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The importance of protein quantity at nutrition of extremely immature newborns
Lamberská, Tereza ; Plavka, Richard (advisor)
Thesis I chose based on their interest in neonatology and the care of extremely premature infant, I would like to take after graduation. The rapid development of neonatology in the last two decades have brought significant change in the possibilities of survival of premature infants.Improving quality of care critically ill newborns in perinatal centers have significantly reduce neonatal mortality. The main challenge for neonatology in addition maintaining a low infant mortality in particular the reduction of serious morbidity and improve long-term prognosis. Nutrition extremely preterm infants is one of the most importantfactors affecting their growth. Recent clinical studies show that quantitativecontent some nutrients, particularly protein nutrition in extremely prematureinfants, has significant effect on psychomotor development and long-termprognosis of these children. Optimal intake of nutrients for specific patients is often very difficult and is needs to be sensitively adapted to the specific condition of the newborn.
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Retrospective diagnosis of unknown cause of sudden infant death
Strnadová, Kristina ; Lebl, Jan (advisor) ; Janda, Jan (referee) ; Plavka, Richard (referee) ; Vízek, Martin (referee)
Background: Sudden infant death syndrome (SIDS) is defined as sudden unexpected death of an infant that remains unexplained after thorough post-mortem examination, investigation of the scene of death and case history. The autopsy findings and the physiological characteristics of these infants suggest a possible role of insufficient cardiorespiratory control and arousal mechanisms. The etiology is probably multifactorial based on a genetic predisposition combined with environmental factors. Several candidate genes have been studied, e.g. those involved in serotonin transport, autonomic nervous system embryology, inflammation, energy production, nicotine and glucose metabolism. A small number of cases may be caused by monogenic diseases that can lead to sudden death and leave no characteristic autopsy findings and thus imitate SIDS. Fatty acid beta-oxidation disorders (FAOD) have been associated with SIDS since 1976 and it is nowadays estimated that they may be responsible for about 1% of SIDS cases. Congenital long QT syndrome, a cardiac channelopathy, that may cause a fatal arrhythmia was a logical candidate for SIDS and indeed it was found out that about 9,5% of SIDS cases carry a mutation or a function changing variant in one of seven cardiac ion channel genes. We assumed that the severe salt...
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Doppler parameters of myocardial dysfunction in very low birth weight infants
Širc, Jan ; Straňák, Zbyněk (advisor) ; Plavka, Richard (referee) ; Janota, Jan (referee)
Preterm neonate is exposed to significant hemodynamic changes after delivery. Cardiac and extracardiac shunts, especially ductus arteriosus, play an important role in this process. Failure of postnatal adaptation and persistent patent ductus arteriosus (PDA) may lead to cardiac overload and circulatory failure with hypoperfusion of vital organs and in turn adversely affect the short-term and long-term morbidity and mortality of these patients. Newborns with very low birth weight are at highest risk, however the possibilities for diagnosing circulatory failure in this patient group are limited. Clinical presentation and physical examination are nonspecific and involve subjective measures. Functional echocardiography provides information on systolic and diastolic heart function as well as the possibility to measure cardiac output and superior vena cava flow (SVC flow). Much of what is known about ventricular function pertains to systole rather than diastole. Near infrared spectroscopy provides another noninvasive method, enabling the measurement of tissue oxygenation including that of the brain. Cerebral oxygenation can be measured by placing the probe on the head of the neonate. Further possibility to help diagnose circulatory system failure are biochemical markers, commonly used in diagnosing...
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Stabilisation and resuscitation of extremely preterm newborns at birth.
Lamberská, Tereza ; Plavka, Richard (advisor) ; Zoban, Petr (referee) ; Kokštein, Zdeněk (referee)
Stabilisation and resuscitation in the delivery room is an integral part of the care of extremely premature newborns. The main task is to support essential life functions and to facilitate the adaptation of the immature organism to the extrauterine life. The current recommendations are well defined for the full term and late preterm newborns, but there is a lack of targeted recommendations for the stabilisation and resuscitation of extremely premature newborns. The research part of the submitted thesis summarises the most important results of clinical research performed in 2010-2015 at the Department of Neonatology of the Department of Gynecology and Obstetrics, VFN and First Faculty of Medicine, Charles University in Prague. The research evaluates the efficacy and side effects of the currently recommended methods of stabilisation and resuscitation of extremely premature neonates in the delivery room and presents some new and potentially useful techniques for delivery room care. A significant output of this work is the recommendation for practice, structured according to the gestational age of extremely premature newborns. The proposed guideline is based on our results of partial clinical trials and aims to improve the current level of stabilisation and resuscitation of extremely premature newborns...
