia persisted. The HFOV was initiated. The surfactant was instillated. Left pleural drainage was performed. Impairment of blood circulation persisted. Persistent pulmonary hypertension was diagnosed. Inhaled nitric oxide therapy was initiated. Antibacterial treatment, infusion therapy, sedation were prescribed. At 4th day of life (DOL) the condition of the newborn was aggravated by a spontaneous intestinal perforation. The abdominal cavity was drained. With an improvement of general condition the kangaroos method was initiated. At 44th DOL the newborn was...

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.