Objective: Acute kidney injury is common condition in the neonatal intensive care unit and it is associated with poor outcome. The incidence of neonatal AKI is the highest one followed by adults and children, depending on different factors such as the gestational age, birth weight, contributing conditions and the facilities of the neonatal intensive care unit. The aim of the study was to determine the incidence, risk factors and the outcome of the neonatal acute kidney injury. Subjects and Methods: This was a clinical, prospective study that was performed in a referent NICU at the University Children's Hospital in Skopje. All neonates admitted from January 2012 to December 20014 with documented acute kidney injury were included. The medical data records of the admitted neonates with AKI were analyzed. The material was statistically processed using methods of the descriptive statistics. Results: During the study period 770 newborn infants were admitted to the NICU and 50 (6.5%) infants developed acute kidney injury. The male to female ratio was 2.1:1. Most of the neonates involved in the study were neonates born at term (62%). Oliguric AKI was found in 28 cases (56%) and no oliguric in 22 cases (44%). The prevalence of prerenal, renal and post renal AKI were 78.5%, 19.5% and 2.0% respectively. Perinatal asphyxia was the most common predisposing factor for AKI and was evaluated in 38% of the cases with predominance of term infants and male. The mortality rate was 32% and was significantly higher in the group of patients with congenital heart diseases. Conclusion: AKI is a life threatening condition with still high mortality rate. Early recognition of the risk factors and the rapid effective treatment of the contributing conditions will reduce AKI in the neonatal period.

Sepsis in newborns with RDSy and asphyxia is essential; it is a life-threatening condition and still represents an important cause of mortality and morbidity. The aim of this study was to evaluate the predictive values of procalcitonin (PCT) as an early diagnostic and prognostic biochemical marker for sepsis in newborns with RDS and asphyxia. Material and methods: The study was designed as prospective and we examined 110 newborns with proven sepsis admitted in the Intensive  Care Unit at the University Clinic of Pediatrics – Skopje in the period between December 2018 and Јanuary 2021. Procalcitonin levels were measured by using the immunoassay system Vidas based on the ELFA principles. The newborns with proven sepsis were divided into two groups. The first group comprised 55 newborns with RDS and proven sepsis and the second group included 55 newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ​​of PCT in the analyzed time period in first group of newborns with RDS and proven sepsis, p<0.001. The highest average values (40.37±53.79) ​​were measured on admission with a high level of peak compared to the second group of newborns with asphyxia and proven sepsis. The statistical analysis confirmed significantly different values ​​of PCT in the analyzed time period in the first group of newborns with RDS and proven sepsis with mechanical ventilation (MV) and bubble continuous positive airway pressure (BCPAP) compared to the second group of newborns with asphyxia  and proven sepsis,  p<0.001. PCT is a promising sepsis marker in newborns with RDSy, capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection at the time of ICU admission.

Hydrocephalus is a condition resulting from disorder in absorption and circulation of the cerebrospinal fluid (CSF). It leads to a progressive ventricular dilatation and need of ventriculoperitoneal shunt (VP) placement.The aim of our study was to present our experience with infants with hydrocephalus, ventriculoperitoneal shunt placement, and early postoperative follow-up. A retrospective study was conducted comprising infants with hydrocephalus born between January 2019-January 2022 with ventriculoperitoneal shunt placement performed at the University Clinic for Neurosurgery in Skopje, Macedonia.Demographic and clinical characteristics, complications and the need for ventriculoperitoneal shunt were documented. Of twenty-three infants with hydrocephalus, 14 (60.8%) were preterm infants (median birth weight 2120 g; mean gestational age 33.1 weeks), 9 (39.1%) were term infants (mean birth weight 3600 g; mean gestational age 38.4 weeks).The etiology of hydrocephalus was: congenital hydrocephalus in 5 infants (21.7%), prematurity in 6 infants (26.08%), spina bifida in 2 infants (8.7%), systemic infection in 4 infants (17.3%), and intraventricular hemorrhage in 6 infants (26.08%).Ventriculoperitoneal shunt was placed in all 23 infants, at the mean age of 33.5 (30-43) days. Postoperative complications as a result of ventriculoperitoneal shunt placement were: ventriculitis manifested in 3 preterm (13%) infants, of which 2 (8.6%) died; five term infants (21.7%) had postoperative seizures, of which 2 infants (8.6%) died. Nineteen infants (82.6%) were discharged and transferred to the neonatology department. Ventriculoperitoneal shunt placement is a treatment of choice for infants with hydrocephalus, although postoperative complications in preterm infants increase the percentage of morbidity and mortality.

Acute kidney injury is a sudden loss of renal function that results in deterioration of the renal's ability to excrete urine in sufficient quantity and adequate composition. The aim of the study was to determine the incidence, risk factors and outcomes of acute kidney injury in preterm newborns.The study was conducted at the University Clinic of Pediatrics-Skopje. It was a clinical, epidemiological prospective study. In the period of two years, 40 preterm newborns hospitalized at the Intensive Care Unit (ICU) with documented kidney injury were analyzed. Medical data records of hospitalized preterm infants with kidney injury were processed. The material was statistically analyzed using methods of descriptive statistics.We evaluated 40 preterm newborns with documented acute kidney injury, who at the period of 2 years were treated in the ICU. The prevalence of kidney injury was 6.9%. Most of the involved preterm newborns were male (72%), and born at 32 to 37 weeks with low birth weight (58%). Prerenal injury was evaluated in 79.5% of the cases. The mortality rate was 36% and it was significantly higher in the group of preterm infants born under 28 weeks, with Extremely Low Birth Weight Newborns ELBW. (P=0.01).Acute kidney injury is a life threatening condition with a still high mortality rate. Appropriate treatment of kidney injury in newborns with ELBW improves the outcomes and reduces the mortality of the disease.

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