Background. The study aimed to examine the effect of early hyperglycemia on the morbidity/mortality of very low birth weight premature infants. Methods. This retrospective study included all premature infants with gestational age ≤32 gestational weeks, hospitalized at the Department of Intensive Neonatal Care, Clinical Center Kragujevac, during the period 2017-2019. Hyperglycemia was defined as glycemia of ≥12 mmol/l in one measurement, or > 10 mmol/l in two measurements, at repeated intervals of 2-4 hours. Glycemia was determined from capillary blood, using a gas analyzer of Gem Premier 3000, during the first 7 days of life. Continuous intravenous insulin infusion was administered after ineffective glucose restriction at glycemic values of > 14 mmol/l. Results. Patients with normoglycemia (41/72 (56.94%)) and hyperglycemia (31/72 (43.06%)) did not differ in gender, gestational age, mode of delivery and antenatal administration of steroids, while birth weight had a tendency to be lower in the hyperglycemic group (p=0.052). Hyperglycemia was significantly associated with a low APGAR score at the fifth minute (p=0.048), necrotizing enterocolitis (p=0.011), and shorter duration of mechanical ventilation (p=0.006). Hyperglycemia was associated with significantly more frequent fatal outcomes (35.5%) when compared with the normoglycemic group (4.9%). Accordingly, these patients required inotropic (r=0.036) and insulin therapy (r < 0.001) more often. Retinopathy of prematurity, bronchopulmonary dysplasia and sepsis did not correlate with hyperglycemia in our study. Intraventricular hemorrhage of the first degree was more often associated with normoglycemia in premature infants on prolonged mechanical ventilation while more severe intracranial hemorrhage was more common in the hyperglycemic group but did not result in statistical significance due to the small number of patients. Conclusions. Monitoring glucose levels in the blood of very low birth weight premature infants is clinically important because abnormalities in glucose homeostasis can have serious short-term and long-term consequences.
Neonatal pneumopericardium, a collection of air in the pericardial sac, is less common form of air leak syndrome, but unfortunately with high mortality rate. We report a rare case of male fullterm newborn who soon after birth presented with respiratory distress. Chest radiograph showed spontaneous bilateral pneumothorax after which a chest drain was placed between anterior and midaxillary line in the 5 th right intercostal space. The infant soon presented with tachypnea, dyspnea, muffled heart sounds, acidosis indicating cardiorespiratory worsening. On chest radiograph ''Halo'' sign appeared indicating pneumopericardium. We believe that spontaneous reposition of a chest drain damaged the pericardial sac which combined with ventilation mechanism (''Macklin effect'') most likely led to pneumopericardium. After partial chest drain extraction the infant showed signs of improvement, but had to be closely monitored due to risk of tension pneumopericardium. Careful thoracal drain placement and fixation is crucial to prevent iatrogenic pneumopericardium, which can lead to deadly tension pneumopericardium.
Implantable cardioverter defibrillators (ICD) effectively reduce risk of sudden cardiac death in both primary and secondary prevention, but only a small proportion of patients included in the clinical trials had atrial fibrillation. It is still unclear whether patients with atrial fibrillation have the same benefit from ICD implantation as patients in sinus rhythm. This is a clinical, prospective study which included 210 patients in the period 2014-2018. ICD was implanted in the Clinical Center Kragujevac and a two-year follow-up was performed. Patients were divided into 2 groups: a group in sinus rhythm and a group of patients with atrial fibrillation (paroxysmal, persistent and permanent). At the end of the two-year follow-up, there was no difference in survival between the compared groups. The total number of cardioverter defibrillator activations did not differ between the groups, but a significantly higher number of inappropriate cardioverter defibrillator activations was registered in the group with atrial fibrillation. In most patients who had inappropriate defibrillator activation during the two-year follow-up, appropriate defibrillator activation was also registered.
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