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Biomedical subjects

Ewa Helwich

Publications and source records attributed to Ewa Helwich.

6 recordsLinked to original sources

[Conjoined twins--diagnostic problems, difficult decisions in choosing the most optimal management in one of the rarest pathologies of pregnancy].

Conjoined twins are the rarest type of monozygotic, monochorionic, monoamniotic twins--incidence about 1:50000 - 1:100000. A conjoined twin pregnancy is a very special pathology in obstetrics and usually ends prematurely. 40% of twins are stillborn, while 35% die within 24 hours after delivery. The development of ultrasonography and in the last years also MRI, allows earlier detection and diagnosis of fetal malformation and enables precise evaluation of the anatomy, type of malformation and how the twins are conjoined. Chances of survival and way of delivery depends on the degree of fusion of the organs and possibilities of surgical separation. Obstetric care for a women with conjoined twins does not differ from that in a normal twin pregnancy, but the newborns require special medical care after delivery. We would like to stress the diagnostic problems and the difficult decisions that we encountered. The degree of conjoinment in this case excluded surgical separation of the twins. A multidisciplinary team of experts decided to end the pregnancy at 31 wks by cesarean section. Delivery at a later term could increase the risk of uterine rupture and surgical complications.

Abnormalities, Multiple↗

[The assessment of influence of the diet in the early life, with regard to the effect of protein hydrolysates, on bone mineralization in preterm infants].

UNLABELLED: The aim of the study was to evaluate the influence of the neonatal diet on bone mineralization. We studied 21 neonates (M-10, F-11) in gestational age 27-35 weeks with body birth weight ranging from 860 to 1800 g (mean 1343 g). 12 children received breast milk with fortifier (BMF--group 1) and 9 children were fed with hydrolysate formulas (group 2). The feeding was modified after child body weight reached 3500 g. The bone mineral density measured by densitometry (DPX) technique and body weight gain were evaluated. RESULTS: Mean TBBMD (total body bone mass density--g/cm2) at week 40 of postconceptual age in group 1 was 0.450 +/- 0.021 and in group 2 0.457 +/- 0.049. At 3rd month TBBMD was respectively 0.496 +/- 0.034 and 0.478 +/- 0.016, and at 6 month of corrected age 0.546 +/- 0.055 and 0.564 +/- 0.021. The differences were not statistically significant. There were no differences in body weight gain between both groups. At month 7-9 of corrected age body weight were 8650 g and 8475 g respectively. CONCLUSION: We did not demonstrate the differences in TBBMD and body weight gain between children fed with breast milk and BMF or hydrolysate formulas in the first months of life. The low number of children does not allow to generalize this conclusion.

Calcification, Physiologic↗

[Developmental sequel of prematurity].

Severe developmental impairment in children born as extremly prematures include cerebral palsy, subnormal cognitive function, deafness and blindness. The rate of severe disabilities range from 5 to 30%. This article reviews what is known about early brain injury and its developmental sequel.

Blindness↗

[A two-year evaluation of the development of preterm babies born in the region of Warsaw: a prospective cohort study Prematuritas].

AIM: Complex evaluation of the development of infants until the end of the second year of life, including neurological and sensory development. A prospective cohort study. POPULATION AND METHODS: 1) 264 premature babies born between 24 and 32 weeks of gestation during the period 1st of Oct 1998 and 30th of Sept 1999 in the region of Warsaw. 2) Age of examination at: 4th, 8th and 12th month of postconceptional age and 18th and 24th month of calendar age. 3) Neurological examination according to modified Denver's test, including the development of motor skills, coordination of vision and movement, speech and social contacts. Final division of development into: normal, uncertain and pathological. 4) Cerebral palsy was diagnosed according to the definition and classification proposed by the European Commission in 2002. 5) Retinopathy of prematurity (ROP): back of the eye (Fison's speculum) examination conducted from the 30th day of life, and follow-up depending of the escalation of changes. In cases of diagnosed ROP, stage 3 or 4 laser photocoagulation was performed. 6) Hearing examination: behavioral evaluation, in cases of uncertain or abnormal results ABR (auditory brain stem response) was carried out. RESULTS: 162 children participated in the examination at the age of 2, which comprises 87% of the study population. While evaluating motor and sensory development of study population at 2 years of age, normal development was seen among 88% of children, cerebral palsy of different types (with majority of serious cases) was diagnosed in 8% of children and 2 children were blind. Uncertain development was stated for 4% of children, and 1 of them was deaf. 20% of children experienced delay in speech development and hyperactivity. Among babies born before 28th week of gestational age, 2-3 times higher percentage of 3rd stage of retinopathy of prematurity (ROP) was stated in comparison with developed countries. Nevertheless, no case of blindness was observed in this group of children, which may prove effective screening and effective therapy. At the same time 65% of children with 3rd stage ROP have some problems with vision (squint, short sightedness). The incidence of bronchopulmonary dysplasia-BPD (16%) and chronic lung disease (CLD) (11%) were relatively low. However, the percentage of hospitalization among children with CLD under the age of 2, which was caused by respiratory problems, was 37% compared to 28% of children in which CLD was not diagnosed. CONCLUSIONS: 1) The incidence of cerebral palsy in our study is not different from the results of other authors and was the highest among babies born before 29 weeks of gestation. 2) In the cerebral palsy group, higher incidence of tetraplegia was found, which may be connected with higher prevalence of hemorrhagic changes (IVH grade III or IV) and hypoxic -- ischaemic changes (PVL). 3) A relationship was found between cranial ultrasound (US) at 40 weeks of postconceptional age after PLV and the child's motor development at 2 years of age: normalization in the US was connected with correct development. 4) Incidence of ROP grade 3 was stated to be three times higher compared to other authors. No case of blindness was stated, which proves effectiveness of screening and treatment procedures. 5) Only one case of deafness due to congenital malformation was found. 6) The incidence of bronchopulmonary dysplasia (BPD) and chronic lung disease (CLD) was comparable to data from developed countries. However, the percentage of hospitalization for all respiratory problems among children with CLD under the age of 2 was twice as high as in the remaining population. 7) Developmental disorders such as: hyperactivity, delay of speech and vision problems (strabismus and short sightedness) indicate the need for continued evaluation of this group of children up to school age (5-7).

