Gailienė, Jurgita

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.

TYRIMO TIKSLAS: Vaikų populiacijoje blužnies sužalojimai yra dažniausiai pasitaikančios parenchiminių organų traumos, tačiau potrauminė blužnies pseudoaneurizma (BPA) išlieka reta komplikacija. Šiuo metu nėra aiškių gairių, apibrėžiančių optimalią BPA gydymo taktiką. Šio atvejo tikslas – pabrėžti laiku taikyto gydymo svarbą, siekiant išvengti gyvybei pavojingų komplikacijų. ATVEJO APTARIMAS: 5 metų berniukas buvo pristatytas į LSMUL KK VSPS dėl bukos pilvo traumos. Pradinės apžiūros metu stebėtas saikiai išpūstas pilvas su pilvaplėvės dirginimu kairiojoje pilvo pusėje. Ultragarsinio tyrimo metu buvo stebėta blužnies laceracija su nedideliu kiekiu laisvo skysčio pilvo ertmėje. Atliktoje pilvo KT stebėtas IIׄI° blužnies plyšimas. Pacientas stacionarizuotas, paskirtas konservatyvus gydymas. Gydymo eigoje, bendra berniuko būklė pagerėjo. Šeštą hospitalizacijos dieną berniukui pakartota pilvo echoskopija, kurios metu rasta blužnies apatinio poliaus pseudoaneurizma su aktyvia kraujotaka. Besiruošiant išrašyti pacientą, tos pačios dienos vakarą, berniukas pasiskundė stipriu pilvo skausmu, stebėta hipotenzija, sąmonės sutrikimas. Atliktoje echoskopijoje stebėtas ženkliai padidėjęs laisvo skysčio kiekis pilvo ertmėje. Įtariant kraujavimą į pilvo ertmę, berniukas skubiai operuotas – atlikta laparotomija ir splenektomija dėl BPA plyšimo. Pooperacinis laikotarpis sklandus, berniukas išrašytas į namus devintą dieną po operacijos. IŠVADOS: Nors šiuo atveju buvo išvengta mirties, tačiau šis atvejis pabrėžia aiškių BPA gydymo gairių trūkumą, kas galėtų padėti išvengti tolimesnių gyvybei grėsmingų komplikacijų kitiems pacientams.

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.

Aim of Study: To highlight the severity of air gun injuries in children, focusing on diagnostic challenges and the diverse therapeutic approaches required for varying injury types. Methods:This case series reviews five pediatric patients who sustained severe air gun injuries to different anatomical regions, including the chest, abdomen, and retroperitoneum. Diagnostic imaging and treatment strategies, ranging from conservative management to surgical interventions, were tailored to each case based on injury severity. Results:The injuries affected multiple anatomical areas and presented varying levels of complexity: • Chest injuries: Three children sustained thoracic injuries. One developed pneumothorax and subcutaneous emphysema, managed conservatively due to a retained bullet near the vertebral column. Another suffered a cardiac injury causing asystole, successfully managed with emergency sternotomy. The third child’s lung injury, causing minor pneumothorax, was treated with thoracoscopy and conservative care. • Abdominal injuries: One child required laparotomy for injuries to the liver, stomach, and pancreas. Months later, a migrating kidney bullet caused ureteral obstruction, resolved with stenting and cystoscopic removal. • Retroperitoneal injuries: A lumbar wound caused a retroperitoneal hematoma and ureteral damage, managed with drainage and stenting, leading to full recovery. Conclusions: Air guns can cause diverse and severe injuries across multiple anatomical regions, necessitating a range of diagnostic and therapeutic strategies. Prompt and tailored management is critical for positive outcomes. Public awareness and stricter regulations are essential to prevent such incidents.

Introduction Intestinal atresia represents a range of congenital malformations resulting in a blockage in the intestine, occurring in about 1 in 5000 - 14000 live births, and only 12% are cases of ileal atresia [1]. This case shows challenges that arise in diagnosing ileal atresia. Case Presentation A 1-day-old male newborn presented with vomiting and not passing stool since birth. An initial X-ray showed enlarged intestinal lumens (small intestine 1.2 cm, ascending colon 2.3 cm), with a laterogram indicating several fluid-air surfaces. An enema resulted in “meconium” discharge. Persistent symptoms raised suspicions of intestinal obstruction. An oral water-soluble contrast X-ray revealed only stomach filling before vomiting, delaying diagnosis. Repeated X-rays showed air-filled small intestines and dilated loops. A retrograde contrast enema allowed the contrast to fill the colon. After investigations, small bowel atresia was suspected and emergency laparotomy was performed. During laparotomy, complete atresia was found about 30 cm from the ileocecal angle. The procedure involved resection of the overstretched proximal section (10 cm) and the distal part (4 cm), followed by end-to-end primary anastomosis. The diagnosis was ileal atresia (type IIIA), the patient was discharged with follow-up care instructions. Discussion The main differential diagnoses for ileal atresia are internal hernia, Hirschsprung disease, and meconium ileus [2]. Despite its challenges, X-ray with contrast remains the main diagnostic approach. Surgery is required to treat ileal atresia. The survival rate of patients with this congenital malformation has significantly improved over time [3]. Conclusions This case emphasizes the necessity for accurate diagnostic methods and the challenges of diagnosing ileal atresia.

