Niveska Božinović-Prekajski's research while affiliated with Institute of Physics Belgrade and other places

Introduction/Objective Minimal enteral nutrition (MEN) has an important stimulative effect on morphological and functional development of gastrointestinal system in preterm infants. The aim of this study was to assess effects of early introduced MEN on rate of achieving optimal enteral nutritive intake and on body weight, body length, and head circumference gain in very low birth weight (VLBW) premature infants. Methods This prospective study included 45 VLBW newborns (1,010-1,450; 1,350 ± 305 g), in 30 newborns MEN was introduced within three days after birth, and in 15 newborns enteral intake was introduced after five days due to hemodynamic and metabolic instability. Assessment of effect of early MEN

https://www.nature.com/articles/pr20101235

Background and aims: Feeding with human milk (HM) is in correlation with many useful effects and represents key component in strategy of enteral feeding of preterm infants. Objective of this research was to determine incidence of necrotizing enterocolitis (NEC) in structure of morbidity and relative risk (RR) of acquiring NEC in preterm infants fed with fortified human milk (FHM) and preterm formula (PF) respectively.Methods: Total of 100 preterm infants of gestational age less than 34 weeks were included in this prospective analysis. Subjects were divided in two groups: group I (n=50) fed with FHM (FM 85 Nestle) and group II (n=50) fed with PF (preNAN Nestle) in case where lactation wasn't established, for 4 weeks. NEC was diagnosed if presence of intestinal pneumatosis on X-ray was verified (Bell's stage II and III).Results: Initially, examined groups did not differ considering the gestational age, Apgar score and antropometric parameters at birth. Subjects fed with FHM reached full enteral feeding earlier compared to PF fed group (p< 0,05). Incidence of NEC in FHM fed group was 2%, and in PF fed group 6% (p>0,05). In FHM fed group RR=0,33, 95% CI (0,36-3,097), which means that risk of acquiring NEC is 33% less compared to risk in PF fed group.Conclusion: There is no statistically significant difference between these two groups in incidence of NEC, but RR indicates a smaller risk of NEC in FHM fed group.

Introduction: Drug safety depends on trough levels. Objective: Objective of the study was to measure gentamicin and amikacin trough levels in neonates and to identify risk groups by gestational and postnatal age. Methods: Gentamicin and amikacin were applied according to the clinical practice guidelines. Trough levels (mg/l) were determined using fluorescence polarization immunoassay methodology. Target trough levels were <2 mg/l for gentamicin, and <10 mg/l for amikacin. Patients were divided in 3 groups by gestational age: I < or =32, II 33-36, and III > or =37 gestational weeks and, by postnatal age, in 2 groups: < or =7 and >7 days. Results: Out of 163 neonates, 111 were receiving gentamicin and 52 amikacin. Mean amikacin trough level was 7.8 +/- 4.8 mg/l and, in group 110.5 +/- 4.9 mg/l, which was above the target range and significantly higher than in group II (LSD, p < 0.05). In the amikacin group, 26 patients were 7 and less, and 26 more than 7 days old, without significant differences in trough levels between the groups. In the gentamicin group, 52.3% of neonates had trough values within the target range. Gentamicin trough level in group I was above the trough range, 3.7 +/- 1.8, 2.3 +/- 1.5 in group II and, 1.8 +/- 1.4 mg/l in group III. The difference in trough levels among the groups was highly significant (F = 9.015, p < 0.001, chi2 = 17.576, p < 0.001). Further analysis revealed that differences between groups I and II (LSD, p = 0.002) and between I and III (LSD, p = 0.000) were highly significant. Conclusion: Obtained gentamicin and amikacin trough levels are high. Inverse correlation has been confirmed between trough level and gestational age, with highly significant difference, and the risk group has been identified. There is obviously a need to change the dosing regimen in terms of those with extended intervals, particularly for neonates of the lowest gestational age, along with pharmacokinetic measurements.

