PurposeThe aim of the study was to assess perinatal outcome of pregnancy burdened with maternal addiction in comparison with an unselected population from a European transition country.Materials and MethodsData on pregnancies complicated by illicit drug abuse (n = 85) managed during a 10-year period (1997 - 2007) at Split University Hospital were analyzed. Data on the type of drug, course of gestation and labor, and on perinatal outcome were considered. Data on all non-dependence pregnancies recorded during the study period were used as a control group.ResultsDuring the study period, there were 85 dependence-complicated pregnancies (0.2%). Use of heroin alone during pregnancy was recorded in 51 women (50%), methadone alone in 6 (7%), and a combination of heroin and methadone in 9 (11%). Premature delivery was significantly more common in the group of pregnant addicts (21% vs. 6%); 49% of pregnant addicts were carriers of hepatitis C virus (HCV) and 14% of hepatitis B virus (HBV). Neonatal abstinence syndrome developed in 61 infants (7%) born to addicted mothers. There were 4 cases (4.6%) of early neonatal death; 7 neonates had 5-minute Apgar score ≤ 7 (8%); 29 neonates had low birth weight for age (33%); and 7 neonates had congenital anomalies (8%). The risk of various congenital anomalies was 3-fold in the group of children born to addicted mothers.ConclusionAddiction pregnancies present a small but high-risk group according to perinatal outcome. Appropriate obstetric and neonatal care can reduce the rate of complications in these pregnancies and improve perinatal outcome.

Ponderal index (fetal weight in grams X 100 / (fetal length in centimeters)3) (PI) is one of the anthropometric methods used to diagnose impaired fetal growth. Irrespective of the infant's position on the growth-weight-for-gestational age charts, PI is low in malnourished infants and high in obese ones. As fetal growth is affected by ethnicity, geographic location and socioeconomic status, we developed standards for neonatal PI, and assessed the effects of gestational age, sex and maternal parity. Data on 5798 newborns from singleton pregnancies born in the Department of Gynecology and Obstetrics, Split University Hospital, were retrospectively analyzed. Over a 15-month period in 2000/2001, 5596 newborns from 24 to 42 weeks of gestation were born. The other 202 newborns, born from 24 to 34 weeks of gestation in the ten year period, 1990-1999, were added because of the small number of preterm infants; ensuring a minimum of 30 to fill up at least infants in each gestational week. All mothers were of Caucasian origin. Stillbirths and fetuses with congenital malformations were excluded. The 10th, 50th and 90th percentiles, mean values with standard deviation of PI and the 10th, 50th, and 90th percentiles of birth weight and birth length are presented separately at weekly intervals. PI showed linear correlation with gestational age from 24 to 39 weeks, after witch the data plateaued. Sex and parity had no impact on PI in infants born between 24 and 37 weeks. Analysis of variance revealed PI to be significantly higher in female than in male newborns, and in multiparous than in nulliparous infants after 37 weeks of gestation. In conclusion, gestational age is the most important factor of neonatal PI. The effects of sex and parity on PI should only be considered in term neonates.

We investigated genetic influence on sleep electroencephalogram (EEG) composition by a classical twin study of monozygotic (MZ) and dizygotic (DZ) twins in the first 3 months of life. Polysomnographic (PSG) recordings were obtained in 10 MZ and 20 DZ twin pairs in the 37th, 46th, and 52nd week of postmenstrual age (PMA). The EEG power spectra were generated on the basis of fast Fourier transformation (FFT). Genetic influence on active sleep/rapid eye movement (AS/REM)] and quiet sleep/non rapid eye movement (QS/NREM) sleep composition was estimated by calculating within pair concordance and the intraclass correlation coefficients (ICCs) for delta (0.5-3.5 Hz), theta (4-7.5 Hz), alpha (8-11.5 Hz), sigma (12-14 Hz), and beta (14.5-20 Hz) at central derivation. MZ twins show higher ICCs than DZ twins for alpha, sigma, and beta spectral powers during QS/NREM sleep in the 37th, 46th, and 52nd week PMA. However, there was no significant difference (P > .05) between the 2 types of twins in absolute differences of EEG spectral power of the alpha, beta, and sigma frequency ranges in the 37th, 46th, and 52nd week PMA. The greatest mean absolute difference within MZ and DZ twin pairs and also between MZ and DZ twin groups was identified in the delta frequency range. Our findings gave an indication of genetic influence on alpha, sigma, and beta frequency ranges in the QS/NREM sleep stage.

A grave form of HDN (haemolytic disease of the new-born) is described in female twins, caused by Kell, E and Vel isoimmunisation. The weakly vital and anaemic new-born babies were hospitalised with signs of respiratory distress on the first day of their life after the delivery by Caesarean section in the 38 (th) week of pregnancy in the General Hospital Dubrovnik. Already during the first hours of their life jaundice developed with a high bilirubin level for their age. The direct Coombs' test on the twins and the indirect Coombs' test on the mother were positive. Immuno-haematological analysis proved the presence of anti-Kell, anti-E and the very rare anti-Vel antibodies in the mother's serum and in the plasma of both twins. We had no possibility to obtain appropriate blood for the indicated exsanguine transfusion because cross-probes with the accessible blood samples were positive. Up to the fourteenth day of life the anaemia deepened and was aggravated in one twin, the Kell positive one (phenotype CcDEe,Kk) in relation to the other, the Kell negative (phenotype CcDEe,kk) twin. The recovery of the female twins started on the 15 (th) day of life, after the transfusion of blood (phenotype: 0,ccddee, Vel negative, Kel negative), received from the bank of rare blood groups in London. This is the first described case of haemolytic disease of the new-born caused by antibodies on the antigen Kell, E and Vel. The low frequency of immunisation with rare antigens such as Kell, E and Vel, does not exclude the possibility of the occurrence of grave forms of haemolytic disease. All pregnant women with a positive indirect Coombs' test should be further immuno-haematologically tested in order to identify the antibodies type so that the treatment of the new-borns could be commenced in time.