This study aimed to develop a universally applicable core set of quality indicators for Hirschsprung's disease care through a consensus-driven process, to standardise and improve care quality across Europe.

AIM OF THE STUDY: Although splenic traumas are the most frequent solid organ injuries in the pediatric population, post-traumatic splenic pseudoaneurysm (SPA) is a rare condition seen in up to 9% of cases. Regrettably, there are no guidelines addressing the optimal timing for SPA angioembolization in children. This case report aims to consider the importance of angioembolization, which could reduce the risk of fatal complications. CASE DESCRIPTION: A 5-year-old boy was presented to the Emergency Department due to blunt abdominal trauma. Initial observation revealed a distended abdomen with tenderness on the left side. Ultrasound showed a spleen injury and a small amount of intraabdominal fluid, although there were no signs of anemia. Abdominal CT confirmed a III° laceration of the spleen (Image 1). Nonoperative management was chosen and the patient‘s general condition improved. On 6th day, the patient was symptom-free and ready for discharge; however, the ultrasound revealed a pseudoaneurysm in an inferior pole of the spleen. Later that day, the boy suddenly experienced severe abdominal pain, hypotension, and collapse, prompting a bedside ultrasound that identified an increased volume of intraabdominal fluid, along with a decreased hemoglobin level in a blood test. The patient underwent urgent laparotomy and splenectomy due to a rupture of splenic pseudoaneurysm. The post-operative period was uneventful, and the patient was discharged on the 9th day. CONCLUSION: While this case resulted in a successful outcome it emphasizes the current lack of clear guidelines for the timely consideration of angioembolization of SPA - potentially a lifesaving decision.

Aim To identify and evaluate risk factors of very low birth weight infants who developed NEC. Methods Retrospective single center study of 91 newborns with NEC, who were treated between 2016 and 2021 in Kaunas Clinics. Different risk factors were analyzed. In prospective study all very low birth weight (<1500 g) infants are enrolled and followed up. Patients are divided into two groups: control and the ones who develop NEC during the study. The following biological samples are collected: blood, stool, mother’s milk in order to identify risk markers. Results Retrospectively 91 patients with NEC were included in the study, 73 very low birth weight (VLBW) ˂ 1500 g and 18 > 1500 g. Mortality rate was 30 (41,1%) in VLBW group. Early onset NEC (˂7 days) was diagnosed in group with > 1500 g and late onset NEC (> 7 days) in group with ˂ 1500 g. Chorioamnionitis during pregnancy was more often seen in VLBW group 20(27,4%). No association was found between delivery mode or nutrition. In prospective study, during 7 months period, 30 newborns ˂1500 g were included. The median gestational age was 27,8 week’s, median birth weight – 986,1 g. NEC developed in 4 newborns and 1 was operated. Conclusions Our findings showed that lower gestational age, lower birth weight, infection during pregnancy is associated with NEC. Future prospective studies are planned to better understand the process of this disease.

Superior mesenteric artery syndrome (SMAS) is a very rare manifestation of duodenal obstruction with the incidence of 0.013–0.3% in adult population, but there are only few reports in the literature concerning children. SMAS can be related to a rapid loss of intraabdominal fat by severe, debilitating illnesses such as malignancy, burn, spinal cord injury, anorexia. As a result, compression of the third duodenal portion by the aorta and the overlying superior mesenteric artery occurs, when the angle formed by these two structures becomes smaller. We present a case of a 17-year-old boy who suffered a severe head trauma during a car accident. He had prolonged confinement in the supine position because of ongoing coma. The SMAS developed due to a progressive weight lost. Upper gastrointestinal Barium contrast study, fibroesophagogastroduodenoscopy (FEGDS), abdomen computed tomography scan (CT) were not specific and only, magnetic resonance imaging (MRI) findings suggested diagnosis of SMAS. As there was no response to the conservative treatment, surgical intervention of duodenojejunostomy was performed. The postoperative period was successful.

Introduction. Superior mesennteric artery syndrome is an uncommon cause of the third part of duodenum obstruction. This can be related to loss of intraabdoominal fat by severe, debilitating illnesses such as malignancy, spinal cord injury etc. As a result, aortomesenteric angle and the distance between the superior mesenteric artery (SMA) and aorta are decreasing. The typical symptoms os SMAS are similar to those of incomplete duodenal obstruction, including intermittent abdominal pain, nausea, bilious vomiting. This condition can be diagnosed by the radiologi evidence of vascular obstruction of the third portion of the duodenum using a Barium upper gastrointestinal (UGI) series, computed tomography (CT), CT angiography or magnetic resonance angiography (MRA). The initial treatment of SMAS usually is conservative, but surgical intervention is required in some patients. [...].