Introduction: Ultrasound represents a method of examination of hips of newborn babies capable of defining hip condition and distinguishing stable and unstable hips based on morphological elements. It is accepted in a large number of countries as a method of examination of high risk newborns, or as a method of systematic screening. Objective: The objective of this study was to investigate correlation between ultrasonically estimated hip maturity and respective gestation maturity both in premature and term-born babies, and to investigate the influence of different delivery types on hips condition. Methods: In our study 2045 patients, 1141 males and 904 females, were examined in at the Institute of Neonatology over a period of 5 years. The average age was 34.04 gestation weeks. There were significantly more premature (1698 or 83.03%) than term-born babies (347 or 16.97%). Ultrasound hip examination, as a screening method, was carried out according to Graf. It was followed by clinical examination. Results were analyzed by appropriate statistical methods (chi2-test, one-way ANOVA, multifactor ANOVA). Results: The overall frequency of unstable hips was 3.2%, 1.88% in males and 4.87% in females (p<0.05). 96.8% babies had stable hips, out of which 35.21% were mature and 61.59% immature. In the study of the breech presentation, out of 183 babies, unstable hips were found in 1.58% of male cases, and in 10.23% of female cases. Conclusion: Clinical screening of developmental dysplasia of the hip is insufficient for early diagnosis and decision about the treatment of premature babies. The high frequency of unstable hip type IIc (risky) and IId (decentralized) in premature babies requires early diagnosis and therapy. Wide swaddling for prematures should be applied up to eight months of age. Gentle manipulation is necessary while nursing and conducting physiotherapy of a premature baby.

Enriched human milk may stimulate gain weight in preterm infants during neonatal period. Aim is biochemical assessment of preterm infants, feed by mother's milk fortificated with special domestic formula (pre)Impamil during the first month of life. 80 preterm infants (45 male and 35 female), up to 36 weeks of gestation. BW less than 2500 g, which started enteral intake in the first three day of life. Total volume intake was in range from 70 ml/kg first day, to 170-200 ml/kg, after 10th day of life. Mother's milk fortification was prepared as 5% mixture solution of (pre)Impamil. The dynamics of biochemical analyses started on the first day of study and was repeated once weekly. We analysed levels of: total protein, albumin, prealbumin, transferin, urea, Ca ionised, P and alkaline phosphatase using standard biochemical methods. Statistical analyses completed by ANOVA test, one factorial analyses of variance. During monitoring total protein level increased in the second week of life (p < 0.03), as well as albumin (p < 0.03). Prealbumin level increased, as well as transferin (p-NS). Initial level of ionised fraction of Ca was significantly lower (p < 0.03) at the beginning of the study, compared to the rest. Serum level of P increased, as well as level of alkaline phosphatase at the end of first and second week (p < 0.01). Conclusion is that biochemical parameters as level of protein and albumin are important at the assessement growth in preterm infants on special feeding regimes.

Monitoring of Biochemical Parameters in Preterm Infants on Special Regime Feeding Enriched human milk may stimulate gain weight in preterm infants during the neonatal period. Aim is the biochemical assessment of preterm infants, fed by mother's milk fortificated with the special domestic formula pre Impamil during the first month of life. 80 preterm infants (45 male and 35 female), up to 36 weeks of gestation, BW less than 2500 g, started enteral intake in the first three days of life. Total volume intake was in range from 70 mL/kg first day, to 170-200 mL/kg after a 10 th day of life. Mother's milk fortification was prepared as a 5% mixture solution of pre Impamil. The dynamics of biochemical analyses started on the first day of study and was repeated once a week. We analysed levels of: total protein, albumin, prealbumin, transferin, urea, Ca ionised, P and alkaline phosphatase using standard biochemical methods. Statistical analyses were completed by ANOVA test, one-factorial analyses of variance. During monitoring the total protein level increased in the second week of life (p<0.01), as well as albumin (p<0.01). Prealbumin level increased, as well as transferin (p- NS ). Initial level of ionised fraction of Ca was significantly lower (p<0.01) at the beginning of the study, compared to the rest. Serum level of P increased, as well as the level of alkaline phosphatase at the end of first and second week (p<0.01). Conclusion is that biochemical parameters, such as levels of protein and albumin, are important in the growth assessment of preterm infants on special feeding regimes.