Cerebral Palsy↗

[Comparison of the efficacy of ibuprofen and indomethacin in the treatment of patent ductus arteriosus in prematurely born infants].

AIM: To assess the efficacy and safety of early treatment with ibuprofen (IBU) and indomethacin (INDO) of patent ductus arteriosus in preterm infants. Prospective study with blind trial. MATERIAL AND METHODS: We studied 35 preterm infants (19 treated with INDO, 16 IBU) (gestation age <33 and birth weight < 1500 g), who had an echocardiographicaly confirmed patent ductus arteriosus (PDA). The infants were randomly assigned in two groups to receive INDO (0.2-0.2-0.2 mg/kg) or IBU (10-5-5 mg/kg) in first 72 hours of life (average 2 days of life). The rate of ductal closure, the need for surgical ligation, side effects, complications, and the infants clinical course were recorded. RESULTS: The rate of ductal closure was similar in two groups (15/19, 80% INDO; 11/16, 69% IBU). 27 infants (15 INDO, 12 IBU) were treated per protocol (3 doses). For remaining 8 infants we stopped treatment due to side effects. In the IBU group the main reason to stop treatment was pulmonary hemorrhage (3/16, 19%) and pulmonary hypertension (1/16, 6%), but in the INDO group it was increased serum creatinine and urea nitrogen concentrations (3/19, 16%) and intraventricular hemorrhage (IVH IV) grade (1/19 5%). In IBU group vs. INDO, urine output decreased (p=0.02), but never before below the level of oliguria (defined as urine output below 1 ml/kg/h). Risk of necrotizing enterocolitis (NEC) grade II was similar in two groups, but only patients treated with INDO showed intestinal perforations (p=ns). They received also postnatal hydrocortisone and we showed near significant tendency (p=0.06) for intestinal perforation in patients treated with INDO and hydrocortisone. There were no significant differences with respect to IVH or PVL between the groups. CONCLUSIONS: The efficacy of ibuprofen and indomethacin in PDA treatment is similar. Treatment of ibuprofen and indomethacin may cause transient renal dysfunction: diminished urine output and increase of serum creatinine and urea nitrogen concentrations. Indomethacin, especially with concomitant treatment with hydrocortisone, may increase the risk of intestinal perforation.

Anti-Inflammatory Agents, Non-Steroidal↗

[Selected ethical problems in neonatology -- opinions of physicians and nurses based on questionnaire study].

UNLABELLED: AIM OF THIS PAPER: To present the opinions of doctors and nurses on the limitations of resuscitation and treatment of extremely premature newborns. MATERIAL AND METHODS: Anonymous questionnaire studies were carried out in 342 doctors and 1194 nurses from 6 provinces of Poland. The authors compared the answers of doctors and nurses as well as the answers form different provinces. The results were processed using the Chi2 test, with the significance level p<0.05. RESULTS: The will to resuscitate the neonate, regardless of its birth weight was declared by 29% of the physicians and 49% of the nurses, regardless of the gestational age - by 21% of the physicians and 47% of the nurses. Resuscitation of an extremely immature, asphyctic newborn was declared by 71% of the physicians and 59% of the nurses. Limitation of therapy after diagnosing severe intracranial hemorrhage is declared by 67% of the physicians and 45% of the nurses. 37% of the doctors and 30% of the nurses would comply with parents' will when deciding about resuscitation. 44% of the physicians and 31% of the nurses declare taking parents' decision into account in the matter of abandoning resuscitation. CONCLUSIONS: 1. There is a higher percentage of persons convinced about the necessity of resuscitation of every newborn, regardless of its maturity, among the nurses than among the doctors. 2. Among the nurses there are more persons, who are sceptical about saving the extremely premature newborns born with asphyxia, whereas among the doctors there are more persons inclined to stop therapy in case of a severe intracranial hemorrhage. 3. The most controversial are problems concerning the consideration of parents' will in decision about whether to continue or abandon resuscitation, but physicians are more apt to regard parents' will in resuscitation in some situations. 4. The analysis of the questionnaire points to the need for deeper knowledge of the present mortality rates of the extremely immature newborns and further development of the surviving ones among the physicians and nurses.

Adult↗