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Doppler parameters of myocardial dysfunction in very low birth weight infants
Širc, Jan ; Straňák, Zbyněk (advisor) ; Plavka, Richard (referee) ; Janota, Jan (referee)
Preterm neonate is exposed to significant hemodynamic changes after delivery. Cardiac and extracardiac shunts, especially ductus arteriosus, play an important role in this process. Failure of postnatal adaptation and persistent patent ductus arteriosus (PDA) may lead to cardiac overload and circulatory failure with hypoperfusion of vital organs and in turn adversely affect the short-term and long-term morbidity and mortality of these patients. Newborns with very low birth weight are at highest risk, however the possibilities for diagnosing circulatory failure in this patient group are limited. Clinical presentation and physical examination are nonspecific and involve subjective measures. Functional echocardiography provides information on systolic and diastolic heart function as well as the possibility to measure cardiac output and superior vena cava flow (SVC flow). Much of what is known about ventricular function pertains to systole rather than diastole. Near infrared spectroscopy provides another noninvasive method, enabling the measurement of tissue oxygenation including that of the brain. Cerebral oxygenation can be measured by placing the probe on the head of the neonate. Further possibility to help diagnose circulatory system failure are biochemical markers, commonly used in diagnosing...
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The importance of protein quantity at nutrition of extremely immature newborns
Lamberská, Tereza ; Plavka, Richard (advisor)
Thesis I chose based on their interest in neonatology and the care of extremely premature infant, I would like to take after graduation. The rapid development of neonatology in the last two decades have brought significant change in the possibilities of survival of premature infants.Improving quality of care critically ill newborns in perinatal centers have significantly reduce neonatal mortality. The main challenge for neonatology in addition maintaining a low infant mortality in particular the reduction of serious morbidity and improve long-term prognosis. Nutrition extremely preterm infants is one of the most importantfactors affecting their growth. Recent clinical studies show that quantitativecontent some nutrients, particularly protein nutrition in extremely prematureinfants, has significant effect on psychomotor development and long-termprognosis of these children. Optimal intake of nutrients for specific patients is often very difficult and is needs to be sensitively adapted to the specific condition of the newborn.
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Retrospective diagnosis of unknown cause of sudden infant death
Strnadová, Kristina ; Lebl, Jan (advisor) ; Janda, Jan (referee) ; Plavka, Richard (referee) ; Vízek, Martin (referee)
Background: Sudden infant death syndrome (SIDS) is defined as sudden unexpected death of an infant that remains unexplained after thorough post-mortem examination, investigation of the scene of death and case history. The autopsy findings and the physiological characteristics of these infants suggest a possible role of insufficient cardiorespiratory control and arousal mechanisms. The etiology is probably multifactorial based on a genetic predisposition combined with environmental factors. Several candidate genes have been studied, e.g. those involved in serotonin transport, autonomic nervous system embryology, inflammation, energy production, nicotine and glucose metabolism. A small number of cases may be caused by monogenic diseases that can lead to sudden death and leave no characteristic autopsy findings and thus imitate SIDS. Fatty acid beta-oxidation disorders (FAOD) have been associated with SIDS since 1976 and it is nowadays estimated that they may be responsible for about 1% of SIDS cases. Congenital long QT syndrome, a cardiac channelopathy, that may cause a fatal arrhythmia was a logical candidate for SIDS and indeed it was found out that about 9,5% of SIDS cases carry a mutation or a function changing variant in one of seven cardiac ion channel genes. We assumed that the severe salt...
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Contribution to the problem of bronchopulmonary dysplasia
Herknerová, Magdalena ; Plavka, Richard (advisor) ; Kobr, Jiří (referee) ; Herget, Jan (referee)
Bronchopulmonary dysplasia (BPD) contributes to significant morbidity of infants with birth weight<1000g. Experimental and clinical research of dissertation thesis has focused on two interventions which might have positive influence on the postnatal development of the immature lung. In animal experiment, we tested the capability of retinoic acid (RA) to attenuate hyperoxic lung injury after seven days exposure to 40% or 80% hyperoxia. RA significantly attenuates the 80% hyperoxic growth retardation. The histological changes were attenuated in the lungs of 40A and 80A groups. The expression of the VEGF-A gene was not significantly influenced by RA in 80% hyperoxia. In another experiment, we detected significant increase of the expression of the gene of proinflammatory cytokine TNF- after 72 hours exposure both to 40% and 80% hyperoxia. Mechanical ventilation still remains one of the risk factors of BPD. The management of optimal lung volume strategy is more difficult during HFOV than conventional ventilation. Efficacy and safety of HFOV is hampered by a lack of reliable bedside in-line monitoring of the patient. We determined the values of expiratory tidal volume measured by hot-wire anemometr and assessed the relationship among VTE and other respiratory parameters. We evaluated how often VTE exceeds